By Lisa Deacon, 2019 PharmD Candidate
Suppose you have a diabetic patient with a complicated medication regimen that includes a fast acting insulin injection three time a day with meals, a basal insulin injection at bedtime, metformin twice a day with meals, and three other oral medications for hypertension and dyslipidemia. This patient also has been asked to alter their typical diet drastically and record their carbohydrate, fat, and salt intake daily; all while increasing their exercise to four or five times a week. Oh, and they must also monitor their blood glucose by sticking their finger three times a day. When this same patient comes for a follow up visit with an uncontrolled A1C, admits to non-adherence, and appears to have low motivation to change—-do you get frustrated and think ”How can this be?”
Would you feel the same if you had to “walk in their shoes”?
As a student pharmacist, one essential skill I want to develop is empathy for patients. This skill is commonly taught across the pharmacy curriculum; however, the concept can be abstract and difficult to grasp and fully implement. At my program at the University of Florida I have learned the appropriate empathetic phrases, what to say, and what not to say to a patient. However, the one requirement I found to be most valuable was completing a simulation project focused on empathy.
What this experience was like for a student
In the spring semester of 2018, 2nd and 3rd year pharmacy students at the University of Florida took part in a 2 week Ambulatory Care elective. In this course, students were assigned the “chronic disease state simulation” project. In teams of two, each student played two roles: a diabetic patient and the pharmacist. When I played the role of a diabetic patient I had to set up a pill box filled with multiple “fake” medications (candy) and had a medication regimen comparable to the one mentioned previously. I had to take them two to three times a day, inject “fast acting” insulin three times a day into a subcutaneous practice cushion, perform blood glucose monitoring three times a day and maintain separate logs for food and carbohydrate, blood glucose levels, and a medication log for adherence. Then I was asked to write a reflective paper from the patient’s perspective describing this experience.
The best phrase I can use to sum up the entire experience would be, “It’s easier said than done.” By immersing myself in this patient role for a week, I experienced the challenges of adherence to a complicated diabetic regimen, while also trying to maintain daily life activities. I truly had to “prioritize” my health and medications. Because of this experience, I will practice patient-centered care more consistently and focus on individualizing a patient’s medication regimen to fit their daily life, instead of changing their daily life to fit their medication regimen. One of my peers shared in his reflection that he was perfectly adherent for three days, but then he went to the beach with his family and forgot ALL of his medications. “The simple act of living and enjoying my life with my family for the day was enough to ruin my perfect adherence.” After reviewing reflection papers, my peers and I reported that an important part of this experience was learning how difficult it is to adhere to a complicated medication regimen.
Other Methods Used to Teach Empathy
Other notable examples of how empathy is being taught include:
- The University of Minnesota’s College of Pharmacy’s Approach1
- Incorporated into a pharmacy student Diabetes elective
- Did not incorporate oral medications, only insulin injections and daily monitoring of glucose and carbohydrate intake
- Focused on students’ confidence in performing and teaching diabetes self management, however also resulted in development of empathy as seen in the students’ reflection papers
- Jellybean Polypharmacy Simulation Exercise2
- An eight prescription drug regimen (represented by different color jelly beans) that students manage for 7 consecutive days
- Incorporated into 3rd year pharmacy student Special Populations elective
- Assessed effectiveness using the Kiersma-Chen Empathy Scale which showed personal growth and appreciation for patients managing difficult medication regimens
- Chicago State University College of Pharmacy’s Approach3
- Chronic disease state simulation also incorporated into an ambulatory care elective
- Very similar design to my class
- Students reported “enhanced perceptions” of their empathy towards patients with multiple disease states and counseling skills
Having the ability to properly express empathy to our patients is a learned skill in healthcare that is difficult to teach, but improves the quality of care provided. Overall, based on my personal experience and seeing what other curricula have implemented, I strongly believe that one of the best ways to teach the intangible and abstract concept of empathy is through chronic disease state simulation. Can you empathize with me?
I would like to thank the following University of Florida faculty members: my APPE preceptors, Dr. Kathryn Smith and Dr. Stacey Curtis, for encouraging me to write this reflection and Dr. Christina DeRemer and Dr. Shannon Miller for creating this chronic disease state simulation in the ambulatory care elective.
1. Westberg SM, Bumgardner MA, Brown MC, Frueh J. Impact of an Elective Diabetes Course on Student Pharmacists’ Skills and Attitudes. Am J Pharm Educ. 2010;74(3):Article 49.
2. Blaszczyk AT, Mahan RJ, McCarrell J, Sleeper RB. Using a Polypharmacy Simulation Exercise to Increase Empathy in Pharmacy Students. Am J Pharm Educ. 2018;82(3):Article 6238.
3. Isaacs D, Roberson CL, Prasad-Reddy L. A Chronic Disease State Simulation in an Ambulatory Care Elective Course. Am J Pharm Educ. 2015;79(9):133.
Lisa Deacon is a 4th year pharmacy student at the University of Florida. Educational scholarship interests include ambulatory care and community pharmacy. In her free time, Lisa enjoys working out and taking care of her dogs and horses.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning