Teaching and Learning Forum 2000 [ Proceedings Contents ]

Community based Quality Use of Medicines (QUM) education seminar

Kevin T. Batty and Margaret Boyatzis
School of Pharmacy
Curtin University of Technology
    Recent expansion of the Bachelor of Pharmacy degree to a 4 year course has led to the introduction of a comprehensive practice based component of the degree. In 1999, the final practical rotation was a 10 week placement that facilitated student placements in regional hospital and community pharmacies. The aim of this project was to foster self directed learning skills in 4th year pharmacy students, with particular attention on skills that may be used to enhance the pharmacist's role in the community. The specific objective was for students to develop and present an education seminar on quality use of medicines to a community group. Workshops and tutorials on presentation skills and use of the Internet were conducted and resource packages were assembled. A survey of academic staff and students within the School of Pharmacy showed that 82% of staff (n = 11) and 94% of students (n = 32) thought the QUM seminar was a worthwhile initiative. However, 64% of staff and 94% of students thought that the students had sufficient skills to prepare and deliver the QUM seminar. Upon completion of the project and re-surveying the students, the affirmative response increased to 100% (n = 34). Nine students completed placements in regional centres and 21 city based students were included. The QUM seminar was rated highly by the audiences (mean ± s.d score was 92 ± 5%). The mean scores for the students' oral and written reports (79 ± 6% and 75 ± 20%, respectively) were comparable with results from other practice based units in the 4th year of the degree. In conclusion, these students were able to demonstrate a highly competent level of organizational and presentation skills that will be important in their professional careers. The results augur well for continuing this initiative in the final stages of the Bachelor of Pharmacy degree.
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Introduction

Each year in Australia there are more than 180 million prescriptions written, costing in excess of $2.5 billion [1-3]. These data highlight the need for pharmacists to have a broad knowledge base of the drugs that are available on prescription and 'over the counter', and an understanding of appropriate practices in the use of medicines. Not surprisingly, four year pharmacy degrees have been advocated for several years [4].

The four year pharmacy degree at Curtin University commenced in 1995, with the first group of students graduating in 1998 [5]. The fourth year of the degree is predominantly practice based experience utilising an adaptation of the Kolb Experiential Learning Cycle as the model for optimising the learning experience [5]. Developments that are considered desirable include greater emphasis on self directed learning and broader practice based options such as regional placements. Hence, an innovative development in 1999 was the placement of a small cohort of students in regional centres and a requirement that this practice rotation included the development, delivery and evaluation of a Quality Use of Medicines (QUM) seminar to a community group. This concept was supported by an historical precedent of successful initiatives to increase communication skills of science based students at Curtin University of Technology [6,7].

The practice based component of the 4th year program consists of three rotations, each comprising approximately 400 hours experience in the practice setting. In 1999 the first two rotations were of 13 weeks duration, with students attending university one day per week. The third rotation was modified to a 10 week block in the practice setting, with no attendance at University. This arrangement facilitated the placement of students in regional centres and exposes students to regional pharmacy practice, as well as providing preceptors with opportunities to utilise the students' skills in their practice setting. An important potential outcome of this initiative is that some students will return to practice in the regional setting, thus addressing well recognized recruitment issues in regional Australia [8].

Aims and objectives

The aim of this project was to foster self directed learning skills in 4th year pharmacy students, with particular attention on skills that can be used to enhance the pharmacist's role in the community. With regard to self directed learning objectives, we sought to encourage students to access and apply knowledge sources and information systems and to apply new and established skills and knowledge appropriately in practice.

The specific objective of the program was for the 4th year students to develop and present an education seminar on quality use of medicines to a community group such as members of a service organization, residents of aged care facilities or secondary school students. The QUM seminar concept was developed to provide students with an opportunity to integrate with the community and make a professional contribution, particularly in the regional setting.

Method

Preparation of QUM seminar

Prior to commencement of the practice based placement, a lecture entitled "Effective Presentations" was given to the students by Mr Andrew James, an experienced hospital pharmacist and lecturer on presentation skills for health professionals. Following the lecture, a two hour workshop covering aspects of planning for the QUM seminar was conducted. Students were required to address issues including type and size of a suitable audience, topics for the QUM seminar, resources, important presentation skills and development of an audience evaluation form.

Additional preparation included tuition on Web based resources and collation of a resource kit for students to take to their placement.

At the start of the practice based placement, students were required to identify a suitable community group and arrange a mutually beneficial topic, date and venue for the presentation. Preparation of the material for the QUM seminar was reviewed periodically by academic staff. Where appropriate, this material included pamphlets and visual aids such as medicine advisory labels and storage containers for medicines.

Evaluation of QUM seminar

In parallel with preparation of the QUM seminar material, the students were required to develop an audience evaluation form comprising 6-10 questions relating to the quality of their presentation. The format of the evaluation form allowed members of the audience to tick a box on a five point rating scale, thus facilitating quantitative analysis of the results.

Following the seminar, students were required to summarize the results of the audience evaluation and prepare a brief report outlining the student's perception of the most demanding and rewarding aspects of the QUM seminar, the audience's feedback on the value of the QUM seminar and guidelines or recommendations for future placements and provision of QUM seminars.

Evaluation of students

Students were assessed on the quality of their written report on the QUM seminar and the audience evaluation of their seminar. In addition, the students were required to give an oral presentation on the QUM seminar, the audience feedback and, for the regional students, their experiences in the regional setting. For the regional students, a 15-20 minute oral presentation was delivered to fellow students and academic staff representatives at the end of the rotation and was assessed by six members of the audience. For city based students, a 10 minute oral presentation was delivered to small groups of fellow students and one academic staff representative and was assessed by four members of the audience.

Value of the QUM seminar

Prior to commencement of the project, all academic staff and 4th year students in the School of Pharmacy were sent a questionnaire, to obtain information on their perceptions of the value of regional pharmacy placements, the value of the QUM seminar and the ability of 4th year students to prepare and deliver the QUM seminars. This questionnaire was repeated after the students' final presentations but, due to low attendance by academic staff, only the 4th year students could be surveyed.

Results

QUM seminar

The preparatory workshop generated an impressive array of ideas. Twenty-one potential types of audience were identified, including a range of service clubs and other community organizations (e.g. school parents' groups and Alcoholics Anonymous). Potential topics for the presentations were split into five broad groups, namely 'Elderly people' (e.g. medication aids, pain relief), 'Middle aged people' (e.g. blood pressure, illicit drug use in teenagers), 'Adolescents' (e.g. smoking & illicit drugs, sporting injuries), 'Males' (e.g. stress, hair loss) and 'Females' (e.g. hormone replacement therapy, breast cancer). Recommendations on good presentation skills and audience evaluation, which were consistent with material from the preceding lecture by Mr James, emphasized a degree of conventional thinking about professional presentation to the general community.

Nine students were placed in regional centres; four in hospitals (Port Hedland (2), Geraldton & Bunbury) and five in community pharmacies (Geraldton, Bunbury, Busselton, Narrogin, Albany). In addition, 21 city based students who were completing their third rotation in a community pharmacy were included in the QUM seminar program.

Despite the broad range of ideas for potential audiences, 20 (67%) of the students presented their seminars to groups of approximately 10-30 elderly patients, many of whom resided in aged care facilities. The remaining seminars were presented to staff within the pharmacy (n = 5), a community service club (1), an antenatal class (1), a class of female students at a private secondary school (1) and a group of Aboriginal Medical Service workers in regional Western Australia (2). In general, the topics were based on wise use of medicines, including compliance aids and reasons that drugs cause adverse effects in elderly patients.

Evaluation of QUM seminar

The mean (± s.d.) score from the audience evaluation of the QUM seminar was 92 ± 5% (n = 15 groups). Descriptive feedback was very complementary of the students' delivery and the quality of the material presented.

Evaluation of students

The mean score for the students' oral reports on the QUM seminar was 79 ± 6% (n = 30). This mark was comparable with results for oral exams undertaken by 4th year students in the hospital practice based unit (76 ± 10%; n = 50) but significantly higher than the results from the first community pharmacy unit (66 ± 10%; n = 90; P < 0.01; ANOVA). The mean score for the students' written reports and associated material on the QUM seminar was 75 ± 20% (n = 30). This mark was comparable with overall scores for work completed by 4th year students in the community (76 ± 7%) and hospital (76 ± 6%) practice based units.

Value of the QUM seminar

The initial survey showed that 82% of academic staff (n = 11) and 94% of students (n = 32) thought the QUM seminar was a worthwhile initiative. However, 64% of academic staff and 94% of students thought that the students had sufficient skills to prepare and deliver the QUM seminar. Upon completion of the project and re-surveying the students, the affirmative response to these questions increased to 100% (n = 34).

Discussion

This project provided valuable data and experience to support the concept of self directed learning by 4th year pharmacy students. These students were able to demonstrate a highly competent level of organizational and presentation skills that will be important in their professional careers.

The QUM seminars were rated very highly by the audiences, with a mean score in excess of 90%. Whilst this level of grading is rare in the School of Pharmacy, even the mean scores of 79% and 75% for the oral and written reports respectively, were higher than results that are commonly seen in the first three years of the degree. Nevertheless, the latter results are consistent with comparative forms of assessment such as the oral exams and workbooks that must be completed as part of the practice based units of the 4th year, thus reflecting that competent practitioners should be able to achieve high standards of practice.

An interesting outcome from this project was that two-thirds of the QUM seminars were presented to elderly people. Although the reason(s) for targeting these audiences were not elucidated, this was a fortuitous outcome. Firstly, elderly patients are at risk of adverse events from medicines because they often require treatment for several concurrent medical conditions and the mechanisms for clearance of drugs from the body can be impaired in the elderly. Secondly, poor eyesight and a wide array of dosage schedules may limit elderly patients' ability to comply with instructions for their medicines. Hence, a useful range of relatively inexpensive aids are now available to assist patients with medication compliance. Results from the QUM seminars suggest that several students were able to provide a useful account of the reasons why medicines cause adverse effects and provided strategies for improving use of medicines.

A high level of support for the concept of the QUM seminar, by academic staff and students in the School of Pharmacy, was encouraging when the initial survey was conducted. By comparison, only 64% (7/11) of staff indicated that our students had sufficient skills to prepare and deliver the QUM seminar. Two of the comments were:

You are asking them to undertake a number of tasks that they previously have not done. I wonder how much of a disincentive this will be?

The students will be delivering a message on behalf of the whole profession. Are we prepared to entrust this to (all) undergraduate students? I must express some reservations on this as a general policy.

Thus, it could be concluded that improvements in the degree content may be required if activities such as the QUM seminar are seen to be important features of the 4th year program and the students' careers once they graduate. However, in contrast to the results from academic staff, which came from a relatively small sample size, students were generally comfortable with their level of skill for preparation and delivery of the QUM seminar. Although speculation on this result could include a degree of over confidence amongst the students, one student's comments were:
Of course we do! Please give us some credit! Over four years we have watched and listened to hundreds of lectures - surely we have obtained some benefit from them, other than the pure academic insight.
On balance, the impressive overall results from the QUM seminar support the students' contention that they were adequately prepared and equipped to present QUM seminars of a high standard. Moreover, the following quotes from students at the end of the project indicate that the QUM seminar was a positive educational experience:
This was a great experience that students would not be able to gain in any other way ... it fully tested my knowledge.

Overall, the experience was educational and enlightening. The message I received from the audience was, 'If you spend the time imparting knowledge, you will be rewarded tenfold.'

In conclusion, the students' ability to enhance their self directed learning skills was well demonstrated and a promising outcome for the profession is that many have been encouraged to consider expanding their role as a practising pharmacist. A further benefit from this project was extension of the 4th year practice based experience into the regional setting. This development was acknowledged by the Manager of Allied Health at one of the hospitals, with the following endorsements:
I would like to thank the School of Pharmacy for initiating a rural placement for 4th year students. (The students) are to be congratulated on their professionalism and dedication. I look forward to continuing this fantastic new initiative in the coming years and offer our continuing support to the School of Pharmacy.
These results of this project augur well for continuing this initiative in the final stages of the Bachelor of Pharmacy degree.

References

  1. Nair B. Older people and medications: what is the right prescription? Aust Prescr 1999; 22: 130-131.

  2. Roberts MS, Stokes JA. Prescriptions, practitioners and pharmacists. Med J Aust 1998; 168: 317-318.

  3. Birkett DJ. Economic analysis: a response. Aust Prescr 1999; 22: 51-52.

  4. Sunderland B. Four year Bachelor of Pharmacy courses in Australia. Aust J Hosp Pharm 1996; 26: 405-406.

  5. Boyatzis M, et al. The introduction of the fourth year to the Bachelor of Pharmacy degree in 1998 at Curtin University of Technology. Aust J Pharm 1998; 79: 680-684.

  6. Koczberski G, Curry G. Student oral presentations and peer assessment in geography. In Radloff A (Ed), Communication in Context. Bentley: Curtin University of Technology 1998; 41-52.

  7. Zadnik M, Radloff A, de la Harpe B. Developing science students' communication skills in context: description and evaluation of a student-centred unit. In Radloff A (Ed), Communication in Context. Bentley: Curtin University of Technology 1998; 123-137.

  8. Jestrimski KW. Management challenges in large rural hospital pharmacy departments. Aust J Hosp Pharm 1999; 29: 202-205.
Please cite as: Batty, K. T. and Boyatzis, M. (2000). Community based Quality Use of Medicines (QUM) education seminar. In A. Herrmann and M.M. Kulski (Eds), Flexible Futures in Tertiary Teaching. Proceedings of the 9th Annual Teaching Learning Forum, 2-4 February 2000. Perth: Curtin University of Technology. http://lsn.curtin.edu.au/tlf/tlf2000/batty.html


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