Student-led development and evaluation of a community pharmacy-based cardiovascular risk assessment

Abstract

Robert Gordon University’s key strength is employability (reflecting close liaison with the professions) and courses must therefore offer opportunities for work-based learning, which can be challenging in the current financial climate. This is a particular problem for Pharmacy: opportunities for placement are extremely limited and tend to be focused on the later years of the course. This ‘late and limited’ exposure to practice is thought to be responsible for significant failures in the ability of students and newly-qualified pharmacists to take their knowledge of science and medicines and apply it in the context of solving clinical problems. Furthermore, a lack of engagement with practice makes it difficult for the theoretical learning (especially the underpinning science) to be effectively contextualised, leading to an artificial segregation of the science and practice sections of the course. While pharmacists must be technically capable, success depends on a broader range of non-technical skills, including communication and empathy as well the ability to deal with the unexpected.  Simulation is used as a partial alternative to the practice environment, but there are often vast differences between these highly-managed scenarios and the real situations encountered in practice.  Since there is no ‘ideal’ setting for a pharmacist, students should be educated and trained with an understanding, at the forefront of their minds, of human factors - something which challenges existing course design. Teaching and learning activities must allow students to explore the differences between the ‘ideal’ and ‘real’ clinical environments and to recognise when deviations from the ideal are likely to affect patient safety. This paper discusses a piece of action research by MPharm undergraduate students, exploring ways in which such activities may be developed.  These new activities are based upon an existing cardiovascular risk assessment, currently used to deliver scientific theory and develop technical skills, and involving the identification of modifiable and non-modifiable risk factors and the use of these to calculate the ten-year risk of cardiovascular disease.

The approach involved the building of two simulated scenarios, one representing an ‘ideal’ risk assessment and the other reflecting adverse outcomes arising as a result of practice-based problems.  Developing the simulations required an in-depth analysis of factors contributing to outcomes, and a combination of interviews with healthcare professionals and peer-peer focus groups were used to explore this. This paper discusses the challenges and learning points arising from this work, as well as an evaluation of the ways in which the work was used to enhance teaching in the academic session 2013-14.