Abstract:

Objectives:
To design a 2 credit-hour self-directed Advanced Self-Care Course where students (1) utilize their foundational self-care knowledge to go beyond the basic interview questions and obtain a focused, detailed interview based on patient responses, (2) effectively communicate with patients when approached with awkward situations, difficult patients or culturally sensitive issues and (3) develop a patient specific treatment plan and provide education in a clear and concise manner.

Methods:
Enrollment into the course is restricted to third year pharmacy students. Students are provided with readings related to difficult patient situations. Based on the readings and personal experience, students are required to develop patient profiles. The patient profiles are to include a complex pediatric, adult and geriatric patient in addition to a patient who prefers to use alternative therapy. Each patient profile is to also include an awkward situation, difficult patient scenario or culturally sensitive issue. Faculty select at least 2 patient profiles weekly and add symptoms/complaints to create the simulated patient cases. These simulated patient cases are used in class where a faculty member or student role-plays the patient; this allows each student to further develop the skill of obtaining a focused, detailed interview and ability to effectively communicate with a difficult, culturally sensitive or awkward patient situation. After each simulated patient case, peer and faculty feedback is provided to augment individual student skills. Following the feedback session, faculty facilitate discussion related to difficulties encountered during the interviewing process or patient interaction as a method to enhance problem solving/critical thinking skills.

To evaluate the students’ ability to (1) obtain a focused, detailed interview, (2) effectively communicate with patients when approached with awkward situations, difficult patients or culturally sensitive issues and (3) develop a patient specific treatment plan and provide education in a clear and concise manner, two Objective Student Clinical Evaluations (OSCEs) are administered which comprise of 2/3rd of the course grade.

Results:
During class, students were initially able to conduct a disjointed, basic patient interview and struggled with interacting with awkward and difficult patient situations. By the first OSCE, most students were able to conduct a focused, detailed interview and appropriately communicate with a difficult patient (average exam score of 93%). Most interviews, however, were still generally disjointed. Although the average exam score for the second OSCE was minimally better (average exam score of 93.3%), students had developed the ability to conduct a concise, detailed interview that was logically sequenced. Students also gained the ability to make more thorough assessment and plan as the course progressed (average quiz score of 84% for the first half of the semester compared to an average quiz score of 95% for the second half of the semester). Students acknowledged that these skills were beneficial in practice and for other courses.

Conclusion:
The Advanced Self-Care Elective Course was determined to be successful and will be continued in the future.

Keywords:

Advanced Self-Care, patient interviewing, difficult patients.