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Skip to 0 minutes and 10 secondsOne thing I should mention about automaticity, before we go on to this next experiential learning principle. It's one of the keys to automaticity is repetition. So as we're quizzing students about those critical things that we want them to learn. It's important to be repetitive. I would suggest administering that quiz at least once a week. Every week during the rotation. To make sure that the students learn the material, have a chance to forget it a little bit, and then learn it again. And then continue that process on a weekly basis. Now, our next principle is that students need to progress from cognitive knowledge to performance ability.

Skip to 0 minutes and 48 secondsThis relates to a critical competence pyramid that was developed by George Miller for medical students. According to Miller, the knowledge of medical student starts at the very foundational level of knowing what it is we want them to know. Next level is to know how to do what it is we want them to be able to do. The first step in applying that knowledge. The third level of the pyramid is to be able to show how to do it. And then the highest level of the pyramid is to actually do it in a real-life situation. So we have a situation, in which, in terms of clinical development of a health professional.

Skip to 1 minute and 31 secondsThe two lowest levels, knowing information and knowing how to do things or how to apply that information, they get primarily in the classroom setting. This is something that can be tested on using standard exam techniques. When you increase the elevation of the pyramid, you get to the point where the students need to be able to show how to do something and to actually do it. That doesn't lend itself very well in the classroom anymore. So that is the perfect situation to include into a rotational experience, an APPE rotation. Now it is possible in some cases to have students show how to do something when they're still on campus.

Skip to 2 minutes and 20 secondsBut it's much easier to do that in a practice setting and actual patient care setting. And certainly to be able to actually do it, it is requires to practice care setting. It also raises an interesting point, we have to pay attention to what it is. And that relates to the learning outcomes. What is it that we want the students to know? What is it that we want them to know how to do? To show how to do and to actually do? This has to be clearly defined.

Skip to 2 minutes and 48 secondsAnd once it's clearly defined, then the preceptor can determine what types of assignments and activities will it take for the students to develop the skill to be able to do it whatever it is on a regular basis in a real-life patient care setting. So let's take a look at some of the possibilities for what can be done. And obviously this is going to depend on the nature of the rotation. But there are some general ideas here that we can apply, figuring out what types of activities to have students do during a typical APPE rotation. In the first consideration is direct patient care or drug therapy monitoring.

Skip to 3 minutes and 31 secondsWhat are the opportunities in a given site to get students directly involved in patient care for drug therapy monitoring. Perhaps that the hospital operates with some type of a rounding process where physicians go on patient rounds, that the student could participated in. Or perhaps simply review patients charts and work with nurses and physicians in a patient care area. There might have monitoring forms that students can fill out, to track their monitoring of a patient. So there's a variety of ways that students can be directly engaged in patient care or drug therapy monitoring. The second aspect is pharmacy operation. What types of routine activities, routine services are provided by the pharmacy department?

Skip to 4 minutes and 23 secondsPharmacy department might be engaged regularly in various clinical programs. Perhaps evaluating antibiotic selection against culture and sensitivity results or evaluating the patient's renal function and identifying whether a patient might be a drug that needs to be changed because the patient's renal function is deteriorated. Maybe perhaps involved in nutrition monitoring. Investigational drug monitoring made possibilities of this. It can also relate to basic pharmacy operations, related to drug distribution, drug processing, processing of orders, maintaining inventory, restocking medications. There's a variety of activities that pharmacy are involved in that students can learn from. Drug information is another very common useful element of an APPE rotation. Students can be asked to answer questions of medical staff of the nursing staff or patients.

Skip to 5 minutes and 28 secondsMaybe involve in literature analysis or some type of research. So it is always a benefit to get students involve drug information processes regardless of the nature of the rotation. Now looking at it from a different perspective. There are many opportunities to give students a chance to develop their communication skills. The first would be verbally. They can learn to give presentation. In service presentations, either to the pharmacy staff, nursing staff, medical staff, they can present cases to their preceptors or to members of the pharmacy staff, or medical staff. They can be involved in consultations. This is something that I will always require of my students.

Skip to 6 minutes and 13 secondsIf they discovere something that they thought perhaps should be changed regarding a patient therapy, I would require them the first come to me to talk about it. And if they are indeed have found something that should perhaps be recommended to the medical staff taking care of the patient. We would talk about it. And my preference was to make sure the student fully understood the all the ins and outs. What the recommendation would entail. And then allow the student to go have the experience of direct verbal communication with the prescriber. To see what it's like to try to influence decision-making of a prescriber.

Skip to 6 minutes and 52 secondsTo be able to deal with the possibility of the prescriber saying “No, I'm not going to do that.” Or you're thanking them “Yes I like your idea I think I'll make that change.” But it's all part of the development of verbal communication skills with a health professional. And lastly, they should learn to interview patients or counsel patients. This is all part of the training experience. In addition to verbal communication, students should be able to develop their written communication skills. This could involve writing drug monographs. New drug comes out that's going to be considered by the PNT committee, pharmaceutics committee, allow a student to write up a monograph that describes the ins and outs of the drug.

Skip to 7 minutes and 37 secondsOr perhaps have students write up ADR reports, or other types of reports that relate to patient care. And also, if there's a pharmacy newsletter that's published, have the students provided an opportunity to write up a newsletter article. Or perhaps even a journal article. I've had students discover a very unique case that they were able to write up as a case report that was published in a pharmacy journal. Bottom line is that the activities of the students, as we're trying to get them to develop their skills, need to relate to the practice site. With the opportunity are in the practice site depending in how patient care takes place and how the pharmacy operates. Take full advantage of those opportunities.

Skip to 8 minutes and 30 secondsBut also to coin a phrase, kill two birds with one stone. We should try to accomplish two things with student training. One is to provide a good learning experience for the students. And the other to do so while providing meaningful service to the institution. If the students can learn while they are actually providing patient care while they're actually providing pharmacy services. That's the best of both worlds. That's a win-win situation. So we don't want to set up hypothetical situations where students are learning when we could have them learn from real-life situations in which they're actually providing meaningful valuable services to patients in the hospital or to people who work within the hospital.

Experiential learning principles 4

Students must transition from cognitive knowledge to performance ability.

  • Miller’s pyramid of clinical competence
  • Major types of learning activities in a typical APPE rotation

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Taipei Medical University

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