Effectiveness of a Medication Reconciliation Simulation in an Introductory Pharmacy Practice Experience Course

Kathy Komperda, PharmD; Kelly Lempicki, PharmD

Disclosures

Am J Pharm Educ. 2019;83(4) 

In This Article

Abstract and Introduction

Abstract

Objective: To evaluate the effectiveness of a simulated learning exercise on pharmacy students' ability and perception of their ability to perform medication reconciliation.

Methods: Third-year pharmacy students were divided into three groups. Group A attended a 30-minute lecture; group B attended the lecture and participated in a 90-minute workshop; and group C received no training. After groups A and B completed their assigned learning activities, all students participated in a simulated medication reconciliation activity with a standardized patient (SP). Students also completed a pre- and post-intervention survey.

Results: One hundred eighty-three students participated. Students in group B scored the highest (74.5%) on the SP activity compared to those in group A (68.9%) and group C (66.1%). Students in group B reported high levels of agreement with all statements describing the lecture, workshop, and SP activity, including that more of these activities should be integrated into the curriculum.

Conclusion: A simulated learning exercise significantly improved students' ability to perform medication reconciliation, including obtaining an accurate medication list, correctly identifying medication discrepancies, and proposing appropriate resolutions. Simulated learning exercises should continue to be incorporated in pharmacy education, especially exercises for learning pharmacy practice skills such as medication reconciliation.

Introduction

Medication reconciliation is the process of comparing medications a patient is currently taking or should be taking to existing medication orders and resolving any discrepancies that exist.[1] The importance of medication reconciliation as a component of patient care across health care settings is recognized by many national organizations, including the Joint Commission.[1] The need for effective medication reconciliation is further supported by the growing body of literature evaluating the frequency of and potential outcomes associated with medication discrepancies.[2–4] Toolkits such as the Medications at Transitions and Clinical Handoffs (MATCH) and the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) have been published to guide institutions through development, implementation, and evaluation of medication reconciliation programs.[5,6] A multidisciplinary team approach to medication reconciliation that includes physicians, pharmacists, and nurses is recommended by these guides. Pharmacists are uniquely suited to interview patients and identify medication discrepancies based on their knowledge and patient counseling skills.[3] In two recent systematic reviews of hospital-based medication reconciliation practices, most successful interventions were found to include a high level of pharmacist involvement.[7,8]

The ability of pharmacy students to obtain medication histories and identify and resolve medication discrepancies during introductory and advanced pharmacy practice experiences has been previously studied.[9–12] There is still limited information available about the type of training that will best prepare pharmacy students for their future roles in the medication reconciliation process. No studies have been published about the use of simulation to teach or assess pharmacy students' combined medication history taking and medication reconciliation skills. Simulated medication reconciliation activities were incorporated in the hospital pharmacy module of a pharmaceutical skills course[13] and an order verification activity in an institutional introductory pharmacy practice experience (IPPE).[14] These simulations, however, did not include the opportunity for students to practice obtaining a medication history, a key component of the medication reconciliation process. Separately, studies evaluating techniques to teach medication history taking have been published, such as one that evaluated a game-like tool used to introduce variables such as patient personality and medication problems into a small-group role-playing activity about taking medication histories.[15]

Studies have been published about medication reconciliation instruction in medical education.[16–20] Lindquist and colleagues incorporated a medication reconciliation simulation in an established second-year course for medical students. In this activity, small groups of students attempted to prepare an accurate medication list for a patient (portrayed by an actor) after observing an initial interview conducted by a faculty member. Students then reviewed the patient's medication bottles and partial medication list and completed brief calls and conversations with the patient, community pharmacist, and the patient's primary care provider.[16] A similar simulation activity was developed to teach medication reconciliation in a longitudinal elective at another college of medicine.[17] These simulation activities were well accepted by medical students and improved their perceived skill confidence; however, their abilities to obtain a medication history and perform medication reconciliation after completing the simulation activities were not formally assessed.

At our institution, lectures and/or workshops about medication reconciliation were previously included in two IPPE courses during the second year. While these courses introduced the need for and process of medication reconciliation, the opportunity to apply these skills in a simulated medication reconciliation involving simulated patients, pharmacists, and providers was absent. Therefore, this project was undertaken to design, implement, and evaluate a simulated learning exercise about medication reconciliation in an IPPE course within the third year of a Doctor of Pharmacy (PharmD) program. The primary objective was to evaluate the effectiveness of the simulated learning exercise on students' ability to perform medication reconciliation. Secondary objectives were to compare students' perception of their ability to perform medication reconciliation before and after the simulated learning exercise and to describe the students' perception of the educational intervention.

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