A Simulation Activity to Assess Student Pharmacists' Knowledge and Perceptions of Oncology Pharmacy

Elizabeth Ledbetter, PharmD; Scarlet Lau, PharmD, MPH; Andrea Enterline, PharmD; Bethany Sibbitt, PharmD; Aleda M. H. Chen, PharmD, PhD


Am J Pharm Educ. 2020;84(5):7474 

In This Article

Abstract and Introduction


Objective: To assess the impact of an interactive activity on student pharmacists' confidence in answering oncology-related questions and their perceptions of an oncology pharmacists' roles in practice.

Methods: Two cohorts (2016 and 2017) of third-year student pharmacists completed a two-hour, interactive, four-station activity during the fourth week of an oncology module. Each station simulated a different oncology-related scenario that represented a specific practice settings. Pre- and post-activity surveys were administered to determine changes in students' confidence levels and perceptions.

Results: Over the two years, 66 student pharmacists completed the pre- and post-activity survey instruments. In both cohorts, there was a significant increase in scores on all items regarding students' confidence. Student pharmacists' perceptions of pharmacists' roles also improved significantly.

Conclusion: The simulation activity was effective as confirmed by improvement in student pharmacists' post-activity scores on confidence and perception. Determining student pharmacists' comfort in responding to oncology scenarios is important to prepare them for practice in any setting.


Pharmacists' roles in the care of oncology patients are continually evolving as providers are challenged with medication shortages, rapid availability of newly approved oncolytics (oral chemotherapy), high-cost therapies, and reduced reimbursement. According to studies by the American Society of Clinical Oncology, the demand for oncology services may rise disproportionately to other services because of patient age distribution, provider practice patterns, and the number of oncology fellowship positions for medical graduates available in the United States.[1,2] Pharmacists are well-positioned to compensate for the predicted shortage of providers in this area because of their extensive pharmacology knowledge as well as the postgraduate residency training and advanced specialty certification available in this area.

Oncology pharmacists are responsible for comprehensive medication management; counseling patients; developing therapeutic plans; evaluating drug therapies; monitoring treatment-related toxicities; ensuring safe compounding and preparation of chemotherapies, biologics, and immunotherapy; and serving as an integral member of oncology interdisciplinary teams.[2] Pharmacists also influence formulary management and institutional policies and standards.[3] As treatment options become more targeted toward tumor type, biomarkers, and mutation expression, pharmacists can play a vital role in therapy optimization. Pharmacy-led drug evaluation can subsequently lead to decreased costs, prevention of adverse events, and improved outcomes and quality of life. Growing recognition of pharmacists' value supports the continual need for adequate training in oncology pharmacotherapy to deliver quality patient care.[3,4] To achieve this, it is critical to prepare student pharmacists as future practitioners equipped to address the provider gap in oncology care.

There are few studies in the literature on the implementation of pharmacy oncology courses or advanced pharmacy practice experiences (APPE) in oncology and their impact on student pharmacists' knowledge and perceptions of oncology practice. In a study evaluating the impact of an oncology elective course on student pharmacists' interest in oncology practice, only 45 of 53 students completed two consecutive semesters of the course. There was a decrease in the number of students showing interest in pursuing oncology specialty residencies or becoming board certified in oncology.[5] Another study examined the impact of a one-credit hour oncology elective course on examination scores for a pharmacotherapeutics course between third-year student pharmacists who took the oncology elective course and those who did not. Students who took the elective had significantly higher scores on three out of the six examinations. Students also provided positive feedback and expressed an increased interest in pursuing a career in oncology pharmacy, with 35% agreeing that the course increased their interest in oncology.[6] In a third study evaluating the impact of a comprehensive ovarian cancer case-based simulation on knowledge in 109 third-year student pharmacists, a significant improvement in knowledge was seen as evidenced by higher scores on three of the six items on the post-activity test compared to the pre-activity test. The students' perceptions of oncology pharmacists' roles and students' self-confidence in reviewing and dispensing oncolytics also increased significantly.[7] Another study reported on an acute care oncology pharmacy practice experience in a layered learning practice model for APPE students, PGY1 residents, and PGY2 residents to evaluate learner perception of the model and achievement of knowledge-based learning objectives. All posttest scores significantly increased compared to pretest scores, and learners viewed the experience as positive and felt it allowed for improvement in clinical and self-management skills.[8] Most of the studies discussed here documented improvement in pharmacy students' oncology knowledge after implementation of an oncology APPE or elective course and positive perceptions of oncology pharmacy practice; however, because these were elective experiences, they only impacted those student pharmacists who enrolled in the course.

There are a limited number of studies in the literature that discuss student pharmacists' perceptions about their use of oncology knowledge once they are licensed pharmacists. In a study published in 2017, researchers evaluated Florida student pharmacists' interests (N=532 from five out of six schools of pharmacy) in oncology pharmacy and areas of oncology specialization. Three-fourths (75%) of students were only moderately comfortable or not comfortable with oncology, while over half (56%) of students expressed interest in pursuing oncology in their future pharmacy practice. Most students reported no access to oncology-related experiences, with less than five students reporting having earned experiential hours related to oncology. They also requested additional oncology experiential opportunities and elective courses. Therefore, although some students showed interest in learning more about or pursuing a career in oncology, most students identified a perceived need for further training in oncology topics.[9]

Although studies have been published that discuss improvements in student pharmacists' oncology knowledge based on pre- and post-activity test scores and perceptions of oncology practice at the end of interventions, there are few studies that have evaluated student confidence in their knowledge of oncology pharmacotherapy and compared their perceptions of oncology practice before and after participating in interactive activities in a required oncology module. We address these gaps in the study presented here. The objectives of this study were to assess students' confidence in answering oncology-related questions in different pharmacy practice settings pre- and post-activity and students' perceptions of the importance of pharmacists in the treatment of cancer patients prior to the course and after participating in the interactive activity.