Standardized Colleagues in Pharmacy Education

To the Editor: We would like to thank Gillette and colleagues for their enlightening study titled “Improving Pharmacy Student Communication Outcomes Using Standardized Patients,” published in the August 2017 issue of the American Journal of Pharmaceutical Education. Gillette and colleagues found that students taught using standardized patients performed better on a high stakes communication assessment when compared to students taught using other active learning techniques, including role-play. These results add to the literature supporting the meaningful use of standardized patients in curricula and may be extrapolated to other health care professional degree programs. In their discussion, Gillette and colleagues point to the absence of data describing student perceptions of using standardized patients to practice communication skills and suggest that the student perspective be examined further.¹ As a student and educator, we support the need for additional perspectives by adding our own experiences with standardized patients at the University of Pittsburgh School of Pharmacy. To further the discussion, we also propose a call for complementary design and assessment of standardized colleagues when teaching interprofessional communication skills in the PharmD didactic curriculum.

The University of Pittsburgh uses standardized patients throughout its Doctor of Pharmacy degree program to build and strengthen students’ communication skills, a key element of the Center for the Advancement of Pharmacy Education 2013 Educational Outcomes Domain 3: Approach to Practice and Care.² More specifically, patient interviewing, prescription counseling, self-care assessment with recommendations, and clinical-case activities are taught using standardized patients throughout the three-year didactic curriculum. In our experiences as a learner and educator, we have noticed that students take low stakes and high stakes experiences with standardized patients as seriously as if they were real patient encounters. Because of this, we believe that students find standardized patient activities to be meaningful especially when scenarios mimic real-world experiences and standardized patients provide direct feedback to students during and following the encounter. It also should be noted that students may feel better prepared, feel more comfortable, and perform at a higher level with real patients secondary to their preparatory standardized patient encounters. Therefore, we strongly support the integration of standardized patients within didactic curricula to strengthen student communication skills. We agree that further assessment of the student perspective of standardized patient experiences is warranted.

To further expand our support for standardized patient experiences in didactic pharmacy education, an integrated literature review by Smithson and colleagues found standardized patients to be successful in teaching interprofessional collaboration.³ We believe that this success may be translatable to the use of standardized colleagues in teaching interprofessional team dynamics and communication, a required key element of the Accreditation Council for Pharmacy Education Standards (ACPE) 2016.⁴ In support of our beliefs, a 2015 study by Davies and colleagues showed that there was significant improvement in student confidence when making recommendations to physicians regarding patient care and in student comfort initiating potentially difficult communication topics with physicians as a result of a standardized patient and standardized colleague interprofessional acitivity.⁵ In a separate study, Shrader and colleagues showed improvements in student performance and confidence with interprofessional communication as a result of a standardized colleague simulation in simulated inpatient and outpatient clinical settings.⁶ Lastly, Benedict and colleagues have used standardized colleagues to assess PharmD student readiness for practice.⁷

The ACPE expects that professional Doctor of Pharmacy degree programs prepare students to be “practice-ready” and “team-ready” by providing direct patient care and contributing as a member of an interprofessional team.⁴ We believe that standardized patient and standardized colleague experiences prepare students to embody both. Furthermore, collaboration as a member of an interprofessional team has been identified by the American Association of Colleges of Pharmacy as a core entrustable professional activity for new pharmacy graduates.⁸ Entrustable professional activities, as units of professional practice, are specific tasks or responsibilities entrusted to trainees after obtaining sufficient competence.⁹ Through robust standardized colleague experiences, students may begin demonstrating levels of competency and trust when communicating and collaborating with an interprofessional team prior to the start of Advanced Pharmacy Practice Experiences. However, additional design and assessment of standardized colleague experiences is needed.

In summary, it is our opinion that both standardized patients and standardized colleagues are useful educational tools to prepare students for practice. We believe strongly that there is great value in expanding the design and assessment of standardized patient and standardized colleague experiences, not only to meet accreditation standards but also to prepare pharmacy graduates as contributing members of a collaborative health care team.

• © 2018 American Association of Colleges of Pharmacy