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Purpose: This study was aimed to design Objective Structured Field Examination (OSFE) and also standardize the course plan of community pharmacy clerkship at Pharmacy Faculty of Tabriz University of Medical Sciences (Iran).
Methods: The study was composed of several stages including; evaluation of the old program, standardization and implementation of the new course plan, design and implementation of OSFE, and finally results evaluation.
Results: Lack of a fair final assessment protocol and proper organized educating system in various fields of community pharmacy clerkship skills were assigned as the main weaknesses of the old program. Educational priorities were determined and student’s feedback was assessed to design the new curriculum consisting of sessions to fulfill a 60-hour training course. More than 70% of the students were satisfied and successfulness and efficiency of the new clerkship program was significantly greater than the old program (P<0.05). In addition, they believed that OSFE was a suitable testing method.
Conclusion: The defined course plan was successfully improved different skills of the students and OSFE was concluded as a proper performance based assessment method. This is easily adoptable by pharmacy faculties to improve the educational outcomes of the clerkship course.
The principal mission of Pharm.D. course is educating skilled students in pharmaceutical aspects of health related organizations as a researcher and or a community pharmacist. The overall goals of implementing Pharm.D. course are listed below:
a. Improving pharmacy science understanding
b. Presenting scientific and practical researches in pharmaceutical science
c. Providing knowledge and skill in various related fields such as:
In our university, the aforementioned goals are complemented by passing 210 credit-hours during 6 years. In this regard the whole pharmacy lessons in Pharm.D. course can be classified in four main groups; essential (basic) sciences, main courses, specific fields and community pharmacy and hospital clerkship programs.1
Community pharmacy clerkship program provides practical and scientific experiences for pharmacy students to achieve an acceptable performance in community pharmacies. According to our faculty's rules, pharmacy clerkship program is implemented in 3 individual parts:
Evaluation of the program described above, revealed teachers and students disfavor due to lack of an organized educating system for training in various and necessary fields such as appropriate processing of prescriptions, patient counseling and communication, providing appropriate drug information, monitoring patient-specific disease states and documenting pharmaceutical care outcomes.
Standardization of the community pharmacy clerkship course plan was performed to overcome these shortages and also to improve the overall educational outcomes. Another main source of trainers' objections was raised from the inappropriate assessment methods. It was believed that the examinations were only based on theoretic evaluation of the student’s knowledge and were only capable of simple recalling of the memorized information and therefore were not useful in some practical aspects such as patient counseling and or health related problem solving.2 One of the proper methods which is also suitable for the pharmacy clerkship course skill assessment is named OSCE (Objective Structured Clinical Examination) and was first defined by Harden at 1975.3,4 This method has been selected as an acceptable multilateral way of assessment by numerous universities all over the world.5-10 Many researchers have utilized an OSCE type assessment to evaluate mastery of essential skills of pharmacy students but as OSCE are mainly about clinical abilities, in community pharmacy clerkship; researcher has named it as OSPE (Objective Structured Practical Examination)11 and OSFE (Objective Structured Field Examination).12 OSPE and OSCE are gold standard for assessing pre-clinical and clinical laboratory skills.11
OSFE is a slightly modified type of OSCE. In 2005, Jalili et al. reported acceptable satisfaction of the medical students from the OSCE method.13 In addition, Noohi et al. reported that 86 percent of the teachers in Kerman University of medical sciences preferred OSCE to any other types of clinical evaluation of the trainee’s skills.14 OSCE has been an instrumental part of clinical competence assessment in the faculty of pharmacy at the international Islamic University Malaysia since 2006 and is defined as a performance-based assessment method preferred to conventional methods.6
In the current study, the standardization of the community pharmacy clerkship course plan for Pharm.D. student’s was performed and an OSFE type assessment was designed, implanted and evaluated according to the student's satisfaction rates.
This study was carried out at the faculty of pharmacy, Tabriz University of Medical Sciences, Tabriz (Iran) in 2012. Fifty one students (male=25, female=26; 24.2±2.2 years old) that had contributed in community pharmacy clerkship course were all participated in this study.
The study was implemented in four below stages:
In this stage, 12 meetings and group discussions with trainers (Teaching professors) were arranged to find out the current status of the clerkship program. Student's opinions were also collected using a questionnaire. The results of stage 1 were utilized in designation of the stage 2.
This stage was performed in 7 levels:
A multi station, multi task process of skill assessment (OSFE) compromised a circuit of totally 7 stations. All examinees were assessed using exactly the same stations. Detailed written instructions and scenarios were provided to ensure that the given information is the same to all participants. Seven examiners located in each station and presented their question on an A4 paper. Each student had a 5 minute period to complete each station, thus it takes half an hour for each participant to complete the whole exam.
The below considerations have fundamental importance in the design and implementation of the new course and also the final assessment:
Student’s satisfaction and perception about course implementation and final skill assessment was evaluated by a 5 point scale questionnaires (Likert scale). Questions of the questionnaires were primarily prepared by the research head and then reconsidered in group meetings. The best questions were selected and documented as final standardized questionnaires. Considering ethical issues, writing the name in the questionnaire was optional and all the completed questionnaires and the students’ opinions were kept confidential. The responses were scored and analyzed using SPSS 16 and finally presented as Mean percentages ± SEM. Independent t-student test was used to determine any significant differences between the old and new clerkship programs. Differences were considered significant at a level of P<0.05.
According to the old program rules, at the beginning of the clerkship course, 2-4 students were being introduced to each trainer who were academic staffs with PhD degrees and simultaneously were as responsible pharmacists in the university's pharmacy. Each student performance during the course was being measured using a questionnaire that was filled out by the responsible trainer at the end of the course. There was no written course plan or lesson plan to be followed up and the trainers were free in selecting the topics for teaching. The undefined training time was dependent on the trainer’s free time in the pharmacy. The students were only seeking the trainer’s advice whenever they encounter a problem during reviewing the medicines in the shelves or evaluating the prescriptions. Their questions were usually about indications, mechanism of actions, routes of administration, dosage forms, brand names and some financial workouts.
The student’s attendance during the course was checked using a fingerprint Timex machine available in the pharmacy. The course was assigned as complete when 60 hours period was fully passed.
The old program had no final skill assessment and students ranking were assigned according to their total activity during the course and was completely dependent on his/her individual trainer opinion.
After several group meetings, curriculum design was performed based on educational priorities and also trainers and students feedback. A 60-hour period during 12 training sessions (5 hours each) was defined and implemented. The main competencies tested in the OSFE can be divided into two main parts; one, technical affairs and two, administrative and financial aspects of pharmacy. The detailed description of each part has been listed below:
Technical affaires were compromising of the following parts:
As the complexities of competencies tested at different stations have a clear effect on examination4, attempts were done to remain the stations in the same level. In this study OSFE compromised a circuit of totally 7 stations (5 minutes each). The general contents and OSFE stations design were as follow:
Station 1: Dosage forms, pharmacological classes, refrigerated drugs, special storage conditions, prescription reading and dispensing
Station 2: Regulations on prescriptions, reception, method of administration for special dosage forms, ADR and its reporting, ministerial regulations on pharmacies
Station 3: Analyzing the prescriptions (indications, contraindications, interactions, routes of administration and etc.) and utilizing Informational resources
Station 4: Multi-ingredient dosage forms, OTC drugs administration, herbal medicines, supplements and diet formulas
Station 5: Extemporaneous preparation and dispensing cosmetics and toiletries
Station 6: Pharmacy management, accounting, drug depot, medical devices and cosmetics as well as drugs ordering from licensed distributors
Station 7: Dispensing medicines to a model patient and communicating with patients
Practically the test steps were as below:
The study items in questionnaires were assessed to evaluate the results. Student’s satisfaction about course implementation and also the final skill assessment method was evaluated by their answers. Statistical analysis of the results was also performed to determine the overall success rate. Student satisfactions (expressed as percentages mean ± SEM) in different issues are shown in Table 1 and Table 2. Satisfaction rate in four different areas (Pharmacy clerkship program, trainers, OSFE and extemporaneous preparation) was calculated as mean percentages ± SEM and shown in Figure 1. In addition, successfulness and efficiency of the new clerkship program was compared to the old program. As depicted in Figure 2, in the viewpoints of the students, successfulness and efficiency of the new clerkship program was significantly greater than the old program (P<0.05).
In this study, course objectives and learning outcomes for community pharmacy clerkship program were developed and standardized to improve different skills and knowledge of the participants. A performance based assessment as a final evaluation of the students competency, was performed by OSFE design. According to Table 1 and Figure 1, the results showed that a total of more than 70 % of students were satisfied with new clerkship program and OSFE were accepted by more than 75 % of the examinees. The students also believed that successfulness and efficiency of the new clerkship program was significantly greater than the old program (P<0.05). Extemporaneous preparations and dispensing which has never been offered in old clerkship program, satisfied about 80 % of students collaborated in the new course. Unfortunately, the presentation quality of previous lessons related to clerkship and also their success in preparing students to get their role in clerkship program was rated less than 50 % which indicates the necessity of serious attention to reconsidering the offered course.
Community pharmacy clerkship program is one of the most important courses that provides practical and scientific experiences for Pharm.D. students to achieve an acceptable performance. In this study, standardization of its course plan was performed and OSFE assessment model was designed, implanted and evaluated. Regarding the results, it may be concluded that the defined course plan was successfully improved different skills of the students and OSFE was as a suitable performance based assessment method. This is easily adoptable by pharmacy faculties to improve the educational outcomes of different clerkship courses such as community pharmacy and hospital clerkship programs.
The present investigation was financially supported by Research Center for Medical Education of Tabriz University of Medical Sciences, Tabriz, Iran.
The authors report no conflicts of interest.