A mixed-methods study of the impact of simulation-based education on the general practice clinical pharmacist in NHS Scotland.

Steel, Lyndsay McFarlane

Abstract

Clinical decision making in healthcare is the process by which healthcare professionals make personalised prescribing and treatment choices for patient care using a combination of clinical evidence, patient preferences and their own clinical expertise. Good clinical decision making requires confident and competent management of ambiguity and dubiety from the clinician, and can lead to better treatment responses and increased patient satisfaction. Pharmacists are considered to have high levels of accuracy with regards to prescription checking; however, as the profession advances, there is an increasing requirement for pharmacists to manage risk and clinical decision making. This study was conducted in NHS Scotland in the general practice (GP) setting with pharmacists working in patient-facing roles as independent prescribers (PIPs). It was evident that pharmacists qualified as PIPs were not making full use of their qualifications in clinical practice. Research has shown that pharmacists would benefit from more problem-solving, critical thinking and communication skills type learning: simulation-based education was identified as one learning tool to do this. The aim of this research was to explore the impact of a simulation-based education (SBE) course on general practice clinical pharmacists (GPCPs). This study employed an initial set of quantitative data collection and analysis, using questionnaires, an adapted Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scoring tool and qualitative analysis through interviews and focus groups with 30 PIP-GPCPs from across Scotland. An SBE course, containing four scenarios, was designed for PIP-GPCPs working at or towards an advanced clinical practice level. Ethics approval was granted by the RGU School of Pharmacy and Life Sciences ethics review panel. Key findings align with the Kirkpatrick Model, selected due to its robust qualities in terms of evaluation of training, providing a structured insight into the following: program improvement; optimisation learning, including transferral of learning to behavioural and organisational results; and demonstration of the value of the training to the participants and the organisation. Detailed statistical analysis of self-reported adapted TAMSAD score demonstrated a statistically significant difference between pre and post training values, indicating that the GPCP tolerance of ambiguity increased following attendance at SBE. Following attendance at the GPCP SBE course, reactions were reported through course evaluation feedback and interviews. The reactions from participants were, in general, extremely positive. All participants reported that SBE should become an integral educational tool available in the GPCP learning pathway. Feedback also indicated self-reported advancements of knowledge, confidence and experience for clinical practice. Operational areas were identified that required consideration and change to facilitate optimal service delivery by GPCPs. Participants described support for attendance at SBE training from employers as being generally positive; however, consideration of training needs and protected learning time (PLT) needed to be recognised and formally provided by the organisation / profession and supported by line managers. It was highlighted by participants that other healthcare professionals have PLT to undertake professional development. In conclusion, the GPCP SBE course was received well by participants, effectively contributing to the learning and positive behavioural changes of the GPCP. Limitations include the small cohort size, use of non-validated tools and adaptation of the TAMSAD tool without full psychometric validation in a range of clinician groups. This work highlights the benefits of providing SBE in pharmacy education and training, and the need for operational changes in the profession taking in to account the advances in clinical practice and impact on patients.

Citation

STEEL, L.M. 2024. A mixed-methods study of the impact of simulation-based education on the general practice clinical pharmacist in NHS Scotland. Robert Gordon University, MRes thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2801295

• Thesis Type: Thesis
• Deposit Date: Apr 23, 2025
• Publicly Available Date: Apr 23, 2025
• DOI: https://doi.org/10.48526/rgu-wt-2801295
• Keywords: Pharmacy education; Pharmacists; Simulation-based education; Clinical decision-making; General practice
• Public URL: https://rgu-repository.worktribe.com/output/2801295
• Award Date: Oct 31, 2024