Characteristics of significant events identified by pharmacy students while on early immersion pharmacy practice experiences
Objective: The purpose of this study was to characterize and classify significant events of pharmacy students who completed an early practice experience.
Methods: Significant event analyses (SEAs) were reflections submitted by students about events that they found impactful during their early practice experiences. An online repository has stored 287 SEAs submitted by first year pharmacy students for later use in a pharmacy course. For this study, all significant events were read and coded according to the pre-specified themes and tones (positive, negative, neutral, hybrids) of the event. Themes used were derived from prior literature characterizing major themes from other health professional students’ experiences. Additional themes were added by authors for those that did not fit into the pre-set categories. All themes of the narratives were subsequently categorized. To assure confirmability, the investigators conferred to discuss new themes that emerged and events that were ambiguous. To assure credibility, an external audit of a sample of the coded SEAs was completed. Upon reaching consensus between primary reviewer and secondary reviewers, data were reported as frequencies and percentages. This study received ethics clearance from the Office of the University Registrar and was deemed exempt by the University Institutional Review Board.
Results: A total of 1,055 coded responses were analyzed. The majority of SEAs were positive in tone (n=190, 66.2%) and many were hybrids of negative-turned-positive emotions (n=62, 21.6%). The most common major content theme was “patients and the provision of patient care” (n=412, 39.1%), followed by “pharmacy students and their behavior” (n=260, 24.6%). The most prevalent subthemes were “learning by doing” (n=134, 12.7%) and “feelings of usefulness or uselessness” (n=111, 10.5%).
Conclusions: The majority of students framed significant events in their pharmacy practice experiences in a positive light, even from challenging interactions. The events that resonated most frequently with these students centered around patient interactions and providing patient care. These results will be useful for pharmacy educators developing pharmacy school curriculums to better prepare students to excel and feel more comfortable in direct patient care experiences.
Branch WT. Use of critical incident reports in medical education. J Gen Intern Med. 2005;20(11):1063-1067. https://doi.org/10.1111/j.1525-1497.2005.00231.x
Lister PG, Crisp BR. Critical incident analyses: A practice learning tool for students and practitioners. Practice. 2007;19(1):47-60. https://doi.org/10.1080/09503150701220507
Vachon B, LeBlanc J. Effectiveness of past and current critical incident analysis on reflective learning and practice change. Med Educ. 2011;45(9):894-904. https://doi.org/10.1111/j.1365-2923.2011.04042.x
Flanagan JC. The critical incident technique. Psychol Bull. 1954;51(4):327-358. https://doi.org/10.1037/h0061470
Charon R. Narrative and medicine. N Engl J Med. 2004;350(9):862-864. https://doi.org/10.1056/NEJMp038249
Gathright MM, Thrush C, Guise JB, Krain L, Clardy J. What do medical students perceive as meaningful in the psychiatry clerkship learning environment? a content analysis of critical incident narratives. Acad Psychiatry. 2016;40(2):287-294. https://doi.org/10.1007/s40596-015-0303-3
Krupat E, Pelletier SR, Chernicky DW. The third year in the first person: medical students report on their principle clinical year. Acad Med. 2011 Ja;86(1):90-97. https://doi.org/10.1097/ACM.0b013e3181ff9508
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398-405. https://doi.org/10.1111/nhs.12048
Henderson E, Berlin A, Freeman G, Fuller J. Twelve tips for promoting significant event analysis to enhance reflection in undergraduate medical students. Med Teach. 2002;24(2):121-124. https://doi.org/10.1080/01421590220125240
Downe-Wamboldt B. Content analysis: method, applications, and issues. Health Care Women Int. 1992;13(3):313-321. https://doi.org/10.1080/07399339209516006
Morgan DL. Qualitative Content Analysis: A Guide to Paths Not Taken. Qual Health Res. 1993;3(1):112-121. https://doi.org/10.1177/104973239300300107
Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods. 2017;16(1):1-13. https://doi.org/10.1177%2F1609406917733847
Tsingos-Lucas C, Bosnic-Anticevish S, Schneider CR, Smith L. The Effect of Reflective Activities on Reflective Thinking Ability in the Undergraduate Pharmacy Curriculum. Am J Pharm Educ. 2016;80(4):65. https://doi.org/10.5688/ajpe80465
Crisp BR, Anderson MR, Orme J, Lister PG. Assessment frameworks: a critical reflection. Br J Soc Work 2007; 37:1059-1077. https://doi.org/10.1093/bjsw/bc1053
Daloz LA. Effective teaching and mentoring. San Francisco, CA: Jossey-Bass; 1986.
Young JE, Williamson MI, Egan TG. Students’ reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic. Adv Health Sci Educ Theory Pract. 2016;21(1):63-77. https://doi.org/10.1007/s10459-015-9611-3
Panadero E. A Review of self-regulated learning: six models and four directions for research. Front Psychol. 2017;8:422. https://doi.org/10.3389/fpsyg.2017.00422
Boekaerts M, Cascaller E. How far we moved toward an integration of theory and practice in self-regulation. Educ Psychol Rev. 2006;18(3):199-210. https://doi.org/10.1007/s10648-006-9013-4
Helmich E, Bolhuis S, Dornan T, Laan R, Koopmans R. Entering medical practice for the very first time: emotional talk, meaning and identity development. Med Educ. 2012;46(11):1074-1086. https://doi.org/10.1111/medu.12019
Mylrea MF, Gupta TS, Glass BD. Professionalization in Pharmacy Education as a Matter of Identity. Am J Pharm Educ. 2015;79(9):142. https://doi.org/10.5688/ajpe799142
Lawrence C, Mhlaba T, Steward KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: a scoping review. Acad Med. 2018;93(4):648-656. https://doi.org/10.1097/ACM.0000000000002004
Vosper H, Hignett S. A UK perspective on human factors and patient safety education in pharmacy curricula. Am J Pharm Educ. 2018;82(3):6184. https://doi.org/10.5688/ajpe6184
Rosenbaum ME, Axelson R. Curricular disconnects in learning communication skills: what and how students learn about communication during clinical clerkships. Patient Educ Couns. 2013;91(1):85-90. https://doi.org/10.1016/j.pec.2012.10.011
Reid A, Abrandt Dahlgren M, Dahlgren LO, Petocz P. From Expert Student to Novice Professional. Dordrecht: Springer; 2011.
Schafheutle EI, Hall J. Learning professionalism through practice exposure and role models. Int J Pharm Pract 2012;20(2):118-128.
Dinkins MM, Haltom WR. A Characterization of Student Reflections in an Introductory Pharmacy Practice Experience Discussion Course. Am J Pharm Educ. 2018;82(3):6247. https://doi.org/10.5688/ajpe6247
Somma MA, Meyer SM. “Community of learning” in experiential education. Am J Pharm Educ. 2007;71(1):19. https://doi.org/10.5688/aj710119
Duncan-Hewitt W, Austin Z. Pharmacy Schools as Expert Communities of Practice: A Proposal to Radically Restructure Pharmacy Education to Optimize Learning. Am J Pharm Educ. 2005;69(3):54. https://doi.org/10.5688/aj690354
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