Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505, United States.
Department of Pharmacy Practice and Science, Division of Applied Clinical Sciences, University of Iowa College of Pharmacy, 180 South Grand Avenue, Iowa City, Iowa 52242, United States.
Curr Pharm Teach Learn. 2021 Aug;13(8):1024-1031. doi: 10.1016/j.cptl.2021.06.015. Epub 2021 Jun 20.
It is unclear how clinical reasoning is impacted by a single advanced pharmacy practice experience (APPE) and how preceptors can further develop these skills.
Students completing an APPE within four sites were invited to participate. To assess clinical reasoning skills, students completed a 30 item script concordance test (SCT) during week 1 and week 5 of a rotation. Students were divided into control and intervention groups. The intervention group participated in a clinical reasoning discussion, during which students presented a case and led a discussion on how to reason through treatment options.
Change in mean SCT scores between week 1 and week 5 were 0.84 (2.8%) and 1.23 (4.1%) in the control (n = 15) and intervention groups (n = 28), respectively. There was no significant change in scores in the control group (P = .07, CI -0.34, 2.01). The change in scores was statistically significant in the intervention group (P = .02, CI 0.23, 2.23). An independent samples t-test comparing the SCT score change for the control and intervention group showed no significant difference (P = .62, CI -1.18, 1.96).
This study demonstrated the feasibility of implementing a SCT in experiential education. SCT scores did not significantly improve beyond the standard APPE in response to the focused educational intervention, but investigators found that the discussion facilitated rich conversations about patient cases and was valuable for assessing a student's thinking pattern.
目前尚不清楚单一的高级药学实践经验（APPE）如何影响临床推理，以及导师如何进一步培养这些技能。
邀请在四个站点完成 APPE 的学生参加。为了评估临床推理技能，学生在轮转的第 1 周和第 5 周完成了 30 项脚本一致性测试（SCT）。学生被分为对照组和干预组。干预组参加了临床推理讨论，在此期间，学生提出了一个病例，并就如何通过治疗选择进行推理展开了讨论。
对照组（n = 15）和干预组（n = 28）在第 1 周和第 5 周之间 SCT 评分的变化分别为 0.84（2.8%）和 1.23（4.1%）。对照组的分数没有明显变化（P =.07，CI-0.34，2.01）。干预组的分数变化具有统计学意义（P =.02，CI 0.23，2.23）。对对照组和干预组 SCT 评分变化的独立样本 t 检验显示无显著差异（P =.62，CI-1.18，1.96）。
本研究证明了在体验式教育中实施 SCT 的可行性。在标准 APPE 之外，针对该集中教育干预，SCT 评分并没有显著提高，但研究人员发现，讨论促进了对患者病例的深入讨论，对于评估学生的思维模式具有重要价值。
