Scutt Greg, Williams Sian, Auyeung Vivian, Overall Andrew
Medicines Optimisation Research and Enterprise Group, School of Applied Sciences, University of Brighton, UK.
Clinical Practice and Medicines Use, King's College London, UK.
Explor Res Clin Soc Pharm. 2021 Dec 11;5:100096. doi: 10.1016/j.rcsop.2021.100096. eCollection 2022 Mar.
When providing pharmaceutical care, the pharmacist relies upon a clinical decision-making process that involves information gathering, clinical reasoning, and clinical judgment. Typically, pharmacists have to identify, retain and recall numerous pieces of key information arranged spatially in medical records and prescriptions or verbally from colleagues when making decisions. Executive function, including spatial working memory and verbal reasoning, along with other cognitive domains, will likely contribute to the elements that comprise this process.
To establish the predictive utility of markers of executive function and implicit memory on clinical decision-making and dispensing performance in pharmacy students.
MPharm students from two sites completed a battery of cognitive tasks designed to measure elements of executive and other cognitive functions (e.g., verbal working memory (VWM), visuospatial working memory (VSWM), and implicit memory (IM)). Performance on 2 clinical case studies was used to assess clinical decision-making ability ( = 16), and a prescription screening and dispensing assessment was used to assess dispensing accuracy ( = 32). A statistical model was built to establish whether executive and other cognitive functions markers can predict clinical decision-making and dispensing performance.
Performance in VSWM test and IM tests were found to explain approximately 63% of the deviance in clinical decision-making ability (null residual deviance = 49.4, deviance explained by variables = 31.0; Matrix Model < 0.01, Dot-clearing test p < 0.01). Performance is the VSWM, and VWM tests explained approximately 30% of the deviance in the dispensing task (null residual deviance = 7596.7, deviance explained by variables = 2099.3; Matrix Model*Baddeley Reasoning Model, < 0.05).
The results suggest that specific cognitive domains contribute to the clinical decision-making process. This adds to a growing body of literature that highlights the importance of person-specific factors in predicting clinical competence.
在提供药学服务时，药剂师依赖于一个临床决策过程，该过程包括信息收集、临床推理和临床判断。通常，药剂师在做决策时必须识别、保留并回忆病历和处方中按空间排列的众多关键信息，或者从同事那里口头获取这些信息。执行功能，包括空间工作记忆和语言推理，以及其他认知领域，可能会对构成这一过程的要素有所贡献。
确定执行功能和内隐记忆指标对药学专业学生临床决策和配药表现的预测效用。
来自两个地点的药学硕士学生完成了一系列认知任务，旨在测量执行功能和其他认知功能的要素（例如，语言工作记忆（VWM）、视觉空间工作记忆（VSWM）和内隐记忆（IM））。2个临床案例研究的表现用于评估临床决策能力（n = 16），处方筛查和配药评估用于评估配药准确性（n = 32）。建立一个统计模型，以确定执行功能和其他认知功能指标是否可以预测临床决策和配药表现。
发现VSWM测试和IM测试的表现可解释临床决策能力中约63%的偏差（零残差偏差 = 49.4，变量解释的偏差 = 31.0；矩阵模型p < 0.01，点清除测试p < 0.01）。VSWM和VWM测试的表现解释了配药任务中约30%的偏差（零残差偏差 = 7596.7，变量解释的偏差 = 2099.3；矩阵模型*巴德利推理模型，p < 0.05）。
结果表明特定的认知领域对临床决策过程有贡献。这为越来越多强调个体因素在预测临床能力方面重要性的文献增添了内容。
