PaCT: Development of Patient-centered Communication Tools for Pharmacists. A new tool to measure pharmacy student communication skills.

Theresa R. Prosser, Pharm.D., Gloria R. Grice, Pharm.D., Nicole M. Gattas, Pharm.D., Jill Sailors, Pharm.D., Mychal Voorhees, M.A, Peter Hurd, Ph.D., Clark Kebodeaux, Pharm.D., Amy Tiemeier, Pharm.D., Tricia M. Berry, Pharm.D.

St. Louis College of Pharmacy, St. Louis, Missouri

OBJECTIVES Based on experience using the Four Habits Model-FHM (a validated instrument designed for physicians) to evaluate student pharmacists’ communication skills during patient encounters, the objectives were to: • develop an effective, comprehensive and valid framework with assessment

rubric specific for pharmacist-patient communication skills. • use that framework and rubric to teach, assess and evaluate student

pharmacists’ skills during standardized patient encounters.

DISCUSSION While there are important skills applicable across health care disciplines that foster effective communication during patient encounters, using tools developed for other disciplines may not capture skills important and unique to pharmacists (e.g. changing focus from diagnosis to medication-related issues).

Multiple methodologies were used to strengthen the face and content validity process.

IMPLICATIONS This is the first known pharmacy-specific communication framework with assessment rubric with face and content validity. Testing for reliability, inter-rater reliability, construct validity, concurrent and predictive validity has been performed.

Areas for further exploration include methods to optimize the effectiveness of framework for student pharmacist learning and assessor training and translating the rubric cumulative score into a model grading system. PaCT’s suitability for other health care professionals could be evaluated.

ACKNOWLEDGEMENTS Missouri Foundation for Health is an independent philanthropic foundation dedicated to improving the health of people in our region. MFH works as a changemaker, educator and partner to promote community health and increase access to care for the uninsured and underserved.

We thank Vibhuti Arya, Lynette Bradley-Baker, Robert Beardsley, Lisa Guirguis, Carole Kimberlin, Dee Dee McEwen, Nathaniel Rickles, Sharon Youmans, and Elizabeth Young for their assistance and support as expert panelists in conducting this study.

REFERENCES 1. Stein T, et al. Enhancing clinician communication skills in a large healthcare organization: A longitudinal case study.

Patient Educ Couns. 2005;58:4-12. 2. Paget L, et al. Institute of Medicine Discussion Paper. http://www.iom.edu/~/media/Files/ Perspectives-

Files/2012/Discussion-Papers/VSRT-Patient%20Clinician.pdf. Last accessed 6/24/13. 3. Global Assessment for Student Pharmacist. Leslie Dan Faculty of Pharmacy, University of Toronto. 4. Professionalism Assessment Rating Scale (PARS). Institute for Clinical Competence. New York College of

Osteopathic Medicine. 2009. (unpublished). 5. PACE Communication Strategies. http://www.nhlbi.nih.gov/health/prof/lung/asthma/pace/

media/documents/manual.pdf Last accessed 6/24/13. 6. Levensky ER, et al. Motivational interviewing: An evidence-based approach to counseling helps patients follow

treatment recommendations. AJN 2007;107(10):50-58. 7. Brunett PH, et al. Essential elements of communication in medical encounters: The Kalamazoo Consensus Statement.

Acad Med 2001;76:390-93. 8. Lang F, et al. Communication assessment using the common ground instrument: Psychometric properties. Fam Med

2004;36(3):189-98. 9. Association of American Colleges and Universities. Oral Communication VALUE Rubric.

http://www.aacu.org/value/rubrics/pdf/OralCommunication.pdf. Last accessed 6/24/13.

Visit our website: www.stlcop.edu/pact

METHODS A multi-step process was used to develop and validate a new communication framework and associated assessment rubric for use with student pharmacists.

• Comprehensive literature search identified eight tools and other frameworks • Consensus of content by communication and pharmacy practice faculty (n=9)

Framework Development

• Review by interdisciplinary communication and health literacy experts (n=10) • Feedback incorporated into draft of framework

Face and Content Validity

• Roundtable feedback was provided on by expert panel described above • Assessment rubric was revised by faculty team

Assessment Rubric Created

• Student pharmacists in the 4th professional year on APPEs (n=12) volunteered to participate in a simulated respiratory patient encounter and inhaler instruction with standardized patients (SPs)

• Feedback from SPs (n=11), faculty assessors and students added into rubric

Pilot Testing of Assessment Rubric

• Student pharmacists (n=190) were taught the communication framework and assessed using the rubric in the fall 2012 semester

• Final revisions to framework and rubric were made

Classroom Experience with Framework and Rubric

TOOLS REVIEWED Communication Tools • Four Habits Model1

• IOM Patient-Clinical Communication2

• Global Assessment3

• Institute for Clinical Competence Professionalism Assessment Rating Scale4

• Physician Asthma Care Education (PACE)5

• Motivational Interviewing6

• Kalamazoo Consensus Statement7

• Common Ground8

Other Tools • VALUE Rubric (Communication)9

• DACUM at STLCOP^ • Previous STLCOP evaluation tool^

Face & Content Validity

Other Tools

Internal Faculty Experts

External Expert Panel

Student Pharma-

cists

Faculty Assessor

Group

Standard-ized

Patients

^Internal St. Louis College of Pharmacy (STLCOP) documents IOM – Institutes of Medicine

The FHM authors determined PaCT to be significantly different from FHM. The PaCT framework includes 23 skills categorized into 5 general “tools”. With the PaCT rubric, each skill is assessed on a 5-point scale on the rubric: 1) Unsatisfactory 2) Needs Improvement 3) Adequate 4) Capable 5) Proficient

RESULTS

PaCT: Development of Patient-centered Communication Tools for Pharmacists. A new tool to measure pharmacy student communication skills.

Theresa R. Prosser, Pharm.D., Gloria R. Grice, Pharm.D., Nicole M. Gattas, Pharm.D., Jill Sailors, Pharm.D., Mychal Voorhees, M.A, Peter Hurd, Ph.D., Clark Kebodeaux, Pharm.D., Amy Tiemeier, Pharm.D., Tricia M. Berry, Pharm.D.

St. Louis College of Pharmacy, St. Louis, Missouri