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Service learning in pharmacy: Opportunities for student learning and service delivery
Abstract
High patient load and understaffing in public health care facilities preclude the provision of optimal pharmaceutical services in South Africa. A Service Learning in Pharmacy (SLIP) programme for the University of the Western Cape's final year pharmacy students was implemented in health care facilities to assist in service provision. Students rotated between a pharmacotherapy (patient-oriented) and pharmaceutical formulation (product-oriented) activities to develop skills in prescription analysis, manufacturing and packaging of hospital pharmaceuticals. Structured focus group sessions were held with students and pharmacists to assess the integrated service learning experiences. Student feedback was positive, as the 'real world' experiences enabled them to adapt to intense work pressures, developed a sense of 'personal responsibility' towards patient health and they were sensitized to issues of social injustice. Students became competent in prescription analyses, counseling on medication use, manufacturing and pre-packing procedures. Pharmacists fully supported increased student involvement in the health services. Service learning in pharmacy schools is needed to contextualize learning and to address health care needs in South Africa.
... As such, a module topic would be covered asynchronously or non-systematically in the different disciplines over the four-year study period, thereby fragmenting student learning. In addition to the on campus theoretical and laboratory-based teaching, the school's experiential learning programme, Service Learning in Pharmacy (SLiP), aims to provide real world experiences for students to apply their theoretical knowledge [24]. An externship experience, also allows students to clock hours in pharmacies during their vacation periods. ...
... The School took the new curriculum as an opportunity to embed relevance in its service learning programme and as such expanded it across all 4 years of study (previously only presented in the third and fourth years of study) [24]. SLiP was attached to pharmacology and clinical pharmacy modules in first, second and fourth year, and a pharmacy practice module in the third year, as it was intended to cut across disciplines to offer integrated, real world learning to the students. ...
... However, this contradicts the SLiP experience where 93% participation was recorded in health and wellness promotion for maternal and antenatal care. The interaction could have enhanced participants' performance as alluded to by Bheekie et al. in their study of the opportunities for student learning and service delivery in SLiP where they explained that it enabled contextualized learning [24]. A study evaluating the University of Arizona College of Pharmacy's curriculum and the knowledge and abilities of pharmacy students to counsel pregnant and breastfeeding women about the use of over-the-counter products and prescription medications revealed that the curriculum was deficient in some areas such as teratogenicity and comprehensive case studies. ...
Background
Maternal and child mortality is a global concern and one of South Africa’s quadruple burdens of disease. As easily accessible frontline healthcare workers, pharmacists play an important role in the continuum of maternal and child health (MCH) care according to recommendations by international health regulatory bodies. Pharmacy schools are obliged to train pharmacy students to meet the priority health needs of the population so that graduates are ‘fit for purpose’. The baseline study aimed to evaluate the knowledge and skills of 2017 final year pharmacy students who were exposed to a fragmented MCH care curriculum at a university in South Africa to inform curriculum review.
Methods
A descriptive, quantitative, non-randomized study was conducted among final year pharmacy students using a self-administered structured questionnaire. The questionnaire was designed in sections to assess participants’ knowledge of reproductive and sexual health (RSH), maternal and antenatal care (MAC), neonatal and child care (NCC) and skills related to infant growth assessment procedures. Data was analysed descriptively using frequencies and percentages. A score of 50% in each section of the questionnaire indicated a pass. Participants assessed their exposure to MCH topics in the curriculum.
Results
Of the 89 available students, 61% consented to participate in the study. The average scores attained for each section were; 62.4% for RSH, 54.5% for MAC, 50.4% for NCC and 25.3% for infant growth assessment. The pass rate was 78% for RSH, 56% for MAC, 57% for NCC, and 19% for infant growth assessment. About 13% of the participants passed all the knowledge and the skills sections. Age, gender, being a parent or doing locums did not have any influence on participants’ performance. Participants reported that they had more on-campus curriculum content exposure to RSH compared to other MCH care topics.
Conclusion
Final year pharmacy students showed adequate knowledge of RSH with adequate curriculum exposure. Average knowledge of MAC, NCC and poor skills in infant growth assessment which corresponded to curriculum exposure was observed. The results suggest the need for improvement in the current curriculum in the affected areas to adequately equip students to render desirable services.
... The School of Pharmacy at the University of the Western Cape (UWC) has been strengthening its Service Learning in Pharmacy (SLiP) programme and partnership since 2002 [23]. The primary service-learning goal is to ensure that graduates have the knowledge and skills to become population, community and patient-centred pharmacists who are committed to addressing South Africa's pressing primary healthcare needs. ...
... Up until 2015, the research conducted into the service learning programme had focussed on general programme description [27] and student learning experiences [23]. The first data collection activities from service partners was part of a research project to align pharmacy education with social accountability (2015) that intended to evaluate longitudinal outcomes of the service learning programme and to use this evidence-based approach to improve the programme and strengthen the tripartite partnership. ...
Lifelong learning among healthcare practitioners is crucial to keep abreast of advances in therapeutic and service delivery approaches. In South Africa, continuous professional development (CPD) was mandated (2019) for re-registration of pharmacists to illustrate their learning according to the South African Pharmacy Council’s (SAPC) competency standards. This paper uses a preceptor programme linked to the University of the Western Cape School of Pharmacy’s service learning programme to map the competencies employed by pharmacist preceptors in primary care public healthcare facilities in Cape Town in an attempt to encourage completion of their annual CPDs and strengthening the academic-service partnership. Competencies identified were divided into input competencies related to the preceptor’s role in designing and implementing the educational programme in their facilities and assisting students to complete their prescribed learning activities, and output/outcome competencies that emerged from preceptors identifying the facility needs and employing their input competencies. Input competencies pertained to education, leadership, patient counselling, collaborative practice and human resources management. Output competencies related to pharmaceutical infrastructure, quality assurance, professional and health advocacy, primary healthcare, self-management and patient-centred care. The preceptor programme enabled pharmacist preceptors to employ several competencies that are aligned with the SAPC’s competency framework.
... The work-based experiences of the students form part of the service-learning in pharmacy (SLiP) programme that has been part of the undergraduate pharmacy curriculum since 2003, at the School of Pharmacy, University of the Western Cape, South Africa (Bheekie et al., 2011). Although the service experience is central to servicelearning, it comprises a cycle of events, starting with (1) on-campus orientation, which introduced students to service and community partnerships, learning objectives, assessments and facility requirements, (2) the service experience at the assigned facility, (3) on campus guided group reflection, and (4) a reflection report. ...
Background: The work-based learning environment encompasses a dynamic space where the implementation of theoretical knowledge and skills may prove to be at odds with routine service delivery practices, known as the hidden curriculum.
Objective: To describe incidents reflective of the hidden curriculum of fourth year pharmacy students from work-based learning experiences at public healthcare facilities.
Method: A qualitative, descriptive study was conducted. Data from written student reflection reports were thematically analysed.
Results: From 35 reports, three primary themes including time, binaries, and students’ personal histories, influenced interactions in the workplace. These themes illustrated how the students’ professional and personal traits interlocked with historical, structural and cultural influences in the workplace as well as larger society.
Conclusion: Uncovering of the hidden curriculum revealed that the students’ ability to navigate workload pressure, polarisation between groups and their own biases are crucial to firstly survive, and secondly to learn in the workplace.
... Experiential learning programmes have strengthened capacity in resource-limited settings through pharmaceutical care training, 49 service learning in pharmacy 50 and medical 51 education. In developed countries service learning is integral to undergraduate public health 52 and pharmacy courses, 53 sensitising students to preventive care programmes. ...
South Africa’s transition towards a district-based health system (DHS) aims to offer health promotion and prevention services at community level, through re-engineered primary health care (PHC) services. Along with pharmacy workforce shortages and service delivery challenges, health reform is a clarion call to strategically re-position the pharmacist’s role in DHS strengthening. The pharmacist’s involvement in the three DHS streams, namely the clinical specialist support teams, school health services and municipal ward-based PHC outreach teams, is pertinent. This paper contextualises pharmacists’ current peripheral role in the health system, discusses a team-based approach and identifies opportunities to integrate pharmacy students into the re-vitalised PHC framework. Re-positioning of pharmacists within district clinical specialist support and school health teams could create opportunities for community-based and population-based services whereby a range of clinical and pharmaceutical services could materialise. Pharmacy training institutions could strengthen the DHS through established partnerships with the community and health services. Academic service learning programmes could integrate pharmacy students as part of the PHC outreach teams to promote community health. Interdependence between the health services, pharmacy schools and the community would create a platform to contextualise learning and dismantle existing silos between them. Multi-sectoral engagement could enable pharmacy schools to design strategies to optimise pharmaceutical service delivery and align their activities towards social accountability.
... The Service-Learning in Pharmacy (SLiP) programme of the School of Pharmacy was initiated in 2001 (Bheekie et al, 2011(Bheekie et al, :2546. It evolved from a final (4th) year programme only, to one which includes 3rd, 2nd and 1st year students. ...
... The School of Pharmacy at the University of the Western Cape (UWC) introduced in 2013 two pharmacy-focussed first year modules which incorporated service-learning components. With this step service-learning was institutionalised across all four years of study, which previously only spanned from second to fourth year (Bheekie et al., 2011). Although servicelearning activities are linked to a module code, it is not limited to a specific academic discipline and aims to cross disciplines, providing integrated learning to the student as it would have happened in the 'real world'. ...
Background: South Africa’s shortage of health professionals is most pronounced in rural and underserved communities, where the burden of disease is greatest. One key question is: how pharmacy training contributes to preparing students to address local health priorities in these communities?
Aim: Our aim was to implement a first year service-learning activity that addressed a local health service need.
Method: Case study methodology was used to describe and analyse implementation of the service activity.
Results: Implementation entailed students pre-packing sugar and salt into a sachet for use by clinics for the treatment of diarrhoea-induced dehydration. This activity proved to be beneficial for student learning and the health services. Despite the two-pronged significance, key questions emerged about how this activity aligned with current pharmacy
practice.
Conclusion: Our preliminary attempt to embed relevance in pharmacy training uncovered apparent inconsistencies in expectations for the role of the pharmacist between training institutions, accreditation bodies and the public health system.
... Historically, the student population emanated primarily from lower socioeconomic backgrounds, spurring academic departments, including the School of Pharmacy, to engage with underserved communities to relieve inequity. The SLiP program was initiated in 2001 (Bheekie, Obikeze, Bapoo, & Ebrahim, 2011), following a call from South Africa's reconstruction and development program to implement service-learning in higher education. SLiP is positioned as one of five disciplines within the school, which is located in the Faculty of Natural Sciences. ...
Pharmacy education is required to align itself toward social accountability, a framework that is congruent with the service-learning pedagogy. This paper evaluates the University of the Western Cape’s (UWC) Service-learning in Pharmacy (SLiP) program relative to the conceptualization, productivity, and utility (CPU) model for social accountability. At an operational level, SLiP epitomizes reciprocal partnership with the health services; however, inherent structural constraints within both the university and the health system inhibit influence at strategic and community levels. The way forward is to intensify research efforts in aligning with social accountability, which requires commitment from stakeholders across all levels.
... The Service-Learning in Pharmacy (SLiP) programme of the School of Pharmacy was initiated in 2001 (Bheekie et al, 2011(Bheekie et al, :2546. It evolved from a final (4th) year programme only, to one which includes 3rd, 2nd and 1st year students. ...
Rationale for research: The Canadian Interprofessional Health Leadership Collaborative (CIHLC) is a multi-institutional partnership whose goal is to develop, implement, evaluate and disseminate an evidence-based collaborative health leadership programme. In 2012 the CIHLC proposal was chosen by the Institute of Medicine Board on Global Health as one of four innovative collaboratives from an international competition of academic institutions around the world. This paper describes evidence from four arms of research.
A scoping review of peer-reviewed literature explored collaborative leadership attributes and behaviours. A systematic literature review located existing health leadership programmes, competency-based frameworks and pedagogical strategies. A curriculum inventory of Canadian leadership programmes for health students and professionals identified existing programmes with collaborative leadership curricula. Key informant interviews with stakeholder groups, such as Canadian senior leaders in interprofessional education, revealed their perspectives on collaborative health leadership development.
A synthesis of common thematic findings was used by the CIHLC team to develop a conceptual framework for the leadership programme. The framework suggests that intersections of leadership competencies, values-based principles of enactment and pedagogical strategies will result in complex systems transformation. Core leadership competencies are related to the transition from self-leader development to collaborative leadership development. Major pedagogical strategies include blended learning modalities and a community-engaged service-learning project. Community engagement and social accountability serve as the over-arching principles of enactment. A Canadian pilot programme is planned for 2014. Participants will actively demonstrate their acquired leadership competencies by engaging with stakeholders in community settings to collaboratively identify, plan, implement and evaluate a service-learning project of significance to the population health of their community. Underserved populations will be the communities of interest. Our assumption is that this unique programme will result in effective health systems change. We believe that this programme, once tested within a Canadian context, will be globally adaptable.
Key messages • Access to quality medicines and competent, capable health care professionals are fundamental aspects of any health care system. Pharmaceutical human resources should ensure the uninterrupted supply of quality medicines to the population, their management, and responsible use, as vital components in improving the health of nations. • Multi-stakeholder collaboration incorporating best-available evidence is required to inform needs-based pharmaceutical human resources planning. When relevant, well-informed stakeholders partner to address workforce issues, there are greater possibilities for coordinated workforce planning and implementation. • Pharmacy workforce per capita varies considerably between countries and regions and generally correlates with country level economic development indicators. Countries and territories with lower economic indicators, such as those in Africa, tend to have relatively fewer pharmacists and pharmacy support workers. This has implications for observed inequalities in access to medicines and medicines expertise. In addition, some countries and territories have many times more pharmacies than pharmacists, which may imply a renewed need for supervision of medicines and medicines use. • Strategic frameworks and policies related to the pharmacy workforce are being successfully developed and implemented at the country level through multi-stakeholder processes involving ministries of health, health professional associations, regulators, and educators to drive and achieve both competence and practitioner excellence for care quality. • Improving workforce performance - productivity, competency and the ability to adapt to new roles - is an on-going challenge in the increasingly dynamic environment of rising health care costs, increased demand for health services, and increased burden of chronic diseases. Fuelled in part by an increased focus on patient care and inter-professional collaboration, these elements provide the opportunity for pharmacists to use their professional skills to provide safe, high quality, and cost-effective pharmaceutical services for the benefit of populations. Leadership is a key aspect in empowering pharmacy professionals to maximize these opportunities and to innovate and shape their practice. • Investment in transforming and scaling up professional education is crucial, as education provides the foundation for building a capable health care workforce. The capacity to provide pharmaceutical services in each country is dependent upon having an assured, competent workforce and an integrated academic workforce to train sufficient numbers of new pharmacists and other support staff at both foundation and advanced levels. Ongoing effort is needed to ensure capacity building of skilled medicines expertise meets the pharmaceutical health needs of populations. • A needs-based education strategy allows local systems to best assess the needs of its community and then develop (or adapt) the supporting educational system to produce a workforce relevant to these needs. National health care demands are diverse and complex, often varying widely within and between regions. Although broad and general frameworks may be beneficial at the macro level, a “one-size-fits-all” system does not offer the authenticity needed for full engagement and sustainability at the local level. • Pharmaceutical Human Resources continue to be a priority issue for FIP Education initiatives (FIPEd) to engage collaboratively with all stakeholders; we need to work together towards developing a profession that can meet present and future societal and pharmaceutical health needs around the world (www.fip.org/education).
Objective:
Job satisfaction is a very important contributing factor for a person's productivity and motivation. Naturally, if people are not satisfied with what they practice, they will probably need to change or reshape their way of practice at a certain period in time. Pharmacists are not exception to this principle and have been observed to re-professionalize pharmacy in to clinical and/or pharmaceutical care in many parts of the world. Thus, this survey aims to investigate the Eritrean pharmacists' current level of job satisfaction and their views on re-professionalization of pharmacy.
Method:
A cross-sectional survey was conducted among all Eritrean pharmacists who reside inside Eritrea.
Main outcome measures:
Opinion of pharmacists about job satisfaction and re-professionalization of pharmacy into pharmaceutical care.
Results:
Out of the 95 questionnaires distributed 86 were completed and returned giving a response rate of 90.5 %. Nearly three fourth of the respondents (71 %) have chosen pharmacy as their ever profession and they want to encourage their children or their close relatives to pursue it as a career. Sixty four percent of the pharmacists are either partially or fully unsatisfied to spend the remainder of their working life in a job like their current one and this has a strong statistical association with less years of experience (p = 0.007) and place of work of the younger pharmacists (p = 0.008). Majority of the study participants (86 %) believe there is a great mismatch between pharmacists' level of education and level of practice in the work area. This was significant with lower age (p = 0.002), less years of experience (p = 0.006) and later year of admission to university (p = 0.000). Ninety five percent of the pharmacists perceive that the current role of the Eritrean pharmacists needs to be redefined and re-oriented.
Conclusion:
Although the Eritrean pharmacists are proud to be pharmacy professionals, they want to redefine and reorient their current role into pharmaceutical care.
The majority of patients with type 2 diabetes mellitus in Cape Town who attend primary care community health centres (CHCs) have unsatisfactory glycaemic control. Insulin is rarely prescribed despite its being indicated for type 2 diabetic patients with inadequate metabolic control on maximum oral glucose-lowering agent (OGLA) therapy.
The study examined barriers to initiating insulin therapy in poorly controlled type 2 diabetes patients on maximum OGLAs in CHCs in the Cape Town metropolis.
Five focus group discussions and 10 in-depth semistructured individual interviews were conducted with 46 medical officers working at the CHCs. The discussions and interviews were transcribed and common themes were identified and categorised.
Doctor, patient, and system barriers to initiating insulin therapy were identified. Doctors' barriers include lack of knowledge, lack of experience with and use of guidelines related to insulin therapy, language barriers between doctor and patients, and fear of hypoglycaemia. Patient barriers were mistaken beliefs about insulin, non-compliance, lack of understanding of diabetes, use of traditional herbs, fear of injections, and poor socioeconomic conditions. System barriers were inadequate time, lack of continuity of care and financial constraints.
Suggestions for overcoming barriers include further education of doctors on insulin initiation and the use of standardised guidelines. In addition, a patient-centred approach with better communication between doctors and patients, which may be achieved by reorganising aspects of the health system, may improve patient knowledge, address mistaken beliefs, improve compliance and help overcome barriers. Further research is needed to investigate these recommendations and assess patients' and nurses' perceptions on initiating insulin therapy.
This paper examines the role expansion of community pharmacy in South Africa against the background of phenomena such as professional dominance and boundary encroachments. The study demonstrates pharmacy's thrust towards an extended and more meaningful role, making a clear distinction between the role extension concerning the granting of additional powers to prescribe medications, and that of a wider range of activities. It confirms previous claims that the opposition from the medical profession is particularly fierce when it relates to the pharmacist's ability to prescribe. The successful granting of special permits to a selected group of pharmacists to practice an extended role can be explained by the fact that it has been restricted to rural, under-served areas. The developments to date signify a partial success by the pharmacy profession towards its role extension. However, this is likely to remain limited due to the forces operating against it. Considering this context, the development of "health centres" might prove to be an alternative venue for the integration of pharmacists into the health care team.
Although defining itself as a patient-centred profession, private sector (community and private hospital) pharmacy often appears to be that of a product-for-profit centred occupation. This perception has been at the core of the medical profession's attempts to reduce the professional autonomy of pharmacy, and has appeared at the forefront of the South African Department of Health's positioning of private sector pharmacy. Using as a starting point the debate surrounding attempts by the South African Minister of Health to regulate the price of medicines, I propose that the present negative positioning of private sector pharmacy in South Africa could be ameliorated by pharmacy practice that evidences a redefined understanding of professionalism.
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