In total, 19 students (9 medical and 10 pharmacy) formed four focus groups that generated 92 min of interview data. Detailed analysis of the data yielded four main themes of participant’s experiences of the interprofessional simulation-based prescribing and dispensing activity: (1) IPE simulation activity: creating a broader learning experience; (2) patient-centred practice: a shared understanding; (3) professional skills: explored and shared; and (4) professional roles: a journey of discovery, respect and stereotypes.
IPE simulation activity: creating a broader learning experience
During their prior training, the participants had only a small number of interprofessional learning experiences, often being more theoretically orientated such as class-based tutorials. Together, pharmacy and medical students discovered that the simulated environment offered them an opportunity to apply their theory knowledge into ‘practice’ collectively and safely. Both professions expressed that this method of teaching was perceived to be more beneficial to them, particularly the simulated environment contributing to their understanding and learning of the social and interpersonal dimensions of prescribing and dispensing.
You learn better practically, a lot better than you do being in a lecture. You’re always going to take more away from these sort of sessions than watching an hour’s lecture. (Male, Med FG2)
…obviously in first and second year it was more sitting in a room and going over calculations or something, whereas this is a lot more interactive. I really enjoyed today, it was really good to see it. (Female, Pharm FG2)
The teaching of prescribing can often have a dominant theoretical perspective. However, with the use of a simulated patient further enhanced the realism of this simulation. The participants particularly highlighted that the simulated patients provided them with a more realistic view of the problems that can arise in actual practice.
So they had a sore throat, they didn’t know if they could take tablets, so there’s a bit more counselling and thinking on your feet there ….. it’s quite realistic; patients will have problems in practice and I think this was reflected in the scenario…. (Male, Pharm FG1)
In addition to the participants developing their consulting, prescribing and dispensing skills together, the activity also allowed them to foster their mentorship abilities. Medical students felt that they benefited from the pharmacy students guiding the prescription writing and dispensing sections, as many of them had little understanding of these processes. Conversely, medical students led in history taking enabling the pharmacy students to ‘tailor their consultations’ with the simulated patients after dispensing their medications. As with many other simulation-based teaching methods, the participants appreciated the relative safety and supportive environment of the simulation.
We are going to be writing scripts in a few years’ time so I kind of liked it that they were there and we able to bounce of each other and tell them about what questions we would ask, how we counsel them and they reiterated that and said they liked being able to see what we were telling the patient… (Male, Med FG3)
Patient-centred practice: a shared understanding
The use of simulated patients (SPs) in the simulation very much triggered a critical reflection among students about patient-centred practice. This was particularly enhanced when each profession of students was able to consider how other professions demonstrated patient-centeredness. As often with prescribing, there can be dominance with intellectual learning, with risk of rendering the person (patient) invisible in the process. However, having a ‘human face (i.e. the SP) reinforced the ‘person behind the prescription’—reminding students that the skills they were refining—served to benefit the care of their future patients.
For many medical students, this was their first opportunity to appreciate the dispensing process, and so, admittedly, the continuous focus on patient-centeredness and safety came as a pleasant surprise to them. Steps taken by the pharmacy students, for example, the appropriate use of capital letters on medicine labels and counselling the patient about their medication, impressed the medical students who had not fully considered this aspect of the patient journey in prescribing
it’s opened my eyes to how patient-centred the dispensing and counselling really is. (Female, Med FG2)
Often in the community, patient consultation, prescription writing and dispensing processes are disconnected in students learning. Witnessing each component stage of the patient journey, from GP consultation to receiving medications, gave pharmacy students a critical insight into the patient experience that many had not encountered before. They expressed that speaking with the simulated patients humanised the ‘prescriptions’ written on paper and trained them to dispense and consult in a more empathetic way.
…to be empathetic, you are not just treating a piece of paper you are treating a patient there is a person lies at the end of it (Male, Pharm FG4)
Professional skills: explored and shared
The session highlighted two main skill sets among both professions as areas of development and expertise: prescription writing and consulting with patients. Medical students found prescription writing by hand particularly challenging, having more experience with hospital drug charts and computer-generated prescriptions on clinical placements. Pharmacy students, who had cultivated this skill over their years of study, ensured the format, dosages and instructions of the medical student’s ‘prescriptions’ were written legally and reflected good prescribing practice.
…it was helpful to see the pharmacists being able to show us how they actually make out a prescription, knowing if it’s a capsule or a tablet. As a medical student, you probably wouldn’t even be thinking of that (Female, Med FG1)
Pharmacy students praised the holistic approach medical students applied to their consultations, examining many aspects of the simulated patients’ health including their acute presentation. However, some pharmacy students commented that medical students could often ‘bombard’ simulated patients with questions which seemed irrelevant. This served as a useful advice for future history taking by the medical students.
Something I thought was good was with our patient they weren’t just asking about drug therapy. They gave other options. Our medical student suggested yoga and that sort of thing, lifestyle things that could help, something other than drugs. (Female, Pharm FG2)
Medical students admitted to being unaware that pharmacy students are trained in providing patient education on drug interactions, side effects and dosage regimens. This made medical students feel supported that drug information relayed to patients during GP consultation would be reiterated by their pharmacy colleagues in the community. Participants from both professions noted that the IPE activity strengthened the trust and reliance they had in each other’s knowledge and skills.
I think knowing a pharmacist is checking your prescriptions, they’re the ones that have more knowledge in that area, that you’d go ‘I would like their expertise on it’ over yours. (Female, Med FG1)
Professional roles: a journey of discovery, respect and stereotypes
Participants began to delve into a deeper understanding of the roles each play within their professions. Many differences in attitudes, between the two professions, towards practice were found. Notably, medical students were surprised at pharmacy student’s strict adherence to stipulated guidelines. This appeared to create a ‘natural tension’ between them, namely the use of clinical guidelines is promoted in pharmacy education at an early stage in the interest of patient safety. In contrast to this, medical students are encouraged to develop a more flexible approach to prescribing: ‘guidelines not tramlines’.
This fundamental variation in practice can be misinterpreted by pharmacy and medical practitioners giving rise to professional stereotypes. From the discussions, pharmacy students commented that medical students can often come across as arrogant or ‘cavalier’ in their approach to prescribing. Medical students supported this misconception but added that this activity allowed them to observe the dispensing process and understand how professional conflicts arise.
…in that you do learn to play to each other’s strengths and work as a team and there’s no point in that sort of cavalier approach of ‘I know best’, because it’s rarely what’s best for the patient. (Male, Med FG1)
It was unearthed that pharmacy students and pharmacists can be misjudged as the ‘nag’ character. It was implied that students assumed communications between pharmacists and GPs centred solely on following up the use of medications outside of recommendations, a perceived annoyance for medical students.
I think doctors often see pharmacists as a bit of a nag, but for us the legal requirements are so important on our side so we have to get things sorted out. But for doctors, they see that as annoying, just because it does take time for them. (Female, Pharm FG1)
Students valued the opportunity the simulated activity gave them to view these conflicting ideas in a more empathetic way. Pharmacy students gained an appreciation of how GPs may be trying medications outside of the recommended guidelines and medical students the importance of following guidelines for the benefit of patient safety, which will hopefully benefit both groups in their future practice.
The idea of the ‘production line’ dispensing process was discussed by pharmacy and medical students. The role of a pharmacist in providing optimal medications can often be underestimated , patients and doctors alike may presume dispensing medications to be a pharmacist’s exclusive occupation. This activity was the first occasion many of the medical students had to appreciate the multiple roles of a pharmacist, including dispensing, independent prescribing, referral, consultation and examination.
…I think it’s important that the doctors understand that we’re not just a production line, pill counters or whatever, but we do have that clinical knowledge and know our boundaries, when to pass it on for further investigation or whatever. (Male, Pharm FG1)