CC BY
12PHARMACEUTICS
COMMUNICATION SKILLS IN PRE-GRADUATE AND POST-GRADUATE EDUCATION OF
PHARMACISTS IN UKRAINE
Vlasenko I.
PhD of Pharmacy, Associate Professor, Pharmaceutical Technology and biopharmacy Department,
Shupyk National Healthcare University of Ukraine
Davtian L.
Doctor of Pharmacy, Professor, Head of Pharmaceutical Technology and biopharmacy Department
Shupyk National Healthcare University of Ukraine
Abstract
The aim of this article is to analyze the state of the problem of getting communicative competencies by pharmacists in Ukraine and abroad. It was found that the ability to acquire communication skills for use in professional teaching needs to improve both in scope and teaching methods at the Universities in Ukraine. It is necessary to ensure the development of communication skills throughout the professional life of pharmacists in the curricula of postgraduate education.
Keywords: pharmacist, communication skills, education
INTRODUCTION
The main tasks for healthcare are to ensure the quality medical and pharmaceutical care. It affects the quality of life and health of people, which are among the highest social values in the world [1].
Quality care occurs only when all providers, clinicians and pharmacists communicate clearly and effectively with the patient and in their healthcare teams. In this case proper communication is an important attribution in health care. Improper communication can cause serious problems with patient safety. Research has shown that 80% of serious medical errors in healthcare are the result of communication failures [2]. But effective communication with patients can improve health outcomes.
A communication skill is a discrete mode (unit of speech) by which a healthcare provider can further the clinical dialogue, and thus achieve some goals of outcomes. This definition describes the communication skill as concrete, teachable, and observable [3]. Good communication skills are required for complex activities such as drug reviews, motivating people to follow medications and promoting health [4].
Currently, one of the main activities of a pharmaceutical specialist is the provision of information and consulting assistance. The practice of pharmaceutical care is new and significantly different from what has been the activity of pharmacists in recent years. The provision of pharmaceutical care involves taking responsibility for the pharmacotherapeutic results of patients. Pharmacists can help to achieve positive treatment outcomes by educating, advising, and motivating patients to follow their pharmacotherapy regimens and monitoring plans. [5]. To perform this type of activity requires the ability to communicate effectively with visitors to pharmacies (patients).
Therefore, the new generation of pharmacists must have the knowledge and skills necessary to perform their new functions and responsibilities in order to adequately cope with the role as a member of a medical multidisciplinary team. Pharmacists must adapt their
communication to a wide range of patient needs and achieve patient-centered communication [6] and make communication between patients a vital component of daily practice [7].
Much of their work is related to patient safety because patients very often are prescribed different medicines from different doctors, and patients might be issued drugs that could make them unwell if combined with other medicines. And pharmacist must prevent dangerous drug interactions [8]. Pharmacist counsel and advise the patient to maximize the desired effects of the drug and minimize the side effects of the drug. An important role of the pharmacist is envisaged in achieving the goal of the campaign "Global Patient Safety Challenge: Medication Without Harm ", which was announced by the WHO in 2017, to reduce the number of deaths due to medicine use during 5 years [9].
Thus, the professional activity of pharmacists requires the ability to communicate effectively with people, exchange information, make decisions and transmit the necessary information, which is a communicative process [10]. In the report "The role of the pharmacist in the health care system: training the future pharmacist" by The World Health Organization (WHO) defined the pharmacist as a "communicator" [11]. So, the International Pharmaceutical Federation [12] and the European Union [13] have recommended to students-pharmacists to acquire interpersonal skills.
Providing quality pharmaceutical care is impossible without appropriate communication competencies. All professional competencies should be acquired through training, practice and self-education throughout professional life. Compliance with modern requirements of curricula for both undergraduate and postgraduate education is an opportunity to acquire, develop, and improve professional competencies, which must be considered in curricula and training programs.
Thus, the issue of implementing the acquisition and improvement of communication skills of a pharmacist is timely.
THE AIM. The aim of this article is to analyze the state of the problem of communicative competencies of pharmacists in Ukraine and abroad.
MATERIALS AND METHODS
The materials of the study were 1) scientific articles about communication competencies of pharmacists in Ukrainian and abroad; 2) the national education standards of Pharmacists and official curricula of Universities of Ukraine of pharmaceutical profile in undergraduate and postgraduate education about teaching communication skills. We used content-analysis, analytical methods.
REVIEW AND DISCUSSION
During recent years attention is paid to the actual problem of communication competencies of pharmacists. We found many studies in different countries. For this article we have selected some of them.
So, scientists in Ukraine emphasize on needs to improve the training of pharmacists and to form appropriate communication skills in students in accordance with the new requirements [10,14,15,16,17].
We conducted preliminary research about the competencies among pharmacists in providing pharmaceutical care to patients with diabetes. A representative survey showed that respondents have identified a significant barrier to the provision of pharmaceutical care for patients with diabetes. There is: a lack of appropriate professional skills for counseling. Understanding the factors or problems that may contribute to improving the quality of patient care services is important for optimizing pharmaceutical care [18]. Also, research about priorities in postgraduate education, according to the meaning of pharmacist-practitioners, they need to improve counseling skills to provide the necessary pharmaceutical care [19].
Studies of teaching and assessment of communication skills in the United States and Canada have shown that they need to improve not only teaching about the subject, but also methods of teaching [20,21] and opportunities to practice in specific situations [22].
In Australia, researchers have found that the using of effective communication in the training for pharmacists leads to improved clinical outcomes and patient satisfaction, as well as to the promotion of interprofessional relationships [23].
Analysis of the curricula of pharmaceutical schools in Brazil has identified gaps in pharmacy education programs to include the teaching of communication skills. The programs need to be revised, in connection with the new state guidelines for pharmaceutical education [24].
A survey in Lebanon showed the need to develop empathic communication skills in pharmacists, because the adopted model of pharmaceutical practice requires them to establish effective communication and use of interpersonal skills [25].
The results of a study in Kazakhstan revealed the need for pharmacists to improve their competence in communication skills and the need to implement an additional program about this subject for pharmacist-students [26].
Scientists have found that communicative competence of pharmacists in Russia needed development of effective communication skills [27].
According to modern requirements, communication between pharmacists needs to be developed towards a more patient-centered approach, and additional research is needed to determine how best to teach it to ensure the positive impact of pharmaceutical education to health outcomes [28,29]. Patient-centered care focuses on specific medical needs and desired health outcomes and is thus the driving force behind every healthcare decision which healthcare provider makes [30]. Thus, students must know how to communicate with patients with various diseases.
A study from Japan found that pharmacists faced three types of difficulties in communicating with cancer patients: dealing with negative emotions in patients, issues beyond their competence, and ways to manage patients and their families. These results may facilitate the development of interventions aimed at improving patient-pharmacist communication. The difficulties faced by pharmacists in communicating with cancer patients were classified into the following three areas: overcoming negative emotions of patients; issues beyond the competence of pharmacists; and how to manage patients and their families [31].
Pharmacists also require the possibility of additional time to consult people with dementia and their caregivers [32].
In a previous study by us, practical pharmacists noted that they needed to study the special needs of patients with diabetes to provide pharmaceutical care to those patients (counseling, blood glucose test, body weighing, blood pressure measurement, body mass index calculation, storage insulin etc.) [18,19,33]. This problem is also pointed out by foreign researchers [34].
Foreign researchers emphasize the need to improve communication skills for qualified pharmacists as part of continuing education [35]. A study shows that pharmacists welcome such a development [36].
In Ukraine, there is a Standard of Higher Education for obtaining a master's degree in "Pharmacy, Industrial Pharmacy" [37], which was prepared and implemented according to Law of Ukraine "About Higher Education".
Special (professional) competencies of pharmacists are grouped in five clusters in accordance with International Pharmaceutical Federation (Education Initiatives. Pharmacy Education Taskforce. A Global Competency Framework, v.1) [38] and established in the national educational program. This program describes necessary communication skills for pharmacists (cluster 1. FC 1. and cluster 4. FC 13.) [37].
Compliance with modern requirements of curricula for undergraduate and postgraduate education is an opportunity to acquire, develop, and improve the professional competencies of the specialists. Therefore, we analyzed the standards of higher pharmaceutical education of the leading Universities of Ukraine for their development of students' communicative competencies.
Educational program for the master's degree in "Pharmacy, Industrial Pharmacy" defines a mandatory component of the study in the 1st year of the discipline
"Ethics and Deontology in Pharmacy". One of the tasks in this discipline is to acquire basic knowledge of successful communication and interaction; solving communication problems related to the practical activities of pharmacists.
After the adoption of the order of the Ministry of Health of Ukraine dated 18.09.2018 №1696 Universities determined the list and scope of disciplines, the sequence of their study, the form of training etc. This expanded their autonomy and enabled a creative approach to the education in this subject.
For teaching in the discipline "Ethics and deontology in pharmacy", 90 hours are set aside for teaching, of which 40 hours in classrooms (lectures - 10 hours, seminars - 30 hours) and 50 hours for student's independent work. This amounts to 1% of all education hours during a 5-year study. This is according to the state curriculum for the training of pharmacists, which was approved by the Ministry of Health of Ukraine on 07/26/2016.
Universities develop their curricula based on the state curriculum. The university decides at what level (year), what kind of content and how much (number of hours) is used for this course for the students. Some universities distribute the total hours differently in the direction of increasing the student's independent work (for example, lectures - 10 hours, seminars - 20 hours and 60 hours - for student's independent work), or reduce the total amount of hours for this discipline (for example, 60 hours). Most universities offer the study of this discipline in the first year, but some universities -in the 3rd or 4th year.
It is better to acquire practical communication skills with the teacher and in groups. We can assume
Table 1
Elective disciplines about communication competencies of pharmacists offered by Ukrainian universities
that the predominance of students' independent work provided by the programs is not optimal. Because the variety of aspects of communication indicates the extreme complexity of communication as a practical discipline [39]. We can use a variety of communication skills. For example, the strategy of responding empath-ically to emotion may be accomplished through acknowledgment, validation, or praising the patient's efforts. The strategy of providing information in a way that it will be understood may be accomplished through previewing information, summarizing information, and/or checking patient understanding [3].
Regarding content, in the state curriculum, which is used by most universities, there is only one topic that is directly devoted to the skills of communication with the patient (Topic 3 - Fundamentals of professional communication). We think that is a short time for this topic and it is not optimal.
An interesting example is the teaching of the discipline "Ethics and Deontology in Pharmacy" at Lviv National Medical University, which, unlike the standard program, provides 60 hours, but almost all topics are devoted to the development of communication skills.
In the list of elective disciplines (the student has the right to choose this discipline or another from a certain block), various universities offer elective disciplines that are directly related to communication competencies (Table). Teachers from non-pharmaceutical departments are involved in teaching in this subject.
The name of the elective discipline Hours Year of study
Amount Lecture Seminar Practical lesson Student's individual work
Psychology of communication 90 20 20 - 50 1
Psychology of communication 120 20 20 - 80 2
Psychology of communication. Consumers behavior in pharmacy 120 10 30 - 80 2
Ethics (Ethical problems in medicine) 120 12 - 28 80 2
Theory and practice of professional communication 90 2 - 2 86 1
Ethical problems in pharmacy 90 10 20 - 60 3
Health promotion 90 6 24 - 60 1
Communication Skills of Pharmacist 120 10 30 - 80 2
Analyses proposal of Ukrainian University shows that practicing pharmacists have no offers to improve their communication skills on postgraduate level education in Ukraine.
Thus, based on the analysis of programs for students of pharmacy and scientific literature, we can conclude that the ability to acquire communication skills for use in professional teaching needs to improve both in scope and methods of teaching. For this competence it is important to develop communication skills in
groups and with the teacher (discussions, debates, situational tasks, tests) using new learning models, such as simulation modeling and asynchronous methods (teaching independent of time and place) [40].
CONCLUSIONS
Thus, the acquisition of communication skills by pharmacists needs to be improved at the undergraduate level of education. It is necessary to ensure the development of communication skills throughout the professional life of pharmacists in the curricula of postgraduate education.
In line with current communication requirements, pharmacists need to continue to develop a more patient-centered approach to ensure that pharmaceutical education has a positive impact on health outcomes. It is important to include in the content of the program the features of communication with patients with various diseases, as well as providing a patient-oriented approach to pharmaceutical care.
REFERENCES:
1. Stewart M., Brown J., Donner A., McWhinney I. et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000; 49: 796-804.
2. Joint Commission Center for Transforming Healthcare Releases Targeted Solutions Tool for HandOff Communications. Joint Commission on Accreditation of Healthcare Organizations. 2012;32(8). https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-fold-ers/blogs/tst_hoc_persp_08_12pdf.pdf?db=web&hash =BA7C8CDB4910EF6633F013D0BC08CB1C Accessed June 15, 2021.
3. Brown R.F., Bylund C.L. Communication Skills Training: Describing a New Conceptual Model Academic Medicine. 2008;83(1):37-44. doi:10.1097/ACM.0b013e31815c631e
4. Aina B., Ogunbiyi O. Assessment of communication skills among pharmacy students of the University of Lagos, Lagos, Nigeria. J Basic Clin Pharm. 2011;3(1):215-218. doi:10.4103/0976-0105.103826
5. Kerr A., Strawbridge J., Kelleher C. et al. How can pharmacists develop patient-pharmacist communication skills? A realist review protocol. Syst Rev. 2017;6. doi:10.1186/s13643-016-0396-0
6. Blom L, Krass I. Introduction: the role of pharmacy in patient education and counseling. Patient Educ Couns. 2011; 83(3): 285-287.
7. Wallman A, Vaudan C, Sporrong SK. Communications training in pharmacy education, 19952010. Am J Pharm Educ. 2013; 77(2): 36.
8. 8. Sinha H.K. Role of pharmacists in retailing of drugs. J Adv Pharm Technol Res. 2014;5(3):107. doi: 10.4103/2231-4040.137383
9. Patient Safety: Making health care safer. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO file:///C:/Users/Geir/Down-loads/WHO-HIS-SDS-2017.11-eng%20(1).pdf Accessed August 01, 2021.
10. Nagorna N.O., Nagornij V.V., Kaplaushenko T.M. Formuvannya komunikativnih kompetentostej majbutnih fahivciv farmacevtichnogo profilyu [Formation of communicative competencies of future pharmaceutical specialists]. Dynamics of the development of world science. Abstracts of the 5th International scientific and practical conference. Perfect Publishing. Vancouver, Canada. 2020. 734-743. (In Ukrainian).
11. WHO: The role of the pharmacist in the health care system: preparing the future pharmacist. Report of a third WHO consultative group on the role of the pharmacist Vancouver, Canada 1997:27-29.
12. Nanjing Statements. Statements on Pharmacy and Pharmaceutical Sciences Education. The Hague:
FIP; 2017. https://www.fip.org/files/content/phar-macy-education/fip-education/nanjing-statements.pdf Accessed June 05, 2021.
13. European Parliament and the Council. Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications 17/01/2014 (consolidated version). 2005/36/EC. J Eur Union.
14. Plyaka L.V. Struktura profesijnoyi komunikativnoyi kompetentnosti majbutnih provizoriv. [The structure of professional communicative competence of future pharmacists]. Problemi zagalnoyi ta pedagogichnoyi psihologi : zb. nauk. pr. Institutu psihologiyi im. G. S. Kostyuka / za red. S. D. Maksimenka. Kiyv: Gnozis; 2010, 223 p. (In Ukrainian).
15. Kajdalova L.G., Plyaka L.V. Psihologiya spilkuvannya. [Psychology of communication]. Navchalnij posibnik. Kharkiv: NFaU; 2011. 132p. (In Ukrainian).
16. Slipchuk V. Development of communicative competencies of foreign students in higher medical education institutions in Ukraine. Continuing Professional Education Theory and Practice. 2019; 2(2): 52-57. doi:10.28925/1609-8595.2019.2.5257
17. Goncharenko N.V., Skurativska S.I., Voronenko D.V. et al. Komunikativna kompetentnist majbutnogo farmacevtichnogo pracivnika - osnova bezkonfliktnoyi vzayemodiyi. [Communicative competence of the future pharmaceutical worker is the basis of conflict-free interaction]. Vijskova medicina Ukrayini. 2017; 1: 63-67. (In Ukrainian).
18. Vlasenko I.O., Davtyan L.L. Identification of Barriers to Providing Pharmaceutical Care for People with Diabetes in Ukraine. Polish journal of science. 2020; 27(1): 37-43.
19. Vlasenko I.O., Davtyan L.L. Study of training priorities for providing pharmaceutical care to people with diabetes mellitus in Ukraine. East European Scientific Journal. Wschodnioeuropejskie Czasopismo Naukowe. 2019; 8(48): 72-78.
20. Schwartzman E., Chung E., Sakharkar P. et al. Instruction and assessment of student communication skills in US and Canadian pharmacy curricula. Curr Pharm Tech Learn. 2013; 5(6): 508-17.
21. St John M., Tong B., Li E., Wilbur K. et al. Competency-Based Education Frameworks Across Canadian Health Professions and Implications for Multi-source Feedback. Allied health. 2020; 49(1): el-ell.
22. McDonough RP, Bennett MS. Improving communication skills of pharmacy students through effective precepting. Am J Pharm Educ. 2006; 70(3): 58.
23. Marriott J.L., Nation R.L., Roller L. et al. Pharmacy education in the context of Australian practice. Am J Pharm Educ. 2008; 72(6): 131.
24. Araujo D.C., Santos J.S., Barros I.M. et al. Communication skills in Brazilian pharmaceutical education: a documentary analysis. Pharm Pract (Granada). 2019; 17(1): 1395.
25. Hobeika E., Hallit S., Sacre H. et al. Factors associated with empathy among community pharmacists in Lebanon Journal of pharmaceutical policy and
practice, 2020 ;13(1): 1-32. doi: 10.1186/s40545-020-00237-z
26. Umurzakhova G., Sultanbekov A., Issatayeva N. Communication skills as one of the main competences of pharmacists Annals of Tropical Medicine and Public Health. 2018; 11(3): 62-69. doi: 10.4103/ATMPH.ATMPH_194_17
27. Zheltkevich O.V., Sibireva A.D. Osobennosti lichnosti, vliyayushie na process kommunikacii farmacevticheskih rabotnikov s potrebitelem. [Personality features affecting the process of communication between pharmaceutical workers and consumers]. Remedium. 2019; (1-2): 56-60. doi:10.21518/1561-5936-2019-1-2-56-60. (In Russian).
28. Blom L., Krass I. Introduction: the role of pharmacy in patient education and counseling. Patient Educ Couns. 2011; 83(3): 285-7.
29. Luetsch K., Burrows J. From transitions to transformation - A study of pharmacists developing patient-centered communication skills. Res Social Adm Pharm. 2018; 14(7): 686-694. doi:10.1016/j.sapharm.2017.08.003
30. Patient-Centered Care and What It Means for Healthcare Organizations https://csuitesolutions.com/healthcare-management-system/patient-centered-care-and-what-it-means-for-healthcare-organizations/ Accessed June 07, 2021.
31. Kameda S., Kitamura Y., Masaoka Y. et al. Investigation of the difficulties experienced by pharmacists in Japan when communicating with cancer patients. Journal of clinical pharmacy and therapeutics. 2021; 46(1): 181-189. doi:10.1111/jcpt.13278
32. Heimerl K., Pichler B., Plunger P. Challenges and strategies in communication with people with dementia and their informal caregivers in community pharmacies - a narrative approach. Scandinavian journal of caring sciences. 2020; 34(4): 852-860. doi: 10.1111/scs.12789
33. Vlasenko, I.O., Davtian, L.L. Farmaevtychna dopomoha khvorym na tsukrovyi diabet shchodo zberihannia preparativ insulinu. [Pharmaceutical care for patients with diabetes: storage of insulin]. Far-matsevtychnyi Zhurnal. 2019; 5: 21-34. Doi:10.32352/0367-3057.5.19.03 (In Ukrainian).
34. Ris0y A.J., Kjome R.L., Svensberg K. et al. Pharmacists' experience of a diabetes risk-assessment service and analytical quality control in community pharmacies: a focus-group study. Research in Social and Administrative Pharmacy. 2020-09-19. doi:10.1016/j.sapharm.2020.09.011
35. Cleland J., Bailey K., McLachlan S. et al. Supplementary pharmacist prescribers' views about communication skills teaching and learning, and applying these new skills in practice. Int J Pharm Pract. 2007; 15(2): 101-4.
36. Al-Sulaiti F., Fares H., Awaisu A., et al. Continuing Professional Development Needs of Community Pharmacists in Qatar: A Mixed-Methods Approach. International quarterly of community health education. 2020-06-02. doi:10.1177/0272684X20918048
37. Ministerstvo osviti i nauki Ukrayini. Standart vishoyi osviti Ukrayini pidgotovki fahivciv magister-skogo rivnya vishoyi osviti galuzi znan «Ohorona zdo-rov'ya» specialnosti «Farmaciya». [Ministry of Education and Science of Ukraine. Standards of higher education in Ukraine for the training of specialists of the master's level of higher educational branches of science "Health" in the specialty "Pharmacy]. 2018,30 p.
38. International Pharmaceutical Federation. Pharmacy Education Taskforce. A Global Competency Framework. 2012. https://www.fip.org/files/fip/Phar-macyEducation/GbCF_v1.pdf Accessed June 10, 2021.
39. Jowkar N., Fjelds0 N., N0rgaard L.S. et al. A Presentation of Central Communication Aspects in the Patient-Provider Relationship-Potential Learnings for Community Pharmacists. Pharmacy. 2020;8(4):241. doi: 10.3390/pharmacy8040241
40. Bartlett J.L. Kinsey J.D. Large-group, asynchronous, interprofessional simulation: Identifying roles and improving communication with student pharmacists and student nurses. Currents in pharmacy teaching and learning. 2020; 12(6): 763-770. doi:10.1016/j.cptl.2020.01.023
