- Email: [email protected]
Assessment of the effect of communication skills training on communication apprehension in first year pharmacy students – A two-year study
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Research Paper
Assessment of the effect of communication skills training on communication apprehension in first year pharmacy students – A two-year study ⁎
Connie Rust , William M. Gentry, Heath Ford South College School of Pharmacy, 400 Goody's Lane Suite 101, Knoxville, TN 37922, United States of America
A R T IC LE I N F O
ABS TRA CT
Keywords: Communication apprehension Pharmacy students First year pharmacy students Active learning Communication skills
Introduction: The purpose of the study is to assess the impact of a communication skills course on communication apprehension (CA) in two cohorts of first-year (P1), first quarter pharmacy students over a consecutive two-year span. Methods: The personal report of CA (PCRA-24) was administered at the beginning and completion (pre-post) of a skills-centered communication course to two cohorts of P1, first quarter pharmacy students over a consecutive two-year period. The delivery of the communications course was redesigned during this timeframe based on post-course analysis data and student feedback to incorporate opportunities for students to engage in active learning activities throughout the course. Results: Results of the study revealed a statistically significant reduction of total CA in both cohorts. Cohort 1 had significant reduction of CA in all four measured domains: group discussion meetings, interpersonal communication, and public speaking. Cohort 2 had significant reduction in two of the domains (group and meeting). Conclusions: Overall, this study indicated that the format of this P1, first quarter communications course had a positive effect on student CA. In addition to the data collected for this research project, post-course evaluations and student comments indicated an overall positive reaction to the design and delivery of the course material, active learning assignments, and assessments.
Introduction Communication apprehension (CA) has been described as “an individual's level of fear or anxiety associated with either real or anticipated communication with another person or persons.”1 This phenomenon is not uncommon. CA has been identified as a concern among first year pharmacy students, and literature reveals that one in five pharmacy students report high CA.1–3 Communication skills and CA are separate and distinct aspects of the communication process. Communication skills are behavioral processes whereas CA is a cognitive process.1 Examination of the literature reveals that interventions involving cognitive training have been shown to positively impact CA in pharmacy students.1–4 However, there is a gap in the literature regarding how communication skills training may positively affect or improve student CA. The objective of this research was to explore the question “does communication skills training offered in an active-learning, didactic coursework setting affect CA in first year, first quarter pharmacy students? The goal of the study was to assess the impact of a communication skills course on CA in two cohorts of first-year,
⁎
Corresponding author. E-mail addresses: [email protected] (C. Rust), [email protected] (W.M. Gentry), [email protected] (H. Ford).
https://doi.org/10.1016/j.cptl.2019.11.007
1877-1297/ © 2019 Elsevier Inc. All rights reserved.
Please cite this article as: Connie Rust, William M. Gentry and Heath Ford, Currents in Pharmacy Teaching and Learning, https://doi.org/10.1016/j.cptl.2019.11.007
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
C. Rust, et al.
first quarter pharmacy students over a consecutive two-year span. This study took place within an accelerated, three-year doctor of pharmacy (PharmD) program. Students enter the program having completed one to three communication courses prior to admission. There is one communications course in our institution's pharmacy curriculum that is offered in the first quarter of the first year of the program. At the time of this research, the course had been offered six times in the didactic portion of the pharmacy curriculum, and had undergone revisions based on course evaluations, student feedback, and post-course evaluation analyses conducted by course directors and key faculty. One such revision was the implementation of more types of active learning exercises to allow the students to practice various communication skills within the areas of interpersonal, interprofessional, group, and presentation communication. Prior to the study, student comments and feedback indicated a great deal of stress and apprehension associated with communicating at both the individual and group levels. Changes were made to the delivery of the course over the two-year period based on feedback and post-course evaluation analyses. The rationale for these changes was to respond to student feedback with opportunities to “meet the students where they were” and provide skills training, a behavioral process, to address the cognitive process of CA. It was our desire with this study to ascertain the effect of these active learning opportunities on student CA.
Methods The Personal Report of CA (PCRA-24) was administered at the beginning and completion (pre-post) of a skills-centered communication course to two cohorts of first year, first quarter pharmacy students. The PCRA-24 is a 24-item, four category instrument designed to measure respondent attitudes toward four types of communication. Studies have corroborated that the survey possesses high reliability (consistent alpha > 0.90) and very high predictive validity.5 The survey responses are based on a five-point Likert scale. Possible responses to the statements are 1 = strongly agree, 2 = agree, 3 = undecided, 4 = disagree, and 5 = strongly disagree. Calculated scores range from 24 (low CA) to 120 (high CA). Calculated scores within 83–120 indicate high CA, 5583 moderate CA, and 24–55 low CA.5 There are four categories, or domains, measured in the questionnaire: group discussion, meetings, interpersonal conversation, and public speaking.5 The questionnaire was administered with informed consent during the first lecture of the communications course as a pretest and again at the final lecture as a posttest. The pretest also included a survey of demographic information (age, sex, race, and number of communication courses completed in undergraduate studies). Participation was voluntary and students were assured that choosing whether or not to participate would not affect the student's grade. Upon completion, surveys were coded and de-identified to ensure confidentiality. Institutional review board (IRB) approval was obtained through the IRB of our pharmacy school. The course was designed to deliver core content in a traditional lecture setting with a period reserved for activities to reinforce the lecture material. The course was led by two co-directors, who shared the lectures that were delivered. During both offerings of the communications course, most of the class meetings included skills training activities, either graded or nongraded, designed to reinforce the lecture material. The graded activities were facilitated by the course co-directors, additional faculty, and residents. These activities are described and summarized below. Skills training: active learning, non-graded class activities. The active learning, non-graded activities consisted of case-based activities, small and large group discussions, and role play scenarios. For example, one such activity was a case-based task designed to allow the student to utilize empathy skills and interpretation of nonverbal communication. The students worked independently to construct the dialogue for the case then practiced communicating the dialogue and receiving feedback through role-play with a classmate.
Skills training: graded activities In addition to the non-graded activities, there were six active learning graded activities in year one, and six graded activities in year two. Changes in types of graded activities in year two were based on favorable student feedback and suggestions.
Assigned projects: years one and two: video presentation Groups of three to four students were assigned a specific disease state. The groups were instructed to research the disease state and provide a video presentation on the topic. This video consisted of an overview of the disease, selection of appropriate medication for treatment, and demonstration of proper patient medication counseling. Each group of students submitted a videotape of the presentation for grading by faculty. Grading was conducted according to a standardized rubric.
Assigned projects: year two: topic presentation Topic presentations were implemented in the second year of the study. This was a blended project between immunology and communication courses and provided an opportunity for the students to work in groups and provide a formal oral presentation to the class. Table 1 summarizes graded skills training activities and projects across the two-year span. 2
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
C. Rust, et al.
Table 1 Summary of skills training. Year
Activity
Type
Description
One
Peer interview and introduction Microsoft PowerPoint development Role play Development and practice of open-ended questions (case-based) SBAR7 (situation, background, assessment, recommendation) Fishbowl Video project The pharmacist's role
GA GA GA GA
Practice of interpersonal skills Practice and preparation of presentation skills for video project Student role play designed to practice listening skills and showing empathy Practice for motivational interviewing and patient interview
GA
Case-based practice of structured, interprofessional communication techniques
GA AP GA
Standardized, comprehensive, formative assessment of interpersonal communication skills Group project providing topic presentation and medication counseling Case analysis providing training in interpersonal skills and patient-centered communication Case-based activity of identifying and utilizing empathy skills for patient-centered communication Practice for motivational interviewing and patient interview
Two
Developing empathy
GA
Development and practice of open-ended questions (case-based) Peer review of oral presentation
GA
Fishbowl: role play Reflection and self-awareness
GA GA
Video presentation Disease state presentation
AP AP
GA
Students participated in oral presentations in conjunction with pharmaceutical science course (immunology) and communication course student-led, faculty facilitated assessment of patient centered communication skills Student reflection on the communication skills activities and self-evaluation of strengths and areas for improvement Group project providing topic presentation and medication counseling Groups of two presented disease state oral presentations in conjunction with pharmaceutical science course (immunology)
GA = graded activity; AP = assigned project.
Results Data were collected and analyzed using IBM SPSS Statistics version 25 system software.6 A total of 129 students completed preand post-surveys. Mean age of participants was 25.6 years (range 19–42 years). Participants were comprised of 36.4% males (n = 47) and 63.6% females (n = 82), 65.1% White (n = 84), 1.6% Hispanic (n = 2), 13.2% Black (n = 17), 17.8% Asian (n = 23), and 2.3% mixed (n = 3). The majority of the participants (71.3%, n = 92) reported having one communications course in their undergraduate studies, 17.1% (n = 22) reported having two, and 7.8% (n = 10) reported having three. Table 2 provides demographic information for total participants as well as for cohorts 1 and 2. Statistical tests were conducted on the total survey sample to determine the mean difference in pre- and posttest scores for the total sample. Paired samples t-tests revealed significant positive changes in total survey scores and for all four domains. Table 3 provides details of these results. Year one (cohort 1) Pretest surveys indicated that 21.3% (n = 13) of students reported high CA, which corresponds to empirical data,2 49.2% (n = 30) had moderate CA, and 29.5% (n = 18) had low CA. Analysis of paired samples t-tests indicated a statistically significant difference in the means of pre- (M = 68.51, standard deviation (SD) = 18.09) and post- (M = 61.06, SD = 15.63) scores for overall CA; t = 4.46, sig (two-tailed) < 0.005, and all four measured domains: group discussion (t = 3.22), meetings (t = 3.53), interpersonal communication (t = 2.38), and public speaking (t = 3.49). Year two (cohort 2) Pretest surveys indicated that 17.65% (n = 12) of students reported high CA, which is slightly lower that empirical data,2 58.82% (n = 40) had moderate CA, and 23.53% (n = 16) had low CA. Analysis of paired samples t-tests indicated a statistically significant difference in the means of pre- (M = 67.01, SD = 17.21) and post- (M = 63.03, SD = 15.07) scores for overall CA; t = 2.96, sig (twoTable 2 Comparison of demographic data. Cohort
1 2 Total
n
61 68 129
Gender (%)
Race (%)
Age (years)
Undergrad communications courses (%)
Male
Female
White
Hispanic
Black
Asian
Mixed
Mean
1
2
3
17 (27.4) 30 (44.1) 47 (36.4)
44 (72.1) 38 (55.9) 82 (63.6)
40 (65.6) 44 (64.7) 84 (65.1)
1 (1.6) 1 (1.5) 2 (1.6)
5 (8.2) 12 (17.6) 17 (13.2)
15 (24.6) 8 (11.8) 23 (17.8)
3 (4.4) 3 (2.3)
24.1 25.2 25.6
50 (82) 42 (61.8) 92 (71.3)
7 (11.5) 15 (22.1) 22 (17.1)
4 (6.4) 9 (13.4) 10 (7.8)
3
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
C. Rust, et al.
Table 3 Paired samples test.a
Cohort 1
Cohort 2
Total
Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair
1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
Pregroup - postgroup Premeet - postmeet Preint - postint Prepub - postpub Pretot - posttot Pregroup - postgroup Premeet - postmeet Preint - postint Prepubs - postpubs Pretot - posttot Pregroup - postgroup Premeet - postmeet Preint - postint Prepub - postpub Pretot - posttot
Mean (SD)
Lower
Upper
t
df
Sig.b
1.62 (3.94) 2.2 (4.86) 1.41 (4.62) 2.21 (4.95) 7.44 (13.03) 1.06 (3.84) 1.21 (4.16) 0.75 (4.69) 0.97 (4.51) 3.98 (11.12) 1.32 (3.88) 1.67 (4.51) 1.06 (4.65) 1.56 (4.75) 5.62 (12.14)
0.61 0.95 0.23 0.95 4.10 0.13 0.20 −0.39 −0.12 1.29 0.65 0.89 0.25 0.73 3.51
2.63 3.44 2.59 3.48 10.78 1.99 2.21 1.89 2.06 6.68 2.00 2.46 1.87 2.39 7.74
3.22 3.53 2.39 3.49 4.46 2.27 2.39 1.32 1.77 2.96 3.88 4.21 2.60 3.73 5.26
60 60 60 60 60 67 67 67 67 67 128 128 128 128 128
0.00 0.00 0.02 0.00 0.00 0.026 0.020 0.192 0.081 0.004 0.00 0.00 0.01 0.00 0.00
CI = confidence interval; CA = communication apprehension; pregroup – postgroup = group communication (pre- and post-intervention); premeet – postmeet = meetings communication (pre- and post-intervention); preint – postint = interpersonal communication (pre- and post-intervention); prepub – postpub = public speaking (pre- and post-intervention); pretot – posttot = total CA score. a Paired differences, 95% CI. b Sig(two-tailed).
tailed) < 0.005. The four measured domains all indicated a decrease in posttest scores. Two of the domains (group and meeting) were statistically significant. The mean age (in years) was similar between cohorts and more than likely did not affect the outcomes of the data. The number of undergraduate communication courses was also similar between cohorts, in that the majority of students had only taken one communication course in their undergraduate education. Statistical analysis of comparison between cohorts did not indicate any significant difference in pre- and post-scores, indicating a homogeneity and consistency in results. Discussion CA is fear or anxiety associated with actual or expected communication, either at the group or individual level,1 and is quite common among pharmacy students. Communication skills and CA are separate and distinct aspects of the communication process. There has been a gap in the literature regarding how communication skills training, which involves behavioral processes, may positively affect or improve the student cognitive process of CA. The aim of this study was to help fill that gap and determine the impact of the design of the communications course itself. Results of this study indicate an improvement in overall CA for the two cohorts, significant improvement in all four measured domains (interpersonal communication, group discussion meetings, and public speaking) for the first cohort, and significant improvement in group and meeting communication in the second cohort, after completing the first quarter of the first didactic year of an accelerated pharmacy program. Analysis of demographic data indicates a similarity in class makeup with respect to gender, race, age, and number of undergraduate communications courses taken. According to the pretest responses, over half of the respondents were White females, which may have impacted results. In addition to the communications course, the curriculum for the first quarter consisted of lecture-based content. Other than the Immunology-Communications presentation offered to the second cohort, it is unknown but highly unlikely that opportunities of practice or implementation of communication skills were provided in other courses. Results indicate that provision of opportunities to strengthen communications skills had a positive effect on levels of CA. There are limitations to this study. Not all students completed both a pre- and post-survey. This may have hindered the ability of the results to be representative of the entire class. There is also the absence of a control group for the study, which limits the ability to determine causality. Further, it is unknown how many, if any, additional opportunities there were in other classes to participate in active learning communication activities during the quarter. As mentioned previously, communication skills and CA are separate and distinct aspects of the communication process. Communication skills are behavioral processes whereas CA is a cognitive process.1 The ideal communicator is one who possesses high communication skills and low CA.1,2 Although separate and distinct, this study proposes that the impact of improving communication skills on CA is favorable and necessary when we “meet the student where they are” as they enter the didactic portion of their pharmacy career. Overall, this study indicated that the format of this first year, quarter one communications course had a positive effect on student CA. In addition to the data collected for this research project, post-course evaluations and student comments indicated an overall positive reaction to the design and delivery of the course material, active learning assignments, and assessment. This qualitative component was quite valuable given the positive results of the quantitative data, providing an additional perspective to aid in monitoring the success of the course and make adjustments to continuously improve. If CA is not adequately addressed, student pharmacists are at risk of maintaining and escalating apprehension to interpersonal and 4
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interprofessional communication post-graduation and into practice, affecting patient perception of pharmacist abilities, pharmacist self-efficacy, and interprofessional relationships.1,4,5 Pharmacists with high CA interact less with patients and peers and may not be perceived as an intelligent, credible source of drug information.1,2 Studies indicate that interventions involving cognitive training positively impact CA and confidence in pharmacy students.1–4 Specific interventions have been reported to improve skills and confidence in first year pharmacy students.8–11 Rogers and King report significant reduction of CA among first year pharmacy students upon completion of a 15-week patient counseling course.8 Rickles et al.9 report the improvement of communication skills with the use of standardized patients in patient counseling skills assessment. Lupu et al.10 report similar findings when using standardized patients for active learning using motivational interviewing.10 These examples provide valuable information of specific individualized approaches to communication skills training. Conclusions Overall, this study indicated that the format of this first year, quarter 1 communications course had a positive effect on student CA. In addition to the data collected for this research project, post-course evaluations and student comments indicated an overall positive reaction to the design and delivery of the course material, active learning assignments, and assessments. Emphasis on communication skills for pharmacy students are woven throughout the entrustable professional activities (EPAs) that are expected of graduating pharmacy students as well as the 2016 Standards of the Accreditation Council for Pharmacy Education (ACPE).12,13 For the purposes of this study, addressing multiple aspects of communication was the goal. Results of this exploratory, cross sectional study indicate that communication skills training in an active learning, didactic coursework setting can be effective in reducing CA and merits further study. Disclosures None. Declaration of competing interest None. References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Berger BA, McCroskey JC. Reducing communication apprehension in pharmacy students. Am J Pharm Educ. 1982;46(2):132–136. Baldwin HJ, McCroskey JC, Knutson T. Communication apprehension in the pharmacy student. Am J Pharm Educ. 1979;43(2):91–93. Nayeem N, Khan S, Mehta SK. Communication apprehension and its effects on pharmacy undergraduates. World J Pharm Pharm Sci. 2015;4(12):951–957. Hasan S. A tool to teach communication skills to pharmacy students. Am J Pharm Educ. 2008;72(3) https://doi.org/10.5688/aj720367. McCroskey JC. An introduction to rhetorical communication. 4th ed. Englewood Cliffs, NJ: Prentice-Hall; 1982. IBM Corp Released. IBM SPSS Statistics for Windows, version 25.0. IBM Corp: Armonk, NY; 2017. Institute for Healthcare Improvement. SBAR Toolkit. Retrieved 13 March 2019 from http://www.ihi.org/resources/Pages/Tools/sbartoolkit.aspx; 2017. Rogers ER, King SR. The influence of a patient-counseling course on the communication apprehension, outcome expectations, and self-efficacy of first-year pharmacy students. Am J Pharm Educ. 2012;76(8):152. https://doi.org/10.5688/ajpe768152. Rickles N, Phuong T, Myers L, Galal S, Chung V. The impact of a standardized patient program on student learning of communication skills. Am J Pharm Educ. 2009;73(1):1–10. https://doi.org/10.5688/aj730104 [serial online]. February. Lupu AM, Stewart AL, O’Neil C. Comparison of active-learning strategies for motivational interviewing skills, knowledge, and confidence in first-year pharmacy students. Am J Pharm Educ. 2012;76(2):28. https://doi.org/10.5688/ajpe76228. Luiz Adrian JA, Zeszotarski P, Ma C. Developing pharmacy student communication skills through role-playing and active learning. Am J Pharm Educ. 2015;79(3):44. https://doi.org/10.5688/ajpe79344. Medina MS, Plaza CM, Stowe CD, et al. Center for the Advancement of Pharmacy Education 2013 educational outcomes. Am J Pharm Educ. 2013;77(8):162. https://doi.org/10.5688/ajpe778162. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree (“2016 standards”). Illinois: Chicago; 2015.
5
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Research Paper
Assessment of the effect of communication skills training on communication apprehension in first year pharmacy students – A two-year study ⁎
Connie Rust , William M. Gentry, Heath Ford South College School of Pharmacy, 400 Goody's Lane Suite 101, Knoxville, TN 37922, United States of America
A R T IC LE I N F O
ABS TRA CT
Keywords: Communication apprehension Pharmacy students First year pharmacy students Active learning Communication skills
Introduction: The purpose of the study is to assess the impact of a communication skills course on communication apprehension (CA) in two cohorts of first-year (P1), first quarter pharmacy students over a consecutive two-year span. Methods: The personal report of CA (PCRA-24) was administered at the beginning and completion (pre-post) of a skills-centered communication course to two cohorts of P1, first quarter pharmacy students over a consecutive two-year period. The delivery of the communications course was redesigned during this timeframe based on post-course analysis data and student feedback to incorporate opportunities for students to engage in active learning activities throughout the course. Results: Results of the study revealed a statistically significant reduction of total CA in both cohorts. Cohort 1 had significant reduction of CA in all four measured domains: group discussion meetings, interpersonal communication, and public speaking. Cohort 2 had significant reduction in two of the domains (group and meeting). Conclusions: Overall, this study indicated that the format of this P1, first quarter communications course had a positive effect on student CA. In addition to the data collected for this research project, post-course evaluations and student comments indicated an overall positive reaction to the design and delivery of the course material, active learning assignments, and assessments.
Introduction Communication apprehension (CA) has been described as “an individual's level of fear or anxiety associated with either real or anticipated communication with another person or persons.”1 This phenomenon is not uncommon. CA has been identified as a concern among first year pharmacy students, and literature reveals that one in five pharmacy students report high CA.1–3 Communication skills and CA are separate and distinct aspects of the communication process. Communication skills are behavioral processes whereas CA is a cognitive process.1 Examination of the literature reveals that interventions involving cognitive training have been shown to positively impact CA in pharmacy students.1–4 However, there is a gap in the literature regarding how communication skills training may positively affect or improve student CA. The objective of this research was to explore the question “does communication skills training offered in an active-learning, didactic coursework setting affect CA in first year, first quarter pharmacy students? The goal of the study was to assess the impact of a communication skills course on CA in two cohorts of first-year,
⁎
Corresponding author. E-mail addresses: [email protected] (C. Rust), [email protected] (W.M. Gentry), [email protected] (H. Ford).
https://doi.org/10.1016/j.cptl.2019.11.007
1877-1297/ © 2019 Elsevier Inc. All rights reserved.
Please cite this article as: Connie Rust, William M. Gentry and Heath Ford, Currents in Pharmacy Teaching and Learning, https://doi.org/10.1016/j.cptl.2019.11.007
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
C. Rust, et al.
first quarter pharmacy students over a consecutive two-year span. This study took place within an accelerated, three-year doctor of pharmacy (PharmD) program. Students enter the program having completed one to three communication courses prior to admission. There is one communications course in our institution's pharmacy curriculum that is offered in the first quarter of the first year of the program. At the time of this research, the course had been offered six times in the didactic portion of the pharmacy curriculum, and had undergone revisions based on course evaluations, student feedback, and post-course evaluation analyses conducted by course directors and key faculty. One such revision was the implementation of more types of active learning exercises to allow the students to practice various communication skills within the areas of interpersonal, interprofessional, group, and presentation communication. Prior to the study, student comments and feedback indicated a great deal of stress and apprehension associated with communicating at both the individual and group levels. Changes were made to the delivery of the course over the two-year period based on feedback and post-course evaluation analyses. The rationale for these changes was to respond to student feedback with opportunities to “meet the students where they were” and provide skills training, a behavioral process, to address the cognitive process of CA. It was our desire with this study to ascertain the effect of these active learning opportunities on student CA.
Methods The Personal Report of CA (PCRA-24) was administered at the beginning and completion (pre-post) of a skills-centered communication course to two cohorts of first year, first quarter pharmacy students. The PCRA-24 is a 24-item, four category instrument designed to measure respondent attitudes toward four types of communication. Studies have corroborated that the survey possesses high reliability (consistent alpha > 0.90) and very high predictive validity.5 The survey responses are based on a five-point Likert scale. Possible responses to the statements are 1 = strongly agree, 2 = agree, 3 = undecided, 4 = disagree, and 5 = strongly disagree. Calculated scores range from 24 (low CA) to 120 (high CA). Calculated scores within 83–120 indicate high CA, 5583 moderate CA, and 24–55 low CA.5 There are four categories, or domains, measured in the questionnaire: group discussion, meetings, interpersonal conversation, and public speaking.5 The questionnaire was administered with informed consent during the first lecture of the communications course as a pretest and again at the final lecture as a posttest. The pretest also included a survey of demographic information (age, sex, race, and number of communication courses completed in undergraduate studies). Participation was voluntary and students were assured that choosing whether or not to participate would not affect the student's grade. Upon completion, surveys were coded and de-identified to ensure confidentiality. Institutional review board (IRB) approval was obtained through the IRB of our pharmacy school. The course was designed to deliver core content in a traditional lecture setting with a period reserved for activities to reinforce the lecture material. The course was led by two co-directors, who shared the lectures that were delivered. During both offerings of the communications course, most of the class meetings included skills training activities, either graded or nongraded, designed to reinforce the lecture material. The graded activities were facilitated by the course co-directors, additional faculty, and residents. These activities are described and summarized below. Skills training: active learning, non-graded class activities. The active learning, non-graded activities consisted of case-based activities, small and large group discussions, and role play scenarios. For example, one such activity was a case-based task designed to allow the student to utilize empathy skills and interpretation of nonverbal communication. The students worked independently to construct the dialogue for the case then practiced communicating the dialogue and receiving feedback through role-play with a classmate.
Skills training: graded activities In addition to the non-graded activities, there were six active learning graded activities in year one, and six graded activities in year two. Changes in types of graded activities in year two were based on favorable student feedback and suggestions.
Assigned projects: years one and two: video presentation Groups of three to four students were assigned a specific disease state. The groups were instructed to research the disease state and provide a video presentation on the topic. This video consisted of an overview of the disease, selection of appropriate medication for treatment, and demonstration of proper patient medication counseling. Each group of students submitted a videotape of the presentation for grading by faculty. Grading was conducted according to a standardized rubric.
Assigned projects: year two: topic presentation Topic presentations were implemented in the second year of the study. This was a blended project between immunology and communication courses and provided an opportunity for the students to work in groups and provide a formal oral presentation to the class. Table 1 summarizes graded skills training activities and projects across the two-year span. 2
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
C. Rust, et al.
Table 1 Summary of skills training. Year
Activity
Type
Description
One
Peer interview and introduction Microsoft PowerPoint development Role play Development and practice of open-ended questions (case-based) SBAR7 (situation, background, assessment, recommendation) Fishbowl Video project The pharmacist's role
GA GA GA GA
Practice of interpersonal skills Practice and preparation of presentation skills for video project Student role play designed to practice listening skills and showing empathy Practice for motivational interviewing and patient interview
GA
Case-based practice of structured, interprofessional communication techniques
GA AP GA
Standardized, comprehensive, formative assessment of interpersonal communication skills Group project providing topic presentation and medication counseling Case analysis providing training in interpersonal skills and patient-centered communication Case-based activity of identifying and utilizing empathy skills for patient-centered communication Practice for motivational interviewing and patient interview
Two
Developing empathy
GA
Development and practice of open-ended questions (case-based) Peer review of oral presentation
GA
Fishbowl: role play Reflection and self-awareness
GA GA
Video presentation Disease state presentation
AP AP
GA
Students participated in oral presentations in conjunction with pharmaceutical science course (immunology) and communication course student-led, faculty facilitated assessment of patient centered communication skills Student reflection on the communication skills activities and self-evaluation of strengths and areas for improvement Group project providing topic presentation and medication counseling Groups of two presented disease state oral presentations in conjunction with pharmaceutical science course (immunology)
GA = graded activity; AP = assigned project.
Results Data were collected and analyzed using IBM SPSS Statistics version 25 system software.6 A total of 129 students completed preand post-surveys. Mean age of participants was 25.6 years (range 19–42 years). Participants were comprised of 36.4% males (n = 47) and 63.6% females (n = 82), 65.1% White (n = 84), 1.6% Hispanic (n = 2), 13.2% Black (n = 17), 17.8% Asian (n = 23), and 2.3% mixed (n = 3). The majority of the participants (71.3%, n = 92) reported having one communications course in their undergraduate studies, 17.1% (n = 22) reported having two, and 7.8% (n = 10) reported having three. Table 2 provides demographic information for total participants as well as for cohorts 1 and 2. Statistical tests were conducted on the total survey sample to determine the mean difference in pre- and posttest scores for the total sample. Paired samples t-tests revealed significant positive changes in total survey scores and for all four domains. Table 3 provides details of these results. Year one (cohort 1) Pretest surveys indicated that 21.3% (n = 13) of students reported high CA, which corresponds to empirical data,2 49.2% (n = 30) had moderate CA, and 29.5% (n = 18) had low CA. Analysis of paired samples t-tests indicated a statistically significant difference in the means of pre- (M = 68.51, standard deviation (SD) = 18.09) and post- (M = 61.06, SD = 15.63) scores for overall CA; t = 4.46, sig (two-tailed) < 0.005, and all four measured domains: group discussion (t = 3.22), meetings (t = 3.53), interpersonal communication (t = 2.38), and public speaking (t = 3.49). Year two (cohort 2) Pretest surveys indicated that 17.65% (n = 12) of students reported high CA, which is slightly lower that empirical data,2 58.82% (n = 40) had moderate CA, and 23.53% (n = 16) had low CA. Analysis of paired samples t-tests indicated a statistically significant difference in the means of pre- (M = 67.01, SD = 17.21) and post- (M = 63.03, SD = 15.07) scores for overall CA; t = 2.96, sig (twoTable 2 Comparison of demographic data. Cohort
1 2 Total
n
61 68 129
Gender (%)
Race (%)
Age (years)
Undergrad communications courses (%)
Male
Female
White
Hispanic
Black
Asian
Mixed
Mean
1
2
3
17 (27.4) 30 (44.1) 47 (36.4)
44 (72.1) 38 (55.9) 82 (63.6)
40 (65.6) 44 (64.7) 84 (65.1)
1 (1.6) 1 (1.5) 2 (1.6)
5 (8.2) 12 (17.6) 17 (13.2)
15 (24.6) 8 (11.8) 23 (17.8)
3 (4.4) 3 (2.3)
24.1 25.2 25.6
50 (82) 42 (61.8) 92 (71.3)
7 (11.5) 15 (22.1) 22 (17.1)
4 (6.4) 9 (13.4) 10 (7.8)
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Table 3 Paired samples test.a
Cohort 1
Cohort 2
Total
Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair Pair
1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
Pregroup - postgroup Premeet - postmeet Preint - postint Prepub - postpub Pretot - posttot Pregroup - postgroup Premeet - postmeet Preint - postint Prepubs - postpubs Pretot - posttot Pregroup - postgroup Premeet - postmeet Preint - postint Prepub - postpub Pretot - posttot
Mean (SD)
Lower
Upper
t
df
Sig.b
1.62 (3.94) 2.2 (4.86) 1.41 (4.62) 2.21 (4.95) 7.44 (13.03) 1.06 (3.84) 1.21 (4.16) 0.75 (4.69) 0.97 (4.51) 3.98 (11.12) 1.32 (3.88) 1.67 (4.51) 1.06 (4.65) 1.56 (4.75) 5.62 (12.14)
0.61 0.95 0.23 0.95 4.10 0.13 0.20 −0.39 −0.12 1.29 0.65 0.89 0.25 0.73 3.51
2.63 3.44 2.59 3.48 10.78 1.99 2.21 1.89 2.06 6.68 2.00 2.46 1.87 2.39 7.74
3.22 3.53 2.39 3.49 4.46 2.27 2.39 1.32 1.77 2.96 3.88 4.21 2.60 3.73 5.26
60 60 60 60 60 67 67 67 67 67 128 128 128 128 128
0.00 0.00 0.02 0.00 0.00 0.026 0.020 0.192 0.081 0.004 0.00 0.00 0.01 0.00 0.00
CI = confidence interval; CA = communication apprehension; pregroup – postgroup = group communication (pre- and post-intervention); premeet – postmeet = meetings communication (pre- and post-intervention); preint – postint = interpersonal communication (pre- and post-intervention); prepub – postpub = public speaking (pre- and post-intervention); pretot – posttot = total CA score. a Paired differences, 95% CI. b Sig(two-tailed).
tailed) < 0.005. The four measured domains all indicated a decrease in posttest scores. Two of the domains (group and meeting) were statistically significant. The mean age (in years) was similar between cohorts and more than likely did not affect the outcomes of the data. The number of undergraduate communication courses was also similar between cohorts, in that the majority of students had only taken one communication course in their undergraduate education. Statistical analysis of comparison between cohorts did not indicate any significant difference in pre- and post-scores, indicating a homogeneity and consistency in results. Discussion CA is fear or anxiety associated with actual or expected communication, either at the group or individual level,1 and is quite common among pharmacy students. Communication skills and CA are separate and distinct aspects of the communication process. There has been a gap in the literature regarding how communication skills training, which involves behavioral processes, may positively affect or improve the student cognitive process of CA. The aim of this study was to help fill that gap and determine the impact of the design of the communications course itself. Results of this study indicate an improvement in overall CA for the two cohorts, significant improvement in all four measured domains (interpersonal communication, group discussion meetings, and public speaking) for the first cohort, and significant improvement in group and meeting communication in the second cohort, after completing the first quarter of the first didactic year of an accelerated pharmacy program. Analysis of demographic data indicates a similarity in class makeup with respect to gender, race, age, and number of undergraduate communications courses taken. According to the pretest responses, over half of the respondents were White females, which may have impacted results. In addition to the communications course, the curriculum for the first quarter consisted of lecture-based content. Other than the Immunology-Communications presentation offered to the second cohort, it is unknown but highly unlikely that opportunities of practice or implementation of communication skills were provided in other courses. Results indicate that provision of opportunities to strengthen communications skills had a positive effect on levels of CA. There are limitations to this study. Not all students completed both a pre- and post-survey. This may have hindered the ability of the results to be representative of the entire class. There is also the absence of a control group for the study, which limits the ability to determine causality. Further, it is unknown how many, if any, additional opportunities there were in other classes to participate in active learning communication activities during the quarter. As mentioned previously, communication skills and CA are separate and distinct aspects of the communication process. Communication skills are behavioral processes whereas CA is a cognitive process.1 The ideal communicator is one who possesses high communication skills and low CA.1,2 Although separate and distinct, this study proposes that the impact of improving communication skills on CA is favorable and necessary when we “meet the student where they are” as they enter the didactic portion of their pharmacy career. Overall, this study indicated that the format of this first year, quarter one communications course had a positive effect on student CA. In addition to the data collected for this research project, post-course evaluations and student comments indicated an overall positive reaction to the design and delivery of the course material, active learning assignments, and assessment. This qualitative component was quite valuable given the positive results of the quantitative data, providing an additional perspective to aid in monitoring the success of the course and make adjustments to continuously improve. If CA is not adequately addressed, student pharmacists are at risk of maintaining and escalating apprehension to interpersonal and 4
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interprofessional communication post-graduation and into practice, affecting patient perception of pharmacist abilities, pharmacist self-efficacy, and interprofessional relationships.1,4,5 Pharmacists with high CA interact less with patients and peers and may not be perceived as an intelligent, credible source of drug information.1,2 Studies indicate that interventions involving cognitive training positively impact CA and confidence in pharmacy students.1–4 Specific interventions have been reported to improve skills and confidence in first year pharmacy students.8–11 Rogers and King report significant reduction of CA among first year pharmacy students upon completion of a 15-week patient counseling course.8 Rickles et al.9 report the improvement of communication skills with the use of standardized patients in patient counseling skills assessment. Lupu et al.10 report similar findings when using standardized patients for active learning using motivational interviewing.10 These examples provide valuable information of specific individualized approaches to communication skills training. Conclusions Overall, this study indicated that the format of this first year, quarter 1 communications course had a positive effect on student CA. In addition to the data collected for this research project, post-course evaluations and student comments indicated an overall positive reaction to the design and delivery of the course material, active learning assignments, and assessments. Emphasis on communication skills for pharmacy students are woven throughout the entrustable professional activities (EPAs) that are expected of graduating pharmacy students as well as the 2016 Standards of the Accreditation Council for Pharmacy Education (ACPE).12,13 For the purposes of this study, addressing multiple aspects of communication was the goal. Results of this exploratory, cross sectional study indicate that communication skills training in an active learning, didactic coursework setting can be effective in reducing CA and merits further study. Disclosures None. Declaration of competing interest None. References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Berger BA, McCroskey JC. Reducing communication apprehension in pharmacy students. Am J Pharm Educ. 1982;46(2):132–136. Baldwin HJ, McCroskey JC, Knutson T. Communication apprehension in the pharmacy student. Am J Pharm Educ. 1979;43(2):91–93. Nayeem N, Khan S, Mehta SK. Communication apprehension and its effects on pharmacy undergraduates. World J Pharm Pharm Sci. 2015;4(12):951–957. Hasan S. A tool to teach communication skills to pharmacy students. Am J Pharm Educ. 2008;72(3) https://doi.org/10.5688/aj720367. McCroskey JC. An introduction to rhetorical communication. 4th ed. Englewood Cliffs, NJ: Prentice-Hall; 1982. IBM Corp Released. IBM SPSS Statistics for Windows, version 25.0. IBM Corp: Armonk, NY; 2017. Institute for Healthcare Improvement. SBAR Toolkit. Retrieved 13 March 2019 from http://www.ihi.org/resources/Pages/Tools/sbartoolkit.aspx; 2017. Rogers ER, King SR. The influence of a patient-counseling course on the communication apprehension, outcome expectations, and self-efficacy of first-year pharmacy students. Am J Pharm Educ. 2012;76(8):152. https://doi.org/10.5688/ajpe768152. Rickles N, Phuong T, Myers L, Galal S, Chung V. The impact of a standardized patient program on student learning of communication skills. Am J Pharm Educ. 2009;73(1):1–10. https://doi.org/10.5688/aj730104 [serial online]. February. Lupu AM, Stewart AL, O’Neil C. Comparison of active-learning strategies for motivational interviewing skills, knowledge, and confidence in first-year pharmacy students. Am J Pharm Educ. 2012;76(2):28. https://doi.org/10.5688/ajpe76228. Luiz Adrian JA, Zeszotarski P, Ma C. Developing pharmacy student communication skills through role-playing and active learning. Am J Pharm Educ. 2015;79(3):44. https://doi.org/10.5688/ajpe79344. Medina MS, Plaza CM, Stowe CD, et al. Center for the Advancement of Pharmacy Education 2013 educational outcomes. Am J Pharm Educ. 2013;77(8):162. https://doi.org/10.5688/ajpe778162. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree (“2016 standards”). Illinois: Chicago; 2015.
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