Clinical Decision Making by Fourth-Year Pharmacy Students: Understanding Their Uncertainty
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2020-12
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Abstract
Clinical decision making is a critical process underpinning much of a pharmacist’s daily activities. Pharmacists in Alberta have a scope of practice that includes prescribing medications, and prescribing includes clinical decision making. Ensuring pharmacy education actively prepares students for clinical decision making is therefore a priority. While it is known that pharmacists hesitate to make decisions, it remains unclear whether pharmacy students experience similar hesitancy. Clinical decision making is dependent on many factors, such as knowledge and experience, that need to be considered when investigating hesitancy and uncertainty in decision making by pharmacy students. Adult learning theories of experiential education and reflective practice are applicable to the pedagogy of decision making given that experience is considered a critical influencer in clinical decision making. This study was designed from a social constructivist paradigm using case study methodology. The purpose was to investigate issues related to hesitancy in clinical decision making by fourth-year pharmacy students. Data was collected through observation of students engaging in simulations, post-simulation interviews, and written reflections. Data analysis included multiple stages of coding, followed by pattern identification and discovery of interrelationships.
The primary themes relating to issues in pharmacy student clinical decision making were relational factors, teaching and learning, degree of certainty, and personal characteristics. These themes represent elements that affected decision making before the final stage where the students were either willing or unwilling to make a decision. Pharmacy students construct their decision making primarily by using the patient care process, through repeated practice, and by observing role models. Students felt facilitated in their decision making when there were positive relationships with patients and physicians, practise in the skills lab, and development of comfort with ambiguity. Students discussed that strategies for responsible decision making were complex and related to many of the previously mentioned themes. Students struggled with responsibility taking for decisions both throughout the curriculum and in experiential education. Future research plans include investigating how Albertan students compare with those in other jurisdictions and investigating the training of preceptors to include building student comfort with ambiguity by creating education underpinned by adult learning theories of experiential learning.
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Charrois, T. L. (2020). Clinical decision making by fourth-year pharmacy students: understanding their uncertainty (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.