Pharmacy emphasizes people skills with patient counseling tourney

	Third-year pharmacy student Kelly Bisgard, a competitor in the College of Pharmacy’s Patient Counseling Competition, explains the use of Vasocidin eyedrops to pharmacy teaching assistant Mahesh Krishnan, who acted as the patient for the competition. Photo by Rex Bavousett.

Except nothing is real. The pharmacist isn’t a pharmacist, at least not yet. She’s a Pharm.D. student. The young father is a teaching assistant. There’s no sign saying Pearson’s, Osco, or Walgreen because it isn’t a real pharmacy. It’s the pharmacy practice lab. Young Josh is just a fictional character. And off in a corner of the room, an unmanned video camera on a tripod silently records the session, monitoring the student’s every word and gesture.

This is a test, and the stakes are high. It’s the College of Pharmacy’s annual Patient Counseling Competition.

Each year, the college invites all interested Pharm.D. students to test their skills in open competition. In recent years, the pharmacy curriculum at Iowa (and at most institutions) has shifted to include more emphasis on patient interaction. In addition to rigorous hard science, counseling is now seen as a necessary tool in the pharmacist’s belt. The competition, which was held this year on Nov. 17, rewards students who excel at it.

Bernard Sorofman, associate professor of clinical and administrative pharmacy, is the faculty adviser for the local chapter of the Academy of Students of Pharmacy (ASP), the student group that organizes the competition.

"It’s a rather intense competition," Sorofman said. "The winner gets a free trip to the annual meeting of the academy and is the college’s representative in the national competition."

This year, the meeting and national contest will be held in San Francisco over spring break. There, Iowa’s chosen champion will face one representative from each of the more than 80 schools of pharmacy in the country. About 20 Iowa students signed up to compete this year, the highest number ever.

Each competitor received an individual appointment time and a list of ten possible drugs in advance. Just before their sessions, the students were told which drug they’d actually be dispensing. They had five minutes to prepare, with access to reference books and the web. The idea isn’t to test their knowledge of the drug but to judge their ability to communicate that knowledge effectively. Finally, each student had five minutes to counsel the patient. The sessions were recorded, and the tape was distributed to three judges.

For fairness, the situation was identical for each contestant. Pharmacy graduate student Mahesh Krishnan played the young father for each student. The scenario was written by a faculty member. Most years it includes some kind of communication barrier, such as an emotionally distraught or rushed patient.

The scenario this year was written by Michael Deninger, an associate in the College of Pharmacy. Deninger is also a past ASP faculty adviser.

"I thought about doing Viagra," Deninger said. "Last year it was for Coumadin, an anticoagulant that takes a lot of monitoring. It’s a fairly technical drug, and there are a lot of things the patient has to be aware of. The idea was to get the students to make sure the patient knew all they needed to know. Two years ago, I had the patient be hard- of-hearing. In this case, I threw them a loop. It was a dad picking up the drug for a kid."

Deninger, who has judged the competition in the past, called it a difficult job. The judges have a list of clearly defined criteria to evaluate the students, but there is still room for individual discretion.

"Typically, they’re looking for the student to use fairly open-ended questions," Deninger said. "The objective is to have the patient do most of the talking. The idea is to verify what they already know, with the pharmacist filling in the gaps."

This method, which was developed by the Indian Health Service, has replaced the traditional model in which the pharmacist recites information to the patient. It’s no different from any other kind of teaching: the more the patient actively talks about the medication, the more they learn and retain.

While the competition is purely extracurricular, counseling itself isn’t. The new pharmacy practice lab, which is designed to simulate a natural setting for patient interaction, is a testament to the importance of communication in the pharmacy curriculum.

"In the lab I teach, there are six core pillars, one of which is communication skills," Deninger said. His students practice counseling all kinds of patients presenting all kinds of communication challenges. "In the competition, we wouldn’t have a patient get overtly hostile. But in the lab sequence, we might do that."

At press time, the winner of the competition was not yet determined, and the judges’ names were being kept confidential. Before the semester break, Deninger expects the winner’s name will be posted on the college’s web site at www.uiowa.edu/~pharmacy. In addition to the first prize, the top ten winners will be awarded a set of three pharmacy reference books.

If the winner goes on to take top honors in San Francisco, he or she will be the second UI student to do so. In 1993, Iowa student Kim Helmbrecht took first prize in the national competition. Helmbrecht is now a practicing pharmacist in Maquoketa.

According to Sorofman, the people who devise the scenarios for competitions might serve up the most difficult problem of all: no problem.

"Sometimes they give them no pitfalls, which is wonderful," Sorofman said. "They come in thinking, ‘Where’s the problem?’ Well, most patients have no problems. It’s challenging for students to be looking for problems that aren’t there."

Article by Sam Samuels