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Application of Science to Patient Care

  • Module code: PY7960
  • Year: 2018/9
  • Level: 7
  • Credits: 30
  • Pre-requisites: None
  • Co-requisites: None

Summary

This module is a core module of the OSPAP diploma course. It introduces the principles and skills required to practice evidence-based medicine and problem solving as a clinical pharmacist. It covers the presentation, clinical features and management of cardiovascular, endocrine, gastrointestinal, reproduction, dermal, respiratory, neurological, inflammatory, and infective disease in patients. This module will provide you with an insight into the management of these conditions in primary and secondary care as well as dealing with aspects of responding to symptoms and public health associated with these conditions. The module is designed to integrate clinical and scientific knowledge as they relate to patient care. It exposes you to real clinical situations and near patient learning, as you will need to spend one and a half days in a hospital setting as part of your compulsory placement.

Aims

  • To develop in students a deep and systematic understanding of the physiology aetiology, epidemiology, pathophysiology of commonly encountered diseases and conditions related to them.
  • To develop in students a deep and systematic understanding of the chemical, physical and pharmacological properties of drugs and a critical appraisal of their use in the treatment of disease.
  • To develop an analytical and systematic approach to the clinical presentation, complications and relevant investigations of commonly encountered conditions and apply critical evaluation, problem solving and creative skills to plan and design therapeutic plans to treat and prevent them.
  • To develop skills and knowledge required for responding to symptoms, patient counselling and health promotion.
  • To develop advanced knowledge in the principles and application of clinical pharmaceutics to ensure optimal drug delivery and make appropriate choices of formulations for individual patients.

Learning outcomes

On successful completion of the module, students will be able to:

  • Describe the physiology of the cardiovascular, respiratory, endocrine, gastro-intestinal, renal, hepatic, reproduction, neurological, dermal, musculoskeletal and haematological systems and the pathophysiology of diseases associated with them.
  • Make an appropriate evaluated decision when responding to symptoms/ answering queries related to diseases and to communicate this information to the patient in an effective way
  • Demonstrate an advanced understanding of the role of pharmacist in detection and prevention of disease, health promotion and treatment optimisation of various diseases.
  • Evaluate the therapeutic strategy used to prevent and treat conditions and associated complications in relation to cardiovascular, respiratory, endocrine, gastro-intestinal, renal, hepatic, reproduction, neurological, musculoskeletal and haematological systems indicating the rationale for use of particular drugs in relevant situations while relating the selection of therapy to treatment guidelines/evidence base, drug properties (structure and formulation) and patient factors (eg. age, pregnancy, etc.)
  • Produce a structured reflective diary and a presentation based on placement experience

Curriculum content

  • The physiology, aetiology, epidemiology, pathophysiology of the cardiovascular, respiratory, endocrine, gastro-intestinal, hepatic, renal, neurological, musculoskeletal, dermal and haematological systems including infections and cancer and conditions related to them.
  • The clinical presentation, complications and relevant investigations of cardiovascular, respiratory, endocrine, gastro-intestinal, hepatic, renal, neurological, mental health, musculoskeletal, dermal and haematological conditions including the symptoms and relevant important physical signs
  • The chemistry and structure/activity relationships of drugs used in the treatment of infections, cardiovascular, respiratory, endocrine, gastro-intestinal, hepatic, renal, neurological, mental health, musculoskeletal, dermal and haematological conditions and the relationship to pharmacological action and therapeutic use.
  • The therapeutic management of acute and long term conditions in both primary and secondary care.
  • The evidence base and guidelines e.g. NICE, for the management of acute and long term conditions
  • Biopharmaceutics and pharmacokinetics of oral, ophthalmic, parenteral and transdermal drug delivery systems, and their therapeutic application
  • Formulation, characterisation and performance of injectable, insertable and implantable drug delivery devices.
  • Drug targeting through chemical manipulation and/or formulation strategies Management of patients with liver and renal diseases and the effect of these conditions on therapy.
  • Pain management
  • The application of pharmacokinetics in drug dosing and Therapeutic Drug Monitoring.
  • Substance abuse and addiction and the role of the pharmacist in substance abuse
  • Health promotion, health education and the prevention of disease, both primary and secondary prevention.
  • Inhaler technology and the use of inhaler devices
  • Use of biotechnological products and the role of monoclonal antibodies as therapeutic agents, their design, rationale for use and the therapeutic challenges they pose
  • Contraception and fertility: menopause and hormone replacement therapy, use of hormonal contraceptives, emergency hormonal contraception. Drugs used in the treatment of infertility and their mechanism of action.
  • Introduction to infection and use of antibiotics
  • Sterilisation and asepsis.
  • Travellers' health
  • Responding to symptoms and counselling patients appropriately in relation to conditions/issues of the cardiovascular, respiratory, endocrine, gastro-intestinal, renal, hepatic, reproduction, neurological, dermal, musculoskeletal and haematological systems
  • Dispensing of medicines for cardiovascular, respiratory, endocrine, gastro-intestinal, renal, hepatic, reproduction, dermal, neurological, musculoskeletal and haematological conditions
  • Motivational interviews (how pharmacists can help and support clients/patients in actually making realistic changes in their health) related to weight loss and alcohol intake.

Teaching and learning strategy

Lectures are used to provide underpinning knowledge while in workshops, tutorials, problem-based learning scenarios are used so that students can learn to apply knowledge to describe how the drugs discussed in the module are used in the treatment of human disease. An underpinning principle is using the scientific learning in this module and applying it to clinical practice and patient care. Practical experiments will be lab based and will require analysis and decision making. The use of a science based computer assisted learning assignment which has therapeutic application will both help to link science and practice and develop use of technological learning platforms.

Students will be able to identify how learning is put into practice in their two clinical placements. An initial simulation placement will be organised, where students obtain drug histories and provide patient counselling to patient actors. This is followed up by a one day hospital pharmacy placement where activities include accessing patients' records and preparing a Patient Management Plan for presentation back at the University. Both placements serve to consolidate learning as well as give students the opportunity to observe and understand how knowledge is applied in the management of patients.

Hospital placements will be organised by the University and will be supervised by academic staff.

Group and team working along with the development of Problem Based Learning (PBL) skills is facilitated in a group piece of work where students working groups develop a public health campaign and present their work to the wider student body.

Breakdown of Teaching and Learning Hours

Definitive UNISTATS Category Indicative Description Hours
Scheduled learning and teaching Lectures, workshops, tutorials 200
Guided independent study Written coursework assignments, set reading and homework pre-lectures/workshops, self-directed and independent learning 388
Study abroad / placement Hospital/community pharmacy placement 12
Total (number of credits x 10) 300

Assessment strategy

The assessment in this module is underpinned by the GPhC's outcome standards and the necessity for students to demonstrate that they can meet these standards. These standards require to be met at a range of levels defined by Miller's Triangle criteria; 'knows', 'knows how', 'shows how' and 'does'. Many of the outcomes associated with this module are at the 'shows how' level and some 'does' hence the use of Objective Structured Clinical Examination (OSCE) style assessments to enable students to demonstrate that they can meet the required level. This is further reinforced by the need for students to demonstrate that they can practice safely, effectively and legally when they progress to their preregistration training and providing care for sick and vulnerable patients. It is important that students also have a deep and systematic understanding of the underpinning scientific and clinical knowledge so they use that knowledge in analysis, problem solving, decision making and planning care in routine and complex situations, including those where there is an absence of complete data and information.

To support the student in meeting these standards diagnostic and formative assessment is used to support learning in addition to the teaching and learning. There will be elements related to this module in the diagnostic testing in induction to assess baseline levels of knowledge and ability in relation to the practice of pharmacy. The tests cover topics like clinical pharmacy, pharmacokinetics, pharmaceutical chemistry, pharmacology, evidence based practice and responding to symptoms. Feedback will be given to students, extra reading material outlined, and signposting to sources of help as appropriate.

To achieve the learning outcomes of the module and GPHC standards a range of assessment methods are used to enable students to demonstrate their acquisition of advanced knowledge and skills such as critical appraisal, problem solving and analysis and apply them in practical situations with regard to patient management. There are a series of formative workshops with feedback to support this. The workshops and placement experience will feed forward to the synoptic OSCE (practical exam) to test clinical decision making related to the effective management of the conditions covered in the module. A range of other assessment methods will be used including oral presentation of the student's case presentation which will facilitate not only the student's oral communication skills but will demonstrate that they can meet a number of the 'shows how' criteria in the GPhC's outcome standards. A group problem based learning (PBL) task to develop a public health campaign will be presented to peers which will enable students to demonstrate a number of the 'shows how' and 'does' outcome criteria as well as meeting the learning outcomes of the module.

Course work activities, placements and assessments, both formative and summative will support the students learning and revision for both the in module assessment and the end of module examination.

To encourage learning and engagement with professional activities placement attendance is part of the Academic and Professional Skills Portfolio. Students will also produce a reflective learning account of their placement which will be reviewed by their personal tutor and is also one of the activities for their Academic and Professional Skills Portfolio.

Patient safety is paramount and in the synoptic OSCE key patient safety issues will be assessed, as well as in the in module assessment and end of module exam. The in module assessment as well as providing an element of the summative mark for the module the feedback with particular regard to patient safety critical elements of the assessment should be of value for students when undertaking the synoptic OSCE and dispensing assessment.

A range of formative assessments undertaken both in-class (workshop and practical) and during independent study, of relatively short duration will be set periodically on content determined by the module leader. This will provide regular and detailed feedback to students so that they can develop and awareness of their rate and level of progress and of their strengths and weaknesses. On-going discussion via the personal tutor and module leader will assist the student in the development of strategies for improvement and enhancement.

OSPAP students are required to pass a synoptic OSCE style assessment and a synoptic calculations test before they can be awarded their accredited Diploma. These are to assure that the graduating student is able to demonstrate that they have the appropriate skills, knowledge, understanding and attributes to become a future pharmacist. Learning in this module feeds forward into these synoptic assessments. In particular critical appraisal and problem solving skills are assessed both formatively in workshops and summatively in the in module assessment through the use of SBA and EMQ style questions, feeding forward into the synoptic OSCE assessment.

Mapping of Learning Outcomes to Assessment Strategy (Indicative)

Learning Outcome Assessment Strategy
1) Describe the physiology of the cardiovascular, respiratory, endocrine, gastro-intestinal, renal, hepatic, reproduction, neurological, dermal, musculoskeletal and haematological systems and the pathophysiology of diseases associated with them. In-class formative assessments End of module exam
2) Make an appropriate evaluated decision when responding to symptoms/ answering queries related to diseases and to communicate this information to the patient in an effective way. In class formative assessments End of module exam Feeds forward to synoptic OSCE
3) Demonstrate an advanced understanding of the role of pharmacist in detection and prevention of disease, health promotion and treatment optimisation of various diseases. In class formative assessments PBL health promotion campaign - formative End of module exam Feeds forward to synoptic OSCE
4) Evaluate the therapeutic strategy used to prevent and treat conditions and associated complications in relation to cardiovascular, respiratory, endocrine, gastro-intestinal, renal, hepatic, reproduction, neurological, musculoskeletal and haematological systems indicating the rationale for use of particular drugs in relevant situations while relating the selection of therapy to treatment guidelines/evidence base, drug properties (structure and formulation) and patient factors (eg. age, pregnancy, etc.) In class formative assessments End of module exam Oral case presentation based on placement Feeds forward to formative OSCE
5) Produce a structured reflective diary and a presentation based on placement experience. Oral case presentation based on placement Reflective record of placement activities – formative. Feeds forward into Academic and Professional Skills Portfolio.

Elements of Assessment

Description of Assessment Definitive UNISTATS Categories Percentage
Written exam End of module exam 60%
Written exam In module assessment 20%
Practical exam Oral presentation 20%
Total (to equal 100%) 100%

Achieving a pass

It is a requirement that the elements of assessment are passed separately in order to achieve an overall pass for the module.

Bibliography core texts

  • Drugs in Use: Clinical case studies for pharmacists 4th edition, Dodds. Pharmaceutical Press (2009). ISBN 0853697914
  • Clinical Pharmacy & Therapeutics (4th Ed), Walker and Whittlesea. Churchill Livingstone (2007). ISBN 0443102856
  • Pathology and therapeutics for pharmacists: A basis for clinical practice (3rd ed), Greene and Harris. Pharmaceutical Press, (2008). ISBN 978 0 85369 6902
  • Clinical Medicine (7th ed). Kumar and Clark. Elsevier Health Sciences (2009). ISBN 0702029939
  • Oxford Textbook of Clinical Pharmacology and Drug Therapy (3rd ed). Grahame-Smith and Aronson. OUP Oxford (2002). ISBN 0192632345
  • Adverse Drug Reactions (2nd revised ed), Lee. Pharmaceutical Press, (2006). ISBN 0853696012
  • British National Formulary, Latest Edition, edited by the Joint Formulary Committee. Pharmaceutical Press.
  • Clinical Biochemistry (4th ed), Gaw, Murphy et al. Churchill Livingstone (2008). ISBN 0443069328
  • Health promotion for pharmacists (2nd ed), Blenkinsopp, Panton and Anderson. Oxford University press (2000). ISBN 9780192630445
  • Saunder's Pocket Essentials of Clinical Medicine (3rd ed), Ballinger and Patchett. Saunders (W.B.) Co Ltd (2003). ISBN 070202645X
  • Pharmacology (7th ed), Rang, Dale, Ritter & Moore. Churchill Livingstone (2011). ISBN 0702034711
  • Integrated Pharmacology (3rd ed), Page, Hoffman, Curtis, Walker. Mosby (2006). ISBN: 0323040802
  • Symptoms in the Pharmacy: A Guide to the Management of Common Illness (6th ed) Blenkinsopp, Paxton and Blenkinsopp. Blackwell Publishing (2008). ISBN 978-1405180795
  • Community pharmacy; symptoms, diagnosis and treatment (2nd ed), Rutter. Churchill Livingstone (2008). ISBN 978-0702029950.
  • Modified-Release Drug Delivery Technology (2nd ed). M.J. Rathbone, J. Hadgraft and M. S. Roberts. Marcel-Dekker (2008). ISBN 1420053558
  • Physico-Chemical Principles of Pharmacy (5th ed). A.T. Florence & D. Attwood, Pharmaceutical Press (2011). ISBN 0853699844
  • Pharmaceutics. The design and manufacture of medicines (3rd ed). M.E Aulton, Churchill Livingstone (2007). ISBN 044310108
  • An Introduction to Medicinal Chemistry (4th ed). Patrick G.L., Oxford University Press (2009). ISBN 0199234477
  • Organic Chemistry. Clayden, Greaves, Warren and Wother. Oxford University Press (2001). ISBN 0198503466
  • Medicinal Chemistry - An Introduction Thomas G. John Wiley (2007). ISBN 9780470025970
  • Medicinal chemistry - a molecular and biochemical approach (3rd ed). T. Nogrady and D. F. Weaver (2005). ISBN 0195104560

Bibliography recommended reading

Essential website reading:

Besides the links listed below, students will be advised to join the Royal Pharmaceutical Society as membership is free and joining the RPS will allow them to have online access to the current new Medicines, Ethics and Practice (MEP) publication and many of the required documents listed in the links below.

Recommended Reading:

  • Basic and Clinical Endocrinology (8th ed) Gardner D.G. and Shoback D.M. Appleton and Lange (2007). ISBN: 0071440119
  • Endocrinology: an integrated approach. Nussey SS & Whitehead SA. Taylor & Francis (2001). ISBN 1859962521
  • Color Atlas of Pharmacology (3rd ed). Luellmann H, Mohr K, Hein L, Bieger D (2005). Georg Thieme Verlag. ISBN: 313781703x
  • Applied Therapeutics: The Clinical Use of Drugs (8th revised ed) Koda-Kimble, Young. Lippincott Williams and Wilkins, (2004). ISBN 0781748453
  • Clinical Pharmacy Survival Guide, Barber and Willson. Churchill Livingstone (1999). ISBN 085369754X
  • Stockley's Drug Interactions (8th ed) Stockley. Pharmaceutical Press (2007). ISBN 0853695040
  • Meyler's Side Effects of Drugs (15th ed): The International Encyclopaedia of Adverse Reactions and interactions (Meyler's Side Effects of Drugs), Aronson (2006). ISBN 0444509984
  • Clinical pharmacokinetics: concepts and applications (3rd ed) Rowland. Williams & Wilkins (1995). ISBN 0683074040
  • Clinical pharmacy pocket companion, Wright et al, Pharmaceutical Press (2006). ISBN: 9780853696490
  • Concise clinical pharmacology, Greenstein, et al. Pharmaceutical Press (2006). ISBN: 9780853695769
  • Current status and future potential of transdermal drug delivery. Prausnitz MR, Mitragotri S, Langer R. Nat Rev Drug Discov. 3 (2):115-24 (2004) Review.
  • Alternative methods of delivering drugs for improving performance, convenience and patient compliance. Henry C. Chemical & Engineering News. 78 (38): 49-65 (2004)
  • Handbook of Pharmacy Health Education (2nd ed), Robin J Harman. Pharmaceutical Press (2006). ISBN 0 85369 471 0
  • Evidence Based Practice. C. Bond, Pharmaceutical Press (2000) ISBN: 9780853694366
  • The Drug Tariff, latest edition (also at: http://www.drugtariff.com/)
  • Non-prescription medicines (4th ed), Nathan. Pharmaceutical Press (2010). ISBN 978 0 85369 644 5
  • Student Success in the Prescribing Safety Assessment (PSA). Savickas S, Kayyali R and Sharma N. Radcliffe Publishing Ltd (2014). ISBN 0 85369 471 0

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