Effect of simulation in training pharmacy students on correct inhaler technique

Objectives: To assess the effect of engaging pharmacy students in a simulated situation in which they counsel real asthma patients on their inhaler technique for Dry Powder Inhalers (Accuhaler and Turbuhaler) and Metered Dose Inhaler (MDI). Methods: This was a single blinded repeated measures parallel group design study, conducted in 2011, involving all 5th year students enrolled in the Clinical Pharmacy and Therapeutics course unit. All students were assessed on their inhaler technique at baseline based on previously published checklists for Accuhaler (ACC, 9 steps), Turbuhaler (TH, 10 steps) and MDI (9 steps). Students were randomly allocated to 2 Interventions, Intervention A ‘supervised hands-on education in groups + Peer assessment/education’; and Intervention B ‘supervised hands on education in groups + Peer assessment + simulated scenario counseling a real asthma patient. Patient counseling involved students in groups of 6, assessing three asthma patients on inhaler technique (each on one of the devices) then delivering an education (verbal information + physical demonstration) till the patient performed all steps in each checklist correctly. Student assessments on inhaler technique skills were repeated one week post-intervention. In addition, this is the first study to investigate students’ perceived barriers to demonstrating correct inhaler technique and future performance of their pre-education role in this area. Results: At baseline, none of the students in Intervention A (n =54) and Intervention B (n =55) performed correct technique for the three devices. One week following intervention, a significantly higher proportion of students in Intervention B demonstrated correct technique for the DIS, TH and MDI (60.0%;70.9%;69.1%) vs. Intervention A (27.8%;40.7%;42.6%, p<0.005,Chi Square test). Barriers perceived by the students towards their role in this area included mostly lack of practical training during undergraduate studies and lack of knowledge about the importance of this topic. No significant difference between the two Interventions was found with regards to the reported perceived barriers. Conclusion: Engaging pharmacy students with real asthma patients in a simulated scenario involving correct inhaler technique education can result in better student inhaler technique demonstration skills. Engaging pharmacy students in targeted practical training in this area would fulfill the needed highlighting of its importance and provide the skills required.