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Student’s from University of the Pacific’s Master of Physician Assistant Studies and the Thomas J. Long School of Pharmacy and Health Sciences compared notes in diagnosing a patient.

Student’s from University of the Pacific’s Master of Physician Assistant Studies and the Thomas J. Long School of Pharmacy and Health Sciences compared notes in diagnosing a patient.

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Simulations give Pacific students real-world exposure to patient care

Nov 14, 2017

Beverly Diaz was rushed to the emergency room Friday by her family when the 55-year-old became confused and suffered hematemesis, according to her medical chart.

While the situation seemed dire, there were 246 students from Pacific's Master of Physician Assistant Studies and Doctor of Pharmacy programs eager to diagnose her case. The students were participating in an interdisciplinary simulation that would have real-world consequences if Diaz were a human patient rather than a fictional part of an exercise. The simulation was developed by Deepti Vyas, an associate professor and director of Interprofessional Program at the Thomas J. Long School of Pharmacy and Health Sciences in Stockton, in conjunction with Tracey Delnero, an associate professor and the director of academics at the MPAS program based at Pacific's Sacramento Campus.

"In the past we hired actors to portray physicians, but I think this worked out much better because it allowed participation from the PA program," Vyas said. "For our students it is very important to learn about communicating with medical teams when a patient's wellbeing is at stake, the diagnosis and decision-making process, and in general being familiar with being part of a provider team focused on the patient."

Vyas said the simulation was designed to reinforce Situation, Background, Assessment, and Recommendation, or SBAR, a tool that provides students with a standardized approach to communications in real-world settings.

"I think these simulations are a fantastic thing for both the PA and pharmacy students, because it gives us the chance to make mistakes without actually impacting a patient's life," said China Spencer, a second-year student pharmacist participating in the simulation. "It's helping us prepare for what it'll be like in the actual environment, working with real nurses, doctors and others. I appreciate that they do this, because it pushes us outside our comfort zone well before we're out of the classroom."

Students put their classroom and real-world experience to work during the simulation.

"Hematemesis is when you vomit blood," explained Brendan Lucas, a first-year student in the physician assistant program. "This patient also suffers from liver cirrhosis, epilepsy and general anxiety disorder. Endoscopy results show she presents with acute esophageal bleeding, which explains the blood. Her condition is serious.

"The pharmacy students will make drug therapy recommendations and review the patient case with us," continued Lucas, as he waited for the simulation to begin. "I think she requires medication to control the bleeding and something to address the confusion and her anxiety."

While Beverly Diaz was not a real patient, the subtle anxiety on the faces the students waiting outside in the hallway showed that didn't matter - to them, Diaz was very real.

"She takes at least six different prescription medications and five over-the-counter drugs, and she's allergic to penicillin," Spencer said.  As she vigorously reviewed the notes from her preparation and research on the Diaz case, Spencer said, "Because of her liver cirrhosis, only certain types of medication can be metabolized, so I'm looking at that issue, as well."

The students were provided patient information ahead of time so that they could do some research before the simulation. Then on Friday, student pharmacists made their way into the rooms where Lucas and 44 other physician assistant students sat waiting at the different stations to confer one-on-one with an assigned pharmacy student, all discussing Beverly Diaz. Each encounter included a spin to the case in real time, which required the students to come up with solutions to simulate real patient care in a hospital setting.

Dialogue filled the room as aspiring physician assistants and pharmacists discussed recommended therapies for Diaz, her lab results, potential side effects and drug interactions, other possible complications, and complicated medical and pharmacology terminology.

"The pharmacy students have about five minutes to make their recommendations and about two minutes to defend that decision to the PAs," said May Chen, a lecturer and fellow in the pharmacy school, and one of several faculty simulation moderators. "Then each faculty facilitator will introduce a surprise variable neither student knows about."

As the clock counted down, facilitators walked through the room handing out slips of paper with new information about the fictional patient. In this variation, each received a note that read, "RN just informs you that the patient is refusing the lactulose, because she does not want to go to the bathroom all of the time. How do you respond?"

The facilitator's curve ball ignited a renewed flurry of dialogue, with students on each side of the simulation looking up information on laptops and discussing how to address the situation.

Lucas agreed that the simulation was worth the time and effort.

"This is a great way for students from both programs to get the kind of exposure we need - especially to learn about communicating with other providers. It was a good experience," he said.

While inter-disciplinary learning events have long been part of the student experience and curriculum at Pacific, this was the first time the MPAS and pharmacy programs collaborated on a simulation for students. 

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