Alignment of undergraduate pharmacology learning outcomes with healthcare practitioner workplace competencies

Abstract

South Africa’s healthcare sector is hindered by numerous challenges exacerbated by debilitating infrastructure, a quadruple burden of disease, staff shortages and inequality of healthcare coverage regarding public and private healthcare institutions. Educational deficiencies and misaligned curricula for healthcare practitioners further complicate the provision of sufficient healthcare, and thus contribute to the disparities in healthcare in the country. Considerable support and recommendations have been directed towards ensuring that healthcare practitioners are thoroughly equipped during their education; however, shortcomings still exist. The three healthcare practitioners relevant to my study – the dietitian, professional nurse, and physiotherapist – all contribute to the healthcare sector and form an important cog within the complex regimens that diseases require for prevention, treatment or management. Based on their roles within the healthcare sector, all three groups require pharmacology as part of their education. However, concern has been raised about how this discipline is presented, and whether competencies are adequately developed. Pharmacology, as a discipline is important in a variety of healthcare professions due to its nature as a basic and clinical science. Depending on the scope of practice of the healthcare practitioner, the role and value of pharmacology is subject to change that inherently alters the way the curriculum for it should be presented. Unfortunately, pharmacology is often approached from a generalised basic sciences vantage that fails to cover the scope of practice of the healthcare practitioner adequately, and assuch becomes subject to a myriad of challenges, including content overload, misalignment and theory-practice gaps. Consequently the potential exists for healthcare practitioners not to develop the necessary core competencies for their world-of-work, and thus fail to contribute effectively to the healthcare sector. Each healthcare practitioner relevant to this study has a different valuation of pharmacology within their profession. The dietitian provides medical nutrition that may affect or be affected by pharmacotherapy, thus necessitating understanding of the complex interactions between nutrients and medicines. Nurses, as medication managers, serve an important role within pharmacotherapy’s administration, monitoring and evaluation, to mention a few and thus require high level understanding of how these are integrated with the nursing process. Physiotherapists, although being the furthest removed from pharmacotherapy engage with physical treatment modalities that may benefit from or be affected by pharmacotherapy, necessitating understanding of how it may alter the treatment regimen. At the University of Pretoria, all three these healthcare practitioners are currently enrolled for a generalised basic sciences pharmacology curriculum that is shared with Bachelor of Science students, thus creating a myriad of complex challenges for me the course coordinator to deal with, apart from the lack of alignment with graduate competencies. However, no competency frameworks are available to guide curriculum changes to resolve the problem. The current study aimed to engage in a research-guided approach to facilitate curriculum development and address the following research question and research sub-questions: Research question: Which pharmacological competencies required by Bachelor of Dietetics, Bachelor of Nursing Science, and Bachelor of Physiotherapy students at the University of Pretoria should be aligned with their workplace needs? Research sub-questions: 1. What are the pharmacological competencies that the prospective dietitian, professional nurse and physiotherapist in South Africa need to function as a healthcare practitioner? 2. What are the targeted needs of the prospective dietitian, the professional nurse and the prospective physiotherapist at the University of Pretoria regarding their pharmacology education when assessing their current programme structure? 3. What are the proposed learning outcomes and assessment criteria of an undergraduate pharmacology curriculum presented to these students at the University of Pretoria? A mixed-methods approach was used for the study following Kern’s six-step medical curriculum model. A general needs assessment was performed by conducting a scoping review for each of the healthcare practitioners to describe the pharmacological competencies relevant to their profession and to compile a list of proposed competencies. The proposed competency list was distributed to experts within each profession as a modified, reactive Delphi study to determine the nationally relevant pharmacological competencies for each healthcare practitioner. Thereafter, a targeted needs assessment was conducted by mapping the current and proposed pharmacology curriculum for each group’s bachelor programme at the University of Pretoria using available module guides and year books. Linkages were defined between learning outcomes and assessment criteria of the respective modules to guide a focus group interview with the department of each healthcare practitioner to refine the proposed pharmacology curriculum for focused education in the future. Results from the scoping review for each healthcare practitioner grouping highlighted relevant competencies for their professional practice. Although there was a paucity of information for dietetics and physiotherapy, nursing had a wealth of information that helped propose a comprehensive list of competencies that needed to be developed. While the proposed competencies for dietitians and physiotherapists were almost exclusively within the cognitive domain, nursing had a proportion of their competencies in the psychomotor and affective domain. The Delphi study further refined these lists to create a proposed national competency framework for each healthcare practitioner group to allow for focused, relevant and expected pharmacological competencies necessary for their education. Importantly, each competency framework could be justified based on the professional scope of practice of the respective healthcare practitioner, including the common diseases that they would engage with. Targeted needs analysis showed that the current Pharmacology modules had poor alignment with the core disciplines for each healthcare practitioner’s bachelor programme. However, a larger linkage was present with prerequisite modules, such as Physiology, Molecular and Cell Biology, and Chemistry. Although linkage was present with such basic sciences modules, invariably superficial description of the learning outcomes and assessment criteria was present, suggesting potential theoretical gaps during their scaffolded education that may hinder development of pharmacological competencies. The proposed pharmacology curricula had a higher level of linkage to the core disciplines; however, several gaps were identified that lacked sufficient prerequisite education. The focus group interviews further highlighted the concerns identified in the curriculum mapping exercise. Although decontextualised theoretical knowledge of pharmacology was developed, a clear deficiency in the ability to apply the knowledge within the clinical environment was present. Furthermore, a concerning misalignment with the scope of practice of the healthcare practitioners was present, creating cognitive overload, missed expectations of education, fear of pharmacology, and theory-practice gaps. Participants highlighted the fact that the proposed pharmacology curricula had a greater relevance to their scope of practice, and thus enthusiasm was displayed for its inclusion. Recommendations were to ensure horizontal and vertical integration were present, as well as the inclusion of as much of an authentic environment during learning so that contextualisation could be achieved. Given the potential inadequate understanding of prerequisite physiology for the Pharmacology module and for the core disciplines, recommendations included engaging with a programme level review to accommodate broader changes for constructive alignment. The study allowed for three individual, focused and nationally relevant pharmacological competency frameworks to be developed for dietitians, professional nurses and physiotherapists in South Africa. As such, a potential exists for greater benchmarking of pharmacology education among institutions. Furthermore, using the targeted needs analysis, preliminary proposals for how to focus the pharmacology education at the University of Pretoria’s current healthcare practitioner bachelor programmes could be developed. Given the curriculum mapping done, a broader understanding of the complexity of such curriculum design could be showcased by using Harden’s ten windows of the curriculum. As such, a stronger, research-guided curriculum development approach was engaged with, providing evidence for curriculum reform to benefit students at the University of Pretoria.