Daniel Greer, PharmD, BCPP
Clinical Assistant Professor
Rutgers School of Pharmacy
Piscataway, NJ
Joseph Cusimano, PharmD, BCPP
Assistant Professor
Shenandoah University
Winchester, VA
Pharmacist-patient interactions are an important aspect of patient care. Medication reconciliation, discharge counseling, and post-discharge phone calls conducted by pharmacists decrease readmissions and emergency department visits.1 Despite these services, many patients may still have questions about their illness and treatment options upon discharge from an inpatient psychiatric unit. Patient medication education groups (PMEG) are a strategy utilized in psychiatric units to facilitate discussions between the pharmacist and patients. PMEG services decrease readmissions that result from medication non-adherence and emergency department visits.2,3
Involving students in PMEGs benefits both the students and the patients. The 5-week advanced pharmacy practice experience (APPE) psychiatric rotation at my clinical site consists of both inpatient and outpatient psychiatry services. The rotation includes a weekly group called “brain science” for both the inpatient and outpatient services. As well, I like to utilize a stepwise approach to incorporate learners into conducting groups.
For the first week of my rotation, I facilitate both the inpatient and outpatient groups, which allows the students to meet the patients and see the content of the two different groups. During the second week of the rotation, the students complete the outpatient group together while I lead the inpatient group. Conducting the group as a team allows the students to divide the responsibility and pressure, all while making their first group experience collaborative. From the third week onward, the students take turns completing the outpatient groups individually with the option to complete an inpatient group. By this stage of the rotation, they have observed and collaborated in a group and now have the experience and confidence to conduct them by themselves. I still attend the student-led groups to assist with difficult questions and to provide feedback after each session. By the end of the 5-week experience, the students have completed at least one group as a team and one group individually.
Previous students have had positive experiences conducting groups. When asked, “How confident were you in interacting with the patients?” one student responded, “The patients were so welcoming and very attentive when I facilitated my group, which was reassuring and helped build my confidence…I felt much more comfortable interacting with patients and facilitating discussions, and very much enjoyed presenting to the outpatient groups, which is saying a lot since I have always struggled with public speaking.” Involving students in PMEGs benefits the students by providing them with valuable patient counseling opportunities and in turn helps the patients by providing them the chance to ask questions about their illness and treatment options in a low-pressure environment.
In my practice with Winchester Medical Center Behavioral Health Services, I lead a weekly PMEG on the 36-bed inpatient adult psychiatric unit. The group is led as an open forum in the common area of the unit with myself and a whiteboard on wheels at the center. I invite 3rd and 4th-year pharmacy students (P3s and P4s) on rotation to the PMEGs, with different roles.
For the P3 students that have not yet learned psychiatry therapeutics, the experience focuses on absorbing the environment. It is profoundly destigmatizing to spend time with people with serious mental illness, as students quickly learn that the people admitted to an inpatient psychiatry unit are just people, not individuals to be afraid of. By listening to the kinds of questions that patients ask, students learn about what kind of information matters to patients and how should we talk about them. PMEGs provide patients with insight into their illness, help to validate and reduce their fear of side effects, and reassure patients who have tried numerous medications before and are desperate for relief. Students learn by watching my example, and I offer ample opportunity to debrief on group leading skills. We talk about the power of voice and body language, how one’s gaze is used to “pass the microphone,” and how to handle disruptive patients with behavioral management skills like redirection.
P4s, with a semester of psychiatry therapeutics under their belt, are better equipped to lead groups—an opportunity offered to them in the final week of their 5-week rotation. After watching PMEGs several times, the student may be ready to introduce the patients to the activity and lead them through it. As a preceptor, I stand off to the side, ready to address behavioral issues and answer any questions that the student struggles with. In this role, it is important to allow students time to think of an answer and not jump in when they cannot immediately summon a response. This offers students a simulation of real practice with the preceptor as a safety net. Observing students in this role aids in the preceptor’s assessment of students’ pharmacotherapy knowledge and communication skills, as the translation of complex scientific facts into lay terms requires a high level of understanding.
As P4s prepare to transition into practices of their own, the PMEG experience also provides a valuable, low-risk opportunity to try out a pharmacist service that they might have not otherwise considered implementing post-graduation. It is important to emphasize that PMEGs are not unique to psychiatry,4 with endless opportunities for customization and tailoring to the practitioner’s personal style, clientele, available time, and goals.
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