1. Social Pharmacy Pharmacoepidemiology and Pharmacotherapy New Educational Tools Han de Gier, PharmD, PhD Professor of Pharmaceutical Care Groningen University, The Netherlands E-mail: j.j.de.gier@rug.nl

2. University of Groningen Since 1614

3. Outline of the Presentation How do we learn? New Educational Tools? Potential of Playing Games GIMMICS (Pharmacy Practice Game)

4. How do we learn? As a child: ‘learning by doing’ as an experiential way of learning. By contrast at school: sit down quietly and be constantly alert to the words of wisdom…. (‘alternative’ approaches in primary education). Experiential learning theory (Kolb, 1984): a critical approach towards traditional learning and teaching models, especially for adults.

5. Experiential Learning Theory Defines learning as “the process whereby knowledge is created through the transformation of experience” (Kolb, 1984). - Central role for experience in the learning process - To differentiate both from cognitive and behavioural learning theories. - A four-stage learning cycle: concrete experiences  reflections  new implications for action  testing and creating new experiences.

6. New Educational Tools? Do we need new educational tools? - The fundamental challenges of sustainable development education is to integrate science, social sciences and managerial science into systems thinking. - Our intellectual heritage is one of analysis and to focus more on the parts than on the wholes. - Do we focus enough on paradigm, context and practice changes to help ensure that our students make progress toward sustainable professional development?

7. But we have learning modes…… What about case studies? - Most common approach to observing reality and an attempt to understand processes within certain contexts. - Limitation: they provide solutions that are context- specific. And internships? - Students in many cases rather automatically accept the contexts of the pharmacy organization. - Students should be educated how to change existing contexts.

8. New programme elements…… How to be better prepared for internship? In learning concrete experiences: - Within the context of presenting case studies: games like role-plays can serve a significant role. In reflective observation and the exploration of tools and techniques: - Games for self analysis, collaboration and communication should be an essential part of the curriculum

9. Games in the context of ELT Simulate and create realities. Develop an emotional uderstanding of why others act as they do. Learn by doing and failing: no negative consequences for the real world. Manipulate to experience what the consequences are or what they might become. Know what NOT to do and design alternative approaches.

10. Potential of playing games Generate ‘safe’ learning experiences Create shared experiences Contributes to team building Contributes to knowledge of oneself Test alternative solutions Fun and entertainment

11. Playing games is serious business! Impact can be realized if well prepared, well executed and well evaluated. Some generic rules: - Introduction and instructions - Debriefing at the end of the gamming session Further reading: Dieleman H, Huisingh D. (2004) The potentials of games in learning and teaching about sustainable development. http://www.saganet.nl/mm/LinkedDocuments/Article%20Games%20and %20Sustainable%20Development.pdf Greenblat C, Duke R.D. (1975) Gaming-simulation: rationale, design, and applications, Halsted Press Div., John Wiley & Sons, New York. Kolb D. (1984) Experiential learning, experiences as the source of learning and development, Prentice Hall, Englewood Cliffs, New York.

13. Gaming as a new educational provision for pharmacy Starting points (Van der Werf et al., (2004): - Pharmacists are professionals who administer pharmaceutical care by intervening in care processes - Pharmacists should be able to improve knowledge integration across disciplines - Care processes are perceived as social processes (social, managerial, communicative skills) - Integration of knowledge and social competencies in controlled circumstances Van der Werf JJ, Dekens-Konter J, Brouwers JRBJ. (2004). A new model for teaching pharmaceutical care services management. Pharmacy Education, 4:1-5.

14. Product specification…… “An educational provision with properties that reflect pharmacy intervention practice; that it appeals to social skills and integration of knowledge; that students manage, within a controlled setting, their affairs in order to experience pharmaceutical care practice” Although stated in general terms it gives substantial direction => literature on learning theory and gaming

15. Groningen Institute Model for Management In Care Services GIMMICS: The Pharmacy Practice Game

16. Developed at: University of Groningen, Institute for Pharmacy Dept. Pharmacotherapy & Pharmaceutical Care Groningen, The Netherlands Contact: a.w.sillius@rug.nl Developed by: Prof. Koos Brouwers Jackie Dekens, PharmD Prof. Han de Gier Renee Lutke, PharmD Aaldrik Sillius, MSc Prof. Jos van der Werf GIMMICS

17. Curriculum (pre Bachelor/Master): - 4 years: the basics of Pharmacy - 2 years: prepare for position as community pharmacist Survey among teachers and students (1998/2000): - Many courses, but what is ‘the big picture’ ? - A lot of attention to theory, but what about practical and social skills ? History (1)

18. Decisions made: - Tackle these problems - By developing a Pharmacy Practice Game - Good example: Management Games - Focus on: - Integrational aspects (knowledge from several domains) - Competences (knowledge + practical and social skills) 2000: First edition of Pharmacy Practice Game 2003: GIMMICS History (2)

19. Starting point for students: - Almost 6 years of education at university level - Pharmacotherapeutical knowledge and practical skills should be present - 1 internship at a community pharmacy (6 weeks) Game lasts 4 weeks full time: - 4 or 5 teams per game - 5 students per team - Each team in their own class room (responsible for running their own ‘pharmacy’) How the game is organized (1/4)

20. Routine assignments: - Processing flow of prescriptions (daily; 20-25) - Counselling clients at the counter - Dealing with ‘mystery guests’ Long term projects: - Pharmacotherapeutical meeting with physicians - Negotiating contracts with - Board of directors of elderly home - Wholesaler - Insurance company How the game is organized (2/4)

21. Ad-hoc assignments (incidents): - Visit by Inspectorate of Healthcare - Tsjech speaking tourist at the counter - Drug addict demands more methadon - Elderly lady needs instruction on how to use inhaler - Hospital specialist on the phone: “My patient can’t swallow these large capsules” All people involved in incidents are real life persons (=actors) ! How the game is organized (3/4)

22. Week 1: preparing for the game - Define pharmacy policy (vision and mission statement) - define targets which are measurable - e.g. focus on elderly, polypharmacy, selfcare - Define roles - pharmacist (1st, 2nd), pharmacy assistants - Define how decisions are made - Build documentation system - Familiarize with pharmacy computer system Week 2, 3 en 4: the game is on! - Carry out assignments - Define and run own projects In reality of the game: improvisation and hard work! How the game is organized (4/4)

23. Assessment procedure: - Each team starts with 8000 (virtual) patients - Each assignment is assessed - How well are the prescriptions processed? - How well did they manage long term projects? - How well did they prepare for meetings? - Are clients (=real life actors) satisfied? - Outcome: gain or lose a number of patients - Results are made public on GIMMICS website - Overall assessment: attendance, function within team, maintain a minimum number of patients How are students assessed? (1/2)

24. And this one may come as a surprise: Outcomes of assessments are not explained !!! - Students have to reflect on their own actions - As an individual and as a team - If this fails: one wild card per team At the end of the game: Debriefing and the announcement of “the winning team … “ How are students assessed? (2/2)

25. 1: Pharmacy computer systems - Processing of prescriptions - Manipulating date (1 day game time ~ 1 week real time) 2: Website GIMMICS: - Support for game leaders - entering scores (outcome of assessments) - articles in local newspaper "De Omroeper" - Communicating with students - overall ranking (nr of patients per team) - articles in “De Omroeper” - Communicating with third parties - passive: just visit website - active: become an actor in the game! Support (1/2)

26. 3: GIMMICS Management system - For managing actors - For managing cases - Knowledge base - ‘flow charts’ of activities - in preparing the game - in running the game For more information please look at: www.gristos.nl Support (2/2)

27. Game setting: physical Headquarters Room 1Room 2Room 3Room 4Room 5 ground floor 3rd floor 5-6 students 2 computers -> LAN / Internet 1 client: -> Pharmacom or Aposys a small library -> referential purposes 2 teachers, 2 student assistants 3 computers ->LAN / Internet 2 servers: Pharmacom / Aposys -> pharmacy computer systems

28. Game setting: communication Headquarters Room 1Room 2Room 3Room 4Room 5 ground floor 3rd floor website* Pharmacom * Aposys phone email face-to-face

29. Assignments: 4 categories Routine ~:Long term ~: Ad-hoc ~: Self-defined projects * specialize on: - polypharmacy - the elderly - travel * take over other pharmacy * cooperate with other pharmacy negotiate with: - drug retailers - health insurance companies meet with: - local physicians - board of home for the elderly daily processing of prescriptions - N total = 35-40 - N pitfalls =20-25 client needs inhaler instruction physician: “Substitution allowed?” drug addict: “I want methadon!” woman speaking in foreign tongue hospital specialist: “Pills too large!”

35. Experiences with GIMMICS (1/3) Students state that playing GIMMICS …. - is great fun - makes them more prepared for their next internships - stimulates them to reflect on their own actions - allows them to integrate knowledge and skills they have acquired over the past few years

36. Experiences with GIMMICS (2/3) 1) Starting premisse A game with a rich setting creates an appropriate educational environment for learning academic skills 2) Inevitable chain of events: richness of game setting  => number of game interactions  => workload  => mistakes  3) There are ways to reduce workload - carefully analyze all game interactions - identify time-consuming activities - select those that can be foreseen and plan these

37. Experiences with GIMMICS (3/3) Other universities followed our lead: University of Utrecht Faculty of Pharmacy (have introduced GIMMICS in 2004) Free University of Brussels Faculty of Pharmacy (will introduce GIMMICS early 2007)