Mini reflection following triad session #1
Following the first triad counselling session, the team discussed the experience together.
I had only recently viewed the marking rubric for the exercise, and initially felt overwhelmed when reviewing the rubric, and also felt lost when trying to use it to evaluate the other team member’s interaction.
My performance as a pharmacist was rather inadequate, and I was not confident regarding the observation I provided.
While largely due to my own lack of preparation, (and time, but no excuses here!), I believe smaller elements also played a role in my difficulty evaluating the triad. A lack of logical information gathering from the pharmacist during my observational role, combined with my lack of familiarity with the rubric made it difficult to assess. Furthermore, some of the rubric assessment points, such as confirming the patient’s identity, seemed awkward to achieve without that information first being provided by the patient.
I believe that adjusting the case scenarios to also include a section which can be copied into the Zoom chat window, which includes “script information” would more closely emulate the pharmacist experience and remove this awkward element, allowing the pharmacist to perform their role and meet their expectations in a more natural fashion.
I have decided to submit this suggestion to our counselling coordinator, seeking her opinion on the merits of this idea. Our group are willing to utilize the existing information provided with the scenarios to create this “script package”, but the suggestion may also be of benefit to other groups, or the unit as a whole, and therefore I have decided to share the idea in the relevant forum.
Mini reflection following triad session #2
This week for the triad role plays, I sought to emulate the assessment environment by having the group provide a “script-like” entry into the Zoom chat window, and having CMI’s in my possession.
I had mixed feelings regarding the approach: on one hand I considered that it could be seen as lazy, but on the other hand I was happy to be making the practice experience more similar to the actual assessment.
Sadly, the two CMI’s that I had prepared did not cover the third drug type that I was presented with, and my counselling was centered around a different drug completely. While this would have been disastrous in an assessment situation, the counselling otherwise went much better than week 1, with more elements from the rubric addressed.
While not having the correct CMI was clearly disadvantageous, the CMI was useful to prompt counselling elements to ensure a comprehensive counselling service. I do not believe it to be a replacement for learning the content, as simply reading from a paper would detract from the air of confidence that a pharmacist should display. However, a pharmacist should use tools at their disposal to ensure that they meet the counselling expectations, and utilizing a CMI to ensure no detail is missed is not misguided.
I will continue to utilise the CMIs further in my preparation for future triads, as I believe them to be a staple tool for the pharmacist always at hand.
I aim to augment the CMIs with my own knowledge and learning, contributing “time for effectiveness” which is often not elucidated, and also identifying key points which may be lost within all the information contained within the CMI.
Mini reflection following triad session #3
This session was a repeat attempt at doing an "unaided" counselling session. Partially because I intended to do it this way, and partially because I, again, failed to predict the drug I would be presented with, and had not looked over the CMI.
I felt amused as I had failed twice in a row, but undeterred as I was confident that I could counsel in a suitable manner given my recall of the counselling steps.
The counselling session went relatively well, and I was able to recall most of the counselling points required.
While recall of the drug information is important, in a pharmacy setting the drug information would always be readily on hand, so I feel that the true benefit from us undertaking these triad sessions is to gain confidence in asking questions, gathering information, and learning how to present it to a patient.
I am certainly more confident "going in blind" into the assessment scenario
I plan to further optimise this approach, striking a balance between straight memorisation of the unit content, utilisation of the CMIs, and my patient interaction skills.
Mini reflection following triad session #4
For this triad, we had to counsel on the use of asthma devices. I had prepared well for this session by borrowing a number of asthma training devices from a pharmacy.
I felt pretty confident; being able to have the devices in your hand can help to prompt you as you are counselling.
The session went very well. I did not require a device to assist my counselling, and one of the other team members uses the device, so they were able to explain it well. Our third participant was unfamiliar with the drug/device she was presented, but I was able to prompt her by holding the device up to the camera so that she had an idea of what she was being questioned on.
I felt that this was more reflective of the assessment scenario and was glad that, after my rough counselling sessions from the previous two weeks, I was able to make a significant contribution to the smoothness of my team member's counselling.
This was certainly a case where approaching the triads in a manner which tried to emulate the assessment paid off for my team member, and I am glad that my different preparation was able to be helpful to my team.
I have more confidence in my different approach to the triads and plan to look for other ways that a different mindset can help my team.
Mini reflection following triad #5
For this triad, none of the team members had prepared as usual. We were delayed in undertaking our triad due to a Tuesday night training session, and had squeezed the session in at another date. Additionally, assessments for other units were demanding attention and time. We allowed everyone a few minutes to quickly look at their notes once the drug was revealed to them.
I was pretty excited that the other team members would get a chance to approach the triads from my angle: challenged and at short notice. I was confident in their ability and familiarity with the counselling requirements and was excited at the prospect that they would be more comfortable in the counselling assessment having tried it this way.
The counselling went incredibly well, despite the lack of preparation and two triads squeezed into one night. The team got a feel for short-notice counselling and a taste of the assessment conditions. However, part of the preparation problem was caused by trying to get an essay prepared well before its due date. It is good to be on top of commitments, but not at the expense of other commitments.
While preparation and mastery of content is essential for a pharmacist, having the skills to find information, compile it, and relate it quickly back to a patient are vital skills as well. Preparation can help alleviate many issues, but time is not always a luxury for a pharmacist, with many other commitments demanding our attention.
My plan is to address other commitments in a timely fashion, however, do so in moderation: Incorporate the triad sessions into my assessment schedule, so that I factor these in too when allocating my time.
Assessment 1: Reflection 1
Description
As part of our pharmacist training, we undertook roleplay scenarios with two other peers to practice counselling patients on new medications. While I attempted these practice sessions without the use of notes or the marking rubric before me, my partners performed their counselling with the assistance of their notes.
Feelings
I felt somewhat ashamed after delivering my counselling, as I would fumble towards the end; trying to remember all the required counselling points. My counselling was not as well executed as my partners’ counselling and I felt that I was letting them down by not being able to demonstrate an exemplary counselling performance for my scenario. It did reduce my self-confidence; in that they were capable of delivering a better counselling session than I. I also felt doubtful that my approach to the counselling was the optimal approach to take with regard to my group’s and my own training.
Evaluation
By utilising their notes and the rubric during the practice, my team members were able to deliver a near-perfect counselling session. They were able to display to the other team members all of the topics which should be covered. However, access to their notes will not be possible during the assessment. I, on the other hand, having conducted my counselling in a manner similar to the assessment, will be more familiar with that assessment environment.
Analysis
Presenting a perfect, rubric-guided counselling session does benefit the team receiving the counselling, as it displays all required areas. Also, by utilising the rubric and addressing each counselling point in turn, my partners may be able to develop a counselling sequence which allows them to recall all the counselling points during the assessment, and subsequently into their professional careers. However, they may become reliant upon the rubric for their recollection, and without it their recollection may be impaired. The approach I take may not offer an exemplary counselling performance, however, it may assist me in being more comfortable during the counselling assessment and not panic if I falter; shutting my cognition and recall down. Indeed: by being placed into an uncomfortable situation during counselling practice, without notes and a rubric to follow, it may be that I achieve better learning and recall due to being out of my comfort zone (Joëls, Pu, Wiegert, Oitzl, & Krugers, 2006). While I do see that there may be benefits to me from my approach, I am uncertain if my approach benefits the other members of my team. Perhaps they may learn something from my attempts to recover from a lost questioning or counselling sequence, but this is a tenuous hypothesis to propose in comparison to the benefits I derive from their approach.
Conclusions
The ability to determine which approach works best for learning how to deliver a counselling session is rather dependent on the result and the experience of the assessment itself, and as such, cannot be determined at this point. Upon reflection, I have determined that it is unfair for me to judge my own performance against the performance of my partners given the different approaches that we take, and that I should not be so critical of myself to the point that my confidence begins to be
affected. I believe that by continuing to utilise my approach, by partners’ experience will not be negatively affected; they each will still be able to observe the other’s exemplar performance, and they may be able to obtain something useful from my approach by simple virtue of it being different.
Action Plan
As one of the key conclusions is dependent on the upcoming assessment experience, the formulation of an action plan as per the Gibbs reflective cycle is paramount to this reflection (Gibbs, 1988). Following the assessment, I shall meet with my peers and discuss their experience, giving particular attention to how they felt their counselling triads prepared them for this task. Based on their feedback, we may be able to develop a triad approach which integrates the beneficial elements of each approach, or utilises new observations from the assessment experience, in order to optimise our learning.
References
Gibbs, G. (1988). The Gibbs Reflective Learning Cycle. Learning by doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford
Joëls, M. Pu, Z. Wiegert, O. Oitzl, M. Krugers, H. (2006) Learning under stress: how does it work? Trends in Cognitive Sciences, 10 (4) 152-158. https://doi.org/10.1016/j.tics.2006.02.002
Counselling Mini-reflection
As part of our pharmacy degree, we were required to attend campus and undertake an assessment that involved counselling two patients regarding medications.
While I felt confident about my knowledge, I was certainly apprehensive about how the counselling would go. Just prior to my counselling, I had undertaken a 3 hour compounding assessment in complete silence, and I am aware that my mind does not “shift gears” quickly from the internal monologue that accompanies the meticulous, step-by-step, triple checking process that are required for diligent lab work, to an external conversation with other parties that requires immediate decisions made as to the words that utter forth from my mouth.
During the device assessment, the terbutaline drug initially caused panic, as I was not immediately able to recognize the suffix (-ol, -one/-ide, -ium). By the time I had recalled that my recognition for this drug was based on the start of the name, momentary panic had already caused the loss of my counselling sequence. In an effort to calm myself for the next counselling assessment, I tried to focus on it not being an assessment, but just a conversation. Consequently, while I had a lovely chat, I was not mindful of the time, and ran out of it.
While our triad group focused well on counselling process and content, we never once considered assessing and evaluating the time that our counselling took. While an obvious oversight in hindsight, it had never occurred to us to time ourselves during counselling practice.
While the triads were great practice, they never seem to capture the intensity of an actual assessment. While it is unlikely that we could emulate this pressure, by incorporating a time limit into our triad sessions it may convey a sense of urgency and pressure, in addition to simply being good practice for the timed counselling assessment.
I plan to raise this topic with the team and see if they would like to include a timer into our triad sessions.
Mini reflection following triad session #6
This was the first counselling triad following our assessment at the university intensives. Having 2 weeks of intensives for 4 units had led to a number of quizzes and considerably weighted essays nearing their due date. While I had been quite diligent and written the essay (three times over) before the intensive period, clarification and options regarding the scope of the essay gleaned during the intensive prompted me to want to rewrite for a fourth time.
I felt distracted leading up to the triad, as I had been doing nothing else but the essay for the last few days, and contemplating anything else was difficult. I felt that time spent on the essay was more important compared to triad practice, for which the assessment had already been completed.
I was able to deliver adequate counselling advice despite having to recall information from weeks ago and utilizing a CMI that was hastily brought up for the session.
This was probably not my best effort, but it was a satisfactory effort and covered the majority of the required elements (according to my triad assessment). I wanted it done and out the way so as to return to my other commitments, but still managed to meet my commitments to my triad team and my patient. I do not feel that this scenario is the result of not utilizing prior time well; rather than my prior preparation was undone by new information brought to light.
In a pharmacy environment, there are always going to be tasks and responsibilities that demand my attention, and time must be managed between them. In a busy environment, it is crucial to be able to access information quickly, convey this to a patient concisely, and return to your other commitments, in order to meet professional practice standards in regard to customers, but also pharmacy processes.
I back the decision I made about the amount time I allocated to this triad. I believe that utilization of pharmacy assistants may be crucial in alleviating time constraints on a pharmacist. Adequate training of pharmacy team members will mean that patient information gathering can be reliably and accurately obtained where possible, which may save time when counselling patients, allow for professional service standards to be achieved, and pharmacy practice commitments to still be accomplished.
Mini reflection following triad session #7
As part of our counselling triad session #7, I suggested that we include a timer to give ourselves an idea about the duration that we take to complete our counselling. The team were happy to incorporate the idea into the session.
I felt intrigued about what the timer might reveal about the duration of our counselling, and interested in reflecting on what difference the inclusion of the timer may have had on the counselling assessment.
The timer revealed that the counselling scenarios took only 5 or 6 minutes to complete. Unfortunately, when I went to compare this to the duration of past counselling sessions, I discovered that more than 1 month had elapsed, and I was unable to compare these sessions to previous ones.
Although my observation of the counselling didn’t seem to notice any significant changes in delivery, commentary from the team indicated that they felt these counselling sessions were faster. It may have been that the presence of the timer made the counselling delivery progress quicker, however, without past recordings to compare them to, the truth of the matter was unable to be established.
If I had saved these recordings to my hard drive, this would have allowed a direct comparison of counselling delivery times to be made. Of course, incorporating the timer into our sessions from the beginning is also a different course of action we could have undertaken, had any of us thought of it.
I don’t think any significant action plan will come of this; the lesson to take time into consideration has already been learnt from my counselling assessment, and this exercise was merely an act of curiosity to see the impact that the timer could have.
Mini reflection following triad session #8
The counselling sessions that we undertook underwent significant improvement after the initial session, as we became more familiar with the rubric, however, after demonstrating competency with the process, the sessions were rather consistent and began to lack the opportunity for higher insight or observations to be made. In order to shake things up a bit, (and in the spirit of muck-up day), for the final session I chose to portray a pharmacist with an over-exaggerated rapport with their patient, and looked for opportunities to throw of my pharmacist during my patient roleplay.
Feeling mischievous, feeling fun, feeling happy that this was the last triad session. There have been, and are still, a lot of assessments in front of me, so it has been feeling good as I systematically complete each and can put them behind me. It feels less overwhelming as the list reduces.
The experience was different, and enjoyable for all parties from what I could tell. It did not serve as an exemplary counselling performance.
The attempt to put off the pharmacist could be of benefit in the practice counselling session; it may help them maintain composure in the face of patient’s ofttimes confronting answers. And given that the counselling scenarios for our triad were always an example of what to do, the opportunity to observe a flawed counselling delivery may facilitate learning and reflection by seeing what not to do.
I could have done the same old thing that we had done for the other counselling sessions, but I feel that, given 23 other counselling sessions delivered the same way, there may be some benefit in delivering one differently.
I am not sure that I would perform the pharmacist role in the same manner again, however, challenging the pharmacist’s composure as a patient may contribute a tangible benefit to the counselling session and may be worth contemplating. I must temper this though against distracting the team from their initial learning and mastery of the process.
Assessment 1: Reflection 2
Description
As part of the ongoing development of our pharmacy practice skills, I was required to engage in weekly counselling practice sessions with two other peers. Although we critically appraised our counselling skills with the aid of the marking rubric, no thought was ever given to the time that we took when providing this counselling. As a consequence, during my counselling assessment I did not give any thought to the timer until the first alarm sounded, and was not able to deliver optimal counselling.
Feelings
I did not feel as critical of myself as I usually would when not completing an assessment as well as I had hoped. Nor did I feel critical of my triad group, or feel that we had not practiced our counselling skills well enough. I felt a degree of acceptance of the situation; given that all three team members had overlooked the element of time in our practice triads.
Evaluation
The triad group performed well on elements represented within the rubric and appraised each other’s counselling skills constructively. However, the lack of incorporation of a timed element into our practice triads left me unprepared for how quickly the time went within the assessment.
Analysis
I believe that I did not feel so critical of myself as I was confident in my knowledge base and confident with my questioning and counselling skills. Nor could I feel critical of the triad group as we undertook the tasks well and provided constructive feedback to each other. In hindsight, the timed element of the assessment was an obvious factor to incorporate. The fact that all members of our team missed it, despite our competence, establishes it as an unfortunate oversight, a learning opportunity, and an experience warranting a reflection (Gibbs, 1988). While the argument could be made, since the professional practice standards require diligent collection and analysis of patient information, active engagement of the patient via evidence-based advice, and assessment of the patient’s understanding, that no arbitrary time limit should be set which restricts the achievement of this standard (Pharmaceutical Society of Australia, 2017) . Indeed, time spent engaged with the patient may help to build rapport and trust, whereas the appearance of a rushed counselling may contribute to the perception of the pharmacist as not being patient-centric, and undermine trust in the pharmacist.
However, time constraints are a real element of pharmacy practice, and managing them well is an important skill to develop. There are many patients that may require counselling, and aspiring to provide a comprehensive and exhaustive counselling service to one patient may lead to insufficient time to devote to other patients. This is even before consideration of the other administrative tasks that pharmacists must undertake to ensure the practice remains operationally compliant.
Conclusions
The triad counselling practice groups are established to allow us to practice our counselling skills, which I had taken to consist of information gathering, decision making, and medication and lifestyle advice. However, the assessment experience has emphasised the importance of considerations of time in the counselling process; an element which does not appear on the rubric, yet is integral to the successful practice of pharmacy. Arbitrary time limits are not a suitable approach to counselling; each patient may have different needs to meet, and each pharmacy may have differing workloads to manage. However, this experience has caused me to reflect upon the element of time. Just as prompt information gathering, evaluation, and education is required to achieve the quality use of medicines for one patient, the evaluation and determination of how much time a patient requires will be an important factor for maximising the health outcomes of all patients under my care.
Action Plan
I feel that incorporating a time limit into our counselling triad sessions would be useful in acknowledging the time constraints that often affect pharmacists, however it does not fully emulate the decision-making process that needs to be made within pharmacy practice. The true skills to be learnt involve not just evaluating the time needs of the patient, but the perpetual evaluation of the pharmacy environment, and the optimal utilisation of the team members to ensure that my finite time is utilised to the best of its ability. I plan to develop this skill during my next pharmacy placement opportunity.
References
Gibbs, G. (1988). The Gibbs Reflective Learning Cycle. Learning by doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford
Pharmaceutical Society of Australia (2017) Professional Practice Standards. Retrieved from https://www.psa.org.au/practice-support-industry/professional-practice-standards/