Impact Of Low-cost Capstone Simulations On Student Knowledge And Confidence In Managing Cardiovascular Diseases

• By: VYAS, Deepti (University of the Pacific, United States)
• Co-author(s): Dr Deepti Vyas (University of the Pacific, Stockton, United States)
  Dr. Sara Mahmoud (University of the Pacific, Stockton, United States)
  Dr. Jahnavi Yalamanchili (University of the Pacific, Stockton, United States)
  Dr. Caroline Ko (University of the Pacific, Stockton, United States)
  Dr. Vista Khosraviani (University of the Pacific, Stockton, United States)
  Dr Marcus Ravnan (University of the Pacific, Stockton, United States)
  Dr Jessica Song (University of the Pacific, Stockton, United States)
  Ms Jasmin Prasad (University of the Pacific, Stockton, United States)
  Ms Vicky Phung (University of the Pacific, Stockton, United States)
  Ms Thao Pham (University of the Pacific, Stockton, United States)
  
• Abstract:

  Introduction: Therapeutics courses provide foundational knowledge regarding disease management. Simulations can be a powerful tool for training students how to identify, assess, and treat disease. Additionally, they can illustrate disease progression. The objective of this study was to assess the impact of capstone simulations on student knowledge and self-confidence in managing cardiovascular diseases.
  Methods: Second-year pharmacy students enrolled in a Cardiovascular Therapeutics course were eligible for this study. All course content was taught by week 12 of the 14-week trimester and assessed on one of three multiple-choice exams administered on ExamSoft. The subsequent 2 weeks were utilized for timed and graded in-class capstone simulations. Three video games were created in Twine and hosted in itch.io, depicting: 1.) ischemic stroke, 2.) heart failure (HF), and 3.) venous thromboembolism (VTE). Twine was chosen as it is an open-source software product which can be used for the development of interactive and nonlinear stories. The videogames were hosted on itch.io, which is a free website that allows users to host videogames on their platform. Finally, a high-fidelity mannequin depicted HF and atrial fibrillation. Each patient also had additional past medical history such as hypertension, hyperlipidemia, and coronary artery disease. Instructors led a debrief after each simulation. At the end of the course, a multiple-choice final exam was administered. Exam questions were categorized by disease and performance on exam I, II or III was compared to the final. A mixed-methods approach was used to assess self-confidence. All students completed a pre/post self-confidence survey on a Likert scale of 1-5 with 1= not at all confident and 5= very confident. Fifteen students also participated in pre-/post-simulation focus groups. Focus group statements were coded by independent analysts and a thematic analysis was performed. A paired t-test was used to analyze the confidence surveys.
  Results: A total of 486 students participated in this study. Significant improvements were observed in confidence levels for managing all diseases covered in the simulations. Exam scores improved for questions related to HF (52.9% versus 66.5%), stroke (61.9% versus 71.5%) but not VTE (72.9% versus 71%). Post-simulation focus groups (34 statements) revealed increased confidence in assessing disease states, creating tailored therapeutic plans, and improved advanced pharmacy practice experience (APPE) readiness. However, students mentioned that the timed aspect of the simulations caused added stress.
  Conclusion: Low cost capstone simulations were successful in improving student confidence and exam performance.