This article first appeared in PittPharmacy, Spring 2014, and is the first in a multi-part series about PittPharmacy innovations in teaching.

The air is bitter cold and the light is dim in the morning as Deanne Hall, (BS ’96, PharmD ’98), enters the physician office building where she sees patients. Warming up as she reviews her list of patient appointments for the day, she sees that her first patient is a new referral. She notes that the physician has requested a thorough review of medications in a patient with cardiovascular disease who has hyperlipidemia and hypertension complicated by newly diagnosed atrial fibrillation. Warfarin therapy is to be started.

This is a real scenario for Deanne Hall, associate professor of pharmacy and therapeutics. She is an expert in managing patients with these diseases and problems. She has been doing this work since 1999 after graduating with her PharmD from Pitt in 1998 and completion of a Pharmacy Practice Residency at the Veterans Affairs Medical Center in Phoenix, Arizona. In addition to her technical and extensive pharmacology and disease-state knowledge, she is a therapeutic decision-maker who instates drug therapy, changes doses, discontinues unnecessary medications, and orders laboratory tests under a collaborative practice agreement. She listens to patients, often uncovering information about medications that patients may not have shared with other health professionals. She empowers patients to take charge of their own health.

So how do we prepare our student pharmacists today to become experts like Deanne Hall through our PharmD curriculum?

“Our goals are to personalize education and to facilitate getting to expert faster.” according to Randall Smith, senior associate dean.

We seek to graduate students who are decision makers and leaders—students who will work with healthcare teams, become entrepreneurs and business leaders, develop the next pharmacy practice model, and make important discoveries and lead research groups.

Our strategies are to immerse students in experiences that develop problem identification and decision making. And we provide substantial opportunities for personalizing education. The students’ learning experiences are rooted in complex problem solving, team work, and self-knowledge.


From the very beginning of the P1 year, students actively engage in patient care experiences. Their first exposures are simple problems in standardized patients. Over time, students are gradually required to integrate information from multiple sources and make decisions about complex problems where the answers are not necessarily black and white. Philip Empey, assistant professor of pharmacy and therapeutics, remarks, “In a traditional testing situation, answers are fixed as right or wrong. In real life, situations are often more complicated and professionals are expected to address complex problems. By changing our model of learning and assessment, we getting to that stage earlier and develop higher performing professionals.”

In the school’s standardized patient program, which is one form of simulation, trained actors portray specific symptoms, personality traits, and behaviors, while students master the art of patient interaction, clinical inquiry, and critical thinking in an environment where mistakes cost little but significant knowledge is gained.

By second semester of the P1 year, students meet real patients through the SilverScripts™ program. Students go into the community to interview patients at senior centers, review their medications, and hear their questions. Over the next two weeks, they develop answers to those questions, review them witha preceptor, and provide answers directly to the patients on their next visit. After the first experience a decade ago, the seniors and the staff of the centers asked for more. Melissa Somma McGivney (PharmD ’98), assistant dean for community partnerships, is one of the originators of the program and remarks that “The experience makes our students mature quickly and gain confidence as professionals. Students have their first interaction with a real patient wearing their newly acquired white coats. They feel empowered and responsible for the patient. In one giant step, we move from just talking with actors to talking with real patients who have real medication questions.”

The experience has been mutually beneficial for students and seniors. Today, each student returns to visit their patient the next fall (P2 year), and then transfers the responsibility for the specific patient to a P1 student the following spring. To further integrate SilverScripts™ in a longitudinal fashion, we engage P4 students in a layered educational approach where the P4 students learn to mentor P1 students under the oversight of licensed pharmacy faculty members and residents.

Student experiences with patients continues to expand with real patients when, in the spring of the P2 year, they interact with a minimum of 35 patients at community pharmacies during required community practice experiences.


As they learn disease states and therapeutics, they hone clinical decision-making skills through simulated experiences, which have been integrated throughout the PharmD curriculum. “Simulation enables students to grow their problem solving, communication, and collaboration skills, the most crucial tools at any pharmacist’s disposal. Interactive computer-delivered cases, standardized patients, and high fidelity human simulators (mannequins) allow learning in a safe environment where students can learn by trial and error,” says Neal Benedict, assistant professor of pharmacy and therapeutics, a national leader on the use of simulation in student learning.

Benedict is an early innovator of VpSim™, a software system of virtual patient cases that is an interactive version of case-based, self-paced learning. The cases in VpSim are used to supplement lectures, are used in practicum sessions, and are sometimes a primary method of instruction to stimulate classroom discussion. A great advantage to these cases is that students receive immediate feedback—a technique known to enhance learning and motivation.

Our goal of getting to expert faster seems to accelerate when students make drug and dosage decisions using a high-fidelity human simulator that gives immediate feedback through sophisticated computerized responses. Principles of pharmacology are reinforced when students witness the mannequin’s EKG rhythm change, hear changes in breathing, or develop a seizure as effects or side effects of drugs. The impact of the mannequin’s responses is so realistic that students have been known to faint at the sight of blood, or at the sound of agonal breathing. Through these mannequins, students practice giving their first immunizations, taking their first blood pressures, and performing cardiopulmonary resuscitation all on mannequins.

These realistic scenarios allow students abundant opportunities to make clinical decisions and most importantly, build a sense of responsibility for each patient’s care. Benedict illuminates, “Simulation makes students aware that patients are their responsibility and gives them experience clinical decision making. Simulation prepares them for the responsibilities they will face as licensed pharmacy professionals.”

Student pharmacists apply all of their previous learning and experience to patient care in their Advanced pharmacy practice experiences (APPEs) in the fourth year.

Sandra Kwarteng, P4 student on APPE rotation with Dr. Hall, is just finishing up her review of her last patient of the day when Dr. Hall stops by to go over Sandra’s recommendations and approach to the patient’s problems. Sandra and Dr. Hall have a short discussion and then go to meet the patient. Afterwards, they debrief how the patient visit went and the problems Sandra helped solve for the patient. Sandra, in her last week of rotation, has seen many patients and is feeling confident in her patient care skills. As the day’s end, as they leave the clinic to go to journal club, Dr. Hall confirms Sandra is progressing well on her journey to “expert”.

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