医薬品相互作用研究

Vol.39, No. 1（2015）17（17）

医薬品相互作用研究
一
般論
文
39（1） 17-23 （2015）

Hands-on experiential training of self-monitoring of blood glucose andself-injection of insulin, and its learning eﬀects in
4th year pharmacy students
Kazuhiro WATANABE*, Hirohisa DOI, Masayoshi HIROHARA, Ayako OTA, Miki NAKAMURA,
Kazuki KUSHIDA, Kimihiko TAKADA, Yutaka MASUDA, Jun-ichi KITAJIMA, Akihito TAKANO,
Ryoko CHIBA, Jun TODA, Yukihiko HAGIWARA, Hajime HAMASHIMA, Tomoyuki HAMAMOTO,
Ryuji FUKUMORI, Yoshie HORIGUCHI, Michiko YAMAMOTO, and Kyoji TAGUCHI
Educational and Research Center for Clinical Pharmacy, Showa Pharmaceutical University（Received February 12, 2015; Revised April 7, 2015; Accepted April 22, 2015）

Self-monitoring of blood glucose (SMBG) and self-injection of insulin (SII) are complex and diﬃcult
for diabetes patients. In the education of pharmacists and medical students, it is important to experience these procedures to adequately understand the psychological state of patients. Therefore,
Showa Pharmaceutical University students participated in SMBG and SII experiential training,
followed by a questionnaire survey to evaluate the training. Participants were 4th year students
enrolled in the university in 2013 and 2014. The experiential training was implemented within the
4th year practical training (pre-training) program. Training comprised lectures on diabetes education, as well as SMBG and SII experiential training. According to an analysis of survey results
obtained from 439 students who completed the SMBG and SII experiential training, 96% responded
that they “were able to understand how patients who continually engage in SMBG and SII must feel”.
Additionally, 97% responded that they “were able to understand the need for diabetes patient education through the SMBG and SII hands-on experiential training”. It can therefore be considered that
SMBG and SII experiential training enables students to understand the feelings of diabetes patients
who perform SMBG and SII on a daily basis. The results also suggest that the training enables
students who will go on to become pharmacists to recognize the need for diabetes patient education.
Key Words: Self-monitoring of blood glucose, Self-injection of insulin, Patient education, Pre-training,
Questionnaire survey

Introduction

for Pharmaceutical Education' is for students to

In 2006, the requirements for pharmaceutical“understand and consider the emotional state of theeducation in Japan changed from the former 4-year

patient”, but training or education that incorporates

system to a 6-year system. This 6-yearsuch a goal has not yet been established w ithin

pharmaceutical education system, which focuses on

universities.

pharmaceutical health care, bioethics, andAccording to the results of the 2012 Nat ional

communication studies, uses the 'Model CoreH e a l t h a n d N u t r i t i o n S u r ve y, a b o u t 9 . 5 m i l l i o nCurriculum for Pharmaceutical Education' as a baseindividuals are “strongly suspected to haveand aims to develop pharmacists with good clinicaldiabetes” and there are about 11.0 million

skills by emphasizing medical professional

individuals whose “possibility of having diabetes istraining

1,2). One goal of the 'Model Core Curriculum

undeniable”; thus, a total of 20.5 million people are〒194-8543 東京都町田市東玉川学園3-3165 昭和薬科大学 医療薬学教育研究センター
Educational and Research Center for Clinical Pharmacy, Showa Pharmaceutical University,
Tokyo 194-8543, Japan＊Corresponding author, E-mail: kazunabe@ac.shoyaku.ac.jp (K. Watanabe)3-3165 Higashi-Tamagawagakuen, Machida,18（18）

医薬品相互作用研究

Vol.39, No. 1（2015）

aﬀected by diabetes 3) . In the treatment of diabetes,

Methods

it is important to have many pharmacists involved,

1. Outline of SMBG and SII hands-on

and diabetes is one of the diseases that is listed

experiential training

within category “F. Pharmacy Clinical Education” of

The training strategy is shown in Table 1.

the 'Mo del Core Curriculum for Pharmaceut ical

Training was conducted in groups of 15‒17

Education'. This curriculum, whose revision is tostudents. The procedures were strategicallybegin in 2015, speciﬁcally lists diabetes as aplanned by combining lectures about diabetes,

disease where practical training should be utilized

speciﬁcally, on the pathophysiology of diabetes

in education 4 ) . Among chronic diseases, diabetes

and drug treatment as well as diabetes education,

stands out as one where constant, ongoingwith hands-on training on SMBG and SII withwillpower from the patient and ongoing supportive

students divided further into small groups of 2 orcare from medical staﬀ are important in treatment.

3. The SMBG experiential training was conducted

To support patients, medical staﬀ must consider

ut ilizing the Medi Safe®Mini ( TERUMO, Tokyo,

their emotional condition and understand theJapan) through verbal explanation and throughdiﬃculties that they face, and to foster thisstudents actually using it on themselves. SMBG wasunderstanding, treatment should be experienced

conducted twice, at approximately 1 and 2 hours

through simulation. Experiential training canafter lunch, exposing students to the experience ofprovide an eﬀective method for this.

changes in self-monitored glucose level as well as

Self-monitoring of blood glucose (SMBG) andexperiencing the emotional aspects of SMBG. SII

self-injection of insulin (SII) are diﬃcult andexperiential training with an insulin kit (Flex Pen®,complicated processes, and thus education provided

Novo Nordisk, Tokyo, Japan; commonly used forby doctors, pharmacists, and nurses is an importantthe treatment of diabetes) was conducted throughfactor for patients. Therefore, these processes

verbal explanation and through learning how toshould be experienced hands-on as a student to

use two types of pen needles (Penneedle®30G,

provide education that fosters understanding of the

N I P R O , T o k y o , J a p a n ; N A N O PA S S ® 3 4 G , N o v oemotional status of patients.

Nordisk, Tokyo, Japan) by actually injecting the

There have been reports on the implementation ofneedle into the arm. Both types of needles wereexperiential training on SMBG and SII for theused in the experiential training, because

purposes of diabetes patient education training forPenneedle®30G has a large outer diameter (0.3

medical students. There have also been reports onmm) while NANOPASS®34G ®has a small one (0.18

the implementation of experiential training on dietmm), and they are clinically used in the treatment

for nursing students as well as experiential trainingof diabetes. The students experienced theon pharmaceutical treatments for diabetes.

emotional aspects of SII as well as the pain of

However, no reports have evaluated theself-injecting.

implementat ion of both SMBG and SII hands-on
experiential training for pharmaceuticalstudents

5-10).

2. Questionnaire survey of students regarding
SMBG and SII hands-on experiential training

For this reason, SMBG and SII hands-on

The 4th year students who partook in the 2013

experient ial training was structured w ithin ourand 2014 practical pre-training were given auniversityʼs 4th year practical pre-training

verbal explanat ion of the experient ial training

curriculum. A questionnaire survey was later

contents before giving their written consent to

distributed to students who completed the SMBG

part icipate in the study. Self-administered

and SII hands-on experiential training with the aim

questionnaire surveys were given to the studentsof evaluating the training and clarifying studentsʼ

after completing the experiential training.

learning process throughout the SMBG and SII
hands-on experiential training course.

The questionnaire comprised 6 items in relation
to the studentsʼ realizations obtained through the
SMBG training, 6 items in relation to the studentsʼ
realizations obtained through the SII experiential

医薬品相互作用研究

Learning

Time

Strategy

(min)

1

15

Vol.39, No. 1（2015）19（19）

Specific Behavioral Objects (SBOs)
Overall Explanation
Informed Consent
Experiential Training 1-1

2

40

SMBG Explanation, demonstration of procedure
SMBG Experience, first time (Within 1 hour after lunch)

3

35

4

20

Lecture (1) “Pathophysiology of Diabetes and Drug Treatment“
Experiential Training 1-2
SMBG Experience, second time (Within 2 hours after lunch)
Experiential Training (2)520

Self-Injection with Pen Needle, explanation demonstration
Self-Injection with Pen Needle, experience

6

35

7

45

Lecture (2) “Diabetes Patient Education”
Summary
Reporting, Questionnaire Survey
Table 1. SMBG and self-injection of insulin hands-on experiential training

training (including hands-on experience ofstudy would not aﬀect their grades, and that while

self-injecting the pen needle), and 4 items in

the questionnaire contents may be made public forrelation to what students gained through thethe study, their anonymity would be maintained.

experiential training (overall evaluation). Thus, a
total of 16 questions were asked. The responses to

Results

each quest ion were scored on a 5-point Likert

1. Implementation of SMBG and SII hands-on

s c a l e , c o m p r i s i n g “ S t r o n g l y a g r e e ” , “A g r e e ” ,experiential training“Neither”, “Disagree”, and “Strongly disagree”. To

The SMBG and SII hands-on experiential training

capture possible trends by subject attribute, the(including self-injection with the pen needle) wasq u e s t i o n n a i r e a l s o a s k e d a b o u t t h e s t u d e n t sʼimplemented as per the experiential training

current year in school, gender, and future

strategy shown in Table 1 for both sessions (Fig. 1,

prospects after graduation.

2). A total of 433 students, comprising 238 andData analysis and descript ive stat ist ics were

1 9 5 s t u d e n t s i n 2 0 1 3 a n d 2 0 1 4 , r e s p e c t i ve l y,

conducted via Microsoft Oﬃce® Excel 2013

participated in the “practical pre-training” course(Microsoft).

in the second half of their 4th year term. Of thosestudents, a total of 424 students (98%), 234

3. Ethical considerations

students and 190 students in 2013 and 2014,

The present study was conducted following

respectively, were able to participate in the SMBG

approval from the Showa Pharmaceuticalexperiential training and the SII hands-on

University Research Ethics Committee (approval

experiential training. Those who were unable tonumber H25-9, H26-12). Additionally, eﬀorts wereparticipate in the training experience (9 students,

taken not to compel the students to participate.

2%) were able to observe the training experience ofStudents were assured verbally and in writing that

their classmates.

whether they consented to or opted out of the20（20）

医薬品相互作用研究

Fig. 1 Students during SMBG experiential training

Vol.39, No. 1（2015）

Fig. 2 Students during experiential training of self-injection with pen needle

2. Results of questionnaire survey distributed

Fig. 3 shows the results for the questions into students regarding SMBG and SII

regards to studentsʼ realizations acquired throughhands-on experiential training

the SMBG experiential training. For the following 4
items, 80% or more of the responses were2-1. Subjects
In total, 424 questionnaire subjects comprising“ S t r o n g l y a g r e e” o r “Ag r e e” : “ I w a s a b l e t o

259 women (61%) and 165 men (39%) completed

understand the need for SMBG" (96%), “I was able

the SMBG and SII hands-on experiential training.

to retain the procedures and methods of SMBG”

First-choice future prospects were as follows: 24%(97%), “I was able to understand how patients who

were hoping to work for a hospital pharmacy (102continuously engage in SMBG must feel” (96%),

people), 20% for a dispensary or drugstore (85and “I am able to teach SMBG education（84%）.

people), 8% for a pharmaceut ical company (33The question with the lowest percentage of

people), 3% “other” (11 people), and 45%“ S t r o n g l y a g r e e” o r “A g r e e” r e s p o n s e s w a s “ I“undecided” or did not give an answer (193

thought the injection hurt more than I thought itpeople).

would” (45%).
In addit ion, an analysis of the data strat iﬁed

2-2. Studentsʼ realizations acquired through
SMBG experiential training

according to students in 2013 and 2014 found no
signiﬁcant diﬀerences between the two groups.

Fig. 3 Studentsʼ realizations acquired through SMBG experiential training (n=424)

医薬品相互作用研究

2-3. Studentsʼ realizations acquired through SII
hands-on experience

Vol.39, No. 1（2015）21（21）(94%), “I was able to retain the procedures andmethods of self-injection” (95%), and “I was able toFig. 4 shows the results to the questions inunderstand how patients who continuously engage

regards to studentsʼ realizations acquired throughin SII must feel.” (96%). The quest ion w ith thethe SII hands-on experiential training (including

lowest percentage of “Strongly agree” or “Agree”

self-injection of the pen needle). For the following

responses was “SII hurt more than I thought it

4 items, 80% or more of the answers werewould.” (64%).

“Strongly agree” or “Agree”: “I felt anxiety, fear, andIn addit ion, an analysis of the data strat iﬁed

nervousness prior to this training” (81%), “I was

according to students in 2013 and 2014 found noable to understand the need for self-inject ion”

signiﬁcant diﬀerences between the two groups.

Fig. 4 Studentsʼ realizations acquired through SII experiential training (n=424)

2-4. What students gained from SMBG-SII
experiential training (overall evaluation)r e s p o n s e s w e r e “ S t r o n g l y a g r e e ” o r “A g r e e ”(median: 94%, range: 83‒97%).

Fig. 5 shows the results in regards to what theIn addit ion, an analysis of the data strat iﬁed

students g ained from the experient ial training

according to students in 2013 and 2014 found no

overall. For all 4 items, 80% or more of thesigniﬁcant diﬀerences between the two groups.

Fig. 5 Studentsʼ realizations acquired from the experiential training and overall evaluation (n=424)

22（22）

医薬品相互作用研究

Discussion

Vol.39, No. 1（2015）

process of the students, starting from their

In the present study, we implemented the SMBG

emotions before experiential training, skill

and SII hands-on experiential training within theretention through experiential training, anduniversityʼs practical pre-training program for 4th

emotions after experiential training. The survey

year students with the aim of uncovering therevealed that, the students had anxiety, fear, andlearning eﬀects of the training. Questionnaire

nervousness in regards to the SMBG and SII

surveys were distributed to students who

hands-on experience, but once they implemented

completed the experiential training. Several

the SMBG and SII procedures in their experiential

ﬁndings were obtained from the results.

training, they did not feel as much pain as they
thought they would. Addit ionally, from the

1. Implementation of SMBG and SII hands-on

experiential training, they were able to acquire theexperiential training

procedures and methods of SMBG and SII

The results in Fig. 5 indicate that the experiential

hands-on, understand the patientsʼ feelings,

training was suitable in respect to diﬃculty, ability

recognize the need for these procedures, andto facilitate understanding of diabetes pat ientrealize that they are capable of teaching the SMBG

education, fostering increased interest, and overall

and SII procedures. These results and thestudent satisfaction. This suggests that the value ofquestionnaire answers regarding studentsʼ overall

the program, including the planning of theevaluation of the program (Fig. 5) suggest that thetraining, time allocation, grouping, and program

evaluation of the program was quite high. Similar

content, is high. However, 9 students (2%) were

results were produced in a study by Kawai et al. 6)

unable to carry out self-inject ion, likely due toin their study of SMBG and SII experiential training

anxiety or other negative feelings regarding thein nursing students. This suggests that the value ofpro cedure. A few of the students who were not

SMBG and SII experiential training is not speciﬁcable to participate in the training indicated thatto nursing students but also applies to pharmacy

they were “able to better understand thestudents. It is important for students to obtain

diﬃculties of diabetes patients who perform SMBG

needed knowledge regarding SMBG and SII, and be

and SII every day, from the experience of not being

able to realistically imagine diabetes patientable to do it themselves”. They also indicated that

education through experiencing the procedures“if given the chance, they would like to attempt thethemselves.

SMBG and SII pro cedure ag ain”. From these

The present study is limited in that it included

positive remarks we would like to believe that even

only a single universityʼs students as subjects in its

for those who were unable to experience theevaluation of SMBG and SII hands-on experientialtraining, the training experience was one thattraining. Thus, when considering the diﬀerences inincreased their consciousness of diabetes patient

program implementation theories foreducation. Furthermore, when they become

pharmaceutical practical pre-training programs at

pharmacists in the future, we hope that theseother educational institutions, there is a limit tostudents will revisit the SMBG and SII hands-on

which the present ﬁndings can be generalized.

experience and enthusiastically take part in

Additionally, because we conducted only simple

diabetes patient education.

descriptive statistics when analyzing andevaluating the questionnaire surveys, there is a

2. Questionnaire survey results of students inlimitation to generalizing the interpretation of theregards to SMBG and SII hands-on

results. However, despite these limitat ions, we

experiential training

could conclude that the training enabled students

First, we will consider the studentsʼ realizations

seeking to become pharmacists in the future toin regards to the SMBG and SII hands-on

recognize the need for diabetes patient education.

experiential training, which are shown in Fig. 3

Students were able to recognize this need by

and Fig. 4, respectively. All 6 question items inunderstanding patientsʼ feelings of having to carryboth questionnaires aimed to capture the learningout a self-invasive treatment, such as SMBG or SII,

医薬品相互作用研究

on a daily basis by taking part in SMBG and SII

Vol.39, No. 1（2015）23（23）

８）Seki M, Ueda C, Takemura S：The analysis ofhands-on experiential training. Our ﬁndings cancontent about patient teaching by students inpossibly become basic data for other educational

simulative nursing practice：From the content

institutions when implementing SMBG and SII

that students wrote about insulin injection

hands-on experiential training within aself-care、Journal of Japan Academy of Nursing

pharmaceutical practical pre-training program.

Education, 11, 35-43, 2002．
９）Suemaru K、Yamashita R、Takeichi K、Acknowledgement
We would like to express our deepest

Yamaguchi T、Kohei Y、Okamoto C、Ikazaki S、
Ido K、Tanaka M、Miyoshi Y、Moriguchi T、

appreciation and gratitude to the 4th year students

Ikegawa Y、Araki H：Evalution ofof Showa Pharmaceutical University (Class of 2013

experience-oriented hospital practical training

and Class of 2014) who participated in thefor fourth-year undergraduate students、Jpn．J．

evaluation of this training.

Pharm．Health Care Sci．, 32, 139-145, 2006．
10）Kikuchi C、Hori E、Maeda T、Matsunaga T、Conﬂict of interest
The authors declare that they have no conﬂict ofinterest.

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