Teaching innovation: enhancing undergraduate student pharmacist consultation skills by introducing ‘Fishbowl’ prescribing workshops
Authors: Roberts K , Evans A , Westley E 
Published: November 2024

Abstract

Introduction
The new ‘Standards for the initial education and training of pharmacists’1 outline the skills, knowledge, and attributes required to enable pharmacists to independently prescribe at the point of registration. Third-year MPharm students at the University of Nottingham have previously practised consultation skills in professional practice workshops, conducting shorter form, over the counter-type consultations. These lacked the depth required for pharmacy students to develop skills they will now need. Therefore, we identified a requirement for advanced consultation practice, including prescribing, alongside clinical history taking, to better prepare students to be prescribers.
Creation of a new module occurred, ‘Pharmaceutical Care and Prescribing’, including ‘Fishbowl’ workshops. ‘Fishbowl’ is a small group teaching method where an individual student engages in a discussion, while observers form a circle around them2. Students were able to ‘tap out’ of consultations at any point, to discuss consultation direction with their peers. Five case studies were written to incorporate a variety of clinical conditions, patient demographics and clinical settings, with a key emphasis of holistic, patient-centred care. All third-year students were timetabled for five workshops, in groups of around 25. Facilitators regularly discussed consultation progress, outstanding care issues and gave feedback on areas done well or needing improvement.

Aim
Do students perceive ‘Fishbowl’ workshops to enhance their clinical history taking skills and prescribing knowledge?

Methods
Following the five workshops, all third-year students (n=256) were invited via email to complete a Microsoft Forms questionnaire, to evaluate the workshop aims . The questionnaire included ten 5-point Likert-scale questions and free-text answers. Primarily quantitative methods were used with free-text responses used to contextualise results.
This study obtained ethical approval from the University of Nottingham, School of Pharmacy Postgraduate Research Projects Ethical Approval group.

Results
82 students (32%) completed the questionnaire.
91% of students felt they helped practice taking a clinical history. 80% of students felt they better understood how to include share care decision making into their consultations. One student commented, they were ‘very thought-provoking sessions and easy to interact and learn from each other’. 67% said the sessions helped them to better understand the pharmacist’s role in prescribing. With regards to prescribing awareness, a student commented ‘It would have been nice to have scenarios where we prescribed a POM in the end for more of the sessions to help us get used to thinking like prescribers.’
85% of students would recommend the teaching technique to other MPharm students, 76% felt these sessions should be introduced in earlier years of the MPharm course.
A few students commented that the facilitation style varied considerably depending on academics involved.

Discussion/Conclusion
‘Fishbowl’ method of teaching provides a suitable environment for practising clinical history taking and prescribing and were generally well received by students. Further work is needed to integrate this teaching technique earlier in the MPharm programme.
Facilitator skills play a significant part in student engagement, we need to ensure there is appropriate staff training to run this session type.
Limitations of the study include lack of comparison against other student teaching tools.

References
1. General Pharmaceutical Council. Standards for the initial education and training of pharmacists. 2021
2. Sutherland, R., Reid, K., Kok, D. and Collins, M. (2012), Teaching a fishbowl tutorial: sink or swim?. The Clinical Teacher, 9: 80-84.