Exploring transformative learning for trainee pharmacists through interprofessional simulation: a constructivist interview study

Abstract

Background The expanding roles of UK pharmacists have prompted substantial changes to the initial pharmacy education and training, including increasing recognition of the value of learning alongside other professional groups in acute settings. Interprofessional immersive simulation training appears to represent a useful educational tool to meet the evolving needs of the profession, but the impact of such training on workplace behaviour and relationships has not been explored. This study aimed to explore how interprofessional simulation training facilitates transformative learning in pre-registration pharmacists. Methods Across three different locations in Scotland, pre-registration pharmacists were paired with medical students to participate in immersive simulation scenarios with post-scenario debriefs. Pre-registration pharmacists were individually interviewed shortly after their simulation session, using a semi-structured interview schedule based on the transformative learning framework. Transcripts were analysed using template analysis, with Mezirow’s phases of perspective transformation forming the initial coding template. Results Fifteen interviews following five simulation sessions at three different sites were undertaken. Phases 1–6 of the transformative learning framework all resonated with the pre-registration pharmacists to varying degrees. Two prominent threads became evident in the data: a change in participants’ perceptions of risk, and deepened understanding of their role within an acute context. These themes were woven throughout phases 2–6 of the transformative learning framework. Conclusions Interprofessional immersive simulation training involving acute clinical scenarios has been found to be helpful for pre-registration pharmacists and can foster transformative learning. Through this powerful process, they developed new ways to see the world, themselves and their professional relationships. Positive future actions and roles were planned. As the patient-facing roles of pharmacists expand, educational practices that translate into meaningful change to workplace behaviour and relationships become increasingly important. Carefully constructed interprofessional immersive simulation training should be utilised within pharmacy education more widely.

A conceptual validation of transformative learning theory

“…However, over the last 20 years, it has become an interdisciplinary lens through which adult learning (i.e., change in beliefs and behavior) can be conceptualized across various disciplines and situations (Taylor and Snyder 2012). Along with extensive practical applications, research on transformative learning has grown significantly in the 30 years in adult education (e.g., Brendel and Cornett‐Murtada 2018; Gawlicz 2022), medicine or public health (e.g., Kerins et al 2020; Tallentire et al 2021; Vipler et al 2021), and general research (Hoggan and Kloubert 2020, Schnepfleitner and Ferreira 2021; Schnitzler 2020) just to mention a few. Most of the research has been qualitative in nature, and few studies have attempted to measure transformative learning, which has limited researchers’ ability to generalize transformative learning theory beyond narrow descriptive accounts and to establish the effectiveness of interventions focused on fostering change.…”

When I say… transformative learning

“…5 Nevertheless, we have ample qualitative evidence demonstrating that transformative learning is occurring for our learners in clinical and extracurricular settings. 3,11,14,16,18 Many of these studies identify how the educator can tie learner experiences to various Transformative Learning Theory…”

“…Merriam and Baumgartner astutely point out that as of 2020, we do not have any empirical evidence comparing Transformative Learning Theory with other educational theories 5 . Nevertheless, we have ample qualitative evidence demonstrating that transformative learning is occurring for our learners in clinical and extracurricular settings 3,11,14,16,18 . Many of these studies identify how the educator can tie learner experiences to various Transformative Learning Theory steps, in order to move the learner to the next stage.…”

“…These venues may take the form of Balint groups, one-on-one remediation sessions, focus groups, 10 debriefing after simulation 3,14 and guided reflection on the humanities (e.g., art, literature, film). 10 Scenarios that foster transformative learning in interprofessional settings may be even more impactful, 14 as 'transformative learning' and 'interdependence in education' were identified as two interconnected pillars that will ultimately lead to equity in health. 17 Merriam and Baumgartner astutely point out that as of 2020, we do not have any empirical evidence comparing Learning Theory with other educational theories.…”

“…The coach can help create such venues, ask good questions of the learners, encouraging introspection and self‐growth. These venues may take the form of Balint groups, one‐on‐one remediation sessions, focus groups, 10 debriefing after simulation 3,14 and guided reflection on the humanities (e.g., art, literature, film) 10 . Scenarios that foster transformative learning in interprofessional settings may be even more impactful, 14 as ‘transformative learning’ and ‘interdependence in education’ were identified as two interconnected pillars that will ultimately lead to equity in health 17 …”