Physical Exams Becoming More Vital to Pharmacy Students

When Touro College of Pharmacy (TCOP) student Marilyn Flores and her classmates learned they were required to enroll in a class titled 'Physical Assessment' in their second year, they initially questioned why they had to take the course.¹

Even though Flores is in pharmacy school, the image of pharmacists working furiously behind the counter sorting pills and putting them into bottles had stuck with her, she said in an interview with a college publication. However, today's pharmacy customers often have their blood pressure or heart rate checked, receive flu shots, or consult with a pharmacist about symptoms.¹

TCOP is not the only school or organization tackling physical assessments, however. Attendees at the 2019 ASHP Summer Meeting explored best practices for physical assessments as well.

"Really, our hands are the best tools that we'll use to be able to detect temperature, and to be able to detect is it soft? Is it hard? Detecting shape, consistency—all of those things through palpation," said presenter Melanie A. Dodd, PharmD, BCPS, FASHP during the session.

Pharmacy is becoming increasingly hands-on with patients, and physical assessments are a vital piece of the puzzle.

"The image I had, it's not like that anymore," said Flores.¹ "Now we have pharmacists who are an essential part of the medical team, and if they can perform these tasks it adds more value and recognition to our profession."

Shifting Away from the 'Dispensing' Model

The physical assessment course is a hands-on class that teaches, through lectures and labs, basic exam techniques used in outpatient clinics, and in retail and acute care settings. Faculty from both TCOP and the Touro College of Osteopathic Medicine lecture on a wide range of topics, including: how to take patient histories; administering infusions; examining hair, nails, and skin for the possibility of cancer; mastering GI and self-exam techniques; and performing neurological, psychiatric, pulmonary, cardiovascular, pediatric, and geriatric assessments.¹

In an interview with Pharmacy Times, Henry Cohen, PharmD, MSc, Dean of the Touro College of Pharmacy, said the evolving role of pharmacists has made it more vital than ever that they have the ability to perform physical exams.

"The role of a pharmacist as a clinician is here," Cohen said.

This change, however, is not merely a trend, said Cohen. It is a change that's here to stay, and courses like the physical assessments course are preparing students for that new reality.

As pharmacists advocate for provider status, it becomes increasingly important for pharmacists to expand their role in patient outcomes. Should those advocates be successful, the inability to perform physical assessments would limit their capacity to document and bill for services.²

Assistant professor and course director Andrew Smith, PharmD acknowledged that the class doesn't cover nearly everything involved in performing exams, and that not all students will end up using all of the skills they learn, since they will be working in a range of settings. Pharmacists in critical care and emergency medicine, Smith's specialty, are called upon to do even more exams, and more complicated ones, than are taught in his basic course.¹

Still, he said, it's an invaluable skill for pharmacists, especially since they are the most frequently seen medical professional. Thus, can catch problems sooner than other medical providers. He added that many states have already implemented programs allowing patients to see pharmacists for management of chronic conditions like diabetes.¹

"We've seen better outcomes with patients that were managed by a pharmacist, than with patients that see a doctor once every 6 months or every year," Smith said.¹

Flores, now a fourth-year student aiming to pursue a postgraduate residency in emergency medicine, told Pharmacy Times she enjoyed the more hands-on experience. While she understands how traditional industry paths may not utilize the skills as often, Flores said clinical positions have many opportunities to educate patients and their families.

Resources

• Touro College of Pharmacy. Let's Get Physical: As Pharmacy Practice Evolves, Students Learn to do Physical Exams. 2019 Dean's Update. https://issuu.com/touro3/docs/touro_college_of_pharmacy_deans_upd. Published July 24, 2019. Accessed August 28, 2019.
• Turingan EM, Bates JS, AMerine LB. Integration of physical assessment into pharmacy practice. American Journal of Health-System Pharmacy. 2018;75(4):169-170.