In order to address public health needs, many of today’s health professions students are learning new skills that prepare them to improve access to primary health care, narrow health disparities, and advance prevention efforts in a collaborative manner. Pharmacists’ accessibility and comprehensive training make them well positioned to address some of these unmet health care needs within their communities. As pharmacists continue to transition into more direct patient care roles and in the provision of public health care, patient assessment will become part of their everyday practice, in a similar manner that it has been for doctors and nurses. In fact, there are many functions of public health that can benefit from pharmacists’ unique pharmacotherapy knowledge and expertise including chronic disease management, health promotion and preventative care such as, immunization, risk factor management, and lifestyle counseling [1] [2] [3] . As such, pharmacists are now expected to perform physical examinations (PEs), utilize point-of-care (POC) laboratory devices for health/disease screening (HDS), order and interpret laboratory tests to justify indication or appropriateness of medication use, to monitor for efficacy and tolerability of drug therapy, or to refer patients for further assessment when indicated [4] [5] [6] [7] [8] .

The College of Pharmacy (CPH) at Qatar University (QU) offers a Canadian-accre- dited bachelor of science in pharmacy program. Current accreditation guidelines in North America require that the curriculum of first professional degrees in pharmacy includes instruction on patient assessment. The Association of Faculties of Pharmacy of Canada (AFPC) educational outcomes for Canadian-accredited pharmacy programs stipulate that graduates must be able to perform PE and HDS [9] . To ensure pharmacy students receive instruction in such skills, the Accreditation Council for Pharmacy Education (ACPE) standards require that curriculums include a patient assessment laboratory addressing PE techniques [10] . Also, the educational outcomes of the 2013 American Association of Colleges of Pharmacy (AACP) Center for the Advancement of Pharmaceutical Education (CAPE) call for students to be able to perform and evaluate aspects of patient physical assessment [11] . In a recent survey of colleges of pharmacy in the United States (US) published in 2014, 93 percent of colleges surveyed indicated that PE skills are taught within their respective curriculum [12] .

In this article, we intend to describe and compare the PE and HDS assessment learning delivered in undergraduate curricula across disciplines involved in the provision of public health care (medicine, nursing, and pharmacy) in Qatar. The aim is to explore course content and the pedagogies utilized, as well as to describe commonalities and differences in the health assessment curricula among these three disciplines. In addition, the students’ perceived training in a variety of health assessments will be explored to help educators identify potential curricular gaps that may need addressing. We used the term “health assessment” to simplify the text and include educational activities related to PE and HDS assessments.

In the current study, we reviewed the health assessment curricula across three different professional degree programs, allowing content, teaching approaches and summative assessment activities to be compared. Then, we used information derived from a student survey to assess the students’ perceived training on a variety of health assessments in an attempt to understand if any findings could be the result of differences in the curricula or the pedagogy used in the three professional programs.

Most similarities were observed within the pharmacy and nursing curricula. Both programs offer courses specific to health assessment which are integrated with other relevant courses that are delivered simultaneously. A difference however was noted in the timing of the delivery of health assessment content; which for pharmacy students is in their second year and for nursing students it is in their first year. The health assessment

curricula in the medical program is quite different as health assessment is not taught specifically in one particular course or a sequence of courses, rather health assessment teaching and learning is embedded throughout the entire four years of the medical program.

The findings of the students’ survey also served to highlight additional differences in the health assessment curricula among the three health disciplines, particularly in where the content is delivered. Pharmacy students indicated that they received most of their health assessment training on campus, either in the classroom or in a laboratory (simulated) setting, compared to nursing and medical students who reported their health assessment training was during clinical placements and through problem-based learning (PBL). These similarities can be the result of the synergy between the scope of practice of doctors and nurses [15] . Clinical placements are different for pharmacy students, as their clerkships include dispensing components that do not provide complementary learning to further develop health assessment skills.

Despite these differences, an important similarity in the pedagogical approaches used for delivering health assessment curricula was observed. In all disciplines, health assessment is taught utilizing a system-based approach and is integrated with other relevant courses (such as pharmacology in the nursing program, laboratory data and pathophysiology in the pharmacy program, and the examination of heart and lungs in the Cardiovascular and Respiratory organ systems units respectively, in the medicine program). The three degree programs build their students’ knowledge-based competencies through lectures and required readings. With the exception of the medicine program in which students build on their health assessment skills from direct patient contact through early practical experiences, building skill-based competencies in the pharmacy and nursing programs rely on the use of laboratories appropriately equipped for PEs, using simulated patients, mannequins, and simulation equipment. The pharmacy program utilizes a variety of health professionals for delivering the health assessment course, including a doctor, pharmacist and ad-hoc nursing instructors. A study by Awaisu et al. indicated that students were satisfied with this collaborative instructional methodology and that this approach might improve student knowledge and ability. In this study students indicated gaining above average to excellent PE skills and understanding of the importance of learning these skills when the course was taught by physician-pharmacist collaboration compared to physician alone (75% vs 42% and 83% vs 50%, respectively) [16] . Another observed similarity is the aspect of student evaluations (mainly practical tests including OSCE) at the three colleges. Additionally, the topics included in patient assessment course in the pharmacy curricula are very similar to those covered in pharmacy programs in the US [17] .

Although some students perceived having received limited training in certain health assessments, these findings must be interpreted with caution. For example, only a small proportion of medical students indicated to have received training in BMD measurement, INR, blood cholesterol and urine glucose testing. Considering that in medical school the health assessment curricula is mostly delivered through PBL tutorials and largely during clinical placements, it is possible that these findings are rather an indication that these health assessments are outside the medical students’ scope of training during their clinical placements. Similar findings have been illustrated in other studies comparing curricula among health-related degree programs [18] .

Pharmacy students reported limited training in some health assessments during clinical placements (e.g., heart sounds, waist circumference measurement and urine glucose testing), again probably because currently these are not an everyday practice for pharmacists. Health assessment training during experiential education is an area that needs to be addressed in the pharmacy curricula, particularly for health assessments that are considered vital when monitoring pharmacotherapy outcomes, such as INR testing, BP and PR measurements. Other studies with pharmacy students have reported similar findings, where only a small proportion of students indicated they received instruction on PE and that they rarely or never had the opportunity to use those skills at their internship sites [19] .

This study has several limitations. The most important to highlight is the self-re- porting aspect of the curricular review, and the potential for variability in the students’ interpretation of the health assessment training definitions. Students’ experiences and recall of what they have learnt is helpful, although we emphasize that the numbers are small and thus the findings cannot be seen as statistically rigorous. However, the findings have provided some data that the individual colleges could use in curricular review and redesign.

Forming competent pharmacists for future primary care multidisciplinary roles requires proper conduct of health assessments and yet this study shows that for a number of fundamental skills, although covered in the pharmacy curricula, students perceive there is insufficient training for them to achieve mastery. Efforts should be made to incorporate consistent experiential opportunities for pharmacy students during clinical placements. The study may also be able to raise awareness of the benefits of collaboration, and the future design of inter-professional education, particularly in health assessments that are likely to be within the scopes of practice of all three disciplines as we move towards achieving Qatar’s public health strategy which is inherently collaborative.

This study has identified a close alignment between each of the health discipline’s scope of practice and the health assessment content taught in each individual program. Improvement in the experiential component of the pharmacy health assessment curricula is needed. The findings of this study also suggest that health assessment training of pharmacy, medical and nursing students lends towards collaborative learning in preparation of future collaborative roles in primary care.

Zolezzi, M., Abdallah, O., Major, S., White, D., Owusu, Y. and Sankaralingam, S. (2016) Teaching Physical Assessment and Disease Screening to Students in the Health Professions: A Focus in Pharmacy Education. Health, 8, 1713-1725. http://dx.doi.org/10.4236/health.2016.815166