Critical Review: Pharmacy Students

Perceptions of Cultural Competence

Encounters during Practice Experiences.
Part 1
This article mainly about the opinion of pharmacy students regarding the cultural
competence encounters during their practice experiences. In order to provide
effective health care service, a pharmacist must be prepared to interact with patients
with culturally diverse background.
In this study, a questionnaire type of survey instrument was completed by the
forth-year pharmacy (P4) students were asked to complete a questionnaire right
after they finished over their forth advanced pharmacy practice experiences
(APPEs).
From the study, it is known that the most common type of cultural competence
encountered by the students was caring upon patients that lack in English
proficiency. The study also finds that the students responded differently to different
kind of cultural competence experiences including finding cheaper medication for
patients with financially problematic, using translator to overcome patients that are
not very good in English. However, most of the responses to cultural events reported
by the students are known to be invalid. Pertaining to the degree of comfort by the
students, they are known to be more comfortable when they are confronting patients
that are homosexual, different races or ethnics, having disabilities and patients that
are not easily understand health communication due to low level of education.
However, the report suggested enhancement for students to be comfortable to
encounter situations patients that seek alternative therapies, having nonverbal cues
and refuse eye contact.
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PART 2
The main purpose of the study was to determine pharmacy students
perceptions regarding cultural competence training, cross-cultural experiences
during advanced pharmacy practice experiences (APPEs), and perceived comfort
levels with various cultural competence encounters. Other purposes are to know
whether students are having their chance to relate cultural competence training
during their first 4 APPEs experiences, types of cultural competence events faced by
the students, their application on cultural competence understanding and comfort
degree perceived throughout their cultural competence care to patients.
There are there authors that are responsible over this study. The first author,
Loren-Ashley Cooper was the corresponding author. She is a pharmacy doctorate
who affiliates with Midwestern University Chicago College of Pharmacy and
Concordia University Wisconsin School of Pharmacy. The second writer is known to
be Rosalyn Padiyara Vellurattil. Dr. Vellurattil received her Doctor of Pharmacy
degree from the University of Illinois at Chicago, and completed a specialty
residency in primary care with a focus on education from Midwestern University

Chicago College of Pharmacy. The last writer is known as Ana Qui

~
n

ones-Boex.

She is an Associate Professor at Midwestern University Chicago College of

Pharmacy.
In terms of the timeliness, this article is considered recent as it was submitted
on February 2013, received 7 months later on September and published on March
2014. However, the date or year of the event of cultural competence encounter
experienced by the students are not specified as they were only asked based on
their first 4 APPEs.

The targeted audience of this journal is for those who are concerning over the
challenges of cultural competence that are faced mostly by people who are meant to
improve effective health care services. However, this study was narrowed based on
the experiences or perceptions of forth-year pharmacy students of Midwestern
University.
The organization was put in order from the abstract, introduction, methods,
results, discussion, conclusion, acknowledgements, and ended with the references.
The method instrument used in this study was a questionnaire given to P4
pharmacy students of Midwestern University. The questionnaires were divided into 5
parts. The first part was only about demographic information of the students in terms
of their age, gender, and work experience. The rest portions of the questionnaires
may include different types of question such as likert scale, free response, and scale.
Most of the references used in this study are known to be quite recent as
more than half of the reference are published were published for at least on the year
of 2010 to 2013. For example, the most recent article given was Integrating cultural
competency throughout a first-year physician assistant curriculum steadily improves
cultural awareness.

Part 3
In conjunction with the purpose of this study which is to determine the
perception of pharmacy students regarding cultural competence, I think that this
study is a very good initiative to promote better understanding regarding the barriers
of cultural competence especially among pharmacy students as increasing the
students' awareness of their own health beliefs was one of the goals of the exercise
as it is important for students first to understand their own cultural beliefs prior to
attempting to understand their patients' beliefs.(Vyas and Caligiuri, 2010)
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However, as students may perceive cultural competencies that are theorybased as easier to score than the application of cultural competence principles in
real-world settings such as an exam room or community pharmacy.(Echeverri,
Brookover and Kennedy, 2013) Therefore, -Edgren and colleagues suggested that
cultural awareness, rather than cultural competency, may be a reasonable and
appropriate goal for graduating students. (Kardong-Edgren and Campinha-Bacote,
2008) Okoro and her colleagues recommended that to ensure that pharmacists are
adequately equipped to deliver competent care to the diverse patient populations
that they will serve, clinical cultural competency and health-disparity instruction be
incorporated into pharmacy colleges and schools curricula (Okoro et al., 2012)
In terms of the method of the survey, this study is considered weak as the
level of comfort and the students response toward multicultural patients results were
self-reported by students and therefore exaggeration of the answers by students and
important details of the previous event may have been forgotten. For better
improvement, this study may include preceptor observer and demand immediate
feedback right after the student. According to Haack and Phillips, observation upon
student interactions and counseling with diverse patients is one of a way to evaluate
cultural competence. (Haack and Phillips, 2012)
This study is unlikely to be reliable if the sample size were to be considered
internationally as the respondents are merely among of those pharmacy students
from Midwestern University Chicago College of Pharmacy and did not mentioned to
be among international students that studied abroad. Haack and his colleague
mentioned that the impact on students from undeveloped countries is different from
international students that study in developed countries. (Haack and Phillips, 2012)
Based on the reliability of references, this study is considered recent and
highly reliable research as more than half of the references are referred to be no
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longer than 5 years back and quite updated. Although there are some references are
referred to be more than 5 years back but as the studys issue regarding cultural
competence is an ongoing lifetime process that must be encountered by almost most
of health care professionals, this topic is considered never to be outdated as this
issues do not quite varied regardless of time. Ofstad and Brunner also supported
that pharmacy education is a lifelong learning skills that does not stop by the end of
graduation. (Ofstad and Brunner, 2013)
Finally, it can be concluded that it is important to nurture understanding and
awareness toward cultural competence. Moreover, it is agreeable that cultural
competence skills are not limited in classroom only but also need to be enhanced by
the practical with the real-world settings. Students performance during a cultural
competence event also should be observed in order to get better accuracy results.
The study should also consider including the perception globally by taking in
international students perception regarding cultural competence as different
countries offer different kind of cultural competence. Last but not least, cultural
competence skills is believed to be an ongoing lifetime process that need to be
enhanced in order to fulfill the health care professionals strategy to improve health
care service, reduce health disparities and improving patient outcome.

References
Echeverri, M., Brookover, C. and Kennedy, K. (2013). Assessing Pharmacy Students
Self-Perception of Cultural Competence. Journal of Health Care for the Poor
and Underserved, 24(1A), pp.64-92.
Haack, S. and Phillips, C. (2012). Teaching Cultural Competency Through a
Pharmacy Skills and Applications Course Series. American Journal of
Pharmaceutical Education, 76(2), p.27.
Kardong-Edgren, S. and Campinha-Bacote, J. (2008). Cultural competency of
graduating US Bachelor of Science nursing students. Contemporary Nurse,
28(1-2), pp.37-44.
Ofstad, W. and Brunner, L. (2013). Team-Based Learning in Pharmacy
Education. American Journal of Pharmaceutical Education, 77(4), p.70.
Okoro, O., Odedina, F., Reams, R. and Smith, W. (2012). Clinical Cultural
Competency and Knowledge of Health Disparities Among Pharmacy
Students. American Journal of Pharmaceutical Education, 76(3), p.40.
Vyas, D. and Caligiuri, F. (2010). Reinforcing Cultural Competency Concepts During
Introductory Pharmacy Practice Experiences. American Journal of
Pharmaceutical Education, 74(7), p.129.