Background
The role of the pharmacist in medicines management demands good consultation skills in order to identify and meet the patient's health needs. Furthermore, good consultation skills underpin the principles of adherence and concordance. While some acronyms have been used in the community setting, (e.g. WWHAM) there is little structure given to the way pharmacists consult. Furthermore, there is a perceived misconception that 'good communication skills' and 'good consultation skills' are the same.

Objectives

1. To develop a training programme using simulated-patients
2. To evaluate the impact of the programme on students' perceptions of their ability and confidence in carrying out a structured consultation.

Methods
Simulated patients (SPs) who satisfied the inclusion criteria were recruited and enrolled onto a training programme. Consultations were filmed, viewed on video and evaluated using a standard feedback process. Third year undergraduate Pharmacy students at the University of Brighton participated in the training programme from October 1999 to March 2000 (data from the second cohort of students to complete this programme, October 2000 to March 2001 will also be presented). Working in groups of 12, students participated in two 4 hour seminars. A structured questionnaire was designed to assess students' perceptions of the difficulty of conducting a consultation and their confidence in delivering a structured consultation. Questionnaires were administered before the first and immediately after the second teaching programme. Reliability of 'perceived difficulty' and 'perceived confidence' scales were tested using Cronbach alpha test for internal consistency. Changes in mean scale scores over time were analysed using paired t-tests.

Results
Key skills and knowledge were identified from the literature as important features of the consultation-training programme. A total of 25 individuals expressed initial interest in being trained as simulated patients, this fell to 12 once the screening criteria had been applied. A total of 91 students participated in the programme (mean age=23 years, SD=4.5). Questionnaire scales were found to have good internal reliability, test-re-test and validity scores. Prior to participation in the programme, students' mean 'confidence' scores was 13.7 (SD=3.4) where over half (58%) scored highly on this scale. After participation in the programme 'perceived confidence' scores increased significantly to 14.5 (SD=3.2, t=5.9, p<0.01) where 82% scored highly on this scale. Prior to the programme students' mean 'perceived difficulty' score was 15.8 (SD=4.5) where approximately one quarter (24%) of students scored highly on this scale. After participation in the programme there was a statistically significant decrease in students' perception of the difficulty (mean= 13.7, SD=4.1, t=4.0, p<0.01) of conducting a structured consultation.

Conclusions
On completion of this structured teaching programme students thought that conducting a consultation was less difficult and were more confident in their ability to do so. Providing skills training around the consultation process, using simulated patients provides pharmacists with a good framework around which to practice pharmaceutical care. Future research will focus on the impact that this training method has on students' actual performance in real-life situations such as ward-based training exercises.