Enhancing pharmacy student injection training with the CARD™ system

BACKGROUND: Immunization stress-related responses (ISRR) such as fear, pain and fainting contribute to negative immunization experiences and non-compliance in about 20% of un-immunized people. We introduced the CARD™ (Comfort, Ask, Relax, Distract) system - the first vaccine delivery framework demonstrated to reduce ISRR - to 240 second year pharmacy students undergoing mandatory immunization injection training and subsequent elective practical experience delivering immunizations in 2022 at the University of Toronto, Canada. OBJECTIVES: The objective was to explore pharmacy students’ perceptions and behaviours following CARD™ education within the injections training course and then after participating as immunizers at influenza pop-up clinics. RESULTS: Eighteen pharmacy students participated after the injections training course and 19 participated after the pop-up clinics. Students reported CARD™ was aligned with client needs and preferences and national professional standards. They believed it was important to address ISRR and had higher confidence in their ability to support clients during immunization. Students reported deeper understanding of CARD™ after practical experience, including inviting client participation rather than imposing coping strategies. CONCLUSIONS: We are the first group to incorporate evidence-based education about reducing ISRR to training curricula of pharmacy students. We demonstrated that students value education about CARD™ and that including a practical component is important to implementation fidelity. This information is relevant for injection training programs across disciplines and countries. KEY MESSAGES: • Incorporating CARD™ in injections training and experiences is acceptable to pharmacy students. • Reducing ISRR promotes more positive experiences for clients and immunizers.