Geriatric care curriculum in US PharmD programs: What's happening?

Pharmacy Students' Initial Interest in Working With Older Adults and Their Relationship to Change in Attitudes After Required Curricula on Aging

Background There is an urgent need to prepare our health care workforce for the aging population. Pharmacy programs should equip students with foundational knowledge about aging and therapeutic skills for the rising demands of health care for older adults. Objectives This study examined the relationship between initial student interest in working with older adults and change in attitudes toward aging and providing pharmacy services to older patients after participation in required aging-focused curricula. Methods We measured student pharmacists' interest and attitudes regarding aging and care of older adults in required aging-focused courses in five PharmD programs in the United States and Canada. The University of Arizona Aging and Health Care-Pharmacy (UA AHC-Pharmacy) survey, containing one student-interest question and a 40-item attitudes scale, was used. Pre- and post comparisons were used for the matched student data. The University of Arizona Institutional Review Board (IRB) approved the study (#1912243064), and other colleges received permission to participate from their college or university IRB. Results After completing the required aging-focused course, PharmD students' interest and attitudes toward aging and providing health care to older adults improved significantly compared with the beginning of the course. Less agreement with negative stereotypes of older adults and working with this population was shown. Even those with initially low interest had significantly increased attitude scores post-course. Conclusion Assessment of the impact of aging-focused curricula on student pharmacists' interest and attitudes toward aging and caring for older adults may facilitate meeting the health care demands of the growing older population.

Geriatric education for pharmacy students: A scoping review

BACKGROUND

Comprehensive medication management for older adults requires specific knowledge and skills. Therefore, pharmacy curricula should include appropriate strategies to prepare students for care of this population. This scoping review aimed to identify how geriatric concepts, such as geriatric topics and competencies, are included in pharmacy curricula, and to map current literature on preferred teaching and assessment methods related to geriatric pharmacy education.

METHODS

Four databases were searched to identify papers involving pharmacy learners, education, and geriatrics. Selection process was a two-step approach, involving independent title/abstract screening by two reviewers, then full-text retrieval for eligibility assessment. All types of articles were considered except opinion papers. Data extraction included details on methodology, participants, setting, educational activity, teaching method, and outcomes assessed.

RESULTS

A total of 2537 articles were identified from which 189 met the inclusion criteria: 221 documents after citation and gray literature searching. Articles were grouped for analysis as education-related intervention articles (studies, n = 100 or descriptive articles/case reports, n = 49), studies not including an education-related intervention (n = 49), and others (e.g., reviews, position papers/statements, n = 23). Various teaching methods were reported including experiential, didactic, interprofessional, or simulation. Most articles reported positive outcomes on skills, knowledge, or attitudes, but few articles used a validated assessment tool. Curricula and student's surveys were consistent with suboptimal geriatric education, with few programs offering mandatory dedicated geriatric courses or rotations.

CONCLUSIONS

Gaps remain regarding geriatric inclusion in pharmacy curricula despite decades of evidence, advocacy, and frameworks to guide its development. A wide diversity of teaching methods has been described and their combination may be considered for skills and competency development. There is a need for the scholarship of teaching and learning to be applied to pharmacy programs in order to prepare future pharmacists for an aging society.

The state of the academic pharmacy workforce specializing in geriatrics

OBJECTIVE

To describe the training, career experiences, and roles and responsibilities of faculty members in American and Canadian schools/colleges of pharmacy involved in geriatrics-focused teaching, research, practice, or service.

METHODS

A cross-sectional, web-based, self-administered survey was developed and pre-tested. Pharmacy faculty members with experience and/or expertise in geriatrics-focused practices or scholarships and/or who taught geriatrics-focused topics in US or Canadian pharmacy programs were eligible for participation. Participants were recruited using a multi-pronged approach between June and November 2022.

FINDINGS

A total of 131 completed and non-duplicate surveys were received. Ninety percent of respondents were from US programs and 64.9% worked in public institutions. Sixty-two percent reported greater than 40% teaching efforts, and 39% indicated they were the only person in their program to advocate for geriatrics-focused content. Most reported expectations for scholarship (96.2%), and 77.1% maintained a clinical practice. Among those with research expectations, 53.5% agreed they had an adequate percentage allocation dedicated to research.

CONCLUSION

Geriatrics pharmacy faculty report geriatrics and non-geriatrics teaching expectations, clinical practice workloads, and less time for scholarly productivity. Most respondents have extensive experience in geriatrics; however, many perceive themselves to be the only advocates for geriatrics-focused topics in their programs.

Case mapping of geriatrics: Looking beyond age in skills laboratories

BACKGROUND AND PURPOSE

Development of competencies related to care of older adults is necessary in pharmacy education. Skills laboratories as an essential part of the curriculum represent an important setting to teach geriatrics. The purpose of this research was to describe geriatrics cases in skills/simulation activities of an undergraduate pharmacy program.

EDUCATIONAL ACTIVITY AND SETTING

A retrospective review of one academic year of skills laboratories from the pharmacy program at the Faculty of Pharmacy of University of Montreal was performed. Sessions including cases aged ≥65 years were selected. Content was extracted for characteristics relating to the patient, health, medications, and care context. A framework including geriatric considerations such as geriatric syndromes, frailty status, and potentially inappropriate medications was developed for data collection.

FINDINGS

In total, 210 patient cases were extracted. Older adults (≥ 65 years) were represented in 51 cases (24%), with 8 cases (4%) aged ≥80 years. Geriatric syndromes were documented in 8%, functional status in 10%, and mobility in 12% of the cases. The median number of comorbidities and medications were 4 and 7, respectively. Regarding polypharmacy, only 10 cases had >10 medications, and none had >15 medications. Potentially inappropriate medications were found in 47% (n = 24) of the cases but were addressed in only 14% (n = 7) cases.

SUMMARY

This mapping of skills laboratories highlights gaps in geriatrics content. Inclusion of the oldest patients and geriatrics issues were incorporated in a minority of cases and lacked many characteristics essential for geriatrics care.

Pharmacy students knowledge about aging and rational geriatric pharmacotherapy in India: A cross-sectional study

This study was conducted to compare the knowledge of aging and rational geriatric pharmacotherapy among Bachelor of Pharmacy (BPharm) and Doctor of Pharmacy (PharmD) students in Telangana state, India. A multi-school, cross-sectional study was conducted among final year BPharm and PharmD students from 136 institutions between February and June 2017. A 15-item Geriatric Knowledge Assessment Scale (GKAS) was used to assess aging and rational geriatric pharmacotherapy knowledge among 600 pharmacy students. A total of 530 students participated in the survey, with a response rate of 88.3%, and their mean age was 23.5 (0.5 standard deviation) years. Three-fourth (73%) of the participants were PharmD and 27% were BPharm students. Adequate knowledge about aging was identified in only 41.1% of PharmD students and 16.1% of BPharm students. Both PharmD (73.1%) and BPharm (86.7%) demonstrated poor rational geriatric pharmacotherapy knowledge. Male gender [Adjusted Odds Ratio (AOR): 2.9, 95% CI (1.46-5.71)], students aged <22 years [AOR: 3.5, (2.08-6.03)] and studying PharmD [AOR: 3.3, (1.87-5.78)] were significantly associated with higher knowledge on aging and geriatric pharmacotherapy. Inadequate knowledge may be due to a lack of geriatric content in the pharmacy curriculum and insufficient training in this area.

Development of a board game to assist pharmacists learning the potentially inappropriate medications in older people

BACKGROUND AND PURPOSE

Pharmacists have been reported to have inadequate awareness about potentially inappropriate medications (PIMs) in older people. This warrants more efforts to enhance their familiarity and knowledge in this topic. A board game was developed based on the 2019 American Geriatrics Society (AGS) Beers Criteria to assist pharmacists learning the topic.

EDUCATIONAL ACTIVITY AND SETTING

The board game is played using dice and pawns and involved players encounter questions on various aspects of PIMs in older people. Questions used in the board game were reviewed by a panel of experts. The board game exposed pharmacists to drug-drug and drug-disease/syndrome interactions. The board game was pilot tested among 16 pharmacists and played by a group of 34 pharmacists. Close- and open-ended feedback regarding the board game were sought in both sessions using a self-developed questionnaire.

FINDINGS

All pharmacists in the pilot test (PT) and actual game (AG) sessions agreed that the board game is an innovative, useful, and interesting way to learn about PIMs in older people. All pharmacists in the PT session and a high majority of those in the AG session agreed that the board game increased their knowledge about PIMs in older people. The open-ended responses showed generally positive feedback.

SUMMARY

The board game can be useful as an educational tool to supplement traditional teaching methods to assist pharmacists learning the PIMs in older people. Periodic review and relevant modifications of the board game content can be done to ensure its efficiency and relevance.

The current state of geriatric pharmacy education in the United States - A cross-sectional survey

INTRODUCTION

Concerns exist that the current health care workforce is underprepared to meet the needs of the aging American population. This study evaluated the current emphasis on geriatrics in doctor of pharmacy curricula.

METHODS

A 61-item web-based survey was distributed to associate deans with oversight of pharmacy curricula at all United States (US) schools and colleges of pharmacy (S/COP). Information collected included school demographics, employment of geriatrics faculty, geriatric education (required, elective, and experiential courses), co-curricular geriatric experiences, postgraduate residency training in geriatrics, student interest in geriatrics, and perception of preparedness of the profession to care for older adults.

RESULTS

Of responding S/COP, 35% required a course in geriatrics while 63% offered a geriatrics elective. An advanced pharmacy practice experience (APPE) in geriatrics was required by 14%, and 79% offered an elective APPE. Insufficient curricular emphasis on geriatrics was noted by 44% of responding schools, and 33% lacked confidence that the profession of pharmacy is adequately prepared to care for the aging population.

CONCLUSIONS

According to the survey respondents, most pharmacy schools do not have a required didactic course or APPE in geriatrics. Additional emphasis on foundational principles of medication management for older adults in pharmacy curricula is warranted to meet the health care needs of the rapidly aging US population.

Knowledge and Attitude of Pharmacy Students Regarding Geriatric Care: Questionnaire-Based Analysis in Malaysia

INTRODUCTION

There is a predicted growth of up to 17% in an older adult of Malaysian above 60 years of age by 2040. This will increase the workload of almost every healthcare provider to ensure optimal geriatric care.

PURPOSE

This study aimed to assess pharmacy students' knowledge and attitudes towards geriatric pharmacy education and older patients to determine their preparation in delivering appropriate medical care to the geriatric population.

METHODS

Self-administered questionnaires were distributed among pharmacy students in different Malaysian universities. The survey included several sections to assess multiple aspects such as sociodemographic information, assessment of knowledge using a validated 28-item Geriatric Knowledge Assessment Scale (GKAS), and attitudes towards geriatrics education.

RESULTS

The response rate was around 70% of the respondents. The mean (± standard deviation) age of the cohort was 22.28 (±1.12) years. Despite around 78% of pharmacy students claiming that their knowledge of geriatric care is adequate, their GKAS score showed that only around 20% have high geriatric knowledge. Around 80% of them showed a positive attitude on the importance of taking courses focused on geriatric care and demonstrated interest to further knowledge and training in geriatric care. However, more than half of the students were uncertain of their answers towards their attitudes regarding older patients.

CONCLUSION

Given the growing role of pharmacists in the ageing population, this study highlights the importance of geriatric care education among potential pharmacists. Therefore, we urge the need to improve/develop geriatrics education and training into the pharmacy curriculum to ensure sufficient preparation for actual practice after graduation.

Alumni survey of a combined doctor of pharmacy/graduate certificate in aging studies program

INTRODUCTION

The Certificate in Aging Studies at Virginia Commonwealth University allows students to study gerontology while completing their doctor of pharmacy (PharmD) or graduate pharmaceutical sciences degree concurrently. The objective of the study was to evaluate alumni satisfaction with the Certificate in Aging Studies program, its application, and its perceived usefulness.

METHODS

Alumni of the program (n = 49) were emailed an anonymous electronic survey about their perceptions of the program. The survey was emailed three times. Responses to eight multiple choice questions were summarized using descriptive statistics. Two free response questions were qualitatively analyzed for themes by two investigators.

RESULTS

The response rate to the survey was 59.2% (n = 29). Most respondents practice in hospital settings (24.1%) and did not undertake additional postgraduate clinical training (44.8%) or earn additional geriatric certifications (69%). The majority (65.5%) reported using the dual program in their career and would recommend the Certificate in Aging Studies to others (96.6%). Most (59%) alumni indicated that the best part of the program was the interprofessional interaction, and 69% suggested no further areas of improvement for the program.

CONCLUSIONS

A PharmD-Gerontology dual program is one way to enhance the workforce to care for the growing older population. This partnership approach should be considered by schools of pharmacy that also offer degree programs in gerontology.

Utilizing innovative teaching methods to design a new geriatric pharmacy elective

INTRODUCTION

The geriatric population is growing faster than ever. Pharmacy educators must ensure students are prepared to care for this population through the use of both required and elective courses. In order to bridge the gap between education and real-world practice, colleges of pharmacy have incorporated innovative teaching methods to promote problem-based learning (PBL) that focus on clinical decision-making.

COMMENTARY

The Accreditation Council for Pharmacy Education Accreditation Standards and the American Society of Consultant Pharmacists provide guidance on incorporating geriatric topics into doctor of pharmacy curricula. However, emphasis should also be placed on content delivery and providing an interactive, enjoyable learning environment. To meet this need, the University of Florida created a geriatric-focused elective that utilizes innovative teaching methods to reinforce understanding of material. In this commentary, we discuss questions to consider when developing a geriatric elective and recommend specific and unique innovative teaching methods that can be incorporated to promote PBL.

IMPLICATIONS

Pharmacists must possess the knowledge to address the unique needs of geriatric patients. Creating geriatric-focused electives bridges the gap between theory and practice. Utilizing innovative teaching methods can increase engagement, spark creative thinking, and promote retainment of skills necessary to care for the aging population.

Integrating an Interprofessional Geriatric Active Learning Workshop Into Undergraduate Medical Curriculum

PURPOSE

The aging population in the United States poses a substantial challenge to our health care system, and particularly affects the training of physicians in geriatric care. To introduce undergraduate medical students to a variety of clinical skills and concepts emphasized in geriatrics, we created an interprofessional geriatric workshop and examined changes in student perceptions of working in interprofessional teams, knowledge regarding geriatric concepts, perceptions of the pre-work material, and suggestions for curricular improvement to enhance the workshop for future students.

METHODS

Second-year medical students participated in a 4-hour workshop with tasks that emphasized activities of daily living, geriatric physical assessment, end-of-life discussions, Beers Criteria, and a home health assessment. Pre- and post-surveys were administered including the Students Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) survey and a knowledge assessment. Student perceptions of pre-work and overall program assessment were captured after the workshop. Descriptive statistics and paired t tests assessed for significant differences. Emerging themes were analyzed using the Glaser constant comparative method.

RESULTS

Of the 186 medical student participants, 178 students completed the SPICE-R survey, demonstrating significant increases in students' perceptions of the value of interprofessional education (P < .001). In addition, 111 students completed the pre- and post-test for the knowledge assessment, demonstrating significant gains in geriatric concepts (P < .001). Overall, most students perceived the pre-work as useful and felt prepared to evaluate geriatric patients. Open-ended question analysis supported results, in which 34 students indicated that they felt most comfortable performing a home health assessment and emphasized the usage of the home health simulation.

CONCLUSIONS

Introducing medical students to a variety of geriatric assessments and concepts in an interprofessional environment early in their career positively influences their perceptions of working as an interprofessional team member to deliver comprehensive care to older adults.

Impact of geriatrics elective courses at three colleges of pharmacy: Attitudes toward aging and eldercare

INTRODUCTION

One in five Americans will be 65 years and older by 2030. Training student pharmacists to provide quality eldercare as healthcare professionals is essential. The objective of the study was to assess pharmacy students' attitudes toward aging and eldercare before and after a geriatrics-focused elective course.

METHODS

The University of Arizona Aging and Health Care (UA AHC) survey was modified for pharmacy and administered pre and post to students enrolled in a geriatrics elective course at three United States (US) colleges of pharmacy. Pre and post means were calculated to examine attitudinal changes after course participation. Factor analysis was performed to examine construct validity by identifying the dimensions being measured.

RESULTS

Sixteen of 37 questions differed significantly from pre-course to post-course demonstrating improved attitudes after course participation. Students also reported an awareness of how older adults are viewed and treated. Factor analysis identified seven factors with a range of behaviors, skills, training, and attitudes perceived to be important in geriatric care. Two factors, importance of learning about geriatric care and experience/comfort with older adults, showed significant changes confirming positive impact of the course.

CONCLUSIONS

Geriatrics-focused elective courses in three colleges of pharmacy had a positive impact on students' perceived importance of learning about geriatric care and experience/comfort with elders. Further research to adapt and validate the UA AHC survey to pharmacy education is needed. The identification of the skills and attitudes necessary to meet the growing needs of older adults is necessary for pharmacy curriculum implementation and practice.

Continuing pharmacy education practices in geriatric care among pharmacists in the Upper Midwest

OBJECTIVES

To summarize select continuing pharmacy education (CPE) topics and hours related to geriatric care completed by community, hospital/clinic, and long-term care (LTC)/consultant pharmacists in the previous 12 months, whether pharmacy workplace influenced topic selection or completion, and to describe CPE sources used by community versus hospital/clinic pharmacists.

DESIGN

Cross-sectional survey (2017).

SETTING AND PARTICIPANTS

Licensed pharmacists in North Dakota, South Dakota, Minnesota, Iowa, and Nebraska with primary practice settings in community pharmacies, hospitals, or clinics or those practicing as consultant pharmacists.

MAIN OUTCOME MEASURES

CPE on geriatric-related topics and hours completed in the previous 12 months, CPE providers and sources used, and differences in CPE topic completion and CPE providers and sources by primary pharmacy practice setting.

RESULTS

Pharmacists' response rates for states ranged from 10.5% to 17.1%. Pharmacists (n = 1082) reported limited completion of geriatric-related topics. Almost one-third completed CPE credit in Alzheimer disease (AD) but fewer than 20% of pharmacists in selected age-related chronic diseases (e.g., Parkinson disease, dementia with Lewy bodies, epilepsy, vascular dementia, geriatric syndrome). LTC/consultant pharmacists completed significantly more hours in geriatric-related topics compared with other pharmacists. In contrast, diabetes mellitus, hypertension, asthma, and heart failure were completed by 34% to 64% of the pharmacists. Pharmacist's Letter (57.2%), Power-Pak CE (42.4%), conferences, conventions, and symposia (32.5%), and Pharmacy Times (21.8%), were the most used CPE sources. Other sources were used by fewer than 18% of the pharmacists. Online CPE providers used by high numbers of study participants offered limited AD- or dementia-related topics and hours.

CONCLUSION

Findings revealed modest to minimal CPE completion in select geriatric care topics among pharmacists in the Upper Midwest. Completion rates were higher for LTC pharmacists compared with hospital, clinic, and community pharmacists. Only a few CPE sources were heavily used, and those offered minimal CPE in AD/dementia-related care. Given current findings and previous research, current CPE use habits and CPE offerings from major providers and sources seem insufficient for ensuring continued high-quality patient-centered care for growing U.S. aging populations.

Design, implementation, and evaluation of educational workshop on management of Parkinson's and Alzheimer's disease patients for third-year pharmacy students

BACKGROUND AND PURPOSE

Increasing aging populations in the United States means an increasing number of persons with Parkinson's disease (PD) and Alzheimer's disease (AD) requiring competent pharmaceutical care. The workshop was designed and implemented to integrate pharmacology and therapeutics in management of PD and AD, and evaluate efficacy of students' high-cognitive thinking, and self-rated knowledge improvement, confidence, and interest in the subject.

EDUCATION ACTIVITY AND SETTING

Third-year pharmacy students participated in a three-hour workshop comprised of a foundational knowledge quiz from pathophysiology, pharmacology and therapeutics, performance on high-cognitive thinking in clinical scenarios, and hands-on activities in pharmacology and therapeutics related to PD and AD care. Pre- and post-education, Likert-style questions assessed students' self-rated confidence, interest and knowledge improvement. Descriptive statistics, paired t-test, and chi-square analyses were performed using Stata 10.1 statistical software (College Station, TX: Stata Corp LP).

FINDINGS

Eighty-four of 93 students (90.3%) completed all workshop activities. Students' ability to apply knowledge in complex case mediation problems was not associated with performance on baseline quiz questions (Pearson r: 0.03-0.17). Completion of structured, hands-on active learning integrating clinical pharmacology and therapeutics had measurable immediate benefit solving high-cognitive order problems in clinical scenarios (p < 0.05). Hands-on activity also increased mean self-rated confidence (p < 0.01). Students (85.6%) reported knowledge improved "somewhat" or "very much" after the activity. Mean scores before and after hands-on activity were not associated with interest in the topic.

SUMMARY

Structured, hands-on workshops can aid comprehension of taught/lectured material and its application to PD and AD, and is a way for instructors to close gaps between didactic lecture and clinical practice.