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Auimekhakul T, Suttajit S, Suwannaprom P. Pharmaceutical public health competencies for Thai pharmacists: A scoping review with expert consultation. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100444. [PMID: 38712325 PMCID: PMC11070631 DOI: 10.1016/j.rcsop.2024.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
Background Thai pharmacists' roles have increasingly shifted to a system-focused role in providing public health services. A competency framework in this area is essential to workforce development. Objective This study aimed to summarize and synthesize the literature on pharmaceutical public health competencies of Thai pharmacists. Methods The Scopus, MEDLINE, and Web of Science (Clarivate) databases were searched. The search criteria included "public health", "health promotion", "primary care", "community pharmacy", "pharmacy" and "pharmacist". Documents published in English and Thai between January 2011 and December 2020 were also examined. Unpublished documents were included. A 3-step inductive coding technique was used to develop the competency framework. To validate the findings, a 2-round, modified Delphi method was employed with 20 Thai pharmaceutical specialists between August 2022 and January 2023. The Scale-level Content Validity Index (S-CVI) was used to assess validity. Results The database search yielded 1429 articles. Fifty-seven articles were selected. The analysis identified 5 competency domains. The domains, along with their related competency elements and behavioral statements, were provided for expert assessment. The S-CVI scores in the first and second rounds were 0.78 and 0.93, respectively. The terminology and categories of competencies have been improved. This outcome resulted in a pharmaceutical public health competency framework for Thai pharmacists. The framework consists of 5 competency domains: 1) individual and family health promotion (3 competency elements with 10 behavioral statements), 2) community empowerment for well-being communities (6 competency elements with 23 behavioral statements), 3) information management and evidence-based practice (3 competency elements with 10 behavioral statements), 4) communication for health promotion (3 competency elements with 6 behavioral statements), and 5) pharmacoepidemiology and support for public health emergencies and epidemics (2 competency elements with 5 behavioral statements). Conclusion Pharmaceutical public health competencies for Thai pharmacists were developed through extensive literature review and expert consultation.
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Affiliation(s)
- Thanayut Auimekhakul
- Consumer Health Protection and Pharmaceutical Public Health, Chiang Mai Provincial Public Health Office, Chiang Mai 50200, Thailand
- Master's Degree Program in Pharmacy Management, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siritree Suttajit
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Puckwipa Suwannaprom
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
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Fonseca FLD, Dosea AS, Araújo-Neto FDC, Gois Dos Santos L, Pimentel DMM, Lyra DPD. The academic formation challenges: what does retail expect from higher education institutions in pharmacy? BMC MEDICAL EDUCATION 2024; 24:456. [PMID: 38664828 PMCID: PMC11046822 DOI: 10.1186/s12909-024-05435-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The drug retail represents the main area of activity for pharmacists worldwide. In Brazil, this sector is responsible for employing around 80% of professionals. Before this reality, the academic training of pharmacists requires specialized skills and knowledge so they can fulfill their tasks. In this sector, considering the influence of managers and mentors on the model of pharmaceutical practice, their perceptions about the demands of the market can help discussions related to the training of pharmacists. AIM To analyze the academic training of pharmacists for the drug retail market from the perspective of managers and mentors. METHOD This is a qualitative study conducted with managers and mentors of the drug retail market. A semi-structured interview guide was prepared and applied to the intentionally selected participants. The study was approved by the Research Ethics Committee under the number 4,169,752. The interviews were conducted through videoconference by an experienced researcher. The data obtained were analyzed using Bardin's analysis technique, following the steps of categorical thematic content analysis using the ATLAS.ti software. RESULTS 19 interviews were carried out. Among the reports, the interviewees highlighted the importance of retail in the employability of pharmacists, as well as inconsistency in the academic training for this sector, originating the following categories: curriculum reform to include the market demands, follow-up and career plan, training for entrepreneurship and sales, practical application of knowledge, and encouragement of experience. CONCLUSION Pharmaceutical academic training is linked to several challenges, whether organizational, structural, or budgetary. To overcome these challenges, it is necessary to unite the interested parties in the formulation and implementation of a strategy for the professionalization of pharmacists, considering their social role in patient care, aligned with the company's sustainability, so that both coexist.
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Affiliation(s)
- Francielly Lima da Fonseca
- Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Aline Santana Dosea
- Health Sciences Graduate Program. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Fernando de Castro Araújo-Neto
- Health Sciences Graduate Program. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Lívia Gois Dos Santos
- Undergraduate Pharmacy Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Divaldo Pereira de Lyra
- Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
- Health Sciences Graduate Program. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Dosea AS, de Castro Araújo-Neto F, Fonseca FL, Gois Dos Santos L, Pimentel DMM, de Lyra DP. "Reigns but does not govern": A reflection on professionalism and the autonomy of the pharmacist. Res Social Adm Pharm 2023; 19:1061-1072. [PMID: 37105775 DOI: 10.1016/j.sapharm.2023.04.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION In recent decades, the professionalization of pharmacy has been debated worldwide. With the advent of industrialization, pharmacist autonomy has weakened, especially in the retail pharmacy market. Manegers and mentors of pharmacy chains serve as links between the profession and drug users. This study sought to understand the perceptions of retail pharmacy stakeholders regarding pharmacist autonomy and how to improve it, and to reflect on theories of professionalism. METHOD 19 semi-structured interviews were conducted. The interviews were transcribed and analyzed through analyst triangulation and categorical content analysis, using the ATLAS.ti software. RESULTS Interviews were conducted with nine mentors and ten managers in retail medicine. They reported aspects related to managerial and technical autonomy regulated by law, and strategies for enhancing professional autonomy in retail pharmacy. Autonomy was considered limited by pharmacists' dependence on employability and self-devaluation; and market control exposed the weaknesses in pharmaceutical professionalism. Entrepreneurship and ownership attitude strategies were feasible only in a retail micro-political context. CONCLUSION The retail medicine continues to have business model centered on the product and controlling the pharmaceutical practice model. To ensure autonomy and professional strengthening, it is necessary that pharmacy recognizes itself as a clinical profession and develops a stable professional identity.
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Affiliation(s)
- Aline Santana Dosea
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernando de Castro Araújo-Neto
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Francielly Lima Fonseca
- Graduate Program in Pharmaceutical Sciences. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Lívia Gois Dos Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Divaldo Pereira de Lyra
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Mbonane H, Sibanda M, Godman B, Meyer JC, Matlala M. Knowledge, attitudes and practices of healthcare professionals on the use of an electronic stock visibility and management tool in a middle-income country: Implications for access to medicines. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100233. [PMID: 36845673 PMCID: PMC9945761 DOI: 10.1016/j.rcsop.2023.100233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Background The Stock Visibility System (SVS) is a mobile application and web-based management tool used at public primary health care (PHC) facilities in South Africa to capture and monitor medicines availability, providing visibility at national level. Medicine stock-outs are prevalent despite the implementation of SVS, compromising patient care. This study aimed to assess the knowledge, attitudes and practices (KAP) of healthcare professionals (HCPs) on the use of the SVS at PHC level to provide future guidance. Method A cross-sectional study using a structured self-administered questionnaire among 206 HCPs at 21 randomly selected PHC facilities located in a health district in KwaZulu-Natal Province, South Africa. Closed-ended questions were used to collect data on socio-demographic characteristics, knowledge on the SVS and practices on its use. A Likert scale was used to determine attitudes towards the SVS. Cronbach's alpha (α) was used to assess the internal consistency of the questionnaire and independent samples t-test and one-way analysis of variance (ANOVA) was used to test statistical difference in the mean scores for KAP and socio-demographic variables. Association between knowledge and practices, and attitude and practices was determined using odds ratios (OR) and Chi-square. Results The majority (99.5%) of HCPs had previous training on SVS. Nearly two thirds (62.1%; 128/206) generally had good knowledge about the SVS and 76.7% (158/206) had positive attitudes towards the SVS while only 17.0% had a good practice score. There was no statistically significant association between KAP of HCPs on the use of the SVS, and sociodemographic variables (HCP qualification, age and sex). There was a significant association between the knowledge and practice scores (aOR: 5.44; 95% CI: 1.92-15.4; p = 0.001). Although positive attitudes, was associated with good practices, it was not statistically significant (OR: 1.21; 95% CI: 0.46-3.22; p = 0.702). Conclusions HCPs in this district had poor practices when using SVS despite good knowledge and positive attitudes towards SVS and the higher the HCPs knowledge of SVS, the more desirable the practices on SVS. This underscores the need for continuous training of HCPs to ensure a constant and efficient supply of medicines to meet the health needs of the population.
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Affiliation(s)
- Hlalanathi Mbonane
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,East Boom Community Health Centre, 541 Boom Street, Pietermaritzburg 3201, South Africa
| | - Mncengeli Sibanda
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, Molotlegi Street, Ga-Rankuwa 0208, South Africa,Corresponding author at: Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa 0208, South Africa.
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Moliehi Matlala
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa
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Alhazmi M, Bajuayfir A, Cheema E, Elrggal M, Ali M. Evaluation of Current Community Pharmacist Practice in Saudi Arabia—A Cross-Sectional Study from Pharmacists’ Perspective (Part II). PHARMACY 2022; 10:pharmacy10020038. [PMID: 35314619 PMCID: PMC8938769 DOI: 10.3390/pharmacy10020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to evaluate the current practice of community pharmacists from patients’ and pharmacists’ perspectives in Saudi Arabia. This paper presents the pharmacist’s perspective. A cross-sectional self-administered online survey was designed to collect responses from community pharmacists in Saudi Arabia from February to April 2021. The questionnaire consisted of several statements related to best practice in community pharmacy. Pharmacists’ responses to each statement were scored using a 5-point Likert scale. Higher scores represented a greater extent to which they adhered to best practice in the community pharmacy setting and vice versa. Data of 164 participants were included in the analysis. The minimum median score was related to the statement: Pharmacist explains the main side effects. The maximum median score was related to the statement: Pharmacist explains dosage regimen. Pharmacists aged 30 years or above and non-Saudi pharmacists had significantly higher median scores compared with pharmacists less than 30 years of age (p = 0.016) and Saudi pharmacists, respectively (p = 0.001). A gap between best practice and current practice of community pharmacists was observed. Policymakers can utilize these findings to provide targeted professional development opportunities for the practicing community pharmacists in order to improve the overall service and care for patients.
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Affiliation(s)
- Mohammad Alhazmi
- Pharmacy Services, Ministry of Health, Al-Baha 11176, Saudi Arabia;
| | | | - Ejaz Cheema
- School of Pharmacy, University of Management and Technology, Lahore 54770, Pakistan;
| | - Mahmoud Elrggal
- Faculty of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Majid Ali
- School of Life and Medical Sciences, University of Hertfordshire (Hosted by Global Academic Foundation), New Administrative Capital, Cairo 11835, Egypt
- Correspondence:
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Netthong R, Kane R, Ahmadi K. Antimicrobial Resistance and Community Pharmacists’ Perspective in Thailand: A Mixed Methods Survey Using Appreciative Inquiry Theory. Antibiotics (Basel) 2022; 11:antibiotics11020161. [PMID: 35203764 PMCID: PMC8868194 DOI: 10.3390/antibiotics11020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Global action plans to tackle antimicrobial resistance (AMR) are the subject of ongoing discussion between experts. Community pharmacists have a professional responsibility to tackle AMR. This study aimed to evaluate the knowledge of antibiotic resistance and attitudes to promoting Antibiotic Smart Use (ASU) amongst part and full-time practicing community pharmacists across Thailand. An online mixed-method survey applying Appreciative Inquiry theory was validated and conducted in 2020. Non-probability sampling was used, with online survey dissemination via social networks. A total of 387 community pharmacists located in 59 out 77 provinces seemed knowledgeable about antimicrobial resistance (mean score = 82.69%) and had acceptable attitudes towards antibiotic prescribing practices and antimicrobial stewardship (mean score = 73.12%). Less than 13% of pharmacists had postgraduate degrees. Postgraduate education, training clerkship, preceptors, and antibiotic stewardship training positively affected their attitudes. The community pharmacists proposed solutions based on the Appreciative Inquiry theory to promote ASU practices. Among these were educational programmes consisting of professional conduct, social responsibility and business administration knowledge, up-to-date legislation, and substitutional strategies to compensate business income losses.
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Affiliation(s)
- Rojjares Netthong
- Joseph Banks Laboratories, School of Pharmacy, University of Lincoln, Beevor St., Lincoln LN6 7DL, UK
- Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Warin Chamrab, Ubon Ratchathani 34190, Thailand
- Correspondence: or
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK;
| | - Keivan Ahmadi
- Lincoln Medical School, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK;
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Lias N, Lindholm T, Pohjanoksa-Mäntylä M, Westerholm A, Airaksinen M. Developing and piloting a self-assessment tool for medication review competence of practicing pharmacists based on nationally set competence criteria. BMC Health Serv Res 2021; 21:1274. [PMID: 34823529 PMCID: PMC8620234 DOI: 10.1186/s12913-021-07291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New competence requirements have emerged for pharmacists as a result of changing societal needs towards more patient-centred practices. Today, medication review competence can be considered as basic pharmaceutical competence. Medication review specific competence criteria and tools for self-assessing the competence are essential in building competences and a shared understanding of medication reviews as a collaborative practice. The aim of this study was to develop and pilot a self-assessment tool for medication review competence among practicing pharmacists in Finland. METHODS The development of the self-assessment tool was based on the national medication review competence criteria for pharmacists established in Finland in 2017 and piloting the tool among practicing pharmacists in a national online survey in October 2018. The pharmacists self-assessed their medication review competence with a five-point Likert scale ranging from 1 for "very poor/not at all" to 5 for "very good". RESULTS The internal consistency of the self-assessment tool was high as the range of the competence areas' Cronbach's alpha was 0.953-0.973. The competence areas consisted of prescription review competence (20 items, Cronbach's alpha 0.953), additional statements for medication review competence (11 additional items, Cronbach's alpha 0.963) and medication review as a whole, including both the statements of prescription review and medication review competence (31 items, Cronbach's alpha 0.973). Competence items closely related to routine dispensing were most commonly self-estimated to be mastered by the practicing pharmacists who responded (n = 344), while the more clinical and patient-centred competence items had the lowest self-estimates. This indicates that the self-assessment tool works logically and differentiates pharmacists according to competence. The self-assessed medication review competence was at a very good or good level among more than half (55%) of the respondents (n = 344). CONCLUSION A self-assessment tool for medication review competence was developed and validated. The piloted self-assessment tool can be used for regular evaluation of practicing pharmacists' medication review competence which is becoming an increasingly important basis for their contribution to patient care and society.
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Affiliation(s)
- Noora Lias
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland.
| | - Tanja Lindholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
| | - Aleksi Westerholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
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Jelić AG, Tasić L, Škrbić R, Marinković V, Šatara SS, Stojaković N, Peković VM, Godman B. Pharmacists' clinical knowledge and practice in the safe use of contraceptives: real knowledge vs. self-perception and the implications. BMC MEDICAL EDUCATION 2021; 21:430. [PMID: 34399761 PMCID: PMC8365278 DOI: 10.1186/s12909-021-02864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pharmacists are often the first healthcare professionals that patients contact with their illnesses and requests for medical information, which is enhanced following the recent COVID-19 pandemic. Community pharmacists are expected and required to possess a broad spectrum of knowledge and skills. Self-assessment of these competencies is needed for their self-improvement. PURPOSE OF THE STUDY To assess pharmacists' clinical knowledge and practice in the safe use of contraceptives, and to compare the scores obtained by external observation with pharmacists' self-assessment of their knowledge as well as investigate the significance of preceptorship experiences. Contraceptives was chosen as the subject area in view of high rates of abortions as a means of contraception in Bosnia and Herzegovina. METHODS A questionnaire approach was used. The questionnaire included the following: the first domain contained two case scenarios (safe use of contraceptives), which evaluated clinical knowledge, a second domain in which pharmacists self-assessed their knowledge to resolve cases from the first domain and a third domain that measured the demographics of pharmacists (including experience in preceptorship). Dispensing practice was evaluated in the second domain. The questionnaires were distributed to a convenient sample of 100 pharmacists at the Annual Meeting of Bosnia and Herzegovina Pharmacists. The results were presented as counts (%). The groups (preceptors and non-preceptors) were compared using Mann-Whitney U test, paired assessments were analyzed by Wilcoxon signed-rank test and Spearman's correlation was used to assess the correlation between variables. RESULTS Of the 100 pharmacists invited to participate, 84 completed the questionnaire (84 % response rate). There was no agreement between pharmacists' real knowledge (average score - case 1: 2.71, case 2: 3.3) and their self-assessment (average score - case 1: 3.77, case 2: 3.91). There was no statistically significant difference in the actual knowledge of pharmacists (experienced/non-experienced in precepting), while the difference in the self-assessment was significant between these two groups. CONCLUSION Pharmacists appear to overrate themselves, which leads to self-enhancement bias, in which the experience in precepting has some influence. Pharmacists' capability in performing an objective self-assessment of their clinical knowledge needs to be carefully studied in the future to fully benefit patients.
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Affiliation(s)
- Ana Golić Jelić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Banja Luka – Medical Faculty, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Pharmacy, Department of Social pharmacy and Pharmaceutical legislation, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Ljiljana Tasić
- Faculty of Pharmacy, Department of Social pharmacy and Pharmaceutical legislation, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Ranko Škrbić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Banja Luka – Medical Faculty, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina
| | - Valentina Marinković
- Faculty of Pharmacy, Department of Social pharmacy and Pharmaceutical legislation, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Svjetlana Stoisavljević Šatara
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Banja Luka – Medical Faculty, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nataša Stojaković
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Banja Luka – Medical Faculty, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina
| | - Vanda Marković Peković
- Medical Faculty, Department of Social Pharmacy, University of Banja Luka, Save Mrkalja 14, Banja Luka, Bosnia and Herzegovina
| | - Brian Godman
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Scotland Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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Zeenny RM, Akel M, Hajj A, Sacre H, Hallit S, Salameh P. Descriptive assessment of graduates' perceptions of pharmacy-related competencies based on the Lebanese pharmacy core competencies framework. Pharm Pract (Granada) 2021; 19:2320. [PMID: 34221200 PMCID: PMC8234617 DOI: 10.18549/pharmpract.2021.2.2320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/13/2021] [Indexed: 11/14/2022] Open
Abstract
Background Pharmacists possess a unique and complex body of knowledge, skills, attitudes, and behaviors necessary to enable them to optimize health outcomes. Pharmacy organizations publish routinely updated versions of professional competencies that help pharmacy schools integrate advances into their curricula. In Lebanon, no national framework for pharmacy education is officially adopted yet. In 2017, the Official Pharmacists' Association in Lebanon [OPL - Order of Pharmacists of Lebanon] took the initiative to develop a pharmacy core competency framework. Objective The primary objective of this survey was to evaluate graduates' perceptions of pharmacy-related competencies "taught" across Lebanese pharmacy schools/faculties, based on the suggested Lebanese Pharmacy Competencies Framework. This study also explored the association between graduates' demographics, university attributes, and self-assessed competency performance. Methods A cross-sectional study involving pharmacists who graduated from Lebanese universities was performed through a 40-minute online questionnaire distributed over social media platforms and groups of pharmacists. Results Pharmacists perceived their competence as moderate upon graduation, the lowest scores being in fundamental knowledge and medicine supply; the highest reported scores were in personal skills and safe/rational use of medicines. Moreover, females, younger graduates, PharmD holders, and pharmacists working in hospitals/clinical settings and academia had the highest perception of their competencies. Pharmacists in the public sector and medical laboratory directors had the lowest perception of competence. Conclusions When comparing the taught curriculum to the suggested Lebanese Pharmacy Competency Framework, all domains need to be improved to optimize the perception, education, and practice of pharmacists. It is essential to emphasize fundamental knowledge, medicines supply, and public health competencies in undergraduate curricula and improve continuing professional education.
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Affiliation(s)
- Rony M Zeenny
- PharmD. Department of Clinical Pharmacy, American University Beirut Medical Center. Beirut (Lebanon).
| | - Marwan Akel
- PharmD, PhD. School of Pharmacy, Lebanese International University. Beirut (Lebanon).
| | - Aline Hajj
- PharmD, PhD. Laboratory of Pharmacology, Clinical Pharmacy and Quality Control of Drugs, Faculty of Pharmacy, Saint-Joseph University. Beirut (Lebanon).
| | - Hala Sacre
- PharmD. National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB). Beirut (Lebanon).
| | - Souheil Hallit
- PharmD, PhD. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK). Jounieh (Lebanon).
| | - Pascale Salameh
- PharmD, PhD. Medical School, University of Nicosia. Nicosia (Cyprus).
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Kim Y, Jeong KH, Kim E. A nationwide survey of the perception of the APPE by community pharmacy preceptors in South Korea. J Am Pharm Assoc (2003) 2021; 61:715-721.e3. [PMID: 34119425 DOI: 10.1016/j.japh.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Considering that approximately 75% of active pharmacists work in a community pharmacy globally, experiential practice in community pharmacies is a crucial part of pharmacy education. Skilled preceptors and their perceptions are integral to experiential practice. However, the perception of community pharmacy preceptors on a nationwide level is rarely studied. OBJECTIVES To examine the perception of community pharmacy preceptors who had undertaken the newly implemented community pharmacy experiential practice in South Korea. METHODS This study was based on a self-administered, nationwide, online cross-sectional survey performed by the Korean Pharmaceutical Association in 2017. Active community pharmacy preceptors undertaking experiential practice in South Korea were enrolled. The preceptor's competence, satisfaction, stress, achievement, and the likelihood of continuing preceptorship were evaluated using a 4-point Likert scale. In addition, the determinants of perception were evaluated using multivariate logistic regression analysis. RESULTS Of the 681 active preceptors, 390 (response rate: 57.3%) participated in this study, and the data of 385 participants were used for the final analysis. The majority of the preceptors were satisfied (83.1%), felt high achievement (85.8%), and were likely to continue with the preceptorship (85.7%). However, 52.8% reported increased stress due to the increased workload and lack of personal time. Preceptors who participated voluntarily had higher competence (odds ratio [OR] 2.050, 1.265-3.322) and exhibited lower stress (OR 0.560, 0.368-0.852). The academic degrees of preceptors and the number of preceptees trained by them were significantly related to competence. Preceptor age (>50 years) was negatively associated with stress (OR 0.635, 0.419-0.962). CONCLUSION Because competence is a key element associated with community pharmacy preceptors, it is necessary to create an environment in which preceptors can consider themselves competent. This nationwide study with community pharmacy preceptors will provide a basis for improving the quality of training at community pharmacies and may aid experiential practice administrators in revising the current program.
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The development, validity and applicability to practice of pharmacy-related competency frameworks: A systematic review. Res Social Adm Pharm 2021; 17:1697-1718. [PMID: 33640334 DOI: 10.1016/j.sapharm.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Global reforms in the education of health workers has culminated in the implementation of competency-based education and training (CBET). In line with the CBET model, competency frameworks are now commonplace in the health professions. In pharmacy, these frameworks are used to regulate career entry, benchmark standards of practice and facilitate expertise development. OBJECTIVE This systematic review assessed the development, validity and applicability to practice of pharmacy-related competency frameworks. METHOD PubMed/Medline, CINAHL, Embase, ERIC, Scopus, ProQuest and PsycINFO electronic databases were searched to identify relevant literature. Additional searching included Google Scholar, electronic sources of grey literature, and the Member Organisation websites of the International Pharmaceutical Federation (FIP). The findings of this review were synthesised and reported narratively. The review protocol is registered on PROSPERO with reference number CRD42018096580. RESULTS In total, 53 pharmacy-related frameworks were identified. The majority (n = 38, 72%) were from high income countries in Europe and the Western Pacific region, with only three each from countries in South East Asia (SEA) and Africa. The identified frameworks were developed through a variety of methods that included expert group consultation used alone, or in combination with a literature review, job/role evaluation, or needs assessment. Profession wide surveys and consensus via a nominal group, Delphi, or modified Delphi technique were the primary methods used in framework validation. The competencies in the respective frameworks were generally ranked relevant to practice, thereby confirming validity and applicability. However, variations in competency-related terminologies and descriptors were observed. Disparities on perception of relevance also existed in relation to area of practice, length of experience, and level of competence. For example, pharmaceutical care competencies were typically ranked high in relevance in the frameworks, compared to others such as the research-related competencies. CONCLUSION The validity and applicability to practice of pharmacy-related frameworks highlights their importance in competency-based education and training (CBET). However, the observed disparities in framework terminologies and development methods suggest the need for harmonisation.
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Kallio S, Eskola T, Airaksinen M, Pohjanoksa-Mäntylä M. Identifying Gaps in Community Pharmacists' Competence in Medication Risk Management in Routine Dispensing. Innov Pharm 2021; 12. [PMID: 34007683 PMCID: PMC8102976 DOI: 10.24926/iip.v12i1.3510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Community pharmacists increasingly contribute to medication risk management while dispensing medicines to outpatients. Their risk management actions are shifting from medication counselling towards reviewing medications and following-up their therapeutic effects and outcomes. Acquiring these more clinical tasks require more patient care-oriented competences. Objective To identify gaps in community pharmacists' competence in medication risk management in routine dispensing. Setting All community pharmacies in Finland. Method A national cross-sectional online survey was conducted through the Association of Finnish Pharmacies (n=574 community pharmacies) and the university pharmacies (n=2) in 2015. One pharmacist from each pharmacy was recommended to report on behalf of their outlet. Main outcome measure Community pharmacists' self-assessed competence to: 1) identify medication-related risks, 2) utilise electronic tools in medication risk management, and 3) identify their perceived needs for developing competence in medication risk management. Results Responses were received from 169 community pharmacies (response rate 29%). The highest proportion of good competency estimates were self-assessed in confirming doses (98% of the respondents evaluated their competence to be good) and identifying drug-drug interactions (83%). Competence to identify adverse effects, such as serotonergic load (10%) and anticholinergic load (12%), was most seldomly perceived as good. Of the wide range of electronic databases available, respondents most commonly reported using daily summaries of product characteristics (97% of the respondents), the checklist-type generic medicines information database that supports in medication counselling (85%), and the programme assisting in identifying drug-drug interactions (83%). The most commonly reported training needs were related to the identification of serotonergic load (63%), anticholinergic load (62%), and evaluating the clinical significance of drug-drug interactions (54%). Conclusion The results indicate remarkable gaps in community pharmacists' current competence in medication risk management, particularly in their competence in applied and geriatric pharmacotherapy.
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Affiliation(s)
- Sonja Kallio
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland.,Hyvinkää 3 Pharmacy, Hyvinkää, Finland
| | - Tiina Eskola
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland.,Forssa 1 Pharmacy, Forssa, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
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Zhao R, D’Eon M. Five ways to get a grip on grouped self-assessments of competence for program evaluation. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e90-e96. [PMID: 32821308 PMCID: PMC7417831 DOI: 10.36834/cmej.69276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Self-assessments conducted by individuals when taken together (grouped) provide valid and accurate measures of learning outcomes of the group. This is useful for program evaluation. Grouped self-assessments are simple to understand and construct, easy to implement, relatively accurate, and do not require extensive and complex pre-post testing measures. However, group self-assessments have the potential to be misused. To examine how group self-assessments have been used in medical education, we conducted a search of journal articles published in 2017 and 2018 from eight prominent medical education journals. Twenty-seven (n = 27) articles that used self-assessments for program evaluation were selected for data extraction and analysis. We found three main areas where misuse of self-assessments may have resulted in inaccurate measures of learning outcomes: measures of "confidence" or "comfort", pre-post self-assessments, and the use of ambiguous learning objectives. To prevent future misuse and to build towards more valid and reliable data for program evaluations, we present the following recommendations: measure competence instead of confidence or comfort; use pre-test self-assessments for instructional purposes only (and not for data); ask participants to do the post-intervention self-assessments first followed by retrospective pre-intervention self-assessments afterwards; and use observable, clear, specific learning objectives in the educational intervention that can then be used to create the self-assessment statements.
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Jeon MM, Took RL, Gattas NM. Addressing challenges to precepting advanced pharmacy practice experience students in the community setting. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:872-877. [PMID: 32540050 DOI: 10.1016/j.cptl.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/16/2019] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE An advanced pharmacy practice experience (APPE) in a community pharmacy setting is required in all accredited doctor of pharmacy program curricula in the United States. This setting often presents unique challenges to precepting students that may hinder the development and availability of robust learning experiences. This qualitative review discusses perceived challenges and potential solutions to maintaining a meaningful community rotation experience for students based on published literature and reported preceptor experiences. It also explores the clinical impact of APPE students in community pharmacy. EDUCATIONAL ACTIVITY AND SETTING St. Louis College of Pharmacy (STLCOP) provides a systematic approach to student orientation and evaluation for community pharmacy APPEs. This allows all pharmacy students to be held to the same educational outcome standard. Site preceptors are responsible for communicating site-specific expectations and providing frequent formative feedback to students throughout the five-week rotation. FINDINGS Community rotation students spent approximately 6400 hours providing almost 30,000 patient interventions over two years, indicating a potential benefit in quality of care at student-hosted sites. Despite evidenced benefits of the presence of pharmacy students in community pharmacies, some pharmacists hesitate to precept students due to anticipated obstacles of this additional responsibility. SUMMARY This review explored the community practice APPE structure offered at STLCOP and describes the patient impact that students have made during this clinical rotation. Data seem to indicate a positive return on investment for having APPE students in community pharmacy.
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Affiliation(s)
- Michelle M Jeon
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States.
| | - Roxane L Took
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States.
| | - Nicole M Gattas
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States.
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Ceballos M, Salazar-Ospina A, Sabater-Hernández D, Amariles P. Evaluation of the effects of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in Colombia drugstores and drugstores/pharmacies: study protocol of a multicenter, cluster-randomized controlled trial. Trials 2020; 21:545. [PMID: 32560735 PMCID: PMC7304186 DOI: 10.1186/s13063-020-04481-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background Health disorders, due to the use of drugs with fiscalized substances, including controlled substances, have become a common problem in Colombia. Multiple reasons can help explain this problem, including self-medication, since access to these drugs may be easier. Also, there is a lack of knowledge that these drugs are safer than illicit drugs. The use of these drugs without a valid medical prescription and follow-up can have negative consequences such as drug abuse, addiction, and overdose, and eventually, have negative health consequences. Pharmacy staff is essential to both assure the correct drug use and minimize prescription errors to help outpatients have better management of their pharmacotherapy. For this reason, it is necessary to increase key competencies like knowledge, skills, and attitudes in the pharmacy staff of ambulatory (outpatients) pharmacies. Methods This study is a prospective, cluster-randomized, parallel-group, multicenter trial of drugstores and drugstores/pharmacies (ambulatory pharmacies). The study is designed to determine the effectiveness of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in drugstores and drugstores/pharmacies. Pharmacy staff will be randomly selected and assigned to one of the study groups (intervention or control). The intervention group will receive a continuing education program for over 12 months. The control group will receive only general information about the correct use of complex dosage forms. The primary objective is to evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies (knowledge, skills, and attitudes) to improve the ambulatory (outpatient) pharmacy services: dispensation, health education, and pharmacovigilance of drugs with fiscalized substances. The secondary outcomes include (a) processes associated with the management of drugs with fiscalized substances in drugstores and drugstores/pharmacies, including regulation compliance; (b) degree of implementation of ambulatory (outpatient) pharmacy services targeting these drugs in drugstores and drugstores/pharmacies; (c) patient satisfaction with such services; and (d) pharmacy staff satisfaction with the continuing education program. Discussion This clinical trial will establish whether providing a continuing education program for the adequate utilization of drugs with fiscalized substances improves pharmacy staff competencies regarding these drugs. Trial registration ClinicalTrials.gov NCT03388567. Registered on 28 November 2017. First drugstore or drugstore/pharmacy randomized on December 1, 2018. Protocol version 0017102017MC
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Affiliation(s)
- Mauricio Ceballos
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, U.de.A. Calle 70 No 52-21, Medellin, Colombia.,Research Group on Pharmacy Regency Technology, University of Antioquia, Medellin, Colombia
| | - Andrea Salazar-Ospina
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, U.de.A. Calle 70 No 52-21, Medellin, Colombia.,Research Group on Pharmacy Regency Technology, University of Antioquia, Medellin, Colombia
| | | | - Pedro Amariles
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, U.de.A. Calle 70 No 52-21, Medellin, Colombia.
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van Huyssteen M, Bheekie A, Srinivas SC, Essack A. Continuous Professional Development for Public Sector Pharmacists in South Africa: A Case Study of Mapping Competencies in a Pharmacists' Preceptor Programme. PHARMACY 2020; 8:E96. [PMID: 32503119 PMCID: PMC7356960 DOI: 10.3390/pharmacy8020096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Lifelong learning among healthcare practitioners is crucial to keep abreast of advances in therapeutic and service delivery approaches. In South Africa, continuous professional development (CPD) was mandated (2019) for re-registration of pharmacists to illustrate their learning according to the South African Pharmacy Council's (SAPC) competency standards. This paper uses a preceptor programme linked to the University of the Western Cape School of Pharmacy's service learning programme to map the competencies employed by pharmacist preceptors in primary care public healthcare facilities in Cape Town in an attempt to encourage completion of their annual CPDs and strengthening the academic-service partnership. Competencies identified were divided into input competencies related to the preceptor's role in designing and implementing the educational programme in their facilities and assisting students to complete their prescribed learning activities, and output/outcome competencies that emerged from preceptors identifying the facility needs and employing their input competencies. Input competencies pertained to education, leadership, patient counselling, collaborative practice and human resources management. Output competencies related to pharmaceutical infrastructure, quality assurance, professional and health advocacy, primary healthcare, self-management and patient-centred care. The preceptor programme enabled pharmacist preceptors to employ several competencies that are aligned with the SAPC's competency framework.
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Affiliation(s)
- Mea van Huyssteen
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town 7535, South Africa; (A.B.); (A.E.)
| | - Angeni Bheekie
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town 7535, South Africa; (A.B.); (A.E.)
| | | | - Azeezah Essack
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town 7535, South Africa; (A.B.); (A.E.)
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Bruno-Tomé A, Hadžiabdić MO, Mucalo I, Rennie T. Competency (and Beyond): Think Patient. Collaborate. Develop. Evaluate. Improve. Repeat. PHARMACY 2019; 7:E146. [PMID: 31690053 PMCID: PMC6958416 DOI: 10.3390/pharmacy7040146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 01/16/2023] Open
Abstract
The global workforce needs to be competent, flexible, adaptable, sustainable, and patient-focused. A competency approach towards education, development, and professional practice strengthens services and increases better health outcomes. This paper will provide a global perspective on competency approaches from different health care professions. It will focus on two case reports, describing the use of competency methodologies at an undergraduate and postgraduate level, as well as supporting the internship and/or pre-registration training. Challenges and opportunities will be highlighted by addressing some of the key questions posed for this special edition.
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Affiliation(s)
- Andreia Bruno-Tomé
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia.
| | - Maja Ortner Hadžiabdić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10000 Zagreb, Croatia.
| | - Iva Mucalo
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10000 Zagreb, Croatia.
| | - Timothy Rennie
- School of Pharmacy, University of Namibia, Windhoek, Private Bag 13301, Namibia.
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