Making Diagnostic Instruction Explicit in US Pharmacy Education

Empowering Pharmacy Graduates to Diagnose and Prescribe

This commentary underscores the diagnosis and prescribing skills essential to the pharmacists' role on the healthcare team. It advocates for the integration of these skills into pharmacy curricula and emphasizes the urgent need for collaboration among pharmacy educators and the academy to address the omission of diagnosis and prescribing from key frameworks and standards, including the Pharmacists' Patient Care Process (PPCP) and the Curricular Outcomes and Entrustable Professional Activities (COEPA). The commentary calls on colleges and schools of pharmacy to recognize and incorporate these aspects into curricular outcomes, and urges the American Association of Colleges of Pharmacy and the Joint Commission of Pharmacy Practitioners to integrate them into practice frameworks. By taking these steps, we can reshape the future of pharmacy education, enhancing patient care and advancing the profession. The commentary also includes a case study of one college of pharmacy's integration of diagnosis and prescribing skills into its PharmD curriculum, in a state where pharmacists were granted full diagnostic and prescriptive authority. The integration was achieved through faculty-led modifications to the PPCP and COEPA, making diagnosis and prescribing an explicit part of the curriculum.

A Scoping Review of Calls to Action in Pharmacy Education

OBJECTIVES

Calls to action in pharmacy education are frequently observed in the literature, with little information about their authors, audience, or focus, especially regarding whether these calls led to any changes. This scoping review aims to (1) quantitatively and qualitatively characterize the calls to action in pharmacy education and (2) examine the traits of published articles typically associated with effective advocacy.

FINDINGS

A systematic literature search for the scoping review was conducted using the PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3287 articles, 232 were included and extracted for their specific call to action, including topics, audience, and call quality. Two-thirds (66.7%) of the calls were initiated by faculty groups, 49% were commentaries, opinions, or editorials, and 39% were focused on the Doctor of Pharmacy curriculum. More than 90% of the articles were published between 2013 and 2023, with 26% published in 2023 alone. Most calls were directed to colleges/schools of pharmacy (81%). Only 21% of articles had a strong call to action with next steps or recommendations for enacting change.

SUMMARY

The most frequently published calls to action were related to the pharmacy curriculum, authored by faculty groups, directed to pharmacy programs, and published in the postpandemic years, but were often not sufficiently strong to elicit change. To evoke change, calls to action should include several key characteristics according to this scoping review, such as being written in active voice, to a specific audience, with clearly stated problems, and with actionable solutions that could be implemented.

Interprofessional Coproduction of Diagnosis with Medical and Pharmacy Students: An Interactive Case-Based Workshop

Introduction

The Institute of Medicine and national competencies emphasize the importance of interprofessional education to reduce diagnostic error. Clinical pharmacists are increasingly integrated into clinical teams and participate in the diagnostic process. However, few educational resources explicitly teach medical and pharmacy students to collaborate on the production of diagnoses.

Methods

We implemented a 2-hour, online, case-based workshop with 154 second-year medical students and third-year pharmacy students. After brief didactics on the diagnostic process and scope of practice of pharmacists, small groups of eight to 12 medical and pharmacy students with faculty facilitators worked through a case unfolding in two aliquots. Students were provided different but complementary information authentic to their profession. They had to communicate with each other to develop an appropriate differential diagnosis. Students then reflected on how communicating with the other profession impacted their diagnostic reasoning. Comments were coded and counted.

Results

The majority (99%) of students identified their data gathering and differential diagnoses were impacted by working through the case together. More pharmacy students commented on how medical students broadened their differential diagnosis (71%) and added information (72%), contextualizing information, such as past history, medication indications, and physical exam data. More medical students commented on how pharmacy students helped justify (54%) and clarify (22%) the differential diagnosis, often connecting the underlying mechanism of medications with clinical findings.

Discussion

This interactive case-based workshop was effective in teaching medical and pharmacy students to collaborate in the coproduction of diagnosis. It is feasible with minimal resources.

Words matter: Comments in support of diagnosis education in pharmacy

Diagnosis education is explicitly included in the Draft Accreditation Standards 2025 and should be wholeheartedly supported. To address the staggering number of diagnostic errors in the US, the National Academy of Medicine advocates for diagnosis education for all health professions. Misperceptions of pharmacists' involvement in diagnosis are exacerbated by use of implicit language and euphemisms, and it's long overdue that we provide clarity. Pharmacists are engaged in diagnosis and diagnostic reasoning in everyday practice whether realized or not. Diagnosis education is implicitly included in US pharmacy curricula in the Pharmacists' Patient Care Process, and it is time to give students the language to engage in it responsibly to be practice-ready in all states. The explicit inclusion of diagnosis in the Draft Standards 2025 has positive implications for education, practice, and graduates.

A Qualitative Study of Experiences Contributing to Professional Identity Formation in Recent Pharmacy Graduates

OBJECTIVE

A professional identity has been described as "an individual thinking, acting, and feeling" like a person within the profession. The objective of this study was to learn about professional identity formation (PIF) in recent graduates of a pharmacy program.

METHODS

In-depth interviews were conducted with students graduating from a doctor of pharmacy degree program. Investigators performed a thematic content analysis of interview transcripts.

RESULTS

Participants were from community pharmacy practice (4), residencies (4), industry (1), and ambulatory care (1). At the time of the interview, participants were a range of 5-13 months out from graduation. Analysis of the data revealed 4 thematic findings. First, thinking and acting like a pharmacist occurred frequently while in school but feeling like a pharmacist occurred mostly after graduation. Second, feeling like a pharmacist meant participants felt confident in their knowledge base and ability to independently make decisions. Third, real-world practice is critical to PIF, particularly through interactions with patients. Finally, feedback, mentoring, and reflection support PIF and can aid in reconciling the tensions between concepts taught in school and experiences in practice.

CONCLUSIONS

In this qualitative analysis of data about PIF obtained from recent graduates from a pharmacy school, we found that thinking and acting like a pharmacist preceded feeling like a pharmacist; feeling like a pharmacist involved confidence in the ability to work autonomously; feedback, mentoring, and reflection on experiences supported PIF; and real-world experiences were critical to PIF.

A call to action: next steps to advance diagnosis education in the health professions

OBJECTIVES

Improving diagnosis-related education in the health professions has great potential to improve the quality and safety of diagnosis in practice. Twelve key diagnostic competencies have been delineated through a previous initiative. The objective of this project was to identify the next steps necessary for these to be incorporated broadly in education and training across the health professions.

METHODS

We focused on medicine, nursing, and pharmacy as examples. A literature review was conducted to survey the state of diagnosis education in these fields, and a consensus group was convened to specify next steps, using formal approaches to rank suggestions.

RESULTS

The literature review confirmed initial but insufficient progress towards addressing diagnosis-related education. By consensus, we identified the next steps necessary to advance diagnosis education, and five required elements relevant to every profession: 1) Developing a shared, common language for diagnosis, 2) developing the necessary content, 3) developing assessment tools, 4) promoting faculty development, and 5) spreading awareness of the need to improve education in regard to diagnosis.

CONCLUSIONS

The primary stakeholders, representing education, certification, accreditation, and licensure, in each profession must now take action in their own areas to encourage, promote, and enable improved diagnosis, and move these recommendations forward.