A scale to measure pharmacy students' self-efficacy in performing medication therapy management services

Curricular Assessment Blueprint and Needs Analysis for the Social, Administrative, and Behavioral Foundational Sciences

OBJECTIVES

The objective of this integrative review is to analyze conceptual topics, applied content, teaching and learning strategies, and assessment methods within social, administrative, and behavioral sciences (SAS) syllabi and literature. The goal is to evaluate opportunities for enhancing the adoption and implementation of Curricular Outcomes and Entrustable Professional Activities 2022. Recommendations to better inform curriculum and assessment planning efforts are presented for programs and faculty seeking to optimize the integration of SAS content.

FINDINGS

Our search yielded 69 SAS-related syllabi from the American Association of Colleges of Pharmacy Connect repository and 296 publications from pharmacy journals focused on education. Most SAS literature was published in the didactic setting, which represents an opportunity to interweave and apply SAS knowledge concepts through the experiential, cocurricular, and interprofessional settings. In the future, it would be prudent to thoughtfully design assessment measures that encompass both summative and formative evaluations. The literature findings offer valuable insights and examples regarding content, teaching strategies, and assessment methods. These findings can serve as a practical framework, providing ideas and guidance for programs and faculty aiming to enhance the integration of SAS content into their curricula.

SUMMARY

In response to the recent guidelines from Curricular Outcomes and Entrustable Professional Activities 2022 and the release of the Accreditation Council for Pharmacy Education Standards 2025, programs and faculty have the responsibility to thoughtfully revise and improve the delivery and assessment of SAS content. The intentional integration of SAS knowledge, skills, and attitudes should be guided by a collaborative effort to develop pharmacists who deliver effective person-centered care and are well-equipped to navigate the complexities of health care.

Implementation and evaluation of a student scholarship program to increase care initiatives in rural pharmacies

INTRODUCTION

Availability of patient care services in rural areas is often lacking, which can reduce access to care for patients living in these areas. Patient care within community pharmacies is vital to care access in rural areas, but expanding pharmacy services can often be challenging. Pharmacy students, especially those on advanced pharmacy practice experiences, are positioned to make an impact on sites.

METHODS

The objective of this study was to describe the implementation, evaluation, and impact of a student scholarship program designed to increase patient care initiatives in rural community pharmacies. Scholarships were provided to students to expand patient care initiatives targeting chronic disease in select rural community pharmacies. Before and after participating in the scholarship program, students completed a survey assessing their perceived ability and confidence to initiate new patient care activities. In addition, patient care services provided by students were tracked and reported cumulatively.

RESULTS

During the first year of implementation, 24 student scholarship rotations were completed. Throughout the 24 rotations, 369 patients were screened for prediabetes, 391 were screened for hypertension, and 552 patients were screened for immunizations. Of the 27 items presented in the survey, 20 items showed a mean statistically significant change indicating an increase in student confidence in leading, developing, and performing patient care activities.

CONCLUSIONS

A student scholarship program designed to increase patient care initiatives in rural community pharmacies led to new patient care services in rural areas and increased student confidence in leading, developing, and expanding upon patient care activities.

Fostering empathy and self-efficacy in pharmacy students through service learning

BACKGROUND

Pharmacy student proficiency in direct patient interactions is an integral component of the doctor of pharmacy curriculum. Service-learning experiences offer pharmacy students valuable opportunities to develop self-efficacy and empathy while serving communities with unmet needs. The objective of this review is to evaluate the impact of service-learning experiences on the self-efficacy and empathy of pharmacy and other health professions students.

METHODS

A narrative literature review was conducted using PubMed, ERIC, and CINAHL databases. Articles were included if they described the relationship between any health professions student service-learning experience and changes in self-efficacy and empathy. Articles were excluded if they involved simulation experiences, standardized patients, or international experiences.

RESULTS

A total of 11 relevant articles were identified, seven examined changes in student self-efficacy and six assessed student empathy. Articles included students representing seven health professions, with one eligible article in pharmacy. All articles investigating self-efficacy reported a positive impact of service learning on student confidence. Most articles focusing on empathy found that service learning had a positive impact on student empathy, and only one article noted a negative trend. Students with limited prior direct patient care experience had the greatest improvement in clinical confidence and empathy.

IMPLICATIONS

This review adds a new perspective to the literature by evaluating evidence-based service-learning models in pharmacy education. Offering additional structured service-learning opportunities for pharmacy students fosters self-efficacy and empathy while supporting communities with unmet needs. Future studies evaluating innovative service-learning models and methods of continuous assessment within the pharmacy curriculum are warranted.

Community pharmacy staff oral health training, training needs and professional self-efficacy related to managing children's dental problems

OBJECTIVES

Few studies have explored the oral health training needs and professional self-efficacy (PSE) in both pharmacy support staff and pharmacists related to managing children's dental problems. This study assessed community pharmacy staff perceptions of their (i) training experiences and interests; (ii) PSE; and (iii) whether this was influenced by the pharmacy being part of a minor ailment scheme (MAS), where staff could directly offer advice and issue prescription medications without patients seeing a doctor.

METHODS

All of the 1851 community pharmacies across London, UK, were invited to participate in an online questionnaire. Staff rated their prior training, perceived need for further training and confidence in giving parents advice related to three dental problems in children (dental pain, mouth ulcers and dental trauma). Information was collected about staff roles and whether the pharmacy was a MAS.

KEY FINDINGS

From 752 community pharmacies, 846 community pharmacy staff participated. Positive experiences of training were variable but interest in further training for all three dental problems was high. Pharmacy support staff had significantly lower PSE scores than pharmacy professionals (P = 0.009). A significant interaction showed that pharmacy staff who had poorly rated prior training on advising parents about managing their child's dental pain and who did not work in a MAS had lower PSE scores than staff who had highly rated training and who worked in a MAS (P = 0.02).

CONCLUSIONS

Minor ailment scheme pharmacies may be an optimal environment for frontline pharmacy support staff to develop higher PSE when combined with good quality oral health training.

Exploring learning needs for general practice based pharmacist: Are behavioural and influencing skills needed?

Background

Embedding pharmacists in general practice has been shown to create cost efficiencies, improve patient care and free general practitioner capacity. Consequently, there is a drive to recruit additional pharmacists to work within general practices. However, equipping pharmacists with behaviour and influencing skills may further optimise their impact. Key elements which may enhance behaviour and influencing skills include self-efficacy and resilience.

Objective

This study aimed to: 1) Assess general practice pharmacists' self-efficacy and resilience. 2) Explore differences primarily between pharmacists reporting lower and higher self-efficacy, secondarily for those reporting lower and higher scores for resilience.

Methods

All 159 NHS Greater Glasgow and Clyde general practice pharmacists were invited to complete an online survey in May 2019. The survey captured anonymised data covering: demographics; professional experience; qualifications, prescribing status and preferred learning styles. Unconscious learning needs for behavioural and influencing skills were assessed using validated tools: the new general self-efficacy scale (GSES) and short general resilience scale (GRIT). Participants' responses were differentiated by the lowest quartile and higher quartiles of GSES and GRIT scores, and analysed to identify differences.

Results

The survey was completed by 57% (91/159) of eligible pharmacists; mean age 38 (range 24-60) years; 91% were of white ethnicity and 89% female. The median time qualified was 14 (1-38) years and 3 (1-22) years working in general practices. Overall pharmacists scored well on the GSES, mean 25 (SD 3; 95%CI 24.4-25.6), and GRIT, mean 30 (SD 4; 95%CI 29.6-30.4), out of a maximum 32 and 40 respectively. A significant positive correlation between GSES and GRIT scores was found (Pearson's r=0.284, p=0.006). However, no significant differences were identified between pharmacists scoring in the lower and upper quartiles by GSES or GRIT. Overall respondents reported their preferred learning styles were activists (46%) or pragmatists (29%). The majority (91%) preferred blended learning methods as opposed to 38% or less for a range of online methods.

Conclusions

General practice pharmacists on average scored highly for self-efficacy and resilience. Higher scores did not appear to be associated with demographic, years of practice, professional or educational experience. Prospective interventions to support those with lower scores may enhance and optimise pharmacists' effectiveness in general practice.

Impacting Student Self-Efficacy and Beliefs of Medication Therapy Management Through a Two-Week Elective

Objective. To develop and introduce an intensive, two-week Foundations of Medication Therapy Management (MTM) elective course into the Doctor of Pharmacy curriculum, and to determine whether the course impacted students' self-confidence in their abilities to perform MTM services and future plans and beliefs about implementing MTM in practice. Methods. The MTM course was an interactive learning environment where students performed actual comprehensive medication reviews within a real-world documentation platform. A 20-item, Likert-scale survey was administered before and after the course to measure students' confidence in learned skills, future plans for using MTM, and beliefs about MTM. Results. Students reported a significant improvement in 10 MTM-specific skill domains. There were significant changes in students' self-confidence in their ability to provide MTM services and in their beliefs about MTM-related services. Students reported overall improvement in self-perceived MTM specific skills. There was no significant change in students' willingness or plans to engage in MTM-related practice in the future. Conclusion. The findings showed that following participation in an MTM elective course, student pharmacists' perceived ability to deliver MTM care increased and their opinions about MTM services improved. Providing a brief MTM elective course that used first-person case studies may empower student pharmacists to confidently perform MTM services in subsequent courses and in their future practice.

Incorporating the American Pharmacists Association's Delivering Medication Therapy Management services certificate program into an accelerated pharmacy curriculum

BACKGROUND AND PURPOSE

To describe the incorporation of the American Pharmacists Association (APhA) Delivering Medication Therapy Management (MTM) Services program into a PharmD curriculum and to describe student perceptions of the program.

EDUCATIONAL ACTIVITY AND SETTING

The program was delivered over 12 months to students on two campuses via two didactic courses in the second professional year and during the first two advanced pharmacy practice experiences in the third professional year of an accelerated school of pharmacy program.

FINDINGS

Student perceptions were assessed by review of responses to the APhA MTM program evaluation survey.

DISCUSSION AND SUMMARY

Incorporation of the APhA MTM program into an accelerated PharmD program required careful planning and coordination amongst faculty and course coordinators. Students perceived that the program was valuable, met their educational needs, and incorporated effective learning experiences and cases. These perceptions were reinforced by the high percentage of students who completed the program.

Experiential Education Builds Student Self-Confidence in Delivering Medication Therapy Management

To determine the impact of advanced pharmacy practice experiences (APPE) on student self-confidence related to medication therapy management (MTM), fourth-year pharmacy students were surveyed pre/post APPE to: identify exposure to MTM learning opportunities, assess knowledge of the MTM core components, and assess self-confidence performing MTM services. An anonymous electronic questionnaire administered pre/post APPE captured demographics, factors predicted to impact student self-confidence (Grade point average (GPA), work experience, exposure to MTM learning opportunities), MTM knowledge and self-confidence conducting MTM using a 5-point Likert scale (1 = Not at all Confident; 5 = Extremely Confident). Sixty-two students (26% response rate) responded to the pre-APPE questionnaire and n = 44 (18%) to the post-APPE. Over 90% demonstrated MTM knowledge and 68.2% completed MTM learning activities. APPE experiences significantly improved students' overall self-confidence (pre-APPE = 3.27 (0.85 SD), post-APPE = 4.02 (0.88), p < 0.001). Students engaging in MTM learning opportunities had higher self-confidence post-APPE (4.20 (0.71)) vs. those not reporting MTM learning opportunities (3.64 (1.08), p = 0.05). Post-APPE, fewer students reported MTM was patient-centric or anticipated engaging in MTM post-graduation. APPE learning opportunities increased student self-confidence to provide MTM services. However, the reduction in anticipated engagement in MTM post-graduation and reduction in sensing the patient-centric nature of MTM practice, may reveal a gap between practice expectations and reality.

Know your medicine: A novel student-led community service learning program

INTRODUCTION

The objective of this article is to describe the efforts of the student pharmacist organization called Know Your Medicine (KYM) as they conduct medication therapy management (MTM) for older adults and underserved communities.

METHODS

Patients brought medications, immunization records, and health concerns to KYM events during academic years 2012-2013 and 2013-2014. Student pharmacists performed health screenings, created personalized medication records (PMR), made recommendations, created personal action plans (PAP), and conducted follow-up phone calls.

RESULTS

Student pharmacists provided MTM services for a total of 107 patients. The mean duration of a KYM appointment was 62±21min, and student pharmacists provided a mean of 3.5±2.1 recommendations per patient. Patients had a mean age of 78±11 years, 4.5±3.2 disease states, 6.9±4.6 prescriptions, 1.9±1.9 OTC medications, and 2.8±2.6 vitamins or herbals. At the time of the follow-up phone call, a mean of 2.6±1.9 recommendations per patient had been followed.

DISCUSSION AND CONCLUSIONS

Student pharmacists successfully implemented a new MTM program for older adults and underserved communities. This program can serve as an example of how other pharmacy colleges and schools might implement MTM training and real-world MTM experience for their student pharmacists.

Self-efficacy for deprescribing: A survey for health care professionals using evidence-based deprescribing guidelines

BACKGROUND

Although polypharmacy is associated with significant morbidity, deprescribing can be challenging. In particular, clinicians express difficulty with their ability to deprescribe (i.e. reduce or stop medications that are potentially inappropriate). Evidence-based deprescribing guidelines are designed to help clinicians take action on reducing or stopping medications that may be causing more harm than benefit.

OBJECTIVES

Determine if implementation of evidence-based guidelines increases self-efficacy for deprescribing proton pump inhibitor (PPI), benzodiazepine receptor agonist (BZRA) and antipsychotic (AP) drug classes.

METHODS

A deprescribing self-efficacy survey was developed and administered to physicians, nurse practitioners and pharmacists at 3 long-term care (LTC) and 3 Family Health Teams in Ottawa, Canada at baseline and approximately 6 months after sequential implementation of each guideline. For each drug class, overall and domain-specific self-efficacy mean scores were calculated. The effects of implementation of each guideline on self-efficacy were tested by estimating the difference in scores using paired t-test. A linear mixed-effects model was used to investigate change over time and over practice sites.

RESULTS

Of eligible clinicians, 25, 21, 18 and 13 completed the first, second, third and fourth survey respectively. Paired t-tests compared 14 participants for PPI and BZRA, and 9 for AP. Overall self-efficacy score increased for AP only (95% confidence intervals (CI) 0.32 to 19.79). Scores for domain 2 (develop a plan to deprescribe) increased for PPI (95% CI 0.52 to 24.12) and AP guidelines (95% CI 2.46 to 18.11); scores for domain 3 (implement the plan for deprescribing) increased for the PPI guideline (95% CI 0.55 to 14.24). Longitudinal analysis showed an increase in non-class specific scores, with a more profound effect for clinicians in LTC where guidelines were routinely used.

CONCLUSION

Implementation of evidence-based deprescribing guidelines appears to increase clinicians' self-efficacy in developing and implementing a deprescribing plan for specific drug classes.

Students' Perception of Self-Efficacy Following Medicinal Chemistry Skills Laboratory Exercises

Objective. To analyze student perceptions of self-efficacy in meeting medicinal chemistry course related educational outcomes and skills following a medicinal chemistry skills laboratory. Methods. Four activities were implemented in a pharmacy skills laboratory (PSL) for second-year pharmacy students. Students (n=121) worked individually on exercises for three of the four activities. Pre/post-laboratory surveys on self-efficacy were administered. The McNemar test was performed to evaluate students' self-efficacy above 70% related to course outcomes before and after the exercises in each activity. An independent t test was conducted to compare the mean of students' responses on meeting course outcomes based on the 70% anchor for the perspective confidence on meeting course outcomes. Results. The post-PSL scores on all self-efficacy questions improved. The majority of students reported skill development in all exercises. Students and clinical faculty qualitative responses indicated they felt exercises were effective. Conclusion. A PSL can serve as a valuable opportunity to address course related educational outcomes and specific skill development and can help students assess their self-efficacy in meeting them.

Integrating Medication Therapy Management Education into a Core Pharmacy Curriculum

Objective. To describe the design of a core course directed at improving confidence and competence of students to perform medication therapy management (MTM) services. Design. Using the American Pharmacists Association (APhA) certificate training program framework, a core course was developed to teach MTM concepts to third-year student pharmacists. Using deep learning and authentic assignments, course instructors attempted to improve student confidence and readiness to provide MTM services. Assessment. Student ability to meet course objectives was evaluated by examinations and the APhA MTM program self-assessment. Students had an overall success rate of 93% on all three assessments. Student perceptions of confidence, competence, and importance of performing MTM services were measured using a survey instrument with 56 Likert-type items. Students completing both surveys reported significantly increased confidence and competence. Conclusion. Integrating MTM-specific education into the core curriculum increased student pharmacists' perceived competence and confidence to perform MTM services.

Using confirmatory factor analysis to manage discriminant validity issues in social pharmacy research

Background Confirmatory factory analysis (CFA) and structural equation modelling (SEM) are increasingly used in social pharmacy research. One of the key benefits of CFA is that it allows researchers to provide evidence for the validity of internal factor structure of measurement scales. In particular, CFA can be used to provide evidence for the validity of the assertion that a hypothesized multi-dimensional scale discriminates between sub-scales. Aim This manuscript aims to provide guidance for researchers who wish to use CFA to provide evidence for the internal factor structure of measurement scales. Methods The manuscript places discriminant validity in the context of providing overall validity evidence for measurement scales. Four examples from the recent social pharmacy literature are used to critically examine the various methods which are used to establish discriminant validity. Using a hypothetical scenario, the manuscript demonstrates how commonly used output from CFA computer programs can be used to provide evidence for separateness of sub-scales within a multi-dimensional scale. Conclusion The manuscript concludes with recommendations for the conduct and reporting of studies which use CFA to provide evidence of internal factor structure of measurement scales.