A Cross Sectional and Longitudinal Study of Pharmacy Student Perceptions of Readiness to Serve Diverse Populations

How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review

BACKGROUND

It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes.

AIM

This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education.

METHOD

Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875.

RESULTS

The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other.

CONCLUSION

There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.

Pedagogical Tools and Strategies for Developing Cultural Intelligence in Pharmacy Students and Educators

OBJECTIVE

To review evidence-based pedagogical tools and strategies used to support the development of cultural intelligence in pharmacy education.

FINDINGS

An exhaustive list of search terms was included to capture the variety of terms for "cultural intelligence" (eg, cultural competence). The search was not limited to any publication year range. Search engines included PubMed, Embase, CINAHL, Scopus, ProQuest Dissertations and Theses, ERIC, and PsycInfo. A total of 639 articles were identified after removing duplicates. Eighty-two articles were included for full review after screening. Year of publication ranged from 2004 - 2021. Two articles (2.4%) described tools for educator development, whereas the rest (n = 80, 97.6%) focused on student development. Examples of tools reported included lectures and workshops. Twenty-seven articles (32.9%) described pedagogical tools for fostering cultural intelligence concurrently with interprofessional development; the remaining articles (n = 55, 67.0%) focused only on pharmacy. Thirty-two articles (39.0%) used quantitative analysis methods, and 13 articles (15.9%) used qualitative analysis methods. Sixty-four articles (78.0%) included outcomes of perceptions, 6 (7.3%) included outcomes of participation, and 33 (40.2%) included outcomes of performance. Although not every study addressed all 4 cultural intelligence framework domains (awareness, knowledge, practice, and desire), each domain was apparent within the included articles.

SUMMARY

Various pedagogical tools have been used to develop cultural intelligence in pharmacy students with some tools used more than others. Findings suggest that integrating various pedagogical methods throughout the curriculum aligns more closely with the dynamic nature of learning and continuous self-refinement required to develop cultural intelligence.

A Call to Action for a Programmatic Approach to Addressing Health Disparities and Cultural Competency in Pharmacy Education

Pharmacy has recognized the importance of education in health disparities and cultural competency (HDCC) for two decades. More recently, there has been emphasis on incorporating equity, diversity, and inclusion (EDI) in pharmacy programs. While many institutions identify a need to incorporate a programmatic approach to HDCC education to meet the growing needs of a diverse population, pharmacy curricula continue to lack a holistic, programmatic approach. More than ever, Doctor of Pharmacy (PharmD) students should graduate with the knowledge, values, and skills to provide culturally appropriate care for a diverse patient population. This commentary advocates for a holistic, programmatic approach to integrating HDCC education and serves as a call to action for curricular development. It is hoped that this commentary will also set the foundation for additional scholarly work and recommendations regarding a programmatic approach.

A Systematic Review of Assessment Tools Measuring Cultural Competence Outcomes Relevant to Pharmacy Education

Objective. To identify and describe validated assessment tools that measure cultural competence and are relevant to pharmacy education.Methods. A systematic approach was used to identify quantitative cultural competence assessment tools relevant to pharmacy education. A systematic search of the literature was conducted using the OVID and EBSCO databases and a manual search of journals deemed likely to include tools relevant to pharmacy education. To be eligible for the review, the tools had to be developed using a study sample from the United States, have at least one peer-reviewed validated publication, be applicable to the pharmacy profession, and be published since 2010.Results. The systematic literature and manual search identified 27 tools. Twelve assessment tools met the criteria to be included in the summary and their relevancy to pharmacy education is discussed.Conclusion. A review of literature demonstrates that assessment tools vary widely and there is no one tool that can effectively assess all aspects of cultural competence in pharmacy students or the Doctor of Pharmacy curriculum. As cultural competence is a priority within the accreditation standards for pharmacy education, PharmD programs are encouraged to develop additional tools that measure observed performance.

Identifying areas of improvement for cultural competence in pharmacy curricula: A multi-school study using the self-assessment of perceived level of cultural competence (SAPLCC) questionnaire

INTRODUCTION

The implementation of culturally competent healthcare services has been considered a key strategy for the provision of patient-centered care; however, a need remains to address the requirements of teaching cultural competence, including identifying gaps, designing and evaluating curricula, and assessing students' progress toward program objectives. The objective of this study was to explore the applicability of the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) questionnaire in the identification of improvement areas in cultural competence content in pharmacy curricula.

METHODS

This study used previously-collected SAPLCC data from student pharmacists at eight United States pharmacy schools. Total and factor-specific SAPLCC scores were calculated based on the 14 factors published previously and grouped into six domains (knowledge, skills, attitudes, encounters, abilities, and awareness). Differences in overall scores by domain and factors across various student characteristics were examined using analysis of variance.

RESULTS

The overall mean total SAPLCC score was classified as moderate. Third-year students had significantly higher SAPLCC mean scores than first-year students, and African American students scored significantly higher than their counterparts. At the factor-level, students scored higher in the Attitudes and Awareness domains and scored lower in the Knowledge, Skills, and Encounters domains.

CONCLUSIONS

The application of the SAPLCC in schools participating in this preliminary study allowed for the identification of content areas that may benefit from revision. The SAPLCC may be a useful tool for mapping cultural competence curricular content by each specific domain and identifying areas of potential improvement regarding cultural competence training within pharmacy curricula.

Descriptive assessment of graduates' perceptions of pharmacy-related competencies based on the Lebanese pharmacy core competencies framework

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.

Insights from a capstone workshop: An investigation of soon-to-be pharmacists' readiness to provide culturally competent pharmaceutical care

INTRODUCTION

This study investigated readiness of soon-to-be pharmacists to provide culturally sensitive patient-centered care through administration of a capstone workshop.

METHODS

The workshop was delivered in 2017 and 2018 and consisted of a pre-survey, a didactic lecture followed by group discussions of Worlds Apart cases, and a post-survey. The surveys contained knowledge questions and perception statements. Results were analyzed using descriptive and inferential statistics. Group questions were aligned to constructs from Campinha-Bacote's Model of Cultural Competence. The percentage of groups with correct answers was calculated.

RESULTS

Both cohorts significantly increased their knowledge by the end of the workshop (p = 0.007, 2017; p < 0.001, 2018). Significant increases in respondent agreement to perception statements were also observed post-workshop. The percent of correct group responses varied by construct within the cultural aspect, between the aspects for each year, and between years. The evaluation of overall cultural readiness yielded the lowest results.

CONCLUSION

This research revealed the necessity and value of the capstone workshop. Significant improvements in meeting cultural competence standards were observed upon completion of the exercise. Alignment of group discussion questions to Campinha-Bacote's Model of Cultural Competence constructs was useful in augmentation of assessment armamentarium as it unearthed gaps in cultural competences of pharmacy graduates. Further multi-institutional research aimed to generalize the findings of this study is highly desired.

For a Healthy (and) Higher Education: Evidences from Learning Outcomes in Health Sciences

Increased recognition of outcomes, or competency-based education, has evolved across higher education on health sciences. However, there is significant diversity in the current study of Portuguese programmes. Considering learning outcomes (LO) as indicators of knowledge, skills, abilities, attitudes and the understanding that the student will gain as a result of an educational experience, this study aims to explore which LO are emphasised on the study programmes of health sciences in Portugal. Through a qualitative methodology, carried out through MAXQDA software, all LO of all Portuguese health sciences study programmes submitted to quality accreditation to the Portuguese Agency for Assessment and Accreditation of Higher Education (A3ES) since 2009 until 2016 were analysed. Although specific knowledge was the most referenced LO, transversal skills were also emphasized, such as critical and reflexive analysis/critical thinking, research, ability to organize and plan and professional ethics. Significant differences were found between LO selection when the analysis was made by comparing the diverse study programmes. This required assortment of knowledge and skills seems to reflect not only the specificities of each health science programme but also the challenging demands on professionals in the 21st century, along with the necessary changes imposed by society, fostering intercultural understanding, tolerance, mutual respect and an ethic of global citizenship and shared responsibility, crucial enablers of educational development for all in the scope of the 2030 Agenda for Sustainable Development.

Assessment of a multi-institution integration of cultural competency activities

INTRODUCTION

To meet educational standards and provide effective patient care, student pharmacists must be well-prepared to interact with a diverse patient population. Thus, the objective was to assess the effectiveness of four different active learning strategies in enhancing the cultural competency (CC) of student pharmacists at multiple institutions.

METHODS

Across two years, eight colleges/schools of pharmacy integrated two sets of CC activities with different student cohorts (first-third professional year) that were designed to address different aspects of CC. Pre- and post-activity, a modified electronic version of the Clinical Cultural Competency Questionnaire (CCCQ) that included the addition of activity-specific questions was distributed to students.

RESULTS

A total of 1009 students participated in these activities across eight colleges of pharmacy. The integration of activities resulted in significant increases in most items on three of the four subscales of the CCCQ (knowledge, skills, and encounters/situations). Items on the attitude subscale remained the same. Students also felt the activities were beneficial in addressing their intent.

CONCLUSIONS

Faculty were able to incorporate these activities throughout their respective curricula with minimal time commitment and resources. The activities improved student perceptions of their CC knowledge, skills, and ability to handle encounters and situations. These activities may be useful for other institutions as they determine the best approach to improve student CC and prepare them for practice.

Students' perceptions of global health competencies in the doctor of pharmacy (PharmD) curriculum

INTRODUCTION

This study sought to determine pharmacy students' self-assessment of their level of competency in specified global health statements across various schools. It also evaluated attributes associated with competency and perception of importance, as well as explored students' perspectives on how best to incorporate global health content into pharmacy education.

METHODS

Cross-sectional survey administered online to pharmacy students from three pharmacy schools in the United States.

RESULTS

The self-assessed competency of pharmacy students in global health topic areas was low. Current or prior exposures outside of the PharmD curriculum to the global health content presented in the survey were significant indicators of self-assessed competency scores. Within individual participating schools, demographic characteristics such as gender, age category, speaking a non-English language, and progression through the PharmD curriculum were also significantly associated with competency scores reported. Most respondents (96%) agreed that relevant global health education should be incorporated into the pharmacy curriculum.

CONCLUSIONS

Pharmacy students generally perceive global health competencies to be of great importance in practice, but acknowledge their deficiencies in this area. The current burden of global health education at the schools surveyed relies on individual student experience rather than curricular support. Ensuring that future pharmacists understand their role in global health teams and are able to achieve the necessary level of competency to function in interdisciplinary initiatives will require more strategic incorporation of relevant content into the curriculum.

Assessing Students' Impressions of the Cultural Awareness of Pharmacy Faculty and Students

Objective. To determine pharmacy students' impressions of their faculty's interactions with diverse student and patient populations. Methods. Three student focus groups were convened. Eighty-four page transcripts were coded, and emergent themes were identified by qualitative analysis. Results. Students defined diversity as multidimensional beyond traditional categories. Emergent themes were faculty awareness or lack of awareness of cultural diversity, disparate cultural perspectives and preferences within student groups, teaching/learning approaches to prepare students to be more culturally competent, and student group dynamics. First- and second-year students emphasized student-to-student interactions, while third- and fourth-year students emphasized a lack of preparation for the realities of contemporary practice based on instructional methods. Conclusion. Students perceived the majority of their pharmacy faculty to be culturally sensitive and aware, but microaggression and discrimination from faculty and student peers were experienced. Study implications can potentially improve curricular offerings, cultural awareness of faculty and students, and care to diverse patient populations.