PharmD Education Program Diversity, Equity, & Inclusion: Aligning Accreditation, Curricula, and the Oath

In November 2021, the Oath of a Pharmacist was updated to include the following statement, "I will promote inclusion, embrace diversity, and advocate for justice to advance health equity." These words underscore the responsibility of Doctor of Pharmacy (PharmD) programs and the Accreditation Council for Pharmacy Education to reconsider how diversity, equity, inclusion, and antiracism are integrated within curricula and programmatic processes. To fully embrace the new Oath, the Accreditation Council for Pharmacy Education and PharmD programs should consider the incorporation of diversity, equity, inclusion, and antiracism concepts utilizing the recommendations of external expert bodies with overlapping and complementary frameworks. The intent is not to add more to the accreditation standards or curricula, but rather to intentionally integrate inclusive approaches into programmatic processes and delivery. This can be accomplished through the alignment of our accreditation standards, PharmD programs, and the Oath that is the foundation of the pharmacy profession.

A multicenter study of gender bias in student evaluations of teaching in pharmacy programs

INTRODUCTION

Student evaluations of teaching (SET) are widely used to assess effectiveness of teaching. Studies conducted to assess the presence of gender bias in SET have produced mixed results. The purpose of this study was to evaluate the presence and degree of gender bias in SET of didactic courses in United States pharmacy programs.

METHODS

A three-year, retrospective, multi-institutional analysis of anonymous SET data were analyzed from required didactic courses. Analysis included gender, SET questions, mean scale score, and number of students responding to each question. A hierarchical linear model was used to compare the gender difference with the normalized SET scores as the outcome.

RESULTS

A total of 2114 SET scores were included from seven pharmacy schools across eight campuses. Analysis of the results revealed that the combined data were skewed secondary to one institution whose results fell significantly outside the mean. When this school was excluded, the difference between SET scores did not differ by gender, b = 0.021, t(1,702) = 0.69, P = .49, with similar SET scores for female faculty (mean = 4.41, SD = 0.35, range = 2.54-5) and male faculty (mean = 4.44, SD = 0.32, range = 2.67-5).

CONCLUSIONS

After secondary analysis, the aggregated data showed no significant difference between ratings of male and female instructors. However, there were differences within individual programs. This illustrates the importance of applying assessment principles to SET to determine the presence of bias so that continuous quality improvement strategies may be applied.

Evaluating Fidelity to Comprehensive Medication Management in Pharmacy Education Courses Teaching the Patient Care Process

Objective. To evaluate fidelity to the comprehensive medication management (CMM) framework in a patient care skills course by using CMM essential functions to analyze the domains of content and competency.Methods. A mixed methods approach was used to compare the curriculum of the Pharmacist's Patient Care Process II skills course to the nationally developed CMM framework. The content of the course curriculum was mapped to the CMM framework and the percentage of omissions and deficiencies were calculated. Student competency was analyzed using pharmacy students' assessment scores.Results. Of the 102 class hours in the PPCP II course, 41.5 hours (40.7%) were spent teaching CMM content. Deficiencies in and omissions of content from the CMM framework were calculated at 14.3%, indicating an overall alignment with the CMM framework of 71.4%. For the competency domain, the percentage of students initially achieving competence ranged from 76.6% to 98.7% on formative assessments in 2018-2019 and 2019-2020, combined academic years. For the summative assessment, 87.5% in 2018-2019 and 69.2% in 2019-2020 achieved competency on their first attempt, with levels rising significantly to 98.8% and 98.7%, respectively, after remediation. Overall, 98.7% of students achieved competency in CMM-related course curriculum.Conclusion. About 70% of the CMM framework for the core domain of content can be covered in approximately 40 hours of direct curricular time, and the majority of students can achieve competency. The omissions of and deficiencies in CMM content identified in this study highlight opportunities for course improvement. Remediation of students with deficient skills resulted in a significant improvement in the percentage of students achieving competence in CMM.

Qualitative Analysis of the Impact of Changes to the Student Evaluation of Teaching Process

Objective. To determine how changes to the student evaluation of teaching (SET) survey instrument and process at a college of pharmacy contributed to improved student response rates and to understand how the process could be further refined. Methods. Pharmacy students from the class of 2018 who had participated in both the old and new SET process were recruited to participate in one of four focus group interviews. An inductive approach was used for data collection and analysis. A focus group guide was created based on two major domains: comparing changes between the old and new SET process and survey form, and determining how the new SET process could be further refined. Results. In South Jordan, UT, six students participated in one of the focus groups and seven students participated in the other focus group. In Henderson, NV, seven students participated in each of the two focus groups. Twenty-seven total students participated in the four focus groups across two campuses. Students stated that reducing the number of questions on each SET survey instrument and using a 5-point rather than a 10-point Likert scale were positive changes. The changes also motivated them to complete the surveys, which improved overall response rates. Although students reported that the monetary incentive (contributions toward the cost of the class banquet) that had been added to the new SET process was a strong motivator, the incentive itself would have likely been insufficient without the other changes. Several participants stated that receiving feedback from faculty members on changes made to teaching materials based upon previous student evaluations was also an important motivator for students to continue completing the surveys. Conclusion. Students identified several motivators for SET participation. Improving the process for survey completion is essential to improve response rates to more accurately represent the feedback of the entire student body. Additionally, the evaluation process must ensure that the data gathered are robust, accurate, and insightful, to be of good use of student and faculty time.

Motivators, barriers, and strategies to improve response rate to student evaluation of teaching

INTRODUCTION

Student evaluation of teaching (SET) is a tool that most pharmacy schools use to evaluate faculty. After multiple years of low response rates to SET, Roseman University began a process to identify motivators, barriers, and strategies to improve SET response rates. Multiple strategies were implemented and response rate was analyzed to determine if the changes were effective.

METHODS

A modified Delphi process was used to identify motivators, barriers, and strategies to improve SET response rates. Faculty, students, and administration engaged in a year-long process involving four distinct phases to build consensus regarding SET implementation and processes. The process was implemented and then response rates were evaluated the following academic year.

RESULTS

Barriers included frequency of surveys, length of surveys, length of rating scale, ambiguity of questions, misunderstanding on importance of SET, and lack of perceived benefit for completion of SET. For each pharmacy class, response rates increased two to three times baseline (p < 0.05). For all classes combined, response rates significantly increased from 24% to 66%.

CONCLUSIONS

The modified Delphi process successfully identified barriers, motivators, and strategies for improving SET. Additionally, the process built consensus that led to successful implementation of the new SET with significantly improved response rates.

Incorporation of an Explicit Critical-Thinking Curriculum to Improve Pharmacy Students' Critical-Thinking Skills

Objective. The Health Sciences Reasoning Test (HSRT) is a validated instrument to assess critical-thinking skills. The objective of this study was to determine if HSRT results improved in second-year student pharmacists after exposure to an explicit curriculum designed to develop critical-thinking skills. Methods. In December 2012, the HSRT was administered to students who were in their first year of pharmacy school. Starting in August 2013, students attended a 16-week laboratory curriculum using simulation, formative feedback, and clinical reasoning to teach critical-thinking skills. Following completion of this course, the HSRT was readministered to the same cohort of students. Results. All students enrolled in the course (83) took the HSRT, and following exclusion criteria, 90% of the scores were included in the statistical analysis. Exclusion criteria included students who did not finish more than 60% of the questions or who took less than 15 minutes to complete the test. Significant changes in the HSRT occurred in overall scores and in the subdomains of deduction, evaluation, and inference after students completed the critical-thinking curriculum. Conclusions. Significant improvement in HSRT scores occurred following student immersion in an explicit critical-thinking curriculum. The HSRT was useful in detecting these changes, showing that critical-thinking skills can be learned and then assessed over a relatively short period using a standardized, validated assessment tool like the HSRT.

Instructional scaffolding to improve students' skills in evaluating clinical literature

OBJECTIVE

To implement and assess the effectiveness of an activity to teach pharmacy students to critically evaluate clinical literature using instructional scaffolding and a Clinical Trial Evaluation Rubric.

DESIGN

The literature evaluation activity centered on a single clinical research article and involved individual, small group, and large group instruction, with carefully structured, evidence-based scaffolds and support materials centered around 3 educational themes: (1) the reader's awareness of text organization, (2) contextual/background information and vocabulary, and (3) questioning, prompting, and self-monitoring (metacognition).

ASSESSMENT

Students initially read the article, scored it using the rubric, and wrote an evaluation. Students then worked individually using a worksheet to identify and define 4 to 5 vocabulary/concept knowledge gaps. They then worked in small groups and as a class to further improve their skills. Finally, they assessed the same article using the rubric and writing a second evaluation. Students' rubric scores for the article decreased significantly from a mean pre-activity score of 76.7% to a post-activity score of 61.7%, indicating that their skills in identifying weaknesses in the article's study design had improved.

CONCLUSION

Use of instructional scaffolding in the form of vocabulary supports and the Clinical Trial Evaluation Rubric improved students' ability to critically evaluate a clinical study compared to lecture-based coursework alone.

Alignment of pharmacotherapy course assessments with course objectives

OBJECTIVE

To determine whether instructor-prepared classroom examinations for pharmacotherapy courses were aligned with course goals and objectives.

DESIGN

Assessment items from examinations in 2 pharmacotherapy courses were evaluated. Four categories of alignment (depth of knowledge, categorical concurrence, range of knowledge, and balance of representation) were used to match course assessments with objectives.

ASSESSMENT

While assessments met the criteria for acceptable alignment, there were areas for improvement. Goals and objectives were unevenly assessed, with 1 goal aligning with 45% of all assessment items. The assessments covered all content categories and the range of knowledge established by the objectives, but objectives under specific goals were not evenly assessed.

CONCLUSION

This alignment study provided quantitative data useful for review and revision of pharmacotherapy course objectives and assessments and demonstrated the usefulness of alignment assessment as a tool for continuous quality improvement.

Vitamin D resistant rickets with alopecia: cultured skin fibroblasts exhibit defective cytoplasmic receptors and unresponsiveness to 1,25(OH)2D3

A new case of vitamin D dependent rickets (Type II) with alopecia in a 5 yr old child is reported. Skin fibroblasts were propagated in culture and analyzed for cytoplasmic 1,25(OH)2D3 receptors. The rachitic cells failed to exhibit specific, high-affinity binding sites by either Scatchard analysis or sucrose density gradient. Furthermore, a rise in 24-hydroxylase activity could not be elicited following incubation of the rachitig cells with 1,25(OH)2D3. Fibroblasts from a non-rachitic child examined in parallel experiments demonstrated high affinity binding sites (Kd = 0.1 nM, Nmax = 33 fmol/100 micrograms DNA) and the induction of 24-hydroxylase activity. The molecular basis of the unresponsiveness of the cells from the rachitic child appears to be due to defective or absent 1,25(OH)2D3 receptors.

Demonstration of 1,25-dihydroxyvitamin D3 receptors in human skin biopsies

In this study we report the demonstration of receptors for 1,25-(OH)2 vitamin D3 in fresh and cultured human skin. Cultured fibroblasts grown from infant foreskin exhibit a binding site which by Scatchard analysis had a Kd for [3H]1,25-(OH)2D3 of 0.2 nM and an Nmax of approximately 40 fmol/mg cytosol protein. On sucrose density gradients the receptor sediments at 3.2S. Receptors could also be identified in skin biopsies from adult patients when assayed either in fresh epidermis or cultured keratinocytes and dermal fibroblasts. The human receptors are similar to rodent receptors assessed in classical target organs such as intestine, bone and kidney. The findings that receptors can be measured in cultured human skin after several arterial passages indicates that skin biopsy may provide a means of assessing the 1,25-(OH)2D3 receptor status of patients.