Reconsidering Pharmacy: We Need to Turn Career Regret into Career Options

Declining interest in pharmacy as a career is a growing concern. This commentary investigates the factors contributing to career regret among pharmacy graduates, based on data from the American Association of Colleges of Pharmacy National Graduating Student Survey. We identify 3 key contributing factors: workplace environment, professional identity formation, and marketing of the Doctor of Pharmacy degree. We argue that students observe, in many work environments, a lack of autonomy, repetitive tasks, and unfulfilling work. This leads to diminished job satisfaction and disillusionment. Additionally, marketing tactics and curricular structures can inadvertently contribute to career regret. We propose potential interventions, emphasizing the need for improved working conditions, more versatile roles in pharmacy, and enhanced career development services within colleges/schools of pharmacy. Additional research is needed to fully understand career regret and the steps that academic institutions can proactively take to mitigate career dissatisfaction among their graduates.

Guidance for Pharmacy Curricula to Incorporate Health, Wellness, and Health Inequities Stemming From Climate Change: The Report of the 2022-2023 AACP Argus Commission

The 2022-2023 American Association of College of Pharmacy Argus Commission was charged to provide guidance to schools, curriculum committees, and faculty on how to incorporate health, wellness, and health inequities stemming from climate change into pharmacy curricula. The Argus Commission does not advocate for major changes in the curriculum or standards but suggests a concerted effort across the Academy to enhance the awareness of graduating students of the potential impact of climate change on health both now and in the future. Various examples, along with recommendations and suggestions, are provided of how the impact of climate change on health is currently being integrated into curricula in member schools, as well as a list of resources faculty can use to enhance their awareness of issues related to climate change and health. The Commission was also charged to provide guidance to the American Association of College of Pharmacy regarding future fundraising and business development opportunities. Recommendations in that regard are also included in this report.

Undergraduate Student Perceptions of Pharmacy Entrustable Professional Activities

Introduction: With declining applicant numbers, pharmacy education seeks to effectively communicate the value of the pharmacist on the health care team to attract learners to pharmacy. The American Association of Colleges of Pharmacy (AACP) published entrustable professional activities (EPAs) to outline the expected roles and responsibilities of new pharmacy graduates. However, it is unknown whether these statements resonate with the general public and could potentially attract learners to pharmacy. Description of Innovation: Students in PHAR1001: Orientation to Pharmacy, and online undergraduate course were surveyed using EPA statements. The survey was administered to all students before and after the completion of an undergraduate overview of pharmacy course. Participants were to respond "yes" or "no" to statements assessing the relevance of each EPA to pharmacy practice and the expectation of the activity to occur in all pharmacy practice settings. Findings: A total of 283 students participated in the pre-course survey, with 258 students completing the post-course survey. Pre-course, 11 of the 15 EPA statements had a high level of agreement (>80%) for relevance to practice. The high level of agreement continued in the post-course survey with five EPA statements exhibiting a significant increase in both the relevance and expectation of the role in pharmacy practice. Conclusions: Most students, regardless of prior knowledge of pharmacy, found the EPAs illustrative of pharmacist activities even prior to completing the pharmacy course. Entrustable professional activity statements may be a reasonable means to communicate the value of the pharmacist to the general public.

Opening the Black Box: Agreement and Reliability of a Situational Judgment Test Across Multiple Institutions

OBJECTIVE

The primary objective of this study was to examine the levels of agreement and reliability of a situational judgment test (SJT) using a diverse pool of pharmacy practice faculty as subject matter experts. Secondary aims included analyses to build support for test validity and fairness.

METHODS

An SJT containing 18 scenarios and 118 responses assessing empathy, integrity, and teamwork was developed and delivered to pharmacy practice faculty at 5 schools of pharmacy across the United States. Reliability was assessed by examining internal consistency, inter-rater reliability, and split-half reliability. Only responses which attained an inter-rater agreement>0.7 were included in the final version of the SJT. All responses were scored using a near-miss system, allowing higher scores for answers more closely aligned with the key, which was determined by the faculty who completed the SJT. Test fairness was reported using descriptive statistics.

RESULTS

Thirty-nine faculty across the 5 participating institutions completed the SJT. The final version of the SJT included 105 responses, achieving an inter-rater agreement of>0.7 (inter-rater reliability of 0.98). Split-half reliability was 0.72. The average score was 85.7%, and no differences in performance were observed based on demographic characteristics.

CONCLUSION

An SJT designed to assess empathy, integrity, and teamwork achieved reasonable levels of reliability among pharmacy practice faculty across the United States, and the results provided initial support for test validity and fairness. These results support a pilot to assess this SJT among students representing multiple institutions.

Development of an Entrustment-Supervision Assessment Tool for Pharmacy Experiential Education Using Stakeholder Focus Groups

Objective To devise a pharmacy-specific, expanded entrustable professional activities (EPA) entrustment-supervision scale that would frame preceptor ratings in a prospective and retrospective manner for use in experiential learning settings.Methods A series of focus group sessions were conducted to solicit expert opinion on how to develop and refine two entrustment-supervision scales. Purposive sampling was used to identify experts from different professional groups (physicians, pharmacy experiential administrators, and pharmacy practice faculty) who had extensive knowledge regarding EPAs and at least one publication related to EPAs. Panelists were invited to participate via email. Three focus sessions were conducted via videoconferencing between June and September 2019. The primary outcome was development of a pharmacy-specific EPA entrustment-supervision assessment tool. Secondary outcomes were individual entrustment-supervision statements across five levels of the entrustment-supervision scale.Results The focus group consisted of four pharmacy practice faculty, two experiential administrators, and one academic physician. Four concepts emerged from the focus group discussion: need for more granularity in entrustment-supervision scales; limitations due to differences in licensure requirements across the United States; present and ongoing use of expanded scales by schools and colleges of pharmacy; and uncertainty regarding how to rate entrustment-supervision when a student exhibits unprofessional behavior.Conclusion A pharmacy-specific, expanded EPA entrustment-supervision scale will be useful to support longitudinal assessment of learners in experiential settings where an EPA framework is utilized. Determining when to use a prospective versus retrospective perspective requires further evaluation.

How to use the Delphi method to aid in decision making and build consensus in pharmacy education

OUR SITUATION

As pharmacy educators, we often encounter situations such as designing new curricula or establishing shared values for an organization that may be ambiguous or controversial. To generate effective solutions, it is often necessary to build group consensus with key stakeholders. The purpose of this paper is to describe and provide recommendations for using the Delphi method, a process for facilitating discussions and aiding in decision making.

METHODOLOGICAL LITERATURE REVIEW

An overview of the Delphi method, including its multiple variations, is presented. Steps necessary to complete a Delphi study (building a protocol, developing a research question, defining panelists and panel size, piloting the protocol, round one item creation and analysis, round two and beyond, consensus, increasing clarity, and reporting) is described.

OUR RECOMMENDATIONS AND THEIR APPLICATION(S)

Practical recommendations are provided to support use the Delphi method to build consensus in research. These recommendations include: (1) clarify the purpose of the Delphi, (2) ensure the research questions are grounded in the literature and are relevant, (3) carefully consider panelist processes, (4) determine any definitions that should be given to or developed by panelists, (5) determine methods for enhancing clarity, and (6) employ methods to reduce attrition.

POTENTIAL IMPACT

The Delphi method provides a systematic approach to generating consensus in pharmacy education for commonly encountered situations such as committee meetings, research studies, faculty retreats, classroom activities, and lab meetings.

Critical moments in student learning on international advanced pharmacy practice experiences

INTRODUCTION

The purpose of this study was to evaluate self-perceived critical moments that were transformative to learning in students who participated in an international advanced pharmacy practice experience (APPE).

METHODS

Twenty-two pharmacy students from Purdue University College of Pharmacy, the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and the University of North Carolina Eshelman School of Pharmacy who went on an international APPE participated in a one-hour focus group evaluating self-perceived critical moments that impacted their learning. Focus groups were coded using a conventional content analysis approach and went through a two-cycle open coding process to identify major themes according to country income classification.

RESULTS

Twenty-two students participated in the focus groups with 18% going to a high-income country (HIC) and 82% going to a low-to-middle income country (LMIC) location. Major themes identified within HIC locations included witnessing an innovative patient care technique and experiencing interprofessional healthcare team dynamics. Major themes identified within LMIC locations included engaging in a sensitive patient interaction, experiencing healthcare system barriers, going out of their comfort zone, and making a difference.

CONCLUSIONS

International APPEs in both HIC and LMICs provided students with disorienting experiences that facilitated transformative learning and led to changes in their perspectives on patient care and pharmacy practice. While critical moments were different across country income locations, both provided valuable experiences that could be translated into local context.

The clinical educator's guide to fostering learner motivation: AMEE Guide No. 137

Motivation theory and research remain underused by health professions educators. Some educators say it can seem too abstract. To address this, we applied health care language to learner motivation theories. Using a familiar metaphor, we examined the indications, mechanism of action, administration, and monitoring of learner motivation interventions. Similar to the treatment monographs in medicine compendia, we summarized each motivation intervention in the form of a monograph. The purpose of this guide is for health professions educators to develop an understanding of when (i.e. indication) and how (i.e. mechanism of action) learner motivation interventions work. With this information, they can then access ready-to-implement strategies (i.e. administration) to increase their learner interest and assess the effects of these interventions (i.e. monitoring).

Entrustable Professional Activities (EPAs) for Global Health

PURPOSE

As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings.

METHOD

In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low- to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains.

RESULTS

Twenty-two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability.

CONCLUSIONS

EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions.

The Impact of Two Longitudinal Professionalism Courses on Student Pharmacists' Empathy

Objective. To determine whether empathy increased in first-year student pharmacists after completing longitudinal professionalism courses at two schools of pharmacy, identify potential moderators, and assess whether students' conceptualization of empathy changed with time.Methods. Surveys to assess empathy and other variables were administered to student pharmacists at baseline and at the end of two professionalism courses. Baseline and follow-up scores were compared to detect changes over time. Multivariable analysis was used to identify predictors of empathy scores. Factor analysis was performed to ascertain changes in the dimensionality of empathy.Results. Students' demographics and baseline empathy scores differed between the two schools. Predictors of empathy at baseline included age, female gender, prior health care experience, and altruism score. A small increase in empathy was observed at one school but not in the combined cohort. Empathy was more likely to increase among female students, those with less health care experience, and those who did not work during the school year. Factor analyses suggested that students' conceptual clarity about empathy improved over time and became more consistent with existing models.Conclusion. Although an increase in empathy was not observed in the overall cohort, subgroups of students who may derive greater benefit from empathy-related interventions were identified. Factor analyses suggested that students' conceptual understanding of empathy improved, representing a potential alternative outcome assessment for affective domains. Given differences in demographics, instructional methodologies, and changes in empathy at each school, this study reinforces the importance of replication and multicenter studies to understand the generalizability of educational research.

Global Health Learning Outcomes by Country Location and Duration for International Experiences

Objective. To determine the impact of country income classification and experience duration on learning outcomes for student pharmacists participating in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, longitudinal study evaluated 81 fourth-year student pharmacists participating in an international APPE through one of three US universities. A pre-post survey was administered to evaluate students' self-perceived growth across 13 competencies established by the Consortium of Universities for Global Health (CUGH). The survey included four additional open-ended questions. Student pharmacists were also invited to participate in a focus group. Paired and independent t tests and multiple linear regression were conducted. Qualitative survey and focus group data underwent a two-cycle, open-coding process using conventional content analysis. Results. Students who completed their APPE in a low- to middle-income country had greater growth in all CUGH competency statements compared to those who completed their APPE in a high-income country. Completing the APPE in a low- to middle-income country and prior travel for non-vacation purposes were significant predictors of student growth. Students who went to a low- to middle-income country demonstrated increased cultural sensitivity, more patient-centered care, and skill development, while students who went to a high-income country displayed increased knowledge regarding differences in health care system components, pharmacy practice, pharmacy education, and an appreciation for alternative patient care approaches. Conclusion. Learning outcomes differed between students who completed an APPE in a high-income rather than a low- to middle-income country, with both types of locations providing valuable educational opportunities and professional and personal development.

Co-curricular assessment plan for developing pharmacy professionals (RxPro) after the first professional year

INTRODUCTION

To measure changes in student professionalism from co-curricular activities.

METHODS

A prospective cohort study followed first-year pharmacy students at The University of Texas at El Paso School of Pharmacy. Students completed one co-curricular activity each semester. Learning was assessed using the RxPro VALUE rubric and Professionalism Assessment Tool (PAT) at the beginning and end of the first professional year. The RxPro VALUE rubric included six domains (connections to experience, lifelong learning, diversity of communities and cultures, civic identity and commitment, empathy, and reflection and self-assessment) and was rated from 0 (not yet applied) to 4 (exemplary). The PAT contained 33-items in five domains (reliability, responsibility, and accountability; lifelong learning and adaptability; relationships with others; upholding principles of integrity and respect; and citizenship and professional engagement) and was rated from 1 (knows) to 5 (teaches) (maximum score = 165).

RESULTS

Mean scores on the RxPro VALUE rubric increased (p < 0.05) from baseline to end of year in five domains: connections to experience (1.44 vs. 2.07), diversity of communities and cultures (1.75 vs. 2.3), civic identity and commitment (1.34 vs. 2.33), empathy (1.44 vs. 2.37), and reflection and self-assessment (1.53 vs 2.19). No significant changes were seen in PAT scores from baseline (M = 114.19, standard deviation = 32.832) to end of year (M = 119.56, standard deviation = 29.63, p = 0.35).

CONCLUSIONS

The RxPro VALUE rubric detected growth in professional behaviors among first-year doctor of pharmacy students, while no significant change was observed in the PAT.

Global Health Learning Outcomes in Pharmacy Students Completing International Advanced Pharmacy Practice Experiences

Objective. To examine the global health learning outcomes of Doctor of Pharmacy (PharmD) students from three US schools who participated in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, prospective study was used to assess fourth-year PharmD students at three US pharmacy schools who participated in an international APPE during the 2017-2018 academic year and a matched cohort (control group) of PharmD students who did not participate in an international APPE. To evaluate students' self-perceived growth in the Consortium of Universities for Global Health (CUGH) competencies, all students completed a 13-item retrospective pre-post instrument using a five-point Likert scale. The students who had completed an international APPE were invited to participate in a focus group (N=22). Paired and independent t tests and multiple linear regression were used to analyze data. Qualitative open-ended questions and focus group data were mapped to knowledge, skills, and attitudes themes. Results. The students who completed an international APPE (N=81) showed significantly more growth in CUGH competencies than students who did not (mean improvement in total score of 10.3 [7.0] vs 2.4 [6.0]). International APPE participation was the only significant predictor of growth in CUGH competencies. The international APPE students reported improvements in cultural awareness and appreciation, communication skills, problem-solving skills, adaptability, self-awareness, personal and professional outlook, and global health perspective. Conclusion. Pharmacy students' participation in international APPEs led to significant improvement in all CUGH competencies. The CUGH competency framework appears to be a suitable instrument to assess pharmacy students' global health learning outcomes.

Pharmacy Student Perceptions of the Entrustable Professional Activities

Objective. To determine pharmacy students' perceptions and self-reported preparedness to perform the 15 core entrustable professional activities (EPA) established by the American Association of Colleges of Pharmacy for new pharmacy graduates. Methods. A random sample of Doctor of Pharmacy (PharmD) students from all four professional years at four universities were asked to indicate whether each of the 15 EPA statements was relevant to the practice of pharmacy and whether pharmacists were expected to perform the activity in multiple practice settings. Participants rated their self-perceived level of entrustability for each activity and indicated which three EPAs they felt most and least prepared to perform. Results. Four hundred twenty-three usable responses were received. The majority (≥85%) of students rated all of the EPA statements as relevant and ≥67% indicated that pharmacists were expected to perform them in multiple practice settings with a high percentage of agreement. Students' perceived need for supervision decreased from the P1 to P4 years. These data suggest that students' confidence to perform some activities grew as they gained experience and knowledge. However, in some cases, the self-perceived need for supervision regressed as students better understood the complexity of the activity. The EPA statements students felt most and least prepared to perform varied by year in the program. Conclusion. The core EPA statements were consistently rated by pharmacy students as relevant to pharmacy practice and as an expectation in multiple settings. Students perceived that they require less supervision when performing EPA activities as they progressed through the curriculum.

Validating a Budget Impact Model Using Payer Insight and Claims Data: A Framework and Case Study

BACKGROUND

There is a paucity of studies validating budget impact models. The lack of such studies may contribute to the underuse of budget impact models by payers in formulary decision making.

OBJECTIVE

To assess the face validity, internal verification, and predictive validity of a previously published model that assessed the budgetary impact of antidiabetic formulary changes.

METHODS

4 experts with diverse backgrounds were selected and asked questions regarding the face validity of the structure/conceptual model, input data, and results from the budget impact model. To assess internal verification, structured "walk-throughs," unit tests, extreme condition tests, traces, replication tests, and double programming techniques were used. The predictive validity of the model was evaluated by comparing the predicted and realized budget using mean absolute scaled error. "Realized" budgetary impact of the formulary changes was calculated by taking the difference between realized budget in the year after the formulary changes and the budget had there been no formulary changes (i.e., the counterfactual). The counterfactual budget was modeled using the best fit autoregressive integrated moving average model.

RESULTS

When assessing the face validity of the model, the 4 experts brought up issues such as how to incorporate other health insurance, recent policy changes, cost inflation, and potential impacts on insulin use. The 6 internal verification techniques caught mistakes in equations, missing data, and misclassified data. The realized budget was found to be lower than the predicted budget, with 13% error and an absolute scaled error of 2.60. After removing the model assumption that past utilization trends would continue, the model's predictive accuracy improved (the absolute scaled error dropped below 1 to 0.48). The "realized" budgetary impact was found to be greater than the predicted budgetary impact, largely because of lower-than-expected utilization.

CONCLUSIONS

The budget impact model overpredicted utilization in the year after the formulary changes. Discoveries through the validation process improved the accuracy and transparency of the model.

DISCLOSURES

This project was supported by grant number F32HS024857 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. AHRQ had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or design to submit the manuscript for publication. The findings discussed in this manuscript represent the views of the authors and do not necessarily reflect the views of the Department of Defense, the Defense Health Agency, nor the Departments of the Army, Navy, and Air Force. Hung reports a grant from the AHRQ, during the conduct of the study, and personal fees from CVS Health and BlueCross BlueShield Association, outside the submitted work. Mullins reports grants and personal fees from Bayer and Pfizer and personal fees from Boehringer Ingelheim, Janssen/J&J, Regeneron, and Sanofi-Aventis, outside the submitted work. Mullins, Slejko, and Shaya are employed by the University of Maryland School of Pharmacy. Haines and Lugo have nothing to disclose. Part of this content was previously presented as a poster at the 2017 AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; Denver, CO, and as poster and oral presentations at the 2017 AMCP Nexus Meeting; October 16-19, 2017; Dallas, TX. Part of this content was published as Hung's PhD dissertation.

Using a Budget Impact Model Framework to Evaluate Antidiabetic Formulary Changes and Utilization Management Tools

BACKGROUND

Traditional budget impact models predict the financial consequences of a new drug entering the market. This study provides an example of applying the budget impact framework to a new research question of interest to managed care organizations-what is the budget impact of our formulary and utilization management (UM) policy changes?

OBJECTIVE

To predict the 3-year annual budgetary impact of TRICARE's antidiabetic formulary and UM policy changes using TRICARE claims data.

METHODS

A budget impact model was built in Microsoft Excel using health plan claims data for a 3-year time horizon. Model outcomes included spending on antidiabetic medications and medications used for side effect treatment. In sensitivity analyses, medical costs from inpatient, outpatient, and emergency room visits were also estimated. Model inputs included health plan antidiabetic medication utilization, as well as publicly available drug cost, rebate, dispensing fee, and patient cost-sharing estimates. Type of enrollee and pharmacy were also incorporated into the model. Sensitivity analyses varied estimates for utilization switch rates between preferred and nonpreferred agents, drug costs, rebates, and dispensing fees, as well as predicted impact from implementation delays.

RESULTS

For the 623,827 affected by the formulary and UM policy changes, the model predicted annual savings that increased from $24 million in the first year to $43 million in the third year after the changes. The majority of savings came from drug acquisition costs, as opposed to rebates, copays, and dispensing fees. Sensitivity analyses found savings across all varied parameters and scenarios except an unlikely scenario when 0% of utilization switched from nonpreferred to preferred agents. The model also predicted that the formulary and UM policy changes would lead to $529,439 in savings from medical visit costs in Year 3.

CONCLUSIONS

This budget impact model predicted cost savings from the payer's formulary and UM policy changes.

DISCLOSURES

This project was supported by grant number F32HS024857 from the Agency for Healthcare Research and Quality (AHRQ), which contracted with the University of Maryland School of Pharmacy to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, which had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or design to submit the manuscript for publication. The findings discussed in this manuscript represent the views of the authors and do not necessarily reflect the views of the Department of Defense, the Defense Health Agency, nor the Departments of the Army, Navy, and Air Force. Hung reports a grant from the AHRQ, during the conduct of the study, and personal fees from CVS Health and BlueCross BlueShield Association, outside the submitted work. Mullins reports grants and personal fees from Bayer and Pfizer and personal fees from Boehringer-Ingelheim, Janssen/J&J, Regeneron, and Sanofi, outside the submitted work. Mullins, Slejko, and Shaya are employed by the University of Maryland School of Pharmacy. Haines and Lugo have nothing to disclose. Part of this content was previously presented as a poster at the 2017 AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; Denver, CO, and as poster and oral presentations at the 2017 AMCP Nexus Meeting; October 16-19, 2017; Dallas, TX. Part of this content was published as Hung's PhD dissertation.

Validation of the entrustable professional activities for new pharmacy graduates

PURPOSE

The face validity of the core entrustable professional activities (EPAs) for new pharmacy graduates published by the American Association of Colleges of Pharmacy (AACP) in 2017 was evaluated.

METHODS

A 28-item questionnaire was sent to experienced pharmacy practitioners affiliated with 4 schools of pharmacy. In addition to demographic information about education, training, credentials, and practice setting, participants were asked whether each EPA statement was pertinent to pharmacy practice and an expected activity that all pharmacists should be able to perform. Questions regarding the secondary attributes of the EPA statements examined whether each activity is observable, is measurable, is transferable to multiple practice settings, and integrates multiple competencies.

RESULTS

The questionnaire was distributed to 137 eligible participants, and 71 usable survey responses were received. Participants consistently agreed (≥75% agreement) that the 15 EPA statements for new pharmacy graduates describe activities that are pertinent to pharmacy practice and that pharmacists are expected to perform. A consistent level of agreement was observed regardless of the preceptor's employment with a college or school, board certification status, or completion of postgraduate training, and no statistical differences in level of agreement were found based on these attributes. There was consistent agreement (≥60%) across geographic regions. No statistical differences in agreement were found between acute care practitioners and ambulatory care practitioners.

CONCLUSION

A survey suggested that the core EPAs developed and vetted by AACP have face validity and are believed by experienced pharmacy preceptor-practitioners to be pertinent to pharmacy practice and to describe activities that all pharmacists should be able to competently perform.

Improved Learning Outcomes After Flipping a Therapeutics Module: Results of a Controlled Trial

PURPOSE

To evaluate the impact on learning outcomes of flipping a pain management module in a doctor of pharmacy curriculum.

METHOD

In a required first-professional-year pharmacology and therapeutics course at the University of Maryland School of Pharmacy, the pain therapeutics content of the pain management module was flipped. This redesign transformed the module from a largely lecture-based, instructor-centered model to a learner-centered model that included a variety of preclass activities and in-class active learning exercises. In spring 2015, the module was taught using the traditional model; in spring 2016, it was taught using the flipped model. The same end-of-module objective structured clinical exam (OSCE) and multiple-choice exam were administered in 2015 to the traditional cohort (TC; n = 156) and in 2016 to the flipped cohort (FC; n = 162). Cohort performance was compared.

RESULTS

Learning outcomes improved significantly in the FC: The mean OSCE score improved by 12.33/100 points (P < .0001; 95% CI 10.28-14.38; effect size 1.33), and performance on the multiple-choice exam's therapeutics content improved by 5.07 percentage points (P < .0001; 95% CI 2.56-7.59; effect size 0.45). Student performance on exam items assessing higher cognitive levels significantly improved under the flipped model. Grade distribution on both exams shifted, with significantly more FC students earning an A or B and significantly fewer earning a D or F compared with TC students.

CONCLUSIONS

Student performance on knowledge- and skill-based assessments improved significantly after flipping the therapeutics content of a pain management module.

Impact of a national antimicrobial stewardship mentoring program: Insights and lessons learned

PURPOSE

The impact of an interprofessional mentoring program to advance antimicrobial stewardship programs (ASPs) in selected U.S. hospitals and lessons learned are described.

SUMMARY

A seven-step mentoring process with self-assessment, telephone calls, continuing education, a one-day onsite visit, action plan, and outcome data collection and analysis was provided to ASP teams at nine hospitals. Six hospitals completed the program. A significant improvement in the timeliness and appropriateness of i.v. antibiotic therapy (defined as a hang time within one hour after prescriber order entry and broad-spectrum coverage for gram-negative pathogens administered first when combination therapy was used) was observed in patients with sepsis over the 12-month period after implementation of the mentoring program. As a result of requiring hospital administration's participation in the mentoring program, increased funding became available at three hospitals for the microbiology laboratory to provide new rapid diagnostic tests and for pharmacist and physician time to devote to ASP activities. The collaboration and engagement of ASP team members, inclusion of hospital administrators and pharmacy directors in the onsite mentoring visits, and an experienced mentor team with an infectious diseases (ID) physician and ID pharmacist contributed to ASP success. Challenges included insufficient time to collect outcome metrics due to competing hospital priorities and loss of momentum over time.

CONCLUSION

A mentoring program for antimicrobial stewardship provided the perspective that comes from experience. Engagement of hospital administration was a key factor for both developing and sustaining a stewardship program.

Recommendations for Evaluating Practice-Related Activities of Pharmacy Faculty

Objective: To develop definitions of who pharmacy practice faculty and partners are, identify indicators to measure practice-related activities, and provide guidance for evaluating pharmacy practice faculty. Methods: A 4-round, online Delphi was conducted. Panelists with experience evaluating pharmacy practice faculty were invited. Consensus was achieved when there was agreement by at least 70% of panelists. Round 1: Panelists were asked to identify the essential distinguishing characteristics of pharmacy practice faculty and practice partners as well as metrics that could be used to measure practice productivity and quality. Responses were grouped into common themes. Round 2: Panelists were asked to agree, agree with changes, or disagree with themes and metrics identified. Round 3: Panelists were asked to agree, agree with changes, or disagree with definitions of pharmacy practice faculty and practice partners. Panelists were asked about procedural elements of evaluation processes that colleges/schools should adopt. Round 4: panelists were asked about areas of uncertainty that had not yet achieved consensus. Results: A total of 17 experts participated. Consensus definitions for pharmacy practice faculty and practice partners were achieved . From 291 submitted indicators, 14 productivity and 10 quality indicators reached consensus along with recommended frequencies for collection and review. Peer review was identified as an important quality indicator. Recommendations regarding who should participate in the evaluation process and how the data should be used also achieved consensus. Conclusion: Formal mechanisms for evaluating the practice-related activities of pharmacy faculty are critical to ensure this area of responsibility is fairly recognized and considered.

Development and Validation of an Instrument to Determine Patient Knowledge: The Oral Anticoagulation Knowledge Test

Background:

Studies examining the relationship between patient knowledge regarding warfarin therapy and its safe and effective use are limited by the lack of validated knowledge assessment tools.

Objective:

To develop and validate an instrument to assess patient knowledge regarding oral anticoagulation therapy.

Methods:

Four nationally recognized anticoagulation experts participated in the instrument development process to ensure content validity. The Oral Anticoagulation Knowledge (OAK) test was administered to subjects on warfarin and a group of age-matched subjects not on warfarin to assess construct validity. A subgroup of warfarin subjects were retested approximately 2–3 months after initial testing to assess test–retest reliability. Internal consistency reliability was assessed by calculating a Kuder-Richardson 20 value. Item analysis was used to assess performance of individual questions.

Results:

An initial 23 item instrument was pilot tested for readability and comprehension. The OAK test was administered to 74 subjects taking warfarin and 27 age-matched subjects not on warfarin. Thirty-two subjects on warfarin repeated the OAK test an average of 75 days following initial administration. Subjects taking warfarin scored significantly higher than those not on warfarin (72% vs 52%, respectively; p < 0.001), supporting the construct validity of the instrument. Test–retest reliability was acceptable, with a Pearson's correlation coefficient of 0.81. Internal consistency reliability was confirmed by a calculated Kuder–Richardson 20 value of 0.76.

Conclusions:

The OAK test is a brief, valid, and reliable knowledge assessment instrument that may be a useful tool for research and clinical practice to augment patient education programs.

Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program

PURPOSE

Results of the MENTORED QUALITY IMPROVEMENT IMPACT PROGRAM℠ (MQIIP) on Ensuring Insulin Pen Safety in Hospitals, which was part of an ASHP educational initiative aimed at ensuring the safe use of insulin pens in hospitals, are described.

METHODS

During this ASHP initiative, which also included continuing-education activities and Web-based resources, distance mentoring by pharmacists with expertise in the safe use of insulin pens was provided to interprofessional teams at 14 hospitals between September 2014 and May 2015. The results of baseline assessments of nursing staff knowledge of insulin pen use, insulin pen storage and labeling audits, and insulin pen injection observations conducted in September and October 2014 were the basis for insulin pen quality-improvement plans. Postintervention data were collected in April and May 2015.

RESULTS

Compared with the baseline period, significant improvements in nurses' knowledge of insulin pen use, insulin pen labeling and storage, and insulin pen administration were observed in the postintervention period despite the relatively short time frame for implementation of quality-improvement plans. Program participants are committed to sustaining and building on improvements achieved during the program. The outcome measures described in this report could be adapted by other health systems to identify opportunities to improve the safety of insulin pen use.

CONCLUSION

Focused attention on insulin pen safety through an interprofessional team approach during the MQIIP enabled participating sites to detect potential safety issues based on collected data, develop targeted process changes, document improvements, and identify areas requiring further intervention. A sustained organizational commitment is required to ensure the safe use of insulin pen devices in hospitals.

Processes and Metrics to Evaluate Faculty Practice Activities at US Schools of Pharmacy

Objective. To determine what processes and metrics are employed to measure and evaluate pharmacy practice faculty members at colleges and schools of pharmacy in the United States. Methods. A 23-item web-based questionnaire was distributed to pharmacy practice department chairs at schools of pharmacy fully accredited by the Accreditation Council for Pharmacy Education (ACPE) (n=114). Results. Ninety-three pharmacy practice chairs or designees from 92 institutions responded. Seventy-six percent reported that more than 60% of the department's faculty members were engaged in practice-related activities at least eight hours per week. Fewer than half (47%) had written policies and procedures for conducting practice evaluations. Institutions commonly collected data regarding committee service at practice sites, community service events, educational programs, and number of hours engaged in practice-related activities; however, only 24% used a tool to longitudinally collect practice-related data. Publicly funded institutions were more likely than private schools to have written procedures. Conclusion. Data collection tools and best practice recommendations for conducting faculty practice evaluations are needed.

Treatment Approach to Patients With Severe Insulin Resistance

In Brief Patients with severe insulin resistance require >2 units/kg of body weight or 200 units/day of insulin. Yet, many patients do not achieve glycemic targets despite using very high doses of insulin. Insulin can cause weight gain, which further contributes to worsening insulin resistance. This article describes the pharmacological options for managing patients with severe insulin resistance, including the use of U-500 insulin and newer agents in combination with insulin.

A checklist for the development of faculty mentorship programs

Mentoring of junior faculty members continues to be a widespread need in academic pharmacy in both new programs and established schools. The American Association of Colleges of Pharmacy (AACP) Joint Council Task Force on Mentoring was charged with gathering information from member colleges and schools and from the literature to determine best practices that could be shared with the academy. The task force summarized their findings regarding the needs and responsibilities for mentors and protégés at all faculty levels; what mentoring pieces are in existence, which need improvement, and which need to be created; and how effective mentoring is defined and could be measured. Based on these findings, the task force developed several recommendations as well as the PAIRS Faculty Mentorship Checklist. Academic institutions can benefit from the checklist whether they are planning to implement a faculty mentorship program or are interested in modifying existing programs.

Prevalence of and factors that influence board certification among pharmacy practice faculty at United States colleges and schools of pharmacy

Board certification is a means of demonstrating expertise above the minimum licensing standards. For many health care professionals, this credential is a necessity. As pharmacists become involved in more advanced patient care services, board certification becomes an essential component to ensuring quality care. The prevalence of United States pharmacy practice faculty members who are board certified, however, is unknown. In addition, to our knowledge, factors that serve to motivate or discourage faculty from obtaining board certification have not been previously described; thus, 900 pharmacy practice faculty members listed in the American Association of Colleges of Pharmacy (AACP) online directory were invited to complete an online survey regarding motivators and barriers for board certification. In addition, a list of board-certified pharmacists, obtained from the Board of Pharmacy Specialties, was used to check the board certification status of all pharmacy practice faculty members listed in the AACP directory. In 2011, the prevalence of board certification among the 2867 pharmacy practice faculty members was 37% (1063 pharmacists), with the highest prevalence found among assistant professors (39.4%). A total of 322 faculty members (36% response rate) completed the survey; of these, 308 self-identified as pharmacy practice faculty, and their responses were included in the analysis. Current board certification in pharmacy specialties was reported by 163 respondents (52.9%); 14 (4.5%) were previously certified. Among the 308 respondents, the most common perceived reason why pharmacy practice faculty become board certified was the desire to be recognized as an expert in the field (71.5%). Those who were currently board certified indicated personal growth as the most important reason (60.1%). Those previously certified indicated no perceived benefit as the most common reason for not recertifying (71.4%). Among those never certified, no perceived need (52.0%) or benefit (44.8%) were the most common reasons for not becoming certified; however, a majority of those never certified (68%) stated that they would become board certified if there was no associated cost and they were confident they would pass. To increase the prevalence of board certification in pharmacy practice faculty at U.S. schools and colleges of pharmacy, the benefits of this credential must be addressed at each institution. Steps should be taken to assist and encourage board certification.

Best practice strategies for effective use of questions as a teaching tool

Questions have long been used as a teaching tool by teachers and preceptors to assess students' knowledge, promote comprehension, and stimulate critical thinking. Well-crafted questions lead to new insights, generate discussion, and promote the comprehensive exploration of subject matter. Poorly constructed questions can stifle learning by creating confusion, intimidating students, and limiting creative thinking. Teachers most often ask lower-order, convergent questions that rely on students' factual recall of prior knowledge rather than asking higher-order, divergent questions that promote deep thinking, requiring students to analyze and evaluate concepts. This review summarizes the taxonomy of questions, provides strategies for formulating effective questions, and explores practical considerations to enhance student engagement and promote critical thinking. These concepts can be applied in the classroom and in experiential learning environments.

Anticoagulation; New Pharmacologic Methods to Prevent Venous Thromboembolism in Older Adults: A Meta-Analysis

OBJECTIVE

To conduct a meta-analysis of randomized controlled trials that used newly approved drugs to prevent venous thromboembolism (VTE) in older adults.

DATA SOURCES

PubMed, EMBASE, and International Pharmaceutical Abstracts (through July 2012).

STUDY SELECTION AND DATA EXTRACTION

Full-text clinical trial reports were included if they (1) had a randomized controlled design, (2) used a pharmacologic method approved or anticipated to be approved in the US, (3) enrolled at least 300 subjects, (4) enrolled subjects with a mean age of 65 years or older or performed a subgroup analysis in adults in that population, and (5) scored at least 7 of 8 on quality criteria for clinical trials. Twenty unique studies met the inclusion criteria.

DATA SYNTHESIS

The most common indications for pharmacologic VTE prophylaxis in the identified studies were orthopedic procedures involving the lower extremities and general surgery. Only 2 studies enrolled acutely ill patients admitted to hospital medical services. Fondaparinux (5 studies) was more effective than enoxaparin in preventing VTE (OR 0.5, 95% CI 0.37–0.67; p < 0.00001) but had more bleeding (OR 1.48, 95% CI 1.05–2.08; p = 0.03). Dabigatran 150 mg once daily (3 studies) was less effective than enoxaparin in preventing VTE (OR 1.30, 95% CI 1.09–1.56; p = 0.004) with a similar bleeding risk (OR 0.74, 95% CI 0.46–1.22; p = 0.24). Dabigatran 220 mg once daily (4 studies) was as effective as enoxaparin in preventing VTE (OR 1.02, 95% CI 0.83–1.26; p = 0.84) and had similar bleeding (OR 1.08, 95% CI 0.66–1.76; p = 0.76). Rivaroxaban (4 studies) was more effective than enoxaparin in preventing VTE (OR 0.38, 95% CI 0.23–0.61; p < 0.0001) with a trend toward a higher rate of bleeding (OR 1.8, 95% CI 0.90–3.60; p = 0.09). Apixaban (5 studies) was more effective than enoxaparin in preventing VTE (OR 0.64, 95% CI 0.43–0.96; p = 0.0002) and had a similar rate of bleeding (OR 0.71, 95% CI 0.42–1.21; p = 0.21).

CONCLUSIONS

When compared to enoxaparin, newer drugs exhibit slightly different safety and efficacy profiles when used for VTE prevention in older adults undergoing major orthopedic surgery. There are insufficient data for other indications. The benefits and risks of new pharmacologic methods of VTE prevention are unclear in the oldest old (age ≥85 years) and in those admitted to a hospital for an acute medical illness or to a skilled nursing facility.