The Complicated Middle of the Academic Deanery

The complicated and ever-growing roles of assistant and associate deans (A-deans) can often be compared to those of middle managers. With responsibilities that are rapidly expanding and often unclear or overlapping with other personnel, A-deans may face identity crises. Additionally, because they are often not at the full professor level, they may experience difficulty achieving promotion. In this commentary, the authors call for increased awareness of the challenges associated with these roles and suggest opportunities for change. To maximize effectiveness in their roles, the Academy and colleges/schools are encouraged to explore workload/expectations for A-deans and associated reward structures, including promotion and tenure guidelines with explicit recognition for the important role(s) they play. A-deans are also encouraged to advocate for infrastructure and responsibilities that support both their academic institution and their own individual professional goals.

Cognitive and Metacognitive Processes Demonstrated by Pharmacy Students When Making Therapeutic Decisions

Objective. To characterize the types of cognitive and metacognitive processes demonstrated by third-year pharmacy students during a therapeutic reasoning activity.Methods. A qualitative, descriptive study following a think-aloud protocol was used to analyze the cognitive (analytical) and metacognitive processes observed by third-year pharmacy students as they completed a 25-minute therapeutic reasoning activity. Using a deductive codebook developed from literature about reasoning, two independent coders characterized processes from students' audio-recorded, transcribed think-aloud episodes while making therapeutic decisions about simulated clinical cases.Results. A total of 40 think-aloud episodes were transcribed among the cohort. Categorization of the think-aloud transcriptions revealed a series of cognitive analytical and metacognitive processes demonstrated by students during the therapeutic decision-making activity. A total of 1792 codes were categorized as analytical processes, falling into six major themes: 69% gathering information (1232/1792), 13% processing information (227/1792), 7% making assessments (133/1792), 1% synthesizing information (19/1792), 7% articulating evidence (117/1792), and 4% making a recommendation (64/1792). In comparison to gathering information, a much lower frequency of processing and assessment was observed for students, particularly for those that were unable to resolve the case. Students' movement between major analytical processes co-occurred commonly with metacognitive processes. Of the 918 codes categorized as metacognitive processes, two major themes arose: 28% monitoring for knowledge or emotions (257/918) and 72% controlling the planning of next steps or verification of correct information (661/918). Sequencing the codes and co-occurrences of processes allowed us to propose an integrated cognitive/metacognitive model of therapeutic reasoning for students.Conclusion. This study categorizes the cognitive (analytical) and metacognitive processes engaged during pharmacy students' therapeutic reasoning process. The findings can inform current instructional practices and further research into educational activities that can strengthen pharmacy students' therapeutic reasoning skills.

Preceptor Perceptions of Pharmacy Student Performance Before and After a Curriculum Transformation

Objective. To explore preceptors' perceptions about the performance of undergraduate pharmacy students during experiential placements in Australia, before and after curricular transformation.Methods. Using a semi-structured approach, we interviewed 26 preceptors who had recently supervised students who took part in the transformed curriculum and students from the previous curriculum. A directed content analysis approach was used to analyze the transcripts.Results. Preceptors described students from the transformed curriculum as having improved professional skills, behaviors, and attitudes and as having an increased ability to perform clinical activities compared to students of the previous curriculum. Preceptors also perceived that students in the transformed curriculum had improved clinical knowledge and knowledge application. They less frequently expressed that students in the transformed curriculum had lower-than-expected knowledge levels.Conclusion. The results of this study suggest that curricular transformation with a focus on skill-based and active learning can improve the performance of pharmacy students in terms of their professional behaviors and attitudes, skills, knowledge, and clinical abilities, as perceived by preceptors.

Predicting the Success of International Pharmacists in a Distance-Based US Doctor of Pharmacy (PharmD) Program: Results from a 5-Year Cohort

Background: To establish the predictors of success in an international-trained PharmD (ITPD) program between admission criteria and academic performance. Methods: The primary outcome of this study was the correlation of admission criteria with didactic and experiential grade point averages (GPA) for the first 5 years. Candidates meeting the minimum criteria completed a competency exam or the US-Foreign Pharmacy Graduate Equivalency Exam (US-FPGEE). Tests of English language proficiency (TOEFL(R) and ACTFL’s Oral Proficiency Interview) plus interview with faculty, students, and alumni were also required. Scores were correlated with both didactic and experiential GPAs. Results: The 23 students admitted to the ITPD program had a cumulative GPA of 3.72. There was a significant correlation between total admissions score and the median pharmacy and healthcare course category GPA (ρ 0.53), but not other categories. The composite TOEFL did not predict any performance but TOEFL writing and speaking did correlate with advanced pharmacy practice experience (APPE) performance. The OPI scores were associated with higher GPAs overall, in advanced integrated clinical sciences, and APPEs. The admission interview scores consistently and significantly correlated with preceptor-rated APPE GPA, practitioner skills, and professionalism (ρ > 0.5; p < 0.05). Performance in early courses significantly predicted the performance in advanced courses and experiential performance (ρ 0.48−0.61). Conclusion: The correlations between early and late course performance demonstrated the cohesiveness of this program. Further study is needed between the predictors of success using non-cognitive admission criteria.

Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study

PURPOSE

Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa.

METHOD

The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally.

RESULTS

The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2).

CONCLUSIONS

This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.

Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study

INTRODUCTION

Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition.

METHODS

We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally.

RESULTS

We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3).

DISCUSSION

This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.

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.

Predictors of Pharmacy Student Performance on Written and Clinical Examinations in a Flipped Classroom Curriculum

Objective. To examine the effects of student demographics, prior academic performance, course engagement, and time management on pharmacy students' performance on course examinations and objective structured clinical examinations (OSCEs).Methods. Study participants were one cohort of pharmacy students enrolled in a five-year combined Bachelor and Master of Pharmacy degree program at one institution. Variables included student demographics, baseline factors (language assessment and situational judgement test scores), prior academic performance (high school admission rank), course engagement, and student time management of pre-class online activities. Data were collected from course, learning management system, and institutional databases. Data were analyzed for univariate, bivariate, and multivariate associations (four linear regression models) between explanatory factors and outcome variables.Results. Three years of data on 159 pharmacy students were obtained and entered in the dataset. Significant positive predictors of OSCE communication performance included domestic (ie, Australian) student designation, higher baseline written English proficiency, and pre-class online activity completion. Positive predictors of OSCE problem-solving included workshop attendance and low empathy as measured by a baseline situational judgment test (SJT). Positive predictors of performance on year 2 end-of-course examinations included the Australian Tertiary Academic Rank, completing pre-class online activities prior to lectures, and high integrity as measured by an SJT.Conclusion. Several explanatory factors predicted pharmacy students' examination and OSCE performance in the regression models. Future research should continue to study additional contexts, explanatory factors, and outcome variables.

Sustainable Pharmacy Education in the Time of COVID-19

Pharmacy schools and colleges worldwide are facing unprecedented challenges to ensuring sustainable education during the novel coronavirus (COVID-19) pandemic. The experiences of pharmacy educators in the Asia-Pacific region in delivering emergency remote teaching, ensuring purposeful experiential placements, supporting displaced or isolated students, and communicating with faculty members, staff members, and students are discussed. The role of this pandemic in accelerating opportunities for new models of pharmacy education across the world is also discussed.

Emerging Innovations and Professional Skills Needed Within Pharmacy Curricula

To ensure students are prepared for the rapidly evolving world of health care, curricula must be aligned with emerging innovations, as well as professional skills likely to influence students' abilities to be successful. At the 2019 annual meeting of PharmAlliance institutions, we asked experts to identify innovations and professional skills necessary for the future of pharmacy practice. Experts identified a wide range of topics, including personalized and precision medicine, digital health, interprofessional collaboration, clinical decision making, and overcoming complexity and ambiguity. While these findings are useful for informing curriculum content, we must also commit to ensuring our pharmacy curricula are emerging, forward thinking, and effective at preparing students for the challenges in health care.

To address emerging infections, we must invest in enduring systems: The kinetics and dynamics of health systems strengthening

Clinical pharmacology uses foundational principles of pharmacokinetics (PK) and pharmacodynamics (PD) to address medication use spanning a continuum from molecules to the masses. In the realm of infectious diseases, PK/PD attributes are considered especially important, because subtherapeutic dosing of antibiotics has been associated with poorer clinical outcomes in patients and increased incidences of drug resistance in populations. In consideration of these PK/PD principles, we will describe the analogous relationship between health systems strengthening, including for educating healthcare providers about emerging infections, and the tenets of therapeutic drug monitoring.

Do training programs work? An assessment of pharmacists activities in the field of chemical dependency

OBJECTIVES

The primary objective of this study was to determine if a selected sample of pharmacists who had attended a chemical dependency training program were performing more chemical dependency related activities than a group of American Pharmaceutical Association (APhA) members who had not had this training. Additionally, an assessment of the perceived barriers to performing chemical dependencyrelated activities was performed.

DESIGN

A confidential mail questionnaire was sent to 305 Utah School participants and 305 APhA members who had not participated in the program (See Appendix).

RESULTS

Respondents who had received educational training in chemical dependency were more likely to perform the following activities: lecture to community groups and health care professionals about chemical dependency, participate in a pharmacists' recovery program, provide patients with information about treatment centers, and counsel patients about the alcohol in over-the-counter products. Respondents who had not received chemical dependency training indicated that the following barriers prevented them from taking a more active role in the chemical dependency field: lack of knowledge of chemical dependency resources in the community, unaware of how to get involved with the state recovery program, belief that involvement in the state recovery program would hurt their professional reputation, belief that chemically dependent individuals cannot be rehabilitated, and uncomfortable working with chemically dependent patients.

CONCLUSIONS

Pharmacists who have attended substance abuse training programs are performing more chemical dependency activities than pharmacists who have not received training in chemical dependency. In addition, different barriers to performing chemical dependency related activities exist between pharmacists with and without training in this field.

An evaluation of smoking cessation-related activities by pharmacists

OBJECTIVES

To (1) describe the types of smoking cessation intervention activities performed by community pharmacists and (2) assess the perceived barriers to this type of intervention.

DESIGN

Confidential mail questionnaire.

SETTING AND PARTICIPANTS

541 community pharmacists in North Carolina and 946 community pharmacists in Texas.

RESULTS

North Carolina and Texas differ with respect to the sale of cigarettes at the practice site, with North Carolina pharmacies being more likely to sell tobacco products. Overall, 555 (92.5%) respondents reported that they do not routinely ask new patients if they smoke or use tobacco products. Pharmacists described themselves as knowledgeable about smoking cessation therapies, and 42% of respondents had attended an educational program on smoking cessation. A total of 230 (39.5%) reported consistently counseling individual patients about smoking cessation treatment strategies on at least a weekly basis. Exploratory factor analysis identified four dimensions of barriers that inhibit pharmacists from engaging in smoking cessation-related activities: (1) pharmacist interpersonal characteristics, (2) practice site considerations, (3) patient characteristics, and (4) financial concerns.

CONCLUSION

Pharmacists have an opportunity to identify health risks and counsel patients about disease-preventing lifestyle changes. These findings suggest that although pharmacists believe they are qualified to perform smoking cessation interventions, they do not routinely identify smokers and they perceive several barriers to participating in such activities. Pharmacists should investigate increased involvement in smoking cessation activities for the benefit of their patients and for the potential professional and economic rewards.

Assessment of the readability and comprehensibility of a CFC-transition brochure

BACKGROUND

In anticipation of public confusion about the availability of medications during the metered-dose inhaler CFC phaseout period, a multidisciplinary effort has resulted in the development of a brochure designed to educate patients and health care providers about the health consequences of ozone depletion and the transition to CFC-free inhaled products. This brochure is the subject of this assessment.

OBJECTIVES

The primary purpose of this study was to estimate the grade of reading difficulty of a brochure designed to educate patients about the change to CFC-free inhalation products. A secondary objective was to assess baseline knowledge of patients concerning CFC transition and their comprehension of this issue after reading the brochure.

METHODS

Standard readability formulae were used to assess the grade level of the CFC transition brochure. In addition, baseline knowledge of the CFC transition process and comprehensibility of the brochure were measured via a 2-page questionnaire.

RESULTS

The SMOG, Rix, and Flesch-Kincaid tests yielded readability at grade levels of 14, 10, and 10.4, respectively. The survey indicated that even after reading the brochure, many patients had concerns about the transition process.

CONCLUSIONS

These results suggest that the readability of the brochure entitled Your Metered-Dose Inhaler Will Be Changing... Here Are the Facts...may not be appropriate for a large segment of the population for whom it is intended. Further, the comprehensibility assessment suggests that many patients are either unaware of or unable to understand the impending changes to their inhaled therapies.

Corpus saphenous by-pass in the treatment of priapism

Two cases treated by corpus saphenous by-pass for priapism have been reported. It is suggested that this method of treatment should be considered soon after the condition is established and when sensible local measures fail. Although in these cases no further erections have followed this treatment we believe that prolonged priapism prior to surgical intervention may be partly responsible.