Skills laboratory faculty job satisfaction: Effects of high-contact teaching and the COVID-19 pandemic

INTRODUCTION

The objective of this study is to describe the workload responsibilities and job satisfaction of skills laboratory faculty, both before and during the COVID-19 pandemic.

METHODS

School of pharmacy (SOP) skills laboratory faculty were surveyed in fall 2021 to gather information on workload responsibilities and job satisfaction, before and during the COVID-19 pandemic. Quantitative data were reported using descriptive statistics and, when appropriate, student t-tests were used to compare responses from before and during COVID-19. Qualitative data were coded for themes by two investigators with a third investigator used to reach consensus.

RESULTS

A total of 45 skills laboratory faculty from 44 of 142 SOP responded to the survey. Faculty reported an average percent effort of 43.9% laboratory teaching, 13.9% non-laboratory teaching, 12.8% service, 6.5% administration, 12.5% patient care, and 10.4% scholarship. Overall job satisfaction decreased from before COVID-19 to during COVID-19, and faculty members' satisfaction specifically with their laboratory role decreased from 7.5 to 6.6 (P = .003). Several themes were identified when respondents described what they loved most about teaching in the laboratory as well as the challenges associated, the majority of which were personnel, resources, and time.

CONCLUSIONS

Skills laboratory faculty reported a high number of laboratory courses coordinated each year along with many hours dedicated each week to prepare and conduct skills laboratory activities. While the pandemic is over, the unique aspects of coordinating student-centered courses likely requires more support for skills laboratory faculty members to avoid burnout and improve job satisfaction.

A lot in a little: Assessment of skills laboratory course structures and faculty workloads

INTRODUCTION

Pharmacy skills development is essential to pharmacy programs to ensure "practice-ready" graduates. The objective was to describe the landscape of skills laboratory (lab) courses and faculty workload across United States schools and colleges of pharmacy (S/COP).

METHODS

The American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group disseminated an anonymous questionnaire to collect faculty demographics, skills lab format, faculty workload, and job satisfaction. Descriptive statistics were generated, and paired t-tests were used to assess changes before and during COVID-19.

RESULTS

Faculty from 44 of 142 S/COP responded. Participants (n = 45) were more frequently assistant professors (49%), non-tenure track (80%), and female (98%). A mean of 103 students per class, with a mean of two lab courses in both the first and second years and 1.6 in the third year were reported. Courses had a mean 1.6 lab coordinators each. Many institutions leverage non-lab faculty, pharmacy volunteers, post-graduate trainees, and senior professional students to assist. Faculty reported a mean 28.2 hours per week related to lab activities. The mean assigned percent effort was 44% for teaching in the skills lab, demonstrating consistency with effort calculations. Job satisfaction (scale 1-10) decreased from 7.6 before COVID-19 to 6.4 during COVID-19 (P < .01), with satisfaction specifically with their lab role decreasing from 7.5 to 6.6 (P = .003).

CONCLUSIONS

Skills lab faculty reported significant time coordinating labs and identified the need for additional support. S/COP should ensure appropriate personnel resources are available to provide quality clinical skills training.

Early skills laboratory warnings: Laboratory faculty perspectives on student barriers for progression to experiential education

INTRODUCTION

This study characterized faculty perceptions of student barriers to achieving an Entrustable Professional Activities (EPA) level 2 or higher in the Patient Care Provider domain.

METHODS

Pharmacy skills laboratory faculty participated in a nominal group technique (NGT) session. Participants reflected on two questions: "What behaviors would result in a student not achieving a rank of EPA readiness level 2 or higher?" and "What knowledge and skills would result in a student not achieving a rank of EPA readiness level 2 or higher?" Participants developed a ranked list using silent brainstorming, idea generation, clarification, and discussion.

RESULTS

Two NGT sessions were conducted. Group 1 reported (lack of) professionalism, (inability to perform) physical skills, (lack of) critical thinking and interpreting data gathered during physical skills, and (inability to achieve) programmatic outcomes and mile makers exams as barriers. Group 2 ranked behaviors as lack of independence, not taking roles and responsibilities seriously, inability to follow instructions, lack of classroom engagement, and disorganized and unable to prioritize. Group 2 ranked knowledge and skills of significant errors when making medication recommendations, inability to identify accurate medication history, inability to perform tasks with time constraints, poor patient communication, and inability to identify resources.

CONCLUSIONS

Pharmacy skills laboratory faculty can identify behaviors, knowledge, or skills that may prevent a student from achieving an EPA readiness level 2 or higher such as lack of professionalism and poor critical thinking skills and should be empowered to identify early warning signs for students' success and progression to experiential education.

A Novel Approach to Tally Aculops cannabicola (Acari: Eriophyidae) for Field and Laboratory Studies

The hemp russet mite, Aculops cannabicola (Farkas) is a key pest of hemp (Cannabis sativa L.). Given its microscopic size, estimating the size of its populations can be a major limitation to control this pest. Here, we describe a method to count A. cannabicola using photographs taken with a handheld digital microscope. We compared the consistency and strength of the relationship between photographic- and microscope-based counts of mites from infested plants. Among the three sections of the leaflet, the maximum consistency levels were observed in the proximal (50%) and middle photographs (50%). However, it reached from 64% to 100% when the three sections were considered. Photographic and a microscope-based counts were positively correlated (>0.7). A single photograph can be a good predictor of the total mites per leaflet, however, using two pictures (proximal and middle sections) will increase the consistency of the abundance of A. cannabicola per leaflet. A minimum of 22 leaflets per sampling event can support a strong correlation between the microscope and photographic counts. Our method requires low budget and training and takes short time (0.4 to 1.3 min per leaflet) to count mites per sample. Additionally, photographs can be stored on a smartphone, computer, or tablet, allowing users to share, store and process the photos. This method simplifies counts of A. cannabicola on hemp for research purposes and provides a practical tool for growers to assess mite populations for management decisions. In addition, it may be useful for monitoring eriophyid mites on cultivated plants.

Specialty pharmacy: Incorporating workflow management and medication access into pharmacy lecture and laboratory courses

BACKGROUND AND PURPOSE

The purpose of this study was to implement and evaluate a specialty pharmacy workshop across pharmacy management and skills lab courses.

EDUCATIONAL ACTIVITY AND SETTING

A specialty pharmacy workshop was developed and implemented. The lecture cohort (fall 2019) consisted of a 90-min lecture in pharmacy management. The lecture/lab cohort (fall 2020) consisted of the lecture plus a 30-min pre-lab video assignment and a two-hour laboratory activity. At the completion of lab, students presented findings virtually to specialty pharmacists. Pre-surveys and post-surveys assessed knowledge (10 items), self-confidence (9 items), and attitudes (11 items).

FINDINGS

Of the 123 students enrolled in the course, 88 students (71.5%) completed pre- and post-surveys. On a 10-point scale, knowledge improved from 5.6 (SD = 1.5) to 6.5 (SD = 2.0) points in the lecture cohort and from 6.0 (SD = 1.6) to 7.3 (SD = 2.0) points in the lecture/lab cohort with a significance difference favoring the lecture/lab cohort. Perceived confidence improved for five out of nine items in the lecture cohort but improved significantly for all nine items in the lecture/lab cohort. Attitudes toward learning about specialty pharmacy were generally positive for both cohorts.

SUMMARY

The specialty pharmacy workshop exposed students to workflow management and medication access processes. Students perceived the workshop to be a relevant and meaningful, allowing them to feel confident in developing knowledge and understanding of specialty pharmacy topics. The workshop can be replicated at a larger scale with schools of pharmacy utilizing the integration between didactic and laboratory courses.

Transition from in-person to telehealth standardized patient encounters: A retrospective analysis of 18 cases

INTRODUCTION

Due to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape.

METHODS

This retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (R&C) checklists, as well as to describe student perceptions of the pedagogy.

RESULTS

Total scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but R&C scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth.

CONCLUSIONS

Overall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth.

Tirzepatide, the Newest Medication for Type 2 Diabetes: A Review of the Literature and Implications for Clinical Practice

Objective:

The objective of this article was to review pharmacology, efficacy, safety, and place in therapy of tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist.

Data Sources:

PubMed/MEDLINE and ClinicalTrials.gov were searched through September 7, 2022, using the keyword “tirzepatide.”

Study Selection and Data Extraction:

Clinical trials with available results were included.

Data Synthesis:

Seven published phase 3, multicenter, randomized, parallel-group trials investigated efficacy and safety of tirzepatide versus placebo, semaglutide, insulin degludec, and insulin glargine for type 2 diabetes mellitus (T2DM) treatment. Studies included adults with uncontrolled T2DM and body mass index above 23 or 25 kg/m2. Hemoglobin A1c reduction from baseline was greater with tirzepatide across all studies with absolute reductions up to 3.02% and relative reductions ranging 0.44% (vs semaglutide) to 2.11% (vs placebo). Weight loss was significant. Incidence of gastrointestinal adverse effects (AE) was similar to semaglutide, and major cardiovascular events was similar to insulin glargine.

Relevance to Patient Care and Clinical Practice:

Studies demonstrated greater A1c lowering and weight reduction versus placebo and active comparators with AE similar to semaglutide, suggesting tirzepatide will be a valuable addition to the growing list of antidiabetic medications. Although tirzepatide’s effects on major cardiovascular events was not increased when compared with insulin glargine, further evidence is needed to assess long-term implications on cardiovascular outcomes compared with agents with proven cardiovascular benefits.

Conclusions:

Tirzepatide has the potential to significantly impact the clinical management of T2DM, and results of ongoing clinical trials will help to fully determine its place in therapy.

Shifting from SOAP Notes to Consult Notes for Clinical Documentation by Pharmacy Students

Objective. Clinical documentation is an important element of patient care that pharmacy students traditionally learn through subjective-objective-assessment-plan (SOAP) notes. In clinical practice, pharmacists often document more succinctly, both in length and time, using formats such as consult notes. The objective of this study was to assess consult note assignments for third-year pharmacy (P3) students.Methods. Consult note assignments were implemented in a P3 skills laboratory course by converting SOAP notes to consult notes. The series began with an introduction and a practice consult note. Four graded notes were then completed throughout the semester, whereby the time allotted for writing decreased throughout the semester. To assess the series, grades and estimated time to completion were collected for each graded note. A survey given before and after the course assessed student self-confidence in overall documentation, specific elements of consult notes, and concerns related to writing. Friedman tests were used to compare grades and times. Wilcoxon signed rank tests were used to compare self-assessments.Results. The median grades on the four consult notes were 92%, 88%, 80%, and 90%. Median times for completing each note were 75 minutes, 120 minutes, 60 minutes, and 60 minutes. Students' self-confidence in writing consult notes significantly increased, as did five of the six individual elements.Conclusion. The consult note assignments allowed students to practice documenting patient care in a succinct format with consideration for time efficiency. Further work should evaluate best pedagogies for teaching documentation skills and assess the impact on performance during advanced pharmacy practice experiences.

Design and development of a continuous glucose monitoring educational module for students and practicing pharmacists

INTRODUCTION

This study aimed to investigate a 2-week, hands-on continuous glucose monitoring (CGM) module on third-year pharmacy students' and practicing pharmacists' knowledge and confidence.

METHODS

This was a prospective, single-center study. Week 1 included a CGM lecture and sensor placement. Participants then wore a CGM device for 1 week. Week 2 included reviewing CGM reports and patient cases, examining participants' reports, and discussing experiences. Pre-, immediate post-, and long-term post-surveys were administered to assess CGM-related knowledge, confidence, and clinical use. Immediate and long-term change in knowledge and confidence were assessed using repeated measures analysis of variance.

RESULTS

Pre- and immediate post-surveys were completed by 36 students and five pharmacists. Student CGM knowledge improved significantly. Students reported improved confidence for all CGM-specific tasks. Results from the pharmacist participants showed similar trends. Student confidence was maintained long-term, while knowledge trended downward. All participants stated they would recommend the activity.

CONCLUSIONS

Students and pharmacists demonstrated improved knowledge and confidence following this 2-week, hands-on CGM module. A hands-on CGM pedagogy is effective at increasing knowledge and confidence regarding this technology.

The catalyst for change in teaching and assessing virtual laboratory skills

INTRODUCTION

Historically, pharmacy skills laboratory courses have primarily been delivered utilizing in-person instruction; however, changes in methods of healthcare delivery serve as a catalyst to consider best practices for virtual learning in the skills laboratory setting.

PERSPECTIVE

Shifting to a virtual delivery method is valuable for future curriculum and course development. Three specific delivery methods including flipped classroom, virtual formative simulations, and telehealth objective structured clinical examinations, provide examples of the opportunities and challenges instructors may encounter when shifting delivery methods. Furthermore, the examples illuminate the need to deliberately incorporate virtual technology into pharmacy skills laboratory courses to ensure students are practice-ready for the changing methods of delivery in the healthcare environment.

IMPLICATIONS

Skills laboratory instructors and students must reimagine how patient care skills can be taught and assessed. It is imperative to reassess priorities and adapt skills-based courses to incorporate the virtual learning environment to prepare student pharmacists for future practice.

High-Dose Once-Weekly Semaglutide: A New Option for Obesity Management

OBJECTIVE

To review the pharmacology, efficacy, and safety of high-dose once-weekly semaglutide for chronic weight management.

DATA SOURCES

PubMed/MEDLINE and ClinicalTrials.gov were searched (inception to September 8, 2021) using keywords "semaglutide" and "obesity," "weight," "high dose," "high-dose," or "2.4."

STUDY SELECTION AND DATA EXTRACTION

Clinical trials with published results were included. Publications studying the oral or <2.4 mg formulation of semaglutide were excluded.

DATA SYNTHESIS

Four phase 3, multicenter, randomized, double-blind trials demonstrated efficacy of high-dose once-weekly semaglutide compared with placebo for weight loss. Study populations included patients with overweight or obesity (STEP 1, STEP 3, and STEP 4) or patients with diabetes and with overweight or obesity (STEP 2). Lifestyle interventions for diet and exercise were included for all participants. Weight loss from baseline was significant for all studies, and secondary outcomes demonstrated cardiometabolic improvements including waist circumference, systolic blood pressure, and lipid profiles. Gastrointestinal adverse effects were common, but the medication was otherwise well tolerated.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

High-dose semaglutide offers significant weight-lowering potential and favorable effects on cardiometabolic risk factors and glycemic indices. Clinicians and patients should consider the route and frequency of administration, adverse effect profile, and cost when choosing an antiobesity medication. The importance of concomitant lifestyle interventions should be emphasized.

CONCLUSIONS

High-dose once-weekly semaglutide can significantly reduce weight, and although gastrointestinal adverse effects were common, it is generally well tolerated.

Mindset and team communication in pharmacists: Examination of pharmacist's self-views

OBJECTIVES

Pharmacists provide care in a complex adaptive system, which requires action and teamwork to address unexpected outcomes. We assessed practicing pharmacists' self-views of growth mindset and team communication across multiple practice settings.

DESIGN

The validated Growth Mindset and Team Communication (GMTC) tool, a multicomponent quantitative and qualitative survey instrument was used to conduct a descriptive study of pharmacist self views.

SETTING AND PARTICIPANTS

Survey instrument was distributed electronically to all licensed North Carolina pharmacists.

OUTCOME MEASURES

The survey consisted of 4 sections: (1) growth mindset self-evaluation (14 questions), (2) team communication self-evaluation (13 questions), (3) description of previous teamwork experience (1 question), and (4) demographics (8 questions). Data were analyzed using descriptive statistics, and responses to the open-ended question were assessed using qualitative content analysis.

RESULTS

A total of 507 pharmacists participated in the survey. Participants reported primary practice settings, 42.1% in community, 38.9% in health system, and 17.3% in other settings, and 52.1% reported more than 20 years' total pharmacy experience. The total GMTC scale average score was 81.9 ± 7.9 out of 108 possible points. The growth mindset subscale indicated an overall average score of 43.5 ± 4.4 out of 56 possible points The team communication subscale indicated an overall average score of 38.3 ± 5.2 out of 52 possible points. The self-view of a growth mindset was not affected by years of pharmacy experience or primary practice site, but additional teamwork credentials were positively correlated with the overall GMTC score driven by the team communication subscale.

CONCLUSIONS

A growth mindset is prevalent among experienced pharmacists from multiple practice settings. Pharmacists recognize teamwork as an essential work element and rate their team communication skills highly.

Communicating definitive uncertainty: Teaching pharmacy students to say "I don't know"

BACKGROUND AND PURPOSE

Communicating uncertainty is an art requiring practice. The purpose of this study was to compare pedagogies for the instruction of pharmacy students in communicating definitive uncertainty.

EDUCATIONAL ACTIVITY AND SETTING

A case scenario featuring a busy physician asking a question without a definitive answer was directed to the pharmacy student using two pedagogies: (1) in-person standardized client and (2) virtual written case. Students provided self-assessments of their confidence in communicating uncertainty after completing the case utilizing a survey containing both rating scale questions and open-ended questions. Self-confidence within-group differences were compared using Wilcoxon signed-rank tests and between-group differences were compared using Mann-Whitney U tests. Responses to open-ended questions were descriptively analyzed for themes using qualitative assessment methods.

FINDINGS

Both the in-person standardized client (70 to 81, P ≤ .001) and the virtual written case (74 to 85, P ≤ .001) significantly increased students' self-rated confidence to verbalize "I don't know" to a healthcare provider. No significant differences were observed between the pedagogies. However, students who participated in the virtual written case mentioned a desire for "additional practice opportunities" more frequently than students who participated in the in-person standardized client.

SUMMARY

In-person standardized client and virtual written case are effective methods for increasing pharmacy student comfort with communicating definitive uncertainty. Further research is needed to instruct pharmacists in uncertainty communication.

Comparison of a single day versus a multi-day immunization certificate scheduling for student pharmacists

BACKGROUND AND PURPOSE

The study objective was to determine differences in student pharmacists' knowledge, confidence, and preferences when the in-class portion of the American Pharmacists Association (APhA) Immunization Certificate was conducted in two different scheduling formats.

EDUCATIONAL ACTIVITY AND SETTING

A two-phase, pre-post design was utilized to compare delivery layouts of the certificate program for first-year student pharmacists. In fall 2018, students completed the certificate in eight, one-hour sessions. In fall 2019, students completed the certificate in one, eight-hour session. A pre- and post-survey assessed confidence in immunization-specific skills and scheduling preferences. The APhA self-study and final exams and faculty created knowledge questions were utilized to assess student knowledge before, during, and after the course.

FINDINGS

Student confidence in both fall 2018 and fall 2019 increased significantly between the pre- and post-survey. However, when comparing cohorts, no difference was found in self-confidence or knowledge. Students did tend to show preference for how the course was delivered. Students in fall 2018 slightly leaned towards eight, one-hour sessions (approximately 51%) while students in fall 2019 strongly leaned towards one, eight-hour session (approximately 72%).

SUMMARY

Variation in scheduling of the in-class portion of the APhA Immunization Certificate was not associated with a difference in student confidence or knowledge. However, a difference in student preference for delivery was noted. It is important for instructors to consider student preferences along with best pedagogical practices to ensure learning when scheduling formats are selected.

A Teamwork Workshop to Improve Pharmacy Students' Growth Mindset and Communication Skills

Objective. To determine the impact of a workshop on the growth mindset and team communication of first year Doctor of Pharmacy (PharmD) students.Methods. A multi-week workshop was developed for first year pharmacy students. The workshop included completion of the StrengthsFinder 2.0, a session on identifying individual and team member strengths, a session on situational communication and conflict resolution models, and a work-up of two pharmacy scenarios requiring conflict resolution. The workshop was delivered to two intervention groups (fall 2019 and fall 2018) and compared to a control group (fall 2017). A pre-post survey was administered to measure change in students' growth mindset and team communication using the validated Growth Mindset and Team Communication (GMTC) tool. Data were analyzed using descriptive statistics, independent sample t tests, and chi-square tests to compare difference and association. Focus groups were conducted in fall 2017 and fall 2018 to assess students' views regarding teamwork.Results. Team communication subscale scores increased significantly among students in the intervention group while there was no significant change in these scores among students in the control group. The focus groups reflected that students had overall positive views about team communication and collaboration, which were also supported by discussions of advantages and challenges during teamwork.Conclusion. A teamwork workshop affected pharmacy students' communication skills. Future work should focus on longitudinal measurement of students' self-views to determine the long-term impact of teamwork training interventions.

A Modified Delphi Involving Laboratory Faculty to Define Essential Skills for Pharmacy Graduates

Objective. To define essential skills for Doctor of Pharmacy (PharmD) graduates that are needed in the four most common sectors of pharmacy practice as determined by expert faculty who instruct within pharmacy skills laboratories.Methods. A three-round Delphi method was used to establish consensus. In the first round, participants were asked what skills were needed by students at entry to practice in community, health-system, ambulatory care, and managed care pharmacy settings. In rounds two and three, participants were asked to rate each skill with a level of importance using a 10-point Likert scale (1=not important to 10=very important).Results. In round one, participants produced a collective list of 289 essential skills. These skill statements were sent to participants in rounds two and three to assign a level of importance. After the third round, participants reached consensus using a mean level of importance for a final list of 69 community pharmacy skills, 47 health-system, 60 ambulatory care, and 15 managed care skills. These skills were then mapped to entrustable professional activities domains for schools and colleges pharmacy to use as a resource when assessing core competency development in the curriculum.Conclusion. The Delphi technique was used successfully with expert pharmacy skills laboratory faculty to identify laboratory-focused essential skills that recent PharmD graduates should have prior to entering community, health-system, ambulatory care, or managed care pharmacy practice. These essential skills can be used to guide curriculum development, develop milestone markers, and help ensure students are practice ready.

A comparison of medication counseling evaluation tools utilized in colleges of pharmacy to three recognized guidance documents

INTRODUCTION

A universal tool to assess proficiency in patient counseling has not been developed. The objectives of this project were to assess current practices in evaluating patient counseling at colleges of pharmacy and compare the results with three nationally recognized reference standards: the Omnibus Budget Reconciliation Act of 1990, the American Pharmacists Association Academy of Student Pharmacists National Patient Counseling Competition Evaluation Form, and the American Society of Health-System Pharmacists Guidelines on Pharmacist Conducted Patient Education and Counseling.

METHODS

A cover letter and questionnaire were sent to all members of the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group with an invitation to submit an evaluation tool. Descriptive statistics were used to examine the questionnaire items. An inductive approach was used to analyze the evaluation tools, which was completed independently by two members and then compared to build consensus to establish common content categories.

RESULTS

Five major categories emerged with variability in content. More than 75% of tools included an introduction, almost 59% included collecting information, most included drug information (94%) and counseling points (88%), and most included verification of understanding (94%) and communication skills (94%).

CONCLUSION

Although there was variability, most evaluation tools incorporated aspects of all three guidance documents. A limitation of this study was that data may be subject to non-response bias, as the response rate was limited to 17.8%. Future work should focus on creating and validating a standardized evaluation tool to ultimately promote consistency among student pharmacists.

Using social media and focused learning activities to impact self-efficacy of empathy

BACKGROUND AND PURPOSE

Empathy is a component of emotional intelligence that is critical for healthcare professionals. Intentional learning activities utilizing social media platforms were developed to enhance student growth in self-efficacy of empathy and to assess how the incorporation of social media impacts pharmacy students' empathy and self-efficacy through self-reflection.

EDUCATIONAL ACTIVITY AND SETTING

Activities utilizing social media were implemented in a pharmacy skills lab course. This included following a social media story, focused classroom instruction, and writing personal reflections. Initial surveys assessed baseline empathy and self-efficacy. Post and "think back" surveys at the end of the semester re-assessed empathy and self-efficacy. Reflection assignments were designed to allow students to further self-reflect, and their responses provided qualitative data.

FINDINGS

Data was analyzed for 138 students in the fall semester of study year 1 (SY1) and 111 students in the fall semester of study year 2 (SY2). Overall, student empathy significantly decreased in both study years. However, student self-efficacy demonstrated a non-significant increase in SY1 and a significant increase in SY2. The "think-back" survey results demonstrated a significant increase in total self-efficacy for nine of the ten individual constructs. Qualitative findings supported perceived areas of growth.

SUMMARY

Although challenging to develop and assess empathy, social media can be an avenue for empathy skill development. This approach can easily be adapted by other schools of pharmacy and health professional programs to further develop self-efficacy regarding empathy.

Effect of repeated pulmonary function test training on student self-confidence in a clinical skills laboratory

INTRODUCTION

A skills laboratory session was created to train students to perform basic pulmonary function test (PFT) assessments. The objective of this study was to evaluate whether pharmacy student confidence changed after conducting a PFT in a laboratory session and if this was enhanced by adding a second session.

METHODS

A two-week educational activity was designed. For week one, each student completed a PFT with an instructor coaching to assure proper performance. Week two occurred one week later, and in pairs, students again completed an individual PFT, but the paired student served as the coach rather than the instructor. Students completed three surveys, a baseline before training, and after completing the sessions in week 1 and week 2, to assess confidence in PFT procedures on a 10-point scale. Survey results were analyzed using the sign test. A summary of instructor time and supply costs was also estimated.

RESULTS

Forty-five students consented to all surveys (78.9 percent inclusion rate). There was a significant increase in confidence for all items between the first and second surveys. Between the second and third surveys, only two items increased significantly.

CONCLUSIONS

The educational intervention was successful in improving student self-confidence in performing PFTs. However, limited additional confidence was gained by adding a second week of training, especially in context of resource allocation. These findings informed instructors that a one week PFT training may be sufficient and that resources needed for a second PFT training week may be better invested in another teaching opportunity.

Establishing a successful teaching assistant program in pharmacy skills laboratory courses

INTRODUCTION

Laboratory-based courses often require more manpower than faculty can provide to facilitate active learning activities in the classroom as well as skills-based assessments.

PERSPECTIVE

Pharmacy and graduate student and resident teaching assistants (TAs) can be incorporated into laboratory-based courses to help meet this need. Before using student and resident TAs in laboratory-based courses, a number of items need to be considered. This paper will discuss how to recruit, train, and evaluate student and resident TAs. It will also detail the benefits to the faculty, the students in the classroom, and the TAs themselves. Finally, lessons learned from five schools of pharmacy who use student and/or resident TAs will be shared.

IMPLICATIONS

Schools of pharmacy should implement a formalized process for utilizing student and resident TAs in laboratory-based courses especially where faculty manpower limitations exist.

Design of hospital errors and omissions activities that include patient-specific medication related problems

BACKGROUND AND PURPOSE

Medication-related problems persist in hospital settings. New types of errors have emerged with changing technology. There is a need for updated, realistic, and patient-specific activities to train student pharmacists to identify medication-related problems.

EDUCATIONAL ACTIVITY AND SETTING

We describe efforts to redesign hospital errors and omissions activities in a clinical skills lab course. A hospital errors and omissions template is described with multiple-choice answer options redesigned to reinforce that each instance of dispensing in a hospital is an opportunity for patient-centered care.

FINDINGS

In the redesigned hospital errors and omissions activities, students identified the correct errors and omissions 77% of the time with an average point biserial of 0.491. Qualitative evaluation of student course evaluations and student self-selected learning goals suggest that students perceived the revised activity to be valuable.

SUMMARY

It is possible to create and deliver hospital errors and omissions activities that include patient-specific medication related problems.

Influence of dietary -arginine supplementation of sows during late pregnancy on piglet birth weight and sow and litter performance during lactation

Two experiments were conducted to determine the effect of feeding supplemental -Arg during late pregnancy on piglet birth weight and preweaning performance. In Exp. 1, 97 gilts and sows were allotted (gestation d 93) to receive a control diet (CON; 19.8 g standardized ileal digestible [SID] Arg/d) or the CON + 1.0% -Arg (ARG; 46.6 g SID Arg/d). Gilts and sows were weighed on gestation d 93 and 110, 48 h after farrowing, and at weaning. Data, including number born alive, number weaned, individual birth and weaning weight, and placenta weight, were recorded. Blood samples were collected on d 93 and 110 and analyzed for plasma IGF-1, insulin, and blood urea nitrogen concentration. In a second experiment, 383 sows in a commercial research farm were allotted to receive CON or ARG. An -Arg premix was provided daily by top dress beginning at gestation d 81 (±0.1 d) and fed for an average of 35 d (±0.2 d). Sows received 2.73 kg feed/d with CON sows provided 17 g SID Arg/d and ARG sows receiving a total of 44 g SID Arg/d. Litter birth weight was recorded and average birth weight was computed. In a subset of 82 sows, individual birth weights were recorded. In Exp. 1, there was a tendency for greater late pregnancy maternal BW gain ( = 0.06) in ARG compared with CON. A tendency for a parity × treatment interaction was observed for late pregnancy BW gain, with first litter sows fed ARG gaining the most, gilts fed ARG intermediate, and all other treatments gaining the least ( = 0.10). No differences between treatment groups were observed for maternal plasma IGF-1, insulin, and urea nitrogen and in progeny performance to weaning ( > 0.28). In Exp. 2, piglet birth weight was more effectively tested because of the large number of multiparous sows involved. There was a tendency for individual birth weight to decline in ARG compared with CON ( < 0.08), but birth weight distribution between <0.80 and >2.8 kg was similar. No other differences were observed ( > 0.18). In conclusion, late pregnancy supplementation with -Arg had no effect on number of pigs born alive, piglet birth weight, or lactation performance.

Evaluation of a Teaching Assistant Program for Third-Year Pharmacy Students

Objectives. To determine if a teaching assistant (TA) program for third-year pharmacy students (PY3s) improves confidence in teaching abilities. Additionally, 3 assessment methods (faculty, student, and TA self-evaluations) were compared for similarities and correlations. Methods. An application and interview process was used to select 21 pharmacy students to serve as TAs for the Pharmaceutical Care Laboratory course for 2 semesters. Participants' self-perceived confidence in teaching abilities was assessed at the start, midpoint, and conclusion of the program. The relationships between the scores were analyzed using 3 assessment methods. Results. All 21 TAs agreed to participate in the study and completed the 2 teaching semesters. The TAs confidence in overall teaching abilities increased significantly (80.7 vs 91.4, p<0.001). There was a significant difference between the three assessment scores in the fall (p=0.027) and spring (p<0.001) semesters. However, no correlation was found among the assessment scores. Conclusions. The TA program was effective in improving confidence in teaching abilities. The lack of correlation among the assessment methods highlights the importance of various forms of feedback.

Transitioning Pharmacogenomics into the Clinical Setting: Training Future Pharmacists

Pharmacogenomics, once hailed as a futuristic approach to pharmacotherapy, has transitioned to clinical implementation. Although logistic and economic limitations to clinical pharmacogenomics are being superseded by external measures such as preemptive genotyping, implementation by clinicians has met resistance, partly due to a lack of education. Pharmacists, with extensive training in pharmacology and pharmacotherapy and accessibility to patients, are ideally suited to champion clinical pharmacogenomics. This study aimed to analyze the outcomes of an innovative pharmacogenomic teaching approach. Second-year student pharmacists enrolled in a required, 15-week pharmaceutical care lab course in 2015 completed educational activities including lectures and small group work focusing on practical pharmacogenomics. Reflecting the current landscape of direct-to-consumer (DTC) genomic testing, students were offered 23andMe genotyping. Students completed surveys regarding their attitudes and confidence on pharmacogenomics prior to and following the educational intervention. Paired pre- and post-intervention responses were analyzed with McNemar's test for binary comparisons and the Wilcoxon signed-rank test for Likert items. Responses between genotyped and non-genotyped students were analyzed with Fisher's exact test for binary comparisons and the Mann-Whitney U-test for Likert items. Responses were analyzed for all student pharmacists who voluntarily completed the pre-intervention survey (N = 121, 83% response) and for student pharmacists who completed both pre- and post-intervention surveys (N = 39, 27% response). Of those who completed both pre- and post-intervention surveys, 59% obtained genotyping. Student pharmacists demonstrated a significant increase in their knowledge of pharmacogenomic resources (17.9 vs. 56.4%, p < 0.0001) and confidence in applying pharmacogenomic information to manage patients' drug therapy (28.2 vs. 48.7%, p = 0.01), particularly if the student had received genotyping. Student pharmacists understanding of the risks and benefits of using personal genome testing services significantly increased (55.3 vs. 86.8%, p = 0.001) along with agreement that personal genomics would likely play an important role in their future career (47.4 vs. 76.3%, p = 0.01), particularly among students who participated in genotyping. The educational intervention, including personal genotyping, was feasible, and positively enhanced students' reflections, and attitudes toward pharmacogenomics in a professional pharmacy program.

Pediatric asthma medication therapy management through community pharmacy and primary care collaboration

OBJECTIVES

To design and implement a collaborative medication therapy management (MTM) program targeting pediatric patients with high-risk asthma in a community pharmacy.

SETTING

Underserved inner city of Cincinnati, OH.

PRACTICE DESCRIPTION

A large national grocery store chain pharmacy and an academic hospital developed a partnership aimed at improving asthma care for shared patients. An interdisciplinary project team was formed, including 2 clinical pharmacists, 1 pharmacy district clinical coordinator, 1 pharmacy division clinical coordinator, 1 associate professor at a college of pharmacy, 1 pharmacy resident, and 3 pediatric physicians. This pilot project involved 2 Kroger Pharmacy sites and Cincinnati Children's Hospital Medical Center's (CCHMC) 3 pediatric primary care centers.

PRACTICE INNOVATION

Kroger and CCHMC staff identified shared high-risk asthma patients (those cared for at the included primary care centers who used Kroger for their medication fills) with the use of information from validated symptom assessments (Asthma Control Test), refill history, and recent health care utilization. Community pharmacists recruited jointly identified patients and provided a targeted MTM intervention. Education focused on asthma diagnosis, types of asthma medications, appropriate medication administration, and environmental triggers. Pharmacists suggested medication changes to prescribers via facsimile. Pharmacists followed up with patients in 30 days to assess asthma control, provide additional education, and propose further recommendations.

EVALUATION

Outcomes evaluated included the average number of recommendations made to patients and prescribers and acceptance rates for each of those measures.

RESULTS

Six patients completed the project. Pharmacists provided an average of 3.7 recommendations to each patient and 1.5 to prescribers for each patient; 77.3% and 100% recommendations were accepted, respectively.

CONCLUSION

This pilot project describes the design and implementation of a pharmacist-physician collaborative program for high-risk pediatric asthma patients. The greatest outcome of this project was the formation of a collaborative team between pharmacists and physicians that continues to work together on additional family-centered initiatives.

The pharmacy-level asthma medication ratio and population health

BACKGROUND AND OBJECTIVES

Community pharmacies may be positioned for an increased role in population health. We sought to develop a population-level measure of asthma medication fills and assess its relationship to asthma-related utilization.

METHODS

We conducted a retrospective, ecological study (2010-2012). Medication data from a chain of pharmacies (n = 27) within 1 county were used to calculate a Pharmacy-level Asthma Medication Ratio (Ph-AMR), defined as controller fills divided by controller plus rescue fills. Higher values are superior because they indicate more controller compared with rescue fills. The outcome was the asthma-related utilization rate among children in the same census tract as the pharmacy, calculated by dividing all emergency visits and hospitalizations by the number of children in that tract. Covariates, including ecological measures of poverty and access to care, were used in multivariable linear regression.

RESULTS

Overall, 35 467 medications were filled. The median Ph-AMR was 0.53 (range 0.38-0.66). The median utilization rate across included census tracts was 22.4 visits per 1000 child-years (range 1.3-60.9). Tracts with Ph-AMR <0.5 had significantly higher utilization rates than those with Ph-AMR ≥0.5 (26.1 vs 9.9; P = .001). For every 0.1 increase in Ph-AMR, utilization rates decreased by 9.5 (P = .03), after adjustment for underlying poverty and access. Seasonal variation in fills was evident, but pharmacies in high-utilizing tracts filled more rescue than controller medications at nearly every point during the study period.

CONCLUSIONS

Ph-AMR was independently associated with ecological childhood asthma morbidity. Pharmacies may be a community-based leverage point for improving population-level asthma control through targeted interventions.

The challenge of adversity: three narratives of alcohol dependence, recovery, and adult development

Turning points have been known to reverse the downward spiral of alcoholism and its concomitant associations with divorce, depression, and work-related difficulties. In this study, the authors present the stories of 3 women from the Mills Longitudinal Study who were alcoholic. Using a narrative approach, the authors tracked the women's developmental gains during recovery using Erik Erikson's theory of psychosocial development, specifically focusing on the tasks of identity, intimacy, and generativity. Results show that despite similar personal problems and turning points that moved them to stop drinking, each woman followed a different path to self-reconstruction and psychological growth. These accounts offer important information about individual differences in recovery from alcoholism, which are often lost in larger aggregate accounts of personal change.

Subjectively healthy elderly consuming a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being

OBJECTIVE

To evaluate regular use of a liquid nutrition supplement by subjectively healthy elderly persons in terms of body mass index, nutrient intake, selected biochemical parameters, and perceived quality-of-life changes, and to identify advantages and limitations of use.

DESIGN

A 16-week intervention study in which subjects were assigned randomly to either a supplemented group or a control group and compared in terms of intergroup and intragroup differences in weight, food intake, blood values, and quality-of-life indexes. Adherence to protocol was monitored by monthly visits with an interviewer and food intake records.

SUBJECTS/SETTING

Seventy-one independent living, older Canadian adults (mean age = 70 +/- 7 years) consuming on average less than 4 servings of fruit and vegetables daily and a supplement-free diet before the study. Subjects were without functional limitations and did not require therapeutic diets or medical treatments that affect nutritional status. Data were collected in home interviews. Blood for analysis was obtained from a subsample of 36 subjects.

INTERVENTION

Inclusion of six 235-mL cans of liquid nutrition supplement weekly into the self-selected dietary patterns of the supplemented group.

STATISTICAL ANALYSIS

Results were analyzed by Student t tests or Wilcoxon rank sum test, analysis of variance, and multiple stepwise regression.

RESULTS

Body mass index, energy intake, and consumption of fruit and vegetables did not change throughout the study. In the supplemented group, statistically significant increases occurred from baseline to termination of the study in these nutrients: protein, calcium, iron, magnesium, and folate. Serum albumin, folate, ferritin, hemoglobin, and zinc values were within the normal range for the supplemented and control groups. Scores for the Medical Outcomes Study 36-Item Short-Form Health Status scales increased for the supplemented group from baseline to termination for vitality and general health perception. Values for the General Well-Being Questionnaire improved for anxiety and general well-being. Of the dietary predictors, folate intake explained the most variance for vitality and for general well-being, 8.6% and 14.2%, respectively.

APPLICATIONS

A liquid nutrition supplement could be recommended to the elderly when energy maintenance and increases in nutrient intake are necessary and convenience is an important consideration. Dietetics professionals should address the issues of affordability of the supplement, the role of food in achieving nutritional adequacy, and overall quality of life of clients. Folate intake as a predictor of perceived general well-being and vitality requires further investigation.

Can eucapnic hyperventilation prolong a subsequent breath-hold?

Previous studies have shown that, upon breaking a maximal breath-hold (BH), reinhalation of the expired gas allows an additional period of breath-holding. This indicates that mere ventilatory movements can diminish the urge to breathe. We sought to determine if vigorous ventilations, performed immediately prior to a maximal BH and in such a way that CO2 stores are not changed, can prolong a subsequent BH. Maximal BHs were accomplished with and without a preceding period of hyperventilation. The gas breathed during hyperventilation was air with 4.37% CO2, or oxygen containing either 0.04% CO2 (hypocapnic hyperventilation) or 4.37% CO2 (eucapnic hyperventilation). During hyperventilation, expired minute volume and frequency were clamped at 60 L/min and 30 breaths/min, respectively. End-tidal and transcutaneous CO2 tensions were monitored. Eucapnic hyperventilation did not prolong maximal BHs. Therefore, the ventilatory movements of hyperventilation do not appear to affect the duration of a subsequent maximal BH if these movements are not accompanied by changes in CO2 stores.