How did we get here? Evolution of specifications grading in a required skills-based course series.

BACKGROUND AND PURPOSE: Specifications grading is a mastery-based grading approach to unlock student potential and empower students to focus on learning goals while receiving and acting on meaningful feedback. Within specifications grading, bundles are created to group assignments and assessments. Based on student achievement within each bundle, overall course grade is determined. This article describes the development and implementation of a specifications grading schema in a required skills-based course series, along with lessons learned. EDUCATIONAL ACTIVITY AND SETTING: In a longitudinal course series with both a didactic and lab component, specifications grading was utilized for determination of the overall course grade. Key components of the specifications grading schema were defined by assignment bundles. Assignment bundles aligned with knowledge and skills taught and assessed in each course and also included summative capstone assessments. Each bundle was assigned a numeric grade linked to a letter grade which determined the students' final grade in the course. FINDINGS: Following first course offerings, several changes to the specifications grading schema were made to improve tracking of assignments and activities, to improve consistency across courses, and to aid in final course grade determination. All quizzes were changed to optional, formative quizzes to encourage student accountability. Additional changes were made to the processes of capstone remediation and reassessment, which led to changes in language of the grading schema. SUMMARY: Developing and implementing specifications grading was a crucial first step in building a required skills-based course series, which led to further refinement and improvement for future course offerings.

Successes and challenges in implementing specifications grading in skills-based laboratory courses: Experiences at two colleges of pharmacy.

BACKGROUND AND PURPOSE: Specifications grading, a grading schema focused on mastery of skills, may provide an alternative to traditional grading. Specifications grading uses three components (pass/fail grading, bundles, and tokens) to allow students to demonstrate competency in specific areas as part of competency-based education. The purpose of this article is to outline specifications grading and review its implementation at two colleges of pharmacy. EDUCATIONAL ACTIVITY AND SETTING: Two colleges of pharmacy used specifications grading within a first-year skills-based laboratory course. Instructors identified key skills for each course and the minimum performance levels for each grade (A, B, C, etc.). Each college evaluated skills that aligned with course learning objectives. FINDINGS: Incorporating specifications grading helped better align assignments and assessments to course learning objectives. Instructors felt specifications grading introduced more rigor into the course. Instructors identified four challenges when implementing specifications grading, including: (1) lack of integration into the learning management system, (2) initial student confusion, (3) modifications needed due to unforeseen circumstances, and (4) logistical issues when implementing token exchange. Many of these challenges can be overcome with instructor tracking of passed assignments and earned/redeemed tokens, periodic reinforcement of the grading schema with students, and creating flexibility within the course, especially the first time the schema is implemented. SUMMARY: Specifications grading was successfully implemented in two skills-based courses. Challenges encountered with implementing specifications grading will be continually addressed. Implementation of specifications grading in other forms of course deliveries (e.g., electives, didactic) may require adjustment and further evaluation.

Using Rasch measurement for instrument rating scale refinement.

OUR SITUATION: Rasch measurement is an analysis tool that can provide validity evidence for instruments that attempt to measure student learning or other psychosocial behaviors, regardless if tools are newly created, modified, or previously developed. Rating scales are exceedingly common among psychosocial instruments and properly functioning rating scales are critical to effective measurement. Rasch measurement can help investigate this. METHODOLOGICAL LITERATURE REVIEW: Aside from using Rasch measurement from the beginning to help create rigorous new measurement instruments, researchers can also benefit from employing Rasch measurement on previously developed instruments that had not included Rasch measurement during development. This article is focused on Rasch measurement's unique analysis of rating scales. That is, Rasch measurement can uniquely help examine if and how an instrument's rating scale is functioning among newly studied respondents (who will likely differ from the originally researched sample). OUR RECOMMENDATIONS AND THEIR APPLICATION: After reviewing this article, the reader should be able to describe Rasch measurement, including how it is focused on fundamental measurement and how it differs from classical test theory and item-response theory, and reflect on situations in their own research where a Rasch measurement analysis might be helpful for generating validation evidence with a previously developed instrument. POTENTIAL IMPACT: In the end, Rasch measurement can offer a helpful, unique, rigorous approach to further developing instruments that scientifically measure, accurately and precisely.

Student pharmacists' attitudes, perceptions, and knowledge regarding opioid use, misuse, and overdose: Four years of data.

INTRODUCTION: The American Association of Colleges of Pharmacy has urged pharmacy faculty to commit to actions to reduce the public health threat from opioid use and misuse. Optimizing student pharmacist training necessitates understanding changes in their attitudes and perceptions over time. This study assessed student attitudes, perceptions, and understanding of addiction, opioid use and misuse, and opioid overdose over four sequential years, from 2016 to 2019. METHODS: The participants were third-professional year doctor of pharmacy students enrolled in a required course. Participants voluntarily completed a 27-statement survey to determine student attitudes, perceptions, and understanding. RESULTS: A total of 452 participants completed the survey (response rate = 76.5%). Of the 27 survey items, five survey statements showed year on year positive increases in specific student attitudes towards addiction, hopefulness for its treatment, and confidence to use and train opioid overdose reversal agents. These yearly changes did not appear to be related to any changes in the academic aptitude of the students. The 22 remaining statements showed positive and stable attitudes towards self-perceived understanding of opioid use and misuse, hopefulness for its treatment, and the role of pharmacists. CONCLUSION: To our knowledge, this is the first large multiyear assessment of student pharmacists' attitudes, perceptions, and understanding of opioid use, misuse, and overdose. The data indicate favorable and improving attitudes. Knowledge of student attitudes, perceptions, and understanding regarding opioid use, misuse, and overdose will aid in the development of effective training programs for students in our, and other colleges of pharmacy.

Item response theory in high-stakes pharmacy assessments.

OUR SITUATION: Classical test theory (CTT) and item response theory (IRT) are two measurement models used to evaluate results from examinations, questionnaires, and instruments. To illustrate the benefits of IRT, we compared how results from multiple-choice tests can be interpreted using CTT and IRT. METHODOLOGICAL LITERATURE REVIEW: IRT encompasses a collection of statistical models that estimate the probability of providing a correct response for a test item. The models are non-linear and generate item characteristic curves that illustrate the relationship between the examinee's ability level and whether they answered the item correctly. Several models can be used to estimate parameters such as item difficulty, discrimination, and guessing. In addition, IRT can generate item and test information functions to illustrate the accuracy of ability estimates. OUR RECOMMENDATIONS AND THEIR APPLICATIONS: Researchers interested in IRT should gather the necessary resources early in the research process and collaborate with those experienced in quantitative and advanced statistical models. Researchers should confirm IRT is the optimal choice and select the model ideal for their needs. Once data are acquired, confirm model assumptions are met and model fit is appropriate. Lastly, researchers should consider disseminating the findings with accompanying visuals. POTENTIAL IMPACT: IRT can be a valuable approach in assessment design and evaluation. Potential opportunities include supporting the design of computer adaptive tests, creating equivalent test forms that evaluate a range of examinee abilities, and evaluating whether items perform differently for examinee sub-groups. Further, IRT can have noteworthy visuals such as test information and functions.

Association Between NAPLEX Preparation Program Characteristics and First-Time Pass Rates.

Objective. The objectives of this study were to (1) describe characteristics of preparation programs for the North American Pharmacist Licensure Examination (NAPLEX) that are currently used by colleges and schools of pharmacy and (2) evaluate these program characteristics in relation to first-attempt NAPLEX pass rates.Methods. This cross-sectional study was based on an online survey administered between February and March 2020. Assessment leads from 143 PharmD programs were invited to answer questions on their schools' PharmD program characteristics and various aspects of NAPLEX preparation programs. The study included regression analyses to investigate associations between the NAPLEX first-attempt pass rates and PharmD demographic characteristics as well as between first-attempt pass rates and various aspects of the NAPLEX preparation programs. Finally, common themes from open-ended questions were identified.Results. Fifty-eight participants completed the survey out of 132 successfully delivered email invitations (response rate = 44%). Fifty participants (86%) indicated that their PharmD program offers a NAPLEX preparation program. Our data indicate that offering a NAPLEX preparation program was not significantly associated with higher NAPLEX first-attempt pass rates. The analysis identified possible explanations for this lack of association, including student concerns with balancing a preparation program with advanced pharmacy practice experiences (APPEs) and the faculty workload associated with delivering such programs.Conclusion. The current findings show no association between offering a NAPLEX preparation program and NAPLEX first-attempt pass rates. Future research should continue to examine the impact of these programs on individual school pass rates and factors that may enhance student motivation to engage in these programs.

Description of a novel co-curricular professional engagement program for student pharmacists.

INTRODUCTION: Development of professionalism is essential for student pharmacists. This paper describes the development of a novel co-curricular professional engagement program for student pharmacists. METHODS: At admission, all student pharmacists are enrolled in a faculty-developed professional engagement program. The program was designed to address various key elements of Standards 3 and 4 of the Accreditation Council for Pharmacy Education Accreditation Standards. The program requires student pharmacists to complete a variety of required and electives activities each professional year. Student progression and completion of these activities is monitored and evaluated by an assigned faculty member. Each year, the program is reviewed using various measures, including activity completion rate and student feedback. RESULTS: Approximately 1000 student pharmacists, across four years and seven cohorts of students, have completed at least one portion of the program. All students in the aforementioned groups completed the program in its entirety. Example activities included professional seminars and professional organization involvement, leadership, and community service. Program activities were mapped to key elements of Standards 1 through 4 with an emphasis on Standards 3 and 4. Student feedback was used for continuous quality improvement, and programmatic revisions were made. CONCLUSIONS: The development and implementation of a co-curricular professional engagement program offered the opportunity for student pharmacists to actively participate in a variety of experiences supporting accreditation standards. Other colleges of pharmacy may benefit from the adoption of a similar program to support student pharmacist professional development.

Simulated medication adherence: First and second-year pharmacy students' perceptions of adhering to a multi-drug medication regimen.

BACKGROUND AND PURPOSE: Through a realistic medication adherence activity, the objective was to improve students' ability to identify non-adherent patients, build empathy toward patients, and prepare them to provide patient-centered care. EDUCATIONAL ACTIVITY AND SETTING: First- and second-year student pharmacists completed a two-month activity, which required adherence to a pre-specified medication regimen. Prior to starting, a survey was administered to assess students' perceived difficulty and success of the medication adherence activity. Upon completion, students were asked their perceived success and difficulty with the activity, challenges to maintaining adherence, and lessons learned from the project. Changes in perceived difficulty and success were analyzed using Wilcoxon signed rank tests. Challenges and lessons learned were coded for similar themes and frequencies. FINDINGS: 298 student pharmacists completed the pre- and post-survey (response rate 99%). Students' perceived difficulty of adherence was higher on the post-survey (median on post = 7.0 (out of 10) versus median on pre = 6.0, p = 0.023). Students' perceived success was higher on the presurvey (median on pre = 8.0 versus median on post = 6.0, p < 0.001). The most frequent challenges were remembering to take the medications (n = 133) and medication regimen timing (n = 98). The most frequent lesson learned was that "adherence is a difficult concept" (n = 143). SUMMARY: Students participated in a "hands-on" medication adherence activity. Students found that medication adherence is more difficult than perceived. Future research should examine the long-term impact of students maintaining empathy toward patients and provision of medication adherence services.

Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class.

Objective. To evaluate student pharmacists' knowledge of diabetes and self-perceptions of aptitude and confidence before and after teaching a diabetes self-management education and support (DSMES) class. Methods. Students enrolled in an advanced pharmacy practice experience (APPE) in ambulatory care were randomly assigned to the intervention group (taught a DSMES class) or control group (did not teach a DSMES class) between June 2016 to April 2018. Students self-assessed their aptitude and confidence using a 14-item pre- and post-intervention survey instrument. Additionally, participants completed a 10-item diabetes knowledge evaluation at baseline and during week three or four of the APPE. Results. Forty-six students participated in the study (26 students in the intervention group and 20 in the control group). Students in the intervention cohort demonstrated a significant improvement in their knowledge score (81.8% post-intervention vs 68.4% pre-intervention). Students in the control cohort did not experience a significant change in knowledge scores from pre- to post-intervention evaluation (70.0% vs 74.1%). The intervention cohort achieved a significantly greater improvement in confidence scores compared to the control group (11.8 vs 6.7 increase in scores, respectively). Conclusion. A student pharmacist team-taught DSMES class resulted in significant improvement in diabetes knowledge, aptitude, and confidence. Student pharmacist participation in a DSMES class may improve knowledge and enhance confidence, while offering an opportunity to advance the pharmacy practice model in ambulatory care.

A Classroom Activity to Increase Student Pharmacists Confidence in Dealing with the Opioid Epidemic.

Objective. To implement and assess the impact of a hybrid flipped-classroom activity designed to increase the motivation and confidence of Doctor of Pharmacy (PharmD) students in addressing the opioid crisis. Methods. Third-professional year student pharmacists were provided with reading material developed by federal agencies and professional pharmacy organizations, as well as Georgia-specific information covering medical amnesty and local resources for opioid-overdose prevention prior to class. They then attended a four-hour classroom session that included hearing a lecture on opioid pharmacology and opioid overdose, viewing training videos, and engaging in extensive discussion. The students voluntarily completed pre- and post-intervention assessments regarding opioid abuse and opioid overdose prevention. Results. Seventy of the 107 third-year students enrolled in the course completed the pre-intervention assessment (65% response rate), and 33 of the 70 completed the post-intervention assessment (47% retention rate). The students exhibited a high baseline motivation to assist in combating the opioid crises, but less confidence in their ability to intervene. Significant increases were seen in areas related to student confidence on the post-intervention assessment. Fewer changes were seen in areas related to student motivation. Conclusion. A "hybrid" flipped classroom activity increased the confidence of student pharmacists in their understanding of the physical and adverse effects of opioids and the application of reversal agents. Increased confidence may support increased intervention.

National Trends in the Adoption of Pharmacy Curriculum Outcomes Assessment for Student Assessment and Remediation.

Objective. To determine and describe the current uses of the Pharmacy Curriculum Outcomes Assessment (PCOA) by US schools and colleges of pharmacy. Methods. Assessment professionals from 135 US schools and colleges of pharmacy were invited to complete a 38-item electronic survey. Survey items were designed to investigate common uses of the PCOA, cut points, and "stakes" assigned to the PCOA, identification of at-risk students, and remediation approaches. Results. The school response rate was 68%. The most common uses of the PCOA included curricular assessment (76%), individual student performance assessment (74%), and cohort performance assessment (71%). The PCOA was most frequently administered to third-year pharmacy (P3) students. The approach for assigning "stakes" to PCOA performance varied among programs depending on the student's professional year in the curriculum. Programs used a variety of approaches to establish the benchmark (or cut point) for PCOA performance. Remediation for at risk students was required by less than 25% of programs. Remediation was most commonly required for P3 students (22%). Conclusion. Survey results indicate wide variability between programs regarding PCOA cut points (benchmarks), stakes, and remediation approaches. In the future, it will be important for pharmacy educators to identify and study best practices for use of PCOA within student assessment and remediation plans.

Improving rating scales: Applying Rasch analysis to student pharmacists' attitudes towards herbal medications.

BACKGROUND: This study analyzed the psychometric properties of a cross-sectional survey of student pharmacists' attitudes regarding herbal medications using a polytomous Rasch model. Seven items assessed students' attitudes towards herbal medications using a 6-point agreement scale (0 to 5). Student responses were reviewed to identify outliers and aberrant response patterns, assess scale fit, and perform item analysis. Scale performance was assessed to determine if response categories were independent and equally represented. Items were reviewed for model fit and construct validity with significant item gaps identified using a z-test. IMPACT: A total of 324 students completed the survey. The initial 6-point scale was analyzed. Student responses with outfit mean-square (MNSQ) values >5 were removed, yet the scale did not have appropriate functionality. The categories were merged to form a 4-point scale with no improvement. Therefore, two different 3-point scale options were analyzed: response categories of 0, 1 to 3, and 4 to 5; and response categories of 0, 1 to 4, and 5. With ten students removed, both 3-point scales met the requirements for functionality and all items exhibited good fit with MNSQ values between 0.6 and 1.4, person-separation value of 1.29, and person-reliability value of 0.62. RECOMMENDATIONS: Both 3-point scales met the requirements for Rasch analysis. The most optimal scale was the 0, 1 to 4, and 5 option. DISCUSSION: This study provides findings from the survey validity assessment alongside the survey results, which is useful for readers to have confidence in the quality of the study findings.

Academic success plans in advanced pharmacy practice experiences to promote self-awareness and improve performance.

INTRODUCTION: Pharmacy schools should encourage self-awareness, provide exposure to the continuous professional development cycle, and intervene early when students exhibit performance deficiencies. Academic success plans (ASPs) have been shown in other disciplines to be successful intervention tools which encourage student reflection and self-awareness. This study evaluates the impact of ASPs used during the advanced pharmacy practice experience (APPE) curriculum at two schools. METHODS: ASPs were assigned to students who had either a "needs development" or lower documented for the same learning outcome during more than one APPE, for poor overall performance during an APPE, or for documented professionalism issues. Average scores were calculated by assigning point values to each learning outcome assessment score (exceeds expectations = 1; competent = 0; needs development, needs significant development, remediation required = -1). RESULTS: During AY2014-2015 and AY2015-2016, 104 ASPs were assigned to 75 students (13.5% of students). The majority (89.6%) were assigned due to repeated deficiencies in the same learning outcome(s), with the most frequent being "Develop, Implement, and Monitor Drug Therapy Plans." After completion of an ASP, average scores significantly improved (p < 0.05) in 9 out of 12 learning outcomes among all students who completed an ASP. Thirteen students completed 15 ASPs for professionalism reasons, most commonly punctuality. CONCLUSIONS: Prior to 2015, Experiential Education Office interventions were primarily grades-based, not necessarily based on achievement of specific learning outcomes. ASPs were successfully used to allow students to practice self-awareness skills, to engage in the CPD process, and to improve APPE performance.

Smoking quit rates among patients receiving pharmacist-provided pharmacotherapy and telephonic smoking cessation counseling.

OBJECTIVES: Tobacco use is the nation's leading cause of preventable illness and death, causing a significant burden on the health care system. Many cessation pharmacotherapy treatment options are available to help smokers quit, including nicotine replacement therapies (NRTs) and prescription medications. Research indicates that pharmacists are able to provide a positive benefit to smokers who want to quit through pharmacologic and nonpharmacologic interventions. The aim of the present work was to examine the quit rates among participants who received smoking cessation pharmacotherapy and pharmacist-provided telephone-based quit counseling services. DESIGN: Retrospective database review of enrolled participants. SETTING: Telephone-based pharmacotherapy and medication counseling services offered from a medication management center. PARTICIPANTS: State employees who voluntarily contacted a medication management center for smoking cessation services after receiving promotional flyers. MAIN OUTCOME MEASURES: Long-term quit rates at 7 and 13 months were determined by means of patient self-report in response to questioning. Smoking cessation was considered to be a success if the patient reported not smoking for the past 30 days. RESULTS: A total of 238 participants were included in the review. Thirty-nine participants completed the program after the first treatment, 12 participants after the second treatment, and 4 participants after the third treatment. Two patients completed the program more than once. Eighty-five participants (36%) reported results at 7-month follow-up; of these, 43 (51%) were smoking free. A total of 44 participants (18%) reported results at 13-month follow-up; of these, 24 participants (55%) reported being smoking free. There were no significant differences in the percentages of smoking-free participants at 7 or 13 months, regardless of their first treatment (P = 0.06 and 0.345, respectively). CONCLUSION: Successful quit rates were higher than previously demonstrated with other telephone-based smoking cessation programs. Therefore, pharmacist-provided telephone-based counseling may be beneficial in helping patients to quit smoking. Future research is warranted to examine the benefits of these types of programs.

Health outcomes and cost-effectiveness of certolizumab pegol in the treatment of Crohn's disease.

Crohn's disease (CD) causes chronic inflammation of the gastrointestinal tract and leads to fluctuations between active disease and remission. Certolizumab pegol is one of the newer biological treatments for patients with moderate-to-severe CD. Certolizumab pegol was shown to be effective in CD patients achieving response and remission in both randomized and non-randomized studies, and is an alternative biological treatment for CD. The available data show that certolizumab pegol achieves similar therapeutic efficacy and health-related quality of life scores in CD patients as the other biological agents, but at a higher cost, if dose escalation of other biologics is not considered. Considering subcutaneous self-administration, and lower number and frequency of injections, patients may prefer certolizumab pegol over the other biological treatments.

Critical appraisal of efficacy and safety of abatacept in the treatment of refractory rheumatoid arthritis.

Rheumatoid arthritis is a chronic, progressive, autoimmune disease that leads to significant disability and premature mortality. Various treatment options are available, but the foundation of treatment includes nonbiologic and biologic disease-modifying antirheumatic drugs. The incidence of patients with rheumatoid arthritis refractory to first-line agents is estimated to be at least 20%. Abatacept, a T cell costimulation modulator, is the first agent to interfere with full T cell activation by competing with CD28 for binding of CD80 and CD86, which results in decreased secretion of proinflammatory cytokines and autoantibody production. Current American College of Rheumatology treatment guidelines recommend abatacept for patients with at least moderate disease activity and a poor prognosis demonstrating an inadequate response to other agents. Several key Phase III trials have been conducted to evaluate the efficacy and safety of abatacept in patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy. Response rates in all trials showed statistically significant improvements compared with placebo according to American College of Rheumatology criteria for disease improvement. The most common adverse event report in patients receiving abatacept was infection; however, the frequency of adverse events was similar to placebo. Abatacept is a safe and effective rheumatoid arthritis treatment for patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy.