Longitudinal Assessment of Empathy and Burnout Across a Single Pharmacy Class Cohort.

OBJECTIVE: This is a final analysis of longitudinal evaluation of burnout and empathy among a cohort of Doctor of Pharmacy students throughout their 4-year enrollment. METHODS: The class of 2021 received sequential Qualtrics (Qualtrics, Provo, UT) surveys containing 2 validated survey instruments, the Jefferson Scale of Empathy and the Maslach Burnout Inventory. Surveys were disseminated at the start of the program (PY1start) and the end of each academic year (PY1end, PY2, PY3, PY4). Linear mixed models accounting for repeated measures, Generalized Estimating Equation, and Cochran's Q statistic were used to evaluate longitudinal change in the Jefferson Scale of Empathy and Maslach Burnout Inventory survey scores, categorized subscales, and burnout. RESULTS: Matched survey responses were included for 91 students (85.8% response rate). Across all years, a decrease in empathy and professional efficacy and an increase in exhaustion and cynicism was seen. High categorical levels of exhaustion and cynicism indicated evidence of burnout throughout the program. Year-to-year analysis indicated statistically significant increases in exhaustion and cynicism between PY1start and all subsequent assessments, a decrease in professional efficacy from PY1start to PY1end and PY2, and a decrease in empathy for PY1start to PY1end. CONCLUSION: Students reported trends of decreasing empathy and professional efficacy, with a simultaneous increase in exhaustion and cynicism. Further evaluation of the impact of COVID-19 on these results, as well as additional methods to support overall student wellness, is needed.

Using a virtual simulation platform for dispensing pediatric prescriptions in a community-based pharmaceutical skills course.

BACKGROUND AND PURPOSE: Safe and accurate dispensing of medications is an essential skill. Pharmacy schools must provide students with the knowledge and practice to enhance special population dispensing skills. The objective of this study is to describe a community pharmacy pediatric simulation completed by first-year pharmacy students and to review student perceptions on confidence and knowledge learned after a MyDispense (Monash University) simulation. EDUCATIONAL ACTIVITY AND SETTING: First-year Pharmaceutical Skills students participated in a MyDispense simulation to identify errors and omissions of prescription orders with a focus on pediatrics. Although students had limited therapeutic knowledge, the activity emphasized federal and Florida law requirements. Retrieval and direct application of these principles along with new experiences in identifying medication errors afforded students to learn in a low-stake, controlled environment. FINDINGS: Of the 64 students enrolled in the Pharmaceutical Skills I course, 57 completed the pre-simulation survey and 56 students completed the post-simulation survey (87.5% response rate). Increased confidence and knowledge were found for most questions. The pre-simulation survey had students most frequently answer neutral followed by disagree or strongly disagree for ability to complete the listed task. The post-simulation survey responses shifted with many students responding with agree or strongly agree for the listed task and found MyDispense to be a helpful simulation tool. SUMMARY: Exposing pharmacy students to pediatric virtual simulations early in the curriculum may increase confidence and knowledge. Future pediatric simulation coursework would benefit longitudinally to further build confidence and enhance retention of knowledge.

A Call to Action to Address Well-Being Within Experiential Education.

There is a significant lack of literature exploring or describing pharmacy student well-being during experiential learning even though students spend 30% of their doctor of pharmacy curricula in this environment. Drawing on inspiration from literature describing well-being challenges and solutions for pharmacy residents and other health disciplines, this commentary explores the unique challenges of supporting pharmacy student well-being during experiential education. Approaches for interventions are described along with a call to action for the academy.

Evolution of a capstone exam for third-year doctor of pharmacy students.

BACKGROUND AND PURPOSE: Pharmacy capstone exams are an example of an assessment strategy to evaluate student competency and practice-readiness. Capstone exam processes have been discussed in the literature; however, description of format, evolution of the process, and implementation in the year prior to rotations is lacking. This manuscript discusses the development, implementation, and utilization of a third professional year pharmacy capstone exam to assess advanced pharmacy practice experience (APPE) readiness. EDUCATIONAL ACTIVITY AND SETTING: A pharmacy year three (PY3) capstone exam was initially developed prior to enrollment of the inaugural graduating class. Since the first iteration, utility has remained the same, but the overall development and implementation process has evolved due to changes in programmatic and student learning outcomes, curricular mapping, student and faculty feedback, and practice expectations. FINDINGS: The entities responsible for exam implementation perceive faculty and students have a positive perception of the exam evolution and improvements implemented. Specifically, feedback from students and faculty mentioned clear expectations, comfort with the new capstone exam process, and an appreciation for the focus on interrater reliability. As assessment is an iterative process, quality improvement strategies continue to be implemented to address feedback regarding the PY3 capstone exam. SUMMARY: Purposeful utilization of capstone exams in the third year is one method to assess APPE readiness. Sharing one college's experience with the evolution of such an exam, quality improvement methods, and experience in implementing reliability and validity measures may provide a model for institutions to implement similar assessment methods efficiently.

The Relationship Between Pharmacist Resilience, Burnout, and Job Performance.

BACKGROUND: Resilience aids healthcare professionals in navigating through and bouncing back from stressful situations in the workplace. Resilience can increase job satisfaction, work motivation, and professional commitment while decreasing burnout, and ultimately job turnover. More resilient employees experience lower instances of burnout and greater life satisfaction. OBJECTIVE: The primary study objective is to determine the relationship that pharmacist resilience has on burnout and job performance. METHODS: Licensed pharmacists in Florida were sent a Qualtrics survey (Qualtrics, Provo, UT) via email, which included demographics data, and valid and reliable assessment tools for resilience, burnout, and job performance. Linear regressions were used to test if resilience significantly predicted each of the output variables: burnout and job performance. RESULTS: Survey responses were received from 942 pharmacists. The regressions showed that resilience significantly predicted both burnout (ß1 = -.701, P < .001) and job performance (ß1 = .35, P < .001). As resilience increased, the levels of burnout decreased, and job performance increased. Resilience explained 29% of the variance in burnout, and 11% of the variance in job performance. CONCLUSION: The results of this study suggest that resilience significantly predicts both pharmacist work-related burnout and job performance. The more resilient the pharmacist, the lower the chances of work-related burnout and the higher the likelihood of better job performance. Organizations should pursue opportunities to educate healthcare workers on methods to increase resilience and to bring attention to the importance of this topic.

The Impact of Leadership Program Formatting on Perceived Development Within Pharmacy Cohorts.

Objective. To assess the impact of variable leadership development program formats on perceived participant growth.Methods. In 2020, the Phi Lambda Sigma national office began offering national Leader Academies to members, while University of South Florida Health Taneja College of Pharmacy simultaneously offered a Leader Academy program to its Phi Lambda Sigma students. Both programs used virtual leadership development tools from GiANT Worldwide, but differed in meeting frequency, content focus, and participant diversity. A 17-question pre- and postsurvey was developed from the Emotional Intelligence Leadership Inventory. Descriptive and inferential statistics were used to compare the cohorts.Results. Twenty-two respondents in the national cohort (66.7% response rate) and 15 in the single-institution cohort (100% response rate) were included. There was more diversity in age, ethnicity, and previous education in the national cohort. Significant improvements in perceived growth were noted in almost all areas. The only decrease noted was the national cohort response to "I strive to improve myself." The overall change in mean response values was generally higher for the single-institution cohort. Qualitative data supported these results and showed more notable references to emotional intelligence in the national cohorts (∼50%) as compared to the single-institution cohort (<25%).Conclusion. Study results suggest that participation in a longitudinal leadership development program, regardless of cohort format, leads to perceived participant improvement in three categories. However, perceived benefit within each of these categories may vary depending on the cohort. Future studies are needed to further evaluate specific leadership arenas and validate the leadership assessment tool.

Implementing cognitive apprenticeship theory for an ethics module within a first-year pharmacy skills course.

BACKGROUND AND PURPOSE: Critical thinking and problem solving are two skills required to be a successful pharmacist. These skills are often difficult to teach and assess within the classroom. Cognitive apprenticeship theory has been discussed in literature to foster the cognitive and meta-cognitive processes of thinking. Coordinators of a first year Pharmaceutical Skills I course explore how they incorporated this theory into an ethics module to enhance student awareness of thinking and application. EDUCATIONAL ACTIVITY AND SETTING: An ethics module was incorporated into a first year doctor of pharmacy skills course in fall 2021. This module was developed following the four dimensions of cognitive apprenticeship. Lecture materials and ethical debate topics were created by course coordinators and mirrored real time ethical issues surrounding the field of pharmacy. Students were required to use primary literature, the American Pharmacists' Association Code of Ethics, and other ethical terms to support their arguments. Cognitive apprenticeship theory was used throughout the module and post-debate discussions. FINDINGS: The ethics module presented in this course incorporated all dimensions of cognitive apprenticeship. Course coordinators perceived students were able to apply knowledge of ethical principles to scenarios and debates in an effective manner. Purposeful introduction, reiteration, and application offers students the chance to showcase critical thinking and ethical reasoning. SUMMARY: Utilizing the cognitive apprenticeship theory to prepare students for critical thinking is effective when incorporated into a course module. This theory could be successfully implemented into other topics throughout the course and throughout the pharmacy curriculum.

Emergent transition to remote learning: Impact on student performance for real-time comprehensive case simulations.

INTRODUCTION: To determine the impact of emergent transition from in-person to remote learning on student performance within real-time objective structured clinical examinations (OSCEs). METHODS: A university mandate, due to severe SARS-CoV-2, was issued requiring didactic courses to transition to remote learning in spring 2020. The third-year internal medicine elective had six remaining weekly OSCEs, accounting for 55% of course grades. Full credit was awarded for the first OSCE as students familiarized themselves with the new virtual format. The primary outcome was the overall average OSCE performance for the course's remaining five virtual simulations compared to the traditional in-person offering in 2019. Secondary outcomes included individual OSCE performance, OSCE performance with inclusion of the first OSCE, and overall course grades. RESULTS: There were no statistically significant differences in overall average OSCE performance between 2019 and 2020 cohorts for the five simulations (82.7% vs. 86.8%, P = .20). Secondary outcomes showed statistically significant differences favoring performance in the 2020 cohort for infectious diseases (78.3% vs. 89.4%, P < .001) and anticoagulation (74.4% vs. 90%, P = .002), while cardiology favored the 2019 cohort (91.1% vs. 82.8%, P = .03). There was no statistically significant difference in performance on the cumulative I (86.1% vs. 82.2%, P = .41) or cumulative II (83.3% vs. 89.4%, P = .29) simulations or in final overall course grades (86.6% vs. 90.2%, P = .06). CONCLUSIONS: An emergent transition to remote learning may not negatively impact student performance on real-time OSCE activities.

The relationship between pharmacist emotional intelligence, occupational stress, job performance, and psychological affective well-being.

BACKGROUND: Emotional intelligence (EI) is known to improve teamwork, communication, and organizational commitment. The role of EI has also influenced pharmacists' ability to empathize, control emotions, and actively listen. Although EI's impact on work-related components, including occupational stress, job performance, and psychological affective well-being, has been studied, there are no data specific to the practice of pharmacy. OBJECTIVE: The primary objective of this study was to determine whether a significant correlation exists between pharmacist EI and work-related components. METHODS: A voluntary Qualtrics survey (Qualtrics, Provo, UT) was distributed electronically to all active pharmacists licensed by the Florida Board of Pharmacy, which included questions from valid and reliable assessment tools. Spearman correlations were used to examine the association between EI facets and dependent variables of occupational stress, job performance, and psychological affective well-being. A subanalysis was conducted to evaluate demographic data. Statistical significance was set at P < 0.05 for all tests. Incomplete survey responses were included in the analysis. RESULTS: A total of 942 responses were received and analyzed. Most of the respondents were aged 44 years or younger (42.5%), female (46.9%), identified as Caucasian (52.8%), and worked 31-40 hours weekly (20.6%). Most of the respondents reported a primary employment setting within community (29.3%) or hospital (18.6%) pharmacy. Higher EI correlated with lower levels of occupational stress, higher job performance, and higher psychological affective well-being. Secondary outcomes reported increased stress for both females and those practicing in the community setting; hospital-based pharmacists reported higher job performance and psychological affective well-being. Stress decreased with both age and years of experience. CONCLUSION: Higher EI may support overall wellness for pharmacists on the basis of the results of this study. Additional evaluation of demographic data, including practice settings, and a more robust cohort of participants would provide more insight in this area.

Measures of Burnout and Empathy in United States Doctor of Pharmacy Students: Time for a Change?

PURPOSE: To review interim data regarding longitudinal burnout and empathy levels in a single Doctor of Pharmacy class cohort. METHODS: Students were emailed an electronic survey during their first semester and annually at the end of each academic year for a total of 3 years (2017-2020). Validated survey tools included the Jefferson Scale of Empathy (JSE) and the Maslach Burnout Inventory (MBI) student version. The JSE survey consists of 20 questions, with higher scores denoting more empathy. The MBI student version contains 3 subscales: exhaustion (higher scores are worse), cynicism (higher scores are worse) and professional efficacy (higher scores are better). RESULTS: The median JSE score at the end of the third academic year (PY3) was 110, with females scoring significantly higher (114.5 vs. 103.5; p<0.02). A majority of the 62 students reported burn out (82.3%), scoring in the highest category for either exhaustion (76%) or cynicism (55%). A majority (66%) also reported a low or moderate professional efficacy score, a negative finding. Measures of student burnout increased after the start of the program and remained at the higher level each subsequent year (p<0.0001). In the Spring of 2020, during the COVID-19 pandemic, nearly every student had moderate or high levels of emotional exhaustion (97%) and cynicism (78%) as measured by the MBI. CONCLUSION: This interim data suggests high degrees of pharmacy student burnout. Empathy levels remained stable throughout the duration of the study. Pharmacy schools may need to focus on reform regarding well-being and prevention of burnout.

Designing and evaluating game-based learning for continuing pharmacy education using an "escape room" activity.

INTRODUCTION: Continuing education (CE) standards by the Accreditation Council for Pharmacy Education emphasize that educational methodologies should contribute to the development of participants' critical thinking and problem-solving skills. Employment of serious gaming can meet this expectation through motivation, timely feedback, and challenging all performance levels. Current literature is lacking regarding use of game-based learning, such as "escape rooms" in pharmacy CE programming. METHODS: This pilot study enrolled participants at a two-hour medication error CE presentation. Study investigators utilized the first hour for lecture and the second hour for application through an "escape room" activity. During this activity, participants used critical thinking and teamwork to unlock puzzles for root cause analysis (RCA) creation in a provided timeframe. An optional, online anonymous survey was emailed to attendees. Responses were rated on a five-point Likert scale; descriptive statistics were represented by percent distributions. RESULTS: A total of 40 pharmacists and seven technicians responded to the perception survey. Most respondents felt this activity emphasized critical thinking (87%) and was appropriate for the topic of medication errors (83%). The majority (63%) agreed this activity helped them to better understand a RCA, 48% felt the group sizes were appropriate, and 76% felt instructions for the activity were clear. Over 75% would like to see this type of activity utilized in another CE programs. CONCLUSIONS: This activity was well received by participants and may emphasize critical thinking and understanding of topics presented. Further studies assessing pre-/post-program knowledge are needed to ensure adequate retention of information.

Emerging therapies for the treatment of nonalcoholic steatohepatitis: A systematic review.

To describe the mechanism, efficacy, and safety of novel agents that have reached phase 3 clinical trials for the treatment of biopsy-proven nonalcoholic steatohepatitis (NASH). A literature search was conducted using the PRISMA guidelines of MEDLINE databases (1990 to October 2020) with the following MeSH terms: NASH, nonalcoholic liver disease, fatty liver, liver diseases, steatohepatitis, liver fibrosis; combined with obeticholic acid, FXR agonist, cenicriviroc, CCR5 receptor antagonist, elafibranor, PPAR, selonsertib, ASK-1 inhibitor, resmetirom, THR-ß receptor, arachidyl amido cholanoic acid (Aramchol™), and SCD-1 modulator. Results were verified via clinicaltrials.gov, Google Scholar, and Google. Articles were included if the medications of interest had ongoing or completed phase 3 trials in biopsy-proven NASH with outcomes directly related to NASH resolution. Eleven studies were identified involving obeticholic acid (OCA), elafibranor, cenicriviroc, Aramchol, and resmetirom. Two agents have reported data from phase 3 trials: OCA and elafibranor. OCA demonstrated safety and efficacy in NASH with a primary end point of improvement or NASH resolution; a new drug approval has been submitted. Elafibranor failed to show efficacy in NASH in the preliminary report from the RESOLVE-IT trial; however, the study is being extended to reassess outcomes. The remaining agents demonstrated positive results in phase 2b studies and have initiated phase 3 trials. With projections for increased prevalence of patients with NASH and the current lack of treatment options, novel agents with targeted mechanisms could potentially change the treatment landscape. The manufacturer of OCA is first to submit a new drug application for the treatment of NASH. These novel agents may fill a pharmacotherapy gap in patients with NASH and possibly prevent progression to advanced liver disease.

Effectiveness of a pharmacy teaching certificate program offered to practicing pharmacists.

INTRODUCTION: Regardless of the practice setting, pharmacists' roles often expand beyond patient-centered services and into health-related educational roles for patients, healthcare providers, and student pharmacists. Teaching roles of a clinical pharmacist can include providing invited presentations (such as continuing education lectures), teaching colleagues about new clinical initiatives, precepting students during advanced pharmacy practice experiences (APPEs) and introductory pharmacy practice experiences (IPPEs), and precepting residents on rotations. This program was designed to evaluate the effect of a university-affiliated pharmacy teaching certificate program on participant knowledge and perceived confidence in specific areas of academic pharmacy and preceptor development. METHODS: A 10-month program consisting of four live modules with associated continuing education (CE) credit was offered to pharmacy residents and practicing pharmacists in the surrounding area. The program format utilized didactic and active learning strategies with "at home" assignments to reinforce material presented. Content knowledge was measured with written summative assessments provided at the start and end of each module. Perceived confidence was assessed through online surveys provided at the start and end of the program. All results were evaluated using paired t-tests. RESULTS: Data were obtained from 14 participants in the first cohort and 18 participants in the second cohort. For each of the four modules, there was a significant difference in pre- and post-knowledge assessments. Confidence data was also significantly increased regarding topics in each module. CONCLUSION: Knowledge assessments and perception surveys suggest that this university-affiliated teaching certificate program improved both knowledge and perceived confidence for program participants.

Peer-assisted Learning: Clinical Skills Training for Pharmacy Students.

Objective. To assess the impact of peer-teaching on student scores and confidence when preparing for a final objective structured clinical examination (OSCE) within a Doctor of Pharmacy program. Methods. First-year pharmacy students (n=45) attended a peer-led training session led by upperclassmen (n=17) on a variety of clinical skills to be assessed on a final course OSCE. Their scores were collected and compared to students who did not attend the training. Confidence scores were also evaluated using voluntary pre- and post-surveys. Results. An overall 3% increase in scores was recorded from the objective skills examination. Student confidence scores also increased for each of the skills evaluated with an overall improvement of 1.1 on a 5-point Likert scale. Conclusion. Peer-assisted learning was effective in increasing student performance and confidence in the OSCE. Based on the positive results, the peer-led training event will be improved upon and used again in the future.

Incorporation of Professionalism Expectations and Evaluative Processes Within a College of Pharmacy.

Objective. To determine professionalism factors of interest to the University of South Florida (USF) College of Pharmacy (COP) and develop a programmatic plan to monitor the professionalization of students, faculty, preceptors and staff. Methods. In 2013, the USF COP began investigating how best to incorporate processes to capture professionalism across all aspects of the program. A Professionalism Task Force was convened to identify key professionalism factors valued by faculty and preceptors to be incorporated in pharmacy practice experiences, didactic courses, faculty, and preceptor performance evaluations. A factor analysis was performed to identify items for inclusion in professional practice experience evaluations, course syllabi, faculty, preceptor and staff evaluations. Results. The analysis identified 11 factors for practice experiences, three for syllabi, and five for performance evaluations. The information from the factor analysis spurred additional discussion that led to the development of a programmatic plan for professionalization. Conclusion. A brief description of the programmatic professionalization plan is provided, including possible assessment processes. The goal of this endeavor was to ensure appropriate support and development of professionalization across the COP community.

Development of a Student-Led Ambulatory Medication Reconciliation Program at an Academic Institution.

OBJECTIVES: To integrate fourth-year student pharmacists on advanced pharmacy practice experience (APPE) rotations within several different ambulatory clinics to perform medication reconciliations and enhance interdisciplinary practice. METHODS: The study design was a descriptive, prospective multisite study among a variety of ambulatory care outpatient clinics. Student pharmacists were partnered with physicians to conduct medication reconciliations during clinic visits for 4 hours per week, with data collection from January 2016 to September 2016. This program originated from physician requests for additional pharmacy involvement and led to the development of a successful implementation strategy to involve student pharmacists in the medication reconciliation process. RESULTS: Student pharmacists identified 537 medication discrepancies among 491 patients, including commission of medications (36%), documentation of previously omitted medications (27%), and incomplete patient allergy information (11%). Students spent an average of 10 minutes on each encounter. CONCLUSION: Documentation from this innovative program suggests improvement in medication reconciliation and enhanced patient care with limited time required of student pharmacists. A similar program could be developed and utilized at other clinical sites.