Impact of Simulation Manikins to Train Pharmacy Students in Nasal, Throat, and Oral Fluid Swab Collection.

Introduction: A point-of-care testing (POCT) certificate was implemented in a required pharmacy skills-based course. The purpose of this study was to evaluate the impact of manikins on student confidence in performing POCT swabs for infectious diseases. Innovation: Manikins were used to train second-year pharmacy students on nasal swabs, throat swabs, and oral fluid swabs. Student skills were assessed on manikins first, then on a peer. Proficiency was defined as a score of 90% or higher. Students completed a pre- and post-training survey regarding their confidence performing swabs. Student confidence was based on Likert style responses (i.e., 'Strongly Disagree' [score: 1], to 'Strongly Agree' [score: 5]) performing the swabs. Median change in confidence was calculated using quantile regression. Findings: All students (n=63) demonstrated proficiency in performing swabs. Median confidence for nasal, throat, and oral fluid swabs changed by 2.0 (95% CI: 1.5, 2.5), 2.0 (95% CI: 1.5, 2.5), and 2.0 (95%CI: 1.3, 2.7), respectively. The majority of students reported time spent practicing was adequate for the nasal (n=51, 81%), throat (n=51, 81%), and oral fluid swab (n=59, 94%). All participating students reported manikins to be moderately (n=17, 27%) or extremely (n=46, 73%) valuable, and all students rated their overall experience with manikins as positive (n=63, 100%). Student comments revealed manikins helped to visualize anatomy, practice skills without peer discomfort, and minimize risk during the COVID-19 pandemic. Conclusion: This study demonstrated that inclusion of practice on manikins increased student confidence in performing POCT for infectious diseases. In addition, the majority of students indicated that the use of manikins was valuable to their learning and reported feeling prepared to perform POCT in practice after using the manikins.

Evaluating a Skills Laboratory Curriculum to Determine the Essential Skills for Pharmacy Students to Learn.

The profession of pharmacy is complex and diverse, encompassing a wide range of necessary practice skills. Decisions regarding which skills are essential for students are made by faculty of skills-based laboratory courses, who also determine how these skills are taught and assessed. This commentary aims to further the discussion regarding how the essential skills taught and assessed in skills laboratory curricula are identified, with the intention of preparing student pharmacists for both current and future pharmacy practice. Guidance on essential skills is provided by various organizations and documents, but ultimately each institution has the autonomy to decide what to teach. As such, this piece discusses the importance of frequent curriculum evaluation to determine how to train pharmacists of the future so they will practice at the top of their license rather than simply meet competency with historical skills.

Using a design-based research framework to refine a desirable difficulties activity for sterile compounding in a skills-based laboratory course.

BACKGROUND AND PURPOSE: Design-based research (DBR) processes aim to connect educational research with instructional techniques by focusing on the development and evaluation of multiple iterations of learning activities for systematic improvement within learning environments. Desirable difficulties (DD) are purposeful challenges introduced to facilitate deeper learning of material. The purpose of this work was to evaluate a second iteration of a sterile compounding DD study in the context of DBR in order to allow for the identification and refinement of the educational methods. EDUCATIONAL ACTIVITY AND SETTING: In this second iteration, doctor of pharmacy students in their second professional year were exposed to both a mechanical and mathematical difficulty in sterile compounding training. Afterwards, students completed a questionnaire to rate their change in confidence and reflect on the activity. FINDINGS: An increase in confidence in sterile compounding skills was seen by the majority (97.9%) of students. Students' reflections highlighted gains in strategic knowledge, split between internal and external strategies. SUMMARY: Course instructors saw value in the refinement of a DD sterile compounding activity and plan to continue incorporating DBR processes in order to allow for the further improvement of this educational method. Faculty at other institutions could apply these processes to further refine a variety of educational activities.

Lessons learned from an investigation exploring association between grit and student performance in a pharmacy skills laboratory course.

BACKGROUND: A challenge for many pharmacy educators is early identification of students who may struggle with various aspects of the pharmacy curriculum. While grade point average, demographic factors, and personality traits may be helpful considerations, we felt there was a need to further explore methods for readily identifying at-risk students who may benefit from early intervention. The Grit Scale has recently been explored, presented, and published in academic pharmacy. The goal of this study was to determine if there was an association between students' grit scores and performance on a laboratory practical examination. However, it became apparent that there were substantial limitations leading to difficulties analyzing and interpreting our study data and results. IMPACT: The interpretation of data was confounded due to study design limitations, including use of the Grit-O scale (rather than Grit-S), low response rate, and lack of validation evidence for laboratory practical assessments. RECOMMENDATIONS: Thoughtful consideration during the design of the study may have produced better data for analysis. Psychometric considerations are paramount, both for the instrument (Grit-O) and the dependent/outcome variable (laboratory practical assessment). DISCUSSION: While this study did not yield meaningful results for interpretation, it highlighted important lessons for investigators at the college to use moving forward. We hope that the lessons learned from this investigation might support the academy in improving design and rigor of educational research.

Suggested pharmacy practice laboratory activities to align with pre-APPE domains in the Doctor of Pharmacy curriculum.

OUR SITUATION: The Accreditation Council for Pharmacy Education outlines ability statements that pharmacy students should be able to demonstrate prior to beginning their Advanced Pharmacy Practice Experiences (APPEs). Practice laboratory courses offer extensive opportunities for students to participate in activities and assessments that enable them to meet the objectives outlined in the Pre-APPE Core Domains in Standards 2016. This review identifies selected published literature, activities, and assessment methods that can be adapted and implemented in practice laboratory courses to help achieve the abilities outlined within the Pre-APPE Core Domains. METHODOLOGICAL LITERATURE REVIEW: The Medline database and journals related to pharmacy education were searched to identify activities and assessments for each domain. Search terms for each core domain were extracted from the domain titles, ability statements, and performance competencies and coupled with "laboratory" or "lab." "Pharmacy" was also added as a search term when searching the Medline database. Preference was given to example activities published in the last 15 years. Abstracts and activities based on author experience were also included. OUR RECOMMENDATIONS AND THEIR APPLICATIONS: Specific examples of how activities and assessments can be included in practice laboratories to develop or refresh skills identified in the pre-APPE core domains were described. POTENTIAL IMPACT: The practice laboratory setting is an ideal place for students to learn and practice the skills necessary to demonstrate readiness for APPEs. This paper serves as a resource for instructors, curriculum committees, or pharmacy programs looking for ideas to expand specific training or develop particular skill areas.

Comparison of faculty and student self-assessment scores of aseptic technique skills and the impact of video review on self-awareness for second-year pharmacy students.

BACKGROUND AND PURPOSE: Educating students about aseptic technique presents many challenges. Students at Drake University have limited exposure to this skill outside of the classroom setting, and students have previously shown a lack of awareness related to their own aseptic technique skills. One approach to developing self-awareness in this area may be the incorporation of activities involving video viewing and self-reflection. EDUCATIONAL ACTIVITY AND SETTING: Second-year pharmacy students in the Intermediate Pharmacy Skills and Applications 2 course completed four total aseptic technique activities, each of which was assessed by faculty using a standardized assessment tool. Each student was video-recorded during one of these aseptic technique activities. Students were asked to self-reflect on their performance immediately after the activity and again after viewing the video recording of their performance (using the same criteria included in a standardized faculty assessment tool). Student self-reflection scores before and after video viewing were then compared to faculty scores. FINDINGS: One-hundred six students participated in the video recording and self-reflection activity. Compared to faculty assessment scores, there was no significant difference between the self-reflections before or after video viewing (p = 0.571). DISCUSSION: Video self-reflection had no significant impact on the ability to accurately self-assess aseptic technique skills, but this study did reveal several other opportunities for future teaching and research. SUMMARY: Future efforts to impact student self-awareness should include additional self-reflection instruction, repeated self-reflection activities conducted over the course of a semester, and improved video recording technology.

Utilizing desirable difficulties for sterile compounding training in a skills-based laboratory course.

BACKGROUND AND PURPOSE: Sterile compounding skills are essential components of a professional pharmacy curriculum. The theory of desirable difficulties has been used to facilitate deeper learning of material in other disciplines, but has not been described in pharmacy sterile compounding instruction. The purpose of this work was to evaluate whether challenges introduced in sterile compounding would act as desirable difficulties and result in greater student confidence in their sterile compounding competency. EDUCATIONAL ACTIVITY AND SETTING: Students in the fourth semester of Pharmacy Skills and Applications, a laboratory-based skills course, were presented with challenges in sterile compounding and were asked to complete a questionnaire rating their confidence and describing their experience. FINDINGS: The majority (92.8%) of students reported that the activity increased their confidence in their sterile compounding skills. Students' open-ended responses suggested that most of the knowledge gained was strategic in nature. DISCUSSION: The results of this activity met the instructors' initial goals by positively impacting students' confidence in their ability to overcome challenges with sterile products compounding. Course instructors may explore additional skills in which to introduce desirable difficulties in order to build student confidence. SUMMARY: Course instructors were pleased with the implementation and results of this desirable difficulties activity and plan to continue its use again in future semesters. Incorporating more real-world challenges throughout the skills-lab course may be beneficial to student learning and confidence. With thoughtful planning, faculty at other institutions can readily incorporate similar activities within their own courses.

Comparison of electronic versus paper rubrics to assess patient counseling experiences in a skills-based lab course.

BACKGROUND AND PURPOSE: To evaluate an electronic counseling rubric to facilitate timely student feedback and explore differences in student performance, student anxiety, and self-perceived preparedness in a high stakes practical exam when using a paper rubric versus an electronic rubric. EDUCATIONAL ACTIVITY AND SETTING: Two cohorts of students in the third professional year were evaluated using the same rubric criteria: cohort 1 (n = 97) used traditional paper rubrics and cohort 2 (n = 104) used electronic rubrics. Cohorts were surveyed to measure anxiety and perceived preparedness in patient counseling skills one week prior to a practical exam, and cohort responses were compared. Student practical exam performance was also compared between the two cohorts. FINDINGS: Results showed no significant relationship between electronic rubric use and student anxiety (p = 0.07) or student exam performance [average score 53.42 points (SD 3.65) and 53.93 points (SD 3.78) in Cohort 1 and Cohort 2, respectively]. Perceived exam preparedness was higher among students using electronic rubrics, with timing of feedback being the mediating process in increasing preparedness (p < 0.01). DISCUSSION AND SUMMARY: Electronic rubrics resulted in more timely feedback on patient counseling skills, and students felt more prepared for their practical exam. This did not result in a significant difference in practical exam performance between the two cohorts. Additional methods to incorporate electronic rubrics into the course will be explored.

Retrospective Evaluation of ASCVD Risk and Statin Therapy Need in Nondiabetic Patients Based on the 2013 ACC/AHA Cholesterol Guidelines.

PURPOSE: Study goal was to assess the impact of the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) Cholesterol Guidelines on patients in the fourth statin benefit group which included patients aged 40 to 75 years, without diabetes or clinical atherosclerotic cardiovascular disease (ASCVD), and have an ASCVD score ≥7.5%. These patients could benefit from treatment interventions by a pharmacist. METHODS: Patients were identified from electronic health records. A sample of 3503 patients was ascertained from having a lipid panel performed within the 12 months before November 1, 2013. Patients were excluded if we were unable to calculate 10-year ASCVD risk. RESULTS: A total of 3203 patients were included, with 2008 not on statin therapy. Of those, 1507 (75%) had a 10-year ASCVD risk score <7.5% and 501 (25%) had a score > 7.5%. Patient characteristics leading to an increase in risk included advanced age, smoker, male, and hypertension treatment. Of 2008 nonstatin patients, there were 466 (23.2%) who fit criteria for initiation of moderate- or high-intensity statin. CONCLUSION: Widespread adoption of the 2013 ACC/AHA Cholesterol Guidelines will expand prescribing rates of statins. Implementing screening strategies may help identify patients who require treatment in this fourth statin benefit group. A pharmacist can be vital in screening patients, educating patients regarding the need for medication therapy, and monitoring for adherence in these new regimens.

An Industrial Engineering Approach to Cost Containment of Pharmacy Education.

A 2-semester project explored employing teams of fourth-year industrial engineering students to optimize some of our academic management processes. Results included significant cost savings and increases in efficiency, effectiveness, and student and faculty satisfaction. While we did not adopt all of the students' recommendations, we did learn some important lessons. For example, an initial investment of time in developing a mutually clear understanding of the problems, constraints, and goals maximizes the value of industrial engineering analysis and recommendations. Overall, industrial engineering was a valuable tool for optimizing certain academic management processes.

A multiyear analysis of team-based learning in a pharmacotherapeutics course.

OBJECTIVES: To evaluate the impact of team-based learning (TBL) in a pharmacotherapeutics course on pharmacy students' ratings of faculty instructors and the course, and to assess students' performance after implementation of team-taught TBL. DESIGN: Teaching methodology in a pharmacotherapeutics course was changed from a lecture with recitation approach in 2 semesters of a 6 credit-hour course to a TBL framework in a 3-semester 3+4+5 credit hour course. The distribution of faculty of instruction was changed from 4 faculty members per week to 1 faculty per 1-credit-hour module. TBL consisted of preclass study preparation, readiness assurance (Individual Readiness Assessment Test and Group Readiness Assessment Test), and in-class application exercises requiring simultaneous team responses. ASSESSMENT: Retrospective analysis of student ratings of faculty and instructional methods was conducted for the 2 years pre-TBL and 4 years during TBL. Final course grades were evaluated during the same time period. Student ratings showed progressive improvements over 4 years after the introduction of team-based learning. When aggregated, ratings in the "excellent teacher" category were unchanged with TBL compared to pre-TBL. Improvements in faculty instructor approaches to teaching were noted during TBL. Group grades were consistently higher than individual grades, and aggregate course grades were similar to those prior to TBL implementation. CONCLUSION: Implementation of TBL in a pharmacotherapeutics course series demonstrated the value of team performance over individual performance, indicated positive student perceptions of teaching approaches by course faculty, and resulted in comparable student performance in final course grades compared to the previous teaching method.

Irritable bowel syndrome: a concise review of current treatment concepts.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, "classic" treatments for IBS as well as newer agents and "alternative" therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.

A checklist for the development of faculty mentorship programs.

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

Assessing pharmacy students' ability to accurately measure blood pressure using a blood pressure simulator arm.

OBJECTIVE: To compare student accuracy in measuring normal and high blood pressures using a simulator arm. METHODS: In this prospective, single-blind, study involving third-year pharmacy students, simulator arms were programmed with prespecified normal and high blood pressures. Students measured preset normal and high diastolic and systolic blood pressure using a crossover design. RESULTS: One hundred sixteen students completed both blood pressure measurements. There was a significant difference between the accuracy of high systolic blood pressure (HSBP) measurement and normal systolic blood pressure (NSBP) measurement (mean HSBP difference 8.4 ± 10.9 mmHg vs NSBP 3.6 ± 6.4 mmHg; p<0.001). However, there was no difference between the accuracy of high diastolic blood pressure (HDBP) measurement and normal diastolic blood pressure (NDBP) measurement (mean HDBP difference 6.8 ± 9.6 mmHg vs. mean NDBP difference 4.6 ± 4.5 mmHg; p=0.089). CONCLUSIONS: Pharmacy students may need additional instruction and experience with taking high blood pressure measurements to ensure they are able to accurately assess this important vital sign.

Adherence to treatment guidelines in two primary care populations with gout.

Published guidelines for the treatment of gout aim to improve the evidenced-based management of this disorder. Unfortunately, several studies suggest that these guidelines are not routinely followed in clinical practice. Limited data exist comparing different groups of primary care providers regarding compliance with published gout guidelines. We conducted a retrospective study comparing two different general internal medicine (IM) practices and evaluated compliance with these guidelines. All patients with a billing code for gout seen in two large IM clinics (Clinic A, an inner-city urban clinic, and Clinic B, a suburban clinic) between January 2004 and December 2007 were selected for chart review. Patients referred to a rheumatologist for management of gout were excluded. The care received by these patients for gout was compared to recommendations from published guidelines, with the primary outcome assessing the percentage of patients who received at least yearly monitoring of serum uric acid (SUA) levels. In both clinics, yearly monitoring of SUA levels occurred in approximately one quarter of the patients with gout (Clinic A 27.5% vs. Clinic B 28.9%, P = 0.87). Compared to SUA, renal function was monitored more frequently in each of the groups. Listed indications for antihyperuricemic therapy were similar between groups, although gouty flares were reported more frequently in clinic B (P = 0.005). In this retrospective review of gout management in two IM clinics, general care for patients with this condition did not differ significantly. However, overall compliance with recommendations from published guidelines was low.

Intensive insulin therapy in critical care settings.

Hyperglycemia in hospitalized patients has been shown to increase both morbidity and mortality, regardless of the presence of preexisting diabetes. In order to achieve recommended glycemic goals, many patients require the use of intravenous insulin therapy in the critical care setting. Following the publication of a landmark trial evaluating the benefits of intensive insulin therapy in critically ill patients, a worldwide increased effort to achieve strict glycemic control has ensued. Maintaining blood glucose levels between 80 and 110 mg/dL has been shown to improve outcomes such as mortality and infectious complications in critically ill patients, while also decreasing length of hospital stay and healthcare expenditures. However, achieving strict glycemic control has proven to be a challenge for many institutions, partly due to the prevalence of hypoglycemia. As demonstrated by studies which have been terminated prematurely due to increased risk for hypoglycemic episodes, the benefits versus risks of intensive insulin therapy must be weighed carefully. Patients receiving continuous infusions of insulin require close monitoring, which may increase workload for intensive care unit staff. In an effort to balance the risks and benefits of intensive insulin therapy, many hospitals are incorporating standardized protocols and using an interdisciplinary approach toward patient care.

Oral aloe vera-induced hepatitis.

OBJECTIVE: To report a case of possible oral aloe vera-induced hepatitis. CASE SUMMARY: A 73-year-old female was admitted to the hospital for acute hepatitis. Extensive laboratory testing did not reveal the cause of the patient's disease. She was asked multiple times whether she was taking any home medications, which she initially denied. It was only after an extensive medication history done by a clinical pharmacist that the patient admitted to using oral aloe vera capsules for constipation. Upon discontinuation of the oral aloe vera, liver markers of hepatotoxicity returned to normal levels. DISCUSSION: Herbal medications pose an increasing problem in patient safety, as the different types of these products and the number of patients who use them continue to grow. In the US, these products are not subject to the same regulatory scrutiny as prescription medications; thus, safety information can be difficult to obtain. In particular, hepatic toxicity due to herbal agents is poorly described in the medical literature. Aloe vera, often used topically for minor burns, can also be used orally as a laxative or an "anti-aging" agent. According to the Naranjo probability scale, the hepatotoxicity in this case was possibly related to ingestion of oral aloe vera. Additionally, using the Roussel Uclaf Causality Assessment Method for determining drug hepatotoxicity, the patient's symptoms were scored as probably caused by oral aloe vera. The more conservative designation was used in our report. CONCLUSIONS: With the widespread use of oral aloe vera and other herbal products, clinicians faced with a case of acute hepatitis that is not readily diagnosed should question patients about herbal use.

Apparent anaphylactoid reaction after treatment with a single dose of telithromycin.

BACKGROUND: Telithromycin, the first ketolide antimicrobial agent available in the United States, is related to the macrolide class of antibiotics. Reports of immediate-type hypersensitivity reactions with macrolides or ketolides are rare overall. OBJECTIVE: To describe a patient with a severe, apparent mast cell-mediated reaction to telithromycin. METHODS: A 54-year-old woman with a history of hypertension was prescribed telithromycin by her primary care physician for presumed bacterial sinusitis. Shortly after ingesting the first dose of telithromycin she developed severe shortness of breath, wheezing, and angioedema. Her allergic history was significant for the development of a maculopapular rash after taking sulfonamide antibiotics, but she had received erythromycin and azithromycin in the past with no adverse effects. She was intubated with difficulty and was treated with epinephrine, diphenhydramine, and corticosteroids. The patient made a full recovery. RESULTS: Although not confirmed, the patient's severe symptoms were anaphylactoid and were ascribed to an immediate-type hypersensitivity reaction to telithromycin. No other causative agents, including other drugs, foods, and environmental exposures, were implicated in this case. Her history of tolerability to macrolide antibiotics is of interest considering the chemical similarities between these drugs and telithromycin. CONCLUSION: To our knowledge, this is the first reported case of a severe, immediate-type hypersensitivity reaction to telithromycin. Physicians prescribing this drug should be aware of this rare but serious effect.