A Call to Action for Integrating Introductory Pharmacy Practice Experiences With Purpose.

Introductory pharmacy practice experiences (IPPEs) are essential to exposing students to contemporary pharmacy practice and promoting advanced pharmacy practice experience readiness. An IPPE curriculum should be sequenced and progressive, with IPPE experiences built upon each other and coordinated with the didactic curriculum. Pharmacy programs are faced with several internal and external challenges that can influence the design and implementation of their IPPE curriculum. Periodic IPPE curricular review is imperative as new challenges arise and existing challenges abate. Pharmacy programs should use a systematic and holistic process to evaluate and revise their IPPE programs. It is an opportune time to begin this process, with new standards being released in 2024. This commentary describes common challenges associated with integrating a high-quality IPPE program into a Doctor of Pharmacy curriculum along with potential solutions, with the intention for individual programs to use this as a tool to guide IPPE evaluation and revision.

Instrument development to determine student self-efficacy to present a patient to a pharmacy preceptor (4P).

INTRODUCTION: Effective patient assessment is often supported through simulated experiences where students identify potential drug-related problems (DRPs) through evaluation of the patient's electronic health record and verbally present their assessment and proposed resolutions for DRPs. This research aimed to initiate validation of a Patient Presentation to a Pharmacy Preceptor (4P) tool using exploratory factor analysis (EFA) to examine underlying constructs, refine items, and improve tool conciseness. The 4P tool was designed to assess student self-efficacy to identify, assess, resolve, and verbally present DRPs to a pharmacy preceptor. METHODS: The 4P instrument was administered to third-year doctor of pharmacy students in a performance-based skills laboratory course. EFA was conducted on student confidence data to examine underlying 4P constructs and improve survey conciseness. Laboratory faculty evaluated EFA results and came to consensus on factor extraction, item reduction and revision, and a finalized version of the 4P tool. RESULTS: Faculty interpretation of EFA results suggested elimination of two constructs resulting in a four-factor solution. Item evaluation further led to renaming the four constructs based on underlying factor themes. Out of the original 34-item tool, 13 items were eliminated, eight items were revised, and 1 new item was generated to retain relevant concepts. The refined 4P instrument contained four factors and 22 items. CONCLUSIONS: Use of EFA was useful to determine core 4P tool constructs and improved tool conciseness. This final four-factor model including 22 items will be used for a future confirmatory factor analysis.

Associating Student Performance in Pharmacy Practice Didactic and Skills-Based Courses With Advanced Pharmacy Practice Experiences.

Objective. To determine the association between pharmacy practice didactic course examinations and performance-based assessments with students' performance during their advanced pharmacy practice experiences (APPEs).Methods. This retrospective analysis included data from the graduating classes of 2018 to 2020. Students were coded as APPE poor performers (final course grade <83%) or acceptable performers. Assessments in pharmacy practice didactic and skills-based courses in students' second and third years were included in the analysis, with thresholds correlating to grade cutoffs. The association between poor performance mean examination scores and performance-based assessments with APPE performance was calculated.Results. Of the 403 graduates, analysis sample sizes ranged from 254 to 403. There were 49 students (12%) who met the criteria for poor performance in the APPE year. When comparing pharmacy practice didactic course performance to APPE poor performance, the proportion of mean examination scores that were <83% for six of the seven pharmacy practice didactic courses was significant; five of the seven mean examination scores were significant at the <78% threshold. Performance-based assessments that were significantly associated with APPE poor performance often required critical thinking.Conclusion. A gap in identification of students with APPE poor performance who did not fail a didactic course was demonstrated. Specifically, this finding suggests that pre-APPE curriculum should focus on assessments that include critical thinking. These methods could be used by other pharmacy programs to find components of their curricula that help identify students who need additional support prior to the APPE year.

Antimicrobial stewardship in solid organ transplantation: Perspective from a Veterans Affairs Medical Center.

BACKGROUND: The importance of antimicrobial stewardship (AMS) activities specifically focused on solid organ transplant (SOT) recipients is increasingly recognized. In 2014, the Veterans Health Administration (VHA) created national guidance and committed resources to establish AMS programs at Veterans Affairs (VA) medical centers across the country. However, the AMS implementation is at the discretion of individual VA centers. METHODS: We undertook an environmental scan of AMS activities in a tertiary care VA medical center. RESULTS: We describe AMS activities focused on SOT recipients. Strategies based on local epidemiology that leverage the electronic medical record together with engagement by transplant infectious diseases personnel are likely to be beneficial. CONCLUSION: AMS in SOT recipients is challenging yet impactful. Strategies described here may be useful for AMS activities focused on the SOT population.

Application of consolidated framework for implementation research to improve Clostridioides difficile infection management in district hospitals.

BACKGROUND: Clostridioides difficile infection (CDI) contributes the global threats of drug resistant infections, healthcare acquired infections and antimicrobial resistance. Yet CDI knowledge among healthcare providers in low-resource settings is limited and CDI testing, treatment, and infection prevention measures are often delayed. OBJECTIVES: to develop a CDI intervention informed by the local context within South African public district level hospitals, and analyze the CDI intervention and implementation process. METHODS: A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa that volunteered to participate. Data collection included a retrospective medical records review of patients hospitalized with C. difficile test orders during the 90 days post-implementation. Patient outcomes and checklist components (e.g. antibiotics) were collected. Qualitative interviews (n = 14) and focus groups (n = 6) were conducted with healthcare providers on-site. The Consolidated Framework for Implementation Research (CFIR) and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) were applied to collected data and observations in order to identify drivers and barriers to implementation and understand differences in uptake. RESULTS: One of the three hospitals displayed high intervention uptake. Highly relevant CFIR constructs linked to intervention uptake included tension for change, strong peer intervention champions, champions in influential leadership positions, and the intervention's simplicity (CFIR construct: complexity). Tension for change, a recognized need to improve CDI identification and treatment, at the high uptake hospital was also supported by an academic partnership for antimicrobial stewardship. CONCLUSIONS: This research provides a straight-forward health systems strengthening intervention for CDI that is both needed and uncomplicated, in an understudied low resource setting. Intervention uptake was highest in the hospital with tension for change, influential champions, and existing academic partnerships. Implementation in settings with fewer academic connections requires further testing of collaborative implementation strategies and proactive adaptations.

Determination of Interrater Reliability of a Universal Evaluator Rubric to Assess Student Pharmacist Communication Skills.

Objective. To evaluate the interrater reliability of a universal evaluator rubric used to assess student pharmacist communication skills during patient education sessions.Methods. Six US schools and colleges of pharmacy each submitted 10 student videos of a simulated community pharmacy patient education session and recruited two raters in each of the five rater groups (faculty, standardized patients, postgraduate year one residents, student pharmacists, and pharmacy preceptors). Raters used a rubric containing 20 items and a global assessment to evaluate student communication of 12 videos. Agreement was computed for individual items and overall rubric score within each rater group, and for each item across all rater groups. Average overall rubric agreement scores were compared between rater groups. Agreement coefficient scores were categorized as no to minimal, weak, moderate, strong, or almost perfect agreement.Results. Fifty-five raters representing five rater groups and six pharmacy schools evaluated student communication. Item agreement analysis for all raters revealed five items with no to minimal or weak agreement, 10 items with moderate agreement, one item with strong agreement, and five items with almost perfect agreement. Overall average agreement across all rater groups was 0.73 (95% CI, 0.66-0.81). The preceptor rater group exhibited the lowest agreement score of 0.68 (95% CI, 0.58-0.78), which significantly deviated from the overall average.Conclusion. While strong or almost perfect agreement scores were not observed for all rubric items, overall average interrater reliability results support the use of this rubric in a variety of raters to assess student pharmacist communication skills during patient education sessions.

Revisions to a patient presentations curricula informed by longitudinal evaluation of student confidence.

BACKGROUND AND PURPOSE: Presentation of patient cases to a preceptor is a complex skill taught throughout the pharmacy curriculum. However, published literature to guide instruction on this skill is lacking. The objective of this project was to inform revisions to a patient presentations curriculum through measurement and evaluation of student confidence to perform skills necessary to effectively present a patient case to a preceptor. EDUCATIONAL ACTIVITY AND SETTING: A patient presentations to pharmacy preceptor curriculum was implemented into a pharmacotherapy skills laboratory course. Students were invited to complete three surveys over the course of the semester to evaluate areas for improvement in the teaching of this skill. Surveys measured student confidence in ability to identify and present relevant components within an electronic health record, identify and resolve drug-related problems, and communicate effectively during a patient presentation (34 items, 7-point Likert type scale). Survey results were analyzed, and instructional interventions were identified and designed. FINDINGS: Student confidence to present a patient to a pharmacy preceptor improved over the semester. Four interventions were designed and implemented to address five low self-reported student confidence items. Interventions included creation of large-group discussions, standardization of student feedback, and revision of a lab to limit student preparation time. Survey data revealed students understood the importance of evaluating patient cases and agreed these skills are applicable to multiple practice settings. SUMMARY: Based on student confidence data, areas for improvement in a patient presentations curriculum were identified, allowing for implementation of instructional interventions that targeted specific performance items.

A state-level needs analysis of community pharmacy point-of-care testing.

BACKGROUND: The uptake of point-of-care testing (POCT) within community pharmacies at state and national levels is largely unknown despite the endorsement and advocacy efforts of pharmacy organizations, recent legislative advances, and numerous models for successful POCT implementation within individual pharmacy sites. OBJECTIVES: The study aimed to describe the current landscape of POCT in Wisconsin community pharmacies and identify opportunities for the advancement of testing and the key factors influencing the realization of these opportunities. METHODS: A survey was administered over the telephone to pharmacy managers of community pharmacies in Wisconsin. The sites were randomly selected from predefined geographic regions to mirror pharmacy distribution across Wisconsin. The survey items evaluated provision of POCT, future direction of POCT, barriers and motivators to offering POCT, and pharmacy demographics. Descriptive statistics and thematic analysis were used to analyze data. RESULTS: Pharmacy managers from 147 of the 938 registered community pharmacies (15.7%) participated in the survey. Only 17.1% of the pharmacies were offering POCT; however, 48.3% of managers reported that their pharmacy would likely implement or expand POCT within the next 5 years. The most commonly reported barriers to initiating or expanding POCT were the limitations on pharmacist availability to oversee testing and workflow restrictions. Continuing to advance the pharmacy profession was a top reason for offering or expanding testing services. DISCUSSION: While few pharmacies are offering POCT in Wisconsin, there is motivation for expansion in coming years. Understanding, anticipating and addressing common barriers can faciliate this process. CONCLUSION: This needs analysis offers a blueprint for researchers, educators, and clinicians to shape POCT efforts by examining the landscape of pharmacy-based testing in their own states and communities.

Let External Stakeholders Be Your Guide to Curricular Revision.

Schools and colleges of pharmacy undertake curriculum revisions for a variety of reasons ranging from the reactionary (eg, responding to changes in practice patterns, accreditation standards) to the proactive (eg, striving for innovation and excellence). Continuous quality improvement processes and published curriculum models, both described in this commentary, should be used to guide revision processes. Equally important is engaging the expertise of external stakeholders. While there may be challenges to incorporating external stakeholders in a curriculum revision process, their perspectives and knowledge can contribute to a more robust result, often in unexpectedly positive ways. Logic modeling is one mechanism to structure this approach, maximize the utility of external stakeholders, and strengthen the overall curriculum revision process. Regardless of the size of the revision, a good rule of thumb is to engage external stakeholders at the outset and to let their expertise be your guide.

Expert Consensus to Finalize a Universal Evaluator Rubric to Assess Pharmacy Students' Patient Communication Skills.

Objective. To use an expert consensus-building process to develop a rubric used by multiple evaluator types to assess Doctor of Pharmacy students' patient communication skills.Methods. Faculty and staff members from six schools and colleges of pharmacy collaborated on a multi-step expert consensus-building process to create the final version of a communication rubric. First, faculty and patient content experts evaluated each item in the rubric for its relevance, criticality, and global comprehensiveness using a five-point Likert scale (0=not at all, 4=to a high extent). Descriptive statistics were used to analyze the resulting data. Faculty members evaluated the results and came to a consensus on the second version of the rubric. A corresponding codebook was developed and refined through a two-phase process.Results. The initial communication rubric was evaluated by 13 expert reviewers. Mean global comprehensiveness on the rubric was 3.83 for faculty experts and 3.5 for patient experts. After evaluating results from the expert consensus-building process, 14 items on the rubric did not change, five items were revised, three items were removed, and two items were added. The second version of the instrument included 20 items in six topic areas. A codebook was finalized to increase scoring consistency for the 20 communication items.Conclusion. Overall, content experts concluded that the rubric had high global comprehensiveness. Collaboration involving faculty members from multiple schools of pharmacy resulted in a 20-item communication rubric and codebook that can be used to increase consistency in scoring student pharmacists' patient communication skills.

Development of a Holistic Assessment Plan to Evaluate a Four-Semester Laboratory Course Series.

Objective. To implement a holistic assessment plan to evaluate the impact of a four-semester laboratory course series entitled Integrated Pharmacotherapy Skills on students' readiness to begin advanced pharmacy practice experiences (APPEs) following separation of the laboratory component from the Pharmacotherapy lecture component. Design. Faculty prospectively selected and employed a variety of course assessment methods including student self- and preceptor evaluation during APPEs, course evaluations, and a student confidence survey to evaluate student readiness for APPEs and ensure a quality learning experience for students. Assessment. APPE students' self-perceived confidence to perform skills increased after completion of the redesigned curriculum and after experiencing two APPE rotations. APPE preceptors did not report a change in student performance. Results from course evaluations suggest that separating the laboratory course from the lecture course created a positive learning experience for students. Conclusion. Students completing the new laboratory curriculum were equally prepared to begin APPE rotations as students who had completed the old curriculum. A similar multidimensional, holistic assessment plan could be used at other institutions to evaluate skills-based courses as part of continuous quality improvement.

Development and Application of a Stepwise Assessment Process for Rational Redesign of Sequential Skills-Based Courses.

Objective. To develop and apply a stepwise process to assess achievement of course learning objectives related to advanced pharmacy practice experiences (APPEs) preparedness and inform redesign of sequential skills-based courses. Design. Four steps comprised the assessment and redesign process: (1) identify skills critical for APPE preparedness; (2) utilize focus groups and course evaluations to determine student competence in skill performance; (3) apply course mapping to identify course deficits contributing to suboptimal skill performance; and (4) initiate course redesign to target exposed deficits. Assessment. Focus group participants perceived students were least prepared for skills within the Accreditation Council for Pharmacy Education's pre-APPE core domains of Identification and Assessment of Drug-related Problems and General Communication Abilities. Course mapping identified gaps in instruction, performance, and assessment of skills within aforementioned domains. Conclusions. A stepwise process that identified strengths and weaknesses of a course, was used to facilitate structured course redesign. Strengths of the process included input and corroboration from both preceptors and students. Limitations included feedback from a small number of pharmacy preceptors and increased workload on course coordinators.

Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived Confidence and Engagement.

OBJECTIVE: To evaluate online case simulation vs a paper case on student confidence and engagement. DESIGN: Students enrolled in a pharmacotherapy laboratory course completed a patient case scenario as a component of an osteoarthritis laboratory module. Two laboratory sections used a paper case (n=53); three sections used an online virtual case simulation (n=81). Student module performance was assessed through a submitted subjective objective assessment plan (SOAP) note. Students completed pre/post surveys to measure self-perceived confidence in providing medication management. The simulation group completed postmodule questions related to realism and engagement of the online virtual case simulation. Group assessments were performed using chi-square and Mann Whitney tests. ASSESSMENT: A significant increase in all 13 confidence items was seen in both student groups following completion of the laboratory module. The simulation group had an increased change of confidence compared to the paper group in assessing medication efficacy and documenting a thorough assessment. Comparing the online virtual simulation to a paper case, students agreed the learning experience increased interest, enjoyment, relevance, and realism. The simulation group performed better on the subjective SOAP note domain though no differences in total SOAP note scores was found between the two groups. CONCLUSION: Virtual case simulations result in increased student engagement and may lead to improved documentation performance in the subjective domain of SOAP notes. However, virtual patient cases may offer limited benefit over paper cases in improving overall student self-confidence to provide medication management.

Evaluation of pharmacotherapy laboratory revisions implemented to reduce cost.

OBJECTIVES: To revise a pharmacotherapy-laboratory curriculum to decrease course expenditures while maintaining a quality educational experience. DESIGN: Course mapping identified laboratory activities that achieved the defined learning outcomes. Redundant activities were eliminated, and remaining activities not requiring active in-laboratory participation were converted into prelaboratory assignments and simulations. An online course-management system provided a platform for simulations and automated grading. ASSESSMENT: An evaluation of economic data showed a 64% and 43% decrease in total course expenditures for Pharmacotherapy Laboratory III and IV, respectively. Although a comparison of examination and course grades before and after redesign revealed a small decrease in grades for the Pharmacotherapy III and IV course, the reasons for this decrease were unclear and could not be directly attributed to the redesign. Comparison of students' evaluation scores before and after the redesign showed continued high satisfaction with the course. CONCLUSIONS: Revisions made to the curriculum for a pharmacotherapy laboratory decreased course expenditures while maintaining the quality of education. The successful redesign was related to several key components including course mapping and enhanced use of technology. A similar revision process can be considered by other colleges and schools of pharmacy facing budgetary reductions.