Evaluating the Strengths and Barriers of Competency-Based Education in the Health Professions.

OBJECTIVE: To define competency-based education (CBE) for pharmacy education and describe how strengths and barriers of CBE can support or hinder implementation. METHODS: A narrative synthesis was performed via search of English-language articles related to CBE within health professions education from 2015-2021. Articles were included if they described CBE or the strengths or barriers of its use. Articles could be of any type. Full text review and data extraction occurred independently by each author for a subset of included articles. To aid in application of the identified CBE strengths and barriers to pharmacy education, data were as placed in a readiness for change model. RESULTS: Sixty-five studies were included from a variety of health professions. From seven theme categories identified a CBE definition was developed; Competency-based pharmacy education (CBPE) is an outcomes-based curricular model of an organized framework of competencies (knowledge, skills, attitudes) for pharmacists to meet healthcare and societal needs. This learner-centered curricular model aligns authentic teaching and learning strategies and assessment (emphasizing workplace assessment and quality feedback), while de-emphasizing time. Barriers and benefits were identified from learner, faculty, institution, and society perspectives. For CBE implementation, motivations and intervention-capacity benefits and barriers are addressed across frame perspective and intervention components. CONCLUSION: This paper defines CBE for utilization within pharmacy education. The strengths and barriers for CBE were elucidated from other health professions' education literature. Identified implementation strengths and barriers aid in the discussions on what will support or hinder the implementation of CBE in pharmacy education.

The Need for Competency-Based Education.

While pharmacy education updates learning as new information arises, changes to learning experiences can trail behind current practices and technology. There have been multiple calls for radical changes in how health professions education is delivered in order to ensure patients are receiving high-quality care. Competency-based education (CBE) has been one way discussed in the literature for how to handle this need to develop students who have a willingness to learn and can problem solve. The goal of this review is to examine whether CBE is needed to drive the profession of pharmacy forward. To address, we collaboratively to identified stakeholder perspectives to evaluate the need. The following stakeholders achieved consensus among the committee members: patients/society, learners, workplace/profession, and academic institutions. Based on those perspectives, needs and gaps to address those needs were identified and are presented in this review.

Enabling Factors for the Implementation of Competency-Based Curricula in Colleges and Schools of Pharmacy.

OBJECTIVES: To review the implementation drivers of competency-based pharmacy education (CBPE) and provide recommendations for enablers. FINDINGS: Competency-based education is an emerging model in the health professions, focusing on time-variable competency development and achievement compared with a time-bound, course-based, traditional model. CBPE is an outcomes-based organized framework of competencies enabling pharmacists to meet health care and societal needs. However, challenges need to be recognized and overcome for the successful implementation of CBPE. Competency drivers include defining the competencies and roles of stakeholders, developing transparent learning trajectories and aligned assessments, and establishing lifetime development programs for stakeholders. Organization drivers include developing support systems for stakeholders; facilitating connections between all educational experiences; and having transparent assessment plans, policies, and procedures that align with core CBPE precepts, including the sustainability of time-variability. Leadership drivers include establishing growth mindset and facilitating a culture of connection between workplace and educational environments, program advocacy by institutional leaders, accepting failures as part of the process, shifting the organizational culture away from learner differentiation toward competence, and maintaining sufficient administrative capability to support CBPE. SUMMARY: The successful implementation of CBPE involves enabling the competency, organization, and leadership drivers that will lead to program success. More research is needed in the areas of creation, implementation, and assessment of CBPE to determine success in this model. We have reviewed and provided recommendations to enable the drivers of successful implementation of CBPE.

Report of the 2023 AACP Council of Deans Taskforce on Pharmacy Research and Scholarship.

OBJECTIVE: The objective of this review is to provide the conclusions from the American Association of Colleges of Pharmacy (AACP) Council of Deans (COD) Taskforce on Research and Scholarship. FINDINGS: The charges and the findings of the committee are: (1) Define the scholarship needs/opportunities to strengthen the outputs. The committee recommends that AACP update its definitions of research/scholarship to include discovery, integration, application/practice, and teaching/learning. A deployed survey demonstrated a high Special Interest Groups research/scholarship interest. (2) Assemble a toolkit of grant and scholarship resources to assist colleges/schools. The AACP should update the existing funding opportunity listing and combine it with additional resources. (3) Create a framework for effective research collaboration and mentorship. The AACP should identify key areas of pharmacy research and experts to serve as mentors and to meet with external stakeholders. (4) and (5) Consider the need for and purpose of a COD standing committee for research and scholarship. Explore the value of a formal research dean's subcommittee. It was recommended that AACP form a research/scholarship committee or Special Interest Groups and create the Pharmacy Scholarship, Research, and Graduate Education pre-meeting to the Interim Meeting. (6) Identify key statements/outputs of the COD that need to be prepared for publication/sharing. We recommended the key statement/outputs in the areas of discovery, integration, application/practice, and teaching and learning. SUMMARY: The taskforce reviewed the state of research and scholarship across the Academy and provided recommendations with the goal of advancing research across all areas of the pharmacy profession.

Competency-based pharmacy education definition: What components need to be defined to implement it?

OBJECTIVES: This study aimed to define the essential elements in the proposed competency-based pharmacy education (CBPE) definition, provide the key defining components of each essential element on the basis of educational theory and evidence, and define how the essential elements meet the identified needs for CBPE. METHODS: best-practice integrative review was conducted as part of the work of the American Association of Colleges of Pharmacy CBPE Task Force to define the essential elements in the CBPE definition and how these elements fit with the need for CBPE. The definition was compared with other published competency-based education definitions across K-12, higher education, medical education, and veterinary education. Task Force members then met to develop a consensus on the core components of the 5 essential elements in the definition. Next, the Task Force evaluated the fit of CBPE by matching the identified needs, discussed in detail elsewhere, across each of the stakeholder perspectives with the core components of the 5 essential elements in the derived definition of CBPE. FINDINGS: Upon review of the proposed CBPE definition, the Task Force identified 5 essential elements. These elements include the following: meeting health care and societal needs, outcomes-based curricular model, de-emphasized time, learner-centered culture, and authentic teaching and learning strategies aligned to assessments. SUMMARY: This article helps to establish a common language for CBPE by defining the essential elements of the core components of the definition, and provides a starting point for further exploration of CBPE.

'R' you ready to save time? Using R to facilitate question creation in a pharmaceutical calculations course.

BACKGROUND AND PURPOSE: Pharmacists are expected to perform quick and accurate calculations throughout their careers. To achieve a proficient skill level, student pharmacists need ample and varied opportunities to practice pharmaceutical calculations. However, the creation of practice modalities can be time-consuming and labor-intensive for instructors. EDUCATIONAL ACTIVITY AND SETTING: We used the statistical analysis programming language R to create an efficient method to generate multiple variations of existing calculation questions. The method was evaluated with a group of student pharmacists as part of an 11-week calculations course. FINDINGS: This process can be challenging to set up initially. The method was able to generate over 100 variations of each calculation question. The student pharmacists who participated in the pilot study found the method to be easy to use and helpful for practicing pharmaceutical calculations. SUMMARY: We have developed an efficient method to generate multiple variations of existing calculation questions. This method can be used to create practice modalities that are more varied and challenging, which can help student pharmacists develop the skills they need to perform accurate calculations in their future careers.

Recommendations and Next Steps For Competency-Based Pharmacy Education.

In July 2021, the chairs of the American Association of Colleges of Pharmacy Council of Deans, Council of Faculties, and Council of Sections developed a task force to discuss potential ways to improve pharmacy education. The Competency-Based Education (CBE) Joint Task Force was created to explore the pros and cons of advancing a competency-based approach to pharmacy education (CBPE) and to determine ways to create more flexibility within pharmacy curricula to enable CBE. To achieve these goals, the Task Force systematically reviewed available resources and outlined the pros and cons of CBPE, best practices for implementation, strategies to minimize barriers, and recommendations on whether CBE should be implemented in pharmacy education. This commentary summarizes the Task Force's findings regarding whether CBPE is a suitable approach for pharmacy education and the next steps if implemented.

"Put me in Coach!" Engaging Faculty to Form a Winning Assessment Team.

This commentary uses the metaphor of an athletic team model to provide guidance when managing a successful assessment committee and assessment processes. To become a winning team, a joint effort must be exerted by players, coaches, and the athletic director. The topics of developing a team of productive members, creating, and implementing an assessment plan, forming a positive culture, and establishing leadership are discussed. Examples and advice are provided to assist with promoting an engaged faculty to form a well-rounded and productive assessment committee with clearly defined roles and responsibilities.

A Scoping Review of the Hidden Curriculum in Pharmacy Education.

Objective. The hidden curriculum has been defined as teaching and learning that occur outside the formal curriculum and includes the knowledge, skills, attitudes, behaviors, values, and beliefs that students consciously or subconsciously acquire and accept. It has been identified as an inherent part of learning in health professions education and may affect students' formation of professional identity. This scoping review investigated the definition and evidence of the hidden curriculum for pharmacy education.Findings. A comprehensive literature search was conducted for primary articles investigating the hidden curriculum in pharmacy education through August 2021. A total of five papers were included in the review: four papers from the United Kingdom and one from Sweden. The focus of each paper and the elements of the hidden curriculum, along with the study quality as assessed by the quality assessment tool, varied. Three papers focused on professionalism or professional socialization, and the other two focused on patient safety. All five studies used qualitative methods including focus groups and semistructured interviews of the students and faculty. Studies also identified approaches to addressing the hidden curriculum, such as integrating formal and informal learning activities, integrating work experiences, providing sustained exposure to pharmacy practice, and development of professionalism.Summary. The definition of the hidden curriculum varied across the five studies of varying quality. The evidence of the hidden curriculum was measured qualitatively in experiential and academic settings. Recognition of the impact of the hidden curriculum and strategies for addressing its negative effects are critical to the success of not only the students but also the pharmacy profession at large.

2020 rankings for US PharmD programs, research, and overall quality.

Background: US News and World Report (USNWR) publishes well-known rankings of graduate health programs. Medicine and nursing are ranked with weighted metrics using multiple criteria, and medical schools are ranked separately according to their focus (research or primary care). USNWR pharmacy school rankings are based on a single-question peer perception survey. Objective: The objective of this study was to develop a simple, transparent framework to rank US colleges and schools of pharmacy in overall quality and separately based on program quality and research quality, using data that are readily available to the academy. Methods: Data for three education quality and four research quality metrics were obtained for 2020. Each metric was standardized and ranked, and then each set was summed to determine separate ranks for education and research. Education and research scores were combined using equal weights to provide a single rank for overall quality. A sensitivity analysis was performed to determine the effect of assigning higher proportionate value to education, similar to USNWR medical school rankings. Results: Distinct ranks were produced for education, research, overall (education: research) 50:50, and overall 60:40. Sensitivity analysis suggests the more disproportionately the education and research factors are weighted, the more ranks change. Mid-ranked schools were most impacted when weightings changed due to relative strength in one factor and relative weakness in the other. When weighted 60:40, nine (7%) mid-ranked programs improved in rank, while 11 (11%) worsened in rank compared to the 50:50 model. Conclusion: Separately ranking education and research can highlight the diverse strengths of pharmacy schools. The proposed model is based on easily obtainable data and is easily reproducible, allowing for annual rankings. These rankings may be used by PharmD and PhD applicants when selecting schools and by pharmacy schools to benchmark true and aspirational peers.

A pilot study on the use of the nominal group technique to refine core pharmacy roles and to determine what competencies may be missing from pharmacy education.

INTRODUCTION: To describe the use of the nominal group technique (NGT) to refine pharmacy core roles and to compare these roles with current pharmacy outcomes and other literature to highlight potential deficiencies. METHODS: The NGT process was used for this proposal review. The process was conducted in four key stages: silent generation, round-robin, clarification, and voting. A convenience sampling of five pharmacy faculty and administrators that have researched the areas of practice-readiness and pharmacy competencies formed the panel of participants for the NGT process. RESULTS: Study findings offer seven core roles that define pharmacists' scope of practice: knowledge, patient care skills, professional, scholar, system-based practice/manager, collaborator, and advocate/health promoter. Development of these core roles revealed several missing pharmacy competencies or ones only covered in optional learning objectives: conflict management, professional advocacy, scholarship, empathy, personal health, transitions of care, health outcomes, quality improvement, and health insurance. CONCLUSIONS: The development of pharmacy roles is one way to ensure students are adequately prepared for pharmacy practice following graduation. Mapping of competencies to core professional roles would allow schools/colleges of pharmacy to have one cohesive document to guide pedagogical and assessment practice. More research and consensus building will be needed before these core roles could be disseminated more broadly.

Assessment Structure, Culture, and Resources at US AAVMC-Accredited Colleges of Veterinary Medicine.

While outcomes assessment is commonplace in colleges of veterinary medicine, no information is published on how veterinary colleges resource, administer, and view assessment. Consequently, this article has the following objectives: (a) to determine the current level of resources (personnel, committees, software) allocated toward education assessment and program evaluation in colleges of veterinary medicine, (b) to characterize any common organizational structures within colleges of veterinary medicine for assessment, (c) to determine assessment personnel (faculty and staff) perceptions regarding whether existing assessment resources and structures are sufficient, and (d) to examine the perceived strength of the culture of assessment. Our survey found that most assessment professionals had been in their position for 4 years or less and over 50% did not have formal assessment training. A majority of respondents agreed that assessment was encouraged and supported at their institution, but there was much less agreement on items related to formal plans and structures. For example, only one quarter of respondents reported that assessment was connected to planning and budgeting, and only one third reported having a formal assessment plan. We hope that our survey will be a resource tracking the development of assessment resources and climate at American colleges of veterinary medicine.

Considerations for remediation policy and procedures in pharmacy education.

INTRODUCTION: Despite the heterogeneous nature of remediation definitions, processes, and impact on learning, it is commonly understood as a process for identifying student deficiencies in knowledge, skills, and attitudes that need to be corrected prior to student progression in the program. COMMENTARY: Current issues related to remediation in pharmacy education include inconsistencies in practices and types within and among institutions, a lack of correlation to student academic success, effects on attrition both positive (student staying on-time for graduation) and negative (students sitting back one year), increase in faculty workload, and negativity or stigma associated with the student. IMPLICATIONS: Key considerations in developing and implementing remediation policies and procedures include being student-focused, providing a positive frame for remediation, implementing a clear process, and early identification of students who need help.

Nailed it! Doctor of pharmacy learners' self-awareness of performance on authentic assessments.

INTRODUCTION: The primary objective of this pilot study was to determine the reliability and validity of an objective structured clinical examination (OSCE) self-awareness survey. A secondary objective was to assess learner self-awareness in OSCE performance. METHODS: A retrospective review of OSCE data from a single cohort in a three-year accelerated doctor of pharmacy program occurred. The cohort completed four OSCEs with a total of 23 discrete cases. At the end of each case, before receiving feedback, learners completed an evaluation of their skills, communication, overall performance, and identified if they believed the patient/provider would return ("nailed or failed"). These self-evaluations were then compared with respective learner performance scores for each case. Content validity was assessed for the self-awareness survey via the Lawshe method. Reliability of the OSCE cases and self-awareness survey were conducted utilizing Cronbach's alpha and the Spearman-Brown formula, respectively. RESULTS: The OSCE self-awareness survey was found to be face valid and reliable for the overall survey. The subsections of return to pharmacist and overall learner performance were also found to be valid and reliable. A statistical relationship was found between learner self-assessment of pass/fail and their actual grade for overall performance and return to pharmacist. CONCLUSIONS: Results from this study may guide remediation plans related to OSCE performance and development of other self-awareness activities in practice settings. Further studies are needed to evaluate the broader application and use of self-awareness tools.

Rethinking the Pharmacy Workforce Crisis by Exploring Unconventional and Emerging Career Pathways and Training.

Given the limited availability of conventional pharmacy positions, pharmacy programs face a challenge in ensuring that all graduates obtain jobs that fulfill their goals and ambitions. Thus, it is imperative to explore and discuss unconventional but promising positions, specifically regarding their availability and needs. In exploring these positions, it is important to recognize technical and nontechnical skill sets that pharmacy graduates possess at graduation, identify unique pathways to help students explore job alternatives, and educate faculty and students about employment opportunities beyond the traditional setting if desired or necessary. Students must become aware of the opportunities that exist in both conventional (pharmacist clinician) and unconventional (pharmacist innovator) pharmacy careers and be able to articulate the translational skills from their training. Pharmacy programs and faculty can better support students by fostering the development and marketing of their skills.

Educational research and scholarship - Brainstorming, developing, and publishing together as teams.

INTRODUCTION: Collaborative educational research and scholarship is a powerful tool to help schools/colleges of pharmacy learn from and with each other to continuously improve by sharing best practices. COMMENTARY: There are significant advantages including developing projects with more generalizability and impact, leveraging different and complementary expertise, informal mentorship of junior faculty researchers, task sharing, and group accountability. There are also challenges such as managing multiple participants, sticking to productivity goals and timelines, and scheduling virtual meetings across multiple time zones. IMPLICATIONS: For a number of years, the American Association of Colleges of Pharmacy's Assessment Special Interest Group has intentionally created opportunities for new connections with the purpose of fostering scholarship projects to pursue interesting questions and engage in educational research with other like-minded colleagues. The purpose of this commentary is to share with members of the academy several practical tips for leading and engaging in group projects of educational scholarship.

Multisite Study Assessing the Effect of Cognitive Test Anxiety on Academic and Standardized Test Performance.

Objective. To evaluate the degree of cognitive test anxiety (CTA) present in student pharmacists at multiple pharmacy programs in the United States and to determine if there are associations between self-reported CTA and relevant academic outcomes.Methods. All 2018-2019 advanced pharmacy practice experience (APPE) students from three US Doctor of Pharmacy (PharmD) programs (N=260) were invited to participate in the study. Participants completed a validated 37-question survey that included the Cognitive Test Anxiety Scale-2 (CTAS-2) along with demographics-related questions. Responses were analyzed using analysis of variance (ANOVA), Kruskal Wallace, and multiple linear regression where appropriate.Results. One hundred twenty-four students (48%) from the three programs participated in the study, and the individual data of 119 (46%) were included in the final analysis. Twenty-two students (18.5%) were classified as having high CTA, 41 (34.5%) as having moderate CTA, and 56 (47.1%) as having low CTA. High CTA predicted a 8.9 point lower NAPLEX total scaled score after accounting for other variables and was also correlated with lower cumulative didactic GPA, performance on the Pharmacy Curriculum Outcomes Assessment (PCOA), and increased likelihood of requiring course remediation.Conclusion. High cognitive test anxiety affects 18% of pharmacy students and may significantly impact their performance on a variety of traditional student success measures, including the NAPLEX. Pharmacy educators should consider further use and adoption of test anxiety measurements to identify and assist potentially struggling students.

Perceptions of programs that orient non-practice faculty to the pharmacy profession: A pilot study.

INTRODUCTION: Faculty collaboration across disciplines plays an important role in pharmacy education, and in particular, the American Association of Colleges of Pharmacy (AACP) faculty survey asks whether colleges/schools of pharmacy (C/SOPs) have programs available to orient non-practice faculty to the profession of pharmacy. The purpose of this pilot study was to characterize perceptions of the importance and effectiveness of such programs, and to examine barriers to their successful implementation. METHODS: An online survey was developed to collect demographic information and perceived importance, effectiveness, and barriers of programs designed to orient non-practice faculty to the pharmacy profession. The survey was posted to the AACP Connect Council of Deans and Council of Faculties listservs and responses were gathered and analyzed using descriptive statistics. RESULTS: Responses from 157 individuals representing 90C/SOPs were collected. While the majority (82%) of respondents rated programs that orient non-practice faculty to the pharmacy profession as extremely or very important, only 17% rated such programs as extremely or very effective. Lack of time was identified as the primary barrier. Differences were identified between various interest groups, including practice vs. non-practice disciplines and administrators vs. non-administrators. CONCLUSIONS: Programs to orient non-practice faculty to the pharmacy profession were perceived to be important; however, such programs were found to lack efficacy.

Impact of Intersession Course Remediation on NAPLEX/PCOA Scores in an Accelerated Doctor of Pharmacy Program.

Objective. To compare Pharmacy Curriculum Outcomes Assessment (PCOA) scaled scores and North American Pharmacist Licensure Examination (NAPLEX) pass rates in students who completed a two-week intersession remediation or repeated a course with the scaled scores and pass rates of students who did not require any form of didactic remediation and did not have to repeat a course. Methods. Data examined for this study included NAPLEX/PCOA scores, NAPLEX pass/fail status, and remediation history for students at one college of pharmacy. Students from the graduating classes of 2016, 2017, and 2018 were organized into four groups: non-remediation, one course remediation and no repeats, more than one course remediation and no repeats, and one or more course repeats. Differences were analyzed using linear regression, logistic regression, and Pearson correlations. Results. The PCOA scores for students in the remediation groups were significantly lower than scores for students in the non-remediation groups, with a reduction of 37.8 to 50.9 points from the expected non-remediators' score. The NAPLEX scores for students who remediated more than one course or repeated one or more courses were 16-20 points lower compared to students who did not remediate. The likelihood of a student failing the NAPLEX was also not significantly lower for students who remediated one course but was significantly lower for other remediation groups. Conclusion. Although single course remediation in this curricular model appears to have minimal impact on NAPLEX outcomes and may be an acceptable intervention for many students, additional support and interventions may be warranted for students who qualify for remediation in multiple courses and/or for repeating a course.

Assessing the Relationship Between Didactic Performance and Standardized Examination Scores in Pharmacy Students.

Objective. To examine the effect size of third professional (P3) year students' grade point average (GPA) on Pharmacy Curriculum Outcomes Assessment (PCOA) scores and to summarize the effect size of PCOA scores on North American Pharmacist Licensure Examination (NAPLEX) scores. Methods. To accomplish the objective, meta-analyses were conducted. For inclusion in the meta-analysis, studies were required to compare PCOA scores to and report data that permitted calculation of a numeric effect size for the chosen outcome variables. Multiple databases were searched, including PubMed, CINAHL, EMBASE, ProQuest Dissertations and Thesis (abstract limited), Academic Search Complete, and Google Scholar. Correlations were used as the effect size metric for all outcomes. All analyses used an inverse variance weighted random effects model. Study quality was reviewed for each study included in the meta-analyses. Results. This study found that PCOA scores were moderately correlated with P3 GPAs, accounting for 14% to 48% of the variability in PCOA scores. The meta-analyses also showed that PCOA scores were moderately correlated with NAPLEX and accounted for 25% to 53% of the variability in NAPLEX scores. Both meta-analyses showed a high degree of heterogeneity and many studies included were of low quality. Conclusion. This first set of meta-analyses to be conducted on the PCOA showed that third professional year GPA does correlate with PCOA results and that PCOA scores correlate with NAPLEX results. Though there are significant limitations to interpretation of the results, these results do help further elucidate the role of the PCOA as a benchmark of progress within the pharmacy curriculum.