Health advocacy: A gulf between instruction and practice.

BACKGROUND: Systematic ways to teach health advocacy, an educational outcome for pharmacy graduates, is lacking. We developed a workshop to facilitate understanding and application of a novel structured framework for health advocacy and explored how pharmacy students enacted opportunities for health advocacy during subsequent outpatient experiential training. EDUCATIONAL ACTIVITY AND SETTING: A two-hour workshop was introduced for year 2 students in 2019. Its content was organized around a health advocacy framework. With patient and faculty facilitators, students worked through examples characterized into the framework's four quadrants: 1) shared advocacy "with patients" at the individual- or 2) systems-level and 3) directed advocacy "for patients" at the individual-or 4) systems-level. We then conducted a longitudinal diary study asking pharmacy students (N = 23) to reflect on opportunities to practice health advocacy skills in community pharmacy practice. A systematic, multi-coder reflexive thematic analysis of diary entries was employed. FINDINGS: Pharmacy students did not express a fulsome view of patient health advocacy and mischaracterized self-reported practice examples into inappropriate categories of the health advocacy framework. Most overemphasized usual pharmacist care as acts of health advocacy. No systems-level activities were undertaken, although isolated episodes of shared advocacy with patients were identified. SUMMARY: Lasting impacts of a health advocacy workshop in our pharmacy curriculum were not widely apparent. While longer training periods in community pharmacy practice may yield more opportunities to develop and enact this role, gaps in student conceptualization of health advocacy and inabilities to practically observe and exercise system-level advocacy are ultimately problematic for patient care.

Pathways to Developing Clinical Pharmacist Practitioners: Is There a Better Way Forward? (Path-CPP).

Background: Clinical Pharmacist Practitioners (CPPs) are independent care providers who practise to their full scope and have a positive impact on the quality of patient care. Ideally, all pharmacists in Canada would perform at this level. However, there is significant diversity in pharmacy practice across the country and among practice settings. It would be valuable to better understand how pharmacists attain CPP-level practice and what strategies might enable more pharmacists to practise at this level. Objectives: To understand the perceptions of current CPPs and stakeholders in the health care system regarding the status of the CPP role in Canada and to propose pathways that would facilitate the attainment and recognition of CPP-level practice. Methods: A qualitative study was conducted using semistructured interviews of peer-nominated CPPs and health care system stakeholders. Interviews were recorded, transcribed, and then analyzed using thematic analysis. Results: Interviews involving 13 CPPs and 6 health care system stakeholders, conducted between March and July 2020, yielded 3 theme categories related to CPP roles, each containing subthemes, and 3 distinct themes relating to pathways forward. The 3 pathway themes were the following: that a legislative solution for expanded pharmacist scope is needed, that a new degree program is not required for pharmacy in Canada, and that a unified national credential signifying high-level practice might allow for better recognition of CPPs. Conclusions: The full potential of pharmacists practising with advanced scope of practice in Canada has yet to be realized. Although significant external challenges exist, pharmacists must reframe the narrative by clearly articulating and defining their role within the Canadian health care system to increase CPP-level practice.

Contexte: Les praticiens cliniciens sont des prestataires de soins indépendants qui exercent toutes leurs compétences et ont une incidence positive sur la qualité des soins aux patients. Idéalement, tous les pharmaciens au Canada devraient exercer à ce niveau. Cependant, la pratique de la pharmacie diffère grandement au pays et selon le milieu d'exercice. Il serait utile de mieux comprendre comment les pharmaciens atteignent le niveau de pratique de praticiens clinicien et quelles stratégies pourraient permettre à davantage d'entre eux d'exercer à ce niveau. Objectifs: Comprendre les perceptions des praticiens cliniciens actuels et des parties prenantes du système de soins de santé concernant le statut du rôle des praticiens cliniciens au Canada et proposer des voies visant à faciliter la réalisation de la pratique au niveau de praticien clinicien et la reconnaissance de celle-ci. Méthodes: Une étude qualitative a été menée à l'aide d'entretiens semi-structurés avec des praticiens cliniciens désignés par leurs pairs et des parties prenantes du système de soins de santé. Les entretiens ont été enregistrés, retranscrits, puis analysés à l'aide d'une analyse thématique. Résultats: Des entretiens impliquant 13 praticiens cliniciens et 6 parties prenantes du système de soins de santé, menés entre mars et juillet 2020, ont permis de distinguer trois catégories thématiques liées aux rôles des praticiens cliniciens, chacune contenant des sous-thèmes, ainsi que trois thèmes distincts concernant les voies à suivre. Ces trois derniers thèmes étaient les suivants : la nécessité d'une solution législative pour l'élargissement du champ des compétences des pharmaciens; le fait qu'un nouveau programme diplômant ne soit pas requis pour la pharmacie au Canada; et l'idée qu'une accréditation nationale unifiée signifiant une pratique de haut niveau pourrait permettre de mieux reconnaître les praticiens cliniciens. Conclusions: Le plein potentiel des pharmaciens exerçant avec une portée de pratique avancée au Canada reste encore à réaliser. Malgré l'existence de défis externes importants, les pharmaciens doivent reformuler le récit en articulant et en définissant clairement leur rôle au sein du système de soins de santé canadien afin d'accroître la pratique au niveau de praticien clinicien.

Pharmacy Students Practicing Health Advocate Competency Roles in Workplace-Based Training.

OBJECTIVE: Health advocacy competency roles are found in the educational outcomes of many health disciplines, yet their development is neglected in the professional curriculum and clinical learning environment. We explored how pharmacy students conceptualize health advocacy through their practice in workplace-based learning and any feedback they receive. METHODS: We conducted a longitudinal diary study of Canadian pharmacy students completing Advanced Pharmacy Practice Experiences in hospital and community practices in their graduating year. At pre-determined intervals, 25 students recorded workplace-based activities they recognized as health advocacy and any feedback they received from supervisors, patients, or other staff. Written diary data from 180 records were analyzed by 5 researchers according to inductive content analysis steps and principles. RESULTS: Pharmacy student records reflecting health advocacy roles were organized into 5 categories including, (1) disease prevention; (2) health promotion; (3) seamless care; (4) usual pharmacist care; and (5) professional advocacy. Although many activities were consistent with current competency role descriptions, they do not reflect educational outcomes associated with patient- or systems-level support necessary to address socio-political determinants of health. Although Advanced Pharmacy Practice Experience in training evaluation reports included scores for items related to health advocacy competency, few students confirmed receiving specific written or verbal feedback. CONCLUSION: Pharmacy students construct health advocacy roles in workplace-based training through biomedical-oriented practices with little direct input offered by supervisors. Pharmacy educational outcomes require contemporary updates to health advocacy competency descriptions which offer examples for practical enactment at system-level and recommendations for feedback and assessment.

Training for Collaborative Care: How Hospital Team Members View Pharmacy Students.

Background: Interprofessional education activities are prevalent across health professional curricula in Canada. Students develop collaborative roles through structured on-campus programming; however, the ways in which established teams engage learners in hospital settings are unknown. Objective: To explore how mixed-discipline professionals describe expectations and experiences related to collaborating with pharmacy students who join their team for training. Methods: Mixed-discipline team members of an acute medicine clinical teaching unit were interviewed according to a semistructured interview guide. Participants described encounters with pharmacy trainees and shared expectations of the students' collaborator roles in patient care. Audiorecordings of the interviews were transcribed and coded independently by 2 researchers, who synthesized the data and used the template analysis method to derive themes. Results: Fourteen team members from various disciplines were recruited. Participants' descriptions of collaborative roles were organized into 2 main themes: pharmacy students as informants and pharmacy students as a bridge. A third integrative theme, engagement, encompassed how team members described pharmacy trainees enacting these roles. Team members sought pharmacy students' medication-oriented expertise (e.g., dosing, compatibilities), and physicians often relied on the students' familiarity with study data to guide treatment choices. Nonphysicians capitalized on pharmacy student proximity to physicians to understand such decision-making and inform their own patient care. Accounts of pharmacy students' consultations with team members for patient assessments or to access other multidisciplinary knowledge were infrequent. Conclusions: Most team members' expectations of pharmacy students in terms of the collaborator role lacked routine engagement or shared decision-making. These views represent challenges to the development of skills in collaborative care in workplace-based learning, which might be addressed through intentional interprofessional exercises assigned by preceptors. Further study is required to understand the potential of practice-based interprofessional education initiatives.

Contexte: Les activités de formation interprofessionnelle sont répandues dans les programmes d'études des professionnels de la santé au Canada. Les étudiants développent des rôles collaboratifs grâce à des programmes structurés sur les campus; cependant, on ne sait pas comment les équipes de fournisseurs de soins de santé font participer les apprenants en milieu hospitalier. Objectif: Étudier comment des professionnels de disciplines variées décrivent les attentes et les expériences liées à la collaboration avec les étudiants en pharmacie qui se joignent à leur équipe pour se former. Méthodes: Les membres de l'équipe mixte d'une unité de formation clinique en médecine aiguë ont été interviewés selon un guide d'entretien semi-directif. Les participants ont décrit leurs rencontres avec des stagiaires en pharmacie et ont communiqué leurs attentes concernant les rôles collaboratifs des étudiants dans le domaine des soins aux patients. Les enregistrements audio des entretiens ont été retranscrits et codés indépendamment par 2 chercheurs qui ont synthétisé les données et utilisé la méthode d'analyse de modèles pour en dériver les thèmes. Résultats: Quatorze membres de l'équipe provenant de diverses disciplines ont été recrutés. Les descriptions des rôles collaboratifs offertes par les participants ont été organisées en 2 thèmes principaux: les étudiants en pharmacie « informateurs ¼ et les étudiants « passerelles ¼. Un troisième thème d'intégration, « l'engagement ¼, englobait la façon dont les membres de l'équipe décrivaient les stagiaires en pharmacie jouant ces rôles. Les membres de l'équipe recherchaient l'expertise des étudiants en pharmacie en matière de médicaments (par exemple, dosage, compatibilités), et les médecins s'appuyaient souvent sur leur familiarité avec les données d'études pour guider les choix de traitement. Les non-médecins tiraient parti, eux, des échanges entre les étudiants en pharmacie et les médecins pour comprendre ce processus décisionnel et informer leurs propres soins aux patients. Les comptes rendus des consultations des étudiants en pharmacie avec les membres de l'équipe pour l'évaluation des patients ou pour accéder à d'autres connaissances multidisciplinaires étaient peu fréquents. Conclusions: Les attentes de la plupart des membres de l'équipe à l'égard des étudiants en pharmacie en termes de rôle de collaborateur manquaient d'engagement de routine ou de prise de décision partagée. Ces points de vue représentent des défis pour le développement des compétences en soins collaboratifs dans l'apprentissage en milieu de travail, qui pourraient être abordés par des exercices interprofessionnels intentionnels confiés par les précepteurs. Une étude plus approfondie est nécessaire pour comprendre le potentiel des initiatives de formation interprofessionnelle fondées sur la pratique.

Real Patient Participation in Workplace-Based Assessment of Health Professional Trainees: A Scoping Review.

The aim of this scoping review is to outline the existing landscape of how real patients participate in the workplace-based assessment of trainees across diverse healthcare professions. In 2019-2020, the authors searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, and Web of Science databases for studies that included descriptions of experiences whereby patients received care from a health professional trainee and participated in workplace-based assessments of that trainee. Full-text articles published in English from 2009 to 2020 were included in the search. Of the 8770 studies screened; 77 full-text articles were included. Analysis showed that strategies for patient participation in workplace-based assessment varied widely. Aspects studied ranged from validation of an assessment tool to evaluation of the impact of an educational intervention on trainees' performance. Assessment of patient satisfaction was the most common approach to patient involvement. The majority of studies were conducted in North America and in the context of physician training. Formal patient participation in the assessment of health professional trainees appears heterogeneous across health professions. Gaps in the literature are evident; therefore, this review points to an inclusive approach to workplace-based assessment to ensure patient feedback of the trainees who care for them is represented.

Pharmacist trainees narrow scope of interprofessional collaboration and communication in hospital practice.

Early curricular exposure to interprofessional education (IPE) is intended to acclimatize health professional trainees to shared-care in the practice settings they will ultimately join. However, IPE activities typically reside outside actual organizational and social systems in which interprofessional care is delivered. We aimed to explore how pharmacist trainees experience collaborator and communicator competency roles during team-based workplace-based learning. Participants maintained written diaries reflecting on interprofessional collaboration and communication during an eight-week hospital clerkship. Diary entries and transcripts from semi-structured follow-up interviews were analyzed from the social constructivist perspective using reflective thematic analysis. Participant accounts of on-ward activities represented most collaborator and communicator roles outlined in pharmacy and interprofessional competency frameworks, but were predominantly between the pharmacist trainee and physicians. Pharmacist trainees did not routinely engage with other health professions on a daily basis. Additionally, reported encounters with other team members were typically information exchanges and not episodes of authentic interdependent or shared care. Interactions were almost completely devoid of perceived interpersonal or role conflict. These findings offer insight into how pharmacist trainees perceive and develop competencies for team-based care. Further work is required to understand how such limited scope of interprofessional communication and collaboration might ultimately impair quality patient care.

Reducing health provider stereotypes through undergraduate interprofessional education.

Objective: Stereotypes among health professionals can jeopardize the delivery of collaborative healthcare and the achievement of positive patient outcomes. However, interprofessional education (IPE) can promote early clarification of roles, and understanding and mutual respect among trainees from different health disciplines. We studied the effects of IPE activities on the views and attitudes of pharmacy students toward nurse- and physician-trainees. Methods: Pharmacy students completed a structured written reflection exercise immediately following two separate IPE activities with nursing and medical students, both oriented around diabetes care. We conducted an inductive content analysis of these texts to identify key themes according to the domains of the contact hypothesis theoretical framework: organizational authority, common goals, intergroup cooperation, equal group status and intergroup status. Pharmacy students were also asked how these IPE activities have influenced their views regarding their future pharmacy practice. Results: Pharmacy students felt that their groups had cooperated to solve the common patient care goals in each IPE activity, and noted no distinction between the nursing and medical students. However, through either explicit or implicit negotiation of overlapping roles, many pharmacy students ultimately assumed deferential positions relative to medical students. Overall, pharmacy students' attitudes and views regarding the abilities and roles of nursing and medical students in patient care were favorably altered through the IPE activities. Notably, nurses' drug knowledge and diagnostic abilities of nurses and physicians' familiarity with the primary literature and prescribing regimens was previously under-rated but became recognized after IPE activities. Conclusion: Pharmacy students' stereotypical views towards nursing and medical students were positively shifted when IPE activity conditions were optimized for intergroup contact.

A systematic review of the use of simulation and reflection as summative assessment tools to evaluate student outcomes following interprofessional education activities.

Despite the increasing emphasis on interprofessional education (IPE) in curricula and the potential benefits for student learning, there appears to be a lack of evidence directing authentic and accurate assessment of student-learning outcomes and translation of assessment data into scores and grades. Given the increasing importance of reflection and simulation in IPE, the purpose of this systematic review was to identify, appraise, and synthesize published literature using reflection and simulation as summative assessment tools to evaluate student outcomes following IPE activities. The Crowe Critical Appraisal Tool was used to appraise the included articles for quality. This systematic review yielded only five studies of marginal quality that could highlight the limited rigorous use of either reflection or simulation for summative assessment purposes. This review has identified a need for summative IPE assessment alongside formative assessments. Furthermore, training needs to be offered to both faculty assessors, to ensure they are competent and results are reproducible, and students, to equip them with the knowledge, critical thinking skills, and attitude for becoming reflective practitioners who are able to practice interprofessionally. The assessment of IPE remains a challenge, and there is a clear gap in the literature where research needs to grow.

Team member expectations of trainee communicator and collaborator competencies - so shines a good deed in a weary world?

BACKGROUND: Workplace-based assessment may be further optimized by drawing upon the perspectives of multiple assessors, including those outside the trainee's discipline. Interprofessional competencies like communication and collaboration are often considered suitable for team input. AIM: We sought to characterize multidisciplinary expectations of communicator and collaborator competency roles. METHODS: We adopted a constructivist grounded theory approach to explore perspectives of multidisciplinary team members on a clinical teaching unit. In semi-structured interviews, participants described expectations for competent collaboration and communication of trainees outside their own discipline. Data were analyzed to identify recurring themes, underlying concepts and their interactions using constant comparison. RESULTS: Three main underlying perspectives influenced interprofessional characterization of competent communication and collaboration: (1) general expectations of best practice; (2) specific expectations of supportive practice; and (3) perceived commitment to teaching practice. However, participants seemingly judged trainees outside their discipline according to how competencies were exercised to advance their own professional patient care decision-making, with minimal attention to the trainee's specific skillset demonstrated. CONCLUSION: While team members expressed commitment to supporting interprofessional competency development of trainees outside their discipline, service-oriented judgement of performance loomed large. The potential impact on the credibility of multidisciplinary sources for workplace-based assessment requires consideration.

Public attitudes towards community pharmacy in Arabic speaking Middle Eastern countries: A systematic review.

BACKGROUND: Over the last few years, pharmacy practice in the Arab regions of the Middle East has started to change and develop. There have been small but promising steps to recognize the importance of extending community pharmacists' roles to meet the expanding public healthcare demands. OBJECTIVES: This systematic review aims to identify, synthesize and assess the quality of the literature in the Middle East concerning public attitudes on community pharmacist role and services and in relation to public perceptions on strategies to improve pharmacy services and the image of community pharmacist. METHODS: A systematic search of 11 electronic databases was conducted to identify all published relevant studies from inception till January 2020. Data was extracted using a designed and tested tool. Studies were assessed for quality using Crowe Critical Appraisal Tool. RESULTS: The final study results included 36 studies of which 31 adopted a cross-sectional-survey-based design. Included studies were published between 2004 and 2019. Most studies were done in Saudi Arabia (n = 11) or the United Arab Emirates (UAE) (n = 10). We identified four overarching themes across included studies 1) Use of Community Pharmacies; 2) Attitudes towards Community Pharmacist role; 3) Attitudes towards Current Community Pharmacy Services and 4) Strategies to Improve Community Pharmacy Practice. The most common reason for visiting a community pharmacy was to purchase a prescription or over-the counter-medication. The most common factors that affected patients' choice of a particular pharmacy included convenient pharmacy location, availability of a good range of products or medicines, friendliness of the pharmacy staff and convenient pharmacy opening hours. There was a general public perception of community pharmacist as a business oriented person. Expectations of pharmacist duties included treatment of minor health ailments, consultation on over-the-counter medications and parapharmaceutical products, and accuracy checking of dispensed medications. Overall satisfaction with community pharmacy varied between the studies and ranged from 33% to 67.1%. Most commonly reported recommendations to improve pharmacy practice were provision of diagnostic, screening and monitoring services, keeping patient records in the pharmacy, advice on minor illness and provision of a private area for consultation. Seven articles were considered of low quality and 13 articles were considered of high quality. CONCLUSIONS: While the public in the Middle East has a good understanding of the basic duties of a community pharmacist, there is lack of awareness of advanced pharmaceutical services. Decision makers in Middle Eastern countries should set strategies to improve community pharmacist professional image and competence beyond medication dispensing.

Diversity in health professional education scholarship: a document analysis of international author representation in leading journals.

OBJECTIVES: The global distribution of health professionals and associated training programmes is wide but prior study has demonstrated reported scholarship of teaching and learning arises from predominantly Western perspectives. DESIGN: We conducted a document analysis to examine authorship of recent publications to explore current international representation. DATA SOURCES: The table of contents of seven high-impact English-language health professional education journals between 2008 and 2018 was extracted from Embase. ELIGIBILITY CRITERIA: The journals were selected according to highest aggregate ranking across specific scientific impact indices and stating health professional education in scope; only original research and review articles from these publications were included for analysis. DATA EXTRACTION AND SYNTHESIS: The table of contents was extracted and eligible publications screened by independent reviewers who further characterised the geographic affiliations of the publishing research teams and study settings (if applicable). RESULTS: A total 12 018 titles were screened and 7793 (64.8%) articles included. Most were collaborations (7048, 90.4%) conducted by authors from single geographic regions (5851, 86%). Single-region teams were most often formed from countries in North America (56%), Northern Europe (14%) or Western Europe (10%). Overall lead authorship from Asian, African or South American regions was less than 15%, 5% and 1%, respectively. Geographic representation varied somewhat by journal, but not across time. CONCLUSIONS: Diversity in health professional education scholarship, as marked by nation of authors' professional affiliations, remains low. Under-representation of published research outside Global North regions limits dissemination of novel ideas resulting in unidirectional flow of experiences and a concentrated worldview of teaching and learning.

Views and experiences of decision-makers on organisational safety culture and medication errors.

BACKGROUND: In 2017, the World Health Organization published "Medication Without Harm, WHO Global Patient Safety Challenge," to reduce patient harm caused by unsafe medication use practices. While the five objectives emphasise the need to create a framework for action, engaging key stakeholders and others, most published research has focused on the perspectives of health professionals. The aim was to explore the views and experiences of decision-makers in Qatar on organisational safety culture, medication errors and error reporting. METHOD: Qualitative, semi-structured interviews were conducted with healthcare decision-makers (policy-makers, professional leaders and managers, lead educators and trainers) in Qatar. Participants were recruited via purposive and snowball sampling, continued to the point of data saturation. The interview schedule focused on: error causation and error prevention; engendering a safety culture; and initiatives to encourage error reporting. Interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework Approach. RESULTS: From the 21 interviews conducted, key themes were the need to: promote trust within the organisation through articulating a fair blame culture; eliminate management, professional and cultural hierarchies; focus on team building, open communication and feedback; promote professional development; and scale-up successful initiatives. There was recognition that the current medication error reporting processes and systems were suboptimal, with suggested enhancements in themes of promoting a fair blame culture and open communication. CONCLUSION: These positive and negative aspects of organisational culture can inform the development of theory-based interventions to promote patient safety. Central to these will be the further development and sustainment of a "fair" blame culture in Qatar and beyond.

Competency-Based Education Frameworks Across Canadian Health Professions and Implications for Multisource Feedback.

BACKGROUND: Feedback in health professional clinical training is typically the responsibility of the student's own supervisor. However, assessment in competency-based education may be optimized by drawing upon the judgments of multiple assessors. Specific interprofessional competencies have been deemed appropriate for multisource feedback, but these skills may not be uniformly described and therefore performance expectations may differ across disciplines. METHODS: We conducted a document content analysis of the educational outcomes for seven Canadian health professional training programs. Competency frameworks for dietetics, medicine, nursing, occupational therapy, pharmacy, physiotherapy, and respiratory therapy were located and systematically compared. RESULTS: All professions organized educational outcomes according to core competencies. As anticipated, interprofessional competencies of communicator, collaborator, and professional appeared in almost all frameworks, but with distinctions in described emphasis and scope. Evidence-based practice is not typically identified as an interprofessional competency but is similarly widely represented across the majority of disciplines. CONCLUSION: Our review suggests common understanding of shared competencies should not be taken for granted insofar as how roles are described across disciplines' educational frameworks. Further study to explore how interprofessional competencies are practically interpreted by clinicians and used to judge students training with their team, but who are outside their own health discipline, is warranted.

Law, Culture, and Fear: A Qualitative Study of Health Professionals' Perceptions of Narcotic Use Related to Cancer Pain.

Studies have shown barriers to appropriate narcotic use in the Middle East have negatively impacted patient outcomes. This study aimed to explore health professionals' perspectives regarding opioid use for cancer patients in Qatar. Eight focus groups were conducted with physicians, pharmacists, and nurses. An eight-question topic guide framed discussions and targeted contextual barriers and cultural beliefs. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis was used to identify the following themes: narcotic use process, patient-related factors, and healthcare professional-related factors. Laws and regulations were identified as major barriers to appropriate narcotic access, prescribing, and administration. Government-imposed restrictions on permitted dispensed quantities and associated paperwork impeded continuity of patient care and pain relief. The influence of a patient's culture underpinned patient-related barriers, including fear of addiction and family members discouraging opioid use. Fear of prescribing for patient addiction and accusation of inappropriate prescribing by authorities were identified as health professional-related barriers. Facilitators included patient and provider education, as well as the availability of specialized teams to assess and treat cancer-related pain. Findings show narcotic utilization is not simply influenced by a single factor or subset of factors but by a multitude of factors that can be both independent and interrelated.

Workplace-Based Assessment in Cross-Border Health Professional Education.

Construct: The globalization of healthcare has been accentuated by the export of health professional curricula overseas. Yet intact translation of pedagogies and practices devised in one cultural setting may not be possible or necessarily appropriate for alternate environments. Purposeful examination of workplace learning is necessary to understand how the source or "home" program may need adapting in the distributed or "host" setting. Background: Strategies to optimize cross-border medical education partnerships have been largely focused on elements of campus-based learning. Determining how host clinical supervisors approach assessment in experiential settings within a different culture and uphold the standards of home programs is relevant given the influence of context on trainees' demonstrated competencies. In this mixed-methods study, we sought to explore assessor judgments of student workplace-based performance made by preceptors sharing a pharmacy curriculum in Canada and Qatar. Approach: Using modified Delphi consensus technique, we asked clinical supervisors in Canada (n = 18) and in Qatar (n = 14) to categorize trainee performance as described in 16 student vignettes. The proportion of ratings for three levels of expectation (exceeds, meets, or below) was calculated and within-country group consensus achieved if the level of agreement reached 80%. Between-country group comparisons were measured using a chi-square statistic. We then conducted follow-up semi-structured interviews to gain further perspectives and clarify assessor rationale. Transcripts were analyzed using thematic content analysis. Results: The threshold for between-country group differences in assessor impressions was met for only two of the 16 student vignettes. Compared to Canadian clinical supervisors, relatively more preceptors in Qatar judged one described student as meets rather than exceeds expectations and one as meets rather than falls below expectations. Analysis of follow-up interviews exploring how culture may inform variations in assessor judgments identified themes associated with the profession, organization, learner, and supervisor performance theories but not their particular geographic context. Clinical supervisors in both countries were largely aligned in expectations of student knowledge, skills, and behaviors demonstrated in patient care and multidisciplinary team interactions. Conclusions: Our study demonstrated that variation in student assessment was more frequent among clinical supervisors within the same national context than any differences identified between the two countries. In these program settings, national sociocultural norms did not predict global assessor impressions or competency-specific judgments; instead, professional and organizational cultures were more likely to inform student characterizations of performance in workplace-based settings. Further study situated within the specific experiential learning contexts of cross-border health professional curricula is assuredly warranted.

Exploring the gaps between education and pharmacy practice on antimicrobial stewardship: a qualitative study among pharmacists in Qatar.

Background: Antimicrobial resistance is a public health issue and is the focus of antimicrobial stewardship (AMS) teams within health care institutions. However, AMS is not comprehensively and fully taught in medical or pharmacy curricula and little is known about the relevance of pharmacist training to meet AMS needs in the Middle East region. We aimed to explore the discord that may exist between infectious diseases education and actual clinical practice with regard to AMS knowledge and training skills in Qatar. Then, we sought to further explore pharmacist perceptions of their AMS roles in hospital environments. Methods: A qualitative study was undertaken at Qatar University using three focus groups consisting of 15 pharmacy alumni who are currently practicing as clinical pharmacists in Qatar. Focus groups were facilitated using a topic guide developed by study investigators. Discussions were audio-recorded and transcribed verbatim. Results were analyzed using framework analysis. Results: Two major themes related to the first objective emerged throughout the discussions and associated recommendations made to improve (i) infectious diseases (ID) module content and delivery and (ii) ID knowledge and skills application. Two themes related to the second objective included (i) impact of pharmacist's interventions on decision-making and (ii) continuing professional development programming. Conclusion: Our findings guide ongoing efforts to enhance ID content in the curriculum and will close gaps related to AMS training. Pharmacists are core AMS team members where there is an ongoing need to align continuing education for health professionals with realities of practice.

Student feedback experiences in a cross-border medical education curriculum.

OBJECTIVES: To determine non-Western situated health professional student experiences and preferences for feedback in workplace-based settings. METHODS: We conducted five focus groups with 27 students of Arab-origin enrolled in a Canadian-accredited cross-border pharmacy program in Qatar. Transcripts of recorded discussions were analyzed using the framework method.  Hofstede's and Hall's cultural dimension models were employed to understand described feedback encounters and behaviours. RESULTS: We identified three themes associated with cultural influences on student feedback experiences, namely: 1) collectivism; 2) power distance; and 3) context.  Trainees described clinical supervisors who inadequately recognized individual performance, rejected critique, and insufficiently documented feedback onto the written in-training evaluation report. Conversely, students expected specific and timely feedback, invited criticism for learning, and desired clear written commentary. CONCLUSIONS: Feedback behaviours of clinical supervisors, but not those of trainees, were consistent with local cultural norms as described by Hofstede and Hall.  Instead, feedback expectations of pharmacy students in Qatar largely echo those of other trainees enrolled in professional curricula situated outside the Middle East. Principles for optimal feedback in clinical training largely arise from Western perspectives but are not necessarily universal. Our work demonstrates that practices, in part, may be subject to local socio-cultural influences.  This is of particular importance in the experiential training component of cross-border medical education programs adopted by overseas institutions. Our findings also further add to the growing body of literature reporting suboptimal feedback in workplace-based learning, reinforcing the need to cultivate more student-centered practices in health professional training globally.