Evaluation of an interactive education workshop on hospital pharmacists' ethical reasoning: an observational study.

BACKGROUND: Pharmacists are often faced with scenarios in practice that require application of ethical reasoning and decision-making skills. There is limited research on the ethical decision-making processes of hospital pharmacists. Pharmacists who are compassionate and put the interests of their patients first are thought to positively impact on patient care, but there are often complex health-care system pressures in the hospital setting that cause pharmacists to behave in ways that may conflict with professional values and behaviours. This multisite study aimed to evaluate an interactive education workshop on hospital pharmacists' ethical reasoning skills and explore the need for ongoing training and support. METHODS: This mixed-methods study was carried out across two health services including three hospitals. It incorporated a pre-workshop survey, a feedback survey immediately post-workshop and a third survey four weeks after the workshop. Semi-structured interviews were conducted with hospital pharmacists at least four weeks after the ethics workshop. RESULTS: In total, 32 participants completed the pre-workshop survey, nominating peers/colleagues as the most common source of support they would consult to inform ethical decision-making (17/118 sources of support). Almost all (n = 31/33; 94%) strongly agreed/agreed that the education session provided them with ethical reasoning skills and a process/framework which they could use when faced with an ethical issue. Pre- and post-survey responses showed increased self-confidence in identifying the regulatory frameworks applicable to pharmacy privacy requirements (p = 0.011) and ethical issues applicable to pharmacy privacy requirements (p = 0.002), as well as applying ethical reasoning to scenarios that involve pharmacy privacy dilemmas/issues (p = 0.004). Participants' self confidence in knowing where to find support when faced with clinical and non-clinical ethics questions was improved (p = 0.002 and p = 0.003 respectively). Participants supported the introduction of quarterly ethics cafes after the workshop, compared to before the workshop (p = 0.001). CONCLUSION: Hospital pharmacists rely on discussions with colleagues to brainstorm how to address ethical issues. This study showed that a targeted interactive education workshop facilitated familiarity with ethics resources and decision-making processes. It also demonstrated that this approach could be used to enhance hospital pharmacists' readiness, confidence, and capabilities to recognise and respond to challenging ethical issues.

Lessons Learned in Developing and Testing a Methotrexate Case Study for Pharmacy Education.

This article describes the development, implementation, and evaluation of a complex methotrexate ethics case used in teaching a Pharmacy Law and Ethics course. Qualitative analysis of student reflective writings provided useful insight into the students' experience and comfort level with the final ethics case in the course. These data demonstrate a greater student appreciation of different perspectives, the potential for conflict in communicating about such cases, and the importance of patient autonomy. Faculty lessons learned are also described, facilitating adoption of this methotrexate ethics case by other healthcare profession educators.

Status of Pharmacy Ethics Education in Australia and New Zealand.

Objective. To explore models of teaching in, resources available to, and delivery of a standardized course in pharmacy ethics. Methods. An email invitation was sent to the educator responsible for teaching pharmacy ethics at each of 19 institutions in Australia and New Zealand. Over a six- to eight-week period, semi-structured interviews were conducted in person, by email, or by phone, and were audio-recorded where possible, transcribed verbatim, and entered into data analysis software. Using an inductive analysis approach, themes related to the topics and issues discussed in the interview process were identified. Results. Of the educators invited to participate, 17 completed an interview and were included in this study. Participants reported a paucity of resources available for teaching pharmacy ethics at schools in Australia and New Zealand. Compounding this issue was the lack of expertise and ad-hoc process educators used to create their courses. Assessment methods varied between institutions. Participants felt schools needed to move toward a more standardized pharmacy ethics course with clear and defined guidelines. Conclusion. This study identified many areas in pharmacy ethics that need improvement and revealed the need to develop resources and course structure that adhere to the highest level of Miller's pyramid, while using known frameworks to evaluate ethical competency.

[Present status and the future issues of the ethics education in the department of pharmacy].

The 6-year pharmacology education aims at teaching graduating pharmacists necessary knowledge, techniques and appropriate attitude as medical professionals. To attain these goals, a core curriculum model for pharmacology education has been presented. Based on this model, each university is to draw up an individualized new curriculum. As a result, along with subjects not so familiar to the 4 year education such as Clinical Communication Theory and Medicinal Therapy, long-term practical training is to be implemented. It is essential that pharmacists as medical professionals need to have high ethical standards. As for the core curriculum model, contents concerning ethics have been shown in "A. Learning about Humanism". In our country, "Pharmacist Ethics Regulation" has been established and serves as a model for standards of conduct for pharmacists. Education of these ethical standards needed by pharmacists is considered necessary and important and should be routinely performed within the 6 years of pharmacology education. Therefore ethics education in our schools is given from the 1st year to the first half of the 5th year. Moreover, it is considered important to learn ethical standards not only through lectures but also through on-site experience such as long-term practical training. All kinds of advice concerning the contents necessary for adequate ethics education and for promoting a suitable image of the faculties in charge are welcome.

[What kind of ethical education for pharmacists is necessary? Can "the core curriculum model for pharmacology education" provide the needed guidance?].

Section A of "The core curriculum model for pharmacy education" (2002)- "Learning about Humanism"- outlines the educational contents for ethics in pharmaceutical departments. People who read this section are likely to conclude that the cultivation of human sensitivity is of prime importance in ethics education in pharmacy. However, if a pharmacist found herself or himself on the horns of a moral dilemma during clinical practice, she/he may discover that human sensitivity alone may not provide the answer. When searching for ethically appropriate conduct in concrete cases, both moral insight and good judgment are necessary. The main contents of ethics education in a pharmaceutical department should be instruction in the ethics of medicine and pharmacy and practical exercises in handling moral dilemmas that pharmacists might encounter in actual situations. "Humanism" implies not only humanitarianism but also anthropocentricism. Plants, animals, and ecological systems are considered to be objects of ethical concern in some contemporary ethics, such as L. Siep's "Concrete Ethics (Konkrete Ethik, 2004)". The pharmacist's job specifications require her or him to treat laboratory animals ethically and to have environmental consciousness. Humanism-based ethics are too narrow for pharmacy ethics. Pharmacy students should learn a more comprehensive ethics that covers social ethics, bioethics, and environmental ethics. Such ethics and moral training should be given, especially, both before and after long-term practical training in hospitals and pharmacies.

[Moral dilemmas of the pharmacist--ways of coping with ethical problems in light of case studies].

Pharmacological education in Japan has focused less on the cultivation of medical care providers than on fostering personnel who could develop and manufacture medical products. Pharmacists who passed the national board were able to take part in providing medical treatment even if they lacked the knowledge or capabilities required in a clinical setting. Given both this educational background and the systematic problem that there was no division of labor in the pharmacological field, and given that they operated in a work environment where there was almost no opportunity for direct contact with patients, pharmacists for many years lacked self-awareness as persons who handle medical products that can affect human lives, and failed to take full account of their role as administrators of these products. However, there has been a significant change in the role of pharmacists and in the environment in which they operate since the pharmacist discipline was first established. Whereas in the past the job of pharmacists was simply to deal with the materials of medical products, the job has changed to involve dealing directly with patients. Currently, most pharmacists are engaged in work that provides direct support to people. Ethical behavior is demanded in clinical situations that involve people's interaction with one another. The need is urgent, therefore, for us to apply an understanding of ethical theory and conduct systematic case method-based ethical education to cultivate an ethical outlook among pharmacological students and pharmacists.

Exploring influences on pharmacists' and students' ethical reasoning in a changing practice landscape in Australia.

Background Practising pharmacists continuously develop their ethical reasoning skills, which evolve with practice experience and exposure to challenging scenarios. Considering the recent expansion of the roles of pharmacists and the paradigm shift in pharmacy practice, it is timely to explore community pharmacists' attitudes regarding the importance of ethics and their ethical reasoning. Objective To explore underlying factors influencing community pharmacists' and pharmacy students' ethical reasoning and attitudes towards pharmacy ethics, ethical reasoning processes and perceived current dilemmas. Setting Practising registered community pharmacists, pharmacists with provisional registration (interns) and final year pharmacy students in Australia. Method Two focus group discussions and two interviews were conducted with 16 Western Australian community pharmacists, interns and students. Participants were purposively selected for gender, background, practice setting, and practice experience. Main outcome measure Emerging themes embracing important influences on community pharmacists', interns' and students' ethical reasoning and perceived current ethical dilemmas and challenges. Results Two major themes embraced participants' ethical reasoning processes and conduct: (1) fundamental underpinning, from personal values and practice exposure, and (2) paradigm influenced, such as the changing healthcare landscape, expansion of roles, management of dilemmas, and competence. Increased frequency and complexity of ethical dilemmas related to role expansion. Rural pharmacists experienced unique ethical dilemmas in relation to practice isolation, privacy and confidentiality. Conclusion Changes in the community pharmacy practice environment has increasingly exposed pharmacists to more complex ethical dilemmas. Pharmacists practising in rural communities experience unique challenges. Structured and sound ethical reasoning skills are essential as pharmacists are faced with contemporary challenges.

[Efforts to Promote Research Integrity in Academia].

　The revised model/core curriculum for pharmaceutical education in Japan was introduced in 2015. The need to provide ethics education, which includes research integrity for pharmacists and those conducting pharmaceutical research, was clearly described in the document: "G: pharmaceutical research (2) rule of law and ethics essential for research activity." Additionally, this newly introduced model/core curriculum was officially requested within each pharmaceutical university. As recently as 2014, a severe situation was exposed in the field of life sciences and clinical research: many reports emerged about scientific misconduct in Japan. The members of Kyoto Pharmaceutical University were deeply concerned about this situation and thus decided that our guidelines of action for research integrity would be approached as follows: All members of Kyoto Pharmaceutical University would individually rethink the university's research integrity and ethics with a strong sense of ownership and importance, discuss concrete countermeasures and future plans to establish our university's research integrity, and collectively implement these strategies through education programs. In this review, we introduce several examples of educational activities undertaken by our university, and use them as a basis for discussing how we should address research integrity and the responsible conduct of research in education for academics, graduate students, and undergraduates.

A practical approach toward teaching ethics to community pharmacists.

Background Pharmacists as highly qualified professionals face ethical dilemmas and conflicts in their daily practice. These issues manifest themselves in the daily practice of pharmacists, which require pharmacists to have the competencies to manage these dilemmas but there is limited formal training in ethical decision making during undergraduate pharmacy education. Objective To describe the implementation and evaluation of a methodological approach to managing ethical dilemma workshop for community pharmacists in Malaysia. Setting Community pharmacists in Klang Valley, Malaysia. Method During the workshop, pharmacists were provided insights into how they could use and apply a methodological approach towards managing a dilemma, followed by a case study and panel discussion. All participants were invited to complete a pre- and post-workshop questionnaire Main outcome measure Number and proportion of respondents answering questions related to practice of ethics and workshop effectiveness Results A total of 37 participants attended the workshop. Most of the participants reported that they had no formal training in professional ethics and often used their own approach to solve an ethical issue. Some of the most common issues mentioned include changing medication to generic. More than three quarter of participants agreed and strongly agreed the content was relevant to their job and they will be able to use what they learned in the program. Conclusion The evidence suggests that a module in ethical decision making should be introduced to community pharmacists in Malaysia. This module can be easily adapted for use in other countries and will help ensure that pharmacist can make a good professional judgement and deliver the deeds of beneficence to all their patients.

A comparison of baseline professional attitudes and behaviors among student pharmacists to inform a co-curricular professional engagement program.

BACKGROUND: Professionalism in pharmacy students is an area of great focus with the release of Accreditation Council for Pharmacy Education (ACPE) Standards 2016. This study assessed and compared student pharmacists' professionalism at one college of pharmacy to inform the implementation of a co-curricular professional engagement program. METHODS: Two validated instruments (Behavioral Professionalism Assessment Instrument [BPAI] and Pharmacy Professionalism Instrument [PPI]) were administered to assess baseline professionalism. Kruskall-Wallis tests compared responses among the three pharmacy classes. Analysis was conducted using SPSS. This research was approved by the Mercer University's Institutional Review Board. RESULTS: A total of 362 students completed the survey (75% response rate), of which 131 were first-year, 139 were second-year, and 92 were third-year students. There were significant differences in agreement among these classes of students as to whether a program focused on professional engagement was important and helpful (p < 0.001). Seven BPAI statements and five PPI statements demonstrated significant differences in the level of agreement among the professional years. These behaviors include: completing assignments independently and without supervision (p = 0.004); commitment to helping others (p = 0.004); reporting a medication error (p = 0.005); using time efficiently (p = 0.02); and being respectful (p = 0.04). DISCUSSION: At baseline, 12 statements were significantly different in the level of agreement among the three pharmacy classes. Differences may be explained by perceived professionalism (in first-year students) versus actual professional behaviors (second- and third-year students), as well as breadth and depth of experience. A co-curricular professional engagement program could increase student awareness of professionalism and professional behaviors and be tailored to meet assessed student needs.

Evaluating the Effectiveness of a Focused Debate on the Development of Ethical Reasoning Skills in Pharmacy Technician Students.

Objective. To evaluate the effectiveness of debating an ethical dilemma on the development of ethical reasoning skills in pharmacy technician students. Methods. A mixture of qualitative and quantitative methods was used. This included analysis of before and after 5-minute papers, a sentiment survey, thematic analysis of student reflective writing and a qualitative questionnaire by an independent observer. Results. Twenty-five students participated in the study. The 5-minute papers showed improvement in student learning. In the sentiment survey, 83% of students agreed or strongly agreed that they had a better understanding of ethical dilemmas following the debate. The main theme identified from student blogs was the variety of different opinions expressed during the debate. Conclusion. Debating was an effective means of exploring ethics with pharmacy technician students.

Ethics in Pharmacy Curriculum for Undergraduate Pharmacy Students: A Needs Assessment Study.

INTRODUCTION: Recent advances in pharmacy practice have created serious ethical challenges for the pharmacists. Pursuing a new philosophy of practice is required to overcome these challenges and optimize the standard of care. In this regard, the current ethics guideline in the Pharmacy curriculum used in Tehran University of Medical Sciences, does not provide a fully comprehensive understanding of the issue. Therefore, the aim of the present study was to revise the current curriculum based on a needs assessment study. METHODS: In this study, a two-part questionnaire was presented to pharmacists to obtain their views on the importance of topics in their daily routine practice. Part one of the questionnaire consisted of demographic data and part two of 23 topics in pharmacy ethics. RESULTS: Out of a total of 200 questionnaires, 158 questionnaires were returned. We reached consensus on 24 topics, of which 8 topics gained a score of higher than 4 (the highest score was considered to be 5) and the rest obtained a score of 3 and higher. The highest score pertained to the pharmacists' relationship with patients, awareness of the rules and regulations, and medication error. CONCLUSION: Based on the results, a revised curriculum was designed for ethics in pharmacy. It seems that the designed curriculum is context-based and will develop appropriate educational material regarding pharmacists' requirements in daily practice. Consideration of interactive methods for teaching the curriculum is highly recommended.

Tecendo redes de educação construtivista em Deontologia Farmacêutica: formação e dispositivos ativos na arte de ensinar / Building constructivist education networks in Pharmaceutical Deontology: education and active devices in the art of teaching / Cómo tejer redes de educación constructivista en Deontología Farmacéutica: formación y dispositivos activos en el arte de enseñar

As metodologias ativas (MA), apoiadas em abordagens construtivistas de educação, são importantes ferramentas que permitem tecer redes de formação individual e coletiva. O objetivo deste artigo foi relatar a vivência do uso de MA e do webfólio como ferramentas de formação construtivista em saúde, visando contribuir como dispositivo educativo para o ensino da Deontologia Farmacêutica. Trata-se de um relato de experiência entre educador e educandos do curso de Farmácia. As MA foram: Acolhimento: o colar diversidade; Deontocinéfilos: viagem educacional e formação construtivista; "Quero olhar pelo seu olhar": compartilhamento dos significados percebidos; Plenária ética simulada: construção da ética profissional farmacêutica; e Uso de mapas conceituais. A utilização desses dispositivos de aprendizagem permitiu a materialização do conteúdo ministrado, a aquisição de competências e, dessa maneira, tornou mais fácil compreender o sentido das práticas sanitárias e, consequentemente, sua aplicabilidade na vida profissional.(AU)

Active education methodologies supported by constructivist education approaches are important tools that enable to build individual and collective education networks. The objective of this article was to report the experience of using active learning methodologies and a webfolio with constructivist health education tools to assist teaching in Pharmaceutical Deontology. It is a teacher-student experience report of the Pharmacology course. The active methodologies were: Embracement: the diversity necklace; Deontocinephile: educational trip and constructivist education; "I want to look through your eyes": Sharing perceived meanings; Mock ethical plenary: building a professional pharmaceutical ethics; Using conceptual maps. These learning devices helped materialize the content and develop competencies, being easier to understand the sanitary practices' meaning and their applicability in professional life.(AU)

Las metodologías activas (MA), apoyadas en abordajes constructivistas de educación, son importantes herramientas que permiten tejer redes de formación individual y colectiva. El objetivo de este artículo fue relatar la vivencia del uso de MA y del webfólio como herramientas de formación constructivista en salud, buscando contribuir como dispositivo educativo para la enseñanza de la deontología farmacéutica. Se trata de un relato de experiencia entre educador y educandos del curso de farmacia. Las MA fueron: Acogida: el collar diversidad; Deontocinéfilos: Viaje educativo y formación constructivista; "Quiero mirar por su mirada": Compartición de los significados percibidos; Plenaria ética simulada: construcción de la ética profesional farmacéutica; Uso de mapas conceptuales. La utilización de esos dispositivos de aprendizaje permitió la materialización del contenido dictado y la adquisición de competencias y, de tal forma, se hizo más fácil comprender el sentido de las prácticas sanitarias y, por lo tanto, su aplicabilidad en la vida profesional.(AU)

Health professions ethics rubric: validation of reliability in an interprofessional health ethics course.

The aim of this study was to validate a health professions ethics rubric by an interprofessional team. The rubric was used by two pharmacy and two dental faculty members to score ethics cases submitted by 16 teams comprised of 80 pharmacy and 50 dental students. A debriefing session for each case was moderated by a non-rater faculty member to arrive at a consensus score for the cases. Interrater reliability was calculated for the four raters and the debriefing scores as well as the four raters without the debriefing scores. The overall interrater correlations were in the range of 0.790 to 0.906 for the four raters. Issues ranged from 0.320 to 0.758. Principles ranged from 0.610 to 0.838. Options ranged from 0.655 to 0.843. Analysis ranged from 0.667 to 0.918. Solution ranged from 0.739 to 0.886. With the inclusion of the consensus scores, the interrater correlations were even higher. The best correlations were for the overall score and solution components of the rubric. With further edits in the rubric and enhanced training by faculty raters and changes in the ethics learning session, the revised rubric could be evaluated again for grading. Further training for faculty using the rubric for grading student cases should enhance its reliability. Demonstrating to students the ethical decision making process using the rubric should enhance the validation process.

Using debate to teach pharmacy students about ethical issues.

OBJECTIVE: To create, implement, and evaluate debate as a method of teaching pharmacy undergraduate students about ethical issues. DESIGN: Debate workshops with 5 hours of contact with student peers and facilitators and 5 hours of self-study were developed for second-year pharmacy students. Student development of various skills and understanding of the topic were assessed by staff members and student peers. ASSESSMENT: One hundred fifty students completed the workshops. The mean score for debating was 25.9 out of 30, with scores ranging from 23.2 to 28.7. Seventy percent of students agreed that the debates were a useful teaching method in the degree program. CONCLUSION: A series of workshops using debates effectively delivered course content on ethical issues and resulted in pharmacy students developing skills such as teamwork, peer assessment, communication, and critical evaluation. These findings suggest that pharmacy students respond favorably to a program using debates as a teaching tool.

Pharmaceutical ethics and physician liability in Side Effects.

We review Side Effects, a 2013 film involving bioethics, pharmaceuticals, and financial conspiracies. After the main character Emily unsuccessfully attempts suicide, she begins receiving care from a psychiatrist, Dr. Banks. Following numerous events, she is placed on a fictional antidepressant, Ablixa, which leads her to suffer from sleepwalking. During an episode of sleepwalking she commits a serious crime. The film poses an interesting dilemma: How responsible would the physician be in this instance? We analyze this question by applying numerous ethical principles.

A comparative pilot study of the professional ethical thinking of Quebec pharmacy residents and French pharmacy interns.

OBJECTIVE: The main objective of this pilot study is to compare the professional ethical thinking of Quebec pharmacy residents and French pharmacy interns. The secondary objective is to compare the professional ethical thinking of Quebec pharmacy residents and first year French pharmacy interns. SETTING: Hospital pharmacy residents from Quebec, Canada and pharmacy interns from France. METHODS: This is a cross-sectional, descriptive, web-based survey. MAIN OUTCOME MEASURE: For this study, professional ethical thinking was defined as the level of agreement/disagreement with statements about pharmacy ethics/dilemmas. RESULTS: A total of 208 usable questionnaires were completed (response rate 91% in Quebec and 11% in France). There were no significant differences between Quebec residents and French interns for 29/43 items (67%). However, there were significant differences in their level of agreement with 14/43 items (33%) surveyed by our questionnaire. The differences related to the following themes: economic aspects (four statements), pharmaceutical care, code of ethics, evaluation, clinical research (two statements each) and training and education, dispensing medications (one statement each). There were statistically significant differences between the two groups in terms of exposure to ethics during academic training and experiential practice. There were significant statistical differences between the two groups of first year pharmacy respondents for 11 statements (26%), with only two out of 11 statements being different from those reported in the overall comparison. CONCLUSION: Published data on the professional ethical thinking of pharmacy residents and interns remain limited. We believe the higher exposure of Quebec residents to ethics during academic courses and experiential/practical training may have contributed to a higher level of agreement with some ethical statements.

Legal and ethical issues regarding social media and pharmacy education.

Widespread use of social media applications like Facebook, YouTube, and Twitter has introduced new complexities to the legal and ethical environment of higher education. Social communications have traditionally been considered private; however, now that much of this information is published online to the public, more insight is available to students' attitudes, opinions, and character. Pharmacy educators and administrators may struggle with the myriad of ethical and legal issues pertaining to social media communications and relationships with and among students. This article seeks to clarify some of these issues with a review of the legal facets and pertinent court cases related to social media. In addition, 5 core ethical issues are identified and discussed. The article concludes with recommendations for pharmacy educators with regard to preparing for and addressing potential legal issues pertaining to social media.