Pharmacists' perspective on providing care when patients engage in unhealthy behaviors.

OBJECTIVE To assess the association between unhealthy lifestyle-related behaviors in patients and the pharmacist's professional obligation for providing care. DESIGN Repeated measures ANOVA was used to examine the effect of severity of lifestyle disease on professional obligation. SETTING Four live continuing education programs on law and management conducted in the state of Florida. PARTICIPANTS 488 Florida pharmacists were surveyed with 65% completing the survey. MAIN OUTCOME MEASURES Pharmacists' opinions based on lifestyle-related diseases classified as follows: low lifestyle-related disease (low LD): nonsmoker with asthma who is adherent with asthma medications; moderate (mod) LD: nonsmoker with asthma who is nonadherent with asthma medications; high LD: smoker with asthma who is adherent with asthma medications. RESULTS The difference between the scales for measuring professional obligation for low and mod LD was significant, with pharmacists reporting greater professional obligation for low versus mod LD. The difference between professional obligation for low and high LD was significant, with pharmacists reporting greater professional obligation for low than high LD. The difference between professional obligation for mod and high LD was significant, with pharmacists reporting a higher professional obligation for mod than high LD. CONCLUSION The differences in professional obligation between the three patient scenarios were small but statistically significant. The findings suggest that certain patient behaviors, such as smoking or medication nonadherence, can have a negative effect on pharmacists' sense of professional obligation to the patient.

Report of the 2018-2019 Strategic Engagement Standing Committee.

EXECUTIVE SUMMARY. Strategic engagement is critical to the success of colleges and schools of pharmacy in expanding pharmacy and public health practice, meeting programmatic needs, and fulfilling institutional missions. The AACP 2019-2020 Strategic Engagement Committee was charged with exploring faculty leadership and development as they relate to strategic engagement, considering challenges and barriers to faculty participation and identifying successes in faculty engagement and opportunities for professional development. The committee reviewed literature and examples regarding strategic engagement across academic pharmacy, with strategic engagement understood as being part of the service mission of academic institutions. The committee found faculty service is often not rewarded or recognized equally to efforts in research and education, including in promotion and tenure. The perceived low value often accorded to strategic engagement efforts, coupled with lack of time and low priority for the work, are barriers to faculty participation in strategic engagement. Service missions thrive when supported by institutional culture, faculty and alumni role models and administration priorities. The committee also found that there is no defined path to leadership in most national organizations, a limited number of leadership positions and a lack of awareness regarding these positions. However, strategic engagement with organizations can open doors and increase visibility for faculty, leading to enhanced opportunities and improved scholarship. Engagement efforts can be particularly successful when aligned with faculty interests and school and departmental priorities. Based on the committee's work, the following recommendations are provided to AACP for consideration.Recommendation #1 - AACP should create a pathway or exemplar stories of members who have become leaders within the Academy including institutional and volunteer leadership roles.Recommendation #2 - AACP should provide an organizational chart to outline the reporting structures, as well as the policy development process to help members understand how AACP works and points of entry for involvement.Recommendation #3 - AACP should develop an initiative to "groom" faculty for leadership roles including providing tools/training programs for emerging leaders within the Academy.Recommendation #4 - AACP should consider creating a community for targeted groups of faculty, eg, tenured/tenure-track and non-tenure track to address leadership development and engagement based on member interest.Recommendation #5 - AACP should establish a "service mentors" program to match current and past leaders with members interested in enhancing their involvement in the association.

A Review of Strategies for Designing, Administering, and Using Student Ratings of Instruction.

Objective. To review and recommend strategies for utilizing student ratings of instruction (course and instructor) including considerations regarding design, administration, and use and interpretation of results. Findings. Improving course delivery and pedagogy using student ratings of instruction requires programs to design evaluation instruments that are aligned with the following good, scholarly teaching criteria: offer 10-20 rating scale questions and at least one written response question, ensure that students understand what the questions are asking, use a standardized form for evaluating all faculty members, allow for additional tailored questions to be added to the form, and employ a four- or five-point rating scale with a "not applicable" option. When administering evaluations, programs should limit the number of faculty members evaluated to those teaching greater than or equal to five clock hours of lecture or schedule evaluations based on academic rank; use an online course evaluation tool; randomly select students to participate; offer the evaluation at the end of the term (and/or midpoint for team taught classes); offer the evaluation during scheduled class time; and allow for voluntary, anonymous student participation. Finally, programs should create an assessment plan that outlines the results' release timeline, a list of who will receive result summaries, and how the results will be used. Programs should also encourage faculty reflection, offer mentoring in results interpretation, coach faculty members to summarize and quantify comments and longitudinally track results using tables, and create an accountability action plan to address deficiencies. Summary. In order to better ensure that student ratings of instruction are used to improve teaching, colleges and schools should adopt intentional design, structured administration processes, and transparent reporting of results.

A Simulated Approach to Fostering Competency in End-of-Life Care Among Pharmacy Students.

Objective. To determine if pharmacy students participating in simulation-based scenarios reported fewer learning needs about the transition from acute to end-of-life (EOL) care compared to students participating in solely case-based scenario delivery. Methods. Four end-of-life cases were developed for both paper-based case study and simulation delivery. Pharmacy students on three distant campuses were exposed to the case study approach while four teams of nine to ten pharmacy students were exposed to simulated versions of the same cases. A validated questionnaire was administered before and after exposure to assess end-of-life care learning needs. Results were analyzed following a Bonferroni-adjustment for multiple testing. Results. The case study groups produced similar pre/post changes on the questionnaire. After results were pooled and compared to the simulation only group, significantly higher changes in pre/post scores were found for the simulation group. Conclusion. Pharmacy students exposed to simulated EOL scenarios experienced significantly reduced learning needs following the scenarios, unlike their classroom-based counterparts.

Impact of training and student self-identification on frequency, constructiveness, and professionalism of pharmacy student evaluations of teaching.

INTRODUCTION: The purpose of this study was to simultaneously assess impact of enhanced training and anonymity on frequency, constructiveness, and professionalism of open-ended comments provided on course and instructor evaluations. METHODS: In a 2 × 2 factorial study, didactic students at one doctor of pharmacy program were randomized to receive enhanced training in providing constructive feedback on student evaluations of teaching or an unrelated control activity at the beginning of the academic year, and to provide or not provide an electronic signature at the time of evaluation completion for two consecutive semesters. After ensuring intercoder reliability and agreement among all investigators, one external investigator coded all open-ended comments based on the following factors: comment provided/comment not provided, constructive/less than constructive, professional/unprofessional, training/no training, and signed/unsigned. RESULTS: Of 836 opportunities to respond to open-ended items, 646 (77.3%) written comments were provided, which was similar by training (76.6% vs. 78.0%, p = 0.631) and signature (76.1% vs. 78.5%, p = 0.401) status. Of the 646 comments, 85.1% (n = 550) were constructive and 98.0% (n = 633) were professional. Students in the untrained/signed group were associated with decreased constructiveness (78.3%, OR 0.43, 95% CI 0.25-0.76, p = 0.003); overall, training was associated with increased constructiveness (88.3%, OR 1.70, 95% CI 1.09-2.65, p = 0.019). No factors were negatively or positively associated with professionalism when accounting for covariates. DISCUSSION: Most students provided comments on course and instructor evaluations; most were constructive and professional. CONCLUSION: Study group assignment did not substantially impact comment frequency or professionalism. Assignment to enhanced training, regardless of signature status, significantly increased constructiveness.

Teaching End-of-Life Care Using Interprofessional Simulation.

BACKGROUND: Competency in end-of-life (EOL) care is a growing expectation for health professions students. This study assessed the impact of four EOL care scenarios, using high-fidelity simulation, on the perceived learning needs and attitudes of pharmacy and nursing students. METHOD: On three campuses, pharmacy students (N = 158) were exposed to standard paper EOL case scenarios, while a fourth campus exposed eight graduate nursing and 37 graduate pharmacy students to simulated versions of the same cases. RESULTS: The paper-based groups produced similar pre-post changes on the End of Life Professional Caregiver Survey. Results were pooled and compared with the simulation-only group, revealing significantly higher changes in pre-post scores for the simulation group. CONCLUSION: Students participating in the simulation group showed some significant differences in attitudes toward EOL care, compared with students in the classroom setting. [J Nurs Educ. 2017;56(4):205-210.].

AACP Special Taskforce White Paper on Diversifying Our Investment in Human Capital.

The 2015-2017 American Association of Colleges of Pharmacy (AACP) Special Taskforce on Diversifying our Investment in Human Capital was appointed for a two-year term, due to the rigors and complexities of its charges. This report serves as a white paper for academic pharmacy on diversifying our investment in human capital. The Taskforce developed and recommended a representation statement that was adapted and adopted by the AACP House of Delegates at the 2016 AACP Annual Meeting. In addition, the Taskforce developed a diversity statement for the Association that was adopted by the AACP Board of Directors in 2017. The Taskforce also provides recommendations to AACP and to academic pharmacy in this white paper.

Determining the Sufficiency of Cultural Competence Instruction in Pharmacy School Curriculum.

OBJECTIVE: To assess the change in the level of cultural competency and knowledge of health disparities among students in the third year of the doctor of pharmacy (PharmD) program at the University of Florida and to explore the demographic correlates. METHODS: A cross-sectional survey was conducted in 3 consecutive academic years. Chi-square tests, analysis of variance (ANOVA), and multivariate regression were used for data analysis. RESULTS: Following the inclusion of relevant instruction, there was some increase in knowledge of health disparities and self-awareness, but no significant increase in cultural competency skills. More students reported receiving relevant instruction within the pharmacy school curriculum than outside the curriculum. CONCLUSION: Current effort to incorporate cultural competence and health disparities instruction into the pharmacy curriculum has met with some success. However, there is a need to establish standards on how much relevant training is required and further explore ways to effectively incorporate it into pharmacy education.

Reliability and validity for the measurement of moral disengagement in pharmacists.

BACKGROUND: Social cognitive theory describes a process in which behavior can be disengaged from moral self control through eight different mechanisms. These mechanisms were used for the development of a new scale for measuring moral disengagement (Moral Disengagement Inventory, or MDI) in pharmacists. OBJECTIVES: The objectives of this study were to assess the reliability and validation of a scale to measure pharmacists' moral disengagement toward patients who exhibit behaviors directly or indirectly leading to their disease condition, such as an asthmatic patient who smokes or a non-compliant asthmatic patient. METHODS: A self-administered survey called the Moral Disengagement Instrument (MDI) was developed for this study. Once the MDI was designed, the items were evaluated for content validity, readability and face validity. The reliability of the developed measures was assessed. The convergent and discriminant validity of the moral disengagement constructs were tested using confirmatory factor analysis. RESULTS: The reliability coefficient for the MDI for the asthmatic smoker was 0.814 and reliability coefficient for the MDI for the non-compliant asthmatic patient was 0.782. Evidence supporting validity of the MDI was provided in a confirmatory factor analysis. CONCLUSIONS: The Moral Disengagement Instrument (MDI), developed as a tool for measuring pharmacists' disengagement beliefs for a smoker asthmatic patient and a non-compliant asthmatic patient, was found to be reliable and valid.

Clinical cultural competency and knowledge of health disparities among pharmacy students.

OBJECTIVE: To evaluate the level of competency and knowledge about health disparities among third-year doctor of pharmacy (PharmD) students at 2 Florida public colleges of pharmacy and to explore the demographic correlates of these variables. METHODS: A cross-sectional survey study design was used to collect data from participants. RESULTS: The students had low health-disparities knowledge and moderate skills in dealing with sociocultural issues and cross-cultural encounters. Speaking a language(s) other than English and having exposure to cultural-competency instruction were the demographic variables found to be most significantly associated with clinical cultural competency and/or knowledge of health disparities. CONCLUSIONS: Clinical cultural competency and health-disparities instruction may not be adequately incorporated into the pharmacy school curricula in the institutions studied. Relevant education and training are necessary to enhance cultural competency among pharmacy students.

Implications of the 2008 amendments to the Americans with Disabilities Act for medical education.

The statutory language of the Americans with Disabilities Act (ADA) affords antidiscrimination protection to persons who have a physical or mental impairment that substantially limits one or more of the major life activities. The ADA comprises two major aspects: (1) whether one has a disability that qualifies for protection, and (2) if one does have a protected disability, whether the accommodations requested by the person with a disability are reasonable or unreasonable. Historically, many students who have challenged an institution's denial of accommodations in a court of law have been unsuccessful because they have been determined not to qualify as legally disabled. However, recent amendments to the ADA will affect how accommodation issues are handled by courts and, therefore, how medical colleges and other institutions make strategic decisions involving persons requesting special accommodations for learning disabilities under the ADA.In this article, the authors examine how the amendments to the ADA will affect the cases of persons with learning impairments who request special accommodations in medical education. This article focuses primarily on the issue of what constitutes a protected disability rather than on the reasonableness of accommodations. To examine this issue, the authors consider the narrow interpretations of the ADA that led to Congress enacting the amendments. The authors then discuss how the amendments might have influenced Wong v Regents of the University of California (2004). Finally, they examine the implications of the amendments for medical education and consider how they may affect a current case.

Disability in cultural competency pharmacy education.

Improving health care providers' knowledge and ability to provide culturally competent care can limit the health disparities experienced by disadvantaged populations. As racial and ethnic cultures dominate cultural competency topics in education, alternative cultures such as disability have consistently been underrepresented. This article will make the case that persons with disabilities have a unique cultural identity, and should be addressed as an important component of cultural competency education in pharmacy schools. Examples of efforts in pharmacy education to incorporate cultural competency components are highlighted, many of which contain little or no mention of disability issues. Based on initiatives from other health professions, suggestions and considerations for the development of disability education within pharmacy curricula also are proposed.