Reducing barriers to COVID-19 vaccine uptake through a culturally sensitive pharmacy-led patient medication education group in a behavioral health population.

BACKGROUND: Hesitancy surrounding the coronavirus disease 2019 (COVID-19) vaccine is high in those with mental illnesses owing to intrapersonal barriers and barriers relating to social determinants of health. OBJECTIVES: This study describes the implementation of a pharmacy-driven, culturally sensitive education program focused on COVID-19 vaccine hesitancy. METHODS: This was an institutional review board-exempt, descriptive, quality improvement study held at a behavioral health facility. An education program dedicated to reduce COVID-19 vaccine hesitancy was developed. Each educator completed training on providing culturally sensitive care to behavioral health patients. Patients voluntarily attended pharmacist-led patient medication education groups (PMEGs) and were offered an anonymous survey. Participation was documented in the electronic health record (EHR). Vaccination status and perception of the education were collected through retrospective analysis of the EHR, survey results, and state COVID-19 vaccine registry. RESULTS: Twenty PMEGs were provided and reached 90 individuals, with 47% identifying as black, indigenous, or person of color. Sixty of 90 patients received at least 1 vaccine. For participants who were eligible for a second dose of a 2-dose series, 62% completed their second vaccination after PMEGs. Vaccination rates were highest in white participants (73.9%) followed by 64.7% of black participants, both higher than state specific rates. Participants self-reported an increase in their likelihood to become vaccinated after PMEG attendance on surveys and rated the quality of education as high. CONCLUSION: Patients who experience vaccine hesitancy had the opportunity to address their concerns on the COVID-19 vaccine. Overall, the program was well received and positively affected the patient's likelihood of obtaining and completing vaccination against COVID-19.

Issues of cultural competence in mental health care.

As the United States' population continues to grow in its diversity, health care providers, including pharmacists, need to be able to provide culturally competent care to their patients. Cultural competence allows patients to feel comfortable with their provider and leads to their continuing to seek out care. Mental health is one of the most underused services in health care, particularly in underrepresented minority communities. This review looks at different published literature that assessed the reasons why individuals from minority communities may avoid seeking mental health care, cultural competence in psychiatric care for underrepresented minority communities, strategies for implementation for training providers in cultural competency, and barriers to implementation in mental health services. Current ideas include providing cultural competency training to students in their respective professional school or residency, incorporating the cultural formulation interview into psychiatric sessions, or increasing minority representation in the psychiatric services. On the basis of the literature examined, research is still needed to identify the best approach to improve culturally competent care in psychiatric services in the United States.

Determination of the prebiotic activity of wheat arabinogalactan peptide (AGP) using batch culture fermentation.

PURPOSE: To test the prebiotic activity of wheat arabinogalactan-peptide (AGP), which is a soluble dietary fibre composed of arabinogalactan polysaccharide linked to a 15-residue peptide, which accounts for up to 0.4% of the dry weight of wheat flour. METHODS: The prebiotic activity of AGP prepared from white wheat flour was tested using in vitro fermentation by colonic bacteria in automated pH-controlled anaerobic stirred batch cultures and compared to fructooligosaccharide (FOS) and wheat flour arabinoxylan (AX). Bacterial populations were measured using fluorescence in situ hybridisation (flow-FISH) and short chain fatty acid (SCFA) concentrations were measured using HPLC. RESULTS: Fermentation of AGP resulted in a significant bifidogenic activity and increased concentrations of SCFAs, mainly acetate after 24 h of fermentation. CONCLUSIONS: These results were comparable to those obtained with AX and confirm the prebiotic potential of AGP. Furthermore, fermentation of a mixture of AGP and AX was faster compared to the single substrates and more similar to FOS, indicating that combinations of fermentable carbohydrates with different structures are potentially more effective as prebiotics than single substrates.

Medication-related characteristics of a high-utilizer psychiatric population.

OBJECTIVE: To identify medication-related and nonmedication-related characteristics and risk factors for readmission in a high-utilizer psychiatric population. METHODS: In this retrospective cohort study, patients were identified through the institution's electronic medical records as high utilizers if they had 5 or more psychiatric admissions or at least 1 30-day psychiatric readmission from July 2012 through March 2014. The primary outcome was to identify medication-related characteristics. Secondary outcomes were to identify if medication- and nonmedication-related factors were related to number of and time to readmissions. RESULTS: A total of 170 patients and 497 readmissions were included. Up to 89% of patients had 30-day readmissions, and 12% had 5 or more readmissions. A total of 52% of patients were discharged on 6 or more medications, with 54% discharged with at least 3 psychotropic medications. A total of 31% of patients had documented medication nonadherence, with adverse effects or cost reported as the most common reasons. Only 32% of patients filled a prescription at the hospital's outpatient pharmacy with 44% doing so within 7 days of discharge. Adherence and use of outpatient pharmacy were unrelated to the number of readmissions and time to readmission, but having a diagnosis of major depressive disorder was related to shorter time to readmission. CONCLUSIONS: Low outpatient pharmacy utilization, multiple psychotropic discharge medications, and unknown or documented nonadherence are common traits of this population. Future studies to determine what medication factors influence readmissions and whether targeting those specific medication-related factors would decrease the risk for readmission are needed.

Assessment of pharmacy-driven transitional interventions in hospitalized patients with psychiatric disorders.

OBJECTIVE: Pharmacy-driven transitions of care (TOC) services for psychiatric patient populations have not been systematically evaluated. The primary objective was to assess pharmacy TOC services for patients hospitalized for psychiatric care at an academic medical center. The secondary objectives were to evaluate the incidence of psychiatric-associated readmission, emergency department (ED) presentations, or both and outpatient clinic follow-up 30 days after discharge, in addition to characterizing the types and frequencies of psychotropic medications prescribed at discharge. DESIGN: Retrospective, double-cohort study. SETTING AND PARTICIPANTS: This study compares adult patients who received at least 1 pharmacy-driven TOC intervention before discharge from a psychiatric unit between June 1, 2017, and June 30, 2018, with a historical control group that was discharged between June 1, 2016, and May 31, 2017. Interventions included discharge education on selected high-risk medications, medication barriers assessment, TOC notes to outpatient providers, postdischarge telecommunication, and bedside medication delivery. OUTCOME MEASURES: The percentage of pharmacy TOC services provided for patients hospitalized for psychiatric care at an academic medical center and the incidence of psychiatric-associated readmission, ED presentations, or both and outpatient clinic follow-up 30 days after discharge. RESULTS: Fifty-three and 104 electronic health records were reviewed within the control and intervention groups, respectively. The most common interventions were discharge education (22.7%), bedside delivery of medications (22.7%), and medication barrier assessments (22.2%). Adherence (26.8%) and cost (19.5%) were the most common medication barriers. Thirty-day psychiatric-associated readmissions, ED presentations, or both occurred in 32.4% and 15.4% of patients in the control and intervention groups, respectively (P < 0.001). Of the patients, 15.1% and 20.1% presented for outpatient follow-up in the control and intervention groups, respectively (P < 0.001). Statistically, more patients in the control group were prescribed antidepressants at discharge (41.8% vs. 13.1%), whereas more patients in the intervention group were prescribed lithium (10.9% vs. 4.3%) and antipsychotics other than clozapine (40.0% vs. 25.9%). CONCLUSION: The findings show significant differences in clinical outcomes between patients receiving and not receiving pharmacy-driven transitional interventions. Future prospective studies are warranted to further elucidate these observations.

Cas9-mediated mutagenesis of potato starch-branching enzymes generates a range of tuber starch phenotypes.

We investigated whether Cas9-mediated mutagenesis of starch-branching enzymes (SBEs) in tetraploid potatoes could generate tuber starches with a range of distinct properties. Constructs containing the Cas9 gene and sgRNAs targeting SBE1, SBE2 or both genes were introduced by Agrobacterium-mediated transformation or by PEG-mediated delivery into protoplasts. Outcomes included lines with mutations in all or only some of the homoeoalleles of SBE genes and lines in which homoeoalleles carried several different mutations. DNA delivery into protoplasts resulted in mutants with no detectable Cas9 gene, suggesting the absence of foreign DNA. Selected mutants with starch granule abnormalities had reductions in tuber SBE1 and/or SBE2 protein that were broadly in line with expectations from genotype analysis. Strong reduction in both SBE isoforms created an extreme starch phenotype, as reported previously for low-SBE potato tubers. HPLC-SEC and 1 H NMR revealed a decrease in short amylopectin chains, an increase in long chains and a large reduction in branching frequency relative to wild-type starch. Mutants with strong reductions in SBE2 protein alone had near-normal amylopectin chain-length distributions and only small reductions in branching frequency. However, starch granule initiation was enormously increased: cells contained many granules of <4 µm and granules with multiple hila. Thus, large reductions in both SBEs reduce amylopectin branching during granule growth, whereas reduction in SBE2 alone primarily affects numbers of starch granule initiations. Our results demonstrate that Cas9-mediated mutagenesis of SBE genes has the potential to generate new, potentially valuable starch properties without integration of foreign DNA into the genome.

Scoping Review of Programmatic Well-Being Interventions and Outcomes to Support Pharmacy Students.

OBJECTIVES: Recent literature highlights various well-being initiatives implemented across pharmacy programs; however, there is much heterogeneity in their implementation and limited studies assessing the impact and success of these initiatives on pharmacy students' well-being. The purpose of this scoping review was to identify the effectiveness of strategies implemented by pharmacy schools to improve the well-being of pharmacy students. FINDINGS: In total, 23 studies were included, and well-being strategies were categorized into 3 groups: organizational wellness programs, curriculum design and educational course activities, and specific relaxation or meditation activities. Strategies included yoga meditation, structured mindfulness courses, and self-directed mindfulness with digital smartphone applications. The majority of studies assessed outcomes of stress, burnout, and mindfulness, though other well-being domains such as resilience and belonging emerged. Some also assessed perceptions and acceptability of the interventions through qualitative approaches. SUMMARY: Despite the heterogeneity of interventions and outcome measures, this review provides a comprehensive scope of well-being domains, assessment tools, interventions, and approaches targeted at pharmacy students and highlights the strongest evidence for interventions on reducing stress. Pharmacy programs can benefit from approaches at both the organization level and those fostering individual accountability by exposing students to a variety of self-help well-being strategies that develop protective factors and motivate them to sustain well-being practices themselves as a shared approach. This scoping review addresses a critical gap by gaining an understanding of the current landscape of well-being initiatives and their effectiveness to better guide pharmacy programs on strategies that are most likely to improve student well-being.

Assessing Workplace Factors That Influence Burnout and Identifying Recommendations to Support Well-being in Pharmacy Faculty.

OBJECTIVE: Creating environments that promote well-being is critical as studies have shown that burnout, and thus poor well-being, results in poor health outcomes and declining workplace retention. While studies have measured the prevalence of burnout in pharmacy faculty, a gap exists regarding workplace factors that impact faculty well-being. The purpose of this study was to assess factors influencing pharmacy faculty burnout and identify recommendations to improve faculty well-being. METHODS: Full-time pharmacy faculty were invited to participate in this exploratory study. Focus groups were divided by faculty rank (ie, assistant, associate, full professor). A semistructured interview format was used to identify factors contributing to faculty burnout and fulfillment as well as solicit suggestions for strategies to improve well-being. Inductive coding was used to identify themes. RESULTS: Eleven faculty participated in 4 focus groups: 6 assistant professors in 2 focus groups (n = 3 faculty/focus group), 3 associate professors in 1 focus group, and 2 full professors in 1 focus group. Common factors influencing faculty burnout included overwhelming workload, workplace inefficiencies, and unexpected factors. Factors contributing to faculty fulfillment included impact, having a passion for work, and connecting with others. Recommendations for improving well-being included school-level well-being initiatives from leadership, encouraging work-life balance, and implementing intentional well-being initiatives and resources. CONCLUSION: Participants identified several workplace factors that contribute to burnout and faculty fulfillment. This study fills a critical gap in the literature regarding factors that influence pharmacy faculty well-being and burnout and can inform strategies for fostering faculty well-being in pharmacy education.

Assessing Factors That Influence Pharmacy Student Burnout and Identifying Recommendations to Support Student Well-Being.

OBJECTIVE: Literature indicates concerning rates of burnout and declining well-being among students. Although well-being initiatives have increased, a gap exists in identifying factors that impact pharmacy student well-being. The purpose of this study was to explore the factors students perceive that influence their burnout and identify recommendations to improve student well-being. METHODS: First- (PY1), second- (PY2), and third-year (PY3) pharmacy students enrolled in the didactic curriculum were invited to participate in this exploratory study. Focus groups were organized by program year to explore the experiences that may be unique to each group. A semistructured interview format was used to discuss factors contributing to student burnout and fulfillment, as well as solicit recommendations for strategies to improve student well-being. Inductive coding was used to identify themes. RESULTS: Twelve students participated in 6 sessions: 1 PY1 interview (n = 1 student), 1 PY2 focus group (n = 2 students) and 1 PY2 interview (n = 1 student), and 3 PY3 focus groups (n = 2-3 students/focus group). Common factors identified as contributing toward burnout included having too little time, overwhelming academic workload, competitive culture, and noncoursework commitments. Factors contributing to student fulfillment included life outside of pharmacy school, well-being resources, and activities aligned with future goals. Participants recommended several strategies to improve student well-being, including curricular changes (eg, course schedule layout, pass/fail grading), culture strategies, and well-being resources. CONCLUSION: The findings underscore the impact of workload and competitive culture on student burnout. This study fills a literature gap regarding the factors influencing student burnout and informs strategies for fostering student well-being in pharmacy education.

Assessing the mental health, physical health, and well-being of doctor of pharmacy students.

INTRODUCTION: Student well-being is a growing area of interest, though existing literature assessing multiple areas of well-being is lacking. This study aimed to evaluate the well-being of pharmacy students corresponding to three well-being domains (physical health, mental health, personal well-being and burnout) and identify characteristics associated with these domains. METHODS: An online survey adapted from various instruments was disseminated to pharmacy students from 11 pharmacy programs. Survey responses were compared using basic descriptive statistics, and Pearson's chi-Square was used for association analyses. RESULTS: Eight hundred thirty-six students from responded to the survey (24.3% response rate). For physical health, 59.3% of students reported sleeping <7  hours per night and 60.4% reported exercising 1 to 5  hours per week. For mental health, 24.8% of students screened positive for depression and 42% screened positive for anxiety. Lastly, 65.9% of students were at risk for decreased well-being and 63.7% for burnout. Based on association analyses, gender and pharmacy year were associated with screening positive for anxiety and burnout, gender was associated with decreased well-being, and relationship status was associated with screening positive for depression. CONCLUSIONS: This study revealed pharmacy students are at risk for lack of sleep and exercise, depression or anxiety, decreased well-being, and burnout. Also, several characteristics were found to be associated with these negative well-being outcomes. Although response rate and participant demographics could impact the generalizability of these findings, findings further increase awareness about student well-being and inform pharmacy programs supporting well-being by better understanding student risks.

Impact of a Brief Suicide Prevention Training with an Interactive Video Case Assessment on Student Pharmacist Outcomes.

OBJECTIVE: To determine whether a brief suicide prevention training with an interactive video case (Pharm-SAVES) improves student pharmacists' suicide prevention knowledge and self-efficacy. METHODS: Student pharmacists (N = 146) from 2 United States universities completed the 75-minute Pharm-SAVES training in September 2021. Suicide prevention knowledge and self-efficacy were measured via an online pre-test and post-test, and a post-test interactive video case assessed self-efficacy to engage in SAVES steps (recognize Signs, Ask about suicide, Validate feelings, Expedite a National Suicide Prevention Lifeline [NSPL] referral, and Set a follow-up reminder). Paired samples t tests compared pre-test and post-test scores (alpha = 0.05). Three months later, students indicated if they had used Pharm-SAVES in practice. RESULTS: Mean knowledge and self-efficacy significantly improved from pre-test to post-test. The interactive video case assessment revealed that students were least confident asking about suicide, moderately confident referring to or calling the NSPL on behalf of patients, and most confident following up with patients. Three months later, 17 (11.6%) students reported that they had recognized someone with suicide warning signs (S in SAVES). Among them, 9 (52.9%) reported asking the person with warning signs if they were considering suicide (A in SAVES), 13 (76.5%) validated feelings (V in SAVES), 3 (9.4%) called the NSPL for the patient, and 6 (35.3%) referred to the NSPL (E in SAVES). CONCLUSION: Pharm-SAVES increased student pharmacists' suicide prevention knowledge and self-efficacy. Within 3 months, more than 10% had used Pharm-SAVES skills with at-risk individuals. All Pharm-SAVES content is now online and available for asynchronous or synchronous instruction.

Access to inclusive and culturally sensitive mental healthcare in Black, Indigenous, and People of Color pharmacy students and residents.

PURPOSE: Disparities in accessing culturally sensitive mental healthcare exist and may be exacerbated in pharmacy trainees. The purpose of this study was to identify barriers to culturally sensitive mental healthcare and how to improve access for racially and ethnically minoritized pharmacy students and residents. METHODS: This institutional review board-exempt study included in-person and virtual focus groups. Eligible participants were first-, second-, third-, and fourth-year doctor of pharmacy (PharmD) students and pharmacy residents completing a postgraduate year 1 or 2 program who identified as Black, Indigenous, and People of Color (BIPOC). Barriers to care, identity's influence on seeking care, and areas in which the training programs are doing well or areas for improvement were assessed. Responses were transcribed and analyzed using an open coding system by 2 reviewers, followed by discussion as a team to reach consensus. RESULTS: This study enrolled 8 first-year, 5 second-year, 7 third-year, and 2 fourth-year PharmD students and 4 residents (N = 26). Barriers to care included time, access to resources, and internal and external stigma. Identity barriers included cultural and family stigma and lack of representation in therapists with regard to race, ethnicity, and gender. Areas going well included supportive faculty and paid time off, while areas for improvement included wellness days, reduced workload, and increased diversity within the workforce. CONCLUSION: This study is the first to identify barriers to culturally sensitive mental healthcare in pharmacy trainees who identify as BIPOC while providing insight on how to increase culturally sensitive mental healthcare resources.

Well-being Content Inclusion in Pharmacy Education Across the United States and Canada.

Objective. To describe the landscape of well-being content inclusion across schools and colleges of pharmacy in the United States and Canada through identification of content implementation, incorporation, and assessment.Methods. A cross-sectional survey was distributed to all accredited schools and colleges of pharmacy in the United States (n=143) and Canada (n=10). Survey questions included curricular and cocurricular timing, frequency, assessment strategies, and support for well-being initiatives, using a framework of eight dimensions (pillars) of wellness to categorize content.Results. Descriptive data analyses were applied to 99 completed surveys (65%), 89 (62%) in the United States and 10 (100%) in Canada. Well-being content was most prevalent within the cocurricular realm and incorporated into didactic and elective more than experiential curricula. The most content came from intellectual, emotional, and physical pillars, and the least content came from financial, spiritual, and environmental pillars. Less than 50% of schools and colleges of pharmacy include well-being within their strategic plans or core values. Funding is primarily at the level of the university (59%) or the school or college of pharmacy (59%). Almost half of respondents reported inclusion of some assessment, with a need for more training, expertise, and standardization.Conclusion. Survey results revealed a wide range of implementation and assessment of well-being programs across the United States and Canada. These results provide a reference point for the state of well-being programs that can serve as a call to action and research across the Academy.

Designing an Inclusive Learning Training Series for Pharmacy Educators.

This article describes the design, implementation, and evaluation of five faculty development sessions focused on inclusive teaching strategies in pharmacy education. Inclusive strategies ensure that every student can clearly understand and engage in meaningful learning opportunities. Three sessions were implemented in fall 2020 and two in spring 2021. Sessions focused on experiential, didactic, and graduate education. A convergent parallel mixed methods evaluation was conducted using descriptive statistics and thematic analysis. Sessions were highly rated, and participants provided suggestions for curriculum improvement (e.g., creating resources, surveying students, and peer auditing syllabi for aspects of inclusiveness). Given the increasing emphasis on inclusion in pharmacy education, this work is timely for sharing strategies aimed at faculty development and teaching practices.

Hybrid metagenome assemblies link carbohydrate structure with function in the human gut microbiome.

Complex carbohydrates that escape small intestinal digestion, are broken down in the large intestine by enzymes encoded by the gut microbiome. This is a symbiotic relationship between microbes and host, resulting in metabolic products that influence host health and are exploited by other microbes. However, the role of carbohydrate structure in directing microbiota community composition and the succession of carbohydrate-degrading microbes, is not fully understood. In this study we evaluate species-level compositional variation within a single microbiome in response to six structurally distinct carbohydrates in a controlled model gut using hybrid metagenome assemblies. We identified 509 high-quality metagenome-assembled genomes (MAGs) belonging to ten bacterial classes and 28 bacterial families. Bacterial species identified as carrying genes encoding starch binding modules increased in abundance in response to starches. The use of hybrid metagenomics has allowed identification of several uncultured species with the functional potential to degrade starch substrates for future study.

Ten Years of TAKE 10!(®): Integrating physical activity with academic concepts in elementary school classrooms.

OBJECTIVE: Current literature supports the link between physical activity (PA) or fitness and a child's ability to achieve academically; however, little structured activity time is incorporated into elementary school classrooms. This paper explores the impact of a classroom-based PA program, TAKE 10!, and health-academic integration through existing state and federal policy and programming. METHODS: Evidence from journal articles, published abstracts, and reports were examined to summarize the impact of TAKE 10! on student health and other outcomes. This paper reviews 10 years of TAKE 10! studies and makes recommendations for future research. RESULTS: Teachers are willing and able to implement classroom-based PA integrated with grade-specific lessons (4.2 days/wk). Children participating in the TAKE 10! program experience higher PA levels (13%>), reduced time-off-task (20.5%), and improved reading, math, spelling and composite scores (p<0.01). Furthermore, students achieved moderate energy expenditure levels (6.16 to 6.42 METs) and studies suggest that BMI may be positively impacted (decreases in BMI z score over 2 years [P<0.01]). CONCLUSION: TAKE 10! demonstrates that integrating movement with academics in elementary school classrooms is feasible, helps students focus on learning, and enables them to realize improved PA levels while also helping schools achieve wellness policies.

Barriers to mental health care and stigma perception in doctor of pharmacy students across the United States.

INTRODUCTION: Pharmacy students are significantly less likely than medical students to seek on-campus mental health services, though barriers are not well known. This study's objective is to expand on perceived barriers to seeking care for mental health concerns among doctor of pharmacy students in the United States. METHODS: An institutional review board-exempt, online survey was disseminated to eight pharmacy programs' students assessing mental health barriers to care, resource interest, attitudes towards treatment, and stigma. Quantitative data were analyzed aggregately and by gender, program type, employment status, and education year. Free-text response analysis used thematic coding. RESULTS: Common barriers to care included lack of time (20.2%), financial support or resources (13.2%), and preferring to solve the issue independently (13.2%). About half agreed their programs had sufficient resources to support mental health (58.4%). Suggested resources included on-site counselors (14.5%), pet therapy (13.4%), and wellness activities (12.3%). Students reported high rates of perceived internal stigma, yet low rates of stigma towards others. No significant differences were found among employment status or program type, but first-year students had more positive attitudes towards mental health treatment. Females were significantly more likely to agree mental health treatment was effective and less likely to view someone differently who received treatment. CONCLUSIONS: Common barriers to care included lack of time, finances or resources, and concerns of being viewed differently. Additionally, substantial stigma exists, particularly public perception and concern for negative impact on future opportunities. Programs should take initiative to understand students' needs and interest in support services.

Mental health resources in pharmacy schools.

INTRODUCTION: This study aims to examine the availability of mental health resources available to pharmacy students. Identifying if pharmacy schools have specific resources is important given the increasing prevalence of mental health disorders among pharmacy students. METHODS: This study has two arms: (1) survey sent to representatives of student affairs of 11 pharmacy schools, and (2) website scan performed of all pharmacy schools in the United States. The survey collected information on mental health resources available including availability, location, and future plans. The website scan examined resources at each school listed on the doctor of pharmacy school directory on the Pharmacy College Application Service website, and the difficulty of locating this information. Microsoft Excel was used to perform descriptive statistics. RESULTS: For the survey arm (n = 9), 83% of respondents were directors of student affairs. Top services located within the university campus, but not within the pharmacy school, were wellness activities (67%) and an on-site counselor (89%). Similarly, for the website scan (n = 150), most schools had availability of an on-site counselor; however, 83% of counselors were located within the university campus, not within the pharmacy school. For 77% of pharmacy schools, no information on mental health resources was found on their websites. The information was considered "somewhat" or "extremely difficult" to find for 45% of schools. CONCLUSION: Both arms found that the most commonly available services, including an on-site counselor, were not located at the pharmacy school but instead part of university campus services.

Establishing the role of the pharmacist in mental health: Implementing Mental Health First Aid into the doctor of pharmacy core curriculum.

INTRODUCTION: The objective of this study was to assess the impact of implementing Mental Health First Aid (MHFA) training in a doctor of pharmacy (PharmD) curriculum on student pharmacists' knowledge, attitudes, self-efficacy, and empathy towards people with mental health conditions and/or crises. METHODS: Participants were third-year PharmD students enrolled in Patient Care Experience, a required communication and ethics course. A survey was administered pre- and post-intervention (i.e. MHFA training). Student pharmacist self-efficacy in assisting someone developing a mental health condition or in crisis was evaluated using confidence measures from the MHFA action plan. Knowledge was measured using Mental Health Knowledge Statements. Attitudes were assessed with the Index of Attitudes Towards Mental Illness, and stigma was evaluated using the Social Distancing Scale. Empathy was measured with the Kiersma-Chen Empathy Scale. RESULTS: Both pre- and post-intervention surveys were completed by 97 of 135 participants (71.9% response rate). MHFA training resulted in significantly increased self-efficacy and empathy. There were no significant differences in knowledge, attitudes, and stigma. CONCLUSIONS: MHFA training was associated with increases in student pharmacist empathy and self-efficacy in providing support to individuals with mental health crises.

A Concept Mapping Activity to Enhance Pharmacy Students' Metacognition and Comprehension of Fundamental Disease State Knowledge.

Objective. To examine the impact of pre-class concept mapping activities on pharmacy students' ability to self-assess their degree of foundational disease state knowledge and predict their pre-class quiz performance.Methods. Second year pharmacy students in a problem-based learning course were responsible for self-directed learning of foundational knowledge for 14 disease states. After completing their independent pre-class reading, students worked in groups to create concept maps for which feedback was provided for four laboratory sessions, worked in groups to create concept maps but received no formal feedback for three laboratory sessions, and did not engage in any formal group activity for seven laboratory sessions. The day following each session, prior to the formal in-class discussion, students were asked to predict the number of questions they could answer correctly on a quiz covering foundational knowledge and then completed the quiz. Quiz performance was compared based on the three conditions, and bias and absolute bias were calculated to evaluate students' metacognitive skills.Results. There was no difference in pharmacy students' metacognition based on the conditions, as reflected by inaccuracy between predicted and actual quiz scores. However, when students had engaged in concept mapping the previous day, their quiz performance was significantly higher than when they had not.Conclusion. Concept mapping did not improve pharmacy students' metacognitive skills but did have a small effect on their quiz performance. More research is needed to tease apart the roles of concept mapping, group activity, and feedback in altering pharmacy students' quiz performance and metacognitive skills.