Exploring the Utility and Fairness of a Multi-institutional Situational Judgment Test.

OBJECTIVE: To pilot a situational judgment test (SJT) developed to assess empathy, integrity, and teamwork and explore differences in performance between first-year (P1) and fourth-year (P4) student pharmacists based on gender, race or ethnicity, and geographical region. METHODS: An SJT was developed to assess empathy, integrity, and teamwork, using best practices. The SJT was piloted tested with P1 and P4 student pharmacists at 5 institutions. Scores were adjusted for elevation and scatter to minimize the subgroup differences in response styles. RESULTS: The unadjusted mean SJT scores for P1 and P4 student pharmacists were 79.7 % and 80.7 %, respectively. The adjusted scores for P1 and P4 student pharmacists were 86.3 % and 87.2 %, respectively. Small differences were observed across institutions which can likely explained by multiple factors. The mean scores were higher among students who were older, female, identified as White, and spoke English as their first language. The subgroup differences persisted even after adjusting scores for elevation and scatter. CONCLUSION: Performance on an SJT designed to assess empathy, integrity, and teamwork was similar to others in the literature; however, differences in performance were observed across subgroups. Additional research is needed to determine whether these differences reflect test bias or other possible factors.

Best Practices in Syllabus Design.

The syllabus is the cornerstone for directing faculty and student interaction within the didactic and experiential settings. Within each syllabus is both essential and optional information to guide students, faculty, and administration in course expectations as well as to explain how the course aligns within current curricular requirements to maintain program accreditation. Most syllabi contain a plethora of information that continues to grow each year, warranting concerns of syllabus bloat combined with dwindling student attention to syllabus detail. This paper summarizes best practices related to designing effective course syllabi and recommendations to promote clear and concise communication between students, faculty, and administrators involved in pharmacy education.

Opening the Black Box: Agreement and Reliability of a Situational Judgment Test Across Multiple Institutions.

OBJECTIVE: The primary objective of this study was to examine the levels of agreement and reliability of a situational judgment test (SJT) using a diverse pool of pharmacy practice faculty as subject matter experts. Secondary aims included analyses to build support for test validity and fairness. METHODS: An SJT containing 18 scenarios and 118 responses assessing empathy, integrity, and teamwork was developed and delivered to pharmacy practice faculty at 5 schools of pharmacy across the United States. Reliability was assessed by examining internal consistency, inter-rater reliability, and split-half reliability. Only responses which attained an inter-rater agreement>0.7 were included in the final version of the SJT. All responses were scored using a near-miss system, allowing higher scores for answers more closely aligned with the key, which was determined by the faculty who completed the SJT. Test fairness was reported using descriptive statistics. RESULTS: Thirty-nine faculty across the 5 participating institutions completed the SJT. The final version of the SJT included 105 responses, achieving an inter-rater agreement of>0.7 (inter-rater reliability of 0.98). Split-half reliability was 0.72. The average score was 85.7%, and no differences in performance were observed based on demographic characteristics. CONCLUSION: An SJT designed to assess empathy, integrity, and teamwork achieved reasonable levels of reliability among pharmacy practice faculty across the United States, and the results provided initial support for test validity and fairness. These results support a pilot to assess this SJT among students representing multiple institutions.

Wicked Problems in Pharmacy Education.

Wicked problems are unstructured, cross-cutting, and relentless. While problem-solving is an expected outcome of pharmacy education programs, are we, as pharmacy educators, acknowledging the "wicked" problems we have in the Academy? This commentary provides examples of wicked problems in pharmacy practice and education and suggestions for engaging with wicked problems in an effort to solve them. Pharmacy educators must hold a summit on wicked problems in pharmacy education in order to address the complex problems we are currently facing in order to shape the profession for the future.

Use of Situational Judgment Tests to Teach Empathy, Assertiveness, Communication, and Ethics.

Objective. The objectives of this study were to develop situational judgment test (SJT) scenarios for use in teaching empathy, assertiveness, and interprofessional communication in second-year pharmacy (P2) students and ethics in third-year pharmacy (P3) students, determine whether the SJTs developed were effective at measuring students' communication skills and ethical judgment, compare the performance of individual third-year students to the performance of teams of third-year students on the ethics SJT, and evaluate student feedback about SJTs as a teaching tool.Methods. Pharmacy faculty developed five SJT scenarios related to communications and five SJT scenarios related to ethics and piloted the scenarios with P2 and P3 students, respectively. Second-year students completed SJTs individually, while P3 students completed SJTs individually and in teams. Scenarios and responses were discussed with faculty after completion of the SJTs, and students completed a questionnaire to provide feedback on the SJTs.Results. The communications SJT was completed by 59 P2 students with a mean score of 67.5%. The ethics SJT was completed by 57 P3 students with a mean score of 80.1%. The ethics SJT was also completed by 10 teams of P3 students resulting in a mean score of 93.2%. Students indicated the SJT content was realistic and the tests provided the opportunity to reflect on how to approach challenging situations.Conclusion. Situational judgment tests were useful for teaching empathy, assertiveness, interprofessional communication, and ethics in pharmacy students. Future research should focus on predictive validity of SJTs for these content areas.

Pharmacy student self-assessment of strength of residency candidacy compared to clinical faculty.

INTRODUCTION: The purpose of this study was to compare student and faculty perceptions of strength of residency candidacy and to identify student preferences and perceptions that influence the process of being selected by a residency program beyond standard application materials. METHODS: A 31-item questionnaire was administered to third-year and fourth-year pharmacy students to collect information regarding factors deemed important for successful residency program candidacy. Global assessment of strength of residency candidacy was self-rated by students and a group of clinical faculty blinded to student responses. Interrater reliability for student-to-faculty and faculty-to-faculty perceptions of strength of residency candidacy was determined. RESULTS: Students generally reported good academic metrics and participation in a wide variety of scholarly activities deemed important in attaining a residency position. Students rated overall strength of residency candidacy as "above average" (n = 54, 37.2%), "average" (n = 60, 41.4%), and "below average" (n = 31, 21.3%), and self-perception increased with matriculation. Student self-assessment of strength of residency candidacy compared to faculty assessment showed poor agreement (mean [SD] kappa = 0.27 [0.08]). Faculty concordance in assessment of strength of residency candidacy was moderate (α = 0.55). CONCLUSIONS: Concordance in self-assessment of strength of residency candidacy of students compared to faculty was poor. In contrast, agreement among faculty was moderate with generally lower ratings compared to student self-rating, suggesting that students are overconfident in this regard. These findings support residency preparedness training in pharmacy curricula which should include formal assessment of strength of residency candidacy to identify gaps.

Assessing professionalism in health profession degree programs: A scoping review.

BACKGROUND: To identify and classify methods for assessing professionalism across health profession degree programs and identify gaps in the literature regarding types of assessments. METHODS: The authors conducted a scoping review of articles published from database inception through 24 January 2020. Included articles described an assessment approach for professionalism in health profession degree programs available in full-text in the English language. Articles were classified based on profession, timing of assessment, feedback type, assessment type, professionalism dimension, and Barr's modified Kirkpatrick hierarchy. RESULTS: Authors classified 277 articles meeting inclusion criteria. Most articles were from medical education (62.5%) conducted during didactic (62.1%) or experiential/clinical curriculum (49.8%). Few articles (15.5%) described longitudinal assessment. Feedback type was formative (32.2%) or summative (35%), with only 8.3% using both. Assessment types frequently reported included self-administered rating scales (30%), reflections (18.8%), observed clinical encounters (17.3%), and knowledge-based tests (13.4%). Ethical practice principles (65%) and effective interactions with patients (48.4%) were the most frequently assessed dimensions of professionalism. Authors observed balanced distribution among Barr's modified Kirkpatrick model at levels of reaction (38.3%), modification of perceptions and attitudes (33.6%), acquisition of knowledge and skills (39%), and behavioral change (36.1%). IMPLICATIONS: The classification scheme identified in current literature on professionalism assessment does not align with International Ottawa Conference Working Group on the Assessment of Professionalism recommendations. Gaps identified were limited description of professionalism assessment during admissions, infrequent longitudinal assessment, limited use of methods for both formative and summative assessment, and limited reports of assessments applicable to interprofessional education settings.

Incorporating the Pharmacists' Patient Care Process Into An Interprofessional Second Year Capstone.

OBJECTIVE: To describe elements of an interprofessional second year capstone experience designed to incorporate each step of the Pharmacists' Patient Care Process (PPCP) and to evaluate changes in attitudes towards interprofessional collaboration. METHODS: Second year pharmacy students collaborated with dental students to collect information from a standardized patient (SP), assess dental and pharmacy-related problems, and develop a plan resolving the problems identified. Students documented via a SOAP note (subjective, objective, assessment, and plan) and followed up with the SP after an emergency room visit, developing a new plan for implementation. Pharmacy students followed up in the inpatient setting when the SP was preparing for discharge, collecting information from the electronic health record (EHR), assessing the patient's medical conditions, and planning for treatment. Multiple assessment methods were used including extended multiple-choice questions (eMCQs) to assess clinical reasoning skills and a rubric for SOAP note grading. RESULTS: Students performed well on the assessments especially communicating with the SP during medication history and discharge counseling and documenting their care in a SOAP note. Students stated value was added to their education through this experience. CONCLUSIONS: This capstone allowed students the opportunity to practice each step of the PPCP and to collaborate as a member of an interprofessional team As the PPCP is integrated into pharmacy curricula, assessments such as this will be essential for determining practice-readiness and team-readiness of graduates.

Development and Validation of a Situational Judgement Test to Assess Professionalism.

Objective. The purpose of this study was to develop, pilot, and validate a situational judgement test (SJT) to assess professionalism in Doctor of Pharmacy (PharmD) students. Methods. Test specifications were developed and faculty members were educated on best practices in item writing for SJTs. The faculty members then developed 75 pilot scenarios. From those, two versions of the SJT, each containing 25 scenarios, were created. The pilot population for the SJT was student pharmacists in their third professional year, just prior to starting their advanced pharmacy practice experiences. The students completed the two versions of the test on different days, approximately 48 hours apart, with 50 minutes allowed to complete each. Subsequently, students completed a questionnaire regarding the SJT at the conclusion of the second test. Results. Version 1 of the SJT was completed by 228 students, and version 2 was completed by 225 students. Mean scores were 390 (SD=20, range 318-429) and 342 (SD=21, range 263-387) on test versions 1 and 2, respectively. The reliability of the tests was appropriate (test version 1, α=0.77; test version 2, α=0.79). Students felt that the content of the tests was realistic with respect to pharmacy practice (90.1%), and that the tests gave them an opportunity to reflect on how to approach challenging situations (82.6%). Conclusion. We developed a reliable SJT to assess professionalism in PharmD students. Future research should focus on creating a personalized learning plan for students who do not meet minimum performance standards on this SJT.

4-Phenyl-7-azaindoles as potent and selective IKK2 inhibitors.

The synthesis and SAR of a novel series of IKK2 inhibitors are described. Modification around the hinge binding region of the 7-azaindole led to a series of potent and selective inhibitors with good cellular activity.

Implementation of objective structured clinical examinations (OSCEs) in a doctor of pharmacy program.

BACKGROUND AND PURPOSE: Objective structured clinical examinations (OSCEs) are an assessment solution that can be adapted in multiple ways within the doctor of pharmacy (PharmD) curriculum to assess clinical and communication skills and to improve teaching and learning across the curriculum. EDUCATIONAL ACTIVITY AND SETTING: The University of Florida College of Pharmacy formed an OSCE Assessment Committee, wrote blueprints for the OSCEs aligned with Entrustable Professional Activities (EPAs), and delivered OSCEs in the first and third professional years of the PharmD program. FINDINGS: Overall, students performed well on both the first year OSCE and third year OSCE (96 to 97% pass rate on first attempt). SUMMARY: OSCEs provide a number of benefits to students, faculty, and preceptors. Students are afforded the opportunity to demonstrate the knowledge and skills they have acquired during pharmacy school. Likewise, faculty are able to determine if the skills they are teaching are being retained by students. Faculty are also able to assess if students are ready for pharmacy practice rotations. OSCEs also identify areas within the curriculum which may need reinforcement or review. In order for OSCEs to provide benefit to students and to the college, thought should be given as to what skills OSCEs will assess, how they will be developed and administered, and how they will be graded and used to determine progression through the curriculum.

Biphenyl amide p38 kinase inhibitors 4: DFG-in and DFG-out binding modes.

The biphenyl amides (BPAs) are a series of p38alpha MAP kinase inhibitors. Compounds are able to bind to the kinase in either the DFG-in or DFG-out conformation, depending on substituents. X-ray, binding, kinetic and cellular data are shown, providing the most detailed comparison to date between potent compounds from the same chemical series that bind to different p38alpha conformations. DFG-out-binding compounds could be made more potent than DFG-in-binding compounds by increasing their size. Unexpectedly, compounds that bound to the DGF-out conformation showed diminished selectivity. The kinetics of binding to the isolated enzyme and the effects of compounds on cells were largely unaffected by the kinase conformation bound.

Biphenyl amide p38 kinase inhibitors 3: Improvement of cellular and in vivo activity.

The biphenyl amides (BPAs) are a novel series of p38alpha MAP kinase inhibitor. The optimisation of the series to give compounds that are potent in an in vivo disease model is discussed. SAR is presented and rationalised with reference to the crystallographic binding mode.

Biphenyl amide p38 kinase inhibitors 2: Optimisation and SAR.

The biphenyl amides are a novel series of p38 MAP kinase inhibitors. Structure-activity relationships of the series against p38alpha are discussed with reference to the X-ray crystal structure of an example. The series was optimised rapidly to a compound showing oral activity in an in vivo disease model.

The development and impact of active learning strategies on self-confidence in a newly designed first-year self-care pharmacy course - outcomes and experiences.

BACKGROUND AND PURPOSE: The primary objective of this investigation was to determine the effectiveness of different active learning exercises in a newly-designed flipped-classroom self-care course in applying newly acquired knowledge of self-care and improving the confidence of first-year pharmacy students to recommend self-care treatments and counsel patients. The early development of these skills is essential for the subsequent Community Introductory Pharmacy Practice Experience (CIPPE). EDUCATIONAL ACTIVITY AND SETTING: An unpaired anonymous survey was administered to students, pre- and post-course, to ascertain their opinions on the effectiveness of various teaching strategies and active learning exercises on learning and on their confidence in treatment-planning and patient counseling for self-care patients. Comparison between pre- and post-course Likert scores was conducted using a one-way ANOVA followed by a post-hoc Tukey's test with significance at p = 0.05. All other tests of significance were conducted using a student's t-test with significance at p = 0.05. FINDINGS: Students' self-confidence in developing treatment plans and in counseling for non-prescription drugs and dietary supplements significantly improved from the beginning to the end of this self-care course. The response rate was high in both the pre- (N = 208, 88.1%) and post- (N = 198, 83.9%) course surveys. The positive change in confidence was not reflected in increased performance on the final exam represented by a lower average score than the midterm exam. DISCUSSION AND SUMMARY: Active learning sessions and the flipped classroom approach in this first-year pharmacy self-care course contributed to increased self-confidence in making recommendations and counseling patients on proper use of nonprescription medications and dietary supplements.

N-4-Pyrimidinyl-1H-indazol-4-amine inhibitors of Lck: indazoles as phenol isosteres with improved pharmacokinetics.

2,4-Dianilino pyrimidines are well-known inhibitors of tyrosine kinases including lymphocyte specific kinase (Lck). Structure-activity relationships at the 4-position are discussed and rationalised. Examples bearing a 2-methyl-5-hydroxyaniline substituent at the 4-position were especially potent but showed poor oral pharmacokinetics. Replacement of this substituent by 4-amino(5-methyl-1H-indazole) yielded compounds with comparable enzyme potency and improved pharmacokinetic properties.

Urotensin II acts centrally to increase epinephrine and ACTH release and cause potent inotropic and chronotropic actions.

Urotensin II is a small peptide whose receptor was recently identified in mammals as the orphan G protein-coupled receptor-14. The reported cardiovascular responses to systemic urotensin II administration are variable, and there is little detailed information on its central cardiovascular actions. We examined the cardiovascular and humoral actions of intracerebroventricular urotensin II (0.02 and 0.2 nmol/kg and vehicle) and intravenous urotensin II (2, 20, and 40 nmol/kg and vehicle) in conscious ewes previously surgically implanted with flow probes and intracerebroventricular guide tubes. Two hours after intracerebroventricular infusion of urotensin II (0.2 nmol/kg over 1 hour; n=5), heart rate (+56+/-13 beats per minute [bpm]), dF/dt (an index of cardiac contractility; +533+/-128 L x min(-1) x s(-1)), and cardiac output (+3.4+/-0.4 L/min) increased significantly compared with vehicle, as did renal, mesenteric, and iliac blood flows and conductances. Plasma epinephrine, adrenocorticotropic hormone, and glucose levels also increased dramatically (+753+/-166 pg/mL, +14.3+/-3.5 pmol/L, and +7.0+/-1.4 mmol/L, respectively). All of these variables remained elevated for up to 4 hours after infusion. In contrast, 1 hour after intravenous urotensin II (40 nmol/kg bolus; n=6), a sustained tachycardia (+25+/-8 bpm) ensued, but cardiac output, cardiac contractility, total peripheral conductance, and plasma glucose levels did not change significantly. In summary, this is the first study to show that urotensin II acts centrally to stimulate sympathoadrenal and pituitary-adrenal pathways, resulting in increased adrenocorticotropic hormone and epinephrine release and potent chronotropic and inotropic actions. In contrast, tachycardia was the only major response to intravenous urotensin II. These findings suggest that urotensin II is a novel stimulator of central pathways that mediate responses to alerting stimuli or stress.