Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce.

This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.

A Mixed-Methods Analysis of the Promotion and Tenure Process for Experiential Education Faculty.

OBJECTIVE: To understand the process of the promotion and tenure (P&T) as experienced by faculty members in experiential education (EE). METHODS: A quantitative survey of EE faculty at any academic rank investigated the general landscape of experiences in P&T. Phenomenological qualitative interviews with faculty who currently work in EE and who achieved promotion to full professor while working within EE provided additional context. Analysis was completed using a mixed-methods approach. Incomplete survey responses were excluded. RESULTS: Survey respondents indicated feeling different from other clinical faculty, particularly in the need to justify their work to the P&T committee (26/38; 68%). Respondents noted how challenging the P&T process was and perceived a lack of understanding of EE work among P&T committee members, chairs, and/or colleagues. In qualitative interviews, 3 themes emerged, which were characterizing a misunderstood role; navigating an unclear process with creativity and courage; and seeking outside-of-the-box mentoring. CONCLUSION: Experiential education faculty may require specific guidance and a thoughtful approach in tailoring their dossier for the P&T process, especially in accounting for administrative work and other unique aspects of the role. To promote inclusivity and retention of EE faculty, greater understanding of the EE role is needed as it applies to guidelines for P&T. Furthermore, EE faculty and others with unique roles should receive guidance to meaningfully apply P&T guidelines in a manner that best represents their role.

The Report of the 2021-2022 Professional Affairs Standing Committee: Resource Guide for the Integration of Clinical Pharmacy Faculty in Professional Practice Settings.

The 2021-22 Professional Affairs Committee was charged to (1) Develop a resource guide for member institutions and faculty regarding payment for the practice-related activities of pharmacy faculty; (2) Nominate at least one person for an elected AACP or Council Office; and (3) Consider ways that AACP can improve its financial health. This report describes the methodology and content utilized for the development of an online resource guide for member institutions, faculty, and practice sites regarding the integration of clinical faculties' patient care services into patient care settings, including models for payment and value-based payment structures that can be utilized to support the practice-related activities of faculty. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

A call to action: next steps to advance diagnosis education in the health professions.

OBJECTIVES: Improving diagnosis-related education in the health professions has great potential to improve the quality and safety of diagnosis in practice. Twelve key diagnostic competencies have been delineated through a previous initiative. The objective of this project was to identify the next steps necessary for these to be incorporated broadly in education and training across the health professions. METHODS: We focused on medicine, nursing, and pharmacy as examples. A literature review was conducted to survey the state of diagnosis education in these fields, and a consensus group was convened to specify next steps, using formal approaches to rank suggestions. RESULTS: The literature review confirmed initial but insufficient progress towards addressing diagnosis-related education. By consensus, we identified the next steps necessary to advance diagnosis education, and five required elements relevant to every profession: 1) Developing a shared, common language for diagnosis, 2) developing the necessary content, 3) developing assessment tools, 4) promoting faculty development, and 5) spreading awareness of the need to improve education in regard to diagnosis. CONCLUSIONS: The primary stakeholders, representing education, certification, accreditation, and licensure, in each profession must now take action in their own areas to encourage, promote, and enable improved diagnosis, and move these recommendations forward.

Consideration of Aggressive and Strategic Approaches to Address Declining Enrollment in US Pharmacy Schools.

Members from Cohort 13 of the Academic Leadership Fellows Program (ALFP) 2016-2017 were challenged to present a debate on the topic: "In Turbulent Times, Pharmacy Education Leaders Must Take Aggressive Action to Prevent Further Declines in Enrollment" at the American Association of Colleges of Pharmacy INfluence 2017 meeting in Rio Grande, Puerto Rico. This paper is the result of thoughtful insights emerging from this debate. We present a discussion of the question of whether pharmacy education leaders must take aggressive action or strategic approaches to prevent further declines in enrollment. There are many thoughts regarding current declines in enrollment. Some educators contend that a more aggressive approach is needed while others argue that, while aggressive actions might lead to short-term gains, a more viable approach involves strategic actions targeting the underlying causes for decreasing enrollment. This paper explores themes of enrollment challenges, current and future workforce needs, and financial issues for both pharmacy programs and students. In summation, both aggressive actions and a strategic, sustainable approach are urgently needed to address declining enrollment.

Essential Elements for Core Required Advanced Pharmacy Practice Experiences.

Since 2004, concerns and calls for greater quality assurance in experiential education have been published. The Accreditation Council for Pharmacy Education (ACPE) "Standards 2016" provide limited differentiation across the four required practice experiences, and, as such, schools interpret them differently. Both schools and accreditation site visit teams would benefit from a common set of guidance for the required Advanced Pharmacy Practice Experiences (APPEs), so that they can ensure consistency and quality in student experiences across practice sites. To address this need for greater standardization, a taskforce of the American Association of Colleges of Pharmacy (AACP) Experiential Education (EE) Section conducted a peer-reviewed, consensus-building process, including experiential faculty and staff across multiple colleges and schools of pharmacy, to determine a common set of elements that could be used to bring consistency to the experiences and expectations for student learning in practice. Over a two year period, the taskforce reviewed the relevant literature and then drafted and revised the elements through an iterative process which allowed for established EE consortia and members of the EE section to review the draft and provide input for revision. The resulting essential elements presented here can be used to guide faculty and staff within experiential education programs in their quality assurance processes in ensuring students receive consistent experience as part of their education prior to graduation.

Inter-rater Agreement of Clinicians' Treatment Recommendations Based on Modified Barium Swallow Study Reports.

The modified barium swallow study (MBSS) is a commonly used radiographic procedure for diagnosis and treatment of swallowing disorders. Despite attempts by dysphagia specialists to standardize the MBSS, most institutions have not adopted such standardized procedures. High variability of assessment patterns arguably contribute to variability of treatment recommendations made from diagnostic information derived from the MBSS report. An online survey was distributed to speech-language pathologists (SLPs) participating in American Speech Language Hearing Association (ASHA) listservs. Sixty-three SLPs who treat swallowing disorders participated. Participating SLPs reviewed two MBSS reports and chose physiologic treatment targets (e.g., tongue base retraction) based on each report. One report primarily contained symptomatology (e.g., aspiration, pharyngeal residue) with minimal information on impaired physiology (e.g., laryngeal incompetence, reduced hyolaryngeal elevation/excursion). In contrast, the second report contained a clear description of impaired physiology to explain the dysphagia symptoms. Fleiss kappa coefficients were used to analyze inter-rater agreement across the high and low physiology report types. Results revealed significantly higher inter-rater agreement across clinicians when reviewing reports with clear explanation(s) of physiologic impairment relative to reports that primarily focused on symptomatology. Clinicians also reported significantly greater satisfaction and treatment confidence following review of reports with clear description(s) of impaired physiology.

Third-Party Onboarding Organizations as Gatekeepers for Student Placement Decisions.

Health system human resource departments are putting new requirements, paperwork, and processes in place to meet new Joint Commission standards for treating students like employees who onboard at the beginning of employment. These processes have significantly increased the workload of experiential education offices and present an additional burden to students. In an attempt to streamline these processes, health systems are contracting with third-party tracking and placement organizations. Converting this process to an electronic one (such as what third-party organizations offer) could present advantages; however, there are many concerns about going through a third-party organization that could control placement decisions. This commentary describes these concerns and provides guidance to schools should they choose to work with one of these organizations.

Building a Theoretically Grounded Curricular Framework for Successful Interprofessional Education.

Experts in the field of interprofessional education (IPE) have called for the use of theory in curriculum design to produce better results with measurable outcomes. While evidence of this practice is growing in the IPE literature, publications about using theoretical approaches to inform curricular design in pharmacy education is nonexistent. This paper describes the process used at the University of Washington for developing a theoretically grounded framework to anchor and guide curriculum design. Faculty charged with implementing IPE at other institutions may learn from our team's approach to co-creating an inclusive framework, developing a common philosophy, and applying appropriate theory in building a framework to guide curriculum development and IPE implementation.

A Systematic Review of Assessment Tools Measuring Interprofessional Education Outcomes Relevant to Pharmacy Education.

Objective. To identify and describe the available quantitative tools that assess interprofessional education (IPE) relevant to pharmacy education. Methods. A systematic approach was used to identify quantitative IPE assessment tools relevant to pharmacy education. The search strategy included the National Center for Interprofessional Practice and Education Resource Exchange (Nexus) website, a systematic search of the literature, and a manual search of journals deemed likely to include relevant tools. Results. The search identified a total of 44 tools from the Nexus website, 158 abstracts from the systematic literature search, and 570 abstracts from the manual search. A total of 36 assessment tools met the criteria to be included in the summary, and their application to IPE relevant to pharmacy education was discussed. Conclusion. Each of the tools has advantages and disadvantages. No single comprehensive tool exists to fulfill assessment needs. However, numerous tools are available that can be mapped to IPE-related accreditation standards for pharmacy education.

Analysis of the Student Experience in an Attending Pharmacist Model General Medicine Advanced Pharmacy Practice Experience.

Objective. To characterize and determine the quality of the student experience in an attending pharmacist model (APM). Methods. In-depth interviews were conducted with students completing an advanced pharmacy practice experience (APPE) at two general medicine services using the APM over a 2-year time period. Quantitative information about student learning and interprofessional interactions were extracted from student evaluations of the site. Data from the mixed model were analyzed to identify strengths of the APM and areas needing improvement. Results. Strengths of the APM included positive student interaction with the pharmacy resident and more students reporting full integration in and accountability to the interprofessional team for patient outcomes compared to students in non-teaching models. A few students at one site reported a need for greater delineation of expectations, more initial support from preceptors, and initial responsibility for fewer patients. These factors were modified before the second APM year and subsequent reports from students at this site were uniformly positive. Students at the second site did not note areas needing improvement. The APM increased student capacity at both sites. Conclusion. The attending pharmacist model provided a high quality learning experience for students, particularly with regard to integration into and accountability for patient outcomes to the interprofessional team. Qualitative research methods enabled precise detection of areas needing improvement at one site and confirmed that changes made at that site improved the student experience.

Best Practices in Establishing and Sustaining Consortia in Pharmacy Education.

Objective. To describe best practices, necessary resources, and success or lessons learned from established consortia in pharmacy education. Methods. Using semi-structured interviews and qualitative analysis, interviews with members of established consortia in pharmacy education were conducted until saturation was reached. Themes were analyzed and meaningful descriptions of consortia characteristics were developed using systematic text condensation. Results. Thirteen interviews were conducted. The primary purpose for forming a consortium was identified as threefold: share ideas/best practices; facilitate collaboration; and perform shared problem-solving. For experiential education consortia, two additional purposes were found: share capacity for practice sites, and promote standardization across programs. When investigating best practices for established consortia, three main themes were identified. These included strategies for: (1) relationship building within consortia, (2) successful outcomes of consortia, and (3) sustainability. Successful outcomes included scholarship and, sometimes, program standardization. Sustainability was linked to structure/support and momentum. Respect was considered the foundation for collaborative relationships to flourish in these consortia. Conclusions. Pharmacy education consortia form through a process that involves relationship building to produce outcomes that promote sustainability, which benefits both pharmacy schools and individual faculty members. Consortium formation is a viable, productive, and often necessary institutional goal for pharmacy schools.

An Elective Course to Train Student Pharmacists to Deliver a Community-based Group Diabetes Prevention Program.

Objective. To develop and assess the impact of an elective course aimed at improving student knowledge of and confidence in delivering a group diabetes prevention program. Design. Two colleges of pharmacy collaborated to develop a 2-credit elective course using didactic and active-learning strategies to prepare students to serve as lifestyle coaches offering a proven group diabetes prevention program. Assessment. Students' confidence in their ability to deliver a group diabetes prevention program increased as a result of the class. However, their knowledge of diabetes prevention facts was unchanged from baseline. Conclusion. A diabetes prevention elective course improved students' confidence in their ability to teach a diabetes prevention program.

An Interprofessional Education Panel on Development, Implementation, and Assessment Strategies.

This report provides a primer for implementing interprofessional education (IPE) within pharmacy and health sciences curricula. In 2013, a panel of administrators and faculty members, whose institutions offered IPE, funded by the Josiah Macy Jr. Foundation, shared best collaborative practice models at the American Association of Colleges of Pharmacy (AACP) Annual Meeting. These presenters subsequently collaborated to write a primer as guidance for other institutions interested in successfully implementing and continuously enhancing the quality of IPE programs. In this article, these IPE faculty members provide a rationale for creating IPE reforms, discuss successful strategies for innovative IPE programs, and share lessons learned for implementing effective assessment tools. A structure and process for determining outcomes of IPE models are presented and strategies for exploring shared education opportunities across health professions and for integrating top-down and bottom-up methods for IPE programs are given.

A qualitative analysis of common concerns about challenges facing pharmacy experiential education programs.

OBJECTIVE: To qualitatively analyze free-text responses gathered as part of a previously published survey in order to systematically identify common concerns facing pharmacy experiential education (EE) programs. METHODS: In 2011, EE directors at all 118 accredited pharmacy schools in the US were asked in a survey to describe the most pressing issues facing their programs. Investigators performed qualitative, thematic analysis of responses and compared results against demographic data (institution type, class size, number of practice sites, number and type of EE faculty member/staff). Expert and novice investigators identified common themes via an iterative process. To check validity, additional expert and novice reviewers independently coded responses. The Cohen kappa coefficient was calculated and showed good agreement between investigators and reviewers. RESULTS: Seventy-eight responses were received (66% response rate) representing 75% of publicly funded institutions and 71% of schools with class sizes 51-150. Themes identified as common concerns were site capacity, workload/financial support, quality assurance, preceptor development, preceptor stipends, assessment, onboarding, and support/recognition from administration. Good agreement (mean percent agreement 93%, ƙ range=0.59-0.92) was found between investigators and reviewers. CONCLUSION: Site capacity for student placements continues to be the foremost concern for many experiential education programs. New concerns about preceptor development and procedures for placing and orienting students at individual practice sites (ie, "onboarding") have emerged and must be addressed as new accreditation standards are implemented.

Student-Valued Measurable Teaching Behaviors of Award-Winning Pharmacy Preceptors.

OBJECTIVE: To identify specific preceptor teaching-coaching, role modeling, and facilitating behaviors valued by pharmacy students and to develop measures of those behaviors that can be used for an experiential education quality assurance program. METHODS: Using a qualitative research approach, we conducted a thematic analysis of student comments about excellent preceptors to identify behaviors exhibited by those preceptors. Identified behaviors were sorted according to the preceptor's role as role model, teacher/coach, or learning facilitator; measurable descriptors for each behavior were then developed. RESULTS: Data analysis resulted in identification of 15 measurable behavior themes, the most frequent being: having an interest in student learning and success, making time for students, and displaying a positive preceptor attitude. Measureable descriptors were developed for 5 role-modeling behaviors, 6 teaching-coaching behaviors, and 4 facilitating behaviors. CONCLUSION: Preceptors may need to be evaluated in their separate roles as teacher-coach, role model, and learning facilitator. The developed measures in this report could be used in site quality evaluation.

Qualitative analysis of common definitions for core advanced pharmacy practice experiences.

OBJECTIVE: To determine how colleges and schools of pharmacy interpreted the Accreditation Council for Pharmacy Education's (ACPE's) Standards 2007 definitions for core advanced pharmacy practice experiences (APPEs), and how they differentiated community and institutional practice activities for introductory pharmacy practice experiences (IPPEs) and APPEs. METHODS: A cross-sectional, qualitative, thematic analysis was done of survey data obtained from experiential education directors in US colleges and schools of pharmacy. Open-ended responses to invited descriptions of the 4 core APPEs were analyzed using grounded theory to determine common themes. Type of college or school of pharmacy (private vs public) and size of program were compared. RESULTS: Seventy-one schools (72%) with active APPE programs at the time of the survey responded. Lack of strong frequent themes describing specific activities for the acute care/general medicine core APPE indicated that most respondents agreed on the setting (hospital or inpatient) but the student experience remained highly variable. Themes were relatively consistent between public and private institutions, but there were differences across programs of varying size. CONCLUSION: Inconsistencies existed in how colleges and schools of pharmacy defined the core APPEs as required by ACPE. More specific descriptions of core APPEs would help to standardize the core practice experiences across institutions and provide an opportunity for quality benchmarking.

Status of pharmacy practice experience education programs.

OBJECTIVE: To assess financial, personnel, and curricular characteristics of US pharmacy practice experiential education programs and follow-up on results of a similar survey conducted in 2001. METHODS: Experiential education directors at 118 accredited US pharmacy colleges and schools were invited to participate in a blinded, Web-based survey in 2011. Aggregate responses were analyzed using descriptive statistics and combined with data obtained from the American Association of Colleges of Pharmacy to assess program demographics, faculty and administrative organizational structure, and financial support. RESULTS: The number of advanced pharmacy practice experience (APPE) sites had increased by 24% for medium, 50% for large, and 55% for very large colleges and schools. Introductory pharmacy practice experience (IPPE) sites outnumbered APPEs twofold. The average experiential education team included an assistant/associate dean (0.4 full-time equivalent [FTE]), a director (1.0 FTE), assistant/associate director (0.5 FTE), coordinator (0.9 FTE), and multiple administrative assistants (1.3 FTE). Most faculty members (63%-75%) were nontenure track and most coordinators (66%) were staff members. Estimated costs to operate an experiential education program represented a small percentage of the overall expense budget of pharmacy colleges and schools. CONCLUSION: To match enrollment growth, pharmacy practice experiential education administrators have expanded their teams, reorganized responsibilities, and found methods to improve cost efficiency. These benchmarks will assist experiential education administrators to plan strategically for future changes.

Quantifying published scholarly works of experiential education directors.

OBJECTIVE: To determine the amount and potential impact of scholarly works that directors of experiential education in US colleges and schools of pharmacy have published since 2001. METHODS: A search in Web of Science was used to identify publications and citations for the years 2001-2011 by experiential education directors as identified by the American Association of Colleges of Pharmacy (AACP) Roster of Faculty and Professional Staff in 2011. Publication productivity was analyzed by position title, faculty rank, and type of institution (public vs private, research vs nonresearch-intensive). Types of published works were characterized, related citations were identified, and a reported h-index was collected for each person who published during this period. RESULTS: Ninety-seven of 226 (43%) experiential education directors published 344 scholarly works which had received 1841 citations, for an average of 1 publication every 3 years and an average citation rate of 5.3 per publication. Directors at publicly funded and research-intensive institutions published slightly more than did their counterparts at private and nonresearch-intensive schools. Publications were concentrated in 6 journals with a weighted mean publication impact factor of 1.5. CONCLUSION: Many experiential education directors have published scholarly works even though their titles and ranks vary widely. While the quantity of such works may not be large, the impact is similar to that of other pharmacy practice faculty members. These results could be used to characterize the scholarly performance of experiential education directors in recent years as well as to establish a culture of scholarship in this emerging career track within pharmacy education.

A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience.

UNLABELLED: To improve U.S. pain education and promote interinstitutional and interprofessional collaborations, the National Institutes of Health Pain Consortium has funded 12 sites to develop Centers of Excellence in Pain Education (CoEPEs). Each site was given the tasks of development, evaluation, integration, and promotion of pain management curriculum resources, including case studies that will be shared nationally. Collaborations among schools of medicine, dentistry, nursing, pharmacy, and others were encouraged. The John D. Loeser CoEPE is unique in that it represents extensive regionalization of health science education, in this case in the region covering the states of Washington, Wyoming, Alaska, Montana, and Idaho. This paper describes a blueprint of pain content and teaching methods across the University of Washington's 6 health sciences schools and provides recommendations for improvement in pain education at the prelicensure level. The Schools of Dentistry and Physician Assistant provide the highest percentage of total required curriculum hours devoted to pain compared with the Schools of Medicine, Nursing, Pharmacy, and Social Work. The findings confirm the paucity of pain content in health sciences curricula, missing International Association for the Study of Pain curriculum topics, and limited use of innovative teaching methods such as problem-based and team-based learning. PERSPECTIVE: Findings confirm the paucity of pain education across the health sciences curriculum in a CoEPE that serves a large region in the United States. The data provide a pain curriculum blueprint that can be used to recommend added pain content in health sciences programs across the country.