Impact of the Integrative Oncology Scholars Program on Oncology Providers' Key Knowledge of Dietary Supplements and Antioxidants for Providing Evidence-based Oncology Care.

Dietary supplements are commonly used among cancer survivors. Oncology providers rarely receive training about dietary supplements. We evaluated whether e-learning modules could improve oncology providers' dietary supplement knowledge. Oncology providers participated in the National Cancer Institute funded Integrative Oncology Scholars (IOS) program. We used posttest readiness assurance tests (RAT) to measure knowledge acquisition from modules. One cohort completed a pre and posttest RAT to assess change in knowledge. Multivariate linear regression models adjusted for gender, race, profession, and years in practice were used to determine if these characteristics were associated with posttest RAT performance and change in pre to posttest RAT scores. Scholars (N = 101) included 86% (N = 87) females; age 44 ± 10 years; 72% (N = 73) Non-Hispanic White; years in practice mean range 11-15 ± 10. There were 37 physicians, 11 physician assistants, 23 nurses, 21 social workers, 2 psychologists, 4 pharmacists, and 2 physical therapists. The posttest dietary supplement and antioxidant RAT scores for all Scholars were 67 ± 18% and 71 ± 14%. In adjusted models there were no significant associations between dietary supplement and antioxidant posttest RAT scores with Scholar characteristics. Change in RAT scores for dietary supplement and antioxidants were 25% ± 23 and 26% ± 27 (P < 0.0001). In adjusted models, there were no significant predictors of change in dietary supplement RATs. For antioxidant RATs, profession was associated with change in scores (P = 0.021). Improvement in Scholar's test scores demonstrate the IOS program can significantly increase oncology providers' knowledge of dietary supplements and antioxidants.

Prevalence and Impact of Workplace Bullying among Pharmacy Practice Faculty in the United States.

Objective: To identify the prevalence and impact of workplace bullying among pharmacy practice faculty in the United States. Methods: Members of the Pharmacy Practice section of the American Association of Colleges of Pharmacy were invited to complete an online survey about the frequency with which they experienced negative workplace behaviors in the communication, humiliation, manipulation, discrimination, and violence domains as well as workplace bullying in the previous 12 months. Independent t-tests and chi-squared tests were used to investigate associations between workplace bullying and pharmacy practice faculty demographic and employment characteristics. Results: Participants (n=256) reported a median of 6 negative behaviors in the workplace, most often in the communication and humiliation domains. A total of 50 (19.5%) reported experiencing workplace bullying. The most common impacts of workplace bullying included increasing their stress level (n=44/49, 89.8%), negative effects on their emotional health (n=42/49, 85.7%), and job dissatisfaction (n=40/49, 81.6%). Female participants more frequently reported workplace bullying (n=43/196, 21.9%) compared to male participants (n=4/56, 7.1%; p=0.012). Individuals who identified as white were less likely to report workplace bullying (n=40/233, 17.2%) compared to individuals of all other races (n=8/19, 42.1%; p=0.008). Conclusion: Most pharmacy practice faculty reported experiencing some degree of negative workplace behaviors during the past 12 months. Additional strategies are needed to create inclusive work environments with transparent, actionable policies when workplace bullying occurs.

Update to the Minimum Requirements for Core Competency in Pediatric Hospital Pharmacy Practice.

Colleges of pharmacy provide varying amounts of didactic and clinical experiential hours in pediatrics therapeutics, resulting in variability in the knowledge, skills, and perceptions of new graduates toward the pharmacist role in providing care to pediatric patients. The Pediatric Pharmacy Association continues to endorse a minimum set of core competencies for all pharmacists involved in the care of hospitalized pediatric patients of all ages. To that end, we have updated our 2015 Position Statement.

Practical Considerations for Community-Based Health Promotion Events during the COVID- 19 Pandemic.

Community-based health promotion events provide student pharmacists the opportunity to give back to the local community while simultaneously applying the knowledge and skills they are learning in the classroom (Accreditation Council for Pharmacy Education Standards 3, 4, and 12). In turn, community members receive benefits, such as receiving a vaccination and learning their blood pressure, as well as strategies to manage their health conditions. Traditionally, both individual community members and student pharmacists receive benefit. As a result of the coronavirus disease 2019 (COVID-19) pandemic, it is critical to consider the impact of public health via the local community when choosing to hold or suspend these activities. It is necessary to consider whether the benefits to individual community members who choose to participate (e.g., older adult with type 2 diabetes or underserved adults with limited access to the influenza vaccine) outweigh the risks to the public due to the pandemic. If there is sufficient benefit, there are practical considerations related to regulations, recruitment of community members, involvement of students and preceptors, location, supplies, delivery of patient care services, and activities after the event.

Joint Statement on Pediatric Education at Schools of Pharmacy.

Providing health care for children is a unique specialty, and pediatric patients represent approximately 25% of the population. Education of pharmacy students on patients across the lifespan is required by current Accreditation Council for Pharmacy Education standards and outcomes; thus, it is essential that pharmacy students gain a proficiency in caring for children. A collaborative panel of pediatric faculty members from schools and colleges of pharmacy was established to review the current literature regarding pediatric education in Doctor of Pharmacy curricula and establish updated recommendations for the provision of pediatric pharmacy education. This statement outlines five recommendations supporting inclusion of pediatric content and skills in Doctor of Pharmacy curricula.

Career and professional development services for pharmacy students.

INTRODUCTION: As the number of pharmacy programs and graduates continue to rise, pharmacy students are being faced with new challenges in seeking post-graduate positions. A Career Connections program was established as part of the student affairs office to develop, implement, and evaluate career and professional development at the University of Michigan College of Pharmacy. The objective of this paper was to evaluate student perceptions and value of career and professional development services in preparing students for competitive job and residency markets. METHODS: An electronic survey was administered to second-, third-, and fourth-professional year students and 2017 graduates to evaluate all facets of career and professional development services offered by the college of pharmacy. RESULTS: The majority of students (76.8%) were satisfied with their access to career development services. Of all the services and events evaluated, students were most satisfied with the internship panel, fourth-year residency seminars, and third-year professional development elective course. Additional services recommended by students included more networking opportunities with alumni, continued exposure to different careers in pharmacy, and more emphasis on the job searching process. CONCLUSIONS: Career development services were generally perceived favorably. The college has implemented several changes based on feedback from students, including splitting students into career-based tracks in the professional development elective and adding additional job-searching seminars. Future initiatives will include increasing outreach to college alumni. Career and professional development services at pharmacy programs should be continuously evaluated in a rapidly changing post-graduate landscape.

Incorporating preauthorization into antimicrobial stewardship pharmacist workflow reduces Clostridioides difficile and gastrointestinal panel testing.

OBJECTIVE: To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea. DESIGN: Single center, quasi-experimental before-and-after study. SETTING: Tertiary-care, academic medical center in Ann Arbor, Michigan. PATIENTS: Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficile enzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours. INTERVENTION: A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained. RESULTS: An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56-0.93; P = .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37-0.77; P = .001), respectively. CONCLUSIONS: We identified an efficient, effective C. difficile and GIPAN diagnostic stewardship approval model.

Impact of virtual simulation in self-care therapeutics course on introductory pharmacy practice experience self-care encounters.

BACKGROUND AND PURPOSE: Pharmacy education programs use simulation to provide a realistic and safe environment for student learning. We studied whether incorporation of virtual simulation into a required first year self-care therapeutics course impacted frequency of interactions, self-reported student confidence, and preceptor-reported student performance during second-year community pharmacy introductory pharmacy practice experiences (IPPEs). EDUCATIONAL ACTIVITY AND SETTING: Virtual simulation cases using MyDispense were incorporated into a self-care therapeutics course in winter 2017. Students and preceptors were surveyed at the end of the fall semester community pharmacy IPPE. Data from IPPE experiences was compared with students who took the self-care therapeutics course in winter 2016 (control). FINDINGS: Students completed 30 virtual simulation cases and three cases as part of the final examination (n = 33). Students in the intervention group reported more patient care interactions during their IPPEs than students who did not complete virtual simulation cases, but there was no difference in self-reported confidence. Preceptors did not report any differences in the ability of students to complete over-the-counter medication interactions during IPPEs. SUMMARY: Cases were well received by students although they took longer to complete than initially anticipated. Students in the intervention group reported significantly more patient care interactions during IPPEs than those in the control group; however, there were no differences in self-reported confidence. Incorporation of virtual simulation was a sustainable change as the cases were able to be re-used the following year with minimal edits.

Impact of a Pharmacy Student Organization on the Admissions Experience and Student Professional Development.

Objective. To evaluate the impact of a program which integrated student pharmacists into the admissions process on pharmacy school candidates' perceptions of the program and on participants' professional development. Methods. An anonymous survey regarding the pharmacy school admission process was sent to candidates following their visit to campus and interviews from fall 2014 through spring 2017. A second survey of all student pharmacists enrolled in January 2018 was conducted to assess the impact of a student-led organization, Pharmacy Student Ambassadors (PSA), on their professional development. Results. The response rate for the survey completed by candidates was 66% (335/504) and the response rate for the survey completed by enrolled student pharmacists was 50% (166/330). Almost all of the candidates were satisfied with the admissions process (96%, 322/335). They cited the welcoming and friendly environment and opportunity to interact with student pharmacists as the best aspects of the admissions process. In the survey of enrolled students, the majority of PSA volunteers agreed or strongly agreed with statements regarding their organization's influence on professional development (76%), enhancing communication skills (77%), self-reflection (78%), and feeling respected and valued (73%). Furthermore, the majority of student pharmacists agreed or strongly agreed that participation in the PSA positively impacted their own admissions process (87%), made interviewees more at ease and comfortable (88%), increased their knowledge and understanding of the culture in the program (82% and 75% respectively), and influenced their personal decisions to attend the University of Michigan College of Pharmacy (63%). Conclusion. Student pharmacist involvement in the admissions process was correlated with pharmacy school candidate satisfaction and contributed to enrolled students' positive perceptions regarding their professional development.

From clinical assistant to clinical associate professor: Examination of a sample of promotion guidelines.

INTRODUCTION: As accreditation standards for doctor of pharmacy programs have placed a greater emphasis on practice experiences, programs have a need for more clinical faculty. While clinical faculty are expected to achieve success in teaching, scholarly activity, and service, they tend to hold lower academic ranks and take more time to achieve promotion. This may be especially true when promotion guidelines lack clarity. METHODS: Guidelines for promotion of clinical faculty from assistant to associate rank for 10, research-intensive pharmacy programs were reviewed for predetermined factors in the areas of teaching, scholarly activity, and service using the following scale: required, desired, considered, not considered, or not specified. Some factors reviewed included: classroom teaching hours, number of clerkship students, types of scholarly activity considered, grantsmanship, and patient care services. RESULTS: There is significant variation in criteria utilized when considering promotion of clinical faculty from assistant to associate rank; few programs provide quantifiable requirements. All programs expect clinical faculty to participate in teaching. Only one program quantifies the amount of teaching expected. One program does not describe types of scholarly activity considered for promotion. No programs expect salary support from grants for clinical faculty. All programs consider direct patient care activities. CONCLUSIONS: A wide variety of criteria are considered when evaluating a clinical faculty member for promotion to the rank of associate professor. Clearly defined promotion criteria may help faculty direct their efforts toward activities that are recognized to ensure timely promotion.

Pre-Class Learning Methods for Flipped Classrooms.

Objective. To review the types of pre-class learning modalities used in flipped classrooms (FC) and team-based learning (TBL) and determine best practices. Findings. Forty-eight articles were included. Reading materials or video lectures were used most often as the primary modality to deliver the pre-class learning. Students favored assignments that have clear objectives, provide guidance, are guided, and are brief. Summary. This study describes how pharmacy schools and colleges are implementing FC into their curricula and the types of pre-class learning that are being developed and assigned with the implementation. More research should be done in comparing the impact of different types of pre-class material on learning outcomes, such as knowledge retention. This is especially important in FC settings because the in-class learning and higher order activities are built upon having a good foundational knowledge, which comes from the pre-class learning.

Implementation of a Palivizumab Order Panel to Decrease Inappropriate Use.

OBJECTIVE: Palivizumab is a monoclonal antibody used to prevent infection from respiratory syncytial virus (RSV) in certain patients who are at high risk for complications. A previous medication use evaluation (MUE) demonstrated 12% of our palivizumab use did not meet criteria for use. Prior to the start of the 2016-2017 RSV season, an order panel was implemented requiring prescribers to select the approved criterion for each patient prescribed palivizumab. In addition, our restriction policy changed to state that palivizumab use outside of preapproved criteria would require authorization from pediatric infectious diseases or the antimicrobial stewardship team. An MUE was conducted during the summer of 2017 to determine whether the order panel had an impact on appropriate prescribing of palivizumab. METHODS: Medication orders for patients who received palivizumab from December 2015 to April 2016 and from December 2016 to April 2017 were reviewed to determine the proportion of patients who did not meet the preapproved restriction criteria. Charts were reviewed to verify indications of palivizumab for each patient during both seasons. A χ2 test was used to compare the proportion of inappropriate orders between the 2 seasons. RESULTS: During the 2015-2016 RSV season, of the 80 palivizumab orders, there were 11 inappropriate administrations (13.8%). During the 2016-2017 RSV season, 70 orders were administered to patients, and 4 doses (5.7%) were inappropriate. The cost of palivizumab increased from year 1 to year 2 (acquisition cost of $2477.44 per 100 mg/mL vial during year 1, $2613.71 per 100 mg/mL vial during year 2). An estimated cost avoidance of $12,807.18 was observed due to the decrease in the number of inappropriate administrations of palivizumab following implementation of the order panel (n = 7). There was an overall reduction in the number of inappropriate orders from year 1 to year 2 (8.1%); however, the reduction was not significant (p = 0.102). CONCLUSIONS: Following the implementation of the order panel plus restriction policy, we observed a decrease in the proportion of inappropriate doses that were administered from the preimplementation period to the postimplementation period, which also resulted in a cost avoidance of approximately $13,000.

A pilot program featuring formative peer review of faculty teaching at a college of pharmacy.

BACKGROUND AND PURPOSE: Although student ratings are the most common method for evaluating faculty performance in the classroom in schools of pharmacy, this should not be the sole approach to provide feedback to faculty regarding teaching. EDUCATIONAL ACTIVITY AND SETTING: This initiative targeted individuals at the ranks of Clinical Assistant or Assistant Professor who taught during the 2016-2017 academic year. As part of the process, the peer reviewer(s) attended a class taught by the faculty member under review. During the observation, the peer reviewer(s) completed rubrics and noted strengths and areas for improvement. Participating faculty members were asked to complete a post-evaluation survey to evaluate the pilot program and offer suggestions for enhancement FINDINGS: Based on a 64.3% response rate (9/14) from reviewers and 92.9% (13/14) from faculty members under review, 100% (9/9) of reviewers and 92.3% (12/13) of faculty members under review would recommend the peer review program to their colleagues. However, 77.8% (7/9) of the reviewers and only 46.2% (6/13) of faculty members under review supported the use of the peer review method as part of the annual faculty evaluation and development process. DISCUSSION/SUMMARY: Ultimately, this process of peer review will be implemented across the college, benefiting faculty evaluation and development, as part of the promotion and tenure process. With our positive feedback and suggestions for improvement, the authors hope this will serve as a guide for institutions to develop peer review programs that will positively supplement student ratings and provide an additional, meaningful form of evaluation for self- improvement and promotion/tenure.

A Randomized Crossover Comparison between Team-Based Learning and Lecture Format on Long-Term Learning Outcomes.

There are limited data evaluating the effectiveness of different teaching pedagogies to maintain gains in learning achieved over the short term. The purpose of this study is to compare long-term learning outcomes between two different teaching pedagogies, team-based learning (TBL) and lecture. Within a therapeutic elective course a randomized crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). Six months following completion of the course, 47 assessment questions (application and recall multiple-choice questions) were re-administered to 16 students from the class with no prior announcement of the assessment. The results showed no significant difference in long-term assessment scores between TBL and lecture formats (67 ± 14% vs. 63 ± 16%, p = 0.2, respectively). In addition, there was a significant (p < 0.0001) and similar decline in short-term gains for TBL (90 ± 9% vs. 67 ± 14%) and lecture (86 ± 11% vs. 63 ± 16%) in assessment scores. In conclusion, there was no advantage gained by employing an active-learning pedagogy when assessing multiple-choice questions six months following end of a therapeutics course in a limited sample size. Neither pedagogy was able to maintain short-term gains in learning outcomes as assessed by multiple-choice questions.

Benefits of a concentrated teaching rotation: Perspectives of pharmacy residents and faculty.

The postgraduate pharmacy residency experience requires residents to develop the proper skillset to not only provide optimal therapeutic management to patients, but to effectively deliver their knowledge to trainees and other health care providers. Without specific recommendations for how to achieve these skills, residents may hone their communication, organizational, and teaching skills through a number of different venues currently offered by residency programs nationwide. Residency programs commonly offer a longitudinal experience in order for residents to obtain didactic teaching skills; less often do programs offer a concentrated rotation dedicated to academia. Residents can acquire a number of skills from a focused academic rotation including curriculum development, career growth, and preceptorship by following a schedule that more closely mimics that of a clinical faculty member. These skills are typically more difficult to develop with a longitudinal experience due to time constraints and other resident and faculty member commitments. Prior to implementing this experience, the impact on both the resident and faculty member should be taken into consideration.

Qualitative Analysis of Student Perceptions Comparing Team-based Learning and Traditional Lecture in a Pharmacotherapeutics Course.

Objective. To qualitatively compare students' attitudes and perceptions regarding team-based learning (TBL) and lecture. Design. Students were exposed to TBL and lecture in an elective pharmacotherapeutics course in a randomized, prospective, cross-over design. After completing the course, students provided their attitudes and perceptions through a written self-reflection and narrative questions on the end-of-course evaluation. Student responses were reviewed using a grounded theory coding method. Assessment. Students' responses yielded five major themes: impact of TBL on learning, perceptions about TBL learning methods, changes in approaches to learning, building skills for professional practice, and enduring challenges. Overall, students report TBL enhances their learning of course content (knowledge and application), teamwork skills, and lifelong learning skills. Conclusion. Students' attitudes and perceptions support TBL as a viable pedagogy for teaching pharmacotherapeutics.

A Randomized Crossover Comparison of Team-based Learning and Lecture Format on Learning Outcomes.

Objective. To compare learning outcomes and student confidence between team-based learning (TBL) and lecture. Methods. A crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). There were two assessments of 24 questions each. A survey (Likert scale) assessing student confidence and attitudes was administered at the end. Results. A significantly higher overall examination score was observed for TBL as compared to lecture. Students were more confident in providing therapeutic recommendations following TBL. Higher survey scores favoring TBL were also seen related to critical-thinking skills and therapeutic knowledge. Conclusion. Learning outcomes and student confidence in performing higher-order tasks were significantly higher with TBL. The findings of this novel crossover type design showed that TBL is an effective pedagogy.

Minimum Requirements for Core Competency in Pediatric Pharmacy Practice.

Colleges of pharmacy provide varying amounts of didactic and clinical hours in pediatrics resulting in variability in the knowledge, skills, and perceptions of new graduates toward pediatric pharmaceutical care. The Pediatric Pharmacy Advocacy Group (PPAG) endorses the application of a minimum set of core competencies for all pharmacists involved in the care of hospitalized children.