Aiding Transformation from Student to Practitioner by Defining Threshold Concepts for the Pharmacists' Patient Care Process.

Objective. To explore critical milestones in the transition from student to practitioner by identifying the threshold concepts associated with learning the Pharmacists' Patient Care Process (PPCP). Methods. A threshold concept represents a transformed way of thinking about a topic or discipline. This study convened five focus groups to identify possible threshold concepts related to learning the PPCP. The data were analyzed by deductive content analysis and confirmed by an expert consensus panel using a modified nominal group technique. Results. Moving beyond the process outlined by the PPCP, the five focus groups identified additional elements of learning required in becoming a patient care practitioner. These elements were focused on the more intangible aspects of patient-centered care, such as practitioner priorities, attitude, and approach. As such, the data help to describe how practitioner's think, feel, and act (ie, their identity). Deductive content analysis resulted in five Patient Care Threshold Concepts (PCTC), which were confirmed by the expert consensus panel. Conclusion. The five PCTCs provide pharmacy educators with an additional tool to use in teaching the PPCP. The PCTCs can aid in the student-practitioner transformation by helping to make implicit aspects of patient care more explicit. They are supplements to patient care competencies that help explain the practitioner's priorities, attitude, and approach. They can also serve as guidance to pharmacy educators in evaluating curricular activities and assessments, as well as identity formation. This approach can be applied to the identification of threshold concepts in other areas of pharmacy education, such as leadership.

Supporting formative peer review of clinical teaching through a focus on process.

BACKGROUND: The professional need for development of clinical faculty is clear. Previous scholarship provides insight into the formative potential of peer review in both didactic and experiential settings. Less information exists on a comprehensive peer review process (PRP) designed to support faculty change. EDUCATIONAL ACTIVITY AND SETTING: A clinical faculty PRP was developed and implemented based on input from the literature, stakeholders, and field experts. The process included: 1) self-reflective pre-work, 2) a peer-observation component, 3) self-reflective post-work, and 4) creation of a specific action plan via meeting with an educational expert. The process was assessed by collecting evaluative data from peer reviewer and clinical faculty participants. FINDINGS: Eight of 26 faculty members participated in a pilot of the PRP and formed four clinical faculty-peer dyads. When surveyed, all participants unanimously reported that they would participate in the PRP again. Aspects perceived among most helpful to clinical teaching included peer observation, self-reflection, and meeting with an educational expert. Challenges related to the process included anxiety of peer observation, burden of pre-work, and logistics of scheduling meetings. DISCUSSION: While instruments are important in guiding and documenting the evaluation of clinical teaching during an observation period, this initiative focused on the process supporting the observation and evaluation, in order to optimize the formative feedback received by participating faculty and encourage professional development actions. SUMMARY: A PRP that incorporates preparation, reflective practice, and a meeting with an educational expert may support meaningful faculty development in the area of clinical teaching.

Using peer teaching to introduce the Pharmaceutical Care Model to incoming pharmacy students.

BACKGROUND: The aim of this initiative was to design and evaluate a peer teaching activity where pairs of second-year pharmacy students introduced the Pharmaceutical Care Model and discussed success in the broader first-year pharmacy curriculum with pairs of first year students. EDUCATIONAL ACTIVITY: Second-year pharmacy students individually created concept maps illustrating the main components of pharmaceutical care to be used as teaching tools with first-year students. First-year students were given a brief introduction to pharmaceutical care by faculty and prepared questions to ask their second-year colleagues. Two second-year students were then matched with two first-year students for a two-part peer teaching event. Each student completed documentation of the peer experience, which included questions about the effectiveness of the teaching, changes to be made in the future, and the usefulness of the exercise. The documentation was analyzed via content analysis and instructors evaluated the concept maps based on their effectiveness as a teaching tool for novices. A rubric was used to evaluate 166 concept maps of which 145 were rated good, 18 were rated as better, and 3 as best. Themes emerging from the content analysis included: positive impact of teaching and learning pharmaceutical care, value of broader curriculum discussion, and beneficial first- and second-year connections. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: A structured peer teaching event outside the traditional classroom setting can create a space for: teaching and learning to occur, student-student connections to be made, and advice on the curriculum to be shared.

Experience with the script concordance test to develop clinical reasoning skills in pharmacy students.

BACKGROUND: The script concordance test (SCT) is used to assess clinical reasoning and was originally developed for medical learners. The Accreditation Council for Pharmacy Education (ACPE) endorses the need for pharmacy students to develop clinical reasoning skills, but there is little documentation of use of the SCT for pharmacy learners. EDUCATIONAL ACTIVITY: A script concordance test activity was designed for a diabetes and metabolic syndrome pharmacotherapy course. Twenty-five cases were created and evaluated by an expert panel of 20 practicing pharmacists. Ten cases were presented as a formative activity in class. The students, design team, teaching team, and expert panel evaluated the activity. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: The SCT was received positively from the students, design team, teaching team, and expert panel. The design team noted that case writing was different for this approach and that the inclusion of various perspectives from panelists was beneficial. Although the activity was formative in nature, the teaching team scored the students and this provided insight into areas where the students may struggle. SUMMARY: This report provides information on the formative use of the SCT in the classroom, as well as categories of items suitable for pharmacy. The SCT provides an approach to illustrate clinical reasoning and clinical decision making among content experts and can be used to stimulate clinical discussions among student learners and content experts. The SCT could help incorporate clinical reasoning skills in a pharmacy curriculum to meet ACPE standards.

Assessing Emotionally Intelligent Leadership in Pharmacy Students.

Objective. To determine the frequency distribution of pharmacy students across Emotionally Intelligent Leadership Inventory (EILI) measures. Methods. The EILI was administered to 235 pharmacy students at two schools. The instrument was systematically compared to the 2013 CAPE Outcomes and analyzed by confirmatory factor analysis. Results. The EILI has primary connections with pharmacy competencies related to interprofessional communication and leadership. The three facets of the EILI were verified for internal consistency (Context, α=.78; Self, α=.74; Others, α=.79). Student scores were the highest for the consciousness of self facet, with a mean score of 31.4 out of 40. Conclusion. The EILI shows promise as an instrument for use in assessing pharmacy students' emotional intelligence and leadership skills.

Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences.

OBJECTIVE: To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). DESIGN: Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students' competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. ASSESSMENT: Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. CONCLUSIONS: Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs.

Development and Validation of a Patient Satisfaction Survey for Comprehensive Medication Management.

BACKGROUND: Comprehensive medication management (CMM) services are a relatively new standard for clinical practice. A patient satisfaction tool for pharmacists providing comparable pharmacy services is essential for measuring quality and sustainability. OBJECTIVE: To develop a psychometrically valid questionnaire for measuring patient satisfaction for CMM services. METHODS: A patient satisfaction survey tool was developed through a multiphase development process. Validation studies were conducted across 2 urban ambulatory care health system settings providing CMM services. The survey consisted of 10 items related to 3 domains: medication-related needs, pharmacist-patient engagement, and overall satisfaction. Using a 4-point scale, the surveys were mailed, collected, and analyzed for descriptive statistics, internal consistency, and factorial composition. RESULTS: Total surveys returned for analysis numbered 195, with an overall survey response rate of 19.2%. Factor analysis and item analysis identified 1 factor of pharmacists' patient care services. The factor was named "patient satisfaction." CONCLUSIONS: The instrument that was developed provided 1 factor of CMM services. This brief patient satisfaction tool appears to be reliable and valid and may serve other CMM providers to assess 1 measure of quality assurance upon further evaluation.

A Five-Year Evaluation of Examination Structure in a Cardiovascular Pharmacotherapy Course.

Objective. To evaluate the composition and effectiveness as an assessment tool of a criterion-referenced examination comprised of clinical cases tied to practice decisions, to examine the effect of varying audience response system (ARS) questions on student examination preparation, and to articulate guidelines for structuring examinations to maximize evaluation of student learning. Design. Multiple-choice items developed over 5 years were evaluated using Bloom's Taxonomy classification, point biserial correlation, item difficulty, and grade distribution. In addition, examination items were classified into categories based on similarity to items used in ARS preparation. Assessment. As the number of items directly tied to clinical practice rose, Bloom's Taxonomy level and item difficulty also rose. In examination years where Bloom's levels were high but preparation was minimal, average grade distribution was lower compared with years in which student preparation was higher. Conclusion. Criterion-referenced examinations can benefit from systematic evaluation of their composition and effectiveness as assessment tools. Calculated design and delivery of classroom preparation is an asset in improving examination performance on rigorous, practice-relevant examinations.