The struggle is real: Facilitating pharmacy student success on rotations when challenges arise.

Pharmacy preceptors are pivotal to facilitating and maximizing student learning on experiential rotations. However, preceptors may encounter a variety of behaviors or barriers that can hinder student success. Although some guidance exists for preceptors, emerging learner challenges along with new educational outcomes call for an updated practical approach to promoting student success on rotations. This paper provides preceptors with a structured approach to facilitate success for students who exhibit challenges on rotations. Four categories that preceptors can use to identify behaviors and barriers to learning are outlined - knowledge, skills, professional attitudes and behaviors, and external factors including the Social Determinants of Learning™. We describe strategies to help preceptors identify and categorize these challenges and provide a stepwise approach to facilitate student success.

Evaluation of an ambulatory care elective to improve practice readiness perceptions utilizing entry-level competencies.

BACKGROUND AND PURPOSE: The objectives of this study are to (1) describe the impact of an ambulatory care elective on students' future interests in ambulatory care careers and (2) evaluate students' perception of practice readiness using entry-level competencies. EDUCATIONAL ACTIVITY AND SETTING: This study employed a mixed methods approach to provide a comprehensive evaluation of a newly designed ambulatory care elective. A pre-post survey was developed to evaluate students' career plans and perceptions of practice readiness in an ambulatory care setting. The primary outcome analyzed the change in students' career plans and pre-post changes in self-perceptions using the institutional advanced pharmacy practice experience (APPE) ambulatory care rotation assessment and key skills from the American Society of Health-System Pharmacists entry-level readiness objectives. A qualitative analysis was also conducted to analyze open-ended response questions within the post-survey as well as the overall course reflections from the students. FINDINGS: There was no significant difference in career plans; however, students' perception of practice readiness for the ambulatory care setting significantly improved following the elective course. SUMMARY: This elective course improved students' perception of practice readiness for the ambulatory care setting. Future research is required to assess the impact of student performance in APPE and post-graduate pursuits.

A scaffolded problem-based learning course for first-year pharmacy students.

BACKGROUND AND PURPOSE: There has been an increased use of active learning pedagogies in pharmacy curricula. Structured, complex pedagogies such as problem-based learning (PBL) may require rigorous training for students to be successful. We aim to describe the development and implementation of an introductory PBL course for first-year pharmacy students. We describe the theoretical framework for course development, including the educational philosophies informing the course design. Development of PBL skills and professional behavior were evaluated using student self-assessment throughout the course. EDUCATIONAL ACTIVITY AND SETTING: This introductory PBL course was developed using educational philosophies to scaffold student learning of the pedagogy and development of PBL skills. A student self-assessment was administered at two time points throughout the course. The self-assessment contained items related to PBL skills and professional behaviors. Self-assessment scores were compared with facilitator evaluations of student performance to determine reliability of self-assessment results. FINDINGS: Eighty-eight students completed both self-assessments (93.6% response rate). Self-assessment of PBL skills increased significantly. There was no improvement in self-assessed professional behaviors. Self-assessment scores did not correlate with facilitator assessment of student performance in a small group. SUMMARY: Integrating a scaffolded, theoretically sound educational approach to introduce students to the PBL pedagogy improves students' self-assessed PBL skills but not professional behavior.

Delivering interprofessional patient safety education using storytelling, a real-life medication error, and synchronous online platform.

INTRODUCTION: Interprofessional education (IPE) about patient safety positively impacts safety and reduces errors but is challenging to deliver. We aimed to determine if a synchronous virtual IPE program using storytelling and interactive learning impacted student perceptions about patient safety. METHODS: An IPE patient safety program involving medical and pharmacy students was synchronously delivered virtually due to the COVID-19 pandemic. The program was framed using storytelling about a medication error told by a family member. Post-program survey data, exploring participants' perspectives on the program, collected between July 2020 and November 2020 was retrospectively reviewed. Quantitative results were grouped by the five components of the program. Responses within each category were averaged to generate a summary measure of each student's experience. Qualitative feedback from two survey questions was evaluated. RESULTS: There were 236 (96.7% of participants) completed surveys included in the analysis. High proportions of participants responded favorably across all five components of the survey. Qualitative responses were largely positive, with themes of increased empathy, behavior, and attitude change, and meaning making. CONCLUSION: An interactive IPE patient safety program using storytelling about a real-life medication error to frame activities and utilizing a virtual platform was a favorable and impactful method to educate students.

Evaluation of an Instrument to Assess Students' Personal and Professional Development During the Faculty Advising Process.

Objective. To evaluate a tool designed to assess Doctor of Pharmacy (PharmD) students' personal and professional development prior to beginning advanced pharmacy practice experiences (APPEs).Methods. A five-item instrument, entitled the Faculty Advisor's Assessment of the Advisee (FAAA) tool, was developed to assess and monitor pharmacy students' progress over the three-year didactic curriculum. Question anchors were created to describe characteristics exhibited by the student that matched categories of not engaged, beginning, emerging, or engaged. Possible FAAA composite scores ranged from 7 to 20. Using the FAAA tool, faculty advisors assessed their advisees' values, engagement, self-awareness, professionalism, and leadership in 2017, 2018, and 2019. Individual and aggregate cohort reports were run and data for each of the three years were matched with students. To determine if the FAAA showed progression in assessed dimensions in the students during the first, second, and third professional (P1, P2, and P3) years, a Friedman test was performed. Cronbach alpha was used to assess the reliability of the instrument.Results. The data of 93 students were matched for the P1 through the P3 years. Median (IQR) for the FAAA composite score levels for the P1, P2, and P3 were 13 (12-16), 17 (15-19) and 18 (16-20), respectively. Significant differences existed at all timepoints compared, including from the P1 to P2, P2 to P3, and P1 to P3 years. The reliability of the FAAA scale was strong across all three years (winter 2017, α=0.87; winter 2018, α=0.89; and winter 2019, α=0.87). All items appeared worthy of retention as removal did not significantly increase their reliability.Conclusion. A five-item tool which assesses pharmacy students' personal and professional development during the first three years of a PharmD program could be used by faculty advisors to assess student's progress across the didactic curriculum.

Incorporating verbal defense into problem-based learning.

INTRODUCTION: The objective of this project was to evaluate the effect of adjusting the solution reporting phase of problem-based learning (PBL) while keeping core components of the pedagogy constant. METHODS: A PBL course for third year pharmacy students changed delivery of the problem solution from a written format to a verbal defense. Comparisons were made between the written format and verbal defense groups. The primary outcome was the change in the motivation domain of the Motivated Strategies for Learning Questionnaire (MSLQ). Secondary outcomes included evaluation of the learning strategies domain of the MSLQ, changes in MSLQ scores within each group, exam scores, and themes identified using focus groups. RESULTS: There was no difference in the change of motivation and learning domains between the groups. However, scores in both groups increased significantly from the beginning to the end of the semester for both motivation and learning. There was no difference in exam scores and facilitator confidence between groups. Themes from focus groups who used the written format were appreciation of PBL outcomes, discomfort with the pedagogy, and disconnect of assessments. Themes from the verbal format group were realism, increased confidence, and comments with course logistics. CONCLUSIONS: No difference in motivation and learning was observed between the groups, although both groups improved over the course of the semester. Changes to PBL approach within the confines of the pedagogy may not impact motivation and learning.

Appropriateness of Term Limits for Administrative Appointments in Pharmacy Programs.

The appropriateness of term limits for administrative appointments is a subject of much discussion, not just within pharmacy programs, but in organizations of all types. The prospect of term limits for involves a wide variety of important organizational issues, including succession planning, institutional memory, strategic decision-making, and concepts regarding leadership styles overall. This paper examines both sides of the debate regarding the appropriateness of term limits for administrative appointments. Arguments supporting term limits include the ability for strategic changes in the diversity of leaders as well as a more focused effort on continuous quality improvement. The arguments against term limits focus around the need for stability and the time involved in the development of effective leaders.

Reliability and Validity of a Checklist to Evaluate Student Performance in a Problem-Based Learning Group.

Objective. To validate a problem-based learning (PBL) evaluation checklist to assess individual Doctor of Pharmacy (PharmD) students' performance in a group. Methods. In 2013, a performance checklist was developed and standardized. To evaluate the reliability and discriminant validity of the checklist, pharmacy students' evaluation scores from 2015-2016 were assessed along with overall program grade point averages (GPA), and scores on knowledge and problem-solving examinations. Predictive analysis software was used to analyze the data. Results. Seventy facilitators generated 1506 evaluation reports for 191 (90 third-year and 101 second-year) students over eight PBL cases. The mean (SD) total score was 40.6 (2.5) for P3s and 39.1 (2.7) for P2s out of a possible 44.2 points. Students' scores improved each semester. Interrater reliability based on intraclass correlation coefficient for all cases was 0.67. Internal reliability as determined by Cronbach alpha was >0.7 for all binary checklist items across all cases. Discriminant validity assessed using Pearson correlation coefficient showed that the total score from the checklist did not correlate with knowledge or problem-solving examination scores. Conclusion. This unique PBL checklist proved to be a reliable and valid tool to assess student performance in small group sessions in a PharmD curriculum.

Pharmacokinetics and investigation of optimal dose ertapenem in intermittent hemodialysis patients.

BACKGROUND: Previous pharmacokinetic studies demonstrated an increase in serum ertapenem concentrations with decreasing kidney function, including patients receiving renal replacement therapy. This study evaluated the pharmacokinetic parameters of ertapenem in patients receiving hemodialysis. METHODS: This prospective, single-center, open-label study examined the pharmacokinetics of a single intravenous (IV) dose of ertapenem 1 g in seven hospitalized noninfected patients undergoing hemodialysis. Blood samples were collected prior to ertapenem administration and at 0.5, 1, 2, 6, 12 and 48 hours (h) after administration. Ertapenem concentrations were determined by validated liquid chromatography mass spectrometry assay. RESULTS: Following an IV bolus of 1 g ertapenem, plasma concentrations declined relatively slowly with a mean ±standard deviation (SD) elimination half-life of 19.3 ±6.6 h. Plasma concentrations were similar in all subjects, with maximum mean plasma concentration observed of 343±48 µg/mL postdose. The mean ±SD values for systemic plasma clearance (CL) and volume of distribution at steady state (Vss) were 2±0.5 mL/min and 3295±1187 mL, respectively. The area under the curve for 0 h-∞ (AUCinf) was 7494 ±1424 h•µg/mL. No gender effect was observed and no serious adverse events were reported. CONCLUSIONS: Ertapenem half-life was prolonged in hemodialysis patients. Considering the nonrenal clearance and the expected 70% removal with high-efficacy hemodialysis, the dose of 1 g ertapenem, three times weekly, after hemodialysis may produce pharmacodynamically sufficient exposure for potential antimicrobial efficacy. Further studies are warranted to assess the clinical efficacy and safety of this dose with prolonged duration of therapy.

Enhancing Academic Success by Creating a Community of Learners.

OBJECTIVE: To enhance academic performance and student progression by creating a community of learners. DESIGN: Academic performance and student progression of students participating in the first 3 years of a second-year pharmacy learning community were compared with those of students in the 3 previous classes. Students participating in the learning community completed surveys at the end of each semester and at the end of the academic year. Peer mentors were surveyed at the end of the academic year. ASSESSMENT: After implementing the learning community, failures during the second year of the pharmacy program decreased. Students had increasingly positive perceptions of the experience over the 3 years. Peer mentors rated their overall experience highly. CONCLUSION: Implementation of a learning community resulted in improved progression through the program and was well received by students.

Implementation and Use of the Pharmacy Curriculum Outcomes Assessment at US Schools of Pharmacy.

OBJECTIVE: To describe how schools and colleges of pharmacy use the Pharmacy Curriculum Outcomes Assessment (PCOA) in relation to student assessment and curricular feedback. METHODS: A survey was distributed to all programs that have implemented the PCOA. The survey was designed to assess 3 domains regarding the use of the PCOA: rationale for use, logistics of administration, and performance data review and distribution. RESULTS: A 79% response rate (41/52) was obtained. The mix of responses was 93% current PCOA users and 7% past users. The most common reasons for PCOA use were for programmatic assessment and benchmarking. The examination was most frequently administered during the P3 year, with minimal stakes attached to performance. Significant differences in responses based on public vs private institution were seen with respect to length of accreditation of current PCOA users, messaging to students regarding performance, inclusion of results in student advising, and distribution of results to stakeholders. CONCLUSION: Programs were using the PCOA primarily as an assessment in the P3 year for reasons related to programmatic and curricular assessment. Some differences existed between public and private institutional PCOA use and examination-related processes and results distribution.

Insulin sensitivity and secretion in Arab Americans with glucose intolerance.

BACKGROUND: This study examined the pathophysiological abnormalities in Arab Americans with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). SUBJECTS AND METHODS: Homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of insulin secretion (HOMA-%ß), and the Matsuda Insulin Sensitivity Index composite (ISIcomposite) were calculated from the fasting and stimulated glucose and insulin concentrations measured during the oral glucose tolerance test in a population-based, representative, cross-sectional sample of randomly selected Arab Americans. RESULTS: In total, 497 individuals (42±14 years old; 40% males; body mass index [BMI], 29±6 kg/m(2)) were studied. Multivariate linear regression models were performed to compare HOMA-IR, HOMA-%ß, and ISIcomposite among individuals with normal glucose tolerance (NGT) (n=191) versus isolated IFG (n=136), isolated IGT (n=22), combined IFG/IGT (n=43), and diabetes (n=105). Compared with individuals with NGT (2.9±1.6), HOMA-IR progressively increased in individuals with isolated IFG (4.8±2.7, P<0.001), combined IFG/IGT (6.0±4.3, P<0.001), and diabetes (9.7±8.3, P<0.001) but not in those with isolated IGT (3.0±1.7, P=0.87). After adjustment for sex and BMI, these associations remained unchanged. Whole-body insulin sensitivity as measured by ISIcomposite was significantly lower in individuals with isolated IFG (3.9±2.3, P<0.001), isolated IGT (2.8±1.5, P<0.001), combined IFG/IGT (1.9±1.1, P<0.001), and diabetes (1.6±1.1, P<0.001) compared with those with NGT (6.1±3.5). HOMA-%ß was significantly lower in diabetes (113.7±124.9, P<0.001) compared with NGT (161.3±92.0). After adjustment for age, sex, and BMI, isolated IFG (146.6±80.2) was also significantly associated with a decline in HOMA-%ß relative to NGT (P=0.005). CONCLUSIONS: This study suggests that differences in the underlying metabolic defects leading to diabetes in Arab Americans with IFG and/or IGT exist and may require different strategies for the prevention of diabetes.

Aspirin for primary prevention of cardiovascular disease events.

Aspirin has been used for the prevention and treatment of cardiovascular disease (CVD) for several decades. The efficacy of aspirin for secondary prevention of cardiovascular disease is well established, but the clinical benefit of aspirin for primary prevention of CVD is less clear. The primary literature suggests that aspirin may provide a reduction in CVD events, but the absolute benefit is small and accompanied by an increase in bleeding. For aspirin to be beneficial for an individual patient, the risk of a future CVD event must be large enough to outweigh the risk of bleeding. The estimation of CVD risk is multifaceted and can involve numerous risk scores and assessments of concomitant comorbidities that confer additional CVD risk. Numerous guidelines provide recommendations for the use of aspirin for primary prevention, but they often contradict one another despite being based on the same clinical trials. Additional literature suggests that the presence of comorbidities that increase CVD risk, such as diabetes mellitus, asymptomatic peripheral arterial disease, or chronic kidney disease, does not ensure that aspirin therapy will be beneficial. Ongoing clinical trials may provide additional insight, but until more data are available, an individualized assessment of CVD risk with careful evaluation of risk and benefit should be performed before recommending aspirin therapy for primary prevention of CVD.

An objective structured clinical examination to assess problem-based learning.

OBJECTIVES: To compare pharmacy students' performance on an objective structured clinical examination (OSCE) to their performance on a written examination for the assessment of problem-based learning (PBL); and to determine students' and faculty members' perceptions of OSCEs for PBL evaluations. DESIGN: Four OSCEs were added to the written examination to assess 4 PBL cases in a third-year pharmacotherapy course. OSCE scores were compared to written examination scores. Faculty members evaluated student performance. ASSESSMENT: OSCE performance did not correlate with the written-examination scores. Most students (≥ 75%) agreed that OSCEs reflected their learning from PBL and measured knowledge, communication, and clinical skills. A majority of faculty members (≥75%) agreed that OSCEs should be part of PBL assessment. CONCLUSIONS: Addition of an OSCE to written examinations was valued and provided a more comprehensive assessment of the PBL experience.