A scoping review of advanced pharmacy practice experience readiness assessment measures across schools of pharmacy.

BACKGROUND: The development and implementation of Advanced Pharmacy Practice Experience (APPE) readiness assessments has been an area of increased interest to the academy since the publication of the Accreditation Council for Pharmacy Education (ACPE) standards in 2016. This scoping literature review aims to provide an updated summary of current APPE readiness assessment practices among ACPE-accredited institutions in the United States (US). METHODS: A literature search was conducted between 2022 and 2024 using the terms "APPE student readiness," "APPE readiness assessment," "APPE preparedness," "APPE student preparedness," "pharmacy" AND "readiness assessment", "pharmacy" AND "practice readiness," and "pharmacy" AND "student practice readiness" in Pubmed and Embase. The websites for the American Journal of Pharmaceutical Education and Currents in Pharmacy Teaching and Learning were also searched using these terms. Abstracts for all results were reviewed. Abstract only and poster presentations were excluded, as well as articles centered on non-US and/or non-ACPE-accredited institutions. Data was collected regarding the outcomes assessed, type of assessment activity, and how the assessment was implemented. Results were reviewed by a second author to ensure consistency in reporting. RESULTS: A total of 289 unique abstracts were reviewed by author pairs for inclusion based on relevance to the review objectives. A total of 13 articles were included in the final analysis. Each institution measured different knowledge areas, abilities, and entrustable professional activities (EPAs). Most programs had a summative component, with APPE readiness being primarily assessed in the final didactic year of the pharmacy curriculum. Most programs report at least one source of validity. IMPLICATIONS: Given the lack of specific APPE readiness assessment requirements in the ACPE Standards 2016, the different assessment methods among programs were not surprising. However, the commonalities identified can be leveraged with the release of the Curricular Outcomes and Entrustable Professional Activities (COEPA) 2022 to promote a standardized definition of APPE readiness. Future research should focus on formative assessment methods embedded throughout the didactic curriculum to identify "at-risk" students prior to a "high-stakes" summative assessment at the end of the didactic curriculum that impedes student progression to the APPE year.

Medicine, Machines, and Medical Education.

While advances in science and technology continue to be at the forefront of the evolution of medical practice, the 21st century is also undergoing a unique and profound cultural shift that is changing the very nature of what it means to be a medical professional, namely humankind's transition to an information-based internet society. Medical care will increasingly depend on computer-generated probabilities guided and supported by a growing variety of individuals in health care-related professions, including statisticians, technologists, and information managers. Perhaps the biggest challenge to the profession will come from the erosion of professional autonomy, driven by smart machines, social networks, and internet search engines. As a result of these and other changes, physicians are facing a systematic loss of control, often without the direct input and leadership of the profession itself. In this commentary, the author urges the profession to adopt several strategies, including shifting its focus from reimbursement to the care patients value most, meaningfully addressing critical issues in health policy, becoming the definitive source for publicly available medical information, reimagining medical education, and overhauling the existing accreditation and licensing systems. Medical education must go beyond a focus on physicians whose professional identity revolves around being the exclusive source of medical knowledge. In the digitized 21st century, medical education should emphasize the centrality of the humanistic interface with patients such that the doctor-patient relationship is paramount in the complex medical world of machines and social media. Removing the roadblocks to successful professional reform is no small task, but the process can begin with a grassroots movement that empowers physicians and facilitates organizational and behavioral change. Failure to take action may well hasten the diminishment of patient care and the profession's trusted role in society.

The Impact of the Global SARS-CoV-2 (COVID-19) Pandemic on Neuroanesthesiology Fellowship Programs Worldwide and the Potential Future Role for ICPNT Accreditation.

BACKGROUND: The COVID-19 pandemic is an international crisis placing tremendous strain on medical systems around the world. Like other specialties, neuroanesthesiology has been adversely affected and training programs have had to quickly adapt to the constantly changing environment. METHODS: An email-based survey was used to evaluate the effects of the pandemic on clinical workflow, clinical training, education, and trainee well-being. The impact of the International Council on Perioperative Neuroscience Training (ICPNT) accreditation was also assessed. RESULTS: Responses were received from 14 program directors (88% response rate) in 10 countries and from 36 fellows in these programs. Clinical training was adversely affected because of the cancellation of elective neurosurgery and other changes in case workflow, the introduction of modified airway and other protocols, and redeployment of trainees to other sites. To address educational demands, most programs utilized online platforms to organize clinical discussions, journal clubs, and provide safety training modules. Several initiatives were introduced to support trainee well-being during the pandemic. Feelings of isolation and despair among trainees varied from 2 to 8 (on a scale of 1 to 10). Fellows all reported concerns that their clinical training had been adversely affected by the coronavirus disease 2019 (COVID-19) pandemic because of decreased exposure to elective subspecialty cases and limited opportunities to complete workplace-based assessments and training portfolio requirements. Cancellation of examination preparation courses and delayed examinations were cited as common sources of stress. Programs accredited by the ICPNT reported that international networking and collaboration was beneficial to reduce feelings of isolation during the pandemic. CONCLUSION: Neuroanesthesia fellowship training program directors introduced innovative ways to maintain clinical training, educational activity and trainee well-being during the COVID-19 pandemic.

Pain Medicine Board Certification Status Among Physicians Performing Interventional Pain Procedures in the State of Florida Between 2010 and 2016.

BACKGROUND: The US Department of Health and Human Services has recommended that physicians performing interventional pain procedures be credentialed based on criteria based guidelines and minimum training requirements. OBJECTIVES: To quantitatively assess gaps in certification related to pain medicine fellowship requirements, we studied the distribution of such procedures in Florida between 2010 and 2016. STUDY DESIGN: This research involved a retrospective analysis with a sample size of n = 1,885,442 interventional pain procedures. SETTING: Data describing interventional pain procedures performed in Florida between January 2010 and December 2016 were obtained from the Florida Department of Health. The National Provider Identifier file and board certification lists from the American Board of Medical Specialties (ABMS), the American Board of Pain Medicine (ABPM), and the American Board of Interventional Pain Physicians (ABIPP) corresponding to this time frame were also obtained. METHODS: The datasets were linked to determine the specialty of physicians performing interventional pain procedures, and whether or not they were pain medicine diplomates of the ABMS, the ABPM, or the ABIPP. The similarity index theta was calculated for the distribution of interventional pain procedure codes among medical specialty groups, and with respect to the practitioners' pain medicine board certification status. RESULTS: Of the interventional pain procedures, anesthesiologists performed 63.5%, physiatrists 19.1%, neurologists or psychiatrists 5.2%, and other practitioners 12.3%. Among procedures performed by anesthesiologists, physiatrists, and psychiatrists or neurologists, 66.2%, 50.3%, and 50.4% were by ABMS pain board-certified practitioners, respectively. Practitioners without ABMS pain medicine boards performed 45.8% of interventional pain procedures. Practitioners without such boards from either the ABMS, ABPM, or ABIPP performed 37.7%. There was very large similarity (theta > 0.9) in the distribution of procedures comparing ABMS pain medicine board-certified practitioners to non-ABMS pain medicine board-certified anesthesiologists, physiatrists, or all other specialties. LIMITATIONS: In countries other than the United States, where pain medicine board certification is relatively recent, there may be a higher percentage of interventional pain procedures performed by individuals without certification than we report. In "opt-out" states, where nurse anesthetists can independently perform interventional pain procedures, the percentage of interventional pain procedures performed by individuals without physician pain medicine board certification may also be higher. The datasets we used do not contain information to allow assessment of outcomes or effectiveness resulting from pain medicine board certification. CONCLUSIONS: Approximately one-third of interventional pain procedures were performed by physicians without at least 1 of the 3 pain medicine board certifications. In addition, the practitioners performed very similar distributions of procedures (i.e., those without pain medicine board certification, overall, have not restricted their practice). These results suggest the need for additional accredited pain medicine fellowship training positions for newly graduated residents. The results also show that, for the recommendations of the Department of Health and Human Services to be satisfied, physicians without board certification performing intervention procedures would need to obtain ABPM or ABIPP certification, or ABMS certification after completion of a full-time Accreditation Council of Graduate Medical Education pain medicine fellowship. KEY WORDS: Chronic pain, education, medical, graduate, specialty boards.

Impact of Local Boards of Health on Local Health Department Accreditation, Community Health Assessment, Community Health Improvement Planning, and Strategic Planning.

INTRODUCTION: Local health departments (LHDs) are increasingly using national standards to meet the challenges presented by the complex environments in which these agencies operate. Local boards of health (LBoHs) might play an instrumental role in improving LHDs' engagement in activities to meet these standards. OBJECTIVES: To assess the impact of LBoH performance of governance functions on LHDs having a current (completed within 5 years) community health assessment (CHA), community health improvement plan (CHIP), strategic plan, and level of engagement in the Public Health Accreditation Board (PHAB) accreditation program. METHODS: Binary and multinomial logistic regression models were used to analyze linked data from 329 LHDs participating in both the 2015 Local Board of Health Survey and the 2016 National Profile of LHDs Survey. RESULTS: Higher performance of LBoH governance functions, measured by an overall scale of LBoH taxonomy consisting of 60 items, had a significant positive effect on LHDs having completed CHA (P < .001), CHIP (P = .01), and strategic plan (P < .001). LHDs operating in communities with a higher score on the overall scale of LBoH taxonomy had significantly higher odds (P = .03) of having higher level of participation in the PHAB national voluntary accreditation program-that is, being accredited, having submitted application for accreditation, or being in the e-PHAB system (eg, by submitting a letter of intent). CONCLUSIONS: LBoHs serve as governance bodies for roughly 71% of LHDs and can play a significant role in encouraging LHDs' participation in these practices. That positive influence of LBoHs can be seen more clearly if the complexity and richness of LBoH governance functions and other characteristics are measured appropriately. The study findings suggest that LBoHs are a significant component of the public health system in the United States, having positive influence on LHDs having a CHA, CHIP, strategic plan, and participation in accreditation.

Compliance to the Integrated School Health Policy: Intersectoral and multisectoral collaboration.

BACKGROUND:  Implementation of the Integrated School Health Policy (ISHP) requires strong intersectoral collaboration on the part of key role players such as the Department of Health, Department of Basic Education and Department of Social Development. These departments and educational structures such as school governing bodies, teacher unions and learner organisations, academic institutions, civil society and development partner organisations are also expected to contribute to the development of sustainable and comprehensive school health programmes. OBJECTIVES:  The objective of this study was to describe the compliance of the schools in the City of Tshwane to the ISHP in 2015. METHOD:  A quantitative, explorative and descriptive study was conducted in the City of Tshwane using a questionnaire to determine the extent of compliance to the application of the ISHP in selected schools. RESULTS:  The results indicated a widespread non-compliance to ISHP programmes. There was insufficient stakeholder integration in the school health programmes at schools in the City of Tshwane. CONCLUSION:  The lack of collaboration with relevant stakeholders in school health service delivery will lead to a fragmented, uncoordinated and unsustainable approach to the execution of ISHP programmes. This might result in delayed or no detection and intervention in cases of, among others, mental, psychosocial and health challenges to learning, as well as development of nutrition-related conditions.

Analysis of Accredited Gastroenterology Fellowship Internet-Available Content: Twenty-Nine Steps Toward a Better Program Website.

GOAL: To assess publicly available content derived from official websites of accredited gastroenterology fellowship programs, specifically evaluating data pertinent to prospective applicants. BACKGROUND: The Internet provides access to key information for applicants applying to gastroenterology fellowship, particularly as competition drives applicants to apply to a large number of programs. Thus, it is important for fellowship program websites to be up to date and contain accurate and pertinent information. METHODS: Twenty-nine variables, determined as important website content on the basis of prior published website analyses and from surveys of preferences, were extracted from the relevant websites of all accredited gastroenterology fellowships in the USA. Results were binary-i.e., a website either contained or did not contain each item. RESULTS: A total of 178 websites were evaluated. The mean number of online content items was 14.1(± 3.2 SD) out of a possible 29 (47.1%). Program coordinator contact information, application information, and the number of current fellows were accessible on > 80% of websites. In contrast, the typical number and types of procedures performed by fellows and number of hospitals covered by fellows on call were found on < 10% of websites. Analysis revealed that 23.2% of lifestyle, 48.3% of training, and 59.6% of program variables were met. CONCLUSIONS: Gastroenterology fellowship websites lacked important content. Websites had a lower mean percentage of lifestyle content compared to training and program-related items. An organized website containing relevant information may not only attract qualified applicants but also avert unnecessary email inquiries and inappropriate applications. This study may provide guidance to gastroenterology fellowship programs seeking to improve their websites for applicants.

Trends in Hospice Quality Oversight and Key Challenges to Making it More Effective, 2006-2015.

Background: Given the limited ability of hospice patients to assess, monitor, and respond to substandard care, quality oversight has an important role to play in the hospice sector. The IMPACT Act of 2014 required that agencies be recertified at least every three years, but it did not otherwise alter hospice quality oversight. Objectives: To illuminate the current hospice quality oversight process and discuss its role alongside other government monitoring and public reporting efforts. Methods: Retrospective analysis (2006-2015) concerning hospice accreditation status, deficiency trends, survey frequency and deficiency outcomes, and termination from the Medicare program. Results: The proportion of privately accredited hospice agencies increased from 15% to 39%, a trend driven largely by its increased use among for-profit agencies. The combined rate of deficiencies per agency increased 35% over the past decade, with issues around care planning, aide and homemaker services, and clinical assessment featured most prominently. Nearly half (45%) of all surveys resulted in deficiency citations; however, less than one-in-four hospice agencies were surveyed in a given year. Over the past decade, 28 agencies were terminated from the Medicare program; most of these agencies were unaccredited and operated on a for-profit basis. Conclusions: The IMPACT Act addressed one of the biggest shortcomings in hospice oversight. Our findings highlight additional reforms that could be considered. First, reporting inspection results from private and public recertification surveys could promote greater transparency and accountability. Second, making a wider range of intermediate sanctions available to oversight agencies could enhance enforcement efforts and, ideally, incentivize agencies to improve quality of care.

The Impact of the Veteran's Affairs Medical System on an Otolaryngology Residency Training Program.

Introduction: The field of otolaryngology has become the leading specialty in the management of head and neck pathology and trauma. Graduate medical education programs tasked to train military head and neck surgeons within the Department of Defense (DoD) maintain certification by ensuring adequate surgical case volume and training. In recent years, surgical case numbers have declined due to an overall healthy active duty patient population and deployments of residency faculty. As such, a novel initiative between the San Antonio Military Medical Center and the South Texas Veteran's Healthcare system was developed to provide seamless care among active duty service members, dependents, retirees, and veterans. The goal of this study is to review the impact on Otolaryngology Key Indicator Procedures (KIP), as defined by the Accreditation Council for Graduate Medical Education (ACGME), following integration of a Veterans Affairs health care population into a military otolaryngology residency program. Further, we aim to assess the potential secondary benefits of an integrated health care initiative between the DoD and the Veteran's Affairs (VA) systems. Materials and Methods: Otolaryngology key indicator procedures, as defined by the ACGME, were reviewed at an academic military medical center before and after implementation of an ENT Federal Healthcare Consortium integrating care of VA patients at a military hospital. The surgical scheduling system at our institution was queried for cases within the KIP categories of "Head & Neck" and "Otology" from 2011 to 2015. Results: Case data was reviewed from the San Antonio Military Medical Center before (2011-2012) and following integration of VA patient care (2013-2015). A total of 520 "Head & Neck" and 532 "Otology" KIP were performed following development of an ENT Federal Consortium. One hundred and sixty-five KIPs were performed on patients referred from the VA. The range of VA-generated cases contributing to total KIPs for "Head & Neck" and "Otology" ranged from 6.8% to 59.5% and 0% to 18.9% per year. Conclusions: The establishment of a Federal Healthcare Consortium and integration of VA patient population provided a tangible and quantifiable increase in otolaryngology KIPs. Development of a training relationship with VA patients is beneficial in reaching outcome-oriented goals for otolaryngology residents.

Trends in Accreditation Council for Graduate Medical Education Accreditation for Subspecialty Fellowship Training in Plastic Surgery.

BACKGROUND: The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. METHODS: The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). RESULTS: Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). CONCLUSION: There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.

Neuroendovascular Fellowship Training: Self-Assessment of a Program Accredited by the Committee on Advanced Subspecialty Training.

The University at Buffalo's neuroendovascular fellowship is one of the longest running fellowship programs in North America. The burgeoning neurointerventional workforce and the rapid growth in the neurointerventional space on the heels of groundbreaking clinical trials prompted us to assess the fellowship's academic impact and its graduates' perceptions and productivity. An anonymized web-based survey was sent to all former neuroendovascular fellows with specific questions pertaining to current practice, research and funding, and perceptions about the fellowship's impact on their skills, competitiveness, and compensation. Additionally, the h-index was calculated to assess the academic productivity of each graduated fellow. Among 50 former fellows, 42 (84%) completed the survey. The fellows came from various countries, ethnic backgrounds, and specialties including neurosurgery (n = 39, 93%), neurology (n = 2, 5%), and neuroradiology (n = 1, 2%). Twenty (48%) respondents were currently chairs or directors of their practice. Most (n = 30, 71%) spent at least 10% of their time on research activities, with 27 (64%) receiving research funding. The median h-index of all 50 former fellows was 14. The biggest gains from the fellowship were reported to be improvement in endovascular skills (median = 10 on a scale of 0-10 [highest]) and increase in competitiveness for jobs in vascular neurosurgery (median = 10), followed by increase in academic productivity (median = 8), and knowledge of vascular disease (median = 8). In an era with open calls for moratoriums on endovascular fellowships, concerns over market saturation, and pleas to improve training, fellowship programs perhaps merit a more objective assessment. The effectiveness of a fellowship program may best be measured by the academic impact and leadership roles of former fellows.

Design and activity evaluation of an Advanced-Introductory Pharmacy Practice Experience (aIPPE) course for assessment of student APPE-readiness.

BACKGROUND AND PURPOSE: The newly implemented Advanced-Introductory Pharmacy Practice Experience (aIPPE) course at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences was designed to assess student readiness for Advanced Pharmacy Practice Experience (APPE) and provide formative feedback regarding skills and abilities needed to be successful during subsequent coursework and practice experiences. EDUCATIONAL ACTIVITY AND SETTING: The aIPPE is a full-time, six week (240hours) direct patient care rotation occurring in the spring semester of the third-professional year following a longitudinal integrated IPPE program. Required aIPPE course elements mimic the activities and expectations students should anticipate encountering during APPE training. FINDINGS: All students participating in the initial aIPPE course offering were described as APPE-Ready. Students and preceptors described the aIPPE course as successful in achieving the primary outcome of preparing students for improved downstream performance. SUMMARY: The aIPPE provided students opportunities to demonstrate readiness to enter advanced pharmacy practice experience.

Development of a college-level assessment framework in line with international accreditation standards: A Middle Eastern perspective.

INTRODUCTION: Accreditation of international pharmacy programs by North American and European accrediting bodies is becoming increasingly popular. Practices regarding assessment and evaluation are especially highlighted in accreditation standards and many programs around the world do not currently have coordinated approaches to meet assessment expectations. This article describes the process of developing a comprehensive assessment framework at our institution and provides discussion regarding facilitators and barriers for those attempting to do the same. METHODS: A coordinator of Assessment and Accreditation was appointed by the Dean. This person subsequently formed an Assessment Committee consisting of faculty, student, and administrative support membership. This committee developed the assessment framework through a review of published and online literature, in addition to extraction of key assessment points from accreditation standards. These data were then categorized according to major domains informed by the literature review and subcategorized based on components to be assessed using consensus techniques. RESULTS: A comprehensive assessment framework was developed consisting of three domains (programmatic assessment, academics, and engagement/satisfaction). The components relating to programmatic assessment included vision/mission and accreditation standards; academics consisted of program learning outcomes, final cumulative assessment, and course and curriculum assessments; and engagement/satisfaction consisted of students, faculty/staff, and other stakeholders. CONCLUSION: An assessment framework guided by accreditation standards can coordinate assessment plans and support program quality.

Global trends in center accreditation by the Joint Commission International: growing patient implications for international medical and surgical care.

Millions of patients travel internationally for medical and surgical care. We found that the annual number of centers accredited by the Joint Commission International increased from one center in 1999 to 132 centers in 2016; there are currently 939 accredited centers across 66 countries. Public health and medicolegal implications related to medical travel deserve attention.

Exploring the Link Between Completion of Accreditation Prerequisites and Local Health Departments' Decision to Collaborate With Tax-Exempt Hospitals Around the Community Health Assessment.

CONTEXT: Community health assessments (CHAs) are a core function of local health departments (LHDs). Recently, completing a CHA has become a prerequisite for LHDs seeking accreditation by the Public Health Accreditation Board (PHAB). Similarly, under the Affordable Care Act, nonprofit hospitals are required to conduct periodic community health needs assessments (CHNAs). Opportunities thus exist for LHDs and hospitals to jointly complete CHAs/CHNAs. OBJECTIVE: This study examined existing LHD-hospital collaborations around CHAs/CHNAs, focusing specifically on the relationship between LHDs' level of engagement with PHAB accreditation activities and their collaboration with hospitals around CHAs/CHNAs. DESIGN: Data came from the 2013 NACCHO (National Association of County & City Health Officials) Profile Study and the Area Health Resource File. Complete data were available for 1332 LHDs that participated in the 2013 NACCHO Profile Study. Logistic regression explored the relationship between LHDs' completion of accreditation prerequisites, in particular completion of a CHA, community health improvement plan, and strategic plan, and their involvement in collaborations with tax-exempt hospitals around CHAs/CHNAs. RESULTS: LHDs that collaborated with tax-exempt hospitals on CHAs/CHNAs were larger, more likely to be locally governed, and more likely to have a local board of health. Bivariate analysis showed that CHA/CHNA-related collaboration with hospitals was significantly correlated (P < .01) with an LHD's completion of accreditation prerequisites. In multivariate regression analysis, completion of all 3 PHAB accreditation prerequisites significantly increased the odds of LHDs collaborating with hospitals when controlling for other LHD and community-level characteristics. CONCLUSION: PHAB accreditation prerequisites together with IRS requirements for hospitals foster potential for collaboration around CHAs/CHNAs. Joint completion of CHAs/CHNAs not only allows partners to complete the assessment more efficiently but has also been shown to produce higher-quality assessments, thus building a strong foundation for continued collaboration to improve community health.

Cultivating Community Psychology for Future Generations: Symbiosis, Synergy, and Separation.

As we near the fiftieth anniversary of the founding of a community psychology division of the American Psychological Association, there are reasons to be concerned about the sustainability of the field. This commentary proposes a need for deliberate, systematic efforts to cultivate settings that can sustain the field. A framework for outreach to build symbiotic relationships and synergistic collaborations with persons who do not identify as community psychologists is proposed. Simultaneously, a strategy of separation from other disciplines may be needed in some circumstances to conserve settings that sustain the field. Finding a balance in these strategies is necessary to cultivate community psychology for future generations.