Implementation and evaluation of a preceptor educational development programme involving the health cluster colleges at Qatar University.

BACKGROUND: 'The Practice Educators' Academy Programme' is an innovative educational intervention developed following a preceptor-focussed needs assessment. The primary aim of this study was to evaluate the programme's effect on self-efficacy and knowledge amongst multi-disciplinary clinical preceptors who precept students across the Health Cluster in Qatar University. The secondary aim was to assess the preceptors' satisfaction with the programme's comprehensiveness, appropriateness, and relevance. METHODS: This is a longitudinal study, with the same participants followed at different time points (i.e., pretest-posttest interventional design). The sample size was calculated to represent 10% of the sample expected for the main study, utilising a stratified convenience sampling technique. Preceptor self-efficacy was assessed using the Preceptor Self-Efficacy Questionnaire, a validated 21-item questionnaire. Preceptor knowledge was assessed through a 25-item multiple-choice question test. Satisfaction with programme content and delivery was assessed through a 14-item questionnaire with open comments. RESULTS: Thirty pretest-posttest respondents for the PSEQ assessment, and 26 pretest-posttest respondents for the knowledge assessment were appropriately matched and analysed. Participation in the self-efficacy questionnaire resulted in a statistically significant increase in their posttest median score (pretest-to-posttest: 3.3-to-3.6, p = 0.001). Participation in the knowledge assessment resulted in a statistically significant increased posttest mean score (pretest-to-posttest: 10.2-to-15.7, p < 0.001). Participants indicated high levels of satisfaction with the programme (average score = 4.42/5). CONCLUSIONS: Our findings suggest the programme is effective as demonstrated through a significant improvement in preceptors' self-efficacy and knowledge. Recommendations for future iterations include placing greater focus on active learning strategies, and inter-disciplinary interactions.

Reshaping experiential education within Qatar University's Health Programs during the COVID-19 pandemic.

Health professions programs heavily depend on experiential learning to prepare learners for practice within the healthcare system. Learners acquire a significant proportion of patient care skills as they participate in experiential learning activities. As the coronavirus disease 2019 (COVID-19) pandemic disrupts education globally, educators have been challenged to reexamine existing teaching approaches to minimize the impact on experiential educational outcomes. This article describes how educators from the College of Pharmacy and College of Medicine at Qatar University utilized nontraditional teaching methods to ensure the continuation of experiential learning despite the disruption due to the pandemic.

A Middle Eastern journey of integrating Interprofessional Education into the healthcare curriculum: a SWOC analysis.

BACKGROUND: Interprofessional education (IPE) is an emerging concept in the Middle East with a number of health professional degree programs continually striving to meet international accreditation requirements to enhance the quality of education and ensure high standards are maintained. Using the College of Pharmacy at Qatar University (CPH QU) as a model, this article describes the IPE initiatives coordinated through the College's IPE Committee, with representation from fourteen programs at four Healthcare institutions: Qatar University; Weill Cornell Medical College in Qatar; the University of Calgary in Qatar; and the College of North Atlantic in Qatar. These activities are based on the model proposed by the University of British Columbia across the different pharmacy professional years. Learning objectives for these initiatives were selected from the IPE shared competency domains and competency statements developed for Qatar context. METHOD: A meeting with six faculty members, who have been instrumental to designing and executing the IPE activities in the previous 2 years, was convened. Faculty members reflected on IPE activities and collaborations with other participating programs. A structured SWOC (Strengths, Weaknesses, Opportunities, Challenges) framework was used to guide discussion. The discussion was recorded and notes were taken during the meeting. Raised points were categorized into each SWOC category for the final analysis. RESULTS: Implementation of IPE program is a major undertaking with a number of challenges that require invested time to overcome. This article highlights the importance of incorporating IPE into healthcare curricula to graduate students ready for collaborative practice in the workforce. Learning objectives for IPE initiatives need to be based on shared competency domains. When developing and implementing an IPE program it is necessary to align activities under a strong theoretical framework. This should be done under the leadership of an IPE steering group or committee to oversee the integration of IPE into the healthcare curriculum. CONCLUSION: The article presents many lessons learned through IPE implementation that are relevant to other academic institutions keen to incorporate IPE into their programs and also provides a successful model for integrating IPE into healthcare curricula.

The impact of antimicrobial stewardship strategies on antibiotic appropriateness and prescribing behaviours in selected countries in the Middle East: a systematic review.

Antimicrobial resistance is a global health problem and antimicrobial stewardship is an essential component of hospital policies worldwide yet little is known regarding effective implementation strategies in the Middle East. We conducted a review of studies carried out in this region that deployed different antimicrobial stewardship strategies to assess antimicrobial appropriateness and prescribing behaviours. A search of MEDLINE, EMBASE, International Pharmaceutical Abstracts, Google and Google Scholar was conducted. Twenty articles met the inclusion criteria; 2 studies evaluated strategies including prospective audit with feedback, while 18 others evaluated strategies including benchmarking antimicrobial utilization against guidelines. Recommendations for implementation of stewardship in the Middle East highlighted the importance of developing and updating local antimicrobial prescribing policies and using collaborative interdisciplinary approaches for success.

Levetiracetam for seizure prevention in brain tumor patients: a systematic review.

Seizures are common complications for patients with brain tumors. No clear evidence exists regarding the use of antiepileptic agents for prophylactic use yet newer agents are being favoured in many clinical settings. The objective of this systematic review was to determine the efficacy of levetiracetam for preventing seizures in patients with brain tumors. A literature search was completed using the databases PubMed (1948 to December 2015), EMBASE (1980 to December 2015), Cochrane Database of Systematic Reviews, and Google Scholar. Studies were included if they reported seizure frequency data pertaining to levetiracetam use in patients with brain tumors as either monotherapy or as an add on agent. The literature search produced 21 articles (3 randomized controlled trials, seven prospective observational studies, and 11 retrospective observational studies). All studies were found to be at high risk of bias. Overall, studies show levetiracetam decreased seizure frequency in brain tumor patients with or without craniotomy. Safety outcomes were also favourable. As such, levetiracetam appears effective for reducing seizures in patients with brain tumors and may be considered a first-line agent. However, there is an urgent need for more high quality prospective data assessing levetiracetam and other antiepileptic drugs in this population.

Attitudes of pharmacy and nutrition students towards team-based care after first exposure to interprofessional education in Qatar.

Little is known regarding attitudes of healthcare professional students towards team-based care in the Middle East. As modernization of health systems is rapidly occurring across the Gulf Cooperation Council countries, it is important for students to engage in interprofessional education (IPE) activities. The objective of this study was to assess pre-clinical students' attitudes towards interprofessional healthcare teams after completion of their first IPE activity. A previously validated questionnaire was distributed to 25 pharmacy and 17 nutrition students at Qatar University after participation in an IPE event. Questions related to quality of team-based care and physician centricity. Results showed high agreement regarding high quality care provided by teams yet students were unsure of the value of team-based care when considering required time for implementation. Results provide baseline data for future studies to assess student attitudes throughout the professional programs and give valuable insight for future IPE program design in the Middle East.

Mental effort in the assessment of critical reflection: Implications for assessment quality and scoring.

INTRODUCTION: Critical reflection is a mainstay in the training of health professionals, yet assessment of reflection is commonly described as difficult, taxing, and resulting in inconsistent scoring across assessors. At the same time, there is evidence from experiential and simulation settings that assessors' mental effort may explain assessor variability, which could be a target for simplifications in assessment design. Assessors' mental effort for assessment of reflection is currently unknown. This study aimed to determine reliability of rubric scoring of critical reflection, variation in pass-fail rates, and the relationship between reflection scores and assessors' perceived mental effort. METHODS: Eleven assessors were recruited to assess six reflection assignments using a published rubric. Mental effort was measured using the Paas scale for each assignment assessed and was correlated with rubric scores for each assignment. RESULTS: Findings showed inconsistency in scoring between assessors, resulting in varying pass rates for each assignment (55-100%). All assignments demonstrated negative correlations between rubric scores and perceived mental effort (r = -0.115 to -0.649). CONCLUSIONS: Findings support the notion that more work should be done to optimize assessment of critical reflection. Future studies should focus on disentangling the influence on mental effort of scoring tools, assignment structures, and writing quality.

Assessment of Educational Needs and Design of a Preceptor Development Program for Health Professional Education Programs in Qatar.

INTRODUCTION: Experiential learning is the backbone of many health care professional education programs; however, the quality of learning is profoundly dependent on the skills and experiences of clinical preceptors. This study was conducted at Qatar University Health Cluster (Colleges of Pharmacy, Medicine, and Health Sciences) with the primary objective of identifying the educational needs of preceptors to design and review an educational professional development program. METHODS: This study adopted a mixed-methods approach and was conducted in three stages: (1) assessment of preceptor educational needs, (2) designing of the Practice Educators' Academy program, and (3) revision and refinement of the designed program. The needs' assessment was conducted at all the three colleges through a validated survey and focus groups comprising of preceptors, students, and clinical faculty members. The sample included 209 survey respondents and 11 focus group sessions. RESULTS: The results yielded five key themes and a variety of individual preferences, which were used to design a five-module face-to-face two-day interactive workshop. For the revision of the designed program, the syllabus was shared purposively with selected scholars and experts in the area of health professions education, and their feedback was collected and critically examined. Furthermore, the refinement of the program was performed on the basis of this feedback, resulting in the revised and representative program being ready for piloting. DISCUSSION: A preceptor development program on experiential teaching and learning skills was successfully designed and revised with the needs of the clinical preceptors at its core. Preceptors' skills development can advance health care outcomes by preparing competent health professional graduates.

Cognitive load theory: Implications for assessment in pharmacy education.

The concept of mental workload is well studied from a learner's perspective but has yet to be better understood from the perspective of an assessor. Mental workload is largely associated with cognitive load theory, which describes three different types of load. Intrinsic load deals with the complexity of the task, extraneous load describes distractors to the task at hand, and germane load focuses on the development of schemas in working memory for future recall. Studies from medical education show that all three types of load are relevant when considering rater -based assessment (e.g. Objective Structured Clinical Examinations (OSCEs), or experiential training). Assessments with high intrinsic and extraneous load may interfere with assessors' attention and working memory and result in poorer quality assessment. Reducing these loads within assessment tasks should therefore be a priority for pharmacy educators. This commentary aims to provide a theoretical overview of mental workload in assessment, outline research findings from the medical education context, and propose strategies to be considered for reducing mental workload in rater-based assessments relevant to pharmacy education. Suggestions for future research are also addressed.

Using motivational interviewing techniques to inform decision-making for COVID-19 vaccination.

Motivational interviewing is a patient-centered communication style used to enhance a person's internal motivation for attitudinal change by exploring and solving inherent ambivalences. In the face of rising COVID-19 vaccine hesitancy, pharmacists and other health care professionals may use motivational interviewing to enable individuals making informed decisions with regards to the COVID-19 vaccines. The purpose of this article is to integrate theory with practice by describing a scenario that illustrates how motivational interviewing skills and strategies can be used to reduce COVID-19 vaccine hesitancy.

An Interventional Call-Back Service to Improve Appropriate Use of Antibiotics in Community Pharmacies.

Pharmacists play a key role in tackling antibiotic misuse through counseling and education of patients and healthcare providers. The study aim is to evaluate the appropriateness of antibiotic prescriptions in community pharmacy settings while implementing an interventional call-back service to assess adherence and symptom resolution among patients prescribed an antibiotic. Patients were recruited by community pharmacists who were assigned to either the call-back, structured counseling, or standard care arms. Patients in the call-back group received intensive antibiotic counseling and a phone call from the study pharmacist 3 to 5 days after antibiotic initiation. The counseling arm patients received intensive antibiotic counseling from the study pharmacist while patients in the standard care arm received routine care. Antibiotic adherence rates among the standard care (n = 25), counseling (n = 29), and call-back (n = 26) groups were 64%, 86.2%, and 88.5%, respectively (X2 = 5.862, p = 0.053). Symptom severity scores after completion of antibiotic treatment among all groups were rated as excellent. Twenty-nine percent of the outpatient antibiotic prescriptions were deemed as inappropriate. A pharmacist call-back service is a simple and inexpensive intervention which can effectively identify opportunities for improving appropriate antibiotic use, particularly with respect to adherence.

Critical appraisal of tobacco dependence treatment guidelines.

Background Tobacco use is a leading preventable cause of morbidity and mortality globally. Clinical practice guidelines for the treatment of tobacco use dependence are of varied scope and quality, making it challenging for users to select and apply recommendations. Objective The study objective is to identify and critically appraise the quality of existing clinical practice guidelines for tobacco cessation. Setting The study occurred between collaborative academic institutions located in Qatar and New Zealand. Methods A systematic literature search was performed for the period 2006-2018 through the following databases: PubMed, EMBASE, CINAHL, ISI Web of Science, Scopus, National Guideline Clearing House, Campbell Library, Health System Evidence, Joanna Briggs Institute Evidence-Based Practice Database, Academic Search Complete, ProQuest, PROSPERO, and Google Scholar. Relevant professional societies' and health agencies' websites were also searched. Two reviewers independently extracted and assessed guidelines' quality using Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Main outcome measure Standardized domain scores according to the AGREE II instrument. Results 7741 hits were identified. After removing duplicates and screening, 24 guidelines were included. Highest guideline quality was for National Institute for Health and Care Excellence (NICE) guideline with an overall ranking score of 87.56% and least quality was for Japanese Circulation Society Joint Working Group with an overall score of 29.34%. Domain 4 of AGREE II (clarity of presentation) had the highest average quality score (70.95%), while the lowest average quality scores were for Domain 2 (Rigour of Development) (50.21%) and Domain 5 (Applicability) (45.05%). Conclusion Seven guidelines were judged to be of high quality (overall score of ≥ 70%). Future guidelines for tobacco dependence treatment should use rigorous methods of development and provide applicable recommendations.

Assessment of Educational Inhaler Technique Interventions Among Community Pharmacists: A Systematic Review.

OBJECTIVE: Community pharmacists are the last point of contact before patients are provided with an inhaled asthma device and are expected to adequately educate and train patients on its use. Evidence has shown that pharmacists lack the knowledge and skills required to appropriately counsel patients on these devices. The aim of this systematic review was to focus on evaluating the effects of educational interventions on community pharmacists knowledge of inhaler technique. METHODS: A literature search was conducted using the databases Pubmed and Embase with no applied time restrictions. The databases were searched from inception to December 2018. Articles were eligible for inclusion if they reported outcomes evaluating the improvement in pharmacists knowledge of inhaler technique after an educational intervention and provided details of the intervention. Pharmacists working in settings other than community pharmacies and inhaler devices used for conditions other than asthma were excluded. RESULTS: Five studies met the eligibility criteria. Workshops and one-on-one instruction were the main educational strategies used in these studies to augment the pharmacists knowledge of asthma inhaler devices. A checklist was utilized by all studies to evaluate the pharmacists improvement of inhaler technique after an educational intervention. All studies showed an improvement in inhaler technique of pharmacists post-intervention. CONCLUSION: Studies identified in this systematic review have shown that an educational intervention produced positive outcomes related to the pharmacists knowledge on the steps involved in using asthma inhaler devices. However, the study findings focused on short-term retention of knowledge of inhaler technique and did not address the application of these results in clinical practice.

Optimizing assessors' mental workload in rater-based assessment: a critical narrative review.

INTRODUCTION: Rater-based assessment has resulted in high cognitive demands for assessors within the education of health professionals. Rating quality may be influenced by the mental workload required of assessors to complete rating tasks. The objective of this review was to explore interventions or strategies aimed at measuring and reducing mental workload for improvement in assessment outcomes in health professions education. METHODS: A critical narrative review was conducted for English-language articles using the databases PubMed, EMBASE, and Google Scholar from conception until November 2018. To be included, articles were eligible if they reported results of interventions aimed at measuring or reducing mental workload in rater-based assessment. RESULTS: A total of six articles were included in the review. All studies were conducted in simulation settings (OSCEs or videotaped interactions). Of the four studies that measured mental workload, none found any reduction in mental workload as demonstrated by objective secondary task performance after interventions of assessor training or reductions in competency dimension assessment. Reductions in competency dimensions, however, did result in improvements in assessment quality across three studies. DISCUSSION: The concept of mental workload in assessment in medical education needs further exploration, including investigation into valid measures of assessors' mental workload. It appears that adjusting raters' focus may be a valid strategy to improve assessment outcomes. Future research should be designed to inform how to best reduce load in assessments to improve quality, while balancing the type and quantity of data needed for judgments.

Evaluating knowledge, skills, and practice change after an accredited evidence-based medicine course for community pharmacy preceptors.

INTRODUCTION: Incorporating evidence-based medicine skills into practice is vital for pharmacists to promote rational medication use while making optimal patient care decisions. The objective of this study was to evaluate the impact of an evidence-based medicine course on the knowledge and precepting skills of community pharmacy preceptors. METHODS: This was a longitudinal, multiphase, interventional study, which involved the development of an evidence-based medicine course based on results of an educational assessment. The course was delivered over five sessions and included didactic and active learning strategies. The impact was measured by the preceptor's ability to apply knowledge gained from the course while providing student feedback during a community practice experience using a journal club context. RESULTS: Ten preceptors completed the course with 50% and 70% passing the drug information and critical appraisal assessments, respectively. When measuring course impact, 44% of preceptors were able to provide feedback at a proficient level while 56% needed further development. Preceptors' confidence improved across pre-course, post-course, and after the observation phase in interpreting study results (p = 0.016), teaching the student evidence-based medicine skills (p = 0.008), and providing feedback to the student regarding journal clubs (p = 0.010). Students rated high improvement in the preceptor's ability to provide feedback related to critical appraisal skills. CONCLUSION: A course-based approach to increase preceptor's knowledge of critical appraisal and drug information skills may be effective.

Prevention and screening recommendations in type 2 diabetes: Review and critical appraisal of clinical practice guidelines.

The aim of this review was to identify and appraise guidelines reporting recommendations for the screening and prevention of type 2 diabetes. Five guidelines were included for analysis and all were endorsed by national or international organizations. All guidelines were recommended for practice with or without modifications for both prevention and screening. The overall appraisal scores ranged from 62.5 to 91.7 for prevention and 62.5-83.3 for screening. The highest scored domain was 'clarity of presentation' and the lowest was 'rigor of development'. Findings call for greater attention to rigor when formulating recommendations for prevention and screening of diabetes.

Approaches to Direct Oral Anticoagulant Selection in Practice.

Direct oral anticoagulants (DOACs) carry many advantages over warfarin and are now considered first line or an alternative for mnay thromboembolic disorders. With the emergence of 5 DOAC agents to the market as well as the accumulating evidence gathered from head-to-head comparisons between the agents, we attempt to provide direction for clinicians when selecting the most appropriate DOAC agent. Important aspects such as efficacy, safety, cost effectiveness, approved indications, and other drug-related factors will be addressed to highlight the major similarities and diversities among the DOACs. When considering the safety profile of DOACs, evidence points toward apixaban as the safest followed by dabigatran and then rivaroxaban. On the other hand, dabigatran currently has the only approved antidote, idarucizumab. According to the approved DOAC indications, rivaroxaban may be favorable in European countries given its additional indication for secondary prevention of myocardial infarction. Following rivaroxaban, dabigatran and apixaban have the largest number of approved indications and lastly comes edoxaban and then betrixaban. For patients with renal impairment, betrixaban is the safest option, followed by apixaban and edoxaban, then rivaroxaban and lastly dabigatran. When considering DOAC dosing, rivaroxaban, edoxaban, and betrixaban are mainly dosed once daily compared to dabigatran and apixaban, which are dosed twice daily. However, rivaroxaban and betrixaban must be administered with food, which adds another level of complexity to the DOAC dosing. Lastly, taking into consideration drug interactions, dabigatran, edoxaban, and betrixaban have the least amount of interactions compared to apixaban and rivaroxaban. Each DOAC has its own set of features that makes it better suited than others based on the exact clinical situation. Therefore, no conclusion can be drawn to the most superior DOAC based on the aspects discussed in this review.

Assessing the evidence based medicine educational needs of community pharmacy preceptors within an experiential program in Qatar.

INTRODUCTION: Observations have shown a lack of evidence-based medicine (EBM) knowledge and skills among community pharmacy preceptors in Qatar. These skills are important when delivering evidence-based recommendations to healthcare providers and patients. The aim of this study was to explore the community pharmacy preceptors' knowledge and understanding of EBM and to identify challenges in applying this approach to community practice. METHODS: A survey instrument was developed to assess the knowledge of community pharmacy preceptors related to EBM. Knowledge-based questions were mapped according to National Association of Pharmacy Regulatory Authorities professional competencies for practicing pharmacists. The survey tool was administered to community pharmacy preceptors involved in mentoring Qatar University College of Pharmacy students. RESULTS: Twenty-six community pharmacy preceptors completed the survey with a response rate of 65%. The knowledge-based questions linked to drug information resulted in 18%, 36%, and 46% of correct, incorrect, and unsure responses respectively while the critical appraisal questions showed 18%, 27%, 55% of correct, incorrect, and unsure responses respectively. Major barriers to practicing EBM included lack of EBM training (81%) and interpreting study results (80%). CONCLUSIONS: Community pharmacy preceptors showed poor knowledge and understanding of EBM. These results and expressed needs by pharmacists support the development of a supplementary course to improve EBM skills.

Strategies to Optimize Dual Antiplatelet Therapy After Coronary Artery Stenting in Acute Coronary Syndrome.

The use of aspirin and a P2Y12 receptor antagonist as dual antiplatelet therapy (DAPT) has become the treatment of choice in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention to prevent recurrent thrombotic events. Although DAPT is beneficial for most patients, few patients still experience recurrent thrombotic events and increased bleeding episodes. This article reviews current literature to identify various approaches that may enhance the DAPT benefit-risk ratio in patients with ACS. Three strategies addressed in this article include the following-(1) use of more potent antiplatelet agents other than clopidogrel; (2) addition of direct oral anticoagulants (DOACs) to DAPT; and (3) optimizing DAPT duration. Although the use of prasugrel or ticagrelor improves treatment efficacy, their use has been associated with increased risk of bleeding compared to clopidogrel. The combination of DOACs and DAPT may not be the most viable strategy because of its limited cardiovascular benefits and increased bleeding risks. The optimal duration of DAPT duration remains controversial. Most guidelines recommend 6 to 12 months of DAPT, whereas emerging studies have shown benefit for both shorter and longer duration of treatment. Risk stratification tools such as the DAPT score may play a role in individualizing DAPT duration according to patient's ischemic and bleeding risks.

Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar.

Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t = 6.177; p < 0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community pharmacists focusing on the name of the medication. Pharmacists rarely assessed patient's medical history or medication use. Disease management and problem solving skills of pharmacists were suboptimal with many referring patients back to the physician.