Developing and Implementing an Entrustable Professional Activity Assessment for Pharmacy Practice Experiences.

Objective. To develop, implement, and validate an entrustable professional activity (EPA) assessment tool that could be used to calculate course grades for experiential students in all practice environments. Methods. An EPA assessment tool was developed and directly mapped to 18 EPAs, and a criterion, or passing score, for each EPA was established for all practice experiences. The EPA assessment tool was implemented in the college's experiential program during summer 2018 and comparative outcomes and reliability of the EPA assessment tool were assessed within the core advanced pharmacy practice experiences (APPEs). Results. The EPA assessment tool reliability was strong (Cronbach's alpha=0.93), with preceptor-suggested grades and grades calculated using the EPA assessment tool equivalent in 95% of completed APPEs. All nonequivalent calculated-preceptor grade pairs were evenly split between one grade higher than scored and one grade lower than scored. Conclusion. The EPA assessment tool is a reliable and valid instrument for assessing EPA achievement in the APPE year. Future work should focus on determining the longitudinal utility of the EPA tool by comparing outcomes in introductory and advanced pharmacy practice experiences.

Student performance on a knowledge-based exam may predict student ability to communicate effectively with a standardized patient during an objective structured clinical examination.

BACKGROUND: The purpose of this article is to describe the extent that student performance on in-class exams in a drug information course is associated with student performance on medication counseling in a high-stakes assessment using standardized patients (SP). METHODS: Students completed two traditional knowledge-based exams during a drug information and communication course. The objective structured clinical examination (OSCE) was the final exam for the course. The OSCE consisted of the student counseling an SP on the use of a medication. A counseling rubric was developed for use in a second-year (P2) OSCE based on the Indian Health Services counseling model and social cognitive theory. Multiple linear regression was used to examine if traditional exams and student admission characteristics were associated with student performance on the OSCE. RESULTS: A total of 78 P2 students took the in-class exams and the OSCE. Students with higher scores on the second in-class traditional, knowledge-based exam had significantly higher scores on the OSCE. CONCLUSION: A traditional knowledge-based exam on pharmacist-patient communication was associated with students' actual counseling performance on an OSCE. Faculty may be able to use exam scores to target students at high risk of doing poorly on a medication counseling OSCE.

Predictors of student performance on the Pharmacy Curriculum Outcomes Assessment at a new school of pharmacy using admissions and demographic data.

OBJECTIVES: To characterize student performance on the Pharmacy Curriculum Outcomes Assessment (PCOA) and to determine the significance of specific admissions criteria and pharmacy school performance to predict student performance on the PCOA during the first through third professional years. METHODS: Multivariate linear regression models were developed to study the relationships between various independent variables and students' PCOA total scores during the first through third professional years. RESULTS: To date, four cohorts have successfully taken the PCOA examination. Results indicate that the Pharmacy College Admissions Test (PCAT), the Health Science Reasoning Test (HSRT), and cumulative pharmacy grade point average were the only consistent significant predictors of higher PCOA total scores across all students who have taken the exam at our school of pharmacy. CONCLUSION: The school should examine and clarify the role of PCOA within its curricular assessment program. Results suggest that certain admissions criteria and performance in pharmacy school are associated with higher PCOA scores.

Leadership and Management Are One and the Same.

Defining the attributes of change catalysts within high functioning organizations, including the academic enterprise, is desirable. An understanding of these attributes within our academy may foster faculty interest and engagement in seeking administrative roles and serve to bolster succession planning within our schools. On one hand, there have been numerous publications teasing out the purported differences between leadership and management. On the other hand, does segregating these important characteristics based upon arbitrary distinctions do more harm than good? This commentary represents the work of a group of academic leaders participating in the 2015-2016 AACP Academic Leadership Fellowship Program. This work was presented as a debate at the 2016 AACP Interim Meeting in Tampa, Florida, in February 2016.

Improving Pharmacy Student Communication Outcomes Using Standardized Patients.

Objective. To examine whether standardized patient encounters led to an improvement in a student pharmacist-patient communication assessment compared to traditional active-learning activities within a classroom setting. Methods. A quasi-experimental study was conducted with second-year pharmacy students in a drug information and communication skills course. Student patient communication skills were assessed using high-stakes communication assessment. Results. Two hundred and twenty students' data were included. Students were significantly more likely to have higher scores on the communication assessment when they had higher undergraduate GPAs, were female, and taught using standardized patients. Similarly, students were significantly more likely to pass the assessment on the first attempt when they were female and when they were taught using standardized patients. Conclusion. Incorporating standardized patients within a communication course resulted in improved scores as well as first-time pass rates on a communication assessment than when using different methods of active learning.

Comparison of Pharmaceutical Calculations Learning Outcomes Achieved Within a Traditional Lecture or Flipped Classroom Andragogy.

Objective. To compare learning outcomes achieved from a pharmaceutical calculations course taught in a traditional lecture (lecture model) and a flipped classroom (flipped model). Methods. Students were randomly assigned to the lecture model and the flipped model. Course instructors, content, assessments, and instructional time for both models were equivalent. Overall group performance and pass rates on a standardized assessment (Pcalc OSCE) were compared at six weeks and at six months post-course completion. Results. Student mean exam scores in the flipped model were higher than those in the lecture model at six weeks and six months later. Significantly more students passed the OSCE the first time in the flipped model at six weeks; however, this effect was not maintained at six months. Conclusion. Within a 6 week course of study, use of a flipped classroom improves student pharmacy calculation skill achievement relative to a traditional lecture andragogy. Further study is needed to determine if the effect is maintained over time.

Cost-Effectiveness of Using Standardized Patients to Assess Student-Pharmacist Communication Skills.

Objective. To explore the cost-effectiveness of including standardized patients (SP) in the didactic curriculum for application and assessment of students' pharmacist-patient communication skills. Methods. Five role play/case study (RP/CS) activities from a communication skills curriculum were replaced with five SP encounters. Communication was assessed using a rubric. This study developed an economic model to examine the costs and effectiveness of replacing RP/CS events with SP events in knowledge-application and communication assessment. Costs consisted of SP hourly wages for training and delivery of SP events. Outcomes examined were the incremental cost-effectiveness ratio (ICER) per student. Results. The ICER comparing SP to RP/CS was $100.93 higher per student on first-attempt pass rates and $9.04 per one-point increase in the mean score. Conclusion. SP was more effective and more costly than RP/CS. Further research into students' willingness to pay needs to occur before determining if using SPs is cost-effective in teaching communication skills.

A standardized patient counseling rubric for a pharmaceutical care and communications course.

OBJECTIVE: To restructure a required pharmaceutical care and communications course to place greater emphasis on communication skills and include a high-stakes assessment. DESIGN: A standardized counseling rubric was developed for use throughout the pharmacy curriculum and the counseling laboratory practicals were changed to high-stakes assessments. ASSESSMENT: An annual mid-semester and end-of-semester high-stakes patient-counseling objective structured clinical examination (OSCE) conducted prior to and after revision of the course and counseling rubric documented improvements in students' scores. Performance on the post-course annual assessment patient counseling OSCE improved compared to that on the pre-course (p<0.001). CONCLUSION: The 2010 course revision improved students' medication counseling abilities and readiness to practice. Major course revisions should be undertaken only after input from all stakeholders and with data to support the need for change.

Reliability and credibility of progress test criteria developed by alumni, faculty, and mixed alumni-faculty judge panels.

OBJECTIVE: To compare the reliability and credibility of Angoff-based, absolute criteria derived by faculty, alumni, and a combination of alumni and faculty judge panels. METHODS: Independently, faculty, alumni, and mixed faculty-alumni judge panels developed pass/fail criteria for an 86-item test. Generalizability and decision studies were performed. Root mean square errors (RMSE) and 95% confidence intervals were calculated for reliability and credibility assessment. School graduate performance upon the North American Licensure Examination (NAPLEX) was the comparator for credibility assessment. RESULTS: RMSEs were 1.06%, 1.42%, and 2.32% for the alumni, faculty, and mixed judge panels respectively. The school's NAPLEX pass rate was 97.5%. This rate triangulated well with the faculty judge panel (pass rate = 93.9%, CI95% = 87.1%-98.2%), but did not with either mixed judge or alumni judge panels. CONCLUSIONS: Faculty-derived criteria offer superior pass/fail decision defensibility relative to both alumni derived and mixed faculty-alumni derived criteria.

Retrospective evaluation of a possible interaction between warfarin and levofloxacin.

STUDY OBJECTIVES: In order to clarify the clinical significance of a suspected drug interaction, we sought to determine if the international normalized ratio (INR) is affected when levofloxacin is administered in patients receiving long-term warfarin therapy. DESIGN: Retrospective cohort study using pharmacy and medical records. SETTING: Outpatient clinic. PATIENTS: Forty-three patients receiving long-term warfarin therapy who subsequently were prescribed either levofloxacin (22 patients) or felodipine (21 controls); felodipine was chosen as it has been shown not to interact with warfarin. Patients in both groups were required to have a documented INR before the start of levofloxacin or felodipine (pre-INR) and either during levofloxacin or felodipine therapy or within 15 days after the drug had been started (post-INR). MEASUREMENTS AND MAIN RESULTS: Patient demographics were similar between the two treatment groups. The mean +/- SD age of the patients in the levofloxacin and control groups was 59.5 +/- 8.7 and 65.3 +/- 11.5 years, respectively (p=0.07). The mean change between the pre- and post-INR (primary outcome measure) was 0.31 +/- 0.82 (pre-INR 2.46, post-INR 2.76) and 0.21 +/- 0.54 (pre-INR 2.46, post-INR 2.67) in the levofloxacin and felodipine groups, respectively (p=0.65). A post hoc power analysis, based on a sample-derived, weighted standard deviation of 0.68, revealed that the study had 66% power to detect a change of 0.5 in the INR value. The percentage of patients who required a warfarin dosage adjustment based on the post-INR (secondary outcome measure) was 41% (9 of 22 patients) in the levofloxacin group and 33% (7 of 21 patients) in the felodipine group. CONCLUSION: Although our primary analysis did not detect a warfarin-levofloxacin interaction, the potential for such an interaction, especially in idiosyncratic cases, cannot be ruled out. Clinicians should closely monitor INR values when levofloxacin is administered jointly with warfarin.

Drug identification: a survey of poison control centers.

OBJECTIVE: The objective of this study was to determine current practices and opinions of poison center staff and directors regarding drug identification (ID) calls. METHODS: Surveys were developed and mailed to 911 poison center staff members and 69 managing directors at 69 poison control centers in the United States in December 2001. RESULTS: Responses were received from 317 staff members and 33 directors from 49 centers. Nearly half of the staff respondents stated that they had not received drug ID training beyond how to look up the identity of an oral medication. About one-half of staff and director respondents stated that their centers had only informal (unwritten) drug ID policies, while one-fourth each responded they had formal written policies or had no policy at all. A majority of respondents indicated that their centers either allow or require specialists to provide ID for non-ingestion-related cases. Nearly all staff and director respondents routinely provide ID services to law enforcement officers and health care professionals regardless of whether ingestion was involved. Slightly more than one-half of staff respondents inquire about possible ingestion with almost every request, while one-third only inquire when the caller gives some indication that ingestion may have occurred. Case-based questions reveal that different practices are utilized depending on the type of medication for which ID is being requested. Factors such as risk of liability, patient confidentiality, guardianship, and the person's best interest appear to contribute to decisions regarding the provision of medication ID. CONCLUSION: Drug identification practices vary from center to center throughout the United States. Though the service is greatly utilized, few centers have written policies. In addition, training for the provision of this service appears to be inadequate in many centers. The development of drug identification guidelines to be utilized throughout poison centers would provide much needed consistency and guidance.

Determination of the lack of a drug interaction between azithromycin and warfarin.

STUDY OBJECTIVE: To determine the effect on the international normalized ratio (INR) of adding azithromycin to patients receiving stable dosages of warfarin. DESIGN: Retrospective chart review. SETTING: Outpatient clinic. PATIENTS: Ambulatory patients receiving warfarin and azithromycin concurrently who had a documented therapeutic INR value before the start of azithromycin therapy (pre-INR) and a documented INR value within 30 days after the start of azithromycin therapy (post-INR). MEASUREMENTS AND MAIN RESULTS: Patients given felodipine during long-term warfarin therapy formed a comparative control group. Patient demographics were similar in both treatment groups. Mean age of the azithromycin group (17 patients) was 59 +/- 13 years and of the control group (20 patients) 65 +/- 12 years. All 17 patients in the azithromycin group and 16 of the controls were women. Mean change from pre-INR to post-INR in the azithromycin and control groups, respectively, was 0.14 +/- 0.64 (pre-INR 2.46, post-INR 2.61) and 0.19 +/- 0.54 (pre-INR 2.46, post-INR 2.66) (p = 0.74). A post hoc power analysis based on a pooled standard deviation of 0.60 revealed that the study had 68% power to detect a 0.5 change in the INR value. CONCLUSION: No interaction between azithromycin and warfarin was observed in ambulatory patients with therapeutic baseline INR values.

A retrospective cohort analysis of the clinical effectiveness of a physician-pharmacist collaborative drug therapy management diabetes clinic.

The glycemic control of patients with diabetes in a physician-supervised, pharmacist-managed primary care clinic was compared with that of patients receiving standard care in the same health care system. We retrospectively analyzed the glycemic control of 87 men with type 1 or type 2 diabetes whose diabetes-related drug therapy was managed by clinical pharmacists compared with a control group of 85 similar patients whose care was not augmented by clinical pharmacists. Primary outcomes were differences in fasting blood glucose (FBG) and glycosylated hemoglobin (A1C) levels between groups. Secondary outcomes were relative risk (RR) for achieving an A1C of 7% or below, frequency of diabetes-related scheduled and unscheduled clinic visits, and frequency of hypoglycemic events. The study group had 864 clinic visits and the control group had 712 between October 1997 and June 2000. No statistical differences were noted in FBG or A1C between groups. The RR of achieving an A1C of 7% or below was significantly higher in the study cohort (RR 5.19, 95% confidence interval [CI] 2.62-10.26). The frequency of hypoglycemic events did not differ between groups. The mean +/- SD frequency of unscheduled diabetes-related clinic visits/patient/year was higher in the control group (1.33 +/- 3.74) than in the study group (0.11 +/- 0.46, p = 0.003). Pharmacist-managed diabetes care was effective in improving glycemic control and was not associated with an increased risk for hypoglycemic events or unscheduled diabetes-related clinic visits.