Successes and challenges in implementing specifications grading in skills-based laboratory courses: Experiences at two colleges of pharmacy.

BACKGROUND AND PURPOSE: Specifications grading, a grading schema focused on mastery of skills, may provide an alternative to traditional grading. Specifications grading uses three components (pass/fail grading, bundles, and tokens) to allow students to demonstrate competency in specific areas as part of competency-based education. The purpose of this article is to outline specifications grading and review its implementation at two colleges of pharmacy. EDUCATIONAL ACTIVITY AND SETTING: Two colleges of pharmacy used specifications grading within a first-year skills-based laboratory course. Instructors identified key skills for each course and the minimum performance levels for each grade (A, B, C, etc.). Each college evaluated skills that aligned with course learning objectives. FINDINGS: Incorporating specifications grading helped better align assignments and assessments to course learning objectives. Instructors felt specifications grading introduced more rigor into the course. Instructors identified four challenges when implementing specifications grading, including: (1) lack of integration into the learning management system, (2) initial student confusion, (3) modifications needed due to unforeseen circumstances, and (4) logistical issues when implementing token exchange. Many of these challenges can be overcome with instructor tracking of passed assignments and earned/redeemed tokens, periodic reinforcement of the grading schema with students, and creating flexibility within the course, especially the first time the schema is implemented. SUMMARY: Specifications grading was successfully implemented in two skills-based courses. Challenges encountered with implementing specifications grading will be continually addressed. Implementation of specifications grading in other forms of course deliveries (e.g., electives, didactic) may require adjustment and further evaluation.

Qualitative Analysis of Pharmacy Students' Self-identified Preconceptions Regarding the Term Clinical Pharmacy.

Objective. To evaluate third-year pharmacy students' self-identified preconceptions regarding the term clinical pharmacy as defined by the American College of Clinical Pharmacy (ACCP).Methods. Third-year pharmacy students were led in a multipart activity focused on evaluating their preconceptions about the term clinical pharmacy after exposure to the unabridged definition published by ACCP. Students were asked to identify two preconceptions they had before the activity that were dispelled after reading the article. Thematic coding was used to identify semantic themes and generate summaries of student perceptions.Results. Three hundred twenty-two third-year pharmacy students' assignment data was coded to reveal six major themes about their preconceptions related to the term clinical pharmacy: setting, required training, job responsibilities, scope within the health care system, job environment (physical, emotional, financial), and limited knowledge about clinical pharmacy. Consistencies in thought were found within two of these themes, namely setting and required training. Significant variance was seen in the remaining four themes, specifically regarding types of activities performed, job environment, the scope of practice, and impact in the health care system.Conclusion. Third-year pharmacy students' preconceptions about clinical pharmacy were related to the exclusivity of where it can be practiced and the need for additional training as a requirement. However, high variability was seen in the majority of the remaining themes, illustrating an inconsistent view of what clinical pharmacy is and the need for intentional focus on professional identity formation within the pharmacy curriculum.

Student perceptions of non-technical skills development during advanced pharmacy practice experiences.

INTRODUCTION: In today's workforce, non-technical skills (NTS) are essential in determining an employee's ability to fit into an organization. However, it is unknown whether pharmacy students consider these skills essential to their future work or believe they are sufficiently trained. Therefore, this study evaluated student perceptions of the value of NTS as a pharmacist and their satisfaction with NTS training. METHODS: A 45-item survey was distributed to 111 fourth-year pharmacy students at Texas A&M College of Pharmacy in March 2019. Given the diverse nature of NTS, this study collected student perceptions about the 2016 Accreditation Council for Pharmacy Education Standard 4 Key Elements: self-awareness, leadership, innovation, and professionalism. Results were analyzed utilizing descriptive statistics. RESULTS: Approximately 84% (n = 93) of students completed the survey. More students perceived professionalism as an important skill to have, followed by leadership, self-awareness, and innovation. Similar results were shown with students' satisfaction with NTS training. Also, results highlighted that students' satisfaction level with their NTS training and their belief regarding their strengths relied on two factors: the number of advanced pharmacy practice experiences (APPEs) where NTS training occurred and the amount of time spent practicing the NTS. CONCLUSION: These data add to the existing literature to support NTS training in experiential pharmacy education. While APPEs should not be the only setting where these skills are practiced in the curriculum, our study's findings may further guide curricular priorities and assessment strategies for NTS in the experiential setting.

Once- Versus Twice-Daily Angiotensin-Converting Enzyme Inhibitors for Blood Pressure Control in Adult Patients With Hypertension.

This review aimed to assess the efficacy and safety of once- versus twice-daily administration of angiotensin-converting enzyme (ACE) inhibitors for the management of hypertension. A literature search on PubMed and Google Scholar was performed (January 1980 to June 2020) using the following search terms: ACE inhibitors, lisinopril, enalapril, fosinopril, trandolapril, ramipril, perindopril, captopril, benazepril, ambulatory blood pressure, hypertension, twice-daily dosing, once-daily dosing. Reference lists from retrieved articles were examined for additional reports. Relevant English-language studies or those conducted in humans were considered. Overall, six studies were included that compared the efficacy of once-daily to twice-daily dosing of ACE inhibitors. Similar blood pressure-lowering effects, and, in some studies, greater blood pressure lowering has been noted in the twice-daily administration arm than once-daily administration of ACE inhibitors. ACE inhibitors' pharmacokinetic and pharmacodynamic properties play an integral role in determining the expected blood pressure-lowering outcome. It is noteworthy that adherence issues may arise when transitioning from a once-daily regimen to a twice-daily regimen. There appear to be no added safety concerns between twice-daily and once-daily administration of ACE inhibitors regarding safety outcomes. After reviewing the available literature, twice-daily dosing of ACE inhibitors may promote added blood pressure-lowering effects, with the advantages of reducing cost, reducing the risk of drug-drug interactions, reducing polypharmacy, and reducing patient confusion about their medications. Recommendations for twice-daily administration of ACE -inhibitors should be made via shared decision-making with the patient, and clinician judgment, to drive treatment selection.

Patient and provider characteristics and outcomes associated with outpatient antibiotic overuse in acute adult bronchitis.

Nonbacterial acute bronchitis leads to many outpatient clinic visits in the US that result in an antibiotic prescription. Understanding antibiotic prescribing patterns and their clinical consequences will help improve antimicrobial stewardship efforts. A retrospective chart review was conducted to identify any correlations between patient and provider characteristics with antibiotic use in adult acute bronchitis (AAB) and to compare the clinical outcomes and rates of health care utilization between those who did and did not receive antibiotics. Study participants included adults with uncomplicated AAB seen by family medicine or internal medicine, specialty, and mid-level practitioners in a Baylor Scott & White Health outpatient facility. Phase 1 investigated whether prescribing rates varied by provider- or patient-level characteristics. Phase 2 compared clinical outcomes and health care utilization between patients who received an antibiotic versus those who did not receive an antibiotic for AAB. Among 35,383 visits for AAB, 81.4% resulted in a prescription for an antibiotic. Physicians >35 years of age and internal and family medicine physicians were more likely to prescribe antibiotics. Health care utilization rates did not differ between cohorts. The number of Clostridium difficile events was negligible.

Sodium-glucose co-transporter 2 inhibitors: evidence and place in therapy.

Type 2 diabetes effects millions of people yet remains difficult to treat with oral pharmacotherapy. Metformin is the first line recommended therapy, and current guidelines suggest individualized therapy for second line selection. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are the newest class of agents in treating type 2 diabetes via an insulin independent mechanism to lower blood glucose. Currently marketed agents, including canagliflozin, dapagliflozin, empagliflozin, and luseogliflozin, reduce hemoglobin A1c (HbA1c) ~0.8-1%, reduce fasting and post prandial glucose, and have little hypoglycemia associated with them when added to therapies including metformin, a sulfonylurea, pioglitazone, or insulin. Patients receiving SGLT-2 inhibitors have reduced weight and blood pressure, but are more susceptible to urinary tract infections and genital mycotic infections. This review summarizes current literature regarding the SGLT-2 inhibitors.