Early skills laboratory warnings: Laboratory faculty perspectives on student barriers for progression to experiential education.

INTRODUCTION: This study characterized faculty perceptions of student barriers to achieving an Entrustable Professional Activities (EPA) level 2 or higher in the Patient Care Provider domain. METHODS: Pharmacy skills laboratory faculty participated in a nominal group technique (NGT) session. Participants reflected on two questions: "What behaviors would result in a student not achieving a rank of EPA readiness level 2 or higher?" and "What knowledge and skills would result in a student not achieving a rank of EPA readiness level 2 or higher?" Participants developed a ranked list using silent brainstorming, idea generation, clarification, and discussion. RESULTS: Two NGT sessions were conducted. Group 1 reported (lack of) professionalism, (inability to perform) physical skills, (lack of) critical thinking and interpreting data gathered during physical skills, and (inability to achieve) programmatic outcomes and mile makers exams as barriers. Group 2 ranked behaviors as lack of independence, not taking roles and responsibilities seriously, inability to follow instructions, lack of classroom engagement, and disorganized and unable to prioritize. Group 2 ranked knowledge and skills of significant errors when making medication recommendations, inability to identify accurate medication history, inability to perform tasks with time constraints, poor patient communication, and inability to identify resources. CONCLUSIONS: Pharmacy skills laboratory faculty can identify behaviors, knowledge, or skills that may prevent a student from achieving an EPA readiness level 2 or higher such as lack of professionalism and poor critical thinking skills and should be empowered to identify early warning signs for students' success and progression to experiential education.

Empathy levels among health professional students at a large midwestern public university - a cross-sectional study.

BACKGROUND: Empathic care is considered extremely important by patients and providers alike but there is still an ample need for assessing empathy among healthcare students and professionals and identifying appropriate educational interventions to improve it. This study aims to assess empathy levels and associated factors among students at different healthcare colleges at the University of Iowa. METHODS: An online survey was delivered to healthcare students, including nursing, pharmacy, dental, and medical colleges (IRB ID #202,003,636). The cross-sectional survey included background questions, probing questions, college-specific questions, and the Jefferson Scale of Empathy-Health Professionals Student version (JSPE-HPS). To examine bivariate associations, Kruskal Wallis and Wilcoxon rank sum tests were used. A linear model with no transformation was used in the multivariable analysis. RESULTS: Three hundred students responded to the survey. Overall JSPE-HPS score was 116 (± 11.7), consistent with other healthcare professional samples. There was no significant difference in JSPE-HPS score among the different colleges (P = 0.532). CONCLUSION: Controlling for other variables in the linear model, healthcare students' view of their faculty's empathy toward patients and students' self-reported empathy levels were significantly associated with students' JSPE-HPS scores.

Medication-Related Problems and Interventions Identified and Addressed by Pharmacists Conducting Enhanced Medication Therapy Management Services.

Pharmacists identify, resolve, and document medication-related problems (MRPs) in community pharmacies. Enhanced medication therapy management (eMTM) targets specific situations, such as high-risk medications, while continuous medication monitoring (CoMM) occurs for every patient and is integrated into the dispensing process. This study describes types and frequencies of MRPs and interventions for health plan-directed eMTM and pharmacist-identified CoMM for a cohort of Medicare Part D patients. Pharmacy dispensing and clinical records from one independent community pharmacy in the Midwest were reviewed for patients eligible for eMTM in 2019. Data were coded for medication-related problems and interventions; descriptive statistics were calculated. Forty-seven patients were included in the study, resulting in 439 health plan-directed and 775 pharmacist-identified MRPs and corresponding interventions for a total of 1214 over 12 months. The average age of the patients was 77; they received an average of about 14 medications dispensed over 25 dates. Nonadherence was the most common MRP overall, as well as for the two categories separately. Patient Counseling and Lab Values Needed MRPs were found more often by pharmacists. Continue to Monitor was the most common intervention flagged overall. Medication Discontinued was found more often in health plan-directed interventions; Patient Counseling occurred more frequently in pharmacist-identified interventions. Using pharmacists to identify MRPs can complement health plan-driven eMTM, which can provide more complete medication management. Future work is needed to determine if this approach is reproducible in other pharmacies.

Determination of Interrater Reliability of a Universal Evaluator Rubric to Assess Student Pharmacist Communication Skills.

Objective. To evaluate the interrater reliability of a universal evaluator rubric used to assess student pharmacist communication skills during patient education sessions.Methods. Six US schools and colleges of pharmacy each submitted 10 student videos of a simulated community pharmacy patient education session and recruited two raters in each of the five rater groups (faculty, standardized patients, postgraduate year one residents, student pharmacists, and pharmacy preceptors). Raters used a rubric containing 20 items and a global assessment to evaluate student communication of 12 videos. Agreement was computed for individual items and overall rubric score within each rater group, and for each item across all rater groups. Average overall rubric agreement scores were compared between rater groups. Agreement coefficient scores were categorized as no to minimal, weak, moderate, strong, or almost perfect agreement.Results. Fifty-five raters representing five rater groups and six pharmacy schools evaluated student communication. Item agreement analysis for all raters revealed five items with no to minimal or weak agreement, 10 items with moderate agreement, one item with strong agreement, and five items with almost perfect agreement. Overall average agreement across all rater groups was 0.73 (95% CI, 0.66-0.81). The preceptor rater group exhibited the lowest agreement score of 0.68 (95% CI, 0.58-0.78), which significantly deviated from the overall average.Conclusion. While strong or almost perfect agreement scores were not observed for all rubric items, overall average interrater reliability results support the use of this rubric in a variety of raters to assess student pharmacist communication skills during patient education sessions.

An Exploratory Mixed Methods Study of Standardized Patient Comments on Empathy and Student Communication Scores.

Objective. To quantify student pharmacists' communication ability based on scores from standardized patient (SP) communication rubrics, describe and categorize SP comments about student empathy, and test the relationship between students' communication scores and empathy.Methods. A concurrent mixed methods research design was used to assess a graded performance-based assessment (PBA) of student pharmacists that had been conducted at one college of pharmacy. The PBA rubrics (n=218) completed by SPs contained 20 assessment items and space for open-ended feedback. Scoring categories for communication assessment included: yes, inconsistent, no, and not applicable (N/A). Descriptive statistics were calculated for rubric scores. Feedback from standardized patients was analyzed and used to categorize student interactions during the encounter as reflecting high empathy, mixed empathy, or low empathy. Kruskal-Wallis ANOVA was used to test the relationship between empathy category and communication score.Results. Standardized patients had written comments on 141 of the 218 rubrics (64.7%). The mean communication score was 39.0±1.6 (range, 31-40) out of a maximum 40 points. The total scores for the low, mixed, and high empathy category transformations were 6 (4.3%), 95 (67.4%), and 40 (28.4%), respectively. The results of the Kruskal-Wallis ANOVA were significant, suggesting that communication scores were different between empathy categories.Conclusion. There was a positive association between students' scores on communication rubrics and student empathy categorization, with student pharmacists exhibiting different levels of clinical empathy. While the PBA of interest was not specifically focused on empathy, SPs frequently provided feedback about empathy to students, suggesting that showing empathy during the encounter was important.

Improving the Remediation Process for Skills-based Laboratory Courses in the Doctor of Pharmacy Curriculum.

When students fail to meet minimum competence standards on summative pharmacy skills-based assessments, remediation can be used to ensure student readiness for progression. Skills-based remediation is challenging as a high volume of resources is required to develop an action plan that addresses the heterogeneity in student needs and to create and execute another assessment equivalent to the initial assessment. Although many Doctor of Pharmacy (PharmD) programs face these same challenges, there is no consensus on how to best address them. Recently, faculty from six PharmD programs convened to share ideas and approaches to overcoming these challenges. This commentary aims to define remediation as it pertains to summative skills-based assessments, share our consensus views regarding remediation best practices, and highlight areas where there is more work to be done. Our intent is to advance the ongoing conversation and empower institutions to develop their own effective and impactful skills-based remediation policies, procedures, and activities.

Changes to summative skills-based assessments within the Big Ten Academic Alliance Performance-Based Assessment Collaborative (BTAA-PBAC) due to COVID-19.

Background: In Spring 2020 many academic institutions transitioned to remote learning in response to the developing COVID-19 pandemic. These changes affected skills-based training, as schools of pharmacy were forced to transition traditionally in-person assessments to a remote setting. The purpose of this article is to describe the experience of pharmacy skills lab coordinators when transitioning summative skills-based assessments (SSBA). Methods: A web-based survey instrument administered through QualtricsXM was sent to all institutions in the Big Ten Academic Alliance-Performance Based Assessment Collaborative. Only one member from each institution completed the survey on behalf of the institution. The survey consisted of four sections: changes made to skills evaluated; changes made to the delivery of those evaluations; challenges to and strategies used by the skills lab program when switching to remote learning; and recommendations for incorporating remote learning within future SSBAs. Survey respondents were invited to participate in an optional unstructured interview regarding survey answers. Results: Nine of ten invited institutions responded to the survey. Of the nine respondents, three participated in the post-survey interview. Overall, 79.5% (93/117) of skills planned to be assessed were assessed with or without modification, with 8.5% (10/117) of skills canceled and 10.3% (12/117) of skills assessments postponed. The most common challenges mentioned were the lack of preparation time, inability to assess certain skills virtually, and student barriers. The most common recommendations made were to prioritize lab components and incorporate flexibility in planning and scheduling. Discussion: The results indicate that most skills were still assessed during the Spring 2020 semester. Though the transition to remote learning was challenging and unique for each institution, common strategies and recommendations identified here provide opportunities for academics to analyze and prioritize learning objectives and to rethink how to develop and deliver SSBAs as remote assessments.

Incorporating LGBTQ health into the curriculum: Assessment of student pharmacists' knowledge and comfort level in caring for transgender patients.

BACKGROUND AND PURPOSE: This study aimed to measure the effects of instruction regarding transgender health in second-year student pharmacists and provide qualitative insight regarding their impressions of the educational experience. EDUCATIONAL ACTIVITY AND SETTING: Students completed a pre- and post-survey assessing knowledge regarding transgender therapeutics, the pharmacist's role, level of comfort providing care, and impression of exposure to the topic. McNemar's test and paired t-tests compared respondent data before and after the activity. The post-survey evaluated the learning activity, with an opportunity to leave open comments that were then analyzed using content analysis. FINDINGS: Eighty-five of 107 (79.4%) students completed both surveys and were included in the analysis. Transgender therapeutics knowledge, participant understanding of pharmacist's role, comfort level, and assessment of adequateness of exposure improved significantly (p < 0.001). A majority (82.4%) affirmed that more than one exposure to issues regarding care of transgender patients is needed in the curriculum. Fifty-five open comments offered by 23 students were coded and categorized into two overall themes with four and two subthemes, respectively. Strengths of the activity were topic importance, exposure appreciation, presentation style, and knowledge foundation. Opportunities for improvement included providing more information and different types of information. SUMMARY: The activity increased student pharmacists' knowledge regarding transgender therapeutics, the pharmacist's role, and comfort level in caring for this patient population. Respondents found the content valuable and desired more. Colleges of pharmacy should consider increasing exposure to specific patient populations, such as transgender patients, to prepare students for practice.