Menstrual health matters. Period.

Menstrual health is composed of physical and psychosocial factors and fundamental to the well-being of menstruating individuals. Clinicians are urged to assess markers of menstruation as a vital sign, informing potential current and future health risks. Period poverty, or lack of access to menstrual hygiene products, sanitation, and clinical support, is a concern worldwide, particularly for vulnerable populations. As global health authorities and professional medical associations call for menstrual health as a priority, pharmacists are well-positioned to contribute solutions through access, education, advocacy, and research.

Finding our Voice: Evaluation of Goal Setting Using the Habits of Preceptors Rubric in Terms of Focus, "SMARTness," and Impact.

INTRODUCTION: Effective leadership propels teams from effectiveness to greatness and is accomplished when everyone achieves and contributes their full potential, or "voice." The Clinician Educators Program Teaching and Learning Curriculum fosters preceptor development using the Habits of Preceptors Rubric (HOP-R) to guide participants in finding their precepting "voice." After the HOP-R self-assessment, participants select a habit of focus (HOF) and craft a SMART (specific/measurable/achievable/relevant/time-bound) goal. This report describes a pilot rubric, SMART-EP (emotional intelligence(EI)/professionalism), exploring goal "SMARTness" alongside change (impact) in participants' perceived precepting capabilities. METHODS: HOP-R self-ratings (2018-2020) and HOF/SMART goals (2019-2020) were retrospectively reviewed by two raters. Perceived preceptor capabilities were measured by analyzing the change in self-assessed habit level ratings between the first/fourth-quarter surveys. SMART goals were categorized by HOF and inclusion of SMART-EP components. Participants were guided in the inclusion of SMART, but not -EP, components. RESULTS: In aggregate, 120 participants completed HOP-R surveys (2018-2020). Within-subject changes across all 11 habits were significant (P < .001). For the SMART-EP rubric analysis (2019-2020), 71 participants had an average "SMARTness" score of 3.92 (of 5) with corresponding interrater reliability of 0.91. Goals included 2.77 (of 4) EI traits and 1.72 (of 3) professionalism components. DISCUSSION: The SMART-EP rubric provided insights into preceptor development opportunities among participants. Beyond SMART components, participants often included elements of EI and professionalism. Ratings confirm and support the consistency of the HOP-R as a tool to assess precepting habits.

Evaluating the impact of integrating SMART goal setting in preceptor development using the Habits of Preceptors Rubric.

PURPOSE: The impact of goal setting in pharmacy preceptor development was evaluated using the Habits of Preceptors Rubric (HOP-R), a criterion-referenced assessment developed to assess, quantify, and demonstrate growth across 11 preceptor habits. METHODS: This study retrospectively evaluated initial and follow-up survey responses from the 2019-2020 Clinician Educators Program cohort at Midwestern University College of Pharmacy, Glendale Campus. Enrollees in this teaching and learning curriculum (TLC) were invited to assess their precepting habits using the HOP-R after attending the first seminar and again toward the end of the longitudinal program. Using online surveys, participants rated their precepting capabilities as developing, proficient, accomplished, or master level for each habit. In the initial survey, each participant selected a habit of focus for deliberate development and established an individualized goal using the specific, measurable, achievable, relevant, and time-bound (SMART) framework. In the follow-up survey, participants indicated their satisfaction with and progress toward accomplishing their precepting goal. RESULTS: Initial survey results from 55 study participants identified developing as the most frequently self-reported habit level (53%; n = 605 ratings), while master was the least frequently reported (1%). In the follow-up assessment, accomplished (45%) was the most frequently self-reported habit level, while master (5%) remained the least reported. The cohort reported a median progress in SMART goal accomplishment of 69% (range, 12% to 100%; n = 54). CONCLUSION: Preceptor and resident pharmacists reported perceived advancement in precepting capabilities within the conceptual framework of the HOP-R encompassing both their self-selected habit of focus and adjacent habits while enrolled in a TLC. SMART goals facilitated qualitative and quantitative assessment of development.

Use of Learning Management System Data to Predict Student Success in a Pharmacy Capstone Course.

Objective. Learning management system (LMS) data from online classes may provide opportunities to identify students at risk of failure. Previous LMS studies have not addressed the possibility of change in student engagement over time. The purpose of this study was to apply a novel statistical technique, group-based trajectory modeling (GBTM) to LMS data in an online course to identify predictors of successful course completion.Methods. Exploratory GBTM was used to assess the association of LMS activity (total activity time, dates of activity, and pages viewed) and attendance at virtual synchronous learning sessions with examination performance in a capstone disease-management course delivered in the final didactic quarter of a three-year Doctor of Pharmacy program. Groups were assigned based on trajectories of weekly page view counts using structural-equation modeling.Results. Group-based trajectory modeling identified three page view engagement groups (median total page views, n): group 1, high (1,818, n=24): group 2, moderate (1,029, n=74), and group 3, low (441 views, n=35). Group assignment alone was somewhat associated with final grade. Stratification based on consistent virtual synchronous learning session attendance improved predictive accuracy; for example, a top (A or A-) grade was earned by 49.0% and 24.0%, respectively, of group 2 students with and without consistent synchronous engagement.Conclusion. Application of GBTM to LMS data, including information about synchronous engagement, could provide data that allow educators to identify early warning signs that a student may fail a course and target interventions to those at-risk students. The technique should be further tested with alternative LMS data and obtained early in the didactic curriculum, before patterns of engagement are established.

Impact of the COVID-19 Pandemic on the Emotional Intelligence of Student Pharmacist Leaders.

Objective. To assess changes in Emotional Intelligence Appraisal (EIA) scores following the COVID-19 pandemic for pharmacy students within a voluntary cocurricular leadership development program.Methods. Participants from the class of 2021 (pandemic group) completed an EIA self-assessment near the beginning of the leadership program in August 2019 (pre-pandemic) and at the end of the program in July 2020 (during peak first-wave COVID-19 activity) and wrote an accompanying self-reflection. To determine changes in students' emotional intelligence potentially attributable to COVID-19, differences in EIA scores from the pandemic group were compared to the pooled results of previous program cohorts (classes of 2017-2019). Prevalent themes in student self-reflections were also highlighted.Results. Thirty-five student leaders comprised the pandemic group, with 166 students included within the control group. The proportion of students with final EIA scores indicating high emotional intelligence was greater within the pandemic group (74.3% vs 50.6%). While both groups had increased final EIA scores compared to baseline values, score increases were significantly higher among students in the pandemic group with respect to overall emotional intelligence and relationship management. Students commented that the pandemic highlighted the importance of emotional intelligence during stressful situations, although the lack of in-person interaction was noted as a limitation for social development.Conclusion. Pharmacy students participating in a leadership development program during the COVID-19 pandemic experienced greater increases in emotional intelligence than did the program's pre-pandemic cohorts. This may support the ability of health professional students to maintain resiliency through the pandemic and develop both personal and interpersonal relationship-building skills.

Enhancing the Emotional Intelligence of Student Leaders Within an Accelerated Pharmacy Program.

Objective. To determine student pharmacists' perceptions of a leadership development program for student organization officers and report the changes in their Emotional Intelligence Appraisal (EIA) scores.Methods. Between 2015-2018, three different cohorts of Doctor of Pharmacy students participated in a voluntary leadership development program that spanned six academic quarters. The program included a variety of self-assessments and large-group topic discussions, followed by quarterly individual written reflections with feedback from faculty mentors. These activities primarily addressed the topics of emotional intelligence, strengths-based leadership, and continuous leadership development. Participants' EIA scores near the beginning and end of the program were compared. An anonymous online survey of participant perceptions was administered at the end of the program.Results. One hundred sixty-six student pharmacists completed all program activities. Each cohort's final mean overall, self-awareness, self-management, and social awareness EIA scores were higher than their corresponding mean initial scores. The overall response rate for the online survey was 61%. All respondents either strongly agreed or agreed that participating in the program enhanced their leadership skills. The majority of respondents additionally rated each of the program's activities as being either beneficial or very beneficial. The emotional intelligence assessment and strengths-based leadership assessment were the activities that were most frequently cited as being very beneficial.Conclusion. The pilot implementation of this leadership development program appears to have been both impactful and well received. Programs structured like this one may provide an effective way of increasing the emotional intelligence of student pharmacists, particularly within accelerated pharmacy programs.

Evaluation of a peer- and self-grading process for clinical writing assignments.

OBJECTIVES: As class sizes in pharmacy education increase, faculty must develop new assessment strategies for essay writing assignments. This study evaluated accuracy and student perceptions of an innovative grading process that utilizes both peer- and self-assessment. METHODS: Four SOAP note sessions were evaluated. Each session included four activities: a writing workshop, assessment workshop, and reflection session. For each assessment workshop students scored their note and a blinded peer's note using a grading form, facilitated by a faculty-led discussion. In a subsequent reflection session, students reviewed their peer- and self-assigned grades and could petition for faculty review if desired. The average self-, peer-, and final-grades were compared for each of the four SOAP note sessions using ANOVA. After the fourth session, students completed an anonymous 10-question Likert-scale survey regarding their perceptions of the process and three open-response questions. Survey results were analyzed with descriptive statistics. RESULTS: Approximately 140 students participated. No difference was found between the average self-, peer-, and final-grades for all four sessions (p > 0.05). The survey response rate was 65% (91/140). Survey questions were grouped into three themes. The majority of students either strongly agreed or agreed that sessions were well organized and effective (≥84%), assessment workshops enhanced learning (≥68%), and the scoring method was fair (≥72%). The lowest score (mean 2.53 on a 4-point scale) reflected satisfaction with peer-provided feedback. When asked what they liked most, respondents most commonly cited that faculty-led review and discussion enhanced clinical knowledge. IMPLICATIONS: The combination of a peer- and self-assessment process was accurate, well-received, and can be used to decrease faculty workload.

Development of a tool to assess and advance the effectiveness of preceptors: The Habits of Preceptors Rubric.

PURPOSE: Present the research performed to identify and describe habits of effective pharmacy preceptors and provide a framework for targeted preceptor assessment and development. METHODS: A 5-round Delphi consensus-building process was used to refine the initial Habits of Preceptors Rubric (HOP-R) developed by the research team. Twenty experts in pharmacy experiential education participated. During the Delphi process, feedback and agreement on all parts of the HOP-R were sought, including the premise, introductory content, framework, preceptor domains, habits, habit level descriptions, and continuous professional development (CPD) plan. After each Delphi round, the research team grouped responses into themes and modified the draft rubric accordingly. These themes were used to frame the response document sent to the expert panel for the following Delphi round; this document explained modifications made to the HOP-R. Consensus was defined as a mean score of ≥3.25 on a 4-point scale (4 = strongly agree, 1 = strongly disagree) for posed statements or ≥70% agreement for ranked items. RESULTS: In the final Delphi round (response rate, 95%), consensus was achieved for all HOP-R individual structural and content elements except the habit level descriptors, for which a secondary rank order analysis was performed. The final HOP-R has 3 domains encompassing 11 preceptor habits that can be displayed across 4 habit levels progressing from developing to master. CONCLUSION: The HOP-R was developed to assess, quantify, and demonstrate growth across a wide variety of pharmacy preceptor habits. Potential utility includes use as a framework to articulate the knowledge, skills, and behaviors of effective preceptors, facilitate the creation of individualized CPD plans, and assess the impact of participation in teaching and learning curricula.

Evaluation of the leadership strengths of the officers serving within an APhA-ASP chapter: Implications for the profession.

BACKGROUND AND PURPOSE: To evaluate the strengths of the officers who recently served within an American Pharmacists Association Academy of Student Pharmacists (APhA-ASP) chapter and to discuss the potential impacts of these strengths upon the pharmacy profession. EDUCATIONAL ACTIVITY AND SETTING: The chapter officers from the Classes of 2010-2016 (n = 67; 66% female) voluntarily participated in a variety of leadership development programs created by the chapter advisors. Each of these programs included activities based upon the book, Strengths Based Leadership, and the determination of each officer's top five strengths using the StrengthsFinder 2.0 assessment. For this study, all of the officer's top five strengths were compiled (n = 335) and evaluated based upon their individual frequencies and their association with each of the strengths based leadership domains (i.e. executing, influencing, relationship building, and strategic thinking). FINDINGS: All 67 officers completed the StrengthsFinder 2.0 assessment with the five most frequently identified strengths being achiever (n = 27), harmony (n = 27), learner (n = 26), input (n = 19), and individualization (n = 17). In addition, the officer's strengths most frequently corresponded to the leadership domain of relationship building (35%), followed by the domains of executing (28%), strategic thinking (26%), and influencing (11%). SUMMARY: These findings may help explain why the profession continues to succeed with respect to implementing collaborative patient-centered care, but continues to be challenged with respect to maximizing professional advocacy.

Developing emotionally intelligent leaders within a chapter of a student pharmacist organization.

This article was migrated. The article was marked as recommended. Introduction: Emotional intelligence (EI) refers to an individual's awareness, management, and use of emotions, which has been shown to correlate with successful leadership. The objective of this study was to facilitate the development of emotionally intelligent leaders amongst the student officers within a chapter of the American Pharmacists Association-Academy of Student Pharmacists. Methods: During the 2012-2015 academic years, the chapter officers (n=27) participated in a leadership development program that included self-assessments, group discussions, reflection activities, and/or individual mentoring sessions based upon the concepts of organizational management, strengths-based leadership, team dysfunction, and continuous professional development. The officers also completed the Emotional Intelligence Appraisal® at the beginning and end of the program, and a perception survey after completing the program. Results: The officers' initial and final EI scores ranged from 54-100 and 59-100, respectively. In addition, their final mean overall, self-awareness, self-management, and relationship-management scores were higher than their corresponding initial scores ( P < 0.05). Most officers (89-100%) also rated each of their developmental experiences as being either very beneficial or beneficial. Conclusion: The implemented program appears to be an effective method for increasing the EI of student organization officers and provides a model for similar efforts in other health professions settings.

Assessment of a Revised Method for Evaluating Peer-graded Assignments in a Skills-based Course Sequence.

OBJECTIVE. To evaluate the modified peer-grading process incorporated into the SOAP (subjective, objective, assessment, plan) note sessions in a skills-based pharmacy course sequence. DESIGN. Students assessed a de-identified peer's SOAP note in a faculty-led peer-grading session followed by an optional grade challenge opportunity. Using paired t tests, final session grades (peer-graded with challenge opportunity) were compared with the retrospective faculty-assigned grades. Additionally, students responded to a survey using 4-point Likert scale and open-answer items to assess their perceptions of the process. ASSESSMENT. No significant difference was found between mean scores assigned by faculty members vs those made by student peers after participation in 3 SOAP note sessions, which included a SOAP note-writing workshop, a peer-grading workshop, and a grade challenge opportunity. The survey data indicated that students generally were satisfied with the process. CONCLUSION. This study provides insight into the peer-grading process used to evaluate SOAP notes. The findings support the continued use of this assessment format in a skills-based course.

What new therapeutic options exist for the relief of menopausal symptoms?

Two new products recently approved for the treatment of menopausal symptoms contain estrogen receptor agonists/antagonists, which have varying effects on bone, breast, endometrial, and vaginal tissues. Ospemifene improves symptoms of dyspareunia associated with vulvovaginal atrophy. Bazedoxifene combined with conjugated estrogens improves vasomotor symptoms and bone mineral density in postmenopausal women. Clinicians must consider the increased risk for venous and arterial thromboembolic disease posed by these drugs. Clinical trials are ongoing to fully evaluate the drugs' efficacy and safety compared with traditional estrogen-based regimens.

The pharmacist's role in promoting preconception health.

OBJECTIVE: To review the pharmacist's role in preconception health. DATA SOURCES: PubMed search using the terms preconception, immunizations, epilepsy, diabetes, depression, tobacco, asthma, hypertension, anticoagulation, pharmacist, pregnancy, and current national guidelines. DATA SYNTHESIS: Preconception health has become recognized as an important public health focus to improve pregnancy outcomes. Pharmacists have a unique role as accessible health care providers to optimize preconception health by screening women for tobacco use, appropriate immunizations, and current medication use. Counseling patients on preconception risk factors and adequate folic acid supplementation as well as providing recommendations for safe and effective management of chronic conditions are also critical and within the scope of practice for pharmacists. CONCLUSION: Pharmacists play an important role in medication screening, chronic disease state management, and preconception planning to aid women in preparing for healthy pregnancies.

Safety of varenicline in patients with cardiovascular disease.

Smoking cessation lowers the risk of death substantially in patients with cardiovascular disease. Although varenicline is an effective medication for smoking cessation, its safety in this population has been questioned and evaluated in several studies. In 2 randomized controlled trials of patients with cardiovascular disease, the rates of serious cardiovascular events were up to 2% higher in patients receiving varenicline than placebo, though the differences were not statistically significant. In the first meta-analysis of mostly trials involving patients with a history of cardiovascular disease, varenicline was found to significantly increase the risk of cardiovascular events by 72%; however, a second meta-analysis did not find a significant increased risk. In an observational study, varenicline was not associated with an increased risk of events when compared to bupropion in a subgroup analysis of patients with a history of cardiovascular disease. Because the evidence on the safety of varenicline in this population is limited and conflicting, additional data are needed to formulate stronger conclusions. In the meantime, health care professionals should consider individual smoking patterns, concomitant medical conditions, and cost when recommending smoking cessation pharmacotherapy for patients with cardiovascular disease.

An elective course on pharmacy-based health screenings.

OBJECTIVE: To provide an elective course for pharmacy students focused on the knowledge and skills necessary to implement health screenings in a pharmacy environment. DESIGN: Course lectures focused on expert recommendations for health screenings as well as regulatory requirements and procedures integral to the implementation of screening services. Workshops provided hands-on experience with blood glucose, body composition, bone density, and cholesterol testing devices. ASSESSMENT: Attainment of knowledge and skills was assessed by patient case assignments, screening device demonstrations, group projects, and a final quiz. Annual course evaluations revealed consistently favorable student feedback regarding the course design and content. students reported a high level of preparedness and interest in participating in health screening services in future practice. CONCLUSION: An elective course focused on the delivery of health screenings in pharmacy settings was well received by student participants and exposed students to a unique opportunity in patient care.

Immunizations and pregnancy: an update for pharmacists.

OBJECTIVE: To review the safety of immunizations in pregnancy. DATA SOURCES: PubMed search using the terms vaccine, immunizations, and pregnancy, as well as current national guidelines. DATA SYNTHESIS: Immunizations for women of childbearing age are an integral component of pregnancy planning. Some vaccines are compatible with pregnancy, whereas others, in particular live-attenuated vaccines, are contraindicated because of the theoretical risk to the fetus. The immunizing pharmacist must be aware of updated guidelines regarding the safe and appropriate use of vaccines during pregnancy. Certain routine adult vaccines are contraindicated during pregnancy, including the live-attenuated intranasal influenza, measles-mumps-rubella, varicella, zoster, and human papillomavirus vaccines. The trivalent inactivated influenza vaccine is specifically recommended for all women who are pregnant during influenza season. The hepatitis B, tetanus-diphtheria-acellular pertussis, and several other routine adult and travel vaccines may be administered safely in pregnancy if the patient meets certain risk criteria. Breast-feeding is compatible with all routine adult vaccines. Vaccinia (smallpox) and yellow fever vaccines are cautioned against use except in certain circumstances. CONCLUSION: Pharmacists can play an important role in recommending safe and appropriate vaccines before and during pregnancy.

Cranberry and warfarin interaction: a case report and review of the literature.

This case reports on a patient whose International Normalized Ratio (INR) increased after ingestion of cranberry sauce while stabilized on warfarin. It is followed by a review of the published literature on the potential interaction between the two.An 85-year-old woman on chronic warfarin therapy for atrial fibrillation experienced INR elevations of two- to three-fold after two separate ingestions of cranberry sauce. In each case, her INR values decreased after withholding three to four doses and resuming a similar maintenance dose of warfarin. Although the majority of the pharmacokinetic and pharmacodynamic studies did not find a significant interaction between cranberry and warfarin, several case reports indicate that cranberry products may increase INR values in patients on warfarin. Practitioners should consider cranberry usage as a potential contributor in the evaluation of supratherapeutic INR values in patients on warfarin.

Assessment of anticoagulation management in a simulated ambulatory care clinic.

OBJECTIVES: To assess the effectiveness of adding a simulated anticoagulation clinic practical examination for formal assessment of PharmD students' skills. DESIGN: A practical examination requiring students to review a mock medical record and role-play a follow-up anticoagulation clinic visit with a standardized patient was designed. Students assessed the patient's vital signs, laboratory values, and subjective complaints during an in-depth interview and documented clinical recommendations in a progress note. ASSESSMENT: Student feedback indicated that the simulated clinic was pertinent to preparation for experiential rotations. Ninety-five percent of the students recommended that it be continued as a required component of the course. CONCLUSION: The simulated ambulatory care clinic exercise reinforces principles of anticoagulation management as well as the assessment of clinical data, performance of a patient interview, and written documentation of recommendations.