Racial and ethnic harm in patient care is a patient safety issue.

Health equity and antiracism can contribute to enhanced patient safety in healthcare settings. The Oath of the Pharmacist states, "I will promote inclusion, embrace diversity, and advocate for justice to advance health equity." Part of this commitment means upholding these principles in patient care settings. Racial and ethnic harm negatively impact patient safety. Racial and ethnic harm are reviewed in the context of social learning theory, critical race theory, and medical and scientific racism. Pharmacists and healthcare systems must actively prevent and mitigate racial and ethnic harm to patients from personal and organizational levels to create a culture of safety. Part of this strategy involves acknowledging when you have contributed to patient harm, issuing a genuine apology, and offering to mend or re-establish trust between racially and ethnically minoritized patients and the pharmacist or the health system to contribute to patient safety. These strategies may help create a culturally safe space for racially and ethnically marginalized patients in the healthcare system.

Mitigating stereotypes and bias in professional identity formation for those with marginalized identities.

Pharmacists have many identities within the profession from medication experts, clinicians, educators, mentors, patient advocates, and more. It can be especially challenging for racially and ethnically minoritized persons (REMPs) to form a professional identity when they are surrounded by stereotypes and biases which are pervasive in the community, academia, and pharmacy practice settings. As pharmacist educators, preceptors, and mentors, it is important to create safer spaces that decrease stereotyping and biases for students so they may envision themselves thinking, acting, and feeling like a pharmacist. Here, literature on professional identity formation in underrepresented groups in the United States is reviewed to continue the conversation of creating safer spaces for underrepresented students as they develop their professional identity.

Navigating power dynamics between pharmacy preceptors and learners.

Pharmacy preceptors are crucial in pharmacy experiential education. They help develop learners during didactic learning, experiential learning, and post-graduate training. Preceptors hold a position of authority over learners as they are responsible for providing feedback and ultimately completing evaluations that determine whether the student passes or does not pass the rotation. Preceptor status, behavior, and communication style may cause students to feel intimidated. Preceptors should be aware of this power differential and keep generational, gender, cultural, and other factors in mind when providing feedback. Preceptors should also receive training and be open to constructive feedback from learners to ensure the experience meets the needs of the learner and allow for adjustments on the experiential rotation. Students should be empowered to provide open and honest feedback to preceptors in a psychologically safe environment without fear of repercussions.

Recognizing and Mitigating Racial and Ethnic Interview-Associated Microaggressions Across the Academy.

Microaggressions in pharmacy education interviews can have a significant impact, often reinforcing a message that underrepresented minority (URM) candidates must assimilate for acceptance, rather than being invited to contribute their authentic identities to diversify and strengthen the institution. Interviewers may ask inappropriate questions or make offensive comments without intending to cause harm; however, the impact of the words on the interviewee are valid and cannot be ignored. This text focuses on the challenges faced by URM faculty in the context of academic pharmacy interviews, which potentially contribute to their underrepresentation in academic pharmacy. The authors provide examples of perspectives and experiences from URM pharmacy faculty when interviewing for academic pharmacy positions. This article proposes several recommendations, such as microaggression prevention strategies, bias training, and institutional culture improvement. These solutions can help institutions achieve a sustainable means of recruiting and retaining URM faculty.

Prioritizing ethical patient care responsibilities: A call to restructure student training practices in federally qualified health centers.

Federally Qualified Health Centers (FQHCs) are federally funded clinics that often serve medically underserved groups. Many Colleges of Pharmacy have faculty and non-faculty pharmacist preceptors who provide clinical services such as drug therapy management to FQHCs. It is critical that Colleges of Pharmacy and pharmacist preceptors reinforce and uphold the standard of providing high quality and evidenced based care when students rotate at these sites. Learners may have implicit biases and variable levels of emotional intelligence prior to a clinical rotation at an FQHC, which can affect the quality-of-care patients receive. Colleges of Pharmacy who send learners onto rotations at FQHCs should collaborate with FQHC sites to ensure learner readiness in clinical and emotional levels and mediate for any concerns that may arise.

Training Student Pharmacists How to Mitigate Racial or Ethnic Microaggressions in Patient Encounters.

The experience of interfacing with the health care system is a taxing one for racially or ethnically marginalized patients (REMPs). The seemingly inevitable occurrence of encountering microaggressions is reason enough to avoid the interaction for many resulting in worse health outcomes. Microaggressions result in conflict, loss to follow-up, and reinforcing the unwelcome atmosphere of the health care system to REMPs. Teaching antimicroaggressive content in doctor of pharmacy curricula is critical for reducing strain on the fragile relationship between REMPs and the health care system. Whether it is gathering a patient history, devising a patient-centered care plan, or counseling patients, there is an opportunity for an interaction that could sever the patient's trust in the health care system. Teaching each of these skills-based learning activities should be combined with didactic lessons in nonjudgmental and nonmicroaggressive communication approaches. In addition, lessons regarding the impact of microaggressions on REMPs should also be present so that learners may appreciate the impact of a clinician's actions on REMPs in this regard. To establish evidence-based best practices, more research on teaching antimicroaggressive didactic and skills-based content to student pharmacists is needed.

Initiating Primary Care Services when the World Is Paused: Lessons for Pharmacists in the Post-COVID-19 Era.

The COVID-19 pandemic impacted primary care and required pharmacists to adapt when implementing primary care services. Many lessons learned through this process are applicable in the post-pandemic era. First, primary care pharmacists must prepare for an ever-changing role and communicate with stakeholders to align with shifting institutional priorities. Additionally, designing a workflow given limited staffing and in-person communication require flexibility for scheduling and referral processes. Proactive outreach and communication via virtual platforms may be used to build trust in place of in-office interactions with providers. Lastly, fostering relationships with patients is essential to the success of the service and often requires creation of patient-centered goals to account for personal barriers. Many pandemic obstacles are transient; however, telehealth, virtual communication, and the subsequent lessons learned in adaptability, creativity, and flexibility when building a clinic practice are everlasting.

Black salve: risky escharotic.

Introduction: Black salve ointments are variable in their composition with no standard formula. Patient's may turn to unregulated products to self-treat their conditions. Products that are accessible without a prescription are not necessarily safe and may pose risk to those who use them, as in this case with the use of black salve ointment. Methods: This case report discusses the use of black salve ointment on a nodular neck cyst in a 55-year-old Hispanic male patient. The patient applied the black salve ointment (Two Feathers Healing Ointment®) to the cyst, where the ointment remained in contact with his skin for seven days. He required oral antibiotics and was referred to wound care for follow up. Discussion: After close follow up and treatment with antibiotics, the eschar healed and left a concave scar on his neck with no other observed complications. Conclusion: Healthcare providers are encouraged to discuss complementary and alternative medicine options with patients as some may lead to dangerous effects. Lay Summary: This is a case report about a 55 year old male patient who used an over the counter product called Black Salve to treat a cyst on his neck. He came to his primary care doctor's office for a usual checkup. Just before leaving his appointment, he mentioned a dark discolored area on his neck appeared after applying the black salve ointment. The black salve caused his skin to break down, get infected, and turn black. He was treated with antibiotics and close follow up care. After the wound healed, he was left with a scar on his neck from where the ointment broke down the skin. Since this product is available without a prescription, it is important that consumers know that it is not safe for use and may cause complications. If in doubt, ask a healthcare provider about a products risks before use.

Tatted not tattered.

Tattoos are common practice in underrepresented groups. However, institutional policies often prohibit visible tattoos of health professionals. This affects marginalized groups where tattoos may be the cultural norm. There are conflicting findings on perceptions of tattoos on medical professionals from the perspectives of peers, patients, and learners. Tattoo restriction can be discriminatory against already marginalized persons and sends a message of exclusion. Policies surrounding tattoo restriction should be re-evaluated to create an inclusive environment for all.

Professional tress code: I look like a pharmacist.

Hair color, style, and length are facets to a person's self-expression. There is evidence of bias against those who wear natural hair styles in job recruitment settings, which can affect how the candidate is perceived. In addition, there have been discriminatory hair policies that affect minoritized people. In the profession of pharmacy, most definitions of professionalism do not comment on physical appearance as a component but focus on characteristics such as knowledge, respect, communication, and empathy. It is critical to ensure that comments about someone's hair are not microaggressions. To embrace natural hair styles, pharmacists should combat any policies that are discriminatory and provide a safe space for others to feel comfortable wearing their hair in natural styles or with hair coverings. These actions will help create a space for authenticity, self-acceptance, and comfort.

Evaluation of pharmacy resident perceived impact of natural disaster on stress during pharmacy residency training.

INTRODUCTION: Natural disasters present unique challenges for healthcare training programs. Limited literature has been published regarding the impact of natural disasters on pharmacy residency training. The objective of this study was to determine the degree of perceived impact natural disasters have on pharmacy resident stress and which factors contribute to any perceived change in stress. METHODS: A cross-sectional study was conducted via a survey distributed to pharmacy residents whose program was located in an area potentially affected by natural disaster in the first six months of the 2017-2018 resident year. A modified Likert scale utilizing a 10-point scale was used to assess resident stress. Potential sources of stress were assessed via multiple-choice questions. The primary outcome was the degree of change in resident perceived stress compared to baseline during and after the natural disaster. RESULTS: One hundred twenty-nine pharmacy residents completed the survey. Stress increased from baseline during the natural disaster and remained elevated after compared to baseline. Main sources of stress were increased residency workload, natural disaster preparation and recovery, and concerns regarding friends and family. Half of residents reported their residency program did not have an established natural disaster policy in place. CONCLUSIONS: Improved planning and communication regarding workload expectations may minimize stress among residents balancing increased personal responsibilities during times of natural disaster.