Working environment for historically marginalized faculty, administrators, and librarians in pharmacy education.

INTRODUCTION: Promoting diversity among faculty, administrators, and librarians in schools and colleges of pharmacy (SCOP) would be beneficial for the recruitment and retention of students from diverse backgrounds. Graduating such diverse pharmacists could assist in reducing healthcare disparities. Promoting diversity requires a climate that is inclusive of people from all backgrounds. The goal of this study was to examine the working environment of historically marginalized faculty, administrators, and librarians within pharmacy education. METHODS: An electronic survey was administered to all faculty, administrators, and librarians listed in the American Association of Colleges of Pharmacy roster. RESULTS: Responses from 339 participants were analyzed. Twenty-seven percent of these participants either observed or personally experienced misconduct during the previous five years. When action was taken, it resulted in the cessation of the misconduct only 38% of the time. Respondents most frequently identified the following as ways to make it easier to address misconduct: support from supervisors, support from peers, and education on how to address misconduct. CONCLUSIONS: Exclusionary, intimidating, offensive, and/or hostile communication/behaviors towards historically marginalized faculty, administrators, and librarians do exist in SCOP. The academy should work towards promoting diversity, equity, and inclusion in SCOP through education and provide administrative and peer support for reporting and managing professional misconduct.

Implementation of a Student Pharmacist-Led Program to Enhance Health Access in an Arab-American Community Head: Health Program in an Arab-American Community.

Objectives: Immigration of Arabs to the United States has increased in recent years due to political instability and need for improved access to healthcare. Cardiovascular disease, diabetes, and obesity disproportionally affect Arab Americans. Student pharmacists are well positioned to increase health awareness by providing health screening services and education classes to the Arab immigrant community. This report will describe the development of a student-run Arab American Health Awareness Program (AAHAP) that provides culturally-sensitive community screening services targeting common health disparities seen among Arab-Americans. Design: Data were collected on the number of patient cardiometabolic screenings, referrals for medical care, and health classes which were performed over the course of 2 years. The practice setting included community centers, faith-based centers, and grocery stores in the Chicago area participating in the AAHAP. Results: Over the course of two years, eight cardiometabolic screenings and four community health classes were provided to the Arab-American community. Over 100 student pharmacists provided screenings to 929 patients through AAHAP. Twenty percent (n=193) of all patients screened were referred for further medical care. A total of 77% patients were within goal for blood pressure, 82.3% for blood glucose, and 39.4% for BMI. Patients with a known history of hypertension (n=83) or diabetes (n=64) were more likely to have uncontrolled blood pressure (45% vs 11%, p<0.05) or blood glucose (39% vs 14%, p<0.05) compared to patients without a history of these chronic conditions. Conclusion: Student pharmacists can be drivers for health access through community health programs for ethnically minoritized populations. Development of a health awareness program focused on known health disparities in Arab Americans has provided student pharmacists with opportunities to deliver culturally-sensitive care and medical referral services to an underserved community.

The Influence of Intersectionality on Professional Identity Formation among Underrepresented Pharmacy Students.

OBJECTIVE: The objective of this study is to explore professional identity formation (PIF) among student pharmacists from underrepresented groups (URGs). METHODS: In this qualitative study, 15 student pharmacists from the University of Georgia and Midwestern University Colleges of Pharmacy were recruited for interviews to explore the influence of intersectionality of race, ethnicity, and gender on PIF. Interview data were analyzed using constructivist grounded theory to identify themes and then further analyzed using Crenshaw's theory of intersectionality, namely structural, political, and representational intersectionality. RESULTS: Intersectionality of identities created situations where participants expressed advantages belonging to certain social categories, while simultaneously being disadvantaged belonging to other social categories. This awareness led to strategies to overcome these collective obstacles for themselves and their communities. Participants then described ways to shift perceptions of how society depicts pharmacists and the pharmacy profession. The results depict these processes and how intersectionality influences PIF for URG student pharmacists. CONCLUSION: The sociocultural aspects of race, ethnicity, and gender influence the PIF of student pharmacists who belong to URGs. Intersectionality helps us better understand the ways in which inequality compounds itself, and this results in URG student pharmacists creating opportunities for belongingness and representation. Resultantly, URGs create opportunities for inclusivity and representation. To continue to facilitate this it is essential for educators and university systems to promote ways to foster and incorporate PIF in student pharmacists.

The Intersection of Professional Identity Formation, Bias, and Marginalized Identities.

OBJECTIVES: The objective of this integrative review is to call attention to the limited published literature on professional identity formation (PIF) in students who hold marginalized identities and to promote more inclusive PIF models. FINDINGS: A person's identity is complicated and PIF is a dynamic and continuous lifelong process. A foundational component to PIF is for students to integrate their developing professional identity with their existing selves. Most PIF theoretical frameworks used in health education were created with a dominant culture lens and during a time when most professionals in practice were cisgendered, White, and/or male. These frameworks do not consider ways in which PIF may differ in learners who hold marginalized identities nor the influence that their marginalized identities may have on facilitators and barriers to their PIF journeys. SUMMARY: PIF is a growing area of focus in pharmacy education and scholarship. To effectively support PIF for each member of a diverse student body, pharmacy educators must recognize the limitations of existing PIF theoretical frameworks owing to the historical exclusion of considerations of students' and practitioners' marginalized identities as a layer of professional identity, especially in the context of historical injustices. As members of the pharmacy Academy begin or continue to explore PIF in pharmacy education, they must be mindful and intentional about how they account for the impact that students' marginalized identities may have on their PIF.

Preparing Pharmacy Educators as Expedition Guides to Support Professional Identity Formation in Pharmacy Education.

Objective. To provide an educator-friendly travel guide for supporting pharmacy students' lifelong journey to professional identity formation.Findings. In contrast to professionalism, which has emphasized externally visible behaviors, professional identity focuses on the internalization of the attitudes, standards, and behavioral norms of a profession, such that one "thinks, acts, and feels" like a member of that profession. Identity, whether personal or professional, is continuously developed in part during interactions with others and in response to internal and external feedback on those interactions. Educators play a critical role in helping students navigate the "provocative moments" (eg, transitions, dissonance) that accompany identity formation. To help educators travel with purpose, several identity formation theories suggest means of creating learning experiences and supporting the development of a professional identity. Additionally, guidebooks for the trip (ie, published literature) provide examples of didactic and experiential teaching approaches that can be used to promote professional identity formation. While further exploration and research are necessary, traveling this journey with colleagues can help members of the Academy succeed in sustainably and effectively infusing intentional professional identity formation within pharmacy education and training.Summary. There are myriad ways for educators to develop and support professional identity formation, which can present a challenge when defining the role that educators play in this complex, dynamic process. Educators must understand the reasoning behind various approaches and the common dialogue used to engage and support learners as their expedition guides on the lifelong journey to professional identity formation.

Taking Action Towards Equity, Diversity, and Inclusion in the Pharmacy Curriculum and Continuing Professional Development.

Increased awareness of social injustices and inequities highlight the relevance and importance of diversity, equity, inclusion, and accessibility (DEIA) in health care. Former and recent graduates of pharmacy schools remain deficient in their knowledge of DEIA topics such as unconscious bias, which can directly influence health outcomes in an undesirable manner. Particular DEIA areas that are pertinent to pharmacy practice include: race, gender, sexual orientation, gender identity, ability status, religion, socioeconomic status, and political beliefs. The American Association of Colleges of Pharmacy (AACP) affirmed its commitment to DEIA as a priority. However, existing gaps in knowledge of pharmacy graduates in this area have the potential to contribute to health disparities and inequities, which are significant public health issues. We call on academic pharmacy institutions and professional pharmacy organizations to elevate DEIA topics and to designate them as essential to both addressing health equity and improving care for underserved populations. We also implore licensing boards to require continuing education related to DEIA as a foundational step to closing the knowledge gap for pharmacists in this area.

Engaging in Authentic Allyship as Part of Our Professional Development.

Educational institutions increasingly recognize the importance of diversity, equity, and inclusion (DEI) efforts to combat and dismantle structures that sustain inequities. However, successful DEI work hinges on individuals being authentic allies and incorporating allyship into their professional development. Allyship involves members of dominant groups recognizing their privilege and engaging in actions to create inclusivity and equitable spaces for all. Individuals from dominant groups with desires to actively support others from marginalized groups are often unsure how to fight oppression and prejudice. Our goal as faculty with diverse perspectives and heterogeneous intersectional identities is to provide readers with the tools to develop as an authentic ally through educating themselves about the identities and experiences of others, challenging their own discomfort and prejudices, dedicating the time and patience to learning how to be an ally, and taking action to promote change toward personal, institutional, and societal justice and equality. Ultimately, each person must advocate for change because we all hold the responsibility. When everyone is an authentic ally, we all thrive and rise together.

Oral anticoagulants and relative risk of acute kidney injury in patients with atrial fibrillation: A systematic review and network meta-analysis.

Study objective: Oral anticoagulants (direct oral anticoagulants [DOACs] or warfarin) prevent stroke in patients with atrial fibrillation (AF), but their use may be associated with acute kidney injury (AKI). We aimed to compare AKI risk across individual oral anticoagulants in patients with AF. Design: Systematic review and network meta-analysis. Setting: Randomized trials and population-based studies. Participants: Patients with AF. Interventions: Oral anticoagulants. Main outcome measures: AKI. Results: A systematic literature search in Medline and Embase databases performed on December 17, 2021 identified ten randomized trials and eight population-based longitudinal studies based on prespecified inclusion criteria for systematic review. Clinical trials had short follow-ups and reported only low event rates of serious AKI. Retrospective longitudinal studies were assessed to be at higher risk for bias from confounding and outcome ascertainment, but follow-up was longer (1.5 to 8 years), with AKI incidence ranging from 2 to 29/100 person-years. Eight longitudinal studies that met transitivity assumption were included in a random-effects network meta-analysis within a Bayesian framework. All DOACs were associated with significantly lower risk of AKI compared to warfarin. Dabigatran was associated with lower risk of AKI compared to apixaban (hazard ratio [HR] = 0.82; 95% confidence interval [CI]: 0.68-0.99), rivaroxaban (HR = 0.84; 95%CI: 0.72-0.98), and warfarin (HR = 0.68; 95%CI: 0.59-0.77). Effect size estimates varied by chronic kidney disease status and study geographic locations. Conclusion: Apixaban, rivaroxaban, and dabigatran were associated with lower long-term risk of AKI compared to warfarin among patients with AF, with dabigatran potentially associated with the lowest risk.

Student Stress Management and Wellness Programs among Colleges of Pharmacy.

OBJECTIVE: To describe the programmatic stress-related interventions that colleges of pharmacy are providing for their students. METHODS: A paper-based questionnaire was distributed to 80 college teams who attended two consecutive offerings of the American Association of Colleges of Pharmacy institute focused on promoting student well-being. The five-part questionnaire consisted of: 1) tracking and assessment of perceived student stress levels, 2) the types and formats of stress-coping interventions that are offered, 3) the measured impacts of any stress-coping interventions, 4) the level of faculty/staff training and involvement in student stress remediation, and 5) institutional demographics. RESULTS: Of the 40 college teams responding to the survey there were similar numbers of private (44%) and public (56%) institutions. More than half (57.5%) reported measuring student stress levels. The most common interventions offered were counseling (95%), academic advising (82%), physical exercise support (77%), and relationship building activities (70%). Topics offered in the curriculum were most often related to handling substance abuse (50%), time-management (45%), and finances (40%). A majority (79.5%) of schools reported they do not offer formal training on student stress and mental health to faculty and staff and do not formally assess the impact of stress and coping interventions. CONCLUSION: Colleges of pharmacy are addressing student stress and well-being, yet variability exists in terms of assessment, interventions, and didactic offerings. Multiple barriers to improvement remain and mediating barriers and determining assessments for coping and interventions may be next steps for Colleges of Pharmacy.

Report of the 2019-2020 AACP Student Affairs Standing Committee.

The 2019-2020 Student Affairs Standing Committee addressed charges related to professional identity formation (PIF) in order to set direction and propose action steps consistent with Priority #3.4 of the AACP Strategic Plan, which states "Academic-practice partnerships and pharmacist-involved practice models that lead to the progress of Interprofessional Practice (IPP) are evident and promoted at all colleges and schools of pharmacy." To this end, the committee was charged to 1) outline key elements of PIF, 2) explore the relationship between formal curricular learning activities and co- or extra-curricular activities in supporting PIF, 3) determine the degree to which there is evidence that strong PIF is embedded in student pharmacists' educational experience, and 4) define strategies and draft an action plan for AACP's role in advancing efforts of schools to establish strong PIF in pharmacy graduates. This report describes work of the committee in exploring PIF and provides resources and background information relative to the charges. The committee offers several suggestions and recommendations for both immediate and long-term action by AACP and members to achieve goals related to integrating PIF into pharmacy education. The committee proposes a policy statement relative to the committee charges. Furthermore, the report calls upon the profession to develop a unified identity and incorporate support for PIF into pharmacy education, training, and practice.

Promoting cultural sensitivity with the ethical and professional use of social media during global pharmacy experiences.

INTRODUCTION: While the use of social media and blogging is an attractive and rapidly growing method to disseminate student reflections and information, the use of digital online methods of learning also require professional and ethical accountability. This commentary describes two approaches to using a checklist to promote the culturally sensitive, professional, and ethical use of social media platforms when students are expected to share their global pharmacy experiential experiences. COMMENTARY: Social media sites and online blogs have the potential to enhance student experiences and promote intercultural competence of participants due to their ease of use and familiarity. If social media applications are used by students as a means of gaining self-awareness of cultural differences or promotion of cultural knowledge and attitudes, a framework for how to approach this process methodically should be employed by educators. E-professionalism criteria, such as self-evaluation of implicit biases, appropriateness of visual images, and timing of online posting can be used to set expectations as part of pre-departure training and to ensure ethical dissemination of online student reflections. IMPLICATIONS: Pharmacy educators can assist students during global experiences abroad by improving their cultural competence when sharing reflections online. To ensure postings are culturally sensitive, ethical, and professional, consideration should be given to the deliberate use of a checklist that can assist with ensuring appropriateness of content and student reflections as part of a formal educational experience.

Assessment of a multi-institution integration of cultural competency activities.

INTRODUCTION: To meet educational standards and provide effective patient care, student pharmacists must be well-prepared to interact with a diverse patient population. Thus, the objective was to assess the effectiveness of four different active learning strategies in enhancing the cultural competency (CC) of student pharmacists at multiple institutions. METHODS: Across two years, eight colleges/schools of pharmacy integrated two sets of CC activities with different student cohorts (first-third professional year) that were designed to address different aspects of CC. Pre- and post-activity, a modified electronic version of the Clinical Cultural Competency Questionnaire (CCCQ) that included the addition of activity-specific questions was distributed to students. RESULTS: A total of 1009 students participated in these activities across eight colleges of pharmacy. The integration of activities resulted in significant increases in most items on three of the four subscales of the CCCQ (knowledge, skills, and encounters/situations). Items on the attitude subscale remained the same. Students also felt the activities were beneficial in addressing their intent. CONCLUSIONS: Faculty were able to incorporate these activities throughout their respective curricula with minimal time commitment and resources. The activities improved student perceptions of their CC knowledge, skills, and ability to handle encounters and situations. These activities may be useful for other institutions as they determine the best approach to improve student CC and prepare them for practice.

An Elective Course to Train Student Pharmacists to Provide Culturally Sensitive Health Care.

Objective. To design and implement an elective course that prepares student pharmacists to provide culturally sensitive health care by developing their knowledge, self-confidence, and clinical and communication skills for working with patients from various cultural backgrounds during community health screenings. Methods. In this one-credit-hour elective course, second- and third-year pharmacy students were taught about chronic disease states affecting various minorities, approaches to improve their communication with patients from various cultural backgrounds, and proper use of cardiometabolic equipment during health screening events. After a health screening event at the end of the course, knowledge scores, self-confidence, clinical skills, and communication skills were compared between students who took the elective course and those in a control group. A pre-post elective survey was administered to second- and third-year students enrolled in the elective course to assess differences in understanding, self-confidence, clinical skills, and communication skills. Results. The 31 students who completed the elective course performed better on the knowledge quiz questions than did the 31 students in the control group (response rate 100%). Self-confidence, and communication and clinical skills scores were higher among those who completed the elective course than those who did not. There was an increase in knowledge scores for all students enrolled in the course. Second-year students were just as confident in their abilities as third-year students by the end of course. Conclusion. An elective course focused on better preparing students to provide culturally sensitive health awareness through community health screenings improved students' overall knowledge, clinical skills, communication skills, and self-confidence.

Review of Cardiovascular Drugs in Pregnancy.

Cardiovascular disease is now the leading cause of pregnancy-related deaths in the United States. Increasing maternal mortality in the United States underscores the importance of proper cardiovascular management. Significant physiological changes during pregnancy affect the heart's ability to respond to pathological processes such as hypertension and heart failure. These physiological changes further affect the pharmacokinetic and pharmacodynamic properties of cardiac medications. During pregnancy, these changes can significantly alter medication efficacy and metabolism. This article systematically reviews the literature on safety, efficacy, pharmacokinetics, and pharmacodynamics of cardiovascular drugs used for hypertension and heart failure during pregnancy and lactation. The 2017 American College of Cardiology/American Heart Association hypertension guidelines recommend transitioning pregnant patients to methyldopa, nifedipine, or labetalol. Heart failure medications, including beta-blockers, furosemide, and digoxin, are relatively safe and can be used effectively. Medications that block the renin angiotensin-aldosterone system have been shown to be beneficial in the general population; however, they are teratogenic and, therefore, contraindicated in pregnancy. Cardiovascular medications can also enter breast milk and, therefore, care must be taken when selecting drugs during the lactation period. A summary of the safety of drugs during pregnancy and lactation from an online resource, LactMed by the National Library of Medicine's TOXNET database, is included. High-risk pregnant patients with cardiovascular disease require a multispecialty team of doctors, including health care providers from obstetrics and gynecology, maternal fetal medicine, internal medicine, cardiovascular disease specialists, and specialized pharmacology expertise.

Using Patient Case Video Vignettes to Improve Students' Understanding of Cross-cultural Communication.

Objective. To develop, implement, and assess whether simulated patient case videos improve students' understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students' understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum.

Time Spent, Workload, and Student and Faculty Perceptions in a Blended Learning Environment.

Objective. To evaluate student perception and time spent on asynchronous online lectures in a blended learning environment (BLE) and to assess faculty workload and perception. Methods. Students (n=427) time spent viewing online lectures was measured in three courses. Students and faculty members completed a survey to assess perceptions of a BLE. Faculty members recorded time spent creating BLEs. Results. Total time spent in the BLE was less than the allocated time for two of the three courses by 3-15%. Students preferred online lectures for their flexibility, students' ability to apply information learned, and congruence with their learning styles. Faculty members reported the BLE facilitated higher levels of learning during class sessions but noted an increase in workload. Conclusion. A BLE increased faculty workload but was well received by students. Time spent viewing online lectures was less than what was allocated in two of the three courses.

Women Versus Men: Is There Equal Benefit and Safety from Statins?

Coronary heart disease (CHD) is the leading cause of death in the United States. CHD risk differs between genders, with coronary events lagging behind ten years for women in comparison to men. Low-density lipoprotein cholesterol lowering with statin therapy is a major target for cardiovascular risk reduction. The benefit of statin therapy has been well established in men, for both primary and secondary prevention. However, the same has not been shown for women. While studies have demonstrated benefit in women for secondary prevention, their role in primary prevention of cardiovascular disease remains controversial. Data released over the past several years regarding statin efficacy and safety in men and women has been inconsistent, given that these studies had small sample sizes with numerous study limitations. A recent large scale meta-analysis of both primary and secondary statin prevention trials with sex-specific outcomes demonstrated a similar benefit in both men and women. Statins demonstrated a decrease in cardiovascular events and all-cause mortality in both sexes. In regards to statin safety, additional trials investigating the difference in adverse events of statins in men versus women, particularly new onset of diabetes, myalgias, and liver dysfunction, are warranted. Increased awareness and monitoring of female patients for myalgias and hyperglycemia should be considered as a precaution. Overall, women need to be better represented in prospective clinical trials powered to evaluate gender-specific differences in statin safety and efficacy in the management of cardiovascular disease.

Impact of Food and Drug Administration hepatotoxicity warning on prescribing and monitoring of dronedarone in a tertiary teaching hospital.

OBJECTIVES: The purpose of this study was to determine the impact of a Food and Drug Administration (FDA) hepatotoxicity warning on 14 January 2011 on the prescribing practices and hepatic monitoring of patients receiving dronedarone. METHODS: Patients who received dronedarone 1 year before and after the FDA warning were retrospectively evaluated for the appropriateness of dronedarone prescribing, hepatic injury evaluation and medication discontinuation rates in a tertiary medical centre. KEY FINDINGS: Ninety-one patients (66.4%) were prescribed dronedarone prior to the FDA warning, compared with 46 patients (33.6%) after the warning. The frequency of liver function testing (72.5% versus 76.1%) and discontinuation rates (42.9% versus 50%) were similar before and after the FDA warning. CONCLUSIONS: There was no significant change in dronedarone prescribing practice, monitoring of hepatic function or discontinuation rates following an FDA hepatotoxicity warning.