The Report of the 2021-2022 AACP Research and Graduate Affairs Committee.

EXECUTIVE SUMMARY. The work of the 2021-2022 AACP Research and Graduate Affairs Committee (RGAC) focused on barriers to graduate education and research-related careers in pharmacy education. AACP President Stuart Haines charged the RGAC with identifying the critical barriers that hinder current PharmD students/recent graduates as well as under-represented groups (e.g., Black and Latino) from pursuing advanced degrees and research-related career paths in the pharmaceutical, social & behavioral, and clinical sciences and recommending changes that might address these barriers - this may include recommendations to change the fundamental structure of graduate education.The committee began its work with a literature review to survey current perspectives on these barriers and assess the supporting evidence for effective solutions and programs, including their relevance to pharmacy education. Based on the review, the committee was able to identify numerous obstacles to entry into and progression through research training, for both underrepresented learners and student pharmacists. Obstacles are individual, e.g., lack of exposure to and self-efficacy in research, financial constraints, structural, e.g., lengthy training time, programmatic rigidity, and institutional, e.g., implicit and explicit bias. The committee found evidence of effective approaches and programs to address these barriers that could be applied in pharmacy schools. These approaches include improvements to existing practices in recruitment, admissions and hiring practices as well as creation of new programs and structural changes to existing programs to increase accessibility to learners. The committee also recognized a need for more research and development of additional approaches to address these barriers.The committee makes a series of recommendations that AACP develop resource guides and programs to address key issues in the recruitment and retention of underrepresented students and student pharmacists into graduate education and research careers, including as faculty. The committee also proposes new AACP policies to support innovative graduate programs and early, longitudinal engagement of learners from elementary school onward to increase access to graduate education and to support environments and cultures of commitment to accessibility, diversity, equity, inclusiveness, antiracism in pharmacy education.

Strategies for Incorporating Health Disparities and Cultural Competency Training into the Pharmacy Curriculum and Co-curriculum.

Objective. To identify and review strategies reported in the literature for strengthening instruction about both health disparities and cultural competency (HDCC) within various portions of the Doctor of Pharmacy curriculum and co-curriculum.Findings. The classroom strategies reported in the literature for incorporating HDCC into the PharmD curriculum involved teaching a single course or series of courses in HDCC. Activities found to be effective in teaching HDCC were those that involved case-based and community engagement exercises. Recommendations for incorporating HDCC into the experiential education included preceptor development in areas of HDCC to assess student understanding of health disparities concepts, increasing student engagement with diverse patient populations, and implementation of cross-cultural communication models at clinical sites. Co-curricular and interprofessional (IPE) portions of pharmacy training were found to permit greater methodological flexibility for incorporating training in HDCC, as they often confronted fewer time or space constraints than classroom endeavors. Documented methods for teaching HDCC within co-curricular and IPE experiences included service learning, study abroad, symposia, and forums.Summary. There is a paucity of literature describing processes for incorporation of health disparities and cultural competency education and training into the PharmD program. Findings suggest that conceptual frameworks for HDCC should be used throughout the pharmacy curriculum, with learning activities mapped to relevant pharmacy education standards to ensure coverage of important practice competencies. Best practices also involve the use of contemporary tools, strategies, and resources from a cross-section of disciplines that provide opportunities for learners to correct misconceptions and biases through active situational problem-solving.

Predictors of Academic Success in a Nontraditional Doctor of Pharmacy Degree Program at a Historically Black College and University.

Objective. Rapid changes in the current US health care system, especially in the fields of pharmacy and pharmaceutical sciences, require practicing pharmacists to acquire new knowledge and skills. Despite the growth of opportunities for pharmacists within new spaces such as nanotechnology, informatics, and pharmacogenomics, those without a Doctor of Pharmacy (PharmD) degree could be eliminated from consideration by employers who seek new graduates with more contemporary training and skills. The purpose of this study was to determine what associations exist between student success within a nontraditional Doctor of Pharmacy (NTDP) program and certain demographic factors.Methods. This quantitative longitudinal study was designed to determine which factors predict academic success among NTDP students entering the College of Pharmacy at Howard University. Academic success was measured by cumulative graduating grade point average (GPA). Data from four cohorts of students were used to develop multivariate linear regression models with several predictors including age, region of residence, citizenship status, previous pharmacy work background, and ethnicity.Results. The study sample included 81 students whose mean cumulative GPA was 3.44. A foreign-born African heritage was predictive of a GPA that was significantly higher in comparison to African Americans after adjusting for other factors.Conclusion. Findings showed that international students had a higher cumulative GPA in comparison to African American students in the NTDP program.

Introduction to Implementing Health Disparities and Cultural Competence Content in the Doctor of Pharmacy Curriculum.

The 2013 American College of Clinical Pharmacy (ACCP) White Paper by O'Connell and colleagues introduced instructional approaches and resources for assessing health disparities and cultural competency training within the pharmacy curriculum. Instructional standards, such as the Accreditation Council for Pharmacy Education (ACPE) Standards 2016, have been updated to state the importance of teaching "cultural awareness" and exposure to "diverse populations" within pharmacy curricula. There remains a gap in understanding how various programs should implement these concepts. To ensure that the knowledge students learn is meaningful, it is critical for approaches to HDCC education to be intentional, integrative, and comprehensive. Without this type of approach, students may lose key skills and be unable to deliver culturally responsive, patient-centered care upon graduation. In this theme issue, three papers will introduce areas for HDCC inclusion and explore how these topics are currently being covered in pharmacy education. Recommendations on best practices are provided.

The association between students' emotional intelligence, cultural competency, and cultural awareness.

INTRODUCTION: Emphasis has been placed on health professionals' employment of social and behavioral skills to negotiate complex patient-clinician relationships. One example is a professional's ability to provide culturally appropriate care. This study evaluated the relationship between pharmacy students' cultural awareness, emotional intelligence, and their ability to engage in appropriate cross-cultural interactions as measured by a cultural competency scale. METHODS: A cross-sectional study was conducted in first-year pharmacy students using three distinct survey instruments to measure cultural awareness, emotional intelligence, and cultural competence. Demographic characteristics assessed included gender, race, ethnicity, and previous cultural competency training. Descriptive statistics were used to characterize performance on each survey instrument. Pearson's correlation was used to evaluate the statistical significance of associations observed between the variables measured within the study. RESULTS: Forty-four students responded, of which 34% had previous cultural competency training. No statistically significant associations were observed between overall cultural competence, emotional intelligence, or cultural awareness. The self-cultural scale (part of the cultural awareness scale) was significantly related to higher overall emotional intelligence scores (P = .02). Previous cultural competency training was associated with significantly higher scores on the cultural competence scale (P = .004). Previous cultural competency training was also associated with enhanced ability to perceive one's own emotions as measured by the emotional intelligence scale (P = .02). CONCLUSIONS: Previous exposure to cultural competency training impacts cultural competence scores most significantly.

Developing the "Upstreamist" through Antiracism Teaching in Pharmacy Education.

Objective. To present antiracism teaching as a key modality and an upstream approach to addressing health disparities in pharmacy education. Relevant theoretical frameworks and pedagogical strategies used in other health disciplines will be reviewed to present how antiracism curricula can be integrated into pharmacy educational outcomes.Findings. Various disciplines have incorporated antiracism pedagogy in their respective programs and accreditation standards. While challenges to implementation are acknowledged, structural racism continues to compromise health outcomes and should be centralized when addressing health disparities.Summary. Pharmacy curricula has explored and implemented cultural competency as a means to address the social determinants of health. By intentionally addressing racism in the context of health disparities, student pharmacists will further acknowledge racism as a public health issue and a systemic barrier to patient-centered care.

Inclusion of Health Disparities, Cultural Competence, and Health Literacy Content in US and Canadian Pharmacy Curriculums.

Objective. To determine how US and Canadian pharmacy schools include content related to health disparities and cultural competence and health literacy in curriculum as well as to review assessment practices.Methods. A cross-sectional survey was distributed to 143 accredited and candidate-status pharmacy programs in the United States and 10 in Canada in three phases. Statistical analysis was performed to assess inter-institutional variability and relationships between institutional characteristics and survey results.Results. After stratification by institutional characteristics, no significant differences were found between the 72 (50%) responding institutions in the United States and the eight (80%) in Canada. A core group of faculty typically taught health disparities and cultural competence content and/or health literacy. Health disparities and cultural competence was primarily taught in multiple courses across multiple years in the pre-APPE curriculum. While health literacy was primarily taught in multiple courses in one year in the pre-APPE curriculum in Canada (75.0%), delivery of health literacy was more varied in the United States, including in a single course (20.0%), multiple courses in one year (17.1%), and multiple courses in multiple years (48.6%). Health disparities and cultural competence and health literacy was mostly taught at the introduction or reinforcement level. Active-learning approaches were mostly used in the United States, whereas in Canada active learning was more frequently used in teaching health literacy (62.5%) than health disparities and cultural competence (37.5%). Few institutions reported providing professional preceptor development.Conclusion. The majority of responding pharmacy schools in the United States and Canada include content on health disparities and cultural competence content and health literacy to varying degrees; however, less is required and implemented within experiential programs and the co-curriculum. Opportunities remain to expand and apply information on health disparities and cultural competence content and health literacy content, particularly outside the didactic curriculum, as well as to identify barriers for integration.

A Six-Semester Integrated Pharmacy Practice Course Based on Entrustable Professional Activities.

Objective. To design and assess the outcomes of a longitudinal, integrated pharmacy course.Methods. A one-credit course, Applications of Pharmacy Practice, was built into a revised curriculum. The course was offered during the first six semesters of the Doctor of Pharmacy curriculum and met once every three weeks for a total of five sessions per semester. Each session integrated curricular material from all courses taught during a given semester into an individual, case-based assessment and a team activity. Team activities were evaluated using rubrics developed based on the Core Entrustable Professional Activities for New Pharmacy Graduates.Results. First-year students were automatically enrolled in the inaugural offerings of the course in fall 2018 and spring 2019, and the majority of students achieved final course grades of 70% to 89% for each semester. Students reported that the course helped them to develop critical-thinking skills and to keep up with semester material. Although the majority of students believed the addition of the course to the curriculum was beneficial, some felt the expectation for them to keep up with all course material was excessive.Conclusion. The addition of a longitudinal integrated course, Applications of Pharmacy Practice, appeared to benefit students, helping them integrate material from all of their courses during the semester. This integration of clinical, administrative, and pharmaceutical sciences material reduced compartmentalization of knowledge. Future studies should investigate the impact of this course on student success and performance on standardized assessments.

An Ethics-based Approach to Research in Global Health: A Call to Action for Pharmacists.

As opportunities and interests in international partnerships and research continue to grow in pharmacy, so, too, does the likelihood of encountering ethical challenges. We posit that the chance of encountering an ethical challenge in global health is almost inevitable. This commentary serves as an introduction to a series of four papers highlighting ethical issues in global health research for pharmacists. The authors draw on core ethical principles to guide collaborative global research in working to advance the health of people and populations worldwide.

An Ethics-based approach to Global Health Research Part 3: Emphasis on Partnership Funding.

Acquiring funding for global health research within pharmacy can be challenging, particularly for new investigators who may have a strong interest in resolving global dilemmas related to health. Moreover, there can be inherent imbalances and ethical issues when navigating the funding process for global partnerships. There exists a lack of literature providing ethical guidance for mitigating dilemmas that may arise. This commentary discusses current funding streams for investigators interested in global pharmacy research, as well as specific recommendations for the funding process. These recommendations include managing award funds, ethical considerations for funding research partnerships, and balancing power between low to middle income countries and high-income countries. Lastly, case examples of funding partnerships involving pharmacy are highlighted, emphasizing important lessons learned. This commentary addresses the critical need for providing global health researchers with both important considerations and experience-based recommendations for navigating global funding partnerships using an ethical approach.

Cultural Sensitivity and Global Pharmacy Engagement in Africa.

Global engagement between schools and colleges of pharmacy in the United States and Africa is increasing. For a balanced and fruitful engagement, sensitivity towards the cultural and clinical needs of the people and professionals of the African region is critical. In this paper, we have divided the discussion into Southern, East, Central, and West Africa. General information about Africa, with unique aspects for individual subregions and countries, will be introduced. Stereotypes and misconceptions about the region and the people will also be discussed, along with recommendations for culturally sensitive engagement for pharmacy and other health care practitioners when hosting members from, or visiting this region. The paper is a resource for schools and colleges of pharmacy who are currently engaged or considering future outreach opportunities in Africa.