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.

A meta-narrative review of choose-your-own-adventure style patient case activities in pharmacy education.

BACKGROUND: The objective of this review was to characterize the methods of delivery and assessment of Choose Your Own Adventure (CYOA)-style activities in pharmacy education. A secondary objective was to utilize available data to determine best practices for educators interested in developing similar activities. METHODS: A meta-narrative approach according to the guidance of the RAMESES standards was used for this review. A broad literature search was conducted using PubMed and Embase. Studies published on the use of a CYOA-style patient case format in pharmacy education were identified and appraised individually for their relevance. RESULTS: Thirteen studies from the pharmacy education literature were included in the review. Activities were delivered for 25 unique topics, largely in small groups during class via patient simulation or interactive data collection software. Overall, students have a positive perception of CYOA-style activities, with positive results regarding knowledge development and student engagement. The most commonly reported challenge to implementing CYOA-style patient case activities was the up-front time commitment to develop activities. IMPLICATIONS: This review provides a snapshot of the small but expanding body of literature on CYOA-style patient case activities in pharmacy education. CYOA-style activities are recommended for expanded use in pharmacy education as the preponderance of studies that assessed knowledge development showed significant improvement in knowledge after participation in CYOA-style activities. Additionally, students have a positive perception of CYOA-style activities and reported that they were enjoyable, improved their confidence, and helped them learn course material.

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.

"Following your dreams, and not killing yourself to do so": Black PharmDstudent perceptions of pharmacy residency.

OBJECTIVE: Residency training is a key element of advancing the roles of pharmacists in patient care. Diversifying the healthcare workforce is also crucial in reducing health disparities and improving health equity.1 The objective of this study was to investigate Black Doctor of Pharmacy students' perceptions of pursuing pharmacy residency training to aid pharmacy educators in creating and improving structures to support the professional advancement of Black student pharmacists. METHODS: A qualitative study employing focus groups was conducted at one of the top 20 colleges of pharmacy. Four focus groups consisting of Black students in years 2 through 4 of the Doctor of Pharmacy program were organized. A constructivist grounded theory approach2 was utilized to collect and analyze the data, which was organized into a conceptual framework. RESULTS: The elements of the framework developed showcase Black students' consistent negotiation between personal well-being and pursuit of professional advancement. This framework also highlights how the experience of navigating personal wellness is unique for Black students, rather than simply a work/life balance concern. CONCLUSION: The concepts in this framework may be valuable for colleges of pharmacy seeking to increase diversity in their residency pipeline. Targeted interventions to ensure adequate mentorship, mental health resources, diversity and inclusion efforts, and financial support will be necessary if the profession truly desires to expand increased diversity in clinical pharmacy.

Pharmacist Preceptor Exposure, Comfort and Awareness of Resources to Address the Social Determinants of Health-A Pilot Study.

As preceptors are responsible for the experiential education of future pharmacists, it is important to assess understanding and identify knowledge gaps for preceptor development. The purpose of this pilot study was to assess the exposure to social determinants of health (SDOH), comfort in addressing social needs, and awareness of social resources among the preceptors at one college of pharmacy. A brief online survey was sent to all affiliated pharmacist preceptors with screening criteria for pharmacists who had regular one-on-one patient interactions. Of 166 preceptor respondents (response rate = 30.5%), 72 eligible preceptors completed the survey. Self-reported SDOH exposure increased along the educational continuum (with increasingly more emphasis from the didactic to experiential to residency). Preceptors who graduated after 2016, practiced in either community or clinic settings and served >50% of underserved patients were the most comfortable addressing social needs and the most aware of social resources. Preceptor understanding of SDOH has implications for their ability to educate future pharmacists. Colleges of pharmacy should evaluate practice site placement as well as preceptor knowledge and comfort in addressing social needs in order to ensure that all students are exposed to the SDOH throughout the continuum of learning. Best practices for up-skilling preceptors in this area should also be explored.

Pharmacy personnel comfort and confidence in screening for social needs: A pilot study.

BACKGROUND: Addressing social needs (such as lack of adequate housing, food, and transportation) has been shown to improve medication adherence and overall patient outcomes. However, screening for social needs during routine patient care can be challenging due to lack of knowledge of social resources and adequate training. OBJECTIVES: The primary objective of this study is to explore the comfort and confidence of community pharmacy personnel in a chain community pharmacy when discussing social determinants of health (SDOH) with patients. A secondary objective of this study was to assess the impact of a targeted continuing pharmacy education program in this area. METHODS: Baseline confidence and comfort were measured through a brief online survey consisting of Likert scale questions regarding various aspects of SDOH (e.g., importance and benefit, knowledge of social resources, relevant training, workflow feasibility). Subgroup analysis of respondent characteristics was conducted to examine differences between respondent demographics. A targeted training was piloted, and an optional posttraining survey was administered. RESULTS: The baseline survey was completed by 157 pharmacists (n = 141, 90%) and pharmacy technicians (n = 16, 10%). Overall, the pharmacy personnel surveyed lacked confidence and comfort when conducting screenings for social needs. There was not a statistically significant difference in comfort or confidence between roles; however, subgroup analysis revealed trends and significant differences between respondent demographics. The largest gaps identified were lack of knowledge of social resources, inadequate training, and workflow concerns. Respondents of the posttraining survey (n = 38, response rate = 51%) reported significantly higher comfort and confidence than the baseline. CONCLUSION: Practicing community pharmacy personnel lack confidence and comfort in screening patients for social needs at baseline. More research is needed to determine if pharmacists or technicians may be better equipped to implement social needs screenings in community pharmacy practice. Common barriers may be alleviated with targeted training programs to address these concerns.

Patient perspectives of discussing social determinants of health with community pharmacists.

BACKGROUND: Social determinants of health (SDOH) have a considerable impact on the lives and health outcomes of Black communities. Although the implementation of social needs screening in various clinical settings has been studied, the patient perspective of discussing SDOH with health care providers has not been thoroughly investigated. There is an opportunity for community pharmacists to help identify social risk factors and address social needs, particularly in minoritized communities. OBJECTIVES: The objectives of this project were to (1) characterize the perspectives of Black patients regarding social risk discussions with community pharmacists and (2) to develop a framework for community pharmacists to engage in conversations with patients about social risk factors. METHODS: A qualitative study was conducted using principles of grounded theory. Patient perspectives regarding discussions of 5 key determinants of health (economic stability, education, social and community context, health and health care, and neighborhood and built environment) were elicited through semistructured interviews. Data analysis included interpretation of interview transcripts from 14 Black adults living in medically underserved areas in Memphis, TN. Charmaz's approach to theory development was followed. RESULTS: Three themes emerged to characterize the needs and expectations for patients in discussing social risk factors with community pharmacists. The themes of rationale, relationship, and resources were compiled to construct the newly developed Social Determinants of Health Patient Communication Framework. This framework describes the key factors that affected the patient receptiveness and willingness to discuss their social needs. CONCLUSION: Although patients are open to sharing social issues with community pharmacists, they may be reluctant to discuss social factors if initial understanding, personal connection, or resources are not present. This proposed, novel framework is a step toward improving the assessment of SDOH for underserved Black patients within community pharmacies. This framework can also be used for future education of pharmacists and other health care providers.

Defining the role of pharmacists in addressing the social determinants of health.

As one of the overreaching goals of Healthy People 2030, addressing the social determinants of health (SDOH) to reduce health disparities is a nationwide concern, with objectives informed by interdisciplinary teams of experts. However, there remains much discussion regarding the roles of healthcare providers in addressing SDOH. While current guidance suggests that all members of the healthcare team must be empowered to address SDOH, current guidance explicitly references physicians, nurses, social workers and staff, and do not specifically include pharmacists. While pharmacists are taught about the impact of SDOH in pharmacy curricula, actionable strategies for pharmacists to address SDOH in practice have not been clearly outlined. Pharmacists have multifaceted interactions with patients and may be influential in meeting individual patient needs, identifying social risk factors, and addressing upstream causes of health disparities. This paper proposes a framework for the role of pharmacists in addressing the SDOH through strategies at the patient, practice, and community levels. The concepts presented in this paper are meant to serve as a launch point for discussion and to promote the inclusion of pharmacists in the conversations around sustainable efforts to achieve health equity. This framework is not intended to limit the scope of pharmacists in addressing SDOH - on the contrary, it is our hope that this outline may be used to expand the education of future healthcare professionals regarding their role in addressing the social determinants of health.

Development of a Remote Public Health Advanced Pharmacy Practice Experience in Response to COVID-19.

OBJECTIVES: In order to meet the needs of the COVID-19 public health crisis and to actively engage students in patient care opportunities, the University of Tennessee Health Science Center College of Pharmacy in partnership with the Tennessee Health Department, developed a remote Public Health Advanced Pharmacy Practice Experience (APPE) Elective. The objectives of this paper are to describe the development of and students' experiences and learning outcomes during the elective. Faculty preceptor and experiential administrator's perspectives are also described. METHODS: This month-long APPE was developed in mid-March and delivered in April and May of 2020. The students volunteered in-person with the State of Tennessee COVID-19 Hotline call centers and conducted topic discussions and assignments virtually with a remote preceptor. RESULTS: A total of 16 students completed this rotation experience. Student ratings of the experience were positive, and their knowledge improved in all topic areas. Students collectively completed approximately 700 hours manning the COVID-19 hotline and logged over 1,000 phone calls. CONCLUSIONS: In a time of unprecedented disruption to experiential learning, the development of this unique public health APPE directly benefited the college, the students, and the citizens of our state. The APPE described in this paper could be replicated in additional waves of the pandemic or adapted for similar disaster response.

Reimagining Pharmacy Education through the Lens of a Choose Your Own Adventure Activity-A Qualitative Evaluation.

BACKGROUND: Successful pharmacy curricula expose students to a variety of teaching and assessment methods to prepare students for clinical practice. However, development of clinical decision-making skills is often challenging for learners. To meet this need, the Choose Your Own Adventure (CYOA) Patient Case Format was developed to enhance traditional paper patient cases by integrating problem-based and case-based learning to improve pharmacy student learning. The objectives of this evaluation were to qualitatively evaluate the CYOA case format. The qualitative assessment of the student pharmacist's learning experience utilizing this novel patient case format was used to formulate a template for extrapolation to other disease states. METHODS: Focus groups were conducted with second year Pharm.D. students enrolled at the University of Tennessee Health Science Center (UTHSC) College of Pharmacy. The focus groups were conducted in Fall 2020, beginning the week after they were exposed to the CYOA case format. The corpus of data was analyzed thematically to identify themes using inductive coding. To establish the validity of this evaluation, the team met to assess the consistency of the data reduction methods and guard against methodological issues that could influence and affect coding decisions. RESULTS: Participants were recruited until thematic saturation was achieved. Out of 25 participants, 23 participants provided demographic information, with 74% identifying as female. Thematic analysis identified three themes: (1) "It was just fun!" (2) Empowering Pharmacy Students through Groupwork: "Collaboration [is] going to be vital" and (3) Meeting the Need for Real-Life Scenarios: "This is a real person." Conclusions: The data highlight that there are numerous advantages of adopting the CYOA format for delivering applied pharmacotherapy content. The CYOA format presents students with a realistic scenario that is fun and engaging and challenges students to justify their decisions regarding patient care in a structured group environment.

Effects of Racial Trauma on Black Doctor of Pharmacy Students.

Objective. In the wake of several high-profile police killings, in 2020 the United States began another reckoning with structural racism, injustice, and violence against Black Americans. The objectives of this study were to explore the impact of racialized sociopolitical events on Black Doctor of Pharmacy (PharmD) students.Methods. Focus groups were conducted with second- to fourth-year Black PharmD students enrolled at the University of Tennessee Health Science Center College of Pharmacy. The focus groups were conducted in summer 2020, beginning two months after the murder of George Floyd and concluding before the start of the fall semester. Data analysis was conducted using a phenomenological approach, and themes were identified using inductive coding.Results. Twenty-four participants were recruited into five focus group sessions. Thematic analysis of the transcripts resulted in three distinct themes related to the study objectives: Vicarious Trauma, Hypervigilance, and Fight or Flight Responses. Black students reported that they experienced significant psychological distress as a result of prominent racially traumatic events. Some Black students reported withdrawing from non-Black persons due to hypersensitivity and anxiety while others were willing to engage in candid conversations.Conclusion. Racial trauma has implications for student wellness and academic success. As racism and police brutality have proven to be an ever-present problem, this study offers key information for consideration as institutions recruit, support, and retain diverse learners. The data may also inform educators and pharmacy students regarding interactions with Black patients, coworkers, and health professionals during times of sociopolitical unrest.

Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format.

Educational strategies to teach pharmacy students about diabetes are necessary to prepare future pharmacists to manage complex patients. The Choose Your Own Adventure (CYOA) patient case format is an innovative activity that presents a patient case in an engaging way. The objectives of this study were (1) to describe the development of the innovative teaching activity and (2) to assess its effect on student knowledge and confidence in outpatient management of diabetes. The CYOA patient case activity was designed by transforming a traditional paper patient case involving outpatient diabetes management into an interactive format utilizing an online platform. The activity was conducted with 186 second-year pharmacy students in a skills-based course. This activity was administered virtually through a combination of small group work and large group discussion. After completion of the activity, students completed an online self-assessment questionnaire. Of 178 completed questionnaires, there was a statistically significant difference in students' self-ratings after versus before the activity for all survey items (p < 0.001). The CYOA activity improved self-reported knowledge of outpatient diabetes management and increased self-reported confidence in clinical decision-making skills. This format shows promise as an educational tool that may be adapted for other disease states to enhance clinical decision-making skills.