Point/Counterpoint: Are Outstanding Leaders Born or Made?

The question of whether outstanding leaders are born or made has been debated for years. There are numerous examples of historical figures that came naturally to leadership, while others developed their leadership skills through tenacity and experience. To understand leadership, both nature (the genetic component) and nurture (the environmental influences) must be considered. This article represents the work of two Academic Leadership Fellows Program groups who debated each position at the 2016 American Association of Colleges of Pharmacy (AACP) Interim Meeting in Tampa, Fla., in February 2016.

Genetic Variation in CYP2R1 and GC Genes Associated With Vitamin D Deficiency Status.

This cross-sectional study enrolled 180 patients at a private family practice in Virginia. Total serum vitamin D concentrations were obtained weekly from January 30, 2013, through March 30, 2013, in consecutive patients regularly scheduled for laboratory work at the practice. Patients were categorized into 2 groups and analyzed for variant alleles in vitamin D receptor ( VDR; rs2228570), cytochrome P450 2R1 ( CYP2R1; rs10741657), 7-dehydrocholesterol reductase ( DHCR7; rs12785878), and group-specific component ( GC; rs2282679) to determine whether variants of those alleles influenced total serum 25(OH)D concentrations. One-hundred and eighty patients were enrolled, with 40 (22%) being sufficient, 25-hydroxy vitamin D level 25(OH)D ≥ 30 ng/mL, and 140 (78%) being insufficient, 25(OH)D < 30 ng/mL. Of the 4 genes, 2 genes, CYP2R1 (rs10741657) and GC (rs2282679), demonstrated a significant association related to vitamin D status. Subjects with 1 or more variant alleles at rs10741657 were almost 3.7 (odds ratio [OR] 3.67; 95% confidence interval [CI]: 1.35-9.99) times more likely be insufficient in vitamin D and subjects with 1 or more variant alleles at rs2282679 were about half (OR 0.42; 95% CI: 0.18-0.93) as likely to be insufficient in vitamin D. Allelic variations in CYP2R1 (rs10741657) and GC (rs2282679) affect vitamin D levels, but variant alleles on VDR (rs2228570) and DHCR7 (rs12785878) were not correlated with vitamin D deficiency, 25(OH)D < 30 ng/mL.

A Self-Assessment Guide for Resident Teaching Experiences.

The 2015 American College of Clinical Pharmacy (ACCP) Educational Affairs Committee was charged with developing a self-assessment guide for residency programs to quantitatively and qualitatively evaluate the outcomes of resident teaching curricula. After extensively reviewing the literature, the committee developed assessment rubrics modeled after the 2013 ACCP white paper titled "Guidelines for Resident Teaching Experiences" and the revised American Society of Health-System Pharmacists (ASHP) 2014 accreditation standards for PGY1 residencies, which place greater emphasis on the teaching and learning curriculum (TLC) than the previous accreditation standards. The self-assessment guide developed by the present committee can serve as an assessment tool for both basic and expanded TLCs. It provides the criteria for program goals, mentoring, directed readings with topic discussions, teaching experiences, and assessment methodology. For an expanded TLC, the committee has provided additional guidance on developing a teaching philosophy, becoming involved in interactive seminars, expanding teaching experiences, developing courses, and serving on academic committees. All the guidelines listed in the present paper use the measures "not present," "developing," and "well developed" so that residency program directors can self-assess along the continuum and identify areas of excellence and areas for improvement. Residency program directors should consider using this new assessment tool to measure program quality and outcomes of residency teaching experiences. Results of the assessment will help residency programs focus on areas within the TLC that will potentially benefit from additional attention and possible modification.

Medication Discrepancies During Transitions of Care: A Comparison Study.

PURPOSE: Concerns surround discontinuity of care and poor communication during transitions of care between inpatient and outpatient settings. This study was designed to examine the differences in medication discrepancies during these transitions between an outpatient clinic with admitting privileges (PCP-AD) and another without admitting privileges (PCP-NOAD). METHODS: Retrospective, chart review of patients admitted to the hospital between January and July 2009, who stated their primary care provider (PCP) was from either one of the outpatient clinics. Charts were evaluated for medication discrepancies on admission and discharge and follow-up with PCP after discharge. RESULTS: On both admission and discharge, PCP-AD had a rate of unacceptable discrepancies less than that of PCP-NOAD, 63.4% versus 90.3% (p < .001) and 44.9% versus 84.1% (p < .001) respectively. Patients prescribed more than 10 medications were more likely to have a medication discrepancy compared with those on fewer medications (p = .003). Additionally, 85% of patients from PCP-AD followed up after discharge compared with 62.7% from PCP-NOAD (p < .001). CONCLUSIONS: The differences between the two groups in medication discrepancies and follow-up are suggestive of increased continuity of care with fewer discrepancies when PCPs are directly involved in inpatient care. A comprehensive and accurate medication history is imperative regardless of practice model.

The value of pharmacy services on a short-term medical mission trip: description of services and assessment of team satisfaction.

BACKGROUND: Pharmacists should be key members of a medical mission trip by providing assistance with medication knowledge and therapeutics. OBJECTIVE: To determine the value of a pharmacist as a member of a medical mission team through (1) pharmacy interventions on 2 medical teams and 1 women's health team and (2) team satisfaction with the pharmacy services. METHODS: Pharmacy interventions were documented by 2 medical teams and 1 women's health team and included, but were not limited to, dosing recommendations, medication selection, and therapeutic substitution. Team satisfaction was determined from a 10-question survey administered on the last clinical day to all team members except pharmacists, pharmacy students, and physical therapists. RESULTS: The pharmacy service dispensed 2119 prescriptions, with an average number of prescriptions of 1.84 per patient. A total of 2340 interventions were provided by the pharmacy service, averaging 2.04 interventions per patient and 1.1 interventions per prescription. The survey indicated that a pharmacist serves an integral role for the multidisciplinary medical team. CONCLUSIONS: Pharmacists play an important role in a short-term medical mission trip by serving as sources for medication knowledge and ensuring appropriate medication therapy management as part of the interdisciplinary team.