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.

Considering the Intercultural Development Inventory (IDI) to Assess Intercultural Competence at U.S. Pharmacy Schools.

BACKGROUND: U.S. pharmacy schools need to engage in improving intercultural competence among administrators, faculty, staff, and students. The Intercultural Development Inventory (IDI) can be a possible tool to determine the level of intercultural competence. U.S. pharmacy schools need to examine the validity of the IDI within the context of health professional education prior to using this tool. OBJECTIVES: To describe the relationship between the IDI and its underlying theory, identify whether the validity of the IDI has been established within two specific contexts, and discuss the practical issues and implications of using the IDI. METHODS: Medline, Embase, and selected health professional education journal websites were searched to identify fully published studies utilizing the IDI within health professional education. Eligibility of articles was determined with a standardized approach. RESULTS: Ten studies were identified by full-text reviews, but none investigated the validity of the IDI. CONCLUSIONS: The IDI has been shown to be valid in certain contexts, but its validity has yet to be confirmed within health professional education. U.S. pharmacy schools need to examine practical issues and implications when deciding if the resources required to administer, analyze, and report IDI results are reasonable.

An assessment of patient experiences as teachers of cultural sensitivity in an interprofessional setting.

BACKGROUND AND PURPOSE: The importance of cultural sensitivity training in pharmacy education is well-recognized, though best practices are not well described. Traditional teaching approaches such as faculty lectures may result in overgeneralization, lack of nuance, or tokenization. Utilizing patients from diverse special populations as teachers of cultural sensitivity may mitigate these risks. However, faculty must ensure patients feel comfortable, empowered, valuable, and prepared to serve as partners in education. EDUCATIONAL ACTIVITY AND SETTING: Patients were used as teachers of cultural sensitivity in an interprofessional education panel activity at two colleges of pharmacy over two years. Patient experiences with training and preparation for the activity as well as their perceived benefits of partnering in student education were assessed. FINDINGS: Overall, patients reported that training was adequate, and the educational activity provided a sufficient platform for sharing their knowledge with students. Patients felt they provided meaningful contributions to student education, learned valuable information in the process, and formed sincere relationships with each other and faculty. SUMMARY: Faculty at other institutions may wish to adapt this activity to meet the needs of their own institution and empower patients to contribute to the education of health professions students. Practical recommendations are provided for promoting a positive patient experience. A comprehensive training program prepared and empowered patients to teach cultural sensitivity principles to an interprofessional group of health care students.

Correlation Between Pharmacy Students' Implicit Bias Scores, Explicit Bias Scores, and Responses to Clinical Cases.

Objective. The purpose of this study was to identify the extent of implicit and explicit bias in a sample of pharmacy students and to determine whether there is an association between implicit bias, explicit bias, and responses to clinical cases.Methods. Investigators sent links to two online surveys to students at six US schools and colleges of pharmacy. In the first survey, students responded to two clinical cases. Students were presented with a picture of a White or Black patient with each clinical case. On the second survey, students indicated their level of racial implicit bias as assessed by the Harvard Implicit Association Test and their level of racial explicit bias. Pearson's correlation was used to determine the correlation between bias and responses to the clinical cases.Results. Three hundred fifty-seven first, second, and third year pharmacy students responded to both surveys (response rate 52%). The students who were presented with the picture of a Black patient rated the patient's pain and the reliability of the patient's family as higher than students presented with the picture of a White patient. Students had more negative implicit and explicit bias towards Black patients. Neither implicit nor explicit bias correlated with student responses to the clinical cases.Conclusion. Evidence of slight to moderate negative implicit bias and slight negative explicit bias towards Black patients was identified in this group of pharmacy students. Future studies that include a more representative population and heighten the stakes of the clinical scenario should be done to investigate a possible correlation between bias and clinical behaviors.

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 critique of validity analysis from instruments assessing the affective domain.

BACKGROUND: Schools and colleges of pharmacy need to show evidence that their students have internalized professional values, and many choose to do so through quantitative instruments. A review of the literature was completed to identify the evidence of validity of the scores from instruments designed to assess pharmacy students in the affective domain. METHODS: Electronic databases were searched to identify instruments. Basic information regarding the instruments, the facets of validity assessed, and the evidence for validity were reviewed. RESULTS: Of the studies identified, 25 focused on assessing the affective domain and reported evidence of at least one facet of validity. Most reported evidence of validity from two or more sources, and most reported evidence concerning test content and internal structure (i.e. internal consistency reliability or factor analysis). Other sources of validity were missing from most studies. IMPLICATIONS: More research is needed to investigate the validity of the scores of instruments developed to assess pharmacy students within the affective domain, especially regarding relations to other variables, response processes, and consequences of use.

Relative efficacy of antilipemic agents in non­high-density lipoprotein cholesterol reduction.

The investigators sought to summarize the percentage reduction in non­high-density lipoprotein cholesterol (non-HDL-C) achieved with various antilipemic regimens and to determine whether certain antilipemic regimens have been proven more effective in lowering non-HDL-C. A search of MEDLINE, International Pharmaceutical Abstracts, and Iowa Drug Information Service Database from 1970 to May 2011 was performed. Criteria were used to exclude studies not published in English, studies with methodology limitations, and studies with variables that may affect efficacy beyond the antilipemic agent administered. Only randomized, controlled trials comparing medications approved by the Food and Drug Administration were reviewed to determine whether significant differences in percentage reduction in non-HDL-C had been observed between different medication regimens. A total of 51 trials reported data that could be used to determine the range of percentage reduction in non-HDL-C achieved by select antilipemic regimens. Of these 51 trials, 38 provided head-to-head comparisons of antilipemic regimens. Rosuvastatin and atorvastatin are the most potent 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) in lowering non-HDL-C. Adding ezetimibe, fibric acid derivatives, and omega-3 fatty acids to antilipemic monotherapy may result in further reduction in non-HDL-C. Subjects with certain characteristics (eg, nonwhite) were not prevalent in these studies.

Variety and quantity of professional electives.

OBJECTIVES: To compare the elective courses offered by US colleges and schools of pharmacy to establish a benchmark for individual colleges and schools to use in assessing whether they offer a sufficient amount and variety of electives. METHODS: Internet Web sites of US doctor of pharmacy (PharmD) programs were reviewed to identify the number of elective lecture-based courses and elective advanced pharmacy practice experiences (APPE) offered and required. Elective courses were grouped into categories to determine the variety of offerings. RESULTS: Pharmacy students were required to complete a mean of 7 hours of classroom-based elective courses. Thirty-two lecture-based elective courses were offered per college or school, and the mean number of categories of courses offered was 24. An average of 3 required APPEs was offered within 24 categories. CONCLUSIONS: Pharmacy programs varied in the number of and requirements for elective courses. Most elective courses expanded on what was taught in the required curriculum vs informing on unique concepts or skills.

Review of Gardasil.

Human papillomavirus (HPV) is necessary for the development of cervical cancer. Cervical cancer is the second most common cancer in women worldwide but 80% occurs in developing countries, not countries with Pap screening programs. Pap screening programs in industrialized countries have reduced the incidence of cervical cancer to 4-8/100,000 women. HPV vaccines may be a promising strategy for cervical cancer in women without access to screening programs. In industrialized countries, the benefit of HPV vaccines focuses on individual abnormal Pap test reduction not cancer prevention. The focus of this review is to cover the side effects of Gardasil in perspective with the limited population benefit cervical cancer reduction in countries with organized Pap screening programs. In addition, information about Gardasil benefits, risks and unknowns for individual patient decision making for vaccination is presented. Gardasil offers protection against CIN 2+ lesions caused by HPV 16/18 and against genital warts caused by HPV 6/11 for at least 5 years. Combining Gardasil with repeated cytology screenings may reduce the proportion of abnormal cytology screens and hence reduce the associated morbidity with the subsequent colposcopies and excisional procedures.

Peer tutoring programs in health professions schools.

OBJECTIVE: Peer tutoring programs may be one method of maintaining quality of pharmacy education in the face of growing student enrollment and a small faculty body. A critical review of the literature was performed to ascertain whether peer tutoring programs improve or maintain the academic performance of health care professional students. METHODS: Various electronic databases and abstracts from past American Association of Colleges of Pharmacy's annual meetings were searched to identify pertinent research. Only those articles with quantitative data, an experimental design, and comparative statistical analysis were included for review. RESULTS: Most studies found that peer tutoring had a positive impact on academic performance. These results may not be readily generalizable as there were numerous methodological flaws and limited descriptions of the programs and participants. IMPLICATIONS: Studies with better designs and more detail are needed to answer definitively whether peer tutoring is of benefit. Details of what resources were required should be included in the study to allow the reader to determine the feasibility of the intervention.

Corticosteroids for herpes zoster: what do they accomplish?

For some patients, herpes zoster infections not only result in acute pain but serious consequences, including postherpetic neuralgia and damage to ocular tissues. Some authors have recommended corticosteroids for the treatment of these acute symptoms and complications. The literature concerning the use of corticosteroids for herpes zoster, however, either provides conflicting results or includes recommendations based on clinical experience rather than clinical trials. The author performed a search of the literature to address the question of whether corticosteroids are well tolerated and effective for the treatment/prevention of the acute pain of herpes zoster, postherpetic neuralgia, and/or the ocular complications resulting from herpes zoster. While smaller trials found oral corticosteroids beneficial for preventing postherpetic neuralgia, larger, better designed trials have not found oral corticosteroids to be more efficacious than placebo in preventing postherpetic neuralgia. Trials investigating the effect of oral corticosteroids for the acute pain of herpes zoster have found that corticosteroids provide a statistically significant improvement. Whether these improvements are clinically significant is uncertain. Thus, oral corticosteroids may confer a slight benefit for initial symptoms as long as the patient is not at risk for complications resulting from corticosteroid therapy. Most trials of topical and injectable corticosteroids are limited by several shortcomings. Therefore, topical and most forms of parenteral corticosteroids have yet to be proven effective for the treatment of acute pain or prevention of complications. Two controlled, blinded trials investigating the use of intrathecal corticosteroid administration for intractable postherpetic neuralgia suggest that corticosteroid administration results in a significant improvement in pain. Despite this, several authors have voiced concern over possible serious adverse events with the intrathecal administration of corticosteroids. Intrathecal corticosteroids may provide a benefit for intractable postherpetic neuralgia, but because of risks of serious complications, this is a last-line option and should only be administered by experienced personnel.