The Challenge of Curricular Overload in the Pharmacy Academy.

The American Association of Colleges of Pharmacy Council of Faculties commissioned a task force during the 2021-2022 academic year to examine the problem of curricular overload. As a result of this task force and the Academy-wide discussions around curricular overload, a consensus has formed around the significance of defining and addressing this challenge. Many institutions have begun work on identifying solutions to curricular overload. This theme issue will identify and describe current solutions to curriculum overload that can be implemented at the course, curricular, or Academy level. Future directions are also described. This introduction provides an overview of the theme issue.

Backward Design to Combat Curricular Expansion in a Large, Interdisciplinary, Team-Taught Course.

OBJECTIVE: Recently, there have been calls to action to address curricular expansion, including modifying standards, using curricular analytics, and optimizing interdisciplinary collaboration, all of which focus on program-level changes. The primary objective of this study was to describe how the process of backward design can be used as a strategy to reduce curricular expansion at the individual course level while maintaining student performance and decreasing student and coordinator stress. METHODS: Backward design was applied to a large, interdisciplinary, team-taught pharmacotherapy course to identify opportunities to reduce content volume and align assessment content with course objectives. Didactic content hours were measured and compared with historical controls. Student performance on examinations was measured and compared with previous years. Student feedback on examination alignment and other course-related stressors was gathered via semester-end course evaluations and compared with previous years. Course coordinator reflections before and after implementation were described. RESULTS: The amount of didactic content hours delivered to students decreased by over 37 hours (33%), allowing space for the expansion of application-based practice, study time, and wellness breaks. Student performance on examinations was maintained, while student stress with examination content and the course design was decreased. Coordinators noted less stress and time spent negotiating didactic content time and examination content and alignment with individual instructors. CONCLUSION: Using backward design as a framework to intentionally evaluate didactic content volume and assessment alignment can address curricular expansion while maintaining student learning and decreasing student and instructor stress.

Tracking carbon from subduction to outgassing along the Aleutian-Alaska Volcanic Arc.

Subduction transports volatiles between Earth's mantle, crust, and atmosphere, ultimately creating a habitable Earth. We use isotopes to track carbon from subduction to outgassing along the Aleutian-Alaska Arc. We find substantial along-strike variations in the isotopic composition of volcanic gases, explained by different recycling efficiencies of subducting carbon to the atmosphere via arc volcanism and modulated by subduction character. Fast and cool subduction facilitates recycling of ~43 to 61% sediment-derived organic carbon to the atmosphere through degassing of central Aleutian volcanoes, while slow and warm subduction favors forearc sediment removal, leading to recycling of ~6 to 9% altered oceanic crust carbon to the atmosphere through degassing of western Aleutian volcanoes. These results indicate that less carbon is returned to the deep mantle than previously thought and that subducting organic carbon is not a reliable atmospheric carbon sink over subduction time scales.

How well do we understand our patients' perioperative experience? A qualitative analysis of themes derived from patient-centric resident conferences.

BACKGROUND: Patient-centric resident conferences (PCRCs) provide meaningful time to connect with and learn from patients. This qualitative study explores themes of patients' perioperative experiences from PCRCs through patient and resident perspectives. METHODS: General Surgery residents participated in six PCRCs, which include condensed standard didactics to accommodate a patient panel regarding their perioperative experience. Panel transcripts and resident survey responses describing what they learned were coded using grounded theory methodology. Themes were evaluated and compared. RESULTS: 76 identified codes were grouped into major categories: "Medical/Surgical Knowledge," "Patient Perspective," "Patient-Physician Relationship," and "Communication." Themes from resident responses predominantly paralleled patient discussion, with common themes including "impact of disease and surgery on patient" and "compassion/empathy." "Medical/surgical knowledge" was only present in resident responses while themes regarding quality of life were more frequent in patient transcripts. CONCLUSIONS: PCRCs are a valuable tool in resident education to understand patients' perioperative experiences. Themes from patient panels complement, but do not replace, information covered in didactic lectures.

Improving Knowledge of Top 200 Medications Through Retrieval Practice, Content Alignment, and Autonomous Learning.

Objective. To determine the impact of the holistic redesign of top 200 medications learning activities within a Doctor of Pharmacy (PharmD) curriculum by comparing student performances on a comprehensive examination before and after the redesign.Methods. During a curricular revision at The Ohio State University College of Pharmacy that began with the class of 2020, learning activities involving the top 200 medications were implemented that involved repeated retrieval and mastery concepts, alignment with therapeutic coursework, and autonomous learning regarding the top 200 medications. A high-stakes comprehensive top 200 medications examination was administered to students at the end of their third professional year both before and after implementation of these activities. The difference in the percentage of students who achieved a satisfactory score on the comprehensive examination was compared between cohorts prior to and following the curricular redesign.Results. The study analyzed results from 134, 130, and 120 students from three PharmD classes (one before and two after the redesign of top 200 medications activities). Following the redesign, a higher percentage of students achieved a satisfactory score of 85% on the examination (class of 2020: 116/130, 89.2%; class of 2022: 107/120, 89.2%) compared to before the redesign (class of 2019: 88/134, 65.7%).Conclusion. The combination of repeated retrieval and mastery, alignment with therapeutic coursework, and development of autonomous learning can significantly increase student knowledge and retention of top 200 medications.

Transanal total mesorectal excision outcomes for advanced rectal cancer in a complex surgical population.

BACKGROUND: Total mesorectal excision (TME) is the gold standard for oncologic resection in low and mid rectal cancers. However, abdominal approaches to TME can be hampered by poor visibility, inadequate retraction, and distal margin delineation. Transanal TME (taTME) is a promising hybrid technique that was developed to mitigate the difficulties of operating in the low pelvis and to optimize the circumferential resection and distal margins. METHODS: The objective of this study was to characterize our experience implementing taTME at our institution in a technically challenging patient population. We performed a retrospective review of consecutive patients who underwent taTMEs between November 2013 and May 2019 for rectal cancer at a tertiary community cancer center. Outcome measures included pathologic grading of TME specimen, post-operative complications, and oncologic outcomes. RESULTS: Forty-four patients with mid and low rectal cancer underwent low anterior resection via taTME. The most common staging modality was rectal MRI which demonstrated T3 or T4 tumors in 89% of our patients prior to neoadjuvant. Eighty-six percent of patients underwent neoadjuvant chemoradiation. The initial cases were performed sequentially as a single team, but we later transitioned to a synchronous, two-team approach. Ninety-one percent of TME grades were complete or near complete. Only one patient (2.3%) had a positive circumferential margin. Six patients developed anastomotic leaks with an overall anastomotic complication rate of 18.2%. Two patients (4.5%) with primary rectal cancer developed local recurrence, one of which developed multifocal local recurrence. CONCLUSIONS: Using the taTME approach on selected locally advanced low rectal cancers, especially in technically complex irradiated and obese male patients, has yielded comparably safe and effective outcomes to laparoscopic proctectomy.

Identifying High-Impact and Managing Low-Impact Assessment Practices.

Those in pharmacy education who are tasked with assessment may be overwhelmed by deadlines, data collection, and reporting, leaving little time to pause and examine the effectiveness of their efforts. However, assessment practices must be evaluated for their impact, including their ability to answer important questions, use resources effectively, and contribute to meaningful educational change. Often assessments are implemented, but then attention is diverted to another assessment before the data from the former assessment can be fully interpreted or used. To maximize the impact of assessment practices, tough and uncomfortable decisions may need to be made. In this paper, we suggest an approach for examining and making decisions about assessment activities and provide guidance on building high-impact assessment practices, evolving or "sunsetting" low-impact assessment practices, and managing mandated assessment.

Benign Anal Disease: Implementation of an Educational Program Across Specialties.

BACKGROUND: Benign anal diseases, including hemorrhoids, fissures, abscesses, fistulas, and anal condylomata, affect 10%-15% of our population. Most patients seen by nonsurgical providers experience delayed treatment. We examined at our institution whether an educational session on anorectal diseases would benefit trainees from medical and surgical specialties. MATERIALS AND METHODS: The study took place at Oregon Health & Science University, a primary institutional practice with 130 resident participants. An exploratory study using a 10-point pretest and posttest regarding these diseases was designed and administered to medical subspecialties, including general surgery (GS), emergency medicine, internal medicine, and family medicine, obstetrics/gynecology, and pediatric residents. Intervention was a 50-min presentation highlighting anatomy, history and physical findings, and disease treatment. The posttest was repeated after 6 mo to evaluate retention and overall satisfaction, and differences were evaluated. RESULTS: With the exception of GS, posttest scores improved. Internal medicine improved most significantly. GS residents scored better on the pretest than other specialties; their posttest scores, however, declined. The survey demonstrated residents with prior education scored better on the pretest. PGY-1 and PGY-2 residents improved most on their posttest. On 6-mo retest, 17.6% of residents responded and posttest performance was 72%. CONCLUSIONS: Nonsurgical residents have limited knowledge about benign anal diseases but demonstrate improvement after educational intervention. Surgery residents performed well, but demonstrate regression to the mean, common in test taking, but may also require a more advanced lecture. Formal institutional, regional, and national educational interventions are needed to improve the understanding of these diseases.

Employment Trends for Doctor of Pharmacy Graduates of Research-Intensive Institutions, 2013-2017.

Objective. To determine the current state of employment for doctor of pharmacy (PharmD) graduates based on 5-year trends among graduates of research-intensive institutions and the Pharmacist Demand Index. Methods. Data from a cross-sectional survey of PharmD graduates from 10 research-intensive colleges of pharmacy conducted over a 5-year period were used to generate an overview of graduating students' experiences and the outcomes of their job searches. Results. The average response rate of graduates of programs over the 5 years was 75.4%. Overall, 86% of graduates had postgraduate placements (ie, jobs, residencies, fellowships, further education) at the time of graduation. Across all years, 85% of respondents who had placements indicated they were satisfied with the postgraduation offer they received. Conclusion. An examination of postgraduate outcomes of research-intensive schools and the Pharmacist Demand Indicator over the past 5 years indicates a trend toward a balance between the supply and demand for pharmacists. Careful attention needs to be given to these two metrics moving forward.

Implementation of a medical coding curriculum for surgery residents.

BACKGROUND: Medical coding knowledge is important for practice. We hypothesized that general surgery residents lack confidence in medical coding (MC) and that implementation of focused didactics would increase resident confidence and knowledge. METHODS: A MC curriculum was delivered to general surgery residents covering domains of the global procedural period (GPP), evaluation and management (E/M) coding, and hospital payment and quality metrics (HPQM). A 21-question survey was developed to assess resident comfort coding knowledge. Efficacy of the MC curriculum was measured by anonymous paper pre-test and post-test surveys. RESULTS: Pre-test (n = 50) findings revealed that residents were uncomfortable with MC. Following three MC lectures, the post-test (n = 24) demonstrated significant increases in resident comfort with MC (p < 0.001) and resident performance on domains of GPP (p = 0.014), E/M (p < 0.001), and HQPM (p = 0.025). CONCLUSIONS: Residents feel uncomfortable with MC without formal education. This study supports a focused curriculum to prepare residents for practice.

Clinical Research Using the National Inpatient Sample: A Brief Review of Colorectal Studies Utilizing the NIS Database.

The National Inpatient Sample (NIS) is the largest collection of longitudinal hospital care data in the United States and is sponsored by the Agency for Healthcare Research and Quality. The data are collected from state organizations, hospital associations, private organizations, and the federal government. This database has been used in more than 400 disease-focused studies to examine health care utilization, access, charges, quality, and outcomes of care. The database has been maintained since 1988, making it one of the oldest on hospital data. The focus of this review is to explore and discuss the use of NIS database in colorectal surgery research and to formulate a simplified guide of the data captured for future researchers.

Review of Colorectal Studies Using the National Cancer Database.

The National Cancer Database (NCDB) is a large clinical oncology database developed with data collected from Commission on Cancer (CoC)-accredited facilities. The CoC is managed under the American College of Surgeons, and is a multidisciplinary team that maintains standards in cancer care delivery in health care settings. This database has been used in multiple cancer-focused studies and reports on cancer diagnosis, hospital-level, and patient-related demographics. The focus of this review is to explore and discuss the use of NCDB in colorectal surgery research. Furthermore, our aim for this review is to formulate a guide for researchers who are interested in using the NCDB to complete colorectal research.

Pharmacists opinions of the value of specific applicant attributes in hiring decisions for entry-level pharmacists.

OBJECTIVE: The Hiring Intent Reasoning Examination (HIRE) was designed to (1) explore the relative value of applicant-specific attributes evaluated during the hiring of entry-level pharmacists; (2) examine how each of these attributes influences hiring decisions; and (3) identify which attributes practicing pharmacists perceive as most and least valuable. METHODS: An electronic questionnaire was developed and sent to 36,817 pharmacists; 3723 (11%) responded representing a broad cross-section of practice settings and job roles. Forty-eight attributes were analyzed, 24 character traits and 24 markers of academic success. Respondents identified: 1) the relative importance the possession of each attribute would play in the decision to hire an applicant; 2) the relative importance the lack of possession of the attribute would play on the decision to hire an applicant; 3) the 10 most important attributes used when considering an applicant, and; 4) the 10 least important attributes used when considering an applicant. After investigating the relative importance of the 48 traits, a factor analysis to further group the traits was undertaken. RESULTS: Character traits were consistently ranked higher than academic traits, both in importance and as more likely to effect the hiring decision. Additionally, "the top ten most important attributes" were dominated by character traits and "the top ten least important attributes" used in the hiring of an entry-level pharmacist were dominated by the academic traits. A factor analysis provided further evidence of the distinction of the character traits from the academic success markers. CONCLUSION: When selecting employees from a pool of qualified applicants, the most important attributes used in hiring decision relate to the character of the pharmacist. The results are similar across all practice settings and types of respondents completing the survey.

MiR-486-5p Downregulation Marks an Early Event in Colorectal Carcinogenesis.

BACKGROUND: MicroRNAs are dysregulated in colorectal cancer and subsets correlated with advanced tumor stage and metastasis. Data are lacking on microRNA dysregulation from early to late-stage disease. OBJECTIVE: The purpose of this study was to identify a microRNA signature associated with the primary tumor and metastatic site in stage IV disease and to examine whether the signature is evident in earlier stages. DESIGN: A microRNA profile was generated and then explored in normal colon tissue (n = 5), early stage (stage I and II; n = 10), and late-stage (stage III and IV; n = 14) colorectal primary tumors via polymerase chain reaction to delineate molecular events that may promote colorectal carcinogenesis. SETTING: Genome-wide microRNA expression profiling was performed. PATIENTS: A total of 14 patient-matched stage IV primary colorectal cancer tumors and corresponding liver metastases were included. MAIN OUTCOME MEASURES: MicroRNA array technology was used to identify microRNA expression-predictive metastatic potential in the primary tumor. RESULTS: A distinct 9-member signature group of microRNAs was concurrent in stage IV primary colorectal cancer and their corresponding liver metastases, when compared with surrounding unaffected colon and liver tissue (microRNA-18b, microRNA-93, microRNA-182, microRNA-183, microRNA21, microRNA-486-5p, microRNA-500a, microRNA-552, and microRNA-941). Of the microRNA panel, only microRNA486-5p was differentially expressed in early stage colorectal cancer samples compared with normal tissue (p = 0.001) and additionally differentially expressed between late-stage colorectal cancer samples and normal tissue (p < 0.01). LIMITATIONS: Our microRNA profile was generated in a small subset of patients and will require validation in more samples. CONCLUSIONS: We identified a distinct microRNA signature in primary colon and matched metastatic disease. On additional investigation, 1 microRNA was differentially expressed in both early and late-stage cancer patient samples, and it may herald an early event in colorectal carcinogenesis. This study warrants additional investigation with a larger patient cohort to better understand the effect of microRNAs in carcinogenesis. See Video Abstract at http://links.lww.com/DCR/A723.

Validation of an Instrument for Measuring Professional Behaviors Across Students Enrolled in Allied Health Professional Programs.

Students enrolled in professional education programs preparing for a career in a healthcare need to learn knowledge, skills, and a wide range of professional attributes. However, the nature of clinical and didactic curricula germane to allied health professional programs makes it difficult to find accurate and useful means of measuring knowledge of and the skills associated with professional behaviors. As allied health educators, it is critically important to identify a reliable and effective instrument that can assess professional attributes of students in terms of their knowledge and skill. In the current study, 180 of 189 students (response rate 95.2%) from five allied health pro¬grams completed the online Professionalism Assessment Tool (PAT) to assess their professional attributes. The PAT was analyzed by each domain for internal consistency and by each item for floor and ceiling effects. Each domain met the a priori Cronbach alpha (range 0.90-0.94) and item floor effects were acceptable (range 1.17%-18.75%). Fourteen items in three domains exceeded a priori ceiling effects. Based upon the results of the current study, the PAT, originally created and validated for pharmacy students, appears to address common weaknesses identified in other instruments measuring professional behaviors within other health professional students.

Gastrointestinal Stromal Tumors of the Distal Gastrointestinal Tract.

Gastrointestinal stromal tumors (GISTs) are rare in occurrence, but comprise the most common mesenchymal tumors of the gastrointestinal tract and affect between 15 and 20 individuals per million per year. Due to recent advancements in molecular classification of these tumors, medical therapy has provided improved outcomes to a historically surgically managed disease. This review article briefly discusses the molecular characteristics, medical and surgical therapies, and future of GIST management.

Travel distance influences readmissions in colorectal cancer patients-what the primary operative team needs to know.

BACKGROUND: Many colorectal cancer patients receive complex surgical care remotely. We hypothesized that their readmission rates would be adversely affected after accounting for differences in travel distance from primary/index hospital and correlate with mortality. MATERIALS AND METHODS: We identified 48,481 colorectal cancer patients in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Travel distance was calculated, using Google Maps, and SAS. Multivariate negative binomial regression was used to identify factors associated with readmission rates. Overall survival was analyzed, using Kaplan-Meier and Cox proportional hazard. RESULTS AND CONCLUSIONS: Thirty-day readmissions occurred in 14.9% of the cohort, 27.5% of which were to a nonindex hospital. In the colon and rectal cancer cohorts, readmissions were 14.5% and 16.5%, respectively. Rectal cancer patients had an increase in readmission by 13% (incidence rate ratios [IRR] 1.13; 95% confidence interval [CI] 1.05-1.21). Factors associated with readmission were male gender, advanced disease, length of stay (LOS), discharge disposition, hospital volume, Charlson score, and poverty level (P < 0.05). Greater distance traveled increased the likelihood of readmission but did not affect mortality. Travel distance influences readmission rates but not mortality. Discharge readiness to decrease readmissions is essential for colorectal cancer patients discharged from index hospitals.

StrengthsFinder® signature themes of talent in pharmacy residents at four midwestern pharmacy schools.

BACKGROUND AND PURPOSE: StrengthsFinder® is a widely-used assessment that can be used to help student pharmacists discover their talents (i.e., signature themes [STs]) and develop their leadership skills. The assessment has also been used in pharmacy residents, but the prevalence of various STs in that group has not been compared to those in student pharmacists. EDUCATIONAL ACTIVITY AND SETTING: Residents from four midwestern pharmacy institutions completed StrengthsFinder® 2.0 and received their top five STs. STs were organized and examined by domains (executing, influencing, relationship building, and strategic thinking). StrengthsFinder® data on student pharmacists were obtained from a previously published study. The distribution of the themes and domains was compared between residents and student pharmacists. FINDINGS: Responses from 31 residency program cohorts, including 290 pharmacy residents from a pool of 304 (95.4%) possible respondents, were included in the study. The learner ST was more frequently reported in the top five in pharmacy residents versus student pharmacists (42.8% versus 35.5%, p = 0.022). The woo and communication STs were also more frequently reported in the top five, while the consistency ST was reported less frequently in the top five in pharmacy residents versus student pharmacists (p < 0.05). The executing and relationship building domains had the highest average number of STs (1.58 and 1.56, respectively). DISCUSSION AND SUMMARY: The ST profile of pharmacy residents at residency programs affiliated with four midwestern schools of pharmacy is generally similar to that of pharmacy graduates. However, several STs were more or less prevalent in pharmacy residents. Recognition of these differences may assist residency program directors in marketing and design of programs and ranking of candidates.

Understanding and Resetting Radiation Sensitivity in Rectal Cancer.

OBJECTIVE: The aim of the study was to explore specific microRNAs (miRs) in rectal cancer that would predict response to radiation and identify target pathways that may be exploited for neoadjuvant therapies. SUMMARY BACKGROUND DATA: Chemoradiotherapy (CRT) response is a predictor of survival in rectal cancer. Studies have demonstrated changes in RNA expression correlate with chemoradiation sensitivity across cancers. METHODS: Forty-five rectal cancer patients, partial responders (PR = 18), nonresponders (NR = 13), and complete responders (CR = 14) to CRT, as defined by a tumor regression score, were examined. miRs differentially expressed, using NanoString microArray profiling, were validated with qPCR. We quantified 1 miR and its downstream targets in patient samples. Chemosensitivity was measured in HCT-116, a human colorectal carcinoma cell line, using inhibitors of SHP2 and RAF. RESULTS: miR-451a, 502-5p, 223-3p, and 1246 were the most upregulated miRs (>1.5-fold change) in a NanoString profiling miR panel. qPCR revealed a decrease in expression of miR-451a in NRs. EMSY and CAB39, both downstream targets of miR-451a and involved in carcinogenesis (shown in TCGA) were increased in NRs (qPCR). Both targets are associated with worse survival in colorectal cancer. Inhibition of miR-451a in HCT-116 cells significantly decreased cell proliferation with treatment of SHP2 and RAF inhibitors. CONCLUSIONS: An integrated analysis of rectal cancer miRs may yield biomarkers of radioresistance and offer treatment targets for resensitization.