Longitudinal Measurement of Empathy in Student Pharmacists.

Objective. To assess empathy longitudinally in student pharmacists and describe how it changes during their four years of pharmacy education.Methods. The Jefferson Scale of Empathy Health Professions Student version (JSE-HPS) was completed by a cohort of student pharmacists at the beginning and end of their first year of pharmacy school (P1), then at the end of their second, third, and fourth years of pharmacy school (P2, P3, P4). Demographic data and information about students' previous pharmacy work experience and experience interacting with patients were also collected.Results. Student pharmacists' empathy scores were relatively high at the beginning of P1, comparable to scores reported for medical and other health professions students. Empathy scores declined over the first two years of the pharmacy curriculum but increased during both P3 and P4, recovering to the level observed at the beginning of P1. Factor analysis identified three factors, namely "perspective taking," "compassionate care," and "walking in a patient's shoes" that accounted for 26%, 19%, and 7% of the variance, respectively, and supported the construct validity of the JSE-HPS.Conclusion. Student pharmacists' empathy decreased during the early, primarily didactic years of the pharmacy curriculum but increased during the latter years that emphasize clinical experiences.

The Impact of an Early Clinical Experience on Pharmacy Student Learning About Ambulatory Care Practice.

Objective. To determine whether student confidence in their knowledge of ambulatory care pharmacy and ability to contribute to patient care in this setting increased after participating in an ambulatory care introductory pharmacy practice experience (IPPE), and whether it changed student interest in pursuing a career in ambulatory care pharmacy.Methods. Second-year pharmacy students (n=86) completed a required ambulatory care experience which included four hours of didactic work and 13.5 hours of clinic experience with an ambulatory care pharmacist. Before and after the experience, students completed an eight-question survey in which they rated their confidence in their knowledge of ambulatory care practice and in providing patient care in this setting, as well as their interest in a career in ambulatory care. A five-point Likert scale was used to assess student confidence (1=not at all confident, 5=very confident) and interest in ambulatory care (1=not at all interested, 5=extremely interested). The Wilcoxon signed rank test was used to compare pre-post survey responses.Results. Eighty-five pharmacy students completed both the pre- and post-survey. Median scores on the post-intervention test increased from 3 to 4 in seven of the domains assessed. Student interest in a career in ambulatory care remained unchanged.Conclusion. An ambulatory care IPPE increased student confidence in their understanding of ambulatory care pharmacy practice and caring for patients in this setting.

Evaluating pharmacy student use of ExamSoft strength and opportunity reports.

INTRODUCTION: This paper assesses use of ExamSoft strength and opportunity (S&O) reports amongst doctor of pharmacy students, student perceptions of the reports, and the effect of instructing students on how best to use the reports. METHODS: Second-year pharmacy students enrolled in the medicinal chemistry and pharmacology course sequence completed a baseline survey regarding use of S&O reports in the fall semester. Educational interventions describing best practices on how to use the S&O report were provided to students. A follow-up survey was conducted in the winter semester. RESULTS: Eighty-four percent (69/82) of students returned a valid baseline survey, and 89% (71/80) returned a valid follow-up survey. At baseline, 55% (38/69) always/sometimes downloaded the report; this increased to 68% (48/71) after educational interventions (P = .06). Students who downloaded the report were asked to provide their perceived usefulness of the S&O report. At baseline, 76% (29/38) of students downloading the report rated it as either somewhat/very useful; this increased to 94% (45/48) following educational interventions (P = .002). Fewer students reported not being able to interpret the report post-intervention vs. baseline, although the decrease was not significant (9% vs. 21%, respectively; P = .07). CONCLUSIONS: Our findings indicate that providing students with a downloadable S&O report after exams is beneficial. There was a trend towards increased student use and a significant increase in perceived usefulness of the report following brief educational interventions. Our pilot data suggest that educational interventions on use of S&O reports should be included in student ExamSoft training.

The Drug Shortage Era: A Scoping Review of the Literature 2001-2019.

Drug shortages continue at crisis levels in the United States, with no end in sight. Extensive research in disparate areas has been conducted to explore the impact that shortages have on patients and the healthcare system. We conducted a scoping review to categorize existing work in order to identify opportunities for further research. We considered peer-reviewed and non-peer-reviewed articles involving non-vaccine, human drug shortages in the United States published in English between January 2001 and May 2019. In total, 430 papers were charted according to the following categories: causes, impacts on care, health outcomes, costs, management, prevention, and federal government response. Of these, 112 papers considered causes; 199 discussed effects, 158 considered management strategies, and 140 discussed prevention. We provide a resource to navigate the vast literature on drug shortages in the United States, identifying areas in need of further research. This review highlights the widespread negative effects that drug shortages have on patients, providers, and health system costs in the United States. Evidence of their ramifications should be sufficient to justify policy change. Future work should move from characterizing the problem to working toward solutions to reduce the impact, occurrence, and effects of shortages.

Pharmacy Phamilies as a Component of a Co-Curricular Program for Doctor of Pharmacy Students.

BACKGROUND: Pharmacy student professional growth depends heavily on co-curricular involvement, in addition to classroom learning. Co-curricular programming can be supported by an innovative structure using self-directed learning and a unique mentorship process. INNOVATION: A novel faculty and peer mentorship structure, called Pharmacy Phamilies, is integrated into a credited Lifelong Learning course that spans the 4 years of our PharmD program. This course is comprised of student-chosen activities to meet requirements in six domains, as well as reflections and other assignments. Recent changes include a new Pharmacy Phamily group reflection process and the use of co-curricular logs to document student activities. FINDINGS: Based on a student survey, the majority of respondents were satisfied with their level of engagement with their Pharmacy Phamily (72%) and with their advisor (76%). The majority also reported that the Pharmacy Phamily program is meeting its goals of establishing a sense of community at the college (76%) and enhancing students' professional development (72%). A total of 86% of students preferred the Pharmacy Phamily group reflection over the former six individual reflections and 93% of students agreed the co-curricular log was a useful tool to document involvement in professional activities. CONCLUSION: Pharmacy Phamilies and peer-reviewed, group reflection can provide an inclusive structure of support and social connection for students at the college of pharmacy.

Characterization of Use of the Pharmacy Curriculum Outcomes Assessment Across Accredited Colleges of Pharmacy.

Objective. To characterize use of the Pharmacy Curriculum Outcomes Assessment (PCOA) in terms of timing, manner of delivery, and application of the results by accredited colleges of pharmacy. Methods. Accredited pharmacy programs were surveyed regarding PCOA administration, perceived benefits, and practical application of score reports. Survey items were comprised of new items developed from a literature review and items from prior studies. The survey addressed five domains: program demographics, administration, student preparation, use of results, and recommendations to improve the utility of the PCOA. Results. Responses were received from 126 of 139 (91%) surveyed programs. The majority of respondent programs administered PCOA in one session on a single campus. Most indicated PCOA results had limited use for individual student assessment. Almost half reported that results were or could be useful in curriculum review and benchmarking. Considerable variability existed in the preparation and incentives for PCOA performance. Differences in some results were found based on prior PCOA experience and between new vs older programs. Open-ended responses provided suggestions to enhance the application and utility of PCOA. Conclusion. The intended uses of PCOA results, such as for student assessment, curricular review, and programmatic benchmarking, are not being implemented across the academy. Streamlining examination logistics, providing additional examination-related data, and clarifying the purpose of the examination to faculty members and students may increase the utility of PCOA results.

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.

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.

A Modified Delphi Process to Define Competencies for Assessment Leads Supporting a Doctor of Pharmacy Program.

Objective. To define the competencies for individuals designated as assessment leads in colleges and schools of pharmacy. Methods. Twenty-three assessment experts in pharmacy participated in a modified Delphi process to describe competencies for an assessment lead, defined as the individual responsible for curricular assessment and assessment-related to doctor of pharmacy program accreditation. Round 1 asked open-ended questions about knowledge, skills, and attitudes. Round 2 grouped responses for comment and rating for consensus, which was prospectively set at 80%. Results. Twelve competencies were defined and grouped into 3 areas: Context for Assessment, Managing the Process of Assessment, and Leadership of Assessment Activities. In order to verify the panel's work, assessment competencies from other disciplines were reviewed and compared. Conclusions. The competencies describe roles for assessment professionals as experts, managers, and leaders of assessment processes. They can be used by assessment professionals in self-assessing areas for professional development and by administrators in selecting, developing, and supporting designated leads.

Career Placement of Doctor of Pharmacy Graduates at Eight U.S. Midwestern Schools.

OBJECTIVE: To characterize postgraduation placement plans of 2013 doctor of pharmacy (PharmD) graduates. METHODS: A cross-sectional survey of PharmD graduates from 8 midwestern colleges of pharmacy was designed to capture a comprehensive picture of graduating students' experiences and outcomes of their job search. RESULTS: At graduation, 81% of 2013 respondents had postgraduate plans, with approximately 40% accepting jobs and 40% accepting residencies or fellowships. Eighty-four percent of graduates reported being pleased with offers received, and 86% received placement in their preferred practice setting. Students perceived that securing residencies was more difficult than securing jobs. Students who participated in key activities had a nearly sevenfold increase in successful residency placement. CONCLUSION: While the demand for pharmacists decreased in recent years, responses indicated successful placement by the majority of 2013 graduates at the time of graduation.

Drug shortages: a complex health care crisis.

National tracking of drug shortages began in 2001. However, a significant increase in the number of shortages began in late 2009, with numbers reaching what many have termed crisis level. The typical drug in short supply is a generic product administered by injection. Common classes of drugs affected by shortages include anesthesia medications, antibiotics, pain medications, nutrition and electrolyte products, and chemotherapy agents. The economic and clinical effects of drug shortages are significant. The financial effect of drug shortages is estimated to be hundreds of millions of dollars annually for health systems across the United States. Clinically, patients have been harmed by the lack of drugs or inferior alternatives, resulting in more than 15 documented deaths. Drug shortages occur for a variety of reasons. Generic injectable drugs are particularly susceptible to drug shortages because there are few manufacturers of these products and all manufacturers are running at full capacity. In addition, some manufacturers have had production problems, resulting in poor quality product. Although many suppliers are working to upgrade facilities and add additional manufacturing lines, these activities take time. A number of stakeholder organizations have been involved in meetings to further determine the causes and effects of drug shortages. A new law was enacted in July 2012 that granted the Food and Drug Administration additional tools to address the drug shortage crisis. The future of drug shortages is unknown, but there are hopeful indications that quality improvements and additional capacity may decrease the number of drug shortages in the years to come.

Reenvisioning assessment for the Academy and the Accreditation Council for Pharmacy Education's standards revision process.

Assessment has become a major aspect of accreditation processes across all of higher education. As the Accreditation Council for Pharmacy Education (ACPE) plans a major revision to the standards for doctor of pharmacy (PharmD) education, an in-depth, scholarly review of the approaches and strategies for assessment in the PharmD program accreditation process is warranted. This paper provides 3 goals and 7 recommendations to strengthen assessment in accreditation standards. The goals include: (1) simplified standards with a focus on accountability and improvement, (2) institutionalization of assessment efforts; and (3) innovation in assessment. Evolving and shaping assessment practices is not the sole responsibility of the accreditation standards. Assessment requires commitment and dedication from individual faculty members, colleges and schools, and organizations supporting the college and schools, such as the American Association of Colleges of Pharmacy. Therefore, this paper also challenges the academy and its members to optimize assessment practices.

Impact of drug shortages on U.S. health systems.

PURPOSE: A study was performed to quantify the personnel resources required to manage drug shortages, define the impact of drug shortages on health systems nationwide, and assess the adequacy of information resources available to manage drug shortages. METHODS: An online survey was sent to the 1322 members of the American Society of Health-System Pharmacists who were identified as directors of pharmacy. Survey recipients were asked to identify which of the 30 most recent drug shortages listed affected their health system, to identify actions taken to manage the shortage, and to rate the impact of each shortage. Employees responsible for completing predefined tasks were identified, and the average time spent by each type of employee completing these tasks was estimated. Labor costs associated with managing shortages were calculated. RESULTS: A total of 353 respondents completed the survey, yielding a response rate of 27%. Pharmacists and pharmacy technicians spent more time managing drug shortages than did physicians and nurses. There was a significant association between the time spent managing shortages and the size of the institution, the number of shortages managed, and the institution's level of automation. Overall, 70% of the respondents felt that the information resources available to manage drug shortages were not good. The labor costs associated with managing shortages in the United States is an estimated $216 million annually. CONCLUSION: A survey of directors of pharmacy revealed that labor costs and the time required to manage drug shortages are significant and that current information available to manage drug shortages is considered suboptimal.

Lutein and zeaxanthin for macular degeneration.

PURPOSE: The effects of increasing lutein and zeaxanthin dosages in people with age-related macular degeneration (AMD) are discussed. SUMMARY: AMD is a disorder of the macula, the area associated with the sharpest visual acuity. AMD is classified as dry (nonneovascular) or wet (neovascular) and is associated with several risk factors, the biggest being age. The pathogenesis of AMD is unknown. Like many chronic illnesses, prevention is a key factor for managing AMD. Lutein and zeaxanthin, natural xanthophylls not synthesized by the human body, have been investigated for their use in promoting visual health. Lutein and zeaxanthin are dietary carotenoids that are components of a normal diet. The mechanism of protection that they confer is unknown, but two mechanisms have been hypothesized. Several studies have been conducted to assess the relationship between plasma levels of lutein and zeaxanthin and the risk of developing AMD and have yielded conflicting results. Increased dietary intake of or supplementation with lutein and zeaxanthin was found to result in increased plasma levels, which were positively and significantly associated with macular pigment optical density. Limited data have suggested that supplementation may also improve visual function. The optimal dose of lutein and zeaxanthin for the prevention or treatment of AMD has not yet been defined. CONCLUSION: A definite association between lutein and zeaxanthin supplementation and clinical benefit has yet to be shown; however, it may still be an appropriate cautionary measure for patients at high risk for developing AMD.