You'll have to call the attending: Impact of a longitudinal, "real-time" case-based infectious diseases elective on entrustable professional activities to enhance APPE readiness.

BACKGROUND AND PURPOSE: Transitioning from the didactic to experiential setting is challenging for student pharmacists, perhaps due to lack of experiences providing "real-time" clinician interaction. We describe findings from a semester-long infectious diseases (ID) didactic elective that utilized a national cohort of preceptors and faculty across the United States to mimic clinician interaction and "real-time" ID management of various disease states. The mechanics of this elective provide a framework for others to implement to enhance advanced pharmacy practice experience (APPE) readiness. EDUCATION ACTIVITY AND SETTING: Students enrolled in an ID elective course at a school of pharmacy participated in "real-time" acute care scenarios. They assisted in multidisciplinary management of a patient's infection, mimicking "rounds" on an APPE, via interaction with external pharmacist volunteers (playing the roles of other healthcare personnel). Additionally, students formally presented and discussed their cases within the class, further promoting learning while optimizing presentation skills. Pharmacist volunteers were surveyed to assess student performances as measured by four entrustable professional activities (EPAs). FINDINGS: A total of 48 volunteer opportunities occurred during two course offerings. Results from 43 surveys were analyzed (90% response rate). Of those responses, 22/24 (92%) played the role of attending physician, and 19/24 (79%) played the role of technician. Volunteers agreed that students met the four EPAs evaluated (agreement was 85-100%). SUMMARY: This semester-long elective provided "real-time" experience and feedback for pre-APPE students to enhance APPE readiness and reinforce EPAs. Students are likely to benefit from mimicked intra-professional interaction and augmented critical thinking skills that could be adapted to various disease states within pharmacy curricula.

Residency preparation elective courses (and other factors) as predictors of pharmacy residency match rates.

INTRODUCTION: The current demand for pharmacy residencies far exceeds supply. The primary purpose of this study was to determine if presence of a pharmacy residency elective course has an effect on the American Society of Health System Pharmacists Residency Matching Program ("the Match") rates. METHODS: Data from the 2018 residency match were collected. Independent variables such as presence of a residency preparation elective course, residency track availability, school's affiliation with a residency program, interest in residency (as measured by the number of students enrolled in the Match divided by the number of degrees conferred), age of pharmacy school, first-time 2018 North American Pharmacist Licensure Examination pass rates, number of degrees conferred in 2018, funding status, and geographic region were analyzed to determine factors that could affect or had an association with match rates. RESULTS: From 139 accredited pharmacy schools, data from 135 schools of pharmacy were included in this study. The match rate for schools with a residency preparation elective course compared to those without was 61% and 62%, respectively. Following univariate linear regression analysis, availability of a residency course did not significantly affect residency match rates. The covariates of geographic region and funding source were significantly predictive of residency match success. CONCLUSIONS: The presence of a residency preparation elective course in the curriculum did not have a significant effect on 2018 match rates when accounting for various variables. It is uncertain whether enrollment in such an elective would have an effect on match rates.

Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy.

Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 µg/mL at 2 hours and 81 µg/mL at 11.5 hours), which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient's actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.