Evaluating the Need for Competency-Based Pharmacy Education (CBPE): The Report of the 2023-2024 Academic Affairs Standing Committee.

The 2023-2024 Academic Affairs Committee was charged to 1) Create a sense of urgency around the concept of Competency-Based Pharmacy Education (CBPE); 2) Develop a "readiness for change" instrument that is based on the five essential elements that make up the definition of CBPE. This report describes the process undertaken by the committee to determine the societal needs of pharmacists and current state of pharmacy practice and pharmacy education. Practice gaps in pharmacy education and key drivers needed to close these gaps are evaluated. In order to complete the charges, the committee conducted evidence-based literature reviews and completed a series of focus groups with stakeholders and thought leaders with experience in competency-based education (CBE).

Evaluation of Student Academic Performance After Curricular Content Reduction.

OBJECTIVE: To evaluate the effect of curricular content reduction in an integrated course sequence spanning 3 years of a Doctor of Pharmacy curriculum on student examination scores and course grades. METHODS: This 2-year, prepost study compared student overall average and final examination scores and overall course grades after the transition from a 5-day to a 4-day week of an integrated learning experience (ILE) course sequence. In addition, an anonymous, optional 23-item survey was distributed to first to third year pharmacy students asking about the 4-day week change, how they utilized the non-ILE day, and additional demographic and social characteristics to identify factors influencing success on examination and course performance during the 4-day week. RESULTS: There were 533 students included in the overall analysis, with no significant differences in overall course grades in the 5-day vs 4-day week. Examination scores were not significantly different after the transition, except in 2 of 12 courses where scores were higher and final examination scores were not significantly different, except for higher final examination scores in 1 course during the 5-day week. Significant positive influencers of top quartile of examination performance included prepharmacy grade point average ≥ 3.5, age 25 to 29 years, and prepharmacy coursework at the parent institution, whereas using the non-ILE day primarily to sleep negatively influenced outcomes. CONCLUSION: Curricular density is a prevalent problem and addressing it at a program level is essential. Reducing curricular content and hours at our institution did not adversely impact student examination and course performance and slight improvement was noted in some areas.

The Need for Competency-Based Education.

OBJECTIVES: While pharmacy education updates learning as new information arises, changes to learning experiences can trail behind current practices and technology. There have been multiple calls for radical changes in how health professions education is delivered to ensure patients are receiving high-quality care. Competency-based education has been one way discussed in the literature for how to handle this need to develop students who have a willingness to learn and can problem-solve. The goal of this review is to examine whether competency-based education is needed to drive the profession of pharmacy forward. FINDINGS: To address, we collaboratively identified stakeholder perspectives to evaluate the need. The following stakeholders achieved consensus among the committee members: patients/society, learners, workplace/profession, and academic institutions. SUMMARY: Based on those perspectives, needs, and gaps to address those needs were identified and are presented in this review.

Examining Competency-Based Education Through the Lens of Implementation Science: A Scoping Review.

OBJECTIVES: This study aimed to identify evidence for the implementation and assessment of competency-based education (CBE) in health professions curricula using an implementation science framework. FINDINGS: Using the PRISMA framework, a systematic review of the literature applying a prespecified and piloted search strategy from 2017 to the present in PubMed and CINAHL was performed. References identified from the search strategy were imported into Covidence for title and abstract screening and full-text review by 2 researchers. A third researcher resolved discrepancies. Data were extracted and synthesized to identify key elements from the article related to implementation science, with a quality appraisal. A total of 25 studies out of 304 initially identified records were included. The studies covered a broad range of health professions and countries. Key findings were limited use of implementation science elements, including variability in CBE implementation, limited fidelity assessment, and partial examination of the process continuum. Programs with a more robust implementation approach have a team-based strategy to lead, implement, and support CBE. Motivation and training of faculty are also key components of successful CBE implementation. SUMMARY: Competency-based education is implemented differently across institutions, with variation among programs in their choice of elements of implementation science used. Further research is needed to examine CBE from an implementation science perspective and address remaining questions.

Competency-based pharmacy education definition: What components need to be defined to implement it?

OBJECTIVES: This study aimed to define the essential elements in the proposed competency-based pharmacy education (CBPE) definition, provide the key defining components of each essential element on the basis of educational theory and evidence, and define how the essential elements meet the identified needs for CBPE. METHODS: best-practice integrative review was conducted as part of the work of the American Association of Colleges of Pharmacy CBPE Task Force to define the essential elements in the CBPE definition and how these elements fit with the need for CBPE. The definition was compared with other published competency-based education definitions across K-12, higher education, medical education, and veterinary education. Task Force members then met to develop a consensus on the core components of the 5 essential elements in the definition. Next, the Task Force evaluated the fit of CBPE by matching the identified needs, discussed in detail elsewhere, across each of the stakeholder perspectives with the core components of the 5 essential elements in the derived definition of CBPE. FINDINGS: Upon review of the proposed CBPE definition, the Task Force identified 5 essential elements. These elements include the following: meeting health care and societal needs, outcomes-based curricular model, de-emphasized time, learner-centered culture, and authentic teaching and learning strategies aligned to assessments. SUMMARY: This article helps to establish a common language for CBPE by defining the essential elements of the core components of the definition, and provides a starting point for further exploration of CBPE.

Recommendations and Next Steps For Competency-Based Pharmacy Education.

In July 2021, the chairs of the American Association of Colleges of Pharmacy Council of Deans, Council of Faculties, and Council of Sections developed a task force to discuss potential ways to improve pharmacy education. The Competency-Based Education (CBE) Joint Task Force was created to explore the pros and cons of advancing a competency-based approach to pharmacy education (CBPE) and to determine ways to create more flexibility within pharmacy curricula to enable CBE. To achieve these goals, the Task Force systematically reviewed available resources and outlined the pros and cons of CBPE, best practices for implementation, strategies to minimize barriers, and recommendations on whether CBE should be implemented in pharmacy education. This commentary summarizes the Task Force's findings regarding whether CBPE is a suitable approach for pharmacy education and the next steps if implemented.

Exploring standardized persons' expectations for practice-readiness among student pharmacists.

INTRODUCTION: Although patient expectations and preferences for healthcare selection have been described in the literature, there are no studies exploring what qualities and behaviors standardized persons (SPs) identify for the practice-ready pharmacist. This manuscript explores those qualities and behaviors within an objective structured clinical examination (OSCE) to determine SP interest in having the student as their pharmacy provider. METHODS: Using open-ended questions via a Qualtrics survey, SPs were asked to provide qualities and behaviors they associated with each of three practice-readiness rating levels. Using a constant comparative approach, the researchers coded the collected data over multiple stages to allow for authentic reflection and interpretation of the data. Coders used both inductive and deductive processes prior to establishing a unified understanding and corresponding codebook. RESULTS: A total of 55 SPs (61.1% response rate) participated in the survey, with the majority of participants working for the organization no more than two years (58.2%). Through the coding process, several major themes emerged across each of the three ratings including professionalism, patient-centered skills, communication, and preparation. Findings indicated the differences in ratings were influenced by the degree that students demonstrated each theme. CONCLUSIONS: Overall, these findings provide a better understanding of the qualities and behaviors SPs associate with student pharmacists completing OSCEs acting as practicing pharmacists. However, additional research is needed to determine if the same qualities and behaviors would be viewed as essential with SPs at other academic institutions.

Assessment of student performance on a mock new prescription counseling session and an objective structured clinical examination across five years.

INTRODUCTION: New prescription counseling (NPC) provides vital information to patients regarding newly prescribed medications to improve treatment outcomes. This evaluation's goals were to describe the implementation of teaching and assessment methods incorporated into an NPC module across two courses at Auburn University and evaluate student performance on assessments of NPC skills over five years. METHODS: Assessments included self and peer evaluations of a recorded mock NPC session, NPC objective structured clinical examination (OSCE), and overall course grade. Scores were analyzed over a five-year period (2012 to 2016) to evaluate mean student performance in each of four domains (gathering information, communication, management strategies, and monitoring and follow-up) and overall for each assessment. Pearson's correlation coefficients between these scores were calculated by combining all five years of data. RESULTS: Seven-hundred thirty-three students were included in the analysis. No trends in mean domain and total assessment scores were noted across years. Self and peer evaluation domain and total scores were significantly, though moderately, correlated across assessments (r = 0.43-0.51), except in the communication domain (r = 0.12). Overall, NPC OSCE total scores were not correlated with NPC recording self or peer evaluation total scores (r = 0.06 and r = 0.11, respectively). Assessment total scores were all moderately correlated with overall course grades. CONCLUSIONS: Utilization of a scaffolding approach with class discussion, demonstration, role-play, self and peer evaluation, and OSCEs, is an effective means of building student competence in patient counseling for the NPC context.

Identifying future pharmacists: Development and implementation of a pharmacy camp experience.

INTRODUCTION: Hands-on learning continues to serve as a positive mechanism for gaining interest and increasing recruitment in the health professions. This paper explores the Harrison School of Pharmacy's (HSOP) development and implementation of a week-long pharmacy camp designed to engage learners through active learning experiences to provide early exposure to the pharmacy profession. METHODS: The planning committee was formed in fall 2016, with the inaugural camp occurring summer 2017. A partnership with Auburn University Youth Programs allowed the committee to utilize existing university infrastructure and resources. Designed to expose campers to a variety of practice settings, the curriculum immersed participants in active learning experiences that allowed them to learn more about the clinical skills and knowledge needed for practice. To create diverse and learner-centric experiences, the planning committee recruited current second- and third-year student pharmacists to serve as counselors and peer instructors for all camp activities. RESULTS: Over two years, the camp hosted 40 campers representing nine states. Campers were predominantly female (65.3%), an average age of 16.8 years, and 16% were from diverse backgrounds. Camper feedback found overall satisfaction with the camp was high, with most indicating they attended camp to learn more about the pharmacy profession, specifically the school. As of spring 2019, 20% of total campers had applied and been accepted into the HSOP's Early Assurance Program. CONCLUSIONS: While early findings are good, the true value of the camp will be found over time as the committee explores if more students are choosing pharmacy as a career.

Exploring the Impact of Participating as Pharmacy Camp Counselors on Student Pharmacists' Professional Identity.

Objective. To explore how participation as a pharmacy camp counselor impacted pharmacy students' professional identity and views on professionalism. Methods. A pharmacy camp was developed to introduce rising high school juniors and seniors to the pharmacy profession. First- and second-year student pharmacists were invited to serve as counselors and, afterward, to participate in a focus group to share their experiences. Researchers used the focus group data to explore the impact of the camp experience on the student pharmacists. A direct interpretation approach was used to examine data as it allowed the research team to assess this single instance and draw meaning from focus group findings. Categories/themes were constructed through the interpretations of patterns and relationships discovered within the deconstructed results. Results. Ten student pharmacists participated in the focus group. The students provided their perspectives on the camp experience, including their role as camp counselors, the campers attending the camp, and the differences observed between student pharmacists and non-pharmacy camp counselors. Student pharmacists' comments gravitated toward the topic of professionalism. Student pharmacist counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts. Conclusion. Inclusion of student pharmacists in leadership roles such as this proved to be an effective means for further developing professional attributes. The focus group feedback provided novel insights into the professional mindset of student pharmacists. After serving as camp counselors, student pharmacists described their new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists.

Assessing student pharmacist communication skills: Development and implementation of a communication rubric.

PROBLEM DESCRIPTION: Communication between healthcare providers and those they serve has become increasingly important as the need to prevent and manage chronic conditions has increased. To adequately learn these skills, future healthcare providers must be trained and assessed prior to entry into practice. QUALITY IMPROVEMENT METHODS: With the implementation of an integrated curriculum, the Harrison School of Pharmacy developed a communication rubric to assess student pharmacists' patient communication skills. Developed over five stages, the communication rubric contained seven criteria with three standards or performance levels. Prior to finalizing the rubric, faculty tested the rubric with 56 standardized persons (SPs) to determine its readability, functionality, and grader consistency, and also collected student perceptions of the rubric for feedback purposes. RESULTS OF CQI INQUIRY: At the conclusion of the 2017/18 academic year, 66.5% of second- and third-professional year students (P2s and P3s) somewhat agreed to strongly agreed that reviewing the rubric helped improve their overall patient communication; 65% of students felt that feedback was more substantial than the previous checklist. Of the P3s surveyed, 73% indicated that they preferred the new rubric. INTERPRETATION AND DISCUSSION: The integration of the new communication rubric allowed for richer, and more meaningful feedback. The addition of multiple performance levels allowed students to focus on specific areas for improvement. CONCLUSIONS: The communication rubric was successfully integrated into the curriculum, particularly with objective structured clinical examinations. With its integration into other curriculum areas, the communication skills of student pharmacists may be further enhanced.

Evolution and expansion of a resident teaching and learning program sponsored by a school of pharmacy.

PURPOSE: The evolution and expansion of a school of pharmacy-sponsored resident teaching and learning program (RTLP) are described. SUMMARY: Since its establishment in 2012, Auburn University Harrison School of Pharmacy's RTLP has grown to include up to 12 residency programs in Alabama and on the Gulf Coast of Mississippi and Florida. Program requirements include seminar attendance, teaching experiences and observations, and development of an electronic teaching portfolio. Residents are provided support and guidance from an assigned faculty mentor and from chosen teaching mentors in each teaching activity. A program satisfaction survey was developed to assess residents' reasons for RTLP participation and their views on the manageability of program requirements, the level of residency program support received, the usefulness of seminar content, and other aspects of the program. Resident feedback has been used by RTLP coordinators to modify and refine program requirements. Major changes have included a switch to alternative information delivery mechanisms, clarification of mentor roles and responsibilities, and a transition from longitudinal seminars to intensive workshop days. At the end of the 2016-17 residency year, the RTLP had hosted a total of 66 residents from 12 different residency programs, with a 93.9% retention rate and a more than 3-fold increase in total resident enrollment. CONCLUSION: Evolution of a school of pharmacy-sponsored RTLP was essential to meet the growing needs of affiliated residency programs while optimizing faculty resources.

Outcomes of Individualized Formative Assessments in a Pharmacy Skills Laboratory.

OBJECTIVE: To determine the effectiveness of an individualized teaching method in a pharmacy skills laboratory. DESIGN: All third-year students enrolled in an Accreditation Council for Pharmacy Education (ACPE) accredited doctor of pharmacy program (n=150) received an individual formative assessment from clinical pharmacists on communication skills and clinical competency after the students counseled standardized mock glaucoma patients during a laboratory focused on alternative dosing formulations. Objective structured clinical examination (OSCE) scores for this station from the 2012 and 2013 classes were compared before and after the intervention. ASSESSMENT: Ophthalmic OSCE station scores were higher after the individual formative feedback intervention. Students in 2013 had a mean score of 83.2 ± 8.3% compared to a mean of 74.3 ± 12.9% in 2012 for this OSCE station. The percentage of students receiving an "A" on the OSCE station increased from 8.1% to 31.3% after the intervention. CONCLUSION: Individualized formative teaching methods benefited students in both their communication skills and clinical assessment. Future research should focus on wider implementation and overcoming obstacles, such as increased facilitator needs.

Elevated hepatic transaminases associated with the use of interferon alfacon-1 and ribavirin.

PURPOSE: The case of a patient with hepatitis C who developed elevated hepatic transaminase levels associated with the use of interferon alfacon-1 and ribavirin is described. SUMMARY: A 55-year-old Caucasian man arrived at a hepatitis C clinic to discuss alternative treatment options for his hepatitis C virus (genotype 1a) infection, which did not respond to a 48-week course of peginterferon and ribavirin therapy. He was subsequently treated with interferon alfacon-1 9 microg subcutaneously daily plus ribavirin 200 mg orally twice daily. During treatment with interferon alfacon-1, he developed elevated hepatic transaminase levels despite a decrease in viral load. His hepatic transaminase levels returned to baseline when interferon alfacon-1 was discontinued and rose again upon rechallenge. Ribavirin was not the likely cause of the increase in transaminases since the patient previously tolerated it in combination with peginterferon. While activation of autoimmune hepatitis is a potential cause of acute decompensation in patients treated with interferons, it was not believed to be the case in this patient. Interferon alfacon-1 was determined to be the probable cause of the rise in hepatic transaminase levels in this patient, since his levels declined when therapy was discontinued and rose dramatically once it was restarted. This case illustrates the importance of monitoring both viral loads and hepatic transaminase levels in patients with hepatitis C being treated with interferon therapy. CONCLUSION: A patient with hepatitis C developed elevated hepatic transaminase levels despite showing an improvement in viral load after receiving interferon alfacon-1 and ribavirin.

The role of vildagliptin in the management of type 2 diabetes mellitus.

OBJECTIVE: To highlight the role of incretin hormones in the management of type 2 diabetes mellitus with a focus on vildagliptin, a dipeptidyl peptidase IV (DPP IV) inhibitor currently in development. DATA SOURCES: Searches were conducted in MEDLINE (1950-April 2007) and International Pharmaceutical Abstracts (1970-April 2007) using the key words vildagliptin, LAF237, and dipeptidyl peptidase IV inhibitor. Additional data were obtained from abstracts presented at the American Diabetes Association Scientific Sessions (2003-2006) and from the manufacturer. STUDY SELECTION AND DATA EXTRACTION: Articles pertaining to the pharmacology, pharmacokinetics, safety, and efficacy of vildagliptin for the treatment of type 2 diabetes were reviewed for inclusion. When available, human trials were included over animal studies. DATA SYNTHESIS: Reduced incretin effect is thought to be associated with type 2 diabetes. Glucagon-like peptide-1 (GLP-1), an incretin hormone, stimulates postprandial insulin release; however, it is rapidly degraded by DPP IV. Studies evaluating the use of vildagliptin in patients with type 2 diabetes found significant decreases in DPP IV and increased GLP-1 activity 45 minutes after dosing. Glucagon levels were reduced, with little to no change in insulin levels. With vildagliptin doses ranging from 25 mg daily to 100 mg twice daily, researchers observed consistent reductions in fasting plasma glucose, 4 hour postprandial glucose, and hemoglobin A1c. Similar benefits were seen when vildagliptin was used in combination with metformin. Vildagliptin was well tolerated after 12 weeks; however, incidences of hypoglycemia increased with longer study duration. Optimal results with minimal adverse effects were achieved with 25 mg twice daily and 50 mg once daily doses. CONCLUSIONS: Vildagliptin represents a safe and effective new approach to targeting GLP-1 deficiencies in patients with type 2 diabetes by inhibiting DPP IV.

Pramlintide for the treatment of diabetes mellitus.

OBJECTIVE: To provide an overview of the role of amylin, as well as that of pramlintide, a synthetic analog of amylin, in maintaining glucose homeostasis; and discuss the pharmacology, pharmacokinetics, efficacy, adverse effects, and role of pramlintide in the control of postprandial hyperglycemia. DATA SOURCES: The data presented in this review were obtained from published literature, abstracts presented at scientific meetings, and information on file with the manufacturer. MEDLINE searches (1986-March 2003) using the search terms pramlintide and amylin were conducted to identify clinical trials and review articles. Additionally, the bibliographies of the identified articles were reviewed. DATA SYNTHESIS: Clinical trials have demonstrated that amylin in combination with insulin controls postprandial glucose levels by decreasing food intake, slowing gastric emptying, and suppressing glucagon secretion. Clinical trials also showed significant decreases in mean plasma glucose levels and glycosylated hemoglobin, as well as the added benefits of weight loss and reduction in insulin doses. The most commonly reported adverse effects associated with pramlintide in clinical trials were gastrointestinal complaints and hypoglycemia, which occurred most frequently during initiation of therapy. CONCLUSIONS: The administration of insulin alone often does not result in optimal metabolic control. The treatment of amylin deficiency, in addition to insulin deficiency, may be warranted in order to obtain glucose homeostasis. The role of pramlintide, an amylin analog, will become clearer as more clinical data become available.