Impact of Pre-Advanced Pharmacy Practice Experience (APPE) Curriculum on Student Pharmacists' Professional Identity Formation.

OBJECTIVE: To (1) evaluate changes in student pharmacists' professional identity during a curriculum prior to advanced pharmacy practice experiences (APPEs) and (2) describe the components of a pre-APPE curriculum that positively and negatively influenced students' professional identity formation (PIF). METHODS: The University of Washington School of Pharmacy launched a new curriculum in 2019 featuring components intentionally designed to support students' PIF. The Macleod-Clark Professional Identity Scale (MCPIS) was administered to the class of 2023 before starting pharmacy school (pre) and upon completion of the pre-APPE curriculum (post). The postsurvey also contained 2 open-response questions asking students to identify the most positive and negative influences on their PIF. Mean pre- and post-responses were calculated for all MCPIS items and each MCPIS item and compared using paired t tests. Responses to the open-ended questions were sorted into categories using inductive thematic analysis and frequencies were calculated. RESULTS: A total of 99 students (96%) completed both surveys. Mean MCPIS pre-scores and post-scores were both 3.3, indicating no statistically significant change in professional identity. The most frequently reported positive influences on PIF were didactic coursework (40%), experiential learning (30%), and student organizations (27%). The most frequently reported negative influences were didactic coursework (27%), none (25%), and perceptions of the pharmacy profession (22%). CONCLUSION: Students' overall professional identity, as measured by the MCPIS, did not change during the pre-APPE curriculum. Didactic coursework had the most common positive and negative influence on professional identity prior to APPEs.

A scoping review of direct oral anticoagulant ambulatory management practices.

Models of care for managing direct oral anticoagulant (DOAC) therapy are evolving. Little is known of what services are provided by anticoagulation managements services (AMS) for DOACs, or what necessitates comprehensive DOAC management and what differentiates it from usual care. The purpose of this scoping review was to describe services, management, or monitoring of DOACs distinct from prescriber-managed or usual care of DOACs. This scoping review reported followed the 2018 Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping reviews (PRISMA-ScR). We searched PubMed, CINAHL, and EMBASE from inception to November 2020 to identify articles of interest. No language restriction was applied. Articles were included if they provided a description of DOAC management services, and described longitudinal anticoagulation follow-up that occurred in ambulatory care, community, or outpatient-related settings. Data was extracted from a total of 23 articles. The specific types of DOAC management interventions provided varied across the included studies. Nearly all studies described some form of DOAC therapy appropriateness assessment. Other common interventions included assessments of DOAC therapy compliance, adverse event triage and management, assessment of DOAC dosing appropriateness, periprocedural management of DOAC therapy, educational interventions, and renal function monitoring. A variety of DOAC management interventions were identified, but additional studies are needed to help health systems decide whether specific interventions performed by dedicated services are preferred over the usual care provided by clinicians prescribing DOAC therapy.