Evaluation of Patient Adherence to Vaccine and Screening Recommendations during Community Pharmacist-led Medicare Annual Wellness Visits in a Family Medicine Clinic.

Background: The Centers for Medicare and Medicaid Services initiated annual wellness visits (AWV) to reduce healthcare costs and improve preventive healthcare for beneficiaries. Provider time constraints and varying preferences to perform AWVs have limited its clinical implementation in some areas, affording pharmacists an opportunity to expand their role. Objective: To evaluate patient adherence to pharmacist recommendations for vaccinations and preventive screenings in an annual wellness visit service at a family medicine clinic in northeast Mississippi. Methods: This study included patients receiving at least one vaccination or screening recommendation during an AWV. Investigators provided vaccination (influenza, pneumococcal and herpes zoster) and screening (mammograms, DEXA, and colorectal cancer) recommendations based on current guidelines. For services not provided in-clinic, investigators contacted outside facilities 45 days post-visit to confirm adherence to recommendations. Primary endpoints included the composite adherence rate of all recommendations and percentage of patients achieving the 60% goal composite adherence rate. Secondary endpoints included individual vaccination and screening adherence rates. Results: Investigators recommended 715 interventions to a total of 254 patients, of which 239 were completed within 45 days for a 33.4 percent composite adherence rate. 20.1 percent of all participants achieved the goal composite adherence rate (60%). Overall, participants were 30.5 and 41 percent adherent to all vaccinations and preventive screening recommendations, respectively. Conclusion: Pharmacists providing AWVs increased patient access to preventive health recommendations. Although, adherence to recommendations remains a challenge and warrants further study. The findings and limitations observed in this study have identified opportunities for future research to evaluate pharmacist-led AWV services.

Guidance for Qualitative Research Manuscripts in Pharmacy Education.

The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and journals' guidance from related fields were reviewed, and recommendations and resources applicable to qualitative research in pharmacy education were compiled for researchers planning to conduct and publish qualitative research. This review provides recommendations, not requirements, for publication in the Journal and is intended to be a guide, especially for authors and reviewers relatively new to the field of qualitative research. Additionally, researchers planning to publish their qualitative research are advised to review available best practices and standards, such as the Consolidated Criteria for Reporting Qualitative Research checklist and the Standards for Reporting Qualitative Research. Given the diverse methodology of qualitative research, it is important for authors to provide sufficient details and justifications of selected methods for transparency and to report collected results in a manner that allows reviewers and readers to adequately assess the validity of their study and the applicability of the findings.

Residency application content and considerations based on residency director review of a fictitious CV: What really matters?

PURPOSE: This research was conducted to evaluate the influence of a pharmacy residency candidate's prior work or research experience on the potential for selection for an interview. Additionally, residency program directors (RPDs) were asked to evaluate the importance of letters of intent and recommendation, rank the importance of typical curriculum vitae (CV) items along with general preferences, and provide advice for a standout CV. METHODS: This cross-sectional, survey-based study recruited RPDs to review a work-focused or research-focused fictitious residency candidate CV and complete a 33-question survey regarding interest in interviewing the fictitious candidate and their general perceptions of significant factors in interview candidate selection. RESULTS: A total of 456 RPDs responded to the survey, with 229 respondents assigned to evaluate the work-focused CV and 227 assigned to review the research-focused CV. Among RPDs who provided CV evaluations, 81.2% (147/181) of those who reviewed the research-focused CV and 78.3% (137/175) of those who reviewed the work-focused CV gave a positive evaluation (P > 0.05). Work experience and extracurricular activities were considered the most important CV sections, and high-quality advanced pharmacy practice experience (APPE) rotations and pharmacy work experience were perceived to have the highest correlation with success in residency. CONCLUSION: This work supports the importance of candidates creating a well-rounded CV in preparing themselves for residency. Pharmacy-related work experience and high-quality APPE rotations seem to be key in an RPD's opinions of predicted success in a residency program. The CV remains a vital document in the residency candidate review process, and it deserves a high degree of effort in ensuring it adequately reflects professional experiences.

Improving and Expanding Research on Burnout and Stress in the Academy.

Objective. To conduct an integrative review of existing literature evaluating burnout and stress to identify reliable, valid, psychometrically sound survey instruments that are frequently used in published studies and to provide best practices in conducting burnout and stress research within academic pharmacy.Findings. We reviewed 491 articles and found 11 validated reliable surveys to be most frequently cited in the literature that can be used in future burnout and stress research. We also noted frequent misunderstandings and misuse of burnout and stress terminology along with inappropriate measurement. Additionally, we identified a variety of useful websites during the review. Lastly, we identified a relative dearth of published research evaluating organizational solutions to burnout and stress beyond personal factors, ie, resilience.Summary. Burnout and stress among student pharmacists, faculty, and staff is an important research area that necessitates more robust, rigorous evaluation using validated reliable surveys with appropriate contextualization within psychological frameworks and theory. Future research evaluating organizational-level attempts to remedy sources of burnout and stress is also needed.

Impact of Communication Method and Timeliness on Student and Faculty Perception of Professionalism and Value.

Objective. This study sought to evaluate the impact of faculty, preceptor, and student preferences for type of communication received and timeliness of communication on their perceptions of professionalism and personal value.Methods. An anonymous questionnaire was designed to assess pharmacy faculty, preceptor, and students' preferred method of communication, response time expectations, impact on their perception of the sender's professionalism, and personal perception of being valued. The questionnaire was sent to 924 faculty, preceptors, and students.Results. Of the 253 responses received, 27 (11%) were from full-time faculty, 94 (37%) from part-time faculty preceptors, and 132 (52%) from students. Overall, email was the preferred communication method for receiving information that was not time sensitive (98%), with a majority of faculty, preceptors, and students indicating that 48 hours was a reasonable response time. Most participants felt that less than 24 hours was a reasonable response time for texts or phone calls. Most students indicated that response time was somewhat or not impactful (58%) on their view of the faculty or preceptor's professionalism, while faculty and preceptors indicated that response time was neutral or somewhat impactful on their view of the student's professionalism (60%). Most students (77%) indicated that a faculty or preceptor's response time to their text or phone call impacted their perceptions of feeling valued and important.Conclusion. Communication preferences among faculty, preceptors, and students differ. Professionalism related to communication was important to all groups, and timeliness of communication between faculty, preceptors, and students impacted their perception of their value and self-worth.

Evaluating the Efficacy of 3 Recruitment Methods for Enrolling Patients in Chronic Care Management Services: A Pilot Study.

Chronic Care Management (CCM) is a billable service that pharmacists can provide either in person or via telephone in ambulatory clinics or community pharmacies. Pharmacists may use this service to expand current roles in patient care and add billable services to an ambulatory care practice. The number of clinics employing CCM is steadily increasing, and to date, there has been limited information published to aid pharmacists who are considering implementing these services. The purpose of this study is to compare enrollment success in a clinic-based, pharmacist-led CCM service using three recruitment strategies to enroll patients: in person, telephone, and provider referred recruitment. This pilot study examined the success of three recruitment strategies using 94 patients eligible for CCM services in a rural health clinic. The primary outcome was successful enrollment in the CCM program with differences in recruitment strategy enrollment success examined using a Chi-square test. Overall, 42 of 94 patients (45%) were successfully enrolled in the CCM program with no statistical difference appreciated between telephone, in person, and provider referred recruitment. Nearly 33% (14/42) of patients enrolled in person, 40% (17/42) enrolled via telephone, and 26% (11/42) enrolled when referred from a provider. Ten patients (11%) declined enrollment outright. The remaining 42 patients were hesitant to enroll and requested follow up. In conclusion, there was no statistical difference in CCM enrollment success with in person, telephone, or provider referred recruitment, although more patients were enrolled via telephone than with the other two strategies. Pharmacists implementing new CCM programs may tailor their recruitment and enrollment strategy to suit their specific needs.

Evaluation of a novel process for selecting advanced pharmacy practice experiences.

INTRODUCTION: Matching an increasing number of pharmacy students with a limited number of advanced pharmacy practice experience (APPE) sites has become challenging for pharmacy schools. Selective tiered optimization (STO), a process for matching students with competitive APPE electives, was implemented by The University of Mississippi School of Pharmacy (UMSOP) in 2015 to address these concerns. This pilot study sought to evaluate student and preceptor satisfaction with the process. METHODS: Electronic surveys were sent to students enrolled in APPEs and individuals who precepted APPE students at the UMSOP from 2016 to 2019. The surveys were designed to gauge satisfaction with STO's process, goals, utility, and fairness. RESULTS: There were 63 responses from 149 preceptors (42% response rate) and 70 respondents from 314 students (22% response rate). Overall, both students and preceptors expressed satisfaction and found value in participating in STO. Both groups indicated that the benefit they received from participating in STO outweighed the extra effort required. Preceptors indicated that students who participated in STO were of higher quality and more focused, hardworking, and interested than those who did not participate. CONCLUSIONS: Respondents were satisfied with the STO process and experience. The process was perceived by preceptors to be fair for all students and worthwhile for its participants. Our results also demonstrated that this process is effective for easing the competitive APPE selection process. Schools and colleges of pharmacy should consider utilizing this process to alleviate applicable challenges with APPE selection.

Multisite Study Assessing the Effect of Cognitive Test Anxiety on Academic and Standardized Test Performance.

Objective. To evaluate the degree of cognitive test anxiety (CTA) present in student pharmacists at multiple pharmacy programs in the United States and to determine if there are associations between self-reported CTA and relevant academic outcomes.Methods. All 2018-2019 advanced pharmacy practice experience (APPE) students from three US Doctor of Pharmacy (PharmD) programs (N=260) were invited to participate in the study. Participants completed a validated 37-question survey that included the Cognitive Test Anxiety Scale-2 (CTAS-2) along with demographics-related questions. Responses were analyzed using analysis of variance (ANOVA), Kruskal Wallace, and multiple linear regression where appropriate.Results. One hundred twenty-four students (48%) from the three programs participated in the study, and the individual data of 119 (46%) were included in the final analysis. Twenty-two students (18.5%) were classified as having high CTA, 41 (34.5%) as having moderate CTA, and 56 (47.1%) as having low CTA. High CTA predicted a 8.9 point lower NAPLEX total scaled score after accounting for other variables and was also correlated with lower cumulative didactic GPA, performance on the Pharmacy Curriculum Outcomes Assessment (PCOA), and increased likelihood of requiring course remediation.Conclusion. High cognitive test anxiety affects 18% of pharmacy students and may significantly impact their performance on a variety of traditional student success measures, including the NAPLEX. Pharmacy educators should consider further use and adoption of test anxiety measurements to identify and assist potentially struggling students.

Pharmacists need to participate and pay closer attention to the Medicare for All discussion.

It has been a decade since the Patient Protection and Affordable Care Act (ACA) was signed into law. The ACA's reception remains mixed, despite its moderate success in increasing insurance coverage, and discussions of health care reform have not abated. Among ongoing efforts to reform or repeal the ACA, "Medicare for All" appears in several prominent policy proposals. Public opinion polls from across the United States have demonstrated the growing popularity of reform proposals, which has encouraged legislators to be stronger advocates for such changes. Between 2017 and 2020, the 115th and 116th U.S. Congress introduced more than a dozen legislative proposals aimed at health care reform. Unfortunately, the variety and nuance of these legislative proposals have resulted in considerable confusion and division across the nation among health care providers and patients regarding definitions and implications of Medicare for All. This commentary aims to improve pharmacists' understanding of Medicare for All, discuss the possible impact of Medicare for All on pharmacy practice, and serve as a call for U.S. pharmacists to participate in advocacy and reform of the health care system in which they practice. We argue that only through proactive participation in legislative advocacy will the pharmacists' role in patient care continue to evolve. This brief commentary is divided into 5 major sections: (1) support for Medicare for All, (2) definitions of existing Medicare for All policy proposals, (3) estimation of the impact of Medicare for All proposals on the health care system, (4) the pharmacist perspective on the impact of Medicare for All, and (5) recommendations for pharmacy practice and advocacy.

The Impact of COVID-19 Through the Eyes of a Fourth-Year Pharmacy Student.

This commentary, written primarily by a recent pharmacy graduate, discusses the impact of COVID-19 on the class of 2020. Everyone has been impacted by COVID-19, but pharmacy students have been affected by and experienced COVID-19 in unique ways. This was the first class to complete pharmacy practice experiences in an online format, miss out on milestone events including graduation, and face uncertainty about becoming licensed and entering the job market in the midst of a pandemic. However, instead of discouraging them, these events have in many ways strengthened the resilience of the class of 2020. Additionally, COVID-19 has highlighted the importance of continued advocacy for the profession and articulation of the pharmacist's expanded role and value to the health care team, and inspired the class of 2020 to join the ranks of colleagues nationwide in raising awareness in these areas. Nevertheless, uncertainty over their future and that of their peers lingers as COVID-19 has forever changed pharmacy education and practice.

Applying safety lessons from aviation to pre-licensure health professions education: A narrative critical review.

BACKGROUND: Significant numbers of patients continue to be harmed annually by healthcare systems in the United States (US) and around the world. Through a lens of safety, the fields of aviation and healthcare share many similarities in the non-technical skills required by team members, including situational awareness, communication, problem-solving, and leadership. Despite these links and evidence of effective interventions in the clinical setting, there is a lack of a guidance on how to incorporate non-technical skills training into pre-licensure health professions curricula. METHODS: Following guidance for a narrative critical review, a comprehensive literature search was conducted looking for studies incorporating non-technical skills training including crew resource management (CRM) and human factors and ergonomics (HFE) into pre-licensure health professions curricula. RESULTS: Eleven example articles were organized into three broad themes: (1) changing the teaching paradigm around errors, (2) targeted curricular interventions, and (3) interprofessional team training. Several useful tools for evaluating training effectiveness were highlighted, but consistent measures of efficacy for CRM/HFE training are lacking. Interprofessional team training may have the most tangible and broadly applicable link to pre-licensure curricula. IMPLICATIONS: Additional research is needed to identify best practices for consistent incorporation of non-technical skills into pre-licensure curricula. A cultural shift to focus on error management (vs. solely error avoidance) is also needed early in training with development of a common language to discuss patient safety issues and opportunities for improvement across various healthcare settings.

Design, implementation, and evaluation of an online elective course on current topics in pharmacy.

INTRODUCTION: To describe the design and implementation of the Current Topics in Professional Pharmacy online elective course and evaluate the degree to which the course improved student pharmacists' awareness of and interest in current topics affecting the profession of pharmacy. METHODS: A one-credit hour online summer elective included weekly modules of current topics affecting the profession of pharmacy, along with a longitudinal final project in which students created their own current topic module. Each module consisted of assigned reference materials and online discussion forum posts to answer discussion questions and share professional opinions. Student achievement of curricular outcomes and course-specific objectives was measured utilizing pre- and post-course surveys, assessment of weekly module forum posts, and a final course knowledge and comprehension quiz. RESULTS: Student self-rated awareness and desire to stay updated on current topics in pharmacy increased significantly from pre-survey to post-survey (39.7% to 98.3% agree or strongly agree, p<0.001; 25.9-87.9%, p<0.001, respectively). Student confidence in their ability to formulate and effectively express their professional opinion also significantly improved (67.2% to 93.1%, p<0.001). Seven of the 12 course competencies assessed by the survey significantly improved from pre- to post-course. The majority of students agreed or strongly agreed that the course adequately addressed all 12 pre-selected Accreditation Council for Pharmacy Education (ACPE) Appendix B content areas. CONCLUSIONS: Performance assessment and survey results demonstrated achievement of curricular outcomes and course objectives. Students completing the course showed an increased interest and awareness related to current topics affecting the profession of pharmacy.

Measurement of Grit and Correlation to Student Pharmacist Academic Performance.

Objective. To describe grittiness of students from three pharmacy schools and determine if grit is associated with academic performance measures. Methods. Pharmacy students completed an electronic questionnaire that included the Short Grit Scale (Grit-S). Associations were determined using logistic regression. Results. Grit-S total score was a significant and independent predictor for participants who reported a GPA ≥3.5, and Consistency of Interest (COI) and Perseverance of Effort (POE) domain scores were significantly higher compared to participants with a GPA of 3.0-3.49. Participants reporting a D or F had slightly lower average total Grit-S scores and COI domain scores compared to participants who did not. In addition, the group who reported a GPA <3.0 had lower scores in the POE domain compared to those with a GPA of 3.0-3.4. Conclusion. Grittiness may be associated with student pharmacist academic performance and the Grit-S Scale may have substantive implications for use in pharmacy programs.

Collaborative Examination Item Review Process in a Team-Taught, Self-Care Sequence.

OBJECTIVE: To improve examination item quality by educating and involving course instructors in evidence-based item review and encouraging use of this process in future courses. METHODS: A peer-review process was implemented in a 2-course sequence (intervention) that involved training and review sessions before each examination and was compared to the previous year's courses (control). Instructors completed a presurvey and postsurvey on training, experience, self-confidence, and self-rated success in multiple-choice item writing. Statistics were calculated for all items in the control and intervention sequences and compared using independent t tests. Items also were classified into levels based on difficulty and discrimination, and distribution into these levels was compared between sequences with independent t tests. RESULTS: No significant difference was found between control and intervention sequence items with regard to mean difficulty (86.3% and 84.4%) or discrimination (0.23- and 0.25), respectively, although item classification distribution did appear to change between the control and intervention sequences' subjective feelings of confidence, and success in item writing increased between presurvey and postsurvey. Confidence in ability to peer-review test items and to implement a formal item evaluation process also increased. CONCLUSION: Item statistics did not change significantly, but reviewed and edited items distributed more favorably into item statistic-based categories. This method of review positively affected instructors' perceptions of their item-writing confidence and success and improved self-rated opinions of their ability to edit items and train others to do so.

An elective course on application of clinical pharmacy principles.

OBJECTIVE: To design and implement an elective therapeutics course and to assess its impact on students' attainment of course outcomes and level of confidence in applying clinical pharmacy principles and pharmacotherapy knowledge. DESIGN: A 3-credit hour elective for third-year pharmacy students was structured to include problem-based learning (PBL), journal club and case presentations, and drug information activities. ASSESSMENT: Student achievement of curricular outcomes was measured using performance on SOAP (subjective, objective, assessment, plan) notes, case and journal club presentations, drug information activities, and peer evaluations. RESULTS: from a pre- and post-course survey instrument demonstrated significant improvement in students' confidence in applying clinical pharmacy principles. CONCLUSION: Students completing the course demonstrated increased attainment of course outcomes and confidence in their abilities to evaluate a patient case and make pharmacotherapeutic recommendations.

Effects of question formats on student and item performance.

OBJECTIVE: To determine the effect of 3 variations in test item format on item statistics and student performance. METHODS: Fifteen pairs of directly comparable test questions were written to adhere to (standard scale) or deviate from (nonstandard scale) 3 specific item-writing guidelines. Differences in item difficulty and discrimination were measured between the 2 scales as a whole and for each guideline individually. Student performance was also compared between the 2 scales. RESULTS: The nonstandard scale was 12.7 points more difficult than the standard scale (p=0.03). The guideline to avoid "none of the above" was the only 1 of the 3 guidelines to demonstrate significance. Students scored 53.6% and 41.3% (p<0.001) of total points on the standard and nonstandard scales, respectively. CONCLUSIONS: Nonstandard test items were more difficult for students to answer correctly than the standard test items, provided no enhanced ability to discriminate between higher- and lower-performing students, and resulted in poorer student performance. Item-writing guidelines should be considered during test construction.