A Call to Action for Integrating Introductory Pharmacy Practice Experiences With Purpose.

Introductory pharmacy practice experiences (IPPEs) are essential to exposing students to contemporary pharmacy practice and promoting advanced pharmacy practice experience readiness. An IPPE curriculum should be sequenced and progressive, with IPPE experiences built upon each other and coordinated with the didactic curriculum. Pharmacy programs are faced with several internal and external challenges that can influence the design and implementation of their IPPE curriculum. Periodic IPPE curricular review is imperative as new challenges arise and existing challenges abate. Pharmacy programs should use a systematic and holistic process to evaluate and revise their IPPE programs. It is an opportune time to begin this process, with new standards being released in 2024. This commentary describes common challenges associated with integrating a high-quality IPPE program into a Doctor of Pharmacy curriculum along with potential solutions, with the intention for individual programs to use this as a tool to guide IPPE evaluation and revision.

Evaluation of a Patient Education Game Design Activity.

BACKGROUND: Game-based learning has been used in pharmacy education settings with the instructor developing a game for students to play to enhance learning. However, there is a paucity of data about health sciences students designing a game themselves to further their understanding of a complex topic. The purpose of this study was to describe and assess a game design activity focused on patient education of anticoagulants in a pharmacotherapy skills laboratory setting. INNOVATION: Second-year pharmacy students enrolled in a pharmacotherapy skills laboratory course worked in teams in a one-hour active learning activity to design a game intended to educate patients about their medication. A pre/post analysis of student attitudes about game-based learning and the activity, as well as knowledge, was conducted. FINDINGS: The large majority of students (80.5%) agreed that the activity was an effective way to develop patient education strategies. Through the survey and free-response questions, students reported that the game design activity facilitated positive group collaboration and allowed students to take the perspective of their patients. Students also requested additional time to complete the activity. Knowledge assessment scores of key patient education points increased from 66.5% prior to the activity to 71.5% one week following the activity (p<0.05). CONCLUSION: The game design activity served as a novel teaching method for pharmacy students to actively learn about anticoagulant medications while developing an innovative patient education strategy. Although there was an increase in knowledge scores, students highlighted the impact on group collaboration and taking the perspective of their patients.

Design and Assessment of Telepharmacy and Telehealth Training in Two Pharmacy Programs.

Objective. To develop and assess the impact of a learning module through the evaluation of students' knowledge of, perceptions of, and intent to provide telepharmacy and telehealth services.Methods. Second- and third-year students from two schools of pharmacy completed a telepharmacy and telehealth learning module and discussion questions. A postsurvey measured their knowledge, perceptions of, and intent to provide remote services.Results. Students scored an average of 94.8% on a post-knowledge assessment. The theory of planned behavior was used to develop a survey measuring intent to provide remote services. Mean scores (1=strongly disagree to 4=strongly agree) were attitude (mean=3.18, SD=0.36), subjective norm (mean=3.02, SD=0.43), behavioral control (mean=2.67, SD=0.41), and intent (mean=2.63, SD=0.59). Thematic analysis of discussion question responses found that students felt the delivery and quality of care was similar between in-person and remote care. Students felt that differences with face-to-face care included technology use and troubleshooting, perceived difficulty in building relationships, and, finally, the inability to provide device training, medication show-and-tell, and physical examinations. They felt telehealth services would expand in the next five years due to increased access, convenience, and cost savings.Conclusion. Upon completion of a learning module, students were knowledgeable about telepharmacy and telehealth. Students agreed that remote services positively impact patient care and would be well received by patients and providers. Students had lower intent to offer remote services upon graduation; thus, simulations and service management information should be added to curricula to prepare students for and develop student interest in telepharmacy and telehealth.

Associating Student Performance in Pharmacy Practice Didactic and Skills-Based Courses With Advanced Pharmacy Practice Experiences.

Objective. To determine the association between pharmacy practice didactic course examinations and performance-based assessments with students' performance during their advanced pharmacy practice experiences (APPEs).Methods. This retrospective analysis included data from the graduating classes of 2018 to 2020. Students were coded as APPE poor performers (final course grade <83%) or acceptable performers. Assessments in pharmacy practice didactic and skills-based courses in students' second and third years were included in the analysis, with thresholds correlating to grade cutoffs. The association between poor performance mean examination scores and performance-based assessments with APPE performance was calculated.Results. Of the 403 graduates, analysis sample sizes ranged from 254 to 403. There were 49 students (12%) who met the criteria for poor performance in the APPE year. When comparing pharmacy practice didactic course performance to APPE poor performance, the proportion of mean examination scores that were <83% for six of the seven pharmacy practice didactic courses was significant; five of the seven mean examination scores were significant at the <78% threshold. Performance-based assessments that were significantly associated with APPE poor performance often required critical thinking.Conclusion. A gap in identification of students with APPE poor performance who did not fail a didactic course was demonstrated. Specifically, this finding suggests that pre-APPE curriculum should focus on assessments that include critical thinking. These methods could be used by other pharmacy programs to find components of their curricula that help identify students who need additional support prior to the APPE year.

Assessment of a two-school collaborative telepharmacy simulation.

BACKGROUND AND PURPOSE: The objectives of this study were to implement and assess a telepharmacy simulation for third-year students at two universities. EDUCATIONAL ACTIVITY AND SETTING: Using telepharmacy, students completed a prescription verification activity and a patient counseling activity. Students completed surveys at baseline and after both activities. Focus groups were conducted after the second activity. Descriptive statistics, Cronbach's alpha, paired t-tests, and qualitative analysis were used to evaluate data. FINDINGS: There was a statistically significant increase in students' perceptions using telepharmacy to deliver patient education before (mean (M) = 2.68, SD = 0.36) to after the experience (M = 2.97, SD = 0.52). A comparison of attitudes toward and intent to provide telepharmacy services found no differences before and after the experience. Following each activity, students felt somewhat to very confident in their abilities to verify a prescription medication and to counsel a patient using telepharmacy. Students demonstrated slight gains in knowledge pre-/post- regarding the use of telepharmacy. Focus group comments referred to the activities as realistic and of value. SUMMARY: A purposeful telepharmacy simulation impacted students' perceptions and knowledge on the use of telepharmacy. Students were confident in their abilities to verify and counsel on medications and felt the simulation helped them better understand the pharmacist's role in telepharmacy. However, students indicated little intent to explore telepharmacy-based opportunities in the future. The results support the development of a more robust simulation and incorporation of didactic content into pharmacy curricula to train students in the use of telepharmacy.

Development of a scale to determine student self-efficacy in performing key pharmacists' patient care skills.

BACKGROUND: The Pharmacists' Patient Care Process (PPCP) was developed to describe a consistent process in which pharmacists in any setting provide patient care. Faculty at a midwestern university developed and refined an assessment tool which provides an indirect approach to measure student confidence in performing skills essential to the PPCP. The objective of this paper is to conduct a stepwise factor analysis to refine the PPCP survey. METHODS: Assessing appropriateness of survey response data led to an exploratory factor analysis (EFA) on student confidence data to refine the survey instrument and examine the underlying constructs that influence student responses. Post EFA, the results were presented to the research team that collaboratively reached consensus on inclusion or exclusion of items. RESULTS: EFA factor loadings identified a 4-factor solution suggesting elimination of 30 items from the original 53 item survey. Team discussions led to eliminating 29 items, combining two items and generation of 5 new items in order to retain important concepts. The outcome was a well-conceptualized and refined 29 item-survey model assessing 4 constructs. CONCLUSION: To potentially improve patient outcomes, it is imperative to utilize comprehensive yet concise survey instruments, like the PPCP Skills Self-Efficacy Survey, to prepare students to translate PPCP skills to practice.

Evaluating a Skills Laboratory Curriculum to Determine the Essential Skills for Pharmacy Students to Learn.

The profession of pharmacy is complex and diverse, encompassing a wide range of necessary practice skills. Decisions regarding which skills are essential for students are made by faculty of skills-based laboratory courses, who also determine how these skills are taught and assessed. This commentary aims to further the discussion regarding how the essential skills taught and assessed in skills laboratory curricula are identified, with the intention of preparing student pharmacists for both current and future pharmacy practice. Guidance on essential skills is provided by various organizations and documents, but ultimately each institution has the autonomy to decide what to teach. As such, this piece discusses the importance of frequent curriculum evaluation to determine how to train pharmacists of the future so they will practice at the top of their license rather than simply meet competency with historical skills.

The Illusion of Urgency.

Faculty frequently have many tasks that need to be completed on a daily basis. Prioritizing these tasks effectively can be challenging, especially considering the relative urgency and importance of each. Decision matrices such as the Eisenhower Matrix and the Time Management Matrix can assist individuals in categorizing tasks in order to value what is truly career building versus a distraction. It is imperative for faculty to develop strategies to address common distractors, such as email, meetings, and requests from others. Identifying tasks that are truly urgent over those that only appear to be urgent may help faculty increase their productivity and efficiency.

A state-level needs analysis of community pharmacy point-of-care testing.

BACKGROUND: The uptake of point-of-care testing (POCT) within community pharmacies at state and national levels is largely unknown despite the endorsement and advocacy efforts of pharmacy organizations, recent legislative advances, and numerous models for successful POCT implementation within individual pharmacy sites. OBJECTIVES: The study aimed to describe the current landscape of POCT in Wisconsin community pharmacies and identify opportunities for the advancement of testing and the key factors influencing the realization of these opportunities. METHODS: A survey was administered over the telephone to pharmacy managers of community pharmacies in Wisconsin. The sites were randomly selected from predefined geographic regions to mirror pharmacy distribution across Wisconsin. The survey items evaluated provision of POCT, future direction of POCT, barriers and motivators to offering POCT, and pharmacy demographics. Descriptive statistics and thematic analysis were used to analyze data. RESULTS: Pharmacy managers from 147 of the 938 registered community pharmacies (15.7%) participated in the survey. Only 17.1% of the pharmacies were offering POCT; however, 48.3% of managers reported that their pharmacy would likely implement or expand POCT within the next 5 years. The most commonly reported barriers to initiating or expanding POCT were the limitations on pharmacist availability to oversee testing and workflow restrictions. Continuing to advance the pharmacy profession was a top reason for offering or expanding testing services. DISCUSSION: While few pharmacies are offering POCT in Wisconsin, there is motivation for expansion in coming years. Understanding, anticipating and addressing common barriers can faciliate this process. CONCLUSION: This needs analysis offers a blueprint for researchers, educators, and clinicians to shape POCT efforts by examining the landscape of pharmacy-based testing in their own states and communities.

Let External Stakeholders Be Your Guide to Curricular Revision.

Schools and colleges of pharmacy undertake curriculum revisions for a variety of reasons ranging from the reactionary (eg, responding to changes in practice patterns, accreditation standards) to the proactive (eg, striving for innovation and excellence). Continuous quality improvement processes and published curriculum models, both described in this commentary, should be used to guide revision processes. Equally important is engaging the expertise of external stakeholders. While there may be challenges to incorporating external stakeholders in a curriculum revision process, their perspectives and knowledge can contribute to a more robust result, often in unexpectedly positive ways. Logic modeling is one mechanism to structure this approach, maximize the utility of external stakeholders, and strengthen the overall curriculum revision process. Regardless of the size of the revision, a good rule of thumb is to engage external stakeholders at the outset and to let their expertise be your guide.

Expert Consensus to Finalize a Universal Evaluator Rubric to Assess Pharmacy Students' Patient Communication Skills.

Objective. To use an expert consensus-building process to develop a rubric used by multiple evaluator types to assess Doctor of Pharmacy students' patient communication skills.Methods. Faculty and staff members from six schools and colleges of pharmacy collaborated on a multi-step expert consensus-building process to create the final version of a communication rubric. First, faculty and patient content experts evaluated each item in the rubric for its relevance, criticality, and global comprehensiveness using a five-point Likert scale (0=not at all, 4=to a high extent). Descriptive statistics were used to analyze the resulting data. Faculty members evaluated the results and came to a consensus on the second version of the rubric. A corresponding codebook was developed and refined through a two-phase process.Results. The initial communication rubric was evaluated by 13 expert reviewers. Mean global comprehensiveness on the rubric was 3.83 for faculty experts and 3.5 for patient experts. After evaluating results from the expert consensus-building process, 14 items on the rubric did not change, five items were revised, three items were removed, and two items were added. The second version of the instrument included 20 items in six topic areas. A codebook was finalized to increase scoring consistency for the 20 communication items.Conclusion. Overall, content experts concluded that the rubric had high global comprehensiveness. Collaboration involving faculty members from multiple schools of pharmacy resulted in a 20-item communication rubric and codebook that can be used to increase consistency in scoring student pharmacists' patient communication skills.

Patient Satisfaction With Extended International Normalized Ratio Follow-up Intervals in a Veteran Population.

Background: For highly stable warfarin patients, limited data exists regarding patient satisfaction on extended international normalized ratio (INR) follow-up intervals and how this population compares with patients on a direct oral anticoagulant (DOAC). Objective: To assess the impact on patient satisfaction of extending INR follow-up intervals. Methods: Veterans on stable warfarin doses had extended INR follow-up intervals up to 12 weeks in a single-arm prospective cohort study for 2 years. This analysis included participants who completed at least 2 Duke Anticoagulation Satisfaction Scales (DASS). The primary outcome was the change in the DASS. A focus group described participant experiences. Participant satisfaction was compared to patients on a DOAC. Results: Of the 51 participants, 48 were included in the warfarin extended INR follow-up group. Compared with baseline, the mean DASS score (42.9 ± 12.08) was worse at 24 months (46.82 ± 15.2, P = 0.0266), with a small effect size (Cohen's d = 0.29). The 8 participants in the focus group were satisfied with the extended INR follow-up interval but would be uncomfortable extending follow-up past 2 to 3 months. The extended INR follow-up interval study had similar DASS scores as the 33 participants included on DOAC therapy (46.8 ± 15.1, P = 0.9970) but may be limited by differing populations using DOACs. Conclusion and Relevance: For patients currently stable on warfarin therapy, extending the INR follow-up interval up to 12 weeks or changing to a DOAC does not appear to improve patient satisfaction.

Impact of an extended International Normalized Ratio follow-up interval on healthcare use among veteran patients on stable warfarin doses.

PURPOSE: To analyze the impact of a 12-week extended International Normalized Ratio (INR) follow-up interval on healthcare use. METHODS: A prospective cohort study of the use of an extended INR follow-up interval of up to 12 weeks was conducted over 2 years in a pharmacist-managed anticoagulation clinic. A detailed protocol was used to extend the INR follow-up interval to 5-6 weeks and then 7-8 weeks and 11-12 weeks. The number of planned and unplanned anticoagulation encounters, procedures requiring warfarin interruption, telephone triage phone calls, emergency department visits, and hospitalizations were collected. A post hoc subanalysis was also completed on participants who were scheduled for 4 consecutive 12-week intervals. RESULTS: Compared to baseline, at 12 months there was a mean decrease in planned anticoagulation encounters of 2.24 visits (p < 0.001) among 44 participants. From 12 to 24 months compared to baseline, there was a mean decrease in planned anticoagulation encounters of 3.13 visits (p < 0.001) and an increase of 0.54 unplanned anticoagulation encounters (p = 0.04) among 39 participants. The remainder of healthcare use variables were not statistically significantly different from baseline at any time point. Of the 15 participants scheduled for 4 consecutive 12-week intervals, there was a decrease from baseline of approximately 5 visits over the course of a year (p < 0.001). CONCLUSION: An extended INR follow-up interval appears to decrease anticoagulation healthcare use without an increase in acute healthcare use. While this intervention could be cost-effective, institutions need to consider safety, efficacy, and feasibility prior to implementation.

Establishing a successful teaching assistant program in pharmacy skills laboratory courses.

INTRODUCTION: Laboratory-based courses often require more manpower than faculty can provide to facilitate active learning activities in the classroom as well as skills-based assessments. PERSPECTIVE: Pharmacy and graduate student and resident teaching assistants (TAs) can be incorporated into laboratory-based courses to help meet this need. Before using student and resident TAs in laboratory-based courses, a number of items need to be considered. This paper will discuss how to recruit, train, and evaluate student and resident TAs. It will also detail the benefits to the faculty, the students in the classroom, and the TAs themselves. Finally, lessons learned from five schools of pharmacy who use student and/or resident TAs will be shared. IMPLICATIONS: Schools of pharmacy should implement a formalized process for utilizing student and resident TAs in laboratory-based courses especially where faculty manpower limitations exist.

Feasibility and safety of a 12-week INR follow-up protocol over 2 years in an anticoagulation clinic: a single-arm prospective cohort study.

The 2012 American College of Chest Physicians' guidelines recommended a 12-week INR follow-up interval may be appropriate for patients on stable warfarin doses. Limited evidence supports this recommendation. A single-arm, prospective cohort study over 24 months was completed in a Veterans Affairs anticoagulation clinic to determine the long-term feasibility and safety of implementing an extended INR follow-up interval in Veterans on stable doses of warfarin. Participants were required to have a stable warfarin dose for 6 months prior to enrollment. A prespecified protocol was used to titrate, extend, and manage the INR interval up to 12 weeks. Scheduling of extended INR intervals was a primary outcome. Safety outcomes included major and serious bleeding and thromboembolic events. A post-hoc comparison of baseline characteristics between individuals who were scheduled for at least 4 consecutive 12-week INR follow-up intervals and those who were not was completed. Of the 50 participants, 36 (72%) were scheduled for at least one 12-week interval and 15 (30%) were scheduled for 4 consecutive intervals. There were 2 thromboembolic events that occurred in 1 participant. There were 28 major and serious bleeding events in 19 participants; 8 occurred while on the extended INR interval. In the post-hoc analysis, no participants scheduled for 4 consecutive 12-week intervals had heart failure. Based on 2 years of monitoring, a 12-week INR follow-up interval using a detailed protocol with titration of INR interval extension appears feasible for a subset of patients. Patients with heart failure may not be suitable for this intervention.

Interprofessional development and implementation of a pharmacist professional advancement and recognition program.

PURPOSE: The interprofessional development, implementation, and outcomes of a pharmacist professional advancement and recognition program (PARP) at an academic medical center are described. SUMMARY: Limitations of the legacy advancement program, in combination with low rates of employee engagement in peer recognition and professional development, at the UW Health department of pharmacy led to the creation of a task force comprising pharmacists from all practice areas to develop a new pharmacist PARP. Senior leadership within the organization expanded the scope of the project to include an interprofessional work group tasked to develop guidelines and core principles that other professional staff could use to reduce variation across advancement and recognition programs. Key program design elements included a triennial review of performance against advancement standards and the use of peer review to supplement advancement decisions. The primary objective was to meaningfully improve pharmacists' engagement as measured through employee engagement surveys. Secondary outcomes of interest included the results of pharmacist and management satisfaction surveys and the program's impact on the volume and mix of pharmacist professional development activities. Of the 126 eligible pharmacists, 93 participated in the new program. The majority of pharmacists was satisfied with the program. For pharmacists who were advanced as part of the program, meaningful increases in employee engagement scores were observed, and a mean of 95 hours of professional development and quality-improvement activities was documented. CONCLUSION: Implementation of a PARP helped increase pharmacist engagement through participation in quality-improvement and professional development activities. The program also led to the creation of organizationwide interprofessional guidelines for advancement programs within various healthcare disciplines.

Best Practices for Use of Blended Learning.

Objective. To determine instructional best practice recommendations for use of blended learning from the students' perspective. Methods. Three focus groups were created, one for each of the first three years at a school of pharmacy. The focus group discussions were audio recorded and transcribed for content analysis. Results. Ten instructional best practices were identified from the focus groups: setting the stage, consistency when team teaching, timeliness in posting materials, time on task, accountability for online activities, use of structured active learning, instructor use of feedback on student preparation, incorporation of student feedback into the course, short reviews of online material during class, and ensuring technologies are user friendly. Conclusion. Instructors using blended learning should consider incorporating these best practices into their course design and management. More evaluation is needed to see if implementation of these practices affects student performance.

Development of a Holistic Assessment Plan to Evaluate a Four-Semester Laboratory Course Series.

Objective. To implement a holistic assessment plan to evaluate the impact of a four-semester laboratory course series entitled Integrated Pharmacotherapy Skills on students' readiness to begin advanced pharmacy practice experiences (APPEs) following separation of the laboratory component from the Pharmacotherapy lecture component. Design. Faculty prospectively selected and employed a variety of course assessment methods including student self- and preceptor evaluation during APPEs, course evaluations, and a student confidence survey to evaluate student readiness for APPEs and ensure a quality learning experience for students. Assessment. APPE students' self-perceived confidence to perform skills increased after completion of the redesigned curriculum and after experiencing two APPE rotations. APPE preceptors did not report a change in student performance. Results from course evaluations suggest that separating the laboratory course from the lecture course created a positive learning experience for students. Conclusion. Students completing the new laboratory curriculum were equally prepared to begin APPE rotations as students who had completed the old curriculum. A similar multidimensional, holistic assessment plan could be used at other institutions to evaluate skills-based courses as part of continuous quality improvement.

Use of an extended INR follow-up interval for Veteran patients in an anticoagulation clinic.

A prospective, single-arm study of 50 participants evaluated an extended INR follow-up interval to determine the implementation feasibility and safety of an extended interval in Veterans on a stable dose of warfarin. A protocol was designed to allow for a rigorous, yet pragmatic evaluation of a 12-week INR follow-up interval. Feasibility was determined by study enrollment, retention, and participant achievement rates for the extended INR interval. Safety was determined by bleeding and thromboembolism rates. Participants were monitored for 6 months. Despite the long-term stability of participants prior to enrollment, only 56% achieved a 12-week follow-up interval and only 34% of enrolled participants maintained a 12-week interval. Sixteen percent of participants were never eligible for an extension of their INR follow-up interval despite meeting initial enrollment criteria. There were two major bleeding events and one participant who experienced a thromboembolic event. Implementation of an extended interval of INR follow-up appears feasible as participant enrollment goals were met and pharmacists were able to follow the study protocol. However, a lower than expected proportion of participants were able to achieve and maintain an extended INR follow-up interval. Future evaluations are needed to confirm the safety of an extended INR interval.