Implementation of a re-designed pre-departure training program for global health advanced pharmacy practice experiences.

BACKGROUND AND PURPOSE: This article describes the re-design and preliminary impact of a pre-departure global health training program for nine advanced pharmacy practice experience (APPE) sites. EDUCATIONAL ACTIVITY AND SETTING: The program was re-designed from a half-day orientation to a six-week (six-hour total) program. Students explored global health, cultural competency, adaptability, safety, and travel logistics. The program's impact on student learning was indirectly assessed using closed- and open-ended items on pre- and post-program surveys. Students reported self-perceived agreement with eight statements regarding travel logistics and 17 statements regarding global health. FINDINGS: Fifty-five students took the pre-course survey, and 47 students took the post-program survey for response rates of 100% and 85%, respectively. Students indicated significant change on 23 out of 25 statements, demonstrating meaningful improvements in agreement in both global health, logistics, and safety. Students were most interested in learning about travel logistics and healthcare information about their specific country upon entry into the program. At the conclusion of the program, students most often reported learning about cultural competency and adaptability. Most students reported no remaining questions. Course design, delivery, and assessment experience was provided for two academic postdoctoral fellows through the implementation of the re-designed program. SUMMARY: Students perceived improved understanding and comfort with global health concepts and travel logistics after the pre-departure program, despite the diverse nature of rotation sites covered. More research is needed to understand what impact a pre-departure training program has on the overall global health student experience.

The role of a pharmacy residency program in global health: Establishing pediatric clinical pharmacy services in a Malawian hospital.

PURPOSE: To describe the establishment of pediatric clinical pharmacy services in a Malawian hospital as part of a pharmacy residency program's engagement in global health. SUMMARY: While pharmacy is expanding its role in global health through the introduction of international advanced pharmacy practice experience (APPE) rotations at US schools of pharmacy, international experiences for pharmacy residents are currently very limited. Such programs are advantageous for pharmacists planning for a career in public or global health, and there is also great opportunity for clinical pharmacists to work with international partners for professional development and to help advance pharmacy practice. The University of North Carolina at Chapel Hill Eshelman School of Pharmacy recently expanded its international APPE rotation in Malawi into the postgraduate training space through creation of a pediatric pharmacy residency training program, with the specific aim of working with partners in Malawi to introduce pediatric pharmacy services at Kamuzu Central Hospital. As this was the first time there was a pharmacist involved in patient care on the pediatric wards, the focus for the participating pharmacy resident was on establishing a positive relationship with the medical team through providing high-quality collaborative patient care for the pediatric population. In addition to working to establish pediatric clinical pharmacy services, the resident further contributed to sustainable improvements in pediatric patient care by identifying areas for quality improvement. We discuss several considerations for the successful implementation of international experiences and their impact on participating residents. CONCLUSION: Pharmacy has an opportunity to build on the success of international APPE rotations and expand postgraduate offerings. Through collaboration with other institutions already involved in global health and identifying international rotation sites, residency programs across the country can create similarly beneficial global health experiences for their pharmacy residents.

Critical moments in student learning on international advanced pharmacy practice experiences.

INTRODUCTION: The purpose of this study was to evaluate self-perceived critical moments that were transformative to learning in students who participated in an international advanced pharmacy practice experience (APPE). METHODS: Twenty-two pharmacy students from Purdue University College of Pharmacy, the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and the University of North Carolina Eshelman School of Pharmacy who went on an international APPE participated in a one-hour focus group evaluating self-perceived critical moments that impacted their learning. Focus groups were coded using a conventional content analysis approach and went through a two-cycle open coding process to identify major themes according to country income classification. RESULTS: Twenty-two students participated in the focus groups with 18% going to a high-income country (HIC) and 82% going to a low-to-middle income country (LMIC) location. Major themes identified within HIC locations included witnessing an innovative patient care technique and experiencing interprofessional healthcare team dynamics. Major themes identified within LMIC locations included engaging in a sensitive patient interaction, experiencing healthcare system barriers, going out of their comfort zone, and making a difference. CONCLUSIONS: International APPEs in both HIC and LMICs provided students with disorienting experiences that facilitated transformative learning and led to changes in their perspectives on patient care and pharmacy practice. While critical moments were different across country income locations, both provided valuable experiences that could be translated into local context.

Exploring career development through a student-directed practicum to provide individualized learning experiences.

INTRODUCTION: The primary objective was to assess the impact of an optional student-directed career development program on career and professional development between the second and third year of a doctor of pharmacy curriculum. METHODS: Students who completed the student-directed practicum (SDP) completed a nine item pre-/post-survey assessing its impact on their career development within the learning constructs of discovery, application, and reflection. Additional open-ended questions assessed why students participated in the SDP and their perceived benefits of doing so. An additional questionnaire regarding the impact of the practicum was conducted at graduation. Quantitative data were analyzed with Wilcoxon signed-rank test for the pre-/post-survey and descriptive statistics for the graduation survey while qualitative data used a two-cycle open coding process. RESULTS: Statistically significant increases were noted with those responding with "agree" or "strongly agree" to each of the nine statements in the pre-/post-survey. Students participated to further explore career options, and believed doing so resulted in enhanced career direction and future employability. The graduation survey showed those participating in the SDP had a higher rate of: postgraduate placement (86% vs. 77%), receiving ≥ five residency interview offers (81% vs. 69%), and first or second choice residency match (92% vs. 85%) compared to those who completed an internship outside of the SDP. Students commented that the SDP was a valuable part of their education and helped them take the next steps for their career. CONCLUSIONS: A student-directed career development experience can positively impact student's career direction and professional development.

Entrustable Professional Activities (EPAs) for Global Health.

PURPOSE: As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings. METHOD: In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low- to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains. RESULTS: Twenty-two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability. CONCLUSIONS: EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions.

Development of a Global Health Learning Progression (GHELP) Model.

There has been a steady increase in global health experiential opportunities offered within healthcare professional training programs and with this, a need to describe the process for learning. This article describes a model to contextualize global health learning for students who complete international advanced pharmacy practice experiences (APPEs). Students from University of North Carolina at Chapel Hill, Purdue University, and the University of Colorado completed a post-APPE survey which included open-ended questions about knowledge, skills, and attitudes one week after completing an international APPE. Students were also invited to participate in a focus group. All 81 students who participated in an international APPE completed the open-ended survey questions and 22 students participated in a focus group discussion. Qualitative data from both the survey and focus groups were coded in a two-cycle open coding process. Code mapping and analytic memo writing were analyzed to derive to a conceptual learning model. The Global Health Experience Learning Progression (GHELP) model was derived to describe the process of student learning while on global health experiences. This progression model has three constructs and incorporates learning from external and internal influences. The model describes how students can advance from cultural awareness to cultural sensitivity and describes how student pharmacists who participate in international experiential education develop global health knowledge, skills, and attitudes.

Global Health Learning Outcomes by Country Location and Duration for International Experiences.

Objective. To determine the impact of country income classification and experience duration on learning outcomes for student pharmacists participating in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, longitudinal study evaluated 81 fourth-year student pharmacists participating in an international APPE through one of three US universities. A pre-post survey was administered to evaluate students' self-perceived growth across 13 competencies established by the Consortium of Universities for Global Health (CUGH). The survey included four additional open-ended questions. Student pharmacists were also invited to participate in a focus group. Paired and independent t tests and multiple linear regression were conducted. Qualitative survey and focus group data underwent a two-cycle, open-coding process using conventional content analysis. Results. Students who completed their APPE in a low- to middle-income country had greater growth in all CUGH competency statements compared to those who completed their APPE in a high-income country. Completing the APPE in a low- to middle-income country and prior travel for non-vacation purposes were significant predictors of student growth. Students who went to a low- to middle-income country demonstrated increased cultural sensitivity, more patient-centered care, and skill development, while students who went to a high-income country displayed increased knowledge regarding differences in health care system components, pharmacy practice, pharmacy education, and an appreciation for alternative patient care approaches. Conclusion. Learning outcomes differed between students who completed an APPE in a high-income rather than a low- to middle-income country, with both types of locations providing valuable educational opportunities and professional and personal development.

Creating global health leaders in pharmacy by evolving postgraduate training.

There has been a push for increasing global health education and training opportunities within the pharmacy profession. Global health postgraduate learning opportunities are necessary to define pharmacy career paths in global health and develop global health leaders. There are many challenges to starting a global health postgraduate training program including economic burden, logistics of extramural rotations, local and international resources, and program sustainability. In the face of barriers inhibiting formal program establishment, different strategies can be used to incorporate global health topics into existing postgraduate training opportunities. Possible solutions include relating local health to global health to develop a global mindset, expanding upon existing partnerships to provide international global health experiences, use of technology and simulation for virtual global health interaction, and emphasis of implementation science principles to connect and translate local health interventions to a global scale.

Global Leaders in Development: a global leadership module across three international pharmacy schools.

OBJECTIVES: The objective of this study was to assess the impact of the Global Leaders in Development (GLIDE) module to determine whether the concepts of global mindset, citizenship and leadership can be effectively taught within a short-term didactic module. METHODS: Faculty members of PharmAlliance, a partnership between three schools of pharmacy, created a three-week optional, non-credit-bearing distance-based global leadership development module. Material and assignments focused on the concepts of global mindset, global citizenship and global leadership as applied to the global health issues of non-communicable diseases, universal health coverage and primary care. Student self-rated growth was measured with an adapted fifteen question pre-post-survey that also included open-ended questions. KEY FINDINGS: Most statements showed growth on the pre-post-survey with seven being statistically significant (P < 0.05). The largest growth involved students' perceived potential to be a global leader in pharmacy (global leadership category), the students' connectedness to the pharmacy profession worldwide (global citizenship category) and the students' awareness of global challenges faced in the pharmacy profession (global mindset category). Qualitative analysis identified several themes for each of the open-ended questions. Student expectations focused on the desire to expand their global mindset, better understand global pharmacy practice, develop teamwork skills and understand global pharmacy challenges and strategies for engagement. CONCLUSIONS: The concepts of global mindset, global citizenship and global leadership may help promote awareness of global health challenges, opportunities to make a global difference in a local context and connectivity to the profession on a global scale.

Global Health Learning Outcomes in Pharmacy Students Completing International Advanced Pharmacy Practice Experiences.

Objective. To examine the global health learning outcomes of Doctor of Pharmacy (PharmD) students from three US schools who participated in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, prospective study was used to assess fourth-year PharmD students at three US pharmacy schools who participated in an international APPE during the 2017-2018 academic year and a matched cohort (control group) of PharmD students who did not participate in an international APPE. To evaluate students' self-perceived growth in the Consortium of Universities for Global Health (CUGH) competencies, all students completed a 13-item retrospective pre-post instrument using a five-point Likert scale. The students who had completed an international APPE were invited to participate in a focus group (N=22). Paired and independent t tests and multiple linear regression were used to analyze data. Qualitative open-ended questions and focus group data were mapped to knowledge, skills, and attitudes themes. Results. The students who completed an international APPE (N=81) showed significantly more growth in CUGH competencies than students who did not (mean improvement in total score of 10.3 [7.0] vs 2.4 [6.0]). International APPE participation was the only significant predictor of growth in CUGH competencies. The international APPE students reported improvements in cultural awareness and appreciation, communication skills, problem-solving skills, adaptability, self-awareness, personal and professional outlook, and global health perspective. Conclusion. Pharmacy students' participation in international APPEs led to significant improvement in all CUGH competencies. The CUGH competency framework appears to be a suitable instrument to assess pharmacy students' global health learning outcomes.

Connecting Rural and Global Health Education for Workforce Development.

Healthcare workforce shortages are continuing to increase worldwide with more profound deficits seen in rural communities in both developed and developing countries. These deficits impede progress towards heath equity and global health initiatives including the 2030 Sustainable Development Goals. Medical training has supported the idea that having a rural background influences future practice in rural settings. With a majority of global health experiences taking place in rural settings, there is an opportunity for health profession programs to take advantage of expanding global health education to encourage future practice in rural settings and address inequalities in workforce distribution.

Development of a medication health literacy program for refugees.

OBJECTIVES: To develop a community-based educational workshop to improve medication health literacy in refugees. SETTING: Workshops were provided in community locations including a local resettlement agency and English as a Second Language facility. PRACTICE DESCRIPTION: Pharmacy faculty mentored small group student workshop presentations to recently arrived refugees regarding medication health literacy topics. PRACTICE INNOVATION: A program was developed to use translated materials, interpreters, hands-on materials, and evaluations to teach refugees about medication-related issues. A needs assessment was conducted with a local refugee resettlement agency to determine topics. EVALUATION: Evaluations were administered after the workshop to ensure understanding of the workshop material. Verbal feedback and faculty oversight during interactions between pharmacy students and refugees in addition to evaluation responses were used for quality improvement. RESULTS: Workshop materials have been translated into 11 of the most common languages for our local refugee population. Twelve workshops were administered during the past year and a half, educating 282 refugees from 33 countries. There was an average of 78% correct responses on postevaluation questions assessing refugees' understanding of workshop concepts. Verbal feedback from the refugees supported an increase in knowledge regarding how to open a medication bottle, how to read medication labels, and how to dose liquid medications. CONCLUSION: Implementation of this health literacy program allowed us to address medication-related concerns with refugees. Working within the community setting provided a learning environment in which the refugees trusted the workers and were comfortable asking questions. Small group settings and evaluation allowed us to review concepts until proficiency was achieved.