Reflective metacognition and objective structured clinical examination performance in introductory pharmacy practice experiences.

BACKGROUND AND PURPOSE: Objective structured clinical examinations (OSCEs) allow for holistic evaluation of clinical competence, but integration of reflective practices on OSCE performance has not been well-studied. EDUCATIONAL ACTIVITY AND SETTING: To develop metacognitive skills, second-year pharmacy students completed a self-reflection assignment on a mock medication therapy management OSCE in an introductory pharmacy practice experience course. Students who completed the course during the prior year (no self-reflection assignment) served as the control. The study assessed the correlation of students' reflections of their OCSE abilities to OSCE performance and evaluated if student demographics influenced the correlation. FINDINGS: There were 107 students in the control group and 95 students in the intervention group. A higher proportion of students passed the overall OSCE in the control group (67.4%) compared to the intervention group (58.9%), but this was not statistically significant. Neither gender, age, nor Pharmacy College Admissions Test score had an effect on OSCE pass rates. Grade point average did have a significant effect on OSCE pass rates (P = .019). Overall, no statistically significant association was seen in summative OSCE performance between students who used structured, guided questions to reflect on their formative OSCE performance and those who did not (P > .05). SUMMARY: Despite this study's results, faculty continue to embrace the concept of reflective practice. Further research is needed to assess the value and role of reflective practice in pharmacy education.

An Elective Course in Lesbian, Gay, Bisexual, and Transgender Health and Practice Issues.

Objective. To design, implement and assess a lesbian, gay, bisexual, and transgender (LGBT) health and practice elective course for second- and third-year Doctor of Pharmacy (PharmD) students. Methods. The course focused on health promotion, health care barriers, disease prevention, and treatment throughout an LGBT person's lifespan. The course included topic discussions, reading assignments, various active-learning activities, an objective structured clinical examination (OSCE) with a transgender person, and guest speakers from the LGBT community. Five quizzes were administered during the course that were mapped to specific session learning objectives and course learning outcomes. Students completed an anonymous pre- and post-course survey on the seven course learning outcomes to assess their knowledge and skills regarding the health of LGBT people. Results. Students exhibited significant learning with improvement in the seven course learning outcomes. The two most improved course learning outcomes were the medications used for LGBT people and summarizing health care resources available to LGBT people. The content of student portfolios included general themes of discrimination, health care access problems, advocacy, inclusive pharmacy environments, and desire to be a better practitioner. More than 91% of the students actively engaged the guest speakers from the LGBT community. Student performance on quizzes and in the OSCE activity was excellent. The capstone presentations covered a variety of topics including LGBT in Islam. Conclusion. Students demonstrated knowledge of the unique health care issues among the LGBT community. This elective course provides a framework for other pharmacy programs to incorporate LGBT health topics into the curriculum and to engage with their local LGBT community.

Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population: a pilot intervention study.

BACKGROUND: Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7-8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients' satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. METHODS: A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. RESULTS: The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11-12) vs. 10(8-11), p < 0.001). The study group had a 'time in therapeutic INR' range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. CONCLUSIONS: Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. TRIAL REGISTRATION: The study was retrospectively registered with: NCT03650777 ; 9/18/18.

Evaluation of pharmacy-based telephone interventions on medication pick-up rates: a retrospective, quality improvement study at charity outpatient clinics.

OBJECTIVES: To evaluate a live telephonic outreach intervention made by clinical pharmacists and clinical pharmacy technicians on medication pick-up rates. METHODS: A retrospective, quality improvement study conducted at six outpatient charity clinics in Dallas-Fort Worth area between 1 January 2017 and 31 July 2017. A live telephonic call was made by a pharmacy team member if the patient did not pick-up at least one prescription item. Patients may receive more than one call if they did not pick-up medication(s) more than once during the study period. A live telephonic call resulted in three categories: contacted, left a voice message and unable to contact. Medication pick-up rates were obtained from a pharmacy claims database. KEY FINDINGS: The study population included 1726 individual patients who failed to pick-up at least one medication from Baylor Scott & White Health pharmacy. A total of 2551 live telephonic calls were made for the study population. A total of 1175 live telephonic calls (46.1%, n = 2551) resulted in a patient picking up medication(s). Results from the generalized estimating equation logistic regression models showed that patients who received a voice message (OR: 1.37; 95% CI: 1.05 to 1.80; P < 0.021) or was contacted (OR: 1.99; 95% CI: 1.54 to 2.60; P < 0.001) were more likely to pick-up their medications as compared to the 'unable to contact' group. CONCLUSIONS: Telephonic interventions from the pharmacy team can serve as a successful means to increase medication pick-up rates among charity clinic patients.

Impact of a low-cost simulated electronic medical record on perceptions of APPE readiness.

BACKGROUND: Meaningful use of electronic medical records (EMRs) is critical for providing high-quality, patient-centered care. However, many pharmacy students are not exposed to EMRs until the experiential components of the curriculum. EDUCATIONAL ACTIVITY AND SETTING: We created a low-cost simulated EMR (SEMR) using Microsoft PowerPoint software (Microsoft, Redmond, WA, Version 16.16) to use in a case-based application course for second-year pharmacy students for two consecutive years. FINDINGS: Pre- and post-assessment surveys of 162 students indicated that perceived confidence and efficiency navigating EMRs improved after the activity. Students agreed that the activity enhanced learning, improved understanding of how to extract meaningful data from EMRs, benefited their preparation for the fourth professional year, and demonstrated the role of informatics in patient care. SUMMARY: Incorporation of a SEMR using Microsoft PowerPoint enhances student perceptions of proficiency in navigating the patient medical record. Adoption of similar activities into pharmacy curricula may be an attractive option when adequate financial resources for simulation are unavailable.

Use of the Muddiest Point Technique as an exam review in an integrated pharmacotherapy course.

BACKGROUND AND PURPOSE: The objective of this study was to evaluate the impact in student pharmacists' exam performance learning outcomes and satisfaction after integrating the Muddiest Point assessment technique into exam reviews. EDUCATIONAL ACTIVITY AND SETTING: In 2016, the Muddiest Point, a formative assessment tool, was used to develop exam review sessions for second-year student pharmacists in an integrated pharmacotherapy course focused on the cardiovascular system. Performance scores on all four exams were compared between students in the 2015 and 2016 courses. Students' complexity of learning was categorized using a taxonomy of learning structure. A survey was used to evaluate student perceptions of exam reviews and the Muddiest Point technique (MPT). FINDINGS: Scores were higher on the second exam for the 83 students in the 2016 course (78.0% vs. 86.0%, p<0.001). There was no difference on other exam scores or overall course failures. Muddiest points submitted by students demonstrated a variety of taxonomy of learning levels. Student pharmacists surveyed at the conclusion of the course agreed that exam reviews were helpful for their preparation for exams and that the MPT was a valuable use of class time. SUMMARY: Incorporating the MPT into exam reviews maintained exam scores and supported evaluation of student learning. In addition, student pharmacists were satisfied with this exam review method.

Assessing a traditional case-based application exercise and a student question creation exercise on student performance and perceptions.

BACKGROUND AND PURPOSE: To compare the impact of a traditional case-based application exercise with a student question creation exercise on a) student exam performance, b) student perceptions of enjoyment, competence, understanding, effort, interest in continuing participation, and interest in the subject. EDUCATIONAL ACTIVITY AND SETTING: Subjects were 84 second-year pharmacy students in a pharmacotherapy course. The research focus was active learning involving the topic of chronic kidney disease-mineral bone disorder. Student teams were randomly assigned to either case-based or student question creation exercises using PeerWise. Student performance was assessed by a pre- and posttest and on block and final exams. After completion, an online survey assessed student perceptions of both exercises. FINDINGS: Statistically significant differences were revealed in favor of the student question creation group on enjoyment and interest in the subject matter. No statistically differences were found between the traditional case-based group and the student question creation group on gain score from pre-test to posttest. The student question creation group performed slightly better than the case-based application group on two of the five questions on the block exam but none of these differences reached statistical significance. DISCUSSION AND CONCLUSIONS: Students randomly assigned to groups that created and reviewed questions exhibited slightly improved summative exam performance and reported significantly more positive perceptions than students engaging in a more traditional case-based learning activity. Student question creation has demonstrated potential as a useful learning activity. Despite inherent difficulties in designing studies involving educational research in a controlled environment, students who have submitted, created, rated, and answered peers' questions have overall performed well.

Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis.

BACKGROUND: Little is known about the use and effectiveness of over-the-counter (OTC) fish oil supplements for triglyceride (TG) lowering. OBJECTIVES: To (1) perform a medication-use evaluation (MUE) and (2) assess the efficacy of OTC fish oil. METHODS: Retrospective, observational cohort study using electronic medical records and the pharmacy database from Parkland Health and Hospital System in Dallas, Texas. Parkland is a tax-supported county institution that provides patients with single-brand OTC fish oil. Two separate analyses were conducted. Six hundred seventeen patients (prescribed fish oil between July 1, 2012, and August 31, 2012) were included in the MUE analysis and 235 patients (109 fish oil, 72 fenofibrate, and 54 gemfibrozil, prescribed between January 1, 2012, and July 31, 2013) were included in the efficacy analysis. The main outcome measure for the MUE was fish oil prescribing habits including dosages and patient adherence, as defined by medication possession ratio. The main outcome measure for the efficacy analysis was change in lipids measured using the last value before fish oil treatment and the first value after fish oil treatment. RESULTS: MUE: 617 patients received prescriptions for OTC fish oil. Sixty-four percent were prescribed a total daily dose of 2000 mg. Only 25% of patients were adherent. Efficacy analysis: despite being prescribed suboptimal doses, fish oil reduced TGs by 29% (95% confidence interval, 34.3-22.7). Compared with fish oil therapy, fibrate therapy resulted in a greater TG reduction: 48.5% (55.1-41.0) with fenofibrate and 49.8% (57.6-40.5) with gemfibrozil (P < .0001, both medications compared with fish oil). CONCLUSIONS: Health care providers prescribe suboptimal doses of fish oil, and adherence is poor. Even at low doses (2 g/d), though, fish oil lowers TGs by 29%.