Virtual reality in experiential pharmacy education: A quasi-experimental study.

Introduction: Extended reality (XR) technologies are an umbrella term for simulated-based learning tools that cover 3-dimensional technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR). At King Saud University, first-year pharmacy students are required to experience hospital observational training during the Introductory Pharmacy Practice Experience (IPPE). We aimed to measure the effectiveness and satisfaction of the VR learning experience among IPPE students. Methods: A Quasi-Experimental study was conducted. The experimental arm included first-year PharmD students. VR headset was used to watch three narrated videos capturing 360° views of the outpatient, inpatient pharmacy, and counseling clinic. A test measuring students' general knowledge was required prior to and post the experience, followed by a satisfaction survey. The control arm included second-year PharmD students who had traditional hospital visits and were administered a knowledge test and satisfaction survey. Results: A total of 336 students were enrolled, 174 in the experimental arm and 162 in the control arm. The results showed improvement in the knowledge scores average among the experimental arm, 1.9 vs 3.5 in the pre-test and post-test. The control arm had a comparable score with an average of 3.7. Regarding self-assessment using four 5-likert scales assessing pharmacist role, skills, and responsibilities, 31.8 % and 42 % in the experimental arm compared to 28.9 % and 28.9 % in the control group answered strongly agree and agree, respectively. Regarding satisfaction, using five 5-Likert scales assessing the experience time, quality, and content, 53 % and 25 % in the experimental group compared to 34 % and 23 % in the control group answered strongly agree and agree, respectively. Conclusion: VR provides pharmacy students with a standardized and effective learning and training experience. The experimental arm reported higher satisfaction rates and self-reported outcomes. Thus, implementing VR experiences within the pharmacy curriculum will provide students with an advanced educational advantage.

Historical background and current situation of pharmacy education in Mongolia.

In Mongolia, the medical education system with a long history has developed with its characteristics since ancient times. Modern medical education, including pharmacy education, began to grow in 1921. Before modern pharmaceutical science developed in Mongolia, pharmacy and pharmacy education were part of Traditional Mongolian Medicine and education. Medical knowledge and experience were transferred from generation to generation through simple teaching. From the sixteenth century, Manba Datsan was established in religious temples to teach Mongolian medicine through discipleship. Modern pharmacy education in Mongolia began in 1926 with the course training of pharmacy technicians, and pharmacist training started in 1961. Pharmacy technician training with a 3-year and pharmacist training with 5-year programs oriented on patient-centered pharmaceutical care are implemented in Mongolia. Pharmacy technicians can also study towards a B. degree in Pharmacy with an additional 3 years of training. As of 2023, seven state-owned and private higher education institutions offer pharmacy education and the number of institutions and students of pharmacy is expected to increase. The pharmacy education policy and the license examination type may be reformable, and the curricula should be regularly updated in line with international trends.

Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR.

Introduction: Diarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care. Method: Simulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists' practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists' practice was categorized into adequate, less adequate, and poor. Results: 182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription. Conclusion: A high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists' practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.

Drivers of citations in social pharmacy and practice research articles.

BACKGROUND: Research in Social and Administrative Pharmacy has been expanding in the last decade. The recently published Granada Statements offer key recommendations to improve the quality of research in this field. OBJECTIVES: To identify the factors associated with the citations of articles in the field of social, administrative, clinical pharmacy and practice research. METHODS: This study was a retrospective, observational analysis of articles published in three leading journals. Per article Google Scholar citations was the dependent variable. Predictor variables were extracted from all articles published from 2013 to 2015. The dependent variable was dichotomized using sample's median Google Scholar citations. Logistic regression analysis was performed to identify independent predictors of citations ≥ median. RESULTS: The median number of citations per article was 17 (range 0-341), with a mean of 24.2 (SD 27.6). The number of references included in the articles (OR 1.03, CI 1.02-1.04), the year of publication (OR 0.31 CI 0.21-0.46 for articles published 2015), article social media mentions (OR = 1.01, CI 1.01-1.03 and OR 1.10 CI 1.04-1.18 for Facebook and X, respectively), the topic area of research namely pharmacy services (OR 1.65, CI 1.06-2.57) and medication adherence (OR 2.22 CI 1.13-4.33) were independently associated with article having citations ≥ median. CONCLUSIONS: The number of references, the year of publication, social media mentions and the topic area of research, namely pharmacy services and medication adherence, were associated with citations above median in the leading journals of social and administrative pharmacy research. Authors may consider providing a thorough literature review in their articles, while researchers, editors, and publishers are advised to use social media to promote newly published work. This article complements the Granada Statements and may contribute to fostering wider dissemination of the discipline's outputs.

Pharmacist access and training process for residency in Hospital Pharmacy in Argentina. / Proceso para el acceso y formación del farmacéutico a la residencia en Farmacia Hospitalaria en Argentina.

Hospital Pharmacy worldwide has proven to be a crucial element in healthcare. In Latin America, it draws inspiration from two main models: United States, which promoted clinical pharmacy and later pharmaceutical care, and Spain, which shares similar healthcare practices and the added advantage of a common language. Both models influenced the implementation of Hospital Pharmacy residencies in Argentina since the 1980s. Hospital Pharmacy residencies in Argentina constitute a paid system of intensive postgraduate training on a full-time basis with exclusive dedication. They are carried out in 11 provinces across Argentina in services with recognized teaching experience. Currently, there are 46 locations with a total of 75 annual vacancies for applicants. The objective of Hospital Pharmacy residencies is to train pharmaceutical professionals with the necessary competencies to ensure the care of patients through the optimization of the safe, effective, and efficient use of medications and healthcare products tailored to each patient's individual therapy. Hospital Pharmacy residencies have demonstrated that pharmacists acquire specialized training that can be decisive in influencing healthcare policies related to the safe use of medications and healthcare products. Therefore, actions to promote and encourage interest in this field among pharmaceutical professionals are necessary, involving scientific societies, universities, pharmaceutical associations, and the political sphere.

Framework for an interprofessional experience addressing health and disability for health professional students.

BACKGROUND AND PURPOSE: A Health and Disabilities Interprofessional Education (IPE) course was implemented to join three healthcare disciplines together to collaboratively plan, implement, and reflect on professional roles and responsibilities. The goal and purpose of this course was to create an advancement of interprofessional education and practice within health science professions early in their students' programs utilizing innovative teaching methods working directly with individuals with disabilities. EDUCATIONAL ACTIVITY AND SETTING: 72 students were assigned to interprofessional teams of 10-11 people. Through asynchronous and synchronous learning activities, student teams worked together to plan and conduct community-based client interviews. FINDINGS: Quantitative and qualitative evaluation methods were used to explore the impact of interprofessional experiential learning experiences. Qualitative data showed a greater awareness and understanding of the different roles and responsibilities in interprofessional teams as well as a greater appreciation for the value of interacting with persons with disabilities (PWD) during their training. Quantitative data showed a significant change in students' understanding of their roles and responsibilities as a member of an interprofessional team, their confidence with working with PWD in a future healthcare capacity, as well as their understanding of how the social determinants of health may influence the healthcare experience of a PWD. SUMMARY: Interprofessional education and experiential learning opportunities are good ways to facilitate "real" patient care experiences and team roles and responsibilities. This enables healthcare students to practice communication, build relationships, and understand the lived experience of their patients.

Integration of electronic project management software in an investigational drug service pharmacy within an academic medical center.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: An investigational drug services (IDS) pharmacy plays a vital role in supporting clinical trial research by ensuring the safe and efficient management of investigational products. This article describes the implementation of an electronic project management software to improve an IDS pharmacy's study protocol work. The article describes the implementation of the software and how this approach addressed specific challenges, including project oversight, process standardization, documentation, reporting, accountability, and intrateam communication. SUMMARY: We describe an electronic project management software system used to streamline and standardize the work associated with study protocols. This software provides an organized and customizable workspace to manage tasks associated with each study protocol. The software automates task creation, tracks progress, and ensures comprehensive record keeping. Additionally, the software fosters effective communication within the team and offers real-time reporting to assess team productivity and progress. We have observed improved consistency, enhanced revenue, including approximately $18,000 in additional fee capture, and increased collaboration among pharmacy team members. CONCLUSION: Implementing an electronic project management software has proven highly beneficial in the IDS pharmacy. The software has significantly improved workflow efficiency by addressing challenges in study protocol management. While initial setup and training required time and resources, the long-term benefits in project oversight, collaboration, and revenue capture justify the investment. An electronic project management software is a valuable tool in managing the complexity of study protocol activities and supports the pharmacy's crucial role in advancing clinical research.

Comparing pharmacy practice in health facilities with and without pharmaceutically trained dispensers: a post intervention study in Tanzania.

Background: The critical shortage of comprehensively trained healthcare staff in Tanzania affects the capacity to deliver essential health services, attain universal health coverage and compromises health outcomes. There is a specific lack of suitably trained pharmaceutical professionals, thus, an increase in the use of unqualified or poorly trained staff. Following the introduction of a one-year pharmacy dispenser course intervention, this study explored the impact that the new cadre of graduates had on pharmacy practice compared to healthcare facilities with non-pharmacy trained dispensers (NPTDs). Methods: A post intervention assessment was conducted in 2021 using questionnaires formulated to measure indicators of Good Pharmacy Practice, comparing 29 public health facilities employing pharmacy-trained dispensers (PTD) with 32 public health facilities with NPTDs in Dodoma, Shinyanga and Morogoro regions of Tanzania. Data were collected by experienced pharmacists or pharmaceutical technicians and subsequently aggregated and statistically analysed. Results: The dispensing times for medicines were found to be the same for PTDs and the NPTDs (2 min). There were no statistically significant differences in the adequacy of labelling elements between PTDs and NPTDs. Patients' level of knowledge of the medicines dispensed to them, from both PTDs and NPTDs, showed no difference. Moreover, no differences were observed in storage practice and documentation performance, records of dispensed medicines, handling of medicines and the dispensing area cleanliness between both groups. Overall, facilities with PTDs averaged a higher availability of tracer medicines (77%) than those with NPTDs (70%), however, availability of health commodities in all health facilities in the three regions was low and there was no statistically significant difference between both groups. Conclusion: The study showed no significant difference in performance of pharmacy practice between PTDs and NPTDs despite the former undertaking a one-year training course intended to improve knowledge and skills. Practice application not only depends on effective training but on the working environment. Clear job descriptions, appropriate tools and references to guide, Standard Operating Procedures, acceptance by management of the training undertaken to actively encourage recruits to apply these new skills could improve PTDs performance. Training and knowledge alone do not seem to lead to better practice and performance.

Conscientious objection - a cross-sectional, vignette-based, mixed methods exploration of Australian pharmacists' perspectives.

Background: Conscientious objection (CO) in healthcare is a controversial topic. Some perceive CO as freedom of conscience, others believe their professional duty-of-care overrides personal-perspectives. There is a paucity of literature pertaining to pharmacists' perspectives on CO. Aim: To explore Australian pharmacists' decision-making in complex scenarios around CO and reasons for their choices. Method: A cross-sectional, qualitative questionnaire of pharmacists' perspectives on CO. Vignette-based questions were about scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and Voluntary Assisted Dying (VAD) Results: Approximately half of participants (n = 223) believed pharmacists have the right to CO and most agreed to supply prescriptions across all vignettes. However, those who chose not to supply (n = 20.9%), believed it justifiable, even at the risk of patients failing to access treatment. Strong self-reported religiosity had a statistically significant relationship with decisions not to supply for 3 of 4 vignettes. Three emergent themes included: ethical considerations, the role of the pharmacist and training and guidance. Conclusion: This exploratory study revealed perspectives of Australian pharmacists about a lack of guidance around CO in pharmacy. Findings highlighted the need for future research to investigate and develop further training and professional frameworks articulating steps to guide pharmacists around CO.

Implementation of a traceability system and safe manufacturing medications in a clean room. / Implantación de un sistema de trazabilidad y elaboración segura de medicamentos en la sala blanca.

OBJECTIVE: To describe the process of implementing a traceability and safe drug manufacturing system in the clean room of a Pharmacy Service to increase patient safety, in accordance with current legislation. METHODS: The process was carried out between September 2021 and July 2022. The software program integrated all the recommended stages of the manufacturing process outlined in the "Good Practices Guide for Medication Preparation in Pharmacy Services" (GBPP). The following sections were parameterized in the software program: personnel, facilities, equipment, starting materials, packaging materials, standardized work procedures, and quality controls. RESULTS: A total of 50 users, 4 elaboration areas and 113 equipments were included. 435 components were parameterized (195 raw materials and 240 pharmaceutical specialties), 54 packaging materials, 376 standardized work procedures (123 of them corresponding to sterile medicines and 253 to non-sterile medicines, of which 52 non-sterile were dangerous), in addition 17 were high risk, 327 medium risk, 32 low risk, and 13 quality controls. CONCLUSIONS: The computerization of the production process has allowed the implementation of a traceability and secure drug manufacturing system in a controlled environment in accordance with current legislation.

An observational study of root-cause analysis of medication errors in elderly with methotrexate toxicity.

INTRODUCTION: Medication errors are inherent in a healthcare system. This results in both time and cost burdens for both the patient and the health system. The aim of this study was to conduct a root-cause analysis of medication errors in elderly patients with methotrexate toxicity, analyze associated factors, and propose solutions. METHODS: This single-center prospective study was designed to identify medication errors in cases of methotrexate toxicity between November 2022 to May 2023. Categorical data and free-text data are used to describe incidents. Harm assessment, factors related to medication errors, and preventability were evaluated for each case. Possible strategies to prevent similar occurrences are discussed. RESULTS: Out of a total of 15 patients who presented during the study period, nine suffered from methotrexate toxicity due to medication errors. Most medication errors occurred during prescribing or dispensing (seven cases). Inadequate knowledge about medication and dosage, inadequate communication was identified as a contributing factor for all medication errors. Patients on long-term methotrexate treatment are at high risk of methotrexate toxicity. CONCLUSION: This study highlights the challenges of health literacy and lacking communication between healthcare providers and patients that can be met through community pharmacy programs for the elderly in lower-middle-income countries.

A Review of Medication Errors and the Second Victim in Pediatric Pharmacy.

The concept of the second victim, described as the sense of victimization of health care professionals following the exposure to a traumatic, unanticipated medical error, was first introduced in 2000 by Albert W. Wu. Since then, the concept has gained immense traction and inspired the generation of assistance programs for second victims. With most second victim occurrences resulting from medication errors, pediatric pharmacists are at a high risk of experiencing second victim phenomenon. Second victims may experience both psychological and physical symptoms of distress often akin to post-traumatic stress disorder. Typical trajectories for second victims, as well as typical support needs, have been previously described, with several organizations responding by creating formal programs designed to support their staff in the events of traumatic workplace experiences. Most support programs involve peer-to-peer support, group sessions, and programs designed to increase coping skills. Additional resources are available for health care workers who do not have formalized support programs at their institution, although these are limited. Despite these resources, institutions across the country have room for additional growth in their support of employees who become second victims to tragedy.

Empowering early career pharmacists: Unleashing non-clinical competencies through pharmacy residency.

INTRODUCTION: Pharmacy residency programs traditionally prioritize clinical skills development. However, non-clinical competencies, such as leadership, conducting education, and innovation, are now emerging as pivotal factors in propelling pharmacists toward excellence in practice. The extent to which these non-clinical skills are effectively fostered by residency programs remains unclear. This study aims to explore how residency programs propel the development of crucial non-clinical competencies such as leadership, conducting education, and innovation. METHODS: Pharmacists who completed a pharmacy residency program and their preceptors from a tertiary teaching hospital took part in semi-structured interviews. Thematic analysis, employing an inductive approach and aided by NVivo software, was used to identify recurrent themes in the interview responses. RESULTS: Competency development was shaped by four key themes: system-dependent facilitators, system-dependent barriers, individual resident attitudes, and pharmacy department influences. The structure of the residency program was perceived to strongly support competency development in conducting education. The impact on the leadership and innovation competencies development was comparatively lesser. CONCLUSION: Pharmacy residency is perceived as effective in supporting non-clinical competency development when there is a clear structured framework with objectives and guidance for pre-defined activities and tasks known to support competency development. Ambiguity and a lack of standardized guidance in developing specific competencies were identified as factors that diminish their relevance for both residents and preceptors. To enhance residency programs, it is essential to establish clear frameworks, with pre-defined objectives and activities known to support competency development and supplement them with the necessary skills-building courses where appropriate.

Novel opportunities for clinical pharmacy research: development of a machine learning model to identify medication related causes of delirium in different patient groups.

The advent of artificial intelligence (AI) technologies has taken the world of science by storm in 2023. The opportunities of this easy to access technology for clinical pharmacy research are yet to be fully understood. The development of a custom-made large language model (LLM) (DELSTAR) trained on a wide range of internationally recognised scientific publication databases, pharmacovigilance sites and international product characteristics to help identify and summarise medication related information on delirium, as a proof-of-concept model, identified new facilitators and barriers for robust clinical pharmacy practice research. This technology holds great promise for the development of much more comprehensive prescribing guidelines, practice support applications for clinical pharmacy, increased patient and prescribing safety and resultant implications for healthcare costs. The challenge will be to ensure its methodologically robust use and the detailed and transparent verification of its information accuracy.

A survey exploring the barriers and drivers to leader and leadership development of the pharmacy workforce.

INTRODUCTION: Leadership is an essential but under-researched domain in advanced pharmacy practice. AIM: To describe pharmacist leadership training experience and ascertain perceptions of barriers/drivers for leadership development. METHODS: Online survey at a UK tertiary-care organization. Questions related to leadership competencies, personal qualities, barriers, and drivers, with Likert scale responses options, were analysed using Microsoft Excel®. RESULTS: Thirty-nine pharmacists responded. Three quarters reported no formal leadership training. Many identified leadership development as essential for career progression. Main driver was a manager or peer support. Barriers included workload, being undervalued, and lack of strategic opportunities. CONCLUSION: Our findings can inform educators and organizations in developing future strategies.

Adjunct Preceptor Perceptions of Motivation, Understanding, and Support for the Precepting Role.

OBJECTIVE: To determine adjunct pharmacist preceptor perceptions of their precepting role related to three domains: motivation to precept, understanding the precepting role, and support for precepting. METHODS: An online cross-sectional survey of 2429 adjunct preceptors for four schools of pharmacy was conducted. Participants ranked their agreement with 81 statements regarding the three domains, including eleven subdomains. RESULTS: Mean scores for the three domains were slightly below the positive response level, with lower scores found for the subdomains of workload, precepting norms, and extrinsic benefits/rewards. Individual statements indicated increased workload due to precepting, need for more preceptor recognition and appreciation, perceptions that precepting was stressful or draining, and a preference for one concurrent learner. More frequent need for extra coaching for APPE students negatively impacted all domains, including nine subdomains. CONCLUSION: This study provides a formal evaluation of adjunct preceptor perceptions of their precepting role. Compared to previous studies, these results may indicate lower satisfaction with precepting, suggesting opportunities exist to improve the adjunct precepting experience. Actions by schools/colleges of pharmacy are necessary to ensure experiential education capacity including addressing workload concerns, increasing preceptor recognition and appreciation, and supporting preceptors when students need extra coaching.

Patient and pharmacist perspectives on opioid misuse screening and brief interventions in community pharmacies.

BACKGROUND: Pharmacy-based screening and brief interventions (SBI) offer opportunities to identify opioid misuse and opioid safety risks and provide brief interventions that do not overly burden pharmacists. Currently, such interventions are being developed without patient input and in-depth contextual data and insufficient translation into practice. The purpose of this study is to qualitatively explore and compare patient and pharmacist perceptions and needs regarding a pharmacy-based opioid misuse SBI and to identify relevant SBI features and future implementation strategies. METHODS: Using the Consolidated Framework for Implementation Research, we conducted semi-structured interviews with 8 patients and 11 pharmacists, to explore needs and barriers to participating in a pharmacy-based SBI. We recruited a purposive sample of English-speaking patients prescribed opioids for chronic or acute pain and pharmacists practicing in varied pharmacies (small independent, large-chain, specialty retail) settings. We used an inductive content analysis approach to analyze patient interview data. Then through a template analysis approach involving comparison of pharmacist and patient themes, we developed strategies for SBI implementation. RESULTS: Most patient participants were white, older, described living in suburban areas, and were long-term opioid users. We identified template themes related to individual, interpersonal, intervention, and implementation factors and inferred applications for SBI design or potential SBI implementation strategies. We found that patients needed education on opioid safety and general opioid use, regardless of opioid use behaviors. Pharmacists described needing patient-centered training, protocols, and scripts to provide SBI. A short-self-reported screening and brief interventions including counseling, naloxone, and involving prescribers were discussed by both groups. CONCLUSIONS: Through this implementation-focused qualitative study, we identified patient needs such as opioid safety education delivered in a private and convenient format and pharmacist needs including training, workflow integration, protocols, and a time-efficient intervention for effective pharmacy-based SBI. Alternate formats of SBI using digital health technologies may be needed for effective implementation. Our findings can be used to develop patient-centered pharmacy-based SBI that can be implemented within actual pharmacy practice.

Assessment of Academic Resilience and Its Associated Factors Among Pharmacy Students in Twelve Countries.

OBJECTIVE: Academic resilience, a critical determinant of academic achievement, is affected by various factors. There is a paucity of large-scale international assessments of academic resilience among pharmacy students. Therefore, this study aimed to assess academic resilience among pharmacy students in 12 countries and to evaluate factors associated with their academic resilience levels. METHODS: A cross-sectional online survey-based study was conducted among randomly selected pharmacy students in 12 countries: Egypt, Türkiye, Indonesia, Pakistan, Bangladesh, Iraq, Jordan, Nigeria, Malaysia, Saudi Arabia, Sudan, and the United Arab Emirates. After pilot testing, the validated 30-item academic resilience scale (ARS) was used for the assessment. The data were collected between November 1, 2022 and April 15, 2023. Descriptive and inferential statistics were performed, as appropriate. RESULTS: A total of 3950 were received from the 12 participating countries. The mean age was 21.68 ± 2.62 years. About two-thirds of the responses were from female participants and those studying for Bachelor of Pharmacy degrees. Overall, the findings show moderate academic resilience, which varied across countries. The median (IQR) of the total ARS-30 was 114 (103-124). Females exhibited lower negative affective and emotional response subscale levels than males. There were significant cross-country variations in the ARS-30 and all subscales. The highest overall levels were reported for Sudan, Pakistan, and Nigeria and the lowest were reported for Indonesia and Türkiye. Students in private universities tended to have higher overall ARS levels than public university students. Higher academic performance was significantly associated with ARS levels, whereas those with excellent performance exhibited the highest ARS levels. Students with exercise routines had higher ARS levels than those without exercise routines. Finally, students who were engaged in extracurricular activities had higher ARS levels than those who did not participate in these activities. CONCLUSION: The study offers insights into the factors affecting academic resilience in pharmacy students across several countries. The findings could guide interventions and support activities to improve resilience and academic outcomes.