Exploring Pharmacy Students' Leadership Styles Using the 5 Voices Assessment.

OBJECTIVE: Leadership development assessments are a critical component of student pharmacists' understanding and development of effective team strategies. METHODS: The 5 Voices tool, developed by GiANT Worldwide, was incorporated into the leadership curriculum across 2 colleges of pharmacies for second-year Doctor of Pharmacy (PharmD) students. One public land-grant institution administers the assessment in the fall semester during a 2-h class session as part of a leadership elective leadership course and a private liberal arts institution distributes the 5 Voices assessment to all students during a 1-h spring semester required course. RESULTS: Responses from 456 PharmD students were included in the analysis, with 159 (34.9%) and 297 (65.1%) coming from the University of Minnesota and Drake University, respectively. Overall, 49.1% of PharmD students had nurturer as their foundational (first) voice. No differences were found in the distribution of first voices between institutions. The PharmD data are higher than the nurturer population-level average (43%). CONCLUSION: Introducing students to the 5 Voices assessment provides an opportunity for them to gain a better understanding of what they can contribute to a team. In addition, because nurturer is a dominant voice, this understanding can help provide appreciation for other voices necessary for team development.

Debate as an Active Learning Pedagogy Among Pharmacy Students in a Public Health Course.

OBJECTIVE: To evaluate the impact of a debate activity on pharmacy students' knowledge of public health and health policy topics. METHODS: Forty-six second-year pharmacy students in a required public health and health policy course debated universal healthcare coverage for Americans using the Lincoln-Douglas oral debate format. Demographic data, including age and gender, were collected. Knowledge (before/after) of universal healthcare principles was assessed via a rubric-embedded quiz related to the activity objectives. The students' perceptions of the educational value of the debate were assessed before and after the debate using a 12-item Likert scale (1 = strongly disagree through 5 = strongly agree) and open-ended questions. Descriptive statistics and thematic analysis were conducted using SPSS v25 and Atlas.ti version 9, respectively. Wilcoxon t tests were conducted to compare preknowledge and postknowledge scores. An α level of 0.05 was utilized. RESULTS: Forty-two students completed the perceptions survey, yielding a 96 % response rate. The mean age was 24 ± 4 years and primarily female (63 %). Most students had no previous experience with debates (80.4 %) and there was a statistically significant improvement in knowledge after the debate from 66.5 % ± 13.4 % to 80.7 % ± 12 % , for a total increase of 14.2 %. Open responses indicated that students believed their overall knowledge about other healthcare systems increased and they developed literature review and communications skills. CONCLUSION: The debate activity enhanced the students' knowledge and assessment of controversial public health issues that will be useful during their pharmacy education and careers. The students perceived that the debates enriched their learning.

Impact of Transitioning a Senior Seminar Capstone Course to an Intensive Hybrid Course.

Objective. To compare outcomes (grades, resources, and perceptions) from a weekly in-person seminar capstone course (pre-revision group) to an intensive hybrid course design that included a two-day, in-person conference (10- and 25-minute student presentations) and asynchronous seminar skills sessions (post-revision group).Methods. Students' scores on seminar presentation rubrics were compared before and after the course revision. Between the groups, we compared resources, such as number of faculty and hours of involvement, and student time away from advanced pharmacy practice experiences (APPEs). We also assessed student and faculty satisfaction and perception. Comparisons between groups were made using statistical tests, and descriptive statistics were used to summarize student performance and survey responses.Results. The study included 370 students, 205 in the pre-revision group and 165 in the post-revision group. No significant difference was found in mean overall scores for the 25-minute presentation between groups; however, the post-revision group had significantly lower subscores for objectives and slides and significantly higher subscores for critical analysis. The survey was completed by 82% of faculty and 43% of students from the class of 2018. Most students (80%) found all of the asynchronous sessions helpful, and 70.6% preferred the intensive hybrid course format. Compared to the weekly format, all faculty reported student presentations were similar or better in quality and workload was similar or decreased with the intensive hybrid format.Conclusion. Changing the senior seminar capstone course to an intensive hybrid design reduced faculty workload and decreased student time away from APPEs while maintaining similar presentation grades and quality.

Best Practices in Syllabus Design.

The syllabus is the cornerstone for directing faculty and student interaction within the didactic and experiential settings. Within each syllabus is both essential and optional information to guide students, faculty, and administration in course expectations as well as to explain how the course aligns within current curricular requirements to maintain program accreditation. Most syllabi contain a plethora of information that continues to grow each year, warranting concerns of syllabus bloat combined with dwindling student attention to syllabus detail. This paper summarizes best practices related to designing effective course syllabi and recommendations to promote clear and concise communication between students, faculty, and administrators involved in pharmacy education.

Sculpting a teaching and learning curriculum to better meet the career needs of postgraduate year 1 and 2 pharmacy residents.

PURPOSE: To describe implementation of the University of Oklahoma College of Pharmacy (OUCOP) teaching and learning curriculum (TLC) for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents, including the required components, evaluation structure, residency graduate outcomes and perceptions captured by a survey following program completion, generalizability to other institutions, and opportunities for future directions. SUMMARY: As part of their residency training, pharmacy residents are required to develop and refine teaching, precepting, and presentation skills. To meet the required and elective competency areas, goals, and objectives on teaching, precepting, and presentation skills, many American Society of Health-System Pharmacists-accredited residency programs have utilized TLC programs. OUCOP offers 2 distinct TLC programs for PGY1 and PGY2 residents, respectively. CONCLUSION: The OUCOP TLC program provided residents with opportunities for development of teaching and presentation skills in a variety of settings. The majority of residency graduates currently practice as a clinical specialist, and the majority lecture, precept, and deliver continuing education presentations. Graduates felt that the mentorship and diversity of teaching activities were the most beneficial qualities of the program. In addition, the majority noted that mentorship in lecture preparation was helpful in creating presentations after graduation. On the basis of the feedback from the survey, several changes have been made to better prepare residents for their postgraduate careers. TLC programs should conduct ongoing assessments to continue to foster the development of precepting and teaching skills for residents' future careers.

The AACP Academic Affairs Committee's Final 2022 Curricular Outcomes and Entrustable Professional Activities (COEPA) for Pharmacy Graduates to Replace 2013 CAPE and 2016 EPAs.

The American Association of Colleges of Pharmacy (AACP) Academic Affairs Committee was charged with revising both the 2013 Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes (EOs) and the 2016 Entrustable Professional Activities (EPAs). The Committee changed the document name from the CAPE outcomes to COEPA, (Curricular Outcomes and Entrustable Professional Activities) since the EOs and EPAs would now be housed together. A draft of the COEPA EOs and EPAs was released at the AACP July 2022 Annual meeting. After receiving additional stakeholder feedback during and after the meeting, the Committee made additional revisions. The final COEPA document was submitted to and approved by the AACP Board of Directors in November 2022. This COEPA document contains the final version of the 2022 EOs and EPAs. The revised EOs have been reduced to 3 domains and 12 subdomains (from 4 domains and 15 subdomains previously in CAPE 2013) and the revised EPAs have been reduced from 15 to 13 activities.

The AACP Academic Affairs Committee's Guidance for Use of the Curricular Outcomes and Entrustable Professional Activities (COEPA) for Pharmacy Graduates.

The 2021-2023 American Association of Colleges of Pharmacy Academic Affairs Committee (AAC) was charged with and completed the revision of the 2013 Center for the Advancement of Pharmacy Education Outcomes and the 2016 Entrustable Professional Activity (EPA) statements for new pharmacy graduates. This work resulted in a new combined document, the Curricular Outcomes and Entrustable Professional Activities (COEPA) that was unanimously approved by the American Association of Colleges of Pharmacy Board of Directors and was published in the Journal. The AAC was also charged with providing stakeholders with guidance about how to use the new COEPA document. To achieve this charge, the AAC created example objectives for all 12 Educational Outcomes (EOs) and example tasks for all 13 EPAs. Although programs are asked to retain the EO domains, subdomains, one-word descriptors, and descriptions, unless they are adding more EOs or increasing the taxonomy level of a description, colleges and schools of pharmacy can expand or edit the example objectives and example tasks to meet local needs, as these are not designed to be prescriptive. This guidance document is published separately from the COEPA EOs and EPAs to reinforce the message that the example objectives and tasks are modifiable.

Perceptions and Practices for Evaluating Faculty Workload by Pharmacy Education Administration/Leadership.

OBJECTIVE: To assess how department chairs/administrators define, measure, and evaluate faculty workload to better understand practices within the Academy. METHODS: An 18-item survey was distributed to department chairs/administrators via American Association of Colleges of Pharmacy Connect. Participants identified if they are a primary decision maker for faculty workload, whether their program has a workload policy, how workload is calculated, and how faculty satisfaction with workload equity is measured. RESULTS: Of 71 participants initiating the survey, data from 64 participants from 52 colleges/schools were eligible for analysis. Leaders of practice departments reported that their faculty spend an average of 38% of their time on teaching (compared to 46% for non-practice departments), 13% on research (vs 37%), 12% on service (vs 16%), and 36% on clinical practice (vs 0%). Most survey participants (n = 57, 89%) are at schools/colleges with a tenure system, and about 24 participants reported that faculty workload metrics differ across departments/divisions. Teaching assignments and service are reportedly negotiable between faculty and supervisors, and workload expectations are widely variable. The majority indicated they do not analyze faculty satisfaction with workload fairness (n = 35) and faculty do not provide evaluative feedback on how supervisors assign faculty workload (n = 34). Of 6 priorities considered when determining workload, 'support college/school strategies and priorities' ranked highest (1.92) and 'trust between the chair and faculty' ranked lowest (4.87). CONCLUSION: Overall, only half of the participants reported having a clear, written process of quantifying faculty workload. The use of workload metrics may be needed for evidence-based decision-making for personnel management and resource allocation.

Finalizing the Work Related to the Curriculum Outcomes and Example Objectives and Entrustable Professional Activities (COEPA) Document: The Report of the 2022-2023 Academic Affairs Standing Committee.

The 2022-2023 Academic Affairs Committee (AAC) was charged to (1) complete the Center for the Advancement of Pharmacy Education Outcomes and Entrustable Professional Activities (EPAs) revisions (now renamed as COEPA - Curriculum Outcomes and Entrustable Professional Activities) after receiving feedback at the 2022 American Association of Colleges of Pharmacy (AACP) Annual Meeting; (2) offer guidance on how the revised COEPA education outcomes and EPA statements should be used by member institutions, faculty, preceptor, and students; (3) guide input into the ongoing revision of the Accreditation Council for Pharmacy Education (ACPE) standards for the Doctor of Pharmacy program. The published report of the 2021-2022 AAC outlines the work of the Committee through the spring of 2022.1 This 2022-2023 AAC report focuses on the work related to finalizing the COEPA educational outcomes, EPAs, preamble, and glossary and formally receiving approval from the AACP Board of Directors.2 This report also describes the creation of a COEPA guidance document, including educational outcomes example learning objectives, and EPA example tasks for the Academy, however, the actual guidance document will be published separately. Finally, this current report outlines the feedback the AAC sought, received, synthesized, summarized, and prioritized from key interested and affected parties about the ACPE 2016 standards revisions for the ACPE 2025 draft standards.3 The Committee offers revisions for 1 AACP policy statement pertaining to diversity, equity, inclusion, accessibility, justice, and anti-racism. One new policy statement is also offered that urges ACPE to create accreditation standards for pharmacy education that support diversity, equity, inclusion, accessibility, justice, and anti-racism, despite presence of laws, executive orders, and policies that oppose these concepts.

Guidance for Qualitative Research Manuscripts in Pharmacy Education.

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

Evaluating Pharmacy Faculty's Awareness of Teaching and Learning Myths and Misconceptions.

Objective. To assess pharmacy faculty's knowledge of prominent and prevalent teaching and learning myths and misconceptions and evidence-based strategies prior to training.Methods. Participants completed a baseline assessment containing 16 true-false knowledge questions about teaching and learning misconceptions (10) and myths (six), one open-ended application question, and four participant demographic questions including years of experience in pharmacy academia, the focus of their institution (teaching or research), the number of education meetings attended, and whether they had formal training in education. After completing the baseline assessment of the top 16 misconceptions and myths, faculty were trained on the top 10 evidence-based teaching and learning strategies. At session completion, faculty were provided the assessment answers and scored their original responses.Results. Results from the survey revealed that most responders (56%) had been in academics between one and 10 years and attended two to 10 education meetings (62%). The majority of participants worked at teaching-intensive universities (56%), and most had no formal training in teaching (65%). The average score on the assessment was 43% for the myths section versus 70% for the misconceptions section. Faculty participants were overconfident in their predictions (predicted=74%, actual=60%). Faculty demographics did not influence the assessment scores.Conclusion. Pharmacy faculty may not know which teaching and learning strategies are evidence based and which are myths or misconceptions. In addition, they are likely to be overconfident in their knowledge of this evidence. This provides opportunity for faculty development in these areas.

A Systematic Review of Assessment Tools Measuring Cultural Competence Outcomes Relevant to Pharmacy Education.

Objective. To identify and describe validated assessment tools that measure cultural competence and are relevant to pharmacy education.Methods. A systematic approach was used to identify quantitative cultural competence assessment tools relevant to pharmacy education. A systematic search of the literature was conducted using the OVID and EBSCO databases and a manual search of journals deemed likely to include tools relevant to pharmacy education. To be eligible for the review, the tools had to be developed using a study sample from the United States, have at least one peer-reviewed validated publication, be applicable to the pharmacy profession, and be published since 2010.Results. The systematic literature and manual search identified 27 tools. Twelve assessment tools met the criteria to be included in the summary and their relevancy to pharmacy education is discussed.Conclusion. A review of literature demonstrates that assessment tools vary widely and there is no one tool that can effectively assess all aspects of cultural competence in pharmacy students or the Doctor of Pharmacy curriculum. As cultural competence is a priority within the accreditation standards for pharmacy education, PharmD programs are encouraged to develop additional tools that measure observed performance.

Strategies for Measuring Advances in Pharmacy Student Learning.

Objective. To provide guidance to authors and reviewers on how to design and evaluate educational research studies to better capture evidence of pharmacy student learning.Findings. A wide variety of assessment tools are available to measure student learning associated with educational innovations. Each assessment tool is associated with different advantages and disadvantages that must be weighed to determine the appropriateness of the tool for each situation. Additionally, the educational research design must be aligned with the intent of the study to strengthen its impact.Summary. By selecting research methods aligned with Kirkpatrick's levels of training evaluation, researchers can create stronger evidence of student learning when evaluating the effectiveness of teaching innovations.

An Updated National Profile of Curriculum Committees at US Schools and Colleges of Pharmacy.

Objective. To assess how curriculum committees at US schools and colleges of pharmacy have evolved since 2011 regarding their responsibilities, structures, functions, charges, and activities.Methods. A total of 133 fully accredited schools and colleges of pharmacy were included in the survey. Data collection occurred between March and September 2020, and survey questions pertained to academic year 2019-2020. Data were collected on committee membership, leadership, functions, and charges. New questions explored ties to assessments and Standards 2016. Analysis included descriptive statistics and comparisons to the 2011 survey results.Results. The response rate was 80%; one partial response was excluded from analysis. Most schools and colleges (93%) rely on a curriculum committee to provide curriculum oversight. Faculty and students remain the most frequent types of members, but increases have occurred in the number of committees with members from other areas, including experiential programs, staff, directors, librarians, and pharmacy residents. Committee charges have increased beyond the traditional activities of curriculum planning, mapping, and review to include newer tasks. In one-third of the institutions, the primary responsibility for various assessment activities is shared by both committees.Conclusion. Curriculum committees remain a key part of pharmacy education but continue to evolve to meet their responsibilities related to new and increasing numbers of charges and to find ways to communicate and share duties with their assessment counterparts. Based on these findings, recommendations include having clear guidance for curriculum committees and reducing the frequency of their scheduled work to ensure they will be able to address new challenges as they emerge.

An Update on the Progress Toward Gender Equity in US Academic Pharmacy.

Objective. To evaluate the status of gender equity in US pharmacy education since the two previous publications on the topic in 2004 and 2014.Methods. Data were gathered from existing national databases, internal American Association of Colleges of Pharmacy (AACP) databases, AACP meeting minutes, published reports, scholarly articles, pharmacy association websites, individual school websites, and LinkedIn profiles. Differences between men and women were evaluated on degree completion, discipline, rank, tenure status, research, leadership development, leadership positions, salaries, and professional awards. Comparisons were also made to academic medicine and dentistry.Results. Fifty-one percent of full-time faculty members across all academic pharmacy disciplines are women. The percentage of women at the rank of professor was 36.6%, compared to 25% in 2014. Of the 2992 tenured or tenure track pharmacy faculty, 39.2% were women. Out of 388 department chairs, 146 were women. Throughout 2014-2021, there were 121 chief executive officer (CEO) dean permanent appointments, with men holding 91 (75.2%) and women holding 30 (24.8%). Women received 29.7% of the National Institutes of Health grants awarded to pharmacy schools compared to men (70.3%), although women's funding amount was higher. In both the pharmacy practice discipline and all sciences disciplines, the total salary across all ranks and years in rank was significantly higher for men than women, even for department chairs, but there were no differences for CEO deans. To date, women have received 13% of four national pharmacy organizations' top 13 awards.Conclusion. Since 2014, some achievement gaps have narrowed, but areas of concern still exist and need continued attention and resources so inequities can be eliminated. Women in academic pharmacy need mentoring and support to extend throughout the trajectory of their careers in areas such as academic advancement, grant applications, salary negotiation, leadership pursuit, and award applications.

Use of Situational Judgment Tests to Teach Empathy, Assertiveness, Communication, and Ethics.

Objective. The objectives of this study were to develop situational judgment test (SJT) scenarios for use in teaching empathy, assertiveness, and interprofessional communication in second-year pharmacy (P2) students and ethics in third-year pharmacy (P3) students, determine whether the SJTs developed were effective at measuring students' communication skills and ethical judgment, compare the performance of individual third-year students to the performance of teams of third-year students on the ethics SJT, and evaluate student feedback about SJTs as a teaching tool.Methods. Pharmacy faculty developed five SJT scenarios related to communications and five SJT scenarios related to ethics and piloted the scenarios with P2 and P3 students, respectively. Second-year students completed SJTs individually, while P3 students completed SJTs individually and in teams. Scenarios and responses were discussed with faculty after completion of the SJTs, and students completed a questionnaire to provide feedback on the SJTs.Results. The communications SJT was completed by 59 P2 students with a mean score of 67.5%. The ethics SJT was completed by 57 P3 students with a mean score of 80.1%. The ethics SJT was also completed by 10 teams of P3 students resulting in a mean score of 93.2%. Students indicated the SJT content was realistic and the tests provided the opportunity to reflect on how to approach challenging situations.Conclusion. Situational judgment tests were useful for teaching empathy, assertiveness, interprofessional communication, and ethics in pharmacy students. Future research should focus on predictive validity of SJTs for these content areas.

Association Between NAPLEX Preparation Program Characteristics and First-Time Pass Rates.

Objective. The objectives of this study were to (1) describe characteristics of preparation programs for the North American Pharmacist Licensure Examination (NAPLEX) that are currently used by colleges and schools of pharmacy and (2) evaluate these program characteristics in relation to first-attempt NAPLEX pass rates.Methods. This cross-sectional study was based on an online survey administered between February and March 2020. Assessment leads from 143 PharmD programs were invited to answer questions on their schools' PharmD program characteristics and various aspects of NAPLEX preparation programs. The study included regression analyses to investigate associations between the NAPLEX first-attempt pass rates and PharmD demographic characteristics as well as between first-attempt pass rates and various aspects of the NAPLEX preparation programs. Finally, common themes from open-ended questions were identified.Results. Fifty-eight participants completed the survey out of 132 successfully delivered email invitations (response rate = 44%). Fifty participants (86%) indicated that their PharmD program offers a NAPLEX preparation program. Our data indicate that offering a NAPLEX preparation program was not significantly associated with higher NAPLEX first-attempt pass rates. The analysis identified possible explanations for this lack of association, including student concerns with balancing a preparation program with advanced pharmacy practice experiences (APPEs) and the faculty workload associated with delivering such programs.Conclusion. The current findings show no association between offering a NAPLEX preparation program and NAPLEX first-attempt pass rates. Future research should continue to examine the impact of these programs on individual school pass rates and factors that may enhance student motivation to engage in these programs.

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

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

Administration and Evaluation of the American Association of Colleges of Pharmacy Curriculum Quality Surveys in Pharmacy Schools.

Objective. To evaluate how pharmacy programs administer and evaluate American Association of Colleges of Pharmacy (AACP) curriculum quality perception surveys for continuous quality improvement, and to compare usage across the academy to the Principles of Good Use: AACP Quality Perception Surveys document.Methods. A 27-item survey instrument examining how schools used the curriculum quality survey was created and administered between March and June 2019 to assessment contacts of accredited schools and colleges of pharmacy. Descriptive statistics were performed for each survey item.Results. Of the 140 programs invited to participate, 88 (62.8%) responded. Curriculum quality survey data were triangulated with additional existing data (39.8%) or additional data sources were collected for triangulation with the survey data (54.5%). Programs reported on modifications made in the following areas: curriculum (85.2%), communication (75.0%), student services (68.2%), policy and process (61.4%), and professional development (53.4%). Most programs reported the assessment lead was responsible for oversight of the curriculum quality survey.Conclusion. Of respondents, 66% were familiar with the AACP Principles of Good Use document, and results indicate that institutions are generally following the recommendations. Survey analysis revealed that a significant number of programs are utilizing curriculum quality survey data for making meaningful programmatic improvements. Future work should center on further development of best practices for schools and colleges of pharmacy to effectively use the CQS data for continuous quality improvement.

Fulfilling the Tripartite Mission During a Pandemic.

This commentary examines the challenges pharmacy faculty members have faced while working to fulfill their school's tripartite mission of teaching, research, and service during the coronavirus identified in 2019 (COVID-19) pandemic. It also outlines considerations that need to be made before moving forward regarding communication, collaboration, and culture. The pandemic has created opportunities for pharmacy educators to take instructional risks and attempt new didactic and experiential teaching methods and assessment strategies. Working remotely has not only altered pharmacy education, but also scholarship and service. Conducting a broad range of collaborations with accelerated timelines to address COVID-19 has in some instances forged new relationships both between and within universities and focused faculty members on grantsmanship and writing. Faculty governance and administrative leadership have been focused on solving challenges resulting from the COVID-19 pandemic in a collaborative, transparent approach guided by faculty bylaws. Programs have found ways to use these changes to their advantage while advancing the mission of the Academy, which can contribute to changing the culture of how we interact and care about each other with the hope that the positive changes made have an enduring and meaningful impact for years to come.