Educational game improves systems thinking, socialization, and teamwork among students of 13 health professions programs.

Systems thinking and interprofessional collaborative practice competencies are critical to inculcate in students of health professions programs. The purpose of this study was to evaluate the impact that an interprofessional education (IPE) experience consisting of an educational game, Friday Night at the ER (FNER), and structured debriefing had on students' systems thinking and self-assessed interprofessional socialization and teamwork skills. Systems thinking was evaluated using the Systems Thinking Scale (STS), and interprofessional socialization and teamwork were evaluated using a modified Interprofessional Socialization and Valuing Scale-9 (ISVS-9) and Interprofessional Collaboration Competency Attainment Scale (ICCAS) question #21. This single-center study targeted students in 13 health professions programs. In the cohort (N of 626), Systems thinking increased significantly. Interprofessional socialization increased significantly, with a large effect size, and 485 (78%) students indicated their interprofessional collaborative practice competencies improved. Program evaluation data revealed students highly valued the experience and would recommend it to their peers. Based on our findings, an IPE experience consisting of FNER gameplay and structured debriefing can improve systems thinking and interprofessional socialization and teamwork in a large, diverse group of students of health professions programs.

Saving patient x: A quasi-experimental study of teamwork and performance in simulation following an interprofessional escape room.

Graduates of health professions programs are required to work collaboratively as part of interprofessional healthcare teams. The purpose of this study was to create and test the use of an interprofessional escape room, as a method to improve teamwork, prior to interprofessional simulation. The study evaluated performance in simulation with the Observed Interprofessional Collaboration tool and self-reported attitudes toward teamwork using the Interprofessional Socialization and Valuing Scale. A total of 233 students from professional nursing (n of 118) and pharmacy students (n of 115) were split into groups of four (two nursing, two pharmacy students). Groups were randomized to participate in the escape room first followed by simulation, or simulation first followed by the escape room. Results indicated median scores in simulation performance were higher for students who participated in an escape room before simulation compared to an escape room after simulation. There was no difference in the mean change in perceptions of teamwork from pre to post between students who participated in an escape room before simulation. Escape rooms can, in a brief period of time, improve teamwork and consequently performance during simulation. Findings support the use of escape rooms in interprofessional education curriculum as a method to promote teamwork.

Comparative Effectiveness of Vancomycin Versus Linezolid for the Treatment of Acute Pulmonary Exacerbations of Cystic Fibrosis.

Background: Data are limited regarding the preferred antibiotics for treatment of acute pulmonary exacerbations (APEs) of cystic fibrosis (CF), when methicillin-resistant Staphylococcus aureus (MRSA) is suspected. Objective: To compare the rate of return to baseline lung function among individuals with APEs of CF treated with either vancomycin or linezolid. Methods: This retrospective study included individuals hospitalized for APEs of CF from May 1, 2015, to April 30, 2017 who were infected with MRSA and treated with vancomycin or linezolid. The primary outcome was the return to baseline lung function, as measured by forced expiratory volume in 1 s (FEV1). Descriptive and inferential statistics were used. All tests were 2-tailed with α set at 0.05. Results: A total of 122 encounters were included (vancomycin: n = 66; linezolid: n = 66). No difference existed in return to baseline FEV1 between vancomycin (53 [80.3%]) and linezolid (50 [75.8%]; P = 0.53); nor was there a difference in median percentage change in FEV1 from admission to follow-up between vancomycin (24.7%) and linezolid (20.7%; P = 0.61). Adverse drug events occurred more frequently in patient encounters treated with vancomycin (10 [15.2%]) compared with linezolid (2 [3%]; P = 0.002). Conclusion and Relevance: Our study observed no difference in the effectiveness of vancomycin compared with linezolid in terms of change in lung function for APEs of CF. The rate of adverse drug events was low. In individuals with CF infected with MRSA who are experiencing an APE, either vancomycin or linezolid appear to be viable treatment options.

Measuring changes in pharmacy and nursing students' perceptions following an interprofessional high-fidelity simulation experience.

The purpose of this study was to evaluate the effects of interprofessional high-fidelity simulation-based learning (SBL) on third-year pharmacy and senior nursing students' perceptions of interprofessional care. Students participated in an interprofessional high-fidelity SBL experience consisting of two hospital-based scenarios followed by a debriefing. The "Student Perceptions of Interprofessional Clinical Education-Revised" (SPICE-R) instrument was administered pre- and post-SBL. The "Student Satisfaction and Self-Confidence in Learning" (SSSCL) instrument, which uses a 5-point Likert scale, was administered post-SBL. A total of 104 (78%) pharmacy and 93 (77%) nursing students completed both the pre- and post-survey instruments. Baseline differences between pharmacy and nursing students included number of clinical hours completed [200 (190-240) vs. 210 (209-210); p < 0.001] and previous/current experiencing working directly with other healthcare professionals [71 (53%) vs. 88 (73%); p < 0.001]. Median score increases were observed for all SPICE-R items (p < 0.01) for pharmacy students and nine of ten SPICE-R items (p < 0.01) for nursing students. All students rated both the experience and their confidence highly on the SSSCL; however, nursing scores were higher than pharmacy scores for 7 of 13 items (p < 0.05). An interprofessional high-fidelity SBL experience increased pharmacy and nursing students' perceptions of interprofessional care.

Increased Risk of Acute Kidney Injury in Critically Ill Children Treated With Vancomycin and Piperacillin/Tazobactam.

OBJECTIVES: Compare the rates of acute kidney injury in critically ill children treated with vancomycin and piperacillin-tazobactam versus vancomycin and ceftriaxone. DESIGN: Retrospective cohort study. SETTING: A large tertiary care children's hospital in an urban setting. PATIENTS: Children greater than or equal to 2 months old admitted to the PICU who received greater than or equal to 48 consecutive hours of vancomycin and piperacillin-tazobactam or vancomycin and ceftriaxone. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Acute kidney injury was defined as a minimum 50% increase in serum creatinine, adjusted for total fluid balance, from baseline over a 48-hour period. Bivariate analysis compared treatment groups and acute kidney injury groups. A multivariable logistic regression model was fit for acute kidney injury including covariable analysis. The study included 93 children. There were no differences between treatment groups in terms of age, severity of illness, baseline renal function, vancomycin dosing, or vancomycin trough concentrations. Children who received vancomycin and piperacillin-tazobactam had a higher cumulative frequency of acute kidney injury than those who received vancomycin and ceftriaxone 915/58 [25.9%] vs 3/35 [8.6%]; p = 0.041). After controlling for vancomycin trough concentration, age, concurrent nephrotoxin exposure, and use of vasopressors, exposure to piperacillin-tazobactam significantly increased the risk of acute kidney injury (adjusted odds ratio, 4.55; 95% CI [1.11-18.7]; p = 0.035) compared with ceftriaxone. Use of vasopressors (adjusted odds ratio, 3.73 [95% CI, 1.14-12.3]) and a vancomycin trough greater than or equal to 15 mg/dL (adjusted odds ratio, 4.12 [95% CI, 1.12-15.2)] was also associated with acute kidney injury. Length of stay was longer in children with acute kidney injury (median, 18.0 days; interquartile range, 7.76-29.7) compared with those without acute kidney injury (median, 6.21 days; interquartile range, 2.92-15.6; p = 0.017). CONCLUSIONS: In critically ill children, acute kidney injury occurred more in patients treated with vancomycin and piperacillin-tazobactam versus vancomycin plus ceftriaxone. After controlling for covariates, exposure to piperacillin-tazobactam was associated with an increased odds of acute kidney injury development.

Antibiotic management of methicillin-resistant Staphylococcus aureus--associated acute pulmonary exacerbations in cystic fibrosis.

OBJECTIVE: To review the treatment of methicillin-resistant Staphylococcus aureus (MRSA)-associated acute pulmonary exacerbations (APEs) in cystic fibrosis (CF). DATA SOURCES: A search of PubMed, MEDLINE, Cochrane Library and Clinicaltrials.gov databases through November 2014 was conducted using the search terms Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, pulmonary exacerbations, and cystic fibrosis. STUDY SELECTION AND DATA EXTRACTION: All English-language research articles, case reports, and case series were evaluated. A total of 185 articles were identified related to MRSA and CF; 30 articles that studied treatments of MRSA APE in CF were included. DATA SYNTHESIS: The persistent presence of MRSA in the respiratory tract of patients with CF has been associated with higher morbidity and an increased risk of death. Limited clinical data exist supporting the efficacy of any specific antimicrobial currently available for the treatment of APE secondary to MRSA. CONCLUSIONS: Data extrapolated from other populations suggest that vancomycin and linezolid are appropriate first-line treatment options for the treatment of APE secondary to MRSA. Second-line options include doxycycline or minocycline and trimethoprim/sulfamethoxazole, each of which may be useful in patients coinfected with other respiratory pathogens, for which they may provide overlapping coverage. Ceftaroline and ceftobiprole are newer antibiotics that appear to have a potential role in the treatment of APE in CF, but the latter is not currently available to the US market. Although potentially useful, clindamycin is limited by high rates of resistance, telavancin is limited by its toxicity profile, and tigecycline is limited by a lack of demonstrated efficacy for infections that are similar to that seen in the CF population. Studies investigating the clinical utility of the above-cited antibiotics for APE in CF secondary to MRSA are desperately needed to broaden the treatment armamentarium for this medical condition.

Longitudinal Assessment of Pharmacy Students' Collaborative Practice Abilities.

OBJECTIVE: Interprofessional education (IPE) varies across schools/colleges of pharmacy. Long-term impact of IPE on interprofessional collaborative competencies remains uncertain despite available data on singular experiences. This study aimed to evaluate changes in pharmacy students' collaborative abilities over the second and third professional years (PYs). METHODS: Students completed the Interprofessional Collaborative Competency Attainment Scale - Revised (ICCAS-R) after 2 large-scale interprofessional forums that occurred approximately 8 months apart. Four cohorts of students were used to examine the longitudinal change in collaborative abilities: cohort 1 (2019), cohort 2 (2020), cohort 3 (2021) and cohort 4 (2022). The ICCAS-R was used to capture data from 4 timepoints for each student in each cohort: prior to the Spring Forum in PY2 (T1), after the Spring Forum in PY2 (T2), prior to the Fall Forum in PY3 (T3), and after the Fall Forum in PY3 (T4). Using repeated measures analysis of variance, 4 total mean scores (T1 = pre1, T2 = post1, T3 = pre2, T4 = post2) were compared. RESULTS: Four cohorts (N = 414) completed the interprofessional forums and 336 (81%) completed the ICCAS-R instrument and were included. In each cohort, total mean scores increased T1 to T2 and T3 to T4, indicating an increase in self-assessed abilities pre/post-forum. Total mean scores decreased between T2 and T3, indicating that collaborative abilities decreased during the period between interprofessional forums. CONCLUSION: While students' collaborative abilities increased around the time of the forum experiences, these changes decreased in between experiences. These findings suggest that interprofessional competencies should be reinforced at multiple time points to support enduring effects.

Interprofessional Simulation Learning Game Increases Socialization and Teamwork Among Students of Health Professions Programs.

BACKGROUND: Interprofessional (IP) socialization is important to develop early in the training of health professions students. PURPOSE: This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game ( Friday Night at the ER [FNER]). METHODS: The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing. RESULTS: IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development. CONCLUSIONS: An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students.

Impact of Collaborative Testing on Academic Performance in Pharmacy Education.

OBJECTIVE: To determine the impact of 2-stage collaborative testing (CT) on academic performance of pharmacy students and to characterize pharmacy student perceptions of CT. METHODS: Two-stage CT was piloted in a 2-course patient assessment sequence within a Doctor of Pharmacy program. Students were randomly allocated into 2 groups and further divided into teams of 4 to 5 students. Student teams alternated taking section examinations in a traditional 1-stage (individual) and 2-stage CT (individual then team) format to establish an experimental design. Near the end of each semester, students individually took a post-test to facilitate assessment of CT on academic performance. A 12-item, anonymous survey instrument assessed student perceptions of 2-stage CT. The group differences in academic performance and survey responses were analyzed statistically. RESULTS: There were 128 students enrolled in the course sequence, 123 of whom met the inclusion criteria for assessment of academic performance and 100 of whom completed the survey (response rate = 83%). Generally, students performed better on post-test items initially assessed through 2-stage CT (retention marker) and on post-test items that were answered incorrectly under 2-stage CT conditions (learning marker). Approximately 9 in 10 survey respondents preferred 2-stage CT over traditional 1-stage individual testing, with an equivalent proportion reporting it helped them learn from their mistakes and retain what they learned. There was high-level agreement among respondents that 2-stage CT improved their ability to work as a team and think critically. CONCLUSION: The implementation of 2-stage CT in a patient assessment course sequence was associated with improved learning and retention and was well-received by students.

Urinary biomarkers as indicators of acute kidney injury in critically ill children exposed to vancomycin.

STUDY OBJECTIVE: The standard of care for detecting acute kidney injury (AKI) is change in serum creatinine (SCr) and urine output, which are limited. This study aimed to compare urinary biomarkers neutrophil gelatinase-associated lipocalin (uNGAL) with kidney injury molecule-1 (uKIM-1) in critically ill children exposed to vancomycin who did and did not develop AKI as defined by changes in SCr. DESIGN: Single-center, prospective, clinical, observational cohort study. SETTING: Tertiary care children's hospital in an urban setting. PATIENTS: Children aged 0 (corrected gestational age 42 weeks) to 18 years admitted to the intensive care unit who received vancomycin were included. INTERVENTION: None. MEASUREMENTS: The primary outcome was mean change in uNGAL and uKIM-1 between AKI and no-AKI groups. AKI was defined as a minimum 50% increase in SCr from baseline over a 48 h period, within 7 days of first vancomycin exposure. Three urine samples were collected: baseline (between 0 and 6 h of first vancomycin dose), second (18-24 h after the "baseline"), and third (18-24 h after the second sample). Concentrations of uKIM-1 and uNGAL were measured in each sample. MAIN RESULTS: Forty-eight children (52% male; median age 6 years) were included. Eight (16.7%) children developed AKI. Mean changes in uNGAL (713.196 ± 1,216,474 vs. 16.101 ± 37.812 pg/mL; p = 0.0004) and uKIM-1 (6060 ± 11.165 vs. 340 ± 542 pg/mL; p = 0.0015) were greater in children with AKI versus no-AKI, respectively. CONCLUSIONS: uNGAL and uKIM-1 concentrations increased significantly more in critically ill children with AKI compared with those with no-AKI during the first 48-72 h of vancomycin exposure and may be useful as prospective biomarkers of AKI.

An Integrative Review of Micro-Credentials and Digital Badges for Pharmacy Educators.

Micro-credentials (MCs) and digital badges (DBs) have gained popularity in recent years as a means to supplement traditional degrees and certifications. MCs and DBs can play a significant role in supporting student-centered learning by offering personalized and flexible learning pathways, emphasizing real-world relevance and practical skills, and fostering a culture of continuous learning and growth. However, barriers currently exist within health professions education, including pharmacy education, that could limit the full adoption and implementation of MCs and DBs. Research on the use of MCs and DBs in Doctor of Pharmacy degree programs is sparse. In this integrative review, literature on the use of MCs and DBs in health professions education is reviewed, and perspectives on the benefits, issues, and potential future uses within Doctor of Pharmacy degree programs are presented.

Virtual escape room paired with simulation improves health professions students' readiness to function in interprofessional teams.

BACKGROUND: This project investigated the change in nursing, pharmacy, and physical therapy students' interprofessional socialization after participation in a virtual interprofessional escape room and case conference simulation. INTERPROFESSIONAL EDUCATION ACTIVITY: Interprofessional teams of nursing (n = 93), pharmacy (n = 75) and physical therapy (n = 33) students completed asynchronous, online learning (sepsis recognition and total hip replacement post-operative precautions) followed by a virtual escape room and a virtual simulated patient case conference. During the case conference, interprofessional student teams developed a discharge plan for an individual after a hip replacement complicated by post-operative sepsis. Before and after the experience, students completed a knowledge test and a validated survey instrument that assessed their interprofessional socialization (Interprofessional Socialization and Valuing Scale-21). During the simulated patient case conference, faculty assessed student performance using a standardized rubric. After the experience students completed a program evaluation. DISCUSSION: Interprofessional socialization significantly increased (5.5 ± 0.9 vs. 6.0 ± 0.9) among all students with a medium effect size (Cohen's d = 0.56). Faculty assessment of individual student's team performance during the virtual simulation revealed a moderate rate meeting competency, with good interrater reliability. Students highly valued this learning experience as being both effective and important to their professional development, as indicated on the program evaluation. IMPLICATIONS: A virtual interprofessional experience consisting of asynchronous online learning, a virtual escape room, and a virtual case conference positively influenced students' interprofessional socialization. Students valued the experience and recognized its importance in their development as student health professionals.

An Innovation Sprint to Promote Problem-solving and Interprofessional Skills Among Pharmacy and Public Health Students.

Objective. Innovation sprints are a novel pedagogy where small groups of students find creative solutions to problems. The purpose of this study was to extend our understanding of innovation sprint pedagogical design by investigating the impact of an innovation sprint on Doctor of Pharmacy (PharmD) students' and Master of Public Health (MPH) students' interprofessional collaboration and problem-solving skills. We hypothesized that the innovation sprint would increase student self-efficacy and that interprofessional collaborative behaviors would be demonstrated by individuals on a team.Methods. MPH and third-year PharmD students were assigned to teams and participated in a required two-hour innovation sprint. Faculty observed student teams and evaluated their interprofessional collaboration skills using a rubric modeled after the Modified McMaster-Ottawa Scale. Students completed a postprogram survey assessing their interprofessional collaborative behaviors and attitudes toward the innovation sprint.Results. Of the 133 students participating in the innovation sprint, 127 completed the postprogram survey (response rate=95%). Faculty determined that 123 students (92%) met the interprofessional collaboration competencies. The mean interprofessional collaborative competencies attainment survey scores increased for both PharmD and MPH students. Qualitative analyses highlighted themes of interprofessional collaboration and problem-solving skills that students valued. Overall, students enjoyed working with each other and engaging in creative problem-solving.Conclusion. An interprofessional innovation sprint involving PharmD and MPH students demonstrated a positive impact on student self-assessed interprofessional collaboration and problem-solving skills. Further, faculty observed a high rate of interprofessional behaviors within student teams. Based on these findings, an innovation sprint may be an effective pedagogical tool to enhance students' skills in these areas.

An Interprofessional Escape Room Experience to Improve Knowledge and Collaboration Among Health Professions Students.

Objective. The purpose of this study was to extend our understanding of escape room pedagogical design by investigating the impact of escape room puzzle content on changes in students' immediate recall knowledge and demonstration of interprofessional skills during a subsequent simulation.Methods. Students from nursing, pharmacy, and physical therapy programs were randomized to complete an escape room themed around acute management of sepsis (intervention group; n=133) or general acute care (control group; n=129) prior to participating in a simulated patient discharge case conference. Students completed a knowledge assessment before the escape room, immediately after the escape room, and immediately after the simulation. Additionally, students completed the Interprofessional Socialization and Valuing Scale (ISVS-21) before and after the experience along with a post-program evaluation. Faculty rated student achievement of interprofessional learning objectives during the simulation using a standardized rubric.Results. Students in the intervention group had higher scores on the knowledge test administered immediately after the escape room. All participants' ISVS-21 scores increased from before to after the activity. Interprofessional learning objectives, as evaluated by faculty, were met by 248 (94.7%) students.Conclusion. Participating in an interprofessional escape room activity with specific puzzle content improved students' immediate recall knowledge. In both groups, self-assessed interprofessional socialization improved, and a high percentage of students achieved the interprofessional learning objectives in a subsequent simulation. Escape rooms can be an innovative pedagogical tool that can positively impact immediate recall knowledge and interprofessional collaborative skills of health professions students.

Predicting Intravenous Immunoglobulin Resistance Among North American Children Hospitalized With Kawasaki Disease.

OBJECTIVE: The Kobayashi score (KS) is the most widely used tool for predicting intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD). The KS has shown good sensitivity (86%) and specificity (68%) in Japanese children; however, its use is limited outside of Japan. No models accurately predict IVIG resistance of children with KD in the United States. We sought to develop and test a novel scoring system to predict IVIG resistance in hospitalized children with KD. METHODS: A retrospective chart review was conducted of all children diagnosed with KD from January 2000 to December 2015. Subjects were divided into 2 groups: IVIG susceptible or resistant. Variables that differed between the groups were identified and used to create a "new score" to predict resistance to IVIG. The new score was then compared with the KS and performance characteristics were determined. RESULTS: A total of 208 subjects were reviewed. White blood cell count, neutrophil percentage, age, and serum albumin were used in the new score with equal weighting. Overall, the new score achieved improved sensitivity (54% vs 26%) and similar specificity (69% vs 74%) compared with the KS in predicting IVIG resistance in hospitalized children diagnosed with KD. CONCLUSIONS: Predicting IVIG resistance in children diagnosed with KD remains challenging. The KS has low sensitivity in predicting IVIG resistance in children with KD in the United States. The new score resulted in improved sensitivity, but many children with true IVIG resistance may be missed. Further research is needed to improve IVIG resistance prediction.

Incidence and Risk Factors for Acute Kidney Injury in Hospitalized Children Receiving Piperacillin-Tazobactam.

OBJECTIVE: Drug-induced kidney injury contributes to morbidity and mortality in hospitalized children. Antibiotics such as TZP have been implicated in the development of acute kidney injury (AKI) in adults; however, data are limited in children. The purpose of this study was to determine the incidence of AKI in hospitalized children receiving TZP. METHODS: This was a retrospective cohort study of hospitalized children between 2 months and 19 years of age who received TZP for at least 48 hours. Acute kidney injury was defined as a 50% increase from the initial serum creatinine (SCr) prior to TZP initiation. Serum creatinine values were adjusted for fluid balance using a validated approach. Severity of AKI was characterized using the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria. Descriptive and inferential statistics were used to describe the incidence and risk factors of AKI, with an alpha = 0.05. RESULTS: A total of 65 subjects were included. Twenty-five (38.5%) required PICU admission. The incidence of AKI was 7.7% (n = 5) using adjusted SCr (13.37 cases/1000 patient-days). According to pRIFLE, 6.15% (n = 4) subjects met criteria for Risk (n = 3) or Injury (n = 1), and none developed Failure, Loss, or End-Stage (10.70 cases/1000 patient-days for Risk and Injury categories). No risk factors were identified. Hospital length of stay was longer in subjects who experienced AKI compared with those who did not (p = 0.04). CONCLUSIONS: The incidence of AKI in hospitalized children exposed to TZP was low. In those who did develop AKI, peak SCr occurred approximately 1 week after TZP initiation.

An interprofessional activity involving pharmacy and physician assistant students aimed at reinforcing the patient care process.

BACKGROUND: Pharmacy students should have the opportunity to practice applying the Pharmacists' Patient Care Process (PPCP) in an interprofessional environment. The purpose of this study was to compare the change in students' confidence in their ability to complete the five steps of the PPCP before and after participation in an interprofessional activity involving physician assistant (PA) students. INTERPROFESSIONAL EDUCATION ACTIVITY: Second-year pharmacy students and second-year PA students completed an activity in teams of six (four pharmacy and two PA students per team) in which they applied the PPCP to a patient case to create a plan of care. Students completed a pre- and a post-survey regarding their confidence in completing the PPCP and their attitudes toward interprofessional collaboration, as well as a program evaluation after completion of the activity. DISCUSSION: There were 117 pharmacy and 58 PA students divided into 29 interprofessional teams. Of those, 99 (85%) pharmacy and 52 (90%) PA students completed both surveys. There was a statistically significant increase in confidence to perform the PPCP for all students, with a large effect size. There were no changes in attitudes toward interprofessional collaboration. Overall, the program evaluation reflected the activity was rated highly by students. IMPLICATIONS: The interprofessional activity demonstrated a positive effect on students' self-reported confidence in their ability to complete steps of the PPCP. While the interprofessional activity did not affect student attitudes toward interprofessional collaborative practice, the activity was rated highly and most found it to be an important part of their professional development.

Impact of Pharmacy Student Observation Versus Active Participation in an Interprofessional Simulation.

Objective. To compare the change in pharmacy students' self-reported competence toward interprofessional collaboration between those that were active participants in or observers of an interprofessional simulation. Methods. Second- and third-year (P2 and P3) pharmacy students and senior nursing students participated in an interprofessional simulation. Third-year pharmacy students and senior nursing students were divided into teams of four (two from each profession) and were active participants. Second-year pharmacy students were observers. All pharmacy students were asked to complete a brief demographic survey and the Interprofessional Collaborative Competency Attainment Survey (ICCAS) after the simulation. Mean retrospective pretest and posttest ICCAS scores for each group of learners were compared using paired sample t tests. To examine the difference in the change in mean total ICCAS score between observers and active participants, repeated measures analysis of variance was completed. Results. One hundred thirty (95%) P2 pharmacy students and 121 (92%) P3 pharmacy students participated in the interprofessional simulation experience as observers and active participants, respectively, and completed the ICCAS for an overall response rate of 94%. The active participants' mean ICCAS scores were significantly higher than those of the observers on both the retrospective pretest (M=4.9, SD=1.0 vs M=5.2, SD=1.0) and the posttest (M=5.9, SD=0.7 vs M=6.2, SD=0.7). The mean change in scores from retrospective pretest to posttest was not significantly different between observer and active participant pharmacy students. Conclusion. Both observation and active participation in an interprofessional simulation experience may increase pharmacy students' self-reported competence in interprofessional collaboration.

Optimal Antibiotics at Hospital Discharge for Children With Urinary Tract Infection.

OBJECTIVES: Antibiotic stewardship at hospital discharge is an area of need. We assessed the rate of optimal antibiotic prescriptions at hospital discharge, on the basis of urine culture and susceptibility data, for children diagnosed with a urinary tract infection (UTI). METHODS: We conducted a retrospective study of patients ≤18 years of age who were admitted to a general pediatrics service at a freestanding children's hospital during 2017 with a diagnosis of UTI and received an antibiotic prescription at discharge. For the primary analysis, optimal antibiotic at hospital discharge was determined by evaluating if the cultured urinary pathogen was susceptible to the prescribed antibiotic and if the antibiotic was the narrowest-spectrum option available. Secondary objectives included assessment of antibiotic dosing accuracy and description of antibiotic treatment duration. RESULTS: A total of 78 cases were included. Sixty-eight (83%) cases were caused by cefazolin-susceptible Escherichia coli and Klebsiella species. Thirty-one (40%) cases had a discharge antibiotic prescription that was determined to be optimal. Of the 47 (60%) cases that were suboptimal, 44 (94%) were considered to be excessively broad spectrum. In 3 (6%) cases, the causative organism was nonsusceptible to the prescribed antibiotic. Ten (13%) discharge antibiotic prescriptions had inaccurate dosing and/or frequency. CONCLUSIONS: Missed opportunities for narrow-spectrum antibiotic selection at hospital discharge for pediatric UTIs frequently occurred. In particular, higher-generation cephalosporins and ciprofloxacin were often prescribed for cephalexin-susceptible cases. Antibiotic stewardship attention, specifically at hospital discharge for pediatric UTIs, is likely to have a high impact.

Creating a Film to Teach Health Professions Students the Importance of Interprofessional Collaboration.

Objective. To produce, implement, and evaluate the effectiveness of a film to develop the foundational knowledge and skills of health professions students and teach them the importance of interprofessional collaboration. Methods. An existing interprofessional case study about a Hispanic man suffering from multiple chronic health conditions and the impact his health had on his family served as the basis for the film. To ensure a high-quality production, faculty members partnered with a local theatre company to produce the film. Upon completion, the film was integrated into an annual interprofessional forum and evaluated by both students and faculty members in 2016, 2017, and 2018. Results. The 22-minute film, entitled Meet Fred Santiago: Improving Care Through Interprofessional Collaboration, was shown to 1921 students and 250 faculty members who participated in the interprofessional forum over the three years. Of these, 1858 students and 174 faculty members completed a program evaluation following the forum. The majority (>86%) of student and faculty respondents agreed or strongly agreed that the film presented a realistic view of the challenges faced by people with multiple chronic health problems. The majority of students (>85%) agreed or strongly agreed that the film helped them appreciate the breadth of issues confronting individuals with multiple chronic health problems. Conclusion. The film, Meet Fred Santiago, is an effective tool for introducing health professions students to the complex interrelationship of medical, psychological, and social issues experienced by individuals with chronic health conditions.