Training the "clinical scientist" through a combined industrial/academic fellowship.

A novel two-year fellowship program is described which provides specialized training both in clinical drug research and drug development methodology for pharmacists with previous clinical experience. Pharmaceutical industry, university and hospital research facilities are used as the training laboratories, and collectively offer theoretical as well as practical research skills development. Traditional didactic and laboratory training are provided within university and hospital environments with emphasis in the conduct of clinical trials. Extramural experience with pharmaceutical industry provides a corollary experience which includes exposure to ethical, legal and regulatory issues involving both investigational and marketed drugs. Following successful completion of the fellowship, the pharmacist is expected to have developed the fundamental skills necessary for a career in academia, pharmaceutical industry, or clinical practice.

Research--the cornerstone of pharmacy practice. Harvey A.K. Whitney lecture.

Hospital pharmacy's need for a new commitment to research and the attendant sharing of responsibilities between pharmacy educators and pharmacy practitioners are described. Guided by the same philosophy of professional service that motivated early hospital pharmacists, individual pharmacists should work within their differentiated roles to advance the profession as a whole. For this advancement, research to acquire new knowledge and develop and evaluate new services is required. Research enhances the prestige and societal support of a profession. Pharmacists with differentiated skills and practice areas must support each other to advance the profession, particularly because of limited financial resources in both education and practice settings. Universities, including schools of pharmacy, have a responsibility for research as well as for the transmission of knowledge, and pharmacy faculty members should conduct research that supports the advancement of practice. To support research by faculty members, pharmacy practitioners can assume greater teaching responsibility. Schools of pharmacy and practicing pharmacists can work together to support research that will benefit the whole profession and society. Pharmacy practice faculty members who maintain a practice base and are involved in research have a critical role in this cooperative effort.

Career management: understanding the process.

This article is the first of a three-part series on career management for hospital pharmacists. Work attitudes, life cycles, needs, and career trends are discussed. Three basic work attitudes exist. Some see work as punishment. Others believe work in itself is good, i.e., they have a strong work ethic. Some view work as a means to satisfy, at least partially, a range of needs. Attitudinal transition points are likely to occur at specific times in the adult life cycle. The stages of the life cycle can be labeled as leaving, reaching out, questioning, midlife crisis, settling down, and mellowing. A progression through each of these stages is required for normal adult psychological development. Every individual exhibits a blend of needs that changes throughout life. Jobs can fulfill existence, relatedness, and growth needs. Relatedness needs include the need for love, affiliation, social esteem, and power, and growth needs include the need for self-esteem, competence, achievement, and autonomy. Three important career trends are the changing opportunities for advancement, women in careers, and dual-career couples. The number of women pharmacists is increasing as is the number of two-career couples. Tips for managing two-career relationships are presented. Pharmacists can manage their careers more effectively by understanding their needs, identifying their basic attitude toward work, and being aware of the trends occurring in pharmacy.

Assessment of vendors and drug-product selection.

Methods of assessing services and drug products provided by pharmaceutical vendors are discussed. Pharmacists must develop and justify criteria other than cost for selecting drug products to avoid pressures for basing product selection on price alone. Criteria used by many hospitals for evaluating pharmaceutical vendors are inspection of vendor facilities, availability of returned-goods policies, and availability of institution-specific services. Factors influencing a hospital's selection of a particular brand of drugs include product bioavailability, packaging, and labeling. A variety of hospital personnel should be allowed to participate in the evaluation of vendors and drug products to ensure accuracy and broad institutional support of the system. Guidelines for vendor representative activities in hospitals should be developed to promote the most effective use of vendor services and to prevent undesirable use of hospital personnel time. Effective criteria for evaluating pharmaceutical vendors and drug products saves time for the institution and ensures that drugs purchased are not associated with hidden expenses related to drug use.

Career management: an active process.

The self-assessment, goal-setting, and career-planning techniques of career management are discussed, and the organization's role in career management is discussed. Career management is a planned process, initiated and carried out by an individual with the assistance of others. Because work and nonwork activities are so interrelated, career and life management planning can maximize a pharmacist's personal success. The career- and life-management process begins with the development of a personal definition of success. A self-assessment must be made of one's values, needs, interests, and activities. The next step of the process involves setting goals and establishing a plan or strategy to achieve them. Establishing a career path requires researching alternate career goals. Career competencies are identified that can increase an employee's chances of success. The employer shares the responsibility for career development through coaching, job structuring, and keeping the employee aware of constraints. Through the integration of the roles of the individual and the organization in the career-management process, employees can optimize their contribution to an organization. Pharmacists can successfully manage their careers by applying the techniques of self-assessment, goal setting, and career planning.

Career management: an ongoing process.

This article is the last in a three-part series on career management. Reasons to pursue and ways to choose a suitable second career are discussed. A stalled career, a lack of achievement, or a wrong job choice are three reasons why people pursue new jobs or careers. To ensure satisfaction in a second career, individuals must examine an ego ideal--an idealized image of what they would like to be in the future. When a pharmacist's career stalls, introspection can help reveal behavior that interferes with career success. Periodic introspection and self-assessment can help an individual adapt to changes in a career and in the profession throughout the various life stages. For the pharmacist who chooses the wrong job, self-assessment and research of alternative opportunities will increase the likelihood that a second career will be satisfactory. The traditional hospital pharmacy career is linear; the pharmacist starts at the bottom of the organization and rises to the top. A nonlinear career strategy is now suggested because of limited positions at the top and an abundance of well-trained individuals. The nonlinear strategy moves a person indirectly in a career; short-term career moves are designed to meet long-term goals. Pharmacists can grow in a current or second career by using introspection and self-assessment and by adapting to changes that occur in the profession.

Ethical issues associated with managed care pharmacy services.

The authors' purpose in raising these issues and questions is not to provide answers for the profession. We recognize that answers must be derived from a process that includes input from many individuals, and from many sectors of the profession. We also recognize that the pharmacist practicing today realizes that the health care system is changing. We believe that the code of ethics supporting our profession must be revised to reflect these changes to provide more meaningful guidance for pharmacists confronting difficult contemporary issues and dilemmas. We have tried to show that pharmacists working in the HMO setting may face unique problems that must be considered by a revised code of ethics. We are pleased that APhA has begun this process of revision.

Do we have to document pharmacotherapeutic interventions?

We have suggested that some pharmacotherapists may resist documentation because they view it as administrative intrusion rather than an essential component of continuity of care. In the final analysis, it is also a matter of the pharmacotherapist's belief. Pharmacists must understand what it is that they contribute, and must believe that it is both valuable and unique. It is not just an information management function--they are making patient-specific decisions and must be willing to be held accountable for their outcome. The pharmacy manager must also believe that such a responsible decision-making role represents that preferred future for the profession. Unfortunately, because many pharmacy managers have never truly functioned in such a role, developing such a belief system is difficult at best. The hospital administrator must also be made to believe that the contribution of the pharmacist to patient care not only extends beyond materials management but represents an entirely separate professional function. This will not occur simply through documentation of interventions. Yes, we believe that it is necessary to document pharmacotherapeutic interventions, however, not for the reasons that it is most frequently demanded.

Community, hospital and clinical pharmacists and drug information centers as physician drug information sources.

The use of drug information centers and clinical, hospital and community pharmacists by university and community practice physicians in North Carolina was examined. Questionnaires were sent to 674 nonfederal physicians with a response rate of 203 (35.5%). Approximately half of the sample were staff members of a university hospital. The questionnaire covered eight types of drug information. Significant results were reported at the p = 0.05 level. Physicians sought specific drug information approximately one to four times a month. University hospital-affiliated physicians rated clinical and hospital pharmacists significantly higher than community pharmacists for six subject areas, and they also ranked clinical pharmacists over hospital pharmacists on four subject areas and considered them more reliable than other pharmacy drug information sources. Physicians associated with community hospitals ranked hospital pharmacists over community pharmacists as sources of information for four areas and rated them more reliable than other pharmacy drug information sources; this group preferred to use community pharmacists for information on product availability. It appears that clinical pharmacists are used by university-associated physicians as drug information sources. Use in community hospitals of the hospital pharmacist as a drug information source is better than the literature might suggest.

Analysis of a hospital-based drug information center.

The operation of a drug information center (DIC) was studied after it was relocated from a school of pharmacy to a teaching hospital. The output during the last eight months in the school of pharmacy (Period 1) was compared to the output during a three-month period after the DIC became established in the hospital (Period 2). Questions were classified by type and profession or requester. In addition, the number of judgmental questions processed was determined. The average number of questions per month in Period 1 was 58.1, while during Period 2 it was 146.3. There was a statistically significant increase in Period 2 in questions from each profession, with the exception of clinical pharmacists. In Period 2, 30.8% of the questions were asked by physicians, 27.6% by pharmacists, 24.1% by clinical pharmacists, 12.3% by nurses and 5.2% by other professionals. The largest number of questions was in the pharmacological category, with toxicities or side effects as the largest class. The majority of questions asked by nurses were pharmaceutical. Of the 439 questions received during Period 2, 28.0% were judgmental. Pharmaceutical questions were found to require the least amount of time to answer, while therapeutic questions required the greatest amount of time. Judgmental questions required more time than nonjudgmental questions. It was concluded that increased visibility and accessibility of the DIC after its relocation resulted in an increased work load.

Feasibility of symbolic directions on prescription labels.

This project presents the results of a study designed to evaluate the usefulness of graphic labels in assisting functionally illiterate patients to understand how and when to take medication. The project's results indicate that comprehension of symbolic directions did not increase as rapidly as comprehension of typed directions. Symbolic directions did, however, reduce the variation in interpretation of directions among patients with 0-4 grade education. Neither age, nor sex, nor the order of label presentation affected level of comprehension of typed or symbolic prescription labels. The results of this study indicate that use of symbols may not be the sole answer to the problem of assisting patients with inadequate reading abilities. Symbolic prescription directions should be evaluated before their use. Then, when used, they should be accompanied by oral reinforcement.

Job satisfaction of hospital pharmacy technicians in North Carolina.

Factors related to job satisfaction among pharmacy technicians in North Carolina hospitals were studied. To gather data on job satisfaction, job function, and work attitudes, a questionnaire was designed and sent to pharmacy directors and technicians at 83 North Carolina hospitals. The 389 responses represented response rates of 70.3% for technicians and 91.6% for directors. Pharmacy technicians had significantly lower job satisfaction scores (p = 0.05) for work pay, promotion, and coworkers than those reported elsewhere for other workers. There was no difference between technicians and other workers in satisfaction with supervisors. Pharmacy technicians were most satisfied with their supervisors and coworkers, least satisfied with their pay and promotion outlook, and neutral about their work. Higher satisfaction scores were found for technicians who (1) worked in smaller hospitals, (2) performed a wider variety of tasks, or (3) were over 35 years old. Directors judged technician attitudes toward their work to be slightly higher than the technicians did. The study indicates that, in addition to monetary reward, careful consideration of nonmonetary rewards and job functions could contribute to greater technician job satisfaction.

Pharmacy staff training and development: upside-down thinking in a changing profession.

We suggest that the most fundamental change in staff development that must occur is recognition of the need for a professional belief system as the basis for any pharmaceutical care activity. Values derived from fundamental moral ideals and professional beliefs foster the development of attitudes and behaviors. It would be wrong to suggest or imply that such a change need only occur in postbaccalaureate training. The development of personal and professional value systems in existing primary professional training programs is inadequate--we do not yet do enough to develop people before they enter practice. Nevertheless, to say that this failure of the professional education system precludes us from taking action within professional departments is unwise. The primary skills that must be developed during the next decade involve the ability of the practitioner to competently make informed, patient-specific decisions necessary for effective pharmaceutical care. Such decisions are made not only on the basis of a practitioner's knowledge but on the basis of his or her beliefs and values as well. The practitioner also must be willing to assume responsibility for the consequences of those decisions. The pharmacist who professes to deliver pharmaceutical care can no longer be shielded by assigning to the physician the ultimate responsibility for the patient's drug-therapy outcomes. Facilitating the development of a value system and attitude that enhance the pharmacist's ability to make such decisions must be a principal focus of staff training and development in the coming years.(ABSTRACT TRUNCATED AT 250 WORDS)

Statistical and research quality of the medical and pharmacy literature.

The statistical and research quality of reports published in two U.S. medical journals and two U.S. pharmacy journals over a 12-month period was determined. A 50% random sample of issues of New England Journal of Medicine, Annals of Internal Medicine, American Journal of Hospital Pharmacy, and Drug Intelligence and Clinical Pharmacy published in 1979 was reviewed, and all citable items were classified as one of nine types of communications. Items classified as original evaluative research reports were evaluated for experimental design and research goals and rated for appropriateness of statistical testing and overall research quality according to a set of objective criteria. Reports that were not immediately classifiable were reviewed by one additional person, and classifications or ratings were assigned by mutual consent. Of a total of 1506 citable items, 120 met the criteria for original evaluative research reports. The two medical journals had the highest percentages of reports for which statistical methods were rated as correct but also had the most reports for which statistical methods could not be rated as a result of incomplete documentation or publication errors. Reports in the medical journals had conclusions based on a logical progression of hypothesis, methods, and analysis of results more frequently than did reports in pharmacy journals. Reports in the medical and pharmacy journals differed greatly according to research design and research goals. Improvement is needed in the statistical quality and research quality of original research reports published in the pharmacy literature.

Pharmaceutical services in hospices.

Hospices were surveyed to identify the types of pharmaceutical services provided. The directors of 75 hospice organizations were sent questionnaires regarding: (1) the type and scope of pharmaceutical services and (2) their conception of the future of the hospice movement. Of the 48 usable responses, 37 reported pharmacist affiliation. Of the 11 organizations that did not have a pharmacist affiliated, 10 reported they anticipated using a pharmacist's services in the future. Most (68%) pharmacists who worked in hospices were consultants. Pharmaceutical services included the development of policies and procedures regarding drug storage and handling, inservice education, drug information, and patient education. Of the organizations without a pharmacist, 91% provided only outpatient care; of hospices with pharmacists, 51% provided outpatient, 14% inpatient, and 36% outpatient and inpatient care. Forty-six percent of the hospice directors considered the pharmacist affiliated with their organization to be a member of the interdisciplinary team; 55% of such pharmacists worked full-time with the hospice. Hospice directors expressed a need for greater pharmacist involvement in inservice education, staff consultation, and research on pain.

Academic-drug industry fellowships.

The UNC/BW fellowship, like other industry/academia collaborative fellowships, provides a unique training experience in clinical research. Both academia and the pharmaceutical industry have opened their doors and allowed clinical pharmacists to spend a year or more developing clinical research skills and an understanding of the drug development process. Is it worth it? Is this program a benefit to the individuals, to the sponsors, or to the profession of pharmacy? The survey of these fellows provides us with the individual's perspective on the benefit and quality of the fellowship. Most believed the fellowship provided them with training to meet their needs and interests. However, given this small number of individual opinions and comments, how do we determine whether the fellowship is meeting the original goal to train clinical pharmacists to be clinical researchers? By looking at the career paths of those who have completed the program, we may gain insight into whether the fellows are involved with research. Since the fellowship has been in existence for only six years, we really can look only at the initial placement of these clinical pharmacists. A majority have gained employment with clinical research responsibilities within the pharmaceutical industry. One measure of the research capabilities of these fellows is their contributions to the scientific literature; 10 papers and 3 abstracts have been generated by fellows since they completed their fellowships (Appendix I). As expected, the research contributions of the two-year fellows are greater than that of the one-year fellows. Seven one-year fellows did not have a publication.(ABSTRACT TRUNCATED AT 250 WORDS)