Evaluation of technician immunization administration.

OBJECTIVES: To (1) assess technician and supervising pharmacists' attitudes and perceptions toward technicians administering immunizations after a technician training initiative, (2) describe the public health impact of technician-administered COVID-19 immunizations, and (3) describe best practices for technician-administered immunizations. DESIGN: A mixed-methods study collected quantitative and qualitative data. SETTING AND PARTICIPANTS: Kentucky technicians who completed an immunization administration training, and their supervising pharmacists. OUTCOME MEASURES: Surveys were administered to Kentucky technicians who completed immunization administration training between January and September 2021. Surveys assessed the effectiveness of the training, integration of technicians in the immunization workflow, and impact of technicians in their organization's immunization efforts. Similar surveys were deployed to supervising pharmacists. Response frequencies were recorded for each question and descriptive statistics were calculated for each item included in the survey. Key informant interviews were conducted with technicians and pharmacists to further explore study concepts, assess needs, and discuss best practices for implementation. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. RESULTS: Fifty-seven technicians and 37 pharmacists responded to the survey. Technicians were easily integrated into community pharmacy immunization workflow that allowed for increased immunization administration. Ninety-four percent of supervising pharmacists and 98% of technicians supported the use of technicians in the immunization workflow beyond the pandemic. Twenty-seven interviews were conducted. Major themes that emerged from the data included using the "right" technicians, role delineation and collaboration, policies, logistics, financial implications, and public health impact. CONCLUSION: The utilization of pharmacy technicians in administration helped to accelerate the immunization process, alleviate the burden on pharmacists and other health care professionals, and ensure widespread vaccine distribution to combat the pandemic.

Changes in medical student implicit attitudes following a health equity curricular intervention.

PURPOSE: This study assessed the: (1) effect of an LGBTQI + health equity curriculum (eQuality) on implicit attitudes among first (M1) and second year (M2) medical students and (2) utility of dedicated time to explore implicit bias. METHOD: Implicit biases were assessed at baseline using implicit association tests (IAT) for all M2s and a random sample of first years (M1A). These students were then debriefed on strategies to mitigate bias. Following eQuality, all M1 and M2s completed post-intervention IATs. The remaining first years (M1B) were then debriefed. Paired sample t-tests assessed differences between pre/post. Independent sample t-tests assessed differences in post-IATs between M1 groups. RESULTS: IATs indicated preferences for "Straight," "White," and "Thin" at both pre and post. M2s demonstrated statistically significant improvements pre to post for sexuality (p = 0.01) and race (p = 0.03). There were significant differences in post-intervention IAT scores between M1As who received the IAT and debriefing prior to eQuality and M1Bs for sexuality (p = 0.002) and race (p = 0.046). There were no significant changes for weight. CONCLUSION: eQuality reduced implicit preference for "Straight" and "White." Differences in M1 post-intervention IAT scores between groups suggest dedicating time to debrief implicit attitudes enhances bias mitigation.

Baseline Assessment of Systemic Racism Education in Pharmacy Curricula.

Objective. To determine, by survey, the inclusion of systemic racism education in US Doctor of Pharmacy (PharmD) curricula and identify barriers and facilitators to addressing this content.Methods. A survey was developed and distributed to curricular representatives at US colleges and schools of pharmacy. The survey assessed inclusion of systemic racism education in curricula, faculty involvement in teaching systemic racism content, barriers to adding systemic racism content in curricula, and future curricular plans. Data were analyzed using descriptive statistics for institutional background information, curricular content, and barriers to inclusion. Relationships between the inclusion of systemic racism content at public versus private programs were examined, and associations between traditional and accelerated programs were assessed.Results. Fifty-eight colleges and schools of pharmacy provided usable responses. Of the respondents, 84% indicated that teaching systemic racism content and its impact on health and health care was a low priority. For 24% of respondents, systemic racism content was not currently included in their curriculum, while 34% indicated that systemic racism content was included in one or more courses or modules but was not a focus. Despite systemic racism content being offered in any didactic year, it was rarely included in experiential curricula. Top barriers to inclusion were lack of faculty knowledge and comfort with content and limited curricular space. No significant differences were found between program types.Conclusion. Based on the current level of systemic racism education and barriers to inclusion, faculty need training and resources to teach systemic racism concepts within pharmacy curricula. The inclusion of systemic racism concepts and guidance in the Accreditation Council for Pharmacy Education's Accreditation Standards could help to drive meaningful change and promote health equity.

The intersectionality of professional and personal identity formation in a virtual pre-health pathway program.

BACKGROUND AND PURPOSE: To describe the development and implementation of professional and personal identity formation content in a virtual pre-health pathway program. EDUCATIONAL ACTIVITY AND SETTING: Content within a six-week pre-health program for underrepresented and/or disadvantaged college students was redesigned to a virtual format with enhanced focus on professional and personal identity formation. Sessions on personal identity formation were also enhanced through a partnership with local mental health clinicians specializing in trauma-informed care and culturally relevant practices and strategies. FINDINGS: The 2020 and 2021 programs were restructured to include pharmacy professional identity formation content around the following weekly themes: Roadmap to Pharmacy, What Does it Mean to be a Pharmacist?, Expanding Knowledge of Pharmacy, Gaining Insight and Dispelling Myths, Practicing Knowledge and Exploration, and Moving Forward. These pre-pharmacy components emphasized diversity of career paths, pharmacy-based clinical services, and the pharmacist's role in promoting health equity. Overarching components of interprofessional collaboration coupled with health policy applications further emphasized the professional identity of a pharmacist in the collaborative design and delivery of health care. New personal identity formation sessions were implemented in tandem with this content and centering around the following themes: Supporting Scholars in Self-Authorship, Building a Community among Peers, and Strategies for Coping in Times of Challenge. SUMMARY: This project has the potential to serve as a model for the implementation of both personal and professional identity formation initiatives at other programs to promote pharmacy as a desirable and attainable career to pre-health students.

Nailed it! Doctor of pharmacy learners' self-awareness of performance on authentic assessments.

INTRODUCTION: The primary objective of this pilot study was to determine the reliability and validity of an objective structured clinical examination (OSCE) self-awareness survey. A secondary objective was to assess learner self-awareness in OSCE performance. METHODS: A retrospective review of OSCE data from a single cohort in a three-year accelerated doctor of pharmacy program occurred. The cohort completed four OSCEs with a total of 23 discrete cases. At the end of each case, before receiving feedback, learners completed an evaluation of their skills, communication, overall performance, and identified if they believed the patient/provider would return ("nailed or failed"). These self-evaluations were then compared with respective learner performance scores for each case. Content validity was assessed for the self-awareness survey via the Lawshe method. Reliability of the OSCE cases and self-awareness survey were conducted utilizing Cronbach's alpha and the Spearman-Brown formula, respectively. RESULTS: The OSCE self-awareness survey was found to be face valid and reliable for the overall survey. The subsections of return to pharmacist and overall learner performance were also found to be valid and reliable. A statistical relationship was found between learner self-assessment of pass/fail and their actual grade for overall performance and return to pharmacist. CONCLUSIONS: Results from this study may guide remediation plans related to OSCE performance and development of other self-awareness activities in practice settings. Further studies are needed to evaluate the broader application and use of self-awareness tools.

Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care.

Introduction: The purpose of this mixed-methods study was to evaluate an interprofessional academic-practice partnership in end of life care by examining patient medication outcomes, the contributions of student pharmacists and a pharmacy preceptor to care teams, and student learning experiences. Methods: Retrospective chart review assessed polypharmacy differences in hospice patients with a primary terminal diagnosis of non-Alzheimer's dementia between two patient groups; Group 1 managed on interprofessional care teams within the pharmacy partnership, and Group 2, managed on teams without a pharmacist. Team members who interacted with student pharmacists and the pharmacy preceptor participated in semi-structured key informant interviews to document perceptions of pharmacy contributions to care teams and the organization. At the end of their APPE, students completed reflective writings regarding their learning. Results: Patients in Group 1 were on statistically significant fewer medications than Group 2 at both week 4 and weeks 7-12 following admission. Five conceptual themes emerged from interviews: pharmacists as team medication experts, improved patient outcomes, interprofessional collaboration, patient/caregiver trust in medication regimens, and desire for sustainability. Student reflections included the following learning themes: teamwork, respect, value, and patient-centered care. Conclusions: The addition of a pharmacist on interprofessional care teams decreased the average number of medications in the non-Alzheimer's end of life patient population. Team members identified value-added contributions of student pharmacists and the pharmacy preceptor that enhanced team efficiency and patient care. Student pharmacists recognized these contributions and the experience served as an exemplar of interprofessional practice.

Culturally Effective Care for Refugee Populations: Interprofessional, Interactive Case Studies.

Introduction: Within health sciences education literature, the majority of reported student experiences with refugee populations are limited to traditional, professionally independent, elective courses and extracurricular volunteer opportunities. A simulated patient exercise is a learning opportunity that helps participants engage with material in real time in a realistic environment, demanding higher levels of learning. This session utilized a simulated patient facilitator in interprofessional small groups to explore common health needs and barriers to care among refugee populations. Methods: Health professions students from nine degree programs participated in a refugee health session in interprofessional teams of nine to 10 students to explore patient cases. The session concluded with a debriefing discussing the outcomes of the student-patient interaction, best practices, and exemplary practice models as takeaways. The simulated patient facilitators completed an Observation Checklist to assess students' grasp of learning objectives. Results: Five hundred twenty-four students participated in the refugee session, divided into 61 groups. Observation Checklists were completed for 58 groups (95%). Assessment of student engagement focused on general health needs common to refugee populations: barriers to health care, team and individual roles, bias, consequences of nontreatment, and social determinants of health. Most of the groups (95%) reported engagement between the simulated patient facilitator and the group of student providers. Qualitative data indicated student groups were knowledgeable in each of the overarching learning objectives. Discussion: This session allowed health sciences students to focus on culturally effective patient care for refugee populations as a part of an interprofessional team.

Interprofessional LGBT Health Equity Education for Early Learners.

INTRODUCTION: The eQuality project at the University of Louisville aims to train future physicians to deliver equitable quality care for all people by creating an integrated educational model utilizing the competencies identified in the AAMC's Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD. This foundational interprofessional health equity session for early learners addresses knowledge and attitude milestones relating to interprofessional collaboration, professionalism, and systems-based practice competencies for lesbian, gay, bisexual, and transgender (LGBT) populations. METHODS: First-year medical students were assigned to interprofessional teams of approximately 10 health sciences students each. Students participated in a 75-minute session utilizing a group case study activity, including a systems lecture exploring social determinants and community resources related to LGBT health. Students collaboratively discussed the case and recorded strategies for optimal patient care. The Readiness for Interprofessional Learning Scale and health disparities attitudes and knowledge scales were administered pre-/postsession. RESULTS: One hundred fifty-eight first-year medical students participated in the session. Posttest scores reflected an improvement for all disparities knowledge items (p < .001), and an increased interest in working with other health professions students on future projects (p < .001). Changes in attitudes toward systemic and social factors affecting health were also observed. However, content analysis of worksheets revealed that only 36% of teams identified specific action steps for the case scenarios. DISCUSSION: This session was effective in improving knowledge and attitudes related to LGBT health equity and interprofessional education.