Measuring the Impact of a Pharmacist-Driven Blood Factor Education Program: A Prospective, Single-Center Observational Study.

Introduction: Patients with bleeding disorders are best served by multidisciplinary teams. Pharmacists can play a critical role in the optimal management of patients with bleeding disorders through blood factor stewardship strategies and programs. An educational program was developed and implemented wherein a hematology pharmacist provided brief recorded lectures to an entire department of pharmacists in a multi-site health-system with the goal to improve the knowledge base and confidence among this population of general practitioners. Methods: The primary objective of this study was to evaluate the educational outcomes of a blood factor education program for pharmacists. The impact of the educational program was determined by measuring the difference in mean test scores between the pre- and post-program surveys. Results: The final analysis included 214 participants. The primary endpoint of mean competency test score was significantly improved in the post-test compared to pre-test (78.33% vs 52.83%; P < .0001). Any degree of test score improvement was observed in 99% (n = 212) of participants. Pharmacist confidence was significantly improved in all 20 domains of bleeding disorders and blood factor product verification and management. Conclusion: This program identified that most pharmacists in a large multi-site health-system were not familiar with bleeding disorders to a satisfactory degree, commonly because of the relative rare encounters with bleeding disorder-related orders, and that despite systems-based support there was an opportunity to improve practice through education. Such educational programming could be beneficial for the development of pharmacist-provided care and is a measure that could be implemented as part of blood factor stewardship initiatives.

A review to characterise and map the growth mindset theory in health professions education.

INTRODUCTION: Growth mindset is a motivation theory proposed by Carol Dweck that posits our beliefs about intelligence, and the ability to change mindsets can have impacts on how we approach challenges, respond to criticism challenges and orient our goals. This study characterised articles on growth mindset theory in health professions education to: summarise the aspects of growth mindset being researched, describe the discussed benefits of growth mindset theory and outline strategies discussed that may promote a growth mindset. METHODS: A systematic review of the literature yielded 4927 articles-articles were reviewed and excluded if they were outside of health professions education and did not discuss Dweck's growth mindset theory. The final review yielded 14 research articles and 13 commentaries, which were characterised and analysed using content analysis. RESULTS: The included articles were published in 2016 and beyond; the articles represented a diverse context, participant type and approach. Most research studies measured participant mindsets and evaluated the correlation with other variables (eg grit, well-being, anxiety). Articles often highlighted benefits and strategies to promote a growth mindset at the learner, educator and organisation level. The most common learner benefits were to help them be more receptive to feedback as well as increased resiliency and perseverance, educator benefits focused on supporting collaborative relationships and safe learning environments. The most prevalent strategies discussed were teaching learners about growth mindset theory, shifting faculty feedback to emphasise effort and to prioritise feedback across the organisation. CONCLUSION: The growth mindset framework has been shown in other fields to help others manage educational challenges and enhance learning environments. Researchers are encouraged to explore how interventions such as teaching about and prioritising a growth mindset can support learners, health care professionals, educators and organisations.

Twelve tips to stimulate creative problem-solving with design thinking.

Design thinking is increasingly applied in healthcare and health professions education to generate innovative solutions to difficult problems. The design thinking framework helps individuals approach problems with a user-centered focus; the emphasis is on understanding the user experience, their challenges, and possible design solutions that are aligned with their needs. In this twelve tips paper, we describe strategies that health professions educators can use to prepare for, conduct, and support design thinking. These strategies may also be useful to learners, practitioners, and organizations to address complex problems.

Situational judgment test validity: an exploratory model of the participant response process using cognitive and think-aloud interviews.

BACKGROUND: Situational judgment tests (SJTs) are used in health sciences education to measure examinee knowledge using case-based scenarios. Despite their popularity, there is a significant gap in the validity research on the response process that demonstrates how SJTs measure their intended constructs. A model of SJT response processes has been proposed in the literature by Robert Ployhart; however, few studies have explored and expanded the factors. The purpose of this study was to describe the factors involved in cognitive processes that examinees use as they respond to SJT items in a health professions education context. METHODS: Thirty participants-15 student pharmacists and 15 practicing pharmacists-completed a 12-item SJT designed to measure empathy. Each participant engaged in a think-aloud interview while completing the SJT, followed by a cognitive interview probing their decision-making processes. Interviews were transcribed and independently coded by three researchers to identify salient factors that contributed to response processes. RESULTS: The findings suggest SJT response processes include all four stages (comprehension, retrieval, judgment, and response selection) as initially proposed by Ployhart. The study showed factors from other published research were present, including job-specific knowledge and experiences, emotional intelligence, and test-taking. The study also identified new factors not yet described, including identifying a task objective in the scenario, assumptions about the scenario, perceptions about the scenario, and the setting of the item. CONCLUSIONS: This study provides additional SJT validity evidence by exploring participants' response processes through cognitive and think-aloud interviews. It also confirmed the four-stage model previously described by Ployhart and identified new factors that may influence SJT response processes. This study contributes to the literature with an expanded SJT response process model in a health professions education context and offers an approach to evaluate SJT response processes in the future.

Assessing Preceptor Use of Cognitive Apprenticeship: Is the Maastricht Clinical Teaching Questionnaire (MCTQ) a Useful Approach?

Construct: The authors investigated the utility of the Maastricht Clinical Teaching Questionnaire (MCTQ) to assess preceptor use of cognitive apprenticeship teaching methods. Background: The MCTQ is an instrument first studied in medical and veterinary education; it was shown to produce valid and reliable data when evaluating how well preceptors engage in cognitive apprenticeship. Additional validity evidence, however, is needed to determine if the MCTQ is useful and applicable in other healthcare professions, such as pharmacy. Approach: Student pharmacists and pharmacy residents at a large academic medical center completed the MCTQ to evaluate pharmacist preceptors. A confirmatory factor analysis (CFA) was used to determine how consistent the data were with the 5-factor structure of the cognitive apprenticeship teaching methods (e.g., modeling, coaching, articulation, exploration, and safe learning environment). A structural equation model (SEM) was used to evaluate the relationship between the 5 factors. Preceptor and student perceptions were also collected to evaluate the response process and potential consequences of using the instrument. Results: Thirty-eight learners (2nd-year and 4th-year student pharmacists and pharmacy residents) submitted 157 evaluations. The CFA showed appreciable fit with the 5-factor structure of the cognitive apprenticeship framework after 2 modifications (removal of 1 item and moving 1 item to a different factor). The SEM had poor model fit compared to previous studies, and an exploratory analysis suggests that there is a complex relationship between the various teaching methods. Preceptors and students highly agreed that the instrument was valuable for providing feedback. Conclusion: The MCTQ has additional validity evidence that supports it as a viable instrument to assess preceptor engagement in teaching methods consistent with the cognitive apprenticeship framework. Additional research is warranted to explore the relationship between components in the cognitive apprenticeship framework to determine how preceptors can best focus their efforts to improve clinical teaching.

A qualitative review of the design thinking framework in health professions education.

BACKGROUND: Design thinking is a problem-solving framework that has been used to enhance patient experiences, improve clinical outcomes, and refine medical curricula. This study reviewed the use of design thinking in health professions education. METHODS: A search yielded 169 articles, which were excluded if they were: (1) not related to education; (2) lacking an application of design thinking; or (3) not associated with healthcare. The final review yielded 15 articles, which were analyzed using qualitative methods. RESULTS: All articles were published in 2009 or later and were diverse in their context, participants, and approach. Six studies emphasized the early stages of design thinking, with inspiration and ideation stages fostered through a variety of activities, such as lectures, small group discussions, and workshops. Studies examined a range of outcomes, including self-efficacy, perceptions, and solutions to a specific problem. CONCLUSIONS: Our findings raise important considerations for health professions education, including the extent to which we should: 1) teach design thinking to students as a skill-based tool to prepare students for problem solving in complex healthcare environments; and 2) use design thinking to create, implement, and refine health professions curricula and educational programs. Despite the apparent benefits of design thinking, many questions for health professions education remain.

Call for ACTion: Transforming Dental Education at the University of North Carolina at Chapel Hill.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.

Air Quality and Health Impacts of an Aviation Biofuel Supply Chain Using Forest Residue in the Northwestern United States.

Forest residue is a major potential feedstock for second-generation biofuel; however, little knowledge exists about the environmental impacts of the development and production of biofuel from such a feedstock. Using a high-resolution regional air quality model, we estimate the air quality impacts of a forest residue based aviation biofuel supply chain scenario in the Pacific Northwestern United States. Using two potential supply chain regions, we find that biomass and biofuel hauling activities will add <1% of vehicle miles traveled to existing traffic, but the biorefineries will add significant local sources of NO x and CO. In the biofuel production scenario, the regional average increase in the pollutant concentration is small, but 8-hr maximum summer time O3 can increase by 1-2 ppb and 24-hr average maximum PM2.5 by 2 µg/m3. The alternate scenario of slash pile burning increased the multiday average PM2.5 by 2-5 µg/m3 during a winter simulation. Using BenMAP, a health impact assessment tool, we show that avoiding slash pile burning results in a decrease in premature mortality as well as several other nonfatal and minor health effects. In general, we show that most air quality and health benefits result primarily from avoided slash pile burning emissions.

Using the multiple mini interview as an assessment strategy within the first year of a health professions curriculum.

BACKGROUND: The multiple mini-interview (MMI) is a common assessment strategy used in student selection. The MMI as an assessment strategy within a health professions curriculum, however, has not been previously studied. This study describes the integration of a 5-station MMI as part of an end-of-year capstone following the first year of a health professions curriculum. The goal of the capstone MMI was to assess professional competencies of students and to offer formative feedback to prepare students for their upcoming clinical practice experiences. The purpose of this study was to evaluate the psychometric properties of an MMI integrated into a health professions curriculum. METHODS: Five capstone MMI stations were designed to each evaluate a single construct assessed by one rater. A principal component analysis (PCA) was used to evaluate the structure of the model and its ability to distinguish 5 separate constructs. A Multifaceted Rasch Measurement (MFRM) model assessed student performance and estimated the sources of measurement error attributed to 3 facets: student ability, rater stringency, and station difficulty. At the conclusion, students were surveyed about the capstone MMI experience. RESULTS: The PCA confirmed the MMI reliably assessed 5 unique constructs and performance on each station was not strongly correlated with one another. The 3-facet MFRM analysis explained 58.79% of the total variance in student scores. Specifically, 29.98% of the variance reflected student ability, 20.25% reflected rater stringency, and 8.56% reflected station difficulty. Overall, the data demonstrated an acceptable fit to the MFRM model. The majority of students agreed the MMI allowed them to effectively demonstrate their communication (80.82%), critical thinking (78.77%), and collaboration skills (70.55%). CONCLUSIONS: The MMI can be a valuable assessment strategy of professional competence within a health professions curriculum. These findings suggest the MMI is well-received by students and can produce reliable results. Future research should explore the impact of using the MMI as a strategy to monitor longitudinal competency development and inform feedback approaches.

Peracetic Acid Depolymerization of Biorefinery Lignin for Production of Selective Monomeric Phenolic Compounds.

Lignin is the largest source of renewable material with an aromatic skeleton. However, due to the recalcitrant and heterogeneous nature of the lignin polymer, it has been a challenge to effectively depolymerize lignin and produce high-value chemicals with high selectivity. In this study, a highly efficient lignin-to-monomeric phenolic compounds (MPC) conversion method based on peracetic acid (PAA) treatment was reported. PAA treatment of two biorefinery lignin samples, diluted acid pretreated corn stover lignin (DACSL) and steam exploded spruce lignin (SESPL), led to complete solubilization and production of selective hydroxylated monomeric phenolic compounds (MPC-H) and monomeric phenolic acid compounds (MPC-A) including 4-hydroxy-2-methoxyphenol, p-hydroxybenzoic acid, vanillic acid, syringic acid, and 3,4-dihydroxybenzoic acid. The maximized MPC yields obtained were 18 and 22 % based on the initial weight of the lignin in SESPL and DACSL, respectively. However, we found that the addition of niobium pentoxide catalyst to PAA treatment of lignin can significantly improve the MPC yields up to 47 %. The key reaction steps and main mechanisms involved in this new lignin-to-MPC valorization pathway were investigated and elucidated.

Exploring user experience (UX) research methods in health professions education.

OUR ISSUE: Researchers often design interventions or experiences to meet the needs of a specific user. However, the user's perspective is often excluded in the process, which can minimize effectiveness due to a lack of understanding about the user, their perspective, and/or their needs. User experience (UX) research methods offer an opportunity to capture additional information about the user that can inform the design of these solutions. METHODOLOGICAL LITERATURE REVIEW: UX research became prominent during the 1990s to describe the complexity of human interactions with technological solutions. UX research methods emerged in other disciplines as strategies for describing user perspectives, needs, challenges, and potential impact of proposed solutions-these may be useful in health professions education research. OUR RECOMMENDATIONS AND THEIR APPLICATIONS: Those interested in UX research methods should define the user, establish focused research questions, and select applicable strategies cognizant of time and resource constraints. UX research often requires a clear outline of research activities, how they address the questions, and techniques to engage representative users for data collection. Researchers can optimize data collection by creating inclusive spaces that emphasize active listening. Researchers should compile insights regularly and remember UX research emphasizes an iterative approach to design. POTENTIAL IMPACT: UX research can support deeper insights into users, their perspectives, their needs, and offers opportunities to co-construct solutions with their experiences in mind. These methods may help educators design impactful experiences that better achieve targeted outcomes in collaboration with their users (e.g., learners, faculty, teams).

The cognitive apprenticeship model as a framework for desired precepting qualities to inform preceptor development.

INTRODUCTION: Positive learner perceptions of learning experiences have been linked to better learning outcomes. More information is needed on learners' desired qualities of preceptors and learning experiences to inform preceptor development. Aligning learners' perceptions with a teaching framework, such as the Cognitive Apprenticeship (CA) framework, may be useful to guide preceptor self-assessment and development. However, information is lacking regarding whether the CA framework is consistent with learners' expectations. The purpose of this study was to determine pharmacy learner perspectives on desired preceptor behaviors and qualities and to evaluate their alignment with the CA framework to inform preceptor development. METHODS: Twenty-two learners (nine residents and 13 introductory and advanced pharmacy practice students) participated in nine focus group interviews. Data were analyzed qualitatively by inductive coding and pattern coding and then condensed into themes. After initial analysis, the CA framework was adapted into codes and applied to the data to explore the alignment of quality preceptor characteristics with CA. RESULTS: Learners identified desired general preceptor characteristics, teaching behaviors, and qualities of sites and experience structure in their discussion. All four CA dimensions (Methods, Sociology, Sequencing, and Content) were represented in the described desired preceptor qualities. Most comments were connected to the Methods dimension. CONCLUSIONS: This study supports the use of CA as a framework to guide preceptor development and assessment for desired precepting qualities, preceptor behaviors, and learning environments. Additional research is needed for best practices in implementing CA in preceptor assessment and professional development.

Lessons learned from a non-traditional application process: Integrating user experiences to inform admission application design.

PURPOSE: The research aim was to gather applicant expectations and perspectives with a user-centered approach during a pilot application process for a new dental school. The goal was to inform future admissions practices at our institution and for programs broadly. METHODS: The High Point University admission team developed an electronic application external to current centralized services that was launched from May to August 2022. Participants who completed the application were requested to complete an electronic survey of closed- and open-ended questions about the factors influencing their application decisions, feedback about how to optimize the experience, and their overall satisfaction using a Net Promoter Score. RESULTS: A total of 303 applicants (79% response rate) completed the survey about their application experience. The most influential reason for applying to the program was the optional Dental Admissions Test requirement (43%). Participants frequently referenced a need for a more human-centered process focused on the candidate rather than their numerical values and that the process should be smooth, straight-forward, short, easy, and simple. Participants requested that experiences should be weighed the most in the application process followed by letters of recommendation. Most applicants were "promoters" (68%) for the program with a Net Promoter Score of 62. Moreover, 32% and 45% rated the application process as the best or better application experience compared to other programs. CONCLUSION: Programs can benefit from collecting applicant's (i.e., users) opinions and feedback about their expectations and experiences to inform more user-centered application processes.

The Relationship Between a Multiple Mini-interview and Situational Judgment Test for Admissions.

Objective. To explore the relationship between a multiple mini-interview (MMI) and situational judgment test (SJT) designed to evaluate nonacademic constructs.Methods. A 30-question ranked-item SJT was developed to test three constructs also measured by MMIs during a pharmacy school's admissions process. First-year pharmacy students were invited to complete the SJT in fall 2020. One hundred four students took the SJT (82.5% response rate), with 97 (77% of possible participants) having MMI scores from the admissions process. Descriptive statistics and other statistical analyses were used to explore the psychometric properties of the SJT and its relationship to MMI scores.Results. Seventy-four percent of students identified as female (n=72), and 11.3% identified with an underrepresented racial identity (n=11). The average age, in mean (SD), was 21.8 (2.1) years. Students' mean (SD) scores were 85.5 (3.1) (out of 100 points) on the SJT and 6.1 (1.0) (out of 10 points) on the MMI. Principal components analysis indicated that the SJT lacked construct validity and internal reliability. However, reliability of the entire SJT instrument provided support for using the total SJT score for analysis (α=.63). Correlations between total SJT and MMI scores were weak (r p<0.29).Conclusion. Results of this study suggest that an SJT may not be a good replacement for the MMI to measure distinct constructs during the admissions process. However, the SJT may provide useful supplemental information during admissions or as part of formative feedback once students are enrolled in a program.

Lessons From Using Design Thinking to Develop the 2021 AACP Teachers' Seminar.

Objective. To describe and evaluate how a design thinking approach aided the creation of the 2021 American Association of Colleges of Pharmacy (AACP) Teachers' Seminar.Methods. The design thinking framework (ie, inspiration, ideation, and implementation) was used to structure the seminar development process from July 2020 to July 2021. Nine committee members engaged in a persona activity (ie, inspiration), a brainstorming activity (ie, ideation), and a prototyping activity (ie, implementation) to create a user-centered learning experience. Twenty-five small group facilitators were then recruited to create and deliver breakout session content. After the seminar, the team was invited to debrief their experience in a focus group and an electronic survey to evaluate the perceived impact of using design thinking in the planning process.Results. Twenty-one (62%) of the 34 committee members and small group facilitators attended the focus group, and 28 (82%) completed the electronic survey. Most agreed that design thinking was a useful approach to support the Teachers' Seminar, and they were generally positive about the experience. There was a significant increase in self-reported creative self-efficacy for coming up with novel ideas, ability to solve problems, and helping expand others' ideas. Team members identified positive attributes about the seminar and planning process as well as areas for improvement. Team members also acknowledged challenges and potential solutions for professional organizations and program developers to consider when creating user-centered experiences.Conclusion. Design thinking can be a useful framework for seminar planning and implementation to create engaging, meaningful, and valuable educator development experiences.

Nanocellulose reinforced lightweight composites produced from cotton waste via integrated nanofibrillation and compounding.

Cotton is a natural fiber containing more than 95% of cellulose. With worldwide cotton consumption continuously increasing, the amount of cotton waste generated is enormous. Most of the cotton waste ends up in landfill or incinerators, resulting in a huge waste of this excellent natural resource. In this project, cotton waste was recycled to produce polypropylene nanocomposites. Instead of using the traditional two-step nanofiber extraction and compounding technique, an integrated process was adopted to combine nanofibrillation and compounding into one step. Results showed that cotton fibers with a slight prefibrillation and hydrophobic surface modification were successfully fibrillated into tens to hundreds of nanometers in width during compounding. The nanofibers reinforced polypropylene composites exhibited significantly enhanced tensile and flexural strength and moduli. For instance, when 30% fibers from bleached white and indigo-dyed denim fabrics were introduced, the tensile moduli of the resultant composites reached 4.57 and 4.59 GPa, respectively, compared to 1.60 GPa, the modulus of neat PP. Meanwhile, denim fabrics had a remarkable reinforcing effect on the composites' impact strength attributing to the hydrophobic indigo dyes that improved the interfacial bonding between cotton fibers and the matrix. The highest impact strength of denim reinforced composites was 4.96 kJ/m2 with 20% fiber loading; while the impact strength of neat polypropylene was 2.46 kJ/m2. The low water uptake of the composites further indicated the excellent adhesion at the filler/matrix interface. In general, a very promising processing technique to recycle cotton waste for high-value products was demonstrated.

Methodological Challenges in Studies of Personal and Professional Identity Formation.

Demographic information about the identities of faculty, staff, students, and trainees is frequently collected in pharmacy education. A wide range of identities and characteristics can influence the choices and experiences of students as they progress through curricula and develop their professional goals. Understanding personal and professional identity formation within dynamic and complex environments is critical to promoting the success of pharmacy education and practice. Emerging research efforts highlight the importance of considering identity development from varying perspectives, and offer new methods for collecting and analyzing data. The objective of this commentary is to reflect on the methodological challenges of identity formation research in pharmacy education and offer recommendations for those interested in this work.

Assessing the Use of Microlearning for Preceptor Development.

The objective of this study was to evaluate microlearning as a preceptor development method compared to a traditional method of learning. Twenty-five preceptor participants volunteered to engage in a learning intervention about two preceptor development topics. Participants were randomized 1:1 to either a thirty-minute traditional learning experience or a fifteen-minute microlearning experience; participants then crossed over to the other intervention for comparison. Primary outcomes were satisfaction, changes in knowledge, self-efficacy, and perception of behavior, confidence scale, and self-reported frequency of behavior, respectively. One-way repeated measures ANOVA and Wilcoxon paired t-tests were used to analyze knowledge and self-efficacy, and Wilcoxon paired t-tests were utilized to assess satisfaction and perception of behavior. Most participants preferred microlearning over the traditional method (72% vs. 20%, p = 0.007). Free text satisfaction responses were analyzed using inductive coding and thematic analysis. Participants reported that microlearning was more engaging and efficient. There were no significant differences in knowledge, self-efficacy, or perception of behavior between microlearning and the traditional method. Knowledge and self-efficacy scores for each modality increased compared to the baseline. Microlearning shows promise for educating pharmacy preceptors. Further study is needed to confirm the findings and determine optimal delivery approaches.

Simulation-Based Training to Improve Clinical Pharmacist Self-Efficacy in the Management of a Rapidly Decompensating Patient.

Background: The optimal training method to prepare pharmacists as an integral rapid response team or cardiopulmonary arrest responders is poorly described. This study assessed the utility of simulation-based training (SBT) as a training technique for clinical pharmacists. Objective: This study aimed to determine if attending SBT is associated with an improvement in self-efficacy. Methods: This single-center, prospective, interventional cohort study offered three simulations to clinical pharmacists over the course of seven months at a 957-bed quaternary care academic medical center. Pharmacists who participated in at least one simulation were categorized in the intervention group and were compared to pharmacists who did not attend a simulation. All participants were asked to complete a 19-question self-efficacy survey in the form of a 100-point scale, a 15-question multiple-choice knowledge assessment, and a perception survey in the form of 4-point Likert scale administered at baseline and following the conclusion of the SBT. Results: Forty-four clinical pharmacists participated; 20 in the intervention group and 24 in the control group. Median change in self-efficacy score improved significantly in the intervention group compared to the control group (14.3 vs 2.3, P = .009). Median change in perception score improved significantly (2 vs 0, P = .046). Knowledge score did not change significantly from baseline. Conclusion: Simulation-based training improved clinical pharmacist self-efficacy and perceptions in the care of rapidly decompensating patients. These findings support SBT as a viable modality of training clinical pharmacists for the management of rapidly decompensating patients.