A Paradigm Shift in US Experiential Pharmacy Education Accelerated by the COVID-19 Pandemic

The coronavirus identified in 2019 (COVID-19) has caused dramatic disruptions in pharmacy experiential education. Administrators and programs have worked to help external preceptors, faculty members, and students cope with the new realities of virtual or remote experiences and new or increased use of telemedicine. Clear and effective lines of communication as well as well-reasoned and resourced alternative plans are necessary to help manage the current issues and prepare for future challenges. Doctor of Pharmacy programs should enhance their focus not just on the physical health and well-being of students, faculty members, and external preceptors, but also on their mental and emotional health. The full scope of the impact of the pandemic on experiential education in pharmacy is still unclear, but this situation should serve as a stimulus for innovation and rethinking the paradigm of how pharmacy programs educate and prepare students for pharmacy practice.

The Challenge of Coming to Terms With Evolving Priorities

The ideas of "work-life balance" or "work-life blend," both of which were popular topics in the years leading up to 2020, entered an entirely new and uncharted level of complexity when the personal and professional worlds of many suddenly collided, without adequate warning or preparation.1,2 In many cases, years of careful planning or concerted effort to separate or otherwise partition work and home evaporated, and the multitude of challenges inherent in complete integration of work and home became readily apparent. Communal challenges can foster a shared sense of ownership and activate many positive attributes in individuals that can lead to greater individual and group well-being.3 At an individual level, however, separate from the direct physical or health-related complications of the pandemic, the communal challenges of COVID-19 served as a massive disruption to our own plans and goals for our lives and careers that had and continues to have both immediate and sustained, long-term consequences. Many of the impacts of the COVID-19 pandemic on the United States have been compared to those of the terrorist attacks of 9/11, including the collective grief and trauma felt by people across demographic groups and locations.5 Most relevant to this discussion, goals and plans (both personal and professional) were disrupted for many Americans and others from around the world. In the period immediately after the 9/11 terrorist attacks, the disruptions were tangible and prominent, such as the complete grounding of US commercial air travel and the shock to the US financial system after entire companies based in the World Trade Centers in New York City were destroyed.

Response to Smith et al Letter RE: Evolving Priorities Commentary

Too often, the pressure to continue down a path set long ago, perhaps in the form of a tenure-track position with a clock or a rigid five- or 10-year development plan, intersects with reality or changed circumstances (such as the COVID-19 pandemic) and the individual is left with a plan that may have been initiated by a different person entirely than the one they are today. While the authors should rightfully be lauded for their encouragement of long-term goal setting and working to actualize plans and achieve pre-pandemic goals through variation in strategies, my position was to encourage normalization of the full constellation of possibilities present when such a potentially existential evaluation occurs. In other circumstances, the pressures of being at home and forced without notice or preparation to become an elementary school teacher, daycare worker, and camp counselor or activities coordinator all rolled into one in addition to the full-time job as a faculty member both gave the individual a refreshed sincere appreciation for the services these institutions and individuals provide, as well as a newfound appreciation for the quiet and peace of the faculty member's office at the college.

Loneliness as a Downstream Concern in a Pandemic (and Post-Pandemic) World

While the implementation of physical distancing practices and renewed awareness of our ability to spread communicable diseases to one another were (and remain) important in mitigating the spread of infection, a downstream effect of the pandemic that is still not fully appreciated may be the long-term impact of these changes on mental health, specifically as a contributing factor to loneliness.1 Even as the world begins to emerge from the worst of the pandemic in terms of immediate danger to life and physical well-being, a full understanding of the overall impact of the last year on our mental health and wellness is just beginning. The negative effects of loneliness and social isolation are not limited to mental health issues, such as depression and anxiety, but also include physical maladies such as heart disease, stroke, type 2 diabetes, and even higher overall mortality.5-7 The risk of a person developing one or more of these illnesses because of loneliness is comparable to that incurred from other, more well-known factors such as smoking and obesity, and in many studies, loneliness has been shown to be independently associated with the outcome.8,9 Especially important for the pharmacy student population, young people (ages 18-30 years) and students are at greater risk of experiencing loneliness, both prior to and during the pandemic, with the incidence of loneliness higher in these groups than in other demographic populations.10 Cross-sectional studies of different age groups have shown that upwards of 60% of older adults have never reported feeling lonely, whereas the rates of severe loneliness among young adults range from 20%-48%.11 Researchers theorize that, because loneliness is the distress experienced when there is a discrepancy between the expected and perceived quantity and quality of an individual's social interactions, loneliness may not be as closely tied to social isolation in older adults who have more fully developed and mature brains as it is in adolescents and young adults.12 Former US Surgeon General Vivek Murthy's book, Together: The Healing Power ofConnection in a Sometimes Lonely World, published in April 2020, details his experience in learning about the wide-ranging effects of loneliness on mental as well as physical health and its pervasive and growing presence in society, even prior to the pandemic.13 As he traveled across the United States speaking to different groups about public health issues such as cancer, smoking, and opioid use disorder, Murthy was surprised at the numbers of people across demographic groups and geographic areas who discussed with him their struggles with loneliness and feeling alone. In addition to disenfranchised grief over the loss of normal life, there can be a natural tendency to compare our own plight to that of others and employ the idea that "things could be worse," an act known as comparative suffering}1 As discussed by author Brene Brown on her podcast Unlocking Us in the early stages of the pandemic, comparative suffering was a natural coping mechanism employed by many individuals in a noble attempt to encourage gratefulness both internally and externally.18 However well-intentioned, the challenge with comparative suffering over the long term is that it devalues and underappreciates the impact of our own emotions and suffering and buries or pushes them away to be dealt with at another time. Whether intentional or not, the message sent and received is that our feelings are wrong, causing some to even experience shame for feeling them. Because clinical loneliness can stem from the subjective experience of our social connections being inadequate to our needs, it is understandable how the pandemic and its aftermath may have set us up to experience loneliness.

A Paradigm Shift in US Experiential Pharmacy Education Accelerated by the COVID-19 Pandemic.

The coronavirus identified in 2019 (COVID-19) has caused dramatic disruptions in pharmacy experiential education. Administrators and programs have worked to help external preceptors, faculty members, and students cope with the new realities of virtual or remote experiences and new or increased use of telemedicine. Clear and effective lines of communication as well as well-reasoned and resourced alternative plans are necessary to help manage the current issues and prepare for future challenges. Doctor of Pharmacy programs should enhance their focus not just on the physical health and well-being of students, faculty members, and external preceptors, but also on their mental and emotional health. The full scope of the impact of the pandemic on experiential education in pharmacy is still unclear, but this situation should serve as a stimulus for innovation and rethinking the paradigm of how pharmacy programs educate and prepare students for pharmacy practice.