Enhancing application and long-term retention of clinical knowledge using an extracurricular non-credit course.

BACKGROUND AND PURPOSE: Curricular overload in doctor of pharmacy (PharmD) programs is necessitating innovative approaches to support student learning. The purpose of this study was to describe the design, delivery, and assessment of a non-credit extracurricular course that reinforced foundational concepts through the application of learning in case-based activities. EDUCATIONAL ACTIVITY AND SETTING: A 14-week extracurricular course, designed using principles of spaced repetition and interleaving in the context of case-based exercises, was offered to third-year PharmD students. Content focused on Top 300 and over-the-counter medications, brown bag sessions/drug utilization review, and medication therapy management. Short-term course effectiveness was assessed through post-course focus groups. Longitudinal effectiveness was assessed nine months post-course using an online survey. Qualitative data were analyzed using a content analysis process with overarching themes identified. Clinical interventions identified in the post-course survey were analyzed descriptively. FINDINGS: Twenty-four students completed the course and all assessments. Focus group themes were: (1) making connections to prior learning; (2) moving beyond memorizing facts; and (3) benefit from a low-stakes course. Students identified 162 course-linked clinical interventions during advanced pharmacy practice experiences (APPEs) in 16 different settings. SUMMARY: Student learning can be enhanced through integration of evidence-based teaching strategies both within and across the curriculum. This can be accomplished not only through introduction of an extracurricular course but through modification of existing courses. Providing additional opportunities for reinforcing core clinical knowledge and applying clinical decision-making in a low-stakes environment was well-received by students and helped them make clinical interventions during APPEs.

Early skills laboratory warnings: Laboratory faculty perspectives on student barriers for progression to experiential education.

INTRODUCTION: This study characterized faculty perceptions of student barriers to achieving an Entrustable Professional Activities (EPA) level 2 or higher in the Patient Care Provider domain. METHODS: Pharmacy skills laboratory faculty participated in a nominal group technique (NGT) session. Participants reflected on two questions: "What behaviors would result in a student not achieving a rank of EPA readiness level 2 or higher?" and "What knowledge and skills would result in a student not achieving a rank of EPA readiness level 2 or higher?" Participants developed a ranked list using silent brainstorming, idea generation, clarification, and discussion. RESULTS: Two NGT sessions were conducted. Group 1 reported (lack of) professionalism, (inability to perform) physical skills, (lack of) critical thinking and interpreting data gathered during physical skills, and (inability to achieve) programmatic outcomes and mile makers exams as barriers. Group 2 ranked behaviors as lack of independence, not taking roles and responsibilities seriously, inability to follow instructions, lack of classroom engagement, and disorganized and unable to prioritize. Group 2 ranked knowledge and skills of significant errors when making medication recommendations, inability to identify accurate medication history, inability to perform tasks with time constraints, poor patient communication, and inability to identify resources. CONCLUSIONS: Pharmacy skills laboratory faculty can identify behaviors, knowledge, or skills that may prevent a student from achieving an EPA readiness level 2 or higher such as lack of professionalism and poor critical thinking skills and should be empowered to identify early warning signs for students' success and progression to experiential education.

Student Perceptions of an Interprofessional Short Course Designed to Increase Awareness of Human Trafficking.

Human trafficking is a global problem with significant impacts on victims' physical and emotional health. Many health care professionals lack human trafficking knowledge, leading to missed opportunities for intervention. This cross-sectional study used evaluation data from a short course on human trafficking to evaluate the course's perceived impact on students. Closed-ended questions were analyzed descriptively while open-ended questions were analyzed using qualitative content analysis. A total of 241 students across eight professions/disciplines completed the evaluation. The vast majority indicated course content was valuable, applicable to their future practice, and recognized interprofessional teamwork is needed to address human trafficking. Despite course effectiveness, there remains a need to continue expanding interprofessional engagement and examining the longitudinal impact of this educational effort.

A Modified Delphi Involving Laboratory Faculty to Define Essential Skills for Pharmacy Graduates.

Objective. To define essential skills for Doctor of Pharmacy (PharmD) graduates that are needed in the four most common sectors of pharmacy practice as determined by expert faculty who instruct within pharmacy skills laboratories.Methods. A three-round Delphi method was used to establish consensus. In the first round, participants were asked what skills were needed by students at entry to practice in community, health-system, ambulatory care, and managed care pharmacy settings. In rounds two and three, participants were asked to rate each skill with a level of importance using a 10-point Likert scale (1=not important to 10=very important).Results. In round one, participants produced a collective list of 289 essential skills. These skill statements were sent to participants in rounds two and three to assign a level of importance. After the third round, participants reached consensus using a mean level of importance for a final list of 69 community pharmacy skills, 47 health-system, 60 ambulatory care, and 15 managed care skills. These skills were then mapped to entrustable professional activities domains for schools and colleges pharmacy to use as a resource when assessing core competency development in the curriculum.Conclusion. The Delphi technique was used successfully with expert pharmacy skills laboratory faculty to identify laboratory-focused essential skills that recent PharmD graduates should have prior to entering community, health-system, ambulatory care, or managed care pharmacy practice. These essential skills can be used to guide curriculum development, develop milestone markers, and help ensure students are practice ready.

Assessment of drug utilization review activities within United States colleges of pharmacy.

INTRODUCTION: Limited literature exists regarding current practices in teaching and assessment of drug utilization review (DUR) skills in pharmacy schools. This manuscript aimed to: (1) examine how assessment is conducted for DUR activities using survey results and (2) summarize the assessment strategies of DUR activities via analysis of tools in colleges of pharmacy. METHODS: A survey was administered to members of the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group via Qualtrics. Descriptive statistics were used to evaluate survey results and the assessment tools (i.e. rubrics/checklists) collected were analyzed qualitatively to determine common content areas. RESULTS: Out of the 113 institutions emailed, 48 (42.5%) responses were complete and represented individual colleges. Thirty-four of those 48 both implemented and assessed DUR activities. Fourteen institutions (41%) utilized one DUR assessment tool throughout the entire curriculum. The majority (62%) used the assessment tool in the first professional year, with a paper tool being the most frequently utilized (74%). "Identification of drug-related problems" (97%) and "determination of the pharmacist's action" (85%) were listed as important components of the assessment tool. Faculty noted that the assessment tool was easy to use (55%) and adequately assessed students' knowledge/skills (55%). A validated assessment tool (85%) and inclusion of technology (50%) would improve delivery of student feedback. CONCLUSIONS: Wide variability existed in how schools incorporated and assessed DUR activities. Developing a standardized method of teaching and assessing DUR is important to adequately prepare the next generation of pharmacists.

Impact of Interprofessional Telehealth Case Activities on Students' Perceptions of Their Collaborative Care Abilities.

Objective. To describe the development, implementation, and assessment of simulated interprofessional education (IPE) telehealth case activities. Methods. Faculty from pharmacy and physician assistant schools developed interprofessional cases covering topics addressed in both curricula and designed for specific levels of learners. Using a telehealth format, pharmacy students were paired with physician assistant students and met at specified times in a virtual room. Faculty representing both professions assessed students as they discussed a patient case, determined a diagnosis, and collaborated to develop appropriate treatment options. Pre-experience and post-experience data and student reflections were collected. Results. Pharmacy students' responses to items on the Team Skills Scale (TSS) completed after participating in four IPE telehealth case activities indicated positive changes. Mean total TSS scores significantly improved from pre-experience 62.3 (SD 8.4) to post-experience 72.6 (SD 5.7). Quantitative evaluation of student teams' participation in an interprofessional activity was assessed using the Creighton Interprofessional Collaborative Evaluation (C-ICE) instrument and the average score was 90%. Theme analysis was performed on student reflections and the most prominent themes identified were satisfaction from interacting with other health care professionals, increased confidence in clinical decision-making ability, and affirmation that IPE telehealth cases should be included in each year of the curriculum. Conclusion. Implementation of interprofessional cases using telehealth technology is an effective way for pharmacy schools to incorporate IPE into their curriculum. Students reported improved self-perception of interprofessional competence and attitudes toward interprofessional collaboration after participating in IPE telehealth cases.

The development of an instrument to evaluate interprofessional student team competency.

Healthcare institutions, accreditation agencies for higher learning, and organizations such as the National Academy of Medicine in the United States, support interprofessional education (IPE) opportunities. However, incorporating IPE opportunities into academic settings remains difficult. One challenge is assessing IPE learning and practice outcomes, especially at the level of student performance to ensure graduates are "collaboration-ready". The Creighton-Interprofessional Collaborative Evaluation (C-ICE) instrument was developed to address the need for a measurement tool for interprofessional student team performance. Four interprofessional competency domains provide the framework for the C-ICE instrument. Twenty-six items were identified as essential to include in the C-ICE instrument. This instrument was found to be both a reliable and a valid instrument to measure interprofessional interactions of student teams. Inter-rater reliability as measured by Krippendorff's nominal alpha (nKALPHA) ranged from .558 to .887; with four of the five independent assessments achieving nKALPHA greater than or equal to 0.796. The findings indicated that the instrument is understandable (Gwet's alpha coefficient (gAC) 0.63), comprehensive (gAC = 0.62), useful and applicable (gAC = 0.54) in a variety of educational settings. The C-ICE instrument provides educators a comprehensive evaluation tool for assessing student team behaviors, skills, and performance.

A Pharmacist's Role in a Dental Clinic: Establishing a Collaborative and Interprofessional Education Site.

BACKGROUND: Dental patients often have comorbidities and take multiple medications, some of which could impact their dental health and treatment. A pharmacist in a dental clinic can assist with the gathering, documentation and evaluation of a dental patient's medication history as it pertains to their dental visit and overall health. PURPOSE: To develop and implement a collaborative and interprofessional education program with a pharmacist providing services in a dental school clinic. SUMMARY: Creighton University School of Dentistry, a student-operated dental clinic located in Omaha, Nebraska, provides dental care by student dentists, faculty and staff to the surrounding community in a learning-focused environment. A pharmacist was incorporated into the dental clinic to create and establish an interprofessional relationship with both dental students and faculty beginning August 2014. Pharmacy students on an ambulatory care advanced pharmacy practice experience rotation were eventually added to the team. The pharmacy team provided medication therapy management services including disease state and medication counseling, medication reconciliation, identifying drug-related problems and dental implications of medications, and recommendations for prescribed medications. CONCLUSION: The pharmacy team's presence was largely accepted by dental faculty, staff, dental students, and patients. Pharmacists can play an important role in a dental clinic by performing thorough health and medication histories and communicating with dental and medical providers involved in a patient's care.

Role of pharmacists in the treatment of excessive daytime sleepiness.

The focus of this case is a 78-year-old female who is being referred to an assisted living community following several episodes of excessive daytime sleepiness (EDS). EDS in the geriatric patient is widespread and is often underdiagnosed and inadequately treated. It can affect an older patient?s quality of life, as well as increasing physical, psychological, cognitive, and mortality risks. There are many different etiologies for EDS including coexisting medical conditions, circadian misalignment, medications affecting the sleep/wake cycle, and psychiatric or psychosocial circumstances. This case illustrates how the pharmacist can help patients with EDS by recognizing symptoms; performing a targeted medical history, sleep history, and medication review; and offering screening with validated tools to refer patients to sleep specialists. There are both pharmacological and nonpharmacological treatment options. The consultant pharmacist is a vital member of the interprofessional health care team and can play a major role in the education, monitoring, and management of EDS.

Sodium oxybate: a primer for pharmacists in the treatment of narcolepsy.

OBJECTIVE: The purpose of this report is to describe a 57-year-old man who was admitted to a nursing facility for physical therapy. His home medication list included sodium oxybate. This article will provide the pharmacist with a therapeutic overview of sodium oxybate as well as review the unique processes involved with drug acquisition, dosing, patient education, and monitoring. SETTING: Community pharmacy, nursing facility pharmacy, consultant pharmacy practice. PRACTICE CONSIDERATIONS: Sodium oxybate is the only medication in the United States that has approval for both treatment of cataplexy in narcolepsy and treatment of excessive daytime sleepiness in narcolepsy. Sodium oxybate has many unique properties that cause it to differ from past therapies for cataplexy and excessive daytime sleepiness associated with narcolepsy. CONCLUSION: It is important for pharmacists to understand the therapeutic uses of sodium oxybate and to review the processes for acquisition, dosing, and administration to better assist physicians and patients and improve therapeutic outcomes.

"Brown bag" simulations to teach drug utilization review.

OBJECTIVE: To teach drug utilization review (DUR) skills to pharmacy students and assess their abilities and confidence before and after training. DESIGN: Profile reviews and online and live drug-utilization-review activities of increasing difficulty were incorporated into the first (P1), second (P2), and third (P3) years of the Pharmacy Skills Training Laboratory sequence in a doctor of pharmacy (PharmD) curriculum. ASSESSMENT: An online survey instrument was administered to gauge how comfortable students were with specific DUR skills before and after the activities. Students' confidence in performing specific DUR skills improved after completing the activities. CONCLUSION: Profile reviews, as well as online and live medication reviews, gave students numerous opportunities to practice drug utilization review skills throughout the first 3 years of the pharmacy curriculum. Students' confidence in performing specific drug utilization review skills improved after the activities. Students' ability to perform the skills also improved as measured with the developed checklist in section V and VI of the Pharmacy Skills Laboratory sequence.

Repeated testing to improve skills in a pharmacy practice laboratory course.

OBJECTIVE: To evaluate the impact of repeated simulations and testing on the pharmacy practice skills development of third-year doctor of pharmacy (PharmD) students. DESIGN: A pharmacy practice skills laboratory was redesigned to reinforce skills development and enhance retention. Timed, repeated learning experiences that increased in complexity throughout the semester were used to test student knowledge, skills, and abilities. ASSESSMENT: Over a 5-year period, scores from skills-based activities deemed essential to professional practice and repeated 4 or more times in the course were analyzed. There was a significant improvement in scores on drug utilization reviews and patient counseling simulations despite the increasing difficulty and complexity of the medication problems presented (p <0.001). Students' scores on prescription verification and sterile product verification also improved significantly over 3 assessments (p <0.001), but then plateaued, with less improvement seen in performance on subsequent assessments. CONCLUSION: Providing multiple opportunities for students to conduct or simulate pharmacy practice activities and then test their knowledge and skills improves students' learning and performance.

An advanced pharmacy practice experience in community engagement.

OBJECTIVE: To implement a 5-week advanced pharmacy practice experience (APPE) in community engagement and assess the impact of the APPE on students' confidence and ability to provide community-based services. DESIGN: Working with community partners, students provided medication reconciliation, attended interprofessional healthcare meetings, developed health-promotion activities, and conducted medication-therapy reviews. ASSESSMENT: Responses to pre- and post-APPE 10-item surveys, preceptor and practice-experience evaluations, and the documented number of pharmacy student recommendations were determined. CONCLUSION: This APPE provides students opportunities in nontraditional community settings to increase their confidence and enhance their skills in health-promotion activities, medication-therapy management, and interprofessional care of patients, all of which are essential to the practice of pharmacy.

Medication therapy management training using case studies and the MirixaPro platform.

OBJECTIVE: To implement and assess a medication therapy management (MTM) training program for pharmacy students using the MirixaPro (Mirixa Corporation, Reston, VA) platform and case studies. DESIGN: Students received lectures introducing MTM and were given a demonstration of the MirixaPro platform. They were divided into teams and assigned cases and times to interview patients portrayed by faculty members. Using the MirixaPro system, students performed 2 comprehensive medication reviews during the semester, recording the patient's current medications, indications, side effects, allergies, health conditions, and laboratory test recommendations and developed a personal medication record and medication action plan. ASSESSMENT: Based on a rubric with a rating scale of 0-10, campus and distance pathway students received mean scores ranging from 6.3-7.4 for their performance on the second MTM exercise, an increase of 47%-54% over the first MTM exercise. In qualitative assessments, the majority of students believed that their confidence in providing MTM was enhanced by the activity, while faculty members recognized the advantage of using MirixaPro, which allowed students to experience what is required in processing a pharmacist led, billable MTM encounter. CONCLUSIONS: Use of the MirixaPro system and patient cases provides students with a "hands-on" experience that may encourage them to promote MTM during their APPEs and provide MTM services as practicing pharmacists.

A health education program for underserved community youth led by health professions students.

OBJECTIVES: To develop and implement a health fair and educational sessions for elementary school children led by health professions students. DESIGN: The structure and process were developed with elementary school administration to determine the health topics to be covered. Students and faculty members created a "hands-on," youth-oriented health fair and interactive health educational sessions. Quantitative and qualitative data were collected on learning outcomes from the underserved child population and health professions students. ASSESSMENT: The health fair and educational sessions increased awareness of underserved youth in the areas of critical health behaviors, purposeful education on health issues facing their community, and exposure to careers in various health professions. The activities provided meaningful learning experiences for the health professions students. CONCLUSION: The health education program model is an excellent way to teach health education, communication and critical thinking skills, and service learning to health professions students.