A call to uncover the availability, structure, and effects of parental leave policies at academic pharmacy institutions.

Parental leave is often an initial barrier to achieving family-career integration, and thus discussing this issue within the broader academic pharmacy community may have important implications for policy development and change. This commentary aims to reveal the implications of inadequate parental leave policies on faculty while highlighting the benefits well-developed policies can have for both parents and their children. Additionally, we put forth a call to action for additional research into the availability and structure of parental leave policies at pharmacy institutions and the effects such policies have on faculty wellbeing, retention, and job satisfaction.

A Multicenter Study Assessing Burnout and Work Engagement in Student Pharmacists and Faculty Members.

OBJECTIVE: The objective of this study was to characterize work engagement and burnout as well as potential demographic factors associated with each student and faculty member at 2 pharmacy programs in the US. METHODS: A survey including the Utrecht Work Engagement Scale-9 (UWES-9) and a single-item burnout measure was conducted from April to May 2020. Demographic data including age range, gender, and other characteristics were also collected. Mean UWES-9 scores, scoring category results, and the proportion of the cohorts reporting symptoms of burnout were reported. Point biserial correlation was used to compare the relationship between UWES-9 mean scores and burnout rates. Regression analyses were also performed to assess variables predictive of work engagement and burnout. RESULTS: Students (N = 174) reported a mean UWES-9 score of 3.0 (SD = 1.1), while faculty members (N = 35) reported a mean of 4.5 (SD = 0.7). Over half (58.6%) of the students and 40% of faculty members reported symptoms of burnout. Faculty members demonstrated a strong significant negative correlation between work engagement and burnout (r = -0.35), while students did not (r = 0.04). Regression analyses found no significant demographic factors predictive of UWES-9 scores in students or faculty, while first year students were less likely to report burnout symptoms, and no significant factors for burnout were found in faculty. CONCLUSION: Our study found that work engagement scores and burnout symptoms were inversely correlated in pharmacy faculty members surveyed but lacked correlation in students. Larger, more robust studies should be conducted to further elucidate the relationship between work engagement and burnout.

Empowering Students Who Are Breastfeeding a Child While Enrolled in Pharmacy School.

Pharmacy students wishing to maintain their breastfeeding relationship with their child while also excelling within a Doctor of Pharmacy program require important resources and a culture of support. This Commentary examines the challenges that pharmacy students who are breastfeeding face, highlights the importance of pharmacy schools and colleges providing breastfeeding and lactation support, and identifies best practices for implementing support measures for these students. We aim to guide institutions in not only supporting breastfeeding students but empowering them to excel personally, professionally, and academically.

Assessment of Impostor Phenomenon in Student Pharmacists and Faculty at Two Doctor of Pharmacy Programs.

Objective. To evaluate the prevalence of impostor phenomenon in student pharmacists and faculty members at two educational institutions in the United States.Methods. Participants anonymously completed an electronic self-report survey instrument that included the validated Clance Impostor Phenomenon Scale (CIPS) from April 2020 to May 2020. Demographic data including age range, gender, and other characteristics were collected. The Clance Impostor Phenomenon Scale scores were reported as means (SDs), and data were compared between institutions and demographic groups using t tests.Results. The overall mean CIPS survey score (N=209, 35.5% response rate) was 63.8 (SD=15.1). The mean student pharmacist CIPS score for Northeast Ohio Medical University (NEOMED) was 64.7 (SD=14.4) vs 63.8 (SD=16.1) for Sullivan University College of Pharmacy and Health Sciences (SUCOPHS), which was statistically similar. Mean faculty CIPS score for NEOMED was 59.2 (SD=14.0) vs 64.7 (SD=16.8) for SUCOPHS, which was statistically similar. Mean CIPS score for the combined student pharmacist group (NEOMED and SUCOPHS) was 64.3 (SD=15.1) vs 61.2 (SD=15.1) for the combined group of faculty members, which was statistically similar. Overall, most respondents fell in the "moderate" to "frequent" CIPS score classification range (36.4% and 44%, respectively).Conclusion. Impostor phenomenon feelings were common among responding student pharmacists and faculty members at the institutions surveyed; however, little is known about the implications of these findings. Future research should seek to elucidate factors predictive of or associated with impostor phenomenon as well as assess the impact of strategies to prevent or manage impostor phenomenon.

A Call to Action for Lactation Support at Colleges of Pharmacy.

Faculty well-being has been promoted and emphasized in recent years, and the Academy has been implored to develop and implement strategies to minimize stress and burnout among its members. Among those at highest risk of succumbing to burnout are female faculty, particularly those with young children. Numerous work-life issues predispose this cohort to stressors. One specific change that could address the needs of this group is providing lactation support in the workplace. Responding to the broader directive to promote faculty well-being, the aim of this commentary is to stimulate conversation regarding providing lactation support at colleges of pharmacy. Establishing such services has the potential to improve the personal and professional well-being of female faculty who are breastfeeding while also creating a more inclusive and supportive workplace. This article discusses the benefits of breastfeeding; highlights the personal, professional, and institutional ramifications of breastfeeding discrimination; and summarizes best practices related to implementing lactation support services.

Overcoming Past Perceptions and a Profession-Wide Identity Crisis to Reflect Pharmacy's Future.

The profession of pharmacy has come to encompass myriad identities, including apothecary, dispenser, merchandiser, expert advisor, and health care provider. While these identities have changed over time, the responsibilities and scope of practice have not evolved to keep up with the goals of the profession and the level of education of practicing pharmacists in the United States. By assuming that the roles of the aforementioned identities involve both product-centric and patient-centric responsibilities, our true professional identity is unclear, which can be linked to the prevalence of the impostor phenomenon within the profession. For pharmacy to truly move forward, a unified definition for the profession is needed by either letting go of past identities or separating these identities from each other by altering standards within professional degree programs and practice models. Without substantial changes to the way we approach this challenge as a profession, the problems described will only persist and deepen.

Effect of Average Blood Glucose Greater Than 140 mg/dL on Adverse Patient Outcomes in Adult Medical/Surgical Patients.

BACKGROUND: In hospitalized patients, hyperglycemia is defined as blood glucose greater than 140 mg/dL. Hyperglycemia can lead to the development of nosocomial infections as well as cardiovascular events. Despite these risks, current guidelines recommend blood glucose be maintained between 140-180 mg/dL. Previous studies have shown that elevated blood glucose levels are associated with increased patient mortality. However, these studies assessed blood glucose at a single point in time. OBJECTIVE: The primary objective of this study is to determine the impact of average blood glucose >140 mg/dL on a composite outcome of intensive care unit transfer, death, length of stay > 4 days, development of nosocomial infection, or new cardiovascular event (myocardial infarction [MI], ischemic stroke, deep vein thrombosis [DVT], pulmonary embolism [PE], or new onset heart failure) occurring during patient admission. METHODS: This single centered, randomized, case-control, retrospective chart review sorted adult medical/surgical patients into two groups, average blood glucose ≤140 mg/dL or >140 mg/dL, of 120 patients each. RESULTS: Forty-seven (39.2%) patients in the >140 mg/dL group experienced the primary composite outcome versus 27 (22.5%) patients in the ≤140 mg/dL group (p=0.005). Secondary outcomes found that patients with diabetes in the >140 mg/dL group were more likely to experience the primary outcome than those in the ≤140 mg/dL group (41 (48.8%) vs 3 (13.6%) p=0.003). CONCLUSIONS: This study found that medical/surgical patients with an average blood glucose >140 mg/dL may be at an increased risk of developing adverse patient outcomes.

Utilization of High-Intensity Statins in Patients at Risk for Cardiovascular Events: A National Cross-Sectional Study.

BACKGROUND: The 2013 American College of Cardiology/American Heart Association cholesterol guidelines, which identified four groups of patients at risk for atherosclerotic cardiovascular disease events, departed from the target-based approach to managing cholesterol. The impact of these guidelines on high-intensity statin use across the United States is unclear. STUDY QUESTION: The primary objective was to evaluate the rate of high-intensity potential (HIP) statin use before and after the 2013 guidelines. The secondary objective was to identify predictors of HIP statin use within the study population. STUDY DESIGN: A national cross-sectional study was conducted using data from the National Ambulatory Medical Care Survey. Office visits involving patients aged 21-75 years where criteria for HIP statin therapy were met were included. Visits involving pregnant patients were excluded. MEASURES AND OUTCOMES: Prescribing trends of HIP statins were measured from National Ambulatory Medical Care Survey data before and after the 2013 guidelines. Multivariate logistic regression identified variables associated with prescribing HIP statins. RESULTS: A total of 48,884 visits were included, representing more than 940 million office visits nationally. HIP statins were listed in 9.5% and 16.5% of visits before and after 2013, respectively (odds ratio [OR] 1.88; 95% confidence interval [CI] 1.62-2.20). The strongest predictors of HIP statin use were antihypertensive use (OR 5.38, 95% CI 4.67-6.20), comorbid hyperlipidemia (OR 2.93, 95% CI 2.62-3.29), Black race (OR 0.63, 95% CI 0.49-0.81), and Hispanic ethnicity (OR 0.65, 95% CI 0.52-0.80). CONCLUSIONS: Prescribing rates for HIP statins increased after the release of the 2013 guidelines. The prescribing rates were lower than expected, especially in Black and Hispanic patients. These observations signify opportunities to improve the quality of care for patients who are at risk for atherosclerotic cardiovascular disease events in the United States.

The Current Landscape of College-Sponsored Postgraduate Teaching and Learning Curriculum Programs.

Objective. To describe the landscape of teaching and learning curriculum (TLC) programs sponsored by US schools and colleges of pharmacy and evaluate their adoption of best practice recommendations. Methods. A 28-item electronic survey instrument was developed based on best practice recommendations published by the American Association of Colleges of Pharmacy (AACP), American Society of Health-System Pharmacists (ASHP), and American College of Clinical Pharmacy (ACCP) for the conduct of TLC programs. The survey instrument was electronically distributed to 137 accredited colleges and schools of pharmacy in the United States. Results. Eighty-eight institutions responded, resulting in a response rate of 64%. Sixty-one TLC programs were included in the final analysis. Seventy-five percent of TLC programs reported using best practice recommendations; however, 10% of respondents indicated they were not aware of the published recommendations. Inconsistencies among programs were noted in required teaching experiences, participant evaluation, and ongoing programmatic assessment. Conclusion. Most institutions offering TLC programs are aware of published best practice guidelines and have adopted a majority of the published best practices. However, considerable variability exists across the country. Development of a formal external validation process for TLC programs is necessary to ensure consistent quality.

Evaluation of student perceptions of introductory pharmacy practice experiences.

INTRODUCTION: Introductory pharmacy practice experiences (IPPEs) are focused on sharpening the student's knowledge, skills, abilities, and attitudes related to becoming an effective member of the healthcare team. Currently, the literature on student pharmacists' perceptions focused only on advanced pharmacy practice experiences (APPEs). This study gathered perceptions of IPPEs from pharmacy students in their first through third year professional years. METHODS: A voluntary pre- and post-survey instrument was administered to 367 first through third year professional students from Northeast Ohio Medical University (NEOMED) and Cedarville University at the beginning and end of the 2017-2018 academic year. Each survey utilized questions with Likert scales designed to detect differences in student expectations and experiences related to IPPE training. Questions primarily focused on demographics, objectives, goals, interprofessional teamwork, application of knowledge, and preceptor engagement. Students ages 18 and older who were enrolled at the participating institutions were eligible for inclusion in this study. Survey completion was voluntary, and students were not incentivized to participate. RESULTS: Sixty-six students completed the pre- and post- surveys with matching, identifiable data for analysis. Twenty-nine items demonstrated a more negative perception of IPPEs between the pre- and post-surveys (p < 0.05). Eight items demonstrated a difference by institution (p < 0.05), while three items demonstrated a difference between professional years (p < 0.05). CONCLUSIONS: Student expectations of IPPEs were significantly less positive in the pre-survey than in the post-survey. Future studies should examine the implications of these results on student IPPE performance and methods to impact student perception of the value of IPPE training.

Mineralocorticoid Receptor Antagonist Utilization in a Nationally Representative Heart Failure With Reduced Ejection Fraction Outpatient Population: A Cross-Sectional Study.

BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) improve survival among patients with heart failure with reduced ejection fraction (HFrEF); however, studies have identified low utilization rates. No study has evaluated the prevalence and predictors of MRA prescribing in a nationally representative outpatient cohort. STUDY QUESTION: What is the prevalence and predictors of MRA prescribing among outpatients with HFrEF in the United States? STUDY DESIGN: A national cross-sectional secondary analysis of the National Ambulatory Medical Care Survey from 2007 to 2014 including all office visits for HFrEF in patients aged >55 years. Office visits involving patients with any history of chronic renal failure and hyperkalemia were excluded. MEASURES AND OUTCOMES: The primary end point was the MRA prescribing rate. Multivariable logistic regression models were created to identify predictors of use. RESULTS: In total, 1259 visits were eligible for inclusion, representing more than 30 million visits when weighted. MRAs were initiated or continued in 11.1% of HFrEF visits (95% confidence interval [CI] 8.8-13.8). In the full model, predictors included diabetes mellitus (OR 2.27; 95% CI 1.12-4.61), Northeast region (OR 0.20; 95% CI 0.05-0.74), and ≥4 chronic conditions (OR 0.26; 95% CI 0.10-0.71). Among symptomatic patients, predictors included non-Hispanic black patients (OR 4.55; 95% CI 1.81-11.43), patients aged 65-74 years (OR 3.38; 95% CI 1.53-7.44), and office systolic blood pressure >130 mm Hg (OR 0.31; 95% CI 0.16-0.60). Physician specialty, visit year, patient sex, and payor type were not significant predictors of MRA utilization. CONCLUSIONS: Although significant data support the use of MRA in HFrEF, utilization is lower than previously estimated.

Assessment of a structured longitudinal professional identity development curriculum for pharmacy students.

BACKGROUND AND PURPOSE: To describe and assess a longitudinal Professional Identity Development (PID) curriculum at Northeast Ohio Medical Universities (NEOMED) College of Pharmacy. EDUCATIONAL ACTIVITY AND SETTING: Northeast Ohio Medical University, a four-year professional program, has assimilated its career development and advising program into the curriculum as a primary element of the Pharmacist Patient Care Experience (PPCE) course. The concept of PID focuses on student pharmacist career development. The goals for the PID module include guided self-assessment and goal-setting related to career choice with attention to work-life balance, community engagement and leadership. Students also work in small groups, called Professional Development Advising Teams (PDAT), led by a PDAT clinical advisor who is a practicing pharmacist. These meetings provide a forum to debrief self-assessment work and clinical experiences and make connections between the two. FINDINGS: A voluntary survey was administered to six classes of NEOMED alumni (2011-2016) to evaluate the longitudinal PID curriculum. Respondents found many aspects of the PID curriculum to be beneficial in the development of their professional identity and career planning journey. Most felt that PID sessions enabled them to effectively prepare for a career in pharmacy, with goal setting, Curriculum Vitae (CV) review, and career exploration most helpful in planning for their future careers. DISCUSSION: PID curricula are resource-intensive and require a firm commitment from administration and the faculty. Elements of the program can be adapted and utilized in a variety of different ways, making this model accessible to all pharmacy schools.

Toolkit for US colleges/schools of pharmacy to prepare learners for careers in academia.

INTRODUCTION: The objective of this article is to provide an academic toolkit for use by colleges/schools of pharmacy to prepare student pharmacists/residents for academic careers. METHODS: Through the American Association of Colleges of Pharmac (AACP) Section of Pharmacy Practice, the Student Resident Engagement Task Force (SRETF) collated teaching materials used by colleges/schools of pharmacy from a previously reported national survey. The SRETF developed a toolkit for student pharmacists/residents interested in academic pharmacy. RESULTS: Eighteen institutions provided materials; five provided materials describing didactic coursework; over fifteen provided materials for an academia-focused Advanced Pharmacy Practice Experiences (APPE), while one provided materials for an APPE teaching-research elective. SRETF members created a syllabus template and sample lesson plan by integrating submitted resources. Submissions still needed to complete the toolkit include examples of curricular tracks and certificate programs. DISCUSSION AND CONCLUSIONS: Pharmacy faculty vacancies still exist in pharmacy education. Engaging student pharmacists/residents about academia pillars of teaching, scholarship and service is critical for the future success of the academy.

Preparing students for residency interviews through a residency interview boot camp.

BACKGROUND AND PURPOSE: To describe the offering of the residency boot camp activity at one college of pharmacy for students in their fourth professional year. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists in their final professional year of pharmacy school were invited to participate in a voluntary residency boot camp activity. Originally, the activity consisted of four parts: (1) guidance on preparing for residency interviews; (2) a 1:1 mock interview with a resident, faculty member, residency preceptor or area program director; (3) a review of the student's curriculum vitae (CV) and letter of intent; and (4) a review of the application timeline and process. Based on the feedback, the activity was changed to include five parts: (1) orientation/welcome session, (2) mock interview, (3) case presentation, (4) podium presentation, and (5) a debriefing session on the day's activities and to answer any remaining student questions about the residency application process. In the second offering of the residency boot camp, students were invited to complete a voluntary pre- and post-assessment of their perceived readiness for residency interviews. The activity has evolved based on student feedback to focus predominately on the group and 1:1 interviews. FINDINGS: Since starting the activity in 2013, 14 of the 21 students (67%) from the class of 2014, 16 of the 25 students (64%) from the class of 2015 and 24 of the 26 students (92%) from the class of 2016 that applied for residency training participated in the residency boot camp activity. For the Fall 2014 offering where a survey was conducted, the pre- and post-survey instrument used a Likert Scale, ranging from "strongly disagree" (score of 1) to "strongly agree" (score of "5"). DISCUSSION: and conclusions: Simulated exercises such as a residency boot camp can expose student pharmacists to important interview readiness skills. Student pharmacists involved in this activity demonstrated a perceived positive effect of such activities.

Methods Used by Colleges and Schools of Pharmacy to Prepare Student Pharmacists for Careers in Academia.

Objective. To identify the methods used by US colleges and schools of pharmacy to prepare student pharmacists for academic careers. Method. An 18-item survey instrument was developed and distributed to US colleges and schools of pharmacy. Representatives were asked about faculty responsibilities, experiences in academia currently offered to student pharmacists, and representatives' perception of their student pharmacists' preparedness for careers in academia, including barriers in current programming. Results. Representatives from 96 colleges/schools responded. The vast majority (96%) provided academia-focused advanced pharmacy practice experiences (APPEs), 40% provided didactic coursework in academia, 28% offered a longitudinal research track, and 42% offered academia-focused independent studies. Teaching methods and creating learning objectives were the most common pedagogical content, while assessment activities were diverse. Time was the most prevalent barrier to providing training for academic careers; however, degree of student pharmacist interest, faculty inexperience, and lack of leadership support were also commonly reported. Conclusions: Colleges and schools of pharmacy vary in the extent to which they prepare student pharmacists for careers in academia. Advanced pharmacy practice experiences were the most common method of training offered. Standardization of training for academia may better promote this career path to student pharmacists.

Impact of Tranexamic Acid in Total Knee and Total Hip Replacement.

OBJECTIVE: To evaluate the net clinical benefit of tranexamic acid use in patients undergoing total knee or total hip replacement. METHODS: This is a retrospective study of patients undergoing total knee or total hip replacement. The primary outcome was the net clinical benefit of tranexamic acid use. Secondary outcomes included length of stay, incidence of venous thromboembolism, change in hemoglobin, and number of units of blood transfused. RESULTS: Four hundred and six patients were screened for inclusion and 327 patients met inclusion criteria; 174 patients received tranexamic acid versus 153 patients who received usual care. Tranexamic acid demonstrated a positive net clinical benefit versus usual care (40.8% vs 13.7%, P < .01) but did not affect length of stay (3.39 vs 3.37 days, respectively, P = .76). Venous thromboembolism was comparable between groups (2.3% vs 0.7%, P = .38). Average change in hemoglobin and need for transfusion were lower in the treatment group versus the usual care group, respectively (3.46 vs 4.26 mg/dL, P < .01). CONCLUSION: Tranexamic acid demonstrated a significant benefit in decreasing change in hemoglobin as well as the need for blood transfusion with no increase in the risk of venous thromboembolism in patients undergoing total knee or total hip replacement.