An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients.

Introduction: Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, we developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction. Methods: The SP case highlighted a patient on opioids for chronic low back pain resulting from a car accident. Despite no improvement in pain or function, the patient continued taking opioids and developed behaviors that could represent opioid misuse. During the synchronous, online session, interprofessional teams of students interviewed an SP and collaborated to develop a holistic care plan to address the patient's pain and potential opioid misuse. The session evaluation included pre- and postsession surveys. Results: Over 750 students from medicine, pharmacy, nursing, and social work programs participated in the virtual IPE sessions during a single year. Students rated the session positively. Matched survey responses suggested improved confidence in knowledge and skills, and learning through Zoom was rated favorably. Discussion: We successfully implemented a synchronous online IPE session involving SP interactions that allowed students to practice team-based care of a patient with chronic pain who was taking opioids. Based on the success of this IPE session, including the success of the online delivery model, future IPE sessions will continue virtually.

Interprofessional education on opioid use and pain identifies team-based learning needs.

BACKGROUND: An interprofessional education (IPE) activity was designed for health professional students in pharmacy, medicine, nursing, social work, and addiction studies. The goals were to practice team-based collaboration for patients who are prescribed opioids for chronic pain and to evaluate student responses to the activity. INTERPROFESSIONAL EDUCATION ACTIVITY: Student teams were guided through an unfolding patient case that included evaluating the patient's history, screening tool results, morphine equivalent dose, prescription monitoring program report, and videos of a patient-provider interaction. The two-hour, in-person IPE activity culminated in creation of a patient-centered treatment plan. Surveys were administered to compare pre- and post-course opioid knowledge and post-course IPE attitudes among the healthcare professions. DISCUSSION: Pharmacy students' baseline opioid knowledge scores were similar to nursing students, significantly lower than medical students, and significantly higher than social work students. Pharmacy students reported significantly higher gains in opioid knowledge than medical students. Nursing and social work students showed significantly higher levels of agreement that the course enhanced attitudes toward interprofessional collaboration compared to medicine and pharmacy students. Students most frequently noted working with other professions as the most valuable aspect of the IPE activity. IMPLICATIONS: Training gaps can be met using novel IPE activities specific to chronic pain and opioid use. Depending on profession, students demonstrated varied baseline knowledge regarding opioid use for chronic pain. Comparing knowledge gains and attitudes on IPE collaboration among professions can detect areas for program refinement to address each professions' unique needs.

Study Behaviors Associated with Student Pharmacists' Academic Success in an Active Classroom Pharmacy Curriculum.

Objective. To identify the specific study behaviors that promoted student pharmacists' success in an active-learning pharmacy curriculum. Methods. The Washington State University College of Pharmacy and Pharmaceutical Sciences implemented an active-learning, flipped classroom model for instruction to equitably deliver course content to Doctor of Pharmacy students on both its main and extended campuses. Students' ability to adapt to the new model and its impact on their study behaviors were unknown. A qualitative descriptive design that included semi-structured interviews was applied to evaluate the study behaviors of high-performing students. The study sample included 13 third and fourth professional year pharmacy students in the top 20% of their respective classes. Results. Interview responses were unaffected by baseline demographics such as gender and year of graduation. Content analysis generated five primary themes related to the behavioral strategies used by high performers: preparing for class, preparing for testing, seeking help, knowing yourself, and building on strengths. These were mapped to the four tenants of Wenger's social learning theory in the representation of findings: learning as doing, learning as belonging, learning as becoming, and learning as experience. Conclusion. High-performing students demonstrated a refined ability to select and modify study behaviors that aided in their academic success, demonstrating a high degree of metacognition. The results of this research may assist pharmacy faculty members in identifying critical elements for success of students enrolled in pharmacy programs using an active learning model.

Striving for interrater reliability with a patient counseling assessment rubric: Lessons learned.

BACKGROUND: Providing effective patient counseling is an essential pharmacist skill to ensure patients understand how to take medications, prevent medication-related errors, and meet requirements of federal law. This study sought to develop a new patient counseling assessment rubric to minimize interrater variability, deliver a consistent summative competency assessment, and provide students with formative, actionable feedback. IMPACT: A first attempt to achieve statistically significant interrater reliability was not successful due to incorporation of too many variables into study design and the subjective nature of patient counseling. After reducing study variables (number of different medications, number of evaluators, and number of videos) and consulting a statistician, a second attempt was made to analyze interrater reliability for the rubric. However, even with variables minimized, this attempt did not lead to statistically significant agreement. RECOMMENDATIONS: The faculty team identified four recommendations (Omnibus Budget Reconciliation Act of 1990): conduct a norming session for graders prior to the assessment (Rantucci, 2006), conduct a post-hoc analysis after grading to reduce interrater variability and increase consistency (Taitel et al., 2012), simplify the rubric to reduce subjectivity and clarify the intent of rubric elements, and (Saranagam et al., 2013) rubrics can be utilized differently in separate courses to target specific learning objectives. DISCUSSION: Although the goal of creating a rubric with statistically significant interrater reliability was not achieved, we did learn important lessons about evaluating student pharmacist performance with less subjectivity and more consistency. The authors hope the results and lessons learned will be valuable to our colleagues at other institutions as patient counseling content and rubrics are developed.

A student initiative to implement peer-led study groups for a pharmacogenomics course: Evaluation of student performance and perceptions.

INTRODUCTION: To better elucidate the impact of cooperative learning outside the classroom, a student-initiated research project was conducted to explore the effects of participating in peer-led study groups (PLSGs) on student examination scores and perceptions. METHODS: First-year pharmacy students were given the opportunity to participate in weekly PLSGs for a pharmacogenomics course during spring 2016 and spring 2017. Student exam performance was stratified by those who attended vs. those who did not. Optional pre- and post-course surveys examined student perceptions of PLSGs. RESULTS: No significant differences were seen between the attendance groups in spring 2016. In spring 2017, student attendees were significantly more likely to pass two of their six exams (p = .04, p = .0029) and to have higher exam scores on one exam (p = .02) in comparison to non-attendees. Overall exam score averages were significantly different between attendees and non-attendees during spring 2017 (p = .03) but not during spring 2016 (p = .38). Perception surveys indicated students believed participation helped them to demonstrate competency and build confidence. Additionally, students reported they felt more comfortable clarifying questions during the study groups vs. during class time. CONCLUSIONS: The impact of study group participation on student exam performance was minimal over the two years of data collection, but there were instances where exam scores were positively impacted. Students perceived value in study group participation even if it did not translate directly to improved exam performance on all exams.

A Study of the Relationship Between the PCOA and NAPLEX Using a Multi-institutional Sample.

Objective. To examine the relationship between the Pharmacy Curriculum Outcomes Assessment (PCOA) and the North American Pharmacist Licensure Examination (NAPLEX) using a large, multi-institutional sample of student scores. Methods. A matched dataset was obtained from the National Association of Boards of Pharmacy (NABP) consisting of examination scores for the 1,460 students who completed both the PCOA and the NAPLEX between 2012 and 2015 at six schools/colleges of pharmacy (S/COPs). Bivariate correlations were estimated for total and content area scores on both examinations. Students' total NAPLEX scores were predicted using linear regression models containing total and content area scores on PCOA and dummy variables for S/COP and year. Results. Students' PCOA total score and NAPLEX total score were significantly and moderately correlated (r=0.54). All correlations between PCOA and NAPLEX total and content area scores were significant. and ranged from r=0.22 to 0.56. Regression results showed pharmaceutical and clinical sciences PCOA content scores were significant predictors of NAPLEX total score while basic biomedical sciences and social/behavioral/administrative sciences were not. The PCOA total and content scores accounted for 30%-33% of the variance in total NAPLEX score. Conclusion. Student PCOA and NAPLEX total and content area scores were significantly correlated, which is consistent with the findings of previous research. The somewhat modest proportion of variance in NAPLEX scores accounted for by PCOA scores illustrates the need for use of additional performance measures when evaluating student preparedness for the NAPLEX. This study provides important baseline data that can be used by S/COPs for comparison with their own student data as well as by researchers seeking to conduct additional analyses following recent changes in the PCOA and NAPLEX blueprints.

Surveying the current landscape of assessment structures and resources in US schools and colleges of pharmacy.

INTRODUCTION: Expectations for assessment in higher education have increased in recent decades, prompting institutions to invest additional resources in this area. This study aimed to determine the resources, structure, and perception of assessment resources in United States schools and colleges of pharmacy (S/COPs). METHODS: Assessment personnel in S/COPs were surveyed electronically. Information collected included S/COP demographics, composition of assessment positions, experience and training of assessment personnel, and structure and responsibilities of committees engaged in assessment. Respondents' perception of their S/COPs having sufficient assessment personnel, recent changes in assessment, and the factors that prompted assessment changes were also surveyed. RESULTS: Respondents included individuals from 113 S/COPs (84% response rate). Most S/COPs had 1-2 assessment positions and 1-2 assessment-related committees. The most common assessment position titles were assistant/associate dean, director, coordinator/specialist, and administrative assistant. Dean-level administrators typically had worked in assessment the longest, whereas directors were more likely to have formal assessment training. Most respondents (75%) agreed they had sufficient assessment personnel to meet the 2007 Accreditation Council for Pharmacy Education Standards. Nearly two-thirds of respondents agreed they had sufficient personnel to meet the 2016 Standards and support their current assessment plan/process. Most S/COPs had a formal assessment committee (93%) and an average of two committees overseeing assessment. CONCLUSION: Most S/COPs reported having sufficient resources to support assessment activities. Although there were some consistent themes, there does not appear to be a single model for structuring assessment resources or committees. Effectiveness of various assessment structures represents an area for future research.

Factors associated with cultures of assessment at US schools and colleges of pharmacy.

INTRODUCTION: Pharmacy education has standards for assessment that must be met, prompting many programs to develop cultures of assessment. This study assesses the extent to which assessment personnel perceive that a culture of assessment has been established within their schools/colleges of pharmacy (S/COPs) and determines whether a relationship exists between assessment structure and the perceived strength of the culture of assessment. METHODS: An electronic survey was administered to assessment personnel at 134 S/COPs. Respondents were asked about changes within the past five years pertaining to assessment personnel/committees and factors prompting these changes. They were also asked to rate items related to support for institutional assessment (SIA scale) and faculty engagement with assessment (FEA scale). The reliability of each scale was estimated using Cronbach alpha and bivariate correlations were conducted to estimate the relationships among the two scales and other survey items. RESULTS: The S/COP response rate was 84% (113/134). Most (58%) noted the formation or re-structuring of the assessment office, with 26% creating one or more new assessment positions. The most common source of change was new accreditation standards (55%) followed by a new leadership position created in assessment (40%). Cronbach alpha for the SIA scale was 0.79 and 0.84 for the FEA scale. Program size was strongly negatively correlated with school age (rs = -0.58) and the FEA scale (r = -0.21). CONCLUSIONS: There was a strong relationship between SIA and FEA. Future studies are warranted to determine the interdependency of support for assessment and faculty engagement with assessment.

Design, Implementation, and Assessment Approaches Within a Pharmacogenomics Course.

Objective. To design and implement a pharmacogenomics course that focuses on analysis and integration of pharmacogenomic data into clinical practice and to explore how participation in the course influences student self-confidence. Design. The Basic and Clinical Pharmacogenomics course content was divided into three modules: genetic-based didactic sessions, genomic techniques and self-genotype/phenotype laboratory exercise, and clinical-based case studies. Student learning assessment included knowledge- and application-based tests and performance on a group project. Assessment. Effectiveness of the course was evaluated using results of student performance on coded test questions, student perceptions on pre- and post-course self-assessments, performance on a group project, and course evaluation results. Student pharmacists successfully demonstrated competency in pharmacogenomics knowledge-based learning, demonstrated their abilities to apply learned skills in clinical-based scenarios, and reported improved confidence in analyzing patient-based genomic testing results. Conclusions. This course appears to have contributed to student learning and positively influenced student self-confidence in pharmacogenomics.

The implementation of a naloxone rescue program in university students.

OBJECTIVE: Responding to the nationwide opioid overdose epidemic, Washington State University initiated a naloxone safety net project intending to increase awareness of opioid overdose, increase the availability of naloxone, and examine university students' perceptions regarding the usefulness of a novel, large-group audience-training model. SETTING: A Washington State University campus. PRACTICE DESCRIPTION: In September 2014, university students were recruited to attended a large-group audience training event which included opioid overdose prevention, recognition, and first response. All trained participants received an intranasal naloxone reversal kit. PRACTICE INNOVATION: Student pharmacists, who previously received naloxone rescue training and overdose education from the pharmacist lead researcher, acted as trainers. The training consisted of a large-group audience delivery with small-group practice sessions facilitated by the student pharmacists. EVALUATION: Participants who attended the recruitment event completed a pre-training survey to assess knowledge and perceptions about opioid use disorder and overdose. The following week, participants attended the training event. Participants were asked to complete a post-training survey to evaluate the usefulness of the program. RESULTS: Forty-three percent of the participants (65/150) who attended the recruitment event reported knowing someone who used prescription opioids to get "high." Seventy-four participants attended the training, and 92% of them (68/74) completed the post-training survey. The majority of respondents agreed that the training program met their expectations and the skills they learned could be used to intervene in an overdose situation. CONCLUSIONS: Before training, survey responses from recruited participates indicated the need to discuss opioid use disorder among university students is important. Use of a training model involving large-group audiences followed by small-group practice sessions offers an acceptable educational solution regarding opioid overdose and prevention. Our experience suggests using this training model to educate university students to recognize and provide first response is a feasible and acceptable approach.

High-Fidelity Simulation: Preparing Dental Hygiene Students for Managing Medical Emergencies.

Medical emergencies can occur at any time in the dental office, so being prepared to properly manage the situation can be the difference between life and death. The entire dental team must be properly trained regarding all aspects of emergency management in the dental clinic. The aim of this study was to evaluate a new educational approach using a high-fidelity simulator to prepare dental hygiene students for medical emergencies. This study utilized high-fidelity simulation (HFS) to evaluate the abilities of junior dental hygiene students at Eastern Washington University to handle a medical emergency in the dental hygiene clinic. Students were given a medical emergency scenario requiring them to assess the emergency and implement life-saving protocols in a simulated "real-life" situation using a high-fidelity manikin. Retrospective data were collected for four years from the classes of 2010 through 2013 (N=114). The results indicated that learning with simulation was effective in helping the students identify the medical emergency in a timely manner, implement emergency procedures correctly, locate and correctly utilize contents of the emergency kit, administer appropriate intervention/treatment for a specific patient, and provide the patient with appropriate follow-up instructions. For dental hygiene programs seeking to enhance their curricula in the area of medical emergencies, this study suggests that HFS is an effective tool to prepare students to appropriately handle medical emergencies. Faculty calibration is essential to standardize simulation.

Implementation and Use of the Pharmacy Curriculum Outcomes Assessment at US Schools of Pharmacy.

OBJECTIVE: To describe how schools and colleges of pharmacy use the Pharmacy Curriculum Outcomes Assessment (PCOA) in relation to student assessment and curricular feedback. METHODS: A survey was distributed to all programs that have implemented the PCOA. The survey was designed to assess 3 domains regarding the use of the PCOA: rationale for use, logistics of administration, and performance data review and distribution. RESULTS: A 79% response rate (41/52) was obtained. The mix of responses was 93% current PCOA users and 7% past users. The most common reasons for PCOA use were for programmatic assessment and benchmarking. The examination was most frequently administered during the P3 year, with minimal stakes attached to performance. Significant differences in responses based on public vs private institution were seen with respect to length of accreditation of current PCOA users, messaging to students regarding performance, inclusion of results in student advising, and distribution of results to stakeholders. CONCLUSION: Programs were using the PCOA primarily as an assessment in the P3 year for reasons related to programmatic and curricular assessment. Some differences existed between public and private institutional PCOA use and examination-related processes and results distribution.

A tool to assess student performance in a Clostridium difficile infection simulation scenario.

OBJECTIVE: To develop and validate an evaluation tool to assess student pharmacists' performance in a simulation scenario involving a patient with Clostridium difficile infection (CDI). METHODS: The authors used an expert panel review process to establish content validity of the tool. Four faculty members used the tool to evaluate student pharmacist groups during 2011 and tested a modified version of the tool in 2012. The authors analyzed the results for each year to determine internal consistency and inter-rater reliability. RESULTS: The 2011 tool demonstrated sound internal consistency, but several items had poor inter-rater agreement. The revised 2012 tool demonstrated acceptable internal consistency and good to excellent inter-rater agreement for all items except one. CONCLUSIONS: The tool facilitated reliable assessment of student pharmacists' clinical decision-making during simulation performance involving a patient with CDI.

Impact of participation on a solid organ transplant team on student pharmacists' perceptions of interprofessional roles.

OBJECTIVE: To examine student pharmacists' perceptions of interprofessional roles before and after completing an advanced pharmacy practice experience on solid organ transplantation. METHODS: Student pharmacists across the United States participating in an APPE on a solid organ transplant team completed an online pre- and post-APPE survey instrument examining perceptions of interprofessional roles, communication, and teamwork. RESULTS: Student pharmacists' scores on interprofessionalism increased significantly on 17 of 22 items. Positive changes were seen in the interprofessional education core competency areas of roles and responsibilities, interprofessional communication, and teams and teamwork. CONCLUSION: Student pharmacist participation in interprofessional clinical APPEs can positively influence their professional development as they prepare to become members of multi-disciplinary teams in the healthcare workforce.

Use of simulation-based teaching methodologies in US colleges and schools of pharmacy.

OBJECTIVES. To characterize the use of high-fidelity mannequins and standardized patients in US pharmacy colleges and schools. METHODS. A survey instrument was sent to 105 doctor of pharmacy (PharmD) programs to collect data on the use of simulation and to identify barriers to using simulation-based teaching methods. RESULTS. Eighty-eight colleges and schools completed the survey instrument (response rate 84%). Of these, 14 did not use high-fidelity mannequins or standardized patients within the curriculum. Top barriers were logistical constraints and high resource cost. Twenty-three colleges and schools used simulation for introductory pharmacy practice experiences (IPPEs), 34 for interprofessional education, and 68 for evaluation of at least 1 core competency prior to advanced pharmacy practice experiences (APPEs). CONCLUSIONS. Although the majority of US colleges and schools of pharmacy use simulation-based teaching methodologies to some extent in the pharmacy curricula, the role of simulation in IPPEs, interprofessional education, and assessment of competency-based skills could be expanded.

Association of antidepressant medication therapy with inpatient rehabilitation outcomes for stroke, traumatic brain injury, or traumatic spinal cord injury.

OBJECTIVE: To study whether outcomes in patients who have undergone inpatient rehabilitation for stroke, traumatic brain injury (TBI), or traumatic spinal cord injury (TSCI) differ based on antidepressant medication (ADM) use. DESIGN: Retrospective cohort study of 867 electronic medical records of patients receiving inpatient rehabilitation for stroke, TBI, or TSCI. Four cohorts were formed within each rehabilitation condition: patients with no history of ADM use and no indication of history of depression; patients with no history of ADM use but with a secondary diagnostic code for a depressive illness; patients with a history of ADM use prior to and during inpatient rehabilitation; and patients who began ADM therapy in inpatient rehabilitation. SETTING: Freestanding inpatient rehabilitation facility (IRF). PARTICIPANTS: Patients diagnosed with stroke (n=625), TBI (n=175), and TSCI (n=67). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM, rehabilitation length of stay (LOS), deviation between actual LOS and expected LOS, and functional gain per day. RESULTS: In each impairment condition, patients initiating ADM therapy in inpatient rehabilitation had longer LOS than patients in the same impairment condition on ADM at IRF admission, and had significantly longer LOS than patients with no history of ADM use and no diagnosis of depression (P<.05). LOS for patients initiating ADM therapy as inpatients even exceeded LOS for patients without ADM history, but who had a diagnosis for a depressive disorder. Deviation in LOS was significantly larger in the stroke and TBI groups initiating ADM in IRF than their counterparts with no history of ADM use, illustrating that the group initiating ADM therapy in rehabilitation significantly exceeded expected LOS. Increased LOS did not translate into functional gains, and in fact, functional gain per day was lower in the group initiating ADM therapy in IRF. CONCLUSIONS: Explanations for unexpectedly long LOS in patients initiating ADM in inpatient rehabilitation focus on the potential for ADM to inhibit therapy-driven remodeling of the nervous system when initiated close in time to nervous system injury, or the possibility that untreated sequelae (eg, depressive symptoms or fatigue) were limiting progress in therapy, which triggered ADM treatment.

Using human patient simulation to prepare student pharmacists to manage medical emergencies in an ambulatory setting.

OBJECTIVE: To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting. DESIGN: Second-year student pharmacists were assigned randomly to groups and played the role of pharmacists in a community pharmacy setting in which a simulated patient experienced 1 of 5 emergency scenarios: medication-related allergic reaction, acute asthma attack, hypoglycemia, myocardial infarction, and stroke. The students were expected to use patient assessment techniques to determine which emergency the simulated patient was experiencing and the appropriate intervention. Following each simulation, a debriefing session was conducted. ASSESSMENT: Eighty-two student pharmacists completed the simulation activity. Ninety-three percent of student groups correctly identified the emergency. A post-activity survey instrument was administered, and 83% of responders indicated this activity was effective or very effective. CONCLUSION: Simulation of emergencies seen in an ambulatory pharmacy setting allowed students to assert knowledge, practice communication skills, apply assessment techniques, and work as a team in a low-risk environment.

Assessment of human patient simulation-based learning.

The most common types of assessment of human patient simulation are satisfaction and/or confidence surveys or tests of knowledge acquisition. There is an urgent need to develop valid, reliable assessment instruments related to simulation-based learning. Assessment practices for simulation-based activities in the pharmacy curricula are highlighted, with a focus on human patient simulation. Examples of simulation-based assessment activities are reviewed according to type of assessment or domain being assessed. Assessment strategies are suggested for faculty members and programs that use simulation-based learning.

Call to action: Integrating student pharmacists, faculty, and pharmacy practitioners into emergency preparedness and response.

OBJECTIVES: To describe the pharmacist experience in emergency preparedness and response and to provide information and resources to help practitioners engage in this public health effort in their local communities. SETTING: Spokane, WA, health care community, 1998 through 2009. PRACTICE DESCRIPTION: The College of Pharmacy at Washington State University, Spokane, has developed partnerships with local public health and community providers to address emergency preparedness and response needs. Working through the Metropolitan Medical Response System has created opportunities to participate in emergency preparedness planning and exercises. Collaboration with local agencies has provided opportunities for faculty and student pharmacists to respond to meet emergency needs in the community. PRACTICE INNOVATION: Emergency preparedness and response education, training, and service implemented in partnership with public health and community providers prepared student pharmacists and experienced pharmacy practitioners to respond to emergency needs in our community. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Not applicable. CONCLUSION: Colleges and schools of pharmacy can take a lead in preparing student pharmacists for this role by incorporating emergency preparedness training into curricula. Community pharmacists can develop their knowledge and skills in emergency preparedness through individualized continuing education plans and integration into community teams through volunteerism. Partnerships developed with local public health and emergency response agencies provide opportunities for pharmacists to become integral members of planning and response teams. Training exercises provide opportunities to test preparedness plans and provide professional education and experience. Actual emergency response activities demonstrate the value of the pharmacist as an important member of the emergency response team.