How Preceptors Support Pharmacy Learner Professional Identity Formation.

OBJECTIVE: Pharmacy preceptors play a role in helping learners form professional identities during experiential education. However, it is not clear what specific roles and precepting strategies best foster professional identity formation (PIF). The objective of this study was to explore how preceptors support pharmacy learner PIF. METHODS: This qualitative study used an interpretative descriptive approach. Preceptors from 5 experiential education programs were recruited using purposive sampling for individual semistructured interviews. Interviews were recorded, transcribed, coded, and analyzed by thematic analysis. Team members used a reflective and iterative approach for data analysis and generation of themes. RESULTS: A total of 22 participants were interviewed from various pharmacy practice settings and precept a range of learners, including introductory pharmacy practice experiences, advanced pharmacy practice experiences, and residents. Four main themes were identified to support pharmacy leaner PIF: making learners part of the practice and team, preparing learners to assume the role of a pharmacist, helping learners navigate emotions during practice experiences, and supporting learners in finding the right fit within the profession. Specific precepting strategies associated with each theme were identified. CONCLUSION: Preceptors play an important role in supporting learners in thinking and acting as professionals while also helping navigate emotional experiences that may impact PIF and having conversations to help define learner's future aspirations of the pharmacist they want to become. Strategies identified can inform curricular approaches and preceptor development that intentionally supports PIF.

Could coping with your inner critic be the key to unlocking your scholarly writing?

INTRODUCTION: Though various barriers to productive writing habits exist in academia, scholarship is a critical part of faculty expectations. One barrier that has not been well addressed in the literature is the presence and interference of a negative inner critic, an internal voice or dialogue that criticizes work, halts creativity, and paralyzes writing. COMMENTARY: The purpose of this commentary is to describe the limited evidence-base and anecdotal strategies shown to support increased writing productivity by acknowledging and navigating the inner critic. With strategies such as proper identification, acknowledgment, strong mentor-mentee relationships, personifying the inner critic, embracing a growth mindset, and considering the distinct phases of writing, faculty can cope with their critical inner voice and reclaim control of their scholarly writing productivity. IMPLICATIONS: With such a heavy emphasis on writing productivity for faculty, faculty are encouraged to more formally explore and implement professional development strategies to help navigate their inner critic and bolster writing productivity.

Reflections on an evolving pharmacist professional identity from two pharmacy educators.

PURPOSE: The purpose of this article is to describe the Professional Identity Formation (PIF) journeys of two Experiential Education (EE) Directors in a reflective narrative. DESCRIPTION: Using the "What? So What? Now What?" model of reflection, this manuscript will describe the experiences of two EE administrators as they reflect upon the various pivotal moments of their career and professional transitions. ANALYSIS/INTERPRETATION: As pharmacy educators seek to be purposeful and intentional about guiding their students' journeys to form their own professional identities, they must first be willing to engage in their own self-reflection to explore their own journeys. Then, pharmacy educators will be better equipped to assist learners as their own professional identity is developed. CONCLUSIONS AND IMPLICATIONS: In this article, the authors have modeled candid self-reflection and have described their own PIF journeys to serve as a guide for other pharmacy educators seeking to do the same.

A preceptor development program using an interactive board game.

BACKGROUND AND PURPOSE: Colleges and schools of pharmacy and residency programs must be engaged in the purposeful development of their preceptors. Preceptor development needs vary widely from a new preceptor needing foundational preceptor skills to a more experienced preceptor who may wish to incorporate more sophisticated precepting methods such as layered learning or interprofessional precepting. It can be challenging to create preceptor development activities that meet these varied needs and keep preceptors of all levels engaged. EDUCATIONAL ACTIVITY AND SETTING: The Preceptor's Game of Life was developed to incorporate serious gaming into preceptor development to increase engagement and promote learning across all precepting levels. This game was designed to review precepting fundamentals and focused heavily on the application of these principles to authentic precepting scenarios. An element of friendly competition, collaboration, and storytelling created a safe and fun environment where participants could discuss solutions to scenario-based problems. FINDINGS: The Preceptor's Game of Life has been well received by state and national audiences. Audience members were engaged and invested as they discussed the scenarios presented. Individual, informal feedback following the session and formal session evaluations were positive. SUMMARY: Though the Preceptor's Game of Life required careful logistical planning, the outcome was positive. High levels of engagement amongst the participants were noted in the form of note taking and audience participation. Audience members appreciated activating their prior knowledge and experiences and applying that to future scenarios. This manuscript serves as a tool for others interested in novel preceptor development methods.

Interrogating Our Views on the Impact of Education-Related Scholarship.

From junior faculty members to seasoned full professors, pharmacy educators have likely all felt pressure to focus on peer-reviewed publication. Although publication is an important part of an academician's work, have we missed something critical by not focusing greater attention on a more inclusive conceptualization of education-related scholarship's impact? How can we describe the full impact of our education-related scholarship beyond traditional metrics (ie, publications, presentations, and grant funding) if the issue is not critically examined? With the growing expectations for scholarly teaching and interest in the Scholarship of Teaching and Learning in academic pharmacy in both the United States and Canada, this commentary examines and questions the current, often narrow, views on pharmacy educators' scholarly impact. In addition, it provides a new definition of education-related impact to encourage a more expansive view.

Promoting continuing professional development (CPD) through a novel CPD advanced pharmacy practice experience.

BACKGROUND AND PURPOSE: The Accreditation Council for Pharmacy Education Standards 2016 and the Entrustable Professional Activities highlight the importance of continuing professional development (CPD) in pharmacy education. Furthermore, pharmacy graduates must self-direct their learning to sustain professional knowledge, skills, and practice. An advanced pharmacy practice experience (APPE) dedicated to CPD can help meet standards of pharmacy education and prepare students for a career of lifelong learning. EDUCATIONAL ACTIVITY AND SETTING: An innovative CPD APPE centered on the CPD framework and student self-directed learning was developed and implemented by three colleges of pharmacy. Students enrolled in the new CPD APPE were introduced to the CPD framework, engaged in reflection, developed personalized learning objectives, and participated in self-directed learning activities to meet identified educational needs. FINDINGS: Student performance outcomes were assessed via written reflections, portfolio documentation, and attendance records. The novel CPD rotation showed positive findings regarding student-perceived satisfaction, achievement of learning outcomes, and foundational lifelong learning habits. As soon-to-be graduates and practicing pharmacists, final-year pharmacy students are well poised to learn and apply the CPD framework and develop the skills needed to become lifelong learners. SUMMARY: Experiences across three colleges of pharmacy demonstrated that a CPD APPE is feasible, valuable, and effective to integrate comprehensive CPD training within pharmacy education. Other programs within the academy may utilize this scalable model to prepare APPE students to engage in self-directed CPD and lifelong learning as health professionals.

Identifying Student Research Project Impact Using the Buxton and Hanney Payback Framework.

Objectives. To determine whether evidence of the impact of student quality improvement projects and research projects on practice sites and the community can be identified using the Buxton and Hanney Payback Framework (BHPF).Methods. The BHPF was used to identify the broader impact of quality improvement projects and research projects conducted by the Doctor of Pharmacy (PharmD) class of 2020. The BHPF includes five domains of community impact: knowledge production, benefits to health or the health sector, benefits to future research, economic benefits, and policy and product development. Data were collected by having project preceptors complete a questionnaire and by reviewing student project posters. Data were analyzed by calculating frequencies and percentages for each domain.Results. Projects (N=73) were completed by 107 pharmacy students at health-system sites, community sites, academic sites, and other sites, and most often involved clinical care and pharmacy services (49%). Thirty-three preceptors (55%) responded to the questionnaire, and 73 project posters were reviewed. The most frequently identified impact types were knowledge production (n=43 for questionnaire, n=24 for posters) and health/health sector benefits (n=46 for questionnaire, n=8 for posters). Less frequently identified were economic benefits (total n=19), benefits to future research (total n=13), and policy and product development (total n=10).Conclusions. This study provides evidence that the impact of PharmD student quality improvement and research projects on practice sites and communities can be identified using the BHPF framework, and this impact extends beyond the usual academic outcomes of poster presentations and publications to include benefits related to improving quality of services, improving workflow, and providing opportunity for personal development.

Student pharmacists' perceptions of their professional identity.

INTRODUCTION: Professional identity describes the internal feeling of belonging to a community, such that someone "thinks, feels, and acts" like a member of a profession. Clear professional identity formation can improve the transition from school to work. However, there is limited knowledge about student pharmacists' perceptions of their professional identity. This research aimed to identify and compare student pharmacists' perceptions of their professional identity and to compare those perceptions across class cohorts. METHODS: Data were collected using an online questionnaire that incorporated professional identity labels drawn from previous research. The questionnaire was administered over four weeks to all student pharmacists at one United States pharmacy school. Data were analyzed using chi-square tests. RESULTS: One hundred sixteen responses were received (24% response rate) from the four graduating class years (2020-2023). Respondents were predominantly female (73%), Caucasian (43%), and had obtained at least a bachelor's degree (58%). "Medicine Adviser" was the most frequently selected professional identity (38%). "Business Person" was the least frequently selected professional identity (0%). There was no relationship between professional identities and cohorts of students. CONCLUSIONS: Student pharmacists in this study selected multiple professional identities, suggesting pharmacy students and the profession have yet to consolidate their own identity. There was no relationship between student pharmacists' professional identity selections and cohort, suggesting that professional identity formation did not change as a result of moving through the didactic curriculum. Additional training, curricular modification, and faculty support may be warranted to support student pharmacists with their professional identity development.

Improving and validating a rating scale to assess student pharmacists' perception of professional identity.

BACKGROUND: There are limited data on the psychometric properties of instruments evaluating professional identity (PI) among student pharmacists. OBJECTIVES: This study analyzed the psychometric properties of an instrument to assess student pharmacists' perception of their PI. METHODS: Data from a cross-sectional survey were used to establish validity and reliability evidence of student pharmacists' perception of PI using Rasch analysis. Linear regression was conducted to evaluate the association of students' characteristics with their perceived PI. Analyses were conducted in WINSTEPS (SWREG, Minnetonka, MN) and SAS (SAS, Cary, NC). RESULTS: The analysis included 118 student pharmacists. Primary analysis suggested inadequate scale functionality; thus, some response categories were merged. With modified item anchors and the removal of the most misfitting item, the data fit the model as measured by student and item infit and outfit mean-squared values. The item-person map showed appropriate distribution of item difficulty, identifying medicine adviser and entrepreneur being the easiest and hardest items to agree with, respectively. Students' abilities initially mismatched with item difficulty and exhibited a ceiling effect, requiring addition of items reflecting students' higher perceptions of PIs. Although students' reliability coefficient (RC) and separation index were 0.98 and 1.73, respectively, RC of the items was 0.94. Students who reported receiving formal PI training were 0.3 times more likely to have high perception of PI than those who did not report training. CONCLUSION: The instrument exhibited fair validity and reliability evidence for assessing the perception of PI among student pharmacists. Additional items to fill identified item gaps are needed to improve the instrument's content validity.

A Tool for Creating Snapshots of Faculty Contributions to Pharmacy Education.

Most faculty members' contributions to pharmacy education are significant but often challenging to document and describe. In addition, contributions may go unrecognized or rewarded unless the work results in a publication or presentation. Drawing on a metaphor of the importance of a fisher taking a photo to capture memories of a successful fishing trip, this commentary examines methods for faculty to identify and organize their academic contributions. Frameworks and a visual tool are presented to assist pharmacy educators in thinking systematically about the full breadth of education contributions. Using the frameworks and visualization tool provided, a more complete picture of education contributions can be developed, allowing educators to create visual "snapshots" of their work for others to see and appreciate.

What does experiential education look like in a global pandemic? Reflecting back and looking forward.

PURPOSE: The purpose of this reflection or wisdom of experience article is to describe and reflect on the impacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on experiential education (EE) leadership and teams. Additionally, this reflection will shift the focus from the spring 2020 environment of SARS-CoV-2 to what EE teams and college administration can learn from those experiences. Moving forward, EE teams and administrators can be better equipped to proactively plan for future emergencies. DESCRIPTION: Using the "What? So What? Now What?" model of reflection, this manuscript will broadly describe the experiences of three EE administrators and their teams during the SARS-CoV-2 pandemic. Proposed lessons learned as well as future planning strategies will be presented. ANALYSIS/INTERPRETATION: The world of education was unprepared for the SARS-CoV-2 pandemic, and most sectors were left scrambling to adjust to new models very quickly with no planning or preparation. In the realm of pharmacy education, SARS-CoV-2 caused complete disruption for pharmacy students on rotations, clinical sites, preceptors, and EE teams. In reflecting on spring 2020, much can be gained and applied to future planning efforts so that institutions can be better prepared for future crises. CONCLUSIONS/IMPLICATIONS: While still in the pandemic, schools must plan for the coming year. EE teams can work together to prepare for emergencies, craft contingency plans, and build additional capacity into their teams and available rotation offerings.

Assessment of Interprofessional Collaborative Practices and Outcomes in Adults With Diabetes and Hypertension in Primary Care: A Systematic Review and Meta-analysis.

Importance: Interprofessional collaborative practice (ICP), the collaboration of health workers from different professional backgrounds with patients, families, caregivers, and communities, is central to optimal primary care. However, limited evidence exists regarding its association with patient outcomes. Objective: To examine the association of ICP with hemoglobin A1C (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels among adults receiving primary care. Data Sources: A literature search of English language journals (January 2013-2018; updated through March 2020) was conducted using MEDLINE; Embase; Ovid IPA; Cochrane Central Register of Controlled Trials: Issue 2 of 12, February 2018; NHS Economic Evaluation Database: Issue 2 of 4, April 2015; Clarivate Analytics WOS Science Citation Index Expanded (1990-2018); EBSCOhost CINAHL Plus With Full Text (1937-2018); Elsevier Scopus; FirstSearch OAIster; AHRQ PCMH Citations Collection; ClinicalTrials.gov; and HSRProj. Study Selection: Studies needed to evaluate the association of ICP (≥3 professions) with HbA1c, SBP, or DBP levels in adults with diabetes and/or hypertension receiving primary care. A dual review was performed for screening and selection. Data Extraction and Synthesis: This systematic review and meta-analysis followed the PRISMA guideline for data abstractions and Cochrane Collaboration recommendations for bias assessment. Two dual review teams conducted independent data extraction with consensus. Data were pooled using a random-effects model for meta-analyses and forest plots constructed to report standardized mean differences (SMDs). For high heterogeneity (I2), data were stratified by baseline level and by study design. Main Outcomes and Measures: The primary outcomes included HbA1c, SBP, and DBP levels as determined before data collection. Results: A total of 3543 titles or abstracts were screened; 170 abstracts or full texts were reviewed. Of 50 articles in the systematic review, 39 (15 randomized clinical trials [RCTs], 24 non-RCTs) were included in the meta-analyses of HbA1c (n = 34), SBP (n = 25), and DBP (n = 24). The sample size ranged from 40 to 20 524, and mean age ranged from 51 to 70 years, with 0% to 100% participants being male. Varied ICP features were reported. The SMD varied by baseline HbA1c, although all SMDs significantly favored ICP (HbA1c <8, SMD = -0.13; P < .001; HbA1c ≥8 to < 9, SMD = -0.24; P = .007; and HbA1c ≥9, SMD = -0.60; P < .001). The SMD for SBP and DBP were -0.31 (95% CI, -0.46 to -0.17); P < .001 and -0.28 (95% CI, -0.42 to -0.14); P < .001, respectively, with effect sizes not associated with baseline levels. Overall I2 was greater than 80% for all outcomes. Conclusions and Relevance: This systematic review and meta-analysis found that ICP was associated with reductions in HbA1c regardless of baseline levels as well as with reduced SBP and DBP. However, the greatest reductions were found with HbA1c levels of 9 or higher. The implementation of ICP in primary care may be associated with improvements in patient outcomes in diabetes and hypertension.

Expanding pharmacists' roles: Pharmacists' perspectives on barriers and facilitators to collaborative practice.

OBJECTIVE: The pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists' perspectives of CPAs, including barriers and facilitators to CPA implementation. METHODS: Semistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes. RESULTS: Seventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients' health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process. CONCLUSIONS: The pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.

Pharmacists' perceptions of the pharmacists' patient care process and performance in a simulated patient interaction.

OBJECTIVES: To (1) evaluate the use of the pharmacists' patient care process (PPCP) by licensed pharmacists through a simulated patient activity and (2) describe pharmacists' awareness and perceptions of the PPCP in the state of Arizona. DESIGN: Interviews were conducted to elicit pharmacists' perceptions and awareness of the PPCP. A simulated patient activity involved a role-play pharmacist-patient interaction in a community pharmacy setting. The PPCP was employed as the evaluative framework to assess pharmacist behavior. SETTING AND PARTICIPANTS: Pharmacists licensed in the state of Arizona practicing in various pharmacy settings were recruited through e-mail list serves and snowball recruitment. Data were collected in person, by telephone, and via video chat. OUTCOME MEASURES: Emergent qualitative themes from interviews were used to describe pharmacists' awareness and perceptions of the PPCP. The presence or absence of PPCP elements were assessed during the simulations. RESULTS: A total of 17 pharmacists were interviewed; 16 participated in the simulated activity. Of these, 7 (41.2%) participants recalled specific details regarding the PPCP process. Participants felt that the PPCP accurately reflected their daily workflow. Accordingly, a mean of 15.8 of the 19 PPCP elements was observed in simulated pharmacist-patient interactions, still allowing room for improvement in pharmacist-led care planning. Participants indicated perceived value in a shared patient care process that facilitates collaboration with myriad health professionals and as an aid to leverage pharmacists' role on health care teams. CONCLUSION: In this study, pharmacists practicing in Arizona in various settings expressed an awareness of the PPCP, felt it accurately reflected the work they do, and expressed that the tool potentially added value to their work.

Quality Improvement and Safety in US Pharmacy Schools.

Objective. To catalog the methods in which quality improvement (QI) and safety are taught in schools and colleges of pharmacy in the United States and showcase exemplar QI programs. Methods. This descriptive, multi-phase study included an online questionnaire, syllabi review, and phone interviews. The study was approved by the University of Arizona Institutional Review Board (IRB). One representative from each US pharmacy school accredited by the Accreditation Council for Pharmacy Education (ACPE) was invited to participate. Participants indicated the type of QI education their school provided via online questionnaire. Following questionnaire completion, syllabi were requested from the schools and phone interviews were scheduled with a school representative to obtain additional information. From the data, exemplars were chosen using a predetermined, evidenced-based rubric. Results. Of the 136 schools contacted, 56 (41.2%) completed the survey. Of the responding schools reporting their QI and safety offerings, 41 (73.2%) had a required session/module; 24 (42.9%) had a required course; 21 (37.5%) had an elective course; 21 (37.5%) had an introductory pharmacy practice experience (IPPE), advanced pharmacy practice experience (APPE), or internship; 17 (30.4%) had a required project; 17 (30.4%) had interprofessional education integrated into their course; 15 (26.8%) had an error laboratory; and 11 (19.6%) offered postgraduate training. Conclusion. Many of the responding US schools of pharmacy expose students to some aspect of QI and/or safety, most often via class session or module. The exemplar programs serve as examples of how QI can be further integrated into pharmacy curricula.

Implementation of an Interprofessional Medication Therapy Management Experience.

Objective. To measure the impact of an interprofessional experience (IPE) in medication therapy management (MTM) on students' attitudes and skills regarding interprofessional collaboration (IPC). Methods. This interprofessional MTM experience spanned three weeks, with health science students (medicine, nursing, nutrition, and pharmacy) meeting once weekly. The IPE facilitated interprofessional student collaboration via small-group sessions to conduct MTM consultations for patients with complex chronic conditions. Student learning and attitudinal changes were evaluated by comparing pre- and post-IPE survey responses and a qualitative summary of the students' clinical recommendations. Efficacy of student groups was measured via patient satisfaction surveys and was reported by frequency of response. Results. Twenty-seven students participated in the program and 22 completed both pre- and post-IPE surveys (81% response rate). The survey included open-ended and Likert-type items assessing students' attitudes and skills regarding the IPE as well as their reactions to the experience. Significant changes were observed for two attitudinal items regarding interprofessional teams: maintaining enthusiasm/interest and responsiveness to patients' emotional and financial needs. Patient-reported satisfaction and students' complex clinical recommendations provided further evidence of student learning. Conclusion. This novel IPE in MTM promoted interprofessional collaboration and education in this unique patient care area. Students' attitudes toward and skills in interprofessional collaboration improved, and the patients who received care reported positive experiences. Many health professions programs face challenges in meeting IPE requirements. The results of our study may provide the impetus for other institutions to develop similar programs to meet this urgent need.

A co-curricular diabetes-specific elective with interprofessional students and faculty.

BACKGROUND AND PURPOSE: Develop and assess the effectiveness of an interprofessional co-curricular elective in improving pharmacy students' confidence in providing diabetes self-management education and support (DSMES) to patients. EDUCATIONAL ACTIVITY AND SETTING: As part of an interprofessional collaboration, a student organized diabetes-specific enrichment elective, was offered originally to medical students and then extended to include pharmacy students. The interprofessional elective included an overview of diabetes and its prevention, medications, insulin therapy/administration, blood glucose monitoring, insulin pumps, nutrition and fitness. This elective served as a co-curricular activity, in that it was not offered for course credits, rather provided an opportunity to learn in an interprofessional environment with small group, unstructured interactions. The impact of the elective on pharmacy student confidence was evaluated using a retrospective pre-post survey. FINDINGS: A total of 16 pharmacy students participated (response rate of 63%). A Wilcoxon signed-rank test revealed an increase in students' confidence in most of the areas assessed. Eighty percent of respondents found the elective valuable. SUMMARY: An interprofessional co-curricular diabetes-specific elective significantly improved pharmacy students' confidence in providing DMSES to patients in the majority of assessed areas. Pharmacy and medical students were given the opportunity to learn alongside one another and learn from an interprofessional team of instructors in a setting that modeled such communication and collaboration. Developing such enrichment electives may be beneficial to equip students with the skills needed to provide education/support to patients with chronic diseases and interact with other health professionals effectively.

Identification of Key Business and Management Skills Needed for Pharmacy Graduates.

Objective. To identify key business, management, and human resources skills needed by pharmacy graduates. Methods. Pharmacy preceptors were recruited for inclusion in one of four focus groups. At each focus group, participants were asked to complete a demographic questionnaire and to identify key skills that new graduates need but do not have. Each focus group was audio-recorded, transcribed, de-identified, and categorized using a data dictionary. Results. Twenty-seven preceptors participated in the focus groups. Fourteen participants had a Doctor of Pharmacy degree. Participants were involved in management positions for a median of 10.5 years (range 5-21 years) and 50% (median) of their time was devoted to management responsibilities (range 20%-80%). Seven themes were identified as being most critical: communication, business skills, decision-making and time management, conflict resolution, leadership and professionalism, personnel management, and computer software techniques. Conclusion. Communication was the most prominent skill identified, followed by decision-making and business knowledge. These skills should be addressed in pharmacy curricula. Future research should focus on how to best teach these skills.