Exploring the Impact of a Vicarious Learning Approach on Student Pharmacists' Professional Identity Formation Using a Simulated Pharmacist-Patient Encounter.

Purposefully developed professional identity formation (PIF) learning activities within the didactic curriculum provide crucial groundwork to complement PIF within authentic settings. The aim of this didactic exercise was to explore the impact upon student pharmacists' PIF after viewing, analyzing, and reflecting upon a simulated pharmacist-patient encounter (PPE). A 12 min role-play video was created, featuring a pharmacist counseling a standardized patient on a new medication regimen; foundational principles of medication safety, health literacy, social determinants of health, empathic communication, and motivational interviewing were included in the counseling, with some aspects intentionally performed well, others in need of improvement. Also included were the patient's varied reactions to the counseling. Students assumed the observer role and learned vicariously through viewing the PPE. Postactivity debriefs included justifying a foundational principle performed well by the pharmacist, and another in need of improvement, and a self-reflection essay expressing the impact of viewing the PPE on their PIF, from which extracts were thematically analyzed for impact. The main themes of the impact included increased awareness of counseling techniques, patient-friendly medical jargon, patient perspectives/empathy, positive and negative pharmacist role-modeling, and the value of the observer role. This PPE exercise enhanced PIF in terms of students thinking, acting, and feeling like a pharmacist, based on students' self-reflections, which most often referenced effective pharmacist-patient communication and enacting optimal patient care.

Exploring the Impact of an Innovative Peer Role-Play Simulation to Cultivate Student Pharmacists' Motivational Interviewing Skills.

Effective patient-centered communication is a foundational skill for student pharmacists, with recent decades broadening the scope of professional responsibilities to include an increased emphasis on empathic communication and motivational interviewing (MI) as tools to support patients' therapeutic adherence. Role-play is a potentially effective pedagogical approach to cultivate these skills, although previous research has identified common shortcomings that can hinder its educational value, particularly in peer role-play with relatively inexperienced learners. The purpose of this study is to describe and provide initial assessment data for an innovative approach to peer role-play that incorporates pedagogical principles to address these common shortcomings. Using a mixed-methods study design that includes instructor-graded rubrics and inductive thematic analysis of student reflections, our findings indicate that students successfully demonstrated a range of important competencies through this experience and perceived it to be both challenging and highly beneficial for their personal and professional development. Among the MI principles and techniques practiced, students performed especially well on expressing empathy and frequently reflected on its importance for future patient care and clinical collaborations. Our findings also suggest that peer engagement through team activities and partnered role-play provides a felicitous context to explore empathic communication together.

Student Pharmacist Engagement in Infographic Creation to Increase Awareness of Impostor Phenomenon.

OBJECTIVE: To assess first professional year (P1) students learning about impostor phenomenon (IP) through participation in learning activities featuring the creation of an educational IP infographic. METHODS: A total of 167 P1 students were invited to complete a validated survey to determine baseline IP tendencies and attended a near-peer-delivered course lecture on IP. Student groups of 4 created an infographic containing IP lecture information and survey results, aimed at increasing IP awareness in a target audience. Mixed methods were integrated to assess learning outcomes. Qualitatively, infographics were evaluated by rubric for completeness, accuracy, and visual literacy, and student reflections were thematically evaluated on the impact of IP activities; quantitatively, 19 student learning objectives were anonymously self-assessed by Likert Scale survey. Students viewed all 42 created infographics, applied criteria, and voted for the 3 best. RESULTS: Survey results indicated 58% of P1 students exhibited IP tendencies above the scale's defined threshold for significant impostorism. Student groups demonstrated IP learning through developing creative, accurate, and concise infographics, with a mean score of 85% (4.27/5). Assessment survey respondents agreed they can confidently describe IP (92%) and design an infographic for a target audience using acquired knowledge (99%). Through critical reflections on the impact of IP exercises, students expressed improvement in self-awareness and communication skills; described the benefits of engagement in random peer groups; and voiced appreciation for a novel method of learning material (infographic creation). CONCLUSION: Students demonstrated learning about IP by incorporating lecture and survey results into engaging infographics and expressed benefits from learning about this important topic that is prevalent in P1 students.

"How do I say that?": Using communication principles to enhance medication therapy management instruction.

BACKGROUND AND PURPOSE: Medication therapy management (MTM) is a comprehensive, patient-centered approach to improving medication use, reducing the risk of adverse events and improving medication adherence. Given the service delivery model and required outputs of MTM services, communication skills are of utmost importance. The objectives of this study were to identify and describe communication principles and instructional practices to enhance MTM training. EDUCATIONAL ACTIVITY AND SETTING: Drawing on formative assessment data from interviews of both pharmacy educators and alumni, this article identifies and describes communication principles and instructional practices that pharmacy educators can use to enhance MTM training initiatives to develop student communication strategies. FINDINGS: Analysis revealed five key communication challenges of MTM service delivery, two communication principles that pharmacy teachers and learners can use to address those challenges, and a range of specific strategies, derived from communication principles, that students can use when challenges emerge. Implications of the analysis for pharmacy educators and researchers are described. SUMMARY: Proactive communication training provided during MTM advanced pharmacy practice experiences enabled students to apply the principles and instructional strategies to specific patient interactions during the advanced pharmacy practice experiences and in their post-graduation practice settings.

"How dare you question what I use to treat this patient?": Student pharmacists' reflections on the challenges of communicating recommendations to physicians in interdisciplinary health care settings.

A growing number of pharmacists practice within interdisciplinary health care teams, leading pharmacy educators to place increased emphasis on the development of interprofessional collaboration skills. In the pharmacist-physician relationship, pharmacists' medication therapy recommendations (MTRs) are a recurrent and significant interprofessional activity, one that can be challenging for both seasoned and student pharmacists. Drawing on in-depth ethnographic interviews with pharmacy preceptors and advanced student pharmacists, we identify and describe an important distinction between pharmacist-initiated MTRs and physician-initiated MTRs as contexts for interprofessional collaboration. We describe and illustrate a range of social, professional, and communication challenges that students experience in each context, as well as some strategies they use to navigate these challenges. Using the theoretical framework of dialectic tensions, we argue that the pharmacist-physician relationship is characterized by a tension between assertiveness and deference. We also offer recommendations to pharmacy preceptors, who can use this article to enhance the experiential education of pharmacists.

When patients portray their conduct as normal and healthy: an interactional challenge for thorough substance use history taking.

Researchers and medical practitioners have argued that routine substance use histories are performed less frequently and less thoroughly than they should be. Previous research has identified a range of structural, attitudinal, and socio-cultural barriers that help to explain this pattern. Using conversation analytic (CA) methods, this paper complements previous work by exploring a potential interactional barrier to thorough substance use history taking in the USA. In response to routine substance use queries (e.g. "Do you drink alcohol?"), patients often do more than just providing information. They also convey normative stances toward their conduct, essentially making a case for how it should be understood by the physician. One stance that patients may take is that their conduct is normal and healthy. This paper describes three interactional practices that patients used to enact such a stance: 1) employing marked lexical, intonational, or interactional features when indicating no use of a substance; 2) volunteering normalizing details about the type, quantity, frequency, or circumstances of substance use; 3) providing minimizing characterizations of substance use. The paper explores some reasons why physicians treated these as appropriate and sufficient responses and did not seek additional details even when the information provided was quite superficial. Two social functions of patients' "normal/healthy" stances are discussed: 1) redirecting the physician's history taking to other topics and 2) presenting oneself as a health-conscious patient. "Normal/healthy" stances can represent an expression of patient agency, but can also present a dilemma for physicians, who must balance a concern for thoroughness with a concern for rapport. Recommendations for navigating this dilemma are discussed.

Pre-emptive resistance: patients' participation in diagnostic sense-making activities.

In medical clinic visits, patients do more than convey information about their symptoms and problems so doctors can diagnose and treat them. Patients may also show how they have made sense of their health problems and may press doctors to interpret their problems in certain ways. Using conversation analysis, we analyse a practice patients use early in the medical visit to show that relatively benign or commonplace interpretations of their symptoms are implausible. In this practice, which we term pre-emptive resistance, patients raise candidate explanations for their symptoms and then report circumstances that undermine these explanations. By raising candidate explanations on their own and providing evidence against them, patients call for doctors to restrict the range of diagnostic hypotheses they might otherwise consider. However, the practice does not compel doctors to transparently indicate whether they will do so. Patients also display their ability to recognise and weigh the evidence for common, easily remedied causes of their symptoms. By presenting evidence against them, they show doctors the relevance of more serious diagnostic interpretations without pressing for them outright.

A qualitative analysis of a significant barrier to organ and tissue donation: receiving less-than-optimal medical care.

A key reason for the shortage of transplantable organs and tissue in the United States is the degree of resistance among the public to donating organs and tissue after death. In this article, we explore a single barrier to donation: the concern that medical personnel might provide "less-than-optimal" care to intended donors. Using 2 qualitative methodologies-analysis of family discussions about donation and analysis of in-depth interviews about donation-we explore what participants' discourse reveals about the variations and texture of this concern. The analysis revealed 4 aspects of this concern: (a) Participants expressed different versions of less-than-optimal care, each reflecting different assumptions about how medical personnel may approach the treatment of potential donors. (b) Participants expressed their concerns by describing hypothetical scenarios of medical treatment. These scenarios were designed to play up the plausibility of receiving less-than-optimal care and situated the speaker as the victim in the scenario. (c) Participants' uncertainty about the quality of medical treatment was sufficient grounds for not donating. (d) Participants expressed their concerns about medical treatment in terms of the perceived corruptibility of sociocultural institutions, including medical institutions. This analysis also revealed the lines of reasoning through which participants overcame a concern about receiving less-than-optimal-care. In our view, the most promising line of reasoning expressed by participants was to trust the legal and procedural protections built into the recovery process.