The Struggle is Real: Facilitating Pharmacy Student Success on Rotations When Challenges Arise.

Pharmacy preceptors are pivotal to facilitating and maximizing student learning on experiential rotations. However, preceptors may encounter a variety of behaviors or barriers that can hinder student success. Although some guidance exists for preceptors, emerging learner challenges along with new educational outcomes call for an updated practical approach to promoting student success on rotations. This paper provides preceptors with a structured approach to facilitate success for students who exhibit challenges on rotations. Four categories that preceptors can use to identify behaviors and barriers to learning are outlined - knowledge, skills, professional attitudes and behaviors, and external factors including the Social Determinants of Learning™. We describe strategies to help preceptors identify and categorize these challenges and provide a stepwise approach to facilitate student success.

Evaluation of an ambulatory care elective to improve practice readiness perceptions utilizing entry-level competencies.

BACKGROUND AND PURPOSE: The objectives of this study are to (1) describe the impact of an ambulatory care elective on students' future interests in ambulatory care careers and (2) evaluate students' perception of practice readiness using entry-level competencies. EDUCATIONAL ACTIVITY AND SETTING: This study employed a mixed methods approach to provide a comprehensive evaluation of a newly designed ambulatory care elective. A pre-post survey was developed to evaluate students' career plans and perceptions of practice readiness in an ambulatory care setting. The primary outcome analyzed the change in students' career plans and pre-post changes in self-perceptions using the institutional advanced pharmacy practice experience (APPE) ambulatory care rotation assessment and key skills from the American Society of Health-System Pharmacists entry-level readiness objectives. A qualitative analysis was also conducted to analyze open-ended response questions within the post-survey as well as the overall course reflections from the students. FINDINGS: There was no significant difference in career plans; however, students' perception of practice readiness for the ambulatory care setting significantly improved following the elective course. SUMMARY: This elective course improved students' perception of practice readiness for the ambulatory care setting. Future research is required to assess the impact of student performance in APPE and post-graduate pursuits.

Systemic-Sclerosis-Related Interstitial Lung Disease: A Review of the Literature and Recommended Approach for Clinical Pharmacists.

OBJECTIVE: To describe the efficacy, safety, and clinical utility of pharmacologic agents in the treatment of systemic sclerosis-related interstitial lung disease (SSc-ILD). DATA SOURCES: A review of the literature was performed using the terms lung diseases, (interstitial/therapy) AND (scleroderma, systemic/therapy) OR (scleroderma, systemic) AND (lung diseases, interstitial/therapy) in PubMed, Ovid MEDLINE, CINAHL, and Web of Science. ClinicalTrials.gov was also searched to identify ongoing studies. The initial search was performed in October 2022, with follow-up searches performed in October 2023. STUDY SELECTION AND DATA ABSTRACTION: Articles reviewed were limited to those written in the English language, human studies, and adult populations. DATA SYNTHESIS: A variety of therapeutic agents, including mycophenolate, azathioprine, cyclophosphamide (CYC), rituximab (RTX), nintedanib, and tocilizumab (TCZ) have slowed the rate of decline in forced vital capacity (FVC) and disease progression. Only nintedanib and TCZ have a labeled indication for SSc-ILD. Two agents, belimumab and pirfenidone, have shown encouraging results in smaller phase II and phase III studies, but have yet to be approved by the Food and Drug Administration. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Patients with pulmonary manifestations of SSc-ILD have worse outcomes and lower survival rates compared with those without. It is imperative that disease management be individualized to achieve optimal patient-centered care. Pharmacists are uniquely suited to support this individualized management. CONCLUSION: Numerous pharmacologic agents have been studied and repurposed in the treatment of SSc-ILD, with nintedanib and TCZ gaining approval to slow the rate of decline in pulmonary function in SSc-ILD. Other agents, including belimumab and pirfenidone, are on the horizon as potential treatment options; but further studies are needed to compare their efficacy and safety with the current standard of care.

Zavegepant Intranasal Spray for Migraines.

OBJECTIVE: The objective is to review the pharmacology, efficacy, and safety of intranasal zavegepant in the acute treatment of migraine with or without aura. DATA SOURCE: PubMed, Embase database, and ClinicalTrials.gov were searched using the following terms: Zavzpret, Zavegepant, BHV-3500, and migraine. STUDY SELECTION AND DATA EXTRACTION: Articles published in English from January 2013 to September 2023 related to pharmacology, safety, efficacy, and clinical trials were assessed. DATA SYNTHESIS: In a phase 2/3 trial, zavegepant 10 and 20 mg were more effective than placebo on primary endpoints of freedom of pain (22.5%, 23.1%, and 15.5%, respectively), and freedom from most bothersome symptoms (MBSs) (41.9%, 47.9%, and 33.7%, respectively) 2 hours after treatment. The incidence of adverse effects for both doses was similar to placebo. In a phase 3 trial, zavegepant 10 mg was compared with placebo. Two hours after treatment, more patients in the zavegepant group achieved pain freedom (24% vs 15%) and relief from MBSs (40% vs 31%) compared with placebo. Common adverse events included dysgeusia (21% zavegepant vs 5% placebo) and nasal discomfort (5% zavegepant vs 1% placebo). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS: Zavegepant is indicated for acute treatment of migraine with or without aura in adults. Zavegepant method of administration and prompt relief of migraine symptoms may be an attractive alternative to triptans for those in need of relief. CONCLUSION: Zavegepant may be a convenient and useful acute treatment option for migraines with and without aura.

Podcasts and videos and slides oh my!: Traditional vs. nontraditional teaching methods in remote settings.

INTRODUCTION: Nontraditional teaching methods are student-centered and motivate students to participate in class activities. Some studies have shown benefit in using various teaching activities; however, data are limited regarding students' perspective and performance after implementation of nontraditional learning strategies. The study compared student preference and performance assessment with traditional and nontraditional presentation methods. METHODS: This study included first-year pharmacy students enrolled in a course at a research-intensive, public university. Students in 2020 received traditional lectures while students in 2021 were presented three topics as nontraditional activities, including a podcast, an escape room, a video inspired by Khan Academy, and a traditional asynchronous lecture using slides with voice-over. First-year pharmacy students were surveyed in 2021 regarding their perspective on the nontraditional presentations. Students' performance was compared between 2020 and 2021. RESULTS: Ninety-eight students in 2020 and 89 students in 2021 were enrolled in the course. Sixty-seven students completed the 2021 survey. Most students (71.6%) preferred the traditional lecture; the Khan Academy and escape room activities were the least favored. Most students (86.5%) responded they learned "quite a bit" or a "tremendous amount" with the traditional lecture, and 59.7% of students felt they would perform better on assessments with the traditional lecture compared to nontraditional. Students in 2021 only performed better on all exam questions related to the nontraditional podcast activity. CONCLUSIONS: Students preferred traditional lectures and also seemed to perform better on assessment, with the exception of the nontraditional presentation podcast style. Further studies are needed to confirm these findings.

A scaffolded problem-based learning course for first-year pharmacy students.

BACKGROUND AND PURPOSE: There has been an increased use of active learning pedagogies in pharmacy curricula. Structured, complex pedagogies such as problem-based learning (PBL) may require rigorous training for students to be successful. We aim to describe the development and implementation of an introductory PBL course for first-year pharmacy students. We describe the theoretical framework for course development, including the educational philosophies informing the course design. Development of PBL skills and professional behavior were evaluated using student self-assessment throughout the course. EDUCATIONAL ACTIVITY AND SETTING: This introductory PBL course was developed using educational philosophies to scaffold student learning of the pedagogy and development of PBL skills. A student self-assessment was administered at two time points throughout the course. The self-assessment contained items related to PBL skills and professional behaviors. Self-assessment scores were compared with facilitator evaluations of student performance to determine reliability of self-assessment results. FINDINGS: Eighty-eight students completed both self-assessments (93.6% response rate). Self-assessment of PBL skills increased significantly. There was no improvement in self-assessed professional behaviors. Self-assessment scores did not correlate with facilitator assessment of student performance in a small group. SUMMARY: Integrating a scaffolded, theoretically sound educational approach to introduce students to the PBL pedagogy improves students' self-assessed PBL skills but not professional behavior.

Team-based Learning to Promote the Development of Metacognitive Awareness and Monitoring in Pharmacy Students.

Objective. To evaluate the metacognitive abilities of pharmacy students and determine whether introducing the concept along with team-based learning (TBL) enhances metacognition.Methods. Pharmacy students completed a Metacognitive Awareness Inventory (MAI) and a low-stakes pretest during the first class that evaluated students' knowledge about the therapeutic concepts that would be taught through TBL. The same questions were administered on the comprehensive final examination for the course. For each of the course assessments, students were asked to indicate their understanding of the topic and predict their performance. Actual performance was measured as a result of each assessment.Results. The pre-MAI composite score was 77.3%. Scores significantly improved by the end of the course to 84.6%. There were significant differences in both declarative knowledge and conditional knowledge when evaluating performance groups. Students in the middle performance group demonstrated the greatest ability to predict their performance on the final examination. Though these were not significant, students in the low group overestimated their performance, while students in the high group underestimated their performance. Baseline grade point average was the only factor predictive of the final examination score and the final course grade.Conclusion. Pedagogies such as TBL may support development of metacognitive skills in pharmacy students. However, intentional guidance provided by an instructor is required to improve pharmacy students' regulation of cognition skills.

Incorporating verbal defense into problem-based learning.

INTRODUCTION: The objective of this project was to evaluate the effect of adjusting the solution reporting phase of problem-based learning (PBL) while keeping core components of the pedagogy constant. METHODS: A PBL course for third year pharmacy students changed delivery of the problem solution from a written format to a verbal defense. Comparisons were made between the written format and verbal defense groups. The primary outcome was the change in the motivation domain of the Motivated Strategies for Learning Questionnaire (MSLQ). Secondary outcomes included evaluation of the learning strategies domain of the MSLQ, changes in MSLQ scores within each group, exam scores, and themes identified using focus groups. RESULTS: There was no difference in the change of motivation and learning domains between the groups. However, scores in both groups increased significantly from the beginning to the end of the semester for both motivation and learning. There was no difference in exam scores and facilitator confidence between groups. Themes from focus groups who used the written format were appreciation of PBL outcomes, discomfort with the pedagogy, and disconnect of assessments. Themes from the verbal format group were realism, increased confidence, and comments with course logistics. CONCLUSIONS: No difference in motivation and learning was observed between the groups, although both groups improved over the course of the semester. Changes to PBL approach within the confines of the pedagogy may not impact motivation and learning.

Ambulatory care practice in the COVID-19 era: Redesigning clinical services and experiential learning.

The coronavirus disease (COVID-19) has created a variety of challenges for health care professionals, including ambulatory care clinical pharmacists. High-quality remote and minimal-contact care has become a necessity. Ambulatory care clinical pharmacists around the nation have adjusted their practice. In many cases, this included implementation of telehealth programs for comprehensive medication management. The redesign of ambulatory care Advanced Pharmacy Practice Experiences (APPE) also required quick adaptation. In this paper, we describe the clinical practice and experiential education challenges encountered by an ambulatory care clinical pharmacist workgroup in a COVID-19 "hotspot," with an emphasis on solutions and guidance. We discuss how to adapt ambulatory care clinical pharmacy practices including methods of minimal-contact care, reimbursement opportunities, tracking outcomes, and restructuring ambulatory care APPE. As ambulatory care clinical pharmacists continue to expand the services they provide in response to COVID-19, we also describe opportunities to promote pharmacists as providers during times of pandemic and into the future.

Improving transitions of care for critically ill adult patients on pulmonary arterial hypertension medications.

PURPOSE: The purpose of this report is to describe the activities of critical care and ambulatory care pharmacists in a multidisciplinary transitions-of-care (TOC) service for critically ill patients with pulmonary arterial hypertension (PAH) receiving PAH medications. SUMMARY: Initiation of medications for treatment of PAH involves complex medication access steps. In the ambulatory care setting, multidisciplinary teams often have a process for completing these steps to ensure access to PAH medications. Patients with PAH are frequently admitted to an intensive care unit (ICU), and their home PAH medications are continued and/or new medications are initiated in the ICU setting. Inpatient multidisciplinary teams are often unfamiliar with the medication access steps unique to PAH medications. The coordination and completion of medication access steps in the inpatient setting is critical to ensure access to medications at discharge and prevent delays in care. A PAH-specific TOC bundle for patients prescribed a PAH medication who are admitted to the ICU was developed by a multidisciplinary team at an academic teaching hospital. The service involves a critical care pharmacist completing a PAH medication history, assessing for PAH medication access barriers, and referring patients to an ambulatory care pharmacist for postdischarge telephone follow-up. In collaboration with the PAH multidisciplinary team, a standardized workflow to be initiated by the critical care pharmacist was developed to streamline completion of PAH medication access steps. Within 3 days of hospital discharge, the ambulatory care pharmacist calls referred patients to ensure access to PAH medications, provide disease state and medication education, and request that the patient schedule a follow-up office visit to take place within 14 days of discharge. CONCLUSION: Collaboration by a PAH multidisciplinary team, critical care pharmacist, and ambulatory care pharmacist can improve TOC related to PAH medication access for patients with PAH. The PAH TOC bundle serves as a model that may be transferable to other health centers.

Pharmacist implementation of a transitions of care electronic referral process to provide hand-off between inpatient and outpatient settings.

OBJECTIVE: To describe the implementation of an electronic transitions of care referral process within a large, academic medical center. PRACTICE SETTING AND DESCRIPTION: To improve communication between the inpatient and ambulatory care pharmacists, the pharmacy department created an electronic referral (e-referral) order, which becomes part of the patient's electronic medical record. Data were collected to describe use of the electronic order and to discuss the role of the referrals in supporting a newly developed ambulatory care pharmacy service. PRACTICE INNOVATION: The e-referral was built to enhance the efficiency of direct patient care and prioritize patient care activities. This electronic order was built to collect specific details focused on medication-related concerns and provide hand-off to ambulatory care pharmacists for outpatient follow-up. EVALUATION: A retrospective, cohort analysis of patients was conducted from August 1, 2014, to July 31, 2015. Patients were included in the project if they were 18 years of age or older and received an e-referral order upon transition from the inpatient to the outpatient setting. Patients were excluded if the e-referral was sent from an outpatient setting or if they were younger than 18 years of age. Data were collected to describe the e-referral process and discuss how these referrals supported a new outpatient pulmonary clinic. RESULTS: A total of 268 inpatient referral orders were included for analysis. Common indications for the referrals included education (49%), follow-up from inpatient consult (46%), adherence (45%), and therapy optimization (42%). A total of 241 (90%) e-referrals were sent from an inpatient pharmacist to an ambulatory care pharmacist; the other 27 (10%) referrals were sent by a physician or mid-level provider. Of the 241 pharmacist referrals, 46 (19%) were placed by pharmacy residents. The majority of inpatient e-referrals (63.4%) were for chronic obstructive pulmonary disease and sent to the outpatient pulmonary clinical pharmacist for follow-up after discharge. The pulmonary clinic ambulatory care pharmacist completed 110 discharge calls (95.7%). CONCLUSION: An e-referral from inpatient to ambulatory care pharmacists provides pharmacist-to-pharmacist hand-off for medication-related needs after discharge.

Optimization of patient-specific inhaler regimens with the use of the aerosol inhalation monitor.

OBJECTIVES: To describe the addition of a Vitalograph Aerosol Inhalation Monitor (AIM) assessment to a pharmacy bundle to optimize inhaler devices in patients with asthma and chronic obstructive pulmonary disease (COPD). SETTING: Hospital-based outpatient pulmonary clinic. PRACTICE DESCRIPTION: Ambulatory pharmacy service for underserved pulmonary patients in Detroit, MI. PRACTICE INNOVATION: Patients with asthma and COPD received a pharmacy bundle service that included inhaler technique assessment with the use of the AIM. Based on the patient's performance, an optimized pulmonary regimen was developed for the patient in collaboration with the pulmonologists. Follow-up telephone calls were made 1 and 4 weeks after the visit. EVALUATION: A 1-group pretest-posttest quasiexperimental study was conducted over a 6-month period. The primary objective of the study was to describe the impact that a pharmacist had on optimizing individuals' inhaled regimens. In addition, clinical outcomes including changes in asthma control test (ACT) and COPD assessment test (CAT) scores, rescue inhaler use, and patient adherence were assessed. RESULTS: A total of 44 patients were included in the study, of which 27 (61%) were determined to be on an inappropriate inhaler regimen according to their AIM assessment. The pharmacist subsequently made recommendations to change the device(s) for those patients, with the most common recommendation being a change to a nebulized regimen. There was a significant improvement in ACT/CAT scores, patient-reported inhaler use, and patient adherence at week 4 compared with baseline. CONCLUSION: Assessing inhaler technique with the use of the AIM allows pharmacists to identify an optimized inhaled regimen for patients with asthma and COPD and may be a potential solution to the problem of poor inhaler technique.

Identifying opportunities to advance practice at a large academic medical center using the ASHP Ambulatory Care Self-Assessment Tool.

PURPOSE: The use of the ASHP Ambulatory Care Self-Assessment Tool to advance pharmacy practice at 8 ambulatory care clinics of a large academic medical center is described. SUMMARY: The ASHP Ambulatory Care Self-Assessment Tool was developed to help ambulatory care pharmacists assess how their current practices align with the ASHP Practice Advancement Initiative. The Henry Ford Hospital Ambulatory Care Advisory Group (ACAG) opted to use the "Practitioner Track" sections of the tool to assess pharmacy practices within each of 8 ambulatory care clinics individually. The responses to self-assessment items were then compiled and discussed by ACAG members. The group identified best practices and ways to implement action items to advance ambulatory care practice throughout the institution. Three recommended action items were common to most clinics: (1) identify and evaluate solutions to deliver financially viable services, (2) develop technology to improve patient care, and (3) optimize the role of pharmacy technicians and support personnel. The ACAG leadership met with pharmacy administrators to discuss how action items that were both feasible and deemed likely to have a medium-to-high impact aligned with departmental goals and used this information to develop an ambulatory care strategic plan. This process informed and enabled initiatives to advance ambulatory care pharmacy practice within the system. CONCLUSION: The ASHP Ambulatory Care Self-Assessment Tool was useful in identifying opportunities for practice advancement in a large academic medical center.