Best practices for PGY1 letters of intent: Recommendations from a modified Delphi process.

PURPOSE: The aim of this study was to provide consensus recommendations from residency program leaders on letters of intent (LOIs) written by postgraduate year 1 (PGY1) pharmacy residency candidates. METHODS: A 3-round modified Delphi process was used to determine consensus among PGY1 residency program leaders across the country. A screening and demographic survey was utilized to ensure representation of panelists. The initial items for round 1 of the study were developed using existing published literature, with pilot testing by 2 residency program directors. For each round, respondents rated items on a 7-point Likert scale, with opportunities to provide qualitative feedback and modifications for lower-rated items. For future rounds, items were adjusted based on respondent feedback. Only items meeting predefined consensus were included in the final recommendations. RESULTS: A total of 254 pharmacists were invited to participate in the panel, with 41 completing the demographic and study consent survey. There were 35 participants in round 1, 34 of whom remained for rounds 2 and 3. The panel created 18 LOI recommendations for PGY1 residency candidates. Most recommendations were focused on the content of the LOI, while others were related to formatting. CONCLUSION: The recommendations from this study can be employed by PGY1 pharmacy residency candidates to enhance their likelihood of success in the residency application process.

Opioid Use Disorder Curricular Content in US-Based Doctor of Pharmacy Programs.

OBJECTIVES: To characterize the instructional settings, delivery methods, and assessment methods of opioid use disorder (OUD) content in Doctor of Pharmacy (PharmD) programs; assess faculty perceptions of OUD content; and assess faculty perceptions of a shared OUD curriculum. METHODS: This national, cross-sectional, descriptive survey study was designed to characterize OUD content, faculty perceptions, and faculty and institutional demographics. A contact list was developed for accredited, US-based PharmD programs with publicly-accessible online faculty directories (n = 137). Recruitment and telephone survey administration occurred between August and December 2021. Descriptive statistics were computed for all items. Open-ended items were reviewed to identify common themes. RESULTS: A faculty member from 67 (48.9%) of 137 institutions contacted completed the survey. All programs incorporated OUD content into required coursework. Didactic lectures were the most common delivery method (98.5%). Programs delivered a median of 7.0 h (range, 1.5-33.0) of OUD content in required coursework, with 85.1% achieving the 4-hour minimum for substance use disorder-related content recommended by the American Association of Colleges of Pharmacy. Just over half (56.8%) of faculty agreed or strongly agreed that their students were adequately prepared to provide opioid interventions; however, 50.0% or fewer perceived topics such as prescription interventions, screening and assessment interventions, resource referral interventions, and stigma to be covered adequately. Almost all (97.0%) indicated moderate, high, or extremely high interest in a shared OUD curriculum. CONCLUSION: Enhanced OUD education is needed in PharmD programs. A shared OUD curriculum was of interest to faculty and should be explored as a potentially viable solution for addressing this need.

Comparison of Clinical Interventions between Student Pharmacists on Advanced Pharmacy Practice Experiences in Indianapolis, Indiana versus Eldoret, Kenya.

Student pharmacists can have a positive impact on patient care. The objective of this research was to compare clinical interventions made by Purdue University College of Pharmacy (PUCOP) student pharmacists completing internal medicine Advanced Pharmacy Practice Experiences (APPE) in Kenya and the US. A retrospective analysis of interventions made by PUCOP student pharmacists participating in either the 8-week global health APPE at Moi Teaching and Referral Hospital (MTRH-Kenya) or the 4-week adult medicine APPE at the Sydney & Lois Eskenazi Hospital (SLEH-US) was completed. Twenty-nine students (94%) documented interventions from the MTRH-Kenya cohort and 23 (82%) from the SLEH-US cohort. The median number of patients cared for per day was similar between the MTRH-Kenya (6.98 patients per day, interquartile range [IQR] = 5.75 to 8.15) and SLEH-US students (6.47 patients per day, IQR = 5.58 to 7.83). MTRH-Kenya students made a median number of 25.44 interventions per day (IQR = 20.80 to 28.95), while SLEH-US students made 14.77 (IQR = 9.80 to 17.72). The most common interventions were medication reconciliation/t-sheet rewrite and patient chart reviews for MTRH-Kenya and the SLEH-US, respectively. This research highlights how student pharmacists, supported in a well-designed, location-appropriate learning environment, can positively impact patient care.

How to phase II: Timelines, perceptions, and suggestions from PGY-1 residency program directors.

BACKGROUND: Phase II was implemented in 2016 to provide structure for applicants and unmatched residency pharmacy programs to interact. Previous literature has provided some approaches for this process; however, clarification on navigating the phase II process to successfully match for applicants and their mentors is still needed. In addition, with phase II occurring for >6 years, there is a need for continual evaluation. OBJECTIVES: The objectives were to describe (1) program phase II structure and timelines, (2) program personnel demand, and (3) perceptions of and suggestions for phase II from postgraduate year (PGY)1 residency program directors (RPDs) to provide clarity to applicants, mentors, and residency stakeholders. METHODS: A 31-item survey was developed including 9 demographic items, 13 program-specific timeline-based items, 5 skip-logic items on screening interviews, and 4 qualitative questions on the benefits, drawbacks, and suggested changes to phase II. The survey was disseminated to PGY-1 RPDs participating in phase II with available contact information in June 2021 and May 2022, with 3 weekly reminders. RESULTS: The survey was completed by 180 of the 484 RPDs participating in phase II (37.2% response rate). Programs participating in the survey had an average of 1.4 positions (± 0.7) open in phase II and 31 applicants (± 31) per open position. The timelines for screening applications, contacting applicants, and conducting interviews were variable. For qualitative data, RPDs appreciated the structured process and noted high-quality and geographic diversity of applicants in phase II. However, challenges reported were the quantity of applications, lack of time to fully review applications, and technical issues. Suggested changes included an extended phase II timeline, universal application deadline, and technical improvements. CONCLUSION: The structured approach of phase II was an improvement compared with historical approaches; however, variability exists in timelines for programs. Respondents identified further opportunities to refine phase II to benefit residency stakeholders.

Analysis of Pharmacy Cardiac Optimization Clinic for Patients with New Onset Atrial Fibrillation Detected via Cardiac Implantable Electronic Device Clinic.

For patients with cardiac implantable electronic devices (CIEDs), arrythmias such as atrial fibrillation (AF) can be detected and actions taken to rapidly assess and initiate treatment where appropriate. Actions include timely initiation of anticoagulation, review of blood pressure, and optimization of cholesterol/lipids to prevent unfavorable outcomes, such as stroke and other cardiovascular complications. Delays to initiating anticoagulation can have devastating consequences. We sought to implement a virtual clinic, where a pharmacist reviews patient referrals from a CIED clinic after detecting AF from the CIED. Anticoagulation choice is determined by patient-specific factors, and a shared patient-provider decision to start oral anticoagulation is made. In addition, blood pressure readings and medications are assessed with lipid-lowering therapies for optimization. A total of 315 patients have been admitted through this clinic and anticoagulated over a two-year span; in addition, 322 successful interventions were made for optimization of cardiac therapy. Rapid initiation of anticoagulation within five days of referral was likely to have reduced unfavorable outcomes, such as stroke and other cardiovascular optimizations, leading to improved patient outcomes.

Community pharmacist-provided opioid intervention frequencies and barriers.

BACKGROUND: Community pharmacists are well-positioned to engage in opioid-related harm reduction activities (i.e., opioid interventions). However, several barriers to providing these interventions have been identified. Comparing the frequencies of opioid interventions and identifying which barriers are perceived to have the highest impact in providing interventions will yield valuable information for increasing opioid use disorder (OUD) care access within pharmacies. OBJECTIVES: To (1) characterize the frequency of 9 opioid interventions in community practice settings and (2) assess community pharmacists' perceptions of what impact 15 key barriers have on providing opioid interventions. METHODS: This was a multi-state, cross-sectional, and descriptive survey study. Opioid interventions evaluated included prevention (e.g., OUD screening) and treatment (e.g., OUD resource referral); barriers encompassed confidence and knowledge, work environment, provider interactions, and patient interactions. Respondents were recruited from 3 community pharmacy practice-based research networks in the Midwest and South regions of the US. Recruitment and telephone survey administration occurred between December 2021 and March 2022. Descriptive statistics were computed and open-ended items were reviewed to identify common themes. RESULTS: Sixty-nine of 559 pharmacists contacted (12.3%) completed the survey. All opioid interventions were reported to be provided less frequently than indicated in practice. Screening and referral interventions were provided least frequently, at 1.2 and 1.6 times on average, respectively, to the last 10 patients for which respondents felt each intervention was needed. Patient refusal, minimal or no reimbursement, inadequate staffing and time, and negative patient reactions were identified as the highest-impact barriers to providing opioid interventions. Approximately 26% of respondents agreed or strongly agreed that pharmacy school adequately prepared them to provide opioid interventions in practice. CONCLUSION: Prioritizing the resolution of pharmacy work environment barriers will support pharmacists in routinely providing opioid interventions. Changes in Doctor of Pharmacy curricula and continuing education are also indicated to further prepare pharmacists to engage in opioid-related harm reduction.

Critical moments in student learning on international advanced pharmacy practice experiences.

INTRODUCTION: The purpose of this study was to evaluate self-perceived critical moments that were transformative to learning in students who participated in an international advanced pharmacy practice experience (APPE). METHODS: Twenty-two pharmacy students from Purdue University College of Pharmacy, the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and the University of North Carolina Eshelman School of Pharmacy who went on an international APPE participated in a one-hour focus group evaluating self-perceived critical moments that impacted their learning. Focus groups were coded using a conventional content analysis approach and went through a two-cycle open coding process to identify major themes according to country income classification. RESULTS: Twenty-two students participated in the focus groups with 18% going to a high-income country (HIC) and 82% going to a low-to-middle income country (LMIC) location. Major themes identified within HIC locations included witnessing an innovative patient care technique and experiencing interprofessional healthcare team dynamics. Major themes identified within LMIC locations included engaging in a sensitive patient interaction, experiencing healthcare system barriers, going out of their comfort zone, and making a difference. CONCLUSIONS: International APPEs in both HIC and LMICs provided students with disorienting experiences that facilitated transformative learning and led to changes in their perspectives on patient care and pharmacy practice. While critical moments were different across country income locations, both provided valuable experiences that could be translated into local context.

Integration of Intercultural Learning into an International Advanced Pharmacy Practice Experience in London, England.

As the number of international advanced pharmacy practice experiences (APPEs) continues to grow, this is an opportunity to incorporate intercultural learning (ICL) to further advance student pharmacist training. Purdue University student pharmacists participated in a clinical research focused APPE in London, England. To prepare for this APPE, students completed a one-credit course focused on intercultural learning and travel preparation. The purpose of this report is to describe the implementation and assessment of ICL during this course and international APPE. The course includes interactive ICL activities, reflective assignments, and personalized assessments. During the eight-week APPE, student pharmacists worked on an individualized Intercultural Development Plan®, which includes ICL activities, focused reflection, and check-ins. ICL was assessed using the Intercultural Development Inventory® (IDI®) at the beginning of the course and at least four weeks after APPE completion. Student APPE feedback was also reviewed for evidence of ICL. Twenty-seven students completed the course and APPE from 2018 to 2020. The average IDI developmental orientation (DO) before the course was 91.7, placing students in minimization. The average perceived orientation was 120.9, placing students in acceptance. There were 18 students who completed the post-APPE IDI: 12 students demonstrated growth in the DO (range: 1.5-23.72), and six students experienced a decrease in their DO. Intercultural learning can be implemented and assessed as part of an international APPE.

National survey identifying community pharmacist preceptors' experience, knowledge, attitudes, and behaviors influencing intent to recommend cannabidiol products.

OBJECTIVES: The primary study objective was to characterize community pharmacist preceptors' experience, clinical and legislative knowledge, attitudes, and behaviors regarding cannabidiol (CBD). The secondary study objective was to identify which of these factors influenced intent to recommend CBD products. METHODS: A 36-item survey was used to collect respondent demographics, experience, knowledge, attitudes, and behaviors regarding CBD. Items assessing attitudes, behaviors, and intent were developed using the Theory of Planned Behavior (TPB). Community pharmacist preceptors for schools of pharmacy across the United States were eligible to complete an electronic survey open for 12 weeks from January to April 2020. Descriptive statistics were used to summarize respondent demographics, experience, knowledge, and TPB constructs. Ordinal logistic regression was used to evaluate which factors influenced intent. RESULTS: The survey was disseminated to an estimated 2242 community pharmacist preceptors and received 295 responses (13.2% response rate). Of the 272 respondents who met eligibility criteria to progress through the survey, the survey was completed in its entirety by 236 respondents (86.8% completion rate). For experience items, most respondents (70.7%) reported receiving previous education on CBD. Almost half (48.4%) reported CBD sales in their pharmacies, whereas 89.1% reported answering clinical questions about CBD. For knowledge items, respondents performed poorly on CBD adverse effect and drug interaction items. Many respondents were not comfortable counseling on (49.0%) or recommending (56.1%) CBD products for patient use. Most (74.5%) believed more research was needed before they would feel comfortable recommending CBD products. Most (57.8%) reported not having reliable CBD resources available in their pharmacies. Subjective norms and previous CBD education or personal research were the only factors found to have direct influences on respondents' intent to recommend CBD products. CONCLUSION: Opportunities exist to fill knowledge gaps, enhance confidence, and provide desired educational resources for community pharmacist preceptors on CBD products.

Development of a Global Health Learning Progression (GHELP) Model.

There has been a steady increase in global health experiential opportunities offered within healthcare professional training programs and with this, a need to describe the process for learning. This article describes a model to contextualize global health learning for students who complete international advanced pharmacy practice experiences (APPEs). Students from University of North Carolina at Chapel Hill, Purdue University, and the University of Colorado completed a post-APPE survey which included open-ended questions about knowledge, skills, and attitudes one week after completing an international APPE. Students were also invited to participate in a focus group. All 81 students who participated in an international APPE completed the open-ended survey questions and 22 students participated in a focus group discussion. Qualitative data from both the survey and focus groups were coded in a two-cycle open coding process. Code mapping and analytic memo writing were analyzed to derive to a conceptual learning model. The Global Health Experience Learning Progression (GHELP) model was derived to describe the process of student learning while on global health experiences. This progression model has three constructs and incorporates learning from external and internal influences. The model describes how students can advance from cultural awareness to cultural sensitivity and describes how student pharmacists who participate in international experiential education develop global health knowledge, skills, and attitudes.

Framework and case study for establishing impactful global health programs through academia - biopharmaceutical industry partnerships.

BACKGROUND: The field of global health has grown with multiple different public and private stakeholders engaging in the effort to improve health outcomes for underserved populations around the world. There is, however, only limited published guidance on how to promote successful partnerships between academia and the biopharmaceutical industry. OBJECTIVE: This analysis will provide a framework for developing successful partnerships around five central principles. This framework will then be applied to two representative pharmacy collaboration case studies focused on training and donations. FRAMEWORK DESCRIPTION AND CASE STUDY FINDINGS: Within the Academic Model Providing Access to Healthcare (AMPATH), successful collaborations between the biopharmaceutical industry philanthropic entities and academic partners have consistently prioritized 1) contextualization, 2) collaboration, 3) local priorities, 4) institutional commitment, and 5) integration. In the first case study, the application of this framework to clinical pharmacy training activities sponsored by Celgene and implemented by the Purdue Kenya Partnership has helped the program transition from an entirely donor dependent training program to a revenue generating, locally administered program which is now recognized and accredited by the Kenyan government. In the second case study, medication donations from Eli Lilly and Company have been converted from a traditional donation program in one Kenyan health facility to a replicable and sustainable supply chain model which has been expanded to more than 70 public sector facilities across western Kenya. CONCLUSION: Adherence to the five core principles of the proposed framework can help guide partnerships between academic institutions and the biopharmaceutical industry to advance healthcare services for underserved populations around the world. As large-scale government-based development agencies continue to primarily focus on specific disease states, biopharmaceutical industry-based collaborations can help initiate activities in underfunded therapeutic areas such as non-communicable diseases.

Faculty Burnout in Pharmacy Education.

Burnout negatively affects health care faculty members, their professions, and patient care. Academic institutions are culpable in regard to establishing reasonable expectations and a supportive work culture. Together, the health professions must proactively evaluate, develop, and implement strategies to minimize faculty burnout. This commentary suggests multiple ways to address faculty burnout.

Global Health Learning Outcomes by Country Location and Duration for International Experiences.

Objective. To determine the impact of country income classification and experience duration on learning outcomes for student pharmacists participating in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, longitudinal study evaluated 81 fourth-year student pharmacists participating in an international APPE through one of three US universities. A pre-post survey was administered to evaluate students' self-perceived growth across 13 competencies established by the Consortium of Universities for Global Health (CUGH). The survey included four additional open-ended questions. Student pharmacists were also invited to participate in a focus group. Paired and independent t tests and multiple linear regression were conducted. Qualitative survey and focus group data underwent a two-cycle, open-coding process using conventional content analysis. Results. Students who completed their APPE in a low- to middle-income country had greater growth in all CUGH competency statements compared to those who completed their APPE in a high-income country. Completing the APPE in a low- to middle-income country and prior travel for non-vacation purposes were significant predictors of student growth. Students who went to a low- to middle-income country demonstrated increased cultural sensitivity, more patient-centered care, and skill development, while students who went to a high-income country displayed increased knowledge regarding differences in health care system components, pharmacy practice, pharmacy education, and an appreciation for alternative patient care approaches. Conclusion. Learning outcomes differed between students who completed an APPE in a high-income rather than a low- to middle-income country, with both types of locations providing valuable educational opportunities and professional and personal development.

Creating global health leaders in pharmacy by evolving postgraduate training.

There has been a push for increasing global health education and training opportunities within the pharmacy profession. Global health postgraduate learning opportunities are necessary to define pharmacy career paths in global health and develop global health leaders. There are many challenges to starting a global health postgraduate training program including economic burden, logistics of extramural rotations, local and international resources, and program sustainability. In the face of barriers inhibiting formal program establishment, different strategies can be used to incorporate global health topics into existing postgraduate training opportunities. Possible solutions include relating local health to global health to develop a global mindset, expanding upon existing partnerships to provide international global health experiences, use of technology and simulation for virtual global health interaction, and emphasis of implementation science principles to connect and translate local health interventions to a global scale.

Inter-Rater Reliability of Web-Based Calibrated Peer Review within a Pharmacy Curriculum.

Objective. To assess the inter-rater reliability of student evaluations submitted through a web-based calibrated peer review system versus faculty evaluations in a Doctor of Pharmacy (PharmD) curriculum. Methods. Two calibrated peer review assignments were integrated into two sequential pharmacotherapy-based courses in the first professional year of the PharmD curriculum. To assess the inter-rater reliability of student peer and self-evaluations compared to faculty evaluations, 50 student submissions from each assignment were randomly selected for faculty evaluation, using the same evaluation criteria used by students. Statistical analysis was performed to assess the difference between the scores given by students versus faculty members and the correlation between the combined and individual assignment scores given by students versus faculty members. Results. Mean faculty scores did not significantly differ from student peer or self-evaluation scores. When the assignments were combined, there was a significant fair correlation between scores assigned by peers and those assigned by faculty members, and between scores assigned by students (self-evaluation) and faculty members. For individual assignments, one showed significant positive correlations for both peer and self-assessment compared to faculty, while the other assignment did not. Conclusion. Incorporating longitudinal calibrated peer review activities into the PharmD curriculum demonstrated fair inter-rater reliability between scores assigned by pharmacy student and faculty members. Further research on calibrated peer review is needed in pharmacy education to evaluate its reliability and utility. However, the current study suggests that the use of a web-based calibrated peer review system within a pharmacy curriculum could provide additional opportunities for critical evaluation and student self-assessment, as well as encourage more open-ended communication activities without increasing the grading burden on faculty members.

An Ethics-based approach to Global Health Research Part 3: Emphasis on Partnership Funding.

Acquiring funding for global health research within pharmacy can be challenging, particularly for new investigators who may have a strong interest in resolving global dilemmas related to health. Moreover, there can be inherent imbalances and ethical issues when navigating the funding process for global partnerships. There exists a lack of literature providing ethical guidance for mitigating dilemmas that may arise. This commentary discusses current funding streams for investigators interested in global pharmacy research, as well as specific recommendations for the funding process. These recommendations include managing award funds, ethical considerations for funding research partnerships, and balancing power between low to middle income countries and high-income countries. Lastly, case examples of funding partnerships involving pharmacy are highlighted, emphasizing important lessons learned. This commentary addresses the critical need for providing global health researchers with both important considerations and experience-based recommendations for navigating global funding partnerships using an ethical approach.

Global Health Learning Outcomes in Pharmacy Students Completing International Advanced Pharmacy Practice Experiences.

Objective. To examine the global health learning outcomes of Doctor of Pharmacy (PharmD) students from three US schools who participated in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, prospective study was used to assess fourth-year PharmD students at three US pharmacy schools who participated in an international APPE during the 2017-2018 academic year and a matched cohort (control group) of PharmD students who did not participate in an international APPE. To evaluate students' self-perceived growth in the Consortium of Universities for Global Health (CUGH) competencies, all students completed a 13-item retrospective pre-post instrument using a five-point Likert scale. The students who had completed an international APPE were invited to participate in a focus group (N=22). Paired and independent t tests and multiple linear regression were used to analyze data. Qualitative open-ended questions and focus group data were mapped to knowledge, skills, and attitudes themes. Results. The students who completed an international APPE (N=81) showed significantly more growth in CUGH competencies than students who did not (mean improvement in total score of 10.3 [7.0] vs 2.4 [6.0]). International APPE participation was the only significant predictor of growth in CUGH competencies. The international APPE students reported improvements in cultural awareness and appreciation, communication skills, problem-solving skills, adaptability, self-awareness, personal and professional outlook, and global health perspective. Conclusion. Pharmacy students' participation in international APPEs led to significant improvement in all CUGH competencies. The CUGH competency framework appears to be a suitable instrument to assess pharmacy students' global health learning outcomes.

Indiana community pharmacist preceptors' knowledge and perceptions of medication-assisted treatment.

OBJECTIVES: The study aim was to characterize the Indiana community-based pharmacist preceptors' knowledge and perceptions of medication-assisted treatment (MAT) for opioid use disorder (OUD). The secondary objectives were to explore the desired resources, dispensing concerns, and preceptors' involvement in precepting students. DESIGN: A 38-item survey was used to collect respondent demographics, knowledge, and perceptions of MAT for OUD. Perception questions were developed using the social cognitive theory and were adapted from previously published surveys with investigators' permission. SETTING: Community-based Indiana pharmacist preceptors were eligible to complete an electronic survey in February and March 2019. OUTCOME MEASURES: Descriptive statistics were used to characterize preceptor knowledge and perceptions of MAT for OUD. Desired MAT resources, dispensing concerns, and level of involvement in precepting students were collected. Respondent demographics were collected to characterize the study sample. RESULTS: Of the 116 survey responses, 104 were eligible, and 79 community-based pharmacist preceptors completed the survey, yielding a response rate of 76.0%. For knowledge questions, the overall correct score was 56.2%. Respondents had high correct scores on questions related to medication access. However, respondents either self-identified or performed poorly on the following knowledge items: Food and Drug Administration-approved MAT products for OUD, the need to provide an opioid-free interval before initiating treatment with buprenorphine and naltrexone, pregnancy recommendations, and treatment of severe OUD. Respondents reported positive perceptions on MAT for OUD, but identified concerns regarding diversion and misuse of MAT. Most respondents reported a desire for additional education on different aspects of MAT for OUD. Dispensing concerns and preceptors' involvement with students in MAT ranged from no concern and lack of involvement to many different concerns and full student involvement. CONCLUSION: Opportunities exist to fill identified gaps in knowledge, enhance perceptions, and provide desired continuing education for community-based pharmacist preceptors on MAT for OUD.

Perception of immunizations and vaccine recommendation sources for persons living with HIV compared with persons without HIV.

OBJECTIVES: To measure and compare the perception of immunizations, immunization status, and recommendation sources in persons living with HIV (PLWHs) and persons without HIV and determine a strategy for improving immunization rates by increasing awareness of pharmacy services. DESIGN: A 19-item survey based on the Health Belief Model assessed patients' perceptions and recommendation sources regarding immunization acceptance for specific vaccines: Tdap, pneumococcal, and hepatitis B (HepB). Survey items used a 5-point Likert-type scale assessing participants' perceptions, with questions identifying participants' most trusted sources of immunization information and patient demographics. Survey questions were designed to identify perceived susceptibility and severity of vaccine-preventable illness, barriers, benefits, and self-efficacy regarding immunization acceptance, and sources of patient-trusted immunization information. SETTING AND PARTICIPANTS: Survey recruitment occurred in Indiana and included any patient 18 years of age or older picking up medications at a specialty pharmacy predominantly serving PLWHs or a traditional community chain pharmacy. MAIN OUTCOME MEASURES: Primary outcomes included perceived barriers to immunization acceptance obtained from Likert-type scale questions, patient-reported immunization rates of selected vaccines (Tdap, pneumococcal pneumonia, and HepB), and trusted immunization recommendation sources. Logistic regression was performed to model association between perceived barriers, HIV status, and immunization recommendation sources. RESULTS: A total of 142 participants (68 PLWHs, 74 persons without HIV) completed the survey. PLWHs were more likely to have immunization barriers, but this was not statistically significant (odds ratio 2.537, 95% confidence interval 0.585-10.996). Both participant groups reported "family doctor" as the most trusted source, with only 5% selecting "pharmacist." Significantly fewer PLWHs reported completing the HepB series (18% vs. 52%; P = 0.0224). CONCLUSION: PLWHs possess barriers to immunization acceptance similar to persons without HIV yet report lower rates of HepB vaccine completion. Although pharmacists were less frequently selected as the most trusted source, additional studies on percptions of pharmacists' role in immunizing PLWHs should be considered.

Grading trends and evaluation of student performance across advanced pharmacy practice experiences (APPE) in the Big Ten Academic Alliance (The GRAPPES study).

INTRODUCTION: With over a third of the doctor of pharmacy curriculum relying on experiential education (EE), it is critical that students are assessed and graded in accordance with their actual performance. The objective of this paper is to review advanced pharmacy practice experience (APPE) grading across the Big Ten Academic Alliance to describe how APPE grading occurs at these institutions and highlight differences in approach and outcomes. METHODS: Experiential directors/deans were asked to import de-identified data (e.g., APPE curriculum, midpoint and final evaluation score and grade, number of preceptors, number of students, number of years of pharmacy school, total hours of APPEs offered, number and duration of APPEs per year, grading scale information). A chi-square test including pairwise comparisons with a Bonferroni p-value adjustment for multiple comparisons was performed. RESULTS: Seven college/schools submitted data from over 3600 students between 2012-2015. The distribution of letter grades differed significantly across all colleges/schools in 2012-2013, 2013-2014 and 2014-2015 (p < 0.0001). Similarly, the distribution of letter grades by rotation type varied significantly for all colleges/schools (p < 0.0001). Students in acute care, ambulatory care, and other patient care rotation types were less likely to obtain an "A" and more likely to obtain a "B" compared to students in other rotation types. CONCLUSIONS: When letter grades are used for APPEs, the trend suggests over 95% of students receive an "A" or "B" grade. Final grades varied by rotation type with more "B" grades observed in patient care rotations than "A" grades over the three-year period.