The cognitive apprenticeship model as a framework for desired precepting qualities to inform preceptor development.

INTRODUCTION: Positive learner perceptions of learning experiences have been linked to better learning outcomes. More information is needed on learners' desired qualities of preceptors and learning experiences to inform preceptor development. Aligning learners' perceptions with a teaching framework, such as the Cognitive Apprenticeship (CA) framework, may be useful to guide preceptor self-assessment and development. However, information is lacking regarding whether the CA framework is consistent with learners' expectations. The purpose of this study was to determine pharmacy learner perspectives on desired preceptor behaviors and qualities and to evaluate their alignment with the CA framework to inform preceptor development. METHODS: Twenty-two learners (nine residents and 13 introductory and advanced pharmacy practice students) participated in nine focus group interviews. Data were analyzed qualitatively by inductive coding and pattern coding and then condensed into themes. After initial analysis, the CA framework was adapted into codes and applied to the data to explore the alignment of quality preceptor characteristics with CA. RESULTS: Learners identified desired general preceptor characteristics, teaching behaviors, and qualities of sites and experience structure in their discussion. All four CA dimensions (Methods, Sociology, Sequencing, and Content) were represented in the described desired preceptor qualities. Most comments were connected to the Methods dimension. CONCLUSIONS: This study supports the use of CA as a framework to guide preceptor development and assessment for desired precepting qualities, preceptor behaviors, and learning environments. Additional research is needed for best practices in implementing CA in preceptor assessment and professional development.

Exploring Cultural Intelligence Validity and Teaching Self Efficacy in Pharmacy Faculty.

OBJECTIVE: To examine the construct validity of cultural intelligence (CI) and evaluate faculty self-efficacy in developing cultural intelligence in Doctor of Pharmacy students. METHODS: A survey was developed based on a CI framework for pharmacy education consisting of four domains. Survey items were measured on a scale from 1-cannot do at all to 10-highly certain can do. Survey responses from faculty in the Doctor of Pharmacy program who completed ≥90% of the survey items were included. An exploratory factor analysis was conducted using principal components analysis with a varimax rotation and the Kaiser rule. Internal consistency reliability of each cultural intelligence construct was examined using Cronbach's alpha (α). RESULTS: Fifty-four Doctor of Pharmacy faculty members (83% response rate) completed the survey. The exploratory factor analysis revealed three CI constructs: (1) cultural awareness (α = 0.93), (2) cultural practice (α = 0.96), and (3) cultural desire (α = 0.89). Participants rated their CI teaching self-efficacy highest for cultural awareness (6.13 (1.93)), and lowest for cultural desire (3.90 (2.87)). CONCLUSION: Faculty play a critical role in the development of students; understanding CI teaching self-efficacy can inform faculty development strategies and curriculum improvements. Additional research is needed to identify related evidence-based methods for faculty development strategies utilizing the identified patterns and constructs.

Pharmacy Student Stress and Time Use in Pre-Clinical and Clinical Students.

OBJECTIVE: Literature has identified high levels of stress in pharmacy students; however, more information is needed to understand how student stress relates to time use. This study explored the causes of stress and its relationship to time use in pre-clinical and clinical pharmacy students, which were compared, as previous literature has found differences in time management and stress in these groups. METHODS: In this observational, mixed methods study, pre-Advanced Pharmacy Practice Experience students completed a baseline and final stress assessment, recorded daily time use and stress levels for 1 week, and participated in a semi-structured focus group. Predetermined time use categories were used to collect and analyze time use data. Inductive coding was used to determine themes from focus group transcripts. RESULTS: Pre-clinical students were found to have overall higher baseline and final stress scores and spent more time on stress-inducing activities (ie, academics) than clinical students. Both groups reported spending more time on activities related to pharmacy school during the week and increased time on activities of daily life and discretionary activities during the weekend. Common sources of stress for both groups included academics, cocurriculars, and ineffective stress management techniques. CONCLUSIONS: Our findings support the hypothesis that time use and stress are linked. Pharmacy students acknowledged having many responsibilities and too little time to participate in stress-relieving activities. Understanding sources of student stress, including demands on students' time, and the relationship between the two is needed to support student stress management and academic success of both pre-clinical and clinical pharmacy students.

There's no time for no stress! Exploring the relationship between pharmacy student stress and time use.

BACKGROUND: Health professions students experience significantly more stress than students 20 years ago. While prior studies have explored student time use and other studies have begun to explore factors influencing student stress, little is known about the relationship between student time use and stress. As more efforts are employed to promote student wellness and better understand student stress, it is imperative to recognize the implications of time as a finite resource. Thus, it is important to understand if and how time use relates to student stress so the two can be better managed. METHODS: A mixed methods approach exploring the challenge-hindrance stressor framework was used to collect and analyze student stress and time use. First, second, and third year pharmacy students were invited to participate. Participants completed the Perceived Stress Scale (PSS10), a week-long daily time logging activity, and daily stress questionnaire. After the week-long daily time logging, students participated in a semi-structured focus group. Descriptive statistics were used to analyze quantitative data, and inductive coding along with creation of summary reports were created for the qualitative data. RESULTS: Students reported moderate stress on the PSS10, and spending the majority of their time on activities of daily life and academic activities. Students shared that academics, co-curriculars, and working for pay increased their stress, whereas discretionary activities such as socializing and exercising alleviated stress. Finally, students reported feeling overwhelmed due to too little time to complete all necessary activities daily, including limited time to invest in discretionary activities to support their wellbeing. CONCLUSIONS: Increased stress levels among students is a concerning trend that affects students' mental health and therefore limits their ability to perform to their greatest potential. Better understanding of the relationship between time use and stress is critical to improve the quality of life of students in the health professions. These findings provide critical insight into factors contributing towards student stress that can inform curricular strategies that support wellness within health professions education.

COVID-19 vaccination telephone outreach: an analysis of the medical student experience.

INTRODUCTION: The COVID-19 pandemic diminished opportunities for medical students to gain clinical confidence and the ability to contribute to patient care. Our study sought out to understand the value of telephone outreach to schedule COVID-19 vaccines on medical student education. MATERIALS AND METHODS: Forty students engaged in telephone outreach targeting patients aged 65+ without active patient portals to schedule COVID-19 vaccines. Data consisted of a single administration retrospective pre/post survey inquiring about what students learned, expectations, other health-care processes that would benefit from outreach, and interest in a population health elective. Likert items were analyzed and open response analysis involved inductive coding and generation of thematic summaries by condensing codes into broader themes. Demographic data of patients called and subsequently received the vaccine were also collected. RESULTS: There were 33 survery respondents. There was a statistically significant increase in net comfortability for pre-clerkship students for documenting in Epic, providing telehealth care, counseling on common health-care myths, having challenging conversations, cold-calling patients, and developing an initial trusting relationship with patients. The majority called and who received the vaccine were non-Hispanic Black, within the high SVI category, and had Medicare and/or Medicaid. Qualitative data showed that students emphasized communication, the role of trusted messengers, the need to be open minded, and meeting patients where they are. DISCUSSION: Engaging students in telephone outreach early in the COVID-19 pandemic provided students the opportunity to develop their skills as physicians-in-training, contribute to combating the ongoing pandemic, and add value to the primary care team. This experience allowed students to practice patience, empathy, and vulnerability to understand why patients had not received the COVID-19 vaccine; this was an invaluable experience that helped students develop the skills to become empathetic and caring physicians, and supports the continued role of telehealth in future medical school curriculum.

Investigating preceptor experiences with cultural intelligence in pharmacy education.

BACKGROUND: A culturally intelligent pharmacy workforce is critical for addressing health disparities and ensuring that healthcare teams are equipped to support the medication needs of patients. Despite the critical role of preceptors in developing aspiring pharmacists, little is known about how they create or manage cross-cultural situations for students. OBJECTIVE: The objective of this study was to explore preceptor experiences teaching cultural intelligence within experiential pharmacy settings. METHODS: A convergent parallel mixed methods approach was used with a 10-item survey measuring preceptor teaching self-efficacy (measured from 0-cannot do at all to 10-highly certain can do) and interviews/focus groups to further understand cultural intelligence teaching experiences. Data were analyzed according to the 4 domains of the cultural intelligence framework (i.e., cultural awareness, cultural knowledge, cultural practice, and cultural desire). Survey data were analyzed descriptively and qualitative data were analyzed deductively. RESULTS: Participants (n = 24) were most confident Discussing factors underlying health and healthcare disparities (e.g., access, socioeconomic status, environment, racial/ethnic) (7.54 ± 2.04) and least confident in Understanding the importance of cultural desire in teaching students to be culturally intelligent healthcare practitioners (5.21 ± 2.72). All four cultural intelligence domains were identified in the qualitative data (n = 315 codes), with preceptors providing evidence of cultural awareness (n = 38, 12.1%), cultural knowledge (n = 54, 17.1%), cultural practice (n = 183 codes, 58.1%), and cultural desire (n = 40, 12.7%). Preceptors described various pedagogical strategies, such as case discussions, reflection, and simulation. CONCLUSIONS: Participants provided insight into pedagogical strategies for cultural intelligence that could promote student learning in experiential settings and help explicate curricular gaps. Further research regarding applicability of the cultural intelligence framework is needed, including application of these strategies and opportunities for preceptor development.

Exploring cognitive apprenticeship and teaching practices in pharmacy education.

Health professions schools in the United States and internationally have engaged in curricular changes to better prepare students for the future of health care. However, designing or selecting evidence-based teaching activities can be a challenge. Research suggests the Cognitive Apprenticeship theory is an effective framework for the health professions to inform instruction design, yet these studies have mainly focused on the clinical setting and not the didactic learning environment. This study used qualitative methods to explore the Cognitive Apprenticeship framework in the didactic learning environment and the teaching practices that pharmacy faculty used to explicate their expert thinking to students. Faculty were observed using all four Cognitive Apprenticeship dimensions (ie, Content, Sequencing, Methods, Sociology) in their teaching practice. Patterns were observed in the data revealing complex, short and sometimes spontaneous teaching practices that faculty used to promote learning.

An exploration of barriers, facilitators, and practical solutions for adopting medication synchronization into community pharmacies: A qualitative analysis.

Background: Community pharmacies across the nation have adopted medication synchronization (Med Sync) services with the aim of improving medication adherence. To help incorporate Med Sync into a pharmacy's workflow, pharmacy associations and organizations developed implementation guides for community pharmacies. However, considerable variability in the adoption of this service exists as pharmacies struggle to implement Med Sync into traditional workflow. Researchers identified early adopters of Med Sync who dispense majority of their prescriptions as part of a Med Sync program. An exploratory study was undertaken with the aim to reveal themes surrounding facilitators and barriers to adoption of Med Sync in community pharmacies. Objectives: The objective of this study was to explore the barriers and facilitators associated with Med Sync adoption in community pharmacies and generate practical solutions for service adoption. Methods Community pharmacies participating in the North Carolina's Community Pharmacy Enhanced Services Network (CPESNsm) who were early adopters of Med Sync and had greater than 50% of their prescription volume being dispensed as part of a Med Sync program were recruited to participate in semi-structured interviews. Interviews were conducted, recorded, and transcribed verbatim with representatives who led the adoption of Med Sync in their pharmacy. Inductive coding and summary analysis were used to analyze the interview data and determine themes associated with facilitators and barriers. Results: Analysis of the interviews revealed four key themes: program organization, staff engagement, patient engagement, and provider engagements for Med Sync adoption. Each of these themes had several sub-themes, contributing to facilitators and barriers to Med Sync adoption. Subthemes of program organization included having organizational infrastructure, including a pharmacy software system, a dedicated area, and a consistent enrollment process. Subthemes of staff engagement included having a team-based approach, job training, and staff incentives. Patient engagement's subthemes included communication, finances, health literacy, and transportation. Provider engagement resulted with subthemes including lack of communication and provider-pharmacist relationships. Conclusion: To ensure successful adoption of Med Sync into traditional workflow, community pharmacies should employ a multi-factorial approach that includes internal and external components to the community pharmacy. This study identified facilitators associated with successful Med Sync adoption such as adequate staff engagement and requisite program organization. Barriers hindering successful Med Sync adoption resulted from challenges with provider and patient engagement. This study also makes an important contribution by providing practical solutions to Med Sync adoption based on participant responses and identified themes and sub-themes.

Increase in Sharing of Stressful Situations by Medical Trainees through Drawing Comics.

INTRODUCTION: Medical trainees fear disclosing psychological distress and rarely seek help. Social sharing of difficult experiences can reduce stress and burnout. Drawing comics is one way that has been used to help trainees express themselves. The authors explore reasons why some medical trainees chose to draw comics depicting stressful situations that they had never shared with anyone before. METHODS: Trainees participated in a comic drawing session on stressors in medicine. Participants were asked if they had ever shared the drawn situation with anyone. Participants who had not previously shared were asked what prevented them and why they shared it now. The authors performed content analysis of the responses. RESULTS: Of two hundred forty participants, forty-six (19.2%) indicated sharing an experience for the first time. Analysis of the responses revealed dedicated time and space was essential to sharing, trainee insecurity was a barrier, and comics were perceived as a safe way to communicate. DISCUSSION: Depicting a stressful situation may be beneficial for trainees who drew an experience they had never shared before. Providing trainees with the opportunity to externalize their experience and create a community for sharing tough experiences may be one way to reduce trainee stress and burnout.

A Qualitative Preceptor Development Needs Assessment to Inform Program Design and Effectiveness.

Objective. To assess preceptor teaching challenges and development programming design preferences through a qualitative needs assessment of Doctor of Pharmacy student and resident preceptors.Methods. In 2018, 148 experiential education stakeholders across North Carolina (eg, preceptors, residency program directors, experiential faculty administrators, and practice site administrators) were invited to participate in a 60-minute semi-structured interview as part of a broad preceptor development needs assessment. Interview questions focused on: precepting challenges, positive and negative features of development programs, and preferences for program design. Interview transcripts were coded using thematic analysis.Results. Forty-two participants completed interviews, including preceptors from various rotation types, residency program directors, experiential faculty administrators, and institution administrators. Participants identified numerous teaching challenges related to learners, preceptors, and institutional level factors. Participants often noted there was inadequate time, resources, and support to effectively teach. Desirable preceptor development program features included practical strategies, collaboration with preceptors, delivery by education and practice experts, and topics specific to precepting experience. Participants identified live, on-demand, and webinar formats as acceptable if collaboration and engagement were included. Participants also desired unique training opportunities such as online platforms, coaching programs, and simulated learning environments.Conclusion. Preceptors for pharmacy students and residents face numerous challenges and require sufficient time, support, and resources to develop their skills. Participants requested training that included on-demand, frequent sessions delivered through various modalities, collaboration opportunities, a choice in topics and delivery formats, and sessions from educational and practice experts.

Development of a Cultural Intelligence Framework in Pharmacy Education.

Objective. Pharmacists must be equipped with the knowledge, skills, and attitudes necessary to provide culturally intelligent and patient-centered care; however, most are not trained to do so. In order to prepare culturally intelligent pharmacists, standards and curricula for cultural intelligence must be defined and implemented within pharmacy education. The objective of this study was to create a cultural intelligence framework (CIF) for pharmacy education and determine its alignment with Doctor of Pharmacy (PharmD) training.Methods. An extensive literature analysis on current methods of cultural intelligence education was used to construct a CIF, which integrates leading models of cultural intelligence in health care education with Bloom's Taxonomy. Five student focus groups were conducted to explore and map their cultural experiences to the CIF. All focus groups were recorded, transcribed, deidentified and deductively coded using the CIF.Results. The four CIF domains (awareness, knowledge, practice, desire) were observed in all five focus groups; however, not every participant expressed each domain when sharing their experiences. Most students expressed cultural awareness, knowledge, and desire, however, only a few students discussed cultural practice. Participant comments regarding their experiences differed by race and year in the curriculum.Conclusion. This study was a first step toward understanding cultural intelligence education and experiences in pharmacy. The CIF represents an evidence-based approach to cultural intelligence training that can help prepare pharmacy learners to be socially responsible health care practitioners.

Qualitative Evaluation of a Junior Faculty Team Mentoring Program.

Objective. To investigate the strengths and challenges of a structured junior faculty mentoring program at a public four-year school of pharmacy, identify areas of opportunity to improve the program, and describe the mentoring needs of mid-career faculty.Methods. Focus groups and interviews were conducted to elicit participants' experiences, perceptions, and suggestions for opportunity to improve the program. Stakeholder groups included junior faculty enrolled in the mentoring program, mid-career faculty who had graduated from the program, mid-career faculty who had not participated in the program, internal mentors, external mentors, and division chairs. Thematic coding was used to identify semantic themes, and summaries of participant perceptions were generated. The program was mapped to the PAIRS checklist from the 2014 American Association of Colleges of Pharmacy Joint Council Task Force on Mentoring.Results. Participants described the structure of the program and mentee-mentor relationships as strengths of the program. Challenges included finding time to meet and ensuring mentee-mentor fit. Several areas of opportunity were identified, such as adjusting the topics for large mentee seminars, providing mentors with training, and providing mentoring for mid-career faculty. The mentoring needs of mid-career faculty were described as unique and requiring potentially different strategies than those used for mentoring junior faculty.Conclusion. Mentoring is critical to the professional development of faculty, supporting faculty retention and job satisfaction, and reducing faculty burnout. Scholarly endeavors that explore faculty mentoring, specifically those using qualitative methods, can help the Academy better understand and meet the needs of faculty.

Remote OSCE Experience: What First Year Pharmacy Students Liked, Learned, and Suggested for Future Implementations.

During the wake of the COVID-19 pandemic, many schools quickly transitioned their teaching and assessment strategies to online formats. In Spring 2020, a 3-station remote Objective Structured Clinical Examination (OSCE) was implemented for first-year pharmacy students. The day following the remote OSCEs students answered three open-text prompts about the remote OSCE experience: (1) "I liked...", (2) "I learned…", and (3) "I suggest…". Responses were open-coded and frequency counts were calculated to determine the most prevalent codes. Concept maps were created to visualize and explore connections between the codes. Out of 157 students, 156 students completed the reflection assignment, a 99.36% response rate. The three major themes in the Liked data were: Logistics (n = 65, 41.7%), Differences In-person Versus Remote (n = 59, 37.8%), and Skill Development (n = 43, 27.6%). The three major themes in the Learned data were: Technology (n = 66, 42.3%), Communication (n = 58, 37.2%), and Skill Development (n = 56, 35.9%). The three major themes in the Suggest data were: Logistics (n = 89, 57.1%), Technology (n = 31, 19.9%), and Continuation of Remote OSCE (n = 31, 19.9%). Overall, the remote OSCE experience was well-received, and students described it as applicable to their future pharmacy practice. Future work should explore the design, implementation, and outcomes of remote OSCEs.

Developing a process to manage challenges encountered by experiential education administrators.

INTRODUCTION: This study explored preceptor and student related issues reported in pharmacy experiential education settings and solutions that experiential education administrators (EEAs) applied to inform a process to manage these challenges. METHODS: This mixed-methods study was conducted in two phases. In phase one, five EEAs from three schools of pharmacy collected quantitative and qualitative data over a two-year period on issues reported by students and preceptors and the solutions EEAs employed. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. Interviews with six EEAs from four schools were completed in phase two. An additional school was added in phase two. Open coding, pattern coding, and summative analysis were completed on interview data. RESULTS: Preceptors and students reported 156 and 65 issues, respectively. The most common issues reported were student reliability/responsibility (22, 14%) and preceptor communication (13, 20%). The most frequently applied solutions were coach preceptor (51, 24%) and meet with student (20, 24%). Interviews revealed more information about the strategies EEAs used. Approaches included reactive responses such as talking to and coaching preceptors or students. Preventative strategies were desired, such as tracking data and training. CONCLUSIONS: Results informed two approaches that EEAs can employ to resolve student and preceptor issues. In the proactive process, issues are tracked to inform student and preceptor development. The reactive approach involves meeting with the preceptor or student, gathering information from both parties, coaching the preceptor or student, and involving other administrators as needed for serious concerns.

Emerging Innovations and Professional Skills Needed Within Pharmacy Curricula.

To ensure students are prepared for the rapidly evolving world of health care, curricula must be aligned with emerging innovations, as well as professional skills likely to influence students' abilities to be successful. At the 2019 annual meeting of PharmAlliance institutions, we asked experts to identify innovations and professional skills necessary for the future of pharmacy practice. Experts identified a wide range of topics, including personalized and precision medicine, digital health, interprofessional collaboration, clinical decision making, and overcoming complexity and ambiguity. While these findings are useful for informing curriculum content, we must also commit to ensuring our pharmacy curricula are emerging, forward thinking, and effective at preparing students for the challenges in health care.

T.E.A.M.S.Work: Leveraging Technicians to Enhance ABM Med Sync in Community Pharmacies.

The expansion of pharmacy technicians' roles in community pharmacies allows pharmacists the opportunity to focus on providing clinical services to patients. This study explores the tasks pharmacy technicians' perform to support Med Sync programs in community pharmacies. Pharmacy staff members at North Carolina pharmacies with more than fifty percent of their prescription volume being dispensed as part of a Med Sync program were recruited to participate in semi-structured interviews. Inductive coding and summary analysis were used to analyze the interview data. Study participants described pharmacy technicians' roles in identifying patients for marketing and enrollment, reviewing patients' medications list, choosing alignment dates based on patient preference, contacting patients in preparation for dispensing and, lastly, engaging in pickup or delivery of medications. This study highlights technicians' vital role in completing tasks that support Med Sync programs in community pharmacies.

Use of Capstone Experiences in Pharmacy Education to Synthesize and Apply Students' Knowledge and Skills.

Objective. To investigate capstone experiences in pharmacy education with the broad aim of better understanding how they are designed, used, and sustained.Methods. Capstones were defined as culminating experiences that required Doctor of Pharmacy (PharmD) students to apply their knowledge and skills and demonstrate their ability to integrate, extend, and apply multiple components of their academic experience. This study was conducted in two phases. Phase one was a mapping review, which provided insight into the design of pharmacy capstone experiences, including the purpose they served and their associated outcomes. Phase two consisted of conducting follow-up interviews to explore the current status and sustainability of those capstone experiences. Qualitative methods with multiple coders were used to analyze the data.Results. Five distinct purposes for capstone experiences were identified: preparation for advanced pharmacy practice experiences (APPEs), pharmacotherapy education, research, reflection on pharmacy school experiences, and immersive learning through an external organization. Wide variability was found in the design, purpose, and outcomes of capstone experiences. Study authors described the capstone experiences at their institution in terms of the viability, feasibility, desirability, and challenges faced.Conclusion. Capstones can play an important role in assessing student progress and practice readiness in pharmacy education. The findings of this study can be used to help pharmacy schools design capstone experiences that are effective and sustainable.

Exploring the Future of Graduate Education in Pharmaceutical Fields.

To ensure graduate students remain at the forefront of healthcare, curricula must be aligned with current and emerging innovations likely to influence students' ability to be successful. In this study, a modified Delphi technique was utilized to determine and prioritize the innovations and professional skills needed. For innovations, the top three areas experts identified were (1) personalized medicine, (2) big data, and (3) cell and gene therapy. For professional skills, the top three areas were (1) creative problem solving, (2) communication, and (3) data literacy. These results can be used to inform graduate curriculum development within various pharmaceutical fields.

Authorship Considerations for Publishing in Pharmacy Education Journals.

The distinction of authorship and its associated credit has important implications for academia. Pharmacy education encompasses faculty members from a wide and diverse range of disciplines, including the clinical, basic, and social sciences. These disciplines embody varying traditions and perspectives concerning who qualifies for authorship. As an academy, pharmacy education must do more to equip education researchers with the tools needed to navigate authorship decisions. The following commentary provides examples and recommendations concerning the issue of authorship within pharmacy education. We define authorship, examine authorship guidelines from health professions and education disciplines, and discuss authorship order. We then provide authorship recommendations for pharmacy education with the goal of supporting authorship decisions and further promoting discourse about authorship.

Can they imagine the future? A qualitative study exploring the skills employers seek in pharmaceutical sciences doctoral graduates.

Concerns about the extent to which graduate programs adequately prepare students for the workplace have prompted numerous calls for reform. Understanding what employers look for in doctoral graduates can help schools better align graduate training with workplace needs. Twelve pharmaceutical scientists across diverse specialties and career pathways described the skills considered requisite for success in today's science economy. Depth and breadth of knowledge, communication, collaboration, adaptability, research productivity, experiential training, and motivation and drive were among the themes identified. These results can be used to inform the development of doctoral curricula in the biomedical sciences.