A university-wide seed grant program accelerates interprofessional education through faculty and staff engagement.

The University of Texas Health Science Center at San Antonio launched an annual university-wide seed grant program in 2019 to foster innovation in interprofessional education (IPE) and increase IPE opportunities for learners. Program objectives included leveraging hypothesis-driven research to identify sustainable IPE activities for integration into educational programs (i.e. mandated for at least one cohort of learners), increasing scholarly dissemination of IPE efforts, and using pilot data to secure extramural funding. Over the first four funding cycles (2019-2022), US$100,509.00 was awarded to support 22 IPE projects (10 curricular, 12 co-curricular) involving 80 faculty and staff collaborators and over 2,100 student participants. To date, funded projects have yielded nine sustained IPE activities (four of which have been integrated), produced 24 scholarly presentations and three peer-reviewed publications, and contributed to the success of one extramural grant. Barriers experienced are discussed in this report alongside lessons learned and unexpected positive outcomes, including identification of future IPE champions.

Clinical Interprofessional Education in Inpatient Pharmacy: Findings From a Secondary Analysis of a Scoping Review.

OBJECTIVES: Clinical interprofessional education (IPE) is defined as learning that occurs within clinical learning environments such as hospitals, primary care clinics, and long-term care facilities where learners collaborate to deliver care to real patients. The objective of this secondary analysis of a scoping review is to identify, characterize, and summarize evidence from the published literature regarding clinical IPE for pharmacy learners in the inpatient setting. FINDINGS: PubMed, CINAHL, and Scopus databases were searched for clinical IPE articles that met the following inclusion criteria: ≥ 2 health professions, ≥ 2 learner groups, and involvement of real patients/patient care. For this secondary analysis, 12 articles involving pharmacy learners in an inpatient setting were included. The most common interprofessional partner was medicine (66%), and the median number of student participants involved in the activity was 19 (range, 10-525). Five studies conducted clinical IPE in the context of advanced pharmacy practice experiences. Clinical IPE activities were described primarily as inpatient rounding with the medical team, but were often outside the normal clinical workflow (66%). Incorporation of Interprofessional Education Collaborative competencies was limited, as was the use of validated IPE assessment tools to measure outcomes. SUMMARY: Current literature is limited in reports of pharmacy learner involvement in inpatient clinical IPE. Expansion of pharmacy partnerships and alignment of team outcomes with the Interprofessional Education Collaborative competencies are needed to demonstrate the relationship between clinical IPE and patient care outcomes within established workflows.

Risk of Coronavirus Disease 2019-Associated Pulmonary Aspergillosis Based on Corticosteroid Duration in Intensive Care Patients.

Background: Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a potential complication in critically ill COVID-19 patients. Corticosteroids are standard of care for hospitalized COVID-19 patients but carry an increased risk of secondary infections including CAPA. The objective of this study was to evaluate if duration of corticosteroid therapy ≤10 days versus >10 days affects the risk of developing CAPA. Methods: This was a retrospective cohort study of adult patients with severe COVID-19 pneumonia requiring mechanical ventilation who received at least 3 days of corticosteroid treatment. Incidence of CAPA and secondary outcomes were compared using appropriate bivariable analyses. Steroid duration was evaluated as an independent predictor in a logistic regression model. Results: A total of 278 patients were included (n = 169 for ≤10 days' steroid duration; n = 109 for >10 days). CAPA developed in 20 of 278 (7.2%) patients. Patients treated with >10 days of corticosteroid therapy had significantly higher incidence of CAPA (11.9% vs 4.1%; P = .0156), and steroid duration >10 days was independently associated with CAPA (odds ratio, 3.17 [95% confidence interval, 1.02-9.83]). Secondary outcomes including inpatient mortality (77.1% vs 43.2%; P < .0001), mechanical ventilation-free days at 28 days (0 vs 1.5; P < .0001), and secondary infections (44.9% vs 28.4% P = .0220) were worse in the >10 days cohort. Conclusions: Corticosteroid treatment >10 days in critically ill COVID-19 patients is associated with an increased risk of CAPA. Patients may require corticosteroids for reasons beyond COVID-19 and clinicians should be cognizant of risk of CAPA with prolonged courses.

Innovation in Collaborative Online Learning Yields Sustainable Model for University-wide Interprofessional Education.

BACKGROUND: Growing health professional accreditation mandates and expectations for interprofessional education (IPE) have led to heightened interest amongst health professions educators and administrators in the creation and development of effective and sustainable IPE programming. IPE ACTIVITY: At the University of Texas Health Science Center at San Antonio, an institution-wide initiative called Linking Interprofessional Networks for Collaboration (LINC) was initiated to strengthen IPE knowledge and skills, increase IPE offerings, and integrate IPE into curricula. In 2020, stakeholders developed, implemented, and evaluated a university-wide IPE activity called the LINC Common IPE Experience, which includes three collaborative online learning modules that students complete synchronously using a videoconference platform without direct faculty facilitation. Mini-lectures, interprofessional discussions, and authentic case studies using innovative media facilitated meaningful engagement of 977 students from 26 different educational programs. DISCUSSION: Quantitative and qualitative results from evaluations demonstrated significant student engagement, increased awareness and understanding of teamwork, progress towards interprofessional competency development, and benefits related to professional development. The LINC Common IPE Experience provides a valuable example of a robust, high-impact foundational IPE activity that can serve as a sustainable model for university-wide IPE.

Clinical interprofessional education in the health professions: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify, characterize, and summarize evidence from the published literature on clinical interprofessional education. INTRODUCTION: Clinical interprofessional education refers to learning within clinical learning environments, such as hospitals, primary care clinics, and long-term care facilities. The learning involves direct interaction with real patients, where learners collaborate to deliver care and improve health outcomes. INCLUSION CRITERIA: This scoping review will consider clinical interprofessional education activities in the context of patient care. Criteria include two or more health professions, two or more learner groups, and involvement of real patients/patient care. METHODS: This review will be conducted in accordance with the JBI methodology for scoping reviews. Databases searched will include PubMed, CINAHL, and Scopus. Results will be limited to English language publications from 2015 to the present. Extracted data will include the different types of clinical learning environments, the professions involved, the targeted learning/competency outcomes, and the measurement tools used by the authors. Titles/abstracts and full texts of articles will be screened by two reviewers for potential inclusion, with discrepancies resolved by a third reviewer if necessary. Extracted data will be presented in diagrammatic or tabular format. A narrative summary will accompany the tabulated and/or charted results, describing how the results relate to the review objective and research questions, and how the results might inform future clinical interprofessional education in health professions education.

A co-curricular interprofessional education activity to facilitate socialization and meaningful student engagement.

BACKGROUND: Interprofessional education (IPE) and collaborative practice are important drivers of healthcare transformation. Early learning activities designed to foster socialization may help students develop an interprofessional identity, built on an understanding of their unique contributions to interprofessional teams. INTERPROFESSIONAL EDUCATION ACTIVITY: At the University of Texas Health Science Center at San Antonio (UT Health San Antonio), an institution-wide initiative called Linking Interprofessional Networks for Collaboration was started to advance IPE and strengthen students' attitudes, knowledge, and skills related to interprofessional teamwork. An IPE orientation focused on socialization and meaningful student engagement was developed. The event included dinner, a socialization activity, a roles/responsibilities-focused activity, faculty member accounts of interprofessional collaboration, and a recorded patient interview with guided reflection. One hundred thirty-one students attended. The event was evaluated for student satisfaction and meaningfulness of pedagogical strategies to inform the design and implementation of future IPE activities. DISCUSSION: Quantitative results were positive, with activities rated 3.5 or higher using a 4-point Likert scale. Faculty stories were rated the most meaningful component. Student comments indicated a desire to have more time dedicated to socialization activities and an increased opportunity to see their profession highlighted. IMPLICATIONS: Outcomes informed the creation of a Common IPE Experience at UT Health San Antonio, which launched in 2020 for approximately 1000 students. The Common IPE Experience featured interprofessional socialization, wide-ranging representation of professions, case studies inspired by patient experiences, and faculty interpretations of case studies, all of which were derived from lessons learned in this IPE Report.

End of life simulation to improve interprofessional competencies: A mixed methods study.

BACKGROUND: The Accreditation Council for Pharmacy Education "Standards 2016" require that pharmacy student education include training in the management of patients "across the lifespan" (Standard 12). Standards 2016 also require that students are practice-ready to participate as a contributing member of an interprofessional (IP) team (Standard 11). Didactic and experiential education in palliative or end-of-life (EOL) care is limited. Palliative care represents unique patient and team challenges in providing patients with empathetic and holistic care. INTERPROFESSIONAL EDUCATION ACTIVITY: This study describes an IP, palliative care simulation that achieved both IP and "across the lifespan" educational standards. The goals of the activity included increasing communication skills, recognizing roles and responsibilities, and enhancing the value of various healthcare providers' perspectives and expertise when caring for patients at the EOL. Pharmacy, physical therapy, nursing, and counseling students participated in a low fidelity palliative care simulation. The event consisted of a presentation on anticipatory grief and active listening followed by a role-playing simulation and group debrief. The Interprofessional Socialization and Value Scale were administered to assess student perceptions of IP skills. DISCUSSION: Quantitative and qualitative data demonstrated achievement of the goals of the activity. Reflections revealed students felt the simulation improved teamwork and communication skills and that using humility and listening in team-based palliative care transformed wisdom for future practice. IMPLICATIONS: This activity used a cost-effective, low fidelity, role-play simulation to achieve IP education competencies and demonstrated the value of multiple professions in EOL care.

Stop the Bleed: An Interprofessional Community Service Learning Project Assessing the Efficacy of Pharmacist-Led Hemorrhage Control Education for Laypersons.

OBJECTIVES: Stop the Bleed (STB) is a national initiative that provides lifesaving hemorrhagic control education. In 2019, pharmacists were added as health-care personnel eligible to become STB instructors. This study was conducted to evaluate the efficacy of pharmacist-led STB trainings for school employees in South Texas. METHODS: Pharmacist-led STB trainings were provided to teachers and staff in Laredo, Texas. The 60-min trainings included a presentation followed by hands-on practice of tourniquet application, wound-packing, and direct pressure application. Training efficacy was assessed through anonymous pre- and postevent surveys, which evaluated changes in knowledge, comfort level, and willingness to assist in hemorrhage control interventions. Student volunteers (predominantly pharmacy and medical students) assisted in leading the hands-on portion, providing a unique interprofessional learning opportunity. RESULTS: Participants with previous training (N = 98) were excluded, resulting in a final cohort of 437 (response rate 87.4%). Compared with baseline, comfort level using tourniquets (mean, 3.17/5 vs 4.20/5; P < 0.0001), opinion regarding tourniquet safety (2.59/3 vs 2.94/3; P < 0.0001), and knowledge regarding tourniquets (70.86/100 vs 75.84/100; P < 0.0001) and proper tourniquet placement (2.40/4 vs 3.15/4; P < 0.0001) significantly improved. CONCLUSIONS: Pharmacist-led STB trainings are efficacious in increasing school worker knowledge and willingness to respond in an emergency hemorrhagic situation.

Exploring pharmacy residency program director preference of pharmacy student organization membership and leadership involvement on residency candidate interview selection.

INTRODUCTION: Pharmacy student professional organization involvement and leadership are important qualifications of a pharmacy residency candidate. It is unknown if membership in specific student pharmacy organizations or types of leadership roles within these organizations are preferred by residency program directors (RPDs). The purpose of the study was to determine preference and importance of specific pharmacy student professional organization membership and leadership involvement when selecting residency candidates for an interview by RPDs. METHODS: A descriptive study was conducted using an online survey. Pharmacy RPDs with involvement in reviewing applicants for interviews were included. RPDs ranked the importance and preference of specific student professional organization membership, breadth versus depth of involvement, and leadership position held on selecting candidates for an interview. RESULTS: The survey was sent to 2084 RPDs. A total of 232 respondents met inclusion criteria and completed the survey. The majority (95.5%) of RPDs reported student membership as important, while 28.6% had preference for a specific organization. A total of 56.3% of RPDs reported student leadership as "very important" and 76.1% preferred depth over breadth of involvement. A total of 55.6% of RPDs preferred applicants with a high-level leadership position. CONCLUSIONS: Pharmacy student professional organization membership is important to RPDs when selecting residency candidates for an interview. The majority of RPDs have no preference for a specific organization, while 28.6% report a preference that affects interview selection. RPDs report leadership as important and place higher importance on depth versus breadth of involvement, with greater preference for a high-level leadership position.

Determining Indicators of High-Quality Application Activities for Team-Based Learning.

Objective. To determine the indicators of quality for application activities in pharmacy team-based learning (TBL). Methods. A modified Delphi process was conducted with pharmacy TBL experts. Twenty-three experts met the inclusion criteria, including having at least four years of TBL experience, designing at least eight TBL sessions, training others to use TBL, and authoring a peer-reviewed TBL pharmacy paper. In round 1, panelists responded to five open-ended questions about their successful TBL applications activities, including satisfaction with the activity and methods for creating positive student outcomes. In round 2, panelists indicated their level of agreement with the round 1 quality indicators using a four-point Likert rating. Consensus was set at 80% strongly agree/agree. In an open comment period, panelists provided suggestions to help expand the indicator descriptions. Indicators were verified based on TBL and the education literature. Results. Twenty panelists (87% of those eligible) responded in round 1 and 17 (85% participation) in round 2. Sixteen quality indicators were identified in round 1, with 14 achieving consensus in round 2. "Uses authentic pharmacy challenges or situations" (88% strongly agree/agree) and "incorporates or provides effective feedback to groups" (88% strongly agree/agree) met consensus. However, "has multiple right answers" (76% strongly agree/agree) and "incorporates elements from school specific emphases (eg, faith, underserved)" (53% strongly agree/agree) did not reach consensus. Conclusions. These indicators can assist faculty members in designing application activities to provide high-quality TBL exercises that promote deep thinking and engaged classroom discussion. The indicators could also guide faculty development and quality improvement efforts, such as peer review of application activities.

Interprofessional education telephone simulation for campus-based pharmacy students and distance-learning family nurse practitioner students.

BACKGROUND: Interprofessional education (IPE) is an essential component of healthcare professions' curriculum but is often difficult to provide due to scheduling issues, cost, different learning formats, and lack of access to other health care professions. To meet the school of pharmacy's need to have IPE with prescribers and the school of nursing's need to provide IPE to distance-learning students, a telephone-based IPE activity was created. The goals of the simulation activity were to provide students a forum to practice communication skills, work to maintain a climate of mutual respect, and forge interdependent relationships with another profession. INTERPROFESSIONAL ACTIVITY: Each student in a team completed a survey rating the other professional students and qualitative data was collected. Individual care plans were evaluated for appropriateness of therapy, monitoring, and follow-up recommendations. Achievement of the effective communication outcome was evaluated through student survey data, qualitative comments, and concordance of care plans among team members. Concordance was determined based on whether the team was in complete agreement. DISCUSSION: Qualitative data revealed the goals of mutual respect and interdependent relationships between professions were achieved. The majority of students agreed that effective communication was achieved; however, discordance of the patient care plans between team members suggested ineffective communication. IMPLICATIONS: The simulation activity met IPE accreditation needs of both pharmacy and nursing profession in a creative method to address barriers of location, cost, scheduling, and lack of access to other healthcare professions.

Development of a capstone course to improve student confidence and pharmacotherapy knowledge prior to advanced pharmacy practice experiences.

OBJECTIVE: To describe a capstone course designed to improve student confidence with clinical skills, improve confidence with providing medication therapy, and evaluate student knowledge. DESIGN: A 2-week capstone course was incorporated into the third-year pharmacotherapy course in a Doctor of Pharmacy program. Students evaluated complex patient cases and developed pharmacotherapy care plans. Pre- and post-capstone course survey results were used to assess change in student confidence using clinical skills and providing medication therapy, and quiz and exam results were used to assess student knowledge. RESULTS: Student confidence significantly improved from baseline for clinical skills (p < 0.02 across all clinical skills domains) and providing medication therapy (p < 0.01 across all disease states). Students reported the largest improvement in confidence for the clinical skill of creating a Subjective/Objective/Assessment/Plan (SOAP) note on a patient with multiple disease states (p < 0.001). Students reported the highest confidence increase for acute kidney injury (p < 0.001). The average written exam score was 87.2% (standard deviation ± 8.0) and the average verbal exam score was 79.1% (standard deviation ± 15.7). CONCLUSION: A 2-week capstone course can be valuable to improve confidence and assess student knowledge prior to advanced pharmacy practice experiences (APPEs).

Key articles and guidelines in the management of pulmonary arterial hypertension: 2011 update.

Pharmacotherapeutic approaches for the management of pulmonary arterial hypertension (PAH) have expanded greatly in the last 10 years. Pulmonary arterial hypertension is a relatively rare disease and is associated with myriad disease processes. The older term for PAH, primary PAH, has been changed to represent these differences and to distinguish it from postcapillary PAH associated with left-sided heart failure. Limitations in evaluating treatment approaches for PAH include its rarity, the small number of patients included in clinical trials, and issues regarding the use of placebo-controlled trials in a disease with such a high mortality rate if left untreated. Management options include the use of prostacyclin and prostacyclin analogues, endothelin receptor antagonists, and phosphodiesterase inhibitors, as well as traditional background therapy with diuretics, digoxin, calcium channel blockers, and warfarin. Numerous drugs are under investigation to evaluate their possible roles in management. Combination therapy is increasingly becoming a standard approach to therapy, with mounting literature to document effectiveness. Current or emerging roles for the pharmacist in the management of PAH largely involves ensuring access to drug therapy, facilitating specialty pharmacy dispensing, and providing patient counseling. Newer roles may include future drug development, optimized use of investigational drugs, and specialized disease management programs. This compilation includes a series of articles identifying important literature in cardiovascular pharmacotherapy. This bibliography focuses on pharmacotherapeutic management of pulmonary arterial hypertension (PAH). Most of the cited works present the results of significant human clinical studies that have shaped the management of patients with PAH. Limited primary literature is available for some topics, so in addition, consensus documents prepared by expert panels are reviewed. This compilation may serve as a teaching tool, reference resource, or update of the literature for pharmacy clinicians, physicians, and students.