Evaluating knowledge, skills, and practice change after an accredited evidence-based medicine course for community pharmacy preceptors.

INTRODUCTION: Incorporating evidence-based medicine skills into practice is vital for pharmacists to promote rational medication use while making optimal patient care decisions. The objective of this study was to evaluate the impact of an evidence-based medicine course on the knowledge and precepting skills of community pharmacy preceptors. METHODS: This was a longitudinal, multiphase, interventional study, which involved the development of an evidence-based medicine course based on results of an educational assessment. The course was delivered over five sessions and included didactic and active learning strategies. The impact was measured by the preceptor's ability to apply knowledge gained from the course while providing student feedback during a community practice experience using a journal club context. RESULTS: Ten preceptors completed the course with 50% and 70% passing the drug information and critical appraisal assessments, respectively. When measuring course impact, 44% of preceptors were able to provide feedback at a proficient level while 56% needed further development. Preceptors' confidence improved across pre-course, post-course, and after the observation phase in interpreting study results (p = 0.016), teaching the student evidence-based medicine skills (p = 0.008), and providing feedback to the student regarding journal clubs (p = 0.010). Students rated high improvement in the preceptor's ability to provide feedback related to critical appraisal skills. CONCLUSION: A course-based approach to increase preceptor's knowledge of critical appraisal and drug information skills may be effective.

Systematic Review of Standardized Patient Use in Continuing Medical Education.

INTRODUCTION: The standardized patient (SP) has assumed a fundamental role in undergraduate medical education since first conceived over 50 years ago. While widely used in student training and assessment of communication and clinical examination across health disciplines, little is known how SPs enhance knowledge or skill development among professionals. We conducted a systematic review to determine the effectiveness of SPs in continuing medical education (CME) programs. METHODS: Authors independently searched for studies published between 1966 and 2016, describing CME initiatives using SP encounters as practice for participants compared with those which did not. Studies assessing virtual patients or mannequins or employing SPs for assessment only were excluded. Learning outcomes were characterized according to the Kirkpatrick framework for determining the effectiveness of training programs. RESULTS: Four hundred eighty-eight studies were identified, but only five were eligible for analysis. Most were conducted with small numbers of primary care physicians in North America. CME topics related to opioid prescribing, breast cancer examination and cancer screening, smoking cessation, and chronic asthma management. In the two studies testing knowledge, no difference was found between intervention and control groups (Kirkpatrick level 2). Improved behaviors were demonstrated in breast cancer patient examination and interview and decreased opioid-prescribing rates among selected participants in two studies (Kirkpatrick level 3). Only one study investigated patient outcomes and found reduced rates of uncontrolled asthma in practices of physicians who were assigned to SP practice encounters in the CME training (Kirkpatrick level 4). DISCUSSION: There is little rigorous outcome study of CME programs incorporating SPs. Given the necessary human and fiscal resources associated with their use, our review highlights the need to reconsider the SP role in CME unless further purposeful evaluation to determine participant behavior change and related patient outcomes is pursued.

An evaluation of the translation of continuing education into diabetes public health care by pharmacists.

Background Pharmacists are assuming greater public health roles and partaking in continuing education to advance knowledge and skills necessary for the provision of this patient care. Objective We sought to determine what conditions in a Middle East context influence how community pharmacists actually incorporate new information into practice. Setting Community pharmacies in Qatar. Methods A continuing professional development (CPD) program regarding the management of fasting diabetes patients during Ramadan was developed and delivered. Participants then maintained a record of their patient encounters when attempting to screen fasting diabetes patients for risk and offer medication, lifestyle, and monitoring advice. Diary entries were coded using inductive methods and follow-up focus group discussion was conducted to further corroborate the thematic analysis. Main outcome measure Facilitators and barriers to care. Results Forty-one pharmacists attended the CPD program and 35 subsequently made at least one diary entry during the 3-weeks preceding and during Ramadan. One-hundred and forty-eight submitted records and the transcript of one focus group (n = 6) were analyzed. Three main factors were found to influence pharmacists' ability to engage use new knowledge and skills: situational, patient, and pharmacist. Patient reception was the overwhelming influence whereby positive interactions encouraged pharmacists to continue screening and counseling attempts, but difficult encounters were negative reinforcing stimuli in almost equal measure. Conclusion In this Middle East setting, environmental factors play a considerable role in the pharmacists' ability to engage in public health care and reinforce that continuing education for health professionals must be closely aligned with the realities of practice and purposefully considered as part of its evaluation.

A Critical Review of the Current Evidence for Measuring Drug Concentrations of First-Line Agents Used to Treat Tuberculosis in Children.

Tuberculosis is a leading cause of infectious disease-related morbidity and mortality worldwide. Additionally, treatment is complex with most patients requiring combination therapy of first-line agents for multiple months. Children are especially at risk from the medications used to treat tuberculosis and therefore interventions to optimize both efficacy and safety are needed. Protocols exist for therapeutic drug monitoring in tuberculosis patients yet there is a gap in knowledge regarding the extent of any benefits achieved, especially in children. This review aims to summarize and evaluate literature reporting outcomes related to the measurement of drug concentrations of first-line agents used to treat tuberculosis (rifampin, isoniazid, pyrazinamide, ethambutol) in children. Findings showed a lack of strong evidence to support therapeutic drug monitoring in children with tuberculosis. Standard weight-based dosing of first-line agents does not commonly achieve target concentrations yet the effect on clinical outcomes remains unclear. As such, therapeutic drug monitoring should not be recommended currently as a widespread practice for all children with tuberculosis. However, future research should assess any benefit in special populations such as those with relapsing or recurrent disease, or those presenting with adverse drug reactions.