A meta-narrative review of choose-your-own-adventure style patient case activities in pharmacy education.

BACKGROUND: The objective of this review was to characterize the methods of delivery and assessment of Choose Your Own Adventure (CYOA)-style activities in pharmacy education. A secondary objective was to utilize available data to determine best practices for educators interested in developing similar activities. METHODS: A meta-narrative approach according to the guidance of the RAMESES standards was used for this review. A broad literature search was conducted using PubMed and Embase. Studies published on the use of a CYOA-style patient case format in pharmacy education were identified and appraised individually for their relevance. RESULTS: Thirteen studies from the pharmacy education literature were included in the review. Activities were delivered for 25 unique topics, largely in small groups during class via patient simulation or interactive data collection software. Overall, students have a positive perception of CYOA-style activities, with positive results regarding knowledge development and student engagement. The most commonly reported challenge to implementing CYOA-style patient case activities was the up-front time commitment to develop activities. IMPLICATIONS: This review provides a snapshot of the small but expanding body of literature on CYOA-style patient case activities in pharmacy education. CYOA-style activities are recommended for expanded use in pharmacy education as the preponderance of studies that assessed knowledge development showed significant improvement in knowledge after participation in CYOA-style activities. Additionally, students have a positive perception of CYOA-style activities and reported that they were enjoyable, improved their confidence, and helped them learn course material.

Food insecurity and glycemic goals among Medicare beneficiaries with type 2 diabetes.

OBJECTIVE: To examine the association between food insecurity and achieving glycemic goals among Medicare beneficiaries with type 2 diabetes. METHODS: This study analyzed the nationally representative 2019 Medicare Current Beneficiary Survey of 1340 beneficiaries aged ≥65 years with type 2 diabetes. The binary dependent variable was whether beneficiaries' blood glucose was at target (A1C ≤ 7.5% or average fasting blood glucose of ≤140 mg/dL, all/most of the time). Food insecurity, a binary variable, was adapted based on the USDA's food security questions. A survey-weighted multivariable logistic model, adjusted for sociodemographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having above-target blood glucose levels across groups. RESULTS: Of study beneficiaries, 20.9% reported not achieving glycemic targets. The predictive marginal prevalence of having higher than target blood glucose levels was significantly greater in females over males (23.8% [95% confidence interval [CI], 20.1-27.4] vs 17.6% [14.3-20.9]); those with less than high school education over those with college education (31.0% [23.6-38.3] vs 18.6% [14.8-22.3]); and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs 19.1% [16.6-21.7]). CONCLUSIONS: Sociodemographic disparities related to achieving blood glucose goals were observed. Screening for food insecurity and related interventions should be considered for at-risk beneficiaries with diabetes.

Failure to fail - Perspective from junior faculty preceptors on the challenges of evaluating underperforming students in the experiential learning environment.

INTRODUCTION: Preceptors serve as the gatekeepers between individuals progressing from student pharmacist to independent practitioner. This responsibility is challenging if a student is not progressing as required and is at risk of failure. In this article, we will review the potential consequences and barriers of "failing to fail" a student, share the emotions that come with the decision, and suggest actions that may aid in preceptor decision-making. COMMENTARY: A preceptor's failure to fail a student has a global impact on many parties including the student, their future employer and patients, the preceptor, and the school or college of pharmacy. Despite supportive factors, preceptors may experience an internal struggle about the ripple effect of failing or not failing an experiential student. IMPLICATIONS: Underperformance in the experiential setting is a complex issue that remains largely unseen due to "failure to fail," a concept that should be researched further in the pharmacy setting. Empowering preceptors, particularly newer preceptors, to assess and manage failing students is possible through increased discussion around the topic and focused preceptor development programs.

Dissatisfaction of Out-of-Pocket Costs and Problems Paying Medical Bills Among Medicare Beneficiaries With Type 2 Diabetes.

PURPOSE: The purpose of the study was to examine the relationship between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills among Medicare beneficiaries with type 2 diabetes. METHODS: The 2019 Medicare Current Beneficiary Survey Public Use File, a nationally representative sample of Medicare beneficiaries aged ≥65 years with type 2 diabetes, was analyzed (n = 2178). A survey-weighted multivariable logit regression model was conducted to examine the association between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills, adjusted for sociodemographics and comorbidities. RESULTS: Among study beneficiaries, 12.6% reported problems paying medical bills. Among those with and without problems paying medical bills, 59.5% and 12.8%, respectively, were dissatisfied with out-of-pocket costs. In the multivariable analysis, beneficiaries who were dissatisfied with out-of-pocket costs were more likely to report problems paying medical bills than those who were satisfied. Younger beneficiaries, beneficiaries with lower incomes, those with functional limitations, and those with multiple comorbidities were more likely to report problems paying medical bills. CONCLUSIONS: Despite having health care coverage, more than one-tenth of Medicare beneficiaries with type 2 diabetes reported problems paying medical bills, which raises concerns about delaying or forgoing needed medical care due to unaffordability. Screenings and targeted interventions that identify and reduce financial hardships associated with out-of-pocket costs should be prioritized.

Implementing a choose your own adventure activity to improve insulin decision making.

INTRODUCTION: The objective of this educational activity was to evaluate the impact of a virtually simulated Choose Your Own Adventure (CYOA) activity on pharmacy student knowledge and confidence of insulin management. METHODS: An online CYOA activity was created using TypeForm, version 2 (TypeForm SL) for a third-year pharmacy school diabetes elective with 16 enrollees over two course offerings. Through use of interactive storytelling, students used critical thinking skills to make decisions in six simulated patient's care including initiation, counseling, conversions, and titration of multiple types of insulin. Instructor-created surveys were administered to students before and after the activity to assess satisfaction, confidence, and knowledge. RESULTS: Ten students (62.5%) completed the activity and both pre- and post-surveys. Average total scores on the five-question insulin knowledge quiz improved significantly from 46% to 68% (P = .02). High satisfaction scores were recorded for each item in the post-survey. Student confidence improved in all aspects related to insulin management (P < .001). No differences in knowledge, confidence, or satisfaction were found between students who completed the activity in an in-person vs. virtual classroom. CONCLUSIONS: CYOA activities can be successfully implemented in an in-person and virtual pharmacy classroom using a digital platform. Students viewed the CYOA activity as an enjoyable, low-stakes learning tool to increase confidence in their decision making. This small study did find knowledge improvements, but further research is needed to fully establish the validity of the knowledge assessments and ensure knowledge gains are sustainable.

Comparison of the Usability, Accuracy, Preference, and Satisfaction of Three Once-Weekly Glucagon-Like Peptide 1 Receptor Agonist Pen Devices in People With Type 2 Diabetes.

Aim: This study's aim was to compare the time and accuracy of use and participants' satisfaction and preferences with pen devices for the once-weekly glucagon-like peptide 1 (GLP-1) receptor agonists dulaglutide, exenatide XR BCise, and semaglutide. Materials and methods: In this triple crossover, open-label, simulated injection study, GLP-1 receptor agonist pen devices were compared, with time and accuracy of use and participants' satisfaction and preferences as primary outcomes. Participants had type 2 diabetes and were naive to GLP-1 receptor agonist therapy. Participants watched instructional videos for each device, demonstrated administration, and then provided feedback after each demonstration. Investigators tracked errors and omissions of demonstration steps for accuracy and time. Differences across devices were compared using univariate mixed models, adjusting for multiple comparisons. Results: Of the 60 participants, 50% were male, a majority (65%) were Caucasian, and most (65%) had adequate health literacy. Participants rated the dulaglutide device easier to use than those of exenatide XR BCise or semaglutide (P <0.001 for each). Participants expressed greater satisfaction with the dulaglutide device compared with those of exenatide XR BCise or semaglutide (P <0.01 for each). Most participants (75%) preferred the dulaglutide device overall; however, many participants (61%) preferred the size and portability of the semaglutide device. The dulaglutide device took less time to use than the exenatide XR BCise or semaglutide devices (69 vs. 126 and 146 seconds, respectively; P <0.001 for each). Participants were less accurate when using the dulaglutide device. Conclusion: Most participants preferred the dulaglutide device. The dulaglutide device took the least amount of time to demonstrate; however, demonstration accuracy was lower.

Evaluation of an escape room approach to interprofessional education and the opioid crisis.

BACKGROUND: The use of an escape room in education helps promote communication, teamwork, and leadership amongst interprofessional learners in a unique and engaging manner; however, it is unknown if this method can change clinical knowledge related to the opioid crisis and interprofessional attitudes. Our objective was to evaluate the use of an interprofessional escape room activity to increase clinical knowledge related to the opioid crisis and to change attitudes toward interprofessional collaboration. INTERPROFESSIONAL EDUCATION ACTIVITY: The session was developed as part of an interprofessional program at University of Colorado Anschutz Medical Campus. In this educational escape room activity, teams of interprofessional students solved six puzzles to gain knowledge of the opioid crisis. Knowledge gains were assessed using a pretest and posttest, while changes in interprofessional attitudes were assessed using the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument. DISCUSSION: Of the 88 total participants, 70 students from six different health professions completed both the pretest and posttest and were included in the analysis. Knowledge of the opioid crisis improved, particularly in identifying signs of opioid overdose. Overall, SPICE-R ratings increased, which was driven by improvement in understanding professional roles and responsibilities. IMPLICATIONS: The use of an interprofessional escape room as an educational method was effective in increasing some aspects of opioid crisis related knowledge and enhancing attitudes toward interprofessional collaboration. The educational model is applicable to various topics and interprofessional groups.

Bridging health disparities: a national survey of ambulatory care pharmacists in underserved areas.

BACKGROUND: There is a shortage of primary care medical providers, particularly in rural communities and communities of racial and ethnic minority groups. Clinical pharmacists can help fill gaps in care among these vulnerable populations. OBJECTIVE: To identify characteristics of ambulatory care pharmacists that pursue and maintain employment within underserved areas. METHODS: An original survey was distributed nationwide to ambulatory care clinical pharmacists in underserved settings. Respondent characteristics were analyzed using descriptive statistics. RESULTS: Of the 111 completed surveys, a majority of respondents were White, non-Hispanic, female, with English as their only spoken language. A majority of pharmacists completed a clinical experience or specialized training focused on underserved care prior to their position. The top three motivators for pharmacists accepting their clinical position as well as staying at their job were passion for caring for underserved populations, the presence of a faculty appointment, or the freedom and flexibility of advanced clinical roles. CONCLUSIONS: With a large majority of our respondents identifying as White and unilingual, there remains a large opportunity to increase diversity in the clinical pharmacy ambulatory care workforce caring for underserved populations. There is an observed correlation between early experiential or specialized training in underserved care and pharmacists pursuing employment in these areas. Thus, one potential long-term strategy to diversify and grow the ambulatory care clinical pharmacist workforce in underserved settings is for clinical practice sites to partner with colleges of pharmacy to recruit and maintain quality individuals who can meet the needs of diverse patient populations as well as expand student and resident training opportunities in underserved settings.

Bridging health disparities: a national survey of ambulatory care pharmacists in underserved areas

Background: There is a shortage of primary care medical providers, particularly in rural communities and communities of racial and ethnic minority groups. Clinical pharmacists can help fill gaps in care among these vulnerable populations. Objective: To identify characteristics of ambulatory care pharmacists that pursue and maintain employment within underserved areas. Methods: An original survey was distributed nationwide to ambulatory care clinical pharmacists in underserved settings. Respondent characteristics were analyzed using descriptive statistics. Results: Of the 111 completed surveys, a majority of respondents were White, non-Hispanic, female, with English as their only spoken language. A majority of pharmacists completed a clinical experience or specialized training focused on underserved care prior to their position. The top three motivators for pharmacists accepting their clinical position as well as staying at their job were passion for caring for underserved populations, the presence of a faculty appointment, or the freedom and flexibility of advanced clinical roles. Conclusions: With a large majority of our respondents identifying as White and unilingual, there remains a large opportunity to increase diversity in the clinical pharmacy ambulatory care workforce caring for underserved populations. There is an observed correlation between early experiential or specialized training in underserved care and pharmacists pursuing employment in these areas. Thus, one potential long-term strategy to diversify and grow the ambulatory care clinical pharmacist workforce in underserved settings is for clinical practice sites to partner with colleges of pharmacy to recruit and maintain quality individuals who can meet the needs of diverse patient populations as well as expand student and resident training opportunities in underserved settings (AU)