Evaluating the Need for Competency-Based Pharmacy Education (CBPE): The Report of the 2023-2024 Academic Affairs Standing Committee.

The 2023-2024 Academic Affairs Committee was charged to create a sense of urgency around the concept of Competency-Based Pharmacy Education and develop a "readiness for change" instrument that is based on the 5 essential elements that make up the definition of Competency-Based Pharmacy Education. This report describes the process undertaken by the committee to determine the societal needs of pharmacists and current state of pharmacy practice and pharmacy education. The practice gaps in pharmacy education and the key drivers needed to close these gaps are evaluated. To complete the charges, the committee conducted evidence-based literature reviews and completed a series of focus groups with stakeholders and thought leaders with experience in competency-based education.

The Need for Competency-Based Education.

OBJECTIVES: While pharmacy education updates learning as new information arises, changes to learning experiences can trail behind current practices and technology. There have been multiple calls for radical changes in how health professions education is delivered to ensure patients are receiving high-quality care. Competency-based education has been one way discussed in the literature for how to handle this need to develop students who have a willingness to learn and can problem-solve. The goal of this review is to examine whether competency-based education is needed to drive the profession of pharmacy forward. FINDINGS: To address, we collaboratively identified stakeholder perspectives to evaluate the need. The following stakeholders achieved consensus among the committee members: patients/society, learners, workplace/profession, and academic institutions. SUMMARY: Based on those perspectives, needs, and gaps to address those needs were identified and are presented in this review.

Evaluating the Strengths and Barriers of Competency-Based Education in the Health Professions.

OBJECTIVE: This study aimed to define competency-based education (CBE) for pharmacy education and describe how strengths and barriers of CBE can support or hinder implementation. FINDINGS: Sixty-five studies were included from a variety of health professions in order to define competency based pharmacy education (CBPE) and identify barriers and benefits from the learner, faculty, institution, and society perspectives. From the 7 identified thematic categories, a CBPE definition was developed: "Competency-based pharmacy education is an outcomes-based curricular model of an organized framework of competencies (knowledge, skills, attitudes) for pharmacists to meet health care and societal needs. This learner-centered curricular model aligns authentic teaching and learning strategies and assessment (emphasizing workplace assessment and quality feedback) while deemphasizing time." SUMMARY: This article provides a definition of CBE for its application within pharmacy education. The strengths and barriers for CBE were elucidated from other health professions' education literature. Identified implementation strengths and barriers aid in the discussions on what will support or hinder the implementation of CBE in pharmacy education.

Competency-based pharmacy education definition: What components need to be defined to implement it?

OBJECTIVES: This study aimed to define the essential elements in the proposed competency-based pharmacy education (CBPE) definition, provide the key defining components of each essential element on the basis of educational theory and evidence, and define how the essential elements meet the identified needs for CBPE. METHODS: best-practice integrative review was conducted as part of the work of the American Association of Colleges of Pharmacy CBPE Task Force to define the essential elements in the CBPE definition and how these elements fit with the need for CBPE. The definition was compared with other published competency-based education definitions across K-12, higher education, medical education, and veterinary education. Task Force members then met to develop a consensus on the core components of the 5 essential elements in the definition. Next, the Task Force evaluated the fit of CBPE by matching the identified needs, discussed in detail elsewhere, across each of the stakeholder perspectives with the core components of the 5 essential elements in the derived definition of CBPE. FINDINGS: Upon review of the proposed CBPE definition, the Task Force identified 5 essential elements. These elements include the following: meeting health care and societal needs, outcomes-based curricular model, de-emphasized time, learner-centered culture, and authentic teaching and learning strategies aligned to assessments. SUMMARY: This article helps to establish a common language for CBPE by defining the essential elements of the core components of the definition, and provides a starting point for further exploration of CBPE.

Recommendations and Next Steps For Competency-Based Pharmacy Education.

In July 2021, the chairs of the American Association of Colleges of Pharmacy Council of Deans, Council of Faculties, and Council of Sections developed a task force to discuss potential ways to improve pharmacy education. The Competency-Based Education (CBE) Joint Task Force was created to explore the pros and cons of advancing a competency-based approach to pharmacy education (CBPE) and to determine ways to create more flexibility within pharmacy curricula to enable CBE. To achieve these goals, the Task Force systematically reviewed available resources and outlined the pros and cons of CBPE, best practices for implementation, strategies to minimize barriers, and recommendations on whether CBE should be implemented in pharmacy education. This commentary summarizes the Task Force's findings regarding whether CBPE is a suitable approach for pharmacy education and the next steps if implemented.

Fulfilling the Tripartite Mission During a Pandemic.

This commentary examines the challenges pharmacy faculty members have faced while working to fulfill their school's tripartite mission of teaching, research, and service during the coronavirus identified in 2019 (COVID-19) pandemic. It also outlines considerations that need to be made before moving forward regarding communication, collaboration, and culture. The pandemic has created opportunities for pharmacy educators to take instructional risks and attempt new didactic and experiential teaching methods and assessment strategies. Working remotely has not only altered pharmacy education, but also scholarship and service. Conducting a broad range of collaborations with accelerated timelines to address COVID-19 has in some instances forged new relationships both between and within universities and focused faculty members on grantsmanship and writing. Faculty governance and administrative leadership have been focused on solving challenges resulting from the COVID-19 pandemic in a collaborative, transparent approach guided by faculty bylaws. Programs have found ways to use these changes to their advantage while advancing the mission of the Academy, which can contribute to changing the culture of how we interact and care about each other with the hope that the positive changes made have an enduring and meaningful impact for years to come.

How Faculty Recognized for Teaching Excellence Interpret and Respond to Student Ratings of Teaching.

Objective. To determine how experienced pharmacy educators who have been recognized for teaching excellence interpret and respond to end-of-course student ratings of their teaching. Methods. An expert sampling technique was used to identify pharmacy faculty members who had been recognized by the American Association of Colleges of Pharmacy (AACP) for teaching excellence as potential participants in the study. Sixteen of these faculty members were independently identified by two or more of the researchers as trusted candidates for the study, and 10 of these were randomly selected and invited to be interviewed via a web-conferencing platform. The interviews were transcribed and thematic analysis was used to identify overall themes. Results. Nine pharmacy faculty members representing both practice-based (n=5) and non-practice (n=4) backgrounds participated in the interviews. The three primary themes that emerged from the interviews regarding approach to interpreting student evaluations of instruction were "Use to improve," "Trends," and "Value input." The four primary themes that emerged regarding advice for new instructors were "Use to improve," "Reflect," "Do not take personally," and "Themes." Conclusion. The faculty participants recognized for teaching excellence were consistent in their attitudes of valuing student feedback and using it as a tool for continuous quality improvement. While recognizing the limitations of student ratings of teaching, the participants used them as part of a reflective and holistic approach to teaching. These teaching experts provided valuable insight for new instructors, such as do not compromise instruction and do not take student ratings personally.

Desirable Skills in New Pharmacists.

OBJECTIVE: To compare survey responses between licensed pharmacists who work with or employ new graduates and graduating senior pharmacy students at a college of pharmacy. DESIGN: This was a retrospective analysis of surveys given to 2 groups of pharmacists and students. Responses to items regarding importance of desirable qualities in new pharmacists and level of preparation of new graduates were analyzed. Qualities included drug information, pharmacology, therapeutics, communication with patients/customers or health care professionals, professionalism, ethics, management, and conflict resolution. RESULTS: There was consensus between pharmacists and students regarding the importance of all items ( P > .05 for all comparisons). However, the percentage of pharmacists versus students who agreed that new graduates communicate effectively differed (86.7% vs 100%, respectively, P < .05). Of pharmacists surveyed at a career fair, 64.1% chose communication as the 1 skill that would distinguish an applicant, and retail and hospital pharmacists displayed a statistically significant ( P < .05) difference in the audience (patients/customers vs other health care professionals). CONCLUSION: Pharmacists and students agree on the knowledge and skills essential for pharmacy practice but disagree on the level of preparation for effective communication. These results support ongoing efforts to improve the development of communication skills in the professional pharmacy curriculum.

Multiple Mini-Interview Performance Predicts Academic Difficulty in the PharmD Curriculum.

Objective. To identify admissions variable prognostics for academic difficulty in the PharmD curriculum to use for admissions determinations and early identification of at-risk students. Methods. Retrospective multivariate analysis of 2008-2012 admission data were linked with academic records to identify students with academic difficulty (ie, those with Ds, Fs, delayed progression). The influence of prepharmacy grade point average (GPA), composite Pharmacy College Admission Test (PCAT) score, multiple-mini interview (MMI) score, age, credit hours, state residence, and prior degree on academic difficulty was estimated using multivariate logistic regression. Results. Students' (n=587) prepharmacy GPA, composite PCAT score, mean MMI score, and age were 3.6, 72.0, 5.5, 22.8 (SD=4.14 years), respectively. Students having a GPA <3.25, PCAT score <60th percentile, or MMI score <4.5, were approximately 12-, 7-, and 3-times more likely, respectively, to experience academic difficulty than those with a GPA ≥ 3.75, PCAT score >90, or MMI score of 5-6. Conclusion. Using GPA, PCAT, and MMI performance can predict academic difficulty and assist in the early identification of academically at-risk PharmD students.

Development of a Summative Examination with Subject Matter Expert Validation.

Objective. To describe the development, implementation and impact of a summative examination on student learning and programmatic curricular outcomes. Methods. The summative examination was developed using a systematic approach. Item reliability was evaluated using standard psychometric analyses. Content validity was assessed using necessity scoring as determined by subject matter experts. Results. Almost 700 items written by 37 faculty members were evaluated. Passing standards increased annually (45% in 2009 to 67% in 2014) as the result of targeting item difficulty and necessity scores. The percentage of items exhibiting discrimination above 0.1 increased to 100% over the four years. Necessity scores above 2.75 out of 4 increased from 65% to 100% of items over six years of examination administration. Conclusion. This examination successfully assessed student and curricular outcomes. Faculty member engagement observed in this process supports a culture of assessment. This type of examination could be beneficial to other programs.

Pharmacy students' ability to think about thinking.

OBJECTIVE: To investigate students' metacognitive skills to distinguish what they know from what they do not know, to assess students' prediction of performance on a summative examination, and to compare student-identified incorrect questions with actual examination performance in order to improve exam quality. METHODS: Students completed a test-taking questionnaire identifying items perceived to be incorrect and rating their test-taking ability. RESULTS: Higher performing students evidenced better metacognitive skills by more accurately identifying incorrect items on the exam. Most students (86%) underpredicted their performance on the summative examination (actual = 73.6 ± 7.1 versus predicted = 63.7 ± 10.5, p < 0.05). Student responses helped refine items and resulted in examination changes. CONCLUSION: Metacognition is important to the development of life-long learning in pharmacy students. Students able to monitor what they know and what they do not know can improve their performance.

Factors associated with health-related quality of life of student pharmacists.

OBJECTIVE: To assess the health-related quality of life (HRQoL) of student pharmacists and explore factors related to HRQoL outcomes of student pharmacists in a doctor of pharmacy (PharmD) program at a public university. METHODS: A survey instrument was administered to all student pharmacists in a PharmD program at a public university to evaluate differences and factors related to the HRQoL outcomes of first-year (P1), second-year (P2), third-year (P3), and fourth-year (P4) student pharmacists in the college. The survey instrument included attitudes and academic-related self-perception, a 12-item short form health survey, and personal information components. RESULTS: There were 304 students (68.6%) who completed the survey instrument. The average health state classification measure and mental health component scale (MCS-12) scores were significantly higher for P4 students when compared with the P1through P3 students. There was no difference observed in the physical component scale (PCS-12) scores among each of the 4 class years. Significant negative impact on HRQoL outcomes was observed in students with higher levels of confusion about how they should study (scale lack of regulation) and concern about not being negatively perceived by others (self-defeating ego orientation), while school satisfaction increased HRQoL outcomes (SF-6D, p<0.001; MCS-12, p=0.013). A greater desire to be judged capable (self-enhancing ego-orientation) and career satisfaction were positively associated with the PCS-12 scores (p<0.05). CONCLUSION: Factors associated with the HRQoL of student pharmacists were confusion regarding how to study, ego orientation, satisfaction with the chosen college of pharmacy, and career satisfaction. First-year through third-year student pharmacists had lower HRQoL as compared with P4 students and the US general population. Support programs may be helpful for students to maintain or improve their mental and overall health.

A Faculty Toolkit for Formative Assessment in Pharmacy Education.

This paper aims to increase understanding and appreciation of formative assessment and its role in improving student outcomes and the instructional process, while educating faculty on formative techniques readily adaptable to various educational settings. Included are a definition of formative assessment and the distinction between formative and summative assessment. Various formative assessment strategies to evaluate student learning in classroom, laboratory, experiential, and interprofessional education settings are discussed. The role of reflective writing and portfolios, as well as the role of technology in formative assessment, are described. The paper also offers advice for formative assessment of faculty teaching. In conclusion, the authors emphasize the importance of creating a culture of assessment that embraces the concept of 360-degree assessment in both the development of a student's ability to demonstrate achievement of educational outcomes and a faculty member's ability to become an effective educator.

Center for the Advancement of Pharmacy Education 2013 educational outcomes.

An initiative of the Center for the Advancement of Pharmacy Education (formerly the Center for the Advancement of Pharmaceutical Education) (CAPE), the CAPE Educational Outcomes are intended to be the target toward which the evolving pharmacy curriculum should be aimed. Their development was guided by an advisory panel composed of educators and practitioners nominated for participation by practitioner organizations. CAPE 2013 represents the fourth iteration of the Educational Outcomes, preceded by CAPE 1992, CAPE 1998 and CAPE 2004 respectively. The CAPE 2013 Educational Outcomes were released at the AACP July 2013 Annual meeting and have been revised to include 4 broad domains, 15 subdomains, and example learning objectives.

Academic help-seeking behavior among student pharmacists.

Objectives. To identify factors associated with academic help-seeking behavior among student pharmacists at a public university.Methods. Semi-structured focus group interviews were conducted to explore in depth perceptions of facilitators of and barriers to the help-seeking behavior and academic achievement of student pharmacists who had received a D or F grade in any year. A 4-part survey instrument was developed and administered to all student pharmacists and included sections for (1) attitudes and academic help-seeking behavior, (2) health status, (3) demographics, and (4) open comments. A structural equation modeling approach was used to assess relationships among domains of interest.Results. Three student focus groups noted that helpfulness of faculty members and school administrators were 2 prominent facilitators of help-seeking behavior and academic achievement. Diminished quality of life caused by stress and depression was the primary barrier to help-seeking and achievement. Three hundred four (68.6%) student pharmacists completed the survey instrument. Academic help-seeking behavior was influenced mostly by perceived academic competence and perceived faculty helpfulness. In contrast, ambivalence and perception of help-seeking as threatening were 2 factors that were negatively associated with academic help-seeking behavior.Conclusions. Academic help-seeking behavior was positively related to greater perceived academic competence and positive relationships among student pharmacists and faculty members.

Lubiprostone for constipation in adults with cystic fibrosis: a pilot study.

BACKGROUND: Constipation is prevalent in the cystic fibrosis (CF) population and yet there are few data demonstrating the effectiveness of currently used treatments. Lubiprostone is a laxative that works by activating the type 2 chloride channel in the gastrointestinal tract and thus has the potential to be especially effective for constipation associated with CF. OBJECTIVE: To evaluate the effectiveness of lubiprostone for the treatment of constipation in adults with CF. METHODS: In this pilot study, participants acted as their own controls and comparisons were made between run-in and treatment periods. During the 2-week run-in period, participants continued their usual treatment for constipation; during the 4-week treatment period, participants received lubiprostone 24 µg twice daily. Efficacy outcomes included spontaneous bowel movement frequency, Bristol Stool Scale scores, and Patient Assessment of Constipation Symptoms (PAC-SYM) survey scores. Outcomes were assessed during both the run-in and treatment periods (0, 2, and 4 weeks of treatment). Safety outcomes included spirometry, body weight, and serum chemistry. RESULTS: Seven participants completed the study. Mean (SD) baseline forced expiratory volume in 1 second was 83.0% (9.4) of predicted and body mass index was 24.0 (2.8) kg/m², indicating an overall healthy, well-nourished group of adults with CF. Lubiprostone improved overall symptoms of constipation as measured by PAC-SYM survey scores (1.18 [0.56], 0.54 [0.27], and 0.44 [0.36] at 0, 2, and 4 weeks, respectively; p < 0.001). Spontaneous bowel movement frequency and Bristol Stool Scale scores were not statistically significantly different between periods. There were no differences in safety measures. Transient chest tightness and shortness of breath were reported by 2 separate participants, although neither participant withdrew due to these adverse effects. CONCLUSIONS: Lubiprostone may be an effective option for the treatment of constipation in adults with CF.

Human recombinant vascular endothelial growth factor reduces necrosis and enhances hepatocyte regeneration in a mouse model of acetaminophen toxicity.

We reported previously that vascular endothelial growth factor (VEGF) was increased in acetaminophen (APAP) toxicity in mice and treatment with a VEGF receptor inhibitor reduced hepatocyte regeneration. The effect of human recombinant VEGF (hrVEGF) on APAP toxicity in the mouse was examined. In early toxicity studies, B6C3F1 mice received hrVEGF (50 microg s.c.) or vehicle 30 min before receiving APAP (200 mg/kg i.p.) and were sacrificed at 2, 4, and 8 h. Toxicity was comparable at 2 and 4 h, but reduced in the APAP/hrVEGF mice at 8 h (p < 0.05) compared with the APAP/vehicle mice. Hepatic glutathione (GSH) and APAP protein adduct levels were comparable between the two groups of mice, with the exception that GSH was higher at 8 h in the hrVEGF-treated mice. Subsequently, mice received two doses (before and 10 h) or three doses (before and 10 and 24 h) of hrVEGF; alanine aminotransferase values and necrosis were reduced at 24 and 36 h, respectively, in the APAP/hrVEGF mice (p < 0.05) compared with the APAP/vehicle mice. Proliferating cell nuclear antigen expression was enhanced, and interleukin-6 expression was reduced in the mice that received hrVEGF (p < 0.05) compared with the APAP/vehicle mice. In addition, treatment with hrVEGF lowered plasma hyaluronic acid levels and neutrophil counts at 36 h. Cumulatively, the data show that treatment with hrVEGF reduced toxicity and increased hepatocyte regeneration in APAP toxicity in the mouse. Attenuation of sinusoidal cell endothelial dysfunction and changes in neutrophil dynamics may be operant mechanisms in the hepatoprotection mediated by hrVEGF in APAP toxicity.

Use of the chloride channel activator lubiprostone for constipation in adults with cystic fibrosis: a case series.

OBJECTIVE: To describe the use of lubiprostone for constipation in 3 adults with cystic fibrosis (CF). CASE SUMMARY: This case series describes the use of lubiprostone for the treatment of constipation in 3 adults with CF (mean +/- SD length of therapy 17.3 +/- 1.5 mo). All 3 patients were prescribed lubiprostone 24 microg twice daily after hospitalization for treatment of intestinal obstruction. Patient 1 continues on chronic polyethylene glycol (PEG) 3350 and lubiprostone and has not had a recurrence of obstruction. Patient 2 requires aggressive chronic therapy with PEG 3350, lubiprostone, and methylnaltrexone. She has had 1 recurrence of obstruction. Patient 3 continues with lubiprostone taken several times per week with good control of constipation and no recurrence of obstruction to date. The adverse effect profile has been tolerable in all 3 patients. DISCUSSION: CF is caused by a genetic mutation resulting in a dysfunctional or absent CF transmembrane conductance regulator that normally functions as a chloride channel. This results in viscous secretions in multiple organ systems including the lungs and intestinal tract. Accumulation of viscous intestinal contents contributes to constipation, which is common among adults with CF and can sometimes lead to intestinal obstruction. Lubiprostone is indicated for chronic constipation and works by activating type 2 chloride channels (ClC-2) in the intestinal tract. Because it utilizes an alternate chloride channel, lubiprostone may be especially effective for constipation in patients with CF. CONCLUSIONS: Lubiprostone provides an additional option for the treatment of constipation in adults with CF. Its use in the CF population deserves further study.

Multiple rubric-based assessments of student case presentations.

OBJECTIVES: To evaluate a rubric-based method of assessing pharmacy students' case presentations in the recitation component of a therapeutics course. METHODS: A rubric was developed to assess knowledge, skills, and professional behavior. The rubric was used for instructor, student peer, and student self-assessment of case presentations. Rubric-based composite scores were compared to the previous dichotomous checklist-based scores. RESULTS: Rubric-based instructor scores were significantly lower and had a broader score distribution than those resulting from the checklist method. Spring 2007 rubric-based composite scores from instructors and peers were significantly lower than those from the pilot study results, but self-assessment composite scores were not significantly different. CONCLUSIONS: Successful development and implementation of a grading rubric facilitated evaluation of knowledge, skills, and professional behavior from the viewpoints of instructor, peer, and self in a didactic course.

Candesartan cilexetil effectively reduces blood pressure in hypertensive children.

BACKGROUND: The angiotensin-receptor blocker candesartan cilexetil is a well-tolerated antihypertensive agent with demonstrated benefits in adults with hypertension. However, there are few data supporting its use in children with hypertension. OBJECTIVE: To determine the efficacy and tolerability of candesartan cilexetil in the treatment of pediatric hypertension. METHODS: In an open-label, uncontrolled pilot study, hypertensive pediatric patients were eligible for participation if untreated systolic and/or diastolic blood pressure (BP) exceeded the 95th percentile for sex, age, and height. Patients underwent a 7-day washout period prior to initiation of weight-based dosing of candesartan cilexetil (2-8 mg daily). The dose was doubled after 7 days of therapy if inadequate antihypertensive response was determined by clinic-measured casual BP monitoring (CBPM) and home BP monitoring (HBPM). Three methods of BP measurement were compared before and after 2 weeks of treatment with the final dose of candesartan cilexetil: CBPM, HBPM, and 24-hour continuous ambulatory BP monitoring (ABPM). Self-reported adverse effects and clinical laboratory analyses were used to determine tolerability. RESULTS: Eleven patients (mean age 14.2 y) received a final candesartan cilexetil median daily dose of 8 mg (0.13 mg/kg, range 2-16 mg). Study treatment resulted in significant reductions in systolic and diastolic BP as measured by CBPM (-7.4%, p = 0.03 and -5.9%, p = 0.01, respectively) and by ABPM (-6.0%, p = 0.03 and -10.8%, p = 0.006, respectively), but no significant reductions as measured by HBPM. No clinically significant changes in laboratory measures were observed, and patients reported nonspecific mild adverse effects. CONCLUSIONS: Candesartan cilexetil effectively reduced BP as demonstrated by CBPM and ABPM measurements and was well tolerated in this group of hypertensive children.