Use of a Modified Delphi Process to Define the Leadership Characteristics Expected of Pharmacy Faculty Members.

Objective. To reach a consensus on a working definition for leadership and identify expectations for leadership among all pharmacy faculty members. Methods. A modified Delphi process was employed to establish consensus among experienced department and division chairs regarding the definition and expectations of faculty leadership to guide faculty evaluation and development. From the AACP faculty roster, 280 department and division chairs were surveyed to identify participants with at least five years of experience in their roles and willingness to participate. Twenty-three chairs were identified from a variety of colleges and schools to comprise the expert panel and asked to participate in three rounds of questions over a two-month period. One Likert-type question and six open-ended questions were included in round 1. A thematic analysis of round 1 responses provided items for participants to rate their agreement with and provide comments on in rounds 2 and 3. Consensus for items was set prospectively at 80% of participants selecting agree or strongly agree for each item. Items could be modified by the panel in subsequent rounds of surveys if participants suggested edits to items. Results. Consensus was achieved among 23 chairs regarding a definition, 10 guiding principles, four learning competencies, six skills, six expected leadership activities (ELAs), and 20 personal characteristics related to faculty leadership. Conclusion. The results of this study provide guidance to pharmacy faculty members and administrators regarding leadership characteristics including knowledge, skills, and activities expected for faculty members to develop into effective leaders for the academy and the pharmacy profession.

Inviting manuscripts to Leadership Experience and Development Reports (LEADeR).

The Journal announces a new section called "Leadership Experience and Development Reports" within our Short Communications manuscript category. Manuscripts in this section seek to share scholarly activities and experiences within the area of leadership development that are rooted in a leadership framework, model, or theory. Submissions can include work related to student pharmacists, pharmacy residents, fellows, graduate students and faculty/staff development.

Identifying student learning competencies for urban underserved practice using a Delphi process.

INTRODUCTION: The pharmacy profession has a growing opportunity to provide high-quality patient care to urban underserved patients. The Accreditation Council for Pharmacy Education (ACPE) has also recognized the necessity of training pharmacy students to care for underserved patients within Standard 3.5 in Standards 2016. Despite this recognized need to train students to care for urban underserved patients, there is limited literature to guide schools and colleges of pharmacy in developing learning activities and curricula to meet this need. METHODS: This study utilized a three-round modified Delphi process to develop learning competencies. Participation was solicited from pharmacy practice faculty members of the American Association of Colleges of Pharmacy (AACP) Health Disparities and Cultural Competency Special Interest Group (SIG). This study used a proportion of experts rating agree or strongly agree at 80% to determine consensus. RESULTS: The expert pool had a combined 235 years of pharmacy practice experience in urban underserved settings. Ten learning competencies were developed and finalized: Identified learning competencies related to the development of pharmaceutical and social knowledge base; development of pharmaceutical care and social skills; and building awareness of benefits and disadvantages of working with urban underserved patient populations. DISCUSSION: The learning competencies described in this study provide schools and colleges of pharmacy a tool to help guide learning activity and curricular development to educate students to provide high-quality and compassionate care to urban underserved patients. CONCLUSIONS: This study is the first description of practice-based student learning competencies for urban underserved pharmacy practice in the literature.

Editors' Perspectives on Enhancing Manuscript Quality and Editorial Decisions Through Peer Review and Reviewer Development.

Objectives. To identify peer reviewer and peer review characteristics that enhance manuscript quality and editorial decisions, and to identify valuable elements of peer reviewer training programs. Methods. A three-school, 15-year review of pharmacy practice and pharmacy administration faculty's publications was conducted to identify high-publication volume journals for inclusion. Editors-in-chief identified all editors managing manuscripts for participation. A three-round modified Delphi process was used. Rounds advanced from open-ended questions regarding actions and attributes of good reviewers to consensus-seeking and clarifying questions related to quality, importance, value, and priority. Results. Nineteen editors representing eight pharmacy journals participated. Three characteristics of reviews were rated required or helpful in enhancing manuscript quality by all respondents: includes a critical analysis of the manuscript (88% required, 12% helpful), includes feedback that contains both strengths and areas of improvement (53% required, 47% helpful), and speaks to the manuscript's utility in the literature (41% required, 59% helpful). Hands-on experience with review activities (88%) and exposure to good and bad reviews (88%) were identified as very valuable to peer reviewer development. Conclusion. Reviewers, individuals involved in faculty development, and journals should work to assist new reviewers in defining focused areas of expertise, building knowledge in these areas, and developing critical analysis skills.

Guiding principles for student leadership development in the doctor of pharmacy program to assist administrators and faculty members in implementing or refining curricula.

OBJECTIVE: To assist administrators and faculty members in colleges and schools of pharmacy by gathering expert opinion to frame, direct, and support investments in student leadership development. METHODS: Twenty-six leadership instructors participated in a 3-round, online, modified Delphi process to define doctor of pharmacy (PharmD) student leadership instruction. Round 1 asked open-ended questions about leadership knowledge, skills, and attitudes to begin the generation of student leadership development guiding principles and competencies. Statements were identified as guiding principles when they were perceived as foundational to the instructional approach. Round 2 grouped responses for agreement rating and comment. Group consensus with a statement as a guiding principle was set prospectively at 80%. Round 3 allowed rating and comment on guidelines, modified from feedback in round 2, that did not meet consensus. The principles were verified by identifying common contemporary leadership development approaches in the literature. RESULTS: Twelve guiding principles, related to concepts of leadership and educational philosophy, were defined and could be linked to contemporary leadership development thought. These guiding principles describe the motivation for teaching leadership, the fundamental precepts of student leadership development, and the core tenets for leadership instruction. CONCLUSIONS: Expert opinion gathered using a Delphi process resulted in guiding principles that help to address many of the fundamental questions that arise when implementing or refining leadership curricula. The principles identified are supported by common contemporary leadership development thought.

Competencies for student leadership development in doctor of pharmacy curricula to assist curriculum committees and leadership instructors.

OBJECTIVE: To assist curriculum committees and leadership instructors by gathering expert opinion to define student leadership development competencies for pharmacy curricula. METHODS: Twenty-six leadership instructors participated in a 3-round, online, modified Delphi process to define competencies for student leadership development in pharmacy curricula. Round 1 asked open-ended questions about leadership knowledge, skills, and attitudes. Round 2 grouped responses for agreement rating and comment. Round 3 allowed rating and comment on competencies not yet meeting consensus, which was prospectively set at 80%. RESULTS: Eleven competencies attained 80% consensus or higher and were grouped into 3 areas: leadership knowledge, personal leadership commitment, and leadership skill development. Connections to contemporary leadership development literature were outlined for each competency as a means of verifying the panel's work. CONCLUSIONS: The leadership competencies will aid students in addressing: What is leadership? Who am I as a leader? What skills and abilities do I need to be effective? The competencies will help curriculum committees and leadership instructors to focus leadership development opportunities, identify learning assessments, and define program evaluation.

Investigating student pharmacist perceptions of professional engagement using a modified Delphi process.

OBJECTIVE: To develop a definition of professional engagement, a list of professionally engaging and disengaging activities, and characteristics of those activities. METHODS: A 2-round modified Delphi process was conducted using student pharmacists. The first round captured input while the second assessed agreement using a 5-point Likert scale. RESULTS: A definition was created using the 3 items that reached consensus. All engaging characteristics reached consensus, and 25% (3/12) of the disengaging characteristics reached consensus. Lower rates of consensus were observed for activities, with 78% (7/9) of the professionally engaging and none of the disengaging activities reaching consensus. CONCLUSION: The findings of this study have implications for creating professionally engaging learning experiences for student pharmacists and suggest that ensuring activities contain certain professionally engaging characteristics may be more important than the activities themselves.

Pharmacotherapy of fibromyalgia.

PURPOSE: Published evidence on the pathophysiology, diagnosis, and treatment of fibromyalgia is reviewed, with an emphasis on recent clinical trials of various pharmacologic agents. SUMMARY: Fibromyalgia affects an estimated 2% of the general U.S. population, and its incidence is sevenfold higher among women. The diagnostic characteristics of fibromyalgia are chronic widespread pain, thought to arise from abnormalities of ascending pain and descending inhibitory sensory pathways, and allodynia on palpation of specific tender points. Three medications available in the United States are labeled for treatment of fibromyalgia-related symptoms: the serotonin- and norepinephrine-reuptake inhibitors duloxetine and milnacipran and the α(2)-δ ligand pregabalin. Evidence from clinical trials indicates that all three drugs can have a significant impact on fibromyalgia-related pain; duloxetine and pregabalin have been demonstrated to reduce sleep disturbances and improve quality of life (the former also has been shown to improve mood), while milnacipran can offer significant benefits in reducing fatigue. A growing body of evidence suggests that the best treatment approach may involve the use of one or more agents whose mechanisms of action are aligned with patient-specific clusters of symptoms. Several other agents have been used for fibromyalgia, with mixed results, including tricyclic antidepressants, selective serotonin-reuptake inhibitors, opioids, and gabapentin. Given the limitations of the evidence from clinical trials to date, controlled trials directly comparing different agents are needed to better delineate adverse-event risks, cost considerations, and optimal management approaches. CONCLUSION: A broad range of drugs has been used to treat fibromyalgia. Symptoms, comorbidities, adverse effects, and patient preference are important considerations in drug selection.

Refinement of strengths instruction in a pharmacy curriculum over eight years.

OBJECTIVE: To develop, refine, and integrate introductory-level strengths instruction within a doctor of pharmacy (PharmD) curriculum. DESIGN: Over 8 years, student pharmacists completed the StrengthsFinder assessment tool and identified their top 5 Signature Themes (talents). They then participated in either Web-based learning modules or live workshops designed to facilitate professional development. ASSESSMENT: Students preferred the live instruction over Web-based learning modules. Post-instruction evaluations demonstrated that students discussed their Signature Themes with peers, preceptors, and family members. Pharmacists working with students in strengths-related activities reported that the students applied the information in the practice setting. Both pharmacists and students recommended that this material be required for all students. CONCLUSIONS: Identifying a role in pharmacy that aligns with one's personal talents is critical for the success of pharmacy graduates. Strengths instruction is an important component of professional and career development, and can aid in identifying roles.

Using personal strengths with intention in pharmacy: implications for pharmacists, managers, and leaders.

BACKGROUND: The importance of allowing individuals to use their strengths in a work environment has been articulated through research focused on general audiences as well as by thought leaders within pharmacy. In particular, the work of Gallup has described how organizations that foster an environment in which employees frequently use their strengths achieve increased productivity, customer and employee satisfaction, and improved success at meeting goals. Despite acknowledging the importance of such an environment, little has been articulated in the pharmacy literature regarding how pharmacists can identify and apply their unique strengths within their profession. OBJECTIVE: To provide an overview of the concept of individual strengths, the value of utilizing strengths in the profession, and the authors' experiences facilitating an awareness of this concept with student pharmacists, pharmacy residents, and pharmacists. METHODS: Discovery and application of strengths has become a foundational theme in leadership development activities at the University of Minnesota College of Pharmacy. The learning process begins with building awareness and identifying individual talents using the Clifton StrengthsFinder Profile and reflecting on previous use of these talents. Throughout the activities, participants are encouraged to examine how professional experiences that correlate with their talents intersect and affect their knowledge and skills. Finally, participants are encouraged to utilize and maximize their talents in a team environment. RESULTS: Experience has been gained delivering this educational process to 225 student pharmacists, 39 ambulatory care residents, and 22 practicing pharmacists. Participants have viewed this program favorably and articulated that utilization and growth of strengths is valuable to their career. CONCLUSIONS: In order to achieve our potential as a profession, it is critical to identify and apply the strengths that individual pharmacists bring to their practice settings. The identification, understanding, and application of strengths have the potential to increase professional satisfaction, enhance leadership, and empower change that will evolve patient-centered care.

Student leadership retreat focusing on a commitment to excellence.

OBJECTIVE: To design and evaluate a student leadership retreat focused on: leadership regardless of position or title, the need for passionate commitment to excellence, the importance of teamwork, and the value of self-reflection. DESIGN: Students in their second, third, and fourth year of a doctor of pharmacy (PharmD) program were invited to participate in an off-campus leadership retreat that combined organized learning activities and social/networking opportunities. Retreat content utilized didactic, experiential, and self-directed learning activities. ASSESSMENT: Forty-two students participated in the retreat and were surveyed pre- and post-retreat. A student-led group evaluation and course evaluations were also utilized. Responses on the post-retreat evaluation suggested an increased belief in their ability to influence change and an enhanced awareness of the role of self-reflection in creating excellence in the profession. CONCLUSION: An off-campus overnight retreat has value in challenging student perceptions about leadership and promoting reflection on their personal role in leading change within the profession Continued exploration and development of this format is warranted for commitment to excellence programming and also for additional leadership topics and audiences.

A pharmacy course on leadership and leading change.

OBJECTIVE: To develop and implement a course that develops pharmacy students' leadership skills and encourages them to become leaders within the profession. DESIGN: A leadership course series was offered to pharmacy students on 2 campuses. The series incorporated didactic, experiential, and self-directed learning activities, and focused on developing core leadership skills, self-awareness, and awareness of the process for leading change. ASSESSMENT: Students reported increased knowledge and confidence in their ability to initiate and lead efforts for change. The learning activities students' valued most were the StrengthsFinder assessment (67% of students rated "very useful") and a Leadership Networking Partners (LNP) program (83% of students rated "very useful"). CONCLUSION: Teaching leadership skills poses a significant challenge in curriculum development and requires multifaceted course design elements that resonate with students and engage the practice community. Addressing these requirements results in a high level of student engagement and a desire to continue the development of leadership skills.

Preparing pharmacy graduates for traditional and emerging career opportunities.

Educational programs in pharmacy must focus on educating pharmacists of the future who are prepared to serve as competent and confident health care "providers" whose "practice" can occur in any number of current and future settings; and whose expertise is essential to an interprofessional health care team. Graduates must be able to incorporate a scholarly approach to their practice in identifying patient care problems; practicing in an evidence-based manner; and ensuring safe, effective, and appropriate use of medications. It is time for colleges and schools of pharmacy to implement contemporary teaching and assessment strategies that facilitate effective and efficient student learning that is focused at the graduate professional level, to evolve the content around which the curriculum is organized, and clearly articulate the abilities graduates must have to function effectively in the myriad professional roles in which they may find themselves.

Assessing risk for loss of rural pharmacy services in Minnesota.

OBJECTIVE: To quantify rural communities' risks for losing access to local pharmacy services using a newly developed risk-assessment tool. DESIGN: Cross-sectional study. SETTING: Minnesota in June through August 2003. PARTICIPANTS: Pharmacy owners and managers in rural communities with populations less than 5,000 residents and only one community pharmacy. INTERVENTION: Self-administered questionnaire completed by study participants. MAIN OUTCOME MEASURES: Each answer was given a score based on the related factor's ability to affect risk of pharmacy closure. Scores were summed to give a comparative risk score with a positive score indicating higher risk; these scores could range from -13.5 to +30.75, depending on responses. RESULTS: From 126 communities outside of the Minneapolis-St. Paul metropolitan area with populations of fewer than 5,000 residents and only one community pharmacy, 81 (64.3%) usable responses were received. The calculated risk scores ranged from -7 to +12.3, with mean (+/- SD) scores of 1.55 +/- 4.17. Factors that contributed most to rural pharmacies' risk index were dramatic decreases in community populations within 5 years, poor community support for the pharmacy, owner's intent to sell pharmacy within 2 years, less than dollar 750,000 in annual prescription revenue, perceived erosion of total market share of prescriptions, difficulties in recruiting full-time pharmacist-employees, lack of access to local primary care, and perceived likelihood that local primary care clinics would not be active in 5 years. Approximately 26% of pharmacy owners responding expressed interest in selling their pharmacy within 3 years, and 62% were interested in selling within 10 years. CONCLUSION: The tool developed for this study allows prospective assessment of risk, which can facilitate a greater awareness by local and regional officials and consumers of the possibility of loss of rural pharmacies, assist in targeting resources to areas most in need, and serve as a bridge to collaborative relationships aimed at ensuring local access to both pharmacy services and the knowledge of a pharmacist.

Student pharmacist perspectives of rural pharmacy practice.

OBJECTIVE: To evaluate the level of interest of upper-level doctor of pharmacy students in rural pharmacy practice, rural pharmacy ownership, and a proposed rural pharmacy practice model. DESIGN: Cross-sectional study. SETTING: Minnesota, North Dakota, and South Dakota in October through December 2003. PARTICIPANTS: Third- and fourth-year professional student pharmacists at the University of Minnesota, North Dakota State University, and South Dakota State University. INTERVENTION: Self-administered questionnaire completed by study participants. MAIN OUTCOME MEASURES: Student interest in rural pharmacy practice and potential future directions for maintaining access to medications and the knowledge of pharmacists in rural communities. RESULTS: Of 177 respondents, 62.7% has given serious consideration to practice in rural communities with populations of 5,000 or fewer residents. Of these 111 students, 81% would be interested in the proposed practice model explained in the survey. Of the 108 total students expressing interest in the proposed rural pharmacy practice model, 63% had not previously given serious consideration to pursuing ownership (full or partnership) of a community pharmacy. CONCLUSION: Students from the schools that have traditionally supplied the majority of Minnesota rural pharmacists indicated an interest in practicing in rural areas as long as opportunities align with their personal and professional interests.