Implementing the pharmacy technician role in existing pharmacy settings: Stakeholders views of barriers and facilitators.

BACKGROUND: The field of pharmacy will benefit from pharmacy technicians, a higher educated mid-level support workforce. They support pharmacists in providing pharmaceutical patient care through delegated roles and responsibilities. Empirical research on pharmacy technicians within pharmacy practice community and hospital pharmacy practices tends to focus on the practical outcomes of this workforce addition. It mostly addresses the 'WHAT' of service delivered by pharmacy technicians. Literature on the 'HOW' of their role development in practice is scarce. Furthermore, it seems difficult for most pharmacy technicians to effectively fulfil this professional role. OBJECTIVE: This qualitative study explored factors influencing role development of pharmacy technicians in community and hospital pharmacies. METHODS: On site, individual and small-group interviews were conducted with pharmacy technicians (n = 10), and two colleagues: pharmacists (n = 7) and pharmacy assistants (n = 6). Interviews were based on a semi-structured interview guide. Participants were asked to describe specific incidents and organisational, relational and pharmaceutical care perspectives, illustrative of the process of developing and implementing the pharmacy technician role. Template analysis was used to develop a list of codes representing themes identified in the data. RESULTS: Five interrelated themes influenced development and implementation of the pharmacy technician role. Two of them were at a more contextual level: (a) experiencing a lack of vision on added value of the new role within the field of pharmacy and (b) learning climate. The other three were related to personal interactions between staff members: (c) role expectations and organisational fit, (d) personal traits of pharmacy technicians and (e) support of pharmacy technicians through task delegation and role enhancement. CONCLUSIONS: The data showed that development and implementation of pharmacy technician roles is a complicated process. A detailed plan for addressing and remediating the five identified themes is important to promote role development of pharmacy technicians.

Educators' experiences with governance in curriculum change processes; a qualitative study using rich pictures.

In the midst of continuous health professions curriculum reforms, critical questions arise about the extent to which conceptual ideas are actually put into practice. Curricula are often not implemented as intended. An under-explored aspect that might play a role is governance. In light of major curriculum changes, we explored educators' perspectives of the role of governance in the process of translating curriculum goals and concepts into institutionalized curriculum change at micro-level (teacher-student). In three Dutch medical schools, 19 educators with a dual role (teacher and coordinator) were interviewed between March and May 2018, using the rich pictures method. We employed qualitative content analysis with inductive coding. Data collection occurred concurrently with data analysis. Different governance processes were mentioned, each with its own effects on the curriculum and organizational responses. In Institute 1, participants described an unclear governance structure, resulting in implementation chaos in which an abstract educational concept could not be fully realized. In Institute 2, participants described a top-down and strict governance structure contributing to relatively successful implementation of the educational concept. However it also led to demotivation of educators, who started rebelling to recover their perceived loss of freedom. In Institute 3, participants described a relatively fragmentized process granting a lot of freedom, which contributed to contentment and motivation but did not fully produce the intended changes. Our paper empirically illustrates the importance of governance in curriculum change. To advance curriculum change processes and improve their desired outcomes it seems important to define and explicate both hard and soft governance processes.

"My right-hand man" versus "We barely make use of them": change leaders talking about educational scientists in curriculum change processes-a Membership Categorization Analysis.

Health professions education scholarship units (HPESUs) are increasingly becoming a standard for medical schools worldwide without having much information about their value and role in actual educational practices, particularly of those who work in these units, the educational scientists. We conducted a linguistic analysis, called Membership Categorization Analysis, of interviews with leaders of recent curriculum changes to explore how they talk about educational scientists in relation to these processes. The analysis was conducted on previously collected interview data with nine change leaders of major undergraduate medical curriculum change processes in the Netherlands. We analyzed how change leaders categorize HPESUs and educational scientists (use of category terms) and what they say about them (predicates). We noticed two ways of categorizing educational scientists, with observable different predicates. Educational scientists categorized by their first name were suggested to be closer to the change process, more involved in decisional practices and positively described, whereas those described in more generic terms were represented in terms of relatively passive and unspecified activities, were less explicit referenced for their knowledge and expertise and were predominantly factually or negatively described. This study shows an ambiguous portrayal of educational scientists by leaders of major curriculum change processes. Medical schools are challenged to establish medical curricula in consultation with a large, diverse and interdisciplinary stakeholder group. We suggest that it is important to invest in interpersonal relationships to strengthen the internal collaborations and make sure people are aware of each other's existence and roles in the process of curriculum development.

Navigating the Complexities of Undergraduate Medical Curriculum Change: Change Leaders' Perspectives.

PURPOSE: Changing an undergraduate medical curriculum is a recurring, high-stakes undertaking at medical schools. This study aimed to explore how people leading major curriculum changes conceived of the process of enacting change and the strategies they relied on to succeed in their efforts. METHOD: The first author individually interviewed nine leaders who were leading or had led the most recent undergraduate curriculum change in one of the eight medical schools in the Netherlands. Interviews were between December 2015 and April 2016, using a semistructured interview format. Data analysis occurred concurrently with data collection, with themes being constructed inductively from the data. RESULTS: Leaders conceived of curriculum change as a dynamic, complex process. They described three major challenges they had to deal with while navigating this process: the large number of stakeholders championing a multitude of perspectives, dealing with resistance, and steering the change process. Additionally, strategies for addressing these challenges were described. The authors identified an underlying principle informing the work of these leaders: being and remaining aware of emerging situations, and carefully constructing strategies for ensuring that the intended outcomes were reached and contributed to the progress of the change process. DISCUSSION: This empirical, descriptive study enriches the understanding of how institutional leaders navigate the complexities of major medical curriculum changes. The insights serve as a foundation for training and coaching future change leaders. To broaden the understanding of curriculum change processes, future studies could investigate the processes through alternative stakeholder perspectives.