Transitioning From Points-Based Grading to a Modified Pass/Fail Grading Approach in a Simulated Patient Program.

OBJECTIVE: To determine the impact of transitioning from points-based grading to a modified pass/fail grading approach in a simulated patient (SP) program on first year pharmacy (P1) student performance in a PharmD curriculum. METHODS: Course-level data from the 2021-2022 and 2022-2023 academic years were collected to assess the impact of transitioning to a modified pass/fail grading approach on P1 student performance. During the 2021-2022 academic year, points-based grading was used. In 2022-2023, a modified pass/fail grading approach was implemented: communication assessment used pass/fail grading and clinical assessment used points-based grading; each assessment was worth 50% of the total SP activity grade. Chi-square tests were used to compare the percentage of students who passed each assessment (≥70%) with those who failed. RESULTS: Across both academic years, students completed 9 formative (18 rubrics) and 6 summative (12 rubrics) SP activities. Each activity included separate communication and clinical assessment rubrics. There were no significant differences in performance on 27 of 30 rubrics. There were two formative SP activities where the percentage of students who passed the communication assessment using pass/fail grading (2022-2023 academic year) was different than points-based grading (2021-2022 academic year). In one fall semester activity, the cohort with the modified pass/fail grading approach had lower pass rates, but the opposite trend was observed in the winter semester. CONCLUSION: Our program was able to successfully move to a pass/fail approach for communication assessments of SP activities while maintaining points-based grading for clinical assessments in our P1 curriculum with minimal impact on student performance.

The Impact of an Early Clinical Experience on Pharmacy Student Learning About Ambulatory Care Practice.

Objective. To determine whether student confidence in their knowledge of ambulatory care pharmacy and ability to contribute to patient care in this setting increased after participating in an ambulatory care introductory pharmacy practice experience (IPPE), and whether it changed student interest in pursuing a career in ambulatory care pharmacy.Methods. Second-year pharmacy students (n=86) completed a required ambulatory care experience which included four hours of didactic work and 13.5 hours of clinic experience with an ambulatory care pharmacist. Before and after the experience, students completed an eight-question survey in which they rated their confidence in their knowledge of ambulatory care practice and in providing patient care in this setting, as well as their interest in a career in ambulatory care. A five-point Likert scale was used to assess student confidence (1=not at all confident, 5=very confident) and interest in ambulatory care (1=not at all interested, 5=extremely interested). The Wilcoxon signed rank test was used to compare pre-post survey responses.Results. Eighty-five pharmacy students completed both the pre- and post-survey. Median scores on the post-intervention test increased from 3 to 4 in seven of the domains assessed. Student interest in a career in ambulatory care remained unchanged.Conclusion. An ambulatory care IPPE increased student confidence in their understanding of ambulatory care pharmacy practice and caring for patients in this setting.

Impact of virtual simulation in self-care therapeutics course on introductory pharmacy practice experience self-care encounters.

BACKGROUND AND PURPOSE: Pharmacy education programs use simulation to provide a realistic and safe environment for student learning. We studied whether incorporation of virtual simulation into a required first year self-care therapeutics course impacted frequency of interactions, self-reported student confidence, and preceptor-reported student performance during second-year community pharmacy introductory pharmacy practice experiences (IPPEs). EDUCATIONAL ACTIVITY AND SETTING: Virtual simulation cases using MyDispense were incorporated into a self-care therapeutics course in winter 2017. Students and preceptors were surveyed at the end of the fall semester community pharmacy IPPE. Data from IPPE experiences was compared with students who took the self-care therapeutics course in winter 2016 (control). FINDINGS: Students completed 30 virtual simulation cases and three cases as part of the final examination (n = 33). Students in the intervention group reported more patient care interactions during their IPPEs than students who did not complete virtual simulation cases, but there was no difference in self-reported confidence. Preceptors did not report any differences in the ability of students to complete over-the-counter medication interactions during IPPEs. SUMMARY: Cases were well received by students although they took longer to complete than initially anticipated. Students in the intervention group reported significantly more patient care interactions during IPPEs than those in the control group; however, there were no differences in self-reported confidence. Incorporation of virtual simulation was a sustainable change as the cases were able to be re-used the following year with minimal edits.

Mothers in academic pharmacy.

INTRODUCTION: The proportion of women pharmacists has been rapidly increasing for many years, from 43.3% of licensed pharmacists in 2000 to 52.7% in 2014. Yet women may be less likely to consider certain positions in pharmacy due to concerns of balancing work and motherhood responsibilities. The terms "motherhood penalty" and "baby penalty" have been used to describe the consequences of child-bearing responsibilities on the careers of women, including academic pharmacy. Many workplaces have established interventions to address the motherhood and baby penalties, including policies such as extended child-bearing leave and better childcare options. COMMENTARY AND IMPLICATIONS: However, there is still much understanding and improvement needed from the pharmacy academy administration to elicit a true change in culture. How can we create this culture shift? This article emphasizes a call to action to address this need for change.

Description of pharmacist-led quality improvement huddles in the patient-centered medical home model.

OBJECTIVES: This case study describes the implementation of pharmacist-led quality improvement team huddles in the patient-centered medical home clinic model. The purpose of these huddles is to have an impact on clinic-based quality metrics. SETTING: Pharmacists embedded into primary care clinics at 2 separate health centers, within a large academic medical center, were funded by the clinics to lead their quality improvement (QI) team huddles. PRACTICE DESCRIPTION: Huddle team members vary depending on the practice sites and can include physicians, pharmacists, advanced practice providers, nurses, administrative managers, social workers, and medical assistants. These huddles are typically held every 1-2 weeks for 15-20 minutes. Small rapid plan-do-check-act cycles allow the process to be quickly assessed and altered if needed. The quality metric that the team focused on changed based on clinic goals. Two case studies showcase successful examples of quality improvement initiatives that had a significant impact on the individual clinic-based metrics. INNOVATION: The 2 case studies focus on pharmacist-led quality team huddles for controlled substance and asthma action plan metrics. The clinical pharmacists involved were pivotal to organizing and helping incorporate new processes within their clinics sites. RESULTS: The work of the team huddles brought the clinics from a nonreimbursable status to reimbursable for these metrics. DISCUSSION: Because pharmacists in the ambulatory care setting focus on chronic care disease management and QI, they are in an excellent position to lead team huddles focused on QI and registry management. By establishing interdisciplinary QI team huddles led by clinical pharmacists, these clinics were able to increase revenue for the clinic in the way of increasing pay-for-performance measures. CONCLUSION: Pharmacist-led quality improvement team huddles can have a positive impact on quality metrics, population health, and reimbursement.

A Randomized Crossover Comparison between Team-Based Learning and Lecture Format on Long-Term Learning Outcomes.

There are limited data evaluating the effectiveness of different teaching pedagogies to maintain gains in learning achieved over the short term. The purpose of this study is to compare long-term learning outcomes between two different teaching pedagogies, team-based learning (TBL) and lecture. Within a therapeutic elective course a randomized crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). Six months following completion of the course, 47 assessment questions (application and recall multiple-choice questions) were re-administered to 16 students from the class with no prior announcement of the assessment. The results showed no significant difference in long-term assessment scores between TBL and lecture formats (67 ± 14% vs. 63 ± 16%, p = 0.2, respectively). In addition, there was a significant (p < 0.0001) and similar decline in short-term gains for TBL (90 ± 9% vs. 67 ± 14%) and lecture (86 ± 11% vs. 63 ± 16%) in assessment scores. In conclusion, there was no advantage gained by employing an active-learning pedagogy when assessing multiple-choice questions six months following end of a therapeutics course in a limited sample size. Neither pedagogy was able to maintain short-term gains in learning outcomes as assessed by multiple-choice questions.

Qualitative Analysis of Student Perceptions Comparing Team-based Learning and Traditional Lecture in a Pharmacotherapeutics Course.

Objective. To qualitatively compare students' attitudes and perceptions regarding team-based learning (TBL) and lecture. Design. Students were exposed to TBL and lecture in an elective pharmacotherapeutics course in a randomized, prospective, cross-over design. After completing the course, students provided their attitudes and perceptions through a written self-reflection and narrative questions on the end-of-course evaluation. Student responses were reviewed using a grounded theory coding method. Assessment. Students' responses yielded five major themes: impact of TBL on learning, perceptions about TBL learning methods, changes in approaches to learning, building skills for professional practice, and enduring challenges. Overall, students report TBL enhances their learning of course content (knowledge and application), teamwork skills, and lifelong learning skills. Conclusion. Students' attitudes and perceptions support TBL as a viable pedagogy for teaching pharmacotherapeutics.

A Randomized Crossover Comparison of Team-based Learning and Lecture Format on Learning Outcomes.

Objective. To compare learning outcomes and student confidence between team-based learning (TBL) and lecture. Methods. A crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). There were two assessments of 24 questions each. A survey (Likert scale) assessing student confidence and attitudes was administered at the end. Results. A significantly higher overall examination score was observed for TBL as compared to lecture. Students were more confident in providing therapeutic recommendations following TBL. Higher survey scores favoring TBL were also seen related to critical-thinking skills and therapeutic knowledge. Conclusion. Learning outcomes and student confidence in performing higher-order tasks were significantly higher with TBL. The findings of this novel crossover type design showed that TBL is an effective pedagogy.

Team-based learning to improve learning outcomes in a therapeutics course sequence.

OBJECTIVE: To compare the effectiveness of team-based learning (TBL) to that of traditional lectures on learning outcomes in a therapeutics course sequence. DESIGN: A revised TBL curriculum was implemented in a therapeutic course sequence. Multiple choice and essay questions identical to those used to test third-year students (P3) taught using a traditional lecture format were administered to the second-year pharmacy students (P2) taught using the new TBL format. ASSESSMENT: One hundred thirty-one multiple-choice questions were evaluated; 79 tested recall of knowledge and 52 tested higher level, application of knowledge. For the recall questions, students taught through traditional lectures scored significantly higher compared to the TBL students (88%±12% vs. 82%±16%, p=0.01). For the questions assessing application of knowledge, no differences were seen between teaching pedagogies (81%±16% vs. 77%±20%, p=0.24). Scores on essay questions and the number of students who achieved 100% were also similar between groups. CONCLUSION: Transition to a TBL format from a traditional lecture-based pedagogy allowed P2 students to perform at a similar level as students with an additional year of pharmacy education on application of knowledge type questions. However, P3 students outperformed P2 students regarding recall type questions and overall. Further assessment of long-term learning outcomes is needed to determine if TBL produces more persistent learning and improved application in clinical settings.

Employer-based patient-centered medication therapy management program: evidence and recommendations for future programs.

OBJECTIVE: To evaluate a patient-centered employer-based medication therapy management (MTM) program. DESIGN: Randomized controlled study. SETTING: Health promotion program at the University of Michigan from June 2009 to December 2011. PARTICIPANTS: Employees, retirees, and their dependents taking seven or more prescription medications. INTERVENTION: Focus on Medicines (FOM) was a two-visit, patient-centered service with a 4-month follow-up. A comprehensive medication review occurred during the first visit. Pharmacists provided recommendations and a medication action plan at the second visit. The MAP incorporated patient preferences for problem resolution. MAIN OUTCOME MEASURES: Patient uptake, medication cost, medication adherence, patient satisfaction with treatment, patient reasons for participation, patient satisfaction with the FOM program, drug-related problems, pharmacist recommendations, implementation of recommendations. RESULTS: The FOM program attracted 128 individuals wanting information about their medications and an individualized drug regimen assessment to ensure that their therapy was safe and effective and that all medications were necessary. On average, 3.3 medication therapy problems were identified per patient; most were safety related. Overall, 63% of pharmacist recommendations were implemented. When a prescriber was contacted, 83% of pharmacist recommendations were implemented. A reduction in drug cost for patients and the employer was shown. Patients reported improved convenience in taking medications and rated the program favorably. CONCLUSION: A personalized dialogue about medication use appears to meet a need among individuals taking large numbers of medications. Understanding why patients participate in MTM programs and what program features patients appreciate is useful in designing quality MTM programs.

Patient-centered medical home: developing, expanding, and sustaining a role for pharmacists.

PURPOSE: The development of a patient-centered medical home (PCMH) health care model and the role of pharmacists in PCMHs at the University of Michigan are described. SUMMARY: In 2009, Blue Cross Blue Shield of Michigan (BCBSM) provided financial incentives to physician groups to implement PCMH principles. A partnership was formed among the department of pharmacy, college of pharmacy, and faculty group practice at the University of Michigan Health System (UMHS) to integrate clinical pharmacists into the PCMH model at eight general medicine practices. The rationale was that PCMH pharmacists could assist in managing chronic conditions by substituting or augmenting physician care, help achieve quality indicators, and increase revenue by billing for their services. At the University of Michigan, PCMH pharmacists currently provide direct patient care services at eight general medicine health centers for patients with diabetes, hypertension, hyperlipidemia, and polypharmacy, which are billable using T codes, which are payable to UMHS by most BCBSM plans. In the first year, the number of PCMH pharmacist half-day clinics varied from one to six per health center, and the mean number of patients per half-day clinic ranged from 2.2 to 6. Pharmacists in four PCMHs made more medication changes per visit than the other four, particularly for patients with diabetes. CONCLUSION: At the University of Michigan, PCMH pharmacists currently provide direct patient care services at eight general medicine health centers for patients with diabetes, hypertension, hyperlipidemia, and polypharmacy via referral from physicians.