Recommendations for integration of foundational and clinical sciences throughout the pharmacy curriculum.

INTRODUCTION: Pharmacy faculty have the often difficult task of translating and incorporating existing concepts and advances from the foundational sciences into the clinical sciences and practice. This commentary focuses on content integration as a curricular and educational strategy, outcomes data from integration, and recommendations for programs employing or considering curricular integration. COMMENTARY: Integration of foundational and clinical sciences across the curriculum has been emphasized in accreditation standards but met with mixed reactions by faculty across different disciplines in the academy. Many pharmacy programs have already incorporated some level of integration in didactic courses. However, most report coordination of curricular delivery rather than higher levels of integration in which different disciplines work together to design and deliver instructional materials across the entire curriculum. IMPLICATIONS: Curricular integration models should be optimized to minimize or eliminate the risks of marginalization of foundational sciences in pharmacy curricula. A significant problem in implementing curricular integration is determining the appropriate balance between foundational and clinical sciences. Well-designed curricular integration with ongoing reinforcement that builds in complexity over time could enhance knowledge retention, critical thinking abilities, and clinical decision making. Further research is needed into the outcomes achieved from various integrated curricular approaches in pharmacy education.

Provision of Lifestyle Counseling and the Prescribing of Pharmacotherapy for Hyperlipidemia Among US Ambulatory Patients: A National Assessment of Office-Based Physician Visits.

BACKGROUND: An estimated 27.8% of the United States (US) population aged ≥20 years has hyperlipidemia, defined as total serum cholesterol of ≥240 mg/dL. A previous study of US physician office visits for hyperlipidemia in 2005 found both suboptimal compliance and racial/ethnic disparities in screening and treatment. OBJECTIVE: The aim was to estimate current rates of laboratory testing, lifestyle education, and pharmacotherapy for hyperlipidemia. METHODS: Data were derived from the US National Ambulatory Medical Care Survey (NAMCS), a nationally representative study of office-based physician visits, for 2013-2014. Patients aged ≥20 years with a primary or secondary diagnosis of hyperlipidemia were sampled. Study outcomes included receipt or ordering of total cholesterol testing, diet/nutrition counseling, exercise counseling, and pharmacotherapy prescription including statins, ezetimibe, omega-3 fatty acids, niacin, or combination therapies. RESULTS: Compared with previously reported results for 2005, rates of pharmacotherapy have remained static (52.2 vs. 54.6% for 2005 and 2013-2014, respectively), while rates of lifestyle education have markedly declined for diet/nutrition (from 39.7 to 22.4%) and exercise (from 32.1 to 16.0%). Lifestyle education did not vary appreciably by race/ethnicity in 2013-2014. However, rates of lipid testing were much higher for whites (41.6%) than for blacks (29.9%) or Hispanics (34.2%). Tobacco education was ordered/provided in only 4.0% of office visits. CONCLUSION: Compliance with guidelines for the screening and treatment of hyperlipidemia remains suboptimal, and rates of lifestyle education have declined since 2005. There exists an urgent need for enhanced levels of provider intervention to reduce the morbidity and mortality associated with hyperlipidemia.

Improvisational exercises to improve pharmacy students' professional communication skills.

OBJECTIVE: To create and implement improvisational exercises to improve first-year pharmacy students' communication skills. DESIGN: Twelve 1-hour improvisational sessions were developed and added to an existing/established patient communication course to improve 3 basic skills: listening, observing and responding. Standardized patient examinations were used to evaluate student communication skills, and course evaluations and reflective journaling were used to evaluate students' perceptions of the improvisational exercises. ASSESSMENT: The improvisational exercises markedly improved the students' performance in several aspects of standardized patient examination. Additionally, course evaluations and student comments reflected their perception that the improvisational exercises significantly improved their communication skills. SUMMARY: Improvisational exercises are an effective way to teach communication skills to pharmacy students.

Women's trust in and use of information sources in the treatment of menopausal symptoms.

BACKGROUND: Frequent shifts in expert opinion over whether or not women should use hormone therapy (HT) or another menopausal treatment have left women in a difficult position; they must determine where they can obtain trustworthy menopause information. In this study, conducted 10-12 months after the Women's Health Initiative study first published results, we identified sources women use for information about menopause treatments, identified how trust-related dimensions (trustworthiness, knowledge, helpfulness, bias, and vested interest) influenced use of these sources, and determined how these trust dimensions varied with women's HT use status. METHODS: A total of 765 women >45 and <61 years of age from a Midwestern managed care organization responded to a survey. Trust dimensions regarding family, friends, physicians, pharmacists, other health care providers (HCP), and various media as sources of menopause information, and use of these sources for menopause information were examined. RESULTS: Women ranked physicians significantly higher than pharmacists and other HCP for trustworthiness, helpfulness, and knowledgeability. Perceived bias, knowledgeability, and helpfulness showed the strongest influence on trust in physician as well as nonpharmacist HCP. Menopause stage, HT use status, and helpfulness influenced use of physician for information. Helpfulness and knowledgeability influenced trust in the pharmacist, whereas actual use was predicated on having used HT, trust, and helpfulness. CONCLUSIONS: Women who had never used HT trusted HCP less. HCP have important roles in providing menopause information to perimenopausal women. HCP may need to reach out and initiate these important discussions with their patients.