Perceptions of Remediation Policies and Procedures in Pharmacy Education.

OBJECTIVE: This study aimed to (1) explore the perceptions of current remediation processes among pharmacy program administrators and faculty, and (2) identify factors surrounding successful or unsuccessful remediation in a pharmacy program. METHODS: This qualitative study used the following 3 stakeholder focus groups with distinct perspectives: didactic faculty, experiential faculty, and administrators. A screening survey was used to identify eligible participants, and quota sampling was used to represent various institution types and stakeholder experience. Focus groups were conducted using structured interview questions by an expert interviewer who was not part of the research team. Data were coded using the constant comparison method until consensus was achieved on the identified themes. RESULTS: Three themes associated with remediation were identified with 12 coded categories. The codes discussed by all 3 stakeholder groups included methods to identify students who need remediation, types of remediation, remediation challenges, consequences of remediation, remediation effectiveness, and necessary improvements to the remediation process. The didactic and experiential faculty groups discussed the management of remediation plans, methods of remediation prevention, and lessons learned from remediation. The timing of remediation was discussed by didactic faculty. The experiential faculty noted the need for preceptor development to provide timely feedback and ensure successful remediation. All 3 groups mentioned having clear policies and procedures for successful remediation. CONCLUSION: Overall, faculty and administrators had similar perceptions regarding remediation practices. The differences in concerns about remediation were most notable between the experiential and didactic faculty. While all 3 groups believed that remediation may be useful and necessary, challenges remain and monitoring is needed to determine the most effective practices, particularly in experiential education.

A Survey Evaluation of the American Association of Colleges of Pharmacy New Investigator Award Program.

OBJECTIVE: Sponsored by the American Association of Colleges of Pharmacy (AACP), the New Investigator Award (NIA) provides start-up funding for the independent research programs of early-career faculty. However, there is limited information on outcomes. Thus, the objective was to determine the impact of the NIA program on the stimulation of recipient research programs and AACP involvement. METHODS: A cross-sectional survey of 2012-2022 NIA Award recipients and current pharmacy Department Chairs was conducted. The instruments (NIA Recipient:28-items, Chair:15-items) were administered via Qualtrics with data reported descriptively. RESULTS: Responses were received from 96 NIA recipients and 157 Chairs (60%, 49% response rate). From the NIA recipients, most respondents received the award within their first 2 years of appointment (59%), received it on the first submission (61%), remained in academia (96%) at the same institution (90%), and were AACP members (80%) with a variety of involvement. Projects were typically completed (81%) and utilized for another grant (51%). Two-thirds of faculty had received external funding post-NIA (64%), and most felt the grant was valuable or very valuable. From the Department Chair survey, 40% had NIA recipients and 13% had served as a mentor. Departments did not have an NIA development/review process (77%) but had a mentoring program (59%). Most perceived the NIA program to be valuable/very valuable. CONCLUSION: Overall, chairs and NIA recipients have positive perceptions of the value of the NIA and recipients reported evidence of scholarly success.

Effects of Advanced Pharmacy Practice Experience Characteristics on Postgraduate Year 1 Residency Match Rates.

BACKGROUND: Mentors often provide advice to students regarding selection of Advanced Pharmacy Practice Experience (APPE) rotations to strengthen their candidacy for a residency position. However, the impact of APPE characteristics on the chances of matching is unknown. OBJECTIVE: To determine the impact of APPE characteristics on Post Graduate Year-1 (PGY1) residency match rates at a Midwest US college of pharmacy. METHODS: Graduates from a single college of pharmacy who participated in the PGY1 match in 2015 or 2016 were included. Match data were obtained from National Matching Services. APPE characteristics (e.g., rotation timing relative to the Midyear Clinical Meeting [MCM], rotation type, and setting) were stratified by matched status. Independent predictors were identified using multivariate logistic regression and tree-based models. RESULTS: Ninety-nine students were included with 57 matching (57.6%). Students completing an infectious diseases rotation (75 vs. 51%; p = 0.028), a hospital rotation before the MCM (67 vs. 47%; p = 0.039), or a rotation in an ambulatory care clinic (67 vs. 47%; p = 0.045) were more likely to match. Students completing an independent community pharmacy rotation were less likely to match (8.3 vs. 64%; p < 0.001). After multivariate adjustment, all of these factors were associated with the likelihood of matching except completion of an infectious diseases (p = 0.077) or ambulatory care rotation (p = 0.073). CONCLUSION: A hospital rotation prior to the MCM was positively associated with matching while completion of an independent community pharmacy rotation was associated with non-matched status. The utility of these findings in guiding APPE selections for students pursing residency should be explored.

Focus group describing simulation-based learning for cardiovascular topics in US colleges and schools of pharmacy.

INTRODUCTION: This qualitative focus group study sought to describe how colleges of pharmacy use simulation-based learning (SBL) to teach cardiovascular topics and to identify challenges and benefits. MATERIAL AND METHODS: Participants were recruited from a screening survey disseminated via e-mail to select American College of Clinical Pharmacy Practice and Research networks. Subjects were selected based on diversity in institution and simulation types. Two 1-hour focus group sessions were conducted by the primary investigator following a script designed by the research team. Each recorded session was independently reviewed by all investigators and coded into final themes. Results are reported in a qualitative fashion. RESULTS: Five individuals provided consent and participated. Themes identified include topics, formats, interprofessional education, challenges, strategies for success, and benefits. Frequent topics included advanced cardiac life support, heart failure, hypertension, and transitions of care. Multiple formats were used including standardized patients or providers, task trainers, and high-fidelity mannequins. Multiple institutions reported simulating interprofessional teams by involving students from other health professions. Scheduling, pharmacy program size, faculty availability, and logistics around planning and/or conducting an event were identified challenges. Institutions reported success when clear expectations were provided to students and skill development progressed from low-stakes to high-stakes events. Benefits reported included real world applicability with participants noting that students do not realize the importance of SBL until they have reached rotations. CONCLUSIONS: Various topics and simulation methods were employed to teach cardiovascular topics. While challenges exist, institutions have identified strategies for success and report students recognized the benefits to their learning.

Adverse Events Due to Insomnia Drugs Reported in a Regulatory Database and Online Patient Reviews: Comparative Study.

BACKGROUND: Patient online drug reviews are a resource for other patients seeking information about the practical benefits and drawbacks of drug therapies. Patient reviews may also serve as a source of postmarketing safety data that are more user-friendly than regulatory databases. However, the reliability of online reviews has been questioned, because they do not undergo professional review and lack means of verification. OBJECTIVE: We evaluated online reviews of hypnotic medications, because they are commonly used and their therapeutic efficacy is particularly amenable to patient self-evaluation. Our primary objective was to compare the types and frequencies of adverse events reported to the Food and Drug Administration Adverse Event Reporting System (FAERS) with analogous information in patient reviews on the consumer health website Drugs.com. The secondary objectives were to describe patient reports of efficacy and adverse events and assess the influence of medication cost, effectiveness, and adverse events on user ratings of hypnotic medications. METHODS: Patient ratings and narratives were retrieved from 1407 reviews on Drugs.com between February 2007 and March 2018 for eszopiclone, ramelteon, suvorexant, zaleplon, and zolpidem. Reviews were coded to preferred terms in the Medical Dictionary for Regulatory Activities. These reviews were compared to 5916 cases in the FAERS database from January 2015 to September 2017. RESULTS: Similar adverse events were reported to both Drugs.com and FAERS. Both resources identified a lack of efficacy as a common complaint for all five drugs. Both resources revealed that amnesia commonly occurs with eszopiclone, zaleplon, and zolpidem, while nightmares commonly occur with suvorexant. Compared to FAERS, online reviews of zolpidem reported a much higher frequency of amnesia and partial sleep activities. User ratings were highest for zolpidem and lowest for suvorexant. Statistical analyses showed that patient ratings are influenced by considerations of efficacy and adverse events, while drug cost is unimportant. CONCLUSIONS: For hypnotic medications, online patient reviews and FAERS emphasized similar adverse events. Online reviewers rated drugs based on perception of efficacy and adverse events. We conclude that online patient reviews of hypnotics are a valid source that can supplement traditional adverse event reporting systems.

Validity and reliability pilot study of a tool for assessing ambulatory care pharmacist practice.

PURPOSE: The reliability and validity of a survey tool that aims to assess and stratify patient care services provided by ambulatory care pharmacists were evaluated. METHODS: The Tool for Assessing Ambulatory Care Pharmacist Practice (TAAPP) was developed by updating the Pharmaceutical Care Clinical Pharmacist Questionnaire. The TAAPP is organized into 2 sections that include 5 domains derived from the Pharmacists' Patient Care Process (PPCP). The first section of the TAAPP gathers the demographic information of the respondents as well as practice site characteristics. The second section aims to assess the activities that ambulatory care pharmacists participate in when providing direct patient care, stratified by PPCP domains. After the TAAPP was created, face validity was established by the study investigators and content validity was confirmed by 5 experts in ambulatory care pharmacy. Lastly, a reliability study was conducted and included pharmacists providing ambulatory care services in outpatient clinics who had been working at their clinical practice site for at least 2 years. The survey was disseminated electronically through a national pharmacy organization listserver. RESULTS: The results of this pilot study support both face and content validity of the TAAPP survey as well as internal consistency reliability of the TAAPP scores when used to evaluate pharmaceutical practices of ambulatory care pharmacists practicing in outpatient clinics throughout the United States. CONCLUSION: Internal consistency reliability testing demonstrated that the TAAPP scores were reliable with a Cronbach's α of >0.7 for each domain and the TAAPP overall.

Effect of application score strategy on interviews offered to postgraduate year 1 pharmacy residency applicants.

OBJECTIVES: Residency programs may need to spend a large amount of time on the application review process in order to invite the best candidates for interviews. By using a different scoring strategy, this process could be made more efficient while still resulting in selection of the most appropriate candidates to interview. The objective of this study was to explore hypothetical scoring strategies for past residency applicants and to determine the percentage of these applicants that would have received an interview offer compared with the program's standard scoring strategy. METHODS: Two years of residency applications to a postgraduate year 1 (PGY1) program providing the majority of clinical experience in ambulatory care were analyzed. Four models were explored: 1) standard model (original method); 2) simplified model (derived from statistical methods); 3) intuition model (criteria thought to best exemplify program success); and 4) objective model (criteria easy to objectively record, e.g., grade point average). All 3 new models were compared with the standard model to determine the percentage of candidates who would have received an interview if their applications had been scored according to the new model. RESULTS: A total of 110 applications were reviewed (42 interviews offered). After a multivariable analysis, academics, leadership, interest in ambulatory care, and professionalism were included in the simplified model, which predicted 81% of the interviews offered through the standard model. The intuition and objective models predicted 71% and 48% of interviews offered through the standard model, respectively. CONCLUSION: Models scoring only 4 of the initial 12 criteria would have likely predicted 71% to 81% of original interview offers. Residency programs should consider periodically reviewing their application review processes to determine areas for improved efficiency.

Impact of health disparities on staff workload in pharmacist-managed anticoagulation clinics.

PURPOSE: Pharmacists' provision of services unrelated to anticoagulant therapy at an anticoagulation clinic in an area of prevalent health disparities (health status differences between minority and nonminority populations) was evaluated. SUMMARY: A prospective cohort study was conducted to compare the frequency and types of additional services (i.e., services unrelated to anticoagulation) provided by pharmacists during an eight-week period at an urban clinic serving a primarily minority and socioeconomically disadvantaged patient population (clinic A) and a suburban clinic serving a primarily nonminority and affluent population (clinic B). Over the study period, additional services were provided during 42% of all patient visits (n = 444) at clinic A and 8% of all visits (n = 443) at clinic B. The most commonly provided additional services involved nonanticoagulation-related medical problems, which were addressed during about 9% of visits at clinic A and 3% of visits at clinic B; other additional services included setting up appointments, arranging transportation, and providing refills of nonanticoagulant medications. Missed appointments, early or late arrivals, and walk-in appointments were much more common at clinic A. The average daily pharmacist-staffing requirement was 3.8 hours higher at clinic A; over the entire study period, clinic A required a total of about 60 more staffed hours than clinic B. CONCLUSION: Pharmacists practicing in an anticoagulation clinic serving an area of prevalent health disparities frequently spent a substantial amount of time addressing medical problems and administrative tasks unrelated to anticoagulation therapy.