Longitudinal Assessment of Empathy and Burnout Across a Single Pharmacy Class Cohort.

OBJECTIVE: This is a final analysis of longitudinal evaluation of burnout and empathy among a cohort of Doctor of Pharmacy students throughout their 4-year enrollment. METHODS: The class of 2021 received sequential Qualtrics (Qualtrics, Provo, UT) surveys containing 2 validated survey instruments, the Jefferson Scale of Empathy and the Maslach Burnout Inventory. Surveys were disseminated at the start of the program (PY1start) and the end of each academic year (PY1end, PY2, PY3, PY4). Linear mixed models accounting for repeated measures, Generalized Estimating Equation, and Cochran's Q statistic were used to evaluate longitudinal change in the Jefferson Scale of Empathy and Maslach Burnout Inventory survey scores, categorized subscales, and burnout. RESULTS: Matched survey responses were included for 91 students (85.8% response rate). Across all years, a decrease in empathy and professional efficacy and an increase in exhaustion and cynicism was seen. High categorical levels of exhaustion and cynicism indicated evidence of burnout throughout the program. Year-to-year analysis indicated statistically significant increases in exhaustion and cynicism between PY1start and all subsequent assessments, a decrease in professional efficacy from PY1start to PY1end and PY2, and a decrease in empathy for PY1start to PY1end. CONCLUSION: Students reported trends of decreasing empathy and professional efficacy, with a simultaneous increase in exhaustion and cynicism. Further evaluation of the impact of COVID-19 on these results, as well as additional methods to support overall student wellness, is needed.

Evolution of a capstone exam for third-year doctor of pharmacy students.

BACKGROUND AND PURPOSE: Pharmacy capstone exams are an example of an assessment strategy to evaluate student competency and practice-readiness. Capstone exam processes have been discussed in the literature; however, description of format, evolution of the process, and implementation in the year prior to rotations is lacking. This manuscript discusses the development, implementation, and utilization of a third professional year pharmacy capstone exam to assess advanced pharmacy practice experience (APPE) readiness. EDUCATIONAL ACTIVITY AND SETTING: A pharmacy year three (PY3) capstone exam was initially developed prior to enrollment of the inaugural graduating class. Since the first iteration, utility has remained the same, but the overall development and implementation process has evolved due to changes in programmatic and student learning outcomes, curricular mapping, student and faculty feedback, and practice expectations. FINDINGS: The entities responsible for exam implementation perceive faculty and students have a positive perception of the exam evolution and improvements implemented. Specifically, feedback from students and faculty mentioned clear expectations, comfort with the new capstone exam process, and an appreciation for the focus on interrater reliability. As assessment is an iterative process, quality improvement strategies continue to be implemented to address feedback regarding the PY3 capstone exam. SUMMARY: Purposeful utilization of capstone exams in the third year is one method to assess APPE readiness. Sharing one college's experience with the evolution of such an exam, quality improvement methods, and experience in implementing reliability and validity measures may provide a model for institutions to implement similar assessment methods efficiently.

The Relationship Between Pharmacist Resilience, Burnout, and Job Performance.

BACKGROUND: Resilience aids healthcare professionals in navigating through and bouncing back from stressful situations in the workplace. Resilience can increase job satisfaction, work motivation, and professional commitment while decreasing burnout, and ultimately job turnover. More resilient employees experience lower instances of burnout and greater life satisfaction. OBJECTIVE: The primary study objective is to determine the relationship that pharmacist resilience has on burnout and job performance. METHODS: Licensed pharmacists in Florida were sent a Qualtrics survey (Qualtrics, Provo, UT) via email, which included demographics data, and valid and reliable assessment tools for resilience, burnout, and job performance. Linear regressions were used to test if resilience significantly predicted each of the output variables: burnout and job performance. RESULTS: Survey responses were received from 942 pharmacists. The regressions showed that resilience significantly predicted both burnout (ß1 = -.701, P < .001) and job performance (ß1 = .35, P < .001). As resilience increased, the levels of burnout decreased, and job performance increased. Resilience explained 29% of the variance in burnout, and 11% of the variance in job performance. CONCLUSION: The results of this study suggest that resilience significantly predicts both pharmacist work-related burnout and job performance. The more resilient the pharmacist, the lower the chances of work-related burnout and the higher the likelihood of better job performance. Organizations should pursue opportunities to educate healthcare workers on methods to increase resilience and to bring attention to the importance of this topic.

Vancomycin Flight Simulator: A Team-Based Learning Exercise.

BACKGROUND: Team-based learning (TBL) encourages learners to think critically to solve problems they will face in practice. Pharmacokinetic dosing and monitoring are complex skills requiring the application of learned knowledge. The study sought to assess the impact of a TBL, vancomycin dosing activity in a Pharmaceutical Skills IV course measured with exam question performance during the second professional year. METHODS: This retrospective, descriptive study relates a TBL activity, assigned to 85 students, which included an individual student pre-preparation quiz, assigned readings, in-class individual and team-based readiness assessments, small group application of a vancomycin patient case, and group discussion/feedback on clinical decisions with supportive reasoning. The class year before and class year of the TBL implementation were compared using the total percentage of points possible earned by the class years, by topic. To minimize potential confounding, the primary outcome was the change in topic performance by the rank difficulty (e.g., the largest possible benefit being the hardest topic becoming the easiest with no other variation in topic rank difficulty). RESULTS: In the year of implementation, the mean individual readiness assurance test (IRAT) performance was 5.5 ± 1.88 (10 points possible, 55%). The mean team readiness assurance test (TRAT) performance was 10 of 10 points possible (100%). The class exam item performance in the year before (n = 101) and year of (n = 84) TBL implementation showed a general decline in exam scores. However, the vancomycin topic difficultly went from fifth easiest, to second easiest, with less than 1% change in raw score. CONCLUSIONS: Implementation of a pharmacokinetic TBL activity appeared to moderately support the students' vancomycin learning. Additional studies are warranted on APPE readiness and performance.

The Impact of Leadership Program Formatting on Perceived Development Within Pharmacy Cohorts.

Objective. To assess the impact of variable leadership development program formats on perceived participant growth.Methods. In 2020, the Phi Lambda Sigma national office began offering national Leader Academies to members, while University of South Florida Health Taneja College of Pharmacy simultaneously offered a Leader Academy program to its Phi Lambda Sigma students. Both programs used virtual leadership development tools from GiANT Worldwide, but differed in meeting frequency, content focus, and participant diversity. A 17-question pre- and postsurvey was developed from the Emotional Intelligence Leadership Inventory. Descriptive and inferential statistics were used to compare the cohorts.Results. Twenty-two respondents in the national cohort (66.7% response rate) and 15 in the single-institution cohort (100% response rate) were included. There was more diversity in age, ethnicity, and previous education in the national cohort. Significant improvements in perceived growth were noted in almost all areas. The only decrease noted was the national cohort response to "I strive to improve myself." The overall change in mean response values was generally higher for the single-institution cohort. Qualitative data supported these results and showed more notable references to emotional intelligence in the national cohorts (∼50%) as compared to the single-institution cohort (<25%).Conclusion. Study results suggest that participation in a longitudinal leadership development program, regardless of cohort format, leads to perceived participant improvement in three categories. However, perceived benefit within each of these categories may vary depending on the cohort. Future studies are needed to further evaluate specific leadership arenas and validate the leadership assessment tool.

Emergent transition to remote learning: Impact on student performance for real-time comprehensive case simulations.

INTRODUCTION: To determine the impact of emergent transition from in-person to remote learning on student performance within real-time objective structured clinical examinations (OSCEs). METHODS: A university mandate, due to severe SARS-CoV-2, was issued requiring didactic courses to transition to remote learning in spring 2020. The third-year internal medicine elective had six remaining weekly OSCEs, accounting for 55% of course grades. Full credit was awarded for the first OSCE as students familiarized themselves with the new virtual format. The primary outcome was the overall average OSCE performance for the course's remaining five virtual simulations compared to the traditional in-person offering in 2019. Secondary outcomes included individual OSCE performance, OSCE performance with inclusion of the first OSCE, and overall course grades. RESULTS: There were no statistically significant differences in overall average OSCE performance between 2019 and 2020 cohorts for the five simulations (82.7% vs. 86.8%, P = .20). Secondary outcomes showed statistically significant differences favoring performance in the 2020 cohort for infectious diseases (78.3% vs. 89.4%, P < .001) and anticoagulation (74.4% vs. 90%, P = .002), while cardiology favored the 2019 cohort (91.1% vs. 82.8%, P = .03). There was no statistically significant difference in performance on the cumulative I (86.1% vs. 82.2%, P = .41) or cumulative II (83.3% vs. 89.4%, P = .29) simulations or in final overall course grades (86.6% vs. 90.2%, P = .06). CONCLUSIONS: An emergent transition to remote learning may not negatively impact student performance on real-time OSCE activities.

Evidence and Strategies for Including Emotional Intelligence in Pharmacy Education.

Objective. This integrative review summarizes the literature addressing emotional intelligence among health care professionals and students to better define and incorporate it into the pharmacy curricula.Findings. Emotional intelligence is an essential attribute for relationship building, stress management, and self-regulation. Pharmacy students must develop and improve their emotional intelligence to support their development of successful relationships with patients, pharmacy colleagues, and other health care providers. In addition, awareness of one's own biases and emotions can help with behavioral regulation, which can facilitate enhanced communications with others. Increasing evidence suggests that emotional intelligence can influence academic success, the ability to provide compassionate and competent patient care, the ability to lead and influence others, and the ability to manage stress, all of which are important in pharmacy education. Educators can help learners develop emotional intelligence by designing activities that directly identify and target areas of weakness while leveraging areas of strength.Summary. This article discusses key background studies on emotional intelligence in the health professions literature and identifies specific methods and strategies to develop learners' emotional intelligence within the curriculum.

The relationship between pharmacist emotional intelligence, occupational stress, job performance, and psychological affective well-being.

BACKGROUND: Emotional intelligence (EI) is known to improve teamwork, communication, and organizational commitment. The role of EI has also influenced pharmacists' ability to empathize, control emotions, and actively listen. Although EI's impact on work-related components, including occupational stress, job performance, and psychological affective well-being, has been studied, there are no data specific to the practice of pharmacy. OBJECTIVE: The primary objective of this study was to determine whether a significant correlation exists between pharmacist EI and work-related components. METHODS: A voluntary Qualtrics survey (Qualtrics, Provo, UT) was distributed electronically to all active pharmacists licensed by the Florida Board of Pharmacy, which included questions from valid and reliable assessment tools. Spearman correlations were used to examine the association between EI facets and dependent variables of occupational stress, job performance, and psychological affective well-being. A subanalysis was conducted to evaluate demographic data. Statistical significance was set at P < 0.05 for all tests. Incomplete survey responses were included in the analysis. RESULTS: A total of 942 responses were received and analyzed. Most of the respondents were aged 44 years or younger (42.5%), female (46.9%), identified as Caucasian (52.8%), and worked 31-40 hours weekly (20.6%). Most of the respondents reported a primary employment setting within community (29.3%) or hospital (18.6%) pharmacy. Higher EI correlated with lower levels of occupational stress, higher job performance, and higher psychological affective well-being. Secondary outcomes reported increased stress for both females and those practicing in the community setting; hospital-based pharmacists reported higher job performance and psychological affective well-being. Stress decreased with both age and years of experience. CONCLUSION: Higher EI may support overall wellness for pharmacists on the basis of the results of this study. Additional evaluation of demographic data, including practice settings, and a more robust cohort of participants would provide more insight in this area.

Measures of Burnout and Empathy in United States Doctor of Pharmacy Students: Time for a Change?

PURPOSE: To review interim data regarding longitudinal burnout and empathy levels in a single Doctor of Pharmacy class cohort. METHODS: Students were emailed an electronic survey during their first semester and annually at the end of each academic year for a total of 3 years (2017-2020). Validated survey tools included the Jefferson Scale of Empathy (JSE) and the Maslach Burnout Inventory (MBI) student version. The JSE survey consists of 20 questions, with higher scores denoting more empathy. The MBI student version contains 3 subscales: exhaustion (higher scores are worse), cynicism (higher scores are worse) and professional efficacy (higher scores are better). RESULTS: The median JSE score at the end of the third academic year (PY3) was 110, with females scoring significantly higher (114.5 vs. 103.5; p<0.02). A majority of the 62 students reported burn out (82.3%), scoring in the highest category for either exhaustion (76%) or cynicism (55%). A majority (66%) also reported a low or moderate professional efficacy score, a negative finding. Measures of student burnout increased after the start of the program and remained at the higher level each subsequent year (p<0.0001). In the Spring of 2020, during the COVID-19 pandemic, nearly every student had moderate or high levels of emotional exhaustion (97%) and cynicism (78%) as measured by the MBI. CONCLUSION: This interim data suggests high degrees of pharmacy student burnout. Empathy levels remained stable throughout the duration of the study. Pharmacy schools may need to focus on reform regarding well-being and prevention of burnout.

Designing and evaluating game-based learning for continuing pharmacy education using an "escape room" activity.

INTRODUCTION: Continuing education (CE) standards by the Accreditation Council for Pharmacy Education emphasize that educational methodologies should contribute to the development of participants' critical thinking and problem-solving skills. Employment of serious gaming can meet this expectation through motivation, timely feedback, and challenging all performance levels. Current literature is lacking regarding use of game-based learning, such as "escape rooms" in pharmacy CE programming. METHODS: This pilot study enrolled participants at a two-hour medication error CE presentation. Study investigators utilized the first hour for lecture and the second hour for application through an "escape room" activity. During this activity, participants used critical thinking and teamwork to unlock puzzles for root cause analysis (RCA) creation in a provided timeframe. An optional, online anonymous survey was emailed to attendees. Responses were rated on a five-point Likert scale; descriptive statistics were represented by percent distributions. RESULTS: A total of 40 pharmacists and seven technicians responded to the perception survey. Most respondents felt this activity emphasized critical thinking (87%) and was appropriate for the topic of medication errors (83%). The majority (63%) agreed this activity helped them to better understand a RCA, 48% felt the group sizes were appropriate, and 76% felt instructions for the activity were clear. Over 75% would like to see this type of activity utilized in another CE programs. CONCLUSIONS: This activity was well received by participants and may emphasize critical thinking and understanding of topics presented. Further studies assessing pre-/post-program knowledge are needed to ensure adequate retention of information.

Effectiveness of a pharmacy teaching certificate program offered to practicing pharmacists.

INTRODUCTION: Regardless of the practice setting, pharmacists' roles often expand beyond patient-centered services and into health-related educational roles for patients, healthcare providers, and student pharmacists. Teaching roles of a clinical pharmacist can include providing invited presentations (such as continuing education lectures), teaching colleagues about new clinical initiatives, precepting students during advanced pharmacy practice experiences (APPEs) and introductory pharmacy practice experiences (IPPEs), and precepting residents on rotations. This program was designed to evaluate the effect of a university-affiliated pharmacy teaching certificate program on participant knowledge and perceived confidence in specific areas of academic pharmacy and preceptor development. METHODS: A 10-month program consisting of four live modules with associated continuing education (CE) credit was offered to pharmacy residents and practicing pharmacists in the surrounding area. The program format utilized didactic and active learning strategies with "at home" assignments to reinforce material presented. Content knowledge was measured with written summative assessments provided at the start and end of each module. Perceived confidence was assessed through online surveys provided at the start and end of the program. All results were evaluated using paired t-tests. RESULTS: Data were obtained from 14 participants in the first cohort and 18 participants in the second cohort. For each of the four modules, there was a significant difference in pre- and post-knowledge assessments. Confidence data was also significantly increased regarding topics in each module. CONCLUSION: Knowledge assessments and perception surveys suggest that this university-affiliated teaching certificate program improved both knowledge and perceived confidence for program participants.

Peer-assisted Learning: Clinical Skills Training for Pharmacy Students.

Objective. To assess the impact of peer-teaching on student scores and confidence when preparing for a final objective structured clinical examination (OSCE) within a Doctor of Pharmacy program. Methods. First-year pharmacy students (n=45) attended a peer-led training session led by upperclassmen (n=17) on a variety of clinical skills to be assessed on a final course OSCE. Their scores were collected and compared to students who did not attend the training. Confidence scores were also evaluated using voluntary pre- and post-surveys. Results. An overall 3% increase in scores was recorded from the objective skills examination. Student confidence scores also increased for each of the skills evaluated with an overall improvement of 1.1 on a 5-point Likert scale. Conclusion. Peer-assisted learning was effective in increasing student performance and confidence in the OSCE. Based on the positive results, the peer-led training event will be improved upon and used again in the future.

Development of a Student-Led Ambulatory Medication Reconciliation Program at an Academic Institution.

OBJECTIVES: To integrate fourth-year student pharmacists on advanced pharmacy practice experience (APPE) rotations within several different ambulatory clinics to perform medication reconciliations and enhance interdisciplinary practice. METHODS: The study design was a descriptive, prospective multisite study among a variety of ambulatory care outpatient clinics. Student pharmacists were partnered with physicians to conduct medication reconciliations during clinic visits for 4 hours per week, with data collection from January 2016 to September 2016. This program originated from physician requests for additional pharmacy involvement and led to the development of a successful implementation strategy to involve student pharmacists in the medication reconciliation process. RESULTS: Student pharmacists identified 537 medication discrepancies among 491 patients, including commission of medications (36%), documentation of previously omitted medications (27%), and incomplete patient allergy information (11%). Students spent an average of 10 minutes on each encounter. CONCLUSION: Documentation from this innovative program suggests improvement in medication reconciliation and enhanced patient care with limited time required of student pharmacists. A similar program could be developed and utilized at other clinical sites.