Paradoxes: Cholesterol and Hypoxia in Preeclampsia.

Preeclampsia, a hypertensive disease of pregnancy of unknown etiology, is intensely studied as a model of cardiovascular disease (CVD) not only due to multiple shared pathologic elements but also because changes that develop over decades in CVD appear and resolve within days in preeclampsia. Those affected by preeclampsia and their offspring experience increased lifetime risks of CVD. At the systemic level, preeclampsia is characterized by increased cellular, membrane, and blood levels of cholesterol; however, cholesterol-dependent signaling, such as canonical Wnt/ßcatenin, Hedgehog, and endothelial nitric oxide synthase, is downregulated indicating a cholesterol deficit with the upregulation of cholesterol synthesis and efflux. Hypoxia-related signaling in preeclampsia also appears to be paradoxical with increased Hypoxia-Inducible Factors in the placenta but measurably increased oxygen in maternal blood in placental villous spaces. This review addresses the molecular mechanisms by which excessive systemic cholesterol and deficient cholesterol-dependent signaling may arise from the effects of dietary lipid variance and environmental membrane modifiers causing the cellular hypoxia that characterizes preeclampsia.

Engaging Student Pharmacists in Social Determinants of Health and Health Equity Through Photovoice.

OBJECTIVE: This study aimed to evaluate the impact of an interactive photovoice activity on the perceptions of social determinants of health (SDOH) and health equity among first professional year student pharmacists. METHODS: This study used a mixed-methods exploratory approach at 4 institutions. All students completed a standardized intervention using a prerecorded lecture, active learning using photovoice, and an in-depth debriefing session. The photovoice responses and reflections were analyzed through a deductive approach using content analysis with the applied frameworks of Rolfe's reflection model and the social-ecological model. A presurvey/postsurvey assessed the students' perceptions of SDOH and health equity. Paired sample t tests were conducted to assess the prechange and postchange. RESULTS: A total of 349 students participated; most students reflected at the "what" level (97.7%), whereas 65% reached the "now what" level. Students identified more SDOH factors at the institutional/community level (75.9%) than at the individual/interpersonal level (59.4%) or the society/policy level (28.0%); 191 (55%) students had matchable survey data. A statistically significant improvement was found in the comprehension of health equity concepts (4 items), perceptions of health disparities and system response (4 items), awareness of structural factors impacting equity (3 items), and readiness for inclusivity behavior (3 items). CONCLUSION: A structured teaching and learning activity allowed deeper reflections among student pharmacists. Student perception of the basic terminologies and the impact of beliefs on health care improved after the photovoice assignment. Although students became aware of the SDOH, they had difficulty identifying the structural or upstream factors when addressing SDOH.

A randomized controlled trial of an intervention to increase cultural diversity awareness of research mentors of undergraduate students.

Cultural diversity variables like race and/or ethnicity influence research mentoring relationships, but mentors may not know how to address such variables with their mentees. Using a randomized controlled trial design, we tested a mentor training intervention to increase mentors' awareness and skill in addressing cultural diversity in research mentoring relationships, documenting its impact on mentors and their undergraduate mentees' ratings of mentor effectiveness. Participants were a national sample of 216 mentors and 117 mentees from 32 undergraduate research training programs in the United States. Mentors in the experimental condition reported greater gains than those in the comparison condition regarding the relevance of their racial/ethnic identity to mentoring and their confidence to mentor students across diverse cultural identities. Paired mentees of mentors in the experimental group rated their mentors higher at respectfully broaching and creating opportunities to address race/ethnicity matters than those with mentors in the comparison group. Our results support the efficacy of culturally focused mentorship education.

A theoretical model of dietary lipid variance as the origin of primary ciliary dysfunction in preeclampsia.

Serving as the cell's key interface in communicating with the outside world, primary cilia have emerged as an area of multidisciplinary research interest over the last 2 decades. Although the term "ciliopathy" was first used to describe abnormal cilia caused by gene mutations, recent studies focus on abnormalities of cilia that are found in diseases without clear genetic antecedents, such as obesity, diabetes, cancer, and cardiovascular disease. Preeclampsia, a hypertensive disease of pregnancy, is intensely studied as a model for cardiovascular disease partially due to many shared pathophysiologic elements, but also because changes that develop over decades in cardiovascular disease arise in days with preeclampsia yet resolve rapidly after delivery, thus providing a time-lapse view of the development of cardiovascular pathology. As with genetic primary ciliopathies, preeclampsia affects multiple organ systems. While aspirin delays the onset of preeclampsia, there is no cure other than delivery. The primary etiology of preeclampsia is unknown; however, recent reviews emphasize the fundamental role of abnormal placentation. During normal embryonic development, trophoblastic cells, which arise from the outer layer of the 4-day-old blastocyst, invade the maternal endometrium and establish extensive placental vascular connections between mother and fetus. In primary cilia of trophoblasts, Hedgehog and Wnt/catenin signaling operate upstream of vascular endothelial growth factor to advance placental angiogenesis in a process that is promoted by accessible membrane cholesterol. In preeclampsia, impaired proangiogenic signaling combined with an increase in apoptotic signaling results in shallow invasion and inadequate placental function. Recent studies show primary cilia in preeclampsia to be fewer in number and shortened with functional signaling abnormalities. Presented here is a model that integrates preeclampsia lipidomics and physiology with the molecular mechanisms of liquid-liquid phase separation in model membrane studies and the known changes in human dietary lipids over the last century to explain how changes in dietary lipids might reduce accessible membrane cholesterol and give rise to shortened cilia and defects in angiogenic signaling, which underlie placental dysfunction of preeclampsia. This model offers a possible mechanism for non-genetic dysfunction in cilia and proposes a proof-of-concept study to treat preeclampsia with dietary lipids.

Comparing the Outcomes of Face-to-Face and Synchronous Online Research Mentor Training Using Propensity Score Matching.

In this study, propensity score matching (PSM) was conducted to examine differences in the effectiveness of research mentor training (RMT) implemented using two modes-face-to-face or synchronous online training. This study investigated each training mode and assessed participants' perceived gains in mentoring skills, ability to meet mentees' expectations, and overall quality of mentoring, as well as intention to make changes to their mentoring practices. Additional factors that may contribute to participant outcomes were also examined. In total, 152 mentors trained using a synchronous online platform and 655 mentors trained in in-person workshops were analyzed using the PSM method. Mentors were matched based on similar characteristics, including mentee's career stage, mentor's title, mentor's prior mentoring experience, mentor's race/ethnicity and sex, and mentor's years of experience; results show that both face-to-face and synchronous online modes of RMT are effective. Findings indicated that the training mode did not significantly impact the mentors' perceived training outcomes. Factors associated with the reported training outcomes included dosage (hours of training), facilitator effectiveness, race/ethnicity, and previous mentoring experience. The results of this study demonstrate that mentors' perceived training outcomes are comparable regardless of the training modality used-online versus face-to-face.

An assessment of patient experiences as teachers of cultural sensitivity in an interprofessional setting.

BACKGROUND AND PURPOSE: The importance of cultural sensitivity training in pharmacy education is well-recognized, though best practices are not well described. Traditional teaching approaches such as faculty lectures may result in overgeneralization, lack of nuance, or tokenization. Utilizing patients from diverse special populations as teachers of cultural sensitivity may mitigate these risks. However, faculty must ensure patients feel comfortable, empowered, valuable, and prepared to serve as partners in education. EDUCATIONAL ACTIVITY AND SETTING: Patients were used as teachers of cultural sensitivity in an interprofessional education panel activity at two colleges of pharmacy over two years. Patient experiences with training and preparation for the activity as well as their perceived benefits of partnering in student education were assessed. FINDINGS: Overall, patients reported that training was adequate, and the educational activity provided a sufficient platform for sharing their knowledge with students. Patients felt they provided meaningful contributions to student education, learned valuable information in the process, and formed sincere relationships with each other and faculty. SUMMARY: Faculty at other institutions may wish to adapt this activity to meet the needs of their own institution and empower patients to contribute to the education of health professions students. Practical recommendations are provided for promoting a positive patient experience. A comprehensive training program prepared and empowered patients to teach cultural sensitivity principles to an interprofessional group of health care students.

Impact of a stroke interprofessional simulation on health professional students.

INTRODUCTION: The objective was to describe the interprofessional stroke simulation delivered across three campuses with seven types of health professions students and the impact the activity had on the students. METHODS: An interprofessional stroke simulation event was completed with pharmacy, medical, nursing, physician assistant, occupational therapy, physical therapy, and speech pathology students across a multi-site campus. Pre-activity, demographic information was requested including age, gender, discipline, year in respective program, number of experiences in prior interprofessional events, and comfort working with other health care professionals. The survey was repeated after the session and gathered free-text responses on whether learners gained information on working together, if they learned about the roles of other health care workers, and if they found the session useful. RESULTS: A total of 1820 health care professional students completed the simulation activity over four years. Of those students, 1035 (57%) completed the pre-survey, and 884 (49%) completed the post-survey. From the post-survey results, 91.5% of participants felt that they learned how health care disciplines can work together. Also, 87% of participants felt more comfortable working with learners from other professions. Most participants agreed the session was useful (77.1%) and rated it as moderately to extremely effective (81.8%). CONCLUSIONS: Interprofessional sessions with health care professional students are beneficial for learning new information about other professions and enhancing comfort levels in working with interprofessional groups. The interprofessional simulation improved the comfort level of students working with other health care professional students and should be considered in professional student curricula.

Strategies for Incorporating Health Disparities and Cultural Competency Training into the Pharmacy Curriculum and Co-curriculum.

Objective. To identify and review strategies reported in the literature for strengthening instruction about both health disparities and cultural competency (HDCC) within various portions of the Doctor of Pharmacy curriculum and co-curriculum.Findings. The classroom strategies reported in the literature for incorporating HDCC into the PharmD curriculum involved teaching a single course or series of courses in HDCC. Activities found to be effective in teaching HDCC were those that involved case-based and community engagement exercises. Recommendations for incorporating HDCC into the experiential education included preceptor development in areas of HDCC to assess student understanding of health disparities concepts, increasing student engagement with diverse patient populations, and implementation of cross-cultural communication models at clinical sites. Co-curricular and interprofessional (IPE) portions of pharmacy training were found to permit greater methodological flexibility for incorporating training in HDCC, as they often confronted fewer time or space constraints than classroom endeavors. Documented methods for teaching HDCC within co-curricular and IPE experiences included service learning, study abroad, symposia, and forums.Summary. There is a paucity of literature describing processes for incorporation of health disparities and cultural competency education and training into the PharmD program. Findings suggest that conceptual frameworks for HDCC should be used throughout the pharmacy curriculum, with learning activities mapped to relevant pharmacy education standards to ensure coverage of important practice competencies. Best practices also involve the use of contemporary tools, strategies, and resources from a cross-section of disciplines that provide opportunities for learners to correct misconceptions and biases through active situational problem-solving.

Defining the role of pharmacists in addressing the social determinants of health.

As one of the overreaching goals of Healthy People 2030, addressing the social determinants of health (SDOH) to reduce health disparities is a nationwide concern, with objectives informed by interdisciplinary teams of experts. However, there remains much discussion regarding the roles of healthcare providers in addressing SDOH. While current guidance suggests that all members of the healthcare team must be empowered to address SDOH, current guidance explicitly references physicians, nurses, social workers and staff, and do not specifically include pharmacists. While pharmacists are taught about the impact of SDOH in pharmacy curricula, actionable strategies for pharmacists to address SDOH in practice have not been clearly outlined. Pharmacists have multifaceted interactions with patients and may be influential in meeting individual patient needs, identifying social risk factors, and addressing upstream causes of health disparities. This paper proposes a framework for the role of pharmacists in addressing the SDOH through strategies at the patient, practice, and community levels. The concepts presented in this paper are meant to serve as a launch point for discussion and to promote the inclusion of pharmacists in the conversations around sustainable efforts to achieve health equity. This framework is not intended to limit the scope of pharmacists in addressing SDOH - on the contrary, it is our hope that this outline may be used to expand the education of future healthcare professionals regarding their role in addressing the social determinants of health.

Engaging in Authentic Allyship as Part of Our Professional Development.

Educational institutions increasingly recognize the importance of diversity, equity, and inclusion (DEI) efforts to combat and dismantle structures that sustain inequities. However, successful DEI work hinges on individuals being authentic allies and incorporating allyship into their professional development. Allyship involves members of dominant groups recognizing their privilege and engaging in actions to create inclusivity and equitable spaces for all. Individuals from dominant groups with desires to actively support others from marginalized groups are often unsure how to fight oppression and prejudice. Our goal as faculty with diverse perspectives and heterogeneous intersectional identities is to provide readers with the tools to develop as an authentic ally through educating themselves about the identities and experiences of others, challenging their own discomfort and prejudices, dedicating the time and patience to learning how to be an ally, and taking action to promote change toward personal, institutional, and societal justice and equality. Ultimately, each person must advocate for change because we all hold the responsibility. When everyone is an authentic ally, we all thrive and rise together.

Correlation Between Pharmacy Students' Implicit Bias Scores, Explicit Bias Scores, and Responses to Clinical Cases.

Objective. The purpose of this study was to identify the extent of implicit and explicit bias in a sample of pharmacy students and to determine whether there is an association between implicit bias, explicit bias, and responses to clinical cases.Methods. Investigators sent links to two online surveys to students at six US schools and colleges of pharmacy. In the first survey, students responded to two clinical cases. Students were presented with a picture of a White or Black patient with each clinical case. On the second survey, students indicated their level of racial implicit bias as assessed by the Harvard Implicit Association Test and their level of racial explicit bias. Pearson's correlation was used to determine the correlation between bias and responses to the clinical cases.Results. Three hundred fifty-seven first, second, and third year pharmacy students responded to both surveys (response rate 52%). The students who were presented with the picture of a Black patient rated the patient's pain and the reliability of the patient's family as higher than students presented with the picture of a White patient. Students had more negative implicit and explicit bias towards Black patients. Neither implicit nor explicit bias correlated with student responses to the clinical cases.Conclusion. Evidence of slight to moderate negative implicit bias and slight negative explicit bias towards Black patients was identified in this group of pharmacy students. Future studies that include a more representative population and heighten the stakes of the clinical scenario should be done to investigate a possible correlation between bias and clinical behaviors.

Factors associated with medication nonadherence among Medicare low-income subsidy beneficiaries with diabetes, hypertension, and/or heart failure.

BACKGROUND: Previous studies have documented factors influencing medication nonadherence among the Medicare population, but few studies have examined medication nonadherence among the Medicare low-income subsidy (LIS) population. Furthermore, little is known about the factors associated with nonadherence among this population, especially those with prevalent chronic conditions such as type 2 diabetes, hypertension, or heart failure. OBJECTIVE: To examine factors associated with the likelihood of medication nonadherence among Medicare LIS recipients with type 2 diabetes, hypertension, or heart failure. METHODS: This was a retrospective analysis of 2012-2013 Medicare Parts A, B, and D claims (most recent available for this research) linked to the Area Health Resources Files. Beneficiaries aged 65 years or older with continuous Medicare coverage and receiving any LIS were included. Individuals were categorized into full LIS or partial LIS groups. Nonadherence was determined by the proportion of days covered less than 80% for specified oral type 2 diabetes, hypertension, and heart failure medications, as defined by the Pharmacy Quality Alliance. A multivariate logistic regression was used to determine and compare individual-level and community-level characteristics associated with nonadherence among the entire study sample, the full LIS group, and the partial LIS group. RESULTS: The study sample included 505,771 Medicare beneficiaries, with 448,509 (88.7%) receiving full LIS and 57,262 (11.3%) receiving partial LIS. The proportion of individuals nonadherent was higher among the full LIS population (33.2%) than that of the partial LIS population (30.8%). Among the entire population, younger age was associated with nonadherence (OR = 0.98; 95% CI = 0.98-0.99). Men were more likely to be nonadherent than women (OR = 1.12; 95% CI = 1.11-1.14). Compared with non-Hispanic Whites, racial/ethnic minorities had higher nonadherence. Compared with beneficiaries who were non-Hispanic White, the ORs for those who were Black, Hispanic, Asian, and other were 1.41 (95% CI = 1.38-1.43), 1.58 (95% CI = 1.55-1.61), 1.08 (95% CI = 1.05-1.11), and 1.63 (95% CI = 1.56-1.70), respectively. There were higher nonadherence rates among patients living in communities with lower socioeconomic characteristics, such as a metropolitan statistical area (MSA vs non-MSA; OR = 1.05, 95% CI = 1.04-1.07). A higher risk adjustment summary score, indicating worse health status, was associated with an increased likelihood of medication nonadherence (OR = 1.21; 95% CI = 1.20-1.22). These patterns were similar among the full and partial LIS groups. CONCLUSIONS: Individual- and community-level characteristics were associated with the likelihood of medication nonadherence among Medicare LIS recipients with type 2 diabetes, hypertension, or heart failure. These characteristics included younger age, male sex, racial/ethnic minorities, living in lower socioeconomic communities, and a higher risk adjustment summary score. This study provided insight into medication nonadherence within the Medicare LIS population and identified the need to consider these factors when developing future policies to improve medication adherence. DISCLOSURES: This study was funded by the Pharmaceutical Research & Manufacturers of America (PhRMA), which was involved in the preparation and revision of the manuscript. Dougherty is employed by PhRMA. Todor was a PQA-CVS Health Foundation Scholar who was funded to work on this study. Hines is employed by Pharmacy Quality Alliance. Wang reports grants from AbbVie, Curo, Bristol Myers Squibb, and Pfizer, during the time of this study, and fees from the PhRMA Foundation for work on its Heath Outcomes Research Advisor Committee. The other authors have nothing to disclose. This study was presented as a poster at the online 2020 PQA Annual Meeting, May 7, 2020.

Inclusion of Health Disparities, Cultural Competence, and Health Literacy Content in US and Canadian Pharmacy Curriculums.

Objective. To determine how US and Canadian pharmacy schools include content related to health disparities and cultural competence and health literacy in curriculum as well as to review assessment practices.Methods. A cross-sectional survey was distributed to 143 accredited and candidate-status pharmacy programs in the United States and 10 in Canada in three phases. Statistical analysis was performed to assess inter-institutional variability and relationships between institutional characteristics and survey results.Results. After stratification by institutional characteristics, no significant differences were found between the 72 (50%) responding institutions in the United States and the eight (80%) in Canada. A core group of faculty typically taught health disparities and cultural competence content and/or health literacy. Health disparities and cultural competence was primarily taught in multiple courses across multiple years in the pre-APPE curriculum. While health literacy was primarily taught in multiple courses in one year in the pre-APPE curriculum in Canada (75.0%), delivery of health literacy was more varied in the United States, including in a single course (20.0%), multiple courses in one year (17.1%), and multiple courses in multiple years (48.6%). Health disparities and cultural competence and health literacy was mostly taught at the introduction or reinforcement level. Active-learning approaches were mostly used in the United States, whereas in Canada active learning was more frequently used in teaching health literacy (62.5%) than health disparities and cultural competence (37.5%). Few institutions reported providing professional preceptor development.Conclusion. The majority of responding pharmacy schools in the United States and Canada include content on health disparities and cultural competence content and health literacy to varying degrees; however, less is required and implemented within experiential programs and the co-curriculum. Opportunities remain to expand and apply information on health disparities and cultural competence content and health literacy content, particularly outside the didactic curriculum, as well as to identify barriers for integration.

Screening for social determinants of health in community pharmacy: Identifying best practices, barriers, and strategies for success.

The social determinants of health (SDOH) play a key role in patients' access to health care and medications. There exists an area of opportunity to leverage community pharmacists to make a large impact in identifying and incorporating an understanding of a patient's SDOH into their treatment plan. Community pharmacies are accessible and trusted avenues for health care interventions. With the advancement of appointment-based models as well as the increased training of support personnel, community pharmacies may be well suited for this public health task. However, there are major challenges such as paradigm shifts in workflow, reimbursement, and training that must be addressed to make this endeavor successful. This commentary explores the sparse literature related to community pharmacists conducting screening for social risk factors to identify best practices and barriers to implementation and outlines how screening for social needs aligns with the Pharmacists' Patient Care Process.

Incorporation of a mock pharmacy and therapeutics committee as an entrustable professional activity supporting task.

INTRODUCTION: Entrustable professional activities (EPAs) denote activities and tasks students should be able to perform by graduation irrespective of their practice setting. Formulary decision-making includes several core EPA related skills, such as utilization of drug information, written, and verbal skills. The objective of this study was to describe an EPA supporting task aimed at improving utilization of evidence-based medicine skills and its impact on student self-perceived confidence, rating of skills needed, and competence. METHODS: Teams comprised of six to seven students were assigned a drug and instructed to complete the following activities: (1) background literature search, (2) drug monograph, (3) five-min presentation to simulate a live pharmacy and therapeutics (P&T) committee meeting, and (4) vote on a formulary drug in each drug class. Students completed a pre/post five-point Likert scale self-efficacy survey and a perceived importance survey. A scoring rubric assessed monograph and presentation elements (max points 30). Survey items were analyzed using Wilcoxon signed-rank test. Descriptive statistics were used for assignment grades. RESULTS: One hundred ninety students completed the pre/post self-efficacy and perceived importance survey. Confidence showed statistically significant improvement (P < .001) in nine target skill areas. In ranking importance, all 12 assessed skills exhibited a statistically significant increase following the activity. CONCLUSIONS: A mock P&T activity represents an innovative way to evaluate an EPA supporting task that allows students to improve their evidence-based analysis, written, and verbal communication skills.

Development of a State-Wide IPE Faculty Toolkit.

Developing effective interprofessional education (IPE) training activities can be challenging, and faculty at individual programs and schools often take on this task independently. In doing so, similar ideas are frequently recreated for implementation at multiple institutions, and considerable time may be spent in these duplicative efforts. This paper describes a new state-wide effort in Tennessee to compile classroom-based IPE curricular resources and activities being used across the state in order to reduce redundancy, increase efficiency and effectiveness, and ultimately improve training outcomes for students entering health-related professions. We focus on processes involved in developing this contribution to IPE education in order to emphasize feasibility and encourage similar initiatives in other regions.

Race and Ethnicity in Biology Research Mentoring Relationships.

This case study investigated how mentors and mentees in biology experience and understand race and ethnicity in their research mentoring relationships. Semi-structured interviews were conducted with mentors (n = 23) and mentees (n = 15) who had participated in an undergraduate biology summer research opportunity program at a large Midwestern research-intensive university. Interview transcripts were coded using an inductive, thematic analysis. Themes that emerged are presented, describing both participants' experiences with and beliefs about race and ethnicity in research training contexts (e.g., mentoring relationships, lab and field experiences). Although similarities were identified, the experiences and beliefs of mentors and mentees were not always aligned. Implications of the findings for training interventions and institutional partnerships to enhance the effectiveness of research mentoring relationships are discussed, with the goal of positively impacting the educational success of students from historically underrepresented racial/ethnic groups in science career pathways.

Assessment of a multi-institution integration of cultural competency activities.

INTRODUCTION: To meet educational standards and provide effective patient care, student pharmacists must be well-prepared to interact with a diverse patient population. Thus, the objective was to assess the effectiveness of four different active learning strategies in enhancing the cultural competency (CC) of student pharmacists at multiple institutions. METHODS: Across two years, eight colleges/schools of pharmacy integrated two sets of CC activities with different student cohorts (first-third professional year) that were designed to address different aspects of CC. Pre- and post-activity, a modified electronic version of the Clinical Cultural Competency Questionnaire (CCCQ) that included the addition of activity-specific questions was distributed to students. RESULTS: A total of 1009 students participated in these activities across eight colleges of pharmacy. The integration of activities resulted in significant increases in most items on three of the four subscales of the CCCQ (knowledge, skills, and encounters/situations). Items on the attitude subscale remained the same. Students also felt the activities were beneficial in addressing their intent. CONCLUSIONS: Faculty were able to incorporate these activities throughout their respective curricula with minimal time commitment and resources. The activities improved student perceptions of their CC knowledge, skills, and ability to handle encounters and situations. These activities may be useful for other institutions as they determine the best approach to improve student CC and prepare them for practice.

Mentors' Motivation to Address Race/Ethnicity in Research Mentoring Relationships.

The purpose of this study was to investigate the motivation of research mentors to address race/ethnicity in their research mentoring relationships, using self-determination theory as a conceptual framework. Mentors from STEM fields primarily in the biological sciences (N = 115) were asked to report their level of motivation and the reasons behind their motivation to address the role of race and ethnicity in their mentoring relationships. Mentors' responses were coded using a qualitative approach, and results were examined by mentors' degree of motivation, previous experience with mentoring trainees from different racial/ethnic groups, and mentor race/ethnicity. Extrinsic motivation and amotivation were the most frequently assigned codes to mentors' responses. Implications of these findings for mentor practices, higher education initiatives, and for diversifying the STEM workforce are discussed.

Use of virtual patient software to assess student confidence and ability in communication skills and virtual patient impression: A mixed-methods approach.

BACKGROUND AND PURPOSE: Knowledge related to the use of virtual patients (VP) in pharmacy education is limited in relation to student satisfaction with this learning technique. This project aimed to assess students' confidence and impressions in using their communication skills with a VP and to evaluate their skills using this technology. EDUCATIONAL ACTIVITY AND SETTING: This explanatory mixed-methods study was conducted with first-year doctor of pharmacy students. Fourteen survey items that addressed confidence in student abilities and VP impressions were analyzed. Mann-Whitney U tests were conducted to compare pre- and post- scores. Student reflections were reviewed to obtain primary themes and concerns. Descriptive statistics were used for student grades. FINDINGS: Out of 205 students, 203 completed the pre-survey and 163 completed the post-survey. Responses regarding pre-post confidence indicated statistically significant improvement (p < 0.001) for 8 of 10 survey items as follows: understand history taking, conduct an organized interview, elicit subjective information, ask follow-up questions, ask questions related to severity, document subjective data, document objective data, and organize an interview. Regarding their impressions toward VPs, student responses were improved and statistically significant (p < 0.001) for 1 of 4 survey items (tools are easy to use). Forty-two students stressed the need to improve their written communication skills in the self-reflection. The average grade for subjective data was 31.48% and for objective data was 93.66%. SUMMARY: This VP program improved student confidence in their verbal and written communication skills despite low subjective data scores.