Evaluation of Student Peer- and Self-Grading in an Integrated Pharmacotherapy Course.

OBJECTIVE: To determine if student peer- and self-grades correlate with faculty grades on case vignettes. METHODS: This study involved first professional-year students enrolled in an Integrated Pharmacotherapy course. The course included three modified team-based learning (TBL) activities (each consisting of individual and team readiness assurance tests, followed by three open-note case vignettes completed in teams). Each student uploaded completed case vignettes to the learning management system and was assigned to complete a self- and a random, anonymous peer-grade using a provided key. Peer- and self-grades were compared to faculty grades using a null multilevel model to determine the intraclass correlation coefficient (ICC). Faculty time spent grading was captured, and students were surveyed to determine the perceived value of peer- and self-grading. RESULTS: Faculty- and peer-grades had a slightly higher correlation than faculty- and self-grades (ICC = 0.75 vs 0.73, respectively). The ICC between all three grader groups was 0.74. Faculty spent an average of 2.5 h grading the cases after each TBL session. Students reported spending a median of 36 min on the peer- and self-grades for each TBL session. Overall, students agreed that both the self- and peer-grading activities helped identify gaps in knowledge (90% and 56%, respectively). A total of 78% of students agreed that self-grading was beneficial for their learning. CONCLUSION: There was a moderate-to-good correlation between peer-, self-, and faculty- grades for case vignettes. Faculty time may be saved through student self- or peer-grading.

Addressing challenges to precepting advanced pharmacy practice experience students in the community setting.

BACKGROUND AND PURPOSE: An advanced pharmacy practice experience (APPE) in a community pharmacy setting is required in all accredited doctor of pharmacy program curricula in the United States. This setting often presents unique challenges to precepting students that may hinder the development and availability of robust learning experiences. This qualitative review discusses perceived challenges and potential solutions to maintaining a meaningful community rotation experience for students based on published literature and reported preceptor experiences. It also explores the clinical impact of APPE students in community pharmacy. EDUCATIONAL ACTIVITY AND SETTING: St. Louis College of Pharmacy (STLCOP) provides a systematic approach to student orientation and evaluation for community pharmacy APPEs. This allows all pharmacy students to be held to the same educational outcome standard. Site preceptors are responsible for communicating site-specific expectations and providing frequent formative feedback to students throughout the five-week rotation. FINDINGS: Community rotation students spent approximately 6400 hours providing almost 30,000 patient interventions over two years, indicating a potential benefit in quality of care at student-hosted sites. Despite evidenced benefits of the presence of pharmacy students in community pharmacies, some pharmacists hesitate to precept students due to anticipated obstacles of this additional responsibility. SUMMARY: This review explored the community practice APPE structure offered at STLCOP and describes the patient impact that students have made during this clinical rotation. Data seem to indicate a positive return on investment for having APPE students in community pharmacy.

Glucagon-like peptide 1 receptor agonists in type 1 diabetes mellitus.

PURPOSE: The role of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in the treatment of type 1 diabetes mellitus (T1DM), including efficacy and safety evidence, is reviewed. SUMMARY: Currently approved treatment options for glycemic control in T1DM include insulin, which combats insulin deficiency but does not effectively target disease progression or alpha cell dysfunction; and pramlintide, whose use requires multiple daily doses and involves a high likelihood of gastrointestinal side effects. GLP-1 RAs have a unique mechanism of action in T1DM, addressing alpha cell dysfunction and thereby suppressing inappropriate glucagon secretion. GLP-1 RA dosing varies from once weekly to twice daily, and the class is well tolerated in patients with type 2 diabetes. Among the GLP-1 RAs, exenatide and liraglutide have been studied in patients with T1DM, with published evidence consistently demonstrating weight loss, decreases in total daily insulin requirements, and modest improvements in glycemic control. GLP-1 RA therapy appears to be well tolerated in patients with T1DM and is associated with nonsignificant increases in hypoglycemia risk. CONCLUSION: GLP-1 RA therapy represents an important add-on therapy option for achieving decreased insulin doses, weight loss, and modest improvements in HbA1c levels without significantly increasing hypoglycemia risk in patients with T1DM. Patients who have detectable C-peptide and/or are overweight or cannot achieve glycemic goals without hypoglycemia have been found to benefit the most from GLP-1 RA therapy. Further studies are warranted to evaluate these agents' potential impact on clinical outcomes such as microvascular and macrovascular complications.