Impact of Early Implementation of Experiential Education on the Development of Interprofessional Education Knowledge and Skill Competencies.

BACKGROUND: Interprofessional education (IPE) is most effective when delivered as an experiential continuum. When to initiate IPE to undergraduate college students is unclear. This pilot project developed, implemented, and evaluated an IPE modular project introducing Interprofessional Communication and Teams and Teamwork IPE competencies to first-year allied health professions undergraduate students. METHODS: Students (n=127) were divided into two groups such that five different health science majors were represented in each. One group participated in an experiential 4-part IPE modular program, and one did not. Module components consisted of: a) an online IPE component; b) structured in-class IPE activities and discussion; c) an IPE CPR training course emphasizing communication, conflict resolution, and collaborative practice techniques; and d) an IPE CPR simulation with reflective debriefing session. Both groups' self-efficacy and confidence regarding targeted Interprofessional Communication and Teams and Teamwork IPE competencies were assessed at the same timepoints pre- and post-module using standardized Likert scale surveys. RESULTS: Results indicated a positive impact on modular group students' perception of changes in their interprofessional knowledge and skills compared with non-modular group students such that post-module students' self-efficacy and confidence ratings were both significantly higher. CONCLUSIONS: First-year allied health professions undergraduates benefit from experiential IPE targeting foundational communication and teamwork skills.

Lessons Learned from Evaluating a Process for Systematic Curriculum Review.

Objective. To describe an evaluation of and improvements made to a process of systematic curriculum review. Methods. The systematic curriculum review process was developed with the goal of continuous curriculum assessment and improvement. Information on impact and feedback on the processes were collected from curriculum committee experience and an anonymous web-based survey sent to instructors of courses offered by the pharmacy school, and current and past curriculum committee members. Results. Thirty (88%) participants completed the survey with 72% reporting course changes due to systematic curriculum review, such as changes to programmatic outcomes covered (77%), assessment strategies/grading (46%), course outcomes (38%), and content (38%). Based on feedback received, revisions were made to the process: changing the frequency of course review (from every 3 years to 4 years), including experiential and elective courses (supported by 63% of faculty), and streamlining the logistics of course review and presentation to the curriculum committee. Conclusion. The development of the systematic curriculum review process resulted in course improvements and a system to keep curricular mapping current. It was valuable in the most recent preparation of the self-study and could be readily transferred to other institutions.

Implementation of a research capstone course with expanded flexibility.

BACKGROUND AND PURPOSE: A research-focused capstone course was designed to improve flexibility in the way pharmacy students meet the university's capstone requirement. The requirement aims to integrate knowledge, skills, and attitudes from didactic coursework and to apply them in a scholarly way to improve critical and evidence-based thinking, communication skills, and professionalism. This report describes the capstone course and faculty and student perceptions after the first year of implementation. EDUCATIONAL ACTIVITY AND SETTING: The course allows students to work with a faculty advisor on a four-semester hour research project of mutual interest that can be completed in any one of three semesters. After the first student cohort completed their projects, faculty and student perceptions were captured via electronic survey. FINDINGS: A total of 38 students (36%) and 22 advisors (71%) responded to the survey. Approximately 90% of students and faculty agreed that student groups had achieved course objectives upon completion. Although faculty members felt that participating in the capstone course increased their workload and in some cases reduced their productivity, faculty members felt that the course had a beneficial impact for students. SUMMARY: The new capstone course was well received. The flexibility of the course was both a strength and a limitation as most students wanted more structure in the expectations and grading of the project in the form of a rubric or other standardized assessments.

Suggested pharmacy practice laboratory activities to align with pre-APPE domains in the Doctor of Pharmacy curriculum.

OUR SITUATION: The Accreditation Council for Pharmacy Education outlines ability statements that pharmacy students should be able to demonstrate prior to beginning their Advanced Pharmacy Practice Experiences (APPEs). Practice laboratory courses offer extensive opportunities for students to participate in activities and assessments that enable them to meet the objectives outlined in the Pre-APPE Core Domains in Standards 2016. This review identifies selected published literature, activities, and assessment methods that can be adapted and implemented in practice laboratory courses to help achieve the abilities outlined within the Pre-APPE Core Domains. METHODOLOGICAL LITERATURE REVIEW: The Medline database and journals related to pharmacy education were searched to identify activities and assessments for each domain. Search terms for each core domain were extracted from the domain titles, ability statements, and performance competencies and coupled with "laboratory" or "lab." "Pharmacy" was also added as a search term when searching the Medline database. Preference was given to example activities published in the last 15 years. Abstracts and activities based on author experience were also included. OUR RECOMMENDATIONS AND THEIR APPLICATIONS: Specific examples of how activities and assessments can be included in practice laboratories to develop or refresh skills identified in the pre-APPE core domains were described. POTENTIAL IMPACT: The practice laboratory setting is an ideal place for students to learn and practice the skills necessary to demonstrate readiness for APPEs. This paper serves as a resource for instructors, curriculum committees, or pharmacy programs looking for ideas to expand specific training or develop particular skill areas.

Assessment of SOAP note evaluation tools in colleges and schools of pharmacy.

INTRODUCTION: To describe current methods used to assess SOAP notes in colleges and schools of pharmacy. METHODS: Members of the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group were invited to share assessment tools for SOAP notes. Content of submissions was evaluated to characterize overall qualities and how the tools assessed subjective, objective, assessment, and plan information. RESULTS: Thirty-nine assessment tools from 25 schools were evaluated. Twenty-nine (74%) of the tools were rubrics and ten (26%) were checklists. All rubrics included analytic scoring elements, while two (7%) were mixed with holistic and analytic scoring elements. A majority of the rubrics (35%) used a four-item rating scale. Substantial variability existed in how tools evaluated subjective and objective sections. All tools included problem identification in the assessment section. Other assessment items included goals (82%) and rationale (69%). Seventy-seven percent assessed drug therapy; however, only 33% assessed non-drug therapy. Other plan items included education (59%) and follow-up (90%). DISCUSSION AND CONCLUSIONS: There is a great deal of variation in the specific elements used to evaluate SOAP notes in colleges and schools of pharmacy. Improved consistency in assessment methods to evaluate SOAP notes may better prepare students to produce standardized documentation when entering practice.

Interprofessional Curbside Consults to Develop Team Communication and Improve Student Achievement of Learning Outcomes.

Objective. To design and implement a series of activities focused on developing interprofessional communication skills and to assess the impact of the activities on students' attitudes and achievement of educational goals. Design. Prior to the first pharmacy practice skills laboratory session, pharmacy students listened to a classroom lecture about team communication and viewed short videos describing the roles, responsibilities, and usual work environments of four types of health care professionals. In each of four subsequent laboratory sessions, students interacted with a different standardized health care professional role-played by a pharmacy faculty member who asked them a medication-related question. Students responded in verbal and written formats. Assessment. Student performance was assessed with a three-part rubric. The impact of the exercise was assessed by conducting pre- and post-intervention surveys and analyzing students' performance on relevant Center for the Advancement of Pharmacy Education (CAPE) outcomes. Survey results showed improvement in student attitudes related to team-delivered care. Students' performance on the problem solver and collaborator CAPE outcomes improved, while performance on the educator outcome worsened. Conclusions. The addition of an interprofessional communication activity with standardized health care professionals provided the opportunity for students to develop skills related to team communication. Students felt the activity was valuable and realistic; however, analysis of outcome achievement from the exercise revealed a need for more exposure to team communication skills.

A reflective teaching challenge to motivate educational innovation.

OBJECTIVE: To describe a teaching challenge intended to increase faculty use of evidence-based and student-centered instructional strategies in the demanding school of pharmacy context with technology-savvy students. DESIGN: A teaching challenge was created that required faculty members to incorporate a "new-to-you" innovative teaching method in a class, course, or experiential activity. The method was linked to at least 1 of 7 evidence-based principles for effective teaching. Faculty members were exposed to colleagues' teaching strategies via brief voluntary presentations at department meetings. ASSESSMENT: A post-challenge survey provided assessment data about the challenge. Responses to a baseline survey provided additional information about what faculty members were already doing (52% response rate). Eighty-one percent of faculty respondents completed the challenge. A wide array of new strategies (13 categories such as flipped classrooms and social media) was implemented and 75% included the use of technology. Nearly all respondents (96%) thought that participation in the challenge was worth the effort and planned to participate again the following year. All faculty members intended to continue using their new strategy and 56% planned additional modifications with future implementations. The challenge demonstrated how multiple goals of curricular improvement, faculty development, and student-centered instruction could be achieved together. CONCLUSION: The teaching challenge motivated most of the faculty members to try something new to them. Links between evidence-based principles and day-to-day activities were strengthened. The new-to-you design placed the challenge within reach of faculty members regardless of their background, subject, or experience.

Interprofessional socialization as a way to introduce collaborative competencies to first-year health science students.

Interprofessional education (IPE) is the cornerstone of preparing future health care providers but remains to be a challenge for many health science programs. We aimed to develop and evaluate an interprofessional conference for first-year health science students with goals to provide students with interprofessional socialization opportunity and introduce IPE principles. A half-day conference was based upon core competencies for health professionals and involved 277 first-year health sciences, nursing, pharmacy, physical therapy, and speech language pathology and audiology students. Alcohol and substance misuse was chosen as a topic for its relevance to college students and health professionals. Results from program evaluation revealed that the conference was successful in exposing students to core interprofessional competencies and provided useful information about alcohol and substance misuse. This study advocates for early inclusion of IPE in the health professions curricula in the form of interprofessional socialization.

A simulated hospital pharmacy module using an electronic medical record in a pharmaceutical care skills laboratory course.

OBJECTIVES. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. DESIGN. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. ASSESSMENTS. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. CONCLUSIONS. A simulated hospital pharmacy module improved pharmacy students' hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist.

Process indicators of quality clinical pharmacy services during transitions of care.

The American College of Clinical Pharmacy charged the Public and Professional Relations Committee to develop a short white paper describing quality measures of clinical pharmacists' patient care services in transitional care settings. Transitional care describes patient movement from one health care setting or service to another. Care transitions are associated with an increased risk of adverse events for patients. Pharmacists play an important role in ensuring that medication errors and adverse events are minimized during these transitions, largely through the reconciliation of medications and assurance of continuity of care. Quality measures are often divided into three domains: structure, process, and outcome. Given the typical nature of the pharmacist's role, process indicators are best suited to evaluate quality clinical pharmacist services. However, process indicators relevant to pharmacists' activities are not yet fully described in the literature. The committee searched available literature describing quality measures that are directly influenced by the pharmacist during care transitions. This white paper describes these process indicators as quality measures of clinical pharmacists' services, identifies the transitional settings and activities to which they are most applicable, and provides the published sources from which indicators were derived. For process indicators that could not be found in published sources, we propose relevant measures that can be adapted for use in a given setting. As pharmacists become more involved in diverse and emerging patient care areas such as transitional care, it will be critical that they use these types of measures to document the quality of new services and reinforce the need for pharmacist participation during transitions of care.

Improving care transitions: current practice and future opportunities for pharmacists.

During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S. hospitals are high, often because of poor care transitions. Serious adverse drug events (ADEs) caused by an incomplete understanding of changes in complex drug regimens can be an important factor contributing to readmission rates. This paper describes the roles and responsibilities of pharmacists in ensuring optimal outcomes from drug therapy during care transitions. Barriers to effective care transitions, including inadequate communication, poor care coordination, and the lack of one clinician ultimately responsible for these transitions, are discussed. This paper also identifies specific patient populations at high risk of ADEs during care transitions. Several national initiatives and newer care transition models are discussed, including multi- and interdisciplinary programs with pharmacists as key members. Among their potential roles, pharmacists should participate on medical rounds where available, perform medication reconciliation and admission drug histories, apply their knowledge of drug therapy to anticipate and resolve problems during transitions, communicate changes in drug regimens between providers and care settings, assess the appropriateness and patient understanding of drug regimens, promote adherence, and assess health literacy. In addition, this paper identifies barriers and ongoing challenges limiting greater involvement of pharmacists from different practice settings during care transitions. Professional degree programs and residency training programs should increase their emphasis on pharmacists' roles, especially as part of interdisciplinary teams, in improving patient safety during care transitions in diverse practice settings. This paper also recommends that Accreditation Council for Pharmacy Education (ACPE) standards include specific language regarding the exposure of students to issues regarding care transitions and that students have several opportunities to practice the skills needed for effective care transitions. Moreover, reimbursement mechanisms that permit greater pharmacist involvement in providing medication assistance to patients going through care transitions should be explored. Although health information technology offers the potential for safer care transitions, pharmacists' use of information technology must be integrated into the national initiatives for pharmacists to be effectively involved in care transitions. This paper concludes with a discussion about the importance of recognizing and addressing health literacy issues to promote patient empowerment during and after care transitions.

Using Facebook to facilitate course-related discussion between students and faculty members.

OBJECTIVES: To use Facebook to facilitate online discussion of the content of a Comprehensive Disease Management course and to evaluate student use and perceptions of this exercise. DESIGN: A Facebook page was created and coordinators encouraged students to "like" the page and to post and view study tips, links, or questions. At the end of the course, students' use and perceptions were evaluated using an anonymous survey tool. ASSESSMENT: At the end of week 1, there were 81 followers, 5 wall posts, and 474 visits to the course Facebook page. At peak use, the page had 117 followers, 18 wall posts, and 1,326 visits. One hundred nineteen students (97% of the class) completed the survey tool. Twenty-six percent of students contributed posts compared to 11% who posted on the course discussion board on Blackboard. Students were more likely to post and be exposed to posts on Facebook than on Blackboard. Students found Facebook helpful and 57% said they would miss Facebook if use was not continued in subsequent courses. CONCLUSIONS: Students in a Comprehensive Disease Management course found the addition of a Facebook page a valuable study tool and thought most posts added to their learning.

Pharmacist recommendations to improve the quality of diabetes care: a randomized controlled trial.

BACKGROUND: Diabetes mellitus continues to result in substantial morbidity and mortality despite receiving much attention from health care providers. Automated clinician reminder systems have been developed to improve adherence to diabetes care guidelines, but these reminder systems do not always provide actionable information and may be unable to detect relevant, subjective patient information that affects clinical decision making. Face-to-face visits with pharmacists, who have knowledge of care guidelines and medication management strategies, may assist in improving diabetes care. It is unknown if the combination of pharmacist chart review and clinician reminders could improve diabetes care without requiring face-to-face visits. OBJECTIVE: To assess the effects of a comprehensive, pharmacistdelivered, primary care, physician-focused intervention in a large hospital based primary care practice to improve the quality of care for patients with diabetes including rates of semiannual hemoglobin A1c testing and other biomarker and process measures. METHODS: This was a prospective, randomized, controlled study conducted in a hospital-based, primary care practice, composed of 37 faculty primary care physicians (PCPs) and 95 internal medicine residents. The initial sample included 346 patients with diabetes and 72 PCPs caring for them. PCPs were randomized to receive either a personalized letter from a practicing pharmacist containing treatment recommendations for patients with upcoming primary care visits (intervention, n = 33) or to usual care without the letters (control, n = 39). The letter included patient-specific recommendations regarding overdue testing as well as drug therapy to achieve diabetes-related treatment targets. The intervention included addition of the letter to the electronic medical record (EMR) and presentation of the letter to the PCP at the time of the index primary care visit that occurred between November 2003 and August 2004. Follow-up chart review was performed after the primary care visit to determine changes in 5 process and 3 biomarker outcome measures of diabetes care within 30 days of the index visit. The primary study outcome was a process measure, change in rates of semiannual A1c testing from baseline to 30-day follow-up. Baseline differences were tested for statistical significance using Pearson chisquare. The statistical significance of the intervention's effect was tested using logistic regression models predicting achievement of each study outcome, with randomization status (intervention vs. control) as the predictor variable of interest, controlling for baseline performance for each measure. RESULTS: 171 patients were in the 4 medical clinic suites with 33 PCPs who received the intervention, and 175 patients were in the 4 suites with 39 PCPs in usual care. 30-day outcomes were analyzed for 301 patients (87.0%) who attended their scheduled index primary care visit. Of these 301 patients, 44.5% were black, 65.8% were female, and the mean age was 63 years. At baseline, there were no significant differences between the intervention group (n = 150) and the usual care (control) group (n = 151) in the 3 biomarker measures (proportion with A1c less than 7%, proportion with low-density lipoprotein cholesterol [LDL-C] less than 100 milligrams per deciliter [mg per dL], or blood pressure less than 130/80 millimeters mercury [mm Hg]). There were no significant baseline differences in 4 of the 5 process measures; however, the rate of annual LDL-C testing was significantly higher for the intervention than for the control group at baseline (86.0% vs. 74.8%, respectively, P = 0.015). In logistic regression analysis, rates of semiannual A1c testing were not significantly different between the intervention and control groups, increasing from baseline to follow-up by 16% in the intervention group and 9% in the control group (P = 0.146). The proportion of patients with A1c less than 7% at follow-up was 43.3% in the intervention group versus 37.7% in the control group (intervention effect P = 0.099). The only statistically significant difference between the 2 groups in the 8 outcome measures was a higher proportion with an annual eye exam at follow-up in the intervention group (60.0%) versus the usual care group (50.3%, intervention effect P = 0.017). CONCLUSIONS: Pharmacist-generated recommendations delivered by letter to PCPs in an academic medical practice were not associated with statistically significant improvements in most quality measures for diabetes care assessed at 30 days following the intervention. Further research is needed with more patients and a longer follow-up time to determine how best to improve the quality of care of patients with diabetes using focused recommendations for therapy changes and reminder notices to clinicians.

Establishing an interdisciplinary geriatric education center.

To remain viable, academic institutions preparing the future workforce need to be attentive and responsive to changes in the social environment. This is particularly true when considering the preparation of a health care workforce for the field of geriatrics. An Interdisciplinary Geriatric Education Center is an innovative, deliberate, institutional strategy to prepare and deliver an effective healthcare workforce for the future geriatric population. The model and processes for the implementation of such a center are presented.

A tool for measuring active learning in the classroom.

OBJECTIVES: To develop a valid and reliable active-learning inventory tool for use in large classrooms and compare faculty perceptions of active-learning using the Active-Learning Inventory Tool. METHODS: The Active-Learning Inventory Tool was developed using published literature and validated by national experts in educational research. Reliability was established by trained faculty members who used the Active-Learning Inventory Tool to observe 9 pharmacy lectures. Instructors were then interviewed to elicit perceptions regarding active learning and asked to share their perceptions. RESULTS: Per lecture, 13 (range: 4-34) episodes of active learning encompassing 3 (range: 2-5) different types of active learning occurred over 2.2 minutes (0.6-16) per episode. Both interobserver (> or = 87%) and observer-instructor agreement (> or = 68%) were high for these outcomes. CONCLUSIONS: The Active-Learning Inventory Tool is a valid and reliable tool to measure active learning in the classroom. Future studies are needed to determine the impact of the Active-Learning Inventory Tool on teaching and its usefulness in other disciplines.

Role of pharmacist counseling in preventing adverse drug events after hospitalization.

BACKGROUND: Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs. METHODS: We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs. RESULTS: Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (P = .01). No differences were found between groups in total ADEs or total health care utilization. CONCLUSIONS: Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.

Duloxetine: a dual serotonin-norepinephrine reuptake inhibitor for treatment of major depressive disorder.

The burden of mental illness has been underestimated worldwide. Depression was the fourth leading cause of disease burden in the world in 1990 and is projected to be the second leading cause of disability by 2020. It is a leading cause of morbidity and mortality in the United States, costing billions of dollars annually in direct and indirect medical costs and losses in productivity. Patients with major depressive disorder (MDD) may experience both psychological and medical complaints, including somatic sensations or pain. Some antidepressants have been shown to treat chronic pain syndromes, but despite the variety of antidepressants available in the United States, only 65-70% of patients respond to initial antidepressant treatment. Treatments are limited by delayed onset of antidepressant effects, side effects, partial response, and treatment resistance. Duloxetine, approved by the U.S. Food and Drug Administration for the treatment of MDD, is a reuptake inhibitor at serotonergic and noradrenergic neurons and appears to have low affinity for other neurotransmitter systems. In clinical trials, duloxetine was effective for the treatment of MDD and was well tolerated. Further study is needed to compare its efficacy with that of other antidepressants, to clarify effects on somatic symptoms, and to assess potential adverse cardiovascular and sexual side effects. Duloxetine is also approved for the management of diabetic peripheral neuropathic pain and is under investigation for the treatment of stress urinary incontinence in women.