Improving First-Year Family Medicine Residents' Confidence in Safe Opioid Prescribing Through a Multiactivity Educational Program.

BACKGROUND AND OBJECTIVE: It is documented that some of the opioids prescribed to manage chronic pain are diverted and used for nonmedical purposes. We investigated whether a skill-based, chronic pain management (CPM) educational program could improve first-year family medicine residents' comfort, knowledge, and concerns in assessing and managing patients who use opioids for chronic noncancer pain. METHODS: A total of 72 first-year residents (four cohorts of 18) participated in a 3-month CPM training intervention that consisted of didactic lectures, objective structured clinical examination (OSCE) activities, and post-OSCE debriefing with faculty, one being a behavioral health specialist, between 2017 and 2020. We used a single-sample, pre/post design. At three points in time (baseline, 3-months, and 6-months postintervention), participants completed a set of measures assessing comfort, knowledge, and concern. We used repeated measures analyses to assess changes in outcome measures. RESULTS: Participants reported improvements compared with baseline at both follow-up time points. At 6 months postintervention, the participants had significantly better scores on measures of comfort (F[1, 71]=65.22; P<.001), knowledge (F[1, 71]=22.38, P<.001), and concern (F[1, 71]=37.89, P<.001) in prescribing opioids for chronic noncancer pain. CONCLUSION: A multiactivity CPM educational program for first-year residents was associated with improvement in perceived sense of comfort, knowledge, and concerns in assessing and managing patients who use opioids for chronic noncancer pain. CPM training interventions may be an effective tool to educate first-year residents to implement best practices for pain management with the goal of reducing the chances of inappropriately prescribing controlled substances or denying analgesia.

Utilizing clinical pharmacists and a medication assistance program to improve medication access for indigent and underserved patients in primary care.

Background: Medication Assistance Programs (MAP) provide needed medications to uninsured and underinsured patients. In 2019, 24% of adults had difficulty affording their medications. Literature has shown enrollment in MAP decreased emergency department (ED) visits, hospital admission, and total hospital cost. Objectives: Primary objective described cost savings of MAP in patients identified by pharmacists. Secondary objectives included comparing rates one year before and after MAP utilization for hospitalization, ED visits, and combined hospitalization and ED visits. The purpose of the study was to evaluate the effect of pharmacists in improving medication access. Methods: A retrospective observational cohort was conducted in primary care and family medicine resident clinics. Inclusion criteria included one or more visits with a pharmacist and MAP application between January 1, 2019 through December 31, 2019. The primary objective and demographics were analyzed using descriptive statistics. Secondary objectives were analyzed using paired t-test. Results: In total, 18 patients saved $187,789, with an average of $10,432 per patient, for 35 medications. There were no statistically significant differences in average hospitalizations, ED visits, and combined hospitalizations and ED visits. Conclusions: Pharmacists utilizing MAP resulted in cost savings and increased patient access to medications. The study did not find differences in hospital visits, ED visits, or combined hospital and ED visits.

Evaluating the impact of a flipped classroom model based on cognitive science of learning strategies in a pharmacotherapy course.

INTRODUCTION: The purpose of this study was to determine the impact of a flipped classroom method based on cognitive science of learning strategies on student performance and experience in a third-year pharmacotherapy course. METHODS: The cognitive science of learning flipped classroom (CSL-FC) strategies in this study included pre-class learning (Preview), in-class application to cases (Retrieval), after-class learning (Spaced Retrieval), and post-module reflection (Deliberate Reflection) in a required pharmacotherapy course. During fall 2017, one instructor piloted the CSL-FC method. During fall 2018, this method expanded to four instructors. All other instructors used traditional lecture-based methods. The same multiple-choice exam questions were used both years. The average exam question scores between teaching methods were compared by independent t-test. Student focus groups were conducted after the 2017 semester. In 2018, students were surveyed using a 5-point Likert rating (1 = strongly agree, 5 = strongly disagree) to evaluate their experience. RESULTS: The 2017 and 2018 classes included 132 and 137 students, respectively. During the two years, exam question scores were significantly better with CSL-FC (n = 136 questions) compared to traditional (n = 110 questions) (88.8% vs 84.9%, respectively; P = .02). The focus group analysis revealed three main themes including a "love-hate relationship," "time," and "it works." Student agreement to the survey question "the cognitive science of learning flipped classroom helped me learn" was 2.18 (SD 1.12). CONCLUSIONS: Implementing a flipped classroom approach based on cognitive science of learning strategies positively impacted student performance and experience in a pharmacotherapy course.

Integration of Pharmacy Students Into Family Medicine Residency Clinics.

BACKGROUND AND OBJECTIVES: As interprofessional education opportunities become more prevalent within family medicine residency clinics, the benefit of the integration of pharmacy students is unclear in the current literature. Our study objective was to determine the impact of pharmacy student integration into a family medicine residency clinic on family medicine residents' attitudes toward interprofessional collaboration and satisfaction. METHODS: Twenty-two pharmacy students on clinical rotation were individually paired with family medicine residents for approximately 4-5 half days per week over a 10-month period. Residents and students were given a pre/post-validated survey on attitudes toward interprofessional collaboration. Satisfaction surveys were also administered to the residents at the end of the study period. Written components of satisfaction surveys were evaluated for commonly occurring themes. RESULTS: Matched survey responses were available for over 80% of the residents. Both pre- and post-survey responses showed positive attitudes toward physician-pharmacist collaboration. A statistically significant positive change was seen for one item in the family medicine resident surveys. Favorable written comments revealed positive themes toward pharmacy students providing mediation reviews, therapeutic recommendations, and patient education. CONCLUSIONS: Pharmacy students can be integrated into family medicine residency clinics while maintaining positive levels of interprofessional collaboration and providing a perceived benefit to the family medicine residents.

Pharmacy residents' pursuit of academic positions.

OBJECTIVE: To describe pharmacy residents' interest in and pursuit of academic positions. METHODS: An electronic presurvey and postsurvey were sent to pharmacy residents during the 2011-2012 residency year. The initial survey evaluated residents' job preferences and interest in academia at the beginning of residency, and the follow-up survey focused on job selection and reasons for pursuing or not pursuing positions in academia. RESULTS: Nine hundred thirty-six residents responded to the initial survey and 630 participated in both the initial and follow-up survey. Forty-eight percent of those responding to both surveys strongly considered a career in academia in the initial survey, 28% applied for an academic position, and 7% accepted a position. Second-year postgraduate residents were more likely than first-year postgraduate residents to apply for and be offered a faculty position. CONCLUSION: Pharmacy residents are interested in academia. While increasing interest among residents is encouraging for faculty recruitment, the academy should also encourage and develop adequate training experiences to prepare residents to succeed in these positions.