Racial and ethnic harm in patient care is a patient safety issue.

Health equity and antiracism can contribute to enhanced patient safety in healthcare settings. The Oath of the Pharmacist states, "I will promote inclusion, embrace diversity, and advocate for justice to advance health equity." Part of this commitment means upholding these principles in patient care settings. Racial and ethnic harm negatively impact patient safety. Racial and ethnic harm are reviewed in the context of social learning theory, critical race theory, and medical and scientific racism. Pharmacists and healthcare systems must actively prevent and mitigate racial and ethnic harm to patients from personal and organizational levels to create a culture of safety. Part of this strategy involves acknowledging when you have contributed to patient harm, issuing a genuine apology, and offering to mend or re-establish trust between racially and ethnically minoritized patients and the pharmacist or the health system to contribute to patient safety. These strategies may help create a culturally safe space for racially and ethnically marginalized patients in the healthcare system.

Mitigating stereotypes and bias in professional identity formation for those with marginalized identities.

Pharmacists have many identities within the profession from medication experts, clinicians, educators, mentors, patient advocates, and more. It can be especially challenging for racially and ethnically minoritized persons (REMPs) to form a professional identity when they are surrounded by stereotypes and biases which are pervasive in the community, academia, and pharmacy practice settings. As pharmacist educators, preceptors, and mentors, it is important to create safer spaces that decrease stereotyping and biases for students so they may envision themselves thinking, acting, and feeling like a pharmacist. Here, literature on professional identity formation in underrepresented groups in the United States is reviewed to continue the conversation of creating safer spaces for underrepresented students as they develop their professional identity.

Developing and Validating the Diversity, Equity, Inclusion, and Antiracism Faculty Perceptions of College Climate (DEIA FPCC) Scale in Pharmacy Faculty.

OBJECTIVE: This work's objective was to demonstrate acceptable reliability and consistency within and across each domain of the survey tool. METHODS: A survey with 16 questions was distributed to faculty from the AACP membership list and contained 4 domains: DEIA. The survey responses were analyzed using factor analysis and reliability analysis. RESULTS: A total of 877 subjects' responses met inclusion criteria and were used in the analysis. The results demonstrated that the survey had high reliability and discriminating validity within each domain and overall as a scale. CONCLUSION: The finalized tool provides a practical, standardized measure to evaluate faculty perceptions of DEIA efforts in institutions of pharmacy education. This tool can help identify areas of improvement and guide the advancement of DEIA initiatives in colleges of pharmacy. Further research is needed to validate the survey in other populations. Future efforts will also explore predictors of survey scores.

Recognizing and Mitigating Racial and Ethnic Interview-Associated Microaggressions Across the Academy.

Microaggressions in pharmacy education interviews can have a significant impact, often reinforcing a message that underrepresented minority (URM) candidates must assimilate for acceptance, rather than being invited to contribute their authentic identities to diversify and strengthen the institution. Interviewers may ask inappropriate questions or make offensive comments without intending to cause harm; however, the impact of the words on the interviewee are valid and cannot be ignored. This text focuses on the challenges faced by URM faculty in the context of academic pharmacy interviews, which potentially contribute to their underrepresentation in academic pharmacy. The authors provide examples of perspectives and experiences from URM pharmacy faculty when interviewing for academic pharmacy positions. This article proposes several recommendations, such as microaggression prevention strategies, bias training, and institutional culture improvement. These solutions can help institutions achieve a sustainable means of recruiting and retaining URM faculty.

Comparison of Community Pharmacist and Non-Community Pharmacist Perceptions of a Community Pharmacy Specialty Board Certification.

Background: Pharmacy board certification provides pharmacists with formal recognition of their careers and their involvement in direct and comprehensive patient care. Credentialing as a board-certified pharmacist demonstrates that the pharmacist has specialized expertise and is able to provide advanced level patient care in a specific pharmacy practice specialty. There is currently not a community pharmacy board certification available in the United States. With the expanding role and clinical expectations of community pharmacists nationwide, perspectives regarding the utility of a community pharmacy specialty board certification are necessary. Methods: A cross-sectional survey with demographic and perception questions (5-point Likert scale) was distributed electronically via Qualtrics. A random sample of pharmacists registered in Rhode Island, Ohio, and Nebraska were selected and surveyed. Results: 53 survey responses were collected. There was a statistically significant difference in board certification history (P = .001) and history of post-graduate training (P < .001) between community pharmacists and non-community pharmacists. Community pharmacists were more likely to simultaneously see community pharmacists as general practitioners (P = .030) and as pharmacy practice specialists (P = .001). Non-community pharmacists were more likely to be familiar with current maintenance requirements for pharmacy board certifications (P < .001) and to feel that a board certification is an appropriate indicator of experience in a pharmacy specialty area (P = .016). Conclusion: Views regarding community pharmacy and board certification differed between community and non-community pharmacists. There was not a statistically significant difference in the perceived value of community pharmacy board certification between community and non-community pharmacist.

Prioritizing ethical patient care responsibilities: A call to restructure student training practices in federally qualified health centers.

Federally Qualified Health Centers (FQHCs) are federally funded clinics that often serve medically underserved groups. Many Colleges of Pharmacy have faculty and non-faculty pharmacist preceptors who provide clinical services such as drug therapy management to FQHCs. It is critical that Colleges of Pharmacy and pharmacist preceptors reinforce and uphold the standard of providing high quality and evidenced based care when students rotate at these sites. Learners may have implicit biases and variable levels of emotional intelligence prior to a clinical rotation at an FQHC, which can affect the quality-of-care patients receive. Colleges of Pharmacy who send learners onto rotations at FQHCs should collaborate with FQHC sites to ensure learner readiness in clinical and emotional levels and mediate for any concerns that may arise.

Development of a communication-based virtual patient counseling objective structured clinical examination (OSCE) for first year student pharmacists.

Objective: This text seeks to describe a framework for delivering and executing a virtual patient counseling OSCE and compare student performance to the in-person alternative. Methods: A communication-based virtual patient counseling objective structured clinical examination (OSCE) was created to fulfill the educational outcomes of a previously held in-person OSCE in response to the COVID-19 pandemic. The virtual nature of this OSCE simulated a telehealth encounter, which has increased in utilization since the beginning of the COVID-19 pandemic. This OSCE was offered twice in one semester - once as a formative assessment and once as a summative assessment. Student performance was mapped to learning outcomes and compared the previous year's in person performance. Results: The described virtual framework for executing the OSCE successfully decreased the time required and saw <1% change in overall performance from students when compared to the previous year in person which was not statistically significant. Conclusion: This framework for a virtual communication-based OSCE reduces time with a negligible impact on student performance compared to the in person alternative. Innovation: This work describes a telehealth virtual patient counseling model to replace the traditional patient counseling OSCE in pharmacy education with comparable outcomes.

Training Student Pharmacists How to Mitigate Racial or Ethnic Microaggressions in Patient Encounters.

The experience of interfacing with the health care system is a taxing one for racially or ethnically marginalized patients (REMPs). The seemingly inevitable occurrence of encountering microaggressions is reason enough to avoid the interaction for many resulting in worse health outcomes. Microaggressions result in conflict, loss to follow-up, and reinforcing the unwelcome atmosphere of the health care system to REMPs. Teaching antimicroaggressive content in doctor of pharmacy curricula is critical for reducing strain on the fragile relationship between REMPs and the health care system. Whether it is gathering a patient history, devising a patient-centered care plan, or counseling patients, there is an opportunity for an interaction that could sever the patient's trust in the health care system. Teaching each of these skills-based learning activities should be combined with didactic lessons in nonjudgmental and nonmicroaggressive communication approaches. In addition, lessons regarding the impact of microaggressions on REMPs should also be present so that learners may appreciate the impact of a clinician's actions on REMPs in this regard. To establish evidence-based best practices, more research on teaching antimicroaggressive didactic and skills-based content to student pharmacists is needed.

Academic Pharmacy Fellowship Programs are an Innovative Solution to Improve the Faculty Pipeline.

Academic pharmacy fellowship programs can offer an innovative training solution to help prepare pharmacists for successful careers as clinical faculty members. However, there is no well-defined program blueprint or recommendations for what a successful program should include. This commentary describes the program overview for the academic pharmacy fellowship at the University of Houston College of Pharmacy and discusses the implications of incorporating a similar program at a college of pharmacy. The purpose of the fellowship program is to prepare pharmacists for a career in pharmacy education through training in teaching, curriculum development, college service, mentoring, scholarship, and clinical practice. A structured program with monthly rotations in key academic areas, teaching experience and mentorship (didactics and skills labs), committee service, and leading a research project make up the core structure of the program. These experiences, coupled with significant student interaction, can prepare fellowship graduates to transition effectively into clinical faculty roles.

Tatted not tattered.

Tattoos are common practice in underrepresented groups. However, institutional policies often prohibit visible tattoos of health professionals. This affects marginalized groups where tattoos may be the cultural norm. There are conflicting findings on perceptions of tattoos on medical professionals from the perspectives of peers, patients, and learners. Tattoo restriction can be discriminatory against already marginalized persons and sends a message of exclusion. Policies surrounding tattoo restriction should be re-evaluated to create an inclusive environment for all.

Improving pharmacy students' empathy and attitudes regarding opioid overdose and substance use disorder in a skills-based learning environment.

INTRODUCTION: Using a skills-based learning environment as a launch pad for developing empathy for patients with substance use disorder or at high risk for opioid overdose allows for learning continuity and early intervention. Empathy for this patient population may reduce bias and stigma associated with negative health outcomes. Previous studies have assessed empathy in pharmacy students, but not in the context of substance use disorder and opioid overdose harm reduction among first professional year pharmacy students in skills-based education. This cohort study aimed to measure the change in empathy and opioid overdose-related attitudes before and after a two-part skills-based learning activity that focused on drug diversion and opioid overdose treatment. METHODS: First professional year pharmacy students were given a pre- and post-survey consisting of empathy and attitudes sections. The Kiersma-Chen Empathy Scale (KCES) and the Opioid Overdose Attitudes Scale (OOAS) were used. The intervention was a skills-based learning activity with two segments, one that focused on naloxone counseling and the other focused on drug diversion. RESULTS: The aggregate mean change in KCES and OOAS scores of the cohort increased by 1.837 (P = .014) and 2.349 (P = .008), respectively. Of note, students with lower baseline empathy and attitudes scores showed more improvement in both KCES and OOAS scores. CONCLUSIONS: Students showed improvement in empathy and attitudes regarding opioid overdose and substance use disorder. A larger magnitude of improvement was noted with lower baseline scores.

Professional tress code: I look like a pharmacist.

Hair color, style, and length are facets to a person's self-expression. There is evidence of bias against those who wear natural hair styles in job recruitment settings, which can affect how the candidate is perceived. In addition, there have been discriminatory hair policies that affect minoritized people. In the profession of pharmacy, most definitions of professionalism do not comment on physical appearance as a component but focus on characteristics such as knowledge, respect, communication, and empathy. It is critical to ensure that comments about someone's hair are not microaggressions. To embrace natural hair styles, pharmacists should combat any policies that are discriminatory and provide a safe space for others to feel comfortable wearing their hair in natural styles or with hair coverings. These actions will help create a space for authenticity, self-acceptance, and comfort.

A Review of Hypertension Management in Black Male Patients.

Hypertension affects approximately 85 million Americans, or almost 1 in 3 adults. Black men have disproportionately higher rates of hypertension and are more likely to experience complications of hypertension, including stroke, myocardial infarction, and death. In addition, hypertensive black men are less likely to achieve optimal blood pressure (BP) than women and persons of other races. In light of this, we performed a literature search for articles published from January 1, 1966, to December 31, 2018, using terms including hypertension, blood pressure, black male, and African American male. Studies were selected for inclusion according to their relevance regarding hypertensive management in black men. Subsequent findings indicated that targeted identification (ie, barbershops), medication management, and close follow-up resulted in greater control of BP. Also, a reduction of systolic blood pressure greater than 20 mm Hg occurred with the use of pharmacists following algorithms specifically for the management of hypertension in black men. Continued emphasis to identify strategies to improve control of BP and outcomes in this population is needed.

Buffer Standards for the Biological pH of the Amino Acid N-[2 hydroxyethyl]piperazine-N'-[3-propanesulfonic acid], HEPPS, From (278.15 to 328.15) K.

For the HEPPS buffer under investigation, there are seven buffer solutions without NaCl and eight buffer solutions that contain Cl(-) and have an ionic strength (I = 0.16 mol·kg(-1)), which is similar to that of blood plasma. These buffer solutions have been evaluated in the temperature range of (278.15 to 328.15) K using the extended Debye- Hückel equation and the Bates-Guggenheim convention. The previously determined E(j) values have been used to determine the operational pH values of HEPPS buffer solutions at (298.15 and 310.15) K. These are recommended as secondary standard reference solutions for pH measurements in saline media with an isotonic ionic strength of I = 0.16 mol·kg(-1).

Buffer Standards for the Physiological pH of the Zwitterionic Compound, DIPSO from 5 to 55 degrees C.

The values of the second dissociation constant, pK(2), and related thermodynamic quantities of 3-[N,N-bis (2-hydroxyethyl)amino]-2-hydroxypropanesulfonic acid (DIPSO) have already been reported over the temperature range 5 to 55 degrees C including 37 degrees C. This paper reports the pH values of four NaCl-free buffer solutions and four buffer composition containing NaCl salt at I = 0.16 mol.kg(-1). Conventional pa(H) values are reported for all eight buffer solutions. The operational pH values have been calculated for four buffer solutions recommended as pH standards, at 25 and 37 degrees C after correcting the liquid junction potentials with the flowing junction cell.

Buffer Standards for the Biochemical pH of 3-(N-morpholino)-2-hydroxypropanesulfonic Acid from (278.15 to 328.15) K.

The values of the second dissociation constant pK(2) and related thermodynamic quantities of the ampholyte 3-(N-morpholino)-2-hydroxypropanesulfonic acid (MOPSO) have been previously determined at temperatures from (278.15 to 328.15) K. In this study, the pH values of two buffer solutions without NaCl and three buffer solutions with NaCl having ionic strengths (I = 0.16 mol·kg(-1)) similar to those in blood plasma, have been evaluated at 12 temperatures from (278.15 to 328.15) K using an extended form of the Debye-Hückel equation, since the Bates-Guggenheim convention is valid up to I = 0.1 mol·kg(-1). The liquid junction potentials (E(j)) between the buffer solutions of MOPSO and saturated KCl solution of the calomel electrode at (298.15 and 310.15) K have been estimated by measurement with a flowing junction cell. These values of E(j) have been used to ascertain the operational pH values at (298.15 and 310.15) K. Three buffer solutions of MOPSO are recommended as useful reference solutions for pH measurements in saline media of ionic strength I = 0.16 mol·kg(-1).

Buffer Standards for pH Measurement of N-(2-Hydroxyethyl)piperazine-N'-2-ethanesulfonic Acid (HEPES) for I = 0.16 mol.kg from 5 to 55 degrees C.

The values of the second dissociation constant, pK(2) of N-(2-hydroxyethyl) piperazine-N'-2-ethanesulfonic acid (HEPES) have been reported at 12 temperatures over the temperature range 5 to 55 degrees C, including 37 degrees C. This paper reports the results for the pa(H) of eight isotonic saline buffer solutions with an I = 0.16 mol*kg(-1) including compositions: (a) HEPES (0.01 mol*kg(-1)) + NaHEPES (0.01 mol*kg(-1)) + NaCl (0.15 mol*kg(-1)); (b) HEPES (0.02 mol*kg(-1)) + NaHEPES (0.02 mol*kg(-1)) + NaCl (0.14 mol*kg(-1)); (c) HEPES (0.03 mol*kg(-1)) + NaHEPES (0.03 mol*kg(-1)) + NaCl (0.13 mol*kg(-1)); (d) HEPES (0.04 mol*kg(-1)) + NaHEPES (0.04 mol*kg(-1)) + NaCl (0.12 mol*kg(-1)); (e) HEPES (0.05 mol*kg(-1)) + NaHEPES (0.05 mol*kg(-1)) + NaCl (0.11 mol*kg(-1)); (f) HEPES (0.06 mol*kg(-1)) + NaHEPES (0.06 mol*kg(-1)) + NaCl (0.10 mol*kg(-1)); (g) HEPES (0.07 mol*kg(-1)) + NaHEPES (0.07 mol*kg(-1)) + NaCl (0.09 mol*kg(-1)); and (h) HEPES (0.08 mol*kg(-1)) + NaHEPES (0.08 mol*kg(-1)) + NaCl (0.08 mol*kg(-1)). Conventional pa(H) values, for all eight buffer solutions from 5 to 55 degrees C have been calculated. The operational pH values with liquid junction corrections, at 25 and 37 degrees C have been determined based on the NBS/NIST standard between the physiological phosphate standard and four buffer solutions. These are recommended as pH standards for physiological fluids in the range of pH 7.3 to 7.5 at I = 0.16 mol*kg(-1).