Perceptions of the incorporation of health literacy in pharmacy training programs

ObjectivesTo assess pharmacy residents’ perceptions regarding the incorporation of health literacy in pharmacy school and pharmacy residency training and to assess confidence while interacting with patients of limited health literacy.DesignProspective cross-sectional study.SettingUnited States from March to May 2012.ParticipantsPostgraduate year (PGY)1 and -2 pharmacy residents and pharmacy residency program directors.InterventionOnline survey.Main outcome measurePGY1 and -2 resident perceptions of health literacy incorporation into pharmacy school and residency training.Results939 surveys were completed. Residents agreed that their pharmacy school training encouraged the development of health literacy skills (P < 0.001) and made efforts to improve health literacy awareness (P < 0.001) significantly more than their PGY1 programs. In addition, they felt significantly more confident in their ability to communicate with patients with limited health literacy after their pharmacy school training compared with during or following PGY1 residency training (P < 0.001); however, no difference was found regarding confidence in identifying patients of limited health literacy.ConclusionPGY1 residency programs lag behind the efforts of schools of pharmacy to incorporate the health literacy training essential to encountering patients of limited health literacy. Future studies should assess whether these perceptions reflect true health literacy awareness and management among pharmacy residents.     

The influence of an elective introductory clinical research course on pharmacy student interest in pursuing research-based careers

Objective

To assess the impact of an elective clinical research course on second- and third-year pharmacy students'' knowledge of clinical research methods, training programs, career options, and interest in pursuing postgraduate training.

Design

A 2-credit hour elective course in clinical research was designed that included lectures, discussions, workshops, and in-class presentations related to study design and implementation, protocol synthesis, research evaluation, ethical and legal considerations, data analysis, and professional opportunities involving clinical research. Learner knowledge of these topics was assessed using several methods, including 3 assignments related to research protocol, ethical documentation, and presentation.

Assessment

A survey instrument designed to evaluate the effect the course had on pharmacy students'' knowledge of clinical research methods and interest in pursuing postgraduate training in clinical research was administered. Students who completed the elective had a greater level of familiarity with research-related topics, training options, and career opportunities (p < 0.05) and a greater interest in pursuing a career in clinical research (p < 0.05) than did students in a matched control group.

Conclusion

Taking a 2-credit hour elective course in clinical research increased pharmacy students'' interest in pursuing a career in clinical research.     

A mental health elective to improve pharmacy students' perspectives on mental illness

Objective

To evaluate the impact of a mental health elective on pharmacy students'' perceptions and stigmatizing views of mental illness.

Design

An elective was designed that featured an advanced overview of psychopharmacology; student training in motivational interviewing; a presentation by the National Alliance on Mental Illness (NAMI) local chapter; introduction to pharmacy collaborations with peer support specialists, social workers, and psychiatrists; mock patient counseling sessions; and a required psychiatric patient interview at a local community mental health center.

Assessment

A survey instrument with 17 Likert-scale items was constructed to measure 2 distinct areas: social distance and stigmatizing views. The survey instrument was administered at the beginning and end of the spring 2010 semester to pharmacy students enrolled in the mental health elective course and to a control group of pharmacy students enrolled in an unrelated clinical elective. The course had a positive impact on pharmacy students'' perceptions of mental illnesses. Students'' social distance and stigmatizing views of mental illnesses improved, while no significant change in views occurred among students in the control group.

Conclusion

Advanced training in psychiatric medicine and exposure to mental health care are vital to prepare pharmacy students to provide unbiased, patient-centered care to this population.     

Role of Pharmacy Residency Training in Career Planning: A Student’s Perspective

Pharmacy students typically become more focused on career planning and assessment in the final year of their PharmD training. Weighing career options in the advanced pharmacy practice experience year can be both exciting and stressful. The goal of this article is to provide a primer on how pharmacy students can assess how a residency can fit into career planning. This article will describe the various career paths available to graduating students, highlight ways in which a residency can complement career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. Most career paths require some additional training, and a residency provides appropriate experience very quickly compared to on-the-job training. Alternative plans to residency training must also be considered, as there are not enough residency positions for candidates. Directors of pharmacy must consider several factors when giving career advice on pharmacy residency training to pharmacy students; they should provide the students with an honest assessment of their work skills and their abilities to successfully complete a residency. This assessment will help the students to set a plan for improvement and give them a better chance at being matched to a pharmacy residency.Students typically become more focused on career planning and assessment in the final year of their PharmD training. That year is reserved for advanced pharmacy practice experiences (APPEs), in which students rotate for a minimum of 1,500 hours at 9 often unique practice sites under the guidance of a preceptor and additional staff. Throughout this year, the students are exposed to many different aspects of pharmacy including community, ambulatory care, hospital/health system, inpatient/acute care, and elective rotations. The exposure to the different pharmacy practice settings often causes the students to reevaluate or reconsider their chosen career path. In addition, family members, preceptors, friends, and colleagues often inquire about the students’ job plans, further education, or training. This time of exploring career options can be exciting, as well as stressful, for students on the verge of graduation. Often the decisions students make during the final year of the PharmD program are binding for many years following graduation, possibly even limiting their future career goals. Some students may make decisions based on the necessity to pay off a heavy school loan debt or the desire to work in a particular geographic area due to family concerns.Students often request career advice from pharmacy directors, who are acting as either their APPE preceptor or in connection with their employment. The pharmacy profession and job market have changed drastically in the last 10 to 15 years, making a student’s viewpoint on career planning and assessment very different from that of a pharmacy director who has been in the profession for many years. Acting as a mentor, the pharmacy director can help the students explore the following questions: How much school debt do I have? What personal concerns will influence my career plan? What aspects of pharmacy do I enjoy? Where do I see myself in 20 years? How is the profession of pharmacy changing? Should I pursue a residency?To the last question, and as part of the career planning and assessment process, students need to decide whether to pursue a residency or an entry-level pharmacist position upon graduation. Postgraduate residencies are becoming an increasingly popular option as the competition in the job market increases; the additional years of training may provide better preparation for a specific position.Despite the increase in students pursuing residency training, most PharmD students have chosen to work in community practice upon graduation. These practice areas do not require the completion of postgraduate training. According to the 2014 Pharmacy Student Graduating Survey conducted by the American Association of Colleges of Pharmacy (AACP), 5,827 of 9,527 (61%) responding students indicated that they planned to work in a chain community pharmacy upon graduation.¹ For those students entering hospital pharmacy, 3,147 of 9,527 (33%) responding students planned to pursue a staff position. There were 2,461 (25%) responding students who had plans to pursue a pharmacy residency program upon graduation.¹Residency training provides knowledge and experience at a faster pace and in a more systematic manner than can be obtained in an entry-level pharmacist position. Residency training also provides the opportunity for interprofessional collaboration, instills personal and professional confidence, provides avenues in which to advocate for the profession of pharmacy, and broadens clinical decision-making abilities. With the profession of pharmacy becoming an increasingly clinically focused profession, residency training enables a pharmacist to practice at the “top of their license” and provide exceptional patient care. It can also enable a pharmacist to become a sought after candidate by employers.The goal of this article is to provide a primer on how pharmacy students can evaluate the role of a pharmacy residency in their career planning. The article will describe the various career paths available to graduating students, highlight ways in which a residency can compliment career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. The information in this article will help students in deciding whether or not to pursue postgraduate education. In addition, this article may provide a helpful student perspective for pharmacy directors as they serve as mentors for students and young pharmacists.     

An advanced clinical track within a doctor of pharmacy program

Objective. To evaluate the advanced clinical track, a curricular track designed to prepare doctor of pharmacy (PharmD) students for residency training and institutional practice.Design. The advanced clinical track required completion of elective coursework, an additional advanced practice experience, 8 clinical experiences, and a skills checklist, and participation in a clinical skills competition.Assessment. Thirty-two graduates of the advanced clinical track were surveyed. Of the 23 respondents, 95% of those who pursued residency training were successfully matched with a residency program. Ninety-one percent of respondents felt that the advanced clinical track increased their confidence and 74% felt it was definitely an advantage when applying to a residency program. All participants agreed that the advanced clinical track met their expectations or goals and would recommend it to other students.Conclusion. Completion of an advanced clinical track was viewed by PharmD graduates as valuable preparation for residency training and institutional practice and would be recommended to other students.     

National Survey Regarding the Importance of Leadership in PGY1 Pharmacy Practice Residency Training

Background:

Leadership is considered a professional obligation for all pharmacists. It is important to integrate leadership training in residency programs to meet the leadership needs and requirements of the profession.

Objective:

To evaluate the importance of leadership development during postgraduate year 1 (PGY1) pharmacy practice residency training as perceived by new practitioners.

Methods:

A 15-question online survey was distributed to residency-trained new practitioners to assess (1) amount of time dedicated to leadership training during residency training, (2) different leadership tools utilized, (3) residents’ participation in various committees or councils, (4) perceived benefit of increased leadership training, (5) importance of having a mentor, (6) understanding of the residency organization’s strategic objectives, (7) discussion of Pharmacy Practice Model Initiative (PPMI) during residency training, and (8) adequacy of leadership training in preparation to become a pharmacy practice leader.

Results:

Although the majority of resident respondents had less than 20% of their residency devoted to leadership, nearly all survey participants acknowledged that leadership is an important component of PGY1 residency training. Residents agreed that their residency experience would have benefited from increased leadership opportunities. Most residents were knowledgeable about their organization’s strategic objectives but did not have a full understanding of pharmacy initiatives such as the PPMI.

Conclusion:

Feedback from residents indicates that an optimal dedication to leadership training would range between 20% and 30% of the residency year. Increased focus on PPMI, mentorship, and expanded use of leadership tools can serve as a way to help meet the future leadership needs of the pharmacy profession and help to better prepare residents to become pharmacy practice leaders.     

Leadership in a clinical profession

The contributions of residency training programs to pharmacy's development into a clinical profession are described. Residency programs supply institutional pharmacy with mature, highly skilled clinical and managerial practitioners, and ASHP's accreditation process ensures the programs' quality. Residents develop values, philosophy, and vision that breed innovation and advancement of the profession. As pharmacy departments strive to meet the standards set by the accreditation program, the level of services rises; subsequently, higher standards are established and practice advances accordingly. Future residency training for community practice and the movement toward the Pharm.D. as the sole entry-level degree for practitioners must be evaluated in terms of effect on patient care and on pharmacy school and hospital resources. Planning for future pharmacy education and manpower needs should involve the whole profession, but the needs of community and hospital pharmacy may differ. A goal for the future is entry-level residency training for all hospital pharmacists, with the Pharm.D. degree as a prerequisite. Such a residency program would focus on clinical practice and provide experience in all pharmaceutical services and the overall management of a pharmacy department; it would be a prerequisite for advanced specialized residency programs. Managers of departments providing clinical services will need an entry-level clinical residency followed by a specialized residency in administration. In their 25-year history, residency programs have contributed greatly to the profession. Efforts to develop quality residency training sites and promote them to pharmacy graduates should continue.     

Promoting residencies to pharmacy students

A program for promoting pharmacy residency training to pharmacy students at the University of the Pacific (UOP) is described. A residency club was started in 1982 to increase UOP students' interest in residency training and to provide them with relevant information. Some students needed to be convinced that residencies were primarily educational rather than staffing experiences. Students were made aware of pharmacists' practice in specialty areas, for which residency training is needed, and were taught how to prepare themselves for selection for residencies. The club was formed to encourage mutual support among the students, which would be less likely to occur if residencies were promoted only through work with individual students. Club meetings provide information about available residencies, the application process, and the value of residency training to a career in pharmacy. Students are taught how to prepare curricula vitae, how to interview, and how to select programs to which to apply. Applications for residencies increased. Although the rate of acceptance was low at first, it was expected to increase as more UOP students demonstrated their interest in and qualification for residency training. The promotion of residencies as part of a balanced career planning and placement program for pharmacy students is encouraged.     

Pharmacy Students’ Perception of an Elective Course on Evidence-based Learning Strategies

Objective. To examine pharmacy students’ perceptions of an elective course on evidence-based learning strategies.Methods. Pre- and post-course survey questionnaires were administered to students who enrolled in an elective course, to determine the learning strategies they used prior to course attendance, track their use of evidence-based learning strategies and observance of healthy lifestyle habits, and assess their perception of the course. A written assignment was given that required students to reflect on the learning outcomes that resulted from their application of evidence-based learning strategies. Mean scores on the pre- and post-course survey were analyzed using a general linear model repeated measures test.Results. The 59 students in this study predominantly used less-effective strategies (eg, re-reading and re-writing of notes) prior to taking the course. They reported increased use of evidence-based learning strategies, particularly retrieval practice and elaboration, and practice of healthy lifestyle habits (ie, enough sleep, exercise, good nutrition) after course completion. Students believed that using the above learning strategies improved their learning and memory and performance on graded assessments, among other benefits. Students had a positive perception of the course.Conclusion. The elective course was associated with increased use of effective learning strategies, adoption of healthy lifestyle practices that aid learning, and increased appreciation for evidence-based learning strategies by the students. Future studies are needed to examine actual learning outcomes and barriers to implementation of evidence-based learning techniques.     

A Team-Based Learning Course on Nutrition and Lifestyle Modification

Objective. To create, implement, and evaluate an elective team-based learning (TBL) course on nutrition and lifestyle modification for pharmacy students.Design. An elective course with 15 contact hours was developed for second-year pharmacy students based on the principles of TBL. Student knowledge gained and satisfaction with the course were measured.Assessment. Sixty-two students completed the course. Knowledge about nutrition and lifestyle modification was significantly improved by completing the course (59% and 91%, respectively, p=<0.001). The satisfaction survey instrument had a response rate of 97%, and the majority of students (>85%) responded favorably to the TBL components.Conclusion. An elective course using TBL effectively delivered course content while teaching students communication and teamwork skills. The course was well received by students.     

An Elective Course on Application of Clinical Pharmacy Principles

Objective. To design and implement an elective therapeutics course and to assess its impact on students’ attainment of course outcomes and level of confidence in applying clinical pharmacy principles and pharmacotherapy knowledge.Design. A 3-credit hour elective for third-year pharmacy students was structured to include problem-based learning (PBL), journal club and case presentations, and drug information activities.Assessment. Student achievement of curricular outcomes was measured using performance on SOAP (subjective, objective, assessment, plan) notes, case and journal club presentations, drug information activities, and peer evaluations. Results from a pre- and post-course survey instrument demonstrated significant improvement in students’ confidence in applying clinical pharmacy principles.Conclusion. Students completing the course demonstrated increased attainment of course outcomes and confidence in their abilities to evaluate a patient case and make pharmacotherapeutic recommendations.     

An Elective Course on Landmark Trials to Improve Pharmacy Students' Literature Evaluation and Therapeutic Application Skills

Objectives

To determine the impact of a landmark trials elective course on pharmacy students'' attitudes toward evidence-based medicine, students'' comfort with technical concepts used in drug literature, and students'' perceptions of accessibility of PubMed from home computers.

Design

An elective course which gave third-year pharmacy students the opportunity to discuss landmark trials in primary care and reinforced skills in applying evidence from the primary literature to support therapeutic recommendations was design and implemented. The impact of the course was evaluated via a pre- and postcourse questionnaire administered during 3 consecutive course offerings.

Assessment

Overall, students had positive attitudes toward evidence-based medicine before taking the course (97.5% positive or somewhat positive) and these attitudes were unchanged postcourse (p = 0.74). Though 97.6% (n = 40) of students had Internet access at home, only 68.3% (n = 28) indicated having PubMed access at home. The course increased self-assessed comfort with technical concepts used in literature evaluation including random assignment (p < 0.01), placebo-controlled (p < 0.01), and intention-to-treat (p = 0.02).

Conclusion

An elective course on landmark trials allowed third-year pharmacy students to increase their comfort level with literature evaluation and reinforced their positive attitudes toward the use of evidence-based medicine in pharmacy practice.     

Active-learning implementation in an advanced elective course on infectious diseases

Objectives. To describe the development, implementation, and assessment of an advanced elective course on infectious diseases using active-learning strategies.Design. Pedagogy for active learning was incorporated by means of mini-lecture, journal club, and debate with follow-up discussion. Forty-eight students were enrolled in this 4-week elective course, in which 30% of course time was allocated for active-learning exercises. All activities were fundamentally designed as a stepwise approach in complementing each active-learning exercise.Assessment. Achievement of the course learning objectives was assessed using a 5-point Likert scale survey instrument. Students’ awareness of the significance of antimicrobial resistance was improved (p ≤ 0.05). Students’ ability to critically evaluate the infectious-disease literature and its application in informed clinical judgments was also enhanced through these active-learning exercises (p ≤ 0.05). Students agreed that active learning should be part of the pharmacy curriculum and that active-learning exercises improved their critical-thinking, literature-evaluation, and self-learning skills.Conclusion. An elective course using active-learning strategies allowed students to combine information gained from the evaluation of infectious-disease literature, critical thinking, and informed clinical judgment. This blended approach ultimately resulted in an increased knowledge and awareness of infectious diseases.     

A pharmacy political advocacy elective course

Objective. To develop and implement an elective course to increase pharmacy students’ awareness of legislation that might affect the pharmacy profession and to promote advocacy for the profession.Design. Students participated in class discussions regarding current legislative issues and methods to advocate for the pharmacy profession. Assignments included a student-led presentation of the advocacy agendas for various pharmacy organizations, a take-home examination, participation in class debates, and a legislative presentation.Assessment. Forty-eight students enrolled in the elective course over 3 years. Assignments and class participation were assessed using grading rubrics. At the end of the semester, students completed a questionnaire to assess the overall benefit of the course.Conclusions. Participation in an elective course devoted to pharmacy political advocacy increased awareness of legislation and the desire to become involved in pharmacy organizations to promote the pharmacy profession.     

Exploring the relationship between examination pass rates and eligibility pathways among pharmacist candidates for initial board certification

ObjectivesTo compare examination pass rates among different eligibility cohorts for initial board certification in 6 recognized pharmacy practice specialties.DesignRetrospective observational cohort study.Setting and participantsPracticing U.S. pharmacists who were approved candidates for initial board certification examinations in the following Board of Pharmacy Specialties (BPS)–recognized specialties: ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy.Outcome measuresThe number and percentage of BPS-approved candidates that pass initial board certification examinations differentiated by specialty and eligibility pathway (i.e., completion of postgraduate residency training or demonstration of postlicensure specialized practice experience).ResultsInitial board certification examination outcome (i.e., pass or fail) was assessed for a total of 15,171 candidates from Fall 2015 to Fall 2018. Pass rates for that period based on eligibility pathway (e.g., completion of a PGY-2 specialty residency, completion of a PGY-1 residency plus 1–2 years of postlicensure specialized practice experience, or 3–4 years of postlicensure specialized practice experience) were, respectively as follows: ambulatory care pharmacy (n = 2081): 94%, 84%, and 55% (P < 0.0001); critical care pharmacy (n = 2111): 99%, 94%, and 79% (P < 0.0001); oncology pharmacy (n = 1195) 93%, 75%, and 50% (P < 0.0001); pediatric pharmacy (n = 1119): 87%, 73%, and 57%; (P < 0.0001); pharmacotherapy (n = 8368): 88%, 59% (P < 0.0001); and psychiatric pharmacy (n = 477): 93%, 72%, 49% (P < 0.0001).ConclusionFrom 2015 to 2018, the percentage of BPS-approved candidates that passed initial board certification examinations in ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy was significantly higher for cohorts deemed to be board eligible based on completion of postgraduate residency training.     

Cooperation of medical and pharmaceutical sciences between private and national universities to educate professionals in the fields of drug development and rational pharmacotherapy

Cooperation in education and research in medical and pharmaceutical sciences between Kobe Pharmaceutical University and Kobe University was started in 2008 for training professionals in drug development and rational pharmacotherapy. Initially, we started a two-year pharmacy residency program. Our pharmacy residents can attend lectures at our universities, and they also help pharmacist preceptors educate undergraduate pharmacy students in practical training. As curricula for cooperative education of pharmacy, nursing and medical students, we developed two new elective subjects (early exposure to clinical training for first year students and IPW (inter-professional work) seminar for fifth year pharmacy students) to learn about the roles of health care professionals in a medical team. Cooperative research between faculty members and graduate students is also in progress. For faculty and staff developments, invited lectures by clinical pharmacy and medical professors from the United States on the clinical education system in pharmacy and medicine in the United States have been held. This systematic cooperation will contribute to the promotion of a new curriculum for inter-professional education in the health-science fields.     

An elective course to promote academic pharmacy as a career

Objective. To implement and assess an elective course that engages pharmacy students’ interest in and directs them toward a career in academia.Design. A blended-design elective that included online and face-to-face components was offered to first through third-year pharmacy studentsAssessment. Students’ knowledge, skills, and attitudes toward academic pharmacy were measured by pre- and post-course assessments, online quizzes, personal journal entries, course assignments, and exit interviews. The elective course promoting academic pharmacy as a profession was successful and provided students with an awareness about another career avenue to consider upon graduation. The students demonstrated mastery of the course content.Conclusions. Students agreed that the elective course on pharmacy teaching and learning was valuable and that they would recommend it to their peers. Forty percent responded that after completing the course, they were considering academic pharmacy as a career.     

Economic Analysis of Obtaining a PharmD Degree and Career as a Pharmacist

Objective. To evaluate the economic value of pharmacy education/career and the effects of the cost of private or public pharmacy school, the length of degree program, residency training, and pharmacy career path on net career earnings.Methods. This study involved an economic analysis using Markov modeling. Estimated costs of education including student loans were considered in calculating net career earnings of 4 career paths following high school graduation: (1) immediate employment; (2) employment with bachelor’s degree in chemistry or biology; (3) employment as a pharmacist with no residency training; and (4) employment as a pharmacist after completing one or two years of residency training.Results. Models indicated that throughout their careers (up to age 67), PharmD graduates may accumulate net career earnings of $5.66 million to $6.29 million, roughly 3.15 times more than high school graduates and 1.57 to 1.73 times more than those with bachelor’s degrees in biology or chemistry. Attending a public pharmacy school after completing 3 years of prepharmacy education generally leads to higher net career earnings. Community pharmacists have the highest net career earnings, and PGY-1 residency-trained hospital pharmacists have greater net career earnings than those who immediately started their careers in a hospital setting.Conclusion. The economic models presented are based on assumptions described herein; as conditions are subject to variability, these models should not be used to predict future earnings. Nevertheless, the findings demonstrate investment in a pharmacy education yields favorable financial return. Application of results to schools of pharmacy, students, and graduates is discussed.