Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning

Objective. To determine if student pharmacists’ preferences towards experiential and rational thinking are associated with performance on advanced pharmacy practice experiences (APPEs) and whether thinking style preference changes following APPEs.Methods. The Rational Experiential Inventory (REI), a validated survey of thinking style, was administered to student pharmacists before starting APPEs and re-administered after completing APPEs. APPE grades were compared to initial REI scores.Results. Rational Experiential Inventory scores remained consistent before and after APPEs. Overall, APPE grades were independent of REI scores. In a regression model, the REI experiential score was a significant negative predictor of hospital APPE grades.Conclusion. These findings suggest that overall APPE performance is independent of decision-making preference, and decision-making style does not change following immersion into APPEs. Instead of targeting teaching strategies towards a specific decision-making style, preceptors may use pedagogical approaches that promote sound clinical decision-making skills through critical thinking and reflection.     

Pharmacy Student and Preceptor Perceptions of Preceptor Teaching Behaviors

Objectives

To compare PharmD students'' and preceptors'' perceptions of preceptors'' teaching behaviors.

Methods

A 47-item survey instrument was developed and distributed to students and preceptors for rating the frequency and adequacy of each teaching behavior as not done, done but inadequate, and well done and adequate.

Results

Seventy-seven (99%) students and 53 (55%) preceptors responded to the survey. Students were somewhat satisfied with their preceptors'' teaching behaviors. In comparison, preceptors overrated their own teaching behaviors as well done and adequate on 9 of 47 (19%; p ≤ 0.05) items, with the majority being in the areas of providing feedback to students and evaluation.

Conclusion

Preceptors tended to overestimate the quality of their performance compared with students'' evaluations. These findings suggest the need for a preceptor development program.     

临床药师参与药物治疗实践的体会和感受

总结笔者自2004年做专职临床药师以来,特别是带教卫生部临床药师培训试点基地的学员和师资以来的临床药物治疗实践的体会和感受,与各位同行进行交流和讨教,也供新入职的临床药师在实践中参考,共同推进这个新兴职业的健康发展.     

The Impact of Preceptor and Student Learning Styles on Experiential Performance Measures

Objectives. To identify preceptors’ and students’ learning styles to determine how these impact students’ performance on pharmacy practice experience assessments.Methods. Students and preceptors were asked to complete a validated Pharmacist’s Inventory of Learning Styles (PILS) questionnaire to identify dominant and secondary learning styles. The significance of “matched” and “unmatched” learning styles between students and preceptors was evaluated based on performance on both subjective and objective practice experience assessments.Results. Sixty-one percent of 67 preceptors and 57% of 72 students who participated reported “assimilator” as their dominant learning style. No differences were found between student and preceptor performance on evaluations, regardless of learning style match.Conclusion. Determination of learning styles may encourage preceptors to use teaching methods to challenge students during pharmacy practice experiences; however, this does not appear to impact student or preceptor performance.     

Investigating Student Pharmacist Perceptions of Professional Engagement Using a Modified Delphi Process

Objective. To develop a definition of professional engagement, a list of professionally engaging and disengaging activities, and characteristics of those activities.Methods. A 2-round modified Delphi process was conducted using student pharmacists. The first round captured input while the second assessed agreement using a 5-point Likert scale.Results. A definition was created using the 3 items that reached consensus. All engaging characteristics reached consensus, and 25% (3/12) of the disengaging characteristics reached consensus. Lower rates of consensus were observed for activities, with 78% (7/9) of the professionally engaging and none of the disengaging activities reaching consensus.Conclusion. The findings of this study have implications for creating professionally engaging learning experiences for student pharmacists and suggest that ensuring activities contain certain professionally engaging characteristics may be more important than the activities themselves.     

在校本科生实践经验获取途径的探索

高校毕业生就业难,与其“动手能力不强、缺乏实践经验”有一定关系。结合大学生的专业方向,就学生在校期间获取实践经验的途径进行了探索,指出遴选大二、大三学生参与科研活动是使在校大学本科生获取实践经验、培养创新能力投入少而又行之有效的途径,对缓解大学生“就业难”问题有所帮助。     

临床药师量化评估指标体系的建立与实践

目的:探索建立适合中国国情的临床药师量化评估指标体系,为评价临床药师日常工作提供参考。方法:基于我院药学技术人员量化考核体系和临床药师培养系列文件对临床药师的岗位职责要求,通过对临床药师常规工作指标进行分解,以临床药师团队讨论方式,对量化考核指标进行筛选和标准制订,建立并完善临床药师量化考核指标体系,并进行了1年的试用。结果与结论:考核指标体系以药学专业技术人员量化考评体系为基础,采用千分制,分为德、能、勤、绩、体五项考核类别。在保留共性考核指标的基础上,针对"绩"类别中"履职尽责(150分)"项目,参照临床药师常规工作指标进行了个体化的调整,建立了临床药师病区常规工作考评标准和临床药师所在药学科室相关业务工作考评标准。经过1年的试用和完善,该体系初步具备了综合评价临床药师常规工作的功能,但由于临床药师的常规工作内容和技能水平逐年变化,故该量化考核体系应作相应的调整。     

Developing and Implementing an Academy of Preceptors

In response to national trends for preceptor development, the University of Maryland School of Pharmacy conceived, developed, and implemented the Academy of Preceptors to foster preceptor development. The Academy's goals are to recognize preceptor excellence, improve experiential course delivery, develop preceptors' educational skills, and facilitate networking among preceptors.     

Impact of a student-supported pharmacy assessment program on venous thromboembolism prophylaxis rates in hospitalized patients

Objectives

To determine if the addition of a student-supported venous thromboembolism risk assessment strategy could improve rates of venous thromboembolism prophylaxis at a community teaching hospital.

Methods

After receiving education and training on venous thromboembolism risk assessment, students assessed patients and recommended therapy in a 493-bed community teaching hospital over 5 weeks. Both the quantity and quality of venous thromboembolism prophylaxis were measured and compared to a baseline rate.

Results

One hundred three recommendations were made to physicians with a 41% acceptance rate. Compared to previous rates, the percentages of patients receiving “any,” “suitable,” and “optimal” venous thromboembolism prophylaxis increased from 70.5% to 82.7% (p = 0.0005), 64.4% to 75.9% (p = 0.0022), and 56.3% to 68.5% (p = 0.0022), respectively.

Conclusions

A student-supported venous thromboembolism risk assessment strategy resulted in an increase in venous thromboembolism prophylaxis rates and could be used as a model for other institutions to integrate students into population-based care.     

Impact of a Student Leadership Development Program

Objective. To assess the effectiveness of the Student Leadership Development Series (SLDS), an academic-year--long, co-curricular approach to developing leadership skills in pharmacy students.Design. Participants met once per month for activities and a college-wide guest speaker session. Students also completed monthly forms regarding what they had learned, participated in poster presentations, and created a personal leadership platform.Assessment. One hundred twenty-three students participated in the program between 2008 and 2013. On monthly evaluation forms and a summative evaluation, students indicated that the program helped them feel prepared for leadership opportunities and increased their desire to pursue leadership. They valued interacting with pharmacy leaders from the community and learning how they could distinguish themselves as leaders.Conclusions. The SLDS provided pharmacy students with an opportunity to explore personal leadership styles and develop broader understanding of leadership, and increased their desire to pursue leadership positions in the future.     

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy

Objective. To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload.Methods. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes).Results. APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes.Conclusion. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.     

The Importance of Research and Scholarly Activity in Pharmacy Training

Regardless of practice setting, it is imperative that pharmacists be able to either participate in generating new knowledge or use the ever‐expanding body of literature to guide patient care. However, competing priorities in Pharm.D. curricula and residency training programs have resulted in limited emphasis on acquiring research and scholarly skills. Factors likely contributing to this reduced focus include the lack of curricular and postgraduate training standards emphasizing the development of research skills, time to commit to scholarly activity, and accessibility to experienced mentors. Strategies for increasing scholarly activity for pharmacy students and residents should therefore continue to be a focus of professional degree and residency training programs. Several resources are available for academic planners, program directors, and institutions to augment scholarly experience for pharmacy trainees and clinicians. This commentary highlights the importance of providing research opportunities for students and residents, describes the potential barriers to these activities, and provides recommendations on how to increase the instruction and mentoring of trainees to generate and use research.     

临床药师参与1例低镁血症抽搐患儿会诊实践

目的:临床药师通过参与1例低镁血症抽搐患儿会诊的药学实践,探讨临床药师在药物治疗中的作用。方法:回顾性分析临床药师参与1例低镁血症抽搐病例的药物治疗过程。结果:临床药师通过提出会诊建议,提供相对合理的用药方案,使患儿病情得到有效控制。结论:临床药师参与药物治疗,及时进行药学监护,可提高患儿用药的安全性及有效性。     

Development of a Pharmacy Residency Research Certificate Program

Background: Similar to teaching certificate programs, which have been incorporated in many pharmacy residencies to improve teaching skills, resident research certificate programs could provide residents with more exposure to biostatistics and research design. However, few research certificate programs have been described. Objective: To assess the impact of a research certificate program on residents’ attitude toward, confidence in, and knowledge of research. Methods: A resident research certificate program was created for the 2018-2019 residency class at our institution, which included 33 pharmacy residents (15 postgraduate year-1 [PGY1] and 18 PGY2 residents). The program consisted of 7 sessions aimed at providing residents with research training. To earn a certificate, participants were required to attend 6 or more sessions and achieve a score greater than or equal to 70% on a postassessment. An optional questionnaire assessing attitude, confidence, and knowledge was also administered at baseline and following the certificate program. Results: Of the 33 residents participating in the research certificate program, 21 (9 PGY1 and 12 PGY2) residents completed both the baseline and follow-up questionnaire and were included in the analysis. All items assessing attitude and 3 of 6 items assessing confidence improved significantly following the certificate program when compared to baseline (P < .05 for all). Median knowledge scores were no different on the baseline versus follow-up questionnaire (P = .54). Conclusions: After completing a research certificate program, resident knowledge scores did not differ from baseline, but attitudes toward research and confidence appeared to improve. Research certificate programs could be an avenue for providing pharmacy residents with increased exposure to and comfort with biostatistics and research design.     

Impact of Pharmacy Student Interventions in an Urban Family Medicine Clinic

Objectives. To determine the number of interventions made by pharmacy students at an urban family medicine clinic and the acceptance rate of these recommendations by the healthcare providers. The secondary objective was to investigate the cost avoidance value of the interventions.Methods. A prospective, unblinded study was conducted to determine the number and cost avoidance value of clinical interventions made by pharmacy students completing advanced pharmacy practice experiences (APPEs) in an urban family medicine clinic.Results. Eighteen students completed this experience in the 8 months studied. Of the 718 interventions performed, 77% were accepted by physicians, including 58% of the 200 interventions that required immediate action. Projected avoidance was estimated at $61,855.Conclusion. The clinical interventions by pharmacy students were generally well received by healthcare providers and resulted in significant cost savings. Pharmacy students can play an important role in a family medicine clinic.     

论新形势下临床药师专科化建设与队伍管理

目的：为尽快适应医改形势,促进医院临床药学发展,结合临床药师培训现状,寻找发展方向提供参考。方法：通过分析临床药师队伍的现状,提出专科化培养和绩效管理的方案。结果：临床药学队伍还不能适应新形势的要求,需要迅速改进和完善,必须尽快出台专科化临床药师相适应的管理制度和培训措施,促进临床药师队伍的快速发展,以满足人民群众基本药物治疗的需求。结论：临床药师专科化是临床药学发展的方向     

基于柯氏模型构建执业药师培训效果评价指标体系

目的:探索并构建执业药师培训效果评价指标体系。方法:基于柯氏四级培训评估模型理论,通过文献调研、小组讨论与德尔菲法确定执业药师培训效果评价指标体系的条目,以层次分析法(AHP)计算权重。结果:经过两轮专家函询,最终确定包含4项一级指标、10项二级指标、22项三级指标的执业药师培训效果评价指标体系。结论:本次构建的评价指标体系具有一定的科学性与可靠性,对执业药师的规范化培训考核具有参考作用。     

Evaluation of a Dedicated Pharmacist Staffing Model in the Medical Intensive Care Unit

Purpose:

Published studies have shown that pharmacists on medical rounds reduce the incidence of preventable adverse drug events (ADEs). However, the impact of a dedicated pharmacist who provides consistent patient care in a critical care unit remains to be evaluated.

Objective:

To determine the impact of a pharmacist who is permanently assigned to the medical intensive care unit (MICU) on the incidence of preventable ADEs, drug charges, and length of stay (LOS) in the MICU.

Design:

A randomized, experimental versus historical control group design was used. Preventable ADEs were identified and validated by 2 pharmacists and a critical care physician. Information about MICU drug charges and LOS were obtained from the hospital administrative database.

Results:

The intervention group had fewer occurrences of ADEs (10 ADEs/1,000 patient days) when compared to the control group (28 ADEs/1,000 patient days) at a significance level of .03. No significant differences were found between the 2 groups in MICU drug charges and LOS. The vast majority of the 596 documented recommended interventions (99%) were accepted by the medical team. Nutrition monitoring, medication indicated but not prescribed, and dosage modification were the top 3 problems identified by the pharmacist.

Conclusion:

The addition of a dedicated critical care pharmacist to the MICU medical team improves the safe use of medication. The services of a dedicated critical care pharmacist should be expanded to include weekend hours to ensure the benefits of improved medication safety.     

An Enhanced Community Advanced Pharmacy Practice Experience Model to Improve Patient Care

Objective

To quantify the benefits of an enhanced advanced pharmacy practice experience (APPE) community pharmacy model compared to the traditional program by comparing basic and comprehensive pharmaceutical care provided by students and assessing preceptors’ perceptions of the APPE.

Methods

A pilot study consisting of 1 enhanced APPE arm and 2 traditional APPE (control) arms was conducted. The enhanced APPE consisted of a preceptor education program, a 5-day onsite student orientation, and an 8-week experience completed at 1 rather than 2 community sites.

Results

The level of interventions provided by students in the enhanced APPE arm significantly surpassed that of students in the control arms. In addition, preceptor questionnaires indicated overwhelming support for the enhanced model over the traditional APPE.

Conclusions

The study''s findings demonstrated that the enhanced APPE model enabled the participating pharmacies to provide increased level of patient care (as compared to the control sites) and improved preceptor satisfaction with the APPE.