Addressing cultural competence and bias in treating migrant workers in pharmacies: Pharmacy students learning and changing norms

The nature and validity of implicit bias training for health care providers and trainees: A systematic review

The number of health care educational institutions/organizations adopting implicit bias training is growing. Our systematic review of 77 studies (published 1 January 2003 through 21 September 2022) investigated how implicit bias training in health care is designed/delivered and whether gaps in knowledge translation compromised the reliability and validity of the training. The primary training target was race/ethnicity (49.3%); trainings commonly lack specificity on addressing implicit prejudice or stereotyping (67.5%). They involved a combination of hands-on and didactic approaches, lasting an average of 343.15 min, often delivered in a single day (53.2%). Trainings also exhibit translational gaps, diverging from current literature (10 to 67.5%), and lack internal (99.9%), face (93.5%), and external (100%) validity. Implicit bias trainings in health care are characterized by bias in methodological quality and translational gaps, potentially compromising their impacts.

Estimating implicit and explicit racial and ethnic bias among community pharmacists in Canada

Background

Bias, whether implicit (unconscious) or explicit (conscious), can lead to preferential treatment of specific social groups and antipathy towards others. When healthcare professionals (HCPs), including pharmacists, act on these biases, patient care and health outcomes can be adversely affected. This study aims to estimate implicit and explicit racial/ethnic bias towards Black and Arab people among community pharmacists in Ontario, Canada.

Methods

Community pharmacists participated in a secure, web-based survey using a cross-sectional design that included Harvard's Race and Arab Implicit Association Tests (IATs) to examine bias towards Black and Arab people. Explicit (stated) preferences were measured by self-report. Data were analyzed using descriptive and inferential statistics.

Results

The study surveyed 407 community pharmacists, 56.1 % of whom were women with an average age of 46.9. Implicit Association Test (IAT) results showed a statistically significant moderate preference for white people over both Black (mean IAT = 0.41) and Arab people (mean IAT = 0.35). However, most pharmacists explicitly stated that they had no racial/ethnic preference, with 75.7 % expressing a neutral preference between Black and white and 66.6 % neutral between Arab and white. However, a slight preference for white individuals was observed. Demographic factors such as age, place of birth, race/ethnicity, and experience significantly impacted IAT scores. For example, older, Canadian-born, white pharmacists with more experience displayed higher implicit bias scores. A mild correlation was found between implicit and explicit bias, indicating as implicit bias increases, explicit bias tends to become more negative.

Conclusions

This study is the first to explore the issue of pharmacist bias in Canada and concentrate on anti-Arab bias. Our findings reveal that Ontario community pharmacists tend to have an unconscious inclination towards white people, which calls for further understanding of this matter. Additionally, we discovered a moderate degree of anti-Arab bias, indicating that studies on other HCPs should consider bias against this social group. Educational interventions are needed to address the implicit biases among community pharmacists in Ontario, Canada. These findings should aim to raise self-awareness of biases, educate about the potential implications of these biases on patient care, and provide strategies to reduce bias.

Embedding cultural competency and cultural humility in undergraduate pharmacist initial education and training: a qualitative exploration of pharmacy student perspectives

BACKGROUND

Emphasis has been placed upon embedding equity, diversity and inclusion within the initial education and training of healthcare professionals, like pharmacists. Yet, there remains limited understanding of how best to integrate cultural competency and cultural humility into undergraduate pharmacy student training.

AIM

This qualitative study explored the views of pharmacy students to understand perspectives on, and identify recommendations for, embedding cultural competency and cultural humility within pharmacy education and training.

METHOD

Undergraduate pharmacy students from one UK-based School of Pharmacy were invited to participate in an in-person, semi-structured interview to discuss cultural competency in the pharmacy curriculum. Interviews were conducted between November 2022 and February 2023 and were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Ethics Committee.

RESULTS

Twelve undergraduate pharmacist students, across all years of undergraduate training, were interviewed. Three themes were developed from the data, centring on: (1) recognising and reflecting on cultural competency and cultural humility; (2) gaining exposure and growing in confidence; and (3) thinking forward as a culturally competent pharmacist of the future.

CONCLUSION

These findings offer actionable recommendations to align with the updated Initial Education and Training standards from the United Kingdom (UK) pharmacy regulator, the General Pharmaceutical Council; specifically, how and when cultural competency teaching should be embedded within the undergraduate pharmacy curriculum. Future research should further explore teaching content, learning environments, and methods of assessing cultural competency.

A Qualitative Exploration of ACPE Standard 4 Key Elements From the Perspective of Student Pharmacists

OBJECTIVE

Attitudes and skills reflecting the Accreditation Council for Pharmacy Education Standard 4 (ACPE-S4) remain an important component of pharmacy education. The objectives of this study were (1) explore student perspectives on the importance of ACPE-S4 key elements, and (2) identify experiences that students described as supporting ACPE-S4 attitude and skill development.

METHODS

This was a qualitative study using focus groups and dyadic interviews with student pharmacists to collect data on ACPE-S4 key element importance and skill acquisition. A general inductive qualitative approach was used to analyze data, with 2 study authors independently reviewing all transcripts and assigning codes to text segments. Authors then met to discuss coding, iteratively organize coded segments into categories and subcategories, and select representative quotes.

RESULTS

Overall, 3 focus groups and 3 dyadic interviews were conducted with a total of 20 students. Students ranked professionalism and self-awareness as the 2 most important key elements. From qualitative analysis, 4 categories and 10 subcategories of educational activities, programs, and experiences were identified as follows: Mentorship (Identifying a Mentor, Formal Mentorship Programs), Curriculum (Practice Lab, Professional Development Course, Interprofessional Education, Experiential Education), Cocurriculum (Organizational Involvement, Volunteer Hours), and Opportunities Outside Academic Setting (Work, Conferences, and Innovative Pharmacy Practices).

CONCLUSION

Participants articulated several opportunities for developing the skills and attitudes reflecting ACPE-S4 key elements. Incorporating student input into ACPE-S4 attitude and skill development may help pharmacy programs consider how to design, refine, and implement initiatives and experiences to help students develop skills across ACPE-S4 focus areas.