Efficient and effective precepting of pharmacy students in acute and ambulatory care rotations: A Delphi expert panel study

Consensus recommendations for the treatment of migraine prevention

OBJECTIVE

The objectives are to know the opinion of neurologists and hospital pharmacists on those aspects still under debate regarding the role of anti-CGRP monoclonal antibodies in the preventive treatment of migraine. To identify those controversies that still exist. To propose agreed recommendations for improvement of care. And to promote access of clinicians and patients to these new treatments in the prevention of migraine with biological drugs, in order to improve patient care and follow-up.

METHODOLOGY

Recommendations for the use of biological drugs in the prevention of migraine were identified and evaluated through the Delphi consensus methodology, proposing 88 statements grouped into three themes: a clinical module that deals with the management of biological treatments in migraine; a patient module that discusses patient education and adherence improvement strategies; and a coordination module that includes statements related to strategies to improve joint work between the two groups. The 9-point Likert ordinal scale was used to score these recommendations and, subsequently, the data was statistically analyzed through different metrics.

RESULTS

After both rounds of voting, consensus was reached in agreement on 71 of the 88 statements (80.7%), leaving one statement (1.1%) with consensus in disagreement and 16 remaining as indeterminate (18.2%).

CONCLUSIONS

The high degree of consensus indicates that the opinion of neurologists and hospital pharmacists on the role of anti-CGRP monoclonal antibodies in the treatment of migraine is very similar and allows identifying those controversies that still exist, to improve the care and follow-up of patients with migraine.

[Translated article] Consensus recommendations on the preventive treatment of migraine

OBJECTIVE

The objectives are to know the opinion of neurologists and hospital pharmacists on those aspects still under debate regarding the role of anti-Calcitonin Gene-related Peptide monoclonal antibodies in the preventive treatment of migraine. To identify those controversies that still exist. To propose agreed recommendations for improvement of care. And to promote access of clinicians and patients to these new treatments in the prevention of migraine with biological drugs, in order to improve patient care and follow-up.

METHODOLOGY

Recommendations for the use of biological drugs in the prevention of migraine were identified and evaluated through the Delphi consensus methodology, proposing 88 statements grouped into 3 themes: a clinical module that deals with the management of biological treatments in migraine; a patient module that discusses patient education and adherence improvement strategies; and a coordination module that includes statements related to strategies to improve joint work between the two groups. The 9-point Likert ordinal scale was used to score these recommendations and, subsequently, the data was statistically analysed through different metrics.

RESULTS

After both rounds of voting, consensus was reached in agreement on 71 of the 88 statements (80.7%), leaving 1 statement (1.1%) with consensus in disagreement and 16 remaining as indeterminate (18.2%).

CONCLUSIONS

The high degree of consensus indicates that the opinion of neurologists and hospital pharmacists on the role of anti-Calcitonin Gene-related Peptide monoclonal antibodies in the preventive treatment of migraine is very similar and allows identifying those controversies that still exist, to improve the care and follow-up of patients with migraine.

Design, Implementation, and Outcomes of an Interprofessional Mobile Web Application for Preceptors for Challenging Issues

OBJECTIVE

The purpose of this study was to develop and assess an easily accessible interprofessional mobile web application to assist preceptors with challenging teaching and learning situations.

METHODS

Phase 1 was a modified Delphi process of 48 advanced practice nursing, dentistry, medicine, and pharmacy preceptors to determine the content of the application. Phase 2 consisted of 12 preceptors from the 4 disciplines piloting a prototype to refine the tool using design-thinking principles. Feedback was analyzed using inductive coding and thematic analysis. Phase 3 evaluated the impact of the final tool on 80 preceptors' satisfaction, knowledge, self-efficacy, and perception of behavior change.

RESULTS

Consensus on 10 topics was reached in the following 3 themes: feedback and communication, clinical and professional development of learners, and precepting efficiency. Preceptors rated the tool as efficient and applicable. Features perceived as useful included concise and applicable content that was easy to navigate with practical video examples. Features to improve included academic jargon, length of content, and lack of connectivity with other preceptors. Knowledge and self-efficacy improved after the use of the refined tool. Change in perceptions of behavior after 1 month was mixed, with a significant change in accessing resources to address challenging situations and regularly reflecting on challenging situations and no significant change in awareness, frequency, or success in managing challenging situations.

CONCLUSION

An interprofessional mobile web application for challenging teaching and learning situations developed through a modified Delphi process was deemed efficient and relevant and demonstrated positive knowledge and self-efficacy change.

A consortium's approach to developing an EPA-based community IPPE curriculum

INTRODUCTION

Currently, there are limited data on the use of entrustable professional activities (EPAs) within introductory pharmacy practice experiences (IPPEs). The objective of this study was to identify supporting EPA tasks community IPPE students should perform at the "Competent with Support" level to prepare them for advanced pharmacy practice experiences (APPEs).

METHODS

The Southeastern Pharmacy Experiential Education Consortium utilized a modified Delphi process to incorporate EPAs into community IPPE curricula to mirror the consortium's community APPE curricula. Community IPPE and APPE preceptors (N = 140) were invited to participate in focus groups and two surveys to identify and build consensus on EPA-based activities community IPPE students should perform to prepare them for APPEs. The primary outcome was development of an EPA-based community IPPE curriculum.

RESULTS

Nine preceptors (6.43%) participated in a focus group, 34 preceptors completed survey one (24.29%), and 20 preceptors completed survey two (14.29%). The initial list of 62 tasks for 14 EPAs was tailored to reflect an IPPE student skill set. Survey consensus led to a community IPPE curricula with 12 required EPAs and 54 tasks (40 required and 14 suggested).

CONCLUSIONS

The modified Delphi process provided a mechanism for preceptor collaboration with experiential programs to build consensus on community IPPE curricula redesigned around EPAs and supporting tasks. A unified IPPE curriculum adds value to colleges and schools of pharmacy with shared preceptors by improving continuity of experience, expectations, and evaluation of student learners and allows for targeted regional preceptor development.

Implementation of One-Minute Preceptor for Clinical Teaching in Obstetrics and Gynaecology

Background

In absence of a dedicated teaching curriculum for non-PG residents in Obstetrics and Gynecology department, a concise teaching learning method, One-Minute Preceptor (OMP) with feedback being its core component may be introduced to translate their theoretical knowledge into clinical practice.

Methods

This descriptive cross-sectional study included four faculty members and 20 residents. Each resident was exposed to three OMP sessions pertaining to common gynecological case scenarios with a gap of at least two days in between the sessions with faculties acting as preceptor and as observer. After three OMP sessions, feedback from residents and faculty regarding their teaching and learning experience after implementing this tool was obtained through separate pre-validated questionnaires graded on Likert's scale.

Results

The satisfaction index of the residents and faculties for OMP was found to be 96.3% and 95%, respectively. All residents and faculty members had consensus that OMP addressed the learning gaps (mean score 4.45 ± 0.51 and mean score 4.5 ± 0.57, respectively) and expressed being highly satisfied with OMP in busy clinical settings as compared to traditional method of teaching with mean score of 4.9 ± 0.30 and 4.75 ± 0.5, respectively. The faculties had consensuses that OMP can assess all domains of learning (mean score 4.75 ± 0.5). All residents and faculties opined that the time allotted to address all micro-skills was less and 60% residents advocated allotting at least 5 min time to the teaching encounter.

Conclusion

Our study indicates the beneficial role of OMP in time-constraint clinical environment and warrants further research to review the time frame keeping in view the learners' needs and the discipline.

Establishing the Content Validity of a Student Pharmacist Patient Counseling Competency Assessment in Oncology

Objective. The goal of this project was to establish content validity and describe internal consistency of a patient counseling competency assessment instrument used to evaluate student pharmacists practicing in an oncology setting.Methods. The study involved a modified e-Delphi panel of oncology clinical pharmacy specialists, clinical pharmacy generalists, and oncology pharmacy residents. Iterative rounds of the e-Delphi process were conducted until consensus was reached on most instrument items. Consensus was defined as agreement by at least 75% of participants that an item was or was not important.Results. The modified e-Delphi process included three rounds of responses from 13 panelists and resulted in a 35-item instrument with consensus reached on 33/35 (94%) of the items. All participants indicated that the assessment result options allowed them to indicate the student's level of competency either extremely well or very well.Conclusion. A modified e-Delphi method was used to validate a reliable instrument for the assessment of student pharmacist counseling abilities in an oncology setting. Similar methodology should be considered during the development of student assessment tools, especially for high-impact student pharmacist activities such as chemotherapeutic medication counseling.

Identifying health-system pharmacy operational process categories and corresponding tasks across a diverse health system using a modified Delphi process

DISCLAIMER

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

The purpose of this study was to identify and build consensus on operational tasks that occur within a health-system pharmacy.

METHODS

An expert panel of 8 individuals was invited to participate in a 3-round modified Delphi process. In the first round, the expert panel independently reviewed an initial list and provided feedback. All feedback was incorporated into the second round and then reviewed and discussed as a group. The expert panel reviewed an updated list based on feedback from the second round and reached consensus on a final list of operational processes and corresponding tasks.

RESULTS

All 8 participants agreed to serve on the Delphi expert panel and reviewed an initial list of 9 process categories (hazardous intravenous [IV] medications, nonhazardous IV medications, hazardous oral medications, nonhazardous oral medications, controlled substances, total parenteral nutrition [TPN]/fluid preparations, distribution and delivery, clinical tasks, and miscellaneous operational tasks) and 44 corresponding tasks. Through the Delphi process, 72 new tasks were identified in the first round, while 34 new tasks were identified in the second round. In the third and final round, the expert panel reviewed the updated list of 9 process categories and 150 corresponding tasks, made additional edits, and reached consensus on a final list of 9 processes and 138 corresponding tasks that represented operational work within a health-system pharmacy.

CONCLUSION

The modified Delphi process effectively identified operational processes and corresponding tasks occurring within hospital pharmacies in a diverse health system. This process facilitated consensus building, and the findings may inform development of an operational workload model.

Health-system pharmacist preceptor development and educational needs for accessible resources

INTRODUCTION

Skilled preceptors are crucial to the pharmacy profession as they contribute to the growth and development of student pharmacists and resident pharmacists. As a result, providing education and further growth for preceptors is vital. The purpose of this survey was to determine preceptor development topics of interest and preferred platforms for receiving education.

METHODS

A survey was conducted by the American Society of Health-System Pharmacists Section Advisory Group on Pharmacy Practice Experience Precepting. The survey was designed to identify preceptor needs based on experience and background. Professional development opportunities, tools needed to assist preceptors, and the preferred method of delivery were also determined.

RESULTS

Two hundred seventy-two pharmacists completed the entire 30 question survey. On demand webinars were identified as the preferred method of education delivery. A preceptor tip of the week email was selected as the most favored type of online education resource for preceptors. There was no major difference on the types of online resources for students that preceptors would use. A survey to assist in self-identifying areas for developmental improvement was favored by 81% of respondents.

CONCLUSIONS

This needs assessment identified that preceptor development materials are in high demand for all surveyed topic areas provided via live and/or on demand webinars or other virtual means. Accessibility of resources should be highlighted in multiple forums in order to ensure the information reaches all preceptors.

Decision-making framework for an acute care clinical pharmacist productivity model: Part 1

Disclaimer

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose

Clinical pharmacist productivity assessment has long been challenging, as a standard definition does not exist. A multistep project was undertaken with the intent to develop, validate, and implement an acute care clinical pharmacist productivity model. The initial step of the project was designed to identify, define, prioritize, and weight a comprehensive list of daily pharmacist responsibilities stratified by relative time spent on each function via consensus.

Methods

Delphi methodology applied by a panel of experts was used to identify a comprehensive list of acute care pharmacist responsibilities ranked in order of time intensity. Twenty-three acute care clinical pharmacists participated in the process. The consensus list was validated by time observation studies. Each responsibility was assigned a weight and corresponding work outputs by a consensus panel. Weighting of each responsibility was assigned according to the relative time intensity and complexity of each task.

Results

The results of the Delphi consensus process included the top 20 time-intensive responsibilities identified by the acute care clinical pharmacists. Timed observations of acute care clinical pharmacists yielded results similar to those of the consensus process. Selection of corresponding work outputs and weights for each responsibility provided the final requirements for the productivity model.

Conclusion

The development of an acute care clinical pharmacist productivity model first requires the selection of appropriate work outputs and weighting. The consensus process provided a newly identified comprehensive list of pharmacist responsibilities that will serve as the foundation of the clinical productivity model. Validated consensus methodology can be useful for engaging clinical pharmacists in decision-making and the development of a clinical productivity model.

Standardizing and improving the education of pharmacy students in a large health system

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Innovative learning in pharmacy practice: The perceived benefits of and barriers to a layered learning practice model

OBJECTIVE

To assess pharmacy preceptors' perceptions of the benefits of and barriers to a layered learning practice model (LLPM) at their practice site.

METHODS

An online survey was created using Qualtrics and sent to experiential directors at all colleges [or schools] of pharmacy in Ohio and at Big Ten universities. The experiential directors were asked to send the survey to all preceptors affiliated with their program. The survey assessed the perceived or actual benefits of and barriers to a layered learning model. Benefits and barriers to patient care, student or resident learning, and the practice site were assessed.

RESULTS

In total, 304 surveys were initiated by precepting pharmacists. Survey respondents reported precepting introductory pharmacy practice experience students (n = 113, 37.1%), advanced pharmacy practice experience students (n = 184, 60.5%), and residents (n = 176, 57.9%) throughout a given year. Survey respondents' most commonly identified benefits of a LLPM included an increase in patient access to pharmacy team members (n = 97, 42.3%), an increase in the number of precepting opportunities for learners (n = 80, 34.9%), and improvement in patient education (n = 76, 33.2%). The top identified barriers to a LLPM included performing precepting duties that may interfere with preceptor job responsibilities (n = 158, 72.1%), having inadequate workspace for learners (n = 120, 54.8%), and being unable to effectively teach or oversee multiple learners simultaneously (n = 77, 35.1%).

CONCLUSIONS

This research provides insight into pharmacy preceptor perception of how a LLPM impacts practice sites, patient care, and training of pharmacy learners. This information may be valuable in the design of preceptor development for colleges of pharmacy and residency programs.

Clinical educators' skills and qualities in allied health: a systematic review

BACKGROUND

The skills and qualities of effective clinical educators are linked to improved student learning and ultimately patient care; however, within allied health these have not yet been systematically summarised in the literature.

AIMS

To identify and synthesise the skills and qualities of clinical educators in allied health and their effect on student learning and patient care.

METHOD

A systematic search of the literature was conducted across five electronic databases in November 2017. Study identification, data extraction and quality appraisal were performed in duplicate. Qualitative and quantitative data were extracted separately but analysed together using a thematic analysis approach whereby items used in quantitative surveys and themes from qualitative approaches were interpreted together.

RESULTS

Data revealed seven educator skills and qualities: (i) intrinsic and personal attributes of clinical educators; (ii) provision of skillful feedback; (iii) teaching skills; (iv) fostering collaborative learning; (v) understanding expectations; (vi) organisation and planning; and (vii) clinical educators in their professional role. Across all themes was the concept of taking time to perform the clinical educator role. No studies used objective measurements as to how these skills and qualities affect learning or patient care.

DISCUSSION AND CONCLUSION

Despite much primary evidence of clinical educator skills and qualities, this review presents the first synthesis of this evidence in allied health. There is a need to examine clinical education from new perspectives to develop deeper understanding of how clinical educator qualities and skills influence student learning and patient care.

Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity

PURPOSE AND METHOD

We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity.

RESULTS

Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs.

CONCLUSIONS

Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.

The one-minute preceptor model: A systematic review

BACKGROUND AND PURPOSE

Teaching models provide a systemic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. This review aims to integrate the literature on the OMP model by highlighting potential use for nurse practitioners while identifying directions for future research.

METHODS

Electronic databases were searched from December 2017 to January 2018 for articles published in English. The databases included PubMed, CINAHL, and MEDLINE using terms including "preceptor," "clinical teaching," "time-efficient teaching," and "precepting." Of 32 articles in the final search, only 12 experimental quantitative studies were included in the synthesis and 20 descriptive studies in the discussion.

CONCLUSIONS

The OMP model is supported by literature for its effectiveness as a teaching model and preference by students and preceptors. It has been shown to increase teaching techniques including feedback and assessment of students' clinical reasoning.

IMPLICATIONS FOR PRACTICE

The OMP model has the potential to overcome clinicians' barriers to precepting nurse practitioner students. Future research may evaluate the use of this model specific to nurse practitioner preceptors and students, perceived time benefits in clinical teaching, overall improvement in clinical teaching, and use in interprofessional precepting.