Global Health Education in Doctor of Pharmacy Programs in the United States

Learning Through Experience: Analyzing the Impact of Short Study Abroad Programs from the Students' Own Words

OBJECTIVE

The purpose of this study was to determine what students participating in short study abroad program (SSAP) elective courses learned during their experiences and if they satisfied the course learning objectives.

METHODS

University of Florida College of Pharmacy students who participated in an SSAP to Scandinavia in the years 2014, 2016, 2017, and 2018 wrote digital journals describing their experiences. This study used inductive and deductive thematic analysis to analyze the journals and identify codes and themes.

RESULTS

Four cohorts with a total of 39 student journals were analyzed leading to 11 themes being identified. Example themes included Differences in Pharmacy Practice, Differences in Pharmacy Law/Processes, Differences in Pharmacy Education/Training, and History/Culture. These themes were then mapped to the course objectives, and all course objectives were deemed to be fulfilled.

CONCLUSION

Students participating in one College's SSAPs over 4 years through their own words demonstrated a better understanding of health care, pharmacy, and culture as it exists in one or more foreign countries and were able to meet the course objectives.

Assessing perspectives of a global health area of concentration within the PharmD curriculum

INTRODUCTION

While global health education in pharmacy expands, limited research has described the outcome of completing a global health area of concentration on career decisions, perceptions on cultural sensitivity, health disparity awareness, and global health competencies among pharmacists and students.

METHODS

This mixed methods study enrolled 21 graduates and 17 student pharmacists who participated in a global health concentration at one school of pharmacy in the United States. Data sources included graduate interviews and surveys, student pharmacist focus groups, and global health competency self-assessments.

RESULTS

Five themes emerged among graduates: (1) skills were applicable to diverse settings, (2) early exposure to underserved care prepared graduates for current practice, (3) participation impacted the lens through which graduates viewed careers, (4) participation influenced patient care in current practice, and (5) graduates gained insight on complex global health issues. Three themes were identified among student pharmacists: (1) the program provided opportunities to personalize education, (2) participants gained insight through hands-on experience, and (3) participants developed new perspectives on approaching underserved care. Many graduates (77.4%) currently practiced in an underserved setting. Graduates and fourth professional year students reported improvement in all seven global health competency domains.

CONCLUSIONS

A global health concentration in pharmacy curricula can facilitate skills and global health competencies that are applicable across a wide variety of patient care contexts. This concentrated experience provided opportunities to further develop career interests and personalize education, creating a cadre of pharmacists dedicated towards addressing health disparities and serving the underserved.

Characteristics of Successful International Pharmacy Partnerships

Recommendations for global pharmacy collaborations are predominately derived from US institutions. This study utilized semi-structured interviews of global collaborators to assess important partnership components. Interviewees stated personal connections and understanding of each other's programs/systems were key components. Additionally, collaborators indicate that mutual benefits between partners can exist without the requirement for bidirectional exchange of learning experiences, and request and value partners and learners who are culturally aware, global citizens. This structured interview approach provided key insight into how to develop mutually beneficial, sustainable partnerships and provides additional confirmation that the five pillars of global engagement align with an international audience.

Adapting the layered learning model to a virtual international exchange program

INTRODUCTION

The layered learning model (LLM) is a well-established teaching approach designed for attending preceptors to train post-graduate learners and to precept students. The adaptation of a LLM to a virtual exchange program has not been previously described. The purpose of this study was to evaluate the effectiveness of the longitudinal virtual international exchange program in applying principles of the LLM to multiple levels of learners and instructors at West Virginia University (WVU) School of Pharmacy and Kitasato University (KU) School of Pharmacy.

METHODS

The online survey piloted the impact of applying the LLM to virtual international exchange sessions on improving participant knowledge in pharmacy practice, pharmacy education, cultural practices, and cultural awareness. The survey questions assessed the program's structure and effectiveness in achieving learning outcomes related to pharmacy residency topics and cultural competency using a five-point Likert scale.

RESULTS

Median scores of the effectiveness of the virtual international exchange program structure were high (≥ 4.0). Two questions evaluating the use of the LLM had median scores of 4.0. All nine residency-related questions were rated ≥3.0. The median scores for three questions evaluating small group discussions and the use of the LLM were rated significantly higher by WVU participants than KU participants. There were no significant differences in program structure and learning outcome ratings between participant groups (student vs. resident/fellow vs. preceptor/faculty).

CONCLUSIONS

Application of the LLM to the virtual international exchange program was positively received by participants, particularly by United States participants.

Global pen pal education intervention among student pharmacists: A pilot project

INTRODUCTION

Global health, a practice that prioritizes improving health and achieving health equity for all people worldwide, is a priority for pharmacists, schools, and pharmacy colleges. Several initiatives aim to enhance faculty and student exchanges while promoting projects and initiatives among thriving universities and under-resourced countries and institutions. While many organizations recognize the benefit of global collaboration, as demonstrated by the adoption of the 2012 American Association of Colleges of Pharmacy Strategic Plan, which calls for increased global experiences for faculty and students, the COVID-19 pandemic created a demand for international engagement within pharmacy practice. The objective of this study was to evaluate students' perceptions and attitudes toward incorporating a global pharmacy pen pal (PPP) exchange within the pharmacy curricula at two schools/colleges of pharmacy.

METHODS

This mixed-method study included assigned engagement within a required or elective didactic course, followed by a post-experience survey. Each student was pre-assigned a pen pal from a cohort of pharmacy students residing in 11 countries for the assignment.

RESULTS

In total, 184 students completed the learning experience, and across both sites, 63 students completed the post-experience survey. The students' impressions of the PPP varied by site, yet most participants reported an improved awareness of pharmacy practice in other countries.

Implementation of a re-designed pre-departure training program for global health advanced pharmacy practice experiences

BACKGROUND AND PURPOSE

This article describes the re-design and preliminary impact of a pre-departure global health training program for nine advanced pharmacy practice experience (APPE) sites.

EDUCATIONAL ACTIVITY AND SETTING

The program was re-designed from a half-day orientation to a six-week (six-hour total) program. Students explored global health, cultural competency, adaptability, safety, and travel logistics. The program's impact on student learning was indirectly assessed using closed- and open-ended items on pre- and post-program surveys. Students reported self-perceived agreement with eight statements regarding travel logistics and 17 statements regarding global health.

FINDINGS

Fifty-five students took the pre-course survey, and 47 students took the post-program survey for response rates of 100% and 85%, respectively. Students indicated significant change on 23 out of 25 statements, demonstrating meaningful improvements in agreement in both global health, logistics, and safety. Students were most interested in learning about travel logistics and healthcare information about their specific country upon entry into the program. At the conclusion of the program, students most often reported learning about cultural competency and adaptability. Most students reported no remaining questions. Course design, delivery, and assessment experience was provided for two academic postdoctoral fellows through the implementation of the re-designed program.

SUMMARY

Students perceived improved understanding and comfort with global health concepts and travel logistics after the pre-departure program, despite the diverse nature of rotation sites covered. More research is needed to understand what impact a pre-departure training program has on the overall global health student experience.

Financial investment of United States pharmacy schools on international activities

INTRODUCTION

The primary objective of this study was to determine the financial resources that United States (US) pharmacy schools spend and receive for international activities, as well as the future direction of expenditures and revenue.

METHODS

An online survey was sent in April 2019 to the chief financial or administrative officer at each accredited pharmacy school (N = 141) to ask about average annual budget for international activities and areas of expenditure (student travel, partnership development, faculty salary, staff salary, training programs) and revenue (dean's office, university, student tuition and fees, alumni, grants and contracts, other) associated with their budget. Participants were asked whether they anticipated spending or receiving more, the same, or less on the aforementioned expenditure and revenue areas.

RESULTS

Sixty-three programs (45%) responded, with 61 (43%) complete responses used for data analysis. Thirty-eight schools (62%) had an annual budget for international activities with an average of $77,327, a median of $18,750, and a range from $2000 to $615,000. Public schools averaged $102,129 compared to $43,225 for private schools. The largest expenditure source was split evenly between student travel and faculty salaries while the largest revenue source was student tuition and fees. The most common response for future trends was to spend or receive the same amount of support.

CONCLUSIONS

There is wide variance regarding the amount each US pharmacy school spends on international activities, with most programs anticipating spending or receiving the same amount in the future.

Integration of Intercultural Learning into an International Advanced Pharmacy Practice Experience in London, England

As the number of international advanced pharmacy practice experiences (APPEs) continues to grow, this is an opportunity to incorporate intercultural learning (ICL) to further advance student pharmacist training. Purdue University student pharmacists participated in a clinical research focused APPE in London, England. To prepare for this APPE, students completed a one-credit course focused on intercultural learning and travel preparation. The purpose of this report is to describe the implementation and assessment of ICL during this course and international APPE. The course includes interactive ICL activities, reflective assignments, and personalized assessments. During the eight-week APPE, student pharmacists worked on an individualized Intercultural Development Plan^®, which includes ICL activities, focused reflection, and check-ins. ICL was assessed using the Intercultural Development Inventory^® (IDI^®) at the beginning of the course and at least four weeks after APPE completion. Student APPE feedback was also reviewed for evidence of ICL. Twenty-seven students completed the course and APPE from 2018 to 2020. The average IDI developmental orientation (DO) before the course was 91.7, placing students in minimization. The average perceived orientation was 120.9, placing students in acceptance. There were 18 students who completed the post-APPE IDI: 12 students demonstrated growth in the DO (range: 1.5–23.72), and six students experienced a decrease in their DO. Intercultural learning can be implemented and assessed as part of an international APPE.

Provision of clinical pharmacy services during the COVID-19 pandemic: Experiences of pharmacists from 16 European countries

Background

The pharmacy profession has an important role in the frontline healthcare response to COVID-19 across all settings.

Objective

This study sought to explore the views and experiences of clinical pharmacists in relation to the provision of clinical pharmacy services during COVID-19.

Methods

Semi-structured qualitative interviews were conducted with pharmacists working in clinical roles in healthcare settings across Europe. Participants were recruited through professional organisations of clinical and hospitals pharmacists combined with a snowballing technique. The Pharmacy Emergency Preparedness and Response Framework and Disaster Preparedness Framework for pharmacy services were used to generate data which were analysed using the thematic framework method.

Results

Twenty-two participants from 16 European countries described a range of measures to protect patients, public and healthcare staff against virus transmission including developing and disseminating educational materials. Most described their involvement in aspects of evidence provision such as facilitating clinical trials, gathering and appraising evidence and disseminating clinical information. Many hospital-based pharmacists were reassigned to new roles such as intensive care. Routine clinical services were extensively interrupted and remote forms of communication were used. Most were motivated by a strong sense of professionalism to continue delivering services. A number of facilitators and barriers to prevention, preparedness and response actions were identified which related to uptake of new roles, recognition of pharmacists roles in the healthcare team, information gathering, communication with patients and healthcare professionals, and provision of routine clinical services.

Conclusions

Participants in this multinational qualitative study described a range of service adaptations and adoption of novel roles to prevent and mitigate the public health impact of the pandemic. The study findings may help to inform governments, public health agencies and healthcare systems in harnessing ongoing service provision and adapt to any future interruptions.

An ethics-based approach to global health research part 4: Scholarship and publications

Disseminating research findings from global health collaborations is essential to advancing science. However, there are a number of ethical considerations and potential challenges to address to ensure thoughtful and non-exploitative reporting. The factors include the benefits and risks to publication, authorship criteria or values, and the accessibility of forums or journals in which to pursue publication. This paper provides commentary related to planning for writing, communicating intentions to publish, obtaining permissions to publish, risks in internationally collaborative work, authorship principles, and journal selection. Authors' and editors' knowledge of experienced individuals from both pharmacy literature, medical fields, and general publications is incorporated to provide an assessment of risks and benefits of publication of international global health research.

An Ethics-based Approach to Research in Global Health: A Call to Action for Pharmacists

As opportunities and interests in international partnerships and research continue to grow in pharmacy, so, too, does the likelihood of encountering ethical challenges. We posit that the chance of encountering an ethical challenge in global health is almost inevitable. This commentary serves as an introduction to a series of four papers highlighting ethical issues in global health research for pharmacists. The authors draw on core ethical principles to guide collaborative global research in working to advance the health of people and populations worldwide.

A case-based learning exercise to increase students' understanding of the pharmacist's role in public health interventions for individual patients

INTRODUCTION

The purpose of this study was to evaluate whether a public health (PH) micro-level case-based learning exercise increased pharmacy students' self-perceived understanding and confidence in their role as PH pharmacists.

METHODS

Three PH micro-level case-based learning exercises in community pharmacy settings were developed and integrated into the third professional year PH course. Students enrolled in the PH course from January 2012 - May 2015 completed a pre- and post-activity survey consisting of 22 statements with Likert scale responses. Survey questions were grouped into domains: perceptions of pharmacist roles (ROLES) in PH, confidence in ability to identify and address PH problems (CONF), pharmacist impact on improving PH outcomes for patients with human immunodeficiency virus (IMPACT-HIV), diabetes (IMPACT-DM), or alcoholism (IMPACT-AL), perceiving pharmacists as role models in PH (MODEL), and whether PH is beyond the scope of pharmacy practice (SCOPE). Within each domain, paired t-tests were performed on summated scores (pre- vs. post-, alpha = 0.05).

RESULTS

Both surveys were completed by 271 of 336 students (80.7%). Baseline scores were lowest in the CONF and MODEL domains. The activity resulted in significant changes in 21 out of 24 survey questions. Significantly higher scores were found for domains of ROLES (+1.22), CONF (+1.60), IMPACT-HIV (+0.65), IMPACT-DM (+0.42), IMPACT-AL (+0.70), and MODEL (+1.50). Cronbach's alpha ranged from 0.73 to 0.93 for each domain.

CONCLUSION

A PH case-based learning session increased students' scores on a pre- and post-activity survey regarding PH challenges at the micro-level. The activity improved students' perceptions and confidence in providing PH interventions.

Short-term Experiences in Global Health: What is the Cost of Cultural Competence?

Students in a wide variety of health professions are increasingly interested in volunteering on a short-term experience in global health (STEGH). The literature suggests that STEGHs pose a variety of potential risks and benefits, and may carry a significant cost to plan and provide. One potential mitigating factor for any risks and costs is that student participation on a STEGH may enhance their cultural competence. Since monies spent on STEGHs are fungible, and there may be other opportunities to improve students' cultural competence, the objectives of this study were to determine if participation on a STEGH increased students' cultural competence and if so, what the cost for any such increase was. In this study, 20 students who participated on a 1-week STEGH to the Dominican Republic completed the Inventory for Assessing the Process of Cultural Competence Among Health Care Professionals - Student Version (IAPCC-SV) before and after the STEGH. The costs for all students and 7 supervising health professionals to volunteer for the STEGH were calculated, and the size of any increase in cultural competence was determined. The cost was divided by the change in cultural competence to ascertain the cost of the change. Students showed a measureable increase on the IAPCC-SV overall and on the subscales of knowledge and skill. The cost of a 1% overall increase in students' cultural competence ranged from $287 to $401. These results may allow schools offering STEGHs to determine if their offerings are cost-effective or not.

Global Health Learning Outcomes by Country Location and Duration for International Experiences

Objective. To determine the impact of country income classification and experience duration on learning outcomes for student pharmacists participating in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, longitudinal study evaluated 81 fourth-year student pharmacists participating in an international APPE through one of three US universities. A pre-post survey was administered to evaluate students' self-perceived growth across 13 competencies established by the Consortium of Universities for Global Health (CUGH). The survey included four additional open-ended questions. Student pharmacists were also invited to participate in a focus group. Paired and independent t tests and multiple linear regression were conducted. Qualitative survey and focus group data underwent a two-cycle, open-coding process using conventional content analysis. Results. Students who completed their APPE in a low- to middle-income country had greater growth in all CUGH competency statements compared to those who completed their APPE in a high-income country. Completing the APPE in a low- to middle-income country and prior travel for non-vacation purposes were significant predictors of student growth. Students who went to a low- to middle-income country demonstrated increased cultural sensitivity, more patient-centered care, and skill development, while students who went to a high-income country displayed increased knowledge regarding differences in health care system components, pharmacy practice, pharmacy education, and an appreciation for alternative patient care approaches. Conclusion. Learning outcomes differed between students who completed an APPE in a high-income rather than a low- to middle-income country, with both types of locations providing valuable educational opportunities and professional and personal development.

Implementation of an ACPE-Accredited PharmD Curriculum at a Saudi College of Pharmacy

Objective. To establish an academic curricular collaboration between the newly established college of pharmacy at King Saud Bin Abdulaziz Saudi University for Health Sciences (KSAU-HS) and a US college of pharmacy accredited by the Accreditation Council for Pharmacy Education, and assess measures of success. Methods. Criteria for selecting a college for collaboration were established. A systematic approach was followed in negotiating legal, logistical, and financial issues with the selected collaborating institution. Course materials were transferred and implemented and minimal changes were made to the alignment and sequencing of lectures. The faculty at KSAU-HS developed and implemented research and seminar courses. Pharmacy practice experiences were designed and rubrics were developed. Results. All courses were implemented successfully. The PharmD students scored significantly higher in all academic levels in a benchmarked progress test than did students in other programs. Students' evaluation of 43 first-, second-, and third-year courses in 2017-2018 using a survey that assessed numerous aspects of each course showed significantly higher overall satisfaction than the institutional averages. Also, female students indicated significantly higher satisfaction with the PharmD program than did male students. Conclusion. The transfer and implementation of an accredited PharmD curriculum to the KSAU-HS College of Pharmacy went smoothly and the program was launched on time. Learning and teaching success was facilitated by the KSAU-HS faculty. Program outcomes were verified by students' high scores on a benchmarked examination and by their satisfaction with the courses.

Study Abroad Course for Pre-pharmacy and Pharmacy Students to Learn About Global Health

Objective. To design, implement, and assess a study abroad course in Ireland for pre-professional and Doctor of Pharmacy (PharmD) students. Methods. An elective study abroad course was created for pre-professional and PharmD students at North Dakota State University. The course included comparison of the US and Ireland's health care delivery systems and participation in history and cultural experiences in Ireland. Prior to the trip, students and preceptors attended seminars related to the culture of Ireland. The three-week trip to Ireland took place between the spring and summer semesters in 2016. Student assignments while abroad included completion of a self-reflection journal with daily entries describing what the student learned and how the experience impacted them, and completion and presentation of a term paper comparing Ireland's pharmacy system with that in the United States. Pre- and post-travel surveys were conducted to assess students' perceptions of and learning from the experience, and to identify areas for course improvement. Results. Students' evaluations of the course and travel experiences were positive. However, students' perceptions of their cultural awareness were largely unchanged. Conclusion. The course was well received by students. Other PharmD programs may benefit from implementing similar study abroad experiences.

Fulfilling Educational Competencies through Global Pharmacy Experiences

Many Colleges of Pharmacy in the United States offer international education and practice experiences to their students. Multiple publications have described these offerings and related them back to the CAPE 2013 Outcomes. This article describes the multiple international programs offered by one College of Pharmacy, including international Advanced Pharmacy Practice Experiences, Short Study Abroad Programs, and International Health Outreach Trips. The article also details the relevant competencies associated with these international experiences.

Cultural Sensitivity and Global Pharmacy Engagement in the United States

Objective. To provide a resource for schools and colleges of pharmacy in different regions of the world that are considering sending their students and faculty members to the United States for training. Methods. A literature review (2000-2018) was conducted that involved database and Internet searches using specific keywords and terms. Information was also solicited from authors in different regions of the United States who have hosted international students and faculty members. Recommendations for pharmacists and other health care practitioners on culturally sensitive engagement were formulated. Results. Global engagement between schools and colleges of pharmacy from different regions of the world and the United States is increasing. In addition to various cultural aspects, general information about the US health care system, pharmacy education programs, and pharmacy practice were found to be available to individuals who are charged with organizing and facilitating these exchanges. Common stereotypes and misconceptions about the United States were also identified. Conclusion. For international learners to have an enriching and fruitful engagement while in the United States, an understanding of American culture in general as well as the unique cultural aspects of different regions of the country as provided in this paper is critical.

Cultural Sensitivity and Global Pharmacy Engagement in Latin America: Argentina, Brazil, Ecuador, Guatemala, and Mexico

To establish and maintain successful global pharmaceutical and health care partnerships, pharmacists, pharmacy educators, and students should first learn more about the political, cultural, economic and health care dynamics that affect all of the parties involved in these arrangements. This paper explores Latin America within the context of transnational pharmacy and health-based engagement, including pharmacy-related concepts, health care and cultural considerations, behavioral health perspectives, and common misconceptions. Expert knowledge and experience were used to support and corroborate the existing literature about cultural dynamics of health. Recommendations are provided for how schools and colleges of pharmacy can enhance engagement in culturally sensitive partnerships within Latin America. Health-based profiles of Argentina, Brazil, Ecuador, Guatemala, and Mexico are presented to serve as models for establishing, enhancing, and maintaining partnerships across Latin America.

Cultural Sensitivity and Global Pharmacy Engagement in the Arab World

Objective. To create a resource on cultural sensitivity for schools and colleges of pharmacy that are currently engaged or considering future outreach opportunities in the Arab world. Methods. A literature review (2000-2018) of databases and Internet searches with specific keywords and terms were conducted. Authors who had experience in travelling to and hosting students and professionals from the Arab world and authors with local work experience in the Arab world were solicited. Results. General information about the Arab world, including unique aspects of individual countries, is presented. Stereotypes and misconceptions regarding the region and the people are discussed. Specific information about the government and infrastructure of each country, including their health care system is provided, with emphasis given to pharmacy education and practice in the region. In addition, recommendations for culturally sensitive engagement for pharmacy and other health care practitioners are discussed. Finally, recommendations for culturally sensitive engagement when hosting students and/or faculty members from the Arab world are also addressed. Conclusion. Global engagement between schools and colleges of pharmacy in the United States and those in the Arab world is increasing. For an enriching and fruitful engagement, sensitivity toward the cultural and clinical needs of the people, and in particular, the professionals of that region is critical.

An Introduction to Cultural Sensitivity and Global Pharmacy Engagement

Global engagement between schools and colleges of pharmacy in the United States and many regions of the world is increasing. For an enriching and fruitful interaction, sensitivity toward the cultural, ethical, educational, religious, historical, political, regulatory, and practice issues is critical. Lack of sensitivity may negatively impact engagement among students, professionals and other people from different regions of the world. In this special issue, eight papers will introduce general information about five regions of the world that have established and increased global engagements with institutions in the United States: Africa, the Arab world, Asia, the Caribbean, and Latin America. In addition, the special issue will include a paper with key information related to global engagement within the United States. For each paper, the specifics provided about the selected countries include: demographics, culture, climate, pharmacy education, and health care systems, as well as common stereotypes and misconceptions held by and about the people of the country. Further, recommendations for pharmacists and other health care professionals on culturally sensitive engagement will be emphasized. Finally, recommendations for culturally sensitive engagement when US schools are hosting students and faculty members from those regions will be summarized. The papers are based on literature reviews of databases from 2000 to 2018 and internet searches with specific keywords or terms, such as cultural sensitivity, global, pharmacy, stereotypes, and ethics. Additional keywords are identified in individual papers on specific regions. Authors for each paper consist of practitioners with experience in travelling to and hosting students and professionals from the regions; practitioners with local work experience, and professionals from each region. The special issue is intended to serve as a resource for US schools and colleges of pharmacy currently engaged in or considering future outreach opportunities in these regions, and for those seeking opportunities in the United States. The special issue will provide key information to facilitate culturally sensitive engagement in existing or future relationships.

Describing pharmacy student participation in an international, interprofessional medical mission trip as part of an advanced pharmacy practice experience (APPE)

BACKGROUND AND PURPOSE

Several schools of pharmacy across the United States have taken steps to incorporate international medical mission trips into the doctor of pharmacy (PharmD) curriculum. This study aims to describe the impact of advanced pharmacy practice experience (APPE)-level student pharmacists on an interprofessional team during an international medical mission trip to Jamaica.

EDUCATIONAL ACTIVITY AND SETTING

The Jamaica Medical Mission (JMM) trip is an annual event involving healthcare professionals from several disciplines across multiple universities and healthcare systems. At this institution, the JMM trip is included as part of a rural health elective APPE rotation. Students electing to participate in this rotation are provided with the opportunity to serve as active participants on an interprofessional healthcare team in underserved and under-resourced communities throughout Jamaica. The JMM trip that took place during June 2016 included healthcare professionals and students in the fields of medicine, dentistry, optometry, nursing, and pharmacy. A total of five pharmacist preceptors and 10 pharmacy students attended the JMM trip in June 2016. Approximately three to five clinic sites per day were conducted simultaneously on each of the seven clinic days at various locations throughout Jamaica. The interprofessional healthcare teams provided free medical care, including physical exams and access to prescription and non-prescription medications.

FINDINGS

The interprofessional healthcare team saw a total of 1014 patients and dispensed 1879 prescriptions during the seven clinic days. A total of 811 clinical recommendations were made by student pharmacists and/or pharmacy preceptors. Of these recommendations, 561 (69%) were made by student pharmacists without pharmacy preceptor prompting, 103 (13%) were made by the student pharmacist with preceptor prompting, and 147 (18%) were made by pharmacy preceptors. Over 70% of recommendations made by student pharmacists without pharmacy preceptor prompting were accepted by prescribers.

DISCUSSION AND SUMMARY

This study sought to describe the impact of APPE-level student pharmacists on an interprofessional team during an international medical mission trip. Our findings demonstrate that APPE-level student pharmacists were capable of making a substantial number of clinical recommendations without preceptor prompting. The number of recommendations made by students without preceptor prompting were consistently greater than the number of recommendations made with preceptor prompting throughout the trip. Future studies should address student competence in achieving learning objectives associated with international, interprofessional APPE rotations.

Development and Implementation of a Global Health Elective with a Drug Discovery Game for Pharmacy Students

Interest in global health education within the pharmacy curriculum has increased significantly in recent years. However, discussion of different models and methods to evaluate course structures are limited. The overall objective was to (1) describe the structure of our global health elective for pharmacy students, and (2) assess educational outcomes related to perceived/formal knowledge and attitudes associated with global health. Our elective was designed using a competency-centered approach to global health education, incorporating reflection, projects, service and game-learning. In addition to course assessments, a pre-post survey questionnaire assessing attitudes, knowledge perception, formalized knowledge and opinions was utilized. Overall, students demonstrated appropriate performance on course assessments, temporally improving throughout longitudinal projects. The survey demonstrated significant increases in knowledge perception as a result of the course; however, no change in formalized knowledge was evident through the survey assessment. Additionally, the incorporation of game-learning into the course was well received by students. Future iterations of the course will focus on utilization of different assessment methods to meet learning outcomes.

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors' collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities.