Years of Rampant Expansion Have Imposed Darwinian Survival-of-the-Fittest Conditions on US Pharmacy Schools

A Cycle of Reinforcing Challenges and Ideas for Action in Experiential Settings

Evidence suggests that both pharmacy students and preceptors are struggling in the experiential setting. Underlying this phenomenon is a potential interconnected and cyclic set of behaviors being reinforced between students and preceptors. These behaviors can contribute to or are the result of higher levels of burnout and a decrease in the development of student clinical skills and subsequent performance on rotation. In this review, the authors investigate various challenges commonly encountered in the experiential environment. These challenges can range from an observed decrease in student engagement, motivation, and critical thinking skills to an increase in preceptor burnout and culture shifts in the clinical practice environments. These factors all ultimately impact patient care and overall student performance. For each challenge identified, strategies will be presented that can be implemented by students, preceptors, and pharmacy programs to break the cyclic pattern identified.

The Need for Competency-Based Education

OBJECTIVES

While pharmacy education updates learning as new information arises, changes to learning experiences can trail behind current practices and technology. There have been multiple calls for radical changes in how health professions education is delivered to ensure patients are receiving high-quality care. Competency-based education has been one way discussed in the literature for how to handle this need to develop students who have a willingness to learn and can problem-solve. The goal of this review is to examine whether competency-based education is needed to drive the profession of pharmacy forward.

FINDINGS

To address, we collaboratively identified stakeholder perspectives to evaluate the need. The following stakeholders achieved consensus among the committee members: patients/society, learners, workplace/profession, and academic institutions.

SUMMARY

Based on those perspectives, needs, and gaps to address those needs were identified and are presented in this review.

Reconsidering Pharmacy: We Need to Turn Career Regret into Career Options

Declining interest in pharmacy as a career is a growing concern. This commentary investigates the factors contributing to career regret among pharmacy graduates, based on data from the American Association of Colleges of Pharmacy National Graduating Student Survey. We identify 3 key contributing factors: workplace environment, professional identity formation, and marketing of the Doctor of Pharmacy degree. We argue that students observe, in many work environments, a lack of autonomy, repetitive tasks, and unfulfilling work. This leads to diminished job satisfaction and disillusionment. Additionally, marketing tactics and curricular structures can inadvertently contribute to career regret. We propose potential interventions, emphasizing the need for improved working conditions, more versatile roles in pharmacy, and enhanced career development services within colleges/schools of pharmacy. Additional research is needed to fully understand career regret and the steps that academic institutions can proactively take to mitigate career dissatisfaction among their graduates.

Despair and hope: Is the retail community pharmacy workforce in danger of becoming a monopsony labor market?

OBJECTIVE

Mergers of big chain retail community pharmacies can affect the competitiveness of the pharmacy workforce to negotiate better wages and work conditions. However, it is unclear whether these types of mergers are generalizable to the U.S. pharmacy workforce. We should observe this effect when comparing annual wage trends between retail community pharmacy workers and nonretail community pharmacy workers. In the absence of this effect, annual wage trends would be similar. To examine this theory, annual wage trends for community pharmacy workers were compared with hospital pharmacy workers between 2012 and 2022.

DESIGN, SETTING AND PARTICIPANTS

A serial cross-sectional study was performed to compare the annual wages between retail community pharmacy workers and hospital pharmacy workers between 2012 and 2022 using data from the U.S. Bureau of Labor and Statistics (BLS). Pharmacy workforce was categorized as pharmacists, pharmacy technicians, and pharmacy aides (clerks) and grouped into retail or hospital pharmacy settings based on the North American Industry Classification System. Pharmacy workers' annual wages were based on the U.S. BLS Quarterly Census of Employment and Wages data.

OUTCOME MEASURES

Annual wages.

RESULTS

Between 2012 and 2022, statistically significant annual wage reduction was greater among pharmacists in the retail than pharmacists in the hospital setting by -$1974 (95% CI -$2921 to -$1026) per year. However, these trends were not statistically significant among pharmacy technicians and pharmacy aides. Pharmacy technicians in the retail and hospital settings had a 3.4% and 7.0% increase in average annual wages, respectively. Pharmacy aides in the retail and hospital settings had a 16.8% and 21.6% increase in average annual wages, respectively.

CONCLUSION

Although pharmacists' annual wages decreased, it is unclear whether this was caused by the monopsony labor market. These findings suggest that there may be inefficiencies in the retail community pharmacy labor market, which may stimulate policies to improve pharmacy workforce conditions and patient safety.

The intersectionality of professional and personal identity formation in a virtual pre-health pathway program

BACKGROUND AND PURPOSE

To describe the development and implementation of professional and personal identity formation content in a virtual pre-health pathway program.

EDUCATIONAL ACTIVITY AND SETTING

Content within a six-week pre-health program for underrepresented and/or disadvantaged college students was redesigned to a virtual format with enhanced focus on professional and personal identity formation. Sessions on personal identity formation were also enhanced through a partnership with local mental health clinicians specializing in trauma-informed care and culturally relevant practices and strategies.

FINDINGS

The 2020 and 2021 programs were restructured to include pharmacy professional identity formation content around the following weekly themes: Roadmap to Pharmacy, What Does it Mean to be a Pharmacist?, Expanding Knowledge of Pharmacy, Gaining Insight and Dispelling Myths, Practicing Knowledge and Exploration, and Moving Forward. These pre-pharmacy components emphasized diversity of career paths, pharmacy-based clinical services, and the pharmacist's role in promoting health equity. Overarching components of interprofessional collaboration coupled with health policy applications further emphasized the professional identity of a pharmacist in the collaborative design and delivery of health care. New personal identity formation sessions were implemented in tandem with this content and centering around the following themes: Supporting Scholars in Self-Authorship, Building a Community among Peers, and Strategies for Coping in Times of Challenge.

SUMMARY

This project has the potential to serve as a model for the implementation of both personal and professional identity formation initiatives at other programs to promote pharmacy as a desirable and attainable career to pre-health students.

Messaging preferences for the role of pharmacists in pharmacy education recruitment material

INTRODUCTION

Applications to pharmacy programs are declining worldwide. Previous research suggests that positioning of recruitment material according to prospective students' preferences may increase interest in the profession and entry-to-practice programs. The aim of this study was to determine messaging preferences for the role of the pharmacist.

METHODS

This was a best-worst choice survey conducted at one institution in one country. Participants included prospective students, current pharmacy students, and others representing the general public. Thirteen statements (plus one control) describing the role of the pharmacist were extracted from pharmacy program websites. Survey participants completed the best-worst choice analysis, and a conditional logit model was used to estimate statement preference coefficients.

RESULTS

A total of 150 complete survey responses were collected. The top ranked statement was, "Pharmacists are health care professionals who are experts in medicines" and the least ranked statement was the control statement, "Pharmacists are experts in dispensing medications and counting tablets." No differences were observed between the different groups of survey respondents. Other highly ranked statements spoke to the expertise of the pharmacist and promoted a well-defined role. Catchy statements, such as "Pharmacists are medicines superheroes," were not ranked highly.

CONCLUSIONS

This study found that current and prospective pharmacy students preferred descriptive and explicit messages that align with pharmacists' professional identity for promotion of the pharmacist's role.

Prestige and financial stability: motivating factors to pursue a doctor of pharmacy degree

OBJECTIVE

This study aims to identify factors influencing students' decision to pursue a doctorate in pharmacy (PharmD).

METHODS

Focus-group interviews and quantitative surveys were used in sequence to investigate pharmacy students' motivations. A total of 36 current PharmD students from two US colleges of pharmacy participated in five focus groups. The resulting qualitative findings, along with existing literature, informed the development of a survey questionnaire, which was then administered to two cohorts of first-year pharmacy students at one of the participating colleges.

KEY FINDINGS

Identified themes include prestige of a doctorate, patient interaction, career versatility, and pharmacy school's lower intensity vis-à-vis medical school. A total of 110 first-year pharmacy students from a 4-year program (average (SD) age 23 (5); 65% female) completed the survey (98.5% response rate). The order of factors that respondents ranked as important or somewhat important for choosing pharmacy include: financial stability (n = 107 (97%)), prestige of a doctorate degree ((n = 97 (88%)), good work-life balance ((n = 96 (87%)), the opportunity to use critical thinking skills ((n = 93 (85%)), having patient interaction and communication ((n = 91 (83%)), and being in a profession or service ((n = 91 (83%)).

CONCLUSIONS

US PharmD students are mainly drawn by job and financial stability, prestige of a doctorate, and a good work-life balance.

Increasing the PharmD Pipeline, Encouraging Student Success, and Supporting the Underserved Through Pre-Pharmacy Advising

Academic advising for pre-pharmacy students lacks best practice recommendations specific to the pharmacy profession. When considering contemporary challenges in pharmacy education, adoption of high-quality advising approaches will likely have a positive influence on professional school enrollment, general student success, and educational access for the traditionally underserved. As pre-health academic advising is an important component of student professional development, standardizing best-practice strategies in and around pharmacy programs will "[strengthen] the pharmacy pipeline" and "[raise] the profile of pharmacy" as stated in the 2021-2024 Strategic Plan Priorities, Goals and Objectives issued by the American Association of Colleges of Pharmacy (AACP). An investment is needed to codify such practices in pre-pharmacy advising and scale these techniques across pharmacy schools positioned to serve undergraduates.

Redefining 'advanced': Supporting and promoting practice change through community advanced pharmacy practice experiences

INTRODUCTION

Community pharmacy practice in the United States (US) has faced several external pressures, threatening traditional practice models. Schools and colleges of pharmacy (S/COP), particularly through experiential rotations, are perfectly poised to help these practices create new sustainable business models. The purpose of this article is to highlight demonstrated, reproducible successes of community advanced pharmacy practice experience (APPE) advancement initiatives.

PERSPECTIVE

Despite community pharmacists being highly-trained health care providers with roughly equivalent educational backgrounds, community-based practices in the US are not all the same. Student pharmacists can contribute to the design and implementation of revenue-generating services helping individual pharmacies elevate their practice. Doing so involves new models for staffing, workflow, billing, and documentation. Students can help support practice change by focusing on implementation and sustainability. Example APPE integrations focused on community pharmacy practice transformation are described in detail from the University of Arkansas for Medical Sciences College of Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Idaho State University.

IMPLICATIONS

Establishing intentional connections that focus on new sustainable community business models is a responsibility for S/COP. The examples provided serve to demonstrate the feasibility of these partnerships. Training students on innovative practice models and utilizing them is critical in moving community practice forward. As academicians, we must prepare students to be agents of change for the profession and intentionally integrate them into a systematic plan to help promote and change practice activities wherever possible, but especially in community practice.

Pharmacy-faculty work-life balance and career satisfaction: Comparison of national survey results from 2012 and 2018

Background

Changes in demographics and composition of pharmacy faculty, along with faculty perceived stress, work-life balance and career satisfaction have yet to be fully documented.

Objective

To compare recent results from a national survey of work-life balance and career satisfaction of United States (U.S.) pharmacy faculty with results obtained from a similar survey from 2012.

Methods

A 46-item anonymous survey administered via Qualtrics (Provo, UT) was sent to members of the American Association of Colleges of Pharmacy (AACP) in 2018. Information regarding demographics, stress, work-life balance, career satisfaction and intent to leave academia was collected. Although not part of the previous survey, participant information related to bullying and abuse in the pharmacy academic work was also gathered. While actual p-values are reported for all comparisons, a more conservative p-value of 0.01 was chosen a priori to indicate significance as multiple comparisons were made.

Results

A total of 1090 pharmacy faculty completed the survey, comparable to the number obtained in 2012 (n = 811). Overall response rates were similar for both years. The majority of pharmacy faculty in 2018 were female, white, married or with partner, worked in a pharmacy practice department and for a public institution. Notable differences between surveys included an increase in females, more associate professors and an increase in non-white faculty in 2018, relative to 2012. Stress, as measured by mean Perceived Stress Scale (PSS) scores was also significantly higher in 2018 (16.0 ± 6.6 vs. 13.5 ± 6.7, p < 0.01) relative to 2012. Faculty from 2018 were significantly less likely to report an intention to remain in academia (61.8% vs 86.3%, p < 0.01), relative to 2012. A sizable number of pharmacy faculty surveyed in 2018 also reported observing or experiencing hostility in the workplace, which included either bullying or verbal or physical abuse.

Conclusions

The makeup of pharmacy educators has evolved quickly over the last several years to comprise more female and associate professors who work within a pharmacy practice department. Also noteworthy is the significant increase in self-reported stress over the six-year timeframe. The direct implications of these findings are unknown but suggest that pharmacy academia is maturing in rank and changing to reflect the current pharmacy workforce (i.e., more females and additional clinical practice roles). Increases in responsibility likely accompany these maturing roles and may, along with other factors, contribute to the observed changes in the reported stress levels among faculty. Further research is called for regarding the reported hostility in pharmacy academic workplace and dovetails with concurrent work being done on citizenship and organizational citizenship behavior among pharmacy faculty. Findings of the study may aid pharmacy school administrators and stakeholders with plans to recruit, develop and retain faculty.

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Pharmacy faculty report frequent hostility and bullying in their workplace.

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Composition of pharmacy faculty is rapidly changing to include more females working in pharmacy practice departments.

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Pharmacy faculty report increased stress levels relative to a previous survey from 2012.

Wicked Problems in Pharmacy Education

Wicked problems are unstructured, cross-cutting, and relentless. While problem-solving is an expected outcome of pharmacy education programs, are we, as pharmacy educators, acknowledging the "wicked" problems we have in the Academy? This commentary provides examples of wicked problems in pharmacy practice and education and suggestions for engaging with wicked problems in an effort to solve them. Pharmacy educators must hold a summit on wicked problems in pharmacy education in order to address the complex problems we are currently facing in order to shape the profession for the future.

Trends in gender and race/ethnicity of PharmD students and faculty in US pharmacy schools

INTRODUCTION

This study described and compared trends in the distribution of gender and race/ethnicity for doctor of pharmacy (PharmD) students and faculty in schools and colleges of pharmacy in the United States.

METHODS

Institution-level gender (male and female) and racial/ethnic (White, Black/African American, Hispanic/Latino) data for full-time faculty were obtained from the American Association of Colleges of Pharmacy institutional database for 2009-2019. PharmD students' demographic data during the same study period were collected separately for applications, enrollments, and degrees conferred. Generalized linear regression models were applied to examine trends in proportion of PharmD students and faculty distribution in subgroups of different gender and race/ethnicity at P < .05. All analyses were conducted using SAS, version 9.4 (SAS Institute).

RESULTS

Significantly increasing trends in female full-time faculty, PharmD applications, and enrollments were observed; however, the trend in female PharmD degrees conferred remained stable from 2009 to 2019. While the trends in proportion of PharmD applications, enrollments, and degrees conferred for Black/African American and Hispanic/Latino students increased significantly, declines and stable trends in the proportion of Black/African American and Hispanic/Latino faculty, respectively, were identified during the same time.

CONCLUSIONS

Upward trends in proportions of Black/African American and Hispanic/Latino PharmD applications, enrollments, and degrees conferred were not mirrored by trends in proportions of underrepresented faculty. Implementation of effective faculty diversity and inclusion strategies is warranted to better meet the educational needs of PharmD students.

A Bibliometric Analysis of Peer-Reviewed Journal Publications of Pharmacy Practice Department Chairs

Objective. To perform a bibliometric analysis of pharmacy practice department chairs at US schools and colleges of pharmacy to determine factors associated with their level of scholarly productivity.Methods. Scopus was searched for all publications by pharmacy practice chairs from all pharmacy schools through August 11, 2020. Publication metrics (total number of publications and citations and the Hirsch-index (h-index), and year of first publication), as well as characteristics of the individual chair and institution were collected. Characteristics were compared across groups. A generalized linear model was used to determine the correlation between the total number of publications and h-index to school ranking by US News & World Report (USNWR).Results. One hundred forty-one pharmacy practice chairs were identified. The majority were male and at the rank of professor, with a similar proportion from public and private institutions. The median total number of publications and citations was 19 and 247, respectively, with a median h-index of eight. Compared with female chairs, male chairs had a higher median total of publications and citations and a higher h-index. Chairs at public institutions had a higher median total of publications and citations and a higher publication rate, h-index, and m quotient. The USNWR ranking for the school was significantly correlated with total publications and the h-index.Conclusion. Pharmacy practice chairs vary significantly in their scholarship productivity, although those at institutions with a larger emphasis on research were more prolific. Observed differences in the publication metrics of male and female chairs warrants further study to determine possible explanations for this finding and its potential impact.

Continuing to Challenge the Paradigm of What Is Possible in Pharmacy Education and Practice Post-COVID-19

The COVID-19 pandemic has caused boundless disruptions to every element of life. It has also brought with it lessons from the past that will likely extend into the future as humans continue to interface with the ever-increasing threats of zoonotic diseases. The pandemic has challenged the profession and the Academy to adjust, modify, and adapt. It has also stretched the bounds of what had previously been thought possible within the realms of medicine. As the Academy begins to reach and crest the apex of the epidemic it should be reminded of the many lessons associated with the pandemic and of the constant need to challenge the paradigm of what is possible.