Systemic Racism: Pharmacists' Role and Responsibility

Through the Lens of Societal Norms and Experiences: Students' Conceptualization of Patient Case Data When Diversity is Apparent

OBJECTIVE

There are increasing calls to improve representation of diversity within case-based learning materials, yet it is unclear how students interpret inclusion of diversity data when synthesizing case information. The objective of this study was to determine factors that influence students' interpretation of written case data for visualization of a patient case.

METHODS

This was a qualitative study using interviews. Entry-to-practice pharmacy students from Dalhousie University in Canada were recruited to review six cases, each with varying representations of diversity (e.g., race, sexual orientation, gender, relationship status, disability, or none). Students were prompted to state how they visualized the case patient and what factors influenced their perceptions. Interviews were audio-recorded and transcribed verbatim. A reflexive thematic analysis was conducted to interpret themes.

RESULTS

Interviews were conducted with 18 students. Students relied on five factors when interpreting case data in the presence of diversity. In addition to the case data itself, these included personal experience (relating to themselves or personal relationships), professional experience (through work or school), population stereotypes, and perceived societal norms.

CONCLUSION

This study found that students rely on their personal and professional experiences, perceptions, and social conditioning when interpreting the presence of diversity within learning materials. Findings support the notion that educators should deliberately and conscientiously expose students to a broad representation of diverse populations to increase students' knowledge and understanding of populations, and to create intentional time and space to challenge existing stereotypes that contribute to the inequities in healthcare.

Health advocacy: A gulf between instruction and practice

BACKGROUND

Systematic ways to teach health advocacy, an educational outcome for pharmacy graduates, is lacking. We developed a workshop to facilitate understanding and application of a novel structured framework for health advocacy and explored how pharmacy students enacted opportunities for health advocacy during subsequent outpatient experiential training.

EDUCATIONAL ACTIVITY AND SETTING

A two-hour workshop was introduced for year 2 students in 2019. Its content was organized around a health advocacy framework. With patient and faculty facilitators, students worked through examples characterized into the framework's four quadrants: 1) shared advocacy "with patients" at the individual- or 2) systems-level and 3) directed advocacy "for patients" at the individual-or 4) systems-level. We then conducted a longitudinal diary study asking pharmacy students (N = 23) to reflect on opportunities to practice health advocacy skills in community pharmacy practice. A systematic, multi-coder reflexive thematic analysis of diary entries was employed.

FINDINGS

Pharmacy students did not express a fulsome view of patient health advocacy and mischaracterized self-reported practice examples into inappropriate categories of the health advocacy framework. Most overemphasized usual pharmacist care as acts of health advocacy. No systems-level activities were undertaken, although isolated episodes of shared advocacy with patients were identified.

SUMMARY

Lasting impacts of a health advocacy workshop in our pharmacy curriculum were not widely apparent. While longer training periods in community pharmacy practice may yield more opportunities to develop and enact this role, gaps in student conceptualization of health advocacy and inabilities to practically observe and exercise system-level advocacy are ultimately problematic for patient care.

Developing and Validating the Diversity, Equity, Inclusion, and Antiracism Faculty Perceptions of College Climate (DEIA FPCC) Scale in Pharmacy Faculty

OBJECTIVE

This work's objective was to demonstrate acceptable reliability and consistency within and across each domain of the survey tool.

METHODS

A survey with 16 questions was distributed to faculty from the AACP membership list and contained 4 domains: DEIA. The survey responses were analyzed using factor analysis and reliability analysis.

RESULTS

A total of 877 subjects' responses met inclusion criteria and were used in the analysis. The results demonstrated that the survey had high reliability and discriminating validity within each domain and overall as a scale.

CONCLUSION

The finalized tool provides a practical, standardized measure to evaluate faculty perceptions of DEIA efforts in institutions of pharmacy education. This tool can help identify areas of improvement and guide the advancement of DEIA initiatives in colleges of pharmacy. Further research is needed to validate the survey in other populations. Future efforts will also explore predictors of survey scores.

The implications of data aggregation on propagating racial and ethnic disparities within the health care landscape: Actionable recommendations and considerations for pharmacists

As the U.S. population becomes more racially and ethnically diverse, it is increasingly important to characterize health inequities for targeted intervention. As it stands, demographic data regarding race and ethnicity for patients and pharmacy trainees alike are aggregated into heterogenous population groups, resulting in findings that may inaccurately reflect the experiences of smaller subgroups. Disaggregation of patient outcomes data can serve to better inform public health interventions for the most vulnerable populations. In pharmacy, disaggregation can allow for better identification of racial and ethnic subgroups who have been traditionally excluded from funding support among other opportunities. In this commentary, we provide historical context and actionable recommendations to better describe our patient and pharmacy trainee populations, with the objectives of improving pharmacist representation and health equity.

Developing Research-Informed Guidance on Preparing Pharmacy Students to Care for Diverse Populations

OBJECTIVE

The purpose of this study was to develop research-informed guidance on how to better prepare students for working with diverse populations through exposure to diversity representation within case-based learning materials.

METHODS

This was a qualitative interpretive phenomenological study using audio-recorded semi-structured interviews for data collection. Interviews were conducted virtually with 15 recent program alumni from Dalhousie University and 15 members from underrepresented communities in Nova Scotia, Canada. Audio-recordings were transcribed verbatim and framework analysis was used to code and categorize data. Themes were interpreted from categorized data and a conceptual model was developed based on the results.

RESULTS

The conceptual model highlighted that awareness of diversity and health equity paired with practice and application of learning were perceived to be important for preparing graduates for practice. It was found that awareness could be best achieved through exposure to diversity within cases. To effectively expose students, programs must deliberately identify diverse populations to include, seek perspectives and engagement from those populations when writing cases, ensure conscientious representation of diversity without reinforcing stereotypes, and provide resources for discussion and further learning.

CONCLUSION

Through the development of a conceptual model, this study provided research-informed guidance representing diversity within case-based learning materials. Findings support the notion that representation of diversity must be deliberate, conscientious, and collaborative with those offering diverse perspectives and lived experiences.

Baseline Assessment of Systemic Racism Education in Pharmacy Curricula

Objective. To determine, by survey, the inclusion of systemic racism education in US Doctor of Pharmacy (PharmD) curricula and identify barriers and facilitators to addressing this content.Methods. A survey was developed and distributed to curricular representatives at US colleges and schools of pharmacy. The survey assessed inclusion of systemic racism education in curricula, faculty involvement in teaching systemic racism content, barriers to adding systemic racism content in curricula, and future curricular plans. Data were analyzed using descriptive statistics for institutional background information, curricular content, and barriers to inclusion. Relationships between the inclusion of systemic racism content at public versus private programs were examined, and associations between traditional and accelerated programs were assessed.Results. Fifty-eight colleges and schools of pharmacy provided usable responses. Of the respondents, 84% indicated that teaching systemic racism content and its impact on health and health care was a low priority. For 24% of respondents, systemic racism content was not currently included in their curriculum, while 34% indicated that systemic racism content was included in one or more courses or modules but was not a focus. Despite systemic racism content being offered in any didactic year, it was rarely included in experiential curricula. Top barriers to inclusion were lack of faculty knowledge and comfort with content and limited curricular space. No significant differences were found between program types.Conclusion. Based on the current level of systemic racism education and barriers to inclusion, faculty need training and resources to teach systemic racism concepts within pharmacy curricula. The inclusion of systemic racism concepts and guidance in the Accreditation Council for Pharmacy Education's Accreditation Standards could help to drive meaningful change and promote health equity.

Review of Best Practices for Diversity, Equity, and Inclusion Committees Within Colleges of Pharmacy

Objective. To provide a review of best practices for diversity, equity, and inclusion (DEI) committees at United States colleges of pharmacy.Findings. In colleges of pharmacy, DEI committees can play a crucial role in promoting a culture change to ensure pharmacy graduates are equipped to provide equitable and representative care for the patients they serve. There is limited literature available on DEI committee composition, roles, and responsibilities, and their place within a college of pharmacy's organizational structure. A commitment to DEI should be part of the college's strategic plan and embedded and supported at all levels of the college and university to ensure success of DEI-related strategic initiatives. For a DEI committee to be effective, its composition should be intentional to include change agents, campus leaders, and members who are passionate and knowledgeable to execute the DEI goals. For sustainable change, involvement of the entire learning community and an organizational culture change is also important. Thus, DEI committees need to establish active bidirectional collaborations and communication with all key committees, offices, community leaders, and alumni to implement diversity goals.Summary. The DEI committee's established place in the organizational structure of the college is essential to ensure fair and appropriate representation of the community it serves. A clearly defined DEI committee with committee composition, roles, responsibilities, and its association with all constituents of the college and community can help achieve its intended strategic goals.

Taking Action Towards Equity, Diversity, and Inclusion in the Pharmacy Curriculum and Continuing Professional Development

Increased awareness of social injustices and inequities highlight the relevance and importance of diversity, equity, inclusion, and accessibility (DEIA) in health care. Former and recent graduates of pharmacy schools remain deficient in their knowledge of DEIA topics such as unconscious bias, which can directly influence health outcomes in an undesirable manner. Particular DEIA areas that are pertinent to pharmacy practice include: race, gender, sexual orientation, gender identity, ability status, religion, socioeconomic status, and political beliefs. The American Association of Colleges of Pharmacy (AACP) affirmed its commitment to DEIA as a priority. However, existing gaps in knowledge of pharmacy graduates in this area have the potential to contribute to health disparities and inequities, which are significant public health issues. We call on academic pharmacy institutions and professional pharmacy organizations to elevate DEIA topics and to designate them as essential to both addressing health equity and improving care for underserved populations. We also implore licensing boards to require continuing education related to DEIA as a foundational step to closing the knowledge gap for pharmacists in this area.

Considerations for writing and including demographic variables in education research

OUR SITUATION

At many points within pharmacy education, we collect demographic information about faculty, staff, students, and trainees. Admissions procedures and surveys, for example, typically categorize participants based on various identities such as race and ethnicity as well as gender and sex. In this article, we interrogate the complex nature of capturing participant identities through demographic variables, using race and ethnicity, gender and sex, sexual orientation and identity, and disability status as specific examples.

METHODOLOGICAL LITERATURE REVIEW

Various approaches to defining demographic characteristics can be seen in pharmacy education research. To help readers understand why certain characteristics and categories are commonly utilized, we describe common influences of demographic variables, such as federal laws and professional guidelines. We also review several common demographic variables to illustrate the complexity of this issue.

OUR RECOMMENDATIONS AND THEIR APPLICATION(S)

Seven recommendations for improving demographic data collection and use are provided. Examples include respecting and honoring lived student experiences, defining demographic data more precisely, and channeling institutional resources toward specific student needs.

POTENTIAL IMPACT

Collecting demographic information more accurately and thoughtfully could help pharmacy education improve its educational practice and research. The provided recommendations provided will help researchers and educators measure and utilize demographic variables more effectively.

Students' knowledge and perceptions of social determinants of health utilizing interactive computer simulation-based learning

INTRODUCTION

The purpose of this study was to assess if using computer simulations as a supplemental tool for teaching social determinants of health (SDoH) would impact first-year pharmacy students' knowledge and perceptions of SDoH.

METHODS

A brief lecture and online poverty game were followed by completion of two, in-class, computer-simulated SDoH clinical scenarios and corresponding case discussion. Students completed a pre- and post-quiz and perception survey with two open-ended questions. Qualitative analysis of the open-ended questions and quantitative analyses of the poverty game choices, quiz, and perception survey were conducted.

RESULTS

In total, 132 students were enrolled in this study. Thematic analysis of the open-ended question asking students what they learned included empathy (42%), general SDoH knowledge (30%), culture/religion (18%), and economic impact (15%). Student perceptions for all teaching modalities had a mean score of 4. Mean quiz scores on the pre- and post-class quizzes were 2.31 (SD 0.93) and 2.51 (SD 0.89), respectively.

CONCLUSIONS

Computer simulations can be utilized as a supplemental tool to teach and apply clinical patient cases focused on SDoH. Strategically threading SDoH throughout the pharmacy curriculum is recommended to further develop SDoH knowledge and clinical skills.

Acknowledging the intersection of gender inequity and racism: Identifying a path forward in pharmacy

In an effort to expedite the publication of articles, AJHP is posting 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.

Professional tress code: I look like a pharmacist

Hair color, style, and length are facets to a person's self-expression. There is evidence of bias against those who wear natural hair styles in job recruitment settings, which can affect how the candidate is perceived. In addition, there have been discriminatory hair policies that affect minoritized people. In the profession of pharmacy, most definitions of professionalism do not comment on physical appearance as a component but focus on characteristics such as knowledge, respect, communication, and empathy. It is critical to ensure that comments about someone's hair are not microaggressions. To embrace natural hair styles, pharmacists should combat any policies that are discriminatory and provide a safe space for others to feel comfortable wearing their hair in natural styles or with hair coverings. These actions will help create a space for authenticity, self-acceptance, and comfort.

Development of a Cultural Intelligence Framework in Pharmacy Education

Objective. Pharmacists must be equipped with the knowledge, skills, and attitudes necessary to provide culturally intelligent and patient-centered care; however, most are not trained to do so. In order to prepare culturally intelligent pharmacists, standards and curricula for cultural intelligence must be defined and implemented within pharmacy education. The objective of this study was to create a cultural intelligence framework (CIF) for pharmacy education and determine its alignment with Doctor of Pharmacy (PharmD) training.Methods. An extensive literature analysis on current methods of cultural intelligence education was used to construct a CIF, which integrates leading models of cultural intelligence in health care education with Bloom's Taxonomy. Five student focus groups were conducted to explore and map their cultural experiences to the CIF. All focus groups were recorded, transcribed, deidentified and deductively coded using the CIF.Results. The four CIF domains (awareness, knowledge, practice, desire) were observed in all five focus groups; however, not every participant expressed each domain when sharing their experiences. Most students expressed cultural awareness, knowledge, and desire, however, only a few students discussed cultural practice. Participant comments regarding their experiences differed by race and year in the curriculum.Conclusion. This study was a first step toward understanding cultural intelligence education and experiences in pharmacy. The CIF represents an evidence-based approach to cultural intelligence training that can help prepare pharmacy learners to be socially responsible health care practitioners.

Effects of Racial Trauma on Black Doctor of Pharmacy Students

Objective. In the wake of several high-profile police killings, in 2020 the United States began another reckoning with structural racism, injustice, and violence against Black Americans. The objectives of this study were to explore the impact of racialized sociopolitical events on Black Doctor of Pharmacy (PharmD) students.Methods. Focus groups were conducted with second- to fourth-year Black PharmD students enrolled at the University of Tennessee Health Science Center College of Pharmacy. The focus groups were conducted in summer 2020, beginning two months after the murder of George Floyd and concluding before the start of the fall semester. Data analysis was conducted using a phenomenological approach, and themes were identified using inductive coding.Results. Twenty-four participants were recruited into five focus group sessions. Thematic analysis of the transcripts resulted in three distinct themes related to the study objectives: Vicarious Trauma, Hypervigilance, and Fight or Flight Responses. Black students reported that they experienced significant psychological distress as a result of prominent racially traumatic events. Some Black students reported withdrawing from non-Black persons due to hypersensitivity and anxiety while others were willing to engage in candid conversations.Conclusion. Racial trauma has implications for student wellness and academic success. As racism and police brutality have proven to be an ever-present problem, this study offers key information for consideration as institutions recruit, support, and retain diverse learners. The data may also inform educators and pharmacy students regarding interactions with Black patients, coworkers, and health professionals during times of sociopolitical unrest.

Conceptualizing Social Ecological Model in Pharmacy to Address Racism as a Social Determinant of Health

Racism has been declared a public health crisis. The COVID-19 pandemic has highlighted inequities in the US health care system and presents unique opportunities for the pharmacy Academy to evaluate the training of student pharmacists to address social determinants of health among racial and ethnic minorities. The social ecological model, consisting of five levels of intervention (individual, interpersonal, organizational, community, and public policy) has been effectively utilized in public health practice to influence behavior change that positively impacts health outcomes. This paper adapted the social ecological model and proposed a framework with five intervention levels for integrating racism as a social determinant of health into pharmacy curricula. The proposed corresponding levels of intervention for pharmacy education are the curricular, interprofessional, institutional, community, and accreditation levels. Other health professions such as dentistry, medicine, and nursing can easily adopt this framework for teaching racism and social determinants of health within their respective curricula.