Correlation Between Pharmacy Students' Implicit Bias Scores, Explicit Bias Scores, and Responses to Clinical Cases

Creating Competencies for Providing Care in a Diverse, Equitable, and Inclusive Manner: A Delphi Technique

OBJECTIVE

Competencies related to diversity could be essential to training and assessing student pharmacists in their readiness to provide equitable and inclusive care. Such competencies are lacking in pharmacy education; therefore, this study aimed to explore the development of diversity competencies and supporting factors needed to prepare students to meet the competencies and provide patient care in a diverse, equitable, and inclusive manner.

METHODS

Pharmacy diversity thought leaders were invited to participate in a 3-round modified Delphi survey. Survey items were created using a Backward Design. Qualitative data were analyzed using the Constant Comparative Method. Draft competency statements were created based on the collective comments from Round 1 along with themes related to the supporting factors needed to achieve the competencies. Consensus on themes, competency statements, and edits were identified in Round 2. Additional comments and feedback on edits were gathered in Round 3. Consensus was preset at 85.7%.

RESULTS

Seven competency statements were created. Knowledge, skills, attitudes, behaviors, values, curricular content/pedagogy, and resources needed to prepare students to meet the competencies and support faculty would need were identified.

CONCLUSION

Preliminary diversity competencies and supporting factors needed were developed using the perspective of thought leaders. Further evaluation, including the development of student-appropriate competencies, testing and validation of content and assessment tools, and determining place in the pharmacy curriculum, are future steps that should be considered in the competency development process.

Racial and ethnic harm in patient care is a patient safety issue

Health equity and antiracism can contribute to enhanced patient safety in healthcare settings. The Oath of the Pharmacist states, "I will promote inclusion, embrace diversity, and advocate for justice to advance health equity." Part of this commitment means upholding these principles in patient care settings. Racial and ethnic harm negatively impact patient safety. Racial and ethnic harm are reviewed in the context of social learning theory, critical race theory, and medical and scientific racism. Pharmacists and healthcare systems must actively prevent and mitigate racial and ethnic harm to patients from personal and organizational levels to create a culture of safety. Part of this strategy involves acknowledging when you have contributed to patient harm, issuing a genuine apology, and offering to mend or re-establish trust between racially and ethnically minoritized patients and the pharmacist or the health system to contribute to patient safety. These strategies may help create a culturally safe space for racially and ethnically marginalized patients in the healthcare system.

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

Background

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

Methods

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

Results

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

Conclusions

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Creating an inclusive climate within pharmacy practice

OBJECTIVE

Identify the impact of a brief, educational intervention on student pharmacist understanding of unconscious bias and its systemic effects; cultural humility; and commitment to change.

METHODS

A pre-intervention survey, with questions utilizing a five-point Likert scale was embedded into the beginning of a series of online, interactive, educational modules addressing cultural humility, unconscious bias, and inclusive pharmacy practices. Third-year professional pharmacy students completed the course as part of their curriculum. At the conclusion of the modules, participants completed the post-intervention survey with the same set of questions, which was linked to the pre-intervention survey by a participant-generated code. Changes in means for the pre- and post-intervention cohorts were calculated and analyzed utilizing a Wilcoxon signed-rank test. Responses were also grouped dichotomously and evaluated using the McNemar test.

RESULTS

Sixty-nine students completed both the pre- and post-intervention surveys. The greatest change on Likert scale questions was noted in understanding of cultural humility (+1.4). Much or complete confidence in being able to describe unconscious bias and cultural competence improved from 58% to 88% and 14% to 71%, respectively (P < .05). Although a trend toward positive change was noted, a significant impact was not observed for questions assessing understanding of their systemic effects and commitment to change.

CONCLUSION

Interactive educational modules positively impact student understanding of unconscious bias and cultural humility. Further investigation is necessary to determine if continuous exposure to this and similar topics deepens student understanding of systemic impact and commitment to change.

Implementation of implicit bias awareness and action training in a pharmacy residency program

DISCLAIMER

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.

PURPOSE

To implement an implicit bias awareness and action seminar program for the University of Utah Health pharmacy residency program and measure knowledge, awareness, and comfort around race-related topics.

SUMMARY

An implicit bias awareness training program was implemented with a pre- and post-training survey to measure knowledge, comfort, and confidence around understanding and addressing biases. Fifty-one residents and preceptors participated in the implicit bias training, and 47 (92.2%) consented to take the survey. Twenty pharmacy residents and 27 preceptors attended at least 1 of the 4 training modules and completed the pre- and/or post-training survey. Eighteen of 20 residents (90.0%) and 19 of 27 (70.4%) preceptors completed the pretraining survey (37 total), while 11 of 20 residents (55.0%) and 10 of 27 (37.0%) preceptors completed the post-training survey (21 total). On the post-training survey, more correct answers were obtained for knowledge-based questions and a higher number of responses of strongly agree or agree was observed when assessing participants' comfort and confidence in addressing personal biases, bringing marginalized people into a conversation, addressing biased situations, and intervening when bias is observed.

CONCLUSION

After training, higher scores were attained on the survey for overall comfort and confidence in addressing personal biases and identifying and acting on witnessed biases.

Focusing on cultural humility in pharmacy assessment tools

INTRODUCTION

Many pharmacy programs have been reviewing their curricula to ensure that unconscious bias is not interwoven throughout. However, few programs have looked at their assessment tools to determine if unconscious bias exists in them. Since research on unconscious bias in assessment tools is currently limited, this study was developed to explore how race, ethnicity, age, and gender were used in multiple-choice item banks at one pharmacy program.

METHODS

A total of 27 pharmacy test banks, including examinations from first-, second-, and third-year pharmacy curricula, were examined. The exams administered in the 27 courses provided 3621 questions for review and coding based on reference to race, ethnicity, age, and gender.

RESULTS

Of the total 3621 exam items reviewed, 40 referenced race. Of those 40, it was determined that race was only applicable/relevant to two (5%) of the questions, linked to Whites. Gender breakdown was 56% male and 45% female, with no mention of transgender. Gender was central to 72 of the 426 questions. Age was mentioned in 381 of the questions and was central in only 46. Ethnicity was not mentioned in any of the questions. In none of the questions were these variables self-identified.

CONCLUSIONS

The routine mention of race in preparation of materials such as question banks, with no specified goal, risks contributing to racial bias. The goal of all pharmacy educators is to graduate pharmacists that possess sound academic knowledge, clinical skills, and the cultural humility to provide quality care to their patients.