A Scoping Review of Well-being Assessment and Interventions in Student Pharmacists

Analysis of Experiential Education Absence Policies for Mental Health Criteria

OBJECTIVE

This study investigates the language used in experiential education resources from 144 Accreditation Council for Pharmacy Education-accredited Schools of Pharmacy regarding mental health-related absences. While attendance policies at Schools of Pharmacy accommodate medical conditions, the lack of explicit mental health language can leave students uncertain about what is considered excused.

METHODS

This narrative review examined experiential education resources, including student handbooks and syllabi obtained from institutional websites. Content analysis focused on identifying policies, procedures, and accommodations for mental health absences, with key themes coded to highlight mental health-explicit language.

RESULTS

The study found that 55% of available documents explicitly stated experiential education attendance requirements but only 3% included explicit mental health terminology for absences. Commonly used terms were nonmental health specific, such as 'illness' and 'medical emergency.' This highlights a lack of explicit mental health language in experiential education attendance policies and the need for further research on its impact on students' absence requests for mental health reasons.

CONCLUSION

This research contributes to discussions on enhancing mental health support in higher education, aiming to normalize mental health as a criterion for excused absences in pharmacy programs.

Qualitative Analysis of Mental Health Stressors Among Pharmacy and Medical Students Between 2009 and 2020

OBJECTIVE

The primary objective of this study was to identify and compare stressors between pharmacy and medical students that may lead to poor mental health outcomes and decreased quality of professional medical care.

METHODS

We used an inductive reflexive thematic analysis to interpret free-text responses from a stress and depression survey administered to pharmacy and medical students between 2009 and 2020 at a single public university. The inductive process involved several steps, including data familiarization, coding, and theme development. Two of the authors independently coded the data and presented their findings to the research team. After reaching a consensus, the data were recoded according to the new interpretation. Theme generation involved grouping codes into overarching ideas that provided a narrative.

RESULTS

Five major themes emerged among both cohorts: constant overwhelming pressure, stressors of an interpersonal relationship, internal battle with oneself, financial burden, and postgraduation anxiety and uncertainty. Constant overwhelming pressure, stresses of an interpersonal relationship, and internal battle with oneself were the 3 most frequent themes identified. One notable stressor observed only among pharmacy students was having an internship during their training years.

CONCLUSION

Addressing the well-being of pharmacy and medical students early in training is crucial. Despite the different pharmacy and medical school curricula, it was evident that both cohorts faced similar stressors. This study identified specific stressors among pharmacy and medical students that can help health professional programs develop initiatives to support student well-being.

A Review of Survey Instruments and Pharmacy Student Outcomes for Stress, Burnout, Depression and Anxiety

While the need to measure burnout, stress and mental health among pharmacy students has been emphasized in the literature, there is limited information on which validated scales should be used. The objective of this scoping review was to identify published studies that used validated scales for burnout, stress and mental health among pharmacy students to provide recommendations for implementation at schools/colleges of pharmacy. Thirty-two out of 153 articles published in the United States from 1 January 2000 to 30 September 2022 were included and categorized into studies measuring stress (20), burnout (4) and depression/anxiety (8). The most common validated scales used to assess stress and burnout among pharmacy students were the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory and the Oldenburg Burnout Inventory, respectively. For mental health, anxiety was most commonly investigated using a variety of scales such as the Generalized Anxiety Disorder-7; the Patient Health Questionnaire, 9-item was used to measure depression in two studies. Validity, ease of use, cost and generalizability are important considerations for selecting a scale. The PSS has been studied extensively in pharmacy students and has been correlated with other well-being domains. Studies that measured burnout and mental health (specifically, depression and anxiety) have less published evidence among pharmacy students.

Professional Fulfillment and Burnout in Fourth-Year Pharmacy Students and Risk Factors for the Future: A Mixed Methods Study

OBJECTIVE

Many factors shape the professional identity of pharmacy students; however, little is known about the influence of well-being. Two aspects of well-being explored in this study include professional fulfillment and burnout. We describe the current levels of each among fourth-year pharmacy students, identify possible predictors, and uncover themes.

METHODS

The Stanford Professional Fulfillment Index was used to measure professional fulfillment and burnout among students in the prior 2 weeks. Multivariable linear regressions were conducted to identify individual characteristics and activities as predictors of professional fulfillment and burnout. Upon completion of activities to foster personal wellness, student self-reflections were analyzed using thematic analysis to describe student-perceived barriers and facilitators of professional fulfillment and burnout.

RESULTS

In total 54 students completed the Professional Fulfillment Index, wellness activities, and self-reflection. Having already completed the jurisprudence examination required for licensure and having a job upon graduation were statistically significantly associated with higher professional fulfillment scores. We identified that working in a non-pharmacy-related job, while completing practicums, was statistically significantly associated with higher work exhaustion scores. Themes uncovered from student self-reflections included a definition of wellness, how doing what you are supposed to be doing and working in a psychologically and physically safe environment contributes to professional fulfillment, and system-level factors leading to burnout.

CONCLUSION

This study provides evidence of the importance of supporting pharmacy students in the completion of the steps to licensure, the value of exposure to a variety of pharmacist-related activities through experiential education, and well-being as foundational to professional identity.

Pharmacy Students' Perspectives on Human Resource Management: An Examination of Knowledge and Attitudes

(1) Background: This study aims to examine pharmacy students' perceptions of their knowledge and competencies in human resource management (HRM) while also investigating their attitudes toward the educational content provided in a didactic HRM course. (2) Methods: A survey evaluating both course knowledge (pre and post) and attitudes was administered to students enrolled in an HRM class. Data were analyzed using descriptive statistics and measures of associations. (3) Results: All 98 course enrollees completed the survey (N = 98), revealing statistically significant knowledge growth across HRM topics from pre- to post-survey (p < 0.05). Notably, emotional intelligence, workforce diversity, conflict resolution, and recruitment strategies exhibited the most substantial increases. The expert panel session proved highly effective, with 71% reporting it as the most knowledge-enhancing activity. "Global and cultural effectiveness" emerged as the most valued competency, reflecting a positive overall attitude towards HRM. (4) Conclusions: HRM competency is one of the most fundamental skills for pharmacists, as many problems faced by pharmacy organizations and their solutions stem from the workforce. Pharmacy schools should therefore assess their curriculum to ensure that HRM is adequately addressed to meet accreditation standards and to prepare students to navigate HRM challenges in their workplaces post-graduation.

Scoping Review of Programmatic Well-Being Interventions and Outcomes to Support Pharmacy Students

OBJECTIVES

Recent literature highlights various well-being initiatives implemented across pharmacy programs; however, there is much heterogeneity in their implementation and limited studies assessing the impact and success of these initiatives on pharmacy students' well-being. The purpose of this scoping review was to identify the effectiveness of strategies implemented by pharmacy schools to improve the well-being of pharmacy students.

FINDINGS

In total, 23 studies were included, and well-being strategies were categorized into 3 groups: organizational wellness programs, curriculum design and educational course activities, and specific relaxation or meditation activities. Strategies included yoga meditation, structured mindfulness courses, and self-directed mindfulness with digital smartphone applications. The majority of studies assessed outcomes of stress, burnout, and mindfulness, though other well-being domains such as resilience and belonging emerged. Some also assessed perceptions and acceptability of the interventions through qualitative approaches.

SUMMARY

Despite the heterogeneity of interventions and outcome measures, this review provides a comprehensive scope of well-being domains, assessment tools, interventions, and approaches targeted at pharmacy students and highlights the strongest evidence for interventions on reducing stress. Pharmacy programs can benefit from approaches at both the organization level and those fostering individual accountability by exposing students to a variety of self-help well-being strategies that develop protective factors and motivate them to sustain well-being practices themselves as a shared approach. This scoping review addresses a critical gap by gaining an understanding of the current landscape of well-being initiatives and their effectiveness to better guide pharmacy programs on strategies that are most likely to improve student well-being.

Multi-modal mindfulness training and well-being for healthcare students

INTRODUCTION

Mindfulness is a mental state attained through focusing awareness on the present with calm acceptance of thoughts, feelings, and bodily sensations. This study evaluated impact of mindfulness activities on well-being of pharmacy and other healthcare students.

METHODS

Research participants completed pre- and post-intervention questionnaires evaluating multi-modal mindfulness interventions. Due to the pandemic, sessions led by a certified mindfulness instructor were offered live online and recorded, supplemented by a well-being mobile app and reflective discussion component. Four composite scales were administered to participants. The Brief Resilient Coping Scale (BRCS), Five Facet Mindfulness Questionnaire (FFMQ-15), Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and Depression Anxiety Stress Scales (DASS-21) inventories measured resilient coping skills, awareness, and psychological symptoms, including stress, depression, and anxiety. Exploratory factor analysis and Cronbach's alpha were used to determine scale reliability and validity.

RESULTS

Thirty-six participants completed both pre- and post-intervention questionnaires (n = 36). Significant improvement was found in well-being for BRCS, FFMQ-15, and WEMWBS measures (P < .05). Change in DASS-21 was not significant (P = .19). Mobile app use enhanced foundational mindfulness skills. Awareness, connection, and coping themes were identified from written comments.

CONCLUSIONS

Evaluation of this multi-modal interprofessional intervention provides further evidence of benefits of mindfulness for pharmacy and other healthcare students. The mobile app and mindful movement with reflection improved all attributes measured by the composite scales. Further research may explore alternative multi-modal mindfulness interventions and incorporation into healthcare education curricula. Interprofessional collaboration is encouraged among faculty to enhance mindfulness while connecting healthcare professionals.

A Call to Action to Address Well-Being Within Experiential Education

There is a significant lack of literature exploring or describing pharmacy student well-being during experiential learning even though students spend 30% of their doctor of pharmacy curricula in this environment. Drawing on inspiration from literature describing well-being challenges and solutions for pharmacy residents and other health disciplines, this commentary explores the unique challenges of supporting pharmacy student well-being during experiential education. Approaches for interventions are described along with a call to action for the academy.

A longitudinal qualitative study examining the impact of Check-In, a novel learning activity on burnout for pharmacy students

INTRODUCTION

Burnout is a phenomenon that can occur in any occupation, but pharmacists may be more prone to its effects. Because of its relevance to the pharmacy profession, the University of Waterloo School of Pharmacy incorporated an active learning activity to teach pharmacy students about healthcare provider burnout. This activity, named Check-In, was launched in March 2020 and consisted of one-on-one check-ins between pharmacy students and staff. As the first learning activity of its kind, the researchers wished to investigate the ongoing impact of Check-In.

METHODS

This qualitative, descriptive study was composed of telephone interviews with 13 students that partook in Check-In. These interviews were held at two different timepoints: six and 18 months post-activity. Participants were recruited until data saturation, and transcripts underwent thematic analysis.

RESULTS

Four themes were identified from the interviews: (1) Check-In was a valuable learning activity; (2) students performed some form of checking in post-activity; (3) burnout could be recognized and defined by students; (4) Check-In's place in the pharmacy curriculum still needs to be determined.

CONCLUSIONS

Check-In is an innovative learning activity to teach pharmacy learners about healthcare provider burnout. It can be utilized by pharmacy institutions to incorporate wellness and student mental health into curriculum.

Student Pharmacist Engagement in Infographic Creation to Increase Awareness of Impostor Phenomenon

OBJECTIVE

To assess first professional year (P1) students learning about impostor phenomenon (IP) through participation in learning activities featuring the creation of an educational IP infographic.

METHODS

A total of 167 P1 students were invited to complete a validated survey to determine baseline IP tendencies and attended a near-peer-delivered course lecture on IP. Student groups of 4 created an infographic containing IP lecture information and survey results, aimed at increasing IP awareness in a target audience. Mixed methods were integrated to assess learning outcomes. Qualitatively, infographics were evaluated by rubric for completeness, accuracy, and visual literacy, and student reflections were thematically evaluated on the impact of IP activities; quantitatively, 19 student learning objectives were anonymously self-assessed by Likert Scale survey. Students viewed all 42 created infographics, applied criteria, and voted for the 3 best.

RESULTS

Survey results indicated 58% of P1 students exhibited IP tendencies above the scale's defined threshold for significant impostorism. Student groups demonstrated IP learning through developing creative, accurate, and concise infographics, with a mean score of 85% (4.27/5). Assessment survey respondents agreed they can confidently describe IP (92%) and design an infographic for a target audience using acquired knowledge (99%). Through critical reflections on the impact of IP exercises, students expressed improvement in self-awareness and communication skills; described the benefits of engagement in random peer groups; and voiced appreciation for a novel method of learning material (infographic creation).

CONCLUSION

Students demonstrated learning about IP by incorporating lecture and survey results into engaging infographics and expressed benefits from learning about this important topic that is prevalent in P1 students.