Towards Antiracism: Using Critical Race Theory as a Tool to Disrupt the Status Quo in Health Professions Education

The use of words such as race, racism, antiracism, and antiracist has increased in health professions education (HPE). While the words are used more frequently, additional work is needed to demonstrate a commitment to enhance equity, diversity, and inclusion in HPE. It is important that we contextualize these words, understand the connections between them, and use this information to implement sustainable actions to disrupt the status quo in HPE. Critical race theory is a tool to consider for this journey. In this commentary, the author provides an overview of key concepts ranging from race to critical race theory as a primer to the Research in Medical Education plenary.

Exploring career development through a student-directed practicum to provide individualized learning experiences

INTRODUCTION

The primary objective was to assess the impact of an optional student-directed career development program on career and professional development between the second and third year of a doctor of pharmacy curriculum.

METHODS

Students who completed the student-directed practicum (SDP) completed a nine item pre-/post-survey assessing its impact on their career development within the learning constructs of discovery, application, and reflection. Additional open-ended questions assessed why students participated in the SDP and their perceived benefits of doing so. An additional questionnaire regarding the impact of the practicum was conducted at graduation. Quantitative data were analyzed with Wilcoxon signed-rank test for the pre-/post-survey and descriptive statistics for the graduation survey while qualitative data used a two-cycle open coding process.

RESULTS

Statistically significant increases were noted with those responding with "agree" or "strongly agree" to each of the nine statements in the pre-/post-survey. Students participated to further explore career options, and believed doing so resulted in enhanced career direction and future employability. The graduation survey showed those participating in the SDP had a higher rate of: postgraduate placement (86% vs. 77%), receiving ≥ five residency interview offers (81% vs. 69%), and first or second choice residency match (92% vs. 85%) compared to those who completed an internship outside of the SDP. Students commented that the SDP was a valuable part of their education and helped them take the next steps for their career.

CONCLUSIONS

A student-directed career development experience can positively impact student's career direction and professional development.

Exploring the Career Engagement, Interests, and Goals of Pharmacy Students Identifying as Underrepresented Racial Minorities

Objective. To examine pharmacy career engagement, interest, and confidence in Doctor of Pharmacy (PharmD) students identifying as underrepresented racial minorities (URMs).Methods. A 15-item survey about career engagement, confidence, and goals was administered at a business session of a national conference. The survey included demographic items and items about career exposure prior to and during school, career aspirations after graduation, frequency of engagement in various settings, career factors, and career confidence. Cronbach alpha was used to examine survey reliability. Descriptive statistics and nonparametric statistical tests were used to analyze survey responses.Results. Sixty-nine URM students completed the survey. Most indicated frequent engagement with community pharmacy prior to and during school; no engagement with hospital pharmacy prior to school, yet occasional or frequent engagement during school; and no engagement with the pharmaceutical industry prior to and during school. Most selected hospital pharmacy as their career aspiration, followed by community pharmacy and industry. Approximately half indicated an interest in completing a postgraduate fellowship. Items selected as important to career choice included patient care, job security, and level of stress. Group differences were found by gender and year in school.Conclusion. Despite calls for diversity in pharmacy, there is a paucity of research in this area. This study provides a first glimpse into the career engagement, confidence, and goals of students identifying as URMs, raising a number of critical issues for pharmacy education. Moving forward, schools, employers, and researchers must work to better understand the career development of URM students, including barriers and facilitators to access and success.

Qualitative Evaluation of a Junior Faculty Team Mentoring Program

Objective. To investigate the strengths and challenges of a structured junior faculty mentoring program at a public four-year school of pharmacy, identify areas of opportunity to improve the program, and describe the mentoring needs of mid-career faculty.Methods. Focus groups and interviews were conducted to elicit participants' experiences, perceptions, and suggestions for opportunity to improve the program. Stakeholder groups included junior faculty enrolled in the mentoring program, mid-career faculty who had graduated from the program, mid-career faculty who had not participated in the program, internal mentors, external mentors, and division chairs. Thematic coding was used to identify semantic themes, and summaries of participant perceptions were generated. The program was mapped to the PAIRS checklist from the 2014 American Association of Colleges of Pharmacy Joint Council Task Force on Mentoring.Results. Participants described the structure of the program and mentee-mentor relationships as strengths of the program. Challenges included finding time to meet and ensuring mentee-mentor fit. Several areas of opportunity were identified, such as adjusting the topics for large mentee seminars, providing mentors with training, and providing mentoring for mid-career faculty. The mentoring needs of mid-career faculty were described as unique and requiring potentially different strategies than those used for mentoring junior faculty.Conclusion. Mentoring is critical to the professional development of faculty, supporting faculty retention and job satisfaction, and reducing faculty burnout. Scholarly endeavors that explore faculty mentoring, specifically those using qualitative methods, can help the Academy better understand and meet the needs of faculty.

An Exploration of Preceptor-Provided Written Feedback on Entrustable Professional Activities During Early Practice Experiences

Objective. To explore and evaluate open-ended feedback on entrustable professional activities (EPAs) provided by preceptors to Doctor of Pharmacy (PharmD) students completing their first practice experience.Methods. A retrospective review was conducted of qualitative data collected from preceptor evaluations of student pharmacists who had completed a two-month practice experience in either community or health-system pharmacy at the end of their first professional year. Preceptors had used a validated EPA framework to assess students. A codebook was developed around the EPA framework and sub-coding was used to indicate positive, negative, or neutral assessment within each EPA. After several rounds of coding, consensus was reached for all codes by two investigators. A dependability audit was implemented to ensure the trustworthiness of the findings.Results. Preceptor evaluations of 153 student pharmacists were included in the study. Eighty students (52.3%) had completed a community experience and 73 (47.7%) had completed a health-system experience between May and August 2018. The preceptors at both practice settings provided overwhelmingly positive feedback on all EPAs. Opportunities to optimize preceptor-provided feedback were identified. The feedback provided by the preceptors in health-system and community practice settings focused on knowledge and behavior, respectively, with both emphasizing students' skill-based performance.Conclusion. This study provides valuable insight into optimizing preceptor-provided written feedback on EPAs. Conducting deeper analysis of preceptor feedback using focus groups or structured interviews is suggested to further explore preceptors' provision of EPA assessment to student pharmacists practicing in real-world settings.

From the "top-down" and the "bottom-up": Centering Foucault's notion of biopower and individual accountability within systemic racism

None

Piezoelectric and dielectric properties of Bi3TiNbO9 prepared by hot pressing from powders activated using the serial dilution method

Bi-based layer structure ferroelectrics are the most promising compounds for the fabrication of high-temperature piezoelectric materials. Studies aiming to develop and optimize the techniques to produce efficient high-density piezoelectric ceramics, and to investigate the effects of ceramics production conditions on their structure and functional properties, have become high-priority objectives of modern piezo-engineering. We applied ultra high dilution (UHD) technology to pre-treat Bi₃TiNbO₉ powders and used hot pressing to prepare perovskite-layer structured ceramic specimens. Main characteristics of the synthesized piezoelectric ceramic specimens (the dimensions of the Bi₃TiNbO₉ orthorhombic unit cell, dielectric permittivity, dielectric loss, piezoelectric coefficient d₃₃ and pyroelectric coefficient p^σ) and their temperature-dependent variations were studied using piezoelectric, dielectric, and pyroelectric measurements. X-ray diffraction studies demonstrated that the prepared ceramics were single phased, and highly textured, as their plate-like crystallites were preferentially aligned perpendicularly to the pressure axis on hot pressing. For d₃₃, an increase in values of more than 20% was found for samples obtained using a combined modification of the UHD technology and hot pressing (12 pC/N) relative to intact samples, and more than two times relative to unmodified Bi₃TiNbO₉ ceramics (6 pC/N). Due to their characteristics, the obtained ceramics are promising materials for high-temperature applications; of particular interest is potential use, as electroacoustic transducers and sensors for operation at high temperatures. Thus, the UHD technology can modify the properties of ceramics and is relatively easy to implement. This makes it attractive for use in various fields of science and technology.

An Exploration of Pharmacy Education Researchers' Perceptions and Experiences Conducting Qualitative Research

Objective. To investigate pharmacy education researchers' experiences in conducting qualitative research and their perceptions of qualitative research in pharmacy education Methods. A phenomenological approach was used to conduct one-time, in-depth interviews with 19 participants from 12 schools and colleges of pharmacy. Interview transcripts were coded and themes were identified using a modified form of the Sort and Sift, Think and Shift method of data analysis. Results. Faculty members were the largest subgroup in the sample, followed by graduate students, postdoctoral fellows/scholars, and residents. Pharmacy education researchers had varying levels of training in conducting qualitative research and some had none at all. Salient findings included that pharmacy educators' lack of training and exposure to qualitative research was a barrier to entry to conducting qualitative research; the lack of understanding and value of qualitative research in pharmacy education impacts the acceptability of qualitative research projects in Journals and academic meetings; and qualitative research offers several benefits in answering complex research questions. Conclusion. The application of rigorous qualitative research in pharmacy education holds great potential in addressing complex and evolving healthcare problems. This work provides empirical evidence of the ongoing anecdotal dialogue that has long existed in pharmacy education concerning why some researchers are hesitant to conduct qualitative research, the challenges encountered by those who employ qualitative approaches, and the benefits qualitative approaches provide.

Immersive Research Experiences for High School Students Aimed at Promoting Diversity and Visibility in Pharmacy Education

Two challenges frequently faced by schools of pharmacy are the training of a workforce that reflects the racial and ethnic diversity of the populations they serve, as well as raising public awareness of the mission and impact of pharmacy schools. One underutilized strategy in addressing these challenges is directly engaging high school students, whose race and ethnicity more closely reflect the increasing diversity of the US population, in immersive research experiences at schools of pharmacy. Motivated by the multidisciplinary nature of pharmaceutical sciences that involve integration of various science, technology, engineering, and mathematics (STEM) disciplines, the UNC Eshelman School of Pharmacy created the Young Innovators Program (YIP). The program is an eight-week paid summer internship that immerses participants in cutting-edge and innovative research. Through careful planning, strategic collaboration, and a purposeful recruitment process, we believe pharmacy education could benefit from the expansion of immersive programs that promote the engagement of racially and ethnically diverse high school students in real-world research.

Characteristics of significant events identified by pharmacy students while on early immersion pharmacy practice experiences

Objective:

The purpose of this study was to characterize and classify significant events of pharmacy students who completed an early practice experience.

Methods:

Significant event analyses (SEAs) were reflections submitted by students about events that they found impactful during their early practice experiences. An online repository has stored 287 SEAs submitted by first year pharmacy students for later use in a pharmacy course. For this study, all significant events were read and coded according to the pre-specified themes and tones (positive, negative, neutral, hybrids) of the event. Themes used were derived from prior literature characterizing major themes from other health professional students’ experiences. Additional themes were added by authors for those that did not fit into the pre-set categories. All themes of the narratives were subsequently categorized. To assure confirmability, the investigators conferred to discuss new themes that emerged and events that were ambiguous. To assure credibility, an external audit of a sample of the coded SEAs was completed. Upon reaching consensus between primary reviewer and secondary reviewers, data were reported as frequencies and percentages. This study received ethics clearance from the Office of the University Registrar and was deemed exempt by the University Institutional Review Board.

Results:

A total of 1,055 coded responses were analyzed. The majority of SEAs were positive in tone (n=190, 66.2%) and many were hybrids of negative-turned-positive emotions (n=62, 21.6%). The most common major content theme was “patients and the provision of patient care” (n=412, 39.1%), followed by “pharmacy students and their behavior” (n=260, 24.6%). The most prevalent subthemes were “learning by doing” (n=134, 12.7%) and “feelings of usefulness or uselessness” (n=111, 10.5%).

Conclusions:

The majority of students framed significant events in their pharmacy practice experiences in a positive light, even from challenging interactions. The events that resonated most frequently with these students centered around patient interactions and providing patient care. These results will be useful for pharmacy educators developing pharmacy school curriculums to better prepare students to excel and feel more comfortable in direct patient care experiences.

Characteristics of High-Performing Interprofessional Health Care Teams Involving Student Pharmacists

Objective. To identify key themes of interprofessional models of care that offer experiential education opportunities for pharmacy learners. Methods. Six pharmacists from four Area Health Education Centers in North Carolina participated in individual, 60-minute interviews. Using two pre-established frameworks, the data were analyzed qualitatively by two members of the research team to identify the characteristics of interdisciplinary care teams. Results. At the level of the organization or health care system, the theme of appropriate resources and procedures emerged. At the level of the team, the themes of appropriate resources and procedures, communication, appropriate skill mix, climate, quality and outcomes of care, and respecting and understanding roles emerged. At the level of the individual, the themes of communication, respecting and understanding roles, and individual characteristics emerged. Three themes identified in a previous study failed to emerge in the interviews: leadership and management; personal rewards, training and development; and clarity of vision. Conclusion. Although a growing body of evidence highlights the importance of designing practice models to achieve interdisciplinary care that is patient-centered and effective, capacity to support learners and effectively educate them in the principles and practices of team-based care is limited. This study provides critical insight into characterizations of interprofessional models that integrate pharmacy learners. Further research is needed to better understand the barriers to designing and implementing IPE in experiential settings.

A Conceptual Framework for Exploring the Experiences of Underrepresented Racial Minorities in Pharmacy School

Objective. To explore the social and academic experiences of students identifying as underrepresented racial minorities (URMs) in a pharmacy school, how they made meaning of their experiences, and the strategic actions they took to navigate towards degree completion. Methods. Twenty students from a school of pharmacy within a research-intensive institution participated in semi-structured interviews. Data were analyzed through several rounds of coding. Trustworthiness procedures included the use of multiple coders, a dependability audit, and analytic memos to promote reflexivity. Results. The study yields a conceptual model. Pre-pharmacy school factors such as pipeline programs, work experiences, family, and URM health professionals impacted students' interest in and encouragement to attend pharmacy school. Students reported experiences including a lack of diversity, feeling unwelcomed, and concerns about cultural competency and group work challenges. Students were motivated by URM faculty members, self-efficacy, and a sense of purpose. Students were inhibited by the mental impact of sociopolitical events, the pressures of representing their race/ethnicity, and feeling inferior. Students took several actions to navigate the school including "code-switching," finding solace and support with other URMs, seeking cultural competence-related experiences to complement the curriculum, and strategically remaining silent or speaking up during group work conflicts. Conclusion. This exploratory study provides a roadmap to better understand URM students' journey to pharmacy school and experiences therein. Findings could be used by pharmacy schools to create a more inclusive environment for URM students and provide future directions for scholars pursing diversity-related research agendas in health professions education.

Assessing the Co-Curriculum by Mapping Student Organization Involvement to Curricular Outcomes Using Mixed Methods

Objective. To use institution-specific curricular outcomes as a framework to map skill development opportunities available through cocurricular involvement in pharmacy student organizations. Methods. Participants completed a modified Extracurricular Involvement Inventory individually to measure the intensity of their involvement in each student organization. Participants also completed the Co-Curriculum Outcomes Assessment Mapping Survey (COAMS) instrument as a group to indicate what skills (ie, curricular outcomes) they developed through involvement in a student organization and student organization activities, programs, and events, and to provide examples of these skills. Data sources were triangulated to map skill development opportunities in the co-curriculum to curricular outcomes. Results. The COAMS identified all curricular outcomes as skills students have the opportunity to develop through student organization involvement in the co-curriculum. Communication was the most common skill identified. Other common skills included professionalism and ethical behavior, collaboration and influence, and in-depth knowledge and proficient skills. A co-curriculum heat map was used to illustrate the degree to which students reported these skills were emphasized through student organization involvement in the co-curriculum. Conclusion. Evaluation of activities in the context of curricular outcomes can provide a more comprehensive understanding of how the co-curriculum complements the curriculum, thereby complying with accreditation expectations. Cocurricular mapping provides valuable information regarding student skill development opportunities to multiple stakeholders (eg, students, faculty, curriculum leadership). This process can be applied to diverse programs, adapted to measure institution-specific experiences, and measure various constructs of interest.

Conducting and presenting qualitative research in pharmacy education

SITUATION

The evolution of practices in healthcare and the content and delivery of pharmacy education have generated new challenges for practitioners and academicians. Fittingly, pharmacy education research in the academic setting has grown rapidly to provide innovative solutions to these challenges. One approach for addressing these challenges includes the collection and analysis of qualitative research (QR). Though a useful methodological tool, many pharmacy educators are not trained to appropriately conduct QR and present the findings of their work.

METHODOLOGICAL LITERATURE REVIEW

QR offers many advantages for pharmacy education researchers. However, prior to delving into QR projects it is important to understand the key distinctions of the approach, role of the researcher, and the significance of situating the study so that the research question, data collection techniques, and analysis procedures are aligned.

RECOMMENDATIONS

We provide recommendations for several key components for conducting QR, articulating the process, and presenting and contextualizing the findings.

IMPLICATIONS

This article serves as a primer on QR methods, offering relevant background information, ways to apply this approach in pharmacy education research, and recommendations for presenting qualitative findings. Employing rigorous qualitative approaches in pharmacy education and appropriately presenting the procedures and findings will increase the visibility of QR and provide an opportunity for scholars to become familiar with the approach.

Identifying and Mapping Skill Development Opportunities Through Pharmacy Student Organization Involvement

Objective. To describe a process for identifying skills that students can gain through co-curricular involvement and to map these skills to curricular outcomes. Methods. This pilot study used a mixed-methods approach involving document reviews, student involvement surveys, and focus groups/interviews to evaluate skill development opportunities in three pharmacy student organizations. Investigators reviewed key documents (eg, student organization websites, annual review forms) to identify skills emphasized by the organization. Student participants completed modified Extracurricular Involvement Inventory surveys to measure the intensity of their student organization involvement. Two student focus groups, one student leader focus group and one general student member focus group, were held for each student organization. Interviews were conducted with each student organization's faculty advisor. Data sources were triangulated to identify and map skill development opportunities to program core competencies. Results. Six of nine core competencies were identified as skills pharmacy students can develop through involvement in the pilot student organizations. All three organizations provided opportunities for members to develop communication skills and in-depth knowledge and proficient skills of the discipline of pharmacy. Two organizations provided opportunities for students to develop collaboration skills. Conclusion. A mixed-methods approach can be used to identify and map skills that students can develop through co-curricular involvement. This approach provides several advantages: objective evaluation and triangulation of skill development opportunities, evaluation of students' involvement, and identification of linkages between the co-curriculum and curriculum in the context of curricular outcomes.

Identifying Shared Values for School-Affiliated Student Organizations

Objective. To identify shared values for student organizations. Methods. A three-round Delphi approach was utilized to identify and prioritize shared values among student organization leadership. In round 1, student leaders selected 15 values from a list of 36 organizational values and were given an opportunity to include up to five suggestions not incorporated within the original list. Student leaders narrowed the 15 values to 12 in round 2. The top 12 priorities were ranked in round 3 and participants were invited to write a brief statement regarding their perspectives of the results. Results. Twelve shared values were identified and ranked: professional development, improving leadership of your members, advancing the role of pharmacy, planning quality events, networking, improving the academic experience for peers, community service, learning from pharmacy shadowing/speakers, social outlet, recruitment/gaining student membership, attracting students to events, and gaining national/local attention or awards. Conclusion. This study contributes to the small but growing body of literature concerning student organizations in pharmacy education and provides a foundation by which this work could be advanced. Given the importance of student organizations in promoting student development, identifying strategies for supporting and facilitating the effectiveness of these groups is critical for optimizing student outcomes and institutional effectiveness.

The Young Innovators Program at the Eshelman Institute for Innovation: a case study examining the role of a professional pharmacy school in enhancing STEM pursuits among secondary school students

BACKGROUND

Professional schools, such as schools of pharmacy, are rarely involved with promoting STEM interests among secondary school students. To address this shortcoming, the Young Innovators Program (YIP) was created to provide local secondary school students a summer immersive experiential program at the UNC Eshelman School of Pharmacy. The objective of this study was to assess the ability of the inaugural YIP to promote STEM interest, career awareness, and self-efficacy.

RESULTS

YIP interns maintained high levels of STEM interest, career awareness, and self-efficacy. In addition, they reported significant increases in their perceptions of having role models in science.

CONCLUSIONS

Immersion in research laboratories and clinics at a school of pharmacy can promote high levels of STEM interest, career awareness, and self-efficacy and provide interns with STEM professional role models. Our findings support YIP's vision that professional pharmacy schools can play an influential role in recruiting secondary school students to STEM disciplines.

A Review of Contemporary Diversity Literature in Pharmacy Education

Objective. To review and categorize published educational research concerning diversity within colleges and schools of pharmacy. Methods. The Three Models of Organizational Diversity Capabilities in Higher Education framework was used to guide the review efforts. Of the 593 documents retrieved, 11 met the inclusion criteria for review. Each included article was individually reviewed and coded according to the framework. Results. The reviewed articles were primarily influenced by contemporary drivers of change (eg, shifting demographics in the United States), focused on enhancing the compositional diversity of colleges and schools of pharmacy, examined the experiences of underrepresented groups, and suggested process improvement recommendations. Conclusion. There is limited published educational research concerning diversity within schools and colleges of pharmacy. Contemporary drivers of change are influencing this research, but more attention must be given to the focus of the research, individuals targeted, and recommendations suggested.

Exploring the Requisite Skills and Competencies of Pharmacists Needed for Success in an Evolving Health Care Environment

Objective. To identify and describe the core competencies and skills considered essential for success of pharmacists in today's rapidly evolving health care environment. Methods. Six breakout groups of 15-20 preceptors, pharmacists, and partners engaged in a facilitated discussion about the qualities and characteristics relevant to the success of a pharmacy graduate. Data were analyzed using qualitative methods. Peer-debriefing, multiple coders, and member-checking were used to promote trustworthiness of findings. Results. Eight overarching themes were identified: critical thinking and problem solving; collaboration across networks and leading by influence; agility and adaptability; initiative and entrepreneurialism; effective oral and written communication; accessing and analyzing information; curiosity and imagination; and self-awareness. Conclusion. This study is an important step toward understanding how to best prepare pharmacy students for the emerging health care needs of society.

High pressure x-ray diffraction study of nickel-copper chromites solid solutions

A high-pressure synchrotron radiation diffraction study has been carried out on Ni(1-x)Cu(x)Cr(2)O(4) solid solutions. Observed pressure-controlled phase transitions, along with data previously collected for temperature-induced phase transitions, are analyzed in the framework of the unified phenomenological model that results in mapping of the generic phase diagram for the whole family of Ni(1-x)Cu(x)Cr(2)O(4) solid solutions.

[Russian national observational study of nutritional support in children in the ICU--"NutriPed.ru"]

The article deals with results of the first Russian national observational study of nutritional support in children in the ICU. We assessed a frequency of use of enteral and parenteral nutrition and analyzed preparations for enteral and parenteral nutrition. The article discusses methods of the calculation of malnutrition in children in critical states.