Integration of Trauma-informed Care Into the Doctor of Pharmacy Curriculum

Trauma-informed care (TIC) is a framework based on understanding and responding to individuals' experiences of psychological trauma (defined as harmful circumstances that have a lasting impact on emotional well-being), as well as fostering their sense of safety and empowerment. Health profession degree programs are increasingly integrating TIC training into their curricula. Although literature is scarce regarding TIC education in academic pharmacy, student pharmacists will likely encounter patients, co-workers, and peers who have experienced psychological trauma. Students may also have experienced psychological trauma themselves. Therefore, student pharmacists would benefit from TIC learning, and pharmacy educators should consider implementing trauma-informed education. This commentary defines the TIC framework, explores its benefits, and considers an approach to implementing the TIC framework in pharmacy education with little disruption to existing curricula.

Comparison of student performance in therapeutics and communications courses to outcomes of objective structured clinical examinations: A retrospective analysis

INTRODUCTION

The objective was to examine the association between course grades and objective structured clinical examination (OSCE) performances in a pharmacy student cohort.

METHODS

A retrospective analysis of demographics, final grades in the Therapeutics I through IV and Communications courses, and multiple OSCE scores (therapeutic knowledge and general communication skills [GCS]) was performed for two cohorts.

RESULTS

Female students scored higher than male students on the warfarin OSCE therapeutic knowledge (P = .008) and GCS scores (P = .02). Age was inversely correlated with warfarin OSCE therapeutic knowledge score (P = .001). The warfarin OSCE therapeutic knowledge score was positively related to Therapeutics II final grades (P < .001). The Communications course final grade was positively correlated to the warfarin OSCE faculty-rated GCS score (P = .005). Therapeutics final grades were not significantly related to station scores of a multi-station OSCE (P > .05). The final regression model included gender and Therapeutics II final grade and explained 6% of the variance in warfarin OSCE therapeutic knowledge scores.

CONCLUSIONS

A number of significant associations were found between demographics, final course grades, and specific OSCE scores. A regression model was significant, but only explained a low percentage of the warfarin OSCE therapeutic knowledge score variance, suggesting other factors not evaluated had a greater effect on scores. This research suggests that OSCEs play an important role in demonstrating student competency in educational domains other than knowledge and brings forth new data suggesting that age and/or gender may influence OSCE performance.

Effects of Remote Proctoring on Composite Examination Performance Among Doctor of Pharmacy Students

Objective. To determine the impact of remote proctoring on the academic performance of Doctor of Pharmacy (PharmD) students.Methods. This was a retrospective, observational study that compared first professional year (P1) and second professional year (P2) pharmacy students' scores on eight composite examinations administered in spring 2020 (n = 387), the final three of which were proctored remotely, to that of a historical cohort of pharmacy students who took the same examinations in spring 2019 (n = 368). To assess whether remote proctoring affected academic performance, spring 2020 scores for examinations 6, 7, and 8 were compared to those of a historical cohort who took the same examinations in person with a proctor present in spring 2019. Academic performance on examinations 1 through 4 was also compared between the two cohorts to evaluate any possible year-to-year variation in academic performance during non-remote circumstances. Mann Whitney tests were used to compare scores between the two cohorts.Results. The median scores of students in the spring 2020 cohort were significantly lower than the scores of the historical cohort on the first composite examination administered to P1 students after the implementation of remote proctoring. In contrast, median scores were significantly higher on two of the three examinations administered to P2 students using remote proctoring.Conclusion. Remote proctoring has minimal impact on pharmacy students' examination performance and its use should be considered to ensure academic honesty and security of testing content in a distance learning environment.

Student Perceptions of the Pharmacist's Approach Across the Varying Levels of Medication Therapy Management Services

Objective. To explore third-year pharmacy (P3) student perceptions of medication therapy management (MTM) after an introduction to the various levels of MTM services within an MTM course. Methods. A qualitative survey was conducted of 158 P3 students. Open-ended questions were used to explore students' thoughts, feelings, and perceptions related to the pharmacist's approach in MTM following a lecture establishing differences in roles and responsibilities between the varying levels of MTM. Emphasis was placed on the pharmacist's role when providing comprehensive medication management (CMM). CMM is a higher-level direct patient care service with a whole-patient focus that goes beyond medication or disease specific focuses of either a comprehensive medication review (CMR) or targeted medication review (TMR). Thematic analysis was performed and an inductive approach to data analysis was used. Results. The following five themes were identified: misperceptions entering the course, efficient delivery of MTM depends on understanding the differences between services, doctor of pharmacy education is a factor in confused MTM role expectations, role limitations exist and referrals to other providers, and the CMR meets unmet needs. Conclusion. Students noted initial confusion between their roles and responsibilities during a CMM versus a CMR. Pharmacy educators should address the varying roles and responsibility differences across MTM services within their curriculum.

A 5-year analysis of peer-reviewed journal article publications of pharmacy practice faculty members

OBJECTIVES

To evaluate scholarship, as represented by peer-reviewed journal articles, among US pharmacy practice faculty members; contribute evidence that may better inform benchmarking by academic pharmacy practice departments; and examine factors that may be related to publication rates.

METHODS

Journal articles published by all pharmacy practice faculty members between January 1, 2006, and December 31, 2010, were identified. College and school publication rates were compared based on public vs. private status, being part of a health science campus, having a graduate program, and having doctor of pharmacy (PharmD) faculty members funded by the National Institutes of Health (NIH).

RESULTS

Pharmacy practice faculty members published 6,101 articles during the 5-year study period, and a pharmacy practice faculty member was the primary author on 2,698 of the articles. Pharmacy practice faculty members published an average of 0.51 articles per year. Pharmacy colleges and schools affiliated with health science campuses, at public institutions, with NIH-funded PharmD faculty members, and with graduate programs had significantly higher total publication rates compared with those that did not have these characteristics (p<0.006).

CONCLUSION

Pharmacy practice faculty members contributed nearly 6,000 unique publications over the 5-year period studied. However, this reflects a rate of less than 1 publication per faculty member per year, suggesting that a limited number of faculty members produced the majority of publications.

Smoking reduction activities in a federal program to reduce infant mortality among high risk women

OBJECTIVES

To determine the smoking cessation/reduction services offered to pregnant women by federally funded Healthy Start projects designed to reduce infant mortality.

DESIGN

Information was obtained by questionnaires sent to all Healthy Start projects in 1999. Responses were received from 76 sites.

SETTING

The federal government selected the Healthy Start sites on the basis of infant mortality rates that were much in excess of the national average.

PATIENTS

The projects served largely minority clients. Most of the women were poor and eligible for Medicaid.

MAIN OUTCOME MEASURES

The services that projects offered to pregnant smokers, the priority given the smoking related activities, and whether more should be done.

RESULTS

Only 23% of the sites thought that they were doing enough to help pregnant smokers stop or reduce smoking. The sites felt the national office should develop a manual of best practices, provide client materials, and organise workshops. While three quarters of the sites expected home visitors to counsel pregnant smokers, less than half provided training in this area during orientation, but most visitors received on-the-job training. Only 64% of sites gave smoking cessation/reduction activities high priority in comparison to other objectives of home visiting.

CONCLUSIONS

Although Healthy Start sites were aware of the importance of smoking cessation/reduction activities for their clients, they offered a limited range of services. These projects, and others with similar objectives serving similar populations, need a better understanding of the time and money such interventions require and greater belief in their effectiveness, along with more funds, staff training and materials, and office systems that promote counselling.

Influence of menstrual cycle phase on serum concentrations of alpha 1-acid glycoprotein

Serum concentrations of alpha 1-acid glycoprotein (AAG) were studied in nine healthy women at four times in their menstrual cycles. AAG concentrations were significantly higher on day 4 than on days 12, 20, and 28 (with the first day of menstrual flow considered to be day 1). The mean AAG concentration (mg dl-1) on day 4 was 78.55 +/- 5.03 (mean +/- s.e. mean), 70.19 +/- 4.80 on day 12, 70.63 +/- 6.67 on day 20, and 70.40 +/- 5.97 on day 28. Although these results should be considered preliminary because of the small sample size, we conclude that physiologic changes over the course of the menstrual cycle may affect serum AAG concentrations. Since AAG is a major binding protein for several important drugs, the potential exists for altered drug binding and drug effects, and further study of individual drugs is justified.