Leadership development in health professions

BACKGROUND AND PURPOSE

Despite changing clinical care dynamics, health professions education has been slow in addressing gaps in leadership development as teaching and assessment of clinical care-related knowledge, skills, and attitudes remain central across curricula. While accreditation standards across health professions programs acknowledge the importance of leadership development within curricula, it remains an underrepresented aspect of health professions training.

EDUCATIONAL ACTIVITY AND SETTING

Given the varied approach to leadership training, we set out to develop a tailored approach to leadership development that integrated the Center for the Advancement of Pharmacy Education (CAPE) outcomes and was based on self-awareness, skill-building, and application. This pilot included three cohorts of doctor of pharmacy students and measured their knowledge, skills, and self-awareness as they progressed through this year-long program. It also measured leadership competency attainment using a pre- and post-assessment in one cohort.

FINDINGS

Participant satisfaction was assessed using session and program evaluations, while self-perception of growth and leadership competency attainment was assessed using a survey that was administered before and after program participation. Participants found the program to be beneficial in meeting stated objectives and in creating a conducive learning environment. Results of the pre- and post-assessment indicated growth in all dimensions of self-perception of knowledge, skills, and self-awareness, as well as attainment of leadership competency personal leadership commitment and leadership knowledge.

SUMMARY

Offering co-curricular leadership development programs based on CAPE outcomes and leadership competencies provided students with the opportunity to develop leadership skills and acquire knowledge needed to be effective healthcare leaders.

Falling NAPLEX pass rates are cause for concern

INTRODUCTION

First-time pass rates of the North American Pharmacist Licensure Examination (NAPLEX) have declined 7% from 2019 to 2022 with more than a third of schools experiencing a decline of ≥10%.

COMMENTARY

The cause of the decline is likely multifactorial and extends beyond the impact of the COVID-19 pandemic. Changes to the NAPLEX blueprint in 2021, curricular revisions in response to the implementation of Accreditation Council for Pharmacy Education Standards 2016, and changes to prerequisite course requirements in response to declining enrollment must also be evaluated as potential causes.

IMPLICATIONS

The academy must respond to this decline by scrutinizing admissions, curriculum, and assessment processes. We urge the National Association of Boards of Pharmacy to provide access to student-level data on NAPLEX performance and increase transparency in passing standard practices to inform this process.

An intensive summer pipeline program for pre-pharmacy students to increase underrepresented minority matriculation to pharmacy school

BACKGROUND AND PURPOSE

To describe the Summer Academic Enrichment Program (SAEP) for underrepresented minority (URM) matriculants at Virginia Commonwealth University (VCU) School of Pharmacy.

EDUCATIONAL ACTIVITY AND SETTING

The SAEP is a six-week summer pipeline program at VCU for undergraduate and post-baccalaureate students interested in applying to medical, dental, physical therapy, or pharmacy school, divided into school tracks. Demographic and matriculation information about the pharmacy track program participants was obtained from the program and school administration from inception in 2012 through 2019. A retrospective analysis of the impact of SAEP on URM matriculation at VCU School of Pharmacy was conducted.

FINDINGS

Of the 80 pharmacy track participants, 56.3% (n = 45) have enrolled at VCU School of Pharmacy. Among those 45 that matriculated, 33.3% (n = 15) identified as one or more of the following URM populations: Black or African American 28.9% (n = 13), Hispanic or Latinx 4.4% (n = 2), and American Indian 2.2% (n = 1). In comparison, the same URM classifications for students enrolled at VCU School of Pharmacy over the last nine years ranged from 5% to 11% Black or African American, 0% to 5% Hispanic or Latinx, and 0% to 2% American Indian with a total URM representation range of 7% to 25% during this timeframe.

SUMMARY

SAEP is a program utilized to increase matriculation of students from diverse backgrounds, including URM populations. This type of pipeline program is described as one way to improve URM representation.

Changes in student pharmacists' confidence in attaining geriatrics competencies and attitudes toward older adults across the Doctor of Pharmacy curriculum

To determine if student pharmacists' confidence in their knowledge and skills, and their attitudes toward older adults improved throughout pharmacy school with an integrated geriatrics didactic curriculum (years 1-3) and a final year of clinical training including a required advanced pharmacy practice experience (APPE) in geriatrics (year 4). A two-part voluntary anonymous survey was administered at three different time points to two large cohorts of student pharmacists. The first part of the survey assessed students' confidence in attaining geriatrics competencies. The second part of the survey used the UCLA Geriatrics Attitudes Scale to assess students' attitudes. Of the 286 students who were emailed the survey, 236 student pharmacists completed it at the first assessment. Student pharmacists showed an increase in confidence in achieving geriatrics competencies from their first year to their third year, and further increase after their clinical training. Most students also held a generally positive attitude toward older adults from P1 to P4 year. Integration of geriatrics throughout the didactic and experiential curriculum made an impact on student pharmacists' confidence in their competency toward caring for older adults, while maintaining a positive attitude toward older adults throughout pharmacy school.

A call to action: Pharmacy students as leaders in encouraging physical activity as a coping strategy to combat student stress

INTRODUCTION

Pharmacy students share a prevailing sense of stress. Many methods to increase student wellness are pharmacy program specific and faculty driven. This commentary is a call to action for student pharmacists to take shared ownership over improving the current crisis of student well-being. Schools of pharmacy should empower their students to guide the improvement of student wellness. Student-led wellness initiatives can take many forms; this commentary will focus on a student-led walking group as means to bolster wellness within a school of pharmacy.

PERSPECTIVE

Exercise activities promote school-life balance, and when initiated by peers, will naturally conform to their schedule and develop collegial support through socialization. Student pharmacists should begin with encouraging peers to engage in exercise as a positive coping mechanism. Students should lead their peers in developing activities and electronic device sharing to encourage socialization and positive coping mechanisms.

IMPLICATIONS

While many efforts are in place for faculty and schools of pharmacy to improve student well-being, little has been studied on the impact of student-led wellness programs. This article calls student pharmacists to take shared ownership over the student wellness crisis and find ways to intervene. Schools of pharmacy should empower students by providing supportive structures while allowing students to problem-solve and practice wellness themselves.

Could recruiting former college athletes be the answer to less pharmacy student burnout?

INTRODUCTION

Student pharmacists are in a notable wellness deficit. Pharmacy organizations are issuing statements and providing resources addressing efforts to increase student wellness. This commentary suggests that institutions refocus recruiting efforts on students with experience balancing the demands of school, wellness, and mental health.

PERSPECTIVE

The purpose of this commentary is to start the conversation on increasing efforts to recruit candidates who already possess the resilience needed to perform in pharmacy school, with a focus on former college athletes. This piece in no way suggests decreased attention on wellness programs or efforts to reduce burnout. Former student athletes, through their training, have increased experience in resilience and may be less at risk for burnout. These candidates will likely have an increased team mentality and acceptance of constructive criticism. Additionally, this is an untapped resource for candidates as only 2% of collegiate athletes pursuing professional athletic careers. Of the 140 accredited pharmacy schools, 82.9% have an undergraduate program that offers at least one National Collegiate Athletic Association sport.

IMPLICATIONS

Schools of pharmacy should consider additional recruitment efforts and admissions criteria weight for former student athletes who meet the same standards as other candidates. As many pharmacy faculty direct significant effort toward the prevention of student burnout, perhaps an additional approach is to recruit students who are already capable of the expected demands. The athletic community may answer both the need for additional pharmacy recruits and provide a cohort with advanced abilities in stress management, wellness, and teamwork.

Predictors of Emergent Emergency Department Visits and Costs in Community-Dwelling Older Adults

BACKGROUND

The number of yearly emergency department (ED) visits by older adults in the United States has been increasing.

PURPOSE

The objectives were to (1) describe the demographics, health-related variables, and ED visit characteristics for community-dwelling older adults using an urban, safety-net ED; (2) examine the association between demographics, health-related variables, and ED visit characteristics with emergent vs nonemergent ED visits; and (3) examine the association between demographics, health-related variables, ED visit characteristics, and ED visit costs.

METHODS

A cross-sectional, retrospective analysis of administrative electronic medical record and billing information from 2010 to 2013 ED visits (n = 7805) for community-dwelling older adults (⩾65 years old) from an academic medical center in central Virginia was conducted.

RESULTS

Most of the ED visits were by women (62%), African Americans (75%), and approximately 50% of ED visits were nonemergent (n = 3871). Men had 1.2 times the odds of an emergent ED visit (95% confidence interval [CI]: 1.02-1.37). The ED visits by white patients had 1.3 times the odds of an emergent ED visit (95% CI: 1.09-1.57) and 14% higher costs (white race: 95% CI: 1.07-1.21) compared with African American patients. Emergent ED visits were 60% more likely to have higher costs than nonemergent visits (95% CI: 1.52-1.69). White race and arrival by ambulance were associated with both emergent ED visits and higher total ED visit costs in this sample of ED visits by community-dwelling older adults.

CONCLUSIONS

Strategies to maximize opportunities for care in the primary care setting are warranted to potentially reduce nonemergent ED utilization in community-dwelling older adults.

Medical apps used during advanced pharmacy practice experiences

BACKGROUND AND PURPOSE

The purpose of this study was to determine what type of medical applications (apps) are being used by fourth-year students during advanced pharmacy practice experiences (APPEs).

EDUCATIONAL ACTIVITY AND SETTING

Recent doctor of pharmacy school graduates were surveyed pertaining to their use of medical apps on APPEs, frequency of use for select apps, willingness to buy apps and at what cost, and their perceived importance on using medical apps in their pharmacy practice. The survey concluded by inquiring if medical apps should be taught in the pharmacy curriculum.

FINDINGS

Ninety of 132 recent graduates responded to the survey and over 97% of the students used medical apps on their APPEs. Lexicomp^®, UpToDate^® and the Atherosclerotic Cardiovascular Disease (ASCVD) Risk calculator were the most frequently used applications during APPEs. Of those surveyed, 83% believe that medical apps should be taught in pharmacy school.

DISCUSSION AND SUMMARY

Medical apps are frequently used on APPEs. It may be prudent to teach students how to use and evaluate medical apps before going on experiences so that students and patients can get the most benefit from these tools.

Low-Income Senior Housing Residents' Emergency Department Use and Care Transition Problems

Older adults may be at risk of adverse outcomes after emergency department (ED) visits due to ineffective transitions of care. Semi-structured interviews were employed to identify and categorize reasons for ED use and problems that occur during transition from the ED back to home among 14 residents of low-income senior housing. Qualitative thematic and descriptive analyses were used. Ambulance use, timely ED use or a wait-and-see approach, and lack of health-care provider contact before ED visit were emergent themes. Delayed medication receipt, no current medication list, and medication knowledge gaps were identified. Lack of a personal health record, follow-up care instruction, and worsening symptoms education emerged as transition problems from ED to home. After an ED visit, education opportunities exist around seeing primary care providers for nonurgent conditions, follow-up care, medications, and worsening condition symptoms. Timely receipt of discharge medications and medication education may improve medication-related transition problems.

Current drug treatment of hyperlipidemia in older adults

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death, especially in older adults. Managing modifiable risk factors (e.g., hyperlipidemia, hypertension) remains the primary approach to prevent ASCVD events and ASCVD-related mortality. Statins are generally considered one of the most effective approaches to reduce ASCVD risk, especially for secondary prevention, yet remain underutilized in older adults. The evidence to support statin therapy in older adults is less robust than in their younger counterparts, especially in individuals aged 75 years and older. Recent lipid guidelines have raised this concern, yet statin therapy is recommended in 'at risk' older adults. Determining which older adults should receive statin therapy for primary prevention of ASCVD is challenging, as the currently available risk estimation tools are of limited use in those aged over 75 years. Furthermore, non-statin therapies have been de-emphasized in recent clinical practice guidelines and remain understudied in the older adult population. This is unfortunate given that older adults are less likely to tolerate moderate- to high-intensity statins. Non-statin therapies could be viable options in this population if more was understood about their ability to lower ASCVD risk and safety profiles. Nevertheless, lipid-lowering agents remain an integral component of the overall strategy to reduce atherogenic burden in older adults. Future research in this area should aim to enroll more older adults in clinical trials, determine the utility of ASCVD risk estimation for primary prevention, and investigate the role of non-statin therapies in this population.

Critical appraisal of dabigatran in the treatment of deep vein thrombosis and pulmonary embolism

OBJECTIVE

To compare the safety and efficacy of dabigatran to warfarin for the treatment of deep vein thrombosis and pulmonary embolism.

BACKGROUND

Venous thromboembolism (VTE) is a disease comprised of two conditions: deep vein thrombosis and pulmonary embolism. VTE is a major cause of morbidity and mortality worldwide with an annual incidence estimated at 1-3 cases per 1,000 individuals. This incidence increases with age from 0.1 per 1,000 in adolescence to eight per 1,000 in those 80 years of age and older. As the proportion of patients 65 years of age and older expands, the number of patients presenting with VTE will also increase. Anticoagulation remains the cornerstone of VTE treatment. Traditionally, vitamin K antagonists have been used to minimize the risk of thrombus extension and for secondary prevention. Unpredictable pharmacokinetics and pharmacodynamics, routine monitoring, drug-food and drug-drug interactions, and potentially severe adverse events have all been cited as barriers to optimal care. Dabigatran has been proposed as a suitable alternative to warfarin therapy in the treatment of VTE. Therefore, a critical appraisal of dabigatran's safety and efficacy is necessary to determine its role in therapy.

CONCLUSION

Dabigatran remains an alternative to warfarin therapy for the treatment of VTE. However, dabigatran also has distinct disadvantages that warrant consideration. Clinicians must ensure that drug characteristics align with patient characteristics to optimize patient outcomes.

Antidiabetic medications and polypharmacy

Polypharmacy, or the use of multiple medications, is a serious concern for providers who care for older adults, as polypharmacy is associated with medication nonadherence, drug-drug interactions, drug-disease interactions, and adverse drug events. Multiple medications, high chronic disease burden, and age-related physiologic changes make management of older adults with diabetes increasingly difficult. Given high medication burden and potential for increased medication sensitivity in this patient population, it is prudent that providers are aware of potential risks and benefits of antidiabetic medications and implement shared decision-making practices to ensure appropriate care for older adults with diabetes.

Modelling waste generation by the telecom sector in Nigeria: the grey side of the impressive outing

Since the introduction of digital mobile technology into Nigeria in 2001, there has been a phenomenal improvement in mobile subscription, service delivery and in the overall penetration of mobile telecommunication into rural areas in the country. For instance, the country's teledensity increased from less than 1% in 2001 to about 25% in 2006 - an increase of more than 3000%. The aim of this paper is to predict improvements in telephone penetration and waste generation by the Nigerian telecommunications sector. This was achieved by regression analysis of available data on telephone subscription in the country. Our estimations indicate that an average of 3 million phones will be retired annually in the country. Considering an economic phone life of 4 years, the over 32 million phones, (weight estimated at about 3200 tons) in use in 2006 would be at their end-of-life (EoL) by 2010. This volume of waste may contain up to 1800 tons of waste plastics, 15 tons of lead and 124 tons of copper. Our derived regression equation also indicates that mobile phone penetration in the country would be about 40% by 2010. This implies that over 55 million mobile phones would be in use by 2010. The grey side of this impressive statistics is that waste generation by the telecommunications sector will also follow this trend. This paper also highlights the need to introduce a framework for the effective management of waste from this sector considering the toxicity of some of the components of mobile phones and accessories and the prevailing inappropriate disposal practices for such potentially 'toxic' materials.