One School of Pharmacy's Experience of Talking With Student Pharmacists About Coping With Patient Death

OBJECTIVE

End-of-life care is an important aspect of health care profession education; however, little has been published about preparing student pharmacists for the emotional impact of their patient dying. This manuscript describes using a question-and-answer seminar with a mixed faculty and student panel, members of which had been impacted by a patient's death, as a stimulus for student reflection on how they might cope in similar circumstances.

METHODS

Students attending the seminar were provided a guiding prompt for reflecting on what would help them respond to a patient's death. The resulting essays were analyzed for 5 themes inspired by the guiding prompt, and categories of responses for each theme were created using an inductive approach. Descriptive statistics were used to analyze the results.

RESULTS

A total of 69 student pharmacists submitted essays and 552 statements were identified and coded into 5 themes and 23 categories. The most commonly addressed theme was "personal strategies" for coping with loss, whereas the least addressed was "resources" available to pharmacists. The most commonly mentioned strategies were "acknowledge your emotions" and "talk with others."

CONCLUSION

A simple-to-implement seminar was effective at stimulating student reflection on how they would cope with a patient's death. Although some students had already experienced the death of a patient, others stated they had never considered that their patients may die, supporting the importance of the panel discussion.

Musings of Two Administrators for Those Considering a Career Change

There is a learning curve when stepping into an administrative position, whether you have been planning the change for years or find yourself asked to replace someone who has left unexpectedly. Two associate deans offer perspectives on things we wish we had known prior to taking on our current position. Some are practical skills that can also be helpful in any faculty position, while others relate to the different perspectives an administrator needs. We also point out some experiences we feel helped set us up for success, which should be available to anyone considering a similar change of career. Our experiences may offer some benefit for individuals considering administrative positions by helping them reflect on what questions to ask themselves while choosing their next career step.

Preparing Pharmacy Educators as Expedition Guides to Support Professional Identity Formation in Pharmacy Education

Objective. To provide an educator-friendly travel guide for supporting pharmacy students' lifelong journey to professional identity formation.Findings. In contrast to professionalism, which has emphasized externally visible behaviors, professional identity focuses on the internalization of the attitudes, standards, and behavioral norms of a profession, such that one "thinks, acts, and feels" like a member of that profession. Identity, whether personal or professional, is continuously developed in part during interactions with others and in response to internal and external feedback on those interactions. Educators play a critical role in helping students navigate the "provocative moments" (eg, transitions, dissonance) that accompany identity formation. To help educators travel with purpose, several identity formation theories suggest means of creating learning experiences and supporting the development of a professional identity. Additionally, guidebooks for the trip (ie, published literature) provide examples of didactic and experiential teaching approaches that can be used to promote professional identity formation. While further exploration and research are necessary, traveling this journey with colleagues can help members of the Academy succeed in sustainably and effectively infusing intentional professional identity formation within pharmacy education and training.Summary. There are myriad ways for educators to develop and support professional identity formation, which can present a challenge when defining the role that educators play in this complex, dynamic process. Educators must understand the reasoning behind various approaches and the common dialogue used to engage and support learners as their expedition guides on the lifelong journey to professional identity formation.

Understanding Professionalism's Interplay Between the Profession's Identity and One's Professional Identity

Pharmacy schools have taught professionalism for many years but are now discussing the model of professional identity formation adopted by academic medicine. While professionalism is an outward expression of a community's norms, professional identity is an internalization of those norms such that one thinks, acts, and feels like a member of that community. Some have expressed concern that the wide-ranging roles and responsibilities of pharmacists mean there is no universal identity for the pharmacy profession, and therefore a student's professional identity cannot be intentionally developed. This commentary suggests that the profession's identity is an outward expression to patients and other health care providers of what pharmacists do, while one's professional identity is an internal acceptance that being a pharmacist is part of who one is. While a clear identity of the profession may make one's professional identity easier to develop, full agreement on the profession's identity is not required to begin guiding student pharmacists in the formation of their professional identities.

A Pathway to Professional Identity Formation: Report of the 2020-2021 AACP Student Affairs Standing Committee

EXECUTIVE SUMMARY Professional identity formation (PIF) involves internalizing and demonstrating the behavioral norms, standards, and values of a professional community, such that one comes to "think, act and feel" like a member of that community. Professional identity influences how a professional perceives, explains, presents and conducts themselves. This report of the 2020-2021 AACP Student Affairs Standing Committee (SAC) describes the benefits of a strong professional identity, including its importance in advancing practice transformation. Responding to a recommendation from the 2019-2020 SAC, this report presents an illustrative and interpretative schema as an initial step towards describing a pharmacist's identity. However, the profession must further elucidate a universal and distinctive pharmacist identity, in order to better support pharmacists and learners in explaining and presenting the pharmacist's scope of practice and opportunities for practice change. Additionally, the report outlines recommendations for integrating intentional professional identity formation within professional curricula at colleges and schools of pharmacy. Although there is no standardized, single way to facilitate PIF in students, the report explores possibilities for meeting the student support and faculty development needs of an emerging new emphasis on PIF within the Academy.

Report of the 2019-2020 AACP Student Affairs Standing Committee

The 2019-2020 Student Affairs Standing Committee addressed charges related to professional identity formation (PIF) in order to set direction and propose action steps consistent with Priority #3.4 of the AACP Strategic Plan, which states "Academic-practice partnerships and pharmacist-involved practice models that lead to the progress of Interprofessional Practice (IPP) are evident and promoted at all colleges and schools of pharmacy." To this end, the committee was charged to 1) outline key elements of PIF, 2) explore the relationship between formal curricular learning activities and co- or extra-curricular activities in supporting PIF, 3) determine the degree to which there is evidence that strong PIF is embedded in student pharmacists' educational experience, and 4) define strategies and draft an action plan for AACP's role in advancing efforts of schools to establish strong PIF in pharmacy graduates. This report describes work of the committee in exploring PIF and provides resources and background information relative to the charges. The committee offers several suggestions and recommendations for both immediate and long-term action by AACP and members to achieve goals related to integrating PIF into pharmacy education. The committee proposes a policy statement relative to the committee charges. Furthermore, the report calls upon the profession to develop a unified identity and incorporate support for PIF into pharmacy education, training, and practice.

Perceptions and performance using computer-based testing: One institution's experience

BACKGROUND AND PURPOSE

The purpose of this study was to evaluate student and faculty perceptions of the transition to a required computer-based testing format and to identify any impact of this transition on student exam performance.

EDUCATIONAL ACTIVITY AND SETTING

Separate questionnaires sent to students and faculty asked about perceptions of and problems with computer-based testing. Exam results from program-required courses for two years prior to and two years following the adoption of computer-based testing were compared to determine if this testing format impacted student performance.

FINDINGS

Responses to Likert-type questions about perceived ease of use showed no difference between students with one and three semesters experience with computer-based testing. Of 223 student-reported problems, 23% related to faculty training with the testing software. Students most commonly reported improved feedback (46% of responses) and ease of exam-taking (17% of responses) as benefits to computer-based testing. Faculty-reported difficulties were most commonly related to problems with student computers during an exam (38% of responses) while the most commonly identified benefit was collecting assessment data (32% of responses). Neither faculty nor students perceived an impact on exam performance due to computer-based testing. An analysis of exam grades confirmed there was no consistent performance difference between the paper and computer-based formats.

DISCUSSION AND SUMMARY

Both faculty and students rapidly adapted to using computer-based testing. There was no evidence that switching to computer-based testing had any impact on student exam performance.

Comparison of StrengthsQuest Signature Themes in Student Pharmacists and Other Health Care Profession Students

Objective. To determine whether there is a distinctive pattern of StrengthsQuest Signature Themes or leadership domains for Doctor of Pharmacy students compared to students in other health care professional programs. Methods. Students in Doctor of Pharmacy (PharmD), Master of Physician Assistant (PA), Doctor of Physical Therapy (DPT), and Doctor of Osteopathic Medicine (DO) programs at Campbell University completed the online Clifton StrengthsQuest assessment and received their Signature Themes. The frequency of individual themes and the leadership domains into which they are sorted by Gallup was analyzed for each program. Results were compared between programs and with national frequencies among undergraduate students. Results. The most common themes in the total population were Learner, Relator, Responsibility, Harmony, and Achiever. Learner and Relator were among the five most frequent themes for all four individual programs while Responsibility and Harmony were among the top five for three programs. The most frequently reported themes in PharmD and PA students (39% and 38% of all themes, respectively) are grouped by Gallup into the executing domain, and into the relationship-building domain for DO and DPT students (35% and 33% of all themes, respectively). The least frequent themes in PharmD, DO and PA students were those grouped into the influencing domain, reported by 10% or fewer students. Conclusion. Numerous similarities were found in theme frequencies among students in four different health care professions, suggesting there is not a distinctive Doctor of Pharmacy Signature Theme profile.

Impact of Pre-Pharmacy Work Experience on Development of Professional Identity in Student Pharmacists

Objective. To determine the benefit of pharmacy work experience on the development of student pharmacists' professional identity. Methods. Students in all four professional years were surveyed using a validated Professional Self-identity Questionnaire (PSIQ). They were also asked about pharmacy experience prior to matriculation and their performance on Drug Information tests given midway through the P1 year and at the beginning of the P3 year. PSIQ responses and test results were compared based on pharmacy experience. Results. The PSIQ was completed by 293 student pharmacists, for a 67% response rate, with 76% of respondents reporting pharmacy experience prior to matriculation. Statistically higher scores on responses to 6 of the 9 PSIQ Likert-type items were observed from students in the first professional year for those with pharmacy experience; however, only one item in the second year showed differences with none in the third and fourth years. No impact of experience was observed on Top 100 or Top 300 grades. Conclusion. Pre-matriculation pharmacy experience may increase development of professional identity early in the student experience but may have little impact on academic readiness. Schools and colleges of pharmacy hoping to recruit students with an early sense of professional identity should consider adding such experience to their admissions requirements.

Developing an Assessment Process for a Master's of Science Degree in a Pharmaceutical Sciences Program

Objective. To develop a program-level assessment process for a master's of science degree in a pharmaceutical sciences (MSPS) program. Design. Program-level goals were created and mapped to course learning objectives. Embedded assessment tools were created by each course director and used to gather information related to program-level goals. Initial assessment iterations involved a subset of offered courses, and course directors met with the department assessment committee to review the quality of the assessment tools as well as the data collected with them. Insights from these discussions were used to improve the process. When all courses were used for collecting program-level assessment data, a modified system of guided reflection was used to reduce demands on committee members. Assessment. The first two iterations of collecting program-level assessment revealed problems with both the assessment tools and the program goals themselves. Course directors were inconsistent in the Bloom's Taxonomy level at which they assessed student achievement of program goals. Moreover, inappropriate mapping of program goals to course learning objectives were identified. These issues led to unreliable measures of how well students were doing with regard to program-level goals. Peer discussions between course directors and the assessment committee led to modification of program goals as well as improved assessment data collection tools. Conclusion. By starting with a subset of courses and using course-embedded assessment tools, a program-level assessment process was created with little difficulty. Involving all faculty members and avoiding comparisons between courses made obtaining faculty buy-in easier. Peer discussion often resulted in consensus on how to improve assessment tools.

Publication Rates for Pharmaceutical Sciences Faculty Members at Nonresearch-Intensive US Schools of Pharmacy

OBJECTIVE

To provide benchmarking data for faculty productivity by determining publication rates for pharmaceutical sciences faculty members at nonresearch-intensive schools and colleges of pharmacy between January 2010 and December 2013.

METHODS

Scopus and Web of Science databases were searched using faculty names from the AACP faculty and professional staff roster. Annual publication rates were calculated and compared for various demographic subcategories.

RESULTS

The average annual publication rate for the 4-year period was 0.82 per faculty member, and 10.95 per institution. Publication rates were significantly higher in departments offering a PhD program or with NIH funding.

CONCLUSION

Because institutional missions are diverse, it can be useful to evaluate faculty scholarly productivity in relation to similar organizations. Pharmaceutical science faculty members at nonresearch-intensive institutions contribute to the literature despite institutional missions less focused on research.

An Assessment of Service-Learning in 34 US Schools of Pharmacy Follow Up on the 2001 Professional Affairs Committee Report

Objective. To determine if the service-learning components used at a convenience sample of schools and colleges of pharmacy meet the intent of the 2001 AACP Professional Affairs Committee (PAC) report. Methods. An online questionnaire was used to survey faculty members or staff involved with service-learning education at their school of pharmacy. Questions addressed aspects of service-learning including types of activities used, duration of student involvement with community partners, and association of learning objectives with service-learning activities. Results. The majority (85.3%) of respondents reported their institution used service-learning. Activities reported as part of service-learning ranged from working at health fairs to involvement with pharmacy school recruitment. More than half (64.3%) of service-learning activities involved long-term interactions with one community partner, and 74.1% of respondents indicated there was always an opportunity for student reflection on the service-learning activity. Conclusion. There is increasing though inconsistent application of PAC guidelines regarding service-learning.

Age-related alterations in cyclic nucleotide phosphodiesterase activity in dystrophic mouse leg muscle

Previous reports have described both increased and decreased cyclic nucleotide phosphodiesterase (PDE) activity in dystrophic muscle. Total PDE activity was measured in hind leg muscle from a mouse model of Duchenne muscular dystrophy (mdx) and a genetic control strain at 5, 8, 10, and 15 weeks of age. Total PDE activity declined in fractions isolated from mdx muscle over this time period, but was stable in fractions from control mice. Compared with age-matched controls, younger mdx muscle had higher cAMP and cGMP PDE activity. However, at 15 weeks, fractions from both strains had similar cGMP PDE activity and mdx fractions had lower cAMP PDE activity than controls. Particulate fractions from mdx muscle showed an age-related decline in sensitivity to the PDE4 inhibitor RO 20-1724. A similar loss of sensitivity to the PDE2 inhibitor erythro-9-(2-hydroxyl-3-nonyl)-adenine (EHNA) was seen in a particulate fraction from mdx muscle and to a lesser degree in control muscle. These results suggest that the earlier disagreement regarding altered cyclic nucleotide metabolism in dystrophic muscle may be due to changes with age in PDE activity of dystrophic tissue. The age-related decline in particulate PDE activity seen in dystrophic muscle appears to be isozyme-specific and not due to a generalized decrease in total PDE activity.Key words: cyclic nucleotide phosphodiesterase, muscular dystrophy, mouse, RO 20-1724, EHNA.

Cyclic nucleotide phosphodiesterase isozymes expressed in mouse skeletal muscle

To understand changes in cyclic nucleotide metabolism in muscle disease states, the expression of phosphodiesterase (PDE) isozymes in normal mouse leg muscle was examined. Four subcellular fractions were generated by differential centrifugation at 10,000 x g and 100,000 x g. cAMP PDE activity was found predominately in the soluble fractions, while cGMP PDE activity was more evenly distributed amongst soluble and particulate fractions. Pharmacological inhibitors demonstrate that PDE4 represents the major cAMP hydrolyzing activity and PDE2 represents the major cGMP hydrolyzing activity in mouse leg muscle. PDE1 is expressed at low levels, while PDE3 and PDE5 are intermediate. Between 20 and 40% of total PDE activity remained in the presence of inhibitors for PDE1-PDE5, indicating that other PDE families contribute to the total PDE pool. Reverse-transcription PCR with family-specific primers showed expression of mRNA for PDE7-PDE9, supporting this conclusion. Total PDE activity was found to be elevated in tissue extracts from a mouse model of Duchenne's muscular dystrophy.

Identification and tissue-specific expression of PDE7 phosphodiesterase splice variants

Type 7 cyclic nucleotide phosphodiesterases (PDE7s) are a newly described family of enzymes having high affinity and specificity for cAMP. However, little is known about their structure, function, or regulation. We have isolated a mouse skeletal muscle cDNA representing a new alternative splice variant (PDE7A2) of the PDE7 gene. The ORF encodes a 456-amino acid protein having a predicted molecular weight of 52.4 kDa. The 5' end of the mouse PDE7A2 is divergent from the 5' end of the human PDE7A1 sequence and is more hydrophobic. A comparison of the 5' ends of the two cDNA clones with human genomic sequence indicates that they represent alternate splice products rather than species variation. RNase protection analysis of several mouse tissues indicates that PDE7 is expressed widely with highest levels in skeletal muscle. HPLC fractionation and Western blot analysis of two human lymphocyte T-cell lines shows that an unknown PDE activity described by Ichimura and Kase [Ichimura, M. & Kase, H. (1993) Biochem. Biophys. Res. Commun. 193, 985-990] is most likely to be PDE7A1. A single immunoreactive band of approximately 55 kDa, which comigrates with PDE7A1, is seen in fractions of the HPLC profile containing this activity suggesting that the original human PDE7A1 clone contains a full-length ORF, and is not truncated at the 5' end as was originally postulated. In a human lymphocyte B-cell line and also in mouse skeletal muscle, a large amount of PDE7 mRNA but little PDE7 protein or activity is expressed suggesting that the translation or stability of PDE7 protein may be highly regulated in these tissues.

Isolation and characterization of a previously undetected human cAMP phosphodiesterase by complementation of cAMP phosphodiesterase-deficient Saccharomyces cerevisiae

We have established a highly sensitive functional screen for the isolation of cDNAs encoding cAMP phosphodiesterases (PDEs) by complementation of defects in a Saccharomyces cerevisiae strain lacking both endogenous cAMP PDE genes, PDE1 and PDE2. Three groups of cDNAs corresponding to three distinct human genes encoding cAMP-specific PDEs were isolated from a human glioblastoma cDNA library using this functional screen. Two of these genes are closely related to the Drosophila dunce cAMP-specific PDE. The third gene, which we named HCP1, encoded a novel cAMP-specific PDE. HCP1 has an amino acid sequence related to the sequences of the catalytic domains of all cyclic nucleotide PDEs. HCP1 is a high affinity cAMP-specific PDE (Km = 0.2 microM) that does not share other properties of the cAMP-specific PDE family, i.e. extensive sequence homology to the Drosophila dunce cAMP PDE and sensitivity to rolipram and R020-1724. The PDE activity of HCP1 is not sensitive to cGMP or other inhibitors of the cGMP-inhibitable PDEs, such as milrinone. The biochemical and pharmacological properties of HCP1 suggest that it is a member of a previously undiscovered cyclic nucleotide PDE family. Northern blot analysis indicates that high levels of HCP1 mRNA are present in human skeletal muscle.

Regulation of S6 kinase activity in Madin-Darby canine kidney renal epithelial cells

Mitogenic stimulation of mammalian cells results in increased serine phosphorylation of ribosomal protein S6. Phorbol esters, which stimulate protein kinase C activity, can also increase S6 phosphorylation. In order to further investigate the role of protein kinase C in the activation S6 kinase, we studied the stimulation of an S6 kinase activity in response to phorbol ester and epinephrine in a renal epithelial cell line, Madin-Darby canine kidney cells (MDCK). In these cells, S6 phosphorylating activity in cytosolic extracts was increased following the addition of phorbol ester to the intact cells. S6 kinase and protein kinase C activities were measured in separate fractions prepared by DEAE-Sephacel fractionation of cytosolic extracts prepared from the same cells. The time course and dose-response curves for the effects of phorbol 12-myristate 13-acetate (PMA) on S6 kinase activity were similar to those for its effects on protein kinase C binding to the membrane fraction, indicating that S6 kinase activation was correlated with protein kinase C activation. Epinephrine, acting via alpha1-adrenergic receptors, also stimulated S6 kinase activity in MDCK cells; the magnitude of this effect was similar to that of PMA. However, epinephrine causes only a slight and transient association of protein kinase C with the membrane. The effect of epinephrine on S6 kinase activity, unlike that of PMA, was dependent on the presence of extracellular calcium. A23187, a calcium ionophore, could also stimulate S6 kinase activity. These results suggest that S6 kinase can be activated through more than one signaling pathway in MDCK cells. The properties of the PMA-stimulated S6 kinase were further investigated following partial purification of the enzyme. The S6 kinase was distinct from protein kinase C by several criteria. Noteably, the S6 kinase was highly specific for S6 as substrate. These results show that phorbol esters, acting through protein kinase C, stimulate the activity of a unique S6 kinase. This S6 kinase can also be activated through a signaling pathway that appears to be dependent on increased intracellular calcium.

Polyamines differentially inhibit cyclic AMP-dependent protein kinase-mediated phosphorylation in the brain of the tobacco hornworm, Manduca sexta

The effects of the naturally occurring polyamines spermine and spermidine on phosphorylation promoted by cyclic AMP (cAMP)-dependent protein kinase (PK) (cAMP-PK; EC 2.7.1.37) were studied using the brain of the tobacco hornworm, Manduca sexta. Four particulate-associated peptides (280, 34, 21, and 19 kilodaltons) in day 1 pupal brains are endogenous substrates for a particulate type II cAMP-PK. These phosphoproteins are present in brain synaptosomal, as well as microsomal, particulate fractions but are not present in the cytosol. They are distributed throughout the CNS and PNS and are present in several nonneuronal tissues as well. Phosphorylation of these proteins via cAMP-PK was inhibited markedly by micromolar concentrations of spermine and spermidine. Other particulate-associated peptides phosphorylated via a Ca2+/calmodulin-PK or Ca2+ and cAMP-independent PKs were unaffected by polyamines, whereas the phosphorylation of a 260-kilodalton peptide was markedly enhanced. Spermine did not exert its inhibitory effect indirectly by enhancement of cAMP or ATP hydrolysis or via proteolysis, but its action appears to involve a substrate-directed inhibition of cAMP-PK-promoted phosphorylation as well as enhanced dephosphorylation. Although addition of spermine resulted in marked ribosome aggregation in synaptosomal and microsomal particulate fractions, this phenomenon was not involved in the inhibition of cAMP-PK-promoted phosphorylation.

Polyamine regulation of protein phosphorylation in the brain of the tobacco hornworm, Manduca sexta

An analysis of the effects of polyamines on protein phosphorylation in cytosolic fractions of the pupal brain of Manduca sexta showed that spermine elicited an increase in casein phosphorylation in a dose-dependent manner (maximum three- to fourfold at 2.0 mM), whereas spermidine was less effective and putrescine was without effect. In contrast, with phosvitin as the exogenous substrate, higher doses of polyamines, especially spermine, inhibited phosphorylation. High salt conditions abolished the polyamine response. Cytosol protein kinase activity eluted from DEAE-cellulose at 0.2-0.3 M NaCl. This activity was enhanced in the presence of spermine, and inhibited in the presence of heparin (IC50 approximately equal to 30 ng/ml). The enzyme was characterized by a sedimentation coefficient of 6.5S, and a Stokes radius of 49 A, consistent with a Mr of 130,000. Both GTP (Km, 55 microM) and ATP (Km, 34 microM) were utilized as phosphoryl donors (Vmax for ATP being four-fold higher than that observed for GTP). These results indicate the presence in the insect brain of an enzyme very similar to vertebrate casein kinase II. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography demonstrated that low concentrations of spermine (100 microM) strongly enhanced the phosphorylation of three high-molecular-weight cytosolic proteins (305,000, 340,000, and 360,000) localized in the insect nervous system.