Jennifer Phillips

Curriculum and Instructional Methods for Drug Information, Literature Evaluation, and Biostatistics: Survey of US Pharmacy Schools

BACKGROUND: The drug information curriculum in US colleges of pharmacy continues to evolve. The American College of Clinical Pharmacy (ACCP) Drug Information Practice and Research Network (DI PRN) published an opinion paper with specific recommendations regarding drug information education in 2009. Adoption of these recommendations has not been evaluated. OBJECTIVE: To assess which recommendations made in the ACCP DI PRN opinion paper are included in US pharmacy school curricula and characterize faculty qualifications, educational methods, and recent changes in drug information education. METHODS: An electronic survey was designed using the ACCP DI PRN opinion paper and the Accreditation Council for Pharmacy Education standards and guidelines for accreditation of PharmD programs in the US. Survey questions addressed curricular content within the following categories: drug information, literature evaluation, and biostatistics. A letter including the online survey link was sent via email to the dean of each US college/school of pharmacy (N = 128). Recipients were instructed to forward the email to the individual at their institution who was the most knowledgeable about the content and methodology used for didactic drug information education. RESULTS: Sixty-four responses were included in the final analysis. Of the 19 ACCP DI PRN minimum core concepts, 9 (47%) were included in curricula of all responding institutions; 14 of 19 (74%) were included in curricula for all but 1 institution. In contrast, 5 of 16 concepts (31%) were not formally taught by a number of institutions. Many respondents noted an increased focus on evidence-based medicine, medication safety, and informatics. CONCLUSIONS: Although a survey of drug information curricula documented substantial inclusion of the essential concepts presented in the ACCP DI PRN opinion paper, room for improvement remains in drug information curricula in US colleges of pharmacy.

Analysis of reference sources used in drug-related Wikipedia articles.

OBJECTIVE References from drug-related Wikipedia articles and a drug information database were compared. METHODS Drugs in Food and Drug Administration (FDA) MedWatch alerts from January-July 2013 were searched in Wikipedia and Lexicomp to compare reference types and to assess the time for drug safety information to be incorporated into Wikipedia articles. RESULTS Wikipedia most commonly cited peer-reviewed journal articles (49.2%) and news articles (12.0%). MedWatch citations were incorporated into Wikipedia on average in 5.9 days. CONCLUSIONS Wikipedia cited various sources but may not be a reliable, up-to-date resource for drug safety information.

Student Characteristics Associated with Successful Matching to a PGY1 Residency Program

Objective. To identify predictors for postgraduate matching success. Methods. In April 2014, a survey was distributed to students at five schools of pharmacy in the United States assessing organizational involvement, research and work experience, postgraduation plans, match status, and demographics. Results. Five hundred seventy-seven students (82%) completed the survey. Applicants who matched had a higher median number of interview offers compared to those who did not match. Significantly more females than males applied for a residency program. Those who matched had a higher median pharmacy school grade point average (GPA) compared to those who did not. No differences were observed in the rates of matching when leadership positions, student organizational membership, or previous work experience were considered. Conclusion. For pharmacy students in this study, number of applications and interviews, pharmacy school GPA, and female gender were associated with a higher likelihood of matching.

Time Spent, Workload, and Student and Faculty Perceptions in a Blended Learning Environment

Objective. To evaluate student perception and time spent on asynchronous online lectures in a blended learning environment (BLE) and to assess faculty workload and perception. Methods. Students (n=427) time spent viewing online lectures was measured in three courses. Students and faculty members completed a survey to assess perceptions of a BLE. Faculty members recorded time spent creating BLEs. Results. Total time spent in the BLE was less than the allocated time for two of the three courses by 3-15%. Students preferred online lectures for their flexibility, students’ ability to apply information learned, and congruence with their learning styles. Faculty members reported the BLE facilitated higher levels of learning during class sessions but noted an increase in workload. Conclusion. A BLE increased faculty workload but was well received by students. Time spent viewing online lectures was less than what was allocated in two of the three courses.

An Analysis of Motivation Factors for Students’ Pursuit of Leadership Positions

Objective. To identify factors that influence student involvement and leadership within organizations and to assess the impact of involvement in organizations on professional skill development. Methods. A printed survey was administered to fourth-year pharmacy students at one college of pharmacy (N=202). Results. Most students (82%) indicated they were involved in at least one organization during pharmacy school and 58% reported holding a leadership position at some point. Factors with the largest impact on involvement in organizations were desire to present a well-rounded image to employers, ability to network, and interest in the activities sponsored by the organization. Involvement in professional organizations had a strong influence on their leadership, teamwork, confidence, and time-management skills. Conclusion. That presenting a well-rounded image to employers and having the ability to network with mentors and peers drove student involvement in professional organizations may be reflective of increasing competition for residencies and jobs.

Using the Jigsaw Technique to Teach Clinical Controversy in a Clinical Skills Course

Objective. To evaluate the effectiveness and student perception of the jigsaw technique to engage students in a clinical controversy exercise and to assess student engagement level during each step of the process. Design. Students were assigned individual readings pertaining to the controversy surrounding the drug oxybutynin switching from prescription to nonprescription. They met with an expert group and teaching groups during mandatory laboratory time and worked together to formulate a recommendation on the appropriateness of nonprescription conversion for a drug. Assessment. A quiz taken individually was used to measure effectiveness. Student perception and level of engagement was assessed using surveys. Conclusion. The jigsaw technique was successful in teaching the concepts involved in the clinical controversy. Group members rated themselves and fellow participants’ level of engagement as high during both the expert group and teaching group sessions. Most students reported they learned about the same or more with the jigsaw technique compared to another cooperative learning technique used in the curriculum.

Analysis of the accuracy and readability of herbal supplement information on Wikipedia

OBJECTIVE To determine the completeness and readability of information found in Wikipedia for leading dietary supplements and assess the accuracy of this information with regard to safety (including use during pregnancy/lactation), contraindications, drug interactions, therapeutic uses, and dosing. DESIGN Cross-sectional analysis of Wikipedia articles. INTERVENTIONS The contents of Wikipedia articles for the 19 top-selling herbal supplements were retrieved on July 24, 2012, and evaluated for organization, content, accuracy (as compared with information in two leading dietary supplement references) and readability. MAIN OUTCOME MEASURES Accuracy of Wikipedia articles. RESULTS No consistency was noted in how much information was included in each Wikipedia article, how the information was organized, what major categories were used, and where safety and therapeutic information was located in the article. All articles in Wikipedia contained information on therapeutic uses and adverse effects but several lacked information on drug interactions, pregnancy, and contraindications. Wikipedia articles had 26%-75% of therapeutic uses and 76%-100% of adverse effects listed in the Natural Medicines Comprehensive Database and/or Natural Standard. Overall, articles were written at a 13.5-grade level, and all were at a ninth-grade level or above. CONCLUSION Articles in Wikipedia in mid-2012 for the 19 top-selling herbal supplements were frequently incomplete, of variable quality, and sometimes inconsistent with reputable sources of information on these products. Safety information was particularly inconsistent among the articles. Patients and health professionals should not rely solely on Wikipedia for information on these herbal supplements when treatment decisions are being made.

White Paper on Natural Products.

The American College of Clinical Pharmacy (ACCP) published an initial white paper on herbal products in 2000. Since then, the global market for natural products has continued to expand, with tens of millions of consumers using such products on an annual basis in the United States alone. However, despite this expansion, natural products remain largely unregulated compared with prescription medications, have moderate‐ to low‐level clinical evidence for efficacy, and continue to have safety concerns, including adulteration and misbranding. As comprehensive medication management experts, clinical pharmacists are uniquely qualified to navigate these concerns and advise patients appropriately. To develop and recommend a suitable care plan involving natural products, clinical pharmacists must establish a strong pharmacist‐patient relationship, assess the appropriateness of therapy, educate the patient regarding key issues, and continuously monitor and follow up on the effectiveness of the care plan. This process should not only occur in an individual community or hospital setting, but also whenever a patient transitions from one care setting to another in cooperation with other clinicians.

Medical Literature Evaluation Education at US Schools of Pharmacy

Objective. To determine how medical literature evaluation (MLE) is being taught across the United States and to summarize methods for teaching and assessing MLE. Methods. An 18-question survey was administered to faculty members whose primary responsibility was teaching MLE at schools and colleges of pharmacy. Results. Responses were received from 90 (71%) US schools of pharmacy. The most common method of integrating MLE into the curriculum was as a stand-alone course (49%). The most common placement was during the second professional year (43%) or integrated throughout the curriculum (25%). The majority (77%) of schools used a team-based approach. The use of active-learning strategies was common as was the use of multiple methods of evaluation. Responses varied regarding what role the course director played in incorporating MLE into advanced pharmacy practice experiences (APPEs). Conclusion. There is a trend toward incorporating MLE education components throughout the pre-APPE curriculum and placement of literature review/evaluation exercises into therapeutics practice skills laboratories to help students see how this skill integrates into other patient care skills. Several pre-APPE educational standards for MLE education exist, including journal club activities, a team-based approach to teaching and evaluation, and use of active-learning techniques.

Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care

Changes to the U.S. health care landscape have increased the focus on the quality and use of alternative payment models, with a growing focus on value. As health care costs continue to rise, clinical pharmacists will increasingly engage in roles to expand the breadth and depth of clinical services in providing comprehensive medication management (CMM) to improve patient outcomes. The roles of pharmacy technicians and other support personnel must evolve to meet the needs created by this practice change and allow pharmacists to focus their services on activities that use their expertise to improve medication outcomes. Support personnel, including pharmacy technicians, should be identified to assist with clinical pharmacy tasks on the basis of their skills. To ensure competence, support personnel should be adequately trained and (if applicable) certified. Moreover, support personnel should be optimally incorporated into appropriate components of the clinical pharmacists process of care to expand the reach and depth of clinical pharmacy services. When supervised by the pharmacist or others as defined in state practice acts, support personnel may be able to assist in the clinical pharmacists provision of CMM. Finally, research should be conducted and disseminated on the utility and outcomes achieved using support personnel in the clinical pharmacists process of care.