Jody L. Lounsbery

Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences

Objective. To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Design. Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students’ competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Assessment. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Conclusions. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs.

Case-based Assessment in an Online Nursing Pharmacotherapy Course

Objective. To implement and evaluate the effectiveness of case-based assessments in an online pharmacotherapy course for nursing students. Design. Four case-based examinations developed in parallel for the midterm and final examinations and designed to address potential barriers to maintaining academic integrity were compared. Assessment. The use of online, case-based assessments was successful in providing 4 parallel examinations that assessed case-based decision making while maintaining academic integrity and minimizing instructor grading burden. Conclusions. Using an online, case-based assessment strategy is effective and feasible for evaluating the clinical application knowledge of nursing students enrolled in a pharmacotherapy course.

Severe constipation associated with extended-release bupropion therapy

PURPOSE A case of bupropion-induced constipation is reported. SUMMARY A 38-year-old man went to a clinic with a chief complaint of depression. He was prescribed extended-release bupropion 150 mg orally daily. Three weeks later, the patient returned to the clinic for a follow-up visit regarding his depression. He reported that his depression symptoms improved, but he complained of constipation and inflamed hemorrhoids from straining with defecation. He used docusate sodium, fiber supplements, and Preparation H(Wyeth) products with some relief. The bupropion was continued for his depression. Recommendations were given to the patient to increase fluids, maintain fiber intake, and add exercise. One week later, the patient complained of rectal pain and minimal bleeding. Prescriptions were given to the patient for hydrocortisone suppositories and 2.5% cream to be used twice daily. Three days later, the patient returned to the clinic complaining of increased pain and no relief from the hydrocortisone suppositories and cream. The rectal examination showed 3- and 5-cm hemorrhoids, one of which was thrombotic. The patient was instructed to continue hydrocortisone products, increase fluids, and continue docusate. Hemorrhoidectomy surgery was eventually performed, as well as a fissurectomy. The patient discontinued bupropion on his own due to the constipation approximately one week before the surgery. The constipation resolved after discontinuation of bupropion. CONCLUSION Extended-release bupropion was the probable cause of severe constipation in a man with multiple medical problems.

Preceptor and resident perceptions of entrustable professional activities for postgraduate pharmacy training

BACKGROUND Following the development and implementation of entrustable professional activities (EPAs) as a collective graduation standard for pharmacy students, the University of Minnesotas multi-site post-graduate year one pharmacy residency program made a similar transition. EDUCATIONAL ACTIVITY AND SETTING An electronic survey was distributed to program preceptors and residents to describe the perceptions of using EPAs to assess performance. FINDINGS Residents (66.7%) and preceptors (78.3%) found the EPA framework to be more helpful than the traditional progression ratings model, but both groups also described EPAs as less beneficial for some objectives. Sixteen (69.6%) preceptors felt the residency graduation standard for attainment should be an entrustment level 4 or 5. Preceptors found the EPA scale to be more descriptive, more objective, and easier to understand; however, it did not always apply to all skills and was more challenging to provide residents information regarding what they needed to improve upon. Residents commented that the EPA scale was more descriptive, had better clarity, and gave them a better idea of where their progression was at on a continuum. Residents also commented that regardless of the rating scale, specific, day-to-day feedback is more helpful. SUMMARY Residents and preceptors perceive the EPA framework to be more helpful than traditional rating scales when evaluating learning objectives. Preceptors were less certain of what the EPAs entrustment level should be to consider a learning objective or skill achieved for residency. Both found some learning objectives to be more challenging for EPA use.