Sally Haack

A Faculty-Led Mock Residency Interview Exercise for Fourth-Year Doctor of Pharmacy Students:

Purpose: To determine whether a faculty-led mock-interview activity enhanced pharmacy student preparation for the residency interview process and increased match rates. Methods: Twenty-eight doctor of pharmacy students volunteered for a 40-minute mock-interview session with 2-person faculty teams. A standard roster of 12 interview questions was derived from published literature and the faculty members’ experience. Feedback on the student’s interview performance was provided verbally during the session. Following the interview, students were given a 2-part survey instrument. The first part of the survey was administered immediately following the mock-interview session and the second part was administered after the standard date for residency program results (known as “Match Day”). Participant match rates were compared to American Society of Health-System Pharmacists (ASHP) national rates. Results: 82.5% (23 of 27) of students in the mock-interview group matched a postgraduate year 1 (PGY1) program. Compared to national rates (61.9%), more students in our surveyed mock-interview group matched a PGY1 residency (P = .015; odds ratio [OR] 3.546, 95% CI 1.161-12.116). Conclusions: Higher match rates were seen in the students completing the mock residency interview compared to ASHP national rates. In general, students completing the mock interview found the process helpful and felt better prepared for their residency interviews.

Teaching Cultural Competency Through a Pharmacy Skills and Applications Course Series

Objective. To incorporate cultural competency in a Pharmacy Skills and Application course series and assess the level of cultural competency in students who did and did not complete the courses. Design. The course series focused on cultural competency throughout the PharmD curriculum and included such activities as self-reflection, lecture, diversity service-learning, case studies, and discussion. Assessment. The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals – Revised (IAPCC-R) was used to measure cultural competence in 2 cohorts: the last class preceding implementation of the new course series and the first class after its implementation. Overall scores between the 2 cohorts were not significantly different; however, 2 subscale scores were significantly higher among students who completed the course series: cultural skills (p = 0.021) and cultural encounters (p = 0.048). Conclusions. The Pharmacy Skills and Application course series appears to improve some aspects of cultural competence in pharmacy students, but may not be sufficient to elicit change in all areas.

Identification of barriers to medication adherence in a Latino population

BACKGROUND Barriers to medication adherence may present differently in diverse patient populations. Because of changing U.S. demographics, health care providers will be required to identify alternative strategies for managing increasingly diverse patient populations. OBJECTIVES This pilot project identified barriers that may hinder medication adherence in a Latino population. The results of the survey may identify trends in barriers allowing for the development of interventions aimed at improving medication adherence. METHODS The study used a convenience sample of Spanish-labeled prescriptions that had not been picked up from a community pharmacy after a 2-week period to identify study subjects. Patients were contacted by phone and surveyed regarding reasons for not picking up their prescription medication. The 24-item survey instrument consisted of demographic and medication-related questions, reasons for, and associated barriers with failure to pick up medications. RESULTS The most common classes of medications patients failed to pick up were chronic medications. More than 90% of the patients thought that the medication in question was helpful to them, and nearly 80% thought that the medicine was still needed. Patients cited communication issues (ie, content matter, such as when the prescription was ready), logistics, and limited hours of pharmacy operation as the primary barriers in picking up their medications, whereas nearly 40% failed to identify any barriers. Barriers identified by patients that could be improved included confusion regarding when their prescription was ready and limited hours of pharmacy operation. Most of the patients were comfortable using the American health care system. CONCLUSIONS The barriers to medication adherence identified did not appear to be the result of cultural influences. This could be because the community pharmacy had bilingual staff and interpreters available for patient education and prescription processing. Alternative methods are needed to further identify reasons for failure to pick up medications before medication adherence programs can be designed.

Assessing Pharmacy Students’ Ability to Accurately Measure Blood Pressure Using a Blood Pressure Simulator Arm

Objective. To compare student accuracy in measuring normal and high blood pressures using a simulator arm. Methods. In this prospective, single-blind, study involving third-year pharmacy students, simulator arms were programmed with prespecified normal and high blood pressures. Students measured preset normal and high diastolic and systolic blood pressure using a crossover design. Results. One hundred sixteen students completed both blood pressure measurements. There was a significant difference between the accuracy of high systolic blood pressure (HSBP) measurement and normal systolic blood pressure (NSBP) measurement (mean HSBP difference 8.4 ± 10.9 mmHg vs NSBP 3.6 ± 6.4 mmHg; p<0.001). However, there was no difference between the accuracy of high diastolic blood pressure (HDBP) measurement and normal diastolic blood pressure (NDBP) measurement (mean HDBP difference 6.8 ± 9.6 mmHg vs. mean NDBP difference 4.6 ± 4.5 mmHg; p=0.089). Conclusions. Pharmacy students may need additional instruction and experience with taking high blood pressure measurements to ensure they are able to accurately assess this important vital sign.

Knowledge and attitudes of American pharmacists concerning sulfonamide allergy cross-reactivity.

Objective Pharmacists are commonly confronted with patients with a history of sulfonamide allergy. Basic immunologic and clinical data suggest a low likelihood of a patient with a history of sulfonamide hypersensitivity developing an allergic reaction to a non-antimicrobial sulfonamide drug. We conducted a survey to describe the knowledge and attitudes of licensed pharmacists concerning sulfonamide allergy cross-reactivity. Methods A survey instrument was developed and sent to all licensed pharmacists in the state of Iowa. The survey recorded demographic information and included six patient scenarios designed to elicit responses concerning sulfonamide allergy cross-reactivity with a number of non-antimicrobial sulfonamides. Results A total of 421 surveys were returned for a 39% response rate. There was a wide discrepancy in approaches to patients with a history of sulfonamide allergy prescribed a sulfonamide containing non-antibiotic. Differences depended on previous history of tolerating the medication in question, the degree of cautionary statements in product literature, and the familiarity the pharmacist had with the product. Conclusion Our survey suggests a significant diversity in knowledge and attitudes of pharmacists concerning cross-reactivity of sulfonamide antimicrobials and other drugs with a sulfonamide moiety. Depth of training in this area may be an associative factor.

Garnering Widespread Involvement in Preparing for Accreditation Under ACPE Standards 2007

On February 17, 2006, the Accreditation Council for Pharmacy Education (ACPE) announced the release of the revised Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree that became effective on July 1, 2007. (1) Although there are numerous differences between Standards 2007 and previous versions, the general core areas remain similar but are condensed into 6 groupings of the Standards and Guidelines: Mission, Planning, and Evaluation; Organization and Administration; Curriculum; Students; Faculty and Staff; and Facilities and Resources. (2) Within these core areas, significant changes have occurred, including the reorganization of standards to include institutional accreditation, student complaint policies, and more specific requirements for areas such as experiential education hours. Review procedures are more defined with an emphasis on the evaluation form/ rubric, use of standardized survey instruments, and broad participation by faculty members and other key groups. (3) Implementation of Standards 2007 presents several unknowns to schools and colleges undergoing accreditation for the first time under the new standards. Ramifications for being partially or non-compliant with the standards include a limited (2-year) time period to become compliant, potential probation, public availability of a college/schools status, and potential adverse accreditation action. (4) Clearly, colleges/schools need to have their stakeholders knowledgeable and involved in the self-study to assure success. The self-study process also changed, including the use of a self-study template supplied by ACPE. The template offers a consistent format to self-study reports, additional direction on sources of information to be used, and specific requirements for each standard and guideline. The template includes sections for both a summary of self-study process and a formal rating of the overall organization and clarity of the self-study process. The latter addition adds further evidence of the need for broad and inclusive participation during the self-study process. Within the Overall Organization and Clarity section of the template, colleges and schools of pharmacy are rated on 6 general areas, 3 of which are linked directly to the involvement of stakeholders in the self-study process and their awareness of the subsequent findings. These 3 areas are: * Participation: the self-study report was written and reviewed with broad-based input from students, faculty members, preceptors, staff members, administrators, and a range of other stakeholders, such as patients, practitioners, and employers. * Completeness and transparency: all narratives and supporting documentation are thorough, clear, and concise. The content appears thoughtful and honest. Interviews match the self-study findings. * Knowledge of the self-study: students, faculty members, preceptors, and staff members are conversant in the major themes of the report and how the program intends to address any deficiencies. Little information has been published on how schools and colleges of pharmacy approach the self-study process or the new Standards 2007. Although one program published their experiences using a project management approach, no other information is available. (5) To our knowledge, no literature focuses on garnering widespread stakeholder involvement in the accreditation process. This paper describes several practices that may aid programs in achieving such involvement in the self-study process. PARTICIPATION IN THE SELF-STUDY PROCESS When possible, colleges and schools of pharmacy should consider attending a program such as the AACP Institute that can help focus and plan the self-study process. The 2007 AACP Institute coincided with the start of our self-study, and included a topic related to accreditation. (6) Programs like this allow the faculty to begin planning and discussing their self-study, including the main ideals to promote throughout the process. …

New Therapies for Osteoporosis

Osteoporosis is a growing health concern in the United States, with an enormous impact on morbidity and mortality. Despite published guidelines to aid clinicians in its management, several controversies remain. Many trials evaluate surrogate measures of bone strength rather than more clinically relevant outcomes, including fracture. Furthermore, the role of combination and sequential therapy remains unclear. Limited data are available regarding appropriate duration of therapy, management of osteoporosis in men, and treatment of glucocorticoid-induced osteoporosis. The development of unique therapeutic agents could potentially revolutionize the treatment of osteoporosis. Once yearly zoledronic acid may provide advantages over existing therapies. Because of limitations with existing selective estrogen receptor modulators, the search for agents with better efficacy and safety profiles has led to the development of several new medications within this class. Finally, denosumab, a monoclonal antibody to receptor activator for nuclear factor-kappa B ligand, also represents a novel therapeutic option for osteoporosis.

Comparison of electronic versus paper rubrics to assess patient counseling experiences in a skills-based lab course

BACKGROUND AND PURPOSE To evaluate an electronic counseling rubric to facilitate timely student feedback and explore differences in student performance, student anxiety, and self-perceived preparedness in a high stakes practical exam when using a paper rubric versus an electronic rubric. EDUCATIONAL ACTIVITY AND SETTING Two cohorts of students in the third professional year were evaluated using the same rubric criteria: cohort 1 (n = 97) used traditional paper rubrics and cohort 2 (n = 104) used electronic rubrics. Cohorts were surveyed to measure anxiety and perceived preparedness in patient counseling skills one week prior to a practical exam, and cohort responses were compared. Student practical exam performance was also compared between the two cohorts. FINDINGS Results showed no significant relationship between electronic rubric use and student anxiety (p = 0.07) or student exam performance [average score 53.42 points (SD 3.65) and 53.93 points (SD 3.78) in Cohort 1 and Cohort 2, respectively]. Perceived exam preparedness was higher among students using electronic rubrics, with timing of feedback being the mediating process in increasing preparedness (p < 0.01). DISCUSSION AND SUMMARY Electronic rubrics resulted in more timely feedback on patient counseling skills, and students felt more prepared for their practical exam. This did not result in a significant difference in practical exam performance between the two cohorts. Additional methods to incorporate electronic rubrics into the course will be explored.