Schwanda K. Flowers

Report of the 2010-2011 Standing Committee on Advocacy: Leveraging faculty engagement to improve public policy.

According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Advocacy Committee: “will advise the Board of Directors on the formation of positions on matters of public policy and on strategies to advance those positions to the public and private sectors on behalf of academic pharmacy.” COMMITTEE CHARGE President Rodney Carter charged the 2010-2011 Advocacy Committee to: “examine the question how can AACP and its members most effectively leverage faculty scholarship/research to impact on public policy at the state and federal level?” The Committee met in-person in October in Arlington, VA to discuss the charge and determine the approach to meeting the charge. After a wide-ranging discussion guided by the Chair the Committee agreed that a case study approach would meet the intent of the charge and serve the broader Academy by providing examples of evidence-based advocacy. Committee members agreed that the case studies could include completed, ongoing, or developing examples of how faculty scholarship and research did or failed to impact public policy. A framework for case study submission was developed and agreed to by the Committee. Case Study Framework: Each advocacy committee member will present one initiative that supports the integration of the pharmacist or recognizes academic pharmacy as a resource for evidence-based public policy development as a case study that provides a “roadmap for implementation” for AACP members. Each case study will be included as a section in the report. Each section will use the following format: State the healthcare reform/advocacy issue and the opportunity or expectation for the integration of the pharmacist; Describe the development of the partnership with the academic or community-based partner and their understanding and expectation of the integration of the pharmacist into issue activities or how pharmacy faculty can contribute to furthering public policy development; Describe through examples of teaching, research, or service, current activity at the college or school level to address the issue; List the AACP/other resources that provide evidence of academic activity that support the selected issue; and Recommendations regarding additional resources or evidence needed to advance the role of the pharmacist into the activities supporting the healthcare reform/advocacy initiative. BACKGROUND Leveraging public policy development to your advantage requires strong evidence that supports or opposes the policy. Public policy is advanced by science-based contributions.1,2 It is helpful to keep in mind that there is no guarantee that evidence improves the final policy since politics can be a dominant influence. However the strength of the evidence can contribute to its consideration in public policy.3 How and to whom the evidence is presented remains an essential element of influencing public policy. The creation of new knowledge and evaluation of existing knowledge are responsibilities of every faculty member of a college or school of pharmacy. Therefore, leveraging public policy development requires 1) identification of public policy of personal or professional interest and those supporting or opposing the policy, 2) assessing the policy for personal or collective contribution opportunities, and 3) determining the best approach for contributing the evidence. For instance, a significant piece of public policy, the Patient Protection and Affordable Care Act, includes provisions that seek to increase access to medication therapy management. The specific public concern being poor medication management is costly in terms of health and economic outcomes. This public concern was leveraged by evidence generated, translated and provided by pharmacy faculty. This evidence included examples of research, some of it supported by federal grants,4 demonstrating improved health outcomes associated with the provision of MTM services. Influencing public policy through evidence-sharing will continue to be an important goal of academic and professional organizations. The Patient Protection and Affordable Care Act creates many opportunities for academic pharmacy to leverage its implementation through the creation of new knowledge or evaluate current knowledge and translating both new and current knowledge into programs and services that meet the intent of the law.5 Members of the Academy are already providing significant contributions to the literature supporting the integration of the pharmacist across the continuum of care competent to provide patient-centered, team-based care.6,7 Likewise, daily activities such as interactions with state-based organizations, community partners, health insurance payers and even accrediting organizations provide opportunities for your position to be articulated and supported through evidence-sharing. The ability to leverage policy development requires an understanding and appreciation of other individuals and groups that will be engaged in the creation of new policy and its eventual implementation. Understanding and appreciation, regardless of whether you agree or disagree, requires the development of relationships with individuals, institutions and organizations involved in influencing public policy you deem important or relevant to your personal or professional goals. Understanding the advocacy or public policy goals of others is the first step in determining how what information you will provide to leverage their goals to your advantage. Through discussions with other individuals and groups you begin the second step, to assess the relevance of their goals to yours. Identification of goal alignment is an important step toward influencing public policy. Shared goals strengthen advocacy. The recognition of this strength regularly results in the establishment of coalitions and task forces that combine individual or organizational goals into a larger presence to influence public policy development, implementation and evaluation. Coalitions and other groups built upon mutual advocacy goals are sustained and strengthened through the evidence they are able to share with those developing or implementing the policy. Toward this end, pharmacy faculty are able to leverage public policy by working with others that share their goals, creating and communicating evidence that supports those goals.

Academic Help-Seeking Behavior Among Student Pharmacists

Objectives. To identify factors associated with academic help-seeking behavior among student pharmacists at a public university. Methods. Semi-structured focus group interviews were conducted to explore in depth perceptions of facilitators of and barriers to the help-seeking behavior and academic achievement of student pharmacists who had received a D or F grade in any year. A 4-part survey instrument was developed and administered to all student pharmacists and included sections for (1) attitudes and academic help-seeking behavior, (2) health status, (3) demographics, and (4) open comments. A structural equation modeling approach was used to assess relationships among domains of interest. Results. Three student focus groups noted that helpfulness of faculty members and school administrators were 2 prominent facilitators of help-seeking behavior and academic achievement. Diminished quality of life caused by stress and depression was the primary barrier to help-seeking and achievement. Three hundred four (68.6%) student pharmacists completed the survey instrument. Academic help-seeking behavior was influenced mostly by perceived academic competence and perceived faculty helpfulness. In contrast, ambivalence and perception of help-seeking as threatening were 2 factors that were negatively associated with academic help-seeking behavior. Conclusions. Academic help-seeking behavior was positively related to greater perceived academic competence and positive relationships among student pharmacists and faculty members.

Web-based Multimedia Vignettes in Advanced Community Pharmacy Practice Experiences

Objectives. To evaluate the effectiveness of Web-based multimedia vignettes on complex drug administration techniques to augment the training of pharmacy students in advanced community pharmacy practice experiences. Design. During the orientation for a community APPE, students were randomly assigned to either a study group or control group After they began their APPE, students in the study group were given an Internet address to access multimedia vignettes which they were required to watch to augment their training and standardize their counseling of patients in the use of inhalers and ear and eye drops. Assessment. A 12-item questionnaire was administered to students in both groups at the orientation and again on the last day of the APPE to evaluate their knowledge of counseling patients in the use of inhalers and ear and eye drops. The control group did not experience any improvement in their counseling knowledge of the research topics during their month-long experience. Students in the intervention group scored higher on their postintervention test than students in the control group (p < 0.001). Conclusions. Student learning outcomes from experiential training can be improved through the use of Web-based multimedia instructional vignettes.

Multi-Institutional Study of Women and Underrepresented Minority Faculty Members in Academic Pharmacy

Objectives. To examine trends in the numbers of women and underrepresented minority (URM) pharmacy faculty members over the last 20 years, and determine factors influencing women faculty members’ pursuit and retention of an academic pharmacy career. Methods. Twenty-year trends in women and URM pharmacy faculty representation were examined. Women faculty members from 9 public colleges and schools of pharmacy were surveyed regarding demographics, job satisfaction, and their academic pharmacy career, and relationships between demographics and satisfaction were analyzed. Results. The number of women faculty members more than doubled between 1989 and 2009 (from 20.7% to 45.5%), while the number of URM pharmacy faculty members increased only slightly over the same time period. One hundred fifteen women faculty members completed the survey instrument and indicated they were generally satisfied with their jobs. The academic rank of professor, being a nonpharmacy practice faculty member, being tenured/tenure track, and having children were associated with significantly lower satisfaction with fringe benefits. Women faculty members who were tempted to leave academia for other pharmacy sectors had significantly lower salary satisfaction and overall job satisfaction, and were more likely to indicate their expectations of academia did not match their experiences (p<0.05). Conclusions. The significant increase in the number of women pharmacy faculty members over the last 20 years may be due to the increased number of female pharmacy graduates and to women faculty members’ satisfaction with their careers. Lessons learned through this multi-institutional study and review may be applicable to initiatives to improve recruitment and retention of URM pharmacy faculty members.

Multiple Mini-Interview Performance Predicts Academic Difficulty in the PharmD Curriculum

Objective. To identify admissions variable prognostics for academic difficulty in the PharmD curriculum to use for admissions determinations and early identification of at-risk students. Methods. Retrospective multivariate analysis of 2008-2012 admission data were linked with academic records to identify students with academic difficulty (ie, those with Ds, Fs, delayed progression). The influence of prepharmacy grade point average (GPA), composite Pharmacy College Admission Test (PCAT) score, multiple-mini interview (MMI) score, age, credit hours, state residence, and prior degree on academic difficulty was estimated using multivariate logistic regression. Results. Students’ (n=587) prepharmacy GPA, composite PCAT score, mean MMI score, and age were 3.6, 72.0, 5.5, 22.8 (SD=4.14 years), respectively. Students having a GPA <3.25, PCAT score <60th percentile, or MMI score <4.5, were approximately 12-, 7-, and 3-times more likely, respectively, to experience academic difficulty than those with a GPA ≥ 3.75, PCAT score >90, or MMI score of 5-6. Conclusion. Using GPA, PCAT, and MMI performance can predict academic difficulty and assist in the early identification of academically at-risk PharmD students.

Desirable Skills in New Pharmacists: A Comparison of Opinions From Practitioners and Senior Student Pharmacists

Objective: To compare survey responses between licensed pharmacists who work with or employ new graduates and graduating senior pharmacy students at a college of pharmacy. Design: This was a retrospective analysis of surveys given to 2 groups of pharmacists and students. Responses to items regarding importance of desirable qualities in new pharmacists and level of preparation of new graduates were analyzed. Qualities included drug information, pharmacology, therapeutics, communication with patients/customers or health care professionals, professionalism, ethics, management, and conflict resolution. Results: There was consensus between pharmacists and students regarding the importance of all items (P > .05 for all comparisons). However, the percentage of pharmacists versus students who agreed that new graduates communicate effectively differed (86.7% vs 100%, respectively, P < .05). Of pharmacists surveyed at a career fair, 64.1% chose communication as the 1 skill that would distinguish an applicant, and retail and hospital pharmacists displayed a statistically significant (P < .05) difference in the audience (patients/customers vs other health care professionals). Conclusion: Pharmacists and students agree on the knowledge and skills essential for pharmacy practice but disagree on the level of preparation for effective communication. These results support ongoing efforts to improve the development of communication skills in the professional pharmacy curriculum.

Expanding experiential opportunities through patient care services: a focus on immunizations.

A new set of standards, ACPE Standards 2007, adopted by the Accreditation Council for Pharmacy Education (ACPE), required all pharmacy programs to include introductory pharmacy practice experiences (IPPEs) to represent 5% of the curriculum and advance pharmacy practice experiences (APPEs) to represent 25% of the curriculum. This required many pharmacy programs to revise their curriculum to meet these requirements. The challenge of satisfying the increased accreditation requirements along with the increased number of new pharmacy programs in the United States has resulted in increased competition for experiential sites. Drake University College of Pharmacy and Health Sciences and the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy utilized innovative immunization services to help meet the ACPE Standards 2007. Drake utilized P2 and P3 students who were trained to give immunizations in an IPPE patient care elective in order to help experiential sites in their immunization efforts. Senior pharmacy students at UAMS were involved in expanding APPE opportunities by developing immunization clinics and providing immunizations at their experiential sites. Both pharmacy programs were successful in expanding experiential opportunities by focusing on immunizations. Students, preceptors, and patients all benefit from utilizing student pharmacist at experiential sites to provide patient care services.

Factors Associated With Health-Related Quality of Life of Student Pharmacists

Objective. To assess the health-related quality of life (HRQoL) of student pharmacists and explore factors related to HRQoL outcomes of student pharmacists in a doctor of pharmacy (PharmD) program at a public university. Methods. A survey instrument was administered to all student pharmacists in a PharmD program at a public university to evaluate differences and factors related to the HRQoL outcomes of first-year (P1), second-year (P2), third-year (P3), and fourth-year (P4) student pharmacists in the college. The survey instrument included attitudes and academic-related self-perception, a 12-item short form health survey, and personal information components. Results. There were 304 students (68.6%) who completed the survey instrument. The average health state classification measure and mental health component scale (MCS-12) scores were significantly higher for P4 students when compared with the P1through P3 students. There was no difference observed in the physical component scale (PCS-12) scores among each of the 4 class years. Significant negative impact on HRQoL outcomes was observed in students with higher levels of confusion about how they should study (scale lack of regulation) and concern about not being negatively perceived by others (self-defeating ego orientation), while school satisfaction increased HRQoL outcomes (SF-6D, p<0.001; MCS-12, p=0.013). A greater desire to be judged capable (self-enhancing ego-orientation) and career satisfaction were positively associated with the PCS-12 scores (p<0.05). Conclusion. Factors associated with the HRQoL of student pharmacists were confusion regarding how to study, ego orientation, satisfaction with the chosen college of pharmacy, and career satisfaction. First-year through third-year student pharmacists had lower HRQoL as compared with P4 students and the US general population. Support programs may be helpful for students to maintain or improve their mental and overall health.

Adapting Leadership Styles to Reflect Generational Differences in the Academy

The topic of adapting one’s leadership style is controversial and can generate great debate. When one considers adapting one’s leadership style, the question of authenticity often bubbles to the surface. This is even more compelling in the context of generational differences in our society and workforce. How can faculty members be effective if they refuse to adapt their leadership style to students’ learning styles and generational characteristics? Leadership development is an ongoing focus for the American Association of Colleges of Pharmacy (AACP) to prepare faculty for roles as future leaders in higher education while a major redistribution of generations is occurring within the workforce. These generations are molded by many factors, including the economy, significant events, technology, and education. As experienced leaders, we affirm that one’s leadership styles must be honed over time and adapted to reflect generational differences in academic pharmacy among colleagues, students, alumni, and stakeholders, including patients. Current and future leaders need further education and development so that their awareness of generational characteristics prepares them to adapt their leadership styles to more effectively engage and lead people of any generation.

Advanced Pharmacy Practice Experience Evaluation Scores are Positively Associated with Multiple-Mini Interview Score, Pre-pharmacy GPA and Pharmacy GPA

Objective. To determine factors associated with advanced pharmacy practice experience (APPE) performance in the pre-pharmacy and Doctor of Pharmacy (PharmD) curriculum and establish whether performance on the multiple mini interview (MMI) independently predicts APPE evaluation scores. Methods. A multi-case MMI has been used in the admissions process since 2008. Students are scored anywhere from 1 to 7 (unsatisfactory to outstanding) on each interview. Traditional factors (GPA, PCAT, etc.) are also used in the admissions determination. Pearson product-moment correlation and ordinary least squares regression were used to explore the relationships between admissions data, pharmacy GPA, and APPE evaluation scores for the graduating classes of 2011-2014. These analyses identified which factors (pharmacy GPA, PCAT, MMI score, age, gender, rurality, resident status, degree, and underrepresented minority status) related to APPE performance. Results. Students (n=432) had a mean APPE score of 4.6; a mean MMI score of 5.5; mean pharmacy GPA, PCAT and age of 3.14, 73.2, 22.6 years, respectively. Pre-pharmacy GPA and pharmacy GPA positively correlated with mean APPE scores. MMI score demonstrated positive correlations with overall APPE score; including subcategories patient care, documentation, drug information/EBM, public health, and communication. MMI scores were positively related to overall APPE scores in the multivariable regression. Variables showing negative associations with APPE scores included a pre-pharmacy GPA of <3.0 (ref= GPA >3.5) and pharmacy school GPA of >3.0 – 3.5 and GPA 2.6 – 3.0 when compared to GPAs >3.5. Conclusion. GPA (pre-pharmacy and pharmacy) and MMI positively correlate with preceptor-rated performances in the APPE year.