Victor A. Yanchick

Cultivating 'habits of mind' in the scholarly pharmacy clinician: report of the 2011-12 Argus Commission.

The American Association of Colleges of Pharmacy (AACP) Argus Commission is comprised of the five immediate past AACP presidents and is annually charged by the AACP President to examine one or more strategic questions related to pharmacy education often in the context of environmental scanning. Depending upon the specific charge, the President may appoint additional individuals to the Commission. President Crabtree requested that the 2011-12 Argus Commission examine the following questions as part of his examination of critical issues of excellence and relevance in academic pharmacy: • What is core with respect to the scientific foundation of clinical education? • How and when do we teach this foundational material? • How can we infuse an attitude of inquisitiveness and scholarly thinking in pharmacists and other health care professionals? • How can we nurture emerging scientists among our students and young faculty? • What ultimately will keep our graduates from being technicians vs. professional clinicians? The work of the Argus Commission was advanced significantly by examining related reports and projects from outside pharmacy and from engaging in dialogue with education leaders across the health professions. When the Commission met in December 2011 they were joined by leaders from academic dentistry, allopathic and osteopathic medicine, nursing, optometry, physicians assistant, public health, veterinary medicine and health administration programs. The meeting began with a presentation by Cynthia Bauerle, Ph.D., Senior Program Officer for PreCollege and Undergraduate Science Education at the Howard Hughes Medical Institute (HHMI) based in Chevy Chase, MD. HHMI and the Association of American Medical Colleges have collaborated on several projects to ensure that the scientific foundation for physician education remains contemporary and strong. They jointly published the “Report of Scientific Foundations for Future Physicians Committee”1 in 2009, which the Argus Commission considered carefully in its work. Dr. Bauerle presented an on-going HHMI project referred to as the NEXUS Project2. The National Experiment in Undergraduate Science Education is relevant to all programs in health professions education which depend on the adequate undergraduate preparation of future clinical scientists in core competencies in mathematics, physics, chemistry and biology. This four year project which began in early 2010 involves grantees at four universities (Purdue University, University of Maryland College Park, University of Maryland Baltimore County and the University of Miami) and draws heavily upon the scientific foundations for future physicians report as the project teams work to significantly modify the pedagogical approach for teaching and assessing learning in the fundamental building blocks of science at the undergraduate level. Throughout the full day meeting and subsequent analysis by the Argus Commission, participants acknowledged the continuum of learning and competency attainment so vital to ensuring that future pharmacists and colleagues across the spectrum of the health professions are inquisitive learners and problem solvers comfortable in applying both the scientific method and evidence-based content to the identification and resolution of clinical issues/problems at the individual patient and population levels. This begins far down the pipeline in pre-collegiate education and continues throughout the period of pre-professional and professional education with an ultimate goal of creating a scientific thinker with the requisite abilities to apply that knowledge in practice.

Call to action: expansion of pharmacy primary care services in a reformed health system.

The AACP Argus Commission is comprised of thefive immediate past AACP presidents and is annuallycharged by the AACP President to examine one or morestrategicquestionsrelatedtopharmacyeducationofteninthe context of environmental scanning. Depending uponthe specific charge, the President may appoint additionalindividuals to the Commission.The 2009-10 Argus Commission was charged to ex-amine the topic of the pharmacist’s contribution to pri-mary healthcare delivery in the context of nationalhealthcare reform and identify the resources of the Acad-emy and the profession needed to engage in the nationalconversation. The charge further requested the ArgusCommission to scan the environment to determine theopportunitiesforexpansionofprimaryhealthcarecapacityto include pharmacists’ unique contributions to quality,cost, and access as medication use specialists on the team.President Baldwin invited representatives from edu-cation associations of various disciplines recognized asprimary healthcare providers to meet with the ArgusCommission. This included the following individuals:Sandra Carlin Andrieu, Ph.D., President-elect of theAmerican Dental Education Association and ADEA Ex-ecutiveDirectorRichardW.Valachovic,D.M.D.,M.P.H.;Carol A. Aschenbrener, M.D., Executive Vice President,Association of American Medical Colleges; Timi AgarBarwick, Executive Director, Physician Assistant Educa-tion Association and Dana Sayre-Stanhope, Ed.D., PA-C,Physicians Assistants Program Director, Emory Univer-sity School of Medicine; Jean E. Johnson, Ph.D. (repre-senting American Association of Colleges of Nursing),Senior Associate Dean for Health Sciences Programs,School of Medicine and Health Sciences, The GeorgeWashington University; and Harrison Spencer, M.D.,M.P.H., President and CEO, Association of Schools ofPublicHealth. StephenShannon,D.O., M.P.H.,Presidentand CEO, Association of American Colleges of Osteo-pathic Medicine provided input for the meeting but wasunable to attend.The Argus Commission drew upon the issue briefprepared by Manolakis and Skelton and a copy of thepaperwasalsodistributedforreviewbytheinvitedguestsprior to the meeting. Argus Commission members rec-ommend that all individuals who have interest in thepharmacist’s role in primary care should review this doc-ument.

Roles of the Pharmacy Academy in Informing Consumers about the New American Pharmacist: 2010-2011 Argus Commission Report

The AACP Argus Commission is comprised of the five immediate past AACP presidents and is annually charged by the AACP President to examine one or more strategic questions related to pharmacy education often in the context of environmental scanning. Depending upon the specific charge, the President may appoint additional individuals to the Commission. The 2010-2011 Argus Commission was charged to examine how AACP and its members can engage with appropriate consumer and payer groups to increase awareness of “the new American pharmacist” and the pharmacists role and value in patient-centered care. President Carter emphasized that although increasing public awareness will require broad action by all pharmacy organizations, the Argus Commission was to focus their discussions on the unique roles of the Pharmacy Academy in increasing public awareness about “the new American pharmacist” as compared to what other professional organizations may contribute. The following individuals were invited to participate in the discussions with the Argus Commission: Artem Gulish (Citizen Advocacy Center), Marsha Henderson, MCRP (Office of Womens Health, Food and Drug Administration), and Karen Williams (Office of Womens Health, Food and Drug Administration). In preparation of the Argus Commission meeting, these participants were informed that pharmacist roles have changed and that pharmacy educators need to identify the Academys role in increasing consumer awareness. In preparation of the meeting, Commission members read the article by Worley, et al., which reported the results of a study that investigated both patient and pharmacist views about what patients and pharmacists expect of each other in the patient-pharmacist relationship.1 This study reported that both patients and pharmacists have similar views about the pharmacists role in sharing information such as how to watch for medication side effects and whether a medication should be taken with over-the-counter products. However, patients agreed less about pharmacist behaviors such as showing interest in working with patients to meet their health needs and communicating a desire to help patients with their medication concerns. Patients also had less agreement about the pharmacists role in providing a patient-centered relationship such as being approachable when a patient wants to discuss medication concerns. There was also less agreement among patients about the pharmacists role in interpersonal communications such as greeting patients at the prescription counter and taking prescription information. Furthermore, patients had less agreement about the role of the pharmacist in general healthcare communications such as pharmacist availability when patients call the pharmacist via phone to discuss a new medication question. Argus Commission members also reviewed resources from the Patient Safety and Clinical Pharmacy Services Collaborative which included documents communicating the new roles of pharmacists and patient-focused information.2 Articles summarizing the current roles of pharmacists and the value they bring to patient care were also reviewed. Specifically, the 2009-2010 Professional Affairs Committee Report provided a summary of evidence supporting pharmacist integration in primary care practice within community settings where there were also partnerships with patients and other healthcare service providers.3 The recent study by Kassam et al. stimulated Argus Commission members to think about the role of practice experiences in helping the profession increase consumer awareness about the roles of the pharmacist.4 This study compared patients’ expectations and experiences at pharmacies offering traditional APPE learning opportunities to APPEs which provided pharmaceutical care learning activities and found significantly higher in-store satisfaction and fewer service gaps in the later. Several other publications that highlighted the value of pharmacists were also reviewed. A report by the National Association of Chain Drug Stores provided a review of how pharmacies are improving health and reducing costs.5 The recent article by Chisholm-Burns et al. which provided evidence that pharmacists positively impact patient care also provided the Argus Commission with insights.6 The Commission noted this article was published in Medical Care and provided readers such as health systems leaders, payers, health-care CEOs and CFOs with greater awareness about the role of the pharmacist. As the Argus Commission members read this article, they realized the importance of informing healthcare leaders outside the pharmacy profession and the value of having faculty write publications outside the pharmacy profession as a means for communicating to others about the role of “the new American pharmacist.”6 The Argus Commission meeting initially focused on the roles of “the new American pharmacist” and reasons why the public has a low awareness about the value of pharmacists in improving medication therapy outcomes of patients. Discussions then addressed how pharmacy educators can promote greater awareness among consumers, healthcare payer groups, and other stakeholders.