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1.  The global pharmacy workforce: a systematic review of the literature 
The importance of health workforce provision has gained significance and is now considered one of the most pressing issues worldwide, across all health professions. Against this background, the objectives of the work presented here were to systematically explore and identify contemporary issues surrounding expansion of the global pharmacy workforce in order to assist the International Pharmaceutical Federation working group on the workforce.
International peer and non-peer-reviewed literature published between January 1998 and February 2008 was analysed. Articles were collated by performing searches of appropriate databases and reference lists of relevant articles; in addition, key informants were contacted. Information that met specific quality standards and pertained to the pharmacy workforce was extracted to matrices and assigned an evidence grade.
Sixty-nine papers were identified for inclusion (48 peer reviewed and 21 non-peer-reviewed). Evaluation of evidence revealed the global pharmacy workforce to be composed of increasing numbers of females who were working fewer hours; this decreased their overall full-time equivalent contribution to the workforce, compared to male pharmacists. Distribution of pharmacists was uneven with respect to location (urban/rural, less-developed/more-developed countries) and work sector (private/public). Graduates showed a preference for completing pre-registration training near where they studied as an undergraduate; this was of considerable importance to rural areas. Increases in the number of pharmacy student enrolments and pharmacy schools occurred alongside an expansion in the number and roles of pharmacy technicians. Increased international awareness and support existed for the certification, registration and regulation of pharmacy technicians and accreditation of training courses. The most common factors adding to the demand for pharmacists were increased feminization, clinical governance measures, complexity of medication therapy and increased prescriptions.
To maintain and expand the future pharmacy workforce, increases in recruitment and retention will be essential, as will decreases in attrition, where possible. However, scaling up the global pharmacy workforce is a complex, multifactorial responsibility that requires coordinated action. Further research by means of prospective and comparative methods, not only surveys, is needed into feminization; decreasing demand for postgraduate training; graduate trends; job satisfaction and the impact of pharmacy technicians; and how effective existing interventions are at expanding the pharmacy workforce. More coordinated monitoring and modelling of the pharmacy workforce worldwide (particularly in developing countries) is required.
PMCID: PMC2706790  PMID: 19545377
2.  Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda 
BMC Medical Education  2010;10:47.
Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training.
The survey was conducted among 107 newly admitted first year students on the medical, nursing, pharmacy and medical radiography program students, using in-depth interview and open-ended self-administered questionnaires on their first day at the college, from October 28-30, 2008. Data was collected on socio-demographic characteristics, motivation for choosing a medical career, prior exposure to rural health facilities, willingness to have part of their training in rural areas and factors that would influence the decision to work in rural areas.
Over 75% completed their high school from urban areas. The majority had minimal exposure to rural health facilities, yet this is where most of them will eventually have to work. Over 75% of the newly admitted students were willing to have their training from a rural area. Perceived factors that might influence retention in rural areas include the local context of work environment, support from family and friends, availability of continuing professional training for career development and support of co-workers and the community.
Many first year students at Makerere University have limited exposure to health facilities in rural areas and have concerns about eventually working there.
PMCID: PMC2904351  PMID: 20573221
3.  Evaluation of urban-rural differences in pharmacy practice needs in Maine with the MaPPNA 
Pharmacy Practice  2015;13(4):669.
Maine is a rural state with an aging population located in the northeastern United States. Pharmacists play an important role in serving the public’s health as they are often the most available point-of-contact within a community.
To assess the current pharmacy practice needs as viewed by licensed pharmacists across our rural state, and to distinguish issues that are unique to rural pharmacy practice.
An online survey was sent to all licensed pharmacists in the state in the fall of 2014 (n=1,262) to assess their pharmacy practice needs, and specify an rural-specific needs, within the categories of (1) opioid misuse, abuse, and diversion, (2) challenges associated with access to healthcare, (3) poly-pharmacy use, (4) meeting the needs of special populations, (5) lack of antibiotic stewardship, and (6) resources, such as staffing.
The response rate was 22.1 % (n=279). We found the most agreed upon issue facing pharmacists’ in Maine is opioid use, misuse and diversion, followed closely by shortages in staffing. We also learned that pharmacists’ view pharmaceutical care for older adults, those with low health literacy, and those with mental disabilities more time-consuming. Some urban-rural differences were discovered in with regard to the pharmacists’ views; such as the magnitude of the distance barrier, and limited transportation options available to rural residents. Issues related to polypharmacy were viewed as more problematic by pharmacists practicing in urban versus rural sites.
Pharmaceutical care in Maine must focus on meeting the needs of the elderly, those with disabilities, and those with limited health literacy. As with the rest of the nation, opioids challenge pharmacy practice in a variety of ways. These findings clarify areas that present opportunities for pharmacists to focus more specifically on Maine’s largely rural population.
PMCID: PMC4696125  PMID: 26759622
Community Pharmacy Services; Professional Practice; Rural Health; Rural Population; Health Services Needs and Demand; Maine
4.  Beliefs, attitudes and self-use of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy medicines among senior pharmacy students: An exploratory insight from Andhra Pradesh, India 
Pharmacognosy Research  2015;7(4):302-308.
To assess the beliefs, attitudes and self-use of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) medicines among senior pharmacy students.
This was a descriptive cross-sectional study conducted among pharmacy students in four pharmacy schools located in Andhra Pradesh in South India. This study was conducted from the August to September 2014. The study population included all pharmacy students enrolled in Doctor of Pharmacy, Bachelor of Pharmacy and Diploma in Pharmacy programs in studied pharmacy schools. The pretested AYUSH survey had 8 questions on AYUSH related beliefs and 8 question on AYUSH related attitudes. The survey also asked participants about AYUSH related knowledge, frequency of use of AYUSH and the reason for using AYUSH. The data analysis was performed using SPSS Version 20. Chi-square test and Mann–Whitney U-test were employed to study the association between the independent and dependent variables.
A total of 428 pharmacy students participated in the survey. 32.2% of the study population was females and 32.5% of the population resided in rural areas. Males were more likely to have positive beliefs about AYUSH when compared to females (odd ratio [OR] = 4.62, confidence interval [CI] = 2.37−8.99, P < 0.001). Similarly, students living in hostels were more positive in their beliefs about AYUSH compared with students living at home (OR = 2.14, CI = 1.12−4.07, P < 0.05). Students living in hostel also had a positive attitude about AYUSH use (OR = 1.74, CI = 1.03−2.93, P < 0.05).
Pharmacy students held favorable attitude and beliefs about AYUSH use. This baseline survey provides important information about the pharmacy student's perception about AYUSH. Further research is needed to explore the reasons that shape the pharmacy student's beliefs and attitudes about AYUSH.
PMCID: PMC4660507  PMID: 26692742
Attitude; Ayurveda; Yoga and Naturopathy; Unani; Siddha; and Homeopathy; beliefs; India; pharmacy students
5.  Pharmacists’ attitude, perceptions and knowledge towards the use of herbal products in Abu Dhabi, United Arab Emirates 
Pharmacy Practice  2010;8(2):109-115.
The purpose of the study was to assess pharmacists’ current practice, perception and knowledge towards the use of herbal products in Abu Dhabi, United Arab Emirates (UAE). The study assessed the need for incorporating herbal medicine as a separate topic in under- graduate pharmacy student curricula.
The study was done on 600 pharmacists employed in Abu Dhabi, who were contacted electronically, out of which 271 had completed the survey. The data was collected using a structured questionnaire.
Pharmacists’ use of herbal products is high in the UAE, as they have a high belief on the effectiveness of herbal products, and only age was found to be the most predominant variable that was influencing pharmacists’ personal use of herbal products (p-value=0.0171). Pharmacists were more knowledgeable on the uses/indications of herbal products (47%) rather than on other areas. Knowledge of the dispensing mode (prescription only or over the counter medicines) mandated by the Ministry of Health was quite good, however, it is to be noted that the source of information on the dispensing mode was provided by medical representatives (48%). Knowledge of dispensing mode of herbal products was found to be significantly influenced by the place of work with more knowledge of the dispensing mode by pharmacists working in the private sector (p-value 0.0007). The results from the study also underscores the need for including herbal medicine as a separate topic in pharmacy college curriculum and to provide for more seminars and continuing pharmacy education programs targeting pharmacists in the Emirate of Abu Dhabi.
Pharmacists need to be informed on indications, drug interactions, adverse events and precautions of herbal products. Concerned bodies must also provide them with regular continuing education programs apart from putting their efforts to incorporate relevant topics on herbal medicine in the pharmacy students’ curriculum.
PMCID: PMC4133064  PMID: 25132878
Herbal Medicine; Education; Pharmacy; United Arab Emirates
6.  An Interprofessional Rural Health Education Program 
Objectives. To develop, implement, and assess an interprofessional rural health professions program for pharmacy and medical students.
Design. A recruitment and admissions process was developed that targeted students likely to practice in rural areas. Pharmacy students participated alongside medical students in completing the Rural Health Professions program curriculum, which included monthly lecture sessions and assignments, and a capstone clinical requirement in the final year.
Assessment. Fourteen pharmacy students and 33 medical students were accepted into the program during the first 2 years of the Rural Health Professions program. Approximately 90% of the rural health professions students were originally from rural areas.
Conclusions. The rural health professions program is an interprofessional approach to preparing healthcare providers to practice in rural communities.
PMCID: PMC3530061  PMID: 23275664
assessment; interprofessional; rural healthcare; underserved; rural pharmacy
7.  Promoting cessation and a tobacco free future: willingness of pharmacy students at the University of Lagos, Nigeria 
Tobacco Induced Diseases  2009;5(1):13.
Tobacco use is projected to cause nearly 450 million deaths worldwide during the next 50 years. Health professionals can have a critical role in reducing tobacco use. Therefore, one of the strategies to reduce the number of smoking-related deaths is to encourage the involvement of health professionals in tobacco-use prevention and cessation counseling. As future health care providers, pharmacy students should consider providing assistance to others to overcome tobacco use and be involved in promoting a tobacco free future as part of their professional responsibility.
This research was to determine the knowledge of tobacco/smoking policy, willingness to be involved in tobacco cessation, attitude to keeping a tobacco free environment and the smoking habit among pharmacy students at the University of Lagos.
Data was collected by the use of self administered questionnaire which was aimed at assessing their smoking habit, determining their knowledge and attitude to smoking policy and willingness to be involved in smoking cessation. The population sample was all the pharmacy students in their professional years (200 to 500 Levels) at Idi-Araba Campus of the University of Lagos.
Out of 327 qualified participants, 297 responded to the questionnaire which was about 91% participation rate but out of these only 291 questionnaires were useful which came to 89%.
There seemed to be no statistically significant difference between the smoking habits among the different levels (p > 0.05). Overall, the current smoking prevalence was 5.5% which is lower than the national prevalence rate of 8.9%.
Awareness of WHO FCTC global tobacco treaty was low (9.3%) among pharmacy students but they agreed that pharmacists and pharmacy students should be involved in quit smoking program (93.1%) and they were willing to be involved in helping smokers to quit (85.9%). Majority agreed that smoking should not be permitted in pharmacies (87.9%) and at pharmacy students' events (86.9%).
From this study it can be concluded that smoking prevalence is low among pharmacy students at the University of Lagos. Awareness of global policy is low but they are willing to be involved in smoking cessation and promoting a tobacco free future.
PMCID: PMC2739162  PMID: 19698120
8.  A comparative evaluation of pharmacy services in single and no pharmacy towns 
Recent attention has focused on access of communities to pharmacy services in rural areas. To increase access to pharmacy services in rural Western Australia some doctors have been granted a licence to dispense medication on the rationale that a pharmacy would not be economically viable in that community. However, there have been no studies conducted on whether a doctor dispensing service adequately provides a pharmacy service with respect to access and quality.
Residents of seven single pharmacy towns and seven non-pharmacy rural towns were surveyed to evaluate pharmacy services delivered by a pharmacist and doctor. The towns were chosen to match closely on key demographic features, with an average population of 1,246 and 1,263 respectively. A random sample of 150 households from each town was sent the questionnaire on pharmacy services (1050 in each group). Data was also collected from the Health Insurance Commission (HIC) on dispensing locations for the residents of the two groups of towns.
There was a significant difference in access to pharmacy services with 82.4% of participants from pharmacy towns accessing medications within their town compared to 51.3% of non-pharmacy town participants. The HIC data supported these trends with pharmacy town residents having relatively higher prescription rates within their town compared to non-pharmacy town residents where they were more likely to access prescriptions out of their town.
Pharmacy town participants were more satisfied with access to health and pharmacy services within their town. Continuation of the doctor dispensing policy requires a greater consideration of the pharmacy needs of rural residents.
PMCID: PMC1523350  PMID: 16800871
9.  Theoretical and Conceptual Framework for a High School Pathways to Pharmacy Program 
To determine whether participation in the University of Illinois at Chicago College of Pharmacy (UIC-COP) Pathways to Pharmacy, an early urban pipeline program, motivated underrepresented minority students to pursue a prepharmacy curriculum in college and choose pharmacy as a career.
Over a 4-year period, underrepresented minority high school students participated in a comprehensive 6-week program that included 3 weeks of prepharmacy curriculum and intensive socialization and 3 weeks working as a pharmacy technician in a chain pharmacy. The High School Survey of Student Engagement (HSSSE) was administered 3 times to 120 program participants from 2005-2008, with 4 open-ended questions added to the pretest, 3 open-ended questions added to the test administered at the midpoint of the program, and 7 open-ended questions added to the posttest.
After completing the program, 88 (75%) of the 120 students enrolled in the college's prepharmacy curriculum and planned to pursue a career in pharmacy, 10 (8%) were not interested in pursuing a career in pharmacy, and 20 (17%) were undecided, compared to the pretest data which showed that 40 (33%) were interested in a career in pharmacy, and 80 (67%) were undecided (p < 0.0001).
Participation in a Pathways to Pharmacy program grounded in both a theoretical and conceptual socialization model framework increased the number of underrepresented minority students in the pipeline to pharmacy schools.
PMCID: PMC2987289  PMID: 21179260
Pathways to Pharmacy program; socialization; High School Survey of Student Engagement; student recruitment; diversity; minority recruitment
10.  Attitudes toward working in rural areas of Thai medical, dental and pharmacy new graduates in 2012: a cross-sectional survey 
Inequity in health workforce distribution has been a national concern of the Thai health service for decades. The government has launched various policies to increase the distribution of health workforces to rural areas. However, little is known regarding the attitudes of health workers and the factors influencing their decision to work in rural areas. This study aimed to explore the current attitudes of new medical, dental and pharmacy graduates as well as determine the linkage between their characteristics and the preference for working in rural areas.
A cross-sectional survey was conducted, using self-administered questionnaires, with a total of 1,225 medical, dental and pharmacy graduates. They were participants of the meeting arranged by the Ministry of Public Health (MOPH) on 1–2 April 2012. Descriptive statistics using mean and percentage, and inferential statistics using logistic regression with marginal effects, were applied for data analysis.
There were 754 doctors (44.4%), 203 dentists (42.6%) and 268 pharmacists (83.8%) enrolled in the survey. Graduates from all professions had positive views towards working in rural areas. Approximately 22% of doctors, 31% of dentists and 52% of pharmacists selected ‘close proximity to hometown’ as the most important reason for workplace selection. The multivariable analysis showed a variation in attributes associated with the tendency to work in rural areas across professions. In case of doctors, special track graduates had a 10% higher tendency to prefer rural work than those recruited through the national entrance examination.
The majority of graduates chose to work in community hospitals, and attitudes towards rural work were quite positive. In-depth analysis found that factors influencing their choice varied between professions. Special track recruitment positively influenced the selection of rural workplaces among new doctors attending the MOPH annual meeting for workplace selection. This policy innovation should be applied to dentists and pharmacists as well. However, implementing a single policy without supporting strategies, or failing to consider different characteristics between professions, might not be effective. Future study of attitudes and factors contributing to the selection of, and retention in, rural service of both new graduates and in-service professionals was recommended.
PMCID: PMC3817458  PMID: 24148109
Medical graduate; Dental graduate; Pharmacy graduate; Medical education; Supply and distribution; Attitude of health personnel; Rural distribution
11.  Medical student attitudes before and after participation in rural health fairs 
Despite an increased need, residents of rural communities have decreased access to healthcare and oftenpresentuniquehealthcare challenges associated with their rurality. Ensuring medical students receive adequate exposure to these issues is complicated by the urban location of most medical schools. Health fairs (fairs) conducted in rural communities can provide students exposure to ruralhealth;however, it is unknown how participation affects attitudes regarding these issues.
Materials and Methods:
During the 2010-2011 academic year, first-year medical students were surveyed before and after participating in a rural fair regarding the importance of rural health issues, the need for exposure to rural healthcare, their plans to practice in a rural community,andthe educational impact of fairs.
Of the 121participating students, 77% and 61% completed pre- and post-fair surveys, respectively. Few had lived in a rural area or planned to practice primary care. Participants strongly agreed that the delivery of healthcare in rural areas was important, and that all physicians should receive rural health training (4.8 and 3.7 out of 5, respectively) despite less than halfplanning to practice in a rural community. After participating in a rural fair, student attitudes were unchanged, although 87% of participants strongly agreed their involvement had contributed to improving patient health and 70% that the fairs provided rural medicine experience.
Among urban medical school students with varied interests in primary care, there was strong interest in volunteering at rural fairs and appreciation for the importance of rural health. Fairs provided interested students with rural medicine experience that reinforced student attitudes regarding rural health. Further, students felt their participation improved patient health.
PMCID: PMC3527050  PMID: 23267384
Education; Medical; Undergraduate; Rural health services; Preventive health services
12.  A Public Health Pharmacy Course at a Malaysian Pharmacy School 
To develop and implement a new course on public health into the bachelor of pharmacy (BPharm) curriculum in Malaysia.
A required 2-credit-hour course was designed to provide an overview of public health pharmacy roles and the behavioral aspects of human healthcare issues. Graded activities included nursing home visits, in-class quizzes, mini-projects, and poster sessions, and a comprehensive final examination.
The majority of the students performed well on the class activities and 93 (71.5%) of the 130 students enrolled received a grade of B or higher. A Web-based survey was administered at the end of the semester and 90% of students indicated that they had benefited from the course and were glad that it was offered. The majority of students agreed that the course made an impact in preparing them for their future role as pharmacists and expanded their understanding of the public health roles of a pharmacist.
A public health pharmacy course was successfully designed and implemented in the BPharm curriculum. This study highlighted the feasibilities of introducing courses that are of global relevance into a Malaysian pharmacy curriculum. The findings from the students' evaluation suggest the needs to incorporate a similar course in all pharmacy schools in the country and will be used as a guide to improve the contents and methods of delivery of the course at our school.
PMCID: PMC2779651  PMID: 19960093
public health; curriculum; Malaysia
13.  Pharmaceutical care education in Kuwait: pharmacy students’ perspectives 
Pharmacy Practice  2014;12(3):411.
Pharmaceutical care is defined as the responsible provision of medication therapy to achieve definite outcomes that improve patients’ quality of life. Pharmacy education should equip students with the knowledge, skills, and attitudes they need to practise pharmaceutical care competently.
To investigate pharmacy students’ attitudes towards pharmaceutical care, perceptions of their preparedness to perform pharmaceutical care competencies, opinions about the importance of the various pharmaceutical care activities, and the barriers to its implementation in Kuwait.
A descriptive, cross-sectional survey of pharmacy students (n=126) was conducted at Faculty of Pharmacy, Kuwait University. Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (SD) were calculated and compared using SPSS, version 19. Statistical significance was accepted at a p value of 0.05 or lower.
The response rate was 99.2%. Pharmacy students expressed overall positive attitudes towards pharmaceutical care. They felt prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Perceived pharmaceutical care competencies grew as students progressed through the curriculum. The students also appreciated the importance of the various pharmaceutical care competencies. They agreed/strongly agreed that the major barriers to the integration of pharmaceutical care into practice were lack of private counseling areas or inappropriate pharmacy layout (95.2%), lack of pharmacist time (83.3%), organizational obstacles (82.6%), and pharmacists’ physical separation from patient care areas (82.6%).
Pharmacy students’ attitudes and perceived preparedness can serve as needs assessment tools to guide curricular change and improvement. Student pharmacists at Kuwait University understand and advocate implementation of pharmaceutical care while also recognizing the barriers to its widespread adoption. The education and training provided at Kuwait University Faculty of Pharmacy is designed to develop students to be the change agents who can advance pharmacist-provided direct patient care.
PMCID: PMC4161404  PMID: 25243027
Students; Pharmacy; Education; Pharmacy; Curriculum; Attitude of Health Personnel; Professional Role; Kuwait
14.  Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center 
Objective. To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center.
Design. Twenty-two second-year student pharmacists were randomly selected from volunteers, given program training, and scheduled for three 5-hour evening shifts in 2013-2014. Pre/post surveys and reflection statements were collected from 19 students. Data were analyzed with a mixed methods approach.
Assessment. Survey results revealed an increase in student self-efficacy (p<0.05) and positive perceptions of SMART. Qualitative findings suggest the program provided opportunities for students to develop strategies for practice, promoted an appreciation for the various roles pharmacists play in health care, and fostered an appreciation for the complexity of real-world practice.
Conclusion. Early clinical experiences can enhance student learning and development while fostering an appreciation for pharmacy practice.
PMCID: PMC4727375  PMID: 26839428
clinical experiences; self-efficacy; student development; experiential learning; pharmacy practice
15.  Patient attitudes regarding the role of the pharmacist and interest in expanded pharmacist services 
Canadian Pharmacists Journal : CPJ  2014;147(4):239-247.
Pharmacists are consistently ranked among the most trusted professionals, and research shows high levels of satisfaction with pharmacist services. Studies have also shown that the public is generally unaware of the full range of roles and responsibilities of a pharmacist. The purpose of this study was to explore the public’s knowledge and attitudes regarding the role of the community pharmacist and to determine their likelihood of using expanded pharmacist services.
Adults across Newfoundland and Labrador were surveyed by telephone. Survey questions addressed how frequently participants visited the pharmacy, understanding of duties undertaken by pharmacists, perceptions and attitudes regarding pharmacists as health care professionals, likelihood of using expanded pharmacist services and participant demographics. Comparisons were made between responses from urban and rural participants and frequent versus nonfrequent pharmacy users, to determine if there were any differences.
The majority of participants were generally aware of what pharmacists do when filling prescriptions; those who visited the pharmacy more frequently appeared to be more informed. Participants indicated they would take advantage of the expanded services suggested, with greatest interest in receiving advice for minor ailment management and prescription refills from pharmacists. Results support the prevailing view that pharmacists are trusted health professionals who should have access to patients’ health information to provide best care.
The public is aware of aspects of the pharmacist’s role, but opportunities exist to better educate the public on the knowledge, skills and unique professional abilities of pharmacists to support uptake of expanded pharmacist services.
PMCID: PMC4212442  PMID: 25360150
16.  Assessment of professionalism in Iranian pharmacists 
In the recent years, the role of a pharmacist has been significantly changed. Traditionally, in the late 20th century, a pharmacist’s role was considered as merely dispensing medication to patients. This view however, has been significantly altered, and, today, a pharmacist is supposed to provide patients with information regarding the medication they are to take, as well as on different aspects of their disease. Therefore, one can suggest that some other factors have recently come into play in the daily tasks of a pharmacist such as accountability and authority.
The current cross-sectional survey is conducted on a cohort of community pharmacists attending a continuing education program. A questionnaire comprised of 26 Likert-type scale questions was designed to assess pharmacists’ attitude towards professionalism and its subscales which are defined later in detail. A total number of 1000 pharmacists were surveyed and 560 of them filled and returned the questionnaires. On a scale from 1-5 on which 1 was corresponded with strongly agree and 5 with strongly disagree, the total score of pharmacists professionalism was 92.9 ± 10.4 out of 130. As regards the subscales, in the subscale of accountability 46.8% of participants, in the subscale of altruism 90.1% of participants, in the theme of duty 85.7% of participants, and in the subscale of working relationship with physicians 84% of pharmacist achieved more than two third of the total score. Only in term of conflict of interest 67.9% of participants scored less than two third (17–25) of the total score. Women obtained significantly higher scores in altruism (P<0.05). Furthermore, there was a correlation between age and the score of accountability and working relationship with physicians; and, the same was observed in regards with work experience with the score of working relationship with physicians. The employment position affected neither our participants’ response to the whole questionnaire nor any of subscales.
Although the total score for professionalism was not dramatically decreased, the significantly low results are alarming and they should be considered more seriously. In order to enhance the level of pharmacists’ professionalism, especially in some special aspects, it seems necessary to conduct similar surveys on pharmacy students and registered pharmacists with a more comprehensive questionnaire. Overall, it can be concluded that designing a proper teaching course in professionalism for pharmacy students is of paramount importance if we are to promote professionalism in future pharmacists.
PMCID: PMC3713883  PMID: 23908748
Pharmacy professionalism; Altruism; Accountability; Pharmacy ethics
17.  Association between self-efficacy, career interest and rural career intent in Australian medical students with rural clinical school experience 
BMJ Open  2015;5(12):e009574.
To investigate medical student's self-efficacy at the time of finishing their rural clinical school (RCS) placement and factors associated with self-efficacy. Secondary aims are to explore whether interest levels or self-efficacy are associated with rural or remote career intentions.
Design, setting and participants
A cross-sectional study of medical students who had completed their RCS term in 17 Australian universities. Data were derived from the 2013 Federation of Rural Australian Medical Educators (FRAME) evaluation survey. Questionnaire responses were analysed from 653 medical students from regional Australia. All 732 students who completed their RCS term in 2013 were invited to participate.
Primary and secondary outcome measures
Rural self-efficacy: Six questions to measure self-efficacy beliefs in rural medical practice, based on the sources of self-efficacy described by Bandura. Rural career intention: Students were asked to identify their preferred location for future practice. The options were, Capital or Major City; Inner regional city or large town; Smaller town and very remote area.
Questionnaire responses were analysed from 653 medical students from regional Australia (response rate 89.2%). 83.8% of all students recalled an increase in their interest levels for rural medicine as a result of their RCS experience. Actual career intention to work in a regional area or rural area was 60.2%. Bivariate analyses showed female gender (p=0.003), rural background (p<0.001), an RCS preference for clinical training (p<0.001) and general practice intentions (p=0.004) were factors associated with higher levels of self-efficacy. Logistic regression analyses showed that self-efficacy was independently associated with increased interest in rural medicine (OR 1.4 (95% CI 1.3 to 1.5)) and rural career intent (OR 1.2 (95% CI 1.1 to 1.3)). (Model included gender, rural background, preference for RCS, generalist intent, rural practice interest and self-efficacy).
Self-efficacy is associated with increased interest levels for rural medicine and rural medical career intent.
PMCID: PMC4680002  PMID: 26671960
18.  Satisfaction with student pharmacists administering vaccinations in the University of Alberta annual influenza campaign 
Canadian Pharmacists Journal : CPJ  2013;146(4):227-232.
To evaluate University of Alberta staff and students’ acceptance of and satisfaction with receiving influenza vaccinations from student pharmacists during the university’s annual influenza campaign.
Material and methods:
A patient survey was created to collect patient demographics, influenza history and feedback on the services provided by pharmacy students and to measure willingness to receive vaccinations from a pharmacist in a community pharmacy. The 13-question survey was distributed to patients who received an influenza vaccination from a student pharmacist during the influenza campaign.
Key findings:
A total of 1555 staff and students completed the satisfaction survey. Almost all (n = 1533, 99%) survey participants were satisfied or very satisfied with the service provided by student pharmacists. A total of 1437 (92%) participants agreed or strongly agreed that based on this experience, they would be willing to receive vaccinations from a pharmacist in a community pharmacy and 1526 (98%) participants rated their overall experience at the flu clinic as very good or excellent.
Positive responses to the survey suggest that University of Alberta staff and students are satisfied with the service provided by student pharmacists. Their willingness to receive vaccines from a pharmacist in a community pharmacy highlighted public acceptance of the expanding role of pharmacists as immunizers.
PMCID: PMC3734910  PMID: 23940480
19.  Does a transition in education equate to a transition in practice? Thai stakeholder’s perceptions of the introduction of the Doctor of Pharmacy programme 
BMC Medical Education  2015;15:205.
Pharmacy education and pharmacy practice are facing remarkable changes following new scientific discoveries, evolving patient needs and the requirements of advanced pharmacy competency for practices. Many countries are introducing or undertaking major transformations in pharmacy education. The Thai pharmacy curriculum has been changed from a 5-year BPharm and a 6-year PharmD to only a 6-year PharmD programme. Curriculum change processes usually involve stakeholders, including both internal and external educational institutions, at all levels. This study aims to understand the experiences and perceptions of stakeholders regarding the transition to an all-PharmD programme in Thailand.
Semi-structured interviews were conducted in Thailand with 130 stakeholders (e.g., policy makers, pharmacy experts, educators, health care providers, patients, students and parents) from August-October 2013. The interviews were audio recorded, transcribed verbatim and analysed using an inductive thematic analysis.
Three main themes were derived from the findings: 1. influences on curriculum change (e.g., the needs of pharmacists to provide better patient care, the US-Thai consortium for the development of pharmacy education); 2. perceived benefits (e.g., improve pharmacy competencies from generalists to specialists, ready to work after graduation, providing a high quality of patient care); and 3. concerns (e.g., the higher costs of study for a longer period of time, the mismatch between the pharmacy graduates’ competency and the job market’s needs, insufficient preceptors and training sites, lack of practical experience of the faculty members and issues related to the separate licenses that are necessary due to the difference in the graduates’ specialties).
This is the first study to highlight the issues surrounding the transition to the 6-year PharmD programme in Thailand, which was initiated due to the need for higher levels of competency among the nation’s pharmacists. The transition was influenced by many factors. Many participants perceived benefits from the new pharmacy curriculum. However, some participants were concerned about this transition. Although most of the respondents accepted the need to go forward to the 6-year PharmD programme, designing an effective curriculum, providing a sufficient number of qualified PharmD preceptors, determining certain competencies of pharmacists in different practices and monitoring the quality of pharmacy education still need to be addressed during this transitional stage of pharmacy education in Thailand.
PMCID: PMC4653906  PMID: 26585968
Stakeholders; Perceptions; Transition; PharmD programme; Preceptors; Workforce; Thailand; A qualitative study
20.  Qualitative interviews of pharmacy interns: determining curricular preparedness for work life 
Pharmacy Practice  2012;10(1):52-56.
One of the key features affecting the transition from university to paid employment is the graduate’s perception of their capability to satisfactorily perform the work of a graduate. In some professions such as in nursing, the concept of "transition shock" is referred to. There is a need to understand how pharmacy students perceive the transition to their first job as intern pharmacists and identify potential curriculum gaps in their pharmacy studies. To date, little evidence around whether university programs are effective in equipping pharmacy graduates in transitioning to the world of work has been published.
To explore from the perspective of new pharmacy professionals, graduated from one Australian university areas that need to be addressed in pharmacy programs to prepare graduates for the transition to full-time work as interns in pharmacy.
Thematic analysis of interviews with interns.
Subthemes were identified within the responses- relationships within the workplace and graduates needing to interest themselves in other people, adjusting to work hours and the differences between university assessments and performing in a workplace. Suggestions were made by graduates that the placement period within the pharmacy program be increased.
Pharmacy graduates appear prepared for the world of pharmacy work. The concept of "transition shock" or "transition stress" described for graduates of other health professions commencing work was not apparent.
PMCID: PMC3798162  PMID: 24155817
Clinical Competence; Education, Pharmacy; Internship, Nonmedical; Australia
21.  Evaluating the impact of pharmacist health education on the perceptions of the pharmacist’s role among women living in a homeless shelter 
Pharmacy Practice  2015;13(4):649.
To determine the impact of pharmacist-provided educational seminars on the participant’s perception of the pharmacist’s role in providing women’s health education. Secondary objectives include the participant’s level of perceived benefit from the information provided during each presentation, as well as determining characteristics of participants who are interested in attending seminars.
This is a prospective study conducted within a homeless women’s shelter in Phoenix, Arizona. Pharmacists and pharmacy students provided 10 monthly educational seminars on topics related to women’s health. Participants completed a pre- and post-seminar survey regarding their perceptions of the presentations and pharmacists.
Fifty-six participants attended at least one of 10 seminars from January to November 2014. The average age was 46 years old, taking approximately 3 medications, and 66% completed a high school degree or lower. Prior to the presentations, 30% of participants agreed or strongly agreed that they would seek advice from a pharmacist on the topic presented, which increased significantly to 82% of participants after the presentation (p<0.001). Similarly, 55% of participants rated themselves as agreeing or strongly agreeing with being knowledgeable on the topic presented prior to the presentation, and this increased significantly to 77% after the presentation (p=0.001). After attending the educational session, 70% of participants agreed or strongly agreed that they would make changes to their health, and that they would attend an additional session. The participants noted their increased learning about the topic, the clarity of visual aids and presentation, and knowledge of the presenters as the best parts of the presentation.
Pharmacist’s participation in providing educational seminars in the homeless women’s population increases the participant’s knowledge and perception of the pharmacist’s role within the population. Future studies can further investigate an evolving role of pharmacists in optimizing healthcare in the homeless population.
PMCID: PMC4696123  PMID: 26759620
Homeless Persons; Women’s Health; Health Education; Pharmacists; Students; Pharmacy; Professional Role; United States
22.  Awareness, use, attitude and perceived need for Complementary and Alternative Medicine (CAM) education among undergraduate pharmacy students in Sierra Leone: a descriptive cross-sectional survey 
The widespread use of CAM around the world requires health professionals including pharmacists to have the required knowledge to better advise their patients. This has lead to an increased need for the inclusion of CAM instruction into the mainstream undergraduate Pharmacy education. This study was designed to describe pharmacy students awareness, use, attitude and perceived need for CAM education at COMAHS-USL and at the same time, determine how these descriptive outcomes are influenced by the socio-demographic variables considered in this study.
A descriptive cross-sectional survey was conducted among undergraduate pharmacy students (n = 90) at the College of Medicine and Allied Health Sciences, University of Sierra Leone using a structured questionnaire. Chi square, fisher exact test, and general linear model univariate analysis were used to compare data between independent cohorts.
All 90 (100%) of the students were aware and have used (except Ayurveda) at least one of the listed CAM modalities. Herbal/Botanical/Supplements followed by Spirituality/Prayer were the most commonly known and used CAM modalities. Almost two thirds of students considered the CAM modalities they have used to be effective and not harmful. Overall, pharmacy students had a positive attitude towards CAM (Mean attitudinal score = 34.9 ± 4. 5 (range 19–43)) with fourth and fifth year students showing a significantly less positive attitude as compared to the first, second and third year (B = −3.203 p = 0.001, 95% confidence interval - 5.093 to −1.314). The media [53 (58.9%)] was the most frequent source of information about CAM. Nearly all students [89 (98.9%)] agreed that CAM knowledge is important to them as future pharmacist and that CAM should be included into the Pharmacy curriculum at COMAHS-USL [81 (90.0%)].
Pharmacy students in Sierra Leone are aware of and have used at least one of the CAM modalities and do show a positive attitude towards CAM. This was demonstrated by their overwhelming endorsement for CAM course to be part of the undergraduate pharmacy training at COMAHS-USL. This study among others will inform and guide the development and implementation of CAM instruction at COMAHS-USL.
Electronic supplementary material
The online version of this article (doi:10.1186/1472-6882-14-438) contains supplementary material, which is available to authorized users.
PMCID: PMC4236455  PMID: 25380656
Complementary and alternative medicine; Pharmacy students; Awareness; Attitude; Use; Education; Sierra Leone
23.  Audit of Renal Drug Dosing: Comparison of 2 Methods and Evaluation of Pharmacists’ Knowledge, Attitudes, and Behaviour 
The renal dosing directive of the Winnipeg Regional Health Authority Pharmacy Program outlines an auditable pharmacy service whereby pharmacists are required to perform documentation (i.e., document their rationale) only if they do not adjust the dose of any medications listed in the directive.
To compare the suitability of manual orders (hard copy) and reports from the pharmacy information system (computer-generated) for determining pharmacists’ compliance with the renal dosing directive; to measure compliance with the renal dosing directive; and to determine pharmacists’ opinions about audit programs.
A retrospective audit was used to compare 400 manual orders with the corresponding orders in reports from the pharmacy information system, to determine compliance with the renal dosing directive. An e-mail survey was performed to gather pharmacists’ opinions about audit programs.
Of the 400 orders evaluated, 86 (22%) required consideration of a dose adjustment. Of these, 78 (91%) showed that dosing followed the guidelines for renal dysfunction in standard pharmacy references. Six (7%) of 86 manual orders and 8 (9%) of 86 pharmacy information system orders were not compliant with the renal dosing directive (i.e., no dosage adjustment and no documentation of rationale). Of 77 pharmacists approached, 34 (44%) completed the survey. Most respondents (31/34 [91%]) agreed that auditing is beneficial to patients, and the same number (31/34 [91%]) agreed that auditing provides important information to the pharmacy program. Only 17 (50%) were aware of medications listed in the renal dosing directive, and 14 (41%) felt that they had received sufficient education about pharmacy directives. Most respondents (29/34 [85%]) agreed that audits would reveal areas for improvement, and all (34/34 [100%]) would comply with any changes required to facilitate performance of an audit if such changes did not increase workload.
Similar results were obtained with the 2 auditing methods used for this study (manual orders and reports from the pharmacy information system). However, pharmacists’ current use of electronic documentation limits the feasibility of pharmacy information system audits. Survey respondents claimed that they were not familiar with the renal dosing directive, but they did agree that auditing clinical services is beneficial.
PMCID: PMC3420850  PMID: 22919105
renal dose adjustments; pharmacists’ compliance; pharmacists’ behaviours and attitudes; ajustements posologiques chez les insuffisants rénaux; conformité de la part des pharmaciens; comportements et attitudes des pharmaciens
24.  Pharmacist, the pharmaceutical industry and pharmacy education in Saudi Arabia: A questionnaire-based study 
Background: In Saudi Arabia there is an estimated need of more than 100,000 pharmacy graduates to cover all present sectors. The shortage of pharmacists has affected many of these sectors especially the pharmaceutical industry. The contribution of Saudi pharmacists to local pharmaceuticals industry would be extremely beneficial and important for shaping the future of the drug industry within the Kingdom. It is not clear whether future Saudi pharmacists are willing to contribute to local pharmaco-industrial fields. Methods: A cross-sectional, questionnaire-based survey was conducted on all final-year pharmacy students in King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia (KSA). Results: Out of a total of 130 students registered in the final-year of the pharmacy program in KSU, 122 (93.8%) were able to complete the questionnaire. The results showed that the majority (83%) of Saudi pharmacy students indicated that they had not received practical training in the pharmaceutical companies, while only 17.2% of the students felt that they had the knowledge and the skills to work in the pharmaceutical industry after graduation. The majority of the students (66.7%) chose clinical pharmacy as their future career field while only 10.9% indicated willingness to work in a pharmaceutical industry career. Only 8.2% selected working in the pharmaceutical industry. The significant predictor of possibly choosing a career in the local drug industry is a student with a bachelor’s degree (compared to Pharm D degree) in pharmacy (OR = 2.7 [95% CI 1.1–6.3]). Conclusion: Pharmacy students who are enrolled in the capital city of Riyadh are not properly trained to play an influential role in local drug companies. As a result, their level of willingness to have a career in such important business is not promising (more among Pharm D program). Future research in other pharmacy colleges within Saudi Arabia is needed to confirm such results.
PMCID: PMC4605904  PMID: 26594125
Pharmacist; Pharmaceutical industry; Pharmacy education; Saudi Arabia
25.  Impact of clerkship attachments on students’ attitude toward pharmaceutical care in Ethiopia 
The study objective is to investigate the impact of mandatory clinical clerkship courses on 5th-year pharmacy students’ attitudes and perceived barriers toward providing pharmaceutical care (PC).
A cross-sectional survey was conducted among 5th-year pharmacy students undertaking mandatory clinical clerkship in the University of Gondar, Ethiopia. A pharmaceutical care attitudes survey (PCAS) questionnaire was used to assess the attitude (14 items), commonly identified drug-related problem/s (1 item) during clerkships, and perceived barriers (12 items) toward the provision of PC. Statistical analysis was conducted on the retrieved data.
Out of the total of 69 clerkship students, 65 participated and completed the survey (94.2% response rate). Overall, 74.45% of participants opinioned a positive attitude toward PC provision. Almost all respondents agreed that the primary responsibility of pharmacists in the healthcare setting was to prevent and solve medication-related problems (98.5%), practice of PC was valuable (89.3%), and the PC movement will improve patient health (95.4%), respectively. Unnecessary drug therapy (43%), drug–drug interactions (33%), and non-adherence to medications (33%) were the most common drug-related problems identified in wards. Highly perceived barriers for PC provision included lack of a workplace for counseling in the pharmacy (75.4%), a poor image of pharmacist’s role in wards (67.7%), and inadequate technology in the pharmacy (64.6%). Lack of access to a patient’s medical record in the pharmacy had significant association (P<0.05) with PC practice, performance of PC during clerkship, provision of PC as clinical pharmacists, and Ethiopian pharmacists benefiting by PC.
Ethiopian clinical pharmacy students have a good attitude toward PC. Efforts should be targeted toward reducing these drug therapy issues, and aiding the integration of PC provision with pharmacy practice.
PMCID: PMC4445313  PMID: 26056513
students; Ethiopia; clinical pharmacy program; clerkship; pharmaceutical care

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