Canadian faculties (schools) of pharmacy are actively engaged in the advancement and restructuring of their programs in response to the shift in pharmacy to pharmacists having/assuming an advanced practitioner role. Unfortunately, there is a paucity of evidence outlining optimal strategies for accomplishing this task. This review explores several educational changes proposed in the literature to aid in the advancement of pharmacy education such as program admission requirements, critical-thinking assessment and teaching methods, improvement of course content delivery, value of interprofessional education, advancement of practical experiential education, and mentorship strategies. Collectively, implementation of these improvements to pharmacy education will be crucial in determining the direction the profession will take.
pharmacy education; advanced practice; entry-to-practice PharmD
A recent shift in the pharmacy workforce away from stable, long-term employment has been reported by students. Few data exist regarding the postgraduation employment experiences of students.
An electronic survey exploring postgraduation employment experiences was distributed to 2012–2013 graduates from the Universities of Waterloo and Toronto (including the International Pharmacy Graduate program). Follow-up interviews were undertaken to explore survey findings.
Three key themes emerged: 1) the rising prevalence of the “survival job” in pharmacy; 2) tension between professional satisfaction and practical considerations; and 3) an employment market characterized by personal networks, not merit.
Fewer students are securing full-time positions with benefits, and more are relying upon temporary, part-time work with multiple employers. Implications of this employment pattern for the ability to form pharmacist-patient relationships and provide pharmaceutical care require further investigation.
Further exploration of themes identified in this study is required, as is annual study of the experiences of new graduates. Their experiences will shape the future of professional practice and are of interest to academics, educators and practitioners.
Despite the changing role of the pharmacist in patient-centred practice, pharmacists anecdotally reported little confidence in their clinical decision-making skills and do not feel responsible for their patients. Observational findings have suggested these trends within the profession, but there is a paucity of evidence to explain why. We conducted an exploratory study with an objective to identify reasons for the lack of responsibility and/or confidence in various pharmacy practice settings.
Pharmacist interviews were conducted via written response, face-to-face or telephone. Seven questions were asked on the topic of responsibility and confidence as it applies to pharmacy practice and how pharmacists think these themes differ in medicine. Interview transcripts were analyzed and divided by common theme. Quotations to support these themes are presented.
Twenty-nine pharmacists were asked to participate, and 18 responded (62% response rate). From these interviews, 6 themes were identified as barriers to confidence and responsibility: hierarchy of the medical system, role definitions, evolution of responsibility, ownership of decisions for confidence building, quality and consequences of mentorship and personality traits upon admission.
We identified 6 potential barriers to the development of pharmacists’ self-confidence and responsibility. These findings have practical applicability for educational research, future curriculum changes, experiential learning structure and pharmacy practice. Due to bias and the limitations of this form of exploratory research and small sample size, evidence should be interpreted cautiously.
Pharmacists feel neither responsible nor confident for their clinical decisions due to social, educational, experiential and personal reasons. Can Pharm J 2013;146:155-161.
Canadian pharmacy residency programs rely on preceptors to support the growing demand of graduates wishing to pursue hospital residencies. Understanding the educational needs of these preceptors is important to ensure that they are well prepared to deliver successful programs.
To determine what new and experienced residency preceptors self-identify as learning needs in order to become more effective preceptors for pharmacy residents.
A needs assessment of preceptors from the 31 accredited Canadian general hospital pharmacy residency programs was conducted. The study had 4 key components: interviews and focus group discussions with key informants, a pilot study, an online survey, and member checking (seeking clarification and further explanation from study participants). The residency coordinators and a convenience sample of 5 preceptors from each program were invited to participate in the survey component.
Of a possible 186 participants, 132 (71%) responded to the survey. Of these, 128 (97%) were confident that they met the 2010 standards of the Canadian Hospital Pharmacy Residency Board (CHPRB). Preceptors ranked communication skills, giving effective feedback, and clinical knowledge as the most important elements of being an effective preceptor. Managing workload, performing evaluations, and dealing with difficult residents were commonly reported challenges. Preceptors expressed a preference for interactive workshops and mentorship programs with experienced colleagues when first becoming preceptors, followed by 1-day training sessions or online learning modules every other year for ongoing educational support. The most beneficial support topics selected were providing constructive feedback, practical assessment strategies, small-group teaching strategies, effective communication skills, and setting goals and objectives.
This study identified several learning needs of hospital residency preceptors and showed that preceptors would appreciate educational support. Utilization of these results by residency program administrators, the CHPRB, and faculties of pharmacy could be beneficial for residency programs across Canada.
hospital pharmacy residency; preceptor; preceptor development; pharmacy education; résidence en pharmacie d’hôpital; précepteur; perfectionnement des précepteurs; enseignement de la pharmacie
Objective: The objective of the study was to explore the experiences of physicians prescribing gabapentin off label.
Methods: We used a case study approach to explore the experiences of physicians prescribing gabapentin for off-label indications. Semi-structured interviews were conducted with 10 physicians (psychiatry, pain and neurology specialists) in the Greater Toronto Area. Data were collected to the point of saturation of key themes and analyzed using interpretive content analysis.
Key findings: Key informants appeared to rely primarily on informal information from colleagues and meetings, putting into question the accuracy of their information about the potential off-label uses of gabapentin. Our findings suggest the need for more evidence-based information on off-label drug use.
Conclusion: There is a need for greater understanding of off-label prescribing practices as an important step toward improving rational prescribing and ultimately toward improving patient safety and health outcomes.
Introduction: In 2010, the Ontario government brought forward Bill 16, which, among other things, removed pharmacists' professional allowances. While many would disagree with this unilateral action by the Ontario government, it also could have served as a crisis for change towards patient-centred care. We sought to examine the response of the pharmacy profession in Ontario to this crisis as it relates to the vision outlined in the Blueprint for Pharmacy.
Methods: We systematically examined publicly available responses to Schedule 5 of Ontario's Bill 16 during the period from April to June 16, 2010. A rapid textual analysis of the data using tag or word clouds and a qualitative content analysis were performed on all of the data collected.
Results: The rapid textual analysis revealed that the most frequently used terms were “pharmacist,” “pharmacy” and “professional allowances”; the least used were “layoffs,” “service cuts” and “patient care.” Content analysis revealed 4 themes: the desire to maintain the status quo of practice, a focus on the business of pharmacy, pharmacy stakeholders' perceptions of government's attitude towards the profession and changes to patient services.
Discussion: It is notable that patient care was almost completely absent from the discussion, a reflection that our profession has not embraced patient-centred care. This also represents a missed opportunity — a crisis that could have been used to move the profession towards the Blueprint's vision. We thought that the Blueprint had already achieved this consensus, but the Ontario experience has shown that this may not be the case.
Herbal products are readily available over the counter in health food stores and are often perceived to be without risk. The current Canadian adverse event reporting system suffers from severe underreporting, resulting in a scarcity of safety data on herbal products. Twelve health food store personnel in the Greater Toronto Area were interviewed about their responses to herbal product–related adverse reactions. They generally fostered customer loyalty by offering generous return policies, which included collecting contact information to be sent to the manufacturers with the returned product. Thus, despite the public's lack of knowledge about the formal reporting system, adverse reaction information was directed to manufacturers whenever it resulted in a product return. The relationship between health food stores, industry and Health Canada provides a new opportunity to facilitate adverse event reporting. Additional information could be collected during the return process, and educational initiatives could be implemented to augment current post-market surveillance procedures for herbal products.
To reach consensus on core competency statements for natural health products (NHPs) for Canadian pharmacy students.
Four rounds of a modified Delphi method were used to achieve consensus on core competency statements for NHPs. Pharmacy educators from Canada and the United States, and representatives from Canadian pharmacy organizations ranked their agreement using a 5-point Likert scale.
Consensus was achieved on 3 NHP-related core competency statements: (1) to incorporate NHP knowledge when providing pharmaceutical care; (2) to access and critically appraise NHP-related information sources; and (3) to provide appropriate education to patients and other health care providers on the effectiveness, potential adverse effects, and drug interactions of NHPs.
Consensus was reached among leaders in NHP education on 3 NHP-related core competency statements. Implementation of these competencies would ensure that graduating Canadian pharmacists would be able to fulfill their professional responsibilities related to NHPs.
natural health products (NHPs); competencies; Delphi method; complementary and alternative medicine; herbal medicine
Natural health products (NHPs), such as herbal medicines and vitamins, are widely available over-the-counter and are often purchased by consumers without advice from a healthcare provider. This study examined how consumers respond when they believe they have experienced NHP-related adverse drug reactions (ADRs) in order to determine how to improve current safety monitoring strategies.
Qualitative semi-structured interviews were conducted with twelve consumers who had experienced a self-identified NHP-related ADR. Key emergent themes were identified and coded using content analysis techniques.
Consumers were generally not comfortable enough with their conventional health care providers to discuss their NHP-related ADRs. Consumers reported being more comfortable discussing NHP-related ADRs with personnel from health food stores, friends or family with whom they had developed trusted relationships. No one reported their suspected ADR to Health Canada and most did not know this was possible.
Consumers generally did not report their suspected NHP-related ADRs to healthcare providers or to Health Canada. Passive reporting systems for collecting information on NHP-related ADRs cannot be effective if consumers who experience NHP-related ADRs do not report their experiences. Healthcare providers, health food store personnel, manufacturers and other stakeholders also need to take responsibility for reporting ADRs in order to improve current pharmacovigilance of NHPs.
To develop and establish the validity and reliability of a conflict management scale specific to pharmacy practice and education.
A multistage inventory-item development process was undertaken involving 93 pharmacists and using a previously described explanatory model for conflict in pharmacy practice. A 19-item inventory was developed, field tested, and validated.
The conflict management scale (CMS) demonstrated an acceptable degree of reliability and validity for use in educational or practice settings to promote self-reflection and self-awareness regarding individuals' conflict management styles.
The CMS provides a unique, pharmacy-specific method for individuals to determine and reflect upon their own conflict management styles. As part of an educational program to facilitate self-reflection and heighten self-awareness, the CMS may be a useful tool to promote discussions related to an important part of pharmacy practice.
conflict management; pharmacy education; self-reflection; interprofessional
In Canada, the education of pharmacists is built upon a foundation of strong, research-intensive publicly funded universities and a universal health-care system that balances government and private financing for prescription medications. The evolution of pharmacy education and practice in Canada has laid the foundation for a variety of emerging trends related to expanded roles for pharmacists, increasing interprofessional collaboration for patient-centered care, and emergence of pharmacy technicians as a soon-to-be regulated professional group in parts of the country. Current challenges include the need to better integrate internationally educated pharmacists within the domestic workforce and tools to ensure continuous professional development and maintenance of competency of practitioners. Academic pharmacy is currently debating how best to manage the need to enhance the pharmacy curriculum to meet current and future skills needs, and whether a doctor of pharmacy (PharmD) degree ought to become the standard entry-to-practice qualification for pharmacists in Canada.
Canada; comparative education; international pharmacy education
To determine fourth-year Canadian pharmacy students' knowledge of herbal medicine and whether that knowledge is associated with mandatory instruction in herbal medicine.
Standardized multiple-choice tests assessing students' herbal knowledge were distributed to all fourth-year BSc pharmacy students at 5 pharmacy schools in Canada.
The Quebec response rate was too low to include in the analysis. Herbal knowledge test scores were positively associated with having previously taken an herbal medicine class and completion of a pharmacy practicum. However, postsecondary education, age, and gender were not associated with herbal knowledge test scores. Students at the University of British Columbia had the highest score, followed by Alberta, Nova Scotia, and Ontario.
Pharmacy students' knowledge of herbal medicine varies depending on the school attended and higher herbal knowledge test scores appear to be most closely related to mandatory herbal instruction.
herbal supplements; complementary and alternative medicine; assessment
To examine whether self-assessment and reflection-in-action improves critical thinking among pharmacy students.
A 24-item standardized test of critical thinking was developed utilizing previously-validated questions. Participants were divided into 2 groups (conditions). Those in condition 1 completed the test with no interference; those in condition 2 completed the test but were prompted at specific points during the test to reflect and self-assess.
A total of 94 undergraduate (BScPhm) pharmacy students participated in this study. Significant differences (p < 0.05) were observed between those who completed the test under condition 1 and condition 2, suggesting reflection and self-assessment may contribute positively to improvement in critical thinking.
Structured opportunities to reflect-in-action and self-assess may be associated with improvements among pharmacy students in performance of tasks related to critical thinking.
critical thinking; self-assessment; reflection
To evaluate the accuracy of self-assessment skills of senior-level bachelor of science pharmacy students.
A method proposed by Kruger and Dunning involving comparisons of pharmacy students' self-assessment with weighted average assessments of peers, standardized patients, and pharmacist-instructors was used.
Eighty students participated in the study. Differences between self-assessment and external assessments were found across all performance quartiles. These differences were particularly large and significant in the third and fourth (lowest) quartiles and particularly marked in the areas of empathy, and logic/focus/coherence of interviewing.
The quality and accuracy of pharmacy students' self-assessment skills were not as strong as expected, particularly given recent efforts to include self-assessment in the curriculum. Further work is necessary to ensure this important practice competency and life skill is at the level expected for professional practice and continuous professional development.
self-assessment; continuous professional development; pharmacy student; evaluation; assessment
To compare the test-taking skills and abilities (testwiseness) of Canadian senior-level pharmacy students with those of international pharmacy graduates.
A 20-item testwiseness questionnaire was developed and administered to 102 participants: 35 senior-level pharmacy students, 34 international pharmacy graduates, and 34 practicing pharmacists who served as a control group.
Mean testwiseness scores indicated significant differences in performance between senior-level pharmacy students and international pharmacy graduates. Testwiseness deficiencies of international pharmacy graduates were particularly severe in domains requiring discerning use of English language.
Differences in testwiseness appear to exist between Canadian senior-level pharmacy students and international pharmacy graduates. The genesis and implications of these differences must be evaluated further in order to determine whether testwiseness affects learning, professional development, or clinical practice.
examination; testing; test-taking strategies; assessment; international pharmacy graduates
To develop a Professional Skills Enhancement Workshop (PSEW) to assist practitioners who require skills training to maintain competency and meet new standards of practice. Participants for this workshop were identified as those pharmacists who completed the peer review assessment process and who did not meet standards of practice expectations.
The full-day workshop consists of a half-day introduction to use of clinical drug information resources and approaches to addressing practice-based questions. The second part of the workshop introduces participants to the use of structured patient-interviewing techniques to elicit information using standardized patients. Participants in the workshop completed self-assessments as well as course evaluations. Subsequent to completion of the course, participants rechallenged the peer review assessment process, a test of their clinical skills consisting of a written test of clinical knowledge and an objective structured clinical examination (OSCE), to provide objective evidence of skills acquisition.
Over 90% of participants “agreed” or “strongly agreed” that the PSEW was helpful in reacquainting them with current standards of professional practice. Sixty-nine percent of participants who completed the peer review assessment rechallenge process following completion of the course were able to meet standards of practice expectations.
In developing continuous professional development programs, first identifying the needs of all practitioners is essential. The PSEW provides one model for skills training for practitioners who, for a variety of reasons, may not have maintained the expected level of competency.
continuous professional development; quality assurance; pharmacy education; pharmacy practice
To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of “standardized patient” and “simulated patient” educational methodologies.
The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course.
Overall, students responded positively to the shift from “standardized” patients to “simulated” patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice.
Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs.
clinical simulations; simulated patients; objective structured clinical examination
The objective of this study was to examine possible associations between students' self-reported behaviors and opinions towards academic dishonesty, and their attitudes towards curriculum, assessment, and teaching within the pharmacy program.
A questionnaire was developed and distributed to undergraduate (pre-licensure) students at 4 schools of pharmacy in Canada, including students enrolled in the international pharmacy graduate program.
More than 80% of respondents indicated they had participated in one or more of the act of academic dishonesty described in the questionnaire. A weak to moderate correlation was found between students' attitudes towards pharmacy education and their self-reported behaviors related to academic dishonesty.
This study confirmed previous findings suggesting widespread academic dishonesty as well as a hierarchy of values with respect to students' perceptions regarding severity and importance of academic dishonesty. Despite methodological limitations inherent in examining academic dishonesty, there is a definite need to continue to examine this important issue. While this study indicated only a moderate correlation between attitudes towards curriculum and dishonest behaviors, the problem of academic misconduct is multifactorial and will require ongoing study.
academic dishonesty; plagiarism; pharmacy education; attitudes; curriculum