Background: Development of successful, practice-ready pharmacists includes ensuring learners are self-aware and able to reflect on knowledge, skills, and abilities. Single-point rubrics allow for evaluators to provide specific, formative, and actionable feedback to learners while encouraging learner self-reflection. Though evidence indicates reflective practices are important in pharmacy education, there is a general lack of structure for implementation of reflective practices. The primary objective of this study was to compare learner self-evaluations to preceptor and pharmacy resident evaluations for scored learning activities completed on experiential rotations. Methods: This study compared learner self-evaluations to preceptor and pharmacy resident evaluations for three types of assignments completed during experiential rotations at a community teaching hospital. These assignments included clinical presentations, patient counseling, and written drug information responses. The primary endpoint was differences in overall scores between evaluators. Findings: A total of 68 learner evaluations were reviewed, with a majority (89.7%) completed by students on Advanced Pharmacy Practice Experiences. Overall, no significant difference emerged between student and preceptor evaluator scores, indicating that students are able to accurately self-reflect. Conclusion: Pharmacy students on experiential rotations demonstrated consistency in self-scoring and evaluation with preceptors on assignments related to presentations, drug information responses, and patient counseling.

According to the American College of Cardiology and the American Heart Association, warfarin has historically been the standard of care anticoagulant for the treatment of left ventricular thrombus. The use of direct oral anticoagulants (DOACs) has become more prevalent, as they require less frequent laboratory monitoring, offer fixed-dose regimens, are associated with fewer drug-drug and drug-food interactions, and provide more favorable safety profiles when compared to warfarin. However, DOACs are not currently FDA-indicated in the treatment of left ventricular (LV) thrombus. Numerous recent studies have reported and evaluated the use of DOACs for treatment of LV thrombus. Recently, a prospective, open-label, multicenter study evaluated warfarin compared to DOACs for LV thrombus treatment. The AHA recently published a scientific statement regarding the management of patients at risk for and with left ventricular thrombus, which included DOACs as a reasonable alternative to warfarin. This report describes two patients treated with DOACs following LV thrombus diagnosis. The first case is a 71-year-old male admitted for cerebrovascular accident and non-ST-elevation myocardial infarction complicated by a LV thrombus. The second case is an 83-year-old female admitted for acute myocardial infarction complicated with an LV thrombus. Both patients were prescribed apixaban 2.5 mg twice daily. Neither patient has experienced LV thrombus or DOAC treatment related complications. This case series serves as evidence for reduced-dose DOACs as an alternative to warfarin in the treatment of LV thrombus.

Purpose: Objective structured clinical examinations (OSCE) are a valuable assessment within healthcare education, as they provide the opportunity for students to demonstrate clinical competency, but can be resource intensive to provide faculty graders. The purpose of this study was to determine how overall OSCE scores compared between faculty, peer, and self-evaluations within a Doctor of Pharmacy (PharmD) curriculum. Methods: This study was conducted during the required nonprescription therapeutics course. Seventy-seven first-year PharmD students were included in the study, with 6 faculty members grading 10-15 students each. Students were evaluated by 3 graders: self, peer, and faculty. All evaluators utilized the same rubric. The primary endpoint of the study was to compare the overall scores between groups. Secondary endpoints included interrater reliability and quantification of feedback type based on the evaluator group. Results: The maximum possible score for the OSCE was 50 points; the mean scores for self, peer, and faculty evaluations were 43.3, 43.5, and 41.7 points, respectively. No statistically significant difference was found between the self and peer raters. However, statistical significance was found in the comparison of self versus faculty (p = 0.005) and in peer versus faculty (p < 0.001). When these scores were correlated to a letter grade (A, B, C or less), higher grades had greater similarity among raters compared to lower scores. Despite differences in scoring, the interrater reliability, or W score, on overall letter grade was 0.79, which is considered strong agreement. Conclusions: This study successfully demonstrated how peer and self-evaluation of an OSCE provides a comparable alternative to traditional faculty grading, especially in higher performing students. However, due to differences in overall grades, this strategy should be reserved for lowstakes assessments and basic skill evaluations.

Background: The Pharmacists' Patient Care Process (PPCP) offers a method to integrate pharmacotherapy cases between disciplines. However, establishing a consistent grading standard across multiple faculty and disciplines creates a challenge. The purpose of this study was to describe the reliability of a single-point rubric for assessing integrated cases among interdisciplinary graders. Methods: A single-point rubric was developed to provide students with formative and summative feedback on existing integrated cases requiring written PPCP notes. The rubric was calibrated retrospectively on a sample of deidentified cases from two integrated pharmacotherapy courses. Following calibration, 20 submissions were evaluated by an interdisciplinary team of faculty. The following year, four new evaluators graded 12 submissions to ensure continued reliability. Results: Fleiss' kappa was used to determine if there was an agreement between instructors' judgement on the final grade classification of the original 20 submissions. There was almost perfect agreement between the instructors' judgements, kappa= .868. Each section of the PPCP and overall numerical score all showed significant agreement using Kendall's W. Results were similar the following year with four new graders. Conclusion: This study demonstrates the continued reliability of a modified single-point rubric to evaluate written cases involving multiple disciplines.

The notion of consumerism and that students are customers of pharmacy colleges was explored by proponents and opponents to the idea. First, a working definition of a “customer” in pharmacy education is pondered with respect to roles and responsibilities of students and schools/colleges of pharmacy. Second, the pros and cons of “student-centered” education is considered in the light of students and their families being consumers of the educational experience. Third, the duality of student-centered education is discussed including student engagement/disengagement in their learning, professional/unprofessional behaviors and shared/individual responsibilities. Lastly, learning and teaching environment dynamics are discerned when higher education becomes more student-centric and how that may affect the overall outcome of the student and the goals of pharmacy educational programs.

Background: Limited research exists concerning the integration of Chat-Generative-Pre-trained Transformer (ChatGPT) into didactic pharmacy curricula. This project aimed to evaluate the impact of utilising ChatGPT (GPT 3.5) in the development of patient presentations on student perceptions. Methods: Students were given the opportunity to utilise ChatGPT to help organise information included within recorded verbal patient presentations. Following the assignment, students in the second (P2) and third year (P3) pharmacy curriculum completed surveys evaluating perceptions of ChatGPT. Results: Surveys were submitted by 51 P2 students and 48 P3 students. No difference was found regarding perceptions of utilising ChatGPT in patient presentations, except for confidence related to succinctly presenting an assessment and plan and the ability to address patient concerns. Overall, 25/42 (59.5%) P2 and 29/41 (70.7%) P3 respondents felt ChatGPT improved their ability to communicate, 24/42 (57.1%) P2 and 29/41 (70.7%) P3 respondents felt they had improved organisation, and 25/46 (54.3%) P2 and 26/41 (63.4%) P3 respondents felt ChatGPT saved time. Conclusion: Students perceived ChatGPT to positively impact their ability to communicate effectively, organise information, and increase confidence in presenting information. This activity highlights a way to encourage students to develop skills in the use of evolving technology while enabling critical thinking.

Purpose: To describe a case of significantly increased warfarin requirements in a patient receiving rifampin for the management of tuberculosis. Summary: A 76-year-old male was admitted due to altered mentation, cough, and weight loss. He was diagnosed concurrently with tuberculosis and a pulmonary embolism. Given the profound effect of rifampin on CYP450 enzymes, direct oral anticoagulants were avoided and warfarin therapy was selected. Management was further complicated by a gastrointestinal bleed during admission, history of cancer, and low body weight. After several weeks of daily international normalized ratio monitoring, a stable regimen of 14 mg of warfarin daily was established, allowing for the patient's safe discharge. Practice Implications: This report underscores the significance of tailored treatment plans, vigilant monitoring, and interdisciplinary collaboration which are necessary to navigate the complexities associated with these medications and optimize patient outcomes.

Heart failure with mildly reduced ejection fraction (HFmrEF) has been classified using various definitions since its first mention in the literature in 2014. This group was most recently defined in the Universal Definition and Classification of Heart Failure (HF) as HF with a left ventricular ejection fraction of 41% to 49%. An increasing emphasis has been placed on HFmrEF over the past several years, with many recent publications suggesting that common therapies used in HF with reduced ejection fraction provide benefit in this population as well. Patients with HFmrEF comprise approximately one-quarter of all patients with HF. The lack of authoritative guidance concerning pharmacotherapeutic approaches in these patients leaves a significant portion of HF patients without an evidence-based approach. Although it remains unclear if HFmrEF is simply a transitional state from preserved to reduced ejection fraction, or a distinct phenotype requiring medical optimization, there are clear cardiovascular benefits to managing this subset appropriately. This publication was created to help serve as a resource for clinicians on this evolving subset of HF and aid in preventing the progression of this disease state through improved therapy optimization. The objective of this article is to briefly discuss the epidemiology and pathophysiology of HFmrEF and review the pharmacology and clinical application of therapies for the management of HFmrEF.

Objective Describe the pros and cons of considering students as customers of schools of pharmacy. Methods The Academic Leadership Fellows Program (ALFP) contributes to the development of leaders in the academy. ALFP Fellows participate in a debate on current topics in academic pharmacy. Members from Cohort 19 and an ALFP alumni team were assigned sides. Literature reviews of PubMed, Web of Science, Scopus, Eric, and PsycInfo were conducted, and relevant references and online resources were also reviewed. Relevant full-text articles were reviewed and pertinent points included. Results The pro-side argues that students are customers because they pay for their education. However, students are not guaranteed a degree. Second, to financially sustain an institution, students are customers because pharmacy programs respond to their needs and demands. Finally, as customers of the education process, students have a shared responsibility for their education. The con-side argues that students are not customers. Instead, they argue the customers are employers, society, and, most importantly, patients. Second, education is not a transaction, so students cannot be considered customers solely because tuition is associated with the education process. Finally, there are dangers of treating students as customers, including entitlement, poor academic performance, less engagement, and limited relationship building. Conclusions Reflection and collaborative discussions by members of the academy on the transactional and relational elements of student, faculty, and institution relationships can be beneficial in supporting student development, achieving organizational outcomes, and in benefiting society as a whole.

Pharmacy education poses significant challenges and obstacles for students and, ultimately, the profession of pharmacy. Increasing attrition and failure rates in pharmacy schools are a concerning trend, and these issues are projected to worsen in the future. Multiple factors contribute to these outcomes, including the lingering effects of the COVID-19 pandemic, lack of preparedness, motivation, outside distractions, and fragility. Nonetheless, failures provide valuable opportunities for growth and learning. To succeed in pharmacy education, students require the necessary support to overcome the obstacles faced.

Background: Case-based learning has been shown to increase student perception and performance in multiple topics in pharmacy education. However, no studies have evaluated the impact of virtual patients and case-based learning on student knowledge and knowledge retention of therapeutic drug monitoring and dosing. Innovation: Due to a curriculum overhaul promoting integration and application-based learning, the traditional third-year (P3) therapeutic drug monitoring course was reduced from four (4) credit hours to two (2), in order to add time to pharmacotherapy and skills labs. In order to adapt to this change, the course was shifted to a case-based learning format utilizing virtual patients within a simulated electronic health record (EHR) where the course grade distribution shifted in favor of patient cases versus exam questions. An analysis of student knowledge and knowledge retention of antibiotic dosing and monitoring was conducted comparing students who completed the traditional course versus those who completed the case-based course. Findings: Despite the decrease in credit hours, there was no significant difference shown in the initial knowledge assessment between the traditional and case-based courses (87.0 vs 85.5%). Knowledge retention actually improved in the students who completed the case-based course (78.1% vs 82.5%). Conclusion: Utilizing case-based instruction to teach antibiotic dosing and monitoring was successful in preparing students for these skills during their experiential rotations. Even though students had half the instruction time, they were able to perform calculations and retain knowledge as well as students in the traditional curriculum.

Background Minority populations are often underrepresented in landmark trials for the management of heart failure with reduced ejection fraction (HFrEF). Major trials shaping the guidelines sometimes include as few as 5% black patients. Objective The purpose of this pilot study was to evaluate the initiation of guideline-directed medical therapy (GDMT) for HFrEF on hospital discharge for minority vs white populations and its impact on all-cause 30-day readmission rates to identify areas for larger future research studies and opportunities for pharmacist intervention. Methods A retrospective analysis was conducted on patients with HFrEF patients discharged over a 3-month period. The primary objective was to compare all-cause 30-day readmissions in minority vs white patients with HFrEF who were discharged on initial GDMT. Results 300 patients were included in this study, with 188 patients in the minority group and 112 patients in the white group. The minority group was predominantly African American (92%). The primary endpoint demonstrated significantly higher 30-day all-cause readmissions in minority patients compared to white patients who received initial GDMT (20.5 vs 7.7%, P = .0144), despite similar rates of GDMT therapy between groups. Conclusion Initial GDMT in minority patients may not reduce readmissions to the same extent seen in white patients. Special emphasis should be placed on evaluating minority patients with HFrEF for additional therapeutic interventions.

Objective. The 2019 Hospital National Patient Safety Goal 03.05.01 indicates education regarding anticoagulant therapy should be provided to patients and families. Previous studies assessing pharmacist and pharmacy student involvement in oral anticoagulation (OAC) education services have focused on patient-related outcomes, with limited emphasis on the additional benefit to the student. The purpose of this study was to assess the benefit of pharmacy student involvement in anticoagulation education services both clinically and through their perceptions of participating in the service. Methods. This study assessed students' knowledge and perceptions of providing OAC education before and after a 1-month learning experience, where students provided counseling 2-3 days per week. The primary endpoint was comparing each student's pre- and post-rotation OAC education knowledge assessments. Secondary endpoints included percentage change in knowledge between the prospective cohort and a historical comparator group, perceived benefit of student participation in the service, percentage of patients able to recall counseling, and number of interventions made related to OAC therapy. Results. A total of 35 pharmacy students were included in this prospective study with 277 patients receiving counseling from June 2020 through March 2021. A total of 32 pharmacy students had assessment data available for retrospective comparison. The mean pharmacy student score within the prospective cohort improved significantly (21.5%) between the pre-assessment and post-assessment. Change in pre- and post-rotation knowledge assessment was also significantly higher in the prospective cohort compared to the retrospective group. Additionally, students gained confidence in their counseling abilities and OAC knowledge through participation. Conclusion. Pharmacy student participation within anticoagulation education services significantly improved student knowledge and confidence in their counseling abilities. It also allowed for over 70% of patients to successfully recall pertinent information about their anticoagulants over a week later and improved patient care through dosing interventions.

The Impella devices are percutaneous intravascular ventricular assist devices indicated for use in patients with cardiogenic shock that occurs following acute myocardial infarction (MI) or open heart surgery. These devices must be used with a purge solution that contains heparin per manufacturer recommendation, which will prevent blood from reaching the motor causing pump thrombosis and mechanical failure. We describe the utilization of a dextrose-only purge solution plus systemic argatroban in 2 patients with suspected heparin-induced thrombocytopenia (HIT). Each case describes a patient with suspected HIT following Impella placement for cardiogenic shock post-MI that had an increased bleeding risk. In each case, pharmacy monitored and adjusted the patients' argatroban, resulting in therapeutic anticoagulation without major bleeding or thrombotic events. These case reports demonstrate that use of a dextrose-only purge solution in the Impella device may be a safe and effective option when combined with systemic argatroban in patients with suspected or confirmed HIT who exhibit increased bleeding risk. Further research is needed to determine the optimal concentrations and duration of anticoagulation-free purge solution in these patients.

Background Coronavirus disease 2019 (COVID-19) can cause serious complications such as multiorgan failure and death which are difficult to predict. We conducted this retrospective case-control observational study with the hypothesis that low serum albumin at presentation can predict serious outcomes in COVID-19 infection. Methods We included severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed, hospitalized patients from March to July 2020 in a tertiary care hospital in the USA. Patients were followed for 21 days for the development of the primary endpoint defined as the composite outcome which included acute encephalopathy, acute kidney injury, the requirement of new renal replacement therapy, acute hypercoagulability, acute circulatory failure, new-onset heart failure, acute cardiac injury, acute arrhythmia, acute respiratory distress syndrome (ARDS), high flow oxygen support, intensive care unit (ICU) stay, mechanical ventilation or death; and the secondary endpoint of death only. Univariate and multivariate logistic regression analyses were performed to study the effect of albumin level and outcomes. Results The mean age was 56.76 years vs. 55.67 years (P = 0.68) in the normal albumin vs. the low albumin group. We noticed an inverse relationship between serum albumin at presentation and serious outcomes. The low albumin group had a higher composite outcome (93.88% vs. 6.12%, P < 0.05) and higher mortality (13.87% vs. 2.38%, P < 0.05) in comparison to the normal albumin group. The multivariate logistic regression analysis revealed higher odds of having composite outcomes with lower albumin group (odds ratio (OR) 10.88, 95% confidence interval (CI) 4.74 - 24.97, P < 0.05). In the subgroup analysis, the multivariate logistic regression analysis revealed higher odds of having composite outcomes with the very low albumin group (OR 7.94, 95% CI 1.70 - 37.14, P < 0.05). Conclusions Low serum albumin on presentation in COVID-19 infection is associated with serious outcomes not limited to mortality. The therapeutic option of albumin infusion should be investigated.

Objective. The purpose of this study was to determine whether the addition of standardized patients or the addition of interprofessional student teams with standardized patients to the use of a simulated electronic health record improved student knowledge retention and perceptions. Methods. This was a prospective cohort study assessing three cohorts of first-year student pharmacists in pharmacy skills laboratory activities that occurred in 2018, 2019, and 2021. The primary objective of the study was to compare knowledge retention of the case material between groups at one month. Each year, an element of simulated experience was added onto the previous year's case. In 2018, students completed the case using only the electronic health record web application. In 2019, the previous year's experience was combined with an objective structured clinical examination (OSCE) with standardized patients. In 2021, the 2019 experience was supplemented with student physician assistants. Case scores and stu-dent perceptions were also compared between groups. Results. Of the 260 potential participants, 238 students were included in the primary analysis. Results showed that with the addition of interprofessional team-based care and standardized patients, significant improvement was demonstrated in knowledge retention assessments at one month. Mean knowledge retention assessment scores for the 2018, 2019, and 2021 groups were 63.8%, 71.7%, and 76.1%, respec-tively. Significant improvement was also found in student perceptions. Conclusion. Adding standardized patients and interprofessional team-based care to a pharmacy skills laboratory that uses a simulated electronic health record significantly improved student knowledge reten-tion and perceptions.

Objective: The purpose of this study was to evaluate the impact of an Introduction to Internal Medicine (ITIM) elective course on student preparedness for experiential education. Methods: A one-credit elective was offered to second and third-year professional students. It was designed to simulate a typical day as a fourth-year student on rotation while utilising a simulated electronic health record. Upon completion of the course, a survey was sent to assess student preparedness for rotational activities. The students’ reported level of preparedness was compared to their preceptors’ assessment of these same survey items. Results: Thirty-six students and their preceptors responded to the survey. Students rated their preparedness highly, with 80% responding as moderately prepared or higher in navigating a patient chart, identifying patients’ problems, presenting a patient, and identifying treatments for common disease states. Preceptors also noted that over 90% of the students were moderately or much better prepared than students who did not complete the elective. Conclusion: Students completing the ITIM elective course demonstrated high levels of preparedness for a variety of rotational activities from patient care to professional communication.

Background: Area under the curve to minimum inhibitory concentration (AUC/MIC) has been recommended by the 2020 updated vancomycin guidelines for dosing vancomycin for both efficacy and safety. Previously, AUC/MIC has been cumbersome to calculate so surrogate trough concentrations of 15-20 mg/dL were utilized. However, trough-based dosing is not a sufficient surrogate as AUC/MIC targets of 400-600 can usually be reached without achieving troughs of 15-20 mg/dL. Targeting higher trough levels may also lead to adverse events including acute kidney injury (AKI) and nephrotoxicity. Objective: To compare the mean total first day vancomycin dose in traditional trough-based dosing versus dosing recommended by an AUC/MIC dosing program. Methods: Adult inpatients who received at least 24 hours of IV vancomycin treatment were included in this single-center, retrospective cohort study. The primary endpoint was difference in mean total first day vancomycin dose in milligrams (mg) received between patients’ traditional trough-based dosing and recommended dose via AUC/MIC electronic dosing calculator. Patients served as their own control by analyzing both actual dose received and dose recommended by the electronic AUC/MIC program. Rates of vancomycin induced adverse events, including acute kidney injury, elevated steady-state trough concentrations, and Red Man’s syndrome were also compared between patients who received doses consistent with the AUC/MIC dosing recommendation versus those who did not. Results: 264 patients were included in this study. Initial 24-hour vancomycin exposure was significantly lower with the recommended AUC/MIC dose versus the dose received (2380.7; SD 966.6 mg vs 2649.6; SD 831.8 mg, [95% CI 114.7:423.1] p=0.0007). Conclusions: Utilizing an electronic AUC/MIC vancomycin dosing calculator would result in lower total first day vancomycin doses.

IntroductionDecreased well-being in medical careers has resulted in increased burnout, errors, and patient mortality rates. However, while well-being and burnout of providers and medical residents has been studied previously, it is difficult to apply this information to pharmacy residents as the programs are different in time, focus, and requirements. In addition, differences in resident demographics and goals further elucidate difficulties in applying these findings to well-being of pharmacy residents. With residency program directors (RPDs) often having the first and most frequent contact with pharmacy residents, ensuring these individuals better understand resident well-being could facilitate increased well-being and satisfaction, as well as stronger connections to the program itself. ObjectiveThe primary objective was to identify discrepancies between residents and RPDs in the perception of resident well-being. MethodsThis was a pilot cohort study. Resident and RPD responses were solicited utilizing Listservs of RPDs in 15 states, as well as platforms such as the North Carolina Association of Pharmacist's Residency Community. ResultsResidents reported a statistically significant lower overall well-being, with only 49.1% of respondents reporting a "good" or "great" level of well-being, as compared with 80.1% of RPDs reporting their residents' well-being as "good" or "great" (P < .001). Secondary end points, such as perception of communication, relationships, and emotional health, revealed similar significant results of RPDs' higher perception of resident well-being in comparison with resident responses. Of the 15 secondary end points evaluated, 13 showed residents reporting a lower well-being score compared with the RPDs' perception. ConclusionThere is a large disparity between residents' perception and RPDs' perception of well-being. This disparity should be viewed as an opportunity to foster conversation, improve well-being, and implement change in pharmacy residencies across the country. Further studies could be beneficial in understanding specific, successful initiatives that promote higher well-being scores among pharmacy residents.