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The United States healthcare system faces immense challenges related to cost, quality, and access. As the pharmacy profession addresses these challenges by shifting toward a practice model centered around direct patient care clinical services, a competent and capable technician workforce is needed to support the roles of pharmacists. Until recently, little focus has been paid to pharmacy technicians or their role as they relate to practice model change. With ongoing pharmacist practice transformation, an approach that ensures uniform technician education, training, registration, and certification is vital to support a practice model designed to transform medication management across the continuum of care. The purpose of this commentary is three-fold: to review the history of pharmacy technician training and practice, discuss current and future technician practice models, and examine workforce development implications.

The opioid epidemic in the United States has led to a quadrupling of opioid overdoses since the 1990s. Stigmas exist among healthcare professionals, and it is essential to educate the next generation of pharmacy technicians regarding opioid use disorder. The main objective of this study was to characterize the phenomenon of stigma through the pharmacy technician lens when taking care of patients who are using opioid medications. Grounded in Van Manen’s phenomenological approach and the Link and Phelan stigmatization model, a qualitative study was conducted from February to June 2020 to understand pharmacy technicians’ perceptions and attitudes towards patients using opioid medications. Focus groups (n = 46) with pharmacy technicians were conducted in-person and online over five months in 2020. Thematic analysis identified three themes that characterize the stigma and the relationship between pharmacy technicians and patients taking opioid medications: (1) pharmacy technician perspectives on stigma and patients with addictive opioid-use behavior, (2) current approaches of pharmacy technicians towards patients with addictive opioid-use behavior, (3) future approaches of pharmacy technicians towards patients with addictive opioid-use behavior. The findings highlight an “ever-present” negative connotation associated with the stigma that is formed from patient interaction. It is necessary to develop proper resources and educational materials to manage the stigma that exists in pharmacies throughout the nation. These resources will facilitate how to address and prevent the stigma among pharmacy technicians in the U.S.

Entrustable professional activities (EPAs) denote activities and tasks students should be able to perform by graduation irrespective of their practice setting. Formulary decision-making includes several core EPA related skills, such as utilization of drug information, written, and verbal skills. The objective of this study was to describe an EPA supporting task aimed at improving utilization of evidence-based medicine skills and its impact on student self-perceived confidence, rating of skills needed, and competence.Teams comprised of six to seven students were assigned a drug and instructed to complete the following activities: (1) background literature search, (2) drug monograph, (3) five-min presentation to simulate a live pharmacy and therapeutics (PT) committee meeting, and (4) vote on a formulary drug in each drug class. Students completed a pre/post five-point Likert scale self-efficacy survey and a perceived importance survey. A scoring rubric assessed monograph and presentation elements (max points 30). Survey items were analyzed using Wilcoxon signed-rank test. Descriptive statistics were used for assignment grades.One hundred ninety students completed the pre/post self-efficacy and perceived importance survey. Confidence showed statistically significant improvement (P.001) in nine target skill areas. In ranking importance, all 12 assessed skills exhibited a statistically significant increase following the activity.A mock PT activity represents an innovative way to evaluate an EPA supporting task that allows students to improve their evidence-based analysis, written, and verbal communication skills.

Competence in drug information (DI) skills fosters the application of evidence-based medicine (EBM) principles. However, concern exists about whether there is adequate DI preparation in curricula. This report describes the development, implementation, and evaluation of a team project utilizing the critically appraised topic (CAT) approach in a DI course.To assess abilities and skills in DI and EBM principles, student teams (N = 26) were assigned DI requests. A grading rubric based on the validated EBM Critical Presentation Evaluation Tool was used to evaluate each team's project. As a secondary measure, students completed pre-and post-class self-efficacy assessments describing their confidence in DI processes.Twenty-six team posters were submitted with a mean project rubric score of 43 out of 50 points (86%). One hundred one of 172 students (59% response rate) completed the pre- and post-self-efficacy surveys, and results revealed gains in confidence for MEDLINE searching skills, properly citing sources, and knowing where to go next if the answer could not be found in a tertiary resource (all P.001). The majority of respondents noted their teams collaborated to achieve project goals, actively participated, were open and accepting of others' ideas, and were satisfied with group interactions.Student team creation of DI responses via CATs are an innovative way to introduce, measure, and enhance DI skills in a didactic classroom setting. Fostering DI skills prepares pharmacy students for evidenced-based pharmacy practice.

Objectives The role of community pharmacists continues to evolve to meet the changing medication-related needs of patients in the United States, requiring a fundamental shift in the pharmacist’s workflow and tasks including medication dispensing and medication therapy management (MTM). To compare community pharmacists’ current and idealized time allocation. Barriers to, and potential facilitators of, typical and specific pharmacist functions are also reported, with an emphasis on MTM practices. A secondary objective included interpreting how pharmacists perceived the value of social determinants of health to the MTM process. Methods Community pharmacists practicing in Tennessee were surveyed online with 3 distinct foci: time allocation and delegation, MTM barriers, and the perceived value of health-related and social data to the MTM process. For the first 2 sections, the respondents provided responses in 2 different scenarios: (1) current workflow and (2) an idealized workflow. Paired Wilcoxon signed-rank and chi-square tests compared the responses to workday items, and Spearman correlations assessed the relationships between preferences and perceived barriers. Results The pharmacists reported spending the largest share of time verifying product (32.8% [SD 19.28]), and most indicated that they spent no time in either point-of-care testing (POCT) or physical patient assessment. In an ideal work environment, more patient-focused roles would be preferred (e.g., health screening, POCT, MTM, and vaccinations), with more than 80% indicating that they would delegate register activities, data entry, and product verification to technicians. In performing MTM, the pharmacists indicated that they would prefer delegating more data collection and patient management activities to technicians to reserve time for patient assessment and care plan creation. Key barriers to MTM included a lack of time, staff support, and patients’ willingness to participate. Conclusion Ideally, pharmacists would prefer to do no prescription filling or selling or register activities. Facilitating community pharmacy practice evolution will require focusing on building teams around support personnel.

Given the significant public health burden of pulmonary diseases and the vital role pharmacists play in management across the continuum of care (and within transitions in care), an elective course for pharmacy students focused on pulmonary diseases was developed.A month-long elective course for third-year pharmacy students consisting of 12 class sessions delivered in two-hour periods three times per week, was implemented. The course was delivered using the team-based learning (TBL) format in addition to hands-on skills and simulation sessions. Knowledge and skills assessments were administered before and after completion of the course. Student perceptions of self-confidence and ability regarding management of pulmonary diseases pre- and post-course and their perceptions of the course and TBL as a teaching strategy for this course were evaluated upon course completion.Nine students completed the course. Mean scores on knowledge and skills assessment significantly improved after completion of the course (54.5% pre-course vs. 79.3% post-course; p0.05% and 60.3% pre-course vs. 93.2% post-course; p0.05, respectively). Student perceptions of their ability to care for patients with pulmonary diseases significantly increased, compared to pre-assessments, in all areas taught in the course (p0.05). Additionally, students' confidence in managing specific disease states significantly improved in all areas (p0.05) except for spirometry (p = 0.06). Students' knowledge, skills, and confidence regarding management of common pulmonary disease states improved following this month-long elective course delivered using a combination of TBL activities and hands-on skills sessions.

Recent changes in the National Resident Matching Program resulted in an expansion from a one-phase to a two-phase process, thus prolonging the typical pharmacy residency interview cycle. In 2017, 5,752 applicants participated in the Match, with 3,831 candidates matching in Phase I.[1][1] A total of

Objective This study quantifies and describes student self-assessment approaches in colleges of pharmacy across the United States. Methods Faculty members identified as assessment directors from college websites at U.S. colleges of pharmacy were electronically surveyed. Prior to distribution, feedback and question validation was sought from select assessment directors. Surveys were distributed and recorded, via Qualtrics ® survey software and analyzed in Microsoft Excel ® . Results Responses were received from 49 colleges of pharmacy (n = 49/134, 37% response rate). The most commonly used strategies were reflective essays (n = 44/49, 90%), portfolios (n = 40/49, 82%), student self-evaluations (n = 35/49, 71%) and questionnaires/surveys/checklists (n = 29/49, 59%). Out of 49 submitted surveys, 35 programs noted students received feedback on self-assessment. Feedback came most commonly from faculty (n = 31/35, 88%). Thirty-four programs responded regarding self-assessment integration including fifteen colleges (n = 15/34, 44%) that integrated self-assessment both into the curriculum and co-curricular activities, while 14 (n = 14/34, 41%) integrated self-assessment exclusively into the curriculum, and five (n = 5/34, 15%) used self-assessment exclusively in co-curricular activities. Discussion and conclusions Student self-assessment is a critical first step of the Continuing Professional Development (CPD) process. Colleges and schools of pharmacy use a wide variety of methods to develop this skill in preparing future practitioners.

Objectives Tennessee has one of the highest rates of opioid prescribing in the United States; therefore, the objectives of this study were to examine availability, pricing, and pharmacist-initiated recommendations of naloxone in retail community pharmacies in Eastern and Western Tennessee; to identify the most common barriers to naloxone dispensing and strategies to improve access; and to determine regional differences in access to naloxone. Design A cross-sectional survey conducted via telephone. Setting and participants All retail community pharmacies located in the most populous counties in the eastern and western regions of Tennessee were eligible for inclusion, as were all retail community pharmacies in the 5 counties in each region that had the highest rates of opioid prescriptions (316 pharmacies identified in 12 counties). Outcome measures Outcome measures included availability, price, and pharmacist-initiated recommendations of naloxone products, barriers to dispensing, and suggestions to improve naloxone access. Survey responses were summarized as descriptive statistics. Chi-square, independent samples t test, and inductive content analysis were conducted. Results Response rate was 56.3%. Most participants (92.7%) reported that naloxone (Narcan) was available from their pharmacies at a mean cash price of $132.49, with no statistically significant differences between regions. The most commonly reported barrier was cost (70.2%). When queried about recommendations to various groups at a high risk of overdose, as advised by the U.S. Department of Health and Human Services, 42.1% to 69.1% of pharmacies reported recommending naloxone to at least 50% of high-risk patients. Suggestions to increase naloxone access included lowering the cost and improving naloxone-related education for patients, pharmacists, and other providers. Conclusion Although Narcan was widely available, cost was a frequently cited barrier to dispensing. Pharmacist-initiated recommendations for coprescribing and dispensing naloxone to patients at a high risk of overdose were limited. Addressing cost issues in addition to increasing patient and pharmacist education concerning the use and benefit of naloxone were suggested to improve naloxone access.

As the health care environment undergoes rapid transformation, increasing costs paired with technological advancements have highlighted the need for value-based health care services and innovative models of delivery. Simultaneously, the role of the pharmacist is undergoing transformation. Pharmacy graduates are now expected to be able to engage in direct patient care roles via collaborative practice, perform comprehensive medication management, and provide preventive care services. Further, the tenets of pharmacy education, while including preparing and dispensing of product, now extend to all-encompassing pharmaceutical care responsibilities. With these transformations, expectations for ensuring competence have grown.1 To meet these and future challenges, pharmacists must be prepared for continuous learning and growth after earning their doctor of pharmacy degree. Unfortunately, the current continuing education (CE) system does not encourage intentional, individualized plans and may need to be reconstructed to meet the needs of today’s practitioners.2,3 Integrating continuing professional development into the current continuing education structure could transform continuing education into a vehicle that advances both the professional’s practice and the greater health care system. Continuing pharmacy education (CPE) has served as the standard for maintaining professional competence for over 40 years in the United States. Defined by the Accreditation Council for Pharmacy Education (ACPE), CPE is a “structured educational activity designed or intended to support the continuing development of pharmacists and/or pharmacy technicians to maintain and enhance their competence.”4 All 50 state boards of pharmacy, the District of Columbia, Guam, and Puerto Rico require CPE hours as a prerequisite for re-licensure.5 Although specific CPE requirements vary from state to state, the majority of state boards of pharmacy (43 states) require either 15 contact hours [1.5 continuing education units (CEUs)] annually or 30 contact hours (3 CEUs) biennially.5 Twenty-three states specifically require “live” CPE hours, and 17 state boards require specific CPE topics such as law, patient safety, immunizations, HIV, or pain management.5 From a regulatory standpoint, completing the hours-based CPE requirements by definition equals competency. Researchers have debated the impact of continuing education in the health professions in the literature for decades.6 The debate centers around the question, “Does participation in continuing education enable the learner to enhance their practice and ultimately improve health care outcomes?”7 The prevailing evidence suggests the answer to this question is both “yes” and “it’s complicated.” Between 1977 and 2014, 39 systematic reviews were published on the impact of continuing medical education (CME).8 These reviews have consistently demonstrated that CME more reliably impacts provider knowledge and performance versus patient outcomes.8 Further, traditional CE activities (conferences, symposia, lectures) improve participant knowledge but generally have a very limited effect on improving clinician practice and patient outcomes.8 Examples of published practice improvements include screening practices, prescribing, and adhering to guideline measurements. Patient outcome measurements include a broad array of clinical endpoints such as smoking cessation, diet, or blood pressure in patients with hypertension, to name a few.8,9 Specific to the pharmacy profession, studies analyzing individual CPE activities have generally, although not exclusively, shown positive effects on behaviors or patient outcomes,10-16 and one systematic review cited the effectiveness of the majority of CPE programs based on their reported outcomes measures, most often knowledge or skill modification.17 Given the frequency of evidence supporting continuing education outcomes, the ultimate CE research question is not “Is CE effective?” but rather “What kinds of CE are effective?”18 Learning activities that are interactive, use multiple delivery methods (case-based learning, demonstrations, feedback, simulations or patient roleplay), involve multiple exposures, and focus on outcomes considered important by the learner lead to more positive outcomes.18 Other factors that affect performance include audience/room size, shorter versus longer sessions, and complexity of intended behavior.8 ACPE classifies accredited CPE activities as one of three types: knowledge-based, application-based, and practice-based.4 In 2015, almost 90% of the 29,661 CPE activities offered by providers were knowledge-based activities or programs designed for participants to acquire factual knowledge as defined by ACPE CPE standards.4,19 Herein lies perhaps one of the major challenges facing continuing education: the overwhelming majority of activities are knowledge-based programs designed to improve a learner’s knowledge of facts when growing expectations from employers, regulators, and payers call for documented improvements in outcomes. Thus, how can one advance one’s practice in a system dominated by activities designed to improve knowledge? One model that has been proposed to aid learners in achieving goals through education is the Continuing Professional Development (CPD) approach. The CPD Approach ACPE defines CPD as an ongoing, self-directed, structured, outcomes-focused learning cycle focused on maintaining and improving performance of professional practice.20 CPD does not replace CE, but rather enhances CE in a broader approach ensuring pharmacist competence and performance and patient health outcomes.1 CPD exists as a cyclical learning process (Figure 1) where the learner reflects, plans, learns, evaluates, and applies. The determination of learning experience is based on assessment of needs and goals. Central to each step in the cycle is a personal learning portfolio where learners record self-evaluations.20 Open in a separate window Figure 1. The CPD Cycle

Limited information exists regarding medication errors and trainees (students or residents). Yet during the experiential education component of their training, learners are expected to assume significant responsibilities in the medication use process. This commentary addresses both trainees and organization leaders on medication safety practices and the incorporation of learners into the organization’s medication safety culture.

Objectives Postgraduate training, dual degrees, and board certifications are credentials viewed by academic pharmacy communities and professional organizations as positive assets for those seeking pharmacist jobs; however, a key question merits further investigation: do these views match employer expectations? The primary objective of this study was to identify the most common qualifications employers require as stated in job advertisements. Methods Pharmacist job postings from the aggregate jobs website Indeed.com were evaluated for the 20 largest metropolitan areas in the United States. Search criteria included: pharmacist, full-time, and within a 50-mile radius of the metropolitan area. Positions were excluded if they were not pharmacist specific, did not require a pharmacy degree, were part-time, or were temporary. Required and preferred qualifications were collected in the following categories: practice type, experience needed, training, certification, and desired skills. Results Six hundred and eleven of 1356 postings met inclusion criteria. Positions were classified as community (113), health-system (264), industry (149), academia (9), or other (76). Four hundred and six (66.4%) required a minimum of a Bachelor's of Pharmacy degree, while 174 (28.4%) required a Doctor of Pharmacy degree. Experience was required for 467 positions (range of 6 months to 14 years). Postgraduate training was required for 73 positions (66 residency/7 fellowship). One job required a Master's degree, type unspecified. BPS certifications were required for 7 positions (1.1%) and preferred for 22 positions (3.6%). Certifications and skills most required by employers were verbal and written skills (248), Microsoft Office proficiency (93), immunization certifications (51), and Basic Life Support/Cardiopulmonary Resuscitation certifications (37). Conclusion Postgraduate training, dual degrees, and board certification were not significant factors in the qualification criteria for the positions identified. The qualifications most often required by employers were experience and skills. Our findings indicated that employers wanted many soft skills that cannot be quantified.

To compare viewpoints of nationally certified and noncertified technicians and explore the perceived value of technician certification in the job performance domains of medication safety, skills and abilities, experience, engagement and satisfaction, and productivity.A cross-sectional survey of pharmacy technicians, from 6 states representing 4 regions of the United States, was conducted. Technician mailing lists were purchased from Boards of Pharmacy, and randomly selected technicians were sent survey invitations. Surveys were completed via Qualtrics and analyzed with the use of SAS.Six hundred seventy-six technicians (547 certified, 103 noncertified, and 26 previously certified) responded to the survey (9.4% response rate). Certified technicians reported significantly higher confidence rating for desire to take on new responsibilities (P0.01; Cohen d 0.45) and plans to remain in the pharmacy field (P = 0.01, Cohen d 0.35), lower rating for leaving the job in the next 12 months (P0.01; Cohen d 0.35), and perceived lower rate of medication errors (P0.01; Cohen d 0.35) compared with other technicians in the work setting. The majority of respondents stated confidence in performing the "final check" on another technician's preparation of a new or refill medication if allowed. Both certified and noncertified technicians noted dissatisfaction with pay. The majority of respondents reported that they spent none of or less than 10% of their workday assisting pharmacists with medication therapy management (MTM) sessions, immunizations, or point-of-care tests; however, 71 respondents specifically described how they assist pharmacists with MTM.Results from our survey sample indicate that certified technicians have a stronger organizational and career commitment and desire to take on new roles. A majority of respondents noted dissatisfaction with pay but feel a sense of pride in their work. Both groups were confident in their abilities needed for tech-check-tech product verification.