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As preceptors are responsible for the experiential education of future pharmacists, it is important to assess understanding and identify knowledge gaps for preceptor development. The purpose of this pilot study was to assess the exposure to social determinants of health (SDOH), comfort in addressing social needs, and awareness of social resources among the preceptors at one college of pharmacy. A brief online survey was sent to all affiliated pharmacist preceptors with screening criteria for pharmacists who had regular one-on-one patient interactions. Of 166 preceptor respondents (response rate = 30.5%), 72 eligible preceptors completed the survey. Self-reported SDOH exposure increased along the educational continuum (with increasingly more emphasis from the didactic to experiential to residency). Preceptors who graduated after 2016, practiced in either community or clinic settings and served >50% of underserved patients were the most comfortable addressing social needs and the most aware of social resources. Preceptor understanding of SDOH has implications for their ability to educate future pharmacists. Colleges of pharmacy should evaluate practice site placement as well as preceptor knowledge and comfort in addressing social needs in order to ensure that all students are exposed to the SDOH throughout the continuum of learning. Best practices for up-skilling preceptors in this area should also be explored.

Background. Hyperthyroidism causes an increased hypoprothrombinemic response to warfarin anticoagulation. Previous studies have demonstrated that patients with hyperthyroidism require lower dosages of warfarin to achieve a therapeutic effect. As hyperthyroidism is treated and euthyroidism is approached, patients may require increasing warfarin dosages to maintain appropriate anticoagulation. We describe a patient’s varying response to warfarin during treatment of Graves’ disease. Case Presentation. A 48-year-old African American female presented to the emergency room with tachycardia, new onset bilateral lower extremity edema, gradual weight loss, palpable goiter, and generalized sweating over the prior 4 months. She was admitted with Graves’ disease and new onset atrial fibrillation. Primary stroke prophylaxis was started using warfarin; the patient developed a markedly supratherapeutic INR likely due to hyperthyroidism. After starting methimazole, her free thyroxine approached euthyroid levels and the INR became subtherapeutic. She remained subtherapeutic over several months despite steadily increasing dosages of warfarin. Immediately following thyroid radioablation and discontinuation of methimazole, the patient’s warfarin dose and INR stabilized. Conclusion. Clinicians should expect an increased response to warfarin in patients with hyperthyroidism and close monitoring of the INR is imperative to prevent adverse effects. As patients approach euthyroidism, insufficient anticoagulation is likely without vigilant follow-up, INR monitoring, and increasing warfarin dosages.

Abstract Diabetes is a complex disease. Residents are often challenged by its diagnosis and need to work through cases in the controlled atmosphere of the classroom to reinforce their diagnostic skills. This resource presents a set of cases that walk learners through current research on diabetes mellitus type 2. The module can be used to present the step-by-step process of diagnosis and treatment to learners. The resource includes a PowerPoint presentation reviewing how the diagnosis of diabetes is made, what exams/tests should be performed to prevent sequelae of diabetes, and how to determine goals of therapy. This presentation is used in lecture format to teach residents about the need for a systematic approach to diabetes care. Residents learn the answers to the questions posed in the presentation. The significance of the presentation lies in helping physicians learn a systematic approach. The notes section of the PowerPoint slides offers additional information. An instructor guide presents an overview of activities that can be used to consider how to address issues in working with patients with this disease. The resource is aimed at residents but could be used by students as well.