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The objective of this study is to explore the relationship between institutional factors and offerings of global health education opportunities in pharmacy schools.Data for this project came from a review of international advanced pharmacy practice experiences (APPEs) and global course offerings for US pharmacy schools conducted between February 1 and March 31, 2014. These data were merged with data on institutional factors which may influence a school's offering of APPEs or courses. Institutional factors included tuition, class size, academic medical center affiliation, year established, and others. Multivariable regression models were used to evaluate the relationship between individual institutional factors and APPEs and global courses.In multivariable adjusted models, older and more established schools had a larger percent of the graduating class with an international APPE (9.5% vs. 2.6%, p 0.01) and a larger number of international APPEs (3.8 vs. 1.4, p 0.01) than schools founded after 1980. Schools with higher tuition ($25,000/year) had, on average, a larger percent of their graduating class with an international APPE (7.9% vs. 3.1%, p 0.05), a larger number of international APPEs (3.7 vs. 1.5, p 0.01), and more interprofessional international APPEs (3.1 vs. 0.7, p 0.001). There were more course offerings at older schools (1.1 vs. 0.4, p 0.05) and those with higher tuition (1.3 vs. 0.4, p 0.01).More established schools and those with higher tuition appeared to have more robust global offerings. Schools can consider local opportunities to provide global experiential and didactic experiences, which may reduce the financial burden of global programs.

Purpose An innovative certificate program aimed at expanding the rural pharmacy workforce, increasing the number of pharmacists with expertise in rural practice, and improving healthcare outcomes in rural North Carolina is described. Summary Predicted shortages of primary care physicians and closures of critical access hospitals are expected to worsen existing health disparities. Experiential education in schools and colleges of pharmacy primarily takes place in academic medical centers and, unlike experiential education in medical schools, rarely emphasizes the provision of patient care in rural U.S. communities, where chronic diseases are prevalent and many residents struggle with poverty and poor access to healthcare. To help address these issues, UNC Eshelman School of Pharmacy developed the 3-year Rural Pharmacy Health Certificate program. The program curriculum includes 4 seminar courses, interprofessional education and interaction with medical students, embedding of each pharmacy student into a specific rural community for the duration of training, longitudinal ambulatory care practice experiences, community engagement initiatives, leadership training, development and implementation of a population health project, and 5 pharmacy practice experiences in rural settings. Conclusion The Rural Pharmacy Health Certificate program at UNC Eshelman School of Pharmacy seeks to transform rural pharmacy practice by creating a pipeline of rural pharmacy leaders and teaching a unique skillset that will be beneficial to healthcare systems, communities, and patients.

Objectives The primary objective is to describe the impact of an AACP session on participants' opinions toward rural health pharmacy education. The secondary objective is to determine the session's impact at participants' pharmacy institution. Methods Participants were surveyed twice, once via paper during the session and then via telephone, four months after the session. Questions were related to respondent perception of rural health needs and the impact of the session on participant home institution. Results The pre- and post-questionnaires had response rates of 66.7% and 68.4%, respectively. No change was seen in respondent opinion for most prompts, but more respondents disagreed at follow-up with a statement that pharmacists in rural and urban areas require the same skills (65.6% pre and 82.1% post, p Conclusions Pharmacy educators interested in rural health share similar opinions regarding rural health pharmacy education and are motivated to initiate change in this area. Attendance at a national meeting may impact attendee home institutions.

To gain an understanding of pharmacistsʼ and student pharmacistsʼ perceptions of careers in academia. Surveys were administered via e-mail to 13,451 licensed pharmacists in the state of North Carolina and to 304 third- and fourth-year professional students at the UNC Eshelman School of Pharmacy. Overall, 25% of student pharmacists and 35% of pharmacists indicated that they were considering or had considered a position in academia. In addition, 67% of all respondents indicated being informed about pharmacy career opportunities by previous faculty members. Meaningful work, interfacing with students, and flexible hours were cited as being most important in considering academia, while politics, geographical location, and pay were cited as barriers. Perceptions of the academic environment may present a challenge to increasing interest in careers in pharmacy academia. Study results indicate that efforts, in addition to exposing students to careers in academia, are necessary to address barriers that impact perceptions of academia.

Introduction To identify themes regarding the skills used on a regular basis by pharmacists practicing in rural areas. Methods A cross-sectional qualitative survey was administered to pharmacists working in a non-clinical capacity in rural community and hospital practice. Pharmacists were identified in conjunction with departments of experiential education, boards of pharmacy, and other rural health experts. Contacts were interviewed using a semi-structured approach with thematic saturation determining the number of interviews. Themes were identified by reviewing interview notes and transcripts for repeated phrases, concepts, and ideas then compared with the literature. Results Fifteen pharmacists practicing in rural areas were interviewed. Themes related to practice environment, patient population, skills used by rural pharmacists, preparation of students, and continuing education needs were identified. Many of the identified themes are corroborated by published literature. One pharmacy-specific theme not corroborated was “pharmacy specialization is not helpful”. Discussion and conclusions The results of this study coupled with data from rural medical education may be useful for educators developing rural-focused coursework via reverse design.

The development of professional attitudes and behaviors in students who will become pharmacists is an important outcome for pharmacy education. The literature in higher education has shown that student engagement during college leads to positive learning outcomes as well as the development of character. Assuming that character development and professionalism development are parallel processes, this preliminary research seeks to describe first-year experience (FYE) programming and health professional schools' programming intended to promote professional behavior. Objectives (1) To compare strategies used by undergraduate FYE programs to enhance student engagement with approaches used by professional doctoral programs to improve professionalism; and (2) to recommend methods of improving development of professionalism in pharmacy education. Methods Interviews were conducted with FYE leaders and professional school leaders in six US universities that have pharmacy schools. An analysis of the literature in higher education on student engagement and FYE was conducted. Results Both FYE and professional programs used orientation programs, course work, and student codes of conduct to develop character or professionalism, respectively. The FYE programs included more reflective/writing activities, peer mentoring, and diversity activities than professional schools. Conclusions The undergraduate FYE is a useful framework for developing professional attitudes and behaviors in pharmacy students. Recommendations for pharmacy education include: (1) incorporating professionalism development into program mission statements; (2) communicating the importance of developing professionalism to students; (3) offering activities aimed at professional development; and (4) engaging students fully in these activities.

The pharmacy education literature reveals that the clinical performance of students is less than that expected by faculty. Because assessment methods can substantially influence education, poor performance may be improved with more innovative methods of clinical assessment, such as those that involve the use of standardized patients. This manuscript describes the development, coordination, and assessment of the objective structured clinical examinations (OSCEs) administered over three semesters to the same class of students at the University of North Carolina at Chapel Hill. Results of this project indicate that despite the substantial financial expenditures associated with administering OSCEs, both students and faculty find these exams a valuable learning experience.

Objective The objective of this commentary is to explore the potential role of the pharmacist in the field of global health by understanding the definition of global health and how it can be applied to the profession of pharmacy. Summary While the role of the pharmacist in public health has been defined, the literature is limited with respect to the role of the pharmacist in global health. It is suggested that the “global” in global health should refer to the scope of a problem and not necessarily the geographic location. Through this lens, pharmacists have the opportunity to play an important role in both public health and global health. In particular, pharmacists can look at the varied global health careers established in medicine and use this as a framework to understand the potential role of the pharmacist within global health practice and program delivery, research, and policy. Conclusions To further define the role of the pharmacist in global health, pharmacists may have to change their perception of what services they can provide and where these services can be applied.

Objective. To evaluate the structure and impact of student organizations on pharmacy school satellite campuses. Methods. Primary administrators from satellite campuses received a 20-question electronic survey. Quantitative data analysis was conducted on survey responses. Results. The most common student organizations on satellite campuses were the American Pharmacists Association (APhA) (93.1%), American Society of Health-System Pharmacists (ASHP) (89.7%), Christian Pharmacists Fellowship International (CPFI) (60.0%), state organizations (51.7%), and local organizations (58.6%). Perceived benefits of satellite campus organizations included opportunities for professional development, student engagement, and service. Barriers to success included small enrollment, communication between campuses, finances, and travel. Conclusion. Student organizations were an important component of the educational experience on pharmacy satellite campuses and allowed students to develop professionally and engage with communities. Challenges included campus size, distance between campuses, and communication.

Approximately 75% of the United States is rural. (1) While 20% of the US population lives outside of urban areas, only 9% of physicians and 12% of pharmacists practice in rural areas. (2,3) This lack of access to primary care is compounded by the significant need for primary care by citizens in rural areas. More than 1 in 3 adults living in rural America is in poor to fair health, with nearly half having at least 1 major chronic illness. (4) Individuals in rural areas have higher rates of smoking as well as obesity, diabetes, and other chronic diseases. (5) In its 2005 report on rural health care, the Institute of Medicine asserted that many of the challenges faced by those living in rural areas can be attributed to the lack of access to basic health care services. Furthermore, this report described 5 strategies to address the lack of care in rural areas, and 1 strategy was to increase the supply of primary care health professionals in rural areas through improved education and training. (4) Although the report did not specify types of providers, specially trained pharmacists may be able to address the health care disparities found in rural areas. Although the shortage of primary care clinicians has persisted for decades, there is evidence that medical education has made progress in eliminating deficiencies in access to rural health care. (6-8) The following universities, in addition to Jefferson Medical College, all have histories of a strong curricular commitment to rural health care: Alabama, Arizona, Illinois-Rockford, Minnesota, and Washington. Much of the University of Washington's involvement in rural health care has been through a coalition of the University's School of Medicine and 5 states in the Northwest, entitled WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho). With regard to rural health, pharmacy education is in its infancy and can be described as trailing medical education in its efforts. Based on a survey of Web sites of accredited pharmacy colleges and schools, (9) 3 were found that promote programmatic and longitudinal curricular offerings in education and training in rural pharmacy health. (10-12) If less than 3% of accredited pharmacy colleges and schools are promoting and providing formal curricular programming in rural pharmacy health, pharmacy education is probably not meeting the need for qualified pharmacy practitioners in rural areas. RURAL-FOCUSED PHARMACY PROGRAMS When considering creation of a rural-focused pharmacy curriculum, the UNC Eshelman School of Pharmacy first looked to local resources such as the statewide Area Health Education Centers (AHEC) Program. The AHEC system is designed to train and retain health care professionals across the state and has met this objective to an extent; therefore, AHEC could be a vital partner in a rural health-based pharmacy curriculum. Across the state of North Carolina, additional allies were identified who were willing to engage in the education of pharmacists with a rural health interest. The school also researched several programs throughout the country and surveyed prospective students. The information gathered suggested that the approach to fulfilling the rural health education need must be multi-faceted, including aspects of recruitment, admission processes, curricular innovation, and rural experiential training. Medical educators have found that a medical school applicant from a rural area is more likely to practice in a rural area. (6,7,13) This trend is juxtaposed with deficits in educational resources for rural areas that may place such applicants at a disadvantage compared to counterparts from metropolitan areas. Students with an interest in rural pharmacy practice may be encouraged to participate in rural health programs through tuition waivers, early admission, or the chance to obtain an additional designation or certification. Additionally, pharmacists are now included in the National Health ServiceCorps (NHSC) State Loan Repayment Program which gives grants to states to operate their own loan repayment programs for primary care providers in medically underserved areas. …

To determine prospective student pharmacists' interest in a rural pharmacy health curriculum.All applicants who were selected to interview for fall 2011 enrollment at the UNC Eshelman School of Pharmacy were invited to participate in a Web-based survey. Questions addressed participants' willingness to participate in a rural health pharmacy curriculum, interest in practicing in a rural area, and beliefs regarding patient access to healthcare in rural areas.Of the 250 prospective student pharmacists invited to participate, 91% completed the survey instrument. Respondents agreed that populations living in rural areas may have different health needs, and students were generally interested in a rural pharmacy health curriculum.An online survey of prospective student pharmacists was an effective way to assess their interest in a rural pharmacy program being considered by the study institution. Location of the rural program at a satellite campus and availability of housing were identified as factors that could limit enrollment.

To describe and assess a course review process designed to enhance course quality.A course review process led by the curriculum and assessment committees was designed for all required courses in the doctor of pharmacy (PharmD) program at a school of pharmacy. A rubric was used by the review team to address 5 areas: course layout and integration, learning outcomes, assessment, resources and materials, and learner interaction.One hundred percent of targeted courses, or 97% of all required courses, were reviewed from January to August 2010 (n=30). Approximately 3.5 recommendations per course were made, resulting in improvement in course evaluation items related to learning outcomes. Ninety-five percent of reviewers and 85% of course directors agreed that the process was objective and the course review process was important.The course review process was objective and effective in improving course quality. Future work will explore the effectiveness of an integrated, continual course review process in improving the quality of pharmacy education.

According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Academic Affairs Committee shall consider the intellectual, social, and personal aspects of pharmaceutical education. It is expected to identify practices, procedures, and guidelines that will aid faculties in developing students to their maximum potential. It will also be concerned with curriculum analysis, development, and evaluation beginning with the pre-professional level and extending through professional and graduate education. The Committee shall seek to identify issues and problems affecting the administrative and financial aspects of member institutions. The Academic Affairs Committee shall extend its attention beyond intra-institutional matters of colleges of pharmacy to include interdisciplinary concerns with the communities of higher education and especially with those elements concerned with health education. Consistent with a theme of exploring the way in which AACP might foster organizational improvement and success among its institutional members, President Jeffrey Baldwin charged the 2009-10 AACP Academic Affairs Standing Committee to consider the outcomes of the 2009 AACP Curricular Change Summit and the recommendations contained in the 5 background white papers. (1-5) The Committee was charged to synthesize recommendations for AACP and its member institutions with regard to curricular issues that need further development, study or implementation. The Committee reviewed and discussed some of the key outcomes from the AACP Curricular Change Summit. Summit participants were asked to identify the 1 or 2 key outcomes that each graduate should possess upon graduation. The Summit participants concluded that the most essential components were critical thinking and problem solving skills. Another of the major findings from the September 2009 AACP Curricular Change Summit was that the generation of students currently entering undergraduate education and trickling into colleges/ schools of pharmacy learn differently from previous student cohorts. Summit participants suggested that it is not as much what is being taught that is the issue with this generation of learners, but rather the manner in which it is taught; specifically the way critical thinking and problem solving skills are learned. The Changing Learner The ability to educate students is an increasingly complicated task that is impacted by a number of factors including the changing learner. It has become apparent that today's students communicate and may even learn in ways unlike previous generations. (6) These students are more comfortable with technology, having used computers, played videogames, and utilized other interactive technologies throughout most of their lives. They are more adept than previous generations at multi-tasking with media and technology; they listen to music, talk or text and use the computer simultaneously. (7) Some categorize these students as the Net generation, while others refer to them as the Millennial generation. (8) This group, typically born between 1982 and 1991, is the first generation to be raised with Internet availability. (8) Prensky refers to these learners as digital natives, as they are "native speakers" of the digital language of computers and the Internet. (7) Computers, the Internet, online resources, and the desire for instantaneous access are fundamental to these students' lives. (8) They are constantly connected and in communication with others through the use of email, social network sites, instant messages (IM), and text messages. (9) Socialization is very important to this new generation of learners. They are especially attracted to activities that include interaction with their peer group. (6) They like to learn and work in teams, however, their interaction need not be face-to-face. For them, technologies such as email, blogs, and online social networking sites can be just as effective as face-to-face interaction. …

Objectives. To assess differences in the practice of pharmacy and in job satisfaction between graduates of a nontraditional doctor of pharmacy (PharmD) program and a bachelor of science (BS) in pharmacy program. Methods. Two separate survey instruments were mailed to 293 PharmD graduates and 293 BS graduates. Results. Two hundred fourteen (73.0%) of the 293 nontraditional PharmD graduates and 189 (64.5%) of the 293 BS graduates completed the survey instruments. Nontraditional PharmD graduates expressed greater satisfaction, both in their current position and with pharmacy as a career, compared to BS graduates. Nontraditional PharmD graduates were more likely than BS graduates to practice in a hospital and have more clinical responsibilities. Conclusions. Nontraditional PharmD graduates are more likely to have greater satisfaction with their job and with pharmacy as a career compared to BS-trained pharmacists.

This paper reviews trends in higher education, characterizing both the current learning environments in pharmacy education as well as a vision for future learning environments, and outlines a strategy for successful implementation of innovations in educational delivery. The following 3 areas of focus are addressed: (1) rejecting the use of the majority of classroom time for the simple transmission of factual information to students; (2) challenging students to think critically, communicate lucidly, and synthesize broadly in order to solve problems; and (3) adopting a philosophy of “evidence-based education” as a core construct of instructional innovation and reform.

The 2010 Patient Protection and Affordable Care Act proposes strategies to address the workforce shortages of primary care practitioners in rural America. This review addresses the question, "What specialized education and training are colleges and schools of pharmacy providing for graduates who wish to enter pharmacy practice in rural health?" All colleges and schools accredited by the Accreditation Council for Pharmacy Education or those in precandidate status as of December 2011 were included in an Internet-based review of Web sites. A wide scope of curricular offerings were found, ranging from no description of courses or experiences in a rural setting to formally developed programs in rural pharmacy. Although the number of pharmacy colleges and schools providing either elective or required courses in rural health is encouraging, more education and training with this focus are needed to help overcome the unmet need for quality pharmacy care for rural populations.

The typical approach to course delivery in higher education, particularly for those courses that are considered “foundational” and are rich with factual content, has remained unchanged for decades. In the usual paradigm, reading or other activities intended to prepare students or provide background information, often in the form of textbooks authored by the lecturer, are provided prior to class. Educators generally believe that students who come to class with the requisite knowledge will be prepared to ask intelligent and informed questions, engage in dialog, or simply be in position to acquire additional information during the class session. This traditional educational strategy has focused largely on communication, retention, and repetition of factual information. While this approach is efficient in achieving a specific endpoint (graduating students who have been exposed to, and hopefully mastered, a well-defined body of knowledge), it does little to bolster perhaps the greatest asset of a bright and motivated student: the ability to critically assess information and utilize that assessment to solve complex problems. Instead, the end result often is students who have a multitude of facts at their fingertips, but are ill-prepared to bring those facts to bear on real-world problems.

Objectives. To determine the extent to which the structured interview is used in the PharmD admissions process in US colleges and schools of pharmacy, and the prevalence and content of interviewer training. Methods. A survey instrument consisting of 7 questions regarding interviews and interviewer training was sent to 92 colleges and schools of pharmacy in the United States that were accredited or seeking accreditation. Results. Sixty survey instruments (65% response rate) were returned. The majority of the schools that responded (80%) used interviews as part of the PharmD admissions process. Of the schools that used an interview as part of the admissions process, 86% provided some type of interviewer training and 13% used a set of predefined questions in admissions interviews. Conclusions. Most colleges and schools of pharmacy use some components of the structured interview in the PharmD admissions process; however, training for interviewers varies widely among colleges and schools of pharmacy.

Objectives. An emphasis on pharmaceutical care has made interdisciplinary teamwork increasingly important. However, required interdisciplinary education is rare in pharmacy education. The purpose of this paper is to discuss pharmacy student participation in a required interdisciplinary case conference designed and implemented for health professional students. Methods. At the University of North Carolina at Chapel Hill, 439 health professional students, including 113 doctor of pharmacy students, participated in a required series of 2 simulated interdisciplinary case conferences. Evaluation focused on changes in knowledge and attitudes of both students and facilitators and included preconference and postconference surveys of students and postconference surveys of facilitators. Results. In general, students' knowledge of other health care professionals increased. With regard to pharmacy students' attitudes toward interdisciplinary care, students reported generally positive attitudes, with a greater improveme...

A case of acute acetaminophen overdose is presented. After ingesting approximately 36 g of acetaminophen, the patient experienced severe hepatic damage with total bilirubin reaching a high of 26.5 mg/100 ml. The complications and present methods available for treating acute acetaminophen overdose are discussed.

Patient data were analyzed retrospectively to evaluate the relationship between several body-weight variables and creatinine production and clearance. Data from 722 creatinine clearance determinations in 627 patients older than 12 years were analyzed. Weight variables were actual body weight (ABW), lean body weight (LBW), ideal body weight (IBW), and lean body mass (LBM). Weight-independent and weight-dependent clearance prediction methods were evaluated. Actual creatinine clearance values were compared with these predictions. Use of LBW and IBW produced equivalent estimates of creatinine clearance that were closer to measured values than those obtained with ABW. The use of LBW or IBW was not appropriate in patients less than 60 inches tall nor in morbidly obese patients. Weight-dependent clearance estimation was superior to weight-independent predictions in morbidly obese patients. A new LBM-based clearance estimation formula was derived; it may be useful for patients less than 60 inches tall. The use of LBM, particularly in patients less than 60 inches tall, should be investigated further.

Data from 722 urine collections (627 patients) from 14 medical facilities were used to compare measured creatinine clearance values with clearance estimates calculated using three "urine-free' mathematical formulas. The influence of two patient weight variables (actual weight, lean body weight) and the level of renal function on clearance prediction was assessed. In addition, site parameters (region, facility), time parameters (month, day, day of the week), and patient parameters (age, sex, height, weight, diagnoses) were evaluated for their statistical influence on the relationship between measured clearance and estimates calculated with one of the methods. Strong, statistically significant correlations were observed between clearance values estimated with each prediction method and measured clearances. Although statistical differences were noticed between mean values predicted with each method, these differences were clinically insignificant. Use of lean body weight for calculation of creatinine excretion produced clearance estimates that were significantly lower than those obtained with actual weight and substantially closer to measured clearance values. Among patient variables, age and two specific diagnoses (congestive heart failure and pregnancy), were statistically associated with variability in the relationship between measured and predicted clearance. Interregional and interfacility differences in the measured-predicted clearance relationship, variability associated with the day of the week of collection, and tendency of the urine-free formulas to over-predict clearance support potential inaccuracy of measured clearance determination. The results suggest that inaccuracies in clearance determination, rather than inadequacies of urine-free prediction methods, account for the majority of the observed variability in the relationship.

To the Editor : We appreciate the thoughtful response by Dr. Ayers to our publication that assessed the structure of student organizations on pharmacy school satellite campuses.[1][1] Her personal experiences on a satellite campus during her pharmacy education are valuable and insightful. We agree