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Background: There has been considerable discussion regarding the “leadership crisis” in pharmacy, with concerns that insufficient numbers of pharmacists want to take on leadership roles in their own profession. This exploratory study of leaders and influencers in pharmacy was undertaken to characterize the motivations for and behaviours of titled and untitled leaders, in order to help other pharmacists learn from their experiences. Methods: Interviews with 28 individuals who self-identified or were described by others as leaders (with or without formal titles) and influencers in pharmacy were conducted using online platforms (e.g., Zoom, Teams). A semistructured interview guide was used and refined during the interviews. Data were analyzed using a constant comparative method to identify common themes. Results: While participants in this study all described different trajectories towards leadership or influencer roles, several common themes emerged, including 1) personal characteristics that enable leadership roles/activities, 2) environmental supports and drivers that propel leadership forward, 3) positive reinforcers that maintain momentum towards leadership aspirations and 4) general predictors of success as a leader/influencer in pharmacy. Discussion: To address the “leadership crisis” in pharmacy, it will be necessary to motivate and support individuals in assuming these roles. Findings from this study have highlighted the complex and individual pathways current leaders have undertaken to achieve these roles and have signposted ways in which organizations, managers and mentors can support nascent leadership aspirations in productive ways.

Background: The Peel region in Southern Ontario is among the most ethnoculturally diverse and fastest growing areas in Canada. During the COVID-19 pandemic, the multicultural community of Brampton suffered one of the highest infection rates in Canada, in part because of the demographic and socioeconomic characteristics of the community. The role of pharmacists in supporting vaccine uptake in this linguistically, ethnically and religiously diverse community has not been adequately characterized. Methods: A qualitative case study approach was used, focusing on one of the major communities in Peel (Brampton). Interviews with community pharmacists and pharmacy staff directly involved in COVID-19 vaccine administration during the pandemic were undertaken to identify common experiences and trends related to providing care and support to this high-risk community. Constant comparative coding was used to identify common themes that can inform ongoing public health supports in future pandemics. Results: A total of 29 interviews were completed. Key themes that emerged included 1) the impact of operational, organizational and logistical issues on vaccine uptake in the community; 2) the negative influence of inconsistent messaging from public health and other experts during the pandemic; and 3) the identification of an emerging typology of “vaccine hesitancies” describing different reasons/motivations for avoiding COVID-19 vaccination and approaches taken by pharmacy staff to address these within a multicultural, multilingual practice context. Discussion: The COVID-19 vaccination campaign was unprecedented in its size, scope and speed, and community pharmacists were integral in this effort. The unique needs of ethnoculturally, linguistically and socioeconomically diverse communities like Brampton require further studies to examine ways in which the pharmacy profession can positively influence greater vaccine uptake, by increasing understanding of the diverse proliferation of vaccine hesitancies that emerged.

Objectives. To explore the key factors that influence professional identity construction in fourth-year pharmacy students enrolled in a Doctor of Pharmacy program. Methods. A single-site instrumental case study of current fourth-year pharmacy students from the Leslie Dan Faculty of Pharmacy, University of Toronto, was used. Thirteen students participated in semistructured interviews. Poststructural social identity theories were used to analyze the data and identify themes that influence identity construction in pharmacy students. Results. Data analysis identified five overarching themes that influence pharmacy student professional identity construction: Path to pharmacy, curriculum, environment, preceptors, and patient interactions. The Leslie Dan Faculty of Pharmacy curriculum prioritized the health care provider identity, which influenced the students desire to “become” clinicians. Based on their internalized health care provider identity, they rejected preceptors and practice environments that negatively impacted their ability to embody this identity. Conclusion. The findings of this study suggest that pharmacy students align themselves strongly with health care provider identities at the cost of other potentially relevant identities. Pharmacy education programs may benefit from curricular reforms that incorporate and legitimize multiple pharmacist identities to ensure a strong pharmacy workforce for the future.

This project aimed to develop an artificial intelligence (AI)–based tool for improving the consistency and efficiency of decision-making in the nursing complaints process in three jurisdictions. This article describes the tool and the overall process of its development. The AI tool was not designed to replace human judgment but rather to perform three data-driven decision support tasks: (a) an independent risk prediction of the case, (b) a comparison with previous similar cases, and (c) a cross reference to relevant parts of the regulatory standards or rules in each jurisdiction. Three nursing regulatory bodies in the United States, the United Kingdom, and Australia provided anonymized data from 5,700 cases for tool design and testing. Regulatory staff were involved in each stage of development and supported the potential role of an AI-based tool such as this in improving the efficiency and effectiveness of decision-making in disciplinary processes in nursing regulation nationally and internationally..

Introduction: Mock interviews were introduced into a second-year pharmacy course with an embedded pharmacy placement. The aim was to prepare pharmacy students for interviews with possible preceptors when seeking community pharmacy placements. This study aimed to assess students’ perspectives on the impact of this activity. Methods: Second year pharmacy students (n = 35) were provided with general interview guidance and participated in mock placement interviews conducted by community pharmacists. After participating in the mock interview, students were invited to complete two online questionnaires. The first questionnaire was completed following the mock interview and the second questionnaire was completed after students had secured professional placements. Both surveys contained multiple domains including student approach to placement, perceived impact of the mock interview on confidence and preparation, application of the feedback on their real-life interview, understanding employer priorities, linkage with the curriculum and overall student satisfaction. Results: Following the mock interview, most participants (89.5%, n = 17) indicated that they felt better prepared to approach a placement preceptor and for the interview process. All participants who completed the first questionnaire (100%, n = 19) agreed that the feedback following the mock interview was helpful. After securing a placement, more than half (56.5%, n = 13) indicated that they used the skillsets developed during the mock interview when approaching a placement preceptor. Conclusion: The inclusion of mock interviews in the pharmacy curricula was found beneficial and conducive to enhanced skills and confidence in students’ career development.

Pharmacists were integral to the vaccine administration process during the first two years of the COVID-19 pandemic. As such, they encountered a variety of different forms of vaccine resistance. This qualitative study explored 33 community pharmacists (from varying geographical and practice types) responses to vaccine resistance and tactics utilized to support vaccination amongst diverse community members. A typology of 8 different variants of vaccine hesitancy emerged, each with its own root cause and potential opportunities for intervention. Pharmacists in this study described techniques to support adherence to public health guidance based on their assessment of root causes for resistance demonstrated by patients. Importantly, all pharmacists in this study described feelings of anger towards truly anti-vax patients and unwillingness to actually engage or even try to address this group in their practice.

Background: Pharmacists need patients to trust them in order to support best possible health outcomes. There has been little empirical work to test the widely stated claim that pharmacists are the “most trusted” health care professional. This study was undertaken to characterize the factors that shape public trust of individual pharmacists and the profession as a whole. Methods: An exploratory qualitative study was undertaken. Semistructured interviews with 13 patients from 5 different community pharmacies were completed. Interview data were transcribed, coded and categorized to identify trust-enhancing and trust-diminishing factors influencing patients’ perceptions of pharmacists. Results: Four trust-diminishing factors were identified, including the business context within which community pharmacy is practised, lack of transparency regarding pharmacists’ remuneration, lack of awareness of how pharmacists qualify and are regulated and inconsistent previous experiences with pharmacists. Four trust-enhancing factors were identified, including accessibility, affability, acknowledgement and respect. Discussion: This study illustrates that trust-diminishing factors appear to be somewhat outside the day-to-day control of individual community pharmacists, while trust-enhancing factors are elements that pharmacists may have greater personal control over. Further research is required to better understand these factors and to develop a more generalizable understanding of how patients develop trust in their pharmacists. Can Pharm J (Ott) 2021;154:xx-xx.

BACKGROUND: As a result of the COVID-19 pandemic, there has been a significant disruption of the practice of pharmacy. Importantly, in many parts of the world, this disruption occurred literally overnight, requiring pharmacists to demonstrate significant adaptability and resiliency in order to manage continuing and in some cases expanding needs of patients. OBJECTIVES: The objective of this research was to characterize how community pharmacy in Ontario (Canada) responded to the COVID-19 pandemic of winter/spring 2020, in particular in understanding what factors may influence or predict resiliency of individual practitioners and their workplaces. METHODS: One-on-one interviews mediated through technology (Microsoft Teams) were used, following a semi-structured interview protocol. Verbatim transcripts were produced and analyzed by two independent researchers, using an inductive coding process to identify and characterize themes. RESULTS: A total of 21 pharmacists participated in this study. Six themes were identified: a) use of and comfort with technology; b) early adoption of corporate and professional guidance; c) workplaces that emphasized task-focus rather than multi-tasking were more resilient; d) scheduling methods and practices in the workplace are important for personal resilience; e) dedicated specialty staff allowed pharmacists to focus on their work; and f) provision of personal protective equipment was essential. CONCLUSIONS: Traditionally, resilience in professional practice has been characterized as a personal, not a workplace, issue. This study suggests that personal resiliency for pharmacists requires substantial workplace support; further work in this area is required to better understand how pharmacists adapt to complex and difficult situations such as pandemics.

The Canadian experience in managing the first wave of COVID-19 highlights the value of unified political leadership, belief in experts, evidence-informed decision making and social cohesion. Though far from perfect, Canada's response was built upon a foundation of universally accessible health care and faith in public health guidance. Community pharmacy has been an integral part of care delivery during COVID-19. As a second or third wave evolves, it is essential to learn from previous experiences to better prepare for what comes next.

Introduction: Using COVID-19 as the context, this study explored how differences in individual learning styles impacted personal resilience strategies among pharmacy students. This is a uniquely stressful period of time for many learners; pharmacy education has shifted predominantly to novel online forms of teaching, learning, and assessment, and traditional psycho-social support became difficult to access due to lock-down and quarantine requirements. Methods: Data were gathered throughout May and June 2020 via participant-observer, semi-structured interviews. Data analysis was performed using deductive analysis techniques, based on existing themes in resilience research. Results: A total of 21 pharmacy students were interviewed, the majority of whom had ‘Assimilator’ or ‘Converger’ dominant learning styles as classified by Austin’s Pharmacists’ Inventory of Learning Styles (PILS). Assimilators had a stronger sense of professional identity, practiced positive psychology, and utilised journaling as resilience strategies more frequently than Convergers. Convergers were found to be more self-efficacious and adaptable than Assimilators. Conclusions: Rather than providing ‘one-size-fits-all’ advice and programming to pharmacy students, there may be potential to improve resilience by incorporating tailored and specific strategies based on the dominant learning style of each individual student.

Background: Pharmacists report spending a considerable amount of time dealing with drug shortages. There is no research in Canada identifying and describing the strategies and resources that pharmacists use to minimize disruption and continuity of care for patients. Methods: An exploratory qualitative methodology was used. Community pharmacists and technicians in Ontario were interviewed using a semi-structured protocol. Verbatim transcripts were generated and coded by at least 2 independent reviewers using content analysis methods to identify management strategies. Results and Discussion: A total of 14 pharmacists and 7 regulated pharmacy technicians participated in this study. The following 5 main strategies for managing drug shortages were identified: (1) using the supplier, (2) generic options, (3) brand options, (4) contacting other pharmacies and (5) switching to a different medication. Conclusion: The strategies identified through this research can provide pharmacists with some guidance in approaching the real-world problem of drug shortages. It also highlights opportunities for organizations, government and manufacturers to provide additional support for pharmacists to minimize disruptions for patients and to ensure current ad hoc practices do not further compound shortage issues. Can Pharm J (Ott) 2020;153:xx-xx.

Objective. To determine the discourses on professional identity in pharmacy education over the last century in North America and which one(s) currently dominate.Methods. A Foucauldian critical discourse analysis using archival resources from the American Journal of Pharmaceutical Education (AJPE) and commissioned education reports was used to expose the identity discourses in pharmacy education.Results. This study identified five prominent identity discourses in the pharmacy education literature: apothecary, dispenser, merchandiser, expert advisor, and health care provider. Each discourse constructs the pharmacist's professional identity in different ways and makes possible certain language, subjects, and objects. The health care provider discourse currently dominates the literature. However, an unexpected finding of this study was that the discourses identified did not shift clearly over time, but rather piled up, resulting in students being exposed to incompatible identities.Conclusion. This study illustrates that pharmacist identity constructs are not simple, self-evident, or progressive. In exposing students to incompatible identity discourses, pharmacy education may be unintentionally impacting the formation of a strong, unified healthcare provider identity, which may impact widespread practice change.

BACKGROUND Antithrombotic therapy for stroke prevention in atrial fibrillation (AF) is considered a standard of care, but for hemodialysis (HD) patients the benefits are unclear, and bleeding risks are high. Our study objective was to compare cardiologists' and nephrologists' stroke prevention practices in different patient risk scenarios. MATERIALS AND METHODS A cross-sectional, online survey was distributed to members of three Canadian physician societies (Nephrology, Cardiovascular, Heart Rhythm), and to cardiologists affiliated with three Canadian Universities. The questionnaire included four AF scenarios in HD patients with varying stroke and bleeding risks. Physicians selected one of six antithrombotic therapy options for each scenario. RESULTS Cardiologists were 3 times more likely than nephro-logists to choose anticoagulant therapy over both antiplatelet and no drug therapy, regardless of stroke or bleeding risk (p

Objectives Increasingly, narrative assessment data are used to substantiate and enhance the robustness of assessor judgements. However, the interpretation of written assessment comments is inherently complex and relies on human (expert) judgements. The purpose of this study was to explore how expert assessors process and construe or bring meaning to narrative data when interpreting narrative assessment comments written by others in the setting of standardised performance assessment. Methods Narrative assessment comments on student communication skills and communication scores across six objective structured clinical examination stations were obtained for 24 final-year pharmacy students. Aggregated narrative data across all stations were sampled for nine students (three good, three average and three poor performers, based on communication scores). A total of 10 expert assessors reviewed the aggregated set of narrative comments for each student. Cognitive (information) processing was captured through think-aloud procedures and verbal protocol analysis. Results Expert assessors primarily made use of two strategies to interpret the narratives, namely comparing and contrasting, and forming mental images of student performance. Assessors appeared to use three different perspectives when interpreting narrative comments, including those of: (i) the student (placing him- or herself in the shoes of the student); (ii) the examiner (adopting the role of examiner and reinterpreting comments according to his or her own standards or beliefs), and (iii) the professional (acting as the profession's gatekeeper by considering the assessment to be a representation of real-life practice). Conclusions The present findings add to current understandings of assessors' interpretations of narrative performance data by identifying the strategies and different perspectives used by expert assessors to frame and bring meaning to written comments. Assessors' perspectives affect assessors' interpretations of assessment comments and are likely to be influenced by their beliefs, interpretations of the assessment setting and personal performance theories. These results call for the use of multiple assessors to account for variations in assessor perspectives in the interpretation of narrative assessment data.

The Bruyère Evidence-Based Deprescribing Guideline Symposium included a forum on health professional education that brought together health professionals, researchers, professional organization representatives and public members. The goal was to facilitate partnerships among educators and to build knowledge, skills and support for behaviour change to integrate the use of evidence-based deprescribing guidelines into health care professional education. Participant discussions were analyzed under the thematic headings of teaching, learning, and assessment, impact of heuristics in learning, the importance of patient/public understanding and the role of leadership in enabling curricular change to include deprescribing. Deprescribing is considered to be on a continuum with prescribing, and it was recognized that related skills are not consistently taught or assessed, which may be interpreted by learners and health professionals as being less important than diagnostic or other skills. Strategies used currently to teach prescribing may also imply that it is a technical skill, not enabling learners to understand that prescribing and deprescribing involve complex tasks requiring patient consultation. Social barriers to deprescribing were also discussed and the importance of patient perspective in teaching prescribing/deprescribing was recognized. Based on the symposium discussions, the authors make several recommendations that include better teaching of optimal prescribing and deprescribing within an interprofessional context, that education be supported from the pre-licensure, post-graduate levels through to continuing professional development, and that assessment, demonstrating competence in prescribing and deprescribing, be embedded within programs.

Objective: To quantitatively estimate the reliability of narrative assessment data regarding student communication skills obtained from a summative OSCE and to compare reliability to that of communication scores obtained from direct observation.Methods: Narrative comments and communication scores (scale 1-5) were obtained for 14 graduating pharmacy students across 6 summative OSCE stations with 2 assessors per station who directly observed student performance. Two assessors who had not observed the OSCE reviewed narratives and independently scored communication skills according to the same 5-point scale. Generalizability theory was used to estimate reliability. Correlation was used to evaluate the relationship between scores from each assessment method.Results: A total of 168 narratives and communication scores were obtained. The G-coefficients were 0.571 for scores provided by assessors present during the OSCE and 0.612 for scores from assessors who provided scores based on narratives only. Correlation between the two sets of scores was 0.5.Conclusion: Reliability of communication scores is not dependent on whether assessors directly observe student performance or assess written narratives, yet both conditions appear to measure communication skills somewhat differently.Practice implications: Narratives may be useful for summative decision-making and help overcome the current limitations of using solely quantitative scores. (C) 2019 Elsevier B.V. All rights reserved.

Background: Understanding the internalized, psychological sense of being a professional may provide important insight into understanding pharmacists’ behaviours and attitudes in practice. Methods: It is difficult to directly or quantitatively measure an internalized psychological state such as profession-hood. An indirect method was selected in which pharmacists who were themselves patients or caregivers were identified and invited to discuss their experiences, as a vehicle for better understanding how they relied upon personal and professional identities during high-stress, impactful times. Results: A total of 17 community pharmacists from southern Ontario participated in this study. Regardless of demographic background, participants reported little reliance on professional identity, knowledge or role as a pharmacist when advocating for themselves or a loved one. Interpretation: These findings suggest that community pharmacists have incomplete, separated or functional (rather than existential) professional identities. This lack of professional identity may influence behaviours in practice such as interactions with other health care professionals or patients or self-confidence in clinical decision-making. Conclusions: Further work is necessary to better understand the socialization and professional identity formation of pharmacists to help support them through the current evolution of pharmacy towards more interdependent and complex clinical roles and decision-making.

Background The framing of competence as a binary “either-or” process may be shaped by the measurement tools and assessment methods used to define it. Blunt measures such as passing or failing a licensure examination, or revoking/suspending a license after a single dispensing error fosters anxiety amongst professionals and potentially leads to behaviours where learning needs are actually hidden from educators, employers or regulators. Such framing may not accurately capture the lived experience of those labelled “incompetent” and in fact may be counterproductive to remediation and skills enhancement. Objectives To examine the construct of competence as a lived experience amongst pharmacists who had been identified and labelled as incompetent by their regulatory body. Methods A multiple single-case research design (described by Kratochwill and Levin) involving 14 practicing pharmacists identified as not meeting competence standards by their regulatory body in Ontario, Canada was used for this research. Constant-comparative qualitative analysis of semi-structured interview data was coded, categorized and used to identify and describe major research themes. Results Two major themes were identified, related to the personal and professional consequences of being labelled “incompetent” by one's regulatory body, and the importance of psychological engagement in one's own profession in facilitating maintenance of competence. Conclusions This study highlighted the importance of disengagement as both a cause and consequence of competence drift and pointed to the impact of regulatory policies, practices, and assessment systems that may actually inadvertently contribute to this disengagement.

Introduction This research set out to understand the context and explore the reasons for the disproportionate number of complaints raised against paramedics to the United Kingdom professional regulator – the Health and Care Professions Council – relative to other health professions. Methods This paper reports on qualitative findings from one aspect of a mixed-methods study which included a case analysis, Delphi study and literature review. One-to-one semi-structured interviews conducted with 15 stakeholders drawn from practitioners, educators, representatives and regulators, and three focus groups held with 16 practitioners and service users were used to gain an in-depth understanding of the possible reasons for complaints about paramedic practice. Results Five themes were generated from a thematic analysis of the data: the impact of public perceptions and expectations; the challenges of day-to-day practice; the effect of increasingly pressurised services; the organisational and cultural climate which impacts paramedics’ work; and the evolving nature of the profession. Conclusion This study highlights the complex and changing nature of paramedic practice. It provides an insight into the ways in which the character, practice and environment of the profession contribute to a disproportionate number of complaints.

Objectives The objective of this study was to investigate multi-stakeholder perceptions of practice-related facilitators to optimising the quality of Regulated Pharmacy Technician (RPT) integration into the community workforce in Ontario. Facilitators to incorporating technicians into the workflow and supporting their optimal scope of practice were explored. Methods A qualitative exploratory study comprising a series of one-to-one interviews using a piloted, semi-structured interview guide was conducted with four community pharmacy stakeholder groups; pharmacists, RPTs, pharmacy assistants and pharmacy owners. Interviews were conducted until saturation of themes. Verbatim transcripts were coded inductively using the software, NVivo v12 (QSR International) and general inductive analysis identified key findings. Key findings Twenty-seven interviews were conducted consisting of seven pharmacists, seven RPTs, eight assistants and five pharmacy owners working within community pharmacy and/or academia or hospital. All participants from every stakeholder group acknowledged that the promise of regulation of pharmacy technicians was unfulfilled in practice. Three major themes of practical significance were derived: (i) A viable business plan that incorporates RPT remuneration and ensures sustainability is a facilitator to fuller integration of RPTs, (ii) Planning the pharmacy workflow to support RPTs’ and pharmacists’ evolving scopes is a facilitator to RPT integration and (iii) Schedule planning to incorporate RPTs and appropriate staffing ratios in relation to prescription volume and pharmacy services allows for optimal utilisation of RPT skills and facilitates their integration. Conclusions Achieving integration of RPTs into the business of a community pharmacy has educational, workplace and regulatory implications, requiring the effective engagement of all stakeholders in pharmacy.

Background The prevalence of cigarette smoking continues to be a major public health problem In the United Arab Emirates (UAE); the government has recently implemented policies to reduce smoking prevalence. Innovative strategies to support cessation are needed. Community pharmacies are vital venues to extend the reach and effectiveness of smoking cessation support. Objective To evaluate the quality of community pharmacist smoking cessation counseling in the UAE. Methods A cross-sectional, simulated patient (SP) study was conducted among N = 111 urban community pharmacies selected at random in Sharjah city. Two scenarios were developed to cover different types of cessation needs of treatment-seeking smokers and where pharmacists could have a major role in assisting with smoking cessation pharmacotherapy. The quality of pharmacist counseling was defined in terms of comprehensiveness and communication skills. Two formal assessment tools were used; an analytical checklist to assess the comprehensiveness of pharmacists smoking cessation counseling, and a global assessment form to evaluate communication skills. A descriptive analysis of the data was undertaken. Results A total of 101 pharmacists participated in the study. Pharmacist assessment of smoking cessation-specific information and provision of counseling were minimal. Pharmacists most frequently assessed nicotine dependence and provided generic guidance on the use of nicotine replacement products (NRTs) to manage withdrawal, but they largely did not obtain relevant histories (e.g., medical/medication histories, previous quit attempts, smoking triggers), explain individualized management strategies (e.g., setting quit date, changing environment, reassurance and encouragement), or provide advice about ongoing support. Pharmacists attained low scores in verbal and nonverbal communication and were frequently unempathetic and judgmental towards female SPs. Conclusions Pharmacist-led smoking cessation programs can expand primary care-based cessation opportunities in the UAE and address the demand for cessation services. Pharmacists will benefit from additional training on the provision of smoking cessation interventions, with an emphasis on patient-centered communication skills.

Supplemental material, sj-pdf-1-cph-10.1177_1715163521989760 for Understanding the psychology of trust between patients and their community pharmacists by Paul A.M. Gregory and Zubin Austin in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Workforce resilience in pharmacy is required to ensure the practice, education, and administrative systems remain viable and sustainable over time and when facing challenges. Whether it is addressing burnout of pharmacists or students, or the structure and policies/procedures of employment and professional organizations, working to increase resilience across all individuals and sectors is essential to relieve pressure and promote better well-being, especially during the recent pandemic. The purpose of this article is to describe the development of a community of practice global group focused on development of resilience within the pharmacy workforce that is inclusive of students, pharmacy interns/preregistration and registered pharmacists. The steering group meets monthly and has representation of 24 members across eight countries. Members meet to discuss pertinent issues they are facing in practice, as well as to share and progress ideas on education, research, and practice initiatives. To date, members have collectively implemented resilience training in pharmacy education, researched burnout and resilience in both students and pharmacists, and facilitated international collaborations both within and outside core group members. Future activities will focus on strengthening the community of practice in order to harness the power of the collective.

ObjectivesThe objectives of this scoping review were to (a) explore how pharmacists perceive their professional roles and identities and (b) describe factors impacting which professional roles or identities pharmacists embody in different pharmacy practice settings.MethodsA scoping review using a deductive approach was undertaken for this study. Systematic searches were conducted in five databases: Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCO Cumulative Index to Nursing and Allied Health and Scopus (Elsevier). Key words searched included pharmacist, identity, professional role and one variations of these. Results were double-blind screened for relevance by two authors. Data extraction was facilitated by the web-based software platform COVIDENCE. Foucauldian critical discourse analysis was used to deconstruct how pharmacists perceive their professional roles and identities.Key findingsIn total, 21 701 articles were retrieved in the search. Following de-duplication and screening, 23 studies from 11 different countries were included. Five major identity themes were identified: Clinician, Dispenser, Business Person, Patient Counsellor and Physician Supporter. The dispenser identity was the most widespread, but it was viewed by many pharmacists as undesirable. The clinician identity also had a strong presence but was viewed as an identity that pharmacists aspire to embody.ConclusionsThis scoping review illustrates that pharmacists do not uniformly perceive themselves to be clinicians. A significant gap exists between the profession’s desired identity and that embodied by practicing pharmacists. The resulting dissonance may be a contributing factor to the lack of wide-scale practice change that the profession has been seeking for decades.

Background: Transnational funders provide up to 80% of funds for medical devices in resource-limited settings, yet sustained access to medical devices remains unachievable. The primary goal of this study was to identify what factors hinder access to medical devices through the perspectives of frontline public hospital staff in Ghana involved in the implementation of transnational funding initiatives. Methods: A case study was developed that involved an analysis of semi-structured interviews of 57 frontline technical, clinical and administrative public health care staff at 23 sites in Ghana between March and April 2017; a review of the national guidelines for donations; and images of abandoned medical devices. Results: Six key themes emerged, demonstrating how policy, collaboration, quality, lifetime operating costs, attitudes of health care workers and representational leadership influence access to medical devices. An in-depth assessment of these themes has led to the development of an enterprise-wide comprehensive acquisition and management framework for medical devices in the context of transnational funding initiatives. Conclusion: The findings in this study underscore the importance of incorporating frontline health care staff in developing solutions that are targeted at improving delivery of care. Sustained access to medical devices may be achieved in Ghana through the adoption of a rigorous and comprehensive approach to acquisition, management and technical leadership. Funders and public health policy makers may use the study’s findings to inform policy reform and to ensure that the efforts of transnational funders truly help to facilitate sustainable access to medical devices in Ghana.

Background: The coronavirus disease 2019 (COVID-19) pandemic of early 2020 was one of the most impactful events in living memory. As an essential service, community pharmacies remained open to provide care and service. The unprecedented nature and scale of the pandemic triggered considerable change in daily practice. In anticipation of future pandemic waves and similar mass-scale civil disruptions, it is important to understand how community pharmacies adapted and responded in the early weeks of COVID-19. Methods: A combination of convenience, snowball and purposive sampling methods was used to recruit staff from community pharmacies across Ontario, from a variety of different practice locations and types. A semistructured focus group interview protocol was used to elicit experiences. Data gathering was undertaken until the point of saturation. Thematic analysis was used to surface common experiences and to describe how community pharmacies adapted and responded. Results: A total of 39 participants (pharmacists, registered technicians and assistants) from 11 different pharmacies participated in this study. Data were coded based on 1) what happened, 2) how community pharmacies responded, and 3) what worked and did not work to support pharmacy staff in continued provision of service and care. Key findings included the collapse of provision of nondispensing remunerated services, the central role of managerial decisions in supporting resilience (e.g., change to 8-hour shifts from 12-hour shifts) and the central role of technology in supporting continuity of quality pharmacy services. Discussion: With anticipated future pandemic waves, preparedness of community pharmacy will be essential. This study provides important insights based on participants’ own experiences regarding ways employers can better support staff in provision of care and service to patients during times of mass-scale civil disruption. Can Pharm J (Ott) 2020;153:xx-xx.

Background Pharmacists frequently self-describe as “the most trusted health care professional” in society. Beyond the rhetoric of such self-promoting statements, there is little empirical evidence regarding how trust between pharmacists and patients is formed, nurtured, and sustained. Objectives This exploratory qualitative study in Ontario, Canada was undertaken in early 2020 to characterize trust-enhancing factors in community pharmacy practice. Methods Recruitment posters/handouts in purposively-selected pharmacies using a convenience sampling of people collecting prescriptions was used to recruit 28 patient-participants. Inclusion criteria included a minimum of six conversations with a pharmacist regarding health/medication use in the previous 12 months. A semi-structured interview protocol was used to elicit descriptions from patients regarding how experiences with community pharmacists shaped or influenced trust formation in both individual pharmacists and the profession as a whole. Results A total of 28 patients were interviewed for this study. Five trust-enhancing factors were identified: i) availability; ii) affability; iii) acknowledgement; iv) respect; and v) interpersonal chemistry. Within each factor, sub-factors or facets were also identified that focused on specific behaviours of community pharmacists that helped enhance trust. This study suggests that trust-enhancing factors include a series of interpersonal communication behaviours and skills that are within the control of pharmacists; leveraging these behaviours and skills in a more consistent and effective manner may support more trusting relationships between pharmacists and patients. Conclusions For pharmacists to truly live up to the moniker of “most trusted health care professional” it is important to better understand how trust is built and sustained, and to consider opportunities to focus on specific trust-enhancing behaviours that ultimately support better patient care and outcomes.

This article examines the nature of, and reasons for, the disproportionately high rates of fitness to practise referrals of social workers in England to the Health and Care Professions Council (HCPC), compared with other professions regulated by HCPC during 2014–2016. In 2014–2015, the rate of referrals for social workers was 1.42 per cent of registrants, compared with an average for the sixteen professions regulated by HCPC of 0.66 per cent. Drawing on published statistics and unique analysis of a sample of 232 case files undertaken as part of a research project in 2016–2017, the article highlights relatively high rates of inappropriate referrals from ‘members of the public’ (mainly service users) particularly in relation to child placements and contact. A detailed picture is offered of the variety of referrals dealt with at each stage of the fitness to practise process (from initial triage to final hearings), with recommendations for how to prevent inappropriate referrals, whilst focusing concern on the most serious cases of incompetence and misconduct. This research is of significance at a time of increasing pressure for social workers, social services and service users under conditions of austerity and managerialism; on-going concerns about standards in social work; and recent changes in social work regulation.

Background: Despite being regulated and spoken about as professionals, there is little formal research examining professional identity formation among regulated pharmacy technicians. Methods: A semistructured interview protocol was generated, based on Holden et al.’s typology of professional identity formation (PIF). Regulated pharmacy technicians in Ontario with a minimum of 2 years’ experience working a minimum of 32 hours/week were recruited to participate. Interviews were transcribed, coded and analyzed based on professional identity formation. Results: A total of 15 regulated pharmacy technicians from southern Ontario participated in this study. Regardless of demographic background, most participants demonstrated identity splinting as the dominant form of professional identity formation. Issues related to social valuing of the role of the technician and environmental opportunities to develop and grow were highlighted as significant barriers. Interpretation: These findings suggest regulated pharmacy technicians have incomplete professional identities due in part to reasons linked to pharmacists and the pharmacy profession. The type of professional identity expressed by participants in this study may limit opportunities for full and optimal expression of their role. Conclusions: Further work is necessary to better understand the professional identity formation of regulated pharmacy technicians, to help support the evolution of this role. Can Pharm J (Ott) 2020;153:xx-xx.

Health and Care Professionals Council (HCPC) as compared with the other health care professionals regulated by HCPC. This paper discusses findings from interviews and focus groups that formed part of a mixed methods study that aimed to find out the reasons for complaints and the strategies that may reduce complaints. Four themes were identified: social work as an evolving profession; social work involves challenging practice; social work takes place in a pressurised environment; and public perceptions and expectations of social work are often negative and unrealistic. Findings highlight explanations that focus on organisational culture and public responses to social workers’ control functions. We argue that, at a time of change for the profession, there is a need for public education regarding the role and function of social workers and for regulators to have more proactive engagement with registrants and employers.