Student Pharmacists’ Perceptions of a Composite Examination in Their First Professional Year

I chose to read this article because it is directly related to our class as first year students. As P1s, we are thrown into a new type of schooling with difficult exams, usually having more than one professor per exam.  Trial and error is used throughout the year to choose what study habits work best for each course.  This study examines the students’ perceptions on a composite exam before they take it and after they take it.

Each composite exam included 3 to 4 questions per hour of lecture (50 minutes).  The exam included all subjects that the students were currently taking.  There were around 7 CEs throughout the semester.  The students were told ahead of time how many questions would be on the exam for each subject as well as the order of the subjects.

Before the exam, students anticipated that they would study 2 to 4 hours a day, but 31% only studied 1 to 2 hours, 25% studied 3 to 4 hours and 21% studied more than 4 hours.  The type of studyng that the students anticipated to do, cramming, priority studying, studying each day or other, changed from pretest to post test.  In fact, the students’ perceptions of the exam, the ways that they studied, and their personal predicted outcomes all changed from pretest to post test.  Overall, the students favored the format of the CE.  The goal was to reduce the amount of cramming before the exam, so that students would actually retain the information.

The findings in this study show mixed opinions, such as some studies finding that studying in a steady fashion each day will lead to better test results, while some suggest that those who cram can actually do better.  Do you think that we would receive higher semester grades if we would be tested more often?  I think that it will be interesting to answer that question because of the way we are learning Anatomy and Physiology 2 right now, since we are doing small assignments along the way instead of an exam. However, the composite exams used in this study involved all subjects, which I am not sure would work for our pharmacy class.

 

Link to article

McDonough S, et al, Student Pharmacists’ Perceptions of a Composite Examination in Their First Professional Year. American Journal of Pharmaceutical Education. 2016; 80(1):4

Impact of pharmacist-led educational and error notification interventions on prescribing errors in a family medicine clinic

Studies have shown that up to 21% of prescriptions have one or more prescribing errors.  These errors not only create potentially harmful situations for patients, they also increase a pharmacist’s workload.  This problem is potentially due to the small amount of classes given in medical schools for therapeutics and how to write prescriptions.

This study was conducted at a family medicine clinic and observed twenty-four resident physicians and the prescriptions they wrote while conducting outpatient visits.  In the study, the rate of prescription errors for the resident physicians was observed before and after interventions to prevent these errors were put into place.  The interventions included a prescribing educational program, audits and feedback for prescriptions each resident filled and weekly newsletters that included the most common errors, examples of the errors, ways to correct the errors, etc.  These interventions were given for three months.  The assessments of the prescriptions occurred one year apart so that prescribing habits and seasonal illnesses would not differ.

The results of the study showed that overall prescription errors went down 4.1%, from 18.6% to 14.5%.  The study also showed that the pediatric prescription rates for the physicians who took part in the educational program were 36% lower than the error rates of physicians that did not participate.

I found this study interesting because I have firsthand knowledge of how many errors prescribers make.  Working in a retail pharmacy, I see these mistakes in all types of prescriptions.  While mistakes do happen, doctors are just humans, a lot of the mistakes could be prevented just by double checking the prescription and by knowing the proper way to write a prescription and proper dosing for certain medications.  These interventions only took three months and errors went down by over 4%.  Errors not only affect patients, but they also cause increase work for pharmacists and their staff and the doctors that eventually need to fix the mistakes.  By implementing interventions, a lot of time and frustration can ben avoided and patient safety can increase.

Winder, MB, Johnson JL, Planas LG, et al. Impact of Pharmacist-led Educational and Error Notification Interventions on Prescribing Errors in a Family Medicine Clinic. J Am Pharm Assoc. 2015;55(3): 238-45.

http://www.japha.org/article/S1544-3191(15)30054-6/fulltext

Economic Analysis of Earning a PhD after PharmD

I am interested in pursuing a PhD after pharmacy school, but was surprised to find how few students pursue this path. According to this article, only 9.8% of current graduate students in the US also have a PharmD and the percentage has been declining. I understand that the idea of another 4-5 years of school isn’t particularly tempting, but I wanted to investigate other reasons a PhD is not often pursued.

The main conclusion was that there is not sufficient economic incentive to pursue a PhD after graduating pharmacy school. Net present value and internal rate of return for obtaining a PhD were both negative in comparison to community pharmacists. The data analyzed for this longitudinal study was from 1982 to 2008. Since a pharmacist’s salary can exceed $100,000 and student debt can add pressure, the opportunity cost of not immediately working can be unattractive to graduates. Furthermore, careers in academia and industry are often associated with starting salaries approximately $20,000 lower than that of a community pharmacist.

Proposed ways to incentivize pursuit of a graduate degree include providing a competitive stipend, mentoring students, and providing flexibility within the pharmacy curriculum. Do you think that having individuals with a PharmD and PhD is important? Are residencies and fellowships sufficient post-graduate training in lieu of a PhD?

Hagemeier NE, Murawski MM. Economic Analysis of Earning a PhD Degree After Completion of a PharmD Degree. Am J Pharm Educ. 2011; 75(1): 15.

The Need for More Education on Prescribing Opioids

When hearing the term “opioids” several ideas come to mind: addiction, abuse, under-treatment, overtreatment, severe pain, and suspicion are just a few. Opioids are undoubtedly an extremely successful route of treatment for severe pain and play a huge role in daily pain management cases. However, there is always a discussion of the risks associated with prescribing this medication.

There is often an air of distrust between physician and patient when a patient insists on opioid therapy. Unfortunately, pain cannot be measured, and there needs to be trust when prescribing this drug class. The prescriber will not know if the patient really needs the opioid for pain management or if they have developed a dependence on it. The physician is put in a position where they could under-treat the patient by refusing therapy because of the risk of abuse, or they could over-treat the patient by believing their plea for a medication they were addicted to.

There are several guidelines already in place regarding opioid prescribing, but still, much of it is up to the physician’s discretion. Right now, there is a big push for more prescriber education on the topic. For example, in 2012, the FDA encouraged a single shared Risk Evaluation and Mitigation Strategy (REMS) which required manufacturers of extended release or long acting opioids to fund accredited education on safe opioid prescribing. Currently, this program has not reached its goal number of prescribers. However, I believe with the advancement of this program, physicians will be able to make more educated and thorough decisions when it comes to prescribing opioids.

Managing pain is extremely complex, yet education on the topic is lacking. The ultimate goal would be to maintain a patient-centered approach and treat the patient in a manner in which they are comfortable and compliant with. Perhaps with more education on the topic, the physician and pharmacist can work together to make a confident decision in how to proceed with drug therapy, and hopefully avoid the mistakes that have been occurring concerning opioid therapy.

I personally see this as an opportunity for pharmacists to get more involved in the prescribing process, as they have a stronger background education on the topic. Do you think this could play a role in pharmacists eventually gaining prescribing rights?

 

Read the full article here.

Alford, Daniel P.  Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education. N Engl J Med. 2016;374:301-3

 

Safer Use of Medications through Risk Evaluation and Mitigation Strategies

REMs or risk evaluation and mitigation strategies are a baseline of communication between drug and patient. The term itself is relatively new, but pharmacists have been practicing medication education since the beginning of practice. REMs are other wise known as risk minimization action places, because they are proposed to do exactly that. The purpose of REMs is to educate the patient on the medication they are taking to increase therapeutic benefit.

The FDA determines which medications go in certain risk categories and have different guidelines on how to ‘do’ the REMs. Most of the approves REMs are a handout that educates the patient on the medication and usually has some FAQs. Other medications may require verbal counseling to ensure the patient knowledgable on the medication they are about to take. Other high risk medications have iPledge and counseling with the pharmacist.

The goal of REMs is to minimize the risk to our patients and increase their therapeutic outcome through the use of different education strategies. Since pharmacists are at the center of patient and prescriber and patient and drug, it is our responsibility to ensure we are conducting necessary REMs. I believe that pharmacists will continue to play a bigger role in medication safety because of REMs, and that we have the ability to do so. As future pharmacist we need to be sure to give our patients all the information needed and answer any questions about medications to increase our patient’s therapeutic benefit. At my pharmacy, I always have information sheets printing out after the labels. I will be sure to always pass them along to be given to the patient.

 

Hennessy K., Williams K., Bongero D.
J Am Pharm Assoc (2003) 2010;50:556-562. doi:10.1331/JAPhA.2010.10532

Link to Article