Characteristics and Predictors of Patient Care Performed by Clinical Department Chairpersons at U.S. Schools of Pharmacy

Background Clinical pharmacy or pharmacy practice departments at schools of pharmacy are usually composed of practicing pharmacy specialists. There is little known about the requirements for and frequency of patient care provided by clinical department chairpersons. The primary objective of this study was to determine the likelihood that pharmacy practice chairs engage in patient care. A secondary objective was to identify those factors predicting chairperson participation in patient care activities. Methods A brief 22-item adaptive response survey was sent to clinical department chairpersons at schools of pharmacy in the United States. Initial identification of chairs came from the American Association of Colleges of Pharmacy (AACP) with verification by school websites. Surveys from schools without a clinical chairperson (or similar position) were excluded, as were surveys from schools with Ph.D. department chairpersons from blended departments (ie, Clinical with Outcomes/Policy Sciences). Results Of the 128 eligible schools\u27 department chairpersons, 113 completed the surveys (88.3% response rate). Forty-four (38.9%) chairs reported that they maintain an active clinical practice even though 103 (91.1%) report it is not required. Factors that had a significant association with clinical practice were clinical service being an expectation (P = .0004), having a practice prior to becoming chairperson (P = .001), having a higher clinical service expectation (P \u3c .0001), and having a lower administrative percentage (P = .0003). Age, rank, and academic track were not significant predictors. Of those with clinical practice, sites included community (45.4%), acute care (38.6%), primary care (4.5%), and other settings (11.4%). A majority of those with practice reported providing direct patient care (81.8%) or indirectly via supervision of students or other trainees (61.4%). Conclusions Most schools of pharmacy do not require clinical department chairpersons to maintain a patient care practice, but many still choose to practice. Those that practiced before becoming a chairperson and have a lower administrative burden are more likely to continue to provide patient care

Sample-efficient learning with auxiliary class-label information

Building classification models from clinical data collected for past patients often requires additional example labeling and annotation by a human expert. Since example labeling may require to review a complete electronic health record the process can be very time consuming and costly. To make the process more cost-efficient, the number of examples an expert needs to label should be reduced. We develop and test a new approach for the classification learning in which, in addition to class labels provided by an expert, the learner is provided with auxiliary information that reflects how strong the expert feels about the class label. We show that this information can be extremely useful for practical classification tasks based on human assessment and can lead to improved learning with a smaller number of examples. We develop a new classification approach based on the support vector machines and the learning to rank methodologies capable of utilizing the auxiliary information during the model learning process. We demonstrate the benefit of the approach on the problem of learning an alert model for Heparin Induced Thrombocytopenia (HIT) by showing an improved classification performance of the models that are trained on a smaller number of labeled examples.

Conditional anomaly detection methods for patient–management alert systems

Abstract: Anomaly detection methods can be very useful in identifying unusual or interesting patterns in data. A recently proposed conditional anomaly detection framework extends anomaly detection to the problem of identifying anomalous patterns on a subset of attributes in the data. The anomaly always depends (is conditioned) on the value of remaining attributes. The work presented in this paper focuses on instance-based methods for detecting conditional anomalies. The methods rely on the distance metric to identify examples in the dataset that are most critical for detecting the anomaly. We investigate various metrics and metric learning methods to optimize the performance of the instance-based anomaly detection methods. We show the benefits of the instance-based methods on two real-world detection problems: detection of unusual admission decisions for patients with the community-acquired pneumonia and detection of unusual orders of an HPF4 test that is used to confirm Heparin induced thrombocytopenia - a life-threatening condition caused by the Heparin therapy

Tips for Developing an Integrated Online and Simulation Course Based on 6-Years of Experience

Technological advancements, changes in pharmacy students’ learning preferences, and increased educational costs have necessitated the development and implementation of innovative teaching modalities. The University of Pittsburgh, School of Pharmacy has been using simulation-based learning throughout the curriculum for several years. To further advance this practice, a novel course was designed to teach students new concepts through online video lectures, slide sets and quizzes, and knowledge application during weekly practica time involving multiple patient cases taught with high fidelity simulation. While this course has been well received by students, it does require resources, organization, and time for development. In this article, we describe our experience developing, modifying, and sustaining this blended course with the hope that sharing our experiences over the past six years will lead to expediting successes at other institutions. Tips for success such as keeping online segments short, holding students accountable, thinking of simulation approaches beyond the mannequin, and developing standardized assessment tools are discussed. Overall the blended course of online learning and simulation is a unique educational experience akin to real-world pharmacy practice and is worth the effort with a goal of optimizing learning

Advancing interprofessional education through the use of high fidelity human patient simulators

Background: Modern medical care increasingly requires coordinated teamwork and communication between healthcare professionals of different disciplines. Unfortunately, healthcare professional students are rarely afforded the opportunity to learn effective methods of interprofessional (IP) communication and teamwork strategies during their education. The question of how to best incorporate IP interactions in the curricula of the schools of health professions remains unanswered. Objective: We aim to solve the lack of IP education in the pharmacy curricula through the use of high fidelity simulation (HFS) to allow teams of medical, pharmacy, nursing, physician assistant, and social work students to work together in a controlled environment to solve cases of complex medical and social issues. Methods: Once weekly for a 4-week time period, students worked together to complete complex simulation scenarios in small IP teams consisting of pharmacy, medical, nursing, social work, and physician assistant students. Student perception of the use of HFS was evaluated by a survey given at the conclusion of the HFS sessions. Team communication was evaluated through the use of Communication and Teamwork Skills (CATS) Assessment by 2 independent evaluators external to the project. Results: The CATS scores improved from the HFS sessions 1 to 2 (p = 0.01), 2 to 3 (p = 0.035), and overall from 1 to 4 (p = 0.001). The inter-rater reliability between evaluators was high (0.85, 95% CI 0.71, 0.99). Students perceived the HFS improved: their ability to communicate with other professionals (median =4); confidence in patient care in an IP team (median=4). It also stimulated student interest in IP work (median=4.5), and was an efficient use of student time (median=4.5) Conclusion: The use of HFS improved student teamwork and communication and was an accepted teaching modality. This method of exposing students of the health sciences to IP care should be incorporated throughout the curricula.Antecedentes: Los cuidados médicos modernos requieren cada día más trabajo en equipo coordinado y comunicación entre profesionales de la salud de diferentes disciplinas. Desafortunadamente, los estudiantes de profesiones de la salud rara vez pueden permitirse la oportunidad de aprender métodos efectivos de comunicación interprofesional (IP) y estrategias e trabajo en grupo durante su educación. La pregunta de cuál es la mejor forma de incorporar las interacciones IP en los curricula de las facultades de profesionales de la salud permanece sin respuesta. Objetivo: Intentamos resolver al falta de educación IP en el curriculum de farmacia mediante el uso de simulación de alta fidelidad (HFS) para permitir que equipos de médicos, farmacéuticos, enfermeras, auxiliares médicos, y trabajadores sociales trabajasen juntos en un ambiente controlado para resolver casos de problemas médicos y sociales complejos. Métodos: Una vez a la semana, durante un periodo de 4 semanas, los estudiantes trabajaron juntos para completar escenarios de simulación complejos en pequeños grupos IP consistentes en estudiantes de farmacia, medicina, enfermería, trabajo social, y auxiliar médico. Se evaluó la percepción de los estudiantes sobre el uso de la HFS mediante un cuestionario al final de las sesiones de HFS. La comunicación en equipo fue evaluada mediante el Communication and Teamwork Skills (CATS) independientemente por dos evaluadores externos al proyecto. Resultados: Las puntuaciones del CATS mejoraron de la sesión de HFS 1 a la 2 (p=0,01), de la 2 a la 3 (p=0,035), y en general de la 1 a la 4 (p=0,001). La fiabilidad inter-evaluadores fue alta (0,85; 95% CI 0,71 - 0,99). Los estudiantes percibieron que la HFS mejoraba: su capacidad de comunicar con otros profesionales (mediana=4); la confianza en la atención al paciente en un equipo IP (mediana=4). También estimuló el iteres de los estudiantes en el trabajo IP (mediana 4,5), y fue una utilización eficiente del tiempo del estudiante (mediana 4,5). Conclusión: El uso de HFS mejoró el trabajo en equipo y la comunicación de los estudiantes y fue una modalidad de enseñanza aceptada. Este método de exponer a los estudiantes de ciencias de la salud a la atención IP debería incorporarse en los curricula