Preceptor recruitment, training, and retention—a nation-wide survey of colleges of pharmacy

Recent changes surrounding the profession of pharmacy resulted in a growing number of new pharmacy programs as well as expansion of existing class sizes. This extreme growth, coupled with changes to accreditation standards which require volunteer licensed pharmacists to supervise student interns for a minimum of thirty percent of the Doctor of Pharmacy curriculum, have created a great burden amongst higher education administrators to meet these requirements, specifically in terms of recruiting, training, and retaining a qualified and committed pool of preceptors. The purpose of this study was to identify what strategies the American Association of Colleges of Pharmacy Experiential Education Section members utilize to recruit, train, retain, and acknowledge volunteer pharmacist preceptors. The following research questions were answered in this study: 1) What are the strategies utilized by American Association of Colleges of Pharmacy (AACP) schools to: a) recruit, b) train, c) retain, and d) acknowledge volunteer pharmacist preceptors? 2) What are some of the practices associated with ways AACP Experiential Education Section members handle the supply and demand issues associated with training future pharmacists? 3) What are the characteristics of respondents in terms of institutional demographics (geographic location, three- versus four-year programs, private versus public, class size, teaching or research focus, etc.)? An extensive review and report of the literature (AACP, 2004; AAMC, 2008; ACPE, 2007; ACPE 2011; Bandura, 1977; Brown, 2010; Cotter, 2010; Dewey, 1938; Dziedzic, 2010; Freire, 1970; James, 1907; Kolb, 1984; Knowles, 2005; Lewin, 1951; Lillibridge, 2007; NABP, 2012; Rogers, 1961; Zlatic, 2001) preceded design of the survey instrument utilized in the study. Experiential education theoretical frameworks highlighted adult learning theories which showed how hands-on, learning in real world settings promoted meaningful learning experiences. The history of pharmacy education, changes in the profession, and updated accreditation guidelines, including standards which required increased intern hours to be completed under the supervision of a licensed pharmacist preceptor emphasized the necessity for a strong group of volunteer preceptors to successfully fulfill the needs of the Pharm.D. curriculum. Additional literature (ACCP, 2012; Bird, Duong, Hagemann, Burton, Britton, & St. Cyr, 2012; Bock, Duong, & Williams, 2008; Brown, Barner, & Shepherd, 2004; DiFrancesco, 2011; Flaherty, 2011; Hill & Kirkwood, 2005; McDonough & Bennett, 2006; Mersfelder & Bonthillier, 2012; O'Neil & Berdine, 2007; Popovich, Katz, & Peverly, 2010; Rodis, Legg & Casper, 2009; Yorra, 2012) highlighted how such practice opportunities benefited students, preceptors, and positively impacted patient care. Coupled with the positives of such experiences were the realities of the challenges to recruitment, training, and retention faced by higher education administrators. Barriers (Assemi et al., 2011; Cerulli & Briceland, 2004; Crill, 2009; Duncan-Hewitt, 2005; Gulseth et al., 2006; Karimi et al., 2011; Lee et al., 2006; Lillibridge, 2007; Marrs & Rackham, 2010; Marriott et al., 2006; McBane & Karr, 2012; McKauge & Coombes, 2005; Medina, 2008; Reid et al., 2007; Scarvell & Stone, 2010; Snyder et al., 2010; Sonthisombat, 2008; Talley, 2006; Verstraten et al., 2006; Warren & Denham, 2010; Wuller, 2008; Zarembski et al., 2004) to effective precepting listed in the literature included lack of training, insufficient resources and personnel, lack of confidence, workload and time stressors, handling difficult students, and balancing resident, clinician, and student roles. Practices in related fields of international pharmacy, nursing, and medicine provided studies of best practices in regards to preceptor recruitment, training, acknowledgement, and retention. This study utilized a survey design methodology with thirteen quantitative survey items as well as eight open-ended commentaries allowing for qualitative analysis to address the research questions. Active members of the American Association of Colleges of Pharmacy Experiential Education Section were voluntarily surveyed and 233 participants answered using online survey collection in the summer of 2013. Data was analyzed and reported in descriptive statistics. Results identified current strategies utilized by Doctor of Pharmacy programs who are members of the American Association of Colleges of Pharmacy Experiential Education Special Interest Group to recruit, train, retain, and acknowledge volunteer pharmacist preceptors. Additionally, the study provided information related to the practices associated with supply and demand issues associated with training future pharmacists. Findings of this study are useful for those involved in academia in the health professions, specifically higher education administrators looking to fulfill accreditation guidelines for experiential education in a Doctor of Pharmacy curriculum. Conclusions and recommendations revealed opportunity for growth and development in the areas of experiential education especially as related to preceptor recruitment, training, retention, and acknowledgement, as well as for future research

Ezetimibe added to statin therapy after acute coronary syndromes

BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization ( 6530 days after randomization), or nonfatal stroke. The median follow-up was 6 years. RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit