Design and evaluation of a novel professional identity development program for pharmacy students

Professionalism, which is integral to the practice of pharmacy, is evolving to include a recognition of the importance of the development of professional identity. What is lacking, however is the presence of a framework for understanding the formation of student professional identity and the selection of suitable pedagogical approaches to facilitate such development. Educators are under increasing pressure to produce work-ready graduates, which involves the development of student professionalism. Current competency-based approaches focus on promoting student professional attitudes, values and behaviours. While these competencies are important to professional practice, they fail to adequately capture the complexity and richness of the professional role. A greater understanding of the mechanism of identity development, paired with pedagogies, which support identity formation, would better enable educators to adequately prepare students for professional practice. Professional identity is formed on two levels; the individual or psychological level and the collective level, also known as socialisation. The aim of this study was to develop a Professional Identity Program (PIP), designed to facilitate student professional identity formation, targeting the psychological development of the individual student. This study utilised the theoretical tenets of Self-Determination Theory (SDT), a psychological theory of human motivation and identity development, as a basis for the design of the program. SDT states that satisfaction of the three human basic psychological needs; competence, relatedness and autonomy, results in increased motivation (autonomy) and identity development. The PIP featured autonomy-supportive teaching in a longitudinal, early intervention, theory-based approach to professional development for pharmacy students. Methods Design: In line with the central tenets of SDT, the PIP was designed to support student competence, relatedness and autonomy, with a view to enhancing student motivation and eliciting identity development. Recognised pedagogical strategies for providing such support were employed throughout the 2 year program. Early intervention was a feature of this program, providing students with the opportunity to consider professionalism and professional identity development by participating in active discussions with practicing pharmacists and other students, in their first year of study. Emotional intelligence training was included in the program for its link to professional identity development. In addition approaches previously proven to enhance professional development such as reflective activity, role models and authentic practice-related activity were also incorporated into the program. Delivery: The PIP was integrated into the existing curricular structure, in each semester for the first two years of the BPharm. Sessions were delivered together with a practicing pharmacist, offering the students an opportunity to interact with the profession, in the absence of workplace exposure. Autonomy-supportive teaching techniques underpinned the delivery of the program, and a variety of teaching styles were employed to promote student participation and engagement. Evaluation: A previously validated professional identity measure, the McLeod Clarke Professional Identity Scale (MCPIS-9), was utilised as part of a mixed methods approach to the evaluation of the PIP. The Pharm-S, an instrument for measuring student motivation was adapted from an existing scale, modifying the context for pharmacy education. The Pharm-S was validated using recognised techniques and incorporated, alongside the MCPIS-9 and demographic questions to form the student survey. Students in two separate first year cohorts (2014 and 2015 intake) were surveyed at 0, 12 and 24 months. The 2014 cohort did not receive the PIP, whereas the 2015 cohort had the PIP integrated into their curriculum. The student survey scores were summarised as averages in the case of the MCPIS items, and a weighted scoring protocol, the Relative Autonomy Index (RAI) was used for the Pharm-S. To effectively explore inter and intra group differences, inferential statistical techniques, using non-parametric analysis, was undertaken. An additional survey, using likert-response, was also administered to the 2015 students for the purposes of evaluating the content and delivery of the PIP. Data from this survey were analysed using basic descriptive statistical techniques. Focus groups of first and fourth year students were also conducted to gain a more in-depth understanding of the student experience of professional development. Responses from the focus groups were audio recorded and transcribed. The written transcriptions were then analysed using an analytical framework identifying key concepts, which were subsequently organised into themes. Results The Pharm-S instrument proved to be suitable for use after successfully conducting face, content, test-retest, construct and convergent validation techniques. A positive correlation (r=0.64) between motivation scores and professional identity scores was also revealed. Analysis of the systematic monitoring of student motivation during the PIP, using the Pharm- S, showed a statistically significant increase in their motivation (autonomy) after 2 years participation in the program (U=421, Z=-2.5, p=0.012). Comparing student scores from those who received the PIP with student scores who did not receive the PIP, also revealed a statistically significant increase in motivation (autonomy) scores after two years in the program (Z=-2.3, p=0.020). Autonomy-supportive teaching has previously been reported to increase student autonomy through its student-centred focus1 and by increasing motivation to learn.²,³ Observed increases in motivation (autonomy) and a demonstrated link between Pharm-S and MCPIS-9 scores, provided evidence of professional identity formation when support is provided for student competence, relatedness and autonomy. This reflects the theoretical basis of SDT which states that the satisfaction of the three human basic psychological needs, lays a necessary foundation for identity development.⁴ The PIP was positively received by students with 100% stating that they gained a greater understanding of the importance of professionalism and 84% reporting that it improved their sense of professional identity (n=44, 88% response rate, M=18, F=26), mean age=20 yrs, SD=4.2). Student (first and fourth year) perceptions of their professional development revealed three major influencing factors; pharmacist-educators, curriculum and placement. Differences however were noted between groups, however, with the first years prioritising pharmacist educators and the fourth years, placement. Conclusion This study builds on and contributes to work in professional education by demonstrating the impact of an early intervention, theory-based, professional identity program. It is the first of its kind to apply the tenets of a psychological theory on motivation and to feature pedagogies that facilitate motivation and identity development in pharmacy students. Adopting autonomy-supportive teaching, a student-centred approach, increases their motivation and autonomy, this being linked with more effective patient-centred care and better patient health outcomes. References 1. Ten Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Med Teach. 2011;33(12):961-973. 2. Orsini C, Evans P, Jerez O. How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self-determination theory. J Educ Eval Health Prof. 2015;12(8). 3. Niemiec CP, Ryan RM. Autonomy, competence, and relatedness in the classroom: Applying self-determination theory to educational practice. Theory and Research in Education. 2009;7(2):133-144. 4. Luyckx K, Vansteenkiste M, Goossens L, Duriez B. Basic need satisfaction and identity formation: Bridging self-determination theory and process-oriented identity research. J Couns Psychol. 2009;56(2):276-288

A Reliability Centered Maintenance program incorporating probabilistic based simulation

This research project aims to outline the current literature regarding existing Reliability Centered Maintenance (RCM) methodology and to use this methodology as a foundation for implementing RCM in the development of Preventative Maintenance (PM) programs for on-road vehicle fleets. RCM processes are centered on qualitative data and do not readily consider the available quantitative data. The use of probabilistic modelling allows for the consideration of quantitative data which may allow for a more well-rounded PM programming. The reviewed literature points to the importance of integrating quantitative data into the RCM process. The data for the current project was obtained from maintenance records, failure records and component failure analysis reports and in consultation with subject matter experts (SME). A hybrid RCM methodology was then applied as guided by the literature to include quantitative data. This process includes the use of probabilistic methods of analysis to forecast and develop a number of preventative maintenance plans. The hybrid methodology was adapted into a 11-step process to allow for ease of use. These results ultimately provide the utility company with the ability to perform an RCM analysis and to gain a quantitative output on how to model and forecast PM programs. This will further allow for more fluid and informed maintenance decisions to be made in similar fields and recommendations to be made for the application of a modified RCM methodology. There was a realization that the probabilistic modelling not only assisted in the modelling of the systems and components, but it could also assist in the assessment of organisational processes. Modelling outcomes of the organisational process meant that there was greater flexibility in cost savings when the options of maintenance were limited

Mindfulness training: success in reducing first year health professional students' study and exam related stress

Purpose: Students enrolling in high stakes, undergraduate entry, professional programs like medicine, dentistry and pharmacy may struggle to effectively achieve the transition from high school. This often results in high levels of mental distress. Method: The College of Medicine and Dentistry at James Cook University have implemented a health professional self-care program (HPSC) with an aim of helping students recognize stressors and develop coping strategies. The HPSC program has been running for three years in the first year of each of the three courses. The HPSC program was delivered as a series of eight sessions focusing on evidenced based theory with some time for practicing coping strategies. Five-point Likert scale surveys were administered prior to commencing the program and after completion. Results: Across the College, students reported significantly improved abilities to reduce study and exam related stress and develop effective coping skills. These results were more pronounced in students that practiced techniques of mindfulness. Discussion: The HPSC program changed student perceptions in being able to improve their own self-care and reduced study and exam related stress

Do differences in diagnostic criteria for late fetal growth restriction matter?

BACKGROUND: Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable. OBJECTIVE: This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters. STUDY DESIGN: From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32+0 to 36+6 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry. For the comparison, we used standards/charts for estimated fetal weight and abdominal circumference from Hadlock, INTERGROWTH-21st, and GROW and Chitty. Percentiles for umbilical artery pulsatility index and its ratios with middle cerebral artery pulsatility index were calculated using Arduini and Ebbing reference charts. Sensitivity and specificity for low birthweight and adverse perinatal outcome were evaluated. RESULTS: Different combinations of definitions and reference charts identified substantially different proportions of fetuses within our population as having fetal growth restriction, varying from 38% (with Delphi consensus definition, INTERGROWTH-21st biometric standards, and Arduini Doppler reference ranges) to 93% (with Society for Maternal-Fetal Medicine definition and Hadlock biometric standards). None of the different combinations tested appeared effective, with relative risk for birthweight &lt;10th percentile between 1.4 and 2.1. Birthweight &lt;10th percentile was observed most frequently when selection was made with the GROW/Chitty charts, slightly less with the Hadlock standard, and least frequently with the INTERGROWTH-21st standard. Using the Ebbing Doppler reference ranges resulted in a far higher proportion identified as having fetal growth restriction compared with the Arduini Doppler reference ranges, whereas Delphi consensus definition with Ebbing Doppler reference ranges produced similar results to those of the Society for Maternal-Fetal Medicine definition. Application of Delphi consensus definition with Arduini Doppler reference ranges was significantly associated with adverse perinatal outcome, with any biometric standards/charts. The Society for Maternal-Fetal Medicine definition could not accurately detect adverse perinatal outcome irrespective of estimated fetal weight standard/chart used. CONCLUSION: Different combinations of fetal growth restriction definitions, biometry standards/charts, and Doppler reference ranges identify different proportions of fetuses with fetal growth restriction. The difference in adverse perinatal outcome may be modest, but can have a significant impact in terms of rate of intervention.</p

Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction.

BACKGROUND Although fetal size is associated with adverse perinatal outcome, the relationship between fetal growth velocity and adverse perinatal outcome is unclear. OBJECTIVE This study aimed to evaluate the relationship between fetal growth velocity and signs of cerebral blood flow redistribution, and their association with birthweight and adverse perinatal outcome. STUDY DESIGN This study was a secondary analysis of the TRUFFLE-2 multicenter observational prospective feasibility study of fetuses at risk of fetal growth restriction between 32+0 and 36+6 weeks of gestation (n=856), evaluated by ultrasound biometry and umbilical and middle cerebral artery Doppler. Individual fetal growth velocity was calculated from the difference of birthweight and estimated fetal weight at 3, 2, and 1 week before delivery, and by linear regression of all available estimated fetal weight measurements. Fetal estimated weight and birthweight were expressed as absolute value and as multiple of the median for statistical calculation. The coefficients of the individual linear regression of estimated fetal weight measurements (growth velocity; g/wk) were plotted against the last umbilical-cerebral ratio with subclassification for perinatal outcome. The association of these measurements with adverse perinatal outcome was assessed. The adverse perinatal outcome was a composite of abnormal condition at birth or major neonatal morbidity. RESULTS Adverse perinatal outcome was more frequent among fetuses whose antenatal growth was <100 g/wk, irrespective of signs of cerebral blood flow redistribution. Infants with birthweight <0.65 multiple of the median were enrolled earlier, had the lowest fetal growth velocity, higher umbilical-cerebral ratio, and were more likely to have adverse perinatal outcome. A decreasing fetal growth velocity was observed in 163 (19%) women in whom the estimated fetal weight multiple of the median regression coefficient was <-0.025, and who had higher umbilical-cerebral ratio values and more frequent adverse perinatal outcome; 67 (41%; 8% of total group) of these women had negative growth velocity. Estimated fetal weight and umbilical-cerebral ratio at admission and fetal growth velocity combined by logistic regression had a higher association with adverse perinatal outcome than any of those parameters separately (relative risk, 3.3; 95% confidence interval, 2.3-4.8). CONCLUSION In fetuses at risk of late preterm fetal growth restriction, reduced growth velocity is associated with an increased risk of adverse perinatal outcome, irrespective of signs of cerebral blood flow redistribution. Some fetuses showed negative growth velocity, suggesting catabolic metabolism

Current practice in the diagnosis and management of fetal growth restriction: An international survey

Introduction The aim of this survey was to evaluate the current practice in respect of diagnosis and management of fetal growth restriction among obstetricians in different countries. Material and methods An e-questionnaire was sent via REDCap with "click thru" links in emails and newsletters to obstetric practitioners in different countries and settings with different levels of expertise. Clinical scenarios in early and late fetal growth restriction were given, followed by structured questions/response pairings. Results A total of 275 participants replied to the survey with 87% of responses complete. Participants were obstetrician/gynecologists (54%; 148/275) and fetal medicine specialists (43%; 117/275), and the majority practiced in a tertiary teaching hospital (56%; 153/275). Delphi consensus criteria for fetal growth restriction diagnosis were used by 81% of participants (223/275) and 82% (225/274) included a drop in fetal growth velocity in their diagnostic criteria for late fetal growth restriction. For early fetal growth restriction, TRUFFLE criteria were used for fetal monitoring and delivery timing by 81% (223/275). For late fetal growth restriction, indices of cerebral blood flow redistribution were used by 99% (250/252), most commonly cerebroplacental ratio (54%, 134/250). Delivery timing was informed by cerebral blood flow redistribution in 72% (176/244), used from >= 32 weeks of gestation. Maternal biomarkers and hemodynamics, as additional tools in the context of early-onset fetal growth restriction (<= 32 weeks of gestation), were used by 22% (51/232) and 46% (106/230), respectively. Conclusions The diagnosis and management of fetal growth restriction are fairly homogeneous among different countries and levels of practice, particularly for early fetal growth restriction. Indices of cerebral flow distribution are widely used in the diagnosis and management of late fetal growth restriction, whereas maternal biomarkers and hemodynamics are less frequently assessed but more so in early rather than late fetal growth restriction. Further standardization is needed for the definition of cerebral blood flow redistribution

Adjusting to university: perceptions of first-year health professions students

Background: The transition experience into university can be challenging for health profession students as they are required to rapidly learn diverse and adaptable problem solving skills and advanced reflective thinking processes which are necessary to address complex patient-care problems, particularly in the face of uncertainty within a dynamic and rapidly evolving learning environment. Methods: A mixed-methods study was conducted to identify factors influencing this transition for first-year medical, dental, and pharmacy students at a regional Australian university. The Student Adaption to College Questionnaire (SACQ) examined participants’ levels of adjustment to university, while Schlossberg’s 4 S transition model was utilised in a framework analysis of the focus group and interview responses. Results: Complete survey responses were obtained from 198 students, 17 of whom also participated in focus group discussions or interviews. Mean adjustment ratings obtained from the SACQ responses were academic (6.09 ± 1.3) personal-emotional (5.53 ± 1.55), social (6.30 ± 1.38), and institutional attachment (6.96 ± 1.6). These results indicate that the personal and emotional aspects of this transition were more challenging for the students. Analysis of the qualitative data revealed that generally, for these highly motivated health-professions students, dropping out of university was not an option and this had a positive influence on their ability to adjust to their new learning environment. Nonetheless, the transition involved role change; school-leavers were excited about their newly found independence, while for mature-aged students, returning to university allowed them to pursue their lifelong dreams. Adjustment was more challenging for international, mature-aged and female students, with personal and social factors influencing the transition for each of these demographic groups. Conclusions: To facilitate smooth transition into university, tertiary education institutions must consider tailored on-going support strategies that promote social interaction among students with varied backgrounds and personal characteristics

Investigating the physical stability of repackaged medicines stored into commercially available multicompartment compliance aids (MCAs)

Background: Compliance aids are devices which have been developed and are currently used to assist individuals in their medicines management. The use of compliance aids involves the transfer of medicines from the manufacturers' original packaging and repackaged into an multicompartment compliance aid (MCA). MCAs do not guarantee the same level of protection compared to manufacturer's original packaging. Objective: The aim of this study was to investigate the stability profile of atenolol, aspirin and lansoprazole dosage forms repackaged together in two different commercially available MCAs. Methods: In a laboratory in the United Kingdom, the physical stability of the formulations repackaged into two commercially available brands of MCAs was evaluated. After 8 weeks of storage (under controlled ambient conditions), changes in the disintegration (tablets only) and dissolution properties (all formulations) were examined in accordance with British Pharmacopoeia (BP) specifications. Key findings: Findings from this study confirm that changes in solid-dosage form quality are observed when repackaged into MCAs compared to manufacturers packaging resulting in differences in in-vitro dissolution performance. However, even with these changes, overall product performance was acceptable and within BP specifications. Conclusion: There is a need for greater collaboration in this area between manufacturers, hospital and community pharmacists, academics and policymakers to increase the data available on the physical stability and in turn performance of medicines repackaged into MCAs

Dose Administration Aids: Pharmacists’ Role in Improving Patient Care

Dose administration aid (DAA) usage has become increasingly prevalent among populations worldwide and as such has become an important part of pharmacy practice. The evidence for the use of these aids has been favourable in Australia resulting in 2006 in a community based DAA program being considered by the Professional Programs and Services Advisory Committee and the first phase of this program implemented in October 2007. The program was established under the Better Community Health Initiative of the 4th Community Pharmacy Agreement with the Government. The aim of this program is to reduce medication-related hospitalizations and adverse events through improved medication management and adherence for people in the community. The most common patient groups that access this service include the elderly, who are often on several different medications and patients with cognitive disabilities who may have trouble understanding or remembering their dosage regimes. Repackaging of a medication, involving removal from its primary packaging invalidates the stability guarantee of the manufacturer. It is in fact the role of the health team to ensure patient care by making an informed judgment as to the effect on the quality and safety of this repackaging process. Drug manufacturers, on the whole, tend to discourage repackaging of medications and as there is little quality data available to support this process. Indeed, only a small number of medications have been investigated for their stability following repackaging into DAAs, namely atenolol, paracetamol, frusemide, prochlorperazine, sodium valproate, aspirin (dosette boxes) and clozapine. This paper will review the repackaging of medications into DAAs and the role that the pharmacist plays in this process to improve patient care, in addition to presenting the Australian research that has contributed substantially to the body of information available internationally on the quality implications, relating to the stability of repackaging medicines into DAAs