Accreditation Council For Pharmacy Education Research Articles

2018 Annual Report of the Accreditation Council for Pharmacy Education

This is the 88th annual report of the Accreditation Council for Pharmacy Education (ACPE). This report summarizes ACPE's activities covering the period January 21, 2018 – January 17, 2019 and is available to the profession and to the general public. In 2018, the ACPE Board and Staff successfully

Eyelid sebaceous carcinoma: Validation of the 8th edition of the American Joint Committee on cancer T staging system and the prognostic factors for local recurrence, nodal metastasis, and survival.

To investigate the clinicopathological features and prognostic factors for eyelid sebaceous gland carcinoma (SGC) in an ethnic Chinese population and to validate the performance of the T category of the 8th edition AJCC staging systems, with the aim of providing information for refinements. Sixty-three patients with pathological diagnosis of SGC were enroled retrospectively. The clinicopathological features, treatments, and outcomes were collected. Prognostic factors associated with the outcome of local recurrence, regional lymph node metastasis, and tumour-related death were analysed. The performance analysis was performed by comparing the predictive value for survival and the monotonicity of gradients between the 7th and 8th staging systems. The distribution of T1:T2:T3:T4 tumours according to the 7th and 8th edition was 6:40:16:1 and 23:26:5:9, respectively. Positive surgical margin was a poor prognostic factor. Local recurrence was associated with more aggressive histopathological features and surrounding structure invasions. Regional lymph node metastasis was associated with larger tumours. The T category of 8th edition showed better predictability for local recurrence and regional lymph node metastasis, while the T category of 7th edition had better monotonicity of gradients. Tumours classified as T2c or worse had higher risk of regional lymph node metastasis, while tumours T3b or worse in the 8th edition had more tumour-related death. Patients with higher T category are at risk of regional lymph node metastasis and tumour-related death. Further refinement of the T category of AJCC staging system can focus on the predictability for local recurrence and the monotonicity of gradients.

Essential Elements for Core Required Advanced Pharmacy Practice Experiences

Since 2004, concerns and calls for greater quality assurance in experiential education have been published. The Accreditation Council for Pharmacy Education (ACPE) "Standards 2016" provide limited differentiation across the four required practice experiences, and, as such, schools interpret them differently. Both schools and accreditation site visit teams would benefit from a common set of guidance for the required Advanced Pharmacy Practice Experiences (APPEs), so that they can ensure consistency and quality in student experiences across practice sites. To address this need for greater standardization, a taskforce of the American Association of Colleges of Pharmacy (AACP) Experiential Education (EE) Section conducted a peer-reviewed, consensus-building process, including experiential faculty and staff across multiple colleges and schools of pharmacy, to determine a common set of elements that could be used to bring consistency to the experiences and expectations for student learning in practice. Over a two year period, the taskforce reviewed the relevant literature and then drafted and revised the elements through an iterative process which allowed for established EE consortia and members of the EE section to review the draft and provide input for revision. The resulting essential elements presented here can be used to guide faculty and staff within experiential education programs in their quality assurance processes in ensuring students receive consistent experience as part of their education prior to graduation.

An online workshop integrated into Immunology course to teach pharmacogenomics to the first-year pharmacy students

Abstract Genetic basis of antibody structure is taught as a part of didactic course of Immunology to first-year pharmacy students. Therefore, we designed a three-hour workshop for P-1 students as a part of didactic Immunology course. Online workshops offer a rich multimedia learning experience, the interactive format includes guided learning videos, engaging discussion, assessment and comprehensive survey. Accreditation Council for Pharmacy Education (ACPE) Standards 2016 include pharmacogenomics, it is the responsibility of pharmacy schools to prepare pharmacists entering clinical practice to effectively use genetic data in the delivery of precision medicine. However, in a 2010 survey the state of pharmacogenomics instruction at most pharmacy schools was reported as “poor” or “not at all adequate”. Pharmacogenomics is defined as the study of how genes affects a person’s response to drugs. We proposed a new method of instruction using online learning resources to drive better learning and awareness of pharmacogenomics at a very early stage in pharmacy education. 64 students were included in this study. Two YouTube videos 45 minutes each, i.e., one describing basic genetics and the other pharmacogenomics were posted on Moodle. A case-study model was used to bring home the basic concepts. A pre- and post-workshop google forum was posted to assess student’s learning. A Moodle-based chat forum was also incorporated to take students questions during the workshop. The data showed that most of the students were unware of the importance and relevance of pharmacogenomics and the workshop improved learning this significantly. Online learning tools like workshops were found to be student-friendly and a flexible format with no scheduled meeting times.

Long-term natural history of idiopathic epiretinal membranes with good visual acuity.

To evaluate the long-term progression of idiopathic epiretinal membranes (iERMs) with good baseline visual acuity, and to identify predictors of visual decline. Retrospective case series SUBJECTS METHODS: We reviewed records of 145 eyes with iERM and best-corrected visual acuity (BCVA) of 20/40 or greater at presentation, including BCVA, lens status, and central macular thickness (CMT) at yearly visits; as well as anatomic biomarkers including vitreomacular adhesion, pseudohole, lamellar hole, intraretinal cysts, disorganization of the inner retinal layers (DRIL), and disruption of outer retinal layers. Linear mixed effects and mixed-effects Cox proportional hazards models were used to identify clinical and anatomic predictors of vision change and time to surgery. At presentation, mean BCVA was 0.17 ± 0.10 logMAR units (Snellen 20/30) and mean CMT was 353.3 ± 75.4 μm. After a median follow-up of 3.7 years (range 1-7 years), BCVA declined slowly at 0.012 ± 0.003 logMAR units/year, with phakic eyes declining more rapidly than pseudophakic eyes (0.019 ± 0.003 vs. 0.010 ± 0.004 logMAR units/year). Metamorphopsia, phakic lens status, lamellar hole, and inner nuclear layer cysts were associated with faster visual decline. Cumulative rates of progression to surgery were 2.9, 5.6, 12.2, and 21.1% at years 1-4. Visual symptoms, metamorphopsia, greater CMT, and disruption of outer retinal layers were associated with greater hazard for surgery. Eyes with iERM and visual acuity ≥ 20/40 experience slow visual decline, with 21% of eyes requiring surgery after 4 years. Clinical and anatomic predictors of vision loss may be distinct from factors associated with earlier surgical intervention.

Incorporating ACPE Standards in a Holistic Approach to School Operations and Accreditation

Auburn University Harrison School of Pharmacy (AUHSOP) implemented a comprehensive, holistic process of continuous quality improvement (CQI) for its program using the Accreditation Council for Pharmacy Education's (ACPE) Accreditation Standards as the foundation. The process served as a way to increase the impact of the accreditation standards through continuous monitoring and programmatic improvements. Internally generated standards were also included in the CQI process. Design of the program included defining the program, establishing quality criteria, developing a table of measures that provided evaluation metrics, and assessing the program annually. Each year, faculty members, staff, students and other constituents assess the program for strengths, areas for improvement and insights. A CQI report is created and is made available to constituents, including ACPE through the Assessment and Management System (AAMS). Areas for improvement and new goals are then incorporated into the school's strategic plan and committee assignments for the year. Some of the suggestions included making the program appraisal more meaningful and on a continuous, ongoing basis compared to doing an appraisal for accreditation purposes at 8-year intervals. The process has increased constituent awareness of all aspects of the program and prompted numerous improvements since its adoption. A culture of assessment resulted from the process.

A Qualitative Study of Exercise and Physical Activity in Adolescents with Pediatric-Onset Multiple Sclerosis.

Pediatric-onset multiple sclerosis (POMS) accounts for up to 5% of all multiple sclerosis (MS) cases. Of note, the existing literature regarding physical activity and POMS is sparse, and there is limited insight about the lived experiences of individuals with POMS regarding physical activity, including perceptions of its benefits, barriers, facilitators, and promotion. We conducted a qualitative exploration of physical activity perceptions and experiences and of preferences for a physical activity intervention in eight persons with POMS. Using semistructured interviews and interpretative phenomenological analysis, we crafted numerous themes that provide new knowledge of physical activity experiences and preferences in this population. The adolescent participants believed that physical activity would be beneficial and important but further believed that it can often be boring and may worsen POMS symptoms. Participants described adequate symptom management, social support, time, and opportunity as facilitators of physical activity, and lack of social support, time, and opportunity as hindrances. The interviewees described that components of a future intervention should focus on education regarding specific exercises, outcomes, and safety during exercise and provide opportunities for social engagement with other individuals with POMS. This qualitative study provides novel findings regarding the perceptions and experiences of physical activity in POMS. An important step in crafting an understanding of physical activity behavior in POMS, this study serves to inform the development and delivery of physical activity behavioral interventions.

Health Informatics Competencies for Pharmacists in Training

Objective. To gather feedback from focus groups regarding health informatics competencies that should be taught in a Doctor of Pharmacy (PharmD) curricula and to revise the competencies based on this feedback. Methods. The pharmacy informatics task force of the American Association of Colleges of Pharmacy (AACP) used 11 sources to create a list of pharmacy informatics competencies. Subsequently, faculty feedback about the competency list was obtained via two synchronous online focus groups in August 2015. The list was then revised based on the feedback. Results. Eight people (a department chair, six faculty members and a graduate student) participated in the focus groups (six were from private and two were from public institutions). Participants felt the list had too many competencies to be covered in a timely manner and some indicated that basic computer and Internet competencies should be considered pre-requisites. Participants also recommended that competencies be split by proposed curricular placement (eg, prerequisite, required, elective, didactic, experiential) for each objective. The competency list was revised in response to focus group feedback. Conclusion. The proposed curriculum aligns with the new Accreditation Council for Pharmacy Education (ACPE) standards requiring that professional pharmacy curricula cover multiple aspects of health informatics. The proposed competencies list can serve as a reference to assist in the development of the curriculum and ensure compliance with the new standards.

Effectiveness of Fatigue Management Interventions in Reducing Severity and Impact of Fatigue in People with Progressive Multiple Sclerosis: A Systematic Review.

Rehabilitation interventions are recommended to manage multiple sclerosis (MS)-related fatigue. However, existing research has largely been generalized to those with relapsing-remitting MS, making it difficult to determine the effectiveness of these interventions in people with progressive MS. Therefore, this study aimed to systematically review the evidence related to the effectiveness of fatigue management interventions in reducing the severity and impact of fatigue in people with progressive MS. Six electronic databases (CINAHL, Cochrane Library, MEDLINE, PEDro, ProQuest, and Web of Science Core Collections) were searched for relevant articles up until November 2017. Randomized controlled trials and quasi-experimental studies that examined the effects of exercise, behavioral interventions, and rehabilitation on fatigue in people with progressive MS using self-reported fatigue outcome measures were included in this review. Eight exercise, two rehabilitation, and two behavioral interventions were investigated in the 13 articles included in this review. Heterogeneous effects were reported between studies, with only two exercise, one behavioral, and two rehabilitation interventions recording significant improvements in postintervention fatigue severity or impact. However, most studies were underpowered, only two used fatigue as the primary outcome, and only one specifically recruited participants with predefined levels of fatigue. Evidence from this review is inconclusive regarding the effectiveness of nonpharmacologic interventions in reducing the severity and impact of fatigue in progressive MS populations. Adequately powered randomized controlled trials are required to evaluate fatigue management interventions in people with progressive MS experiencing high levels of fatigue and using fatigue as the primary outcome.

Development, Implementation, and Evaluation of Introductory Pharmacy Practice Experiences at an Academic Medical Center

Purpose Introductory pharmacy practice experiences (IPPEs) for pharmacy students are required by the Accreditation Council for Pharmacy Education, but guidance for rotational structure is limited. Objective To describe the design, implementation, and evaluation of IPPE rotations at a large, multisite, academic medical center. Conclusion A large IPPE program was successfully implemented and sustained. Rapid cycle changes were made based on post rotational surveys completed by both preceptors and IPPE students to assess and modify the rotations until the average experience was rated at least a 4 on a 5 point scale, illustrating a mutually beneficial collaboration between the Medical Center and the School of Pharmacy. The IPPE program structure and capacity has continued to grow at the Medical Center in a collaborative manner.

A Modified Approach to Setting Curriculum Boundaries in Pharmacy School

Doctor of Pharmacy department heads are responsible for determining the breadth and depth of content within courses. While the Accreditation Council for Pharmacy Education (ACPE) provides standards for what content, skills, and abilities should be included in PharmD education, the process that schools and colleges use to determine the degree to which these measured outcomes are taught is variable. As new topics and content for instruction are identified, schools and colleges are faced with either extending the PharmD curriculum length, removing other content, or diminishing the depth that other content is covered to make room for new content. To assist with these decisions, the Ebel grid is a tool that can be used to identify the criticality and relevance of encountered topics as well as guide pre-APPE curriculum selection.

The Pharmacy Student Population: Applications Received 2016-17, Degrees Conferred 2016-17, Fall 2017 Enrollments

This report presents data that describe the 2016-17 pharmacy application pool, degrees conferred in 2016-17, and fall 2017 pharmacy program enrollments. Data for this report were requested from 142 U.S. colleges and schools of pharmacy recognized by the Accreditation Council for Pharmacy Education (

Highlighting a gap in student pharmacist training: Intraprofessional education with pharmacy technicians

IntroductionThe Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards suggest integration and inclusion of interprofessional education in doctor of pharmacy programs. Although not directly mentioned by these Standards, intraprofessional education between student pharmacists and student pharmacy technicians may provide valuable preparation for comradery in practice. CommentaryGiven the prevalence of collaboration between pharmacists and pharmacy technicians in pharmacy practice, lack of intraprofessional education could be a vital gap in current programs. There have been previous calls within academic pharmacy and from key stakeholder groups for greater involvement of the profession in the training and education of pharmacy technicians, yet literature is sparse on successful models. This commentary includes a discussion of why intraprofessional training is vital, a brief commentary on example intraprofessional activities, as well as strategies for collaboration. ImplicationsA series of questions with the intention of evoking further conversations and awareness within academic pharmacy completes the commentary.

Factors Associated with Sexual Dysfunction in Individuals with Multiple Sclerosis

Sexual dysfunction is a common symptom of multiple sclerosis (MS) that often goes unreported by both the patient and the clinician. Sexual dysfunction can affect a person's mood, relationships, daily functioning, and quality of life. Gaining a better understanding of the prevalence and nature of sexual dysfunction in individuals with MS would not only help identify patients with this problem but also determine contributing factors, which can inform treatment alternatives available to the patient. Patients with a diagnosis of MS (n = 162) completed the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 during their neurology appointments at the Mellen Center for Multiple Sclerosis at Cleveland Clinic. These data were merged with Knowledge Program data collected as part of standard practice and included measures of mood, disability, and quality of life. Sexual dysfunction was present in 64.2% of the clinic sample. Patients with sexual dysfunction had significantly worse average MS-related disability and depressive symptom scores. Sexual dysfunction is highly prevalent in the MS clinic sample. Assessment and treatment of depression may serve as a starting point for intervention in patients with MS who experience sexual dysfunction. Identifying individuals who are at risk for sexual dysfunction concerns may help with clinician and patient burden in terms of routine assessment of this symptom.

Implementation and lessons learned from a mock trial as a teaching-learning and assessment activity

Background and PurposeTo describe implementation and lessons learned from use of a mock trial as a teaching-learning and assessment activity in a required evidence-based practice course. This innovative self-directed learning strategy reinforced evidence-based skills and affective domain competencies in Center for the Advancement of Pharmaceutical Education (CAPE) 2013 Outcomes and Accreditation Council for Pharmacy Education (ACPE) Standards 2016. Educational Activity and SettingDuring spring semesters 2015 and 2016, first professional year (P1) cohorts were divided into teams and assigned controversial topics to research and debate in mock trials. The activity provided opportunities for teaching-learning and assessment. Statistical analysis included inter-rater reliability (IRR), comparison of faculty-judge and student-juror evaluation of trial performance. FindingsTwo cohorts were divided into eight teams (four per cohort) to debate four issues. Students within each team were assigned individual scores. Mean individual scores are reported by trial/topic. Faculty-judges and student-jurors rated eight criteria including content/knowledge, critical thinking, application/discussion of federal/state law, citations/references, visual aids, delivery/style, and active listening. Analysis indicated students met competency expectations with overall judges’ and jurors’ mean scores above 54/60 points (90%) in 2015 and above 51/60 points (85%) in 2016. Judges’ scores showed a wider distribution than jurors’ scores. Peer evaluation mean scores were above 55/60 points in all four trials. Intra-class correlation was calculated. Judges’ scores had excellent IRR in two trials, and good IRR in a third trial, whereas jurors had good IRR in one trial. SummaryEvaluation scores demonstrated students successfully applied knowledge and skills from this and prior P1 courses, and met competency expectations for the mock trial.

Somatic Symptoms of Depression and Anxiety in People with Multiple Sclerosis.

People with multiple sclerosis (MS) are at increased risk for depression and anxiety. The symptoms of MS are often similar to the somatic or physical symptoms of depression and anxiety (fatigue, trouble concentrating). This study examined whether MS symptoms and effects biased the assessment of somatic symptoms of anxiety and depression. People with MS (n = 513) completed a survey about MS symptoms, treatments, and distress. The Patient Health Questionnaire-9 assessed depression, and the patient-report version of the Primary Care Evaluation of Mental Disorders assessed anxiety. Participants were grouped into low versus high MS symptoms based on self-reported symptoms and as high versus low disability by the Expanded Disability Status Scale (EDSS). Groups were compared using differential item functioning analysis. No bias was found on somatic symptoms of depression comparing high versus low MS symptom groups (P > .15) or comparing groups based on EDSS scores (P > .29). Two anxiety symptoms (fatigue and muscle tension) showed bias comparing high versus low MS symptom groups (P < .01) and comparing high versus low groups based on EDSS scores (P ≤ .01). Intraclass correlations suggested a small effect due to bias in the somatic symptoms of anxiety. Somatic symptoms of depression are unlikely to be biased by MS symptoms. However, the use of certain somatic symptoms to assess anxiety may be biased for those with high MS symptoms.

A comparison of baseline professional attitudes and behaviors among student pharmacists to inform a co-curricular professional engagement program

BackgroundProfessionalism in pharmacy students is an area of great focus with the release of Accreditation Council for Pharmacy Education (ACPE) Standards 2016. This study assessed and compared student pharmacists’ professionalism at one college of pharmacy to inform the implementation of a co-curricular professional engagement program. MethodsTwo validated instruments (Behavioral Professionalism Assessment Instrument [BPAI] and Pharmacy Professionalism Instrument [PPI]) were administered to assess baseline professionalism. Kruskall-Wallis tests compared responses among the three pharmacy classes. Analysis was conducted using SPSS. This research was approved by the Mercer University's Institutional Review Board. ResultsA total of 362 students completed the survey (75% response rate), of which 131 were first-year, 139 were second-year, and 92 were third-year students. There were significant differences in agreement among these classes of students as to whether a program focused on professional engagement was important and helpful (p < 0.001). Seven BPAI statements and five PPI statements demonstrated significant differences in the level of agreement among the professional years. These behaviors include: completing assignments independently and without supervision (p = 0.004); commitment to helping others (p = 0.004); reporting a medication error (p = 0.005); using time efficiently (p = 0.02); and being respectful (p = 0.04). DiscussionAt baseline, 12 statements were significantly different in the level of agreement among the three pharmacy classes. Differences may be explained by perceived professionalism (in first-year students) versus actual professional behaviors (second- and third-year students), as well as breadth and depth of experience. A co-curricular professional engagement program could increase student awareness of professionalism and professional behaviors and be tailored to meet assessed student needs.

An Exploratory Survey of Incorporation of Gender- and Sex-related Differences in the PharmD Curricula.

Clinical presentation and treatment in many disease states vary due to sex- and gender-differences. Sex-related pharmacokinetic differences are particularly important for pharmacists. The Accreditation Council for Pharmacy Education (ACPE) currently has no standard for the inclusion of gender- and sex-related differences in the didactic PharmD curriculum, but encourages advanced pharmacy practice experiences (APPEs) to include diverse populations related to gender. The purpose of this survey is to explore faculty incorporation of gender and sex differences within the PharmD didactic curriculum in preparation for a nation-wide survey. A survey was created to determine how many clinical topics incorporated gender- and sex-related differences and to what extent this information was discussed in the classroom. The survey link was emailed to pharmacotherapeutics and pharmacokinetics faculty at Midwestern University Chicago College of Pharmacy, University of Illinois at Chicago, Roosevelt University, Rosalind Franklin University, and Chicago State University. Chi square analyses were performed to examine relationships across participant responses. A total of 56 faculty members participated in the survey, resulting in a 20% response rate. Of these, 30 (54.5%) faculty indicated that they discussed gender- and sex-related differences in the subject area in which they teach. Approximately 33% of respondents found gender- and sex-related differences very clinically important. Gender- and sex- related differences were taught in a variety of subject areas, including cardiology, diabetes, and chronic obstructive pulmonary disease (COPD). With no current standard, faculty members independently choose to include gender- and sex-related differences in their lecture topics and the extent of the discussion. Faculty should be aware of this lack of standardization and that they are independently responsible for including gender- and sex-related differences in their particular topics. Because the surveyed faculty find gender- and sex-related differences clinically important and literature suggests differences in medications depending on gender and sex, further research is planned to provide insight on a national level.

Hospitals get serious about pharmacy technician training.

Hospitals are starting to take a do-it-yourself approach by developing their own accredited pharmacy technician training programs with the goal of hiring these skilled workers and advancing pharmacy practice. John Armitstead, system director of pharmacy services at Lee Health in Fort Myers and Cape Coral, Florida, said the multihospital system recently hired all 7 graduates of the organization’s inaugural pharmacy technician class. “We’ve already got another class started, and that’s got 6 students in it,” Armitstead said. Lee Health’s technician training program is one of 15 in the state with full or candidate accreditation status from ASHP and the Accreditation Council for Pharmacy Education (ACPE). It’s the only such pharmacy technician training program in Florida that’s operated by a health system. Nationally, just 5 of the 261 ASHP–ACPE-accredited or candidate-status technician training programs are classified as operated by a health system or hospital, said Lisa Lifshin, director of pharmacy technician accreditation and residency services in ASHP’s Accreditation Services Division.

Identifying student learning competencies for urban underserved practice using a Delphi process

IntroductionThe pharmacy profession has a growing opportunity to provide high-quality patient care to urban underserved patients. The Accreditation Council for Pharmacy Education (ACPE) has also recognized the necessity of training pharmacy students to care for underserved patients within Standard 3.5 in Standards 2016. Despite this recognized need to train students to care for urban underserved patients, there is limited literature to guide schools and colleges of pharmacy in developing learning activities and curricula to meet this need. MethodsThis study utilized a three-round modified Delphi process to develop learning competencies. Participation was solicited from pharmacy practice faculty members of the American Association of Colleges of Pharmacy (AACP) Health Disparities and Cultural Competency Special Interest Group (SIG). This study used a proportion of experts rating agree or strongly agree at 80% to determine consensus. ResultsThe expert pool had a combined 235 years of pharmacy practice experience in urban underserved settings. Ten learning competencies were developed and finalized: Identified learning competencies related to the development of pharmaceutical and social knowledge base; development of pharmaceutical care and social skills; and building awareness of benefits and disadvantages of working with urban underserved patient populations. DiscussionThe learning competencies described in this study provide schools and colleges of pharmacy a tool to help guide learning activity and curricular development to educate students to provide high-quality and compassionate care to urban underserved patients. ConclusionsThis study is the first description of practice-based student learning competencies for urban underserved pharmacy practice in the literature.