Single-site Case Research Articles

P01 Adult-onset chronic recurrent multifocal osteomyelitis – case series of four adult patients in Liverpool University Teaching Hospitals Foundation Trust

Abstract Introduction Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disorder. Classically known as a childhood disorder and diagnosis of exclusion, it characteristically presents with relapsing sterile bone inflammation affecting the metaphysis of lung tubular bones, shoulder girdle, clavicle, vertebral column or bony pelvis. Links with autoimmune conditions have been suggested. Evidence of adult-onset cases (age >18 at diagnosis) remains sparse and sporadic, with mostly individual case reports on searches. We present a case series of four patients with adult-onset CRMO in Liverpool, with varying responses to bisphosphonate treatment and no clinical features of SAPHO. Case description We list four cases of adult patients with CRMO. Case 1: 53-year-old female presented in 2023 with a 10 year history of on-off chest pain isolated to her sternum, and back pain since 2021. MRI confirmation of bone marrow oedema. Bone biopsy normal. Treated with zoledronate. MRI following treatment suggested some improvement but patient remained in pain. Case 2: 24-year-old female presented in 2019 to services with a 10 year history of worsening back pain. Medical background of asthma, type 1 diabetes mellitus, primary biliary cirrhosis and psoriasis. MRI suggestive of persistent pre-sacral soft tissue and sacral oedema since 2015. ANA, Anti-CCP, ENA and dsDNA were negative. Bone biopsy done was positive for inflammation. Pain improved with pamidronate. Case 3: 31-year-old male presented in 2022 with 14 years of relapsing pains and swelling in left clavicle and improvement with NSAIDs. Initially presented via orthopaedic services who arranged an MRI scan that demonstrated oedema of his left clavicle. Received zoledronate infusion with improvement in pain. Case 4: 45-year old-female presented in 2024 with eight year history of chronic right hip and right sacroiliac joint pain. Persistent lower back pain, central right sided with radiation down right knee to her knee. Examination showed tenderness over her lumbar spine and sacroiliac joints. PET-CT done showed avid uptake in L3/4, with subtle lucencies in left frontal bone, right femur and right sacrum. Treated as CRMO with pamidronate with a positive response. All patients received bisphosphonate therapy and varied response to treatment was seen. Two of the four patients had an excellent response with complete resolution of symptoms. One patient has had initial positive response to treatment with resolution of pain but is still planned for more bisphosphonate cycles. One patient had no response to treatment. Discussion Current literature searches describe CRMO mostly in the paediatric populace, with peak incidence aged 10. Most cases of CRMO are diagnoses of exclusion, hence leading to diagnostic delays as differentials such as malignancy, infection, and histiocytosis are first excluded. The Bristol review study suggested a mean time of 15 months to diagnosis in the paediatric populace. We highlight here our findings that CRMO can also present within the adult populace. Typically in adults when similar symptoms arise, SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is considered as a differential. Our patients, whilst having features on imaging suggestive of bone inflammation, did not have any features of SAPHO syndrome. Our findings are corroborated by the Eurofever International Registry study that enrolled 485 patients and showed adult-onset disease in 6.3% of their cohort, accounting for 31 cases. Our patients were all treated with bisphosphonate therapies. Currently, bisphosphonate therapies are often agreed as a first line treatment approach. Some reports exist of beneficial effects in the use of corticosteroids, DMARDS - particularly sulfasalazine and methotrexate - and biologic treatments (anti-TNF agents), though no common consensus guideline for treatment of CRMO within the UK exist at the moment to our knowledge. We feel the varied clinical response of our patients highlights a need for more research to be targeted towards this area. Key learning points Learning points are as follows: • Few cases of adult-onset CRMO are reported in the UK. Most are single site case reports or case series of paediatric patients. • This cases series is the largest adult-onset cohort in Europe from a single hospital site. • Bisphosphonates are used first line - typically pamidronate. • Corticosteroids, DMARDs (SLZ/MTX) and biologic treatments (anti-TNF agents) have been reported to be effective in some single case reports. • Additional research is required for a national consensus guideline for the treatment of CRMO, including additional management options for those patients that fail first line treatment (bisphosphonate).

Fifteen years of training courses and implementation of child and adolescent psychiatry in Jimma, South-West Ethiopia: a single site case study

In Ethiopia, as in many other low-and middle-income countries, health professionals, particularly mental health workers, are scarce. The purpose of this case study is to describe the process of establishing training child psychiatry and capacity building to implement clinical care for child and adolescent mental health. We present a case study on training of child and adolescent psychiatry embedded within the master’s degree program in integrated clinical and community mental health at the department of psychiatry in Jimma University, Ethiopia. This program is jointly developed in collaboration between Jimma University and Ludwig-Maximilian-University, Germany. The core elements of the training were to train mental state description, making decisions on possible disorders, perform occupational activities, and design psychosocial interventions. The WHOmhGAP guide is considered as appropriate knowledgebase for our teaching program. Each course was evaluated bidirectional with multiple methods. From 2010 to 2024, twelve trainings were organized. We structured the program in three phases. The initial phase (2010–2014) was to establish collaboration with guest lecturers and to develop, implement, and evaluate the training. The second phase (2015–2019) changed to mentorship and transition from guest lecturers to local trainers and included a refresher course. Phase three (2020–2024) was independent work. An outpatient clinical service for children was implemented by the lead author and now is running at Jimma University. The implementation of the training took place in small steps. A long-term commitment of local and guest lecturers enabled to develop culturally appropriate solutions for the local context. A similar approach can be applied to effectively start and expand child and adolescent mental health care in other resource limited settings.

Mobilising Practices of Human Resources During COVID-19: Application of Managerial Innovation

The health crisis caused by the Coronavirus (COVID-19) has had a major negative impact on the human resources of companies of all sizes and in all sectors (cessation of activity, obligation to stay at home). In the absence of compensatory financial measures, company containment (closure) is not an option to avoid more serious social consequences. It is therefore preferable for companies and managers to adopt other measures to limit the impact of this pandemic on human resources. Given this destabilisation of the business community, a number of innovative management practices will emerge and become a real imperative for mobilising human resources. The aim of this article is to identify models of managerial innovation put in place by managers to mobilise human resources during the current health crisis. Based on a review of the literature on managerial innovation and strategies for mobilising human resources in times of health crisis on the one hand and, on the other, a single-site case study of 6 Cameroonian companies operating in different sectors of activity, we show that, under the prism of COVID-19, a number of managerial innovations such as teleworking, team rotation and part-time working, social communication, salary maintenance, health support and coaching can emerge and become real spurs for the mobilisation of human resources.

Severe Intraocular Inflammation After Intravitreal Injection of Faricimab: A Single-Site Case Series of Six Patients

To describe the patient characteristics and clinical course of severe intraocular inflammation (IOI) following intravitreal injection (IVT) of faricimab. Retrospective case series. Case series at a single French academic center (Dijon University Hospital) where 263 patients were treated with faricimab IVT between January 9, 2024 and May 7, 2024. Over the 4-month period, a total of 1659 eyes (1338 patients) received anti-vascular endothelial growth factor (anti-VEGF) IVTs for a total of 3510 IVTs, of which 343 eyes (263 patients) received faricimab IVTs for a total of 971 IVTs. Overall, 6 pretreated eyes with neovascular age-related macular degeneration that were switched to faricimab developed severe unilateral IOI following faricimab IVT (1/162 injections [0.62%]), including 5 eyes presenting with a severe anterior and intermediate uveitis mimicking infectious endophthalmitis. All eyes were normotensive and presented with mild to moderate pain and predominantly moderate vitritis, associated with granulomatous keratic precipitates in 2 eyes and nonocclusive vasculitis in one eye. The clinical presentation, sterile vitreous sample culture, and rapid improvement with treatment made the diagnosis of infectious endophthalmitis unlikely. Four patients out of 6 did not recover their pre-IOI visual acuity, with an average visual loss of +0.2 logMAR. Two patients had positive antinuclear antibodies, including one with a history of cutaneous lupus. In this case series, we reported 6 cases of severe IOI after intravitreal faricimab over 4 months in a single French center with an estimated incidence rate of 0.6% per injection. Future real-world data will contribute to a better evaluation of the epidemiology of this rare inflammatory adverse event related to intravitreal faricimab.

Empowering Teacher Educators: Advancing Culturally Responsive Practices Through Professional Development

ABSTRACT This single-site case study investigates the effects of a culturally responsive teaching professional development (CRPD) program on seven teacher educators’ self-efficacy and implementation of culturally responsive practices in their coursework. Over five years, the study involved evaluating existing coursework, educator training, community partnerships, and curriculum revisions. Quantitative and qualitative data, including a culturally responsive teaching self-efficacy survey, syllabi content analysis, interviews, exit tickets, and classroom observations, were collected and analyzed. Results show a positive impact of the PD on educator self-efficacy in implementing CR practices, promoting inclusive learning environments, fostering meaningful classroom relationships, improving assessment and instructional practices, enhancing discourse strategies, and cultivating critical consciousness among both educators and students. Cross-disciplinary collaboration, collaborative mentorship, and sustained personal and professional growth emerged as crucial elements in this transformative process. The study highlights the significance of targeted support and training for educators to effectively integrate CR practices into their teaching.

Diffusion with two resetting points.

We study the problem of a target search by a Brownian particle subject to stochastic resetting to a pair of sites. The mean search time is minimized by an optimal resetting rate which does not vary smoothly, in contrast with the well-known single site case, but exhibits a discontinuous transition as the position of one resetting site is varied while keeping the initial position of the particle fixed, or vice versa. The discontinuity vanishes at a "liquid-gas" critical point in position space. This critical point exists provided that the relative weight m of the further site is comprised in the interval [2.9028...,8.5603...]. When the initial position is a random variable that follows the resetting point distribution, a discontinuous transition also exists for the optimal rate as the distance between the resetting points is varied, provided that m exceeds the critical value m_{c}=6.6008.... This setup can be mapped onto an intermittent search problem with switching diffusion coefficients and represents a minimal model for the study of distributed resetting.

Advancing scholarly excellence at midcareer: the influence of exceptional others on faculty professional growth

PurposeThere is a need to support midcareer faculty who have demonstrated scholarly success but require additional development. The purpose of this study was to explore the effects of an initiative for “star faculty” at midcareer, with an emphasis on the role of exceptional others in their professional growth.Design/methodology/approachThis is an exploratory, single-site case study of a midcareer faculty excellence initiative. Data sources include document/site analysis and individual interviews.FindingsFindings reveal the value of “exceptional others” in professional growth among high-performing midcareer faculty. Perceptions about excellence at midcareer emerged as an antecedent to developing midcareer faculty members. Analysis generated themes in behaviors related to supporting midcareer scholars’ professional growth.Research limitations/implicationsThis study is an initial step toward refining concepts such as exceptional others, academic stars and scholarly advancement within the academy. There is a need for equity-minded research about these topics. In addition to replication across institutional and disciplinary contexts, there is also a need for longitudinal mixed-methods studies of midcareer faculty mentoring outcomes over time.Practical implicationsThe study points to the role of the institution and its senior faculty in fostering midcareer scholarly excellence. Mentoring and development around individualized goals may be of value in addition to an emphasis on clarity around institutional expectations and norms in faculty performance reviews.Originality/valueMidcareer faculty are a crucial component of the academy, yet they are often overlooked as needing career support, resources and development. This study focuses on mentoring and coaching for postsecondary faculty at midcareer and the role of exceptional others in facilitating faculty professional growth.

Institutionalization of Quality Management Practices (QMPs): A Case Study of a Sri Lankan Entity

The main purpose of this study was to explore how can Quality Management Practices (QMPs) be institutionalized as a successful strategic performance improvement initiative in a manufacturing organization located in Sri Lanka. Institutional Theory was incorporated as a theoretical lens to make sense of institutionalization process of the organization. Institutionalization Framework of Tolbert and Zucker (1996) which takes into the account the pre-institutionalization, semi-institutionalization and full institutionalization stages of QMPs implementation within the case organization. The study adopted the single-site case study method under the qualitative methodology. Data has been mainly collected through interviews and documentary review. The findings of this study illustrated that implementation of QMPs in the case organization is successful, because quality management has become an institutionalized practice within the case organization. It was further evident that, institutionalization of QMPs is complete when they are both accepted and taken-for-granted as part of the way people feel and think and the way they usually do things. As a result of institutionalization, QMPs are coherently fitted with the main organizational strategy and they have become an integrated QMPs for the entire organization, without remained as isolated quality practices which are narrowly termed as quality tools and techniques.

Interreligious Dialogue For Conflict Prevention

Interreligious dialogue possesses external and internal critical functions. Such dialogue promotes a new resolution for a sustainable community as stable and dynamic interreligious understanding and its application are gained among the plural society. The objective of the study is to reveal whether the interreligious dialogue is a potential in managing conflict prevention. The research uses multi case single-site exploratory case study. Primary data was collected through observation as well as snowballing technique and in-depth interview conducted to village leaders and religious leaders in Punduh Pidada, District of Pesawaran in which the community is religiously diversed. They come from various religions; Islam, Christian and Catholic. Meanwhile secondary data was obtained through document analysis of various religious books, holy books and any documents related to the study. Data was qualitatively analysed by using the NVIVO 10 software. Contributions: Indonesia is a country with the most diverse number of ethnicities, race, languages, cultures and religions in the world, that diversity is wealth and assets for a nation, but if not properly maintained it will cause conflicts in society. Three ways to resolve conflict issues as described in this study can be used as examples and references by the government in overcoming and dealing with conflicts among society in Indonesia, especially conflicts related to religious issues.

Student Privacy and Learning Analytics

This single-site case study will seek to answer the following question: how is the concept of privacy addressed in relation to a student success information system within a small, public institution of higher education? Three themes were found within the inductive coding process, which used interviews, documentation, and videos as data resources. Overall, the case study shows an institution in the early stages of implementing a commercial learning analytics system and provides suggestions for how it can be more proactive in implementing privacy considerations in developing policies and procedures.

How International School Administrators Build Trust

This single-site case study focuses on how administrators in a Vietnamese international school build trust among expatriate teachers to foster informal teacher leadership. A theoretical framework based on Bourdieu’s (1986) social capital theory was used to design the research instruments and analyze the data. Participants took part in semi-structured interviews. Findings suggest that when administrators trust teachers as professionals and listen to their perspective, teachers reciprocate trust back to administrators. Findings also suggest that administrators’ handling of crises generates trust, but constant communication and transparency of information are key. The study highlights the importance of crisis management skills for administrators in international schools as these types of schools tend to be relatively isolated from the host country. The study also highlights the importance of trust for informal teacher leadership as trust was a prerequisite for collaboration. The findings also suggest that administrators play a critical role in building trust. However, administrators’ role is indirect rather than direct. In addition to building trusting cultures, findings suggest that administrators have other means for fostering informal teacher leadership, which should be explored in future research.

Between Global History and Microhistory: Rethinking Histories of “Small Spaces” and Cities

AbstractHow can historians of “small spaces” and cities focus on local events and issues and at the same time carry on conversations with peers in a disciplinary mode marked by the spatial expansiveness of global history, on one hand, and a focus on objects and individuals of microhistory on the other? At stake here are key questions connected with the intellectual value of place-based knowledge and detailed single-site historical case studies. I argue that as long as we are caught between the positivist idea that causal regularity and time-place independence of explanatory mechanisms are the hallmark of theory, and the postmodernist resistance to generalizations, histories of cities and other small spaces will suffer from “defanged empiricism.” This problem is particularly debilitating for non-global histories of small spaces and cities of the global South, which often “do not travel well.” Is there a way out? I argue that a critical engagement with the stratified ontologies of critical realism— in particular, a version that I call “soft critical realism”—and Charles Tilly’s “deep order” can enable historians of small spaces and cities to re-situate their research at the heart and center of social theory, and simultaneously strike a better balance between attention to local details, the narrative form, and engagement with larger processes, concepts, and theories. Finally, I concretize the discussion by offering the example of how my own research on late colonial and early postcolonial Calcutta has benefitted from this approach.

A total productive maintenance & reliability framework for an active pharmaceutical ingredient plant utilising design for Lean Six Sigma

This research investigates the requirement for and relationship and implementation of a total productive maintenance (TPM) and Reliability Centred Maintenance (RCM) strategy within an Active Pharmaceutical Ingredient (API) Plant. This research aimed to study the tools and techniques of TPM and Reliability Engineering and then deploy a designed model to an API plant. A case study involving Design for Lean Six Sigma phases of Define, Measure, Analyse, Design, and Verify was utilised to build an API site TPM pilot program. Data was collected using interviews across Company 'X's local and Global Engineering teams. Process runtime, downtime and plant availability metrics were compiled and a new design for Total Productive Maintenance and Reliability was proposed and verified. A maintenance framework was designed to optimally incorporate Total Productive Maintenance, Reliability and Operational Excellence with an emphasis on Overall Equipment Efficiency (OEE) realizing a 33 % reduction in planned maintenance activities, a 70 % reduction in Corrective Maintenance, Cleaning for Maintenance was reduced by 50 %, the pilot maintenance area of the centrifuge has its OEE increased by 20 % and plant availability increased by two hundred and 6 h. This research highlights the importance of Total Productive Maintenance as a key component of an effective maintenance strategy and its potential to transform maintenance practices. Based on this research and results, TPM is recommended to be applied to any API manufacturing organization. A limitation of the study is that it is a single-site case study. The novelty of this research is based upon the emphasis on Reliability Engineering to remove non-value add Maintenance time from the manufacturing schedule. The Total Productive Maintenance & Reliability model designed and implemented in this research is unique in the literature and can be leveraged by engineering professionals and academics to understand the benefits of TPM.

Analysis of patient factors associated with selection of corticosteroid injection in the freezing phase of idiopathic adhesive capsulitis.

Primary idiopathic adhesive capsulitis (AC) is characterized by shoulder pain and global limitations in range of motion (ROM). The aim of this study was to determine (1) if a spectrum of symptom severity exists during the freezing phase of AC and (2) identify factors associated with patient selection of corticosteroid injection (CSI) for treatment. Patients presenting within 6 months of symptom onset of AC (freezing phase) were enrolled in this single-site retrospective case control study. Visual analog pain scale (VAS) score, shoulder ROM, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, and Patient-Reported Outcomes Measurement Information System (PROMIS function and pain) scores were collected. Each patient was offered oral anti-inflammatory medication, physical therapy, and intra-articular CSI. Patients were divided into 2 cohorts: those electing vs. those deferring CSI. Multivariable logistic regression was performed to identify patient or symptom characteristics predictive of electing CSI. A total of 112 patients (mean age=54.7 ± 8.8 years, female=76 [67.9%], mean symptom duration =13.2 ± 7.9 weeks, elected CSI=74 [66.1%]) were included in our analysis. The overall study population demonstrated a wide spectrum of VAS pain scores (6.0 ± 2.8, range: 0-10) and ROM: forward elevation (99° ± 27°, range: 30°-150°), abduction (82° ± 24°, range: 30°-130°), external rotation (47° ± 13°, range: 0°-90°), internal rotation (38° ± 26°, range: 5°-90°). The CSI group had higher mean VAS pain score (6.6 ± 2.5 vs. 4.9 ± 3.0, P=.005) and greater limitations in ROM for forward elevation (92° ± 27° vs. 113° ± 25°, P=.001) and abduction (77° ± 24° vs. 90° ± 21°, P=.005) compared with the non-CSI cohort. The CSI group demonstrated significantly worse shoulder function based on Constant (P<.05), ASES (P=.001), P-UE (P=.016), P-Intensity (P=.002), and P-Interference (P=.004). Logistic regression demonstrated decreased total shoulder ROM in forward elevation and abduction plane (OR=0.98, 95% CI=0.97-0.99, P=.004). Hispanic ethnicity and increased VAS pain score (OR=1.20, 95% CI=1.01-1.43, P=.04) were associated with increased likelihood of electing CSI. A spectrum of symptom severity exists during the freezing phase of primary AC, despite similar etiology. AC patients with greater pain severity, and greater limitations in ROM at initial evaluation were associated with patient selection of CSI.

Children using a unilateral cochlear implant and contralateral hearing aid: bimodal hearing outcomes when one ear is outside the UK (NICE 2009) audiological criteria for cochlear implantation – a single site case–control study

IntroductionIn the new revised National Institute for Health & Care Excellence (NICE, TA566, 2019) guidelines for cochlear implantation (CI) have clearly stipulated that the hearing loss must be bilateral. Prior...

Leading the transformation: agile success factors in an Irish manufacturing company

Purpose – This study aims to assess the challenges and critical success factors for agile transformation in an Irish manufacturing organisation. Design/methodology – Mixed-methods approaches were used to collect data for this study. A quantitative survey utilising the novel Kano model and qualitative analysis using semi-structured interviews with middle and senior managers were employed as part of a case study. Findings – Critical success factors are identified, analysed and prioritised based on the opinions of members of the organisation studied. The conclusions of this study show that factors such as people, culture, and leadership are critical to agile transformation. The most important components, in particular, are team empowerment, team flexibility, competency development, and creating and communicating a vision. Research limitations/implications – This research focuses on a single-site case study capturing context-specific data from an organisation that recently embarked on an agile transformation. Originality/value – This study bridges the gap between academia and practice by providing valuable insights to guide leaders in their journey to agile transformation. The findings provide new knowledge to leaders and academics concerning the most critical factors for a successful transformation.

'Real-life' benefit of hearing preservation cochlear implantation in the paediatric population: a single-site case–control study

IntroductionCochlear implantation with hearing preservation (HPCI) has allowed a cochlear implant (CI) electrode to be implanted while trying to preserve residual acoustic low-frequency hearing. The concept arises from the importance...

Unwinding the Intelligence Cycle in Denmark

The intelligence cycle has been the standard model for intelligence processes and national intelligence doctrines in the United States and Europe. However, at the same time, it is seen as theoretical flotsam from the Cold War. This study explores the cycle’s application in the Danish Defence Intelligence Services Middle East analytical department. It is a single-site explorative case study of the Middle Eastern analytic department using multiple sources in the form of formal descriptions, organograms, and qualitative interviews with intelligence and government officials to explore and compare the manifest and assumed organization. The study concludes that the cycle is merely a metaphor for a New Public Management framework in use in the Danish Defence Intelligence Service and across the Danish central administration. This framework is used for setting the annual intelligence requirements. This study is an argument for a closer look at the impact of New Public Management on European intelligence organizations.

446 A qualitative exploration using focus groups, of the perceived barriers and enablers of hospital pharmacists to participating in simulation based training

Abstract Introduction The role of hospital pharmacists has changed significantly over the past decade with a need for further educational interventions to support their professional development. Simulation based training (SBT) is widely used by other healthcare professionals to enhance skill acquisition and performance (1). However, the use of SBT does not appear to have evolved to the same level for hospital pharmacists (1), and there is no evidence exploring their experiences of participating in SBT and the barriers and enablers towards engaging with this training modality. Aim To explore the experiences and perceptions of hospital pharmacists of SBT, and to identify perceived barriers and enablers of participating in SBT. Methods This was a descriptive qualitative case study. A purposive sample of trainee and qualified pharmacists from a large acute teaching hospital were invited to participate in a focus group discussion. A topic guide was utilised to guide discussions, with topics such as previous SBT experience, barriers to participation within SBT and how they feel SBT would impact on their clinical practice. The focus groups were conducted within a private room, recorded, and transcribed verbatim, then analysed thematically using COM-B (capability, opportunity, motivation, behaviour) (2) as an analytical framework. Relevant approvals were obtained prior to commencing the research. Results Seventeen participants were recruited into one of four focus groups, with allocation based on Agenda for Change banding (band 5 to 8A). Focus groups lasted 45-60 minutes. Ten themes were identified and mapped across the COM-B domains with contrasting differences reported depending on participant experience and seniority. Psychological capability (knowledge and understanding of SBT, clinical knowledge and skills), physical opportunity (workload and time pressures, infrastructure to support SBT), social opportunity (social expectations of pharmacists, culture of learning within pharmacy), automatic motivation (emotional factors, desires for professional development), and reflective motivation (perceptions of SBT, belief in own role and abilities) were all factors reported as influencing their participation with SBT in hospital settings. All groups expressed that SBT is mainly focused on clinicians with limited pharmacist involvement as an ‘add on’. Pharmacists reported a lack of confidence in SBT, with limited opportunities for involvement within the hospital setting, and concerns on their ability to communicate with other healthcare professionals during any SBT. Conclusion This is the first known study exploring the experiences of SBT amongst hospital pharmacists. There is a desire to participate in SBT, however it is clear, that significant interventions and further training on SBT modalities are required to enable this, including opportunities to participate in contextualised SBT, reflecting the role, expectations, and professional developmental needs of pharmacists. Clear leadership and signposting are needed to operationalise this and reap the benefits of SBT. These results can be utilised as a framework to support the design and implementation of a successful SBT programme for hospital pharmacists as part of intra-professional and multi-professional SBT programmes. This study is limited as a single-site case study and further investigation is required to explore further views of the hospital pharmacist workforce.

Factors Influencing Professional Identity Construction in Fourth-Year Pharmacy Students

Objectives. To explore the key factors that influence professional identity construction in fourth-year pharmacy students enrolled in a Doctor of Pharmacy program.Methods. A single-site instrumental case study of current fourth-year pharmacy students from the Leslie Dan Faculty of Pharmacy, University of Toronto, was used. Thirteen students participated in semistructured interviews. Poststructural social identity theories were used to analyze the data and identify themes that influence identity construction in pharmacy students.Results. Data analysis identified five overarching themes that influence pharmacy student professional identity construction: path to pharmacy, curriculum, environment, preceptors, and patient interactions. The Leslie Dan Faculty of Pharmacy curriculum prioritized the health care provider identity, which influenced the students desire to "become" clinicians. Based on their internalized health care provider identity, they rejected preceptors and practice environments that negatively impacted their ability to embody this identity.Conclusion. The findings of this study suggest that pharmacy students align themselves strongly with health care provider identities at the cost of other potentially relevant identities. Pharmacy education programs may benefit from curricular reforms that incorporate and legitimize multiple pharmacist identities to ensure a strong pharmacy workforce for the future.