	In a 2015 YouTube video, Raney Rogers, PharmD—also known as The Bearded Pharmacist&mdash;cautions against it. 

	In the clip, a pharmacist and his brother become overly exuberant about the availability of OTC Nexium. They open the new product gingerly from its light-emitting box and celebrate its arrival in the pharmacy. 

	After sharing their excitement about the product in the United States, the message is carried to Mexico where families are seen enthusiastically cheering on the good news and popping out of cabinets to tell others that OTC Nexium has arrived. 

	Around 17.5 days later, the glimmer of OTC Nexium excitement fades. However, new OTC Flonase is there to take the limelight. 

	The video encourages patients to talk to their pharmacist if they have questions about new products—and not to get so excited simply because a new product has entered the market. 

		“New Drug Hype” was filmed, edited, and designed by Dr. Rogers, with production help from his brother, Reid Rogers. 

Are you part pharmacist, part YouTube star? Do you have a favorite pharmacy video that never fails to make you laugh? Send links to your best humorous, pharmacy-related video suggestions to mross@pharmacytimes.com, and your picks may be featured in the next Mental Recess

Articles

Careers

Mental Recess: New Drug Hype

Medication therapy management (MTM) has become an important buzzword in the world of pharmacy. Theoretically, MTM serves as a route of communication between pharmacists and patients, allowing patients to gain insight and autonomy over the medications they are prescribed, as well as the opportunity to take an active role in their own health care. Students currently enrolled in colleges of pharmacy across the country are being taught how to conduct an MTM session with a patient and how such a session will contribute to improved health outcomes. 

	Community pharmacists are the most accessible pharmacists, and they are at the forefront of the MTM movement. MTM offers patients the potential to take part in their own recovery or maintenance of a chronic disease, but how effective is MTM in a real-life retail setting?

	As pharmacy students who are hopeful about the potential of using MTM in our future careers, we conducted interviews with pharmacists in a variety of community settings to explore just how prevalent the practice is in the average workday. In our interviews, we aimed to address the perceived barriers, successes, goals, and areas for improvement related to MTM. Below are the interview questions along with the most prevalent findings.

What has been successful in your MTM procedures, outcomes, and process?

	All of the pharmacists interviewed were working on targeted intervention programs and quick interventions, specifically targeting compliance and adherence check-ups. Automatic refill is an easy way for pharmacies to help with monthly compliance. As one pharmacist noted, however, although we can get patients to come pick up their medications, it is hard to ensure that patients are actually taking their medications once they pick them up. 

	MTM has been incorporated successfully into the routine counseling session at a few stores. When patients pick up new medications is an ideal time to schedule a medication review session to help answer any of their questions. For one pharmacy, technicians are highly utilized to help identify new targeted intervention programs and assist in the comprehensive medication review preparation by compiling lists of medications that patients are taking. 

How has MTM led to improved patient compliance, better pharmacist—patient relationships, and improved disease state management?

	MTM has been shown to help improve the pharmacist—patient relationship. Patients appreciate pharmacists going the extra mile and taking an interest in their well-being, the pharmacists interviewed noted. These relationships are most evident when patients are open to the experience, however, as it is still a challenge to obtain their participation. MTM is also a way to help pharmacists better understand how to help patients manage their medications, and the outcomes from one encounter can help improve the next one. 

What are the biggest barriers to providing MTM services? 

	A recurring challenge among community pharmacies was the lack of time to provide MTM services. With increasing demands on pharmacists, it becomes much harder to take time away from the work flow to talk extensively with patients about their medications. It may even be difficult to coordinate an appointment time with a patient. Some pharmacists cited a lack of available staff within the pharmacy as a perceived barrier to MTM. Pharmacists who feel they do not have enough support to cover their normal responsibilities while they are gone are not likely to provide quality MTM services, if any at all. Other pharmacists pointed out difficulties on the patient end, such as patients’ willingness to come into the pharmacy for an MTM session, their understanding of what MTM is, their busy schedules, and their wariness to discuss their complete medical history with someone they may not know very well. 

What can be changed to improve MTM to make it more successful?

	Multiple pharmacists suggested that their staff, including interns and technicians, could be better utilized in performing MTM services. This may involve making phone calls, scheduling appointments, and making other preparations that do not involve clinical expertise. Another proposition was to have a pharmacist on staff whose sole job is to provide MTM services. Other suggestions involved improving the organization or structure of the MTM system within the pharmacy, such as including notes in the computer system that will come to the pharmacist’s attention at pickup and remind the pharmacist to provide MTM services or follow-up at that time. 

	Suggestions involving improvement on the patient end of the MTM encounter included working to develop patient awareness and understanding of MTM. Another idea was to have the patient—pharmacist interaction lead MTM sessions rather than having the sessions driven by insurance policies. One pharmacist noted that (excluding comprehensive medication reviews) shorter, more frequent interactions with patients may be more successful than longer ones. In addition, interactions that can be completed on the phone can help reduce the number of additional visits the patient makes to the pharmacy.

How can pharmacy students get involved with MTM?

	Pharmacists unanimously agreed that students are most useful in the activities that exist in the “in-between” periods of actual MTM sessions with patients. The primary activity in which students can gain MTM experience is in making phone calls to patients, either before or after an MTM session with the pharmacist. Because pharmacists in retail settings are often busy with the daily activities of their work, students are more able to take the time necessary to talk with patients and arrange MTM or follow-up appointments.

	In addition to phone calls, pharmacy students are useful in documenting the MTM session. The documentation process for MTM is infamously time-consuming, but students have the time required for accurate and thorough documentation. Such a process is also beneficial to students because it familiarizes them with MTM documentation programs and disease state guidelines. 

	Students may also play a part in MTM by assisting the pharmacist in preparing for the session. This may involve considering the patient’s profile, medications, medication history, adherence, past and present disease state(s), and notes from physicians. Perhaps most exciting, pharmacy students, if given the opportunity to become an intern at some major pharmacy chains, may take part in all MTM activities if properly trained.

	Pharmacists across various retail settings agree that MTM, although tedious and often difficult to incorporate in a busy pharmacy setting, is a progressive movement. It serves not only to increase pharmacists’ role as health care providers, but perhaps more importantly, it gives patients greater autonomy and understanding of their own health. With greater understanding, patients are more likely to play an active role in their health care and be more compliant.

	Giving patients greater access to their pharmacist strengthens the pharmacist—patient relationship and increases patients’ willingness to take an active role in their personal health. Regardless of the advancing role of the pharmacist, the ultimate advantage of MTM is to obtain better patient outcomes as a result of increased patient communication and education. 

	As pharmacists, it is our job to help patients understand what their medications are for, why they should take their medications, and how they can make healthy lifestyle choices to help manage their disease states. Our role is evolving into a more clinical one in which we are not exclusively dispensing medications, but are also counseling patients on medications and various disease states. 

	Because MTM can seem overwhelming and somewhat unrealistic for some pharmacists, we would like to conclude with some tips for pharmacists to help ease MTM into their busy schedules: 

	Clearly state your name and your intent when initiating an encounter. This will help patients understand the purpose of MTM and will let them know why they should trust you with their health information. Your session will be much more efficient if you do not have to spend as much time convincing patients they will benefit from MTM. 

	Involve your technicians and interns in the preparation and documentation of MTM services. Dividing up tasks will not only give you more time to focus on your other responsibilities in the pharmacy, but it will also give your students valuable experience for the future when they perform MTM services as a pharmacist.

	Create a system to manage medication reviews and claims in progress by printing them out and organizing them into a binder. Document the call attempts made to the patient, and make it a priority to check for new claims online and follow up on claims in progress each day. MTM should become a part of the daily pharmacy routine. 

	For students interested in becoming more involved with MTM, we recommend these tips: 

	1. Shadow your pharmacist while he or she is conducting an MTM session with a patient; take notes on how the pharmacist arranged time away from the counter to accommodate the appointment with the patient.

	2. Offer to document the MTM notes from the session for your pharmacist and become familiar with the program your pharmacy utilizes.

	3. Offer to counsel the patient during a follow-up appointment based on your pharmacist’s notes from a prior MTM session. Not only will you gain a greater understanding of how to navigate an MTM program, but you will also have a great opportunity to practice your communication skills. 

Medication therapy management has become an important buzzword in the world of pharmacy.

What Pharmacy Students Need to Know about MTM

As the pharmacy landscape shifts and evolves, pharmacists across the country continue to work toward a common and crucial goal: gaining legislative recognition as health care providers.

Gaining provider status is a complex and multifaceted objective, but at its heart is the exclusion of pharmacists from the Social Security Act (SSA). Exclusion of pharmacists from the SSA prevents many state and private health care plans from compensating pharmacists for patient care services, such as medication coordination, medication therapy management (MTM), chronic disease management, and patient education.

According to Stacie Maass, BSPharm, JD, senior vice president of pharmacy practice and government affairs for the American Pharmacists Association (APhA), the omission of pharmacists from the SSA also creates barriers for Medicare beneficiaries who seek to utilize these services in outpatient settings.

“For APhA, provider status is about promoting patient access to pharmacist services and recognizing pharmacists for their critical role in providing patient care alongside physicians and other practitioners,” Maass told 

. “While provider status efforts are crucial to the pharmacy profession, they’re equally important to patients.”

While the pursuit of provider status has not been without its challenges, a number of state laws passed in 2015 have given advocates much to celebrate.

For example, in 2015, North Dakota Governor Jack Dalrymple signed into law 4 bills that expanded the role of pharmacists in the Peace Garden State and recognized them as health care providers:

SB 2173, signed on March 18, permits pharmacists to enter into collaborative practice agreements with physicians and allows pharmacists to initiate and modify drug therapy.

SB 2104, signed on April 8, grants pharmacists limited prescriptive authority to distribute naloxone rescue kits to treat an opioid overdose and lists pharmacists as health care professionals alongside physicians, physician assistants, and advanced practice registered nurses.

SB 2320, signed on April 13, creates an MTM program for Medicaid-eligible patients in the medical and hospital benefits coverage group, and names pharmacists as providers who may offer MTM services in person or via telephone and are entitled to reimbursement.

HB 1102, signed on April 20, concerns work-related injuries and includes pharmacists as health care providers in its language.

“Having these bills pass helps promote pharmacists being active members of health care teams and opens additional doors allowing pharmacists to expand their scope of practice,” said North Dakota Pharmacists Association Executive Vice President Michael Schwab in an interview with 

The progress in North Dakota was followed shortly thereafter by Washington Governor Jay Inslee’s signing of SB 5557 on May 11, 2015. The first bill in the country to require the inclusion of pharmacists in health insurance provider networks, SB 5557 amends the state’s Every Category of Health Care Providers law, which obliges commercial health plans to include every category of health care provider within an individual’s participating provider network.

The passage of SB 5557 enables pharmacists in Washington state to collaborate with other providers more fully, allowing them to better contribute to services related to pain management, diabetes, mental health, and other chronic diseases.

“We are excited that pharmacists will have opportunities to increase collaboration within the health care team in patient-centered medical homes and in accountable care organizations, with the focus being on quality and safety,” Washington State Pharmacy Association CEO Jeff Rochon, PharmD, told 

 at the time of the bill’s signing. “This is a huge development within our health care system, and we’re excited that pharmacists will finally be able to utilize all their skills to help patients.”

In addition, Oregon governor Kate Brown signed HB 2028 into law on June 18, 2015. This bill permits pharmacists to receive reimbursement for performing clinical pharmacy services, enabling them to more fully use their skills and knowledge to treat patients.

After HB 2028 was signed, Oregon State Pharmacy Association president Gary E. DeLander, PhD, RPh, explained to 

 that this recognition of provider status also expands the way in which pharmacists can collaborate with other members of the health care team, as larger groups of pharmacists and physicians can now enter into agreements that would give patients easier access to enhanced pharmacy services, such as MTM and chronic disease management.

“Pharmacists in Oregon have had the ability to participate in these opportunities, but their ability to do so has been restricted, with only smaller agreements between a single pharmacist and a sole physician allowed,” Dr. DeLander said. “Now, it’s been opened up so that if a payor wants Oregon pharmacists to provide a particular service, that payor can create a protocol and allow pharmacists to participate.”

Dr. DeLander also expressed hope that achieving provider status would empower pharmacists to use their expertise in providing clinical services. “Pharmacists have consistently demonstrated the value of their service, and it’s important that they now use their status as full members of the health care team to deliver enhanced care,” he added.

Reflecting on the many state laws signed within the past year, Maass suggested that the growing exposure to provider status issues among practitioners and policymakers is an equally noteworthy accomplishment. “There is no question that decision makers now have a much better understanding of what pharmacists are able to do,” she said.

Although these state-level successes are no small achievements, federal recognition remains the primary goal for many proponents of provider status. Fortunately, a proposed bill has given advocates hope that such a victory is well within reach.

Introduced on January 28, 2015, by Representatives Brett Guthrie (R-KY), Todd C. Young (R-IN), G.K. Butterfield (D-NC), and Ron Kind (D-WI), the Pharmacy and Medically Underserved Areas Enhancement Act (HR 592) would amend the SSA to cover pharmacists’ services under Medicare Part B, but only if these services are provided in areas of the country that the Health Resources Services Administration defines as medically underserved areas, medically underserved populations, or health professional shortage areas. Companion legislation (S 314) was introduced the following day by Senators Charles Grassley (R-IA), Sherrod Brown (D-OH), Mark Kirk (R-IL), and Bob Casey (D-PA).

The bill is awaiting approval in both chambers of Congress as of press time, but it has garnered considerable bipartisan support since its introduction, with the House version crossing the majority threshold in October. At the time of writing, HR 592 has 245 cosponsors, while S 314 has 37.

Maass clarified that the bill is relatively limited in its effects, but added that it would nevertheless have a significant impact on the profession. “The federal legislation would only affect pharmacists who are treating patients in underserved areas, and it wouldn’t change these pharmacists’ scope of practice, as that can only be determined by each individual state,” she explained. “However, the bill is still a crucial first step toward the legal recognition of pharmacists as health care providers at a national level, and it’s very encouraging to see the support it has gotten from lawmakers on both sides of the aisle.”

The advances made by the provider status movement have been due in no small part to the work of pharmacists and pharmacy students across the country.

Throughout the past year, pharmacists participated in a number of grassroots efforts to promote provider status, including visits to congressional offices and letter-writing campaigns. In one such campaign organized by the APhA, pharmacists sent over 20,000 letters to congressional lawmakers asking for their support of the Pharmacy and Medically Underserved Areas Enhancement Act. The effort, named the Pharmacists Provide Care campaign, was the largest grassroots advocacy operation in the history of the APhA.

“The support our profession is receiving from state and federal policymakers is remarkable,” said APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD, FAPhA, in a press release. “We owe that growing recognition not only to the advocacy efforts by pharmacists across the country but due to the quality care they provide. Getting involved in the Pharmacists Provide Care campaign and reaching out to members of Congress to explain how this legislation will make a critical difference in your community should be a priority for all of us.”

Menighan also praised pharmacy students for the role they played in the campaign’s success, singling out the pharmacy schools at Samford University, University of Maryland Eastern Shore, Wilkes University, Presbyterian College, and the University of Puerto Rico for their high rates of student participation.

Crystal Atwell, PharmD, associate director of student development at APhA, suggested several ways for pharmacy students to get involved with the provider status movement. In addition to recommending that they write letters and make phone calls to their senators and representatives, Dr. Atwell encouraged them to organize visits to legislators’ offices or, better yet, invite lawmakers to campus to witness firsthand the services that pharmacists can provide.

“Pharmacy students are the future of the profession and, as such, they will be the ones most impacted by provider status,” Maass concluded. “Earning legislative recognition as health care providers will ensure that the next generation of pharmacists is able to treat patients to the full extent of their knowledge and abilities.”  

The State of Provider Status: An Update for Pharmacy Students

When it comes to enjoying a life-long career, mentoring, networking, and learning are all critical. Where can you go to power up on this trifecta of career development all at once?

	Pharmacy association annual meetings, of course!

	There is power in attending and participating in pharmacy professional associations. Learning the trends, getting up-to-date education, and reconnecting with mentors and colleagues can all happen when you take the time to attend professional society or association meetings.

	The start of a new year is always a good time to seek new opportunities to try or new career areas to explore. With so many meetings to consider, I decided to note all of the national pharmacist association society meetings on a calendar and 

	I’ve been lucky enough to garner some of the best ideas I have ever had when it comes to my career while attending annual pharmacy association meetings. The following are just a few examples.

	The drug information association (DIA) offers a great meeting for medical information professionals in the pharmaceutical and biotechnology industries. The DIA was one of the places where I first got the bright idea to publish a book about medical science liaisons. I also learned a lot through this organization about the different types of careers that are possible within the pharmaceutical industry, such as regulatory affairs, clinical operations, medical and drug information, health outcomes research, and medical science liaisons. The 2016 DIA annual meeting is June 26—30 in Philadelphia, Pennsylvania.

	When it comes to women in leadership positions in health care, we have a paucity of women at the helm. That is why I appreciate the healthcare businesswomen’s association (HBA)—its annual meeting honors some of the best and brightest women in the industry. The association helps educate women and expose them to leaders in health care and pharmacy. We all need more diversity in leadership&mdash;in both health care and pharmacy practice. The 2016 HBA annual meeting is November 2—4 in St. Louis, Missouri.

	I met one of my current managers at the american college of clinical pharmacy (ACCP) annual meeting several years ago. That was the ultimate networking experience because I actually got a job out of that connection, and it was a job that never even existed before! Also, ACCP offers several courses for board certification in many clinical specialties. Board certifications are exploding in health care and pharmacy careers. If clinical pharmacy is your passion, consider attending ACCP’s 2016 annual meeting October 23—26 in Hollywood, Florida. 

	Academic pharmacists attend the american association of colleges of pharmacy (AACP) annual meeting. When I attend AACP, I get the chance to catch up with friends and colleagues from other pharmacy schools across the United States. In 2015, I also had the chance to learn more about running editorial content for a journal, which has become handy as the founding editor for a health care journal created by and written for students at Butler University. The 2016 AACP annual meeting is July 23—27 in Anaheim, California.

	 Now that I am a lawyer, a pharmacist, and a teacher of pharmacy law, my hands-down favorite meeting is the american society for pharmacy Law (ASPL) because I can earn continuing education credits. (Full disclosure: I am on the board and a member of ASPL.) I have been fortunate to find many mentors, inspiration, and speakers through this organization. While many think pharmacist-attorneys are rare, this group is growing. Legal issues in pharmacy are exploding, which gives us more challenges and policy for the profession to manage. ASPL’s 2016 fall conference is November 10—13 in Austin, Texas.

	Regardless of your area of practice or the passions you have in pharmacy, do yourself a favor and attend a few pharmacy association meetings this year. Although the cost of attending is high in terms of both time and money, the rewards from participating in these conferences can be immense, from meeting up with colleagues and discovering best practices to learning how to get more involved in pharmacy on a larger level.

	See you at the meetings, and happy 2016! 

Erin Albert, MBA, PharmD, JD, is an associate professor of pharmacy practice, director of continuing education, and founding executive editor of BU Well at Butler University College of Pharmacy and Health Sciences in Indianapolis, Indiana. She is also a health outcomes pharmacist for Myers and Stauffer, LC. For more on her books and writing, visit her website at www.erinalbert.com. 

When it comes to enjoying a life-long career, mentoring, networking, and learning are all critical. 

The Power of Attending Pharmacy Association Meetings

We have officially entered an election year—nationally, and at the state and local levels. We will be selecting the people who will have tremendous power over health care policy, and pharmacy has and will continue to play a significant role in the ever-important political arena.

	As pharmacists continue to work collaboratively with other health care professionals and providers, we know that pharmacy is already playing a pivotal role in the future of health care. We also know that the future of pharmacy rests—in large part&mdash;in the hands of pharmacy students.

	As pharmacy continues to evolve amid the changing health care landscape, there are both incredible opportunities and significant challenges on the horizon. To meet these challenges, we need to create a culture in which the pharmacist becomes a pharmacist advocate. Not only is a pharmacist advocate armed with the practical knowledge and expertise to counsel patients on taking their medications properly, but this individual also understands the industry’s challenges and can communicate them to their elected officials.

	One of the best ways for students to engage and become pharmacist advocates is through the National Association of Chain Drug Stores (NACDS) RxIMPACT program. The purpose of RxIMPACT is to engage pharmacy advocates to become more involved in public policy on behalf of pharmacy. NACDS established this grassroots advocacy program in 2009, and the initiative has since grown exponentially, with a number of components designed to advance pro-patient, pro-pharmacy issues. 

	Earlier this year, NACDS announced its 2016 RxIMPACT Votes program, which is the get-out-the-vote arm of our initiative. This program is designed to help pharmacist advocates engage even more completely in the electoral process—according to their own candidate and party preferences&mdash;for the purpose of demonstrating the political activism of NACDS members. The program will help pharmacist advocates learn more about volunteering on campaigns, registering to vote, and helping to get out the vote on election day.

	The annual NACDS RxIMPACT Day on Capitol Hill aligns pharmacy students with pharmacy executives, state pharmacy association leaders, white-coated pharmacists, and others to promote pro-pharmacy legislation on Capitol Hill. 

	The popularity of this program among students is on the rise. This year’s RxIMPACT Day on Capitol Hill will take place March 16—17, 2016, and will include more than 50 students from 44 schools and colleges of pharmacy nationwide—a 5% increase over schools represented in 2015. In total, more than 450 congressional meetings are expected to be conducted during this annual 2-day advocacy event.

	During the  event, students will have an opportunity to participate in the NACDS RxIMPACT “U” Academy to train to become part of the next generation of pharmacy leaders and advocates and to drive home the pro-patient, pro-pharmacy message during congressional meetings. The academy provides student pharmacists with a half-day of training with experienced advocates 1 day before going “up to the Hill.” This interactive education reviews the policymaking process, the role of congressional committees in policymaking, how to use strategic communications to influence policy outcomes, the power of networking and relationship building, key pharmacy issues, and incorporation of advocacy into pharmacy practice. 

	Students who are unable to attend the event in Washington and those looking for year-round training will find other important resources within the NACDS RxIMPACT program.

	In addition, the RxIMPACT Training Program brings grassroots training to pharmacy schools. This year, training will include challenges to inspire on-campus NACDS RxIMPACT vote activities, such as voter registration and other opportunities to encourage others to vote. 

	Social media is also an incredibly important way to share your message about pharmacy. We urge students to join the NACDS RxIMPACT Pharmacy Advocates 

on LinkedIn. This exclusive online network of pharmacy advocates has access to the latest information on policy issues impacting pharmacy, as well as the inside scoop on the effects of advocacy in politics. Action is necessary when critical issues arise in Congress, in the administration, or in the states, and NACDS will reach out to this group to help get pro-pharmacy, pro-patient messages to lawmakers.

	Students are naturally motivated and empowered to make a difference. That energy is contagious; it motivates and inspires others to get involved, including those who have been involved in the pharmacy profession for decades. This is a great time to be joining the ranks of America’s pharmacy community. 

	We look forward to seeing you in your white coat next month, and for many years to come, at a future NACDS RxIMPACT Day on Capitol Hill, because together we will position pharmacy for the future. 

Steven C. Anderson, IOM, CAE, is the CEO and president of the National Association of Chain Drug Stores.

We know that the future of pharmacy rests in large part in the hands of pharmacy students.

Students' Engagement Key to Making an Rximpact for Pharmacy

The pharmacy profession continues to expand its scope of practice, and some may argue that current PharmD curricula inadequately prepare students for this rapidly growing career. 

	As you may have read in previous Pharmacy Leadership & Education Institute (PLEI) Perspectives written by fellow fourth-year students Kevin Anderson and Devlin Smith, some questions remain: Who will step up to lead the next generation of pharmacists? How do we develop more leaders to push our profession to new heights? 

	The pharmacy profession, including current practitioners and pharmacists in academia, must foster and promote leadership from the start of didactic education if we wish to continue our advancements as essential health care professionals. I offer 2 recommendations for PharmD curricula to consider implementing.

	The term flipped classroom has become a hot topic in many educational programs over the past several years. What does it really mean, and how can it promote leader development? Vanderbilt University Center for Teaching outlines 4 key elements that a flipped classroom offers

		An opportunity for students to gain their first exposure to lessons prior to class

		An incentive for students to prepare for class

		A mechanism to assess student understanding

		In-class activities that focus on higher-level cognitive activities

	A flipped classroom requires students to complete various assignments or studies prior to the scheduled class period. The idea behind this is to use in-class time to focus on higher cognitive work such as patient case discussions that provide real-world clinical information via the instructor. By receiving first exposure prior to entering the classroom, students can focus on processing the necessary information in class with immediate feedback from peers and instructors. 

How People Learn: Bridging Research and Practice

 states that “to develop competence in an area of inquiry, students must: a) have a deep foundation of factual knowledge, b) understand facts and ideas in the context of a conceptual framework, and c) organize knowledge in ways that facilitate retrieval and application.”

 The active learning portion of these sessions may be done primarily via group work on cases, which allows the instructor to float between groups and provide clarification where necessary.

	A flipped classroom approach to teaching has been implemented in several medical and pharmacy programs across the country as a means to promote higher thinking. By mentoring students via active learning, the goal is to improve self-confidence when faced with real-world patients. 

	As the profession of pharmacy continues to expand, we must confidently participate in collaborative practices to solidify our impact as part of the health care team. This education style encourages students to discuss patient care among their peers, thereby refining their communication skills. Immediate feedback from peers, as well as professors, allows students to improve not only their clinical knowledge, but also their communication skills, professionalism, and self-awareness. It also enables students to reason through a problem by providing them with critical thinking skills, so that when presented with new problems they can assemble the facts of a case and develop novel solutions. Competence in this mix of skills will positively impact patient outcomes.

, Kristin K. Janke, PhD, and colleagues provide great insight from professors of pharmacy across the country.

 Students, faculty, and administrators can integrate leadership development into their PharmD curricula from the interview process through graduation. Many of the ideas below are discussed in more detail within this informative article. 

	I believe one of the best ways to foster leadership within a student group is to have faculty members or other pharmacists serve as role models, mentors, and advisors to students and student organizations. These leaders should make themselves easily accessible to any student while promoting leader development for students at all levels. One sign of a great leader is the ability to effectively exert influential reach that will, in turn, create a continuous cycle of leader development. 

	Leadership is a core element of professionalism. This element may be discussed by examining the oath of a pharmacist and the pharmacist’s code of ethics—documents that emphasize and highlight the leadership expected of pharmacists and pharmacy students. Examination and discussion activities around these documents can serve to impact those individuals who feel that leadership is not for them. 

	These documents promote self-awareness to all students because they outline the expectations of health care professionals to lead those around them with the goal of improving patient outcomes. Pharmacists’ roles are rapidly expanding to meet the evolving demands of transforming health care. Pharmacists are well positioned to increase access, improve quality of care, and decrease costs by helping patients optimize medication use. Thus, it is vital that the next generation of pharmacists is able to not only meet, but exceed current boundaries on our profession.

	Opportunities must be provided for student pharmacists to develop and practice their leadership skills. As mentioned above, a flipped classroom dynamic would allow student pharmacists to hone their skills with a group of their peers via case discussion. Leadership opportunities should be made available in curricular, co-curricular, and extra-curricular settings. 

	Key points to emphasize to all current and prospective students include recognizing that leadership does not come only from those with a title, describing the characteristics of effective leaders, helping students become aware of their own leadership abilities, and understanding that it takes a team with diverse abilities to enhance patient outcomes. Through these activities, the needs and expectations for future leaders in pharmacy may be openly discussed. 

Brandon Hill is a fourth-year student pharmacist at Campbell University College of Pharmacy & Health Sciences. Brandon currently serves Phi Delta Chi as the grand vice president for student affairs.

	1.      Brame CJ. Flipping the classroom. Vanderbilt University Center for Teaching website. 

https://cft.vanderbilt.edu/guides-sub-pages/flipping-the-classroom/

. Published 2013. Accessed January 4, 2016.

	2.      Bransford JD, Brown AL, Cocking RR. 

How People Learn: Brain, Mind, Experience, and School. 

Washington, DC: National Academies Press; 2000.

	3.      Janke KK, Nelson MH, Bzowyckyj AS, et al. Deliberate integration of student leadership development in doctor of pharmacy programs. 2014. Unpublished manuscript.

The pharmacy profession continues to expand its scope of practice, and some may argue that current PharmD curricula inadequately prepare students for this rapidly growing career. 


PLEI Perspectives: Flipping Your Idea of Education

Many pharmacy students work part-time as interns, often in community pharmacies, during their schooling. In fact, due to extensive requirements for pharmacy intern hours, students have had ample experience in the community setting by the time they enter their fourth year of pharmacy school. For this reason, some students may find their community advanced pharmacy practice experience rotation to be mundane.

	I was fortunate enough to have had a positive experience that has contributed significantly to my confidence in becoming a strong future pharmacist. As a current fourth-year student, I had the pleasure of having David Jones, PharmD, as a preceptor at Walgreens Pharmacy in Evans, Georgia. From the very beginning, Dr. Jones made sure that his goal as a preceptor was for me to get the most out of this rotation. 

	My responsibilities included offering to counsel all patients on new medication or OTC consults, assisting the technicians with filling prescriptions, administering immunizations, performing medication therapy management with my preceptor, and learning about all verification steps. Knowing and understanding my role as an advanced pharmacy practice experience student from the start helped me to work on developing these skills throughout the 5-week rotation. I also had the opportunity to help technicians deliver medications to local nursing homes.

	Prior to the deliveries, I took time to review each patient’s medications so that I could counsel or answer any questions in person. The appreciation from the nursing home residents made it such a rewarding experience that it truly piqued and confirmed my interest in ambulatory care and geriatrics. 

	I was also fortunate to have the appropriate guidance at a store that was not considered high volume, giving me enough time to be detail-oriented with each task. Even if you are placed in a very busy store, be proactive in your interactions with the preceptor and seek out as many learning opportunities as you can. 

	Despite what you might expect going into it, there are many ways to make the most of your community rotation experience. Here is a quick guide:

	As fourth-year interns, it is crucial to actively learn about all aspects of the filling process. If there is an issue with a medication, instead of telling the pharmacist about it, ask how you can resolve the issue. Ask your preceptor to teach you how to work through any rejections or drug utilization review rejections. Now is the time to practice being a pharmacist, while still under the supervision of your preceptor.

	In many states, pharmacists or pharmacy interns are required to offer counseling to any patient starting new medications. While on rotations, be aware of all tasks occurring in the pharmacy. If you see that a patient will be picking up a new medication, use a drug information resource to determine major counseling points. Review the patient’s current medication list to see if there are any possible interactions, and discuss them with your preceptor. When the patient comes to pick up the prescription, educate him or her on administration and possible adverse effects to look out for.

	This will help you both practice communication skills and retain vital information, while also benefiting the patient.

	A key component to being a well-rounded community pharmacist is to know about both prescription and OTC medications. During the first couple days of your rotation, ask your preceptor if you can spend some time in the OTC section so that you can familiarize yourself with the various medications and their locations. Make yourself a chart with symptoms/disease states and age groups and fill it in with the appropriate recommended agents. Strive to gain enough confidence to make your own recommendations if a patient approaches the consultation window. 

	Many other projects and assignments can be effective learning tools during a community pharmacy rotation. Use this time wisely, and continue to think of ways to make yourself a stronger practitioner in the future. 

Here are 3 ways to make the most of your community rotation experience.

How to Make the Most of Your Community Rotation

	Pharmacy schools have been growing at an unprecedented rate,

 and if the trend continues as expected it could pose problems for the future success of the profession. According to the US Department of Labor, the projected percent change in employment from 2014 to 2024 is currently 3%.

	During the early 2000s, vacancy rates for pharmacist positions reached 8% and higher; by 2004, that number had dropped to 5%.

 In 2013, vacancy rates in hospitals and health systems reached an all-time low of 2.1%, according to the American Society of Health-System Pharmacists.

	Despite a tightening job market for pharmacists, annual pharmacy school enrollments continued to grow between 2001 and 2009, with increases ranging from 3.8% to 10.7%.

 A minimum of 4 new pharmacy schools opened each year between 2005 and 2012,3 and several existing schools expanded, leading to an overall increase in enrollment numbers.1 If enrollment continues to rise, the number of qualified pharmacists may soon outpace job vacancies. 

	In an effort to determine whether pharmacy school enrollment will indeed surpass need, we compared the relative growth rate of pharmacy schools with that of some other professional doctoral degree schools over the past 20 years (1995—2015).

	Data on first-year enrollment from 1994 to 2014 in each of the US colleges and schools of pharmacy and the total number of colleges and universities were obtained from the American Journal of Pharmaceutical Education.

 Similar data for medical, dental, and law schools were collected for comparison from various sources, including the Association of American Medical Colleges

 for allopathic medical schools, American Association of Colleges of Osteopathic Medicine

for osteopathic medical schools, American Dental Association

 and American Dental Education Association

 for dental schools, and American Bar Association

	The data revealed that the number of pharmacy schools and the rate of enrollment in those schools have risen more rapidly than those of most other professional doctoral schools (Figures 1 and 2). Over the past 18 to 20 years there has been a 13% increase in the number of law and allopathic medical schools,

 an 18% increase in the number of dental schools,

 a 76% increase in the number of osteopathic medical schools,

 and a 70% increase in the number of pharmacy schools.

 The only professional doctoral degree program that has slightly outpaced pharmacy in growth in the number of schools over the past 20 years is osteopathic medicine. 

	However, the growth in the number of osteopathic medical schools must be considered in the context of growth in the total number of medical schools, both allopathic and osteopathic, because graduates of both programs are prepared for roles as physicians. 

	The majority of graduates from osteopathic medical schools practice in primary care specialties,

 an area the US Department of Health and Human Services projects will still have significant demand in 2020.

 In addition, osteopathic physicians often practice in rural, underserved communities, fulfilling a vital health care need.

 This helps explain, and perhaps justifies, the rapid growth in osteopathic schools over the past 2 decades. 

	Law is another area that has experienced a change in employment opportunities. The Bureau of Labor Statistics has projected that approximately 74,000 new jobs will be created for lawyers in the United States between 2013 and 2020.

 However, an estimated 308,000 students are expected to graduate from American law schools during this period of time.

 This grim jobs forecast resulted in 30,000 fewer applications to US law schools in January 2013—a 20% decrease from 2012 and a 38% decrease from 2010.

	If this rapid growth rate for pharmacy schools continues unchecked, and the number of pharmacist positions in traditional and nontraditional roles rises at the current rate, supply may soon outpace demand. This could result in a decline in applications and enrollment, much like what law schools have recently experienced. 

How to address the upward trend of schools

	Throughout the past decade, there has been a steady increase in the growth rates of both pharmacy schools and overall student enrollment compared with other professional schools in the United States. This trend, coupled with a slower job growth rate in traditional and nontraditional pharmacist roles, is noteworthy and potentially worrisome. It is important for our pharmacy professional societies, schools, and accrediting organizations to monitor these changes carefully in light of the possibility of an overabundance of pharmacy practitioners in the marketplace. 

	In addition, if major pharmacist employers continue to consolidate—Walgreens has recently announced plans to purchase Rite Aid&mdash;this may further result in a plateau effect or shrinking of the available community pharmacy positions. 

	If these trends are not addressed appropriately, the growing fear of a dearth in future employment opportunities for pharmacists may discourage many students from applying, and both the schools and the profession of pharmacy may suffer as a result.

	Meg Crighton, PharmD, graduated from Massachusetts College of Pharmacy and Health Sciences University—Worcester in 2014. She is currently completing a 2-year Acorda Therapeutics–Rutgers fellowship in marketing.

	Michael Toscani, PharmD, is a research professor/fellowship director at Rutgers Institute for Pharmaceutical Industry Fellowships at Rutgers, the State University of New Jersey. 

		John L. Colaizzi, PhD, RPh, is a university professor of pharmacy and former dean at the Rutgers Ernest Mario School of Pharmacy. 

		Joseph Barone, PharmD, is a professor and dean at the Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey.

American Pharmacists Association and American Society of Health-System Pharmacists. Concerns about the accelerating expansion of pharmacy education: time for reconsideration. American Society of Health-System Pharmacists website. www.ashp.org/DocLibrary/News/Accelerating-Expansion-of-Pharmacy-Education.aspx. Published November 23, 2010. Accessed January 4, 2016.

Occupational outlook handbook, 2016-2017 edition, pharmacists. Bureau of Labor Statistics website. www.bls.gov/ooh/healthcare/pharmacists.htm. Published December 17, 2015. Accessed January 4, 2016.

The adequacy of pharmacist supply: 2004 to 2030. US Department of Health and Human Services website. bhpr.hrsa.gov/healthworkforce/reports/pharmsupply20042030.pdf. Published December 2008. Accessed January 4, 2016.

ASHP pharmacy staffing survey results. American Society of Health-System Pharmacists website. www.ashp.org/DocLibrary/MemberCenter/SPPM/2013-ASHP-Staffing-Survey.pdf. Published 2013. Accessed January 4, 2016.

Taylor DA, Taylor JN. The pharmacy student population: applications received 2012-2013, degrees conferred 2012-2013, fall 2013 enrollments. Am J Pharm Educ. 2014;78(7):S2.  

American Association of Medical Colleges. AAMC Data Book: Medical Schools and Teaching Hospitals by the Numbers. Washington, DC: American Association of Medical Colleges; 2015. 

US osteopathic medical schools by year of inaugural class. American Association of Colleges of Osteopathic Medicine website. www.aacom.org/docs/default-source/data-and-trends/US-COM-by-inaug-class.pdf?sfvrsn=6. Published September 2015. Accessed January 4, 2016.

Trends in osteopathic medical school applicants, enrollment and graduates. American Association of Colleges of Osteopathic Medicine. www.aacom.org/docs/default-source/data-and-trends/2014-trends-COM-AEG-PDF.pdf?sfvrsn=26. Published 2014. Accessed January 4, 2016.

Pharmacy schools have been growing at an unprecedented rate, and if the trend continues as expected it could pose problems for the future success of the profession. 

Pharmacy Careers February 2016