Thursday, January 15, 2015

Pharmaceutical education: Are we THAT far behind?... Yea pretty much.

I watched TRON over the weekend (yes, both the original and re-boot). If you’re familiar with the story, TRON was born in technology and “fights for the User.” I feel that the community of FOAM is taking on the role of TRON, and is fighting for the User/consumer/student of medical education. Often times, we are quite literally fighting (albeit minus a light cycle).

It’s pretty easy now to get a colleague in the emergency department (pharmacist, nurse, PA, resident, physician, CCT, anything else) to check out a blog, listen to a podcast… by into online education. Getting anyone outside that area, particularly on-campus at the brick and mortar school, is a different story. I’m sure by now, others have encountered the same road blocks to even having a conversation about providing some sort of online content in the curriculum- let alone getting scholarly credit for creating content. It’s embarrassing, quite frankly. How has higher education fallen is so far behind that we’re letting fly-by-night pop up institutions become leaders in innovation, teaching, and learning?

Fortunately, Rutgers is coming around. Fresh from the Rutgers Online and Hybrid Learning Conference, I feel that the tide of technology in higher education is shifting.  In fact, an annual report from Inside Higher Ed (never heard of it before) is demonstrating this.  This annual survey has shown that year after year, the attitudes of faculty members at higher education institutions are with respect towards online education. While still only 26% of the surveyed 2,799 faculty members at higher education institutions across the country felt online courses can produce results equal to in-person courses, if you’re familiar with The Law Of Diffusion Of Innovation, we’ve crossed the chasm.  The innovators (first 2.5% of the population) have convinced the early adopters (13.5% of the population), which have now influenced the early majority (34% of the population) to buy into online education.

Faculties from all over the University, as well as neighboring institutions, are waking up and realizing that the paradigm has already shifted: open access is soooooo last year - it's now about increasing your reach and improving the experience.  This refreshing perspective from outside the health-sciences faculties that I often forget to take advantage of, can help solve numerous obstacles to online ed that have been discussed all over #FOAMed.  For instance; while eating lunch with a Geography professor, I realized they have the same issues as pharmacy faculty in making sure students are engaged in the lesson/lecture/assignment.  In other words, while the content might be different, but the challenges and potential innovations in the delivery, assessment, mentorship, etc., are the same.  Why not ask how Colleges of Social Work are overcoming obstacles in providing experiential education (mandatory for their program) for degree programs that are 100% online? They have answers that can help you save years of trial and error. Again, the content may be different, but the method of delivery shares many similarities to pharmaceutical education.

Now, throw the new WHO report on eLearning for undergraduatehealth professional education. Granted, this report may not be directed at the education of health professionals in the developed world, as healthcare professionals in the developed world, we have a responsibility to create the content that will help people with limited access can receive education sufficient to provide pharmaceutical care to their community – wherever it may be. ATTENTION PHARMACISTS: if you really think pharmacists should have a bigger role in primary care/ambulatory care – prove it by providing pharmaceutical education to people in say, Hati, Guyana, West Africa, where they can reclaim the role pharmacists(apothecaries/chemists) once provided as the central figure of medicine in a community (I truly think it can be done).

The early majority is listening, they're buying in: let’s keep it moving.




Thursday, January 8, 2015

Historical Articles in Emergency Medicine Pharmacy

Within our respective specialties, we often set our sights to new beginnings and adventures. With the passage of the resolution 44 by the American College of Emergency Physicians this past October and a recent post written by Bryan Hayes (@PharmERToxGuy) on Academic Life in Emergency Medicine describing in detail the training of EM pharmacists, I have been contemplating the general progression of the initiation and establishment of emergency medicine pharmacy, with ideas mainly surrounding the theme of "Where did we come from?"


I often took for granted the fact emergency medicine pharmacy practice was established in the 1970s, but I had never really thought further related to the "how" of the creation of pharmacy services in the emergency department. Being a bit of a history buff, I decided to dig further deeper to find more literature on the topic. After conducting a somewhat in-depth search that took longer than anticipated (and waiting a few days to receive those articles that were not readily available via an easy PDF download), I found much of the literature written by those pioneers who established pharmacy services in the emergency department. 

Reading these articles made me humbled by their groundbreaking ideas related to establishing a practice in the emergency department, and more specifically related to their roles as emergency medicine pharmacists. It is quite amazing to compare practice from "back in the day" to now. Some of the practices described in these articles are very similar (if not exactly the same) as most of us EM pharmacists, and some of the challenges faced by these pioneers related to practice are still relevant today. Some of the practices described are certainly head-scratchers (along the lines of, "They did that back then?!"), but I believe they are worth being aware of for historical reasons; perhaps some of these practices may even make a comeback at some point in the future. 

These articles are must-reads for anyone who practices or is interested in emergency medicine pharmacy, as they do indeed provide a multitude of answers to the aforementioned question related to our origins. The full citations of these historical articles are provided below:
  • Edwards GA, Samuels TM. The role of the hospital pharmacist in emergency situations. Am J Hosp Pharm 1968; 25(3):128-133.
  • Rapp RP, Piecoro JJ, Swintosky JV. The value of emergency care situations in the clinical pharmacy education of a pharmacist. Drug Intell Clin Pharm 1974; 8(6):392-396.
  • Elenbaas RM, Waeckerle JF, McNabney WK. The clinical pharmacist in emergency medicine. Am J Hosp Pharm 1977; 34(8):843-846.
  • Roberts RW, Russell WL. A pharmacist-based toxicology service. Drug Intell Clin Pharm 1978; 12(11):665-670.
  • Majerus TC. Shock-trauma: Clinical pharmacy in emergency medicine. Top Hosp Pharm Manage 1982; 2(1):87-93.
  • Kasuya A, Bauman JL, Curtis RA, Duarte B, Hutchinson RA. Clinical pharmacy on-call program in the emergency department. Am J Emerg Med 1986; 4(5):464-467.

Some bonus interesting articles that I came across in my search include:
  • Baars R, Amerson AB, Rapp RP. Rapid calculations for emergency practice--a self instructional learning package for students and practitioners of nursing, medicine and pharmacy. Drug Intell Clin Pharm 1977;11(10):610-613.
  • Pelter M, McGhan W. Drug emergencies and the pharmacist. Lancet 1980;1(8177):1086.

As important as it is determine new directions for the specialty of emergency medicine pharmacy, it is also essential to become cognizant of the paths that have been built that will lead us there.

"If you do not know where you come from, then you don't know where you are, and if you don't know where you are, then you don't know where you're going." 
-- Terry Pratchett