- Email: [email protected]
Use of a health screening and education event to change student attitudes toward the elderly
Currents in Pharmacy Teaching and Learning 9 (2017) 101–107
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Short Communications
Use of a health screening and education event to change student attitudes toward the elderly☆
cross
⁎
Eliza A. Dy-Boarman, PharmD, BCPSa, , Sarah A. Nisly, PharmD, BCPS, FCCPb, David Martin, PharmD, BCPSc a b c
Drake University College of Pharmacy and Health Sciences, Des Moines, IA Wingate University School of Pharmacy, Wingate, NC Northwestern Memorial Hospital, Chicago, IL
A R T I C L E I N F O
ABSTRACT
Keywords: Student perceptions Geriatrics Health education Health screening
Background: While many schools have incorporated geriatric pharmacy education into their curricula, questions remain as to how these experiences shape student perceptions of the geriatric population. The objective of this study was to assess student comfort levels and perceptions toward the geriatric patient population before and after participation in a single health screening and education event. Methods: Student perceptions about the elderly (measured via the Geriatrics Attitude Survey) and comfort levels in caring for geriatric patients were assessed before and after an event. Results: Twenty-two students completed pre-event and post-event surveys. Students were primarily female (73%), and half were completing their second year of pharmacy school (50%). Global student perceptions of geriatric patients positively changed from baseline following event participation (p = 0.023). Results reveal significant increases from baseline in student comfort levels with communicating, screening, and counseling elderly patients (p < 0.001, 0.01, and 0.001, respectively). Conclusion: The Geriatrics Attitude Survey is a useful tool in assessing the value of a geriatric experience. Participation in this geriatric experience caused a statistically significant positive change in global perception scores. Additionally, survey results indicate that interactions with geriatric patients at a single event increased student comfort in communication, screening, and counseling.
Introduction The geriatric population in the United States is continually increasing. Between 2005 and 2050, the elderly population in America is predicted to double, and by 2030, one in four Americans will be over the age of 65.1–2 Data published by the Kaiser Foundation suggest that elderly adults use 34% of all prescription medications, and overall prescription use is predicted to rise by 10% each year.3 The Medicare Modernization Act (MMA) of 2003 introduced Medicare Part D prescription drug coverage and medication therapy management (MTM) services for Medicare beneficiaries.4 Pharmacists are expected to play an important role in the continued care for America’s aging population, who often present with unique pharmacotherapy regimens as well as challenges
☆
Butler University Mini-Grant. Corresponding author: Eliza A. Dy-Boarman, PharmD, BCPS, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505. E-mail address: [email protected] (E.A. Dy-Boarman). ⁎
http://dx.doi.org/10.1016/j.cptl.2016.08.041
1877-1297/ © 2016 Elsevier Inc. All rights reserved.
Currents in Pharmacy Teaching and Learning 9 (2017) 101–107
E.A. Dy-Boarman et al.
Table 1 Geriatrics attitudes scale (GAS) Domain
Perception statements
Social value
Old persons do not contribute their fair share toward paying for their health care. In general, old people act too slow for modern society.
Medical care
If I have the choice, I would rather see younger patients than elderly ones. As people grow older, they become less organized and more confused. Taking a medical history from elderly patients is frequently an ordeal. Treatment of chronically ill old patients is hopeless.
Compassion
Most old people are pleasant to be with. Elderly patients tend to be more appreciative of the medical care I provide than younger patients. I tend to pay more attention and have more sympathy toward my elderly patients than my younger patients. It is interesting to listen to old people’s accounts of their past experiences.
Resource distribution
The federal government should reallocate money from Medicare to research on AIDS or pediatric diseases. It is society’s responsibility to provide care for its elderly persons. Medical care for old people uses up too many human and material resources. Old people in general do not contribute much to society.
a
Rating scale: 1 = strongly disagree and 5 = strongly agree.
to delivering quality care. In order to address this growing need for pharmacy care in the geriatric population, it is important to consider the type of geriatric training that student pharmacists should receive. The 2016 Accreditation Council for Pharmacy Education (ACPE) standards offer no specific recommendations for the incorporation of geriatrics into the pharmacy curriculum. Standard 12.4 does, however, state that the pre-Advanced Pharmacy Practice Experience (APPE) curriculum should “provide foundational knowledge and skills that allow for care across the patient’s lifespan.”5 Additionally, ACPE Standard 13.2 guides APPEs to “expose students to diverse patient populations,” including diversity in patient age. Despite several challenges implementing geriatric pharmacy training, such as limited availability of experiential sites, limited room in the curriculum, lack of funding, resistance and competition from faculty with differing interests, and a shortage of geriatricspecialized faculty members, many schools of pharmacy have incorporated some component of geriatric education into their curricula.6–10 Implementation of experiential opportunities necessitates the question: do pharmacy student interactions with geriatric patients improve students’ perceptions of the geriatric populations and therefore increase comfort in working with this population? Faculty members at several schools of pharmacy across the nation have attempted to answer this very question.8–10 One tool that has assisted faculty in assessing student experiences with the geriatric population is the Geriatrics Attitude Survey (GAS). The GAS is a validated assessment tool used to measure perceptions about the elderly that was developed by Reuben et al.11 at the University of California Los Angeles. Responders are asked to rate their level of agreement with each statement using a 5-point Likert scale (see Table 1 for GAS assessment domains and perceptions). The survey was initially created for primary care medical residents, fellows, and faculty; however, it has since been used in the literature to assess students from other health profession disciplines, including pharmacy.8 Additionally, researchers found that the 14-item instrument demonstrates high reliability, validity, and sensitivity to change.11 Rationale and objectives A strong focus on delivering care to the underserved has been incorporated into the curriculum as part of the mission and vision of the Butler University College of Pharmacy and Health Sciences (COPHS).12 Pharmacy students are encouraged to volunteer with various underserved population outreach efforts led by COPHS faculty. Through volunteering, COPHS students are able to gain a variety of experiences that allow them to improve their ability to work with diverse patient populations, such as those in the geriatric population. Focused geriatric content is limited within the curriculum, all occurring during the final didactic sequence. During the spring of the third professional year, a single geriatrics lecture is delivered in both the therapeutic and pharmacokinetics sequences. An optional geriatric course elective is also simultaneously available during this semester. Finally, while a specialty geriatrics-focused APPE is unavailable, the APPE year does offer experiences in long-term care facilities and within the Department of Veterans Affairs. This study aligned with COPHS’s mission by providing pharmacy students the opportunity to participate in a health screening and education event that promoted public health in an underserved geriatric patient population. The primary objective of this study was to assess student comfort levels and perceptions toward the geriatric population before and after participation in a single health screening and education event. Methods The project was approved by the Butler University Institutional Review Board (IRB) in accordance with the research principles outlined in the Declaration of Helsinki.13 Collaborative Institutional Training Initiative Program for research in human subjects was 102
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completed by all investigators prior to beginning the study.14 Written, informed consent was obtained for all student and geriatric participants prior to enrollment. All screenings were included under the Butler University Health Education Center Clinical Laboratory Improvement Amendments waiver. Two separate health screening and education events, one focused on hypertension and the other on diabetes, were planned for geriatric community members at the Catholic Charities in downtown Indianapolis, Indiana. Catholic Charities is a non-profit organization that sponsors the Senior Companions, a group of geriatric community member volunteers who assist fellow underserved senior citizens in the community with health and living needs. The members of this group meet monthly at Catholic Charities, during which time there is often an educational presentation. The events took place at Catholic Charities in the late winter of 2012 and early spring of 2013 and were arranged to take place during the normally scheduled hour-long Senior Companion meeting time. Students were eligible to participate in the study if they had attended at least their first day of class as a student in the COPHS pharmacy program. Students were excluded from the study data analysis if they failed to complete both the pre-event and post-event surveys or if they did not participate in the health event. Students were required to complete training one week prior to participation in an event and be present for a total of two hours per event in order to assist with initial set-up, execution, and cleanup following the event. Students were eligible to receive credit for Introductory Pharmacy Practice Experience (IPPE) hours, if applicable, for the time spent participating in the training and live event. COPHS faculty members were solicited for involvement in overseeing and assisting with screening and education activities throughout the events. Student recruitment began in fall 2012 and continued through completion of the second event in spring 2013. Pharmacy students were recruited through email, word-of-mouth, social media, and preceptor engagement. Training sessions were held for students and faculty participants one week prior to each event. During these training sessions, the purpose, objectives, and logistics of the project were discussed, and written, informed consent for study participation was obtained. Students then reviewed disease state information for the disease state being highlighted at that event (hypertension or diabetes) and were given opportunities to practice screening skills as well as review important patient counseling information. Upon arrival at the Catholic Charities site, students and faculty worked together to greet geriatric participants and distribute packets containing educational and screening materials. After a brief introduction from the event leaders, the geriatric participants were split into three groups and instructed to rotate through the following three designated stations: (1) Ask a Pharmacist, (2) Education, and (3) Screening. Details of each station’s objectives as well as general flow of the event are illustrated in Table 2. Students were allowed to rotate throughout the three stations; however, many students stayed at one station for the entirety of the event. All student interactions with geriatric participants were supervised and facilitated by COPHS faculty. The primary objective of student comfort levels and perceptions was assessed using written surveys. Pre-surveys were administered at the beginning of the training sessions following completion of written, informed consent, and post-surveys were administered immediately after participation in an event to ensure survey completion. Surveys consisted of three main assessments. The first assessment collected demographic information including year in school, gender, and age. The second assessment asked students to rate comfort levels in various areas of geriatric care (communicating, screening, and counseling) on a 5-point Likert scale (see Table 3 for Likert scale assessment) and to identify potential challenges in working with elderly patients via a free response question. The final assessment contained the previously described, unmodified GAS, shown in Table 1. Student pre- and post-survey scores were linked together using a unique student identifier. To assess student comfort levels, median baseline scores were calculated for each comfort level category (communicating, screening, and counseling). These scores were then compared to median scores on the same categories after the event. To assess student perceptions, answers from the GAS were analyzed. Five of the statements included in the GAS were worded positively toward the geriatric population, and nine were worded negatively toward the geriatric population. In order to complete the analysis, responses to the negatively worded statements were reverse-scored before being added to the scores from the positively worded statements. For example, if a student rated a
Table 2 Health screening and education event stations Station
Objectives
Examples
Ask a pharmacist
Allow patients to ask questions regarding the disease state being discussed
Answering patient questions on anti-hypertensive medications Teaching patients about Dietary Approaches to Stop Hypertension (DASH) diet Demonstrating how to identify sodium content on food label
Focus on hands-on lifestyle modification counseling Education
Review pertinent information about disease state being discussed
Defining diabetes Explaining risk factors and prevention strategies for diabetes Emphasizing complications of uncontrolled diabetes Briefly discussing drug and non-drug therapies for diabetes
Screening
Screen patients for disease state being discussed Track progress for those patients who have diagnosis of disease being discussed Refer patients to follow up with primary care provider when appropriate
Checking patients' blood pressures Counseling patients on results, comparing to expected values Referring patients to physician if values fall outside of expected range
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Table 3 Changes in student comfort prior to and following a screening event On a scale of 1–5, please rate how comfortable do you feel with each of the following items
Communicating with the elderly Screening for hypertension and diabetes Counseling elderly patients on hypertension and diabetes
Overall*
Hypertension event*
Diabetes event*
Pre-event (n = 22)
Post-event (n = 22)
Pre-event (n = 10)
Post-event (n = 10)
Pre-event (n = 12)
Post-event (n = 12)
4 ( ± 0.66) 4 ( ± 1.17) 3 ( ± 1.12)
5* ( ± 0.58) 4** ( ± 0.74) 4* ( ± 0.68)
4 ( ± 0.73) 3 ( ± 1.21) 3 ( ± 1.23)
5** ( ± 0.70) 4** ( ± 0.84) 4** ( ± 0.63)
4 ( ± 0.58) 4 ( ± 0.86) 4 ( ± 0.80)
5** ( ± 0.52) 4 ( ± 0.56) 4** ( ± 0.68)
Data reported as median values ( ± standard deviation). * Rating scale: 1 = not at all and 5 = extremely. * p < 0.001. ** p < 0.05.
negatively worded statement a “1,” this score was reversed to a “5,” to reflect the student’s positive perception of the elderly. A total score was then calculated for each student. A median of the average perception scores was then obtained for pre-event and postevent survey responses. Finally, in addition to assessing overall perception scores, the perception statements were further categorized into four domains, which were initially described by Lee et al.15 as a follow-up to the GAS validation. These domains, as seen in Table 1, represent different categories of perceptions of the elderly and include: social value, medical care, compassion, and resource distribution. Median scores were calculated for each domain before and after the event. Paired comparisons were done using the Wilcoxon signed rank test, with an α level set at < 0.05 for statistical significance. All statistical analyses were completed using Statistical Package for Social Sciences v21.0 (SPSS, Inc., Chicago). Impact of these screening and education events on geriatric participants was conducted; however, the results of this arm of the study are not presented here.
Results A total of 33 students completed the training and initial survey for the geriatric events; this cohort represents roughly 6.5% of the total 502 pharmacy students enrolled in COPHS at the time of study initiation. Eleven students were excluded from analysis due to either not participating in the event or failure to complete both the pre-event and post-event surveys. Of the 22 remaining students who completed both the pre-event and post-event surveys, 10 students (seven second-year, one third-year, and two fourth-year students) participated in the hypertension event, and 12 students (four second-year and eight fourth-year students) participated in the diabetes event. No student participated in both events. The majority of these students were females (73%) between the ages of 20–24 years (88.2%), and half of them were currently enrolled in their second year of pharmacy school. A total of 86 geriatric participants were served at these events. Geriatric participants were an average of 72 years old, with 96.5% being female and 79% identifying as African American. Student perceptions showed an overall statistically significant positive change in global GAS scores (p = 0.023) following participation in a single event. Analysis of each singular domain (social value, medical care, compassion, and resource distribution) revealed no statistical difference in any individual domain. Though no changes within a single domain reached statistical significance, all four areas showed a trend toward improvement on a 5-point Likert scale. Table 4 Changes in student comfort for each demographic prior to and following event
Year in Pharmacy School Second year (n = 11) Third year (n = 1) Fourth year (n = 10) Age (years) 20–24 (n = 19) 25–30 (n = 1) > 30 (n = 2) Gender Male (n = 6) Female (n = 16) a b
Comfort in communicating with the elderlya
Comfort in screening for hypertension and diabetesa
Comfort in counseling elderly patientsa
Pre-eventb
Post-eventb
Pre-eventb
Post-eventb
Pre-eventb
Post-eventb
3 (3–4) 3 4 (4–4)
4 (4–5) 5 5 (4.75–5)
3 (2–4) 3 4 (3–4.25)
4 (3–4) 5 4 (4–5)
3 (2–3) 2 4 (3–4.25)
4 (3–4) 4 4 (4–5)
4 (3–4) 4 4.5
5 (4–5) 5 5
3 (3–4) 3 4.5
4 (4–4) 4 4.5
3 (2–4) 3 4.5
4 (4–4) 5 4.5
4 (4–4.25) 4 (3–4)
5 (4.75–5) 5 (4–5)
4 (3–4.25) 3 (2.25–4)
4 (3.75–4.25) 4 (4–4.75)
4 (2.75–4.25) 3 (2–3.75)
4.5 (4–5) 4 (3–4)
Rating scale: 1 = not at all and 5 = extremely. Data reported as median values (interquartile range).
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Following participation in an event, student comfort in communication (p < 0.001), screening (p = 0.01) and counseling (p = 0.001) significantly increased. Table 3 highlights the differences in overall comfort following each event, and Table 4 describes comfort scores for each student demographic. Discussion and conclusion As the elderly population continues to increase over the coming decades, geriatric education in pharmacy schools will become increasingly important. Despite the need for students to be confident in their abilities to care for these patients, there is little guidance on how pharmacy schools can accomplish this task. As previously mentioned, current ACPE standards do not explicitly provide guidance on how to incorporate geriatric topics or experiences into pharmacy curricula.5 Schools of pharmacy across the nation have trialed various ways to incorporate geriatric education components to their curricula.8–10 For example, Adkins et al.8 at the Appalachian College of Pharmacy assessed student attitudes and perceptions following a required geriatric experience in their curriculum. During both the fall and spring semesters, all second-year students were required to participate in a course entitled Early Pharmacy Practice Experience 2. In addition to learning about long-term health care settings in the didactic portion of the course, students were also assigned to a geriatric patient residing in a local nursing home. Students were required to visit the geriatric patient for at least one hour per week over a 24-week period and to provide medication therapy management services related to their assigned patient’s care. In order to assess the attitudes of these students following completion of these experiences, the study investigators administered the GAS. The investigators found that most students completing the survey had positive attitudes toward the geriatric patient population following participation in the Early Pharmacy Practice Experience 2. Geriatric pharmacy education has also been incorporated into experiential learning through geriatric patient interactions during introductory clinical rotations. For instance, Martin et al.9 at the University of Wisconsin-Madison created a geriatric-focused IPPE course for first-year pharmacy students. Each student was paired with a geriatric resident of an independent senior living community. Students were asked to complete a survey before and after participation in the course. At the completion of 10, one-hour visits with the senior residents, surveys indicated that students had increased confidence in many aspects of geriatric care related to communicating with patients, obtaining medication histories, involving patients in their own care, and answering patient questions in a timely manner. Finally, the value of geriatric experiences in the APPE setting has also been evaluated. The University of Illinois at Chicago College of Pharmacy collaborated with a local state agency to provide a geriatric-focused ambulatory care experience for their pharmacy students.10 Students participating in the experience offered a number of services to geriatric patients, including medication therapy management, patient education, and health screenings. Following the creation of this new experience, program faculty then evaluated the program’s objectives through faculty evaluation of students as well as student self-evaluations. The results indicated that the program fostered the development of communication skills, confidence, and understanding of the geriatric population. Each one of the aforementioned studies in the pharmacy education literature allowed for repeated student exposure to the geriatric community over time. Haque et al.16 at the University of Toronto studied changes in medical student GAS scores following a single, full-day geriatrics workshop. Medical students participated in a large group case discussion with a geriatrician in addition to small 25-minute workshops on geriatric concepts such as wound care, polypharmacy, adaptive equipment, and patient transfer. Following participation in this single workshop event, there was no statistically significant change in GAS perceptions scores. Among other things, the authors suggest that direct interaction with a geriatric patient during the workshop may help to improve perceptions in future events. We offer findings of the positive changes in student comfort and perception following a geriatric patient experience. This assessment of student perceptions was possible with the use of the GAS before and after each geriatric health screening and education event. Our experience with the GAS demonstrates the ease of use in administering the survey to students and interpreting the results to evaluate changes in student perceptions. Our study also highlights the utility of the GAS as a valuable tool to ascertain student perceptions, as it also allowed us to identify the value of this type of geriatric learning experience for our students. The positive effect of this geriatric health screening and education event following an individual geriatric patient interaction has not been previously demonstrated in the literature and offers insight into a method for designing and implementing interactive geriatric experiences for students at other schools of pharmacy. Data from this study’s student survey responses suggest that students are more comfortable communicating, screening, and counseling the elderly after participation in a single health education event. The data also indicate that participation resulted in more positive overall perceptions of geriatric patients as determined by changes in GAS scores. These changes in comfort and perception are noteworthy for a number of reasons. First, students benefited from the geriatric experience even after only a few hours of direct interaction with the elderly patients. This study created a unique opportunity to view the changes in students following a single hands-on interaction with a geriatric population. Additionally, most of the students were at or above the second year of pharmacy school, meaning that this change occurred even after students had been exposed to patient care experiences during their first year of school. This study demonstrates one method for incorporating geriatric pharmacy education into pharmacy curricula and the potential impact on student comfort levels and perceptions. As previously discussed, there remain numerous barriers to the addition of geriatric experiences within pharmacy curricula, which must be overcome.6 As a result, schools of pharmacy must work to prioritize geriatric education during the curricular planning and revision process. This study focused on two, one-time experiential events with limited capacity for student involvement, which was easier for faculty to coordinate and precept and may be easier to incorporate 105
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into a pharmacy school curriculum. However, other potential longitudinal strategies for increased geriatric exposure within curricula also include required courses, elective courses, and integration of geriatric topics within other courses.6 There were a number of challenges to this teaching method that led to overall limitations of the study. One of the main limitations of this study is the small sample size. Because of the nature of the Catholic Charities meetings, which occur during the day when most students are required to attend classes, it was challenging to recruit a larger number of students. This small sample size may have contributed to the lack of statistically significant changes when evaluating each individual domain of the GAS. Additionally, there is a potential for selection bias within the student group. Students voluntarily signed up to participate, and it is likely that many of these students had an interest in disease state screening, patient education, and/or geriatric care. This may have falsely increased the initial positive perceptions found within this study. Students were not pre-screened to determine whether they had previously had a geriatrics IPPE or APPE or course elective, which may have impacted their survey results. Additionally, students also varied in their experience at the health event, as some students rotated through the three event stations, while others stayed at the same station for the entirety of the event. As a result, students may have had different types of experiences with the geriatric participants during the event; however, overall interactions with geriatric participants should not have differed significantly between stations. When looking at varying comfort level findings between the hypertension and diabetes events (Table 3), it is apparent that the varying student demographic makeup between events likely had an impact. The diabetes event was largely led by fourth-year pharmacy students (66.7%) who likely had more experience and demonstrated a trend toward greater comfort level in working with elderly patients and overall screening techniques (Table 4), which may explain why comfort levels in screening did not significantly change for students participating in this particular event. The lack of standardization in students participating in each event likely further confounded results. Despite these weaknesses, this study offered a unique opportunity for pharmacy students to work directly with geriatric patients. This study also highlights the value of the GAS assessment tool to assess changes in student perceptions following a geriatric learning experience. Finally, it provided opportunities for students to gain confidence in screening and counseling geriatric patients, and positive changes were seen in students, despite a short exposure time to the geriatric population and a large proportion of fourthyear pharmacy student participants. Due to the positive student experience and continued need for geriatric education, ongoing health screening events are available for our pharmacy students. Additionally, we would encourage other schools of pharmacy across the nation to implement similar community health screening and education events that expose students to the geriatric population and to assess the value of these events on student learning through GAS assessment. The positive changes in perceptions following a single event in our study should prompt schools to consider the utility of this type of event in preparing students to care for geriatric patients in the future. Implementation of this teaching modality at any institution should be mindful of student availability and designed to allow for thoughtful student discussion with the geriatric population. Finally, colleges and schools of pharmacy should continue to seek other opportunities for student engagement with the geriatric population, both as a longitudinal and concentrated experiences, to prepare pharmacy students to care for the increasing geriatric patient population. Overall, we demonstrate pharmacy student participation in a single health education and screening event led to increased comfort in communicating with, screening, and counseling the elderly, alongside improvement in global perceptions of the elderly. This approach to geriatric education can be repeated again in the future at both our institution as well as schools of pharmacy across the country. Conflicts of interest None. Acknowledgments The authors would like to thank Dr. Shefali Patel, PharmD, for contributions to the original design and implementation of the study and Dr. Carrie Maffeo, PharmD, BCPS, CDE, who provided resources for the health screening and education events. References 1 U.S. Population Projections: 2005–2050. Pew Research Center website. Available at: 〈http://www.pewsocialtrends.org/files/2010/10/85.pdf〉 Accessed October 21, 2016. 2 Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995–2050. U.S. Bureau of the Census Current Populations Reports website. Available at: 〈http://www.census.gov/prod/1/pop/p25-1130/p251130.pdf〉 Accessed October 21, 2016. 3 Enough to Make You Sick: Prescription Drug Prices for the Elderly. Publication No. 01-103. Families USA Foundation website. Available at: 〈http://www.cptech. org/ip/health/econ/fu06122001.pdf〉 Accessed October 21, 2016. 4 108th Congress of the United States of America. Medicare Prescription Drug, Improvement, and Modernization Act of 2003. House Resolution 1. Available at: 〈http://www.gpo.gov/fdsys/pkg/BILLS-108hr1enr/pdf/BILLS-108hr1enr.pdf〉; January 7, 2003 Accessed October 21, 2016. 5 Accreditation Council for Pharmacy Education: Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree (“Standards 2016”). Available at: 〈https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf〉; Published February 2015 Accessed October 21, 2016. 6 Odegard PS, Breslow RM, Koronkowski MJ, Williams BR, Hudgins GA. Geriatric pharmacy education: a strategic plan for the future. Am J Pharm Educ. 2007;71(3) Article 47. 7 Graber DR, Bellack JP, Lancaster C, Musham C, Nappi J, O’Neil EH. Curriculum topics in pharmacy education: current and ideal emphasis. Am J Pharm Educ. 1999;63(2):145–151.
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8 Adkins DM, Mayhew SL, Gavaza P, et al. Pharmacy students’ attitudes toward geriatric nursing home patients. Am J Pharm Educ. 2012;76(5) Article 81. 9 Martin BA, Porter AL, Shawl L, et al. A model for partnering first-year student pharmacists with community-based older adults. Am J Pharm Educ. 2012;76(5) Article 85. 10 Mobley Smith MA, Koronkowski MJ, Petersen NM. Enhancing student learning through integrating community-based geriatric educational outreach into ambulatory care advanced practice experiential training. Am J Pharm Educ. 2004;68(1) Article 20. 11 Reuben DB, Lee M, DavisJr JW, et al. Development and validation of a geriatrics attitudes scale for primary care residents. J Am Geriatr Soc. 1998;46(11):1425–1430. 12 COPHS Mission and Goals. Butler University College of Pharmacy and Health Sciences website. Available at: 〈https://www.butler.edu/cophs/mission-goals〉 Accessed October 21, 2016. 13 59th WMA General Assembly, World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research involving Human Subjects. World Medical Association. Available at: 〈http://www.wma.net/en/30publications/10policies/b3/〉 Accessed October 21, 2016. 14 Collaborative Institutional Training Initiative (CITI) Program for Research in Human Subjects. Available at: 〈https://www.citiprogram.org/〉 Accessed October 21, 2016. 15 Lee M, Reuben DB, Ferrell BA. Multidimensional attitudes of medical residents and geriatrics fellows toward older people. J Am Geriatr Soc. 2005;53(3):489–494. 16 Haque AF, Soong DG, Wong CL. Assessing the impact of a geriatric clinical skills day on medical students’ attitudes toward geriatrics. Can Geriatr J. 2014;17(1):12–15.
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Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Short Communications
Use of a health screening and education event to change student attitudes toward the elderly☆
cross
⁎
Eliza A. Dy-Boarman, PharmD, BCPSa, , Sarah A. Nisly, PharmD, BCPS, FCCPb, David Martin, PharmD, BCPSc a b c
Drake University College of Pharmacy and Health Sciences, Des Moines, IA Wingate University School of Pharmacy, Wingate, NC Northwestern Memorial Hospital, Chicago, IL
A R T I C L E I N F O
ABSTRACT
Keywords: Student perceptions Geriatrics Health education Health screening
Background: While many schools have incorporated geriatric pharmacy education into their curricula, questions remain as to how these experiences shape student perceptions of the geriatric population. The objective of this study was to assess student comfort levels and perceptions toward the geriatric patient population before and after participation in a single health screening and education event. Methods: Student perceptions about the elderly (measured via the Geriatrics Attitude Survey) and comfort levels in caring for geriatric patients were assessed before and after an event. Results: Twenty-two students completed pre-event and post-event surveys. Students were primarily female (73%), and half were completing their second year of pharmacy school (50%). Global student perceptions of geriatric patients positively changed from baseline following event participation (p = 0.023). Results reveal significant increases from baseline in student comfort levels with communicating, screening, and counseling elderly patients (p < 0.001, 0.01, and 0.001, respectively). Conclusion: The Geriatrics Attitude Survey is a useful tool in assessing the value of a geriatric experience. Participation in this geriatric experience caused a statistically significant positive change in global perception scores. Additionally, survey results indicate that interactions with geriatric patients at a single event increased student comfort in communication, screening, and counseling.
Introduction The geriatric population in the United States is continually increasing. Between 2005 and 2050, the elderly population in America is predicted to double, and by 2030, one in four Americans will be over the age of 65.1–2 Data published by the Kaiser Foundation suggest that elderly adults use 34% of all prescription medications, and overall prescription use is predicted to rise by 10% each year.3 The Medicare Modernization Act (MMA) of 2003 introduced Medicare Part D prescription drug coverage and medication therapy management (MTM) services for Medicare beneficiaries.4 Pharmacists are expected to play an important role in the continued care for America’s aging population, who often present with unique pharmacotherapy regimens as well as challenges
☆
Butler University Mini-Grant. Corresponding author: Eliza A. Dy-Boarman, PharmD, BCPS, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505. E-mail address: [email protected] (E.A. Dy-Boarman). ⁎
http://dx.doi.org/10.1016/j.cptl.2016.08.041
1877-1297/ © 2016 Elsevier Inc. All rights reserved.
Currents in Pharmacy Teaching and Learning 9 (2017) 101–107
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Table 1 Geriatrics attitudes scale (GAS) Domain
Perception statements
Social value
Old persons do not contribute their fair share toward paying for their health care. In general, old people act too slow for modern society.
Medical care
If I have the choice, I would rather see younger patients than elderly ones. As people grow older, they become less organized and more confused. Taking a medical history from elderly patients is frequently an ordeal. Treatment of chronically ill old patients is hopeless.
Compassion
Most old people are pleasant to be with. Elderly patients tend to be more appreciative of the medical care I provide than younger patients. I tend to pay more attention and have more sympathy toward my elderly patients than my younger patients. It is interesting to listen to old people’s accounts of their past experiences.
Resource distribution
The federal government should reallocate money from Medicare to research on AIDS or pediatric diseases. It is society’s responsibility to provide care for its elderly persons. Medical care for old people uses up too many human and material resources. Old people in general do not contribute much to society.
a
Rating scale: 1 = strongly disagree and 5 = strongly agree.
to delivering quality care. In order to address this growing need for pharmacy care in the geriatric population, it is important to consider the type of geriatric training that student pharmacists should receive. The 2016 Accreditation Council for Pharmacy Education (ACPE) standards offer no specific recommendations for the incorporation of geriatrics into the pharmacy curriculum. Standard 12.4 does, however, state that the pre-Advanced Pharmacy Practice Experience (APPE) curriculum should “provide foundational knowledge and skills that allow for care across the patient’s lifespan.”5 Additionally, ACPE Standard 13.2 guides APPEs to “expose students to diverse patient populations,” including diversity in patient age. Despite several challenges implementing geriatric pharmacy training, such as limited availability of experiential sites, limited room in the curriculum, lack of funding, resistance and competition from faculty with differing interests, and a shortage of geriatricspecialized faculty members, many schools of pharmacy have incorporated some component of geriatric education into their curricula.6–10 Implementation of experiential opportunities necessitates the question: do pharmacy student interactions with geriatric patients improve students’ perceptions of the geriatric populations and therefore increase comfort in working with this population? Faculty members at several schools of pharmacy across the nation have attempted to answer this very question.8–10 One tool that has assisted faculty in assessing student experiences with the geriatric population is the Geriatrics Attitude Survey (GAS). The GAS is a validated assessment tool used to measure perceptions about the elderly that was developed by Reuben et al.11 at the University of California Los Angeles. Responders are asked to rate their level of agreement with each statement using a 5-point Likert scale (see Table 1 for GAS assessment domains and perceptions). The survey was initially created for primary care medical residents, fellows, and faculty; however, it has since been used in the literature to assess students from other health profession disciplines, including pharmacy.8 Additionally, researchers found that the 14-item instrument demonstrates high reliability, validity, and sensitivity to change.11 Rationale and objectives A strong focus on delivering care to the underserved has been incorporated into the curriculum as part of the mission and vision of the Butler University College of Pharmacy and Health Sciences (COPHS).12 Pharmacy students are encouraged to volunteer with various underserved population outreach efforts led by COPHS faculty. Through volunteering, COPHS students are able to gain a variety of experiences that allow them to improve their ability to work with diverse patient populations, such as those in the geriatric population. Focused geriatric content is limited within the curriculum, all occurring during the final didactic sequence. During the spring of the third professional year, a single geriatrics lecture is delivered in both the therapeutic and pharmacokinetics sequences. An optional geriatric course elective is also simultaneously available during this semester. Finally, while a specialty geriatrics-focused APPE is unavailable, the APPE year does offer experiences in long-term care facilities and within the Department of Veterans Affairs. This study aligned with COPHS’s mission by providing pharmacy students the opportunity to participate in a health screening and education event that promoted public health in an underserved geriatric patient population. The primary objective of this study was to assess student comfort levels and perceptions toward the geriatric population before and after participation in a single health screening and education event. Methods The project was approved by the Butler University Institutional Review Board (IRB) in accordance with the research principles outlined in the Declaration of Helsinki.13 Collaborative Institutional Training Initiative Program for research in human subjects was 102
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completed by all investigators prior to beginning the study.14 Written, informed consent was obtained for all student and geriatric participants prior to enrollment. All screenings were included under the Butler University Health Education Center Clinical Laboratory Improvement Amendments waiver. Two separate health screening and education events, one focused on hypertension and the other on diabetes, were planned for geriatric community members at the Catholic Charities in downtown Indianapolis, Indiana. Catholic Charities is a non-profit organization that sponsors the Senior Companions, a group of geriatric community member volunteers who assist fellow underserved senior citizens in the community with health and living needs. The members of this group meet monthly at Catholic Charities, during which time there is often an educational presentation. The events took place at Catholic Charities in the late winter of 2012 and early spring of 2013 and were arranged to take place during the normally scheduled hour-long Senior Companion meeting time. Students were eligible to participate in the study if they had attended at least their first day of class as a student in the COPHS pharmacy program. Students were excluded from the study data analysis if they failed to complete both the pre-event and post-event surveys or if they did not participate in the health event. Students were required to complete training one week prior to participation in an event and be present for a total of two hours per event in order to assist with initial set-up, execution, and cleanup following the event. Students were eligible to receive credit for Introductory Pharmacy Practice Experience (IPPE) hours, if applicable, for the time spent participating in the training and live event. COPHS faculty members were solicited for involvement in overseeing and assisting with screening and education activities throughout the events. Student recruitment began in fall 2012 and continued through completion of the second event in spring 2013. Pharmacy students were recruited through email, word-of-mouth, social media, and preceptor engagement. Training sessions were held for students and faculty participants one week prior to each event. During these training sessions, the purpose, objectives, and logistics of the project were discussed, and written, informed consent for study participation was obtained. Students then reviewed disease state information for the disease state being highlighted at that event (hypertension or diabetes) and were given opportunities to practice screening skills as well as review important patient counseling information. Upon arrival at the Catholic Charities site, students and faculty worked together to greet geriatric participants and distribute packets containing educational and screening materials. After a brief introduction from the event leaders, the geriatric participants were split into three groups and instructed to rotate through the following three designated stations: (1) Ask a Pharmacist, (2) Education, and (3) Screening. Details of each station’s objectives as well as general flow of the event are illustrated in Table 2. Students were allowed to rotate throughout the three stations; however, many students stayed at one station for the entirety of the event. All student interactions with geriatric participants were supervised and facilitated by COPHS faculty. The primary objective of student comfort levels and perceptions was assessed using written surveys. Pre-surveys were administered at the beginning of the training sessions following completion of written, informed consent, and post-surveys were administered immediately after participation in an event to ensure survey completion. Surveys consisted of three main assessments. The first assessment collected demographic information including year in school, gender, and age. The second assessment asked students to rate comfort levels in various areas of geriatric care (communicating, screening, and counseling) on a 5-point Likert scale (see Table 3 for Likert scale assessment) and to identify potential challenges in working with elderly patients via a free response question. The final assessment contained the previously described, unmodified GAS, shown in Table 1. Student pre- and post-survey scores were linked together using a unique student identifier. To assess student comfort levels, median baseline scores were calculated for each comfort level category (communicating, screening, and counseling). These scores were then compared to median scores on the same categories after the event. To assess student perceptions, answers from the GAS were analyzed. Five of the statements included in the GAS were worded positively toward the geriatric population, and nine were worded negatively toward the geriatric population. In order to complete the analysis, responses to the negatively worded statements were reverse-scored before being added to the scores from the positively worded statements. For example, if a student rated a
Table 2 Health screening and education event stations Station
Objectives
Examples
Ask a pharmacist
Allow patients to ask questions regarding the disease state being discussed
Answering patient questions on anti-hypertensive medications Teaching patients about Dietary Approaches to Stop Hypertension (DASH) diet Demonstrating how to identify sodium content on food label
Focus on hands-on lifestyle modification counseling Education
Review pertinent information about disease state being discussed
Defining diabetes Explaining risk factors and prevention strategies for diabetes Emphasizing complications of uncontrolled diabetes Briefly discussing drug and non-drug therapies for diabetes
Screening
Screen patients for disease state being discussed Track progress for those patients who have diagnosis of disease being discussed Refer patients to follow up with primary care provider when appropriate
Checking patients' blood pressures Counseling patients on results, comparing to expected values Referring patients to physician if values fall outside of expected range
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Table 3 Changes in student comfort prior to and following a screening event On a scale of 1–5, please rate how comfortable do you feel with each of the following items
Communicating with the elderly Screening for hypertension and diabetes Counseling elderly patients on hypertension and diabetes
Overall*
Hypertension event*
Diabetes event*
Pre-event (n = 22)
Post-event (n = 22)
Pre-event (n = 10)
Post-event (n = 10)
Pre-event (n = 12)
Post-event (n = 12)
4 ( ± 0.66) 4 ( ± 1.17) 3 ( ± 1.12)
5* ( ± 0.58) 4** ( ± 0.74) 4* ( ± 0.68)
4 ( ± 0.73) 3 ( ± 1.21) 3 ( ± 1.23)
5** ( ± 0.70) 4** ( ± 0.84) 4** ( ± 0.63)
4 ( ± 0.58) 4 ( ± 0.86) 4 ( ± 0.80)
5** ( ± 0.52) 4 ( ± 0.56) 4** ( ± 0.68)
Data reported as median values ( ± standard deviation). * Rating scale: 1 = not at all and 5 = extremely. * p < 0.001. ** p < 0.05.
negatively worded statement a “1,” this score was reversed to a “5,” to reflect the student’s positive perception of the elderly. A total score was then calculated for each student. A median of the average perception scores was then obtained for pre-event and postevent survey responses. Finally, in addition to assessing overall perception scores, the perception statements were further categorized into four domains, which were initially described by Lee et al.15 as a follow-up to the GAS validation. These domains, as seen in Table 1, represent different categories of perceptions of the elderly and include: social value, medical care, compassion, and resource distribution. Median scores were calculated for each domain before and after the event. Paired comparisons were done using the Wilcoxon signed rank test, with an α level set at < 0.05 for statistical significance. All statistical analyses were completed using Statistical Package for Social Sciences v21.0 (SPSS, Inc., Chicago). Impact of these screening and education events on geriatric participants was conducted; however, the results of this arm of the study are not presented here.
Results A total of 33 students completed the training and initial survey for the geriatric events; this cohort represents roughly 6.5% of the total 502 pharmacy students enrolled in COPHS at the time of study initiation. Eleven students were excluded from analysis due to either not participating in the event or failure to complete both the pre-event and post-event surveys. Of the 22 remaining students who completed both the pre-event and post-event surveys, 10 students (seven second-year, one third-year, and two fourth-year students) participated in the hypertension event, and 12 students (four second-year and eight fourth-year students) participated in the diabetes event. No student participated in both events. The majority of these students were females (73%) between the ages of 20–24 years (88.2%), and half of them were currently enrolled in their second year of pharmacy school. A total of 86 geriatric participants were served at these events. Geriatric participants were an average of 72 years old, with 96.5% being female and 79% identifying as African American. Student perceptions showed an overall statistically significant positive change in global GAS scores (p = 0.023) following participation in a single event. Analysis of each singular domain (social value, medical care, compassion, and resource distribution) revealed no statistical difference in any individual domain. Though no changes within a single domain reached statistical significance, all four areas showed a trend toward improvement on a 5-point Likert scale. Table 4 Changes in student comfort for each demographic prior to and following event
Year in Pharmacy School Second year (n = 11) Third year (n = 1) Fourth year (n = 10) Age (years) 20–24 (n = 19) 25–30 (n = 1) > 30 (n = 2) Gender Male (n = 6) Female (n = 16) a b
Comfort in communicating with the elderlya
Comfort in screening for hypertension and diabetesa
Comfort in counseling elderly patientsa
Pre-eventb
Post-eventb
Pre-eventb
Post-eventb
Pre-eventb
Post-eventb
3 (3–4) 3 4 (4–4)
4 (4–5) 5 5 (4.75–5)
3 (2–4) 3 4 (3–4.25)
4 (3–4) 5 4 (4–5)
3 (2–3) 2 4 (3–4.25)
4 (3–4) 4 4 (4–5)
4 (3–4) 4 4.5
5 (4–5) 5 5
3 (3–4) 3 4.5
4 (4–4) 4 4.5
3 (2–4) 3 4.5
4 (4–4) 5 4.5
4 (4–4.25) 4 (3–4)
5 (4.75–5) 5 (4–5)
4 (3–4.25) 3 (2.25–4)
4 (3.75–4.25) 4 (4–4.75)
4 (2.75–4.25) 3 (2–3.75)
4.5 (4–5) 4 (3–4)
Rating scale: 1 = not at all and 5 = extremely. Data reported as median values (interquartile range).
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Following participation in an event, student comfort in communication (p < 0.001), screening (p = 0.01) and counseling (p = 0.001) significantly increased. Table 3 highlights the differences in overall comfort following each event, and Table 4 describes comfort scores for each student demographic. Discussion and conclusion As the elderly population continues to increase over the coming decades, geriatric education in pharmacy schools will become increasingly important. Despite the need for students to be confident in their abilities to care for these patients, there is little guidance on how pharmacy schools can accomplish this task. As previously mentioned, current ACPE standards do not explicitly provide guidance on how to incorporate geriatric topics or experiences into pharmacy curricula.5 Schools of pharmacy across the nation have trialed various ways to incorporate geriatric education components to their curricula.8–10 For example, Adkins et al.8 at the Appalachian College of Pharmacy assessed student attitudes and perceptions following a required geriatric experience in their curriculum. During both the fall and spring semesters, all second-year students were required to participate in a course entitled Early Pharmacy Practice Experience 2. In addition to learning about long-term health care settings in the didactic portion of the course, students were also assigned to a geriatric patient residing in a local nursing home. Students were required to visit the geriatric patient for at least one hour per week over a 24-week period and to provide medication therapy management services related to their assigned patient’s care. In order to assess the attitudes of these students following completion of these experiences, the study investigators administered the GAS. The investigators found that most students completing the survey had positive attitudes toward the geriatric patient population following participation in the Early Pharmacy Practice Experience 2. Geriatric pharmacy education has also been incorporated into experiential learning through geriatric patient interactions during introductory clinical rotations. For instance, Martin et al.9 at the University of Wisconsin-Madison created a geriatric-focused IPPE course for first-year pharmacy students. Each student was paired with a geriatric resident of an independent senior living community. Students were asked to complete a survey before and after participation in the course. At the completion of 10, one-hour visits with the senior residents, surveys indicated that students had increased confidence in many aspects of geriatric care related to communicating with patients, obtaining medication histories, involving patients in their own care, and answering patient questions in a timely manner. Finally, the value of geriatric experiences in the APPE setting has also been evaluated. The University of Illinois at Chicago College of Pharmacy collaborated with a local state agency to provide a geriatric-focused ambulatory care experience for their pharmacy students.10 Students participating in the experience offered a number of services to geriatric patients, including medication therapy management, patient education, and health screenings. Following the creation of this new experience, program faculty then evaluated the program’s objectives through faculty evaluation of students as well as student self-evaluations. The results indicated that the program fostered the development of communication skills, confidence, and understanding of the geriatric population. Each one of the aforementioned studies in the pharmacy education literature allowed for repeated student exposure to the geriatric community over time. Haque et al.16 at the University of Toronto studied changes in medical student GAS scores following a single, full-day geriatrics workshop. Medical students participated in a large group case discussion with a geriatrician in addition to small 25-minute workshops on geriatric concepts such as wound care, polypharmacy, adaptive equipment, and patient transfer. Following participation in this single workshop event, there was no statistically significant change in GAS perceptions scores. Among other things, the authors suggest that direct interaction with a geriatric patient during the workshop may help to improve perceptions in future events. We offer findings of the positive changes in student comfort and perception following a geriatric patient experience. This assessment of student perceptions was possible with the use of the GAS before and after each geriatric health screening and education event. Our experience with the GAS demonstrates the ease of use in administering the survey to students and interpreting the results to evaluate changes in student perceptions. Our study also highlights the utility of the GAS as a valuable tool to ascertain student perceptions, as it also allowed us to identify the value of this type of geriatric learning experience for our students. The positive effect of this geriatric health screening and education event following an individual geriatric patient interaction has not been previously demonstrated in the literature and offers insight into a method for designing and implementing interactive geriatric experiences for students at other schools of pharmacy. Data from this study’s student survey responses suggest that students are more comfortable communicating, screening, and counseling the elderly after participation in a single health education event. The data also indicate that participation resulted in more positive overall perceptions of geriatric patients as determined by changes in GAS scores. These changes in comfort and perception are noteworthy for a number of reasons. First, students benefited from the geriatric experience even after only a few hours of direct interaction with the elderly patients. This study created a unique opportunity to view the changes in students following a single hands-on interaction with a geriatric population. Additionally, most of the students were at or above the second year of pharmacy school, meaning that this change occurred even after students had been exposed to patient care experiences during their first year of school. This study demonstrates one method for incorporating geriatric pharmacy education into pharmacy curricula and the potential impact on student comfort levels and perceptions. As previously discussed, there remain numerous barriers to the addition of geriatric experiences within pharmacy curricula, which must be overcome.6 As a result, schools of pharmacy must work to prioritize geriatric education during the curricular planning and revision process. This study focused on two, one-time experiential events with limited capacity for student involvement, which was easier for faculty to coordinate and precept and may be easier to incorporate 105
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into a pharmacy school curriculum. However, other potential longitudinal strategies for increased geriatric exposure within curricula also include required courses, elective courses, and integration of geriatric topics within other courses.6 There were a number of challenges to this teaching method that led to overall limitations of the study. One of the main limitations of this study is the small sample size. Because of the nature of the Catholic Charities meetings, which occur during the day when most students are required to attend classes, it was challenging to recruit a larger number of students. This small sample size may have contributed to the lack of statistically significant changes when evaluating each individual domain of the GAS. Additionally, there is a potential for selection bias within the student group. Students voluntarily signed up to participate, and it is likely that many of these students had an interest in disease state screening, patient education, and/or geriatric care. This may have falsely increased the initial positive perceptions found within this study. Students were not pre-screened to determine whether they had previously had a geriatrics IPPE or APPE or course elective, which may have impacted their survey results. Additionally, students also varied in their experience at the health event, as some students rotated through the three event stations, while others stayed at the same station for the entirety of the event. As a result, students may have had different types of experiences with the geriatric participants during the event; however, overall interactions with geriatric participants should not have differed significantly between stations. When looking at varying comfort level findings between the hypertension and diabetes events (Table 3), it is apparent that the varying student demographic makeup between events likely had an impact. The diabetes event was largely led by fourth-year pharmacy students (66.7%) who likely had more experience and demonstrated a trend toward greater comfort level in working with elderly patients and overall screening techniques (Table 4), which may explain why comfort levels in screening did not significantly change for students participating in this particular event. The lack of standardization in students participating in each event likely further confounded results. Despite these weaknesses, this study offered a unique opportunity for pharmacy students to work directly with geriatric patients. This study also highlights the value of the GAS assessment tool to assess changes in student perceptions following a geriatric learning experience. Finally, it provided opportunities for students to gain confidence in screening and counseling geriatric patients, and positive changes were seen in students, despite a short exposure time to the geriatric population and a large proportion of fourthyear pharmacy student participants. Due to the positive student experience and continued need for geriatric education, ongoing health screening events are available for our pharmacy students. Additionally, we would encourage other schools of pharmacy across the nation to implement similar community health screening and education events that expose students to the geriatric population and to assess the value of these events on student learning through GAS assessment. The positive changes in perceptions following a single event in our study should prompt schools to consider the utility of this type of event in preparing students to care for geriatric patients in the future. Implementation of this teaching modality at any institution should be mindful of student availability and designed to allow for thoughtful student discussion with the geriatric population. Finally, colleges and schools of pharmacy should continue to seek other opportunities for student engagement with the geriatric population, both as a longitudinal and concentrated experiences, to prepare pharmacy students to care for the increasing geriatric patient population. Overall, we demonstrate pharmacy student participation in a single health education and screening event led to increased comfort in communicating with, screening, and counseling the elderly, alongside improvement in global perceptions of the elderly. This approach to geriatric education can be repeated again in the future at both our institution as well as schools of pharmacy across the country. Conflicts of interest None. Acknowledgments The authors would like to thank Dr. Shefali Patel, PharmD, for contributions to the original design and implementation of the study and Dr. Carrie Maffeo, PharmD, BCPS, CDE, who provided resources for the health screening and education events. References 1 U.S. Population Projections: 2005–2050. Pew Research Center website. Available at: 〈http://www.pewsocialtrends.org/files/2010/10/85.pdf〉 Accessed October 21, 2016. 2 Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995–2050. U.S. Bureau of the Census Current Populations Reports website. Available at: 〈http://www.census.gov/prod/1/pop/p25-1130/p251130.pdf〉 Accessed October 21, 2016. 3 Enough to Make You Sick: Prescription Drug Prices for the Elderly. Publication No. 01-103. Families USA Foundation website. Available at: 〈http://www.cptech. org/ip/health/econ/fu06122001.pdf〉 Accessed October 21, 2016. 4 108th Congress of the United States of America. Medicare Prescription Drug, Improvement, and Modernization Act of 2003. House Resolution 1. Available at: 〈http://www.gpo.gov/fdsys/pkg/BILLS-108hr1enr/pdf/BILLS-108hr1enr.pdf〉; January 7, 2003 Accessed October 21, 2016. 5 Accreditation Council for Pharmacy Education: Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree (“Standards 2016”). Available at: 〈https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf〉; Published February 2015 Accessed October 21, 2016. 6 Odegard PS, Breslow RM, Koronkowski MJ, Williams BR, Hudgins GA. Geriatric pharmacy education: a strategic plan for the future. Am J Pharm Educ. 2007;71(3) Article 47. 7 Graber DR, Bellack JP, Lancaster C, Musham C, Nappi J, O’Neil EH. Curriculum topics in pharmacy education: current and ideal emphasis. Am J Pharm Educ. 1999;63(2):145–151.
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8 Adkins DM, Mayhew SL, Gavaza P, et al. Pharmacy students’ attitudes toward geriatric nursing home patients. Am J Pharm Educ. 2012;76(5) Article 81. 9 Martin BA, Porter AL, Shawl L, et al. A model for partnering first-year student pharmacists with community-based older adults. Am J Pharm Educ. 2012;76(5) Article 85. 10 Mobley Smith MA, Koronkowski MJ, Petersen NM. Enhancing student learning through integrating community-based geriatric educational outreach into ambulatory care advanced practice experiential training. Am J Pharm Educ. 2004;68(1) Article 20. 11 Reuben DB, Lee M, DavisJr JW, et al. Development and validation of a geriatrics attitudes scale for primary care residents. J Am Geriatr Soc. 1998;46(11):1425–1430. 12 COPHS Mission and Goals. Butler University College of Pharmacy and Health Sciences website. Available at: 〈https://www.butler.edu/cophs/mission-goals〉 Accessed October 21, 2016. 13 59th WMA General Assembly, World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research involving Human Subjects. World Medical Association. Available at: 〈http://www.wma.net/en/30publications/10policies/b3/〉 Accessed October 21, 2016. 14 Collaborative Institutional Training Initiative (CITI) Program for Research in Human Subjects. Available at: 〈https://www.citiprogram.org/〉 Accessed October 21, 2016. 15 Lee M, Reuben DB, Ferrell BA. Multidimensional attitudes of medical residents and geriatrics fellows toward older people. J Am Geriatr Soc. 2005;53(3):489–494. 16 Haque AF, Soong DG, Wong CL. Assessing the impact of a geriatric clinical skills day on medical students’ attitudes toward geriatrics. Can Geriatr J. 2014;17(1):12–15.
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