ASHP InterSections ASHP InterSections

May 14, 2019

Mindfulness and Improv Help Pharmacy Students Cope with Burnout

Anne Graff LaDisa, Pharm.D., BCPS, uses improv to teach student pharmacists about effective communication skills.

IN A QUIET LOW-LIT CLASSROOM, students sit comfortably with their eyes closed and their spines straight. They bring attention to their breathing and imagine that they have a balloon in their stomachs. Every time they breathe in, the balloon inflates. Every time they breathe out, the balloon deflates. With every exhale, the students imagine their daily stresses and frustrations floating away. This isn’t a mindfulness retreat at some hideaway resort or the calming conclusion of a power yoga class. It’s a pharmacy course at the Concordia University-Wisconsin School of Pharmacy, where two professors are teaching students to use mindfulness to cope with burnout both during school and throughout their future careers.

According to Christina Martin, Pharm.D., M.S., Director of Membership Forums for ASHP, pharmacist burnout is a serious concern. A 2018 study published in AJHP reported that more than half of health-system pharmacists surveyed felt a high degree of burnout. In addition, a recent salary survey found that two-thirds of pharmacists experienced increased job stress over the previous year, and that 72 percent said workloads increased from the year before.

“When healthcare providers feel stressed, it can also have an impact on their patients,” said Dr. Martin. Burnout is associated with more medical errors and poorer patient safety outcomes, according to the Agency for Healthcare Research and Quality. “We really have to care for the caregiver and ensure that we’re providing resources and support to those who are caring for patients in very chaotic healthcare times,” she added.

Mindfulness in the Classroom

Elizabeth Buckley, Pharm.D., CDE

Elizabeth Buckley, Pharm.D., CDE, Associate Professor of Pharmacy at Concordia University-Wisconsin School of Pharmacy, often includes the balloon-in-the-stomach exercise in her classes. She first introduced it while teaching a diabetes elective for third-year pharmacy students in the spring of 2017 — and she saw immediate changes. It made a huge difference “on attitude, on calmness, on collegiality,” she said.

It worked so well that in the fall of 2018, she added it to her weekly lectures in the Applied Patient Care I course, which is for first-year pharmacy students. “The tone of the class changed in a significant way. Everyone settled down and the discussion was more robust,” she said. “The mindfulness exercise centered me, and it centered the class.”

Dr. Buckley hopes that teaching pharmacy students mindfulness now will help them avoid burnout in the future. “If you’re going to be in a career where you care for other people, you have to figure out self-care in order to be good at being a clinician,” she said.

Improv Shakes Things Up

Anne Graff LaDisa, Pharm.D., BCPS, Associate Professor of Pharmacy at Concordia University-Wisconsin School of Pharmacy, began teaching an improvisational class to first-year students to help bolster communication and teamwork skills. Improv is a theatrical technique where the characters and dialog in scene or story are made up on the spot. Communication skills learned through improv can help a student become a good pharmacist, she noted. Although she didn’t introduce improv classes for pharmacy students with combating burnout in mind, she explained that improv exercises allow students to be creative and break up a school routine.

Anne Graff LaDisa, Pharm.D., BCPS

Dr. LaDisa began taking improv classes herself in 2003. When she discovered that medical schools were using improv to teach and improve medical students’ communications skills, she became intrigued — even more so when she learned that the University of Arizona has been using improv in its pharmacy school since 2004.

She introduced improv to an existing course in 2015, then taught her first stand-alone elective course for first-, second-, and third-year students in 2017. At the beginning of every class, she reviews the rules of improv, which include always saying “yes, and …” to what your partner is trying to communicate, emphasizing the here and now, being specific, and focusing on characters and relationships.

In Dr. LaDisa’s class, a two-person scene requires the students to follow the rules of improv and may involve a scenario unrelated to healthcare. After the students complete the improv exercise, she asks them questions about how they felt about the activity – what things they found challenging and what skills they felt they had to use to be successful. Finally, the students talk about how to apply those skills to clinical pharmacy practice.

Role-playing in a healthcare or social setting can help pharmacy students improve collaboration and teamwork skills. “Improv training gives students an advantage when it comes to communication, which is a critical skill for all pharmacists,” she said.

By Jen A. Miller


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July 24, 2017

Brody Maack Is Driving Success at Family HealthCare

Brody Maack, Pharm.D., BCACP, CTTS

THE 100-YEAR-OLD BUILDING on the northwest corner of N.P. Avenue and Third Street North in Fargo, N.D., once housed Pence Automobile. Now, it is the home of Family HealthCare, a multidisciplinary clinic that has received the highest level of patient-centered medical home (PCMH) recognition in the country.

Although the healthcare staff in the building serve patients rather than service cars, it can be said that Brody Maack, Pharm.D., BCACP, CTTS, is a key component in the smooth running of the clinic’s engine. “I’m always looking at new ways to improve outcomes and make things more efficient,” Dr. Maack said. With that attitude as a starting point, Dr. Maack has become a crucial resource not only for patients, but also for other providers and administrators.

Patients benefit from his lifestyle medicine services, which focus on disease prevention and management of chronic illnesses. “One of my current clinical focuses is trying to increase the number of chronic heart disease patients who are prescribed statins or lipid-lowering therapy,” said Dr. Maack, a member of ASHP.

This initiative comes in light of a chart review conducted by his pharmacy students, which showed that a substantial chunk of patients who could benefit from statin or lipid-lowering therapy were not receiving these drugs. To ameliorate the problem, he has been working with the clinic’s other providers, offering them medication recommendations based on the best available evidence.

Dr. Maack (left) takes a patient’s blood pressure during an appointment, while 4th year pharmacy student Kanako Kabaki (middle) looks on. Students working with Dr. Maack begin their rotations in an observational role and progress to a nearly fully autonomous role by the end.

“We’re now also in the process of expanding my services to include counseling and medication management for patients with several other chronic disease states, including depression, which is important because at the moment we do not have mental health services onsite,” Dr. Maack said.

Highest Level of PCMH Recognition
Family HealthCare offers a cornucopia of services to its roughly 15,000 patients, including dental, optometry, and behavioral health services, in addition to physical therapy and health education. The facility includes 33 medical exam rooms, a laboratory, x-ray imaging facilities, and offices that are used for patient counseling. Interpreters are on hand to help with refugee health.

While those resources are surely put to good use with approximately 60,000 annual patient visits, staff like Dr. Maack help tie the components together in a way that has led to the truly great care that earned Family HealthCare the National Committee for Quality Assurance’s (NCQA) Level 3 recognition, which is the highest level of PCMH recognition. NCQA President Margaret E. O’Kane said the clinic “has the tools, systems, and resources to provide its patients with the right care, at the right time.”

According to Billie Jo Nelson, MLT (ASCP), the clinic’s Director of Quality Improvement, the PCMH certification was a facility wide collaboration, and Dr. Maack is an integral part of the team. “Brody’s work touches on a number of the measures we need to meet to maintain our Level 3 NCQA recognition,” she said.

For example, Dr. Maack helps satisfy PCMH standards by using the electronic health record system to document patient visit notes as part of the continuum of care, Nelson explained. “Helping chronic disease patients with their self-management goals is another way Brody directly contributes to us maintaining our PCMH recognition,” she said. “The time he spends with patients helps them reach a higher level of self-management, which is another standard.”

Medication reconciliations and medication therapy management services mean the clinic meets medication management standards as well, Nelson added.

Educating Patients … and Providers
For patients, Dr. Maack is a guide and partner; for administrators, he is invaluable; and for staff, he is an “excellent” resource, said Nurse Practitioner Kelly Polcher, DNP, APRN, FNP-C. “Brody regularly shares the latest findings and recommendations for medication management with other providers,” Dr. Polcher said.

Dr. Maack (left) reviews a spirometry report with 4th year pharmacy student Joshua Oliver (right), in preparation for an upcoming patient appointment for asthma management. Students enhance their direct patient care skills by taking an active role in seeing patients.

She added that Dr. Maack also helps clinicians select and initiate the most appropriate medical treatment and monitors patients after they start treatment. “This can help limit the excess costs that would otherwise be incurred if patients were to have frequent follow-ups with primary care providers,” Dr. Polcher said.

The staff also appreciates that, through medication reconciliation and chart reviews, Dr. Maack spots inconsistencies in medication use. “We are so fortunate to have Brody working at the clinic,” added Dr. Polcher.

Underserved Populations
Dr. Maack said one of his favorite aspects of the clinical work he does is partnering with underserved populations, including homeless individuals, new Americans, and refugees. “I cherish our refugee population and the opportunity to help them become wonderful friends and citizens,” Dr. Maack said, noting that these individuals also present with unique challenges, such as poor medication adherence.

“Patients who are homeless, for example, may not have a place to keep their insulin cold,” he said. “And new Americans might not be familiar with the idea of taking a medication chronically.” Other patients use forms of tobacco that are traditional to their home country, making smoking cessation best practices possibly less effective, Dr. Maack added. “The no-show rate is also higher with these populations, which is something we’re constantly trying to improve,” he said.

A Sense of Gratification
By providing such a wide variety of services at the clinic, it is no wonder that Dr. Maack is proud of his work. “I feel lucky to be part of a healthcare environment that offers such a breadth of services,” he said.

No doubt, his patients, colleagues, and clinic leadership feel the same sense of gratitude toward him.

By David Wild


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