Comprehensive Study Guide for Introduction to Pharmacy Practice

Personal Development and Professional Skills

Organizational Skills and Emotional Intelligence Defined
- Organizational Skills: The methods and strategies used to manage time, tasks, and personal energy to achieve success in academic programs and professional practice.
- Emotional Intelligence (EIQ): The capacity to recognize, understand, and manage one's own emotions, while effectively recognizing, understanding, and influencing the emotions of others and navigating interpersonal relationships.
Character Strengths and Virtues Framework
- Developed by the VIA Institute on Character, identifying $24$ character strengths organized into $6$ core virtue categories:
- Wisdom: Cognitive strengths that involve the acquisition and use of knowledge.
  - Creativity: Originality, ingenuity, and adaptive problem-solving.
  - Curiosity: Interest, novelty-seeking, openness to experience, and exploration.
  - Judgment: Critical thinking, thinking things through, and open-mindedness.
  - Love of Learning: Mastering new skills, topics, and systematically building knowledge.
  - Perspective: Wisdom, providing wise counsel, and taking a big-picture view.
- Courage: Emotional strengths that exercise will to accomplish goals in the face of opposition or difficulty.
  - Bravery: Valor, speaking up for what is right, and not shrinking from fear.
  - Perseverance: Persistence, industry, and finishing what is started.
  - Honesty: Authenticity and integrity.
  - Zest: Vitality, enthusiasm, vigor, and feeling activated.
- Humanity: Interpersonal strengths that involve caring for, connecting with, and befriending others.
  - Love: Valuing close relations and both loving and being loved.
  - Kindness: Generosity, nurturance, care, compassion, and altruism.
  - Social Intelligence: Awareness of the motives and feelings of oneself and others.
- Justice: Civic strengths that underlie healthy community life and effective group functioning.
  - Teamwork: Citizenship, social responsibility, and loyalty.
  - Fairness: Just treatment without allowing personal feelings to bias decisions.
  - Leadership: Organizing group activities and encouraging collective goal achievement.
- Temperance: Strengths that protect against excess and manage impulses.
  - Forgiveness: Mercy, accepting others' shortcomings, and giving second chances.
  - Humility: Modesty and allowing accomplishments to speak for themselves.
  - Prudence: Carefulness, caution, and avoiding undue risks.
  - Self-Regulation: Self-control, discipline, and managing impulses/emotions.
- Transcendence: Strengths connected to the broader universe that provide meaning and purpose.
  - Appreciation of Beauty and Excellence: Awe, wonder, and elevation.
  - Gratitude: Feeling blessed and actively expressing thankfulness.
  - Hope: Optimism, future-mindedness, and goal orientation.
  - Humor: Playfulness, lightheartedness, and bringing smiles to others.
  - Spirituality: Faith, purpose, and connection to a higher meaning.
Signature Strengths vs. Situational Strengths
- Signature Strengths (Top $5$ Strengths): Essential, effortless, and energizing strengths central to an individual's identity. Suppressing signature strengths leads to diminished well-being; when activated, they foster authentic self-expression.
- Situational Strengths: Strengths drawn upon when specific tasks or circumstances require them; useful and effective, but not core to identity, requiring more conscious energy to exert.
Components of Emotional Intelligence (EIQ)
- According to Daniel Goleman, EIQ consists of $5$ core components:
- Self-Awareness: Ability to recognize moods, emotions, and internal drives, as well as their effect on others. Hallmarks: self-confidence, realistic self-assessment, and self-deprecating humor.
- Self-Regulation: Ability to control or redirect disruptive impulses/moods and think before acting. Hallmarks: trustworthiness, integrity, comfort with ambiguity, and openness to change.
- Motivation: Passion to work for reasons beyond money or status, pursuing goals with persistence and energy. Hallmarks: drive to achieve, optimism in the face of failure, and organizational commitment.
- Empathy: Ability to understand the emotional makeup of other people and treat them according to their emotional reactions. Hallmarks: expertise in building/retaining talent, cross-cultural sensitivity, and service to patients/clients.
- Social Skill: Proficiency in managing relationships, building networks, finding common ground, and establishing rapport. Hallmarks: effectiveness in leading change, persuasiveness, and team building.
Strategies to Build EIQ
- Reflect on personal emotions after unsettling events.
- Solicit constructive feedback from trusted peers regarding conduct during difficult situations.
- Maintain emotional self-observation and pause before responding.
- Consider alternative perspectives and underlying factors influencing others' reactions.
- View criticism as a opportunity to learn and improve.
- Cultivate gratitude and ensure adequate sleep.
Strategies for Success in Pharmacy School
- "Eat the Frog" Technique: Tackling the most difficult, unclear, or unpleasant task first thing in the morning rather than postponing it (Mark Twain).
- Task Clarification: Transforming vague work into specific, actionable steps (David Allen's Getting Things Done).
- Daily Meditation: Engaging in $10$ -minute daily meditation to build willpower, focus, stress management, impulse control, and self-awareness (Kelly McGonigal's The Willpower Instinct).
- Evidence-Based Learning Strategies:
- Test Yourself: Active retrieval practice and self-quizzing solidify long-term memory far better than passive review.
- Learn in Layers: Spacing out study sessions, interleaving subjects, and revisiting material to fill knowledge gaps.
- Work Hard at Learning: Creating personal study guides, teaching concepts to peers, pre-solving problems before learning answers, and connecting new information with prior knowledge.
- Activities to Stop: Passive re-reading (creates false confidence) and cramming (leads to rapid forgetting).
SMART Goals Framework
- Goal Types:
- Performance Goal: Target outcome (e.g., scoring at least $80\%$ on an exam or losing $10\text{ lbs}$ ).
- Habit Goal: Repeated behavior (e.g., completing a topic study guide every Friday or walking $30\text{ minutes}$ three times weekly).
- SMART Criteria:
- S - Specific: Clearly defined, simple, answers who, what, where, why, and which constraints exist.
- M - Measurable: Trackable using quantitative indicators or definitive yes/no benchmarks.
- A - Achievable: Realistic and motivating; challenging without being impossible given existing knowledge and resources.
- R - Relevant: Aligns directly with personal values, current needs, and long-term plans.
- T - Time-Bound: Anchored to a specific deadline or timeframe to create actionable urgency.
- Goal Recommendations (Douglass & Douglass): Goals must be compatible with each other, owned personally, and written down.

Overview of the United States Healthcare System

Ten Major Domains of US Healthcare
1. Healthcare Providers
2. Components of Healthcare
3. Delivery Systems/Models
4. Infrastructure
5. Regulation, Policy, Oversight
6. Public Policy, Prevention, Reform
7. Payment: Insurance
8. Financing
9. Affordability/Access
10. Pharmaceuticals and Medical Devices
Components and Delivery Models of Healthcare
- Preventive Care: Vaccinations, screenings, and health education to prevent disease onset.
- Primary Care: Routine, ongoing care delivered by general practitioners, family physicians, pediatricians, and internists.
- Specialty Care: Advanced care focused on specific organ systems or complex conditions (e.g., cardiology, oncology).
- Emergency/Urgent Care: Immediate treatment for acute illness or injury provided in emergency rooms or urgent care centers.
- Hospital Care: Inpatient (admitted overnight) and outpatient care.
- Long-Term Care: Extended assistance for chronic illness or disability (e.g., nursing homes, assisted living).
- Mental Health Care: Behavioral healthcare, counseling, therapy, and psychiatry.
- Palliative and Hospice Care: Symptom/pain relief for serious or terminal illness to optimize quality of life.
Healthcare Delivery Models
- Fee-for-Service: Traditional reimbursement model paying providers per individual service rendered.
- Value-Based Care: Model aligning financial incentives with patient outcomes, quality metrics, and cost efficiency.
- Integrated Care Systems: Coordinated provider networks delivering continuous care across care settings.
Infrastructure Models
- Evidence-Based Practice (EBP): Triad combining Best Research Evidence, Clinical Expertise, and Patient Values & Preferences.

EBP 5-Step Process:
1. Assess: Formulate clinical questions from patient care.
2. Ask: Construct a structured clinical question.
3. Acquire: Search literature for best evidence.
4. Appraise: Evaluate validity and applicability.
5. Apply: Integrate evidence with clinical judgment and patient values.
Patient-Centered Medical Home (PCMH): Care model surrounding the patient with a primary care physician, nurse care manager, dietician, counselor, hospital, specialist, and diagnostic services.

Accountable Care Organization (ACO): Groups of doctors, hospitals, and healthcare providers coming together voluntarily to give coordinated high-quality care, reduce ER visits, manage medications, address social determinants of health, and prevent avoidable hospital admissions.

Public Health Initiatives: Healthy People Objectives
- Healthy People 2020 Goals: High-quality longer lives free of preventable disease/disability; health equity; health-promoting social/physical environments.
- Healthy People 2030: Released in August 2020 containing $355$ measurable 10-year objectives. New focus areas include:
- Opioid use disorder (OUD)
- Youth e-cigarette use
- COVID-19
- Social determinants of health
Minority Health Disparities Data

Persistence of Minority Health Disparities

Liver and Stomach Cancers: Asian Americans are $2\times$ as likely to die from liver and stomach cancers compared to non-Hispanic whites.
Mental Health: Ethnic and racial minority college students are $4\times$ more likely to consider or attempt suicide.
Chronic Disease: Minorities are $2\times$ as likely to suffer from major chronic diseases.
COVID-19: Ethnic minorities account for nearly $60\%$ of COVID-19 hospitalizations.
Diabetes: Hispanic youth experience a diabetes incidence $4\times$ higher than white youth.
Breast Cancer: Breast cancer mortality among Hispanic women is $40\%$ higher than non-Hispanic white women.
Cervical Cancer: Hispanic women are $2\times$ as likely to develop cervical cancer.
Infant Mortality: US infant mortality rate per $1,000$ live births is $4.9$ for non-Hispanic whites and rises to $5.8$ overall when all ethnicities are included.
Insurance: Hispanics are $2.5\times$ more likely to be uninsured.
AIDS: Hispanics are $5\times$ more likely to have AIDS than non-Hispanic whites.
- Quality Improvement and Safety Landmark Reports
Institute of Medicine (IOM) Reports:
- To Err is Human: Building a Safer Health System (1999): Revealed $44,000$ to $98,000$ hospital deaths occur annually from preventable medical errors, costing $\$17-29\text{ billion}$ per year. Recommended establishing a national patient safety center, mandatory error reporting, raised performance standards, and safety culture development.
- Crossing the Quality Chasm: A New Health System for the 21st Century (2001): Identified $6$ aims for quality improvement:
  1. Safe: Avoiding injuries from care intended to help.
  2. Effective: Providing evidence-based services to those who benefit.
  3. Patient-Centered: Respectful and responsive to individual preferences and values.
  4. Timely: Reducing harmful wait times and delays.
  5. Efficient: Avoiding waste of equipment, supplies, and energy.
  6. Equitable: Care that does not vary based on personal characteristics (gender, ethnicity, location, socioeconomic status).
Quality Accreditation & Measurement Organizations:
- NCQA (National Committee for Quality Assurance): Evaluates health plans using HEDIS (Healthcare Effectiveness Data and Information Set) across $5$ domains: Effectiveness of Care, Access/Availability, Experience of Care, Utilization, and Health Plan Descriptive Info.
- The Joint Commission: Accredits hospitals, health systems, and surgical centers.
- CPPA & URAC: Provide specialty and community pharmacy practice accreditation.
- Healthcare Reform and Legislation
Affordable Care Act (ACA / Obamacare - March 23, 2010): Expanded health insurance access via premium tax credit subsidies ( $100-400\%$ Federal Poverty Level [FPL]), expanded Medicaid to $138\%$ FPL, prohibited pre-existing condition exclusions, guaranteed free preventive care, and eliminated lifetime/annual coverage caps.
No Surprises Act (Effective January 1, 2022): Protects consumers from out-of-network balance billing for emergency care, air ambulances, and out-of-network providers working at in-network facilities.
- US Health System Statistics (American Hospital Association FY2020 Data)

Total US Health Systems: $417$ .
Affiliation: $67\%$ of US hospitals ( $4,097$ out of $6,093$ total) and $76\%$ of US hospital beds ( $696,233$ out of $920,531$ total) are system-affiliated.
Distribution: $244$ systems have $1-5$ hospitals; $17$ systems ( $2\%$ ) have $\ge 100$ hospitals; $236$ systems ( $57\%$ ) have $\le 1,000$ beds. System sizes range from $1-156$ hospitals and $25-39,468$ beds.

History of Pharmacy Practice

Ancient to Early European Origins
- Medicinals derived from plants, minerals, and animals have been gathered since ancient times.
- Hippocrates (circa 425 BCE): Focused on dietary regimens and environmental modifications rather than reliance on heavy medication.
- Galen (2nd Century CE): Believed disease resulted from humoral imbalances, introducing complex polypharmaceutical formulas ("shotgun prescriptions").
- Middle Ages (circa 400–1453 CE): Pharmacy established as a separate occupation in the Islamic world with specialized drug shops catering to physicians and the public.
- Southern Europe (mid-1200s): Formal legal separation of pharmacy from medicine occurred.
- Renaissance (1400s): Introduction of printed herbals and pharmacopeias. Pharmacopeias defined drug characteristics and standardized compounding for over $500$ years.
- Comparison of European Systems: Continental Europe established tightly controlled pharmaceutical guilds; England developed a fragmented system (physicians, apothecaries, druggists), which served as the template for North American colonial practice.
Colonial America and 19th Century Milestones
- Colonial apothecaries functioned primarily as drug wholesalers and manufacturers.
- Pennsylvania Hospital (1751): Established the first American hospital pharmacy. Pharmacist John Morgan advocated for the complete separation of prescribing (physicians) and dispensing (pharmacists).
- United States Pharmacopoeia (USP - 1820): Established by physicians to set national standards for drug preparations.
- Philadelphia College of Pharmacy (PCP - 1821): First formal pharmacy school; published the American Journal of Pharmacy and drafted the first code of ethics.
- American Pharmaceutical Association (APhA - 1852): Founded by William Procter Jr. and Edward Parrish to regulate drug quality standards and represent professional pharmacy.
- Corner Drugstore Era (Post-Civil War): Compounding work moved behind screens to the back of the store. Front-end retail grew (tobacco, candy, soda fountains; by 1929, nearly $60\%$ of drugstores featured soda fountains).
20th Century Practice and Educational Reform
- Flexner Report (1915): Educator Abraham Flexner declared pharmacy was not a profession because primary therapeutic responsibility rested with physicians. Consequently, the US War Department denied military officer commissions to registered pharmacists.
- Educational Standards Progression: $1946$ Pharmaceutical Survey led to the adoption of a mandatory $5$ -year Bachelor of Science in Pharmacy curriculum in $1954$ (implemented in $1960$ ). The $1949$ General Report had originally proposed a $6$ -year professional Doctor of Pharmacy (PharmD).
- Durham-Humphrey Amendment (1951): Amendment to the 1938 FD&C Act establishing formal legal boundaries between prescription-only and OTC medicines.
- Anti-Substitution Laws (1950s–1970s): State laws prohibited pharmacists from substituting generic equivalents for brand-name prescriptions without prescriber consent. Hospital pharmacists pioneered formulary substitution systems to bypass these constraints.
- 1952 APhA Code of Ethics: Explicitly forbade pharmacists from discussing the composition or therapeutic effects of prescription drugs with patients.
- Clinical Pharmacy Era (1965–1990): Paradigm shift transitioning pharmacists from passive dispensers ("count and pour") to active drug information experts, P&T committee participants, and clinical patient care providers. Accelerated by the Millis Commission Report ( $1975$ ).
- Modern Practice: The Asheville Project (late 1990s) proved community pharmacist-led MTM for diabetes lowered healthcare costs. Medicare Part D (enacted under the Medicare Modernization Act of 2003, effective 2006) federally mandated MTM services.

Professional Pharmacy Organizations

Purpose: Educate, support, and unify practitioners; advocate for pharmacy legislation; advance clinical research; and set standards for practice excellence.
Key Professional Organizations:
- APhA (American Pharmacists Association): Oldest and largest national pharmacy society ( $>50,000$ members), representing pharmacists across all practice settings.
- ASHP (American Society of Health-System Pharmacists): Represents pharmacists practicing in hospitals, health systems, and ambulatory clinics; serves as the official accrediting body for pharmacy residency programs; hosts the annual Midyear Clinical Meeting ( $>20,000$ participants).
- NCPA (National Community Pharmacists Association): Founded in 1898; represents independent community pharmacies ( $19,400+$ pharmacies employing $230,000+$ individuals, representing a $\$94\text{ billion}$ market).
- AACP (American Association of Colleges of Pharmacy): Founded in 1900; represents pharmacy degree programs, faculty, and academic leadership in the US.
- ASCP (American Society of Consultant Pharmacists): Represents consultant pharmacists managing medication therapy in senior care, long-term care facilities, and complex geriatric populations.
- ACCP (American College of Clinical Pharmacy): Represents clinical pharmacy specialists and advanced practitioners; spearheaded board certification recognition.

Licensure, Residency, Fellowship, and Career Pathways

Educational and Regulatory Framework
- AACP CAPE Outcomes: Center for the Advancement of Pharmacy Education guidelines outlining core educational competencies for PharmD curricula.
- ACPE (Accreditation Council for Pharmacy Education): Official agency that accredits schools of pharmacy, conducts on-site evaluation visits, and monitors NAPLEX pass rates.
Pharmacist Licensure Process
1. Complete Doctor of Pharmacy (PharmD) degree from an ACPE-accredited institution.
2. Apply for licensure to the target State Board of Pharmacy (BOP).
3. Register with NABP (National Association of Boards of Pharmacy) for exam eligibility.
4. State BOP verifies eligibility and notifies NABP.
5. Receive Authorization to Test (ATT) from Pearson VUE.
6. Schedule and sit for examinations at an authorized Pearson VUE Testing Center.

Examination Breakdown
- NAPLEX (North American Pharmacist Licensure Examination):
- Structure: $225$ total computer-adaptive questions ( $200$ scored, $25$ unscored pre-test items).
- Duration: $6$ hours ( $2$ optional $10$ -minute scheduled breaks).
- Question Types: Multiple choice (single best answer), multiple response (select all that apply without partial credit), constructed response (numeric calculations).
- Scoring: Pass/Fail format with results issued within $14$ days.
- Content Domains:
  1. Foundational Knowledge for Pharmacy Practice: $25\%$ ( $50$ questions).
  2. Medication Use Process (Prescribing, Transcribing, Dispensing, Administering, Monitoring): $25\%$ ( $50$ questions).
  3. Person-Centered Assessment and Treatment Planning: $40\%$ ( $80$ questions).
  4. Professional Practice: $5\%$ ( $10$ questions).
  5. Pharmacy Management and Leadership: $5\%$ ( $10$ questions).
- MPJE / UMPJE (Pharmacy Law Examinations):
- MPJE (State-Specific Multistate Pharmacy Jurisprudence Examination): $120$ questions ( $100$ scored, $20$ unscored pre-test), $2.5$ hours duration, no scheduled breaks. Areas evaluated: Licensure/Personnel ( $22\%$ ), Pharmacy Practice ( $33\%$ ), Dispensing Requirements ( $24\%$ ), Operations ( $21\%$ ).
- UMPJE (Uniform Multistate Pharmacy Jurisprudence Examination): Standardized multistate law exam adopted by selecting states (e.g., Florida). Domains: Pharmacy/Pharmacist Practice ( $30$ q's), Medication Use Process ( $30$ q's), Regulatory Authority ( $20$ q's), Operations ( $20$ q's).
- Associated Costs: NAPLEX application $\$100$ + exam fee $\$520$ . MPJE app $\$100$ + exam fee $\$170$ . UMPJE app $\$100$ + exam fee $\$350$ . State application fees vary (e.g., PA $\$45$ , FL $\$295$ plus background checks and background fees).
Continuing Education (CE) vs. Continuing Professional Development (CPD)
- CE: Mandatory clock-hours required periodically by state pharmacy practice acts for license renewal.
- CPD: Continuous 5-step cyclic model for personal growth:
1. Reflect on practice.
2. Conduct a learning needs assessment.
3. Develop a learning plan.
4. Implement the learning plan.
5. Evaluate learning outcomes.
Residencies vs. Fellowships Comparison
- PGY-1 (Post-Graduate Year 1) Residency: $1$ -year general clinical program enhancing pharmaceutical care competencies across core, longitudinal, and elective rotational blocks in hospitals, community settings, or managed care organizations.
- PGY-2 (Post-Graduate Year 2) Residency: $1$ -year specialized clinical residency (e.g., Critical Care, Oncology, Infectious Diseases, Pediatrics, Ambulatory Care). Focuses on advanced clinical training and subspecialty board certification eligibility.
- Match Process: Applications submitted via PhORCAS in December; interviews held in January/February; computer-matched candidate algorithm results released on Match Day in March (followed by Phase 2 and Scramble for unmatched positions).
- Fellowship: $1-3$ year post-graduate research training program preparing pharmacists to serve as principal investigators in drug development, clinical trials, or academia. Peer-reviewed by ACCP and recruited via PPS (Personal Placement Services) at ASHP Midyear.
- Key Differences Summary:
- Residencies: Always $1$ year; always require licensure; accredited by ASHP; emphasize direct patient care.
- Fellowships: $1-3$ years; licensure may or may not be required; unaccredited (voluntary ACCP peer review); emphasize scientific research and pharmaceutical industry drug development.
Board Certification
- Granted by the Board of Pharmacy Specialties (BPS) to recognize advanced clinical knowledge in specialty areas (e.g., BCPS, BCOP, BCACP, BCCCP, BCIDP, BCPPS). Requires passing a rigorous exam and recertifying every $7$ years.

Self and Time Management Principles

Core Axioms of Time
- There are $86,400$ seconds in every day. Time cannot be saved or banked; it must be spent in real time.
- Time management is fundamentally self-management: controlling behaviors, choices, priorities, and organizational habits.
Six Steps to Time Management Mastery
1. Recognize the need for improvement.
2. Conduct an honest self-reflection (maintain a 15-minute block time log for a week).
3. Establish a personal mission statement and write SMART goals.
4. Get organized.
5. Take action.
6. Review, revise, and modify system performance.
Four Time Management Behavioral Styles
- Leaders: Focus on results; direct, succinct communication ("be brief and be gone"); rapid decision-makers.
- Analytics: Focus on precision, accuracy, facts, logic, and systematic structure.
- Relaters: Focus on interpersonal harmony; dislike conflict; prone to taking on excessive tasks for others.
- Entertainers: Idea generators; dislike rigid schedules; thrive on variety and flexibility.
Operational Steps for Organization
- OHIO Principle: "Only Handle It Once" (applicable to paper mail and emails).
- The Four D's: Do it immediately, Delegate it, Defer it (schedule it), or Delete it.
- Master List & Prioritization: Maintain a unified task list categorized by life domain (School, Work, Home). Prioritize using:
- Goal-Achievement Approach: Prioritize tasks directly driving long-term goals.
- Deadline Approach: Prioritize based on nearest strict completion deadline.
- Consequences Approach: Prioritize based on the severity of negative outcomes if left uncompleted.
- Scheduling Rules: Use conservative time estimates (allow extra time cushion). Schedule ALL tasks directly onto a planner/calendar system; unbudgeted time ("white space") must be protected to prevent burnout.
Overcoming Action Obstacles
- Common human spending patterns (doing what we like first, postponing difficult/unknown tasks, waiting for deadlines).
- Key focus strategies: Minimize interruptions, conquer procrastination and chronic lateness, and overcome perfectionism.

Drug Information Practice

Core Philosophy: "The first question asked is rarely the real clinical question." The pharmacist must act as a clinical detective.
Essential Background Questions
1. Who is asking the question (role, contact info)?
2. Is this request patient-specific?
3. What is the underlying medical problem?
4. Why is the question being asked?
5. What is the urgency/time factor?
6. What are the requester's expectations?
7. What is the history of the problem?
8. What unique circumstances exist?
9. What specific information is needed?
10. What format of reply is preferred?
11. How will the information be utilized?
12. How has the issue been managed so far?
13. What alternative options have been considered?
Systematic 7-Step Approach to Drug Information
1. Identify the requester (name, role, contact info).
2. Obtain comprehensive background information.
3. Formulate the ultimate, true clinical question.
4. Develop a literature search strategy and gather data.
5. Analyze and synthesize findings.
6. Formulate and deliver a clear response and recommendation.
7. Follow up and document the interaction.
Hierarchy of Information Sources

Tertiary Literature: Summarized and compiled information (textbooks, online databases like Lexicomp, Micromedex, Clinical Pharmacology). Advantages: Convenient, accessible, readable. Disadvantages: Author bias, potential lag time (outdated).
Secondary Literature: Searchable indexing and abstracting databases used to locate primary literature (e.g., PubMed, IPA, Embase).
Primary Literature: Original research studies, clinical trials, case reports published in peer-reviewed medical journals (JAMA, The Lancet, NEJM).
- Specialized Tertiary References by Category
Adverse Drug Reactions: Meyler's Side Effects of Drugs, FAERS, VAERS.
Dietary/Herbal Supplements: Natural Medicines, NIH Office of Dietary Supplements.
Drug Identification: Lexi-Drug ID, Ident-a-drug, Micromedex Identidex.
Drug Interactions: Hansten and Horn, Stockley's Drug Interactions.
IV Compatibility & Stability: Trissel's, Handbook on Injectable Drugs, King Guide.
Pregnancy and Lactation: Briggs' Drugs in Pregnancy and Lactation, LactMed, Reprotox.
Pediatrics: Harriet Lane Handbook.
General Therapeutics: DiPiro's Pharmacotherapy, Applied Therapeutics, Harrison's Principles of Internal Medicine, UpToDate, Dynamed.
Toxicology: Goldfrank's Toxicologic Emergencies, Casarett & Doull's Toxicology.
Veterinary Medicine: Plumb's Veterinary Drug Handbook.

Interprofessional Teamwork and TeamSTEPPS

IPEC Core Competencies ( $2023$ Version 3)
- Values and Ethics: Work with team members to maintain a climate of shared values, ethical conduct, and mutual respect.
- Roles and Responsibilities: Use knowledge of one's own role and team expertise to address health outcomes.
- Interprofessional Communication: Communicate in a responsive, respectful, and compassionate manner.
- Teams and Teamwork: Apply teamwork science to adapt roles across settings.
TeamSTEPPS Framework & Principles
- Developed by AHRQ (Agency for Healthcare Research and Quality) to optimize patient safety and performance.

Five Key Principles:
1. Team Structure: Defining multi-team operational units.
2. Communication: Structured, clear exchange of information.
3. Leadership: Maximizing team actions, resource management, and plan coordination.
4. Situation Monitoring: Actively scanning environmental/patient factors to maintain situational awareness.
5. Mutual Support: Anticipating and supporting workload needs of teammates.
- Leadership Tools
Brief: Short planning session held prior to a shift/procedure to assign roles, outline clinical status, establish goals, and identify barriers.
Huddle: Quick, reactive problem-solving meeting called during emergent events to re-evaluate plans and adjust to dynamic changes.
Debrief: Post-event discussion to review performance, reinforce positive behaviors, and capture process improvement lessons.
- Communication Strategies and Tools
Standards: Communication must be Complete, Clear, Brief, and Timely.
SBAR:
- S - Situation: What is happening with the patient right now?
- B - Background: What is the relevant clinical context/history?
- A - Assessment: What do I think the problem is?
- R - Recommendation: What specific action/request do I propose?
Check-Back: Closed-loop communication where the sender transmits a message, the receiver repeats the order back verbatim, and the sender confirms accuracy.
Teach-Back: Asking patients or family members to explain care plans in their own words to confirm comprehension.
- Situation Monitoring & Safety Constructs
Process Flow: Situation Monitoring (individual skill) $\rightarrow$ Situation Awareness (individual knowledge) $\rightarrow$ Shared Mental Model (team alignment outcome).
STEP Checklist for situational awareness: Status of Patient, Team Members, Environment, Progress Toward Goal.
I'M SAFE Checklist (Self-assessment): Illness, Medication, Stress, Alcohol/Drugs, Fatigue, Eating/Elimination.
STAR Self-Check: Stop (pause focus), Think (identify action), Act (perform), Review (confirm result).
Assertiveness & Conflict Resolution:
- Two-Challenge Rule: Voicing an safety concern assertively at least twice; if unacknowledged, escalate up the organizational chain of command.
- CUS Words: Escalation phrase triggers:
  - "I am CONCERNED!"
  - "I am UNCOMFORTABLE!"
  - "This is a SAFETY ISSUE!" ("Stop the Line").

Academic Integrity, Citation Standards, and AMA Style

Plagiarism Definitions and Integrity Rules
- Rooted in Latin plagiarius ("kidnapper"). Defined as presenting the work, ideas, or text of another source as one's own without full acknowledgement.
- Enforced under LECOM Student Handbook Section 9.7 (Honor Code Violations). Sanctions include failed assignments, failed courses, or academic dismissal.
- Forms of Plagiarism: Verbatim copying without quotes, unauthorized copy/pasting, poor paraphrasing, collusion, inaccurate citations, failing to cite professional writing services, self-plagiarism, and submitting AI-generated content as original work without proper attribution.
Generative AI Policy (LECOM Handbook Guidelines)
- Permissible Uses: Brainstorming ideas, summarizing long readings for personal study, grammar/spell checking, generating background presentation visuals.
- Non-Permissible Uses: Generating quiz/exam responses, submitting unedited AI content as original work, circumventing learning outcomes, or uploading instructor proprietary course materials into generative AI tools.
AMA Style ( $11\text{th}$ Edition) Citation Mechanics
- In-Text Citation Rules:
- Use superscript Arabic numerals placed outside periods and commas, but inside colons and semicolons.
- Use hyphens for more than two consecutive references (e.g., $1,3-8,19$ ); use commas without spaces for non-consecutive references.
- Avoid placing superscript numbers directly adjacent to numeric quantities or units of measure to prevent confusion.
- Author Formatting:
- List author last name followed by initials without commas (e.g., Canfield HC).
- If a work has $1$ to $6$ authors, list all authors.
- If a work has more than $6$ authors, list the first $3$ authors followed by et al.
- In narrative text, use only author surnames (e.g., Doe et al reported…).
- Digital Identifiers:
- URLs require access dates (Month Day, Year) and do not end in a period.
- DOIs (Digital Object Identifiers) do not require access dates.
Medication Documentation Rules in AMA Style
- Generic vs Brand Names: Proprietary brand names must be converted to nonproprietary generic drug names in written text (e.g., acyclovir instead of Zovirax).
- Combination Products: Active ingredients and strengths must be fully specified at first mention before using trade names or acronyms (e.g., trimethoprim-sulfamethoxazole [ $160\text{ mg}$ trimethoprim / $800\text{ mg}$ sulfamethoxazole]).
- Vitamins: Express using chemical designations (e.g., cyanocobalamin for Vitamin B12; ascorbic acid for Vitamin C).
- Botanicals: Use official Latin binomial names in italics (e.g., Ginkgo biloba or G biloba).
- Percentages: Numerical percentages must follow the drug name (e.g., proparacaine, 0.5\%).
- Regimen Abbreviations: Spell out complete individual drug components when first referencing acronyms (e.g., CHOP: cyclophosphamide, doxorubicin [hydroxydaunorubicin], vincristine [Oncovin], prednisone).