Academic Pharmacy Now: 2022 Issue 2 by AACP

Academic Pharmacy

The News Magazine of the American Association of Colleges of Pharmacy

NOW

Volume 15 2022 Issue 2

A Marathon, Not a Sprint The second Equity, Diversity and Inclusion Institute highlighted the ongoing work that pharmacy schools must do to build connections, foster authentic exchanges and be persistent in pursuing EDI goals to ensure enduring cultural change. 14

Also in this issue: Addressing Workplace Trauma 10 The Maine Event 22

Pharmacists Help People Live Healthier, Better Lives.

who we are @AACPharmacy

Academic Pharmacy The News Magazine of the American Association of Colleges of Pharmacy

Pharmacists Help People Live Healthier, Better Lives.

1400 Crystal Drive, Suite 300 P Arlington, VA 22202 703-739-2330 P www.aacp.org

Founded in 1900, the American Association of Colleges of Pharmacy is the national organization representing the interests of pharmacy education. AACP comprises all accredited colleges and schools of pharmacy, including more than 6,600 faculty, approximately 63,800 students enrolled in professional programs and 4,800 individuals pursuing graduate study.

NOW

CEO & Publisher

Lucinda L. Maine Editorial Advisor

Lynette R. Bradley-Baker

Editorial Director

Maureen Thielemans Managing Editor

Jane E. Rooney

Letters to the Editor

We welcome your comments. Please submit all letters to the editor to communications@aacp.org.

About Academic Pharmacy Now

Academic Pharmacy Now highlights the work of AACP member pharmacy schools and faculty. The magazine is published as a membership service.

Editorial Assistant

Kyle R. Bagin

Communications Advisor

Stephanie Saunders Fouch

Change of Address

For address changes, contact LaToya Casteel, Member Services Manager, at lcasteel@aacp.org. ©2021 by the American Association of Colleges of Pharmacy. All rights reserved. Content may not be reprinted without prior written permission.

Art Director

Tricia Gordon Digital Designer

Sean Clark

AACP’s Professional Supporter Program

Freelance Writer

Joseph Cantlupe

Promotion Supporter

Freelance Writer

Emily Jacobs

Freelance Writer

Athena Ponushis

Academic Pharmacy NOW  2022 Issue 2

Volume 15 2022 Issue 2

@AACPharmacy a look inside

community impact

campus connection

Overcoming Trauma Through Resilience An AACP Interim meeting panel explored how academic institutions can address workplace trauma.

@AACPharmacy

A Richly Rewarding Career Lucinda Maine looks back on how she cultivated her passion for pharmacy and highlights from her 40-plus years in the profession.

Be Part of the Action at Pharmacy Education 2022!

2022

Academic Pharmacy NOW  2022 Issue 2

community note publisher’s impact

Dear Colleagues: As I muse over the nearly 50 years since I dedicated my professional energy to pharmacy, I am at once struck by the magnitude of the change that has occurred across those years and the pace. The magnitude is indisputably enormous, yet the pace has not been what I and many others have sought. Some examples: Shortly before I entered the Auburn pharmacy program as a pre-pharmacy freshman, Act 205 of the Alabama Pharmacy Practice statute said that a pharmacist was not to put the name of the product on the prescription label. Further, communication courses across the country prepared students to respond to questions about medications with, “This is best discussed with your doctor.” The APhA Code of Ethics for Pharmacists reinforced these outrageous positions until it was updated in 1969 to reflect that pharmacists had the responsibility to share their knowledge (the Code said “his knowledge”) with their patients. Consider how much has changed across the decades with the introduction of a vast array of patient care services delivered by pharmacists across every setting where pharmacists practice. If pharmacists had not embraced the need for and opportunity to become active vaccinators throughout the 1990s, our nation would not have achieved the COVID-19 vaccine penetration that it has (though there is still a very long way to go before we reach our necessary coverage, including adolescent and childhood vaccines as well as boosters for all). It has been estimated that between 70 and 80 percent of all COVID-19 vaccines were administered by pharmacists, student pharmacists and pharmacy technicians. You are my heroes! Despite the evidence of our progress and its impact on individual patients and populations, the pace has in many respects been glacial. Despite significant attention—especially in the last 10 years—on the value of interprofessional education to equip graduates to provide team-based care, teams remain elusive in many patient care settings. Interoperability to exchange critically important patient data and recommendations between clinicians and with patients is not robust in and across most settings. We aren’t compensated in most cases for the value-producing contributions pharmacists make every day. And political opposition to pharmacists and other health professionals working at the top of their education and licenses is still too evident. The APhA House of Delegates took a loud and clear stand at the March Annual Meeting, saying that “enough is enough” and calling on the American Medical Association and other organizations to simply wake up and become supportive of the fact that pharmacists play critically important roles in making medication use safer and outcomes of care better. There is much work to be done, and this issue of Academic Pharmacy Now focuses on the ultra-marathon in which we are running to address long ignored challenges in achieving diversity, equity and belonging in the delivery of care to the communities that pharmacists serve, and doing so with cultural sensitivity and humility. AACP’s leaders, members and staff are poised and committed to doing our best to accelerate progress on several fronts that are not isolated from each other but instead strategically interconnected: accelerating the transformation evident in the 50 Stories from 50 States ACT Pharmacy Collaborative; keeping academic innovation in the forefront; increasing our work in DEIA; and working to achieve well-being for all. It is a tall order, but with Lee Vermeulen, an exciting and visionary new executive leader, assuming his role as our 7th EVP and CEO on July 1, AACP has the components needed to be an agent of change in partnership with all of our members and external partners. Fasten your seat belts. The pace is picking up! Sincerely,

Lucinda L. Maine, Ph.D., R.Ph. CEO and Publisher

Academic Pharmacy NOW  2022 Issue 2

community impact

Spotlighting Community Pharmacies The 50 Stories from 50 States Challenge, an initiative from the ACT Pharmacy Collaborative, amplifies the vital patient care services that community pharmacies are providing nationwide. By Joseph A. Cantlupe The COVID-19 pandemic magnified the value of pharmacists, especially those in community pharmacies who are highly accessible to the public. The doors of community pharmacies stayed open as they always do—and during a time when most other medical practices had limited inperson appointments. Pharmacists found people seeking not only vaccines but medical advice in a manner that many had not previously considered as they stayed closer to home, postponed checkups and preventive screenings, or had lengthy waits for doctors’ appointments. Indeed, community pharmacies are increasingly becoming the go-to places to help patients monitor their health conditions, particularly those with chronic conditions like diabetes or hypertension. This has been a long-standing vision of community pharmacy that is now becoming a reality in communities across the United States.

A key partnership involving the University of Pittsburgh, AACP, the Community Pharmacy Foundation and CPESN USA, a network of independent pharmacies across the country, is highlighting the importance of the evolving pharmacy workplace. They formed a group known as the ACT (Academia-CPESN Transformation) Pharmacy Collaborative. It is a national collaborative bringing together faculty from colleges of pharmacy “to unite, mobilize and amplify community pharmacy transformation efforts.” CPESN USA is a clinically integrated nationwide organization of pharmacy networks, including more than 3,500 pharmacies, working to advance community-based pharmacy practice in America. The collaboration is spearheaded by a team from the University of Pittsburgh School of Pharmacy and a task force including AACP faculty representatives, CPESN USA leaders

Academic Pharmacy NOW  2022 Issue 2

community impact

“Community pharmacy is transforming at a rapid rate, and the ACT Pharmacy Collaborative wants to help equip pharmacy faculty members to keep up with what is happening out there in practice. A big part of this is uniting all the right stakeholders to support the transformation of community-based pharmacy practice.” —Dr. Miranda Steinkopf

and key staff from AACP, NCPA, ACCP and APhA. The ACT Pharmacy Collaborative includes 94 colleges of pharmacy, with each dean stating their school’s commitment to the priority of community pharmacy practice transformation to patient-centered care in our neighborhoods nationwide. One of their latest ventures is the 50 Stories from 50 States Challenge, an initiative designed to accent the positive impacts of pharmacies in communities.

“Together we want to amplify all the positive, impactful patient care that is happening nationwide,” McGivney added. “And so this 50 Stories from 50 States Challenge meets these criteria. We’re uniting together to tell a story, to amplify what is occurring around the country.” As for the regulatory message, she pointed out that “pharmacists are providers of patient care. With drug reimbursement at an all-time low, the business of community pharmacy is changing.”

Stories Across the Nation

While about 80 percent of chronic disease treatment is through drug therapy, “chronic care is often disjointed and complex,” she said. “There are a lot of forces coming together. Pharmacists can help meet these needs.” Among the many issues: People needing access to care, such as in rural areas, where there is a shortage of primary care practitioners. In the meantime, healthcare payers, the insurers, are demanding quality metrics with uneven funding.

The 50 Stories from 50 States Challenge will deliver stories of pharmacists and their teams caring for patients in community pharmacies. The intent is for the stories to inspire and educate students as well as professionals about the importance of pharmacies, including relationships with the medical community, community organizations and academia, said Dr. Melissa Somma McGivney, a professor and associate dean for community partnerships at the University of Pittsburgh School of Pharmacy. The project also is intended to send a message to state and federal lawmakers about the value of community pharmacy as a point of healthcare access and care nationwide. Current laws limit the ability of the pharmacist to be recognized as a provider of healthcare services at state and federal levels. “From my perspective, community pharmacy practice is evolving quickly,” McGivney said. “The 50 Stories from 50 States Challenge represents all the change that is happening. We need all the schools to be sharing and encouraging students to learn about what is being done in community pharmacies. It’s not the same as it historically has been.”

Academic Pharmacy NOW  2022 Issue 2

Dr. Miranda Steinkopf, an Academic Leadership and Education Fellow at AACP who has been instrumental in working on the project, echoed the idea that pharmacy practice is experiencing unrelenting changes and the importance of initiatives like the 50 Stories from 50 States Challenge. “Community pharmacy is transforming at a rapid rate, and the ACT Pharmacy Collaborative wants to help equip pharmacy faculty members to keep up with what is happening out there in practice,” Steinkopf said. “A big part of this is uniting all the right stakeholders to support the transformation of community-based pharmacy practice.” Under the 50 Stories from 50 States Challenge, pharmacy trainees (e.g., students, residents, fellows), practicing community pharmacists and pharmacy professors from each

community impact

state collaborate on stories that reflect the importance of community pharmacies. Each story submission includes a written narrative, a video recording and pictures describing the community pharmacy, its services, the population it serves and a specific story about providing care to an individual or group of patients. Officials are still gathering the stories (with more than 50 submissions so far), hoping to get all 50 states as well as Washington, D.C. and Puerto Rico involved. The documents and recordings will be available for use as early as this summer in a multimedia library on the ACT Pharmacy Collaborative website and promoted on partner sites with open access for practicing pharmacists, pharmacy organizations, students and others. “Pharmacists in community pharmacies have demonstrated their ability to directly care for patients through vaccinations, testing and expanded services such as comprehensive medication management using the appointment based-model, disease-specific monitoring services such as hypertension and diabetes care, to name a few,” McGivney said. “We have witnessed pharmacists going out of the pharmacy to take care of the population, instead of the community always going to them. The pharmacist is one of the only healthcare professionals who tend to be mobile; we tend to take the show on the road—especially for vaccines.”

agement, measuring a patient’s progress and checking them, working with doctors in collaborative practice agreements to make adjustments in medications that ultimately benefit patients.” The ACT Pharmacy Collaborative has featured previous challenges including a national day of service, a legislative day challenge and a patient case challenge, which resulted in a workbook available at www.actforpharmacy.com, said McGivney. CPESN had approached University of Pittsburgh officials knowing the school was active in the community pharmacy practice space and asked them to help launch a nationwide program. Community pharmacists became involved, and various faculty and pharmacist leaders from 14 states designed the ACT Pharmacy Collaborative, she said. “They asked, how can we take this same concept and encourage it in other parts of the country?” McGivney recalled. The university spoke to other groups and attended various meetings involving pharmacy faculty and clinicians. “We heard from faculty members that they often felt isolated from other faculty members because they weren’t practicing in the same environment,” she added. Eventually, the 50 Stories from 50 States Challenge was launched.

“We recognize the power of stories to form connections and better understanding,” Steinkopf said. “We felt the 50 StoMany people in the general population “don’t know the ries from 50 States Challenge could be so powerful in educatotality of what a pharmacist is capable of doing,” McGivney tion and advocacy because the stories allow for a deeper look said. “We are trying to make these stories accessible in everyday language. In general, people have an understanding at the amazingly impactful work occurring in community pharmacies and share this in a way that numbers or statisthat pharmacists can dispense medication, but many people tics never could.” don’t know we can play a huge role for chronic disease man-

Academic Pharmacy NOW  2022 Issue 2

community impact

“We are trying to make these stories accessible in everyday language. In general, people have an understanding that pharmacists can dispense medication, but many people don’t know we can play a huge role for chronic disease management, measuring a patient’s progress and checking them, working with doctors in collaborative practice agreements to make adjustments in medications that ultimately benefit patients.” —Dr. Melissa Somma McGivney

Highlighting How Pharmacies Help Communities Generally, the stories showcase the role pharmacies play in helping people who may be impacted by chronic conditions or receiving vaccinations, said Dr. Sophia Herbert, an assistant professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy. Herbert mentioned a story involving a five-year-old and her father who were in a pharmacy and tested positive for strep throat. Since their illness was detected on a holiday, the pharmacy was allowed under state law to both test and treat the patient with the appropriate medication under protocol, without the need of an additional appointment. A story submitted by the University of Puerto Rico focused on how community pharmacists provide a variety of services to patients, including compounding. As they evaluate the states’ story submissions, students and faculty will examine research, evaluate the writing and review clinical work with experts, Herbert explained. “It’s definitely a team effort. The students helping to review stories are getting a lot out of it, through information gathering and learning about pharmacy practices and patient care. It can be an eye opener, especially for a student who doesn’t know the full breadth of patient care and what’s happening in community pharmacies.”

Academic Pharmacy NOW  2022 Issue 2

The stories are likely to reflect “what pharmacy teams are bringing into the communities, which is ready access to a trained healthcare professional in our rapidly changing healthcare system,” Steinkopf said. “Pharmacists are providing care to communities not only when other access points are shut down but all the time.” In addition, pharmacies are playing a crucial role in communities where people have disproportionately fewer resources and higher disease burden, she said. In areas of chronic disease management, pharmacists have been found to be “uniquely positioned help patients deal with chronic diseases, because people often go to their pharmacy much more frequently than they go to their doctors’ offices,” Steinkopf pointed out. She noted that often regulators who dictate legislation related to pharmacy “don’t know all that the pharmacists are doing, and they are not paid or reimbursed accordingly.” “We are trying to highlight through these stories all of the great work that community pharmacists are doing to care for patients across the country in many different ways,” Steinkopf said. In that way, too, faculty, student pharmacists and legislators continually learn how the profession is evolving and what they can do to help support this evolution. P Joseph A. Cantlupe is a freelance writer based in Washington, D.C.

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Academic Pharmacy NOW  2022 Issue 2

campus connection

Overcoming Trauma Through Resilience An AACP Interim meeting panel explored how academic institutions can address workplace trauma.

2022

AACP INterim Meeting February 19–22 * San Diego, CA

By Emily Jacobs Many leaders and employees are seeing symptoms of workplace trauma in the wake of the COVID-19 pandemic. These include fatigue, absenteeism, disengagement, sleep difficulties, feelings of guilt or shame, avoidance of certain activities and feeling a loss of control. These symptoms may not always be clinically diagnosed as trauma, but they can still affect employee functioning, reduce productivity and increase turnover and costs. Academic institutions have not been immune to these symptoms of trauma. Disrupted operations, interrupted career paths, isolation and fears of illness have created feelings of uncertainty, detachment and anxiety. Many academic leaders may feel unprepared to address these issues in their workplaces.

politics” in an effort to further their careers, creating stress that can lead to some symptoms of trauma. Career advancement often comes with impostor syndrome—a feeling of being unqualified for a role. This is especially common for individuals taking on a new academic position. New pharmacy residents, fellows or professors may feel pressured to become instant experts in their field, even when they still have a lot to learn. They may feel inadequate, even believing that they cannot fulfill their academic role without sacrificing other aspects of their lives. This can create problems with boundaries and work-life balance.

How to Approach Disruptive Behavior

The panelists outlined the best approaches that supervisors can use to address trauma-based behavior. For example, a AACP’s INvigorate 2022 meeting, held in February in San faculty member who has experienced trauma may feel out of Diego, included a session titled “Organizational Strategies for control. He or she may try to compensate by becoming more Recognizing Trauma in Academia and Elevating Workplace controlling in the classroom. This can create resentment, Resilience.” Two of the panelists, Dr. Jeremy Hughes, assotensions and other disruptions. How should a supervisor ciate dean for academic affairs at Chicago State University address such behavior? College of Pharmacy, and Dr. David Fuentes, associate dean When a supervisor notices a problem behavior, Hughes and for academic affairs at the University of Portland School of Fuentes suggest gathering more information about it while Nursing, explained that the session aimed to help academic finding the best moment to interact with the employee. The workplace leaders and team members learn to identify supervisor should consider possible causes of the behavior. trauma and address it appropriately. The supervisor can then meet with the employee to ask about Academic environments come with unique challenges that the behavior, invite conversation and listen. Next, the supervican create trauma. For example, academic expectations, such sor should consider how to provide compassionate support. as contributing to (re)accreditation or publishing a paper, Finally, the supervisor lets the employee decide the next steps, can take months or even years to complete. Over time, these giving him or her an opportunity to change and meet expectalooming expectations can contribute to feelings of anxiety, tions. This may include a decision to seek out professional asuncertainty and a loss of control. Many academic faculty and sistance, including therapy to address the trauma symptoms. staff do not have a single, direct supervisor who conducts a “Giving them kind of a safe space to talk it through and maybe performance evaluation. Promotions and tenure are often ask them some questions…to help them reach some of that determined by committee, including people outside the organization. Staff and faculty may feel forced to play “office awareness on their own [can help employees who feel out of

Academic Pharmacy NOW  2022 Issue 2

campus connection

control],” said Hughes. The session explored helpful attitudes to adopt when responding to trauma-based behavior. One is a “Growth” mindset, which looks at setbacks as opportunities to learn and improve. Supervisors also should adopt a “Coaching” mindset, which listens to the individual and asks questions, rather than a “Superior” mindset that gives orders. The right mindsets also help individuals struggling with impostor syndrome. “When folks are trying to chase the expert mindset and mentality, it’s almost like, ‘When do I get there? When do I arrive?’” Fuentes noted. “But the reality is that the healthiest way to do it is by thinking about ‘becoming’ and the journey and not really thinking about when the end goal is met.”

Preventing Trauma in the Academic Workplace Academic leaders should also understand how to prevent trauma-based behavior in the first place. Helpful resources and policies can reduce stress and encourage a healthier work environment. Transparent policies, with clear expectations for employee behavior, are a crucial tool. Institutions

should set specific procedures for achieving promotion and tenure, receiving awards and being appointed to committees. This can make career paths less political, less stressful and more concrete. Partnerships with other departments, such as the university’s human resources office, can help support supervisors and employees. Departments can work together to establish employee assistance programs for individuals struggling with trauma. As employees and students resume on-campus activities after COVID-19, there may be fears of further disruptions. They may have generalized anxiety and fears of reliving the experience and may attempt to avoid it by exerting excessive control. Understanding what an individual can and cannot control is the first step in building resilience. “What’s our locus of control, what are the things that we’re actually able to influence?” Hughes said. “One of the things [to deal with that anxiety] is just kind of being aware of the difference between our circle of influence and our circle of concern, and recognizing what can we not change, even though we’re anxious about it?”

Academic Pharmacy NOW  2022 Issue 2

campus connection

Dr. David Fuentes and Dr. Jeremy Hughes explained how to identify workplace trauma and address it appropriately.

Academic Pharmacy NOW  2022 Issue 2

campus connection

One approach for promoting resilience at the individual and team level, he continued, is by being aware of our own mindsets. “With selfawareness, we can reflect on how we interpret events in the moment and recognize how we think about circumstances after they occur. Are we seeing setbacks and challenges as opportunities to learn or as lifedefining moments? Are we trying to prevent things from happening or are we trying to promote actions that work toward a positive outcome? The way we think about and process events is tied to our ability to be resilient and impacts our perceptions of success and growth. Similarly, with social awareness we can rec-ognize the feelings and emotions of others and respond with compassion over conflict.” Fuentes referred to the cognitive behavioral therapy model that encourages people to shift their mindsets to see events and circumstances as neutral so we are more likely to engage in constructive actions. He added, “I think [the pandemic] also showed us that we never really had control, and we certainly don’t have it now. We have to be very aware of what changes could be coming and at the same time, not feel overly anxious about them because that won’t serve us.” P

Helpful resources and policies can reduce stress and encourage a healthier work environment. Transparent policies, with clear expectations for employee behavior, are a crucial tool. Institutions should set specific procedures for achieving promotion and tenure, receiving awards and being appointed to committees.

Emily Jacobs is a freelance writer based in Toledo, Ohio.

Academic Pharmacy NOW  2022 Issue 2

campus connection

Academic Pharmacy NOW  2022 Issue 2

campus connection

When Dr. Michael Fulford, assistant dean for institutional effectiveness and strategic initiatives, University of Georgia College of Pharmacy, proposed opening AACP’s second Equity, Diversity and Inclusion (EDI) Institute with a panel featuring student voices, it was an easy sell. “Normally at these events you have a keynote speaker or a big name and those are great, but sometimes when we just talk leader to leader or faculty to faculty we tend to stay in that space and forget about the people we are serving,” said Fulford, who moderated the student panel. “If we’re going to do this work and talk about supporting students and delving into EDI, shouldn’t we start with listening to the people we serve? I thought it might be powerful to hear from our student voices. Everyone bought into that idea.” Academic Pharmacy NOW  2022 Issue 2

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“At what point in the patient care process should we not consider social determinants of health and all the aspects of who they are? If you are doing clinical work then you need to be looking at things through an EDI lens. We design a curriculum and check boxes but we then don’t think about those extra pieces when so much of the process relates to social structures.” —Dr. Michael Fulford

Held virtually this year in late January and co-hosted by the University of Mississippi School of Pharmacy, the Institute drew 287 participants, representing 56 colleges of pharmacy. Once again, the Institute provided an opportunity to help members advance diversity, equity, inclusion and anti-racism efforts at their institutions by collaborating with faculty and staff across the Academy. Dr. Kelly Ragucci, AACP’s vice president of professional development, said the response to this year’s Institute was overwhelmingly positive. “Participants came away with practical institutional action plans and appreciated being able to participate in team times and mixed cohort groups,” she noted. “The ability to interact with colleagues across the country and bounce ideas for how to implement EDI off one another was new to this year’s Institute and will be something we continue in the future. In fact, we are already starting to plan for the next iteration of this Institute in January 2023 at the University of Mississippi School of Pharmacy.”

Be Present for Students The planning committee selected a diverse group of six students representing various backgrounds from pharmacy schools across the country to participate in the opening panel discussion. Kyra Leonard, a P3 student pharmacist at the University of Georgia College of Pharmacy, said that a common refrain among the panelists was frustration at not being heard or being able to express their concerns, as well as the sense of impostor syndrome that can come with the territory for minorities. “Our schools can do more to get feedback from students. How else are you going to know if something is working if you don’t ask the people affected by it?” she pointed out. “As far as faculty members, they need to take an interest in the things we want to learn about. DEI has more of an emphasis now since the murder of George Floyd. Schools are trying to showcase representation but still not implementing it into lectures, so it’s kind of superficial so far.” Fulford noted that the range of panelists’ experiences highlighted the various obstacles that minorities can encounter. “One student who is an Alaskan native discussed how people do not realize that Alaska is so set apart from the rest of the United States. So as a Native American, she experienced every day the things that oppress and divide people,” he said. “Another student mentioned working through different systems to get to where you are—that persistence. Things like language and dealing with stereotypes that stick out. Another student on the panel immigrated from Mexico and didn’t learn to speak English until she was 16. She received a GED and took a long route to pharmacy school. The committee also felt it important to include Caucasian students on the panel. As it relates to their DEI experiences, they had a different but valuable perspective. They discussed experiences that helped them recognize their privilege and how that has impacted aspects

Academic Pharmacy NOW  2022 Issue 2

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of their life. Listening to all of the students’ stories was phenomenal. Their similar experiences with recognizing power constructs and the nuances within these constructs were so important.” Some attendees, he continued, were surprised by Kaitlin’s story, a white student from Athens, Ga., whose summer internship in the Bronx was transformative for her. “These stories made participants think, ‘maybe we should be creating experiences that challenge our students who are in the majority so they can have that ah-ha moment,’” he said. “It’s always been situations where someone who has more power and control wants to maintain that and some is direct and some is indirect. Some faculty members are surprised to hear what students have endured at their own schools. They think, ‘how could that happen at my school?’ It happens everywhere. It is about recognizing those constructs in your own space and doing something about it.” Leonard said she has seen progress in terms of exposing students to situations that take people out of their comfort zone, but there is room for improvement, including having a more diverse faculty and taking a broader view within courses to consider diverse patient populations. “We learn that there are disparities within pharmacy specifically, but in the curriculum, the faculty mention it but don’t elaborate on disparities and ways to overcome those disparities,” she noted. “So we might read about a 45-year-old African American male and explore the clinical issues, but I wish we also focused on external social factors because in the real world we need to know how to help them overcome those. Another thing is more representation in lectures. For example, in a lecture on skin rashes, none of the pictures were of darker skin. The images gave us an idea of what a disease state looks like but only on people [with white skin]. Those are some things that could be improved. There’s a lack of education that emphasizes different disease states within different ethnic populations.”

“Our schools can do more to get feedback from students. How else are you going to know if something is working if you don’t ask the people affected by it? As far as faculty members, they need to take an interest in the things we want to learn about.” —Kyra Leonard

Fulford agreed, adding, “What Kyra said is really important. When people have darker skin, some diseases can get past people’s thought. It’s about how we integrate this lens of DEI in the patient care process.” EDI is a hot topic right now, he continued, but it tends to get compartmentalized when it is incorporated into the pharmacy curriculum. “At what point in the patient care process should we not consider social determinants of health and all the aspects of who they are? If you are doing clinical work then you need to be looking at things through an EDI lens. We design a curriculum and check boxes but we then don’t think about those extra pieces when so much of the process relates to social structures. Maybe we should start asking the patient questions as a building block. Who are you? What can you do? What are the barriers for you being able to heal better? And that’s ultimately what it is: helping people heal without making assumptions about who they are.”

Academic Pharmacy NOW  2022 Issue 2

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“Professionalism has evolved to mean conforming to normative expectations in the workplace. Those norms were based upon things that are norms for people with dominant identities. Traditionally they were geared toward white folks, toward men, toward folks who are straight, who are able bodied. So we don’t always unpack where those expectations came from and instead we just expect everyone to be able and willing to meet them.” —Z Tenney

A priority for pharmacy schools, according to Fulford, should be to treat students with respect and put them at the center of the work, just as pharmacists do with patients. “Take time to create connection. EDI work is actually simpler than people make it out to be. If you are willing to let go of superficial constructs we put in place and willing to challenge our own histories and receive people for who they are and be with them in the moment, then that’s the best thing to do,” he said. “Faculty are sometimes standing on the outside or worse, above their students. Meet students where they are. Be colleagues with them. That’s what humanity is about. If you have the privilege to be in a position to impact rules and protocols, you’ve got to let go of your ego. My job is to be here with students and sit down and talk and listen. If I’m present with students, I can feel all of their concerns and that makes me better and allows me to connect with them.” Leonard echoed the idea that it takes humility for non-minorities to admit they may have benefited from existing social structures. “They could ask themselves, how can I alleviate the implications of that construct? How can I relate to my students? I do think there is a pride aspect. A lot of people don’t want to have those conversations.” Said Fulford, “Kyra’s life experience includes some of these EDI issues. Getting anywhere in life is a journey and a labyrinth. If someone who knows the way can help you know where to turn in the maze, eventually you get there and you get there together. The whole concept is to be in it with them.”

Challenge Existing Norms In the session “Bringing Authenticity to Professionalism/Professional Identity Formation,” Z Tenney (who uses they/their pronouns) explained that expectations in professional settings need to be reconsidered to be more inclusive of those with marginalized identities. Tenney, the inaugural diversity, equity and inclusion officer at The Ohio State University College of Pharmacy, noted that “professionalism has evolved to mean conforming to normative expectations in the workplace. Those norms were based upon things that are norms for people with dominant identities. Traditionally they were geared toward white folks, toward men, toward folks who are straight, who are able bodied. So we don’t always unpack where those expectations came from and instead we just expect everyone to be able and willing to meet them.” The challenge is acknowledging that norms are not the same for everyone. To foster a more inclusive culture, individuals who are in a position to make decisions about expectations within colleges of pharmacy can initiate conversations about when and where traditional norms are genuinely required. “Do folks truly have to be dressed certain ways or have certain hairstyles or hide their tattoos in these spaces or can we

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leave some of these things behind?” Tenney suggested. “Be really clear and proactive and up front about what the expectation is. For example, in pharmacy lab, there’s an expectation that someone dress professionally. But someone who is from Appalachia might show up in dark jeans because that was considered dressed up where they came from. People don’t always have clear guidelines.” It’s essential to steer conversations in an educational direction rather than a punitive one so students aren’t punished for not knowing any unspoken rules. In discussing professional identity formation, Tenney referenced research in higher education about how learners come to be their authentic selves and carve their own pathways. “There is some research on self-authorship about how students move from being instructed and taking everything at face value versus over time maturing to be able to think critically and determine their own path. How can we as professionals help guide students as opposed to telling them what to do step by step?” Tenney proposed thinking of a tandem bicycle—it’s easy to picture pharmacy faculty being the ones in front who are steering. However, “we should be recommending that we switch places and remember that it is the student’s learning journey and their career so they should get to steer. We can guide them and give advice from the back, but our main role is to pedal to help them get where they want to go.” The future of professionalism in pharmacy revolves around rethinking standards and supporting an increasingly diverse workforce. “How do we define [professionalism] and still meet the goals of confidence in the profession and trust from patients? Someone doing their hair a certain way is no less capable of being professional than someone else. What would it look like for us to affirm those things and increase trust in the profession from patients who are often distrustful?”

“If pharmacy schools want to produce the best and brightest and be transformative, but the workforce does not represent America, then you’ve failed. Those voices are not at the table. It behooves pharmacy schools to produce diverse cohorts, have diverse student populations so they represent the needs and cultures of America that are out there.” —Dr. Regina McClinton

Incorporating EDI into the foundations of what pharmacy schools are doing and examining policies through that lens is the only way to effect true change. Tenney is encouraged by data from an internal survey at Ohio State revealing a shift in public opinion supporting EDI initiatives and recent momentum at other higher education institutions to devote more attention and resources to these efforts. “A lot of this has come about as a result of the murder of George Floyd. It did change a lot of hearts and minds in higher education,” they noted. “That event reminded folks who might not have been paying attention to diversity issues that for many students, this is the reality they are still facing. It was a catalyst. More schools are willing to say this is a priority and we are going to put dollars behind it and have someone in the position to do something about it.”

Academic Pharmacy NOW  2022 Issue 2

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Build Bridges to Sustain EDI Efforts In the Institute’s closing session, “How to Be an Accomplice and Cause Good Trouble,” Dr. Regina McClinton, chief officer for diversity, equity and inclusion, University of Michigan College of Pharmacy, reflected on being the power behind EDI efforts and allowing others to take the lead. The key to making sustainable progress around equity, diversity and inclusion is to recognize that it is about building relationships, she said. “You can have the different conversations that need to be had because you built trust and cache first,” McClinton explained. “EDI work is emotional in many ways. Here we are in these schools with pharmacists for whom things have to be perfect or a patient gets hurt. I am asking them to use different parts of their brains and beings to understand the needs of people they have not traditionally considered, or goals they have not traditionally considered.” Attracting a more diverse student population is essential. When McClinton started doing EDI work at Michigan, “people listened because I had built the rapport and made the connections and understood where people were so I could steer them where I needed them to go,” she continued. “The other thing about being an accomplice is when you do that, other people get wins in EDI. The barriers can seem so high.

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If you let them lead something they build their confidence, they build recognition and they begin to embrace the work because they see themselves as part of it.” Understanding an institution’s culture, values and mission is a necessary first step before attempting to implement EDI initiatives. The leadership absolutely must be on board so you have leverage when you are making connections and making the case for change, McClinton said. “If pharmacy schools want to produce the best and brightest and be transformative, but the workforce does not represent America, then you’ve failed. Those voices are not at the table. It behooves pharmacy schools to produce diverse cohorts, have diverse student populations so they represent the needs and cultures of America that are out there.” EDI efforts advance the pharmacy profession as a whole because when students understand these issues, it translates to better patient care. “Even the students that are not from underrepresented groups need to come up to speed and understand cultural differences and values. They will hear their patients differently and will be able to better connect to those patients than those who have not received that kind of training,” she emphasized. “In particular, those who are from similar backgrounds to the populations are more relatable. I know

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that when I work with white clinicians, I’m thinking, ‘how am I saying this so you understand me?’ It is hard labor to have to train your clinician to understand you. When that person understands you, you trust what the clinician is saying. It isn’t that it always has to be a Black clinician treating a Black person. You just need to be aware.” Bringing more diverse voices to these conversations will also result in richer approaches to addressing social determinants of health. “If schools are not producing well-rounded pharmacists that are able to have seats at the table in their organizations or on a larger scale in a city or a state, our ability to effectively address social determinants of health is hampered,” McClinton added. Ensuring that EDI is considered mission critical within a pharmacy school—leading from the top and listening from the bottom—will support its sustainability. “What do you look like to the rest of the world? If you’re bringing in faculty that are people of color, they will have needs that other faculty will not. We understand that about women, so we need to understand that people of color may have additional demands on them,” she noted. “Students of color will flock to that faculty member. You might have that person on three committees. The work of EDI has to be the work of the whole college.” Within the

university, it’s essential to communicate the value and importance of EDI to the president and provost so they can secure necessary funding to support outreach efforts. An ongoing part of EDI work is to help people be comfortable with being uncomfortable and to get to know people who are not like them so they can have authentic exchanges. “For pharmacy schools to create that and model that for the students and demonstrate the value so they are equipped after they leave is part of that sustainability,” she said. “Those people become your alums. It turns those students into bridge builders in areas they would not have been without that kind of exposure.” Finally, she added, “EDI work is a marathon, but it’s like an ultra-marathon that lasts 50 days through a hot desert. People have to understand that you might get quick wins early on, but then the real work begins. If you get off course, you have to find your way back. Build a cohort and network. Build that community of people invested enough to do that work in your organization.” P Jane E. Rooney is managing editor of Academic Pharmacy Now.

Academic Pharmacy NOW  2022 Issue 2

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A Richly Rewarding Career Lucinda Maine looks back on how she cultivated her passion for pharmacy and highlights from her 40-plus years in the profession. By Athena Ponushis

Lucinda Maine tells the story of her career as if it happened through a series of serendipitous accidents, unexpected opportunities and surprises of support. As she tells it, doors opened for her and she simply walked through them. Serving as AACP’s executive vice president and CEO for 20 years, Maine has been a visionary, strategic leader. She was awarded the Remington Honor Medal in 2019 (on its 100th anniversary), the highest honor in pharmacy, recognizing her nearly five decade-long commitment to her vision to elevate pharmacy education and provide better patient care. In this two-part series, Maine reflects on her career and looks forward to what comes next. It’s clear to see her success may stem from the steadfast stance by which she lives: The beginning is always now.

What led you to a career in pharmacy? It was a bit of an accident. I left the first grade and looked at my first-grade teacher, Ms. O’Brien, and said, ‘I am going to be just like you when I grow up.’ And forever I was going to be an elementary school teacher. Then in middle school I had my first taste of biology. I loved it. By the time I graduated from high school and knew I was going to Auburn, I was toying with a health profession. The one that stuck out for me because it had such cool biology classes was laboratory technology, so I declared that as my major. Just before I went to freshman orientation, my stepdad, who built submarines for a living, looked at me and said, ‘Have you ever thought about pharmacy?’ And I said, ‘Nope. Not once.’ He said, ‘Well, you should go talk to our pharmacist, Charles Dart.’ I went to see him. He was probably somewhere between six and 10 years older than me. He was an Auburn grad, working in a small chain but he ran it like an independent, and he loved every minute of what he did. He said, ‘Pharmacy is fantastic. You would love it. And besides, you go to school for five years, you get out and you make $20,000’—this was 1974. And then he read me the classic line, ‘You know, it’s a great career for women because if you want to have a family, it’s flexible.’ So, I got in the car with my mom, we went up to freshman orientation, I changed my major to pre-pharmacy and honestly, never looked back.

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He was so right. And it’s funny, Auburn profiled me in their pharmacy alumni magazine in 2016 or 2017 and he wrote me this letter. We had not been in contact, but he had hired me to work behind the counter with him after my freshman year and I learned so much. I saw his humanity for the people who were his beloved patients. Because of where we lived in Mobile, Alabama, a lot of them were Medicaid patients, and there was one episode of care that I’ll never forget. At that time you didn’t have a computer, you did your third party on a triplicate form that had all the information and the patient signed the form, and somehow he signaled to me as I was checking this person out that she was going to sign her name with an ‘X’ because she didn’t know how to write her name. That could have been so embarrassing, but he got me that information so that I treated her with the same level of kindness that he extended to everyone. So, he saw my name on the bottom left side of the cover of the alumni magazine. In it, I told the story of how I had come to pharmacy. He wrote me a letter and said, ‘I never knew I had that impact on you and I’m just so amazed by the things that you have done.’ It was really emotional. At 70-something he still does relief work a couple times a week and he still loves the pharmacy profession as much as he did in 1974, when he convinced me to come to pharmacy school.

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You can read Dr. Maine’s Remington Address in APhA’s journal here: https://bit.ly/MaineRemingtonAddress

How does it feel to be on the opposite end, to have someone tell you that you were the person who inspired them to pursue pharmacy? When I was at Auburn, it was older students who convinced me to go to the student APhA meeting in New York City in 1977. I’m a volunteer, I get involved, so I said, ‘OK. I’ll come.’ Then they said, ‘And furthermore, Lucinda, you have to interview with the president elect and find yourself a national committee appointment.’ So, I met Dennis Kimmel, who was the president elect. He was a student at Ferris State. I interviewed with him and was told to come back by the office later because the committee assignments would be posted. So, I went out to dinner and got back to the hotel and went down to the office. Dennis was still there but the assignments weren’t posted. I ended up taking his hand-scratched notes and helped him get those committee assignments posted. I was on membership committee, I think. We were talking and I told him a little bit more about myself, he told me a little bit about himself, and he said, ‘Have you ever thought about running for national office?’

Now here I was, a first-year pharmacy student and I’m at my first meeting and this guy’s asking me if I’m going to run for national office, so I said, ‘No, there’s no way.’ But I use that to tell you, the people I think I have inspired the most are people who, when I go to my next APhA meeting—and I’ve never missed one, except the ones that didn’t happen in ’20 and ’21—are the people who will come up to me and say, Lucinda, I know you don’t remember me, but when you were student president of APhA I met you and you just stimulated me to do this or that. I still love going to white coat ceremonies and commencements and sometimes I get to address a class. I was at Belmont not long ago for their white coat and this young lady came up to me to say, ‘How did you get involved and what did you do?’ I asked if she planned to attend the 2022 APhA Meeting and offered to connect with her there, which we did. That’s the paying it forward part.

Academic Pharmacy NOW  2022 Issue 2

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How has the profession changed since you first became a pharmacist? One of the things that most people don’t know about pharmacy, and I was absolutely shocked and appalled when I learned it myself, is that the code of ethics from the ’20s to the late ’60s had a provision that a pharmacist shall never divulge the information about a prescription a physician has written. Pharmacists in classes before mine were taught how to deflect a person’s question. When they asked, ‘What is this drug?’ the answer was, ‘It’s best for you to ask your physician.’ The state practice law at the time said you should not put the name of the drug on the label and you should not tell a patient what it is. And for the longest time, I really didn’t understand that, but drugs weren’t very powerful back then. The ones that we have today are just so much more important. When I was in school we didn’t know about HIV/ AIDS, it wasn’t an issue yet, and then it became a sure death sentence because there was nothing to treat it or prevent it, other than abstinence. Now it is not only preventable thanks to drug therapy but it’s also almost curable. I often put that into a presentation to students, and I say the rapid changes in science are even going to make that miracle pale in comparison. So, the role of the pharmacist has changed, not as far as I want it to, we’ll come back to that, but the whole armamentarium of health maintenance and disease management and prevention and cure has been transformed in my professional lifetime. It’s really astonishing.

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What led you to academia and then to pharmacy associations? Every summer of my pharmacy school tenure I did a different job, so I worked for Charles Dart the first summer in basically an independent pharmacy and I loved it. The next summer I worked in a shipyard chemistry lab, where my stepdad got me a really well-paying job, but I hated it. That answered that; I knew I was not going to be working in a laboratory. I went back to Mobile after I finished my first year in pharmacy school and I got a job in one of the hospitals. Then the summer after my second year in pharmacy school, right after I went to the APhA meeting in 1978 in Montreal and ran for president elect and won, I applied for an internship and went to Upjohn in Kalamazoo, Michigan, and I began to get really confused about what I was going to do. I knew that my bachelor’s degree was not going to be enough, and so I thought about a Pharm.D., after that summer in the industry I thought about an MBA. I knew that I was not going to get a Ph.D., because I didn’t care for research as an enterprise, and so I tell people I accidentally got a Ph.D. I worked my last summer as a COSTEP, which is a government internship program, and the head of the pharmacy program for the Indian Health Service always held this position available to the APhA student president so they could come to the Washington area for the summer and be more in touch with the staff and make sure that everything was ready for the fall. By the time I was done, I was still confused about what I wanted to do. I mentioned that to two people I was serving with on the APhA task force on women in pharmacy, they were Ph.D.s in pharmacy administration, they looked at each other and said, ‘This is a Pharm Ad grad student if I’ve ever seen one.’ I started graduate school at the University of Minnesota in January 1981. Albert Wertheimer, who was the director of the graduate program for the social and administrative pharmacy program, promised me that he would not try to convince me to stay for a Ph.D. I just wanted to get a master’s degree, and there were some other things about Minnesota that I really wanted to learn more about, like long-term

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care. I really cared about drug use in the elderly population, nursing home practice intrigued me and there were some really good long-term care pharmacists based in the Twin Cities. Albert had gotten a grant from the Kellogg Foundation to implement a part of a report that AACP was responsible for developing called Pharmacists for the Future. In that report they talked about how the future work of pharmacists was going to be knowledge work, and they recommended that the profession needed

a small cadre of pharmaceutical clinical scientists. Albert took that idea and turned it into a grant from the Kellogg Foundation to develop this concept of a pharmaceutical clinical scientist who was ‘as comfortable in the laboratory as at the bedside,’ and the grant supported the development of 15 of these graduate students, each with a stipend of $10,000 a year. Albert had enrolled the first five in Fall 1980. When I came in they were in their second quarter and I was in a lot of courses with them.

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At the end of that semester, he broke his promise. He said, ‘Not only do you need to stay, you need to apply to be one of next 10 Kellogg fellows, because you will be a fabulous pharmaceutical clinical scientist with a passion for drug use and the elderly.’ So, I applied, I stayed and I studied drug use and the elderly. Larry Weaver, the dean at the University of Minnesota, and Paul Batalden, a pediatrician and health system leader who served as my clinical advisor in the program, created my first position and I stayed on the Minnesota faculty for two years. I worked in a multi-specialty group practice, which was so hard because ambulatory care pharmacy really just didn’t exist then, but I did enough of the seed work that the practice flourishes yet today. That’s the only part of my career I wish I could go back and do a redo, because what struck me after time, was that four hours away in Iowa two very pioneering pharmacy leaders, Dennis Helling and Barry Carter, were delivering those services in a family medicine practice. If I had known I would have taken a trip down there and learned how they organized their practice, how they sold it to the physicians, and what this patient care model looked like. Then in 1985 I was going to an Auburn football game and someone I was going with told the dean of pharmacy at Samford University that she was going to the game with me. ‘Tell her I need to talk with her before she goes home,’ he said. So, I went to visit him. He had a new position at Samford as director of professional affairs and he said, ‘You would be perfect for that position.’ I took that position in July 1986 and that was my first academic administration position.

In terms of the pivot to association management, after graduate school I stayed actively involved at APhA. There was this thought in the back of my mind that I would work there one day. I ran and was elected as speaker of APhA House of Delegates in ’88 and ’89 and was an APhA At Large Trustee in 1991. I was on the board that hired John Gans as APhA CEO and in June of 1991 he said, ‘I think I have a position for you.’ I was hired to join the APhA staff and served in various roles, including senior vice president for policy, planning and communications, from 1992 to 2002. Over that course of time, my pharmacist husband Dan and I bought our house in ’93, we adopted our boys in ’97, and then in 2011, Dan felt his calling to the ministry and went to seminary. In my 10th year on the APhA staff, the AACP job became available and my phone started to ring. People said, ‘You know, this is really a good job for you.’ I wasn’t sure that being a CEO was in my portfolio. Finally, AACP’s past president, Bill Campbell, called me one day and said, ‘Lucinda, you must apply for the AACP position,’ and when the drum beats loud enough, you go, ‘Alright.’ I got a first-round interview but I still wasn’t sure, so I kind of just put the whole thing in the back of my mind. I got a call in January saying, ‘Congratulations. The board would like you to come down to Houston and interview for this position.’ I was on the plane and thought, ‘What are they going to ask me? They are going to ask me how my background qualifies me for this position,’ so I took out a piece of paper and I wrote, ‘September 1974, entered Auburn pre-pharmacy,’ and I just wrote down all my education, all my involvement in associations, all my work in education, academic administration, my association leadership and employment and senior leadership. I stopped and thought, ‘half my career has been in association management, half in education, I am perfect for this job!’ And that was the first question that they asked and I answered it very quickly. They called me the next day, offered me the job and it’s been such a fabulous 20-year experience. Maine continues her retrospective journey in the next issue of Academic Pharmacy Now. Be sure to check it out!

Academic Pharmacy NOW  2022 Issue 2

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Be Part of the Action at Pharmacy Education 2022! AACP is excited to welcome back attendees to our Annual Meeting, the premier professional development event for pharmacy educators, July 23–27 in Grapevine, Texas. Get ready to connect and collaborate with peers from across the country and share ideas, solve problems, and find solutions to critical issues facing pharmacy education and the changing healthcare landscape. More than 100 sessions will address highly relevant topics, including: •

Building diverse and engaged teams that value uniqueness and belonging

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Assessing student performance in experiential education

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Exploring methods for supporting, implementing, and assessing professional identify formation

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Strategies for advancing health equity initiatives at colleges of pharmacy

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Incorporating DEI in pharmacy curricula, faculty development and student admissions

AACP Annual Meeting

July 23–27, 2022 Grapevine, Texas

Registration opens soon!

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Dive Deep Into the Data for Pharmacist Demand The yearly summary from the 2021 Pharmacy Demand Report is now available: https://bit.ly/2021PDR The PDR aims to provide an enhanced measurement of pharmacist demand in the U.S.—which saw an 18% growth in job postings in 2021. For data from Q1 of 2022, see the latest iteration of the PDR: https://bit.ly/PharmacyDemandReport