mortar and pestle
Robert P. Shrewsbury
ROBERT P. SHREWSBURY PhD
Beard Hall, Room # 202B
Email: bob_shrewsbury@unc.edu
  Resources

Published Literature

Student Evaluation of Online Pharmaceutical Compounding Videos

Objective: The objective was to describe pharmacy students views of the effectiveness of an expansion of the compounding laboratory website at the UNC Eshelman School of Pharmacy. Originally, there were 39 videos and 3 animations available. In 2011, an additional 59 videos and 2 animations were added. Concurrently, all of the interactive questions were updated to fully integrate with the expanded video library.

Method: Professional students were surveyed about the expanded video library regarding accessibility, functionality, and usefulness, and how using the library impacted their learning of compounding. Surveys from 391 students were analyzed by descriptive statistics. Means and SDs were calculated for the rating scale questions; independent t-tests and Wilcoxon nonparametric tests were used to find differences between professional classes and campuses. Analytical results were evaluated with a one-way ANOVA, z-test, and a homogenicity of variance (Levene's) test.

Results: The response rate to the survey was 85%. The compounding videos were used by 386/391 students to prepare for their laboratory sessions. Thirty-four percent (34%) of students used the videos an average of 30 minutes or less per week preparing for lab; 56% used the videos 1-2 hours per week. The videos were preferred to the required textbook, the Formulation Records, and asking for information from their small group teaching assistants. Approximately 80% of students were satisfied with the functionality and accessibility of the videos. There were some statistically significant differences between professional years and/or campuses with some of the rating scale questions. The analytical results of the API concentrations for compounded preparations were not statistically different. All students, regardless of professional year or campus affiliation, put their confidence/competent at about 70% of the rating scale.

Implications: No standardized compounding curriculum was found in U.S. Schools of Pharmacy according to a COS report from AACP. Limited resources was cited as a possible reason for the lack of standardization. This study suggests that pharmlabs, an open access website for pharmaceutical compounding, could be an accessible, functional, and useful resource for Schools of Pharmacy.


 

Long-Term Results of an Analytical Assessment of Student Compounded Preparations

Objective: To investigate the long-term (i.e., 6 year) impact of a required vs an optional remake requirement on student performance in a compounding laboratory course in which students’ compounded preparations were analyzed.

Methods: The analysis data for several preparations made by students were compared for differences in the analyzed content of the active principal ingredient (API) and the number of students who successfully compounded the preparation on the first attempt.

Results: There was a consistent statistical difference in the API amount or concentration in 4 of the preparations (diphenhydramine, ketoprofen, metoprolol, and progesterone) in each optional remake year compared to the required remake year. As the analysis requirement was continued, the outcome for each preparation approached and/or attained the expected API result. Two preparations required more than 1 year to demonstrate a statistical difference.

Conclusion: The analytical assessment resulted in a consistent, long-term improvement in student performance during the 5- year period after the optional remake policy was instituted. Our assumption is that investment in such an assessment would result in a similar benefits at other colleges and schools of pharmacy.


 

Impact of Required Versus Optional Remake of a Preparation on Pharmacy Students’ Compounding Accuracy

Objective: This retrospective study investigated the impact of a required vs an optional remake requirement on student performance in a compounding laboratory course in which students’ compounded preparations were analyzed.

Methods: The analysis data for several preparations made by students over a 3-year period were compared for differences in the analyzed content of the active principal ingredient and the number of students who successfully compounded the preparation on the first attempt.

Results: Students’ compounding accuracy was significantly better for the ketoprofen (pluronic lecithin organogel [PLO]) emulsion (p=0.003) and mock co-enzyme Q10 troches (p=0.001) when remaking an inaccurate preparation was optional rather than required. There were no significant differences in the parameters for the other compounded preparations.

Conclusion: Student performance did not decrease when students were given the option to remake an inaccurate preparation. Factors such as the difficulty of the preparation, time spent compounding, and impact on the student’s final course grade also may have influenced student performance.


 

Assessment and Recommendations of Compounding Education in AACP Member Institutions

In August 2009, the American Association of Colleges of Pharmacy (AACP) Council of Sections established a Task Force to assess the current status of compounding education at its member institutions and to provide recommendations for future direction. The Task Force conducted a survey in late June 2010 of faculty members enrolled in the AACP Pharmaceutics and Pharmacy Practice sections to gain qualitative information of the current state of compounding education. The survey results were then organized around eight curricular topics for which the Task Force members provided interpretations and recommendations. A final report was sent to the AACP Council of Sections on February 15, 2011. This publication provides the information contained in that final report to the professional community.


 

Video Teleconferencing in the Compounding Laboratory Component of a Dual-Campus Doctor of Pharmacy Program

Objectives; To design, implement, and assess the effectiveness of using a live video teleconferencing system to connect the main campus and a satellite campus during laboratory compounding exercises in a doctor of pharmacy (PharmD) program.

Design: A new laboratory facility with identical equipment and supplies to the main campus was built at the satellite campus and teleconferencing equipment was set up. Students on both campuses prepared 20 compounded formulations over a 5-course pharmaceutical care laboratory sequence. Live video teleconferencing was used for students to ask questions and for the lead faculty instructor to observe the students’ technique. Faculty and staff members and teaching assistants facilitated the laboratory sessions on both campuses.

Assessment: The performance of students on assayed products at the main campus was compared with that of students at the satellite campus to ensure program integrity with the compounding laboratory component. The use of video teleconferencing for teaching compounding was successful and no difference in overall student pass rates was seen. The few observed differences in student performance between the 2 campuses were believed to be a result of variations in instructor communication with distant students.

Conclusion: Video teleconferencing can be used successfully to deliver curriculum in laboratory compounding to pharmacy students.


 

A Hybrid CD-Internet Delivery System for Pharmaceutical Care Laboratory Instruction

Objectives: The Laboratory contains twenty compounding experiences. Students can have up to a week delay between the scheduled pre-lab lecture and actual experience. A hybrid CD-Internet CD-ROM was developed to give students on-demand access to multimedia information about the laboratory outside of the School. The CD-ROM allows students to review pre-lab material in preparation for their laboratory.

Methods: The CD-ROM was used in the 1999-2000 academic year. A comparison of these students and the previous year's students (who did not have the CD-ROM) included individual laboratory grades, results of product analysis, and time to complete the laboratory. A survey was also completed by the 1999-2000 students.

Results: Analysis of the Fall semester data showed no statistical difference in time, grades, or analytical accuracy between the two classes. A trend existed between improved total laboratory grade and the usage of the CD-ROM. Students preferred to either print the material, or view and print the material compared to viewing the material alone. An analysis of the Spring semester will also be presented.

Implications: This is a new teaching method for UNC students. Their reliance on printed materials indicates they are not acclimated to using newer online delivery methods. The trand toward improved grades with CD grades was suggestive of the technology's benefit. The full benefit of the CD-ROM delivery system will not be seen immediately but will take time to impact student learning.


 

Accuracy in Prescriptions Compounded by Pharmacy Students

Most compounded prescriptions are not analyzed to determine the accuracy of the employed instruments and procedures. The assumption is that the compounded prescription will be ±5% the labeled claim. Two classes of School of Pharmacy students who received repeated instruction and supervision on proper compounding techniques and procedures were assessed to determine their accuracy of compounding a diphenhydramine hydrochloride prescription. After two attempts, only 62% to 68% of the students could compound the prescription within ±5% the labeled claim; but 84% to 96% could attain an accuracy of ±10%. The results suggest that an accuracy of ±10% labeled claim is the least variation a pharmacist can expect when extemporaneously compounding prescriptions.


 

Abstracts of Work in Progress


Duplicating a Well-controlled Stability Research Study in a Teaching Compounding Laboratory

Objective: A published research study demonstrated the stability of compounded zonisamide suspensions. The teaching laboratory experience was to provide students an opportunity to determine the stability of their compounded suspensions using the research protocol. The objective was to determine if the student results could replicated the research result, or if student results were different, identify possible explanations for the difference.

Method: Zonisamide suspensions were compounded by second-year pharmacy students in either simple syrup or 0.5% methylcellulose and stored at either room or refrigerated temperature (the PCL study).  Students drew samples over a 28 day period, and observed their preparations for color, odor, and the presence of bacteria. The samples were analyzed by HPLC, and the results reported back to the students who compared their results with the published research study.

Results: The PCL study showed average zonisamide concentrations statistically below those of the research study throughout the 28-day period, regardless of the vehicle or storage condition. The PCL study has been conducted over a period of 4 years, and comparable results were seen each year.

Implications: The results suggest that a scale-up of a research study to a teaching laboratory experience is not straightforward. Differences can arise from methylcellulose grade used, multiple samplers, number of samples taken by students, number of samples in each matrix component, and sample collection from satellite campuses.


 

The Effect of Routine Analytical Analysis By Students on the Accuracy of Compounded Preparations and Student Confidence in a Pharmaceutical Care Laboratory Curriculum

Purpose: To assess the effect of analytical analysis by PharmD students on the accuracy of pharmaceutical compounded preparations and confidence in compounding skills of student pharmacists in their first, second, and third years of training at UNC Eshelman School of Pharmacy.

Participants: PharmD candidates from the class of 2018 (PY1), class of 2017 (PY2), and class of 2016 (PY3) currently enrolled in PCL courses. Approximately 525 students.

Procedures: The accuracy of compounded preparations will be determined by analytical analysis for several compounds for they PY1, PY2, and PY3 classes over the 2014-2015 academic year. The comparison of student analysis results will evaluate the variance in the percent of label compounded and the number of students that were successful in compounding the preparation the first time with �10% accuracy. Self-efficacy will be measured via a survey emailed to all participants at the end of each semester. Calibration between self-efficacy and student performance will be performed to evaluate if students are under or over confident.

    Weddendorf E., Shrewsbury R.