Misc

Since 2015, in Keio University, we have developed a set of holistic rubrics for assessing students’ performance in practical training in their f ifth year. We have administered it on a series of trials in Keio University Hospital in 2016 and 2017 to prepare for the practical training in 2019, which is based on a “revised model core curriculum for pharmaceutical education” incorporating out-come based education. The first and second trials in 2016 identified some problems. The mentors felt burdened, and the rubrics did not work well because the descriptions of performance at each achievement level were unclear. To address these issues, first, we revised the rubrics and added examples to help mentors with the assessment. Second, the assessment frequency was decreased. Furthermore, we also organized faculty-led orientation sessions on using the rubrics not only for mentors but for all pharmacists in the facility. These efforts have resulted in the effective use of the rubrics in the subsequent 2017 trial, thus reducing the mentors’ burden of using the rubrics. This is not so different from using the rating scale of Specific Behavioral Objectives (SBOs). Furthermore, to mentors, the rubrics seemed to be more proper and objective for assessing students’ performance than the SBOs’ rating scale. Based on these results, it is feasible to use rubrics for assessing pharmaceutical students’ performance in practical training. However, effective efforts, as follows, are needed: (a) making rubrics clearer and more user-friendly, (b) familiarizing the rubrics, and (c) building unity of purpose among relevant staff.

The next revision of the Model Core Curriculum for Pharmacy Education is planned for 2030. In formulating and revising the core curriculum, we should consider what is needed for pharmacy education, not only in terms of outcomes but also in terms of long-term impact (impact on society and contribution to society after graduation). Pharmacy education in itself is a discipline based on pedagogical theory, and its mission is to contribute to the development and improvement of curricula to produce excellent human resources that will contribute to society, looking at all specializations and curricula from basic science to clinical settings. In this symposium, we present the current research and work of specialists who are impacting the real world beyond the C to F domains of the Core Curriculum (as of 2024), as well as their opinions on what they ask for pharmacy education.

The next revision of the Model Core Curriculum for Pharmacy Education is planned for 2030. In formulating and revising the core curriculum, we should consider what is needed for pharmacy education, not only in terms of outcomes but also in terms of long-term impact (impact on society and contribution to society after graduation). Pharmacy education in itself is a discipline based on pedagogical theory, and its mission is to contribute to the development and improvement of curricula to produce excellent human resources that will contribute to society, looking at all specializations and curricula from basic science to clinical settings. In this symposium, we present the current research and work of specialists who are impacting the real world beyond the C to F domains of the Core Curriculum (as of 2024), as well as their opinions on what they ask for pharmacy education.

薬学教育モデル・コアカリキュラムには各専門領域で育成すべき資質が明示されているが，現在，それは学部教育で目指す枠組みでしかない．医療薬学フォーラム2022／第30回クリニカルファーマシーシンポジウムの「薬学教育」シンポジウムでは，各専門領域の学びの先にある真のアウトカムとも言うべき世界で活躍されている4名の先生方に，現在行っている最先端の研究・お仕事と，そのお立場から今後の薬学教育に求めることを共有いただき，今後のあるべき「薬学教育」について議論した．

Worldwide interest in teaching medical professionalism has increased drastically over the past two decades and is recognized as an important core competency. It is also essential in pharmacy education. However, there is no single definition of medical professionalism owing to its multifaceted nature, leading to difficulty in understanding it. The foundational concept of professionalism are the social contract and accountability, which describe the relationship between the profession and the society which it serves. Profession must understand expectations from the society, which is trustworthy, assures competence, and devoted to the public good for the contract based on their mutual trust. In “teaching,” three basic educational actions (“setting expectations,” “providing experiences,” and “evaluating outcomes”) are required. There are two learning goals of professionalism education: the minimum goal of not doing unprofessional acts and the aspirational goal of pursuing a higher level of interiorized professionalism which leads to the professional identity formation. The true professionals are “reflective practitioners,” who have the ability to manage ambiguous problems using their interiorized professionalism in complicated situations. Therefore, reflection is one of the central concepts of professionalism education. The Professionalism Mini-Evaluation Exercise (P-MEX), an observational tool to evaluate medical professionalism, has some favorable aspects; the Japanese version is available and is a guide to specific actions for professionalism through its items, although some cautions must be exercised when using it. Considering that teaching professionalism includes not only formal but informal and hidden curricula, all of the staff in the educational environments should consider professionalism education by understanding professionalism.

In 2024, a new model core curriculum for pharmacy education based on needs from society will be implemented. Many universities are focused on how to develop the qualities and competencies required for pharmacists in undergraduate education. However, the final goal of outcome in undergraduate education should be the spread to society and the world of the high level of expertise that pharmacy graduates should truly aspire to or demonstrate their competency to contribute to society. In fact, recently, International Pharmaceutical Federation indicates that “Making an impact on society” that is one of the pillars of qualities of pharmacy education is the final proof of it. And based on this, it should be necessary to reflect on undergraduate education and improve and review education. In this symposium, lecturers who have already contributed to society, demonstrated a high level of expertise and made an impact on the world gave lectures and discussed pharmacy education across fields. In particular, the lecturers gave an overview of current cutting-edge research from areas C, D, E and F of the current model core curriculum, from drug discovery to clinical practice. This was followed by a discussion on the future prospects of those areas and the points to be improved and expectations for future pharmacy education as perceived by the lecturers.

【目的】基質特異性拡張型β-ラクタマーゼ産生腸内細菌目細菌（ESBL-E）感染症治療において、カルバペネム系抗菌薬の代替薬としてセフメタゾール（CMZ）が注目されている。CMZは腎排泄型で蛋白結合率が高い薬剤であり、ESBL-Eに対して、fT≧MICが70％になるように投与設計することにより、有効な殺菌効果が得られると報告されている。しかし、ESBL-E感染患者に対する遊離形薬物動態（PK）パラメータを用いた最適投与法は不明である。本研究は、ESBL-E感染患者における遊離形CMZ濃度を用いた母集団薬物動態／薬力学（PPK/PD）解析を実施し、最適投与法を構築する。【方法】本研究は倫理審査委員会の承認を得て、CMZ投与患者よりインフォームドコンセントを取得した。血液サンプルはCMZ投与前、点滴終了直後、点滴終了１時間後時点等から採取した。2020年9月～2022年3月のESBL-E株のMICは、臨床検査標準協会のガイドラインに従い、微量液体希釈法より測定した。PPK解析は、PhoenixR NLMETMより、遊離形CMZ濃度を用いて、ベースモデルを構築、共変量探索、最終モデルの適格性評価を行った。組み込まれた共変量ごとに各投与法（投与量、投与間隔、点滴時間）に応じてモンテカルロシミュレーションを実施し、目標達成確率(PTA)を算出した。PTAは、10,000回のシミュレーション結果のうち70％ fT≧MICを達成する確率を示し、PTA(％)≧90％を達成する投与法を検討した。また、各菌の全株数に占める各MICの分率に、各MICでのPTAを乗じた値を総計した有効反応期待確率として算出し、投与法を検討した。【結果・考察】対象患者37人が組み込まれ、血液サンプル146検体の遊離形CMZ濃度を測定した。ESBL-E株のMIC50値及びMIC90値はそれぞれ2、4 mg/Lだった。ベースモデルは1コンパートメントモデル、混合誤差モデルが選択された。PPK解析後の遊離形CMZの最終モデル式は、CL = 16.2 × (CLCR/4.36)0.781 × (アルブミン/28)1.2 L/h、V = 47.1 × (体重/62.8)0.751 Lであった。適格性評価より、最終モデルの妥当性が示された。患者個々のCLCR、アルブミン及び体重ごとの最適投与法のノモグラムを作成し、投与量及び投与回数の増加もしくは点滴時間を延長することでPTA及び有効反応期待確率を増加することが示された。【結論】遊離形CMZ濃度を用いたPPK/PD解析を実施し、ESBL-E感染患者に対するCLCR、アルブミン及び体重ごとの最適投与法のノモグラムを構築した。

Pharmacy practice experiences (PPEs) based on a revised model core curriculum for pharmaceutical education that incorporates outcome-based education have been implemented in Japan. PPEs is a 22-week period in both a community pharmacy and hospital and is characterized by “participatory and experiential learning,” “performance evaluation,” and “continuous involvement in eight representative diseases.” This mini-review describes the evaluation from preintroduction to implementation of PPEs. During the performance evaluation, using a rubric—consisting of a four-point score—for assessing pharmaceutical students’ performance instead of a rating scale of specific behavioral objectives was feasible. Pharmacist mentors and pharmaceutical students could measure the latter’s performance level and growth in PPEs at a community pharmacy or hospital using a rubric assessment. During the continuous involvement of eight representative diseases, sharing information tools between community pharmacies and hospitals substantially increased the implementation rate related to these eight diseases. Furthermore, experiences of eight representative diseases were considerably associated with the growth of pharmaceutical students’ performance. Results indicate that PPEs with which pharmaceutical students experience a wide range of involvement with eight representative diseases may effectively enhance their competencies.