Clinical pharmacy and pharmaceutical care: a need to homogenize the concepts.

To the Editor. The recent article by Benavides et al1.Benavides S Garcia AS Caballero J Wolowich WR The impact of student-faculty ratio on pharmacy faculty scholarship Am J Pharm Educ. 201074(8)Article 138.Google Scholar explored the correlation of faculty members' publication productivity to student-faculty ratios in colleges of pharmacy. These investigators also evaluated the influence of other factors, such as research funding, public vs. private university status, and supportive faculty members on scholarship. While these areas are important topics of investigation where additional insight would be welcomed, I would like to point out 2 potentially serious methodological errors in the study. These authors attempted to compile publication rates of colleges of pharmacy by searching PubMed. While there is insufficient detail in the article about how these searches were performed, it appears that the authors utilized the affiliation field of the MEDLINE database to search for individual schools and colleges. Unfortunately, the problem with this approach is that the MEDLINE database lists only the address of the corresponding author, not all the authors of the paper. So in a multi-university collaborative paper with, for example, 6 authors, only the corresponding author's address will appear in the MEDLINE record. This is in contrast to a database such as Science Citation Index (Web of Science online) which captures the address of every author on a particular paper. This error would result in a significantly underestimated publication count for some colleges. The second related error is that many authors do not list "college of pharmacy" or "school or pharmacy" in their addresses. If this were part of the search strategy, it also would contribute to a significant underestimation of the true publication count. As an example, a 2007 calendar year PubMed search for just 3 individual basic science faculty members (KM Giacomini, A Sali, and BK Shoichet), all of whom are listed in the AACP Roster for the 2006–2007 academic year from the University of California at San Francisco (UCSF), yielded 43 non-overlapping publications. Since refliometric author searches on any database can be contaminated by homologues2.Smalheiser NR Torvik VI Cronin B Author name disambiguation Annual Review of Information Science and Technology 2009 Vol. 43 Malden, MA John Wiley & Sons 287–313.Google Scholar, 3.Soler JM Separating the articles of authors with the same name Scientometrics. 200772281–290.Google Scholar (ie, authors with the same name who are in different disciplines or institutions), I was able to validate 33 of these papers by searching the Web site of these faculty members at UCSF. The Benavides study lists only 24 total publications for UCSF for this timeframe. A careful inspection of the MEDLINE records for these 3 faculty members reveals that many list "Department of Biopharmaceutical Sciences" at UCSF in the affiliation field without mentioning school of pharmacy. As a result of these possible errors, this study may have seriously underestimated the publication output of some colleges and schools of pharmacy. To the Editor. The article in the Journal by Benavides et al on student-faculty ratio and faculty scholarship is flawed in its methodology and conclusions.1.Benavides S Garcia AS Caballera J Wolowich WR The impact of student-faculty ratio on pharmacy faculty scholarship Am J Pharm Educ. 2010 74 (8) Article 138.Google Scholar The flaws stem from the injudicious measurement and characterization of publications and faculty numbers. The authors searched PubMed for publications during 2007 by searching for the name of the institution as listed in the American Association of Colleges of Pharmacy (AACP) faculty roster.2.Roster of Faculty and Professional Staff, 2006–2007 2006 Alexandria, VA American Journal of Pharmaceutical EducationGoogle ScholarPubMed contains this information in the Affiliation or address field (AD) that may include the institutional affiliation and address of the corresponding author of the article. The Corporate Author field (CN) identifies corporate or collective authorship.3.PubMed Help. National Center for Biotechnology Information, US National Library of Medicine, National Institutes of Health. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=helppubmed%26part=pubmedhelp#pubmedhelp. Accessed October 27, 2010.Google Scholar Entries in these fields depend upon the author's designation and the respective journal's policy, if one exists, for completeness or consistency.4.Jonnalagadda SR Topham P. NEMO: Extraction and normalization of organization names from PubMed affiliations J Biomed Discov Collab. 2010 5 50–75.Google Scholar, 5.Zbar A, Frank E. Significance of authorship position: an open-ended international assessment. Am J Med Sci. 2010: Published ahead of print. DOI 10.1097/MAJ.0b013e3181f683a1.Google Scholar, 6.Wager E Do medical journals provide clear and consistent guidelines on authorship? Med Gen Med. 2007 9 (3) 16.Google Scholar, 7.Dickersin K Scherer R Suci ES Gil-Montero M Problems with indexing and citation of articles with group authorship JAMA. 2002 287 2772–2774.Google Scholar For example, authors may list a street address without the institution's name or use a variation or portion of the name of the institution. Multidisciplinary and multicenter research that included a pharmacy faculty member would not be identified unless the AD or CN fields included the name of the college of pharmacy and university. We performed a search of PubMed for 2007 for the University of Tennessee College of Pharmacy, which has departments of clinical pharmacy and pharmaceutical sciences, and included variants such as UT, UTHSC, Tennessee, TN, Tenn, pharmacy, pharm, and pharmaceutical in the AD field. One hundred eleven papers were identified of which 39 were authored by full-time faculty members compared to the total of 17 given in Appendix 3 of the paper by Benavides et al. A search of CN field did not identify any additional articles. If part-time faculty members were included as listed in the AACP roster,3.PubMed Help. National Center for Biotechnology Information, US National Library of Medicine, National Institutes of Health. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=helppubmed%26part=pubmedhelp#pubmedhelp. Accessed October 27, 2010.Google Scholar the publication number would have been higher, but all may not have been identified using their methods. Since most of our part-time and affiliated faculty members are primarily employed by a non-university entity, the address would likely be the person's principal employer and not that of the university. In the case of the paper by Benavides et al, their own publication would not have been identified by their methods, because the name of their university is not stated in the address. Other reports examining publication rates of pharmacy faculty members used a more rigorous and comprehensive approach by searching by faculty members' names.8.Coleman CI Schlesselmann L White CM Journal publications by pharmacy practice faculty evaluated by institution and region of the United States (2001–2003) Pharm Pract. 2007 5 (4) 151–156.Google Scholar, 9.Thompson DF Callen EC Publication records among college of pharmacy deans (letter) Ann Pharmacother. 2008 42 142–143.Google Scholar, 10.Thompson DF Callen EC Nahata MC Publication metrics and record of pharmacy practice chairs Ann Pharmacother. 2009 43 268–275.Google Scholar, 11.Thompson DF Segars LW Publication rates in US schools and colleges of pharmacy, 1976–1992 Pharmacother. 1995 15 (4) 487–494.Google Scholar Benavides et al state that they searched for "review" and "research" articles in PubMed, but they did not describe their definitions for these types of publications. "Review" is a legitimate publication type in PubMed indexing, but "research" is not a category.12.PubMed Tutorial. US National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/bsd/disted/pubmed.html. Accessed October 27, 2010.Google Scholar, 13.NLM Training: PubMed. US National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/pubs/manuals/pm_workbook.pdf. Accessed October 27, 2010.Google Scholar Text-word searching of PubMed for either term would retrieve records that included the words "review" or "research" in any of the fields. This strategy could falsely include or exclude publications simply on the basis of finding the particular word in the publication's PubMed record which may or may not reflect the nature of the article. The authors used the annual AACP faculty roster4.Jonnalagadda SR Topham P. NEMO: Extraction and normalization of organization names from PubMed affiliations J Biomed Discov Collab. 2010 5 50–75.Google Scholar to calculate the number of faculty per institution as (1) a total number of individuals listed minus nonacademic directors, (2) a value based on a formula by the American Association of University Professors (AAUP), and (3) the AAUP formula with an adaptation by the authors (AAUP Plus) to include emeritus faculty members and instructors. Both AAUP formulae count a part-time faculty member at one-third of the effort of full-time faculty members. In applying these calculations to the University of Tennessee College of Pharmacy based on the same AACP report,5.Zbar A, Frank E. Significance of authorship position: an open-ended international assessment. Am J Med Sci. 2010: Published ahead of print. DOI 10.1097/MAJ.0b013e3181f683a1.Google Scholar the total faculty head count equaled 182 (versus 181 by Benavides et al), AAUP Plus was 114, and AAUP was 103 (values for the latter 2 estimates were not listed by Benavides et al). The total number of full-time faculty members (tenure-track and nontenure-track) at and above the rank of assistant professor was 70 in the AACP report, which does not distinguish between tenure-track and nontenure-track appointments, despite such differentiation by Benavides et al in their discussion. With inter-college variations in appointment policies of clinical and affiliated faculty members, in the use of clinical or adjunct modifiers in academic titles, and in the completeness of part-time faculty entries in the AACP roster, a comparison among colleges with these types of variation in faculty listings is meaningless. By including part-time faculty members whose publications may not have been identified in the literature search and emeritus faculty members who likely would not be publishing papers or receiving National Institutes of Health (NIH) funding, the faculty numbers of Benavides et al are mismatched to the measurements of scholarship. Others have estimated faculty numbers differently and described limitations of the AACP faculty roster.14.Knapp DA Knapp DE Attributes of colleges and schools of pharmacy in the United States Am J Pharm Educ. 2009 73 (5) Article 96.Google Scholar Due to shortcomings in achieving an accurate and robust search of the literature and utilizing a reasoned acquisition and application of datasets, the findings of Benavides et al should not be taken as a measure of reality and should not be considered in accreditation, workforce, or policy decisions. In Reply. The authors of the study on the impact of student-faculty ratio on faculty productivity realize that some limitations exist in the methods we used to determine the publication rate per school.1.Benavides S Garcia AS Caballero J Wolowich WR The impact of student faculty ratio on pharmacy faculty scholarship Am J Pharm Educ. 2010 74 (8) Article 138.Google Scholar Dr. Thompson identifies 2 methodological errors in the study; however, both are related to the accuracy of determining publication rates. The publications per college or school of pharmacy were identified using the official name of the pharmacy institution in the MEDLINE database. In our study, we did not include Web of Science or International Pharmaceutical Abstracts (IPA). As mentioned in the article, the citations were searched by the official name of the pharmacy program as listed in the American College of Clinical Pharmacy (ACCP) Faculty Roster. The citation was counted for the institution of the corresponding author and was not counted for other authors from other institutions. Thus, any co-authorship from another institution was not counted toward that second institution's number of publications. Although Dr. Thompson criticizes our approach, we defend our methodology as the other approaches suggested would have overestimated the publication rates. If credit were given to every institution for each author, the true number of publications published by pharmacy faculty members would be grossly inflated. This approach also assumes that each institution contributed an equal role (even if 1 out of 5 authors was from a different institution). Realistically, this is not the case; therefore, using this method would unfairly overestimate the scholastic contributions and significance of some institutions, while severely underestimating the value of others. Our results are conservative and systematic across all institutions. Credit for a publication was applied, as it should be, to the primary author's institution. Searching Web sites for each college of pharmacy, as Dr. Thompson suggests, would not be practical or methodologically sound. This is due to the heterogeneous nature of Web sites since some are not maintained regularly and are subject to entry errors. Dr. Thompson correctly states that some authors did not include "college of pharmacy" in the corresponding title and ultimately their publication was not counted in our study. Faculty salary is typically paid for by the university, specifically, the respective college of pharmacy. Therefore, just as one states grant funding source (eg, NIH), the salary based institution (ie, college of pharmacy) also should be listed. In the example that Dr. Thompson provided, 34 publications (not 33 as he reported) were indeed published by those 3 UCSF faculty members. However, not including "college of pharmacy" in the corresponding address leaves it unclear which discipline at UCSF is publishing. Deans should remind their faculty members that it is imperative to include "school/college of pharmacy" for the respective institution to receive proper recognition for contributions to the literature of our profession. In reply to the letter by Chyka and Earl, to the best of our knowledge, no data exist that can determine whether the number of students enrolled in a pharmacy program impacts the productivity of faculty members. The authors determined the number of faculty members as reported by the institutions and conservatively employed 2 measures of scholarship: NIH funding and publications by an institution. As indicated by Chyka and Earl, other studies have used a more rigorous and comprehensive approach to determine pharmacy faculty publication rates by searching individual faculty members' names. However, this is a "fallacy of relevance" as the objectives of the studies cited were not similar to ours and therefore their methodologies should not be used to critique our study. Had our intention been to replicate those studies, a similar approach would have been followed. On the contrary, the intent of our study was to determine a publication rate for the college, not to give a specific publication rate for individual faculty members. This issue has been further addressed in the above response to the letter to the editor by Thompson et al. As stated in the methods of our paper,1.Benavides S Garcia AS Caballero J Wolowich WR The impact of student faculty ratio on pharmacy faculty scholarship Am J Pharm Educ. 2010 74 (8) Article 138.Google Scholar the authors searched PubMed for all articles and the PubMed search engine automatically filters the "review" publications. In actuality, the "research" category overestimates the true number of "research" publications because it includes meta-analyses, clinical trials, case reports, and letters to the editor. The authors examined each citation individually to ensure a "review" article was in fact a "review" article. A careful look at the University of Tennessee college of pharmacy demonstrates the inclusion of 181 faculty members (183 counted, excluding 2 with administrative titles), more than any other college of pharmacy in the United States. The inclusion of assistant professors whose salary and/or primary affiliation lies outside of the institution derisorily lowers this institution's publication rate while providing an illusory favorable student-faculty ratio in the eyes of the Academy. This is contrary to the vast majority of institutions who list only full-time faculty members who are paid for by the college of pharmacy. Using the suggested approach by Chyka and Earl of retrieving every publication by each faculty member listed in the American Association of Colleges of Pharmacy (AACP) roster would unjustly devalue the publication rate of the majority of institutions who listed only their funded faculty members while falsely elevating those specious colleges who included "everyone under the sun." Additionally, many institutions do not list their part-time faculty members; therefore, not including these publications for our study was consistent throughout. Chyka and Earl also comment that we were able to distinguish between tenure-track and nontenure-track faculty members; we made no such differentiation. The discussion regarding tenure track only offered potential reasons as to why programs with instructors or clinical faculty members may have yielded a higher productivity. Choosing to focus primarily on the specific student-faculty ratio of 1 institution hinders one's ability to acknowledge the overall conclusions drawn, which are based on the trends in the data. We realize the data have errors of both omission and commission, in both the dependent and independent variables. Statisticians have been working for years to solve the problem of finding a signal in a very noisy environment. Receiver operating characteristic (ROC) analysis is robust and not prone to outlier influence as are simple regression models. Moreover, we never intended this exploration of published data to be the final word on this subject. In fact, we encourage more research in this area. Despite conflicting viewpoints, public institutions appear better equipped for scholastic faculty productivity than private universities and the use of instructors, clinical, and non-tenure track faculty members can increase scholarship and research productivity. To the Editor. We read with great interest the article, "Impact of Online Lecture-capture on Student Outcomes in a Therapeutics Course."1.Bollmeier SG Wenger PJ Forinash AB Impact of online lecture-capture on student outcomes in a therapeutics course Am J Pharm Educ. 2010 74 (7) Article 127.Google Scholar We commend the authors for exploring this ancillary teaching technology and attempting to assess its impact on student outcomes, including course grades and class attendance. We believe a number of their findings merit comment. While the authors demonstrated that final examination scores were higher in the study group, use of historic controls threatens the validity of this comparison, as confounding factors such as course modifications, differences among student cohorts in scholastic ability, and related factors were not formally considered. We were not surprised to learn that the investigators were unable to identify a relationship between accession volume and final course grades, because access is only 1 variable that will determine academic performance, and both academically strong and weak students would be expected to access lecture-capture materials. In 2008, Qatar University College of Pharmacy implemented lecture-capture across all pharmacy courses to support the introduction of a new Canadian-accredited BSc(Pharm) program. We now employ Echo360 media platform (Echo360, Dulles, VA) to record audio, video, and computer/data camera images for all regularly scheduled classes, continuing education sessions, and faculty research/professional development seminars. Links to captured lectures are posted to the course Web site on Blackboard Academic Suite (Blackboard, Inc, Washington, DC), our online course management system, within 24 hours of the activity, and these links remain available for the duration of the semester. Upon completion of the course, the links (and all course materials) are archived and remain accessible to all pharmacy students (including students from other professional years) until graduation. Preliminary analysis of our course accessions reveals that students tend to revisit lectures within a few days of delivery to clarify concepts during the and to scheduled is that investigators to provide their lecture-capture for hours and this could the of influence of this method on final course grades in this study. We believe providing students with the ability to to lectures and courses as as to look ahead at students among the courses they are and the overall study and their of how we to their knowledge, and the tenure of the program. 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