AACP Argus Commission Forecast 2024

AACP ARGUS COMMISSION

FORECAST 2024

Contents Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Introduction and Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Environment of the Pharmacy Academy. . . . . . . . . . . . . . . . . . . . 9 Bold Moves and Brave Experiments Are Needed to Reshape Pharmacy Education. . . . . . . . . . . . . . . . . . . . . . . . . . 16 The Pharmacy Practice Environment will be Dynamic— How will Academic Pharmacy Respond?. . . . . . . . . . . . . . . . . . . 22 The Future of Research in the Pharmacy Academy. . . . . . . . . 27

Pharmacists Help People Live Healthier, Better Lives.

Foreword

Foreword The 2023–2024 Argus Commission, comprised of the five previous AACP presidents and current AACP CEO and Executive Vice President, was charged by AACP President Craig D. Cox, PharmD, to develop this inaugural edition of the AACP Argus Commission Forecast. The intent of the forecast is to provide substantive guidance to colleges and schools of pharmacy in their strategic, academic, and research planning and visioning.

The 2023–2024 Argus Commission entertained the idea of a “different” approach to Argus work, modeling the efforts of other organizations’ forecasting efforts. The 2023– 2024 Argus Commission is grateful to all who facilitated this amazing process to create a tool that will be a guiding light going forward for the pharmacy academy. Over time, the AACP Argus Commission Forecast will provide thoughts about emerging trends that will impact schools and colleges of pharmacy and the profession of pharmacy as a whole.

As with any new process, the Argus Commission acknowledges that input into this process in the form of your comments and suggestions is essential to future forecasts.

Please provide your comments about this process, input on how future forecasts can be improved, and any recommendations for topics to include in subsequent forecasts to Lee Vermeulen, AACP CEO and Executive Vice President, at LVermeulen@aacp.org.

2023–2024 Argus Commission Members David D. Allen, RPh, PhD, Chair, Co-Editor Stuart T. Haines, PharmD Anne Y.F. Lin, PharmD Russell B. Melchert, RPh, PhD Todd D. Sorensen, PharmD Lee C. Vermeulen, BSPharm, MS, Staff Liaison, Co-Editor Acknowledgments The editors are extremely grateful for the time, effort, and expertise of the many contributors who participated in making this forecast a resounding success. The editors are grateful to Bill Zellmer and the ASHP Foundation for their work in creating the ASHP Forecast, which served as the methodologic model for this AACP process. The editors also appreciate Adam Jackson, AACP Manager of Governance, Tricia Gordon, AACP Design Director, Elizabeth Stern, Associate Editorial Director, and the AACP Board of Directors for their contributions to several aspects of this project.

Citation Format Allen DD, Lin AYF, Haines ST, Sorensen TD, Melchert RB, Blouin RA, Austin Z, Moore GD, Poloyac SM, Vermeulen LC. AACP Argus Commission Forecast 2024. Am J Pharm Ed. 2024. In Press. Full PubMed citation elements will be provided at publication.

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Introduction and Methods

Introduction and Methods David D. Allen, RPh, PhD

Lee C. Vermeulen, BSPharm, MS

Chair, 2023–2024 Argus Commission Past President American Association of Colleges of Pharmacy Oxford, Mississippi

Executive Vice President and CEO American Association of Colleges of Pharmacy Arlington, Virginia

Introduction Academic pharmacy, like much of higher education, faces tremendous challenges that require thoughtful planning from academy leaders and those in individual colleges and schools of pharmacy. Strained resources continue to be top-of-mind as a major contributor to the struggles AACP members face, which may preclude colleges and schools of pharmacy from investing in robust strategic planning, which is essential to the overall success of any program.

The Roman philosopher Seneca is attributed to have said that “Luck is what happens when preparation meets opportunity.” The opportunity ahead for the pharmacy academy must be a staunch commitment to our mission that “Pharmacists help people live healthier, better lives.” In striving to achieve our mission, robust forecasting is essential so that leaders in the academy as a whole and in individual colleges and schools of pharmacy can adequately be prepared. Luck is certainly not how we want to approach our strategic planning, but rather well-informed and well-planned preparation is the best pathway to seize and capitalize on what opportunities we encounter as we move forward.

With Seneca’s words in mind, the 2023–2024 Argus Commission set out to provide a tool that will assist in developing well-informed, stakeholder-driven, visionary strategic plans.

A lack of adequately informed strategic plans requires leaders to do their own best-guessing in a vacuum for a plan that may not be achievable, or even possible. Taking advantage of this resource, forecasting coming events can be an exercise to help dedicated leaders create well-informed strategic plans. With this as a backdrop, the AACP Argus Commission Forecast 2024 has been developed to bolster strategic planning and decision-making efforts at member institutions and in the academy as a whole.

Methods The use of “wise crowds” has been a tool for forecasting that takes advantage of broadbased groups in which each panelist provides input based on their locally- and globally-informed perspective. The collective view of the crowd is more informative than any one individual’s view. James Surowiecki’s The Wisdom of Crowds1 has been used by other health-related organizations to synthesize the power of a diverse group of individuals.

The AACP Argus Commission Forecast 2024 is modeled on the successful methods and approach that have been used by the American Society of Health-System Pharmacists2 (ASHP) and the American Hospital Association3 (AHA) in their forecasting efforts over many years. Their forecasts have provided health-system pharmacy leaders and hospital and health system executives with critical guidance, as this report supports the pharmacy academy. Forecasting is not well-suited to quantitative methods, while using “wise crowds” provides informed predictions. The 2023–2024 Argus Commission mapped out a 3

AACP Argus Commission Forecast 2024

Introduction and Methods process that harnesses these evaluation strengths by obtaining the perspective of meticulously identified members of the pharmacy academy, thereby taking individually held perspectives and combining them into a strong, collective view.

Comprised of the five most recent AACP presidents, the Argus Commission provides an ongoing and informed membership for this first and future forecasts. The Argus Commission conducted an environmental scan which focused on the three “legs” of the academic stool—education, practice, and research. A fourth theme that encompassed a broader range of topics is referred to as “environmental” issues. Once these four themes were identified as the starting point for developing the survey, specific scenario statements from the broader environmental scan were categorized within these themes and established as a baseline survey. These specific scenario survey items and their perceived impact on the pharmacy academy for the next 5 years guided the development of the items within each of these four themes. Initially, there were over 100 survey items that were crafted to delve into these areas and then pilot-tested for clarity and face validity, with the final survey including 51 items. The 2023–2024 Argus Commission is grateful to the AACP Board of Directors for serving as the pilot group.

Across the four themed areas, the 51 items reflect scenarios that survey respondents were instructed to consider and rate as to the likelihood that the scenario will occur in the next 5 years. Survey respondents were asked to consider their “top-of-mind” reaction to the likelihood of the scenarios occurring on a four-point grid of agreement (very likely, somewhat likely, somewhat unlikely, or very unlikely). More details of survey respondent make-up and demographics are provided below.

The “typical” Argus Commission report taps the Commission members and AACP CEO/ EVP (as staff liaison to the Commission) as authors. When considering the ideal approach for authoring the forecast, Argus Commission members concluded that, while they should coauthor the themed areas, additional expertise would strengthen the report.

In sum, this AACP Argus Commission Forecast 2024 is a great beginning to the forecasting that will enable the Argus Commission to build upon this success and enhance strategic planning for the academy, as well as individual colleges and schools of pharmacy, well into the future.

Results Forecasting using the “wisdom of the crowd” depends a great deal on the strength of the survey respondents. Thus, the make-up of the respondent group, including their background and involvement in the pharmacy academy, is essential. The Argus Commission identified informed, learned, and actively involved members of the pharmacy academy to participate in the forecast survey. Respondents came from a number of select groups, including CEO deans, past AACP presidents, individuals who volunteered to serve on AACP standing committees, past graduates of the AACP ALFP program, and past NACDS scholars, among others. Over 1,500 individuals were solicited to serve as survey respondents, and 632 accepted. The actual survey participation rate for this forecast was substantial, with 462 completing the survey (response rate of 73.1%), demonstrating the commitment of the pharmacy academy. As active members of AACP, survey respondents have great insight into the pharmacy academy and knowledge of the challenges and opportunities we all face, as well as informed perspectives about our future. At each stage of development and implementing this forecast, it was clear that enthusiasm for the project

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Introduction and Methods was quite strong. This only added to the excitement Argus Commission members experienced when this novel approach to Argus work was introduced.

Information about the composition of the survey respondent pool is provided in the accompanying graphs. Note that responses to demographic questions in the survey were optional. Thus, the percentages presented here do not equal 100%. The regional distribution of respondents varied, with greater representation in the South Atlantic and Great Lakes regions than in New England and Mountain regions (see Figure 1). This distribution is consistent with the distribution of colleges and schools of pharmacy across the US. A larger proportion of survey respondents (55.6%) were from public than private institutions (41.4%) (see Figure 2).

More women (50.2%) than men (41.4%) responded to the survey (see Figure 3), and most survey respondents (60%) have worked in the pharmacy academy for more than 15 years (see Figure 4). Nearly 80% of survey respondents identified themselves as being pharmacists (see Figure 5). The largest group of survey respondents (48.3%) indicated they were in drug information, experiential education, or pharmacy practice, while 33.6% indicated they were in administrative roles. A smaller proportion (12.3%) indicated they were in the basic science faculty at their colleges or schools of pharmacy (see Figure 6). Of those respondents who indicated they were practice-based faculty, those in acute care and ambulatory care were equally represented (44.8% and 47.2%, respectively). A small proportion of survey respondents (7.9%) indicated they were in community practice (see Figure 7).

Forecast Highlights Results from the survey statements are included in the themed sections of this forecast.

Using the outcome, authors (one Argus Commission member along with one or two other noted experts in that area, chosen by the Argus member) provide a discussion and recommendations that build on the individual scenarios and overall conclusions therein to enhance pharmacy academy and individual college and school of pharmacy strategic planning.

Anne Lin and Bob Blouin authored the themed section on the environment of the pharmacy academy. While at first glance, the forecast survey covers a veritable potpourri of topics in this area, several overarching themes are discussed, including the financial future of pharmacy education, the future of diversity in our profession, topics related to governance, and the composition of the workforce in the pharmacy academy.

In the pharmacy education section, Stuart Haines and Zubin Austin tackle long-held notions about the academic enterprise head-on with their discussion and recommendations related to the goals of pharmacy education, the students who pursue pharmacy training, and trends in the delivery of pharmacy education (including the emergence of competency-based pharmacy education). They add to the discussion that Lin and Blouin provide around the financing of pharmacy education. Haines and Austin discuss advanced computing and artificial intelligence (AI), a topic that is mentioned in several sections of the forecast.

Turning to the practice section, Todd Sorensen and Gina Moore address cutting-edge issues in practice that are particularly germane to the academy. They highlight workforce issues and practice transformation (particularly in the community pharmacy setting) and discuss the role of the pharmacy academy in not only participating but leading that transformation in practice.

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AACP Argus Commission Forecast 2024

Introduction and Methods Figure 1 Regions where Respondents are Employed South Atlantic (MD, DC, VA, WV, NC, SC, GA, FL, PR)

80 17.3%

Great Lakes (OH, IN, IL, MI, WI)

77 16.7% 56 12.1%

Southeast (KY, TN, AL, MS) Middle South (AR, LA, OK, TX)

48 10.4%

Mid-Atlantic (DE, NY, NJ, PA)

45 9.7% 40 8.7%

Pacific (WA, OR, CA, AK, HI)

32 6.9%

Western Plains (MN, IA, MO, ND, SD, NE, KS)

25 5.4%

New England (ME, NH, VT, MA, RI, CT)

22 4.8%

Mountain (MT, ID, WY, CO, NM, AZ, UT, NV)

37 8.0%

Not Reported

Figure 2 Type of Institution of Respondents Public

Private

Not Reported

257

191

14

55.6%

41.4%

3.0%

Figure 3 Sex of Respondents Female

Male

Other/Not Reported

232

191

39

50.2%

41.4%

8.4%

Figure 4 Number of Years Respondents have Worked in Academy Fewer than 5–15 years 5 years

8 1.7%

More than 15 years

Not Reported

155

278

21

33.5%

60.2%

4.6%

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Introduction and Methods Figure 5 Proportion of Respondents who are Pharmacists Pharmacist

Non-Pharmacist Not Reported

369

67

26

79.9%

14.5%

5.6%

Figure 6 Department or Division of Respondents Administrative

Biological Sciences, Chemistry, Pharmaceutics

Drug Information and Library Science, Experiential Education, Pharmacy Practice

Not Reported

257

57

223

27

33.6%

12.3%

48.3%

5.8%

Figure 7 Practice Setting of Respondents who are Practice Faculty Acute Care

Ambulatory Care

Community Practice

74 44.8%

78 47.2%

13 7.9%

In the final section of the forecast, Russ Melchert, Sam Poloyac, and David Allen summarize key outcomes and recommendations related to research. Research funding is considered (note that topic as a common element of several sections of the forecast), as well as a discussion of future core competencies for graduate education.

Each section of the forecast is accompanied by graphs summarizing the results of the forecast survey. This report provides insight into the future of the pharmacy academy throughout the narratives of these incredible leaders in the pharmacy academy and their specific recommendations for colleges and schools of pharmacy.

How to Use the Forecast This forecast is intended to provide reliable and innovative predictions that can be informative for proactive strategic planning. It is also designed to stimulate reasoned discourse that will enhance that planning in the academy at individual colleges and schools of pharmacy. As academics, we love a good debate, and this report should provide excellent fodder for dialogue across the academy. Considering the challenges we face, we cannot afford to be reactive with poor anticipation of what may lie ahead. This forecast (and, we anticipate, future forecasts) is intended to augment our ability to achieve successful planning based on transformative views of what lies ahead.

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AACP Argus Commission Forecast 2024

Introduction and Methods With intentionality, the 2023–2024 Argus Commission selected a five-year window for reaction to survey scenario statements. Strategic plans may be trending toward shorter overall plan lengths, generally in the range of three to five years. Taking those trends into consideration, the Argus Commission decided that a five-year window was ideal for this initial forecasting effort. This will, of course, be reevaluated with each future forecast that the Argus Commission conducts. Similarly, it is important to consider there may be topics that are subject to abrupt changes in very short timeframes; in general, we refrained from considering these as part of the themed sections.

Best practices in strategic planning call for broad-based, grassroots stakeholder involvement. As this forecast can inform colleges and schools of pharmacy with our focus on the three “legs” of the academic stool, we encourage member institutions to share the report with all strategic planning participants internally and externally. This will only strengthen those processes.

Given the importance of strategic planning in the current environment, a thorough implementation process with iterative evaluation and follow-up throughout the year should be considered. Individual colleges and schools of pharmacy are multi-faceted, complex organizations facing myriad difficulties related to population demographics, a political landscape that provides several challenges to higher education, and changes in health (notably, COVID-19) and health care in general. These challenges occur on a routine basis and must be evaluated in real time. Restricting strategic planning to only measuring outcomes without evaluating potential changes in what needs to be in the plan may be shortsighted.

Ongoing efforts to stay on top of our game are essential to achieving desired outcomes.

When faced with rapidly changing circumstances, this and future forecasts can be used during interim revisions of strategic plans and while making strategic decisions.

As noted above, and as no surprise to any AACP member, academics cherish a good debate. We cannot emphasize enough that rigorous discussion about the overall landscape of higher education and health care is essential to effective strategic planning. These forecasts may be used as tools to find common ground and areas of disagreement. It should also be noted that while the authors for the various themes were very thoughtful in the writing of their sections, disagreement with the report’s conclusions and recommendations may occur. We welcome discourse and encourage differing views and recommendations as part of the counter-perspective.

It is essential to continuously refine new processes, even those rooted in proven methods, over time. It is our sincere hope that this inaugural forecast will aid and direct colleges and schools of pharmacy, as well as academy leadership, in their strategic planning.

The next step beyond its creation is ensuring that the AACP Argus Commission Forecast 2024 be shared with all stakeholders involved in strategic planning. Undoubtedly, the ultimate value of this effort will hinge upon its integration into the planning process, potentially transforming the way we approach strategic planning.

References 1. Suroweicki J. The wisdom of crowds. New York: Anchor; 2005.

2. DiPiro JT, Hoffman JM, Schweitzer P, et al. Pharmacy forecast 2024: strategic planning guidance for pharmacy departments in hospitals and health systems. Am J Health Syst Pharm. 2024;81(2):5-36. doi:10.1093/ajhp/zxad231 3. American College of Healthcare Executives, Society for Health Care Marketing and Strategy Development.

Futurescan 2023: Healthcare trends and implications. American Hospital Association, 2023. Accessed August 10, 2024. https://www.shsmd.org/resources/futurescan-2023

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Environment of the Pharmacy Academy

Environment of the Pharmacy Academy Anne Y.F. Lin, PharmD

Robert A. Blouin, PharmD

Dean College of Pharmacy & Health Sciences St. John’s University Queens, New York

President and CEO Med Aditus International Research Triangle Park, North Carolina

Introduction The future of academic pharmacy will be influenced by several environmental factors.

These factors include financial viability, tenure and promotion policies, enrollment in schools of pharmacy, faculty workforce, and the ability to maintain a diverse student body, and they are discussed in this section.

The Financial Future of Pharmacy Education One of the most significant issues challenging colleges and schools of pharmacy in the next 5 years will be the financial resources necessary to continue operations, largely driven by enrollment patterns. The Argus survey explored the likelihood of programs closing due to lack of financial viability in addition to strategies that they might explore to ensure continued operation. Nearly 60% of survey respondents believe that it is highly likely that at least 10 PharmD programs will close due to a lack of financial viability over the next 5 years (see Figure 8, Item 1), and survey respondents overwhelmingly disagreed that the number of applicants to PharmD programs will increase by 30% in the coming 5 years (see Figure 8, Item 2).

Over the last few decades, the number of colleges and schools of pharmacy has nearly doubled, from 72 in 1995 to 142 in 2022.1 Seventy-five percent of these schools were opened in private institutions that are heavily tuition dependent.2 The rapid expansion of colleges and schools of pharmacy in the US was predicated on the dramatic growth of the community pharmacy sector, particularly by the national pharmacy chain industry. At that time, pharmacists were in high demand with generous starting salaries and signing bonuses. As new colleges and schools of pharmacy were opened, all were pressured to grow their enrollment.

Pharmacy programs have seen significant reductions in student applications since 2010.

In the 2006–2007 application cycle, there were 1,281 applicants per PharmCAS school, compared to 234 applicants per school in 2022–2023.3 The number of enrolled first professional year students peaked in 2015 at 14,190, but has declined every year since. In 2022, only 9,324 students were enrolled in their first professional year (a 34% decrease in 7 years).3 Several demographic causes for this enrollment decline exist, including lower birth rates, the resulting decrease in high school graduations, and current sentiments among young people regarding the value of four-year undergraduate degrees.

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AACP Argus Commission Forecast 2024

Environment of the Pharmacy Academy Changes within the profession have also affected interest in pharmacy as a career. While the COVID-19 pandemic showed the value of pharmacists, negative publicity regarding work conditions, particularly in the community pharmacy environment, and lack of understanding about the profession, has further negatively impacted the number of students who are interested in pursuing a pharmacy degree. Over the past 20 years, significant changes in community pharmacy, including the consolidation of corporate community pharmacy and expansion of mail-order pharmacies have softened the demand for community pharmacists. Efforts to transform community pharmacy practice are essential to reversing enrollment declines.

Increasing tuition may be needed to counterbalance declining student admission, as colleges and schools of pharmacy seek to balance their budgets. Survey respondents were split on the possibility that at least 20% of colleges and schools of pharmacy will decrease tuition or increase discount rates to achieve an average student debt to first-year salary ratio of 1:1 (see Figure 8, Item 3).

Colleges and schools of pharmacy must more effectively communicate the long-term salary increases that occur over the course of pharmacists’ careers and the many career pathways a pharmacy degree offers. More effective strategies to promote the profession and its benefits are needed so that students and their families are willing to invest in a pharmacy degree.

New strategies are needed in response to enrollment challenges. Over 60% of respondents believe it is somewhat or highly likely that at least 20 colleges and schools of pharmacy will enter formal inter-school partnerships to offer PharmD degrees to remain financially viable (see Figure 8, Item 4). As enrollments remain low, so do budgets, which can lead to the loss of positions. As faculty numbers decrease, schools do not have the same depth and breadth of intellectual talent to provide pharmacy students with everything they need to succeed professionally. Currently, several groups of colleges and schools have strong alliances in assessment and experiential education, and it is likely that more schools will form strategic alliances based on conference affiliation, regional proximity, or commonality of mission to achieve shared academic goals and objectives.

Consequently, these programs must rely on complementary strengths to offer a quality PharmD program. A model for colleges and schools of pharmacy to share resources to meet the curricular needs of member schools beyond the informal sharing of course syllabi exists—accreditation standard changes are needed, and strategic alliances must be formed by individual schools to make that model successful.4 While over 60% of survey respondents indicated that it was somewhat or highly unlikely that a baccalaureate-level pharmacy degree that does not qualify a graduate for licensure as a pharmacist may re-emerge in response to market demands in the coming 5 years (see Figure 8, Item 5), it is possible that the return of the Baccalaureate of Science in Pharmacy might provide relief from current financial pressures. The current climate in the US and general sentiment of our public universities’ constituency groups (eg, legislators, taxpayers, parents, and prospective students) is to demand more from universities in preparing undergraduate students for STEM-related jobs. A general understanding of the pharmaceutical sciences (eg, pharmacology, pharmacokinetics, drug metabolism, clinical trials, and drug manufacturing), which a Bachelor of Science in Pharmacy could provide,

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Environment of the Pharmacy Academy has the potential to support a wide array of job opportunities and societal needs now, and over the next twenty years. These programs must be competitively priced, with the understanding that students’ long-term income potential will not be as high as those of a registered pharmacist.

Diversity of the Pharmacy Academy The forecast survey explored several topics related to the characteristics of student pharmacists and college and school faculty in the coming 5 years.

Based on the results of the forecast survey, diversity in the pharmacy academy’s student body and faculty will also remain a priority in the future. Asked about the likelihood that the 2023 SCOTUS ruling on race-conscious admissions5 would result in a 20% reduction in under-represented minority students entering PharmD programs, nearly 20% of respondents indicated it being a highly unlikely result. However, nearly half of respondents indicated it was only somewhat unlikely (see Figure 8, Item 6).

The 2023 SCOTUS ruling around the Students for Fair Admission (SFFA) case involving Harvard University and the University of North Carolina at Chapel Hill declared that race-based admissions adopted by these two schools were unconstitutional under the Equal Protection Clause of the Fourteenth Amendment.5 However, the court did not prohibit schools from asking students to expound on how race has impacted their lives, so long as that discussion is connected to a quality of character or unique ability that the particular applicant can contribute to the university, which will enable them to continue to recruit and accept an increasingly diversified student population.

Similarly, more than 60% of survey respondents indicated that it would be somewhat or highly unlikely that there will be a 20% reduction in under-represented minority faculty in response to the 2023 SCOTUS ruling on race-conscious admissions (see Figure 8, Item 7).

While the 2023 SFFA does not apply to faculty hiring practices,5 this ruling did have a numbing effect on university and school affirmative action initiatives and has raised concerns around the implementation of aggressive, incentivized programs to attract minority faculty candidates to their institution. Notwithstanding, it should not be interpreted as discouraging our institutions from remaining committed to recruiting a diverse faculty population.

Governance and Faculty Performance in the Pharmacy Academy The forecast survey included several questions exploring areas of faculty governance and processes for faculty performance evaluation.

The future of tenure was explored in one item, with over 75% of survey respondents indicating that it would be somewhat or highly unlikely that at least 20% of colleges and schools of pharmacy at state-supported universities will abolish tenure in the next 5 years (see Figure 8, Item 8).

Although significant reforms in tenure policies are likely to occur in most states, it is unlikely that legislatures will unilaterally act to abolish their tenure policies at this time.

While tenure may not be abolished, significant reform measures are certainly on the

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AACP Argus Commission Forecast 2024

Environment of the Pharmacy Academy Figure 8 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

1

Somewhat Likely

Somewhat Unlikely

Highly Unlikely

At least 10 Pharm.D. programs will close due to a lack of enrollment sufficient to stay financially viable.

57.1%

35.9%

6.1% 0.9%

The number of applicants to Pharm.D. programs will increase by 30%.

2

2.8% 22.1%

49.3%

25.8%

At least 20% of schools of pharmacy will decrease tuition or increase discount rates to achieve an “average student debt to first-year salary ratio” of 1:1.

3 18.4%

4

37.0%

23.6%

12.8%

22.9%

30.1%

36.4%

In response to the 2023 SCOTUS ruling on race-conscious admissions, there will be a 20% reduction in under-represented minority students entering Pharm.D. programs.

8.9%

7

50.6%

A Baccalaureate-level pharmacy degree that does not qualify a graduate for licensure as a pharmacist will re-emerge in response to market demands.

10.6%

6

12.8%

At least 20 schools of pharmacy will enter formal inter-school partnerships to offer Pharm.D. degree to remain financially viable.

13.0%

5

31.8%

27.3%

46.7%

17.1%

In response to the 2023 SCOTUS ruling on race-conscious admissions, race-conscious hiring decision-making will be reconsidered by universities, and there will be a 20% reduction in under-represented minority faculty.

6.5% 25.7%

48.5%

19.3%

At least 20% of schools of pharmacy at state-supported universities will abolish tenure.

8 5.0% 28.6%

AACP Argus Commission Forecast 2024

41.7%

24.7%

12

Environment of the Pharmacy Academy Figure 8 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

9

47.0%

43.3%

44.8%

23.4%

2.8%

44.8%

5.8%

Validated faculty workload instruments will be adopted by a majority of schools of pharmacy to make annual review, promotion and tenure decisions and post-tenure reviews.

19.7%

13

32.9%

Due to demographic shifts affecting higher education, at least 20% of students admitted to Pharm.D. programs will be 30 years of age or older.

4.6%

12

Highly Unlikely

At least 30% of pharmacy faculty will leave the academy for other professional opportunities.

30.5%

11

Somewhat Unlikely

At least 100 tenured faculty members at state-supported universities will be discharged by their school of pharmacy due to under-performance on post-tenure review.

1.7% 18.4%

10

Somewhat Likely

47.4%

26.8%

6.1%

At least 50% of basic science faculty newly hired in schools of pharmacy will have a pharmacy degree.

1.3% 15.6%

50.4%

32.7%

horizon, introducing much higher levels of accountability for faculty performance, which are likely to raise faculty attrition rates. A similar percentage of survey respondents indicated that it would be somewhat or highly unlikely that at least 100 tenured faculty members at state-supported universities will be discharged by their colleges and schools of pharmacy due to under performance on post-tenure review (see Figure 8, Item 9).

This change in accountability will likely create an opportunity for schools to determine which positions are necessary and who, perhaps, should not be retained. All schools have tenured faculty who are no longer as productive as they once were. It is unlikely that we will be able to continue perpetuating this inefficiency.

Of course, increasing accountability of faculty will require validated faculty workload instruments, and nearly 70% of survey respondents agreed that it would be somewhat or highly likely that most colleges and schools of pharmacy will adopt a validated instrument for evaluations.

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AACP Argus Commission Forecast 2024

Environment of the Pharmacy Academy Workforce of the Pharmacy Academy The survey explored the size and composition of the pharmacy faculty with two questions. Nearly 75% of survey respondents agreed with the statement that at least 30% of pharmacy faculty will leave the academy for other professional opportunities (see Figure 8, Item 10).

There has been an increase in faculty resignations for the last several years, with a marked rise after the COVID-19 pandemic. Since the pandemic, the option for hybrid or remote work has led many pharmacy practice faculty to assume positions in the pharmaceutical industry, government agencies, and practice positions. If this turnover continues, this may be another factor that can impact the closing of schools. It is unclear how these faculty positions will be replaced with qualified individuals, and not all schools can attract top talent.

Finally, considering the likelihood that more pharmacists will enter the ranks of the basic science faculty at colleges and schools of pharmacy, a large majority of survey respondents indicated that it would be somewhat or highly unlikely that at least 50% of newly hired basic science faculty will have a pharmacy degree.

Basic science coursework continues to be an important foundational component of the academic curriculum of professional students in the health sciences; this is especially true for schools of pharmacy. It is generally accepted that it is important for basic science faculty to teach their subject matter with a clear understanding of its relevance to clinical practice. Since it is anticipated that many basic science faculty will not have a pharmacy degree, schools of pharmacy must offer opportunities for such faculty to gain an understanding of the subject matter’s applicability to the pharmacy profession and clinical practice.

Conclusion The future success of colleges and schools of pharmacy will be predicated on the profession and institutions’ ability to communicate the diverse career opportunities in pharmacy practice, ability to be nimble in offering degree options that meet market needs, and a willingness to develop partnerships that maximize the use of available resources.

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Environment of the Pharmacy Academy Recommendations 1.

Colleges and schools of pharmacy should strategically partner with one another to maximize available resources for pharmacy programs. These partnerships may be between institutions with similar missions, are in close geographic proximity to one another, or have complementary resources that would be mutually beneficial to partnering institutions.

2. AACP should partner with other pharmacy and pharmaceutical professional organizations to launch a national campaign to educate the American public about the virtues and career opportunities associated with a professional doctorate degree in pharmacy. Special emphasis should be placed on the versatility of the PharmD degree and multiple career options that are available to graduates.

3. Developing an objective faculty workload instrument that can be amended to meet various institutional requirements would help ensure workloads are appropriately distributed and mitigate faculty burnout.

4. Colleges and schools of pharmacy should collaborate to develop and share best practices toward the successful cultivation, recruitment, and matriculation of diverse students and faculty to our campuses.

5. Colleges and schools of pharmacy should work in concert with campus faculty development programs to develop pharmacy-oriented mentoring programs for new and junior faculty hires. These programs should be structured to orient faculty to the expectations of being a faculty member within colleges and schools of pharmacy, enculturate faculty into the academic pharmacy and health sciences community, prepare faculty for success in their area of intellectual focus of responsibility, and teach faculty how to be an effective member of a highly collaborative team.

References 1. Grabenstein JD. Trends in the numbers of US colleges of pharmacy and their graduates, 1900 to 2014. Am J Pharm Educ.

2016;80(2):25. doi:10.5688/ajpe80225 2. Accreditation for Pharmacy Education. Accessed March 29, 2024. https://www.acpe-accredit.org/accredited-programs-by-status/ 3. Student Affairs Report at: AACP Council of Deans Interim Meeting; February 2024; Phoenix, AZ. 4. Bzowyckyj AS, Blake E, Crabtree B, et al. Advancing Pharmacy Education and Workforce Development Amid the COVID-19 Pandemic: Report of the 2020-2021 AACP Academic Affairs Committee. Am J Pharm Educ. 2021;85(10):8716. doi:10.5688/ajpe8716 5. Students for Fair Admissions, Inc v President and Fellows of Harvard College, 600 US ____ (2023)

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AACP Argus Commission Forecast 2024

Bold Moves and Brave Experiments Are Needed to Reshape Pharmacy Education

Bold Moves and Brave Experiments Are Needed to Reshape Pharmacy Education Stuart T. Haines, BSPharm, PharmD

Zubin Austin, BScPhm, MBA, MISc, PhD

Professor, Department of Pharmacy Practice Director, Pharmacy Professional Development University of Mississippi School of Pharmacy Jackson, Mississippi

Professor and Murray Koffler Research Chair Academic Director—Centre for Practice Excellence Leslie Dan Faculty of Pharmacy, University of Toronto Toronto, Ontario, Canada

Introduction Pharmacy education today is at an inflection point similar to where it was in the 1980s.1 During that period, there was a debate about the goal of pharmacy education, and the profession was divided.2,3 External forces prompted the profession to consider whether pharmacists were adequately addressing societal needs.2,3 What were the essential competencies every pharmacy graduate should possess going forward? Rather than being fountains of drug knowledge and masters of distribution systems, many believed that pharmacists’ future role was to manage increasingly complex and costly drug therapies as essential members of health care teams.

While members of the academy were key contributors to these discussions, the academy, as a whole, was not at the vanguard of this movement.4 Indeed, the AACP House of Delegates voted against the adoption of the Doctor of Pharmacy as the entry-level degree for the profession in 1985. Change did not come easy. There were many political, logistical, and financial considerations.

Though the health care landscape today has undoubtedly shifted, external forces are once again prompting a discussion about these core issues. Is the profession adequately addressing societal needs? Do our graduates possess the essential competencies needed going forward? Data from the forecast survey suggests the academy is uncertain about the direction we should take.

Shifting Goals of Pharmacy Education Data from the forecast survey point to shifting perceptions of the meaning of an entry-level pharmacy degree. Historically, the PharmD has been widely viewed as the gateway to professional practice and a practical job.5 Many survey respondents indicated their belief that, in the future, more graduates would not seek licensure following completion of the degree and would not be providing patient care as pharmacists (see Figure 9, Item 1).

Further, many survey respondents indicated that more graduates would be likely to pursue a graduate degree or microcredentials oriented toward evolving marketplace needs (see Figure 9, Items 2 and 3). This suggests that faculty and prospective students recognize that the traditional endpoint of pharmacy education—a job as either a community or hospital pharmacist—is too limiting. Rather, a PharmD can be a springboard to a proliferating array of professional paths and employment opportunities. This raises questions regarding the rigid curricular structures most colleges and schools have implemented and the valorizing of patient care at the core of pharmacy education culture.6

AACP Argus Commission Forecast 2024

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Bold Moves and Brave Experiments Are Needed to Reshape Pharmacy Education Curricular tracks should create greater flexibility for colleges and schools of pharmacy to respond to marketplace demands and enable them to cultivate or cement focused areas of strength. Students who completed the course of instruction in a curricular track would be able to differentiate themselves for employment opportunities and be better prepared for post-graduate training, such as residencies, fellowships, and graduate degrees.

Delivering a Pharmacy Program Survey data suggest that experiential education will continue as an essential mode for teaching, learning, and assessment (see Figure 9, Item 4). Paradoxically, survey respondents recognize that competition for preceptors will tighten while expectations for greater quality increase (see Figure 9, Items 5 and 6). This will be a significant challenge for pharmacy programs to address, given the central role that experiential education plays. Colleges and schools of pharmacy, as well as accreditation standards, may need to broaden the types of experiences that meet the degree requirements. Traditional patient-focused introductory and advanced practice experiences in community and hospital settings will remain the cornerstone. However, they could be complemented by alternative experiences in emerging areas of practice and societal need. Perhaps these elective experiences will align with curricular tracks.

Experiential education, as currently implemented by most colleges and schools of pharmacy, is burdensome to administer and has little payoff to the preceptor or host institution. Introductory pharmacy practice experiences are often sporadic and observational.

Advanced pharmacy practice experiences, typically only 4 to 6 weeks in duration, do not enable students to develop the competence or confidence necessary for independent practice. Unlike in medical education, host institutions do not and cannot rely on student pharmacists to make meaningful contributions to their work.7 Longer durations will reduce administrative burden and costs, increase satisfaction of learners and preceptors, reduce preceptor burnout, enhance opportunities for meaningful contribution, and expand opportunities for students to gain and demonstrate competence and confidence.

As enrollment declines and resources diminish, pharmacy programs may seek to form consortia with former competitors to share resources, talent, and administrative loads (see Figure 9, Item 7). The shift to online learning, accelerated by the COVID-19 pandemic, has illustrated the power and potential of technologically-supported learning.8 This trend is unlikely to abate as housing affordability issues and environmental costs of in-person instruction become more prominent.

Despite a generation of evidence9 and much discussion, respondents to this year’s survey expressed skepticism about whether competency-based education (CBE) will become the norm (see Figure 9, Items 4 and 8). This may reflect the challenges of fundamentally restructuring complex academic institutions rooted in courses and credit hours rather than the merits of CBE.

New Revenue Streams from Educational Programs Colleges and schools of pharmacy in the US, whether state-supported or private, rely on tuition as a significant source of revenue. As enrollment in the PharmD program has fallen, colleges and schools of pharmacy are looking for new sources of funding that align with their missions. Survey responses suggest that some colleges and schools of pharmacy will supplement their educational offerings by developing and implementing new non-the17

AACP Argus Commission Forecast 2024

Bold Moves and Brave Experiments Are Needed to Reshape Pharmacy Education Figure 9 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

1

32.0%

40.3%

16.0%

45.0%

13.6%

0.9%

At least 30% of Pharm.D. students will choose to concurrently pursue a graduate degree (e.g., professional Masters or Ph.D.) to differentiate themselves in the job market.

15.6%

4

Highly Unlikely

At least 50% of schools of pharmacy will offer elective micro-credentials in their Pharm.D. programs to enhance graduates’ competitiveness in the job market.

40.5%

3

Somewhat Unlikely

At least 20% of graduating Pharm.D. students will not take the NAPLEX because they are pursuing a non-traditional career path that does not require a pharmacist license.

11.7%

2

Somewhat Likely

36.8%

36.8%

10.8%

Greater than 50% of school of pharmacy faculty will have received training on competency-based education and creating competency-based assessments.

14.7%

43.5%

31.4%

10.4%

In at least 30% of experiential sites, increased preceptor workload and burnout will lead to reduced IPPE/APPE offerings or discontinued school of pharmacy affiliation agreements.

5 35.5%

43.5%

18.0%

3.0%

At least 25% of schools of pharmacy will require community pharmacy sites to have advanced practice components (e.g., care under collaborative practice agreements, bill for patient care services, offer point-of-care testing, etc.) to qualify as an APPE site.

6

7

13.0%

34.6%

11.9%

At least 30% of schools of pharmacy will contract with other schools of pharmacy to offer required courses, on-line.

9.7%

8

40.5%

41.4%

42.2%

6.7%

At least 20 schools of pharmacy will adopt a time-variable, competencybased curriculum where tuition is not based on credit hours.

7.4%

32.0%

AACP Argus Commission Forecast 2024

43.5%

17.1%

18

Bold Moves and Brave Experiments Are Needed to Reshape Pharmacy Education Figure 9 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

Somewhat Likely

Somewhat Unlikely

Highly Unlikely

At least 25% of schools of pharmacy will offer training or degree programs to educate pharmacy technicians.

9 10.4%

10

51.7%

46.7%

21.9%

7.6%

Nearly all schools of pharmacy will use virtual reality technology to deliver a portion of their curriculum.

13.6%

12

7.6%

All Pharm.D. programs will have a required component of their curriculum focused on the application of artificial intelligence and advanced computing to pharmacy practice.

23.8%

11

30.3%

35.1%

36.8%

14.5%

At least 30 schools of pharmacy will dedicate 50% of their curriculum to experiential education.

6.1% 24.9%

51.7%

17.3%

sis master’s degree programs, certificate programs or microcredentials awarding digital badges, and pharmacy technician training programs (see Figure 9, Items 2 and 9). These programs could address marketplace needs and upskill the current pharmacy workforce.

The emergence and popularity of new interdisciplinary and interprofessional degree programs (eg, palliative care, cannabis science, implementation science, health professions education) are opportunities for colleges and schools of pharmacy to develop focused areas of expertise, enhance their reputation, and address the unmet needs of employers.

Unlike research-intensive graduate programs, non-thesis graduate degree programs can be offered online more easily and are generally completed part-time. These programs can be ramped up quickly to meet market demand but also scaled down and discontinued as demand declines.

Similarly, certificate programs and microcredentials offer new opportunities for colleges and schools of pharmacy to provide education and training to the existing workforce in emerging areas of practice (eg, pharmacogenomics, veterinary pharmacy, and digital health). Microcredentials can be offered within the PharmD program as part of a curricular track and marketed to attract students who wish to pursue these niche areas of practice. These focused training programs can simultaneously enroll students and practitioners, thus achieving an economy of scale. However, colleges and schools of pharmacy have largely ceded certificate training programs to professional organizations, who, iron-

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AACP Argus Commission Forecast 2024

Bold Moves and Brave Experiments Are Needed to Reshape Pharmacy Education ically, rely on academic pharmacy to provide subject matter expertise. Formal partnerships between colleges and schools and professional organizations could be a win-win and expand the depth and breadth of these professional development offerings.

There is a desperate need for high-quality technician training programs, as there have been severe shortages of qualified technicians in most areas of the US. This severe shortage of pharmacy technicians has harmed pharmacists’ ability to provide more advanced patient care services in many settings of care. Formal partnerships between the industry and colleges and schools of pharmacy could enhance revenue, advance the role of pharmacy technicians, free pharmacists to fulfill their potential, potentially attract more applicants to PharmD programs, and meet a critical societal need.

The Knowledge and Skills of the Future Not surprisingly, the majority of survey respondents believe that pharmacy graduates will need to know how to apply artificial intelligence (AI) and advanced computing to their future work (see Figure 9, Item 10). Generative AI has already significantly impacted how learners gather information, brainstorm ideas, and complete assignments. AI is likely to transform the way pharmacy is practiced by further automating medication dispensing, customizing written patient education materials, gathering and summarizing patient information, and identifying patients at high risk for poor health outcomes. Digital therapeutics, the use of software applications to deliver therapeutic interventions, is already a growing area of practice. These software applications are often used in conjunction with traditional pharmacological treatments to facilitate behavior change. The pharmacist of the future will need to know how to harness the power of AI and digital therapeutics, but must also understand the limitations and potential harms therein.10 The challenge, of course, is that curricular overload is already an enormous problem, and the current volume of information that students must learn is untenable. Rather than add new courses to a curriculum, these emerging concepts should be weaved into existing assignments and coursework. Many of these emerging areas might be offered as curricular tracks with didactic instruction, immersive and extended advanced practice experiences, and authentic assessments.

Conclusion The sometimes-contradictory survey responses illustrate how challenging it is to deliver a PharmD program in ways that are aligned with students’ needs, academic requirements, fiscal realities, and practice demands. These challenges require bold moves and brave experiments at a time when financial resources are shrinking. Well-resourced colleges and schools with well-balanced revenue streams will be in a better position to weather declines in enrollment, but may be tempted to rest on their laurels. This would be a grave mistake. Many colleges and schools of pharmacy will need to consider forming consortia and partnerships and shifting a significant portion of their curriculum online to deliver an affordable program that attracts new audiences. Learners today, including practitioners seeking to advance their knowledge and skills, are seeking ways to distinguish themselves in the marketplace. Thus, colleges and schools must be prepared to offer unique elective experiences through curricular pathways, microcredentials, certifications, and non-thesis-requiring advanced degrees in emerging areas of science, technology, and practice.

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The Pharmacy Practice Environment will be Dynamic—How will Academic Pharmacy Respond?

Recommendations 1.

AACP and its member institutions should promote the Doctor of Pharmacy degree as a flexible degree that prepares graduates for a variety of roles in health care. Colleges and schools of pharmacy should offer curricular tracks that meet marketplace needs and play to their institutional strengths.

2. AACP should collaborate with other pharmacy associations, including the Accreditation Council on Pharmacy Education (ACPE), the American Pharmacists Association (APhA), the American Society of Health-system Pharmacists (ASHP), and other health professions associations through the Interprofessional Education Collaborative (IPEC), to establish definitions and standards for certificate programs, microcredentials, and digital badges.

3. AACP, working closely with the Council of Deans and Council of Faculty, should develop and periodically update a framework for career ladders within pharmacy that include recommended non-thesis master’s degree programs. Colleges and schools of pharmacy should form consortia to develop and offer non-thesis master’s degree programs.

4. Colleges and schools of pharmacy should be encouraged to offer at least two immersive, full-time introductory pharmacy practice experiences of at least 8 weeks’ duration. Advanced practice experiences should be at least 12 weeks in duration.

References 1. Urick BY, Meggs EV. Towards a greater professional standing: evolution of pharmacy practice and education, 1920-2020.

Pharmacy (Basel). 2019;7(3):98. doi:10.3390/pharmacy7030098 2. Cocolas GH. Pharmacy in the 21st Century Conference: Executive Summary. Am J Pharm Educ. 1989;(53):1S-5S. doi:10.1016/ S0002-9459(24)06429-5 3. Background Paper II: Entry-Level, Curricular Outcomes, Curricular Content and Educational Process. Am J Pharm Educ.

1993;(57):377-385. doi: 10.1016/s0002-9459(24)01291-9 4. Bussey HI. Ode to beer cans, canoes, house trailers, and Jimmy Buffet. Pharmacotherapy. 1992;12(4):271-272.

5. Ahmed S, Ahmad Hassali MA. The controversy of Pharm D degree. Am J Pharm Educ. 2008;72(3):71. doi:10.5688/aj720371 6. Brown D. It is time to rethink the all-Pharm D educational system: multiple tiered degrees would better serve the diverse nature of pharmacy practice. J Am Coll Clin Pharm. 2020;3(6):1147-1154.

7. Longyhore DS, Woll N. Remuneration for clinical education: understanding the costs and considerations. J Am Coll Clin Pharm. 2024;7(5):414-415. doi:10.1002/jac5.1952 8. Silva ROS, de Araújo DCSA, Dos Santos Menezes PW, Neves ERZ, de Lyra DP Jr. Digital pharmacists: the new wave in pharmacy practice and education. Int J Clin Pharm. 2022;44(3):775-780. doi:10.1007/s11096-021-01365-5 9. Rhoney DH, Chen AMH, Churchwell MD, et al. Recommendations and next steps for competency-based pharmacy education. Am J Pharm Educ. 2023;87(10):100549. doi:10.1016/j.ajpe.2023.100549 10. Wong A, Wentz E, Palisano N, et al. Role of artificial intelligence in pharmacy practice: a narrative review. J Am Coll Clin Pharm. 2023;6(11):1237-1250. doi:10.1002/jac5.1856

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AACP Argus Commission Forecast 2024

The Pharmacy Practice Environment will be Dynamic—How will Academic Pharmacy Respond?

The Pharmacy Practice Environment will be Dynamic—How will Academic Pharmacy Respond?

Todd D. Sorensen, PharmD

Gina D. Moore, PharmD, MBA

Senior Executive Associate Dean for Strategic Initiatives and Faculty Affairs Professor, Department of Pharmaceutical Care and Health Systems College of Pharmacy, University of Minnesota Minneapolis, Minnesota

Senior Associate Dean for Operations and Regulatory Affairs Associate Professor University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Denver, Colorado

Introduction The forecast survey explores an array of topics associated with the intersection of pharmacy practice and the academic enterprise. The items presented to the survey respondents call out three interrelated themes that are interrelated. First, the survey addressed trends in practice that may influence the work of pharmacists over the next 5 years.

These and other changes in practice will require adaptations in how schools engage in pharmacy workforce development, which is the second theme addressed by the survey.

Finally, while some degree of change in practice will occur with or without the engagement of the academic enterprise, the third theme examines the degree to which schools may proactively support an accelerated rate of adopting practice changes in this dynamic environment to meet the needs of patients and society.

Practice Trends From declining enrollment numbers in colleges and schools of pharmacy to community pharmacy outlet closures across the US, it is clear we are witnessing a shift in pharmacy practice trends. Practice models are changing, and pharmacists are becoming more fully integrated members of the patient care team and providing more patient care services.

Over 78% of survey respondents believe it is highly or somewhat likely that ten or more state or national medical associations will have policy statements affirming that pharmacists are essential members of interprofessional care teams in the next 5 years (see Figure 10, Item 1). Over 65% of survey respondents also indicated that it was highly or somewhat likely that at least 25% of integrated health networks will hire most of their pharmacists into interprofessional functional units outside the pharmacy department (see Figure 10, Item 2). These changes may happen organically or as a result of pharmacy leaders taking an active role in advocating for advances in practice roles.

In community pharmacy settings, the majority of survey respondents believe that it will be highly or somewhat likely that billing for patient care services will represent 30% of net profits, further signaling a movement of pharmacists into direct patient care roles (see Figure 10, Item 3). Of note, most survey respondents believe it is highly or somewhat likely that artificial intelligence technologies will play a role in more than half of patient encounters where patient counseling is provided (see Figure 10, Item 4). Although not measured in this survey, others have predicted that state boards will develop regulations allowing the use of artificial intelligence and other advanced computing technologies in order review and verification.1 This increases the importance of colleges and schools of pharmacy preparing student pharmacists for the safe and effective use of these new technologies.

AACP Argus Commission Forecast 2024

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The Pharmacy Practice Environment will be Dynamic—How will Academic Pharmacy Respond?

Workforce Development and Practice Transformation Nearly 80% of survey respondents believe it is highly or somewhat likely that community pharmacy hours will decrease by a third due to severe labor shortages (see Figure 10, Item 5), raising significant concerns regarding patient access to pharmacists’ care and the medications they require. Survey respondents had mixed feelings regarding the likelihood that scholarship support or loan forgiveness programs will become more available to incentivize decisions to pursue pharmacy careers or career paths where workforce shortages are most acute. Nearly 80% of survey respondents felt that was somewhat likely or somewhat unlikely (see Figure 10, Item 6).

Concerning workforce dynamics, not only should the profession expect staffing challenges as a factor that must be strategically managed, but the workforce will also be required to develop new skills to accomplish desired practice transformation—performing new tasks in new practice settings. This raises the question of how current pharmacists might obtain the training, skills, and experience necessary to remain competitive within the workforce and pursue career changes. A large majority of survey respondents believe nearly all health systems will require a residency to obtain an entry-level pharmacist position (see Figure 10, Item 7). Survey respondents were not confident that colleges and schools of pharmacy will offer formal traineeship programs to mid-career pharmacists seeking to advance their careers (see Figure 10, Item 8). Most survey respondents anticipate that a large proportion of pharmacists will seek microcredentials and/or digital badges as part of efforts to develop and demonstrate knowledge and skill acquisition (see Figure 10, item 9). One recent study among New Zealand pharmacists demonstrated a strong preference for a stacked microcredential program in which participants earn a series of microcredentials that count toward a certificate or degree program.2 This may indicate a business opportunity for colleges and schools of pharmacy, associations, education companies, or a combination of organizations working together to create these programs.

Role of The Academy in Driving Change in Practice In the statements addressed in the first two themes of this section, survey panelists clearly see significant discernable and profound change occurring on the 5-year horizon. In turn, it is relevant to consider Amara’s Law, “People tend to overestimate the short-term impact of new technologies while underestimating their long-term effect.”3 With pharmacy on a decades-long journey to transform practice, Amara’s Law may apply to the short-term view (5-year forecast horizon) used in the survey. The most significant factor that will test this law is the degree to which the profession, including colleges and schools of pharmacy, chooses to engage in strategies designed to accelerate practice change.

Sixty-five percent of forecast respondents are bullish on investment in faculty focused on practice transformation and scholarship in community-based pharmacy (see Figure 10, Item 10). First, we would note that the threshold presented (at least two community-based faculty per school) is relatively low in the context of all pharmacy faculty across the US. It is unlikely that this will be enough for academic pharmacy to meaningfully influence change in this area of practice. While colleges and schools of pharmacy could hire additional clinical practice faculty to deliver services in a community setting, a more influential approach, considering these limited resources, would be to employ clinical faculty members who work with leaders of multiple community pharmacy entities to lead, coach, and drive change across their regions. To increase influence, colleges and schools should also invest in faculty who will build funded research programs that address key questions and provide direction for community pharmacy at a systems level,

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AACP Argus Commission Forecast 2024

The Pharmacy Practice Environment will be Dynamic—How will Academic Pharmacy Respond?

Figure 10 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

Somewhat Likely

Somewhat Unlikely

Highly Unlikely

At least 10 state or national medical associations will have policy positions stating that pharmacists are essential members of interprofessional care teams.

1

35.1%

43.7%

18.2%

3.0%

In at least 25% of integrated health networks, a majority of pharmacists will be hired into interprofessional functional units (e.g., family medicine department, transplantation team, critical care unit, etc.), and will not report directly to a traditional department of pharmacy.

2 15.6%

49.8%

28.6%

6.0%

Billing for patient care services (e.g., vaccinations, health screenings, medication therapy management, point of care testing, prescriptions, etc.) will represent 30% of net profit margin in community pharmacies.

3 18.0%

4

44.1%

31.2%

6.7%

At least 50% of patient encounters regarding medication use will involve artificial intelligence-based technology to deliver patient counseling.

12.1%

40.7%

37.5%

9.7%

The number of hours that community pharmacies in the US are open will decrease by 30% due to severe labor shortages.

5

6

29.0%

47.8%

2.0%

In response to workforce shortages in pharmacy, state and federal governments will significantly increase financial aid and implement loan forgiveness programs to encourage candidates to consider pharmacy as a career 6.7% 35.5%

7

21.2%

41.1%

16.7%

Nearly all integrated health systems will require newly-hired pharmacists to have completed a PGY-1 residency for entry-level positions.

27.3%

37.0%

27.3%

8.4%

At least 25% of schools of pharmacy will offer a 6-month, full-time (or equivalent), didactic and experiential traineeship to provide current practitioners with the competence needed to advance their practice.

8 4.1% 28.8%

47.8%

19.3%

Over 50% of pharmacists will voluntarily earn one or more micro-credentials or digital badges to advance their skills and demonstrate continuing competence.

9 23.8%

AACP Argus Commission Forecast 2024

42.7%

27.7%

24

5.8%

The Pharmacy Practice Environment will be Dynamic—How will Academic Pharmacy Respond?

Figure 10 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

10

Somewhat Likely

Somewhat Unlikely

Highly Unlikely

Nearly every school of pharmacy will have at least 2 full-time community pharmacy-focused faculty members, with scholarship and practice transformation responsibilities related to community pharmacy practice.

16.2%

42.2%

30.1%

11.5%

At least 50% of schools of pharmacy will convene and lead communities of practice to accelerate the adoption of services supported by payment reform and available under advanced scope of practice.

11

(Note: A “community of practice,” as first proposed by Jean Lave and Etienne Wenger in their 1991 book Situated Learning is a group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.)

9.5%

36.2%

43.9%

10.4%

At least 50% of schools of pharmacy will appoint a senior leader (e.g., Associate Dean of Professional Affairs) to work with professional associations and regulatory bodies to advance the scope of practice and facilitate payment reform in their state.

12 5.8% 34.4%

13

39.4%

20.4%

At least 20 states will no longer require a stand-alone jurisprudence examination to become a licensed pharmacist.

29.6%

36.6%

23.4%

10.4%

apply implementation science, test payment policies, or evaluate the influence of the regulatory landscape on achieving optimal outcomes from medication use. Without these strategic faculty investments, it is unlikely that the pharmacy academy will have an impact on accelerating transformation in community-based practice.

Two strategies that can influence the adoption rate of change are communities of practice2 and learning collaboratives.4 Both of these strategies require that an entity serve as a “convener” to design and facilitate the participants seeking to transform their practice. Colleges and schools of pharmacy should be viewed as prime candidates to serve as conveners; however, the majority of survey respondents believe that it is unlikely that at least 50% of the colleges and schools of pharmacy will choose to play this role over the next 5 years (see Figure 10, Item 11).

Another choice that colleges and schools of pharmacy may have to increase their influence associated with practice transformation is embedding this work in their formal leadership structure. Forecast respondents are not optimistic that this will be a strategy adopted by schools, with fewer than half of respondents indicating that it is likely that 50% of schools will appoint a senior leader to this role (see Figure 10, Item 12).

Conclusion Survey respondents have established that they believe there will be significant shifts in pharmacy practice in the next 5 years. The pharmacy academy must determine what role it 25

AACP Argus Commission Forecast 2024

The Pharmacy Practice Environment will be Dynamic—How will Academic Pharmacy Respond? will play across its enterprise to respond to this change, including how it will partner with practice-based entities during the next 5 years and beyond. An implication may be how non-academic stakeholders in pharmacy perceive the commitment of colleges and schools of pharmacy to addressing the profession’s challenges.

The survey results highlight that there may be a gap between the type of education and experience mid-career practitioners need to pursue new opportunities in the profession and what schools offer to support career transitions. Colleges and schools of pharmacy must decide to what degree they will serve the educational needs of enrolled students, their alumni, and the practitioners in their region.

Limited financial and personnel resources will be critical factors in deciding what may help address the opportunities and challenges presented—a real and understandable issue. The pharmacy academy must select which forms of engagement will result in the largest return on investment for colleges and schools of pharmacy and the profession at large. It will be essential to recognize and pursue opportunities to work collaboratively across colleges and schools of pharmacy instead of acting individually to increase return on investment.

The survey only explored three strategies through which schools may engage in the collaborative work of driving practice transformation—additional strategies exist. Whether it be through the strategies outlined above or others, to deviate from Amara’s Law and achieve the level of change predicted by forecast respondents over the next 5 years, colleges and schools of pharmacy must urgently determine which strategies they will adopt to support accelerated adoption of practice change.

Recommendations 1.

AACP, with input from its member institutions, should continue to refine the role of the AACP Transformation Center (ATC). They should consider the internal and external fiscal investment opportunities to expand the ATC’s role as a facilitator of the academy’s engagement in both regional and national efforts to influence practice transformation.

2. Every college and school of pharmacy should consider, in the context of its strategic plan, its specific role and direction related to supporting practice transformation with the communities it serves.

3. Colleges and schools of pharmacy should consider the emerging career development needs of mid-career practitioners and create innovative programs that will assist with the development of the professional skills and experience required to adapt to changes in pharmacy practice.

4. Colleges and schools of pharmacy should seek opportunities to partner with regional entities to identify ways to support practice transformation and practitioner development.

References 1. DiPiro JT, Hoffman JM, Schweitzer P, et al. ASHP and ASHP foundation pharmacy forecast 2024: strategic planning guidance for pharmacy departments in hospitals and health Systems. Am J Health Syst Pharm. 2024;81(2):5-36. doi:10.1093/ajhp/zxad231 2. Marra CA, Donat I, Lee M, et al. Pharmacy postgraduate education transformation: pharmacist preferences for microcredentials. Int J Pharm Pract. 2022;30(6):567-570. doi: 10.1093/ijpp/riac065. PMID: 36047515.

3. Ratcliffe, S, ed. Roy Amara. Oxford Essential Quotations. 4th ed. Oxford University Press; 2016.

4. Wenger-Trayner E, Wenger-Trayner B. Introduction to communities of practice. Wenger-Trayner. June 2015. Accessed March 23, 2024. https://www.wenger-trayner.com/introduction-to-communities-of-practice/

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The Future of Research in the Pharmacy Academy

The Future of Research in the Pharmacy Academy Russell B. Melchert, RPh, PhD

David D. Allen, RPh, PhD

Dean & Professor School of Pharmacy University of Missouri–Kansas City

Chair, 2023–2025 Argus Commission Past President American Association of Colleges of Pharmacy Oxford, Mississippi

Samuel M. Poloyac, PharmD, PhD Dean & James T. Doluisio Regents Chair College of Pharmacy University of Texas at Austin

Introduction The foundational disciplines of our profession lie at the interface of basic and applied sciences, truly embracing research cycling from bench to bedside to classroom and back.

Skills in data collection, analysis, and interpretation permeate all aspects of pharmacy, from clinical care to discovery-based research. Students pursuing PharmD, master’s, and doctorate degrees should be equipped with research and scholarship skills to drive discovery and demonstrate the impact pharmacists make on society. In our academy, scholarship is essential to provide evidence-informed approaches to improve our clinical practice, research discovery, and instruction by future generations of pharmacists, scientists, and educators. Research, scholarship, and graduate education are at the heart of our mission, and it is through these efforts that we support our communities and shape the future.

The forecast survey included several questions related to research and graduate education.

In this section, we discuss specific survey questions that had consistent responses that were either predominantly favorable (highly likely or somewhat likely) or predominantly unfavorable (somewhat unlikely or highly unlikely). Comments are also provided as to the likely rationale of the responses, followed by AACP recommendations.

Federal Funding for Advanced Pharmacy Services Survey respondents were strongly negative regarding an item suggesting that federal agencies will earmark $100 million annually for research efforts related to large-scale implementation of advanced pharmacy services (see Figure 11, Item 1), with nearly 75% indicating this is unlikely or highly unlikely. Survey respondents were evenly divided on an item suggesting that at least 20% of research funding secured by faculty in schools of pharmacy will be focused on measuring and addressing health equity (see Figure 11, Item 2).

These results highlight the need for alternative funding sources and payer reimbursement.

Implications for these outcomes are obviously affecting the practice realm of the academy and research. Pharmacy practice research has been impacted by the trend away from tenured/tenure-track faculty in practice departments and is unlikely to change over the next 5 years. How the academy engages practice research has implications for our faculty and the profession. An aggressive, proactive stance toward advancing research about why pharmacy matters in health care and interprofessional practice is warranted.

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AACP Argus Commission Forecast 2024

The Future of Research in the Pharmacy Academy The focus of the pharmacy academy must turn to correcting the disproportionately high cost of our health care system that yields poorer outcomes compared to other high-income countries. We must transition our thinking from the scope of practice to improving patient outcomes. Future surveys should reframe this topic for practice and research statements simultaneously. One consideration is how pharmacy, and more specifically the academy, partners with other professions utilizing implementation science methodologies and funding streams to support advancing pharmacy services. High-level pharmacy support services reducing costs and improving outcomes has been clearly demonstrated.1 Despite continuing challenges, educating payers to understand these benefits is essential for payment and widespread adoption.

Federal Funding for Research and the Peer-Review Process Survey respondents were evenly split on the likelihood that federal funding of biomedical research will decrease by 30% (see Figure 11, Item 3). Similarly, responses to whether the peer-review of grant applications to federal funding sources will be double-blinded (see Figure 11, Item 4) leaned slightly toward somewhat and highly likely, suggesting respondents believe it may occur. Both of these items were mixed, and while funding is stable, it is more accurately described as stagnant. The AACP Council of Deans Task Force on Pharmacy Research and Scholarship2 suggested schools focus on other funding opportunities, such as Advanced Research Projects Agency for Health and other alternative funding streams; we strongly encourage the pursuit of these opportunities.

The implications of not advancing the practice of pharmacy and meeting funding challenges will have detrimental impact on the communities for which our profession vows to serve. We are the health care professionals who can have the greatest impact, but we largely hold the future of our profession in our own hands. We acknowledge the work that AACP has accomplished to date regarding research support, including exploring alternative mechanisms for funding and advancing practice in general. Building on those successes is imperative moving forward.

Core Competencies for Graduate Curricula Over 60% of survey respondents indicated it was highly or somewhat likely that at least 50% of pharmacy graduate programs will adopt the AACP core competencies for PhD education (see Figure 11, Item 5). This item was based on the recommended core competency domains from the Research and Graduate Affairs Committee 2016–2017 Report.3 The six core competency domains include: foundational knowledge, research, scientific communications, education, leadership and management, and personal and professional development. A particular emphasis was placed on the development of “power skills” for student success in the areas of education, leadership and management, and personal and professional development, which go beyond the traditional skills of MS and PhD degree training.

The reality is that a PhD or MS graduate can have in-depth foundational knowledge and strong research skills within their discipline; however, if they do not have the skills to hire and manage people, skills in leadership and management to advance team goals, and personal life skills to manage themselves, they are highly unlikely to achieve career success. Unfortunately, graduate thesis committees typically focus on core competency domains, and “power skill” training is highly variable and dependent on the mentoring of the primary advisor.

AACP Argus Commission Forecast 2024

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The Future of Research in the Pharmacy Academy The pharmacy academy can and should decrease the variability in power skill development in training graduate students across our programs by applying the competency domains. This can and is being done using individualized development plans, which are required by NIH and other federal agencies that fund graduate student support programs. Implementation is the primary barrier to core competency deployment and AACP can help facilitate this implementation.

Collaboration in Graduate Education Most survey respondents indicated that it was highly or somewhat likely that at least 5 colleges and schools of pharmacy will collaborate with other health care and non-health care academic disciplines in areas, such as computer engineering or applied mathematics, to develop a graduate program in artificial intelligence (AI), advanced computing, and data science (see Figure 11, Item 6). This result is likely a reflection of the anticipated impact AI will have on all aspects of our colleges, transforming the ways in which we educate, provide clinical care, and conduct research. Historical “eras of change” included the molecular era to the emergence of clinical and translational science and the human genome project. Uniquely different about the era of AI is that it impacts everything—rapidly and simultaneously. It is both a disruptive and productive force that will impact the way we function in the lab, classroom, and at the bedside.

New health care practice interventions must move from use with patient informed consent to adopted standard of care. This movement only occurs after thorough evaluation to determine if AI-informed approaches are superior to current standards.4 Clinical research studies are already evaluating AI clinical progress, challenges, and opportunities.5 Lower stakes applications of AI are being deployed across a wide array of research applications, from drug discovery to health outcomes. Similarly, AI is rapidly impacting our teaching environments through multiple natural language chatbots and other applications. Changes in research are being integrated into experimental planning and development; however, changes in instruction are occurring both with and without the intentional integration by instructors. AI is rapidly and simultaneously impacting all facets of pharmacy education, practice, and research in different ways—we must adapt.

The questions and issues that AI raises are many. One example is that ChatGPT passed the Japanese National License Examination for Pharmacists.6 This raises the question as to the true value of declarative knowledge versus higher order cognitive processes in training our students. The ethical deployment of AI is similarly critical. Fear of the use of AI ranges from trusting the output to concerns about AI replacing our jobs. How we use, leverage, and maximize the AI-human interface for the full benefit of the communities we serve should be central to AACP and our schools. At the time of publication, it can be said that AI is like a third-year pharmacy student. Can they give accurate information that is vital to care, yes. Would you fully trust them to make a critical decision in the care of an individual, not yet—but AI can train them to be better.

Non-thesis Master’s Degrees Most survey respondents indicated a high likelihood that more colleges and schools of pharmacy would develop and launch new non-thesis master’s degree programs (see Figure 11, Item 7). The pressure on colleges and schools of pharmacy to make up for lost tuition revenue from decreased pharmacy enrollment has stimulated the planning and development of certificate programs and non-thesis master’s programs. These are offer-

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AACP Argus Commission Forecast 2024

The Future of Research in the Pharmacy Academy Figure 11 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

Somewhat Likely

Somewhat Unlikely

Highly Unlikely

Federal agencies (eg, NIH, AHRQ, CMMI, DoD, etc.) will earmark $100 million annually for research efforts related to large-scale implementation of advanced pharmacy services.

1

2

2.8% 22.3%

24.7%

At least 20% of research funding secured by faculty in schools of pharmacy will be focused on measuring and addressing health equity.

8.9%

3

50.2%

42.0%

39.4%

9.7%

Federal funding of biomedical research will decrease by 30%.

7.6%

38.1%

45.4%

8.9%

Peer review of grant applications to federal funding sources will be double-blinded.

4 8.2%

5

49.8%

33.3%

8.7%

At least 50% of pharmacy graduate programs will adopt the AACP core competencies for Ph.D. education.3 10.4%

50.2%

32.3%

7.1%

At least 5 schools of pharmacy will collaborate with other healthcare and non-healthcare academic disciplines (eg, computer engineering, applied mathematics, etc.) to develop a graduate program in artificial intelligence, advanced computing and/or data science.

6 40.9%

7

48.0%

10.2%

0.9%

In order to address budget deficits, at least 50% of schools of pharmacy will develop and launch new non-thesis master’s degree programs.

25.7%

45.7%

23.6%

5.0%

At least 10 off-patent medications will be FDA approved for new indications based on research initiated and/or led by schools of pharmacy.

8 14.3%

50.0%

AACP Argus Commission Forecast 2024

29.4%

30

6.3%

The Future of Research in the Pharmacy Academy Figure 11 How likely is it that the following conditions or circumstances will occur in the next 5 years in U.S. colleges and schools of pharmacy?

Highly Likely

Somewhat Likely

Somewhat Unlikely

Highly Unlikely

At least 20 schools of pharmacy will offer graduate degrees in implementation science.

9 10.4%

10

44.6%

46.8%

21.4%

Carnegie Classification of Institutions of Higher Education will be replaced by any one of several alternative systems for evaluating research productivity and funding (e.g., Blue Ridge Institute for Medical Research).

3.7% 30.9%

12

4.5%

In at least 50% of universities, graduate students will unionize.

6.5% 25.3%

11

40.5%

52.8%

12.6%

Nearly all pharmacy education journals will increase expectations that manuscripts reporting results of scholarship of teaching and learning (SOTL) projects to have a comparator group.

11.0%

49.8%

31.0%

8.2%

Due to declines in federal funding of research, 10 graduate programs will close at schools of pharmacy.

13 12.6%

51.5%

30.3%

5.6%

ings that may be in demand but have lower overhead to run and utilize existing faculty expertise to develop. The focus should be to ensure that programs, existing or newly created, are based on competencies and assess programmatic outcomes. Most importantly, the driving factor for creating new programs must be the graduate’s placement and career advancement, rather than solely recovering lost school revenue.

Certificate programs and non-thesis master’s degrees may provide opportunities to pursue emerging areas of emphasis through curriculum development. For example, a successful 10-12 credit hour graduate certificate program can provide a strong foundation for a non-thesis master’s degree program and might also include the addition of a thesis or dissertation as a ramp toward existing PhD programs. As noted above, programs in AI, advanced computing, and data sciences are ripe for further development. Recently published work from the AACP Council of Deans Taskforce on Pharmacy Research and Scholarship provided great recommendations for research and graduate education and pointed to the need for increased support for research, scholarship, and graduate education in schools of pharmacy.2 Clearly, AACP is uniquely positioned to provide support for exchanging ideas on certificate programs, non-thesis master’s degrees, emerging areas, and possible available supporting resources.

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AACP Argus Commission Forecast 2024

The Future of Research in the Pharmacy Academy Conclusion Research and graduate education remain the cornerstone for the advancement of our profession through our basic and clinical science disciplines that support it. Yet, our research and graduate education mission is perhaps under the greatest disruptive and potentially productive forces that we have seen in many generations. We are at a critical juncture that will likely represent an inflection point, and the opportunity for our profession to lead has likely never been greater. Pharmacy programs have the opportunity to serve as the leading health care professional program driving change through research discovery and innovations in care to the wide array of communities that we serve.

Recommendations 1.

Colleges and schools of pharmacy and AACP should consider dovetailing work on research and practice together to address challenges in obtaining funding while advancing the profession of pharmacy as an integral part of the research agenda. A joint effort of the AACP Research and Graduate Affairs, AACP Professional Affairs Committees, and administrative leaders in research and graduate education within our schools would be well-served to collaboratively address these challenges.

2. AACP should develop a universal individualized development plan (IDP) template for member institutions with recommendations on best practices for the use and assessment of the core competency domains in graduate education.

3. Colleges and schools of pharmacy should serve as the leading minds to train, evaluate, and ethically deploy the use of AI within our profession. It is up to us to craft the future advancement of AI application to pharmacy education, practice, and research to positively maximize our impact on the communities we serve. AACP should help advance this directive with member institutions.

Acknowledgment We would like to acknowledge Dr. Lisa Su, AMD Chair and Chief Executive Officer (https://www.amd.com/en/corporate/leadership/lisa-su.html). Dr. Su’s discussion on the topic of the impact and future of AI in healthcare was part of the framework for the content presented on this topic.

References 1. Dixon DL, Johnston K, Patterson J, Marra CA, Tsuyuki RT. Cost-effectiveness of pharmacist prescribing for managing hypertension in the United States. JAMA Netw Open. 2023;6(11): e2341408. doi:10.1001/jamanetworkopen.2023.41408 2. Poloyac SM, Daugherty KK, DeVilliers MM, et al. Report of the 2023 AACP Council of Deans Taskforce on Pharmacy Research and Scholarship. Am J Pharm Educ. 2024;88(2). doi:10.1016/j.ajpe.2024.100641 3. Poloyac SM, Block KF, Cavanaugh JE, et al. Competency, programming, and emerging innovation in graduate education within schools of pharmacy: the report of the 2016-2017 research and graduate affairs committee. Am J Pharm Educ.

2017;81(8):S11. doi:10.5688/ajpeS11 4. Romagnoli A, Ferrara F, Langella R, Zovi A. Healthcare systems and artificial intelligence: focus on challenges and the international regulatory framework. Pharm Res. 2024;41(4)1-10. doi:10.1007/s11095-024-03685-3 5. Rajpurkar P, Chen E, Banerjee O, Topol EJ. AI in health and medicine. Nat Med. 2022;28(1):31-38. doi:10.1038/s41591-02101614-0 6. Sato H, Ogasawara K. ChatGPT (GPT-4) passed the Japanese National License Examination for Pharmacists in 2022, answering all items including those with diagrams: a descriptive study. J Educ Eval Health Prof. 2024;21:4. doi:10.3352/jeehp.2024.21.4

AACP Argus Commission Forecast 2024