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Characteristics of Successful International Pharmacy Partnerships


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Recommendations for global pharmacy collaborations are predominately derived from US institutions. This study utilized semi-structured interviews of global collaborators to assess important partnership components. Interviewees stated personal connections and understanding of each other’s programs/systems were key components. Additionally, collaborators indicate that mutual benefits between partners can exist without the requirement for bidirectional exchange of learning experiences, and request and value partners and learners who are culturally aware, global citizens. This structured interview approach provided key insight into how to develop mutually beneficial, sustainable partnerships and provides additional confirmation that the five pillars of global engagement align with an international audience.
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Pharmacy 2023, 11, 7.
Characteristics of Successful International Pharmacy
Gina M. Prescott 1,*, Lauren Jonkman 2, Rustin D. Crutchley 3, Surajit Dey 4, Lisa T. Hong 5, Jodie Malhotra 6,
See-Won Seo 7, Marina Kawaguchi-Suzuki 8, Hoai-An Truong 9, Elizabeth Unni 10, Kayo Tsuchihashi 11,
Nubaira Forkan 12 and Jeanine P. Abrons 13
1 Department of Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University at Buffalo,
Buffalo, NY 14214, USA
2 Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh,
Pittsburgh, PA 15261, USA
3 Department of Pharmacotherapy, Washington State University, Yakima, WA 98901, USA
4 College of Pharmacy, Roseman University of Health Sciences, Henderson, NV 89014, USA
5 Department of Pharmacy Practice, Loma Linda University School of Pharmacy,
Loma Linda, CA 92350, USA
6 Department of Clinical Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of
Colorado, Aurora, CO 80045, USA
7 Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, NY 12208, USA
8 Department of Pharmacy, Pacific University Oregon, Forest Grove 97116, USA;
9 Department of Pharmacy Practice & Administration, University of Maryland Eastern Shore,
Princess Anne, MD 21853, USA
10 Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York, NY 10027, USA
11 School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
12 School of Pharmacy, University of Toronto, Toronto, ON M5S, Canada;
13 Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa,
Iowa City, IA 52242, USA
* Correspondence:; Tel.: +1-716-645-4784
Abstract: Recommendations for global pharmacy collaborations are predominately derived from
US institutions. This study utilized semi-structured interviews of global collaborators to assess im-
portant partnership components. Interviewees stated personal connections and understanding of
each other’s programs/systems were key components. Additionally, collaborators indicate that mu-
tual benefits between partners can exist without the requirement for bidirectional exchange of learn-
ing experiences, and request and value partners and learners who are culturally aware, global citi-
zens. This structured interview approach provided key insight into how to develop mutually ben-
eficial, sustainable partnerships and provides additional confirmation that the five pillars of global
engagement align with an international audience.
Keywords: global health; partnerships; pharmacy education; international; experiential education
1. Introduction
Global collaborations between colleges and schools of pharmacy have been increas-
ing over the past decade [1,2]. Developing international collaborations can be time-con-
suming and challenging due to differences in policies, laws, infrastructure, and cultural
considerations. These collaborations are often initiated by an institution in a high-income
country and may or may not reflect a sustainable, mutually beneficial relationship. The
American College of Clinical Pharmacy (ACCP) has developed an expert-based opinion
paper on developing collaborations that are centered around five pillars including: sus-
tainability, shared leadership, mutually beneficial partnerships, local needs-based care,
and host-driven education [3]. There are also additional recommendations available for
Citation: Prescott, G.M.; Jonkman,
L.; Crutchley, R.D.; Dey, S.; Hong,
L.T.; Malhotra, J.; Seo, S.-W.;
Kawaguchi-Suzuki, M.; Truong,
H.-A.; Unni, E.; et al. Characteristics
of Successful International Pharmacy
Partnerships. Pharmacy 2023, 11, 7.
Academic Editor: Daisy Volmer
Received: 29 November 2022
Revised: 23 December 2022
Accepted: 29 December 2022
Published: 1 January 2023
Copyright: © 2023 by the authors. Li-
censee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and con-
ditions of the Creative Commons At-
tribution (CC BY) license (https://cre-
Pharmacy 2023, 11, 7 2 of 13
colleges and schools of pharmacy for planning and managing short-term medical mission
trips and advanced pharmacy practice experiences [47]. These recommendations have
been mainly derived from pharmacists/faculty in the United States (US). There are few
recommendations based on direct input from non-US-based pharmacists. Furthermore,
no available recommendations used a semi-structured interview approach. This study
aims to provide standardized themes and direct feedback on collaborative agreements to
US institutions from the perspectives of international partners.
2. Materials and Methods
2.1. Study Design
The American Association of Colleges of Pharmacy Global Education Special Interest
Group (SIG) Global Outreach Committee (GOC) was comprised of eleven faculty mem-
bers with and without global partnerships from US-based pharmacy institutions. After a
review of the literature and several discussions, the committee developed an interview
guide consisting of twenty-one questions organized into five categories, based on princi-
ples of developing international partnerships (See Table 1). These categories were further
mapped to the five pillars of global health engagement. Committee members pre-tested
the interview questions with an international collaborator and modified the guide for clar-
ity and purpose. These modifications made the question categories more specific. This
included replacing the category of “structure” with “student placement and student/fac-
ulty exchanges” and combining outcomes into the assessment category. An additional
change included opening the interview with a broad question to set the tone for the inter-
view. This question was What factors might you consider when deciding whether to
partner with a US University or College of pharmacy?” Finally, we rearranged our ques-
tion order for better context based on the changes with the categories of questions. The
research team reviewed the finalized interview guide to ensure coverage of all five pillars.
The COREQ checklist was applied to the study (Appendix A) [8].
Table 1. Interview Guide.
Pillar 1
What factors might you consider when deciding whether
to partner with a US University/College of Pharmacy?
What challenges might exist in creating a formal agree-
ment, such as a
memorandum of understanding (MOU)?
What would you expect to see in such an agreement?
Student Placement
How do you weigh the benefits or harms of student ex-
changes or placements at your institution?
What preparation should students be aware of when trav-
eling to a host
Can you tell me about factors that impact the num-
ber/type/time of student placements?
What factors are consistent from year to year and what
factors are dependent upon the current context?
What factors would influence the time of year that would
be appropriate for students to travel?
What supervision would be expected for students partici-
pating in international placements? From the host site?
From the institutional site sending students?
In what types of experiences would you consider involv-
ing students at your institution or partner institutions?
Pharmacy 2023, 11, 7 3 of 13
What is expected of the US students while at the site and
contributions could they make?
From your perspective, what hands-on roles do you feel
are most
appropriate for US-trained students
What strategies have you seen that might allow for stu-
What limitations or challenges exist that would limit inter-
national learners at your site?
Student or Fac-
ulty/Staff Exchange
In thinking about mutually beneficial partnerships, what
would be the value for your students or faculty/staff to re-
What might be some challenges that exist in developing
bilateral exchanges for either students or faculty/staff?
How do you evaluate exchange students on rotation?
2, 5
What are your thoughts about completing evaluations for
US students?
3, 5
What would make you more comfortable or less comforta-
ble with evaluating US students?
3, 5
How would you define a successful collaboration between
a US school of
pharmacy and your institution?
What measures define a valuable experience for students?
For the site? For
1 Pillars include: 1Sustainability, 2Shared Leadership, 3Mutually Beneficial Partnerships, 4
Local Needs Based Care, 5- Host Driven Education.
2.2. Participants
The GOC developed a list of pre-existing collaborators with a minimum of two to
three collaborators from each WHO region (Africa, Americas, Eastern Mediterranean, Eu-
rope, South East Asia, and Western Pacific). Collaborators were known by the committee,
either through direct affiliation or through professional pharmacy organization service
and had experience in global collaborations. Collaborators were selected to be interviewed
on a first-listed basis and upon response to a standardized recruitment email from the
study investigators. Interviewers contacted collaborators at week one; if there was no re-
sponse, one additional contact was made at week two, requesting an interview. Upon
contact, collaborators were made aware of the study purpose and that investigators were
members of the GOC.
2.3. Data Collection
If the collaborator agreed to participate in the standardized interview, two investiga-
tors and the collaborator established a mutually agreed-upon time using Zoom Video
Communications, Inc™ (San Jose, CA, USA). The collaborator was also provided with an
informed consent document to review prior to the interview. One investigator conducted
the interview, while the other scribed. Both faculty members had prior experience with
global collaborations and the faculty interviewers had previous experience conducting
qualitative research.
Pharmacy 2023, 11, 7 4 of 13
Upon initiating the interview, the interviewer obtained informed consent, changed
the interviewee’s name to a number (for anonymity), and recorded the conversation for
transcription purposes. Interviews lasted approximately one hour and were conducted
between November 2021June 2022.
2.4. Data Analysis
Qualitative data analysis followed an inductive and deductive content analysis pro-
cess. A sample size was not determined a priori, instead the GOC team aimed to include
participants from diverse regions and continued interviews until thematic saturation was
achieved meaning that no new concepts emerged from additional interviews. First, upon
completion of each interview, an investigator reviewed and corrected the auto-transcrip-
tions and removed any identifiable information before sharing the transcript with the full
GOC. Next, a codebook was developed from the review of two de-identified transcripts
using an open coding process. Using axial coding, the GOC then integrated the five pillars
into the codebook. Two independent coders reviewed each transcript and discussed and
reconciled any discrepancies. Additional codes were added to the codebook as required
through the analysis process. The final thematic analysis was completed through an im-
mersion-crystallization process whereby themes were coalesced from the codes and then
interrogated by reviewing supportive quotes to ensure that themes aligned with the data.
Overall, the analytic strategy proceeded through an iterative process requiring review of
transcripts and team discussion where, the team developed and confirmed key themes.
3. Results
Fourteen interviews, out of 17 attempts, were completed with 17 international part-
ners representing 14 countries from five WHO regions: Africa (3), Americas (3), Europe
(3), Eastern Mediterranean (2), and the Western Pacific (3).
Four themes were developed and connected to the pillars of global health engage-
ment (Table 2).
Table 2. Global Health Interviews Major Themes and Supportive Pillars.
Global Health
Shared Leader-
Shared Leader-
ship, Host-
driven Educa-
Mutually Bene-
ficial Partner-
ships, Local
Care, Host-
Driven Educa-
Pharmacy 2023, 11, 7 5 of 13
Mutually Bene-
ficial Partner-
ships, Host-
Driven Educa-
tion, Shared
Leadership, and
Local Needs-
Based Care
The first theme highlighted how personal connections are critical to partnership de-
velopment and sustainability. Participants gave examples of the importance of personal
connections to developing international partnerships but noted that sustainability re-
quires expansion beyond just one faculty member. Participants also described the value
of partners with global health experiences as those partners have a better understanding
of differences and similarities and adapt smoothly. Participants described building trust
and rapport with the institution and individual partners as a crucial to relationship devel-
opment. Participants noted the importance of a transition plan if the faculty lead at either
institution leaves to ensure the partnership remains and thrives. Supportive quotes:
I know (the collaborator). There is a personal, level of trust, and we can get
something done. I know MOUs are good to get institutional support. But, if we
don’t have an inside person that we can deal with, the MOU becomes not use-
When you sign an MOU, the partners need to agree to what would be the
benefits in a partnership…I was lucky…those people that approached us, they
knew upfront what they could contribute in terms of research, collaboration, a
teaching collaboration, and so our biggest benefit was this.”
“I really look at relationships I have when Im at different conferences, and we
look to see whether or not there are any similarities within our institutions or
where we can work together. And thats where I start from.”
The second theme emphasized the importance of understanding each other’s pro-
grams and systems is essential to successful collaborative partnership. Participants noted
that due to differences in pharmacy education around the globe, it is critical for partners
to understand each other’s programs. This understanding includes recognition of: the tim-
ing of the academic year, holidays, and other cultural events or weather conditions; the
evaluation strategies used for student assessment and expectations of students; the struc-
ture of the overall program including priorities and how students are trained; student
levels (i.e., expectations for first year students versus third year students as well as differ-
ent global educational programs such as Bachelor of Pharmacy versus Masters of Phar-
macy versus Doctorate of Pharmacy); and prior knowledge before coming on site includ-
ing priorities for the country, the university, and the profession. Further, its essential to
consider the needs of partner sites, particularly in countries where resources are limited,
including staff support to coordinate experiences and space/capacity restrictions. Finally,
participants discussed the need to understand each others overall health systems, includ-
ing how the training programs fit into the context of the overall health system. Adequate
planning of logistics and coordination are critical to ensure the successful execution of
local needs-based care and host-driven education.
“There are differences in practice, which I think being a preceptor, we need to
help the students understand this and how to manage certain issues so that, at
the end of the day, it will be a win-win situation.”
Pharmacy 2023, 11, 7 6 of 13
“Yeah, I think what is most complicated for us, more difficult for us to under-
stand is how the US education system works. Like, you enter the university sys-
tem, and then you take all these different classes and subjects and then you mas-
ter or take your degree. I dont know at some point you decide you want to, how
do you say that, you want to major at some point. I don’t know”
“Institutional memory has been kept because the champions remained constant.
Other people may think differently. And you remember also cultural exchange
rates. You develop bonds, personal bonds, you know cultural bonds. Those are
taken for granted, because you know, sometimes when theres no funding the
push to look for funding, this is coming from inside personally, because you
have not developed your bond with the support group or with children by one
part of the world, and so forth.”
The third theme was that mutual benefits can exist without bidirectional exchange,
and those benefits may differ for each partner. Participants felt that equitable partnerships
do not always require identical exchanges. Needs and opportunities vary between insti-
tutions. Participants discussed the benefits of layered learning with different levels of
learners in other programs sharing what each knows. Participants discussed inequities in
funding and resources between global sites and the impact on the physical exchanges of
students. For instance, students from high-income countries may be able to support travel,
while travel may be more difficult for students in low- or middle-income countries. Par-
ticipants discussed sharing knowledge and best practices, including the experience of
working with limited resources such as the WHO essential medicine lists and vice versa.
Finally, participants noted that both parties might perceive and interpret successful col-
laboration differently. Moreover, it is vital to understand a particular institutions priori-
ties and needs to create a successful partnership and that mutual benefits sometimes carry
different weights for each party. Supportive quotes:
“Partnerships definitely help strengthen our voice when it comes to health care
within the country.”
“Joint publications. You and I published a paper together, or write a book chap-
ter together. And then collaborate [with] students together. That is more than
enough. And then, if we are released into the research, we can write a grant.
Joint grant writing, and we can submit… Okay, otherwise we are jointly training
students, so we might as well jointly develop curriculum.”
“So there has to be trust instead of a document [i.e., MOU]…Once you have a
good partner, that is willing to work on things.”
“I had two students from (institution), they helped me put together the phar-
macy program here. They used their knowledge of pharmacy and my
knowledge, and then the government pharmacist knowledge… If it wasn’t for
that, there would be a massive shortage of pharmacists… right now.”
Finally, partners identified open mindedness, adaptability, global citizenship, and
cultural and structural awareness as essential qualities for partners and learners. Partners
need to be thoughtful about preparing learners who are open-minded, can critically eval-
uate assumptions, can identify collectivist versus individualist perspectives, and maintain
a global rather than ethnocentric mindset. These qualities are necessary for effective part-
nerships and high-quality experiences for learners.
“I wish that going forward when we have a critical mass of mentors that under-
stand global health, what international exchanges is all about. We will do all the
technical, but we must know that we are dealing with a holistic situation…and
a cultural exchange aspect.”
Pharmacy 2023, 11, 7 7 of 13
I think our biggest expectation is that they should be willing to learn new things
because …working in a low to middle income country you might have all the
knowledge, you might know the best way to treat a patient, but that medicine, all
that treatment is not available in the country so how do you juggle that. So in that
instance, that you must be willing to listen, learn how we do things, and its not nec-
essarily that its the best way to do things but its the only way we have and we have
to make that work. We discussed this earlier, you know, is to be culturally sensitive
because we dealing also with this issue of colonialism. And you know as an academic
bringing in US students I get confronted at management level about colonial-
ism…They need to be sensitive towards that and not get offended……Its trying to
give them that opportunity to give a plan of how they would treat this patient in the
US, but then to bring the context to them the challenges that we face with access to
medicine and then develop a new plan and that willingness to learn and change be-
comes important.”
4. Discussion
This is the first study we are aware of that provides a unique insight into pharmacy
partnerships from internationally based key informants representing different regions
from around the world. Interview approaches with international partners have been pre-
viously utilized to assist with important pharmacist advancements, including pharma-
cists as immunizers and understanding the role of continuous professional development
in the health professions [9,10]. Similarly, US schools of pharmacy utilized a network ap-
proach with healthcare systems to determine how to best meet the needs of their partners
and maximize commitments to each other [11]. Finally, the WHO commissioned a report
that explored themes of global interprofessional collaboration in different WHO regions
to determine how collaborative practice was defined across the world [12]. A strength of
our study was the provision of an open dialogue for global collaborators to discuss their
viewpoints on essential components of global partnerships. While the interview had
structured questions, interviewees could speak freely on any aspect to partnership devel-
opment that they felt was important. The inductive thematic analysis of 17 interviews re-
vealed many key issues that were able to be linked to the five pillars of global health en-
gagement [3].
Personal connections and trust between partners were considered key factors in con-
tributing to the sustainability of programs. This is in accordance with the ACCP pillars on
ethical engagement for sustainability. The reputation of an individual and their ability to
navigate cross-cultural communication as well as understand the collaborators’ perspec-
tive of mutual benefit may be as important as the reputation of a particular institution.
Global partnerships are often started through individual connections, and while the liter-
ature on this is mixed with some recommending utilizing pre-existing relationships al-
ready established at your college or university, the key factor here is likely trust with the
intent to develop a sustainable partnership [6,13].
Personal connections were again mentioned along with a shared understanding of
each other’s systems and programs. These connected to the ACCP pillar of shared leader-
ship. Developing a clear goal for each institution based on their local healthcare or aca-
demic setting was important to the interviewees. This is consistent with literature on the
focusing on needs-based care [6,13]. Importantly, participants discussed challenges that
they have faced with students’ work being evaluated using US-based evaluations. Inter-
viewers discussed the need for cultural and structural sensitivity to avoid using a high-
income country lens to look at local needs-based interventions rather than looking to part-
ners for their feedback on the work of students in non-US settings. Examples of long-term,
sustainable global partnerships focused on local needs-based care, have demonstrated im-
provements in patient outcomes and enhancing workforce training [1418]. In Zimbabwe,
a focus on HIV clinical pharmacology and post-doctoral training programs has improved
research training, optimization of antiretroviral use, and development of national
Pharmacy 2023, 11, 7 8 of 13
treatment guidelines [14,15]. In Kenya, improvements through inpatient and outpatient
pharmacy settings have improved clinical pharmacy training and workforce development
[16]. In West Africa, an antimicrobial stewardship train-the -trainer program improved
workforce capacity in this identified area of need [17]. Finally, in Thailand, improvements
to advance clinical pharmacy education led to pharmacists’ recognition in national initia-
tives/practice guidelines, post-graduate programs, and pharmacy workforce [18].
The third theme centered around the concept that mutually beneficial goals did not
necessarily mean that an identical experience was needed in exchange of educational ex-
periences. This was connected to the mutually beneficial partnership and local needs-
based goals stemming from the consideration that partners discussed what their institu-
tions valued and needed for their learners. While our research team initially thought it
should be equitable (as in physically exchanging on a student for student basis) our part-
ners reminded our team that equity meant more than just student exchange. Collaboration
outcomes such as publications, the establishment of programs, and positive impacts to a
country’s health system represented alternative markers of collaboration success. All the
sustainable programs previously mentioned have cited these markers as well in their
measures of successful partnerships [1418]. Travel was not an assumed component of the
collaborations, and in some instances, partners felt that student travel should be deprior-
itized as it has a limited impact on the institution. Bringing US students to areas in which
clinical practice by pharmacists is growing was also discussed as a beneficial opportunity
for collaborative development and has been discussed in the literature as well [6]. An im-
portant component to the mutually beneficial partnership pillar includes providing trans-
parency, developing shared goals, and recognizing a level of equity and mutual respect
[3]. In Taiwan, development of clinical pharmacist services and a residency program
through collaborations has been recognized as an output of successful partnerships. This
can help to improve the overall value of pharmacist globally and with patient care [19,20].
The fourth theme discussed the need for partners and learners to be open-minded,
adaptable, and in general, global citizens. This was a common theme amongst all inter-
viewees. The concept of developing students who are global citizens is a newer phenom-
enon in academia broadly and within pharmacy school curricula specifically [21,22]. The
growing acknowledgement of global interconnectedness reinforced through recent
events, including the pandemic has accelerated a priority on decolonization and identify-
ing and addressing ethnocentrism [22,23]. The Consortium of Universities for Global
Health (CUGH) has competencies related to the development of a global health citizen
and created a toolkit to assist with competency attainment [24,25]. Tools, such as the Cul-
tural Intelligence Tool (CQ), the Intercultural Development Inventory (IDI), or others
could be explored to help further create prospective mindfulness, and reflective abilities
of learners before exchanges [2628]. In preparing to engage in shared work and learning,
elements that should be presented to learners and discussed to ensure common under-
standing between collaborators include cultural humility, cultural nuances or differences,
and structural factors that may influence the collaboration, health system, and educational
One area that was not mentioned as frequently but was integrated into many recom-
mendations from participants was the role of an interprofessional approach to global ex-
changes. This is likely due to a few reasons. The importance of interprofessional education
and collaborative practice for the global healthcare workforce has been recognized by the
WHO, and the pharmacist’s role in an interprofessional environment is also noted in the
2022 International Pharmaceutical Federation Global Competency Framework for Educa-
tors & Trainers in Pharmacy [22,29]. So, while there is support for these initiatives and
improvements have been seen in perspective towards interprofessional education and
practice, these experiences still vary widely across the world [30,31]. The lack of specific
commentary in our study may be due to the interview questions not specifically address-
ing interprofessional approaches or that it was implied by discussing advanced practice
Pharmacy 2023, 11, 7 9 of 13
Limitations to our research include the small number of interviewees per geographic
location, although we continued interviews until thematic saturation was achieved. In ad-
dition, interviewed individuals included existing partners, thereby the study has the po-
tential for social desirability bias.
Future areas of research include providing a series of perspectives on individual
WHO regions, expansion on the topic of interprofessional educational efforts and how
successful collaborations achieve these goals, and how didactic education can be linked
to experiential education with both the host and partner institutions in various WHO ge-
ographical regions.
5. Conclusions
Overall, global perspectives on successful and sustainable partnerships are consistent
with expert-based guidance and descriptions published from sustainable programs.
While most partners agreed that mutual respect and understanding of each other’s pro-
grams and goals are essential, how a successful partnership is achieved and measured can
vary. Following a local needs-based approach may assist with developing partnerships.
Author Contributions: Conceptualization, G.M.P.,, E.U., R.D.C., L.T.H., M.K.-S., L.J., J.P.A.,S.D.,
J.M, H-A.T, and S.-W.S.; methodology, G.M.P., E.U., L.T.H., R.D.C., M.K.-S., L.J., J.P.A., S.D., J.M.,
H-A.T., and S.-W.S.; formal analysis, G.M.P., L.T.H., M.K.-S., R.D.C., L.J., J.P.A.,, K.T.,J.M.,H-
A.T.,K.T., N.F., and S.-W.S.; investigation, G.M.P., L.T.H., M.K.-S., L.J., H-A.T., and S.-W.S.; writ-
ingoriginal draft preparation, G.M.P., E.U., L.J and J.P.A.; writingreview and editing, G.M.P.,
J.M., J.P.A., L.T.H., R.D.C. and M.K.-S.; supervision, G.M.P.; project administration, G.M.P.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted in accordance with the Declara-
tion of Helsinki and approved by the Institutional Review Board of University at Buffalo (protocol
code STUDY00005547 on 06/10/2021), Loma Linda University (IRB# 5210269) on 07/12/2021. Pacific
University (IRB#078-21) on 06/10/2021. University of Pittsburgh (STUDY21100079) on 11/9/2021, Al-
bany College of Pharmacy and Health Sciences (IRB#21-000C on 9/16/2021).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the
Data Availability Statement: Not applicable.
Acknowledgments: We would like to thank our international partners for participating in the in-
Conflicts of Interest: The authors declare no conflicts of interest.
Appendix A
Table A1. COREQ Checklist.
Item No
Guide Question/Description
Page No
Domain 1: Research Team and Reflexivity
Which author/s conducted the inter-
view or focus group? GP, SS, LJ, JA,
What were the researchers creden-
Student (KT/NF)
Title Page
What was their occupation at the
time of the study?
Student (KT/NF)
Title Page
Pharmacy 2023, 11, 7 10 of 13
Was the researcher male or female?
Both were represented
Experience and Training
What experience or training did the
researcher have?
All interviewers had qualitative re-
search experience
Domain 1: Relationship with participants
Relationship Established
Was a relationship established prior
to the study commencement?
Yes, to varying degrees
Participant Knowledge of the Interviewer
What did the participants know
about the researcher?, e.g., personal
goals, reasons for doing the research?
Upon contact, collaborators were
made aware of the study purpose
and that investigators were members
of the GOC. Informed consent was
sent to review via email.
Interviewer Characteristics
What characteristics were reported
about the interviewer/facilitator?
Faculty, GOC member
Domain 2: Study Design
Methodological Orientations/Theory
What methodological orientation was
stated to underpin the study?
Content Analysis
How were the participants selected?
Method of Approach
How were the participants ap-
Sample Size
How many participants were ap-
17 approached; 14 different sites in-
How many people refused to partici-
pate or dropped out?
3 did not respond
Setting of Data Collection
Where was the data collected?
Workplace, Zoom
Presence of Non-participants
Was anyone else present besides the
participants and researchers?
Description of Sample
What are the important characteris-
tics of the sample?
All participants were engaged in
global health collaborations in their
Interviews were conducted between
November 2021-June 2022
Pharmacy 2023, 11, 7 11 of 13
Interview Guide
Were questions, prompts, guides pro-
vided by the authors? Was it pilot
Interview Questions were used; Pre-
testing was performed with one in-
ternational partners
Table 1
Repeat Interviews
Were repeat interviews carried out?
Audio/Visual Recording
Did the research use audio and visual
recording to collect the data?
All interviews were recorded and
Field Notes
Were field notes made during
and/or/after the interview or the fo-
cus group?
Yes, one researcher served as a scribe
What was the duration of the inter-
views or focus groups?
1 h
Data Saturation
Was data saturation discussed?
Yes, continued until enough partici-
Transcripts Returned
Were transcripts returned for com-
ments or correction?
Domain 3: Analysis and Findings
Number of Data Coders
How many data coders coded the
Two for each interviewer
Description of the Coding Tree
Did authors provide a description of
the coding tree?
A code book was developed
Derivation of Themes
Were themes identified in advance or
derived from the data?
Yes, immersion-crystallization
Table 2
What software, if applicable, was
used to manage data?
Participant Checking
Did participants provide feedback on
the findings?
Quotations Presented
Were participant quotations pre-
sented to illustrate the themes/find-
Data and Findings Consistent
Was there consistency between the
data presented and the findings?
Pharmacy 2023, 11, 7 12 of 13
Clarity of Major Themes
Were major themes clearly presented
in the findings?
Table 2
Clarity of Minor Themes
Is there a description of diverse cases
or discussion of minor themes?
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... 8,9 A recent study using semistructured interviews of global collaborators based in Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific highlighted important partnership components. 10 Key characteristics of successful international partnerships provided by interviewees included personal connections and understanding each other's programs and systems. These researchers listed open mindedness, adaptability, global citizenship, and cultural and structural awareness as essential qualities for partners and learners. ...
... These researchers listed open mindedness, adaptability, global citizenship, and cultural and structural awareness as essential qualities for partners and learners. 10 Acquiring funding ...
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Tackling antimicrobial resistance (AMR) through antimicrobial stewardship (AMS) interventions is a key objective within the World Health Organization (WHO)’s Global Action on AMR. We outline the reasons why global collaborations for AMS are needed. We provide examples of global collaborations, and we offer considerations when starting on a global health journey focused on AMS.
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Professional development activity is needed to ensure practitioners are up to date and providing optimal patient care. This includes, but is not restricted to, mandatory continuing professional development (CPD) or continuing education (CE) requirements, which differ by professions globally and within countries. This study aimed to investigate perceptions, participation, and individual practice for healthcare professionals in Great Britain (GB) and pharmacists globally to identify similarities and differences after the introduction of revalidation for pharmacists in GB. Qualitative data was received through interviews, which was analysed using content analysis. In total, 24 interviews were completed with pharmacists registered globally, and healthcare professionals registered in GB. A culture of CPD was seen for healthcare professionals in GB and globally for pharmacists; there was no consistent model. Face-to-face activity was common, with an increase in online provision, especially where large geographies were seen. Most learning was completed in the professional’s own time. Multiple providers were seen, with the evaluation of events using questionnaires being commonplace. Different formats of learning were useful for different topics, with skills learning being better when face-to-face. Although varied requirements were in place, regulation should support patient-based practice outcomes. This study showed that commitment to learning was similar in different professions in GB and by pharmacists globally, with similar benefits and challenges.
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While important advances have been made in the prevention and treatment of Human Immunodeficiency Virus (HIV) infection, limited expertise and resource constraints to effectively manage rollout of HIV programs often contribute to poor treatment outcomes in Sub-Saharan Africa. In 1998, the University of Zimbabwe (UZ) and the University at Buffalo, State University of New York (UB), developed a collaborative clinical pharmacology capacity building program in Zimbabwe to train the next generation of HIV researchers and support rollout of the national HIV program. The collaboration was funded by research and training grants that were competitively acquired through United States of America government funding mechanisms, between 1998 and 2016. Thirty-eight research fellows were trained and a specialty clinical pharmacology laboratory was established during this period. Knowledge and skills transfer were achieved through faculty and student exchange visits. Scientific dissemination output included sixty-two scholarly publications that influenced three national policies and provided development of guidelines for strategic leadership for an HIV infection—patient adherence support group. The clinical pharmacology capacity building program trained fellows that were subsequently incorporated into the national technical working group at the Ministry of Health and Child Care, who are responsible for optimizing HIV treatment guidelines in Zimbabwe. Despite serious economic challenges, consistent collaboration between UZ and UB strengthened UZ faculty scholarly capacity, retention of HIV clinical research workforce was achieved, and the program made additional contributions toward optimization of antiretroviral therapy in Zimbabwe.
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Introduction The high burden of infectious diseases in South Africa and the misuse and overuse of antibiotics are driving antibiotic resistance to the extent that bacterial infections are commonly difficult to treat, and in some cases, are untreatable. Implementing antibiotic stewardship (AS) is challenging due to a lack of physicians and pharmacists trained for treating infectious diseases. Objectives To describe the implementation, outcomes, and sustainability of a collaborative Train the Trainer (TTT) AS pharmacist mentoring program between a US hospital and hospitals in South Africa. Methods The partnership formed in 2012 around the five pillars of global engagement: shared leadership, mutually beneficial partnership, local needs‐based care, host‐driven education, and sustainability. The TTT program included bilateral site visits, development of pharmacists' AS skills, research, and paying‐it‐forward. Results Ten pharmacist mentees from private (n = 6) and public hospitals (n = 4) completed the TTT program between 2013 and 2019. Subsequently, mentees were able to transfer their AS skills to train an additional 120 pharmacists with no prior AS experience. These pharmacists made over 40 000 AS interventions in 60 hospitals across seven provinces. Mentees coauthored 12 AS publications, 1 book chapter, 4 invited commentaries in South African, US, and international journals, and presented 28 AS abstracts at national and international conferences. For nine of the mentees, this was their first AS research experience and publication. One mentee introduced an AS module to the pharmacotherapy course and 160 students completed the module. The first clinical pharmacy AS rotation was established. Mentees participated in national AS committees and engaged in AS public awareness work by delivering radio and TV interviews. Conclusions Shared leadership between the US and South African mentors led to developing a TTT program that met their local needs. The TTT program achieved its goal of helping to develop South African pharmacists capable of implementing sustainable AS interventions that improve patient care.
Objective. To identify and describe validated assessment tools measuring cultural competence relevant to pharmacy education.Methods. A systematic approach was used to identify quantitative cultural competence assessment tools relevant to pharmacy education. A systematic search of the literature was conducted using the OVID and EBSCO databases and a manual search of journals deemed likely to include tools relevant to pharmacy education. To be eligible for the review, the tools had to be developed using a study sample from the US, have at least one peer-reviewed validated publication, be applicable to the pharmacy profession, and be published since 2010.Results. The search identified a total of 27 tools from the systematic literature and manual search. A total of 12 assessment tools met the criteria to be included in the summary and their relevancy to pharmacy education is discussed.Conclusion. A review of literature demonstrates that assessment tools vary widely and there is no universal tool to assess cultural competence in pharmacy education. As cultural competence is a priority within the accreditation standards for Doctor of Pharmacy education, pharmacy programs are encouraged to develop additional tools that measure observed performance.
As globalization has grown, the concept of “global citizenship” has also evolved. The drive to expand citizenship beyond national borders spurred a nascent discipline known as global citizenship education (GCE). This article examines the continuum from globalization, to global citizenship, to a global pandemic (Covid-19)—and how the lessons from this growing age of globalism can serve as a blueprint for a new form of global citizenship following the pandemic, defined as “post-pandemic citizenship”. The first part chronicles the drive toward globalization since the second half of the 20th century. The second part details the defining traits of global citizenship. The third part calls for a new form of global citizenship that should become part of GCE and be included in global-studies-related secondary-school courses and curricula in the wake of Covid-19—a so-called post-pandemic citizenship education (PPCE)—that emphasizes public health, empathy and compassion, self-sacrifice, and cooperative spirit.
Clinical pharmacy services (CPS) have been well established in the United States for decades but are still not fully applied in many other countries, such as Taiwan. Training competent clinical pharmacists through international collaboration could accelerate the improvement and development of high‐quality CPS. This brief report describes the successful experience of National Taiwan University Hospital (NTUH) and its model of CPS development and clinical pharmacist cultivation through working with prestigious pharmacy schools abroad. The profession and value of pharmacists lie in providing patients with better drug treatments and outcomes. CPS provided in inpatient departments, pharmacist clinics, and operating room pharmacy through international collaboration all have shown clinical benefits at NTUH. Besides providing high‐quality pharmaceutical care, competent clinical pharmacists participate in clinical lectures, case discussions, and play a critical role as clinical preceptors for advanced pharmacy practice experiences of National Taiwan University (NTU) Pharmacy School, which supports the first Doctor of Pharmacy (Pharm.D.) program in Taiwan. Clinical pharmacists are also encouraged to be involved in clinical research to show the value of pharmacy services and to improve patient care. Our experience in CPS development and talent cultivation can be a reference for other hospitals so that we can all work together to enhance the value of pharmacists and improve patient care. This article is protected by copyright. All rights reserved.
Introduction Global partnerships and collaboration of pharmacy schools between the United States and Asian countries have great impacts on the development of clinical pharmacy. This article describes the decadal experience of Taipei Medical University (TMU) concerning clinical pharmacy development via partnerships with the American College of Clinical Pharmacy (ACCP) and a number of schools of pharmacy and hospital pharmacies in the U.S. and Asian countries. We specifically focus on describing the process and outcomes of the specialist pharmacist (SP) system and the residency program. Methods After the 6‐year Doctor of Pharmacy (Pharm.D.) program at TMU was approved in 2013, a number of strategies were used to advance clinical pharmacy development, including experiential faculty and site preparation, didactic faculty development, and international conferences. For the purpose of this paper, documents from TMU‐affiliated hospitals (Taipei Medical University Hospital [TMUH], Wan Fang Hospital [WFH], and Shuang Ho Hospital [SHH]) and the TMU College of Pharmacy regarding the SP system and the residency program were reviewed and analyzed. Results In 2017, TMU passed the SP career ladder system and WFH started the pharmacy residency program. As of 2020, there are a total of 7 SPs certified in three major TMU‐affiliated hospitals. Two pharmacy residents completed training in WFH. Global engagement with universities in Vietnam and Indonesia allowed TMU to give back to the global community by offering faculty development and clinical pharmacy preceptor training. Conclusion Through global partnerships, innovations in clinical pharmacy development can be diffused more widely and have resulted in practice changes such as an SP system and residency program at TMU. The experiences may provide value for those seeking to expand clinical pharmacy development via international engagement.
In Thailand during the early 1990s, there was a need for an increased number of pharmacists and expansion of their knowledge and skills to address the need of the nation. Leaders of the Thai pharmacy education community at the time crafted a long‐term plan aiming to expand the pharmacy educator workforce at a national scale through the financial support of the Royal Thai Government. This led to the establishment of the United States‐Thai Consortium for the Development of Pharmacy Education in Thailand in 1994. The aim of the Consortium was to advance pharmacy education in Thailand through the support of leading U.S. pharmacy schools using both short‐term and long‐term trainings. Twenty plus years later, pharmacy education and practice in Thailand have changed dramatically. The number of faculties (schools) of pharmacy in Thailand has increased from 10 in 1993 to 19 in 2013. The ratio of pharmacists to population has decreased from 1:10532 in 1994 to 1:2261 in 2016. The professional pharmacy curriculum has changed from a 5‐year bachelor to a 6‐year Doctor of Pharmacy (Pharm.D.) degree. The role of Thai pharmacists has been endorsed by national health service initiatives and practice guidelines. Currently, 7 universities offer residency/fellowship programs. The 8 Thai founding institutions of the Consortium are now publishing over 500 papers in high‐quality international journals annually. In summary, pharmacy education, practice, and research in Thailand have improved dramatically through the U.S.‐Thai Pharmacy Consortium. This bi‐national model of knowledge and skill transfer may serve as an example for how a large‐scale international partnership can facilitate a rapid and positive transformation of pharmacy in a developing country. Local adjustment and adaptation are required to reflect national identity and to suit the local context. This article is protected by copyright. All rights reserved.
Introduction In 2003, Purdue University College of Pharmacy (PUCOP) in West Lafayette, Indiana, began the Purdue Kenya Partnership (PKP) in collaboration with the Academic Model Providing Access to Healthcare, Moi University, and Moi Teaching and Referral Hospital, in Eldoret, Kenya. PUCOP's involvement utilized a tripartite approach of engagement, education, and scholarship to provide and expand sustainable access to high quality care. Objective This paper discusses outcomes and impacts of this academic partnership. Methods Purdue Kenya Partnership's progress in achieving its stated mission was evaluated using an outcome‐approach logic model. This model highlighted inputs, activities, and results which encompassed outputs, outcomes, and impact. A comprehensive set of ratios were calculated to quantify annual change in PKP investments against estimated metrics for engagement, education, and scholarship. These metrics were weighted by involvement level and pharmacist effort in various clinical domains. Descriptive statistics were completed that identified cumulative and totals per year for each collected data type of data collected. Results Purdue Kenya Partnership implementation utilized initial inputs of human resources, financial capital, and strategic partnerships. These inputs supported pharmacy involvement in 16 distinct care programs in both inpatient and outpatient settings which supported the care of 457 833 individual patients and grown a clinical pharmacy staff from 0 to 22 practicing clinical pharmacists. Five unique educational programs have been established which have graduated 457 trainees. Purdue Kenya Partnership has generated over $6.2 million in grant funding and disseminated 302 peer reviewed manuscripts, posters, and oral presentations combined. Ratios describing trends in engagement, education, and scholarship as a result of using the locally focused PKP approach highlight higher initial costs compared with much lower costs per outcome several years into the partnership. Conclusion The PKP's global health approach of prioritizing the population's care needs (“leading with care”) has enabled the development of sustainable engagement, education, and scholarship infrastructure with significant gains in all three domains.
The scope of pharmacy practice in global health has expanded over the past decade creating additional education and training opportunities for students, residents and pharmacists. There has also been a shift from short‐term educational and clinical experiences to more sustainable bidirectional partnerships between high‐income countries (HICs) and low‐ to middle‐income countries (LMICs). As more institutional and individual partnerships between HICs and LMICs begin to form, it is clear that there is a lack of guidance for pharmacists on how to build meaningful, sustainable, and mutually beneficial programs. The aim of this paper is to provide guidance for pharmacists in HICs to make informed decisions on global health partnerships and identify opportunities for engagement in LMICs that yield mutually beneficial collaborations. This paper uses the foundations of global health principles to identify five pillars of global health engagement when developing partnerships: (1) sustainability, (2) shared leadership, (3) mutually beneficial partnerships, (4) local needs‐based care and (5) host‐driven experiential and didactic education. Finally, this paper highlights ways pharmacists can use the pillars as a framework to engage and support health care systems, collaborate with academic institutions, conduct research, and interface with governments to improve health policy. This article is protected by copyright. All rights reserved.