Objectives. To assess pharmacy students' critical thinking (CT) measures and identify areas for curricular reform. Methods. Pharmacy students were given the California Critical Thinking Skills Test and Disposition Index at various points in the PharmD program. Scores were compared with a national referent group and evaluated for changes across the curriculum and between classes. Results. Students were comparable to national norms. Pretest and posttest scores for total disposition showed improvement. Scores in all subcategories except for truth-seeking were consistently above 40. The CT skills of the pharmacy students varied compared with those of referent students, but the pharmacy students' overall score of 18 was in the 73rd percentile. Pre-and post-skills scores showed improvement. Students scoring low on the pretest improved more than those scoring high. Conclusions. Students had a consistent disposition towards CT and compared favorably to national norms. Both disposition and skills improved across the curriculum. Dimensions of critical thinking on which students score low should be areas for curricular and other program changes.

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Objectives. A course titled "Advanced Diabetes Care" was developed and was offered to pharmacy students as a didactic component of a new diabetes concentration. The purpose of the course was to enhance students' depth of knowledge and skills needed for successful roles in diabetes management. Methods. The course exposed students to principles of diabetes management and its complications, skills training in the use of devices, and marketing strategies for diabetes management services. Contextual learning consisted of class visits by expert guest speakers, guided in-class discussions, training in foot assessment using a video and demonstration, sharing of student experiences in role-playing, "Living the Life" of a diabetic patient, podiatry clinic visits, patient interviews, and student presentations. Results. A pre-and post-class student survey indicated improvement of knowledge and skills in addition to changing attitudes during the course. Conclusions. Students' knowledge and skills improved as a result of active and contextual learning experiences integrated into a new specialty diabetes care course.

Objectives. The objective of this study was to evaluate the effects that skills development and education acquired during a diabetes certificate program had on pharmacists' delivery of diabetes care. Methods. To evaluate the program's effect, a survey was administered as a pretest to a group of pharmacists (N=30) beginning the program. In addition, the survey was administered to all pharmacists completing the certificate program in the last four years (N=126). Survey questions focused on the provision of services, patient contact, and reimbursement. Results. Pharmacists who completed the program reported higher rates of providing consistent blood glucose management, nutrition education, and patient goal setting. In addition, a higher percentage reported documenting and billing for diabetic-related services. Conclusion. The diabetes certificate program in this study had a positive impact on pharmacists' provision of diabetes care services to patients.

Considering their high level of contact with patients, pharmacists are in the best position to provide valuable patient-centered care services to patients with diabetes. Many pharmacists have completed diabetes care certificate programs and/or obtained credentialing through a variety of mechanisms (ie, Certified Diabetes Educator, Board Certified in Advanced Diabetes Management, Certified Diabetes Manager [CDM]). 1 A study conducted in 2003 surveyed CDM pharmacists to determine their disease state management activities. 2 The majority (67%) of the 279 respondents practiced in community pharmacy settings. Sixty-four percent of the respondents cited disease state management with diabetes care (59%) as the most frequently provided service. Although encouraging, 34% of the respondents reported that they spent less than 10% of their time providing direct patient care. 2 In a survey of community pharmacists, nearly all (94%) of the 93 respondents indicated that they performed basic medication counseling services more than 50% of the time. 3 In comparison, 26% of pharmacists provided intermediate care (ie, hypoglycemia information, blood glucose meter use, foot care, administration of insulin, dietary/nutrition and exercise information, when to contact healthcare provider) and 27% provided advanced diabetes patient care (ie, defining target glucose ranges, stressing of importance of yearly eye exams as well as regular lab testing, information regarding the occurrence of illness/severe stress) more than 50% of the time. Likewise, Plake et al. 4 found that 68% of pharmacists (n = 62) who completed a diabetes certificate program for community pharmacists in the Midwest provided diabetes care. The range of care varied widely, with 66% providing blood glucose monitor training, 34% assisting with goal setting, and 9% completing foot checks. All services were part of the certificate program, suggesting that barriers may be preventing the provision of advanced diabetes care.A number of researchers have studied barriers that exist in the delivery of pharmaceutical care in community practice, 5-11 as well as community and migrant health centers 12 and smoking cessation programs. 13 While inadBackground: Pharmacists are in a unique position to provide valuable patient care services to patients with diabetes. Even though many pharmacists have developed their diabetes care knowledge base and obtained credentials, they do not provide diabetes care on a regular basis, suggesting the existence of barriers to care other than knowledge and skills.