Sanya Ram - Academia.edu (original) (raw)

Papers by Sanya Ram

BMC health services research, Feb 20, 2024

Background Professional misconduct has evolved into a worldwide concern, involving various forms ... more Background Professional misconduct has evolved into a worldwide concern, involving various forms and types of behaviours that contribute to unsafe practices. This study aimed to provide insights into the patterns characterising pharmacist misconduct and uncover underlying factors contributing to such instances in New Zealand. Methods This research examined all cases of pharmacist misconduct sourced from the Health Practitioners Disciplinary Tribunal (HPDT) database in New Zealand since 2004. Characteristics of the sampled pharmacists and cases were extracted, followed by a systematic coding of the observed misconduct issues. Identification of risk factors was accomplished through content analysis techniques, enabling an assessment of their prevalence across various forms of misconduct. Results The dataset of pharmacist misconduct cases comprised 58 disciplinary records involving 55 pharmacists. Seven types of misconduct were identified, with the most commonly observed being quality and safety issues related to drug, medication and care, as well as criminal conviction. A total of 13 risk factors were identified and systematically classified into three categories: (1) social, regulatory, and external environmental factors, (2) systematic, organisational, and practical considerations in the pharmacy, and (3) pharmacist individual factors. The most frequently mentioned and far-reaching factors include busyness, heavy workload or distraction; health impairment issues; and life stress or challenges. Conclusions The patterns of pharmacist misconduct are complicated, multifaceted, and involve complex interactions among risk factors. Collaborative efforts involving individual pharmacists, professional bodies, responsible authorities, policy-makers, health funders and planners in key areas such as pharmacist workload and well-being are expected to mitigate the occurrence of misconduct. Future research should seek to uncover the origins, manifestations, and underlying relationships of various contributing factors through empirical research with appropriate individuals.

Pharmacy, Oct 26, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Pharmacy Education, 2011

Background: Students" engagement in dishonest behaviours is problematic and may influence future ... more Background: Students" engagement in dishonest behaviours is problematic and may influence future professional practice. Aims: To consider the antecedents predicting engagement in academic dishonesty. Methods: A total of 433 pharmacy and medical students participated in a survey measuring engagement in academic dishonesty, self deception, justification, and acceptability. Hierarchical linear regression and path analysis methods were conducted. Results: Engagement in academic dishonesty was predicted by later years of study, justification, responses to a case scenario and notions of acceptability (R 2 = 34%). An appropriately fitted path model showed that each explanatory variable correlated with engagement in academic dishonesty separately rather than being mediated by notions of acceptability. Conclusion: It is likely that students are establishing different ethical frames of references when engaging in dishonest behaviours such as rational self-interest or Machiavellianism. The prevention of academic dishonesty and its intervention needs to consider individualised, group-based and institutional processes.

Pharmacy

Introduction: Community pharmacies are high-performance workplaces; if the environment is not con... more Introduction: Community pharmacies are high-performance workplaces; if the environment is not conducive to safe practice, mistakes can occur. There has been increasing demand for pharmacists during the COVID-19 pandemic as they have become integral to the response. Suboptimal practices in the work environment and with pharmacists and their teams can impact the safe delivery of services. New Zealand pharmacists’ perceptions of the current work environment and beliefs around whether suboptimal practice have increased within the last five years and the effect of the COVID-19 pandemic on their practices are unknown. Aim/Objectives: To assess what New Zealand pharmacists associate with suboptimal practice in their workplace and investigate the effect of the COVID-19 pandemic on pharmacists and their workplaces. Methods: We employed an anonymous online questionnaire derived from a human factors framework utilised in the aviation industry to explore the potential environment, team and orga...

This chapter presents an overview of access pathways to high-cost medicines in New Zealand. It de... more This chapter presents an overview of access pathways to high-cost medicines in New Zealand. It describes the avenues via the Pharmaceutical Management Agency’s (PHARMAC) access schemes and also avenues via non-PHARMAC mechanisms.

Prescription stimulants are increasingly used worldwide, beyond their indications by healthy indi... more Prescription stimulants are increasingly used worldwide, beyond their indications by healthy individuals without medical need, to augment performance in academic settings. This research explored the prevalence and motivation for the use of cognitive enhancers (CEs) by students in a tertiary academic setting. It investigated the factors that influence the decision to use CEs. The attitudes of professionals towards the use of CEs, the frequency of requests, and the prescriber’s willingness to prescribe CEs were also examined. This research provides insight into the discourse necessary for the development of policy and guidelines that are congruent among tertiary institutions and professions.

Trials, 2021

Background Regular ingestion of sub-hallucinogenic doses of psychedelics, referred to as “microdo... more Background Regular ingestion of sub-hallucinogenic doses of psychedelics, referred to as “microdosing”, has gained increasing popularity and attention in the press and in online forums, with reported benefits across multiple cognitive and emotional domains. Rigorously controlled studies to date, however, have been limited in scope and have failed to produce results comparable to those reported in the grey literature. Methods Eighty healthy male participants will receive 14 doses of placebo or 10 μg lysergic acid diethylamide orally every 3rd day over a 6-week treatment protocol. A battery of personality, creativity, mood, cognition, and EEG plasticity measures, as well as resting-state fMRI imaging, will be administered at baseline and at the end of the protocol. Creativity, mood, and plasticity measures will additionally be assessed in the acute phase of the first dose. Daily functioning will be monitored with questionnaires and a wearable sleep and activity tracker. Discussion Thi...

American Journal of Pharmaceutical Education, 2019

Objective. To assess pharmacy students' opinions of an interprofessional learning (IPL) course in... more Objective. To assess pharmacy students' opinions of an interprofessional learning (IPL) course in their final year of the Bachelor of Pharmacy program at The University of Auckland. Methods. Pharmacy students participated in the second day of a two-day simulation-based course, WardSim, alongside medical and nursing students in an acute care, hospital ward setting. After finishing the course, all students were asked to complete a questionnaire. The responses of pharmacy, nursing, and medical students on the scaled questions were compared. An in-depth thematic analysis of the pharmacy students' responses to the open-ended questions was completed using an iterative process. Results. Significant differences were found among the students' responses regarding the prioritization of care, systematic assessment of patients, and communication strategies. Pharmacy students had less favourable responses regarding the IPL experience than medical and nursing students. However, overall responses were positive. Some of the themes that emerged among the pharmacy students' responses included: learning communication tools, being assertive in communicating with other health care professionals, and understanding their own and others' roles in the health care team. Furthermore, some pharmacy students reported feeling underprepared for and underutilized during patient care scenarios. Conclusion. An IPL experience in an acute patient care setting demonstrated clear and beneficial learning outcomes for pharmacy students, especially in regards to communicating and understanding their roles and those of others on their team. Tailoring the pre-work or scenarios for the IPL experience to be more pharmacy orientated and having pharmacy students participate on both days may improve the preparedness for IPL.

PLOS ONE, 2020

Introduction and aims The non-medical use of prescription stimulants such as methylphenidate, dex... more Introduction and aims The non-medical use of prescription stimulants such as methylphenidate, dexamphetamine and modafinil is increasing in popularity within tertiary academic settings. There is a paucity of information on awareness, attitudes, and acceptability by professionals of use in this context. This study aimed to investigate professionals’ knowledge of and attitudes towards the use of cognitive enhancers (CEs) in academic settings, and their willingness to use a hypothetical CE. Design and methods A mail survey was sent to doctors, pharmacists, nurses, accountants and lawyers in New Zealand. These disciplines were chosen as they require professional registration to practice. The questionnaire comprised four sections: (1) demographics, (2) knowledge of CEs, (3) attitudes towards the use of CEs, and (4) willingness to use hypothetical CEs. Results The response rate was 34.5% (414/1200). Overall, participants strongly disagreed that it was fair to allow university students to ...

Drugs: Education, Prevention and Policy, 2020

Abstract Cognitive enhancers (CEs) such as methylphenidate, dexamphetamine and modafinil are incr... more Abstract Cognitive enhancers (CEs) such as methylphenidate, dexamphetamine and modafinil are increasingly used beyond their prescribed indications by healthy individuals without medical necessity, in academic settings. Prescribing of these stimulant medicines have increased over the last decade. Aim To explore psychiatrists’ attitudes towards the use of CEs in academic settings, and their willingness to prescribe CEs. Methods The study was conducted via an anonymous, paper-based questionnaire sent to a random sample of 200 psychiatrists in New Zealand. The questionnaire assessed demographics and knowledge of CEs, attitudes towards the use of CEs in healthy individuals, perceptions on the extent of use by university students and attitudes towards, and willingness to prescribe CEs. Results Of the 200 questionnaires distributed, 81 completed questionnaires were returned, giving a response rate of 40.5% (81/200). Although 19.8% of participants reported receiving requests from university students for CEs, only 6.1% reported prescribing medicines for university students that they considered were for cognitive enhancement. None of the participants would routinely prescribe methylphenidate to a healthy university student. Reasons for not prescribing CEs included concern for safety, being unethical, and not warranted in the absence of illness. Conclusion Psychiatrists are aware of the use of CEs by students and play a crucial role in prescribing or curbing its use. There was a lack of consensus within the profession on attitudes towards efficacy, the safety of CEs when prescribed and potential for adverse outcomes.

Medical Science Educator, 2019

There is strong evidence that dishonesty occurs amongst medical students, and other allied health... more There is strong evidence that dishonesty occurs amongst medical students, and other allied health students and growing evidence that it occurs amongst medical academics. We believe that accidental dishonesty (or not knowing about the rules of regulations governing academic integrity) is a common attribution describing engagement in dishonesty; however, we believe that dishonest action is more often influenced and determined according to circumstance. In this paper, we aim to work through the literature that frames dishonest action with a focus on medical education, research and publication. We argue that the implications for medical education are far reaching and the root causes of many instances of dishonesty need to be more fully understood so that comprehensive, case-by-case ameliorative strategies can be developed.

Substance use & misuse, Sep 21, 2017

Cognitive enhancement is the use of prescription stimulant medicines by healthy individuals for n... more Cognitive enhancement is the use of prescription stimulant medicines by healthy individuals for nonmedical use in academic settings. Commonly used cognitive enhancers (CEs) include methylphenidate, amphetamines, and modafinil. To understand the motivation to use CEs, it is important to look beyond prevalence and explore the extent to which attitudes, beliefs, and intentions predict the decision to use CEs. The study aimed to investigate what factors explain the decision to use CEs among tertiary students in New Zealand, using the Theory of Planned Behaviour (TPB). Students from the Schools of Pharmacy, Nursing, Medicine, Law, and Accounting at a university in New Zealand were invited to complete a paper-based questionnaire. The questionnaire elicited students' attitudes, subjective norms, and perceived control toward illicit use of CEs using TPB. An exploratory factor analysis was conducted. Response rate was 88.6% (442/499). Students who perceived CE use to be socially and ethi...

Medical Science Educator, 2016

Many students study overseas which has educational, cultural/social, and economic implications fo... more Many students study overseas which has educational, cultural/social, and economic implications for host countries and those international students. It has been reported that medical and health sciences educational experiences are beginning to develop at a transnational level whereby curricula are shared among educational centres across different countries, which extends the notion of unidirectional internationalization. Quality assurance is required to ensure global standards regarding professional and academic conduct are maintained. This study investigates the development of a questionnaire that measures students' academic integrity in medical and health sciences learning environments. Eight hundred and forty-four medical and health science students from New Zealand and Nigeria completed a newly formed 26-item questionnaire measuring aspects of academic integrity. The responses were primarily analysed using exploratory factor analysis. The exploratory factor analysis suggested three meaningful factors accounting for 34.29 % of the variance that related to specific areas of academic dishonesty. These factors were termed: (1) copying and collusion; (2) cheating; and (3) complying. This study shows that a questionnaire measuring aspects of academic integrity can have cultural meaning to students studying in two diverse nation states. This study is meant as a developmental process whereby further data collection and analyses are required in other nation states. These extensions can be conducted specifically as in the case of medical and health sciences or more broadly taking into account other professional disciplines. It is envisaged that this process would be ongoing and one that will require many iterations.

Journal of medical ethics, Jul 6, 2016

One of the key learning objectives in any health professional course is to develop ethical and ju... more One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the 'four principles' determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded u...

The Asia-Pacific Education Researcher, 2014

ABSTRACT In higher education in New Zealand, there is a burgeoning interest in, and concern with,... more ABSTRACT In higher education in New Zealand, there is a burgeoning interest in, and concern with, the way students conduct themselves in their learning practices. Engagement in academically honest and dishonest behaviours is a crucial area of study within higher education. To operationalize effective teaching and assessment, it is critically important to consider how different ethnic groups operate within the learning environment when preparing for, and completing, assessments. The present study investigated differences between two ethnic groups studying in New Zealand (Asian and European) with respect to their disclosures of academic dishonesty and engagement with ethical learning experiences (ELE). Responses from 312 pharmacy and medical students were analysed in this study. A questionnaire was designed to elicit responses about engagement in academic dishonesty and ELEs. The findings emphasise that there were low rates of engagement in academically dishonest behaviours by both groups and there were no differences in disclosure of cheating and ELE. The findings showed small but significant differences between Asian and European students with respect to disclosure in the areas of copying and collusion. Subtle interactions were also noted for ethnicity and year of study, and ethnicity and gender, indicating that later year students diverged more than earlier year students and differences were more apparent amongst male students. Lastly, the findings showed that those students who read the student code of conduct were more likely to engage in academically ‘honest’ behaviours. These findings have implications for educationalists throughout the world, and it is possible that the hidden curriculum is playing a strong role in reframing the notion and practice of ethical conduct.