Assistant Professors Amanda Margolis and Sin Yin Lim advance research in experiential education and pediatric opioid tolerance

By Emma Gran

Two University of Wisconsin–Madison School of Pharmacy faculty are being honored with prestigious 2021 New Investigator Awards from the American Association of Colleges of Pharmacy (AACP) for their research

Out of a competitive pool of faculty from more than 140 pharmacy schools across the nation, Assistant Professor Amanda Margolis (PharmD ‘09, MS ‘17) and Assistant Professor Sin Yin (Sean) Lim, both of the School’s Pharmacy Practice Division, are two out of just 14 pharmacy educators selected for the recognition.

The AACP New Investigator Awards are intended to be the first extramural research funding received by a faculty member as a principal investigator, to provide a foundation for future scholarly endeavors and continued success.

“Dr. Lim and Dr. Margolis are talented junior faculty and very deserving of this accomplishment.”
—Beth Martin

For Margolis, the award will support her work to improve the evaluation consistency of PharmD students, while Lim will investigate opioid tolerance in young patients.

“Early career awards are extremely competitive,” says Professor Beth Martin (BS ’90, MS ’03, PhD ’06), chair of the Pharmacy Practice Division. “Dr. Lim and Dr. Margolis are talented junior faculty and very deserving of this accomplishment.”

Margolis and Lim will join the other awardees at the 2022 AACP Annual Meeting in Grapevine, Texas, to present the findings of this research and be publicly honored. 

Experiential education evaluation

Margolis’s award-winning project aims to improve the ability of PharmD students to receive consistent, valuable feedback regarding interprofessional communication and teamwork when participating in Advanced Pharmacy Practice Experience (APPE) rotations with the use of a validated assessment tool.

A critical feature of these experiential rotations is the working relationship between the student and their pharmacist preceptor, as preceptors are responsible for providing ongoing support and feedback for the students — markedly shaping their skills and professional development.

As one of School’s APPE coordinators, Margolis frequently interacts with PharmD students about their clinical rotations, giving her a strong understanding of students’ experiences in the multitude of APPE sites that span the state of Wisconsin.

“I get feedback from students that some preceptors schedule a time for observation and to have a discussion,” she says, while other students report a less in-depth experience.

To improve the consistency of preceptor evaluations, with a particular focus on the new accreditation standard of interprofessional communication and teamwork, Margolis began implementing iTOFT (Individual Teamwork Observation and Feedback Tool) in 2018.

“iTOFT is a validated tool that includes a checklist of 12 skills related to interprofessional teamwork that we ask preceptors to get a direct observation of their students engaging in,” Margolis explains. “Then, we ask them to give students clear feedback on how they did. For example, did the student understand the different roles and responsibilities of the teams they are interacting with?”

By providing a universal system to provide feedback to students on clinical rotations, Margolis hopes student pharmacists will not only have improved experiences, but also will be better equipped to refine their skills and be more prepared for their pharmacy careers.

After a year of preceptors using iTOFT, Margolis surveyed the preceptors and students to evaluate the process and experience using the tool. The survey revealed mixed results for preceptor satisfaction and suggested preceptors were not completing the activity as intended, pushing Margolis to apply for the New Investigator Award to continue improving the student experience and preceptor satisfaction with the validated tool.

“We have already learned some really interesting things and there will definitely be some beneficial revisions to how we are teaching and evaluating PharmD students.”
—Amanda Margolis

The research grant has allowed Margolis, with collaboration from Professor Beth Martin and Social and Administrative Sciences Assistant Professor Olufunmilola Abraham, to begin two phases of intensive qualitative research to fully understand the survey results and identify areas needing modification — both to iTOFT itself and preceptor use of the assessment activity.

For the first phase, Margolis held a series of focus groups with some of the School’s preceptors to gather qualitative data on their experiences using iTOFT. The second phase will consist of direct interviews with preceptors to further augment and refine their collection of data.

The funding also allowed Margolis to hire two students, such as Health Services Research in Pharmacy graduate student Maeleigh Tidd, to assist her team in transcription and qualitative analysis — greatly speeding up the process of gathering data and allowing for more in-depth interviews.

“We have already learned some really interesting things and there will definitely be some beneficial revisions to how we are teaching and evaluating PharmD students,” Margolis says. “I am really excited to see what the final product ends up being.”

Pediatric opioid tolerance

Pediatric patients can receive opioid infusions for several days after a surgery to manage pain, which may result in a build-up of opioid tolerance and need for increased dosages to achieve the same levels of pain management during their hospital stay.

In as little as five days of exposure to opioid infusions, patients are at risk of experiencing withdrawal, which carries symptoms such as anxiety, irritability, increased pain, nausea, vomiting, and muscle cramping.

Lim’s awarded research seeks to reduce opioid exposure and tolerance among pediatric patients requiring pain management drugs after surgery by examining the relationship between immune responses and opioid dependence.

“There is currently no method for preventing opioid tolerance, so I am hoping to find some ways to help these young people recover sooner and in a more harmless way,” Lim says.

For the past year, he has been examining data from the pediatric ICU at the American Family Children’s Hospital to look for clues as to which patients are more likely to have an increased tolerance to opioids, and therefore a higher risk of dependence and withdrawal.

For patients under the age of 18, the long-term impacts of opioid dependence and withdrawal are unknown. To Lim, the risks associated with youth exposure to opioids are exigent, especially as recent research findings point to a relationship between immune response and opioid tolerance. Through the New Investigator Award, Lim wants to further explore the relationship.

“If we look at how immune responses are changed by opioids, we can use that as a clue to see whether patients are becoming tolerant through exposure or are prone to opioid tolerance,” says Lim.

“There is currently no method for preventing opioid tolerance, so I am hoping to find some ways to help these young people recover sooner and in a more harmless way.”
—Sin Yin Lim

He hopes the funding will allow his team to expand their analysis of data from the American Family Children’s Hospital to identify more testable hypotheses and begin a series of investigations into reducing opioid exposure in young patients. 

To begin, Lim aims to identify whether certain immune responses can be used as a predictor of opioid tolerance and withdrawal in critically ill children. Other hypotheses will test a variety of other composite predictors, such as demographics and genetics.

“If we can find a predictor, we can take action early on instead of waiting until patients become tolerant, and change the trajectory of these young patients’ lives,” says Lim.