Developing a comprehensive APPE-readiness plan with a focus on skills, attitudes, and behaviors

A scoping review of advanced pharmacy practice experience readiness assessment measures across schools of pharmacy

BACKGROUND

The development and implementation of Advanced Pharmacy Practice Experience (APPE) readiness assessments has been an area of increased interest to the academy since the publication of the Accreditation Council for Pharmacy Education (ACPE) standards in 2016. This scoping literature review aims to provide an updated summary of current APPE readiness assessment practices among ACPE-accredited institutions in the United States (US).

METHODS

A literature search was conducted between 2022 and 2024 using the terms "APPE student readiness," "APPE readiness assessment," "APPE preparedness," "APPE student preparedness," "pharmacy" AND "readiness assessment", "pharmacy" AND "practice readiness," and "pharmacy" AND "student practice readiness" in Pubmed and Embase. The websites for the American Journal of Pharmaceutical Education and Currents in Pharmacy Teaching and Learning were also searched using these terms. Abstracts for all results were reviewed. Abstract only and poster presentations were excluded, as well as articles centered on non-US and/or non-ACPE-accredited institutions. Data was collected regarding the outcomes assessed, type of assessment activity, and how the assessment was implemented. Results were reviewed by a second author to ensure consistency in reporting.

RESULTS

A total of 289 unique abstracts were reviewed by author pairs for inclusion based on relevance to the review objectives. A total of 13 articles were included in the final analysis. Each institution measured different knowledge areas, abilities, and entrustable professional activities (EPAs). Most programs had a summative component, with APPE readiness being primarily assessed in the final didactic year of the pharmacy curriculum. Most programs report at least one source of validity.

IMPLICATIONS

Given the lack of specific APPE readiness assessment requirements in the ACPE Standards 2016, the different assessment methods among programs were not surprising. However, the commonalities identified can be leveraged with the release of the Curricular Outcomes and Entrustable Professional Activities (COEPA) 2022 to promote a standardized definition of APPE readiness. Future research should focus on formative assessment methods embedded throughout the didactic curriculum to identify "at-risk" students prior to a "high-stakes" summative assessment at the end of the didactic curriculum that impedes student progression to the APPE year.

A Systematic Review of APPE Readiness Assessments Utilized by US Schools of Pharmacy

OBJECTIVE

The 2016 Accreditation Council for Pharmacy Education standard 25.8 requires schools of pharmacy to assess student readiness for Advanced Pharmacy Practice Experiences (APPEs). We performed a systematic review to identify how schools of pharmacy in the United States assess student readiness for APPE rotations in accordance with Accreditation Council for Pharmacy Education accreditation guidelines.

FINDINGS

From a search of 6 databases, we identified 1053 unique studies, of which 11 were eligible for inclusion in our review. The most commonly reported assessment method was the use of a capstone course; however, these courses varied significantly from school to school in duration, resources used, and content. Regardless of the specific approach used, first-time and overall pass rates were high.

SUMMARY

We found that while most studies reported using some type of capstone course for APPE readiness assessment, there was variability in how these courses were structured and the assessment methods used within the courses. The future 2025 standards may dictate a more uniform structure for readiness assessments; however, further research is needed to identify best practices regarding the assessment of APPE readiness.

Development and Initial Evaluation of an Advanced Pharmacy Practice Experience Readiness Assessment Plan

Objective. To describe the composition of an advanced pharmacy practice experience (APPE) readiness assessment plan (APPE-RAP) along with initial findings following retrospective application to a cohort of students.Methods. The APPE-RAP uses existing summative assessment data within the ExamSoft platform on six skills and 12 ability-based outcomes from the pre-APPE curriculum. Thresholds were created to sort students into three readiness categories for skills and knowledge, determine overall readiness, and identify need for curricular review. Students that completed their third professional year in spring 2021 served as the pilot cohort. The APPE-RAP was applied after the cohort progressed to APPEs to analyze appropriateness of categorization and revise the plan before full implementation.Results. The APPE-RAP was applied to 131 students that progressed to APPEs in spring 2021. Overall, 87.9% were APPE ready for all skills and aggregate knowledge. Two skills met criteria for curricular review. Seven students (5.3%) were categorized as red on at least one skill after one remediation attempt. Nine students (7%) were categorized as red on an aggregate knowledge-based ability-based outcomes (ABO) evaluation. Four students (3.1%) did not pass one of their first two experiential rotations. Using a red categorization on aggregate knowledge as a risk indicator identified APPE failure with 94% specificity and a 98% negative predictive value.Conclusion. Existing assessment data may be leveraged to identify assessment targets to help quantify APPE readiness. Further research is warranted to identify additional assessment thresholds that enhance quantification of APPE readiness as well as the impact of focused remediation on attainment of APPE readiness.

Implementation of a series of advanced pharmacy practice experience (APPE) preparatory topics into a skills lab curriculum

BACKGROUND AND PURPOSE

Advanced pharmacy practice experiences (APPEs) play a significant role in readying students for professional practice. Factors beyond traditional knowledge and skills taught in the didactic curriculum may play a role in APPE success. The purpose of this manuscript is to describe an activity implemented within a third-year skills lab focused on APPE preparedness, the methods used, and student feedback related to the series.

EDUCATIONAL ACTIVITY AND SETTING

Experiential and skills lab faculty collaborated to generate advice for students regarding common misconceptions or areas of difficulty encountered on APPEs. The advice was developed into short topics that were paired with and presented at the start of most lab sessions with impromptu contributions from faculty and facilitators integrated at the time of delivery.

FINDINGS

One hundred twenty-seven third-year pharmacy students (54% of the cohort) consented to complete a follow-up survey and provided feedback on the series. Most students agreed or strongly agreed with the elements evaluated, providing positive feedback for all ranked statements. Feedback from free-text response questions indicated that many students found all topics presented to be beneficial and suggested that topics of interest for the upcoming semester included advice regarding residencies/fellowships/employment, wellness, and communication with preceptors.

SUMMARY

Student feedback indicated an overall perception of benefit and value from most respondents. Implementation of a similar series in other courses is a potential area for future study.

Teaching of the patient workup process improves students' perceptions of preparation for advanced pharmacy practice experiences

BACKGROUND AND PURPOSE

One of the most common daily tasks on Advanced Pharmacy Practice Experiences (APPEs) is "working up" patients for inpatient rounds or outpatient visits. The purpose of this study was to assess a change in student pharmacist comfort level in performing a patient workup before and after the Pre-APPE Workshop by specifically teaching this process.

EDUCATIONAL ACTIVITY AND SETTING

The patient workup process was included in the Pre-APPE Workshop, a one-week APPE orientation course at the end of the third professional year. Students completed a 34 question self-assessment prior to instruction and after completion of the course to assess their comfort level with working up patients and readiness for APPEs. Student perceptions were compared pre- and post-assessment. Additionally, performance on assignments and results from a voluntary course evaluation were assessed.

FINDINGS

One hundred and fifty-two (100%) students enrolled in the Pre-APPE Workshop completed the pre- and post- self-assessments. Differences in student comfort level were found between the pre- and post-course self-assessments (median, [interquartile range]) related to performing an inpatient workup (3 [2-3] versus 3 [3-3], median change 0 [range - 2, 3]), and the outpatient workup (3 [2-3] versus 3 [3-4], median change 1 [range - 2, 3]), Overall, students felt more prepared to start APPEs after the Pre-APPE Workshop (3 [2-3] versus 3 [3-4]).

SUMMARY

Incorporating teaching of the patient workup process into the pre-APPE curriculum improved student pharmacist's comfort level with completing patient workups, and perceptions of preparation for APPE rotations.

Predictors of student pharmacist success on an advanced pharmacy practice experience-readiness performance-based assessment

INTRODUCTION

The study objective was determining the relationship of certain predictor variables with student performance on an advanced pharmacy practice experience (APPE)-readiness performance-based assessment (PBA) in the third professional year (P3).

METHODS

This retrospective study aimed to identify if student predictors and/or curricular-related predictor variables correlate with student performance on a patient interview and documentation activity (PIDA), an APPE-readiness assessment. Student predictors included Pharmacy College Admission Test score, pre-pharmacy cumulative grade point average (GPA), end of first professional year (P1) GPA, end of second professional year GPA, end of fall P3 GPA, and elective Pharmacists' Patient Care Process (PPCP) score. Curricular-related predictor variables comprised specific activities with emphasis on patient care skill development in P1 through P3 years. Adjusted and unadjusted linear regression models assessed correlations between PIDA score and student predictors as well as curricular variables.

RESULTS

Students from the Classes of 2018 through 2020 at Southern Illinois University Edwardsville School of Pharmacy (N = 231) were included. Two student predictors, P3 GPA and PPCP elective score, showed statistically significant correlations with PIDA performance. One curriculum-related variable, P3 activity with an emphasis on medication reconciliation, demonstrated a statistically significant correlation with student performance on the PIDA.

CONCLUSIONS

Student performance on a cumulative PBA may be predictive from prior curricular learning experiences that assess similar patient care skills. The predictive impact of the elective PPCP score on a PBA needs additional research. Recent implementation of a new curriculum may lead to identification of other predictors of student success on PBAs.

Exploring Multiple Perspectives on Pharmacy Students' Readiness for Advanced Pharmacy Practice Experiences

Objective. This study aimed to enrich the Academy's understanding of pharmacy students' readiness for advanced pharmacy practice experiences (APPEs) by exploring the perspectives of three primary stakeholders: APPE students, APPE preceptors, and APPE faculty site directors.Methods. A descriptive qualitative study of APPE readiness was conducted using workplace learning as a guiding conceptual framework. Data were collected between March and September 2019 through semi-structured focus groups and interviews with students (five groups), preceptors (four groups), and faculty site directors (one group, two individual interviews). The data were analyzed using directed content analysis.Results. Participants described APPE readiness as a multifaceted construct comprised of four themes: learner characteristics, participation in workplace activities, relationship-building, and workplace practices to orient and support students. While all participants addressed each category, faculty site directors and preceptors tended to focus on learner characteristics, while students emphasized their participation in the workplace and relationship building.Conclusion. Knowledge is widely recognized as a requirement for APPE readiness. This study identified learner characteristics, workplace participation, and relational skills as additional requirements. Some of these criteria are challenging to assess prior to APPEs, which makes orienting students both prior to and at the start of APPEs particularly important to support readiness. Thus, a comprehensive review of APPE readiness might also include assessing the readiness of workplaces, administrators, and preceptors for APPE students.