Barriers to expanding advanced pharmacy practice experience site availability in an experiential education consortium

Pharmacogenomics Concierge Service as an Opportunity for Pharmacist Reimbursement and Practice-based Learning

OBJECTIVE

To assess the feasibility of a pilot pharmacogenomics concierge service that incorporates student practice-based learning opportunities and a survey to determine the patients' interest and willingness to pay.

METHODS

Participants in the pilot study (n = 34) completed a survey to determine their willingness to pay for concierge services. Six participants indicating the highest level of interest were selected to participate in the program free of charge. Students conducted preliminary genetic testing to assess the potential value of a pharmacogenomics service. For the subset of participants (n = 6) invited to the concierge service, confirmatory genetic testing was completed by a third-party laboratory. A layered learning model allowed senior students to mentor and train junior students in the area of pharmacogenomics.

RESULTS

Six invited participants completed the concierge program and third-party pharmacogenomic testing, and the majority (83%) received pharmacogenomic consultation with the pharmacist. Completed surveys from participants in the pilot program (n = 34) indicated a willingness to pay $25 to $50 per month to have continued access to a pharmacist. Surveyed individuals rated their likelihood of utilizing the concierge service at a mean rating of 8.6 (SD 1.88) on a scale of 1 to 10, although this rating dropped significantly when insurance did not cover the cost. The pilot program offered opportunities for practice-based learning through a layered learning model.

CONCLUSION

This pilot concierge program presented several successes and challenges which may help others avoid common pitfalls and spur discussion on optimal ways to develop new pharmacy services and experiential opportunities for students.

A Snapshot of Introductory Pharmacy Practice Experience Program Characteristics

OBJECTIVE

To provide schools and colleges of pharmacy a snapshot of Introductory Pharmacy Practice Experience (IPPE) program characteristics to generate and share ideas for IPPE program modifications to improve student learning outcomes and comply with Standards 2025.

METHODS

A 41-item electronic survey was distributed to 140 Accreditation Council for Pharmacy Education fully accredited schools and colleges of pharmacy in 2023. IPPE program characteristics such as structure, learning activities, assessments, and requirements were described.

RESULTS

Eighty-seven programs participated in the survey (62.1% response rate). Notable findings included 64.4% of programs starting IPPEs during the first professional year, 78.6% did not count simulation hours toward Accreditation Council for Pharmacy Education hour requirements, 24.1% incorporated patient care electives, over 90% incorporated various patient care activities, 40.2% exceeded a 2:1 student-to-preceptor ratio, 15.7% incorporated layered learning, 50.0% incorporated interprofessional education, 57.5% used summative assessment rubrics based on Entrustable Professional Activities, and 77.0% used pass/fail grading.

CONCLUSION

Owing to evolving accreditation standards, the study provided valuable information about the current state of IPPEs. The study results included examples and components that programs can use to ensure that they comply with Standards 2025.

An Advanced Pharmacy Practice Experience in a University's Office of Experiential Education

The Accreditation Council for Pharmacy Education (ACPE) requires pharmacy students to complete 1440 hours of advanced pharmacy practice experiences (APPEs). The majority of all APPE hours should be in direct patient care; however, non-patient care electives can also help to prepare students to become practice ready as well as allow them to explore areas of interest. Many pharmacy schools offer elective academic rotations, but an office of experiential education (OEE) academic rotation offers a unique academic elective. This Commentary describes an OEE APPE and includes the views of a preceptor and a pharmacy student regarding the experience. A detailed list of activities for an OEE APPE that can be easily duplicated by other schools is provided. The OEE APPE can be completed online or in-person, creating greater flexibility for administration.

Characteristics of High-Performing Interprofessional Health Care Teams Involving Student Pharmacists

Objective. To identify key themes of interprofessional models of care that offer experiential education opportunities for pharmacy learners. Methods. Six pharmacists from four Area Health Education Centers in North Carolina participated in individual, 60-minute interviews. Using two pre-established frameworks, the data were analyzed qualitatively by two members of the research team to identify the characteristics of interdisciplinary care teams. Results. At the level of the organization or health care system, the theme of appropriate resources and procedures emerged. At the level of the team, the themes of appropriate resources and procedures, communication, appropriate skill mix, climate, quality and outcomes of care, and respecting and understanding roles emerged. At the level of the individual, the themes of communication, respecting and understanding roles, and individual characteristics emerged. Three themes identified in a previous study failed to emerge in the interviews: leadership and management; personal rewards, training and development; and clarity of vision. Conclusion. Although a growing body of evidence highlights the importance of designing practice models to achieve interdisciplinary care that is patient-centered and effective, capacity to support learners and effectively educate them in the principles and practices of team-based care is limited. This study provides critical insight into characterizations of interprofessional models that integrate pharmacy learners. Further research is needed to better understand the barriers to designing and implementing IPE in experiential settings.

Length of advanced pharmacy practice experience and first-time NAPLEX pass rate of US pharmacy programs

INTRODUCTION

The objectives of this study were to (1) report the length in weeks of advanced pharmacy practice experiences (APPEs) of US pharmacy programs in 2016 and (2) compare first-time North American Pharmacy Licensure Examination (NAPLEX) pass rates according to the length in weeks of the programs' APPEs.

METHODS

First-time NAPLEX pass rate was obtained from the National Association of Boards of Pharmacy public web page. The length in weeks of programs' individual APPEs (iAPPEs) and program characteristics were obtained from the individual pharmacy programs' web pages. Analysis of variance was used to compare iAPPE length and first-time NAPLEX pass rate and multiple regression was used to quantify the independent influence of iAPPE length on first-time NAPLEX pass rate.

RESULTS

The length in weeks was evenly distributed among four-, five- and six-week iAPPEs for NAPLEX testing years 2013 to 2015, although six-week iAPPEs have been preferred recently. The first-time NAPLEX pass rate was not associated with the total APPE length or whether the program used four-, five- or six-week iAPPEs for all three years and for the three-year aggregate pass rate.

CONCLUSION

Six-week iAPPEs were the most common, but not the majority among pharmacy programs. Longer total or individual APPEs did not translate into higher first-time NAPLEX pass rates. Length of iAPPE rotations can be chosen without concern that student pharmacists' performances on first-time NAPLEX pass rates will be significantly impacted.

Perceived value of partnerships between schools of pharmacy and health systems

INTRODUCTION

This study sought to quantify opinions of statewide health systems stakeholders regarding the value of partnerships with schools of pharmacy. Being better able to meet the needs of preceptors and their employers will allow schools to increase capacity of high-quality pharmacy practice experiences.

METHODS

A brief survey was developed and administered to statewide contacts from systems currently partnering with member schools of the North Carolina Experiential Education Consortium. Respondents were asked to rate, using a Likert scale, 15 incentive statements relating to potential benefits provided by schools in exchange for experiential rotations.

RESULTS

Forty-one responses were received from 53 invitees (77% response rate). The two most highly-valued incentives per survey respondents were continuing education (CE) accreditation by the school (74% essential), and access to school resources (74% essential). The lowest scoring incentives included system-wide committee involvement by faculty (26% essential), co-funded faculty positions (29% essential), and resident precepting by faculty (34% essential).

CONCLUSIONS

Incentive ratings differed significantly from previous reports describing value, which primarily focus on clinical interventions and cost savings provided by student pharmacists. Experiential staff at schools of pharmacy should consider a similar study to ascertain how best to meet the needs of their local partners and maximize commitments for pharmacy practice experiences.

Preceptor Perceptions of Virtual Quality Assurance Experiential Site Visits

Objective. To determine preceptor perceptions of the value of experiential quality assurance site visits between virtual and onsite visits, and to gauge preceptor opinions of the optimal method of site visits based on the type of visit received. Methods. Site visits (12 virtual and 17 onsite) were conducted with 29 APPE sites located at least 200 miles from campus. Participating preceptors were invited to complete an online post-visit survey adapted from a previously validated and published survey tool measuring preceptor perceptions of the value of traditional onsite visits. Results. Likert-type score averages for survey questions ranged from 4.2 to 4.6 in the virtual group and from 4.3 to 4.7 in the onsite group. No statistically significant difference was found between the two groups. Preceptors were more inclined to prefer the type of visit they received. Preceptors receiving onsite visits were also more likely to indicate no visit type preference. Conclusion. Preceptors perceived value from both onsite and virtual site visits. Preceptors who experienced virtual site visits highly preferred that methodology. This study suggests that virtual site visits may be a viable alternative for providing experiential quality assurance site visits from a preceptor's perspective.

Role and impact of student pharmacists and a pharmacist on an international interprofessional medical brigade

BACKGROUND AND PURPOSE

Colleges of pharmacy will be seeking new opportunities to provide student pharmacists with interprofessional and global experiences. The objectives of this paper are to describe an international experience to expand interprofessional and global pharmacy education and to evaluate the roles and impact of fourth-year pharmacy students and a pharmacist integrated into an interprofessional team on a medical brigade to Guatemala.

EDUCATIONAL ACTIVITY AND SETTING

In August 2014, two fourth-year student pharmacists and one pharmacist/professor joined a group of 26 pre-medical students from Boston College (BC), six medical doctors and a nursing assistant as part of a one-week medical brigade to Quetzaltenango, Guatemala. An electronic survey was administered to all brigade members upon completion of travel. The survey assessed the most useful services provided by the pharmacist and pharmacy students on the brigade and changes in perspective towards the role of pharmacy on an interprofessional healthcare team. The survey also collected information describing satisfaction with communication, efficiency, professionalism and knowledge of the pharmacy staff.

FINDINGS AND DISCUSSION

Pharmacy staff was utilized for knowledge of drug products, therapeutic substitution, counseling and drug dosing/calculations. The brigade directly resulted in an increased likelihood for physicians and students to refer a question to a pharmacist. After this brigade, all non-pharmacy members viewed pharmacists as important members of the medical team and felt better prepared to work as part of a team.

SUMMARY

The experience was effective in fostering interprofessional relationships amongst healthcare students and professionals.

Development of a template to facilitate reflection among student pharmacists

BACKGROUND

Reflective practice activities utilizing appropriate tools enhance learning during and after experiential placements. Reflective tools described in the literature, used to support students on traditional placements of a duration of at least two weeks, sit at the unstructured end of a continuum (completely unstructured to just minimal structure). Additionally, non-traditional settings in role-emerging placements are of value as an alternative for experiential education. There were no reflective tools in the literature to provide a means of supporting pharmacy students as novice reflectors in non-traditional settings.

OBJECTIVES

To develop one fit-for-purpose tool that students could utilize across their experiences, regardless of type or duration of experiential placement.

METHODS

A multi-phased approach was adopted, including a mix of methodologies: interviews, focus groups, informal feedback from stakeholders, and grading reflective accounts utilizing Mezirow's categories of reflection. A range of stakeholders were involved at each stage to ensure the reflective tool was fit-for-purpose. These included students, placement preceptors, and academic staff acting as graders of student reflective accounts.

RESULTS

A total of 24 students participated in focus groups, 13 supervisors/preceptors engaged in interviews and informal feedback, and 853 student reflective accounts were graded, over 3 years. The final tool that has been developed and evaluated in this research supported students to develop to critical reflectors (6% - Phase 2 increased to 62.9% - Phase 3).

CONCLUSIONS

This novel and innovative approach supports novice reflectors, encourages reflection on action and enhances professional development. It is a structured yet flexible tool, for which there was a gap in the published literature. It can be utilized in varied placements in pharmacy curricula internationally.

Assessment of clinical and educational interventions that Advanced Pharmacy Practice Experience (APPE) students contributed to a family medicine residency program

BACKGROUND AND PURPOSE

The literature firmly establishes that clinical interventions made by pharmacy students on Advanced Pharmacy Practice Experience (APPE) rotations contribute significantly to cost-savings realized by the hosting practice sites. The Accreditation Council for Pharmacy Education (ACPE) specifies the experiential curricula include opportunities for students to learn about, from, and with other members of the healthcare team through interprofessional education activities.

EDUCATIONAL ACTIVITY

This study assesses clinical and educational interventions contributed by APPE students at a family medicine residency program to determine the extent students were engaged in the interprofessional team and physicians' receptiveness to the recommendations.

FINDINGS

Student interventions made from January 2009 to September 2012 were recorded in a Microsoft Excel Spreadsheet. Data was evaluated to determine 1) the most common types of clinical and educational interventions, 2) potential associated cost-savings/avoidance, and 3) provider receptiveness to recommendations based upon acceptance rates. A standardized scheme was utilized to assign a cost savings value according to Midwest America Division of Hospital Corporation of America (HCA) clinical savings standards. Pharmacy students contributed 2868 interventions in 3.5 years. A total of 59.2% of interventions were clinical and accounted for an estimated cost savings of $55,892. The remaining 40.8% of interventions were pharmacy care activities, none were associated with a cost savings and three-fourths were considered educational. Intervention acceptance rate was over 80%, showing providers were very receptive to pharmacy students.

SUMMARY

This study lends support that APPE students provide substantial clinical and educational contributions to healthcare providers and patients affiliated with family medicine residency programs. Additionally, healthcare providers and patients are very receptive to pharmacy students as members of the interprofessional team.

Analysis of the Student Experience in an Attending Pharmacist Model General Medicine Advanced Pharmacy Practice Experience

Objective. To characterize and determine the quality of the student experience in an attending pharmacist model (APM). Methods. In-depth interviews were conducted with students completing an advanced pharmacy practice experience (APPE) at two general medicine services using the APM over a 2-year time period. Quantitative information about student learning and interprofessional interactions were extracted from student evaluations of the site. Data from the mixed model were analyzed to identify strengths of the APM and areas needing improvement. Results. Strengths of the APM included positive student interaction with the pharmacy resident and more students reporting full integration in and accountability to the interprofessional team for patient outcomes compared to students in non-teaching models. A few students at one site reported a need for greater delineation of expectations, more initial support from preceptors, and initial responsibility for fewer patients. These factors were modified before the second APM year and subsequent reports from students at this site were uniformly positive. Students at the second site did not note areas needing improvement. The APM increased student capacity at both sites. Conclusion. The attending pharmacist model provided a high quality learning experience for students, particularly with regard to integration into and accountability for patient outcomes to the interprofessional team. Qualitative research methods enabled precise detection of areas needing improvement at one site and confirmed that changes made at that site improved the student experience.

Evaluation of a Longitudinal Advanced Pharmacy Practice Experience

Objective. To describe satisfaction and career path of students who participated in the longitudinal advanced pharmacy practice experience (APPE). Methods. A 3-part survey was administered to students enrolled between January 1, 2010, and December 31, 2013. The sections of the survey evaluated respondents' baseline characteristics, satisfaction, and career path. Results. Majority of the respondents had a GPA above 3.0 (91%), pharmacy school honors (84%), work experience in retail (16%) or multiple pharmacy sites (38%), and were members of at least one professional organization (76%). Sixty-nine percent reported that the program exceeded their expectations. Strengths included practice site consistency, rotation diversity, preceptors, presentations, and collaboration with health care professionals. Students gained approximately 76 hours of additional clinical experience, compared to if they completed rotations at individual sites. After graduation, more than half of the respondents accepted a pharmacy practice residency (67%). Conclusion. The results of this study support the need for APPE programs that prepare students to deliver advanced patient care, while providing them with professional development.

Best Practices in Establishing and Sustaining Consortia in Pharmacy Education

Objective. To describe best practices, necessary resources, and success or lessons learned from established consortia in pharmacy education. Methods. Using semi-structured interviews and qualitative analysis, interviews with members of established consortia in pharmacy education were conducted until saturation was reached. Themes were analyzed and meaningful descriptions of consortia characteristics were developed using systematic text condensation. Results. Thirteen interviews were conducted. The primary purpose for forming a consortium was identified as threefold: share ideas/best practices; facilitate collaboration; and perform shared problem-solving. For experiential education consortia, two additional purposes were found: share capacity for practice sites, and promote standardization across programs. When investigating best practices for established consortia, three main themes were identified. These included strategies for: (1) relationship building within consortia, (2) successful outcomes of consortia, and (3) sustainability. Successful outcomes included scholarship and, sometimes, program standardization. Sustainability was linked to structure/support and momentum. Respect was considered the foundation for collaborative relationships to flourish in these consortia. Conclusions. Pharmacy education consortia form through a process that involves relationship building to produce outcomes that promote sustainability, which benefits both pharmacy schools and individual faculty members. Consortium formation is a viable, productive, and often necessary institutional goal for pharmacy schools.

The Offering, Scheduling and Maintenance of Elective Advanced Pharmacy Practice Experiences

The Accreditation Council for Pharmacy Education (ACPE) provides standards for colleges of pharmacy to assist in the provision of pharmacy education to student pharmacists. An integral part of all college educational programs includes the provision of experiential learning. Experiential learning allows students to gain real-world experience in direct patient care during completion of the curriculum. All college of pharmacy programs provide several Advanced Pharmacy Practice Experiences (APPEs), which include a balance between the four required experiences and a number of other required or elective APPEs. Required APPEs include advanced community, advanced institutional, ambulatory care, and general medicine. The elective APPEs include a myriad of opportunities to help provide a balanced education in experiential learning for student pharmacists. These unique opportunities help to expose student pharmacists to different career tracks that they may not have been able to experience otherwise. Not all colleges offer enough elective APPEs to enable the student pharmacist to obtain experiences in a defined area. Such an approach is required to produce skilled pharmacy graduates that are capable to enter practice in various settings. Elective APPEs are scheduled logically and are based upon student career interest and site availability. This article describes the offering, scheduling and maintenance of different elective APPEs offered by The University of Tennessee College of Pharmacy.

A qualitative analysis of common concerns about challenges facing pharmacy experiential education programs

OBJECTIVE

To qualitatively analyze free-text responses gathered as part of a previously published survey in order to systematically identify common concerns facing pharmacy experiential education (EE) programs.

METHODS

In 2011, EE directors at all 118 accredited pharmacy schools in the US were asked in a survey to describe the most pressing issues facing their programs. Investigators performed qualitative, thematic analysis of responses and compared results against demographic data (institution type, class size, number of practice sites, number and type of EE faculty member/staff). Expert and novice investigators identified common themes via an iterative process. To check validity, additional expert and novice reviewers independently coded responses. The Cohen kappa coefficient was calculated and showed good agreement between investigators and reviewers.

RESULTS

Seventy-eight responses were received (66% response rate) representing 75% of publicly funded institutions and 71% of schools with class sizes 51-150. Themes identified as common concerns were site capacity, workload/financial support, quality assurance, preceptor development, preceptor stipends, assessment, onboarding, and support/recognition from administration. Good agreement (mean percent agreement 93%, ƙ range=0.59-0.92) was found between investigators and reviewers.

CONCLUSION

Site capacity for student placements continues to be the foremost concern for many experiential education programs. New concerns about preceptor development and procedures for placing and orienting students at individual practice sites (ie, "onboarding") have emerged and must be addressed as new accreditation standards are implemented.

Unique collaboration between a private college of pharmacy and a private academic health system

Advanced experiential education represents the culmination of a pharmacy student's training, where students can apply the knowledge they have learned in the classroom to real patients. Unfortunately, opportunities for students to provide the direct patient care recommended by pharmacy organizations and accrediting bodies are lacking. Additionally, academic health systems that can provide these experiences for students are experiencing hardships that have stalled the expansion of postgraduate training programs and services. Formal cooperation between unaffiliated colleges of pharmacies and academic health systems has the potential to increase the number of experiential students completing rotations in an academic environment, expand postgraduate education training programs, enhance the development of resident educators, increase research and scholarly opportunities, and expand clinical pharmacy services. This article describes the formation of a unique joint initiative between a private academic health system without a college of pharmacy and a private college of pharmacy without a hospital. The successful cultivation of the relationship has resulted in professional growth at both institutions and can be implemented at other sites around the country to synergize the efforts of academic health systems and colleges of pharmacy.

Qualitative analysis of common definitions for core advanced pharmacy practice experiences

OBJECTIVE

To determine how colleges and schools of pharmacy interpreted the Accreditation Council for Pharmacy Education's (ACPE's) Standards 2007 definitions for core advanced pharmacy practice experiences (APPEs), and how they differentiated community and institutional practice activities for introductory pharmacy practice experiences (IPPEs) and APPEs.

METHODS

A cross-sectional, qualitative, thematic analysis was done of survey data obtained from experiential education directors in US colleges and schools of pharmacy. Open-ended responses to invited descriptions of the 4 core APPEs were analyzed using grounded theory to determine common themes. Type of college or school of pharmacy (private vs public) and size of program were compared.

RESULTS

Seventy-one schools (72%) with active APPE programs at the time of the survey responded. Lack of strong frequent themes describing specific activities for the acute care/general medicine core APPE indicated that most respondents agreed on the setting (hospital or inpatient) but the student experience remained highly variable. Themes were relatively consistent between public and private institutions, but there were differences across programs of varying size.

CONCLUSION

Inconsistencies existed in how colleges and schools of pharmacy defined the core APPEs as required by ACPE. More specific descriptions of core APPEs would help to standardize the core practice experiences across institutions and provide an opportunity for quality benchmarking.

Status of pharmacy practice experience education programs

OBJECTIVE

To assess financial, personnel, and curricular characteristics of US pharmacy practice experiential education programs and follow-up on results of a similar survey conducted in 2001.

METHODS

Experiential education directors at 118 accredited US pharmacy colleges and schools were invited to participate in a blinded, Web-based survey in 2011. Aggregate responses were analyzed using descriptive statistics and combined with data obtained from the American Association of Colleges of Pharmacy to assess program demographics, faculty and administrative organizational structure, and financial support.

RESULTS

The number of advanced pharmacy practice experience (APPE) sites had increased by 24% for medium, 50% for large, and 55% for very large colleges and schools. Introductory pharmacy practice experience (IPPE) sites outnumbered APPEs twofold. The average experiential education team included an assistant/associate dean (0.4 full-time equivalent [FTE]), a director (1.0 FTE), assistant/associate director (0.5 FTE), coordinator (0.9 FTE), and multiple administrative assistants (1.3 FTE). Most faculty members (63%-75%) were nontenure track and most coordinators (66%) were staff members. Estimated costs to operate an experiential education program represented a small percentage of the overall expense budget of pharmacy colleges and schools.

CONCLUSION

To match enrollment growth, pharmacy practice experiential education administrators have expanded their teams, reorganized responsibilities, and found methods to improve cost efficiency. These benchmarks will assist experiential education administrators to plan strategically for future changes.

A demonstration study comparing "role-emergent" versus "role-established" pharmacy clinical placement experiences in long-term care facilities

BACKGROUND

Increasing challenges to recruit hospital sites with full-time on-site pharmacy preceptors for institutional-based Advanced Pharmacy Practice Experiences (APPE) has made it necessary to consider alternate experiential models. Sites with on-site discipline specific preceptors to supervise students have typically been referred to in the literature as "role-established" sites. In British Columbia, long-term care (LTC) facilities offered a unique opportunity to address placement capacity issues. However, since the majority of these facilities are serviced by off-site community pharmacists, this study was undertaken to explore the viability of supervising pharmacy students remotely - a model referred to in the literature as "role-emergent" placements. This paper's objectives are to discuss pharmacy preceptors' and LTC non-pharmacist staff experiences with this model.

METHODS

The study consisted of three phases: (1) the development phase which included delivery of a training program to create a pool of potential LTC preceptors, (2) an evaluation phase to test the viability of the LTC role-emergent model with seven pharmacists (two role-established and five role-emergent) together with their LTC staff, and (3) expansion of LTC role-emergent sites to build capacity. Both qualitative and quantitative methods were used to obtain feedback from pharmacists and staff and t-tests and Mann-Whitney U tests were used to examine equivalency of survey outcomes from staff representing both models.

RESULTS

The 76 pharmacists who completed the training program survey rated the modules as "largely" meeting their learning needs. All five role-emergent pharmacists and 29 LTC participating staff reported positive experiences with the pharmacy preceptor-student-staff collaboration. Preceptors reported that having students work side-by-side with facility staff promoted inter-professional collaboration. The staff viewed students' presence as a mutually beneficial experience, suggesting that the students' presence had enabled them to deliver better care to the residents. As a direct result of the study findings, the annual role-emergent placement capacity was increased to over 45 by the end of the study.

CONCLUSIONS

This study demonstrated that role-emergent LTC facilities were not only viable for quality institutional APPEs but also provided more available sites, greater student placement capacity, and more trained pharmacy preceptors than could be achieved in role-established facilities.

Development of a collaborative psychiatric advanced pharmacy practice experience

Introduction: Faculty are required to balance multiple duties, including, but not limited to teaching, precepting, and scholarly activity. Likewise, pharmacy managers with faculty appointments are challenged with balancing teaching and administrative duties. With increasing numbers of pharmacy students enrolled in colleges of pharmacy and the recent economic decline, there are concerns that increased responsibilities of faculty and preceptors may lead to sub-optimal advanced pharmacy practice experiences (APPEs).

Objectives: Describe a collaborate approach in teaching a psychiatric APPE allowing for additional time for other responsibilities while providing a favorable environment for students.

Methods: Pharmacy faculty and managers developed a collaborative psychiatric APPE. The pharmacists divided lectures and case discussions. Students were given many responsibilities (e.g., counseling, intervention documentation). Preceptor evaluations were documented and evaluated.

Results: Sixty-four students were precepted over two years. Student evaluations of APPE preceptors averaged 3.74/4.00. Additionally, faculty and pharmacy managers accomplished other activities.

Conclusion: It appears this collaborative team taught approach succeeded in providing an auspicious environment for students while allowing preceptors to be productive.

Capacity ratios to assess the solvency of a college's advanced pharmacy practice experience program

OBJECTIVE

To use the capacity ratio to determine solvency in 10 advanced pharmacy practice experiences (APPEs) offered by a college of pharmacy.

METHODS

Availability in each APPE was determined based on preceptor responses, and student need was tabulated from 3 preference forms. Capacity ratios were calculated by dividing preceptor availability by the sum of student requests plus 20% of student requests; ratios ≥ 1 indicated solvency. For the 3 required APPEs, minimum capacity ratios were calculated by dividing availability by the sum of student number plus 20% of the student number. When possible, the capacity ratio for the APPE was calculated by geographic zone.

RESULTS

The 3 required APPEs had statewide minimum capacity ratios that were consistent with solvency: advanced community (2.8), advanced institutional (1.6), and ambulatory care (2.5). Only 3 of 7 elective APPEs demonstrated solvency. The elective APPEs for which requests exceeded availability were association management (0.8), emergency medicine (0.8), cardiology (0.6), and human immunodeficiency virus (HIV) ambulatory care clinic (0.4). Analysis by zone revealed additional insolvent practice experiences in some locations.

CONCLUSIONS

The capacity ratio allowed for assessment of 10 APPEs and identification of practice experience areas that need expansion. While the capacity ratio is a proposed standardized assessment, it does have some limitations, such as an inability to account for practice experience quality, scheduling conflicts, and geographic zone issues.

Promoting direct patient care services at community pharmacies through advanced pharmacy practice experiences

OBJECTIVES

To determine the relative benefits of three different models of advanced pharmacy practice experience (APPE) in successfully integrating the delivery of direct patient care into students' final year community pharmacy clerkships.

METHODS

All fourth-year pharmacy students at the University of British Columbia were divided into one of three study arms for their community APPE: a 2 × 4-week rotation in a traditional format, a 1 × 8-week rotation where their preceptors had experienced a 2-day education course and a 1 × 8-week rotation with both preceptor education plus a 5-day pre-APPE in-store orientation and peer debriefing.

KEY FINDINGS

All 123 students conducted patient consultations and documented their care. Students in the pre-APPE + preceptor education arm provided nearly double the number of direct patient consultations than did students in the preceptor-education-only arm or the traditional 2 × 4-week arm. Numbers of drug-related problems identified and interventions performed per patient consult did not differ across study arms.

CONCLUSIONS

Pre-APPE orientation activities provided an enhanced learning environment, promoted greater student engagement, provided care to more patients, increased preceptor preparedness and enhanced in-store patient-centred care practice. Certain of these learning activities can also form part of third- and fourth-year introductory pharmacy practice experiences to prepare students for their final-year APPE.

The use of capacity ratios in introductory pharmacy practice experiences

OBJECTIVE

To describe the use of capacity ratios following the assignment of introductory pharmacy practice experiences (IPPEs) to a rising third-year pharmacy (P3) class.

METHODS

Practice experience availability for IPPEs was collected by means of preceptor response to requests. Following assignment of IPPEs to the rising P3 class, capacity ratios from the IPPEs available across the entire state and within each of 4 geographic zones were calculated. Capacity ratios for both community pharmacy and institutional pharmacy also were calculated.

RESULTS

The capacity ratio for IPPEs across the entire state was 2.11, which documents solvency. When the capacity ratios were calculated individually for community pharmacy and institutional pharmacy, solvency was also achieved. Likewise, IPPE capacity ratios were solvent in all 4 geographic zones.

CONCLUSIONS

Capacity ratios are helpful in evaluating IPPE availability as they can be used to determine practice experience need in either type of practice experience or geographic zone.

An online module series to prepare pharmacists to facilitate student engagement in patient-centered care delivery: development and evaluation

INTRODUCTION

Accreditation bodies across North America have adopted revised standards that place increased emphasis on experiential education and preceptors to promote and demonstrate patient-centered, pharmaceutical care practices to students. Since such practices are still evolving, challenges exist in recruiting skilled preceptors who are prepared to provide such opportunities. An online educational module series titled "A Guide to Pharmaceutical Care" (The Guide) was developed and evaluated to facilitate this transition. The objectives of this paper are: (1) to describe the development of the modules; and (2) to present the evaluation results from its pilot testing.

METHODS

The Guide was developed as an online, self-directed training program. It begins by providing an overview of patient care (PC) philosophy and practice, and then discusses the tools that facilitate PC. It also provides a range of tips to support students as they provide PC during their experiential learning. Pharmacists participating in the pilot study were recruited using purposive and snowball sampling techniques. A pre-post quantitative survey with additional open-ended questions was used to evaluate the modules.

RESULTS

THE MODULES INCORPORATED A VARIETY OF TEACHING STRATEGIES: self-reflection exercises, quizzes to review important concepts, quick tips, flash cards, and video clips to illustrate more in-depth learning. Thirty-two pharmacists completed the pre-post assessment and reported significant increases in their confidence because of this training. The most influenced outcome was "Application of techniques to facilitate learning opportunities that enable pharmacy students to practice pharmaceutical care competencies." They also indicated that the training clarified necessary changes in their teaching techniques as well as increased their own practice skills.

CONCLUSION

The study results indicated that a series of self-paced online modules with appropriate content improved the pharmacists' confidence to nurture students' experiential learning for PC practice as well as enhanced their PC knowledge and skills within their own practices.

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy

OBJECTIVE

To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload.

METHODS

Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes).

RESULTS

APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes.

CONCLUSION

APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

The capacity ratio as a measure of solvency in experiential education

OBJECTIVE

To determine the utility of the capacity ratio to measure and compare solvency in experiential education in 6 colleges and schools of pharmacy in the Northwestern United States.

METHODS

The 6 colleges and schools of pharmacy combined data on student placements needed, site availability, and changes made to placements during the 2009-2010 and 2010-2011 academic years and calculated capacity ratios for the advanced and introductory experience programs in the region. Comparisons also were made to previously published capacity results to determine whether the capacity ratio was useful in identifying trends and guiding preceptor and site development.

RESULTS

Capacity ratio calculations were successful in facilitating comparison of capacity within and across regions. Experiential education is solvent in the Northwest overall, but specific parts of experiential programs were found to have more capacity than others. Trends in the Northwest were consistent with capacity in other regions.

CONCLUSIONS

The capacity ratio can determine and facilitate comparison of solvency within and across colleges and schools of pharmacy and thereby inform decisions about resource management in experiential education.

Dietitian Preceptor Knowledge, Skills, Attitudes, and Training: Key Informant Perceptions

Purpose: Through consultation with Canadian dietitian informants, we aimed to identify the desired knowledge, skills, and attitudes (KSA) for preceptors, training opportunities, and the barriers that prevent preceptor training.

Methods: In this qualitative study, an open-ended survey was sent electronically to 100 key informants across Canada. Informants had experience as preceptors or with dietitian preceptors. Informants were asked to reflect upon the desired KSA, training needs, and barriers to training for dietitian preceptors. Categories of responses under each of these headings were developed on the basis of informants’ responses.

Results: Forty-nine key informants completed the survey, for a 49% response rate. Of the respondents, 41% (20/49) were in clinical practice and 35% (17/49) worked in community/public health areas. The knowledge and skills domains consisted of themes related to teaching and learning, including assessing, planning, and evaluating. Attitudes expressed included considering learners as colleagues and the training of learners as a professional responsibility. Perceived barriers to training preceptors included workload demands and a lack of recognition from peers and employers for this work. Dietitian preceptor training opportunities ranged from no training to formal programs.

Conclusions: These findings are integral to the basic understanding of the desired KSA and training needs of Canadian dietitian preceptors.

High-fidelity patient simulation series to supplement introductory pharmacy practice experiences

OBJECTIVE

To introduce a high-fidelity simulation series into a 5-year doctor of pharmacy (PharmD) curriculum to demonstrate a hybrid model for introductory pharmacy practice experience (IPPE) delivery.

DESIGN

Fourth-year pharmacy students at a satellite campus participated in a 6-week high-fidelity patient simulation series in which small groups of students worked with members of a patient care team to care for patients in the following scenarios: asthma exacerbation, acute decompensated heart failure, and infective endocarditis with a subsequent anaphylactic reaction to the antibiotic. Fourth-year pharmacy students at the main campus who did not participate in the simulation served as a comparator group.

ASSESSMENT

Students' scores on a knowledge-based post-simulation quiz were significantly higher than scores on the presimulation quiz (p < 0.05). Knowledge retention was significantly higher among the simulation participants than students in the comparator group (p = 0.004). The majority (76%) of students felt more confident "making clinical recommendations to a healthcare provider" after completing the simulation series (p = 0.01).

CONCLUSION

High-fidelity patient simulation is an effective active-learning strategy to augment IPPEs that allows students to apply clinical skills in a realistic but low-risk patient care setting.

Web-based portfolios for pharmaceutical care plans during advanced pharmacy practice experiences

OBJECTIVE

To implement and assess a Web-based patient care portfolio system for development of pharmaceutical care plans by students completing advanced pharmacy practice experiences (APPEs) throughout a statewide preceptor network.

DESIGN

Using a Web database, students in APPEs documented 6 patient cases within 5 disease state categories. Through discussion of the disease states and inclusion of patient information such as problems, desired outcomes, and interventions, a complete pharmaceutical care plan was developed for each patient.

ASSESSMENT

Student interventions were compared by geographical regions to assess continuity of patient care activities by students. Additionally, students completed an evaluation of the portfolio course to provide feedback on the portfolio process. Students documented an average of 1.8 therapeutic interventions per patient case and documented interventions in all geographical regions. The majority of students indicated that the portfolio process improved their ability to develop a pharmaceutical care plan.

CONCLUSION

The Web-based patient care portfolio process assisted with documentation of compliance with Accreditation Council of Pharmacy Education (ACPE) standards and College of Pharmacy Competency Statements. Students indicated the portfolio process was beneficial in developing skills needed for creating pharmaceutical care plans.