Successful Remediation of an Advanced Pharmacy Practice Experience for an At-risk Student

Perceptions of remediation policies and procedures in pharmacy education

OBJECTIVE

This study aimed to (1) explore the perceptions of current remediation processes between pharmacy program administrators and faculty, and (2) identify factors surrounding successful or unsuccessful remediation in a pharmacy program.

METHODS

This qualitative study used 3 stakeholder focus groups with distinct perspectives: didactic faculty, experiential faculty, and administrators. A screening survey was used to identify eligible participants and quota sampling was used to represent various institution types and stakeholder experience. Focus groups were conducted using structured interview questions by an expert interviewer outside the research. Data were coded using the constant comparison method until consensus was achieved on the identified themes.

RESULTS

Three themes associated with remediation were identified with twelve coded categories. The codes discussed by all three stakeholder groups included methods to identify students who need remediation, types of remediation, remediation challenges, consequences of remediation, remediation effectiveness, and changes needed for remediation. The didactic and experiential faculty groups discussed the management of remediation plans, methods of remediation prevention, and lessons learned from remediation. The timing of remediation was discussed by didactic faculty. The experiential faculty noted preceptor development for timely feedback to ensure a successful remediation. All three groups mentioned having clear policies and procedures for successful remediation.

CONCLUSION

Overall, faculty and administrators had similar perceptions regarding remediation practices. The concerns about remediation between experiential and didactic faculty were most different. While all three groups believed that remediation may be useful and necessary, challenges remain and monitoring is needed to determine the most effective practices, particularly in experiential education.

A National Survey Exploring Practices and Perceptions of Sharing Experiential Evaluations With Future Preceptors

OBJECTIVE

This study aimed to understand pharmacy programs' policies and processes of sharing Advanced Pharmacy Practice Experience (APPE) assessment information among preceptors and to determine the types of grading scales currently being used nationally.

METHODS

A 14-question survey was utilized to collect information on Experiential Education policies and practices regarding APPE evaluations and assessment data sharing. The survey was administered electronically to Experiential Education Administrators at accredited schools of pharmacy nationally and gathered information on approach to APPE assessment, information sharing with future preceptors and open-ended responses on how struggling student learners are supported. Descriptive statistics were used to analyze quantitative responses, while qualitative open-ended comments were analyzed using thematic analysis.

RESULTS

A total of 95 responses were included in the analysis (67.9% response rate). The majority of programs (83.2%) reported not sharing student performance assessments with future preceptors. Themes that emerged from the analysis of open-ended comments included concerns about bias and privacy violations, and the benefits of sharing evaluations for preceptor preparation and longitudinal student growth. The grading approach varied, with 53.7% of programs using traditional tiered letter grades and 45.3% using a pass/fail grading system.

CONCLUSION

Most pharmacy programs do not share APPE assessment information with future preceptors due to concerns about bias and protecting student privacy. However, programs may be looking for alternative processes that address the need to facilitate student growth and to support struggling learners. Examples shared may provide stimulus and insight for Experiential Education Offices to engage in programmatic discussions about the approach to assessment sharing practices.

Associating Student Performance in Pharmacy Practice Didactic and Skills-Based Courses With Advanced Pharmacy Practice Experiences

Objective. To determine the association between pharmacy practice didactic course examinations and performance-based assessments with students' performance during their advanced pharmacy practice experiences (APPEs).Methods. This retrospective analysis included data from the graduating classes of 2018 to 2020. Students were coded as APPE poor performers (final course grade <83%) or acceptable performers. Assessments in pharmacy practice didactic and skills-based courses in students' second and third years were included in the analysis, with thresholds correlating to grade cutoffs. The association between poor performance mean examination scores and performance-based assessments with APPE performance was calculated.Results. Of the 403 graduates, analysis sample sizes ranged from 254 to 403. There were 49 students (12%) who met the criteria for poor performance in the APPE year. When comparing pharmacy practice didactic course performance to APPE poor performance, the proportion of mean examination scores that were <83% for six of the seven pharmacy practice didactic courses was significant; five of the seven mean examination scores were significant at the <78% threshold. Performance-based assessments that were significantly associated with APPE poor performance often required critical thinking.Conclusion. A gap in identification of students with APPE poor performance who did not fail a didactic course was demonstrated. Specifically, this finding suggests that pre-APPE curriculum should focus on assessments that include critical thinking. These methods could be used by other pharmacy programs to find components of their curricula that help identify students who need additional support prior to the APPE year.

Failure to fail - Perspective from junior faculty preceptors on the challenges of evaluating underperforming students in the experiential learning environment

INTRODUCTION

Preceptors serve as the gatekeepers between individuals progressing from student pharmacist to independent practitioner. This responsibility is challenging if a student is not progressing as required and is at risk of failure. In this article, we will review the potential consequences and barriers of "failing to fail" a student, share the emotions that come with the decision, and suggest actions that may aid in preceptor decision-making.

COMMENTARY

A preceptor's failure to fail a student has a global impact on many parties including the student, their future employer and patients, the preceptor, and the school or college of pharmacy. Despite supportive factors, preceptors may experience an internal struggle about the ripple effect of failing or not failing an experiential student.

IMPLICATIONS

Underperformance in the experiential setting is a complex issue that remains largely unseen due to "failure to fail," a concept that should be researched further in the pharmacy setting. Empowering preceptors, particularly newer preceptors, to assess and manage failing students is possible through increased discussion around the topic and focused preceptor development programs.

Considerations for remediation policy and procedures in pharmacy education

INTRODUCTION

Despite the heterogeneous nature of remediation definitions, processes, and impact on learning, it is commonly understood as a process for identifying student deficiencies in knowledge, skills, and attitudes that need to be corrected prior to student progression in the program.

COMMENTARY

Current issues related to remediation in pharmacy education include inconsistencies in practices and types within and among institutions, a lack of correlation to student academic success, effects on attrition both positive (student staying on-time for graduation) and negative (students sitting back one year), increase in faculty workload, and negativity or stigma associated with the student.

IMPLICATIONS

Key considerations in developing and implementing remediation policies and procedures include being student-focused, providing a positive frame for remediation, implementing a clear process, and early identification of students who need help.

Pharmacy student reflections and perceptions of competency and predictors of success in remediation

INTRODUCTION

Pharmacy programs employ a variety of remediation methods intended to bring underperforming students to a level of competency. Our objective was to evaluate pharmacy students' perceptions of eligibility criteria and academic outcomes of remediation and potential predictors for lack of success in the original and remediated course.

METHODS

Palm Beach Atlantic University School of Pharmacy revised its remediation policy in fall 2017, shifting from a course-centric to student-centric policy. Pharmacy students (N = 265) were surveyed in spring 2019 regarding eligibility criteria and academic outcomes of remediation. Enrolled students who remediated under the revised policy were surveyed on the lack of success in the original course and the remediation process.

RESULTS

Students viewed remediation as an opportunity to prevent delayed graduation. They agreed with the revised, student-centric eligibility criteria and with the new approach allowing all courses to be remediated. First-year students provided lower scores, whereas students who never failed a course gave higher scores. Students agreed that remediation produces proficient students who are as competent as those who passed the original course. The main reason for failing the original course was lack of study time. Students who failed remediation tended to spend more time on external activities and used less remediation resources.

CONCLUSIONS

A student-centric approach to remediation with active involvement from students and faculty support was successful in producing students who are viewed just as proficient and competent as students who passed the original course. Predictors for success were study time and the use of remediation resources.

Improving the Remediation Process for Skills-based Laboratory Courses in the Doctor of Pharmacy Curriculum

When students fail to meet minimum competence standards on summative pharmacy skills-based assessments, remediation can be used to ensure student readiness for progression. Skills-based remediation is challenging as a high volume of resources is required to develop an action plan that addresses the heterogeneity in student needs and to create and execute another assessment equivalent to the initial assessment. Although many Doctor of Pharmacy (PharmD) programs face these same challenges, there is no consensus on how to best address them. Recently, faculty from six PharmD programs convened to share ideas and approaches to overcoming these challenges. This commentary aims to define remediation as it pertains to summative skills-based assessments, share our consensus views regarding remediation best practices, and highlight areas where there is more work to be done. Our intent is to advance the ongoing conversation and empower institutions to develop their own effective and impactful skills-based remediation policies, procedures, and activities.

Supporting students with academic difficulties

INTRODUCTION

Up 15% of health professions students experience academic difficulties. We describe an early tracking system that effectively identifies and supports students with performance deficiencies. The objectives of this study were to discuss changes made in an academic success system at our new college of pharmacy, describe effectiveness of the updated program after one-year of use, and present changes that are being discussed based on the faculty and student feedback.

METHODS

We conducted in-person faculty interviews using open-ended questions to evaluate the effectiveness of our original program for supporting students with academic difficulties called the Early Tracking System (ETS). We then developed a new program titled the Individualized Plan for Academic Success System (IPASS). We conducted more faculty interviews and a student survey after the implementation of IPASS to evaluate its effectiveness.

RESULTS

In the 2018-2019 academic year at our institution, IPASS was activated 291 times, of which there were 27 course failures. The results of our study indicated a pass rate of 90.72% post-IPASS for all pharmacy students.

CONCLUSIONS

The goal of this study was to revise and implement an early tracking system that all faculty members, students, and administrators can utilize efficiently and effectively. This study demonstrated that students with academic difficulties have the potential for progression if their deficiencies are detected early. We described a unique system by which we addressed the needs of the at-risk students. The interview of faculty and survey of students indicated satisfaction with IPASS.

Remediation and reassessment methods in pharmacy education: A systematic review

BACKGROUND

Colleges of pharmacy are currently required to implement a remediation program within their curricula, but no specifications are provided on the ideal methodology. While the need for successful remediation strategies continues to grow, literature describing positive or negative outcomes of different approaches is significantly lacking. The objective of this literature review was to describe and evaluate remediation methodologies in pharmacy education.

METHODS

This literature review was completed following PRISMA criteria. A search of the PubMed, Cochrane Library, Cumulative Index of Nursing and Allied Health, Academic Search Complete, PsycInfo, Scopus, and ProQuest Central databases was conducted in July 2019. Studies were included if they involved pharmacy student education and described either remediation or reassessment.

RESULTS

The evaluated studies discussed a range of course types being remediated, a large variety of remediation strategies and timeframes, and differing overall outcomes. No studies provided comparison of remediation techniques or provided details on the implementation of their chosen approaches. A consistent finding within the evaluated studies was the inclusion of prevention strategies to attempt to avoid the need for remediation preemptively. Overall outcomes for each remedial program were inconsistent and no clear patterns were evident other than an improvement in student performance following remediation.

IMPLICATIONS

Remediation strategies included course repetition, summer restudy, reassessment, and individualized plans. Outcomes varied significantly between studies, making methodology comparisons difficult. Future studies that include more detail and consistency in the reported outcomes would be beneficial to students and help clarify remediation for colleges of pharmacy.

Getting Rigor Right

A colleague of mine once shared a story he heard of an organic chemistry teacher who would tell people he had one of the most important, lifesaving jobs in the world. Why? Because he made sure academically unprepared premed students never made it to medical school. Teachers can have many possible motivations for maintaining high academic standards in their courses. A desire to ensure future health practitioners are adequately prepared to engage in the intellectual rigor of their profession may be just one of them.

SOAP Notes During APPEs: Assessment of Student Performance

OBJECTIVES

To evaluate and compare students' ability to perform in each area of the subjective, objective, assessment, and plan (SOAP) note during advanced pharmacy practice experiences (APPEs) within an academic year. This study also aimed to compare the quality of SOAP notes between semesters: summer (1-3 rotation blocks), fall (4-6 rotation blocks), and spring (7-9 rotation blocks).

METHODS

During internal medicine and acute-care APPEs, students were required to submit a minimum of 2 SOAP notes. Each SOAP note was assessed by a full-time faculty member at a College of Pharmacy. Students were rated on the ability to perform in each area of the SOAP note using a rubric with a scale of 1 to 5 (1 = unacceptable/needs significant improvement, 5 = exemplary). This study was granted exempt approval by the Long Island University institutional review board.

RESULTS

Quality of the SOAP note summer versus fall versus spring rotations: Thirty-four SOAP notes were assessed during the summer, 48 SOAP notes were assessed during the fall, and 46 SOAP notes were assessed during the spring. Students performed similarly regardless of the semester they took for "subjective/objective, assess, and plan." All P values were nonstatistically significant. Performance on SOAP note #1 versus SOAP note # 2: On overall rubrics for SOAP notes 1 versus SOAP notes 2, students did better on SOAP notes 2 after feedback, and an opportunity to improve was provided. There were statistically significant differences on all areas of SOAP note "subjective/objective, assess, and plan." Conclusion: Overall, students performed adequately on the SOAP note activity during APPE rotations. Students performed similarly regardless of the semester/time when students took the APPEs during an academic year.

Effect of preceptor-initiated referral system on advanced pharmacy practice experience (APPE) students' rotation progress and graduation rate

INTRODUCTION

The objective of this study was to determine whether the referral and monitoring system developed at Butler University College of Pharmacy and Health Sciences (BUCOPHS) for advanced pharmacy practice experience (APPE) students is successful in improving on-time and overall graduation rates and decreasing rotation failures.

METHODS

In May 2014, a formalized process for referral and monitoring of APPE students was established. This allows preceptors to recommend (via the electronic final evaluation form) additional monitoring or intervention in the areas of professionalism, time management, drug information, communication, and therapeutic/drug knowledge. The experiential education director subsequently meets with referred students and develops a customized longitudinal plan to help each student improve in the identified areas. Data collected for students who were referred included the rotation block, rotation type, preceptor type, and the specific areas recommended for monitoring and referral. In addition, each student's quarterly progress, specific assessments outlined in each student's customized longitudinal plan, number of failed rotations, on-time graduation, and overall graduation status was recorded. The university's institutional review board approved the study.

RESULTS

Between May 2014 and April 2017, a total of 36 students were referred to the experiential education office for monitoring and/or intervention. Of these, 35/36 (97.2%) graduated on time. There were eight students who failed one APPE; no students received more than one failure.

CONCLUSIONS

Development of a referral and monitoring system for preceptors aids in retention of professional pharmacy students and increases on-time and overall graduation rates.

Academic success plans in advanced pharmacy practice experiences to promote self-awareness and improve performance

INTRODUCTION

Pharmacy schools should encourage self-awareness, provide exposure to the continuous professional development cycle, and intervene early when students exhibit performance deficiencies. Academic success plans (ASPs) have been shown in other disciplines to be successful intervention tools which encourage student reflection and self-awareness. This study evaluates the impact of ASPs used during the advanced pharmacy practice experience (APPE) curriculum at two schools.

METHODS

ASPs were assigned to students who had either a "needs development" or lower documented for the same learning outcome during more than one APPE, for poor overall performance during an APPE, or for documented professionalism issues. Average scores were calculated by assigning point values to each learning outcome assessment score (exceeds expectations = 1; competent = 0; needs development, needs significant development, remediation required = -1).

RESULTS

During AY2014-2015 and AY2015-2016, 104 ASPs were assigned to 75 students (13.5% of students). The majority (89.6%) were assigned due to repeated deficiencies in the same learning outcome(s), with the most frequent being "Develop, Implement, and Monitor Drug Therapy Plans." After completion of an ASP, average scores significantly improved (p < 0.05) in 9 out of 12 learning outcomes among all students who completed an ASP. Thirteen students completed 15 ASPs for professionalism reasons, most commonly punctuality.

CONCLUSIONS

Prior to 2015, Experiential Education Office interventions were primarily grades-based, not necessarily based on achievement of specific learning outcomes. ASPs were successfully used to allow students to practice self-awareness skills, to engage in the CPD process, and to improve APPE performance.