A Study of Layered Learning in Oncology

Exploring Feedback Mechanics during Experiential Learning in Pharmacy Education: A Scoping Review

(1) Background: This scoping review aims to explore the literature on feedback for pharmacy students during experiential learning, with a focus on identifying the modes of delivery of feedback and the perceived impact of feedback on student learning outcomes. (2) Methods: The scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, Web of Science, Embase, EBSCO, ERIC, and ProQuest Central were searched electronically from their inception until the end of February 2023 using a combination of keywords and MeSH terms related to feedback, pharmacy education, and student learning outcomes. Data were synthesized narratively. (3) Results: This review included 13 studies published between 2008 and 2022. Almost half of the included studies were conducted in the USA (n = 6, 46%) and reported the perspective of undergraduate pharmacy students (n = 6, 46%). Verbal feedback was the most common mode of feedback delivery (n = 6, 46%). The enablers of effective feedback included timely feedback (n = 6, 46%), feedback provided in a goal-oriented and objective manner (n = 5, 40%), and student-specific feedback (n = 4, 30%). On the other hand, the most common impediments to feedback efficacy were providing extremely positive feedback and lack of constructive criticism. (4) Conclusions: Our findings highlight the importance of feedback model implementation in pharmacy education and preceptor training programs to ensure effective and quality feedback to pharmacy students.

Adapting the layered learning model to a virtual international exchange program

INTRODUCTION

The layered learning model (LLM) is a well-established teaching approach designed for attending preceptors to train post-graduate learners and to precept students. The adaptation of a LLM to a virtual exchange program has not been previously described. The purpose of this study was to evaluate the effectiveness of the longitudinal virtual international exchange program in applying principles of the LLM to multiple levels of learners and instructors at West Virginia University (WVU) School of Pharmacy and Kitasato University (KU) School of Pharmacy.

METHODS

The online survey piloted the impact of applying the LLM to virtual international exchange sessions on improving participant knowledge in pharmacy practice, pharmacy education, cultural practices, and cultural awareness. The survey questions assessed the program's structure and effectiveness in achieving learning outcomes related to pharmacy residency topics and cultural competency using a five-point Likert scale.

RESULTS

Median scores of the effectiveness of the virtual international exchange program structure were high (≥ 4.0). Two questions evaluating the use of the LLM had median scores of 4.0. All nine residency-related questions were rated ≥3.0. The median scores for three questions evaluating small group discussions and the use of the LLM were rated significantly higher by WVU participants than KU participants. There were no significant differences in program structure and learning outcome ratings between participant groups (student vs. resident/fellow vs. preceptor/faculty).

CONCLUSIONS

Application of the LLM to the virtual international exchange program was positively received by participants, particularly by United States participants.

Implementation and evaluation of pharmaly houses as learning communities to promote community, wellness, and advising

INTRODUCTION

Although medical education has demonstrated learning communities promote wellness and community while supporting advising and mentoring, its application in pharmacy is limited. This study explored faculty and student perceptions of pharmacy learning communities (PLC), including structure, member interactions, and curriculum topics.

METHODS

PLCs involving first-year (PY1) student advisees, third-year (PY3) peer mentors, and faculty coaches were implemented. The PLC model included Pharmaly Houses, which were compromised of multiple Pharmalies, with each Pharmaly consisting of one faculty coach, two PY3 peer mentors, and approximately 10 PY1 advisees. PLC members were invited to participate in semi-structured focus groups, and transcripts were analyzed using inductive coding.

RESULTS

Three major themes and related subthemes emerged: strengths of the PLC structure (e.g., multiple perspectives, community, networking); interactions of Pharmaly members (i.e. faculty coaches, PY3 peer mentors, PY1 advisees); and feedback on PLC curriculum topics (e.g., topic consultation, continued learning). Participants indicated the multiple perspectives provided by Pharmaly members was a strength and highlighted the PLC structure facilitated a sense of community and belonging among Pharmaly members while promoting expanded networking within the House. While the PLC expanded networks, faculty and PY1 advisees desired more one-to-one interactions. Further, students reflected on how current PLC curriculum topics (e.g., wellness) prompted continued learning, reflection, and discussion outside the House or Pharmaly meeting.

CONCLUSIONS

Participants indicated PLCs can support student access to mentoring and advising, promote wellness, and foster a sense of community and belonging. The unique peer mentoring model further promoted community.

Pharmacy Resident Perspectives on the Layered Learning Practice Model

Objective: To describe pharmacy resident perspectives on the layered learning practice model (LLPM) at large academic medical centers in the United States and identify the types of training residents receive to prepare for the LLPM. Methods: This was a cross-sectional, mixed methods study that surveyed pharmacy residents completing training at large, academic medical centers on their perspectives of the LLPM. Residents with at least 4 weeks of precepting experience were eligible to complete an online survey. Descriptive statistics were generated for demographic and Likert data while themes were identified from narrative free responses. Results: Twenty-seven resident responses from 10 institutions were included. Likert data showed generally positive perspectives toward overall experience with the LLPM and perceived LLPM impact on clinical knowledge and professional practice, with 100.0% of respondents agreeing they enjoyed precepting under the LLPM. However, 44.4% also agreed that precepting was stressful. LLPM impact on resident behavior received positive to neutral responses; 63.0% neither agreed nor disagreed that the LLPM changed their approach to patient care. Written comments revealed themes such as sources of stress within the LLPM, increased depth of learning, improved comprehensive patient care, and improved professional growth. The most common forms of LLPM training occurred through preceptor and student evaluations (73.1% and 61.5%, respectively) and orientation (50.0%). Conclusion: These findings identified a variety of resident perspectives on the LLPM ranging from positive to negative and revealed possible areas of improvement related to LLPM implementation. Residency programs may consider exploring stressors on the resident role in the LLPM to better structure resident precepting training and maximize their clinical learning experience.

Feedback for Learning in Pharmacy Education: A Scoping Review

Feedback is an effective pedagogy aimed to create cognitive dissonance and reinforce learning as a key component of clinical training programs. Pharmacy learners receive constant feedback. However, there is limited understanding of how feedback is utilized in pharmacy education. This scoping review sought to summarize the breadth and depth of the use of feedback within pharmacy education and identify areas for future research. PubMed, Embase, Scopus, and Web of Science were searched for English articles since January 2000 to identify studies related to feedback in pharmacy education. Sixty-four articles were included for analysis, stratified by moderate and major theory talk, where moderate theory talk explicitly included feedback into study design and major theory talk included feedback into both study design and analysis. Feedback was provided in Bachelor (14%), Master (15.6%), Doctor of Pharmacy (67.2%) and post-graduate programs (4.7%) on a variety of curricular objectives including communication and patient work up in didactic, objective structured clinical examination (OSCE), and experiential settings, and career/interview preparation in the co-curriculum. Feedback comments were mostly written in didactic courses, and both written and verbal in OSCE, experiential, and co-curricular settings. The pharmacy education feedback literature lacks depth beyond student perceptions, especially with respect to assessing the effectiveness and quality of feedback for learning. While feedback has been utilized throughout pharmacy education across myriad outcomes, several areas for inquiry exist which can inform the design of faculty and preceptor development programs, ensuring provision of effective, quality feedback to pharmacy learners.

Exploring practice site contributions and professionalization impact of engaging student pharmacists on hematology-oncology advanced pharmacy practice experience rotations

INTRODUCTION

Student pharmacists contribute meaningfully to patient care during Advanced Practice Pharmacy Experiences (APPEs) in varied settings. We aimed to characterize and evaluate the impact of student participation in hematology-oncology (hem-onc) APPEs on the practice site, and on student professionalization.

METHODS

For students completing hem-onc APPEs during 2016-2019, rotation activities and post-APPE self-reflections describing meaningful impact were reviewed; activities were categorized into direct and indirect patient care, and up to three reflection themes of professionalization impact were extracted from each self-reflection. Hem-onc preceptor cohort was surveyed to assess impact of student contributions on the practice site.

RESULTS

171 students completed hem-onc APPEs in ambulatory care (133) and/or inpatient (38) settings. Of 932 student-reported activities, the most common were: evaluating patient pharmacotherapy (209), providing education to medical staff (132), patient counseling [non-chemotherapy (99); chemotherapy (82)], and providing drug information (96); 89% involved direct patient care/education. Survey results from 16 of 33 preceptors identified the most impactful student activities as evaluating pharmacotherapy, medication education/adherence resources, and in-service presentations. Of 392 student self-reflections, themes of impact focused on professionalization/self-awareness (39.3%), counseling/communication skills (27.8%), practice skills development (20.4%) and collaborative teamwork (12.5%).

CONCLUSION

Pharmacy students make significant direct patient care contributions to hem-onc practice settings by evaluating pharmacotherapy and providing education to patients and healthcare personnel. Participation in hem-onc APPEs is highly influential to the professionalization of students, particularly in developing skills in oncology practice, patient interactions/communications, and developing self-awareness.

Implementing a high-risk medication education introductory pharmacy practice experience

BACKGROUND AND PURPOSE

The purpose of this project was to implement a sustainable high-risk medication education (HRME) experience for student pharmacists, assess the impact on institutional metrics, and evaluate student competence.

EDUCATIONAL ACTIVITY AND SETTING

Students completed a longitudinal introductory pharmacy practice experience (IPPE) to provide patient education on anticoagulant and antiplatelet medications. Data collected included student feedback on the experience, the achievement of applicable pre-advanced pharmacy practice experience (APPE) core domains, student effect on number of patients counseled, and number of patient interactions per student.

FINDINGS

Student feedback of the HRME experience indicated that 98% either strongly agreed or agreed to meeting defined parameters. Ninety-seven percent of students completing the experience demonstrated achievement of all applicable domain abilities. Over a three-year period, students educated 1055 patients.

SUMMARY

The creation of a sustainable HRME experience for student pharmacists allowed for the achievement of applicable pre-APPE core domains. It also enhanced institutional metrics by greatly increasing the number of patient touches and providing students with direct patient care opportunities on a consistent basis.

How to Incorporate the Experiential Student Pharmacist Into the Pediatric Practice Setting

Experiential education conducted in the pediatric practice setting provides student pharmacists the opportunity to learn about a unique patient population. For many students, experiential rotations may be the only form of pediatric education they receive in pharmacy school. Providing quality pediatric experiences is essential to stimulate students' interest in this practice area and train those with goals to become pediatric pharmacists. It is also important to ensure graduating pharmacists have exposure to fundamental pediatric pharmacy concepts. Although pediatric practice areas and institutions differ in patient populations and services, a well-rounded rotation experience should be provided for the pharmacy student. Preceptors must decide what concepts to teach and what activities students should be incorporated into during this experiential period. This article provides goals and activities for student pharmacists that can be included in newly designed introductory pharmacy practice experiences and advanced pharmacy practice experiences within various pediatric settings.

A Simulation Activity to Assess Student Pharmacists' Knowledge and Perceptions of Oncology Pharmacy

Objective. To assess the impact of an interactive activity on student pharmacists' confidence in answering oncology-related questions and their perceptions of an oncology pharmacists' roles in practice. Methods. Two cohorts (2016 and 2017) of third-year student pharmacists completed a two-hour, interactive, four-station activity during the fourth week of an oncology module. Each station simulated a different oncology-related scenario that represented a specific practice settings. Pre- and post-activity surveys were administered to determine changes in students' confidence levels and perceptions. Results. Over the two years, 66 student pharmacists completed the pre- and post-activity survey instruments. In both cohorts, there was a significant increase in scores on all items regarding students' confidence. Student pharmacists' perceptions of pharmacists' roles also improved significantly. Conclusion. The simulation activity was effective as confirmed by improvement in student pharmacists' post-activity scores on confidence and perception. Determining student pharmacists' comfort in responding to oncology scenarios is important to prepare them for practice in any setting.

An Analysis of Canadian Doctor of Pharmacy Student Experiences in Non-Traditional Student-Preceptor Models

Objective. To describe students' experiences and perceptions of non-traditional student-preceptor learning models and evaluate the effectiveness of these models on students' learning experience. Methods. Pharmacy students who had completed at least one experiential rotation with a non-traditional learning model participated in semi-structured interviews. Models included peer-assisted learning (PAL; two or more students of same educational level), near-peer teaching (NPT; one or more junior students with one or more senior students), and co-preceptorship (CoP; two or more preceptors). Interviews were transcribed, coded, and analyzed for themes. Themes were mapped according to the Kirkpatrick model for evaluating educational training. Results. Twenty semi-structured interviews were conducted. Forty-three experiences (19 CoP, 14 PAL, 10 NPT) from 14 institutions were described. Many themes overlapped between the three models. In CoP, learners described increased preceptor availability and exposure to different patient care approaches. Challenges arose when preceptors had different expectations. Students overwhelmingly endorsed a multi-learner environment. Both PAL and NPT learners felt supported as collaboration with other learners was readily fostered. Potential challenges in PAL and NPT were difficulties when personalities conflicted and when there was a significant knowledge gap between the learners. All three models allowed for the development of skills, including communication and collaboration. Learners reported an enhanced approach to patient care and professional practice, including approaches to teaching as new preceptors. Conclusion. Pharmacy students and graduates valued their experiences in non-traditional student-preceptor models. Institutions may find support for using these precepting models to increase placement capacity.

Preparing pharmacy students to communicate effectively with adolescents

OBJECTIVES

To develop an elective workshop designed to equip pharmacy students with skills to effectively communicate with adolescents. To conduct preliminary evaluation of the workshop to assess its impact on pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.

METHODS

Academics from three universities in three countries collaborated on the workshop development and evaluation. The workshop structure was designed upon the foundations of communication best practices and established techniques, and it consisted of two online modules and an in-person tutorial. Pharmacy students undertaking a 4-year Bachelor, Master or Doctor of Pharmacy degree from all three participating universities evaluated the workshop via pre- and post-questionnaires.

KEY FINDINGS

A total of 81 pharmacy students volunteered to attend and evaluate the workshop. Of these 81 students, 31 completed paired pre- and post-questionnaires, 44 students completed unpaired questionnaires and six students were lost to follow-up. Of the paired pre- and post-questionnaires, students were mostly female (67.7%) with an average age of 24.9 years (standard deviation, SD = 5.6) and were in the first (32.3%), second (16.1%) or third (51.6%) year of their pharmacy programme. Over 80% of students somewhat or strongly agreed that the workshop made them feel more comfortable speaking with young people in pharmacy settings. Mean (SD) perceived confidence (pre = 21.7 (4.0) and post = 24.9 (4.5)) and knowledge scores (pre = 5.2 (1.5) and post = 6.6 (1.6)) significantly improved after undertaking the workshop.

CONCLUSIONS

The workshop increased pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.

Impact of a Layered Learning Practice Model on Delivery of Clinical Pharmacy Key Performance Indicators under a Tertiary Care Centre Oncology Service

BACKGROUND

The layered learning practice model (LLPM), within which a pharmacist supervises both a pharmacy resident and a student, mitigates the growing demand for clinical rotations that has accompanied national expansion of Doctor of Pharmacy programs. A Canadian collaborative of hospital pharmacists established consensus on 8 clinical pharmacy key performance indicators (cpKPIs), activities associated with improved patient outcomes. Increased implementation of the LLPM alongside cpKPI measurement offers opportunities to compare the LLPM with standard practice in terms of pharmaceutical care delivery.

OBJECTIVE

To quantify clinical productivity, as measured by proportions of eligible patients receiving cpKPIs and absolute numbers of completed cpKPIs, across scenarios involving pharmacists working with and without pharmacy learners.

METHODS

In this retrospective observational study, pharmacy students, pharmacy residents, and pharmacists recorded completion of 7 cpKPIs for oncology inpatients over a total of 6 months in 2017 and 2018. Clinical productivity was described across the following 3 scenarios: presence of one or more pharmacists with one resident and one or more students (P-R-S); presence of one or more pharmacists with one or more students (P-S); and presence of one or more pharmacists only (P; standard practice).

RESULTS

During the study, there were 685 recorded admissions to the inpatient oncology service. Generally, the proportions of patients who received cpKPIs were similar for scenarios with and without pharmacy learners present. Standardized to 20 pharmacist workdays, the total number of cpKPIs 1, 2, 3, 5, 6, and 7 (255 with P-R-S scenario, 281 with P-S scenario, and 258 with P scenario) and the total number of drug therapy problems resolved (i.e., cpKPI 3; 153 with P-R-S scenario, 180 with P-S scenario, and 149 with P scenario) were similar across the scenarios. Scenario P had fewer admitted patients per pharmacist workday (3.2) than scenarios P-S and P-R-S (3.4 and 3.7, respectively), which may have contributed to a trend toward greater proportions of patients receiving cpKPIs under scenario P.

CONCLUSIONS

Compared with standard practice, integration of pharmacy learners within an oncology unit did not appear to impair clinical productivity, as demonstrated by the comparable proportions of patients receiving cpKPIs and the total number of completed cpKPIs.

Layered learning pharmacy practice model in Ethiopia

PURPOSE

Ethiopia is home to a growing population of more than 100 million people. Healthcare in the region functions with a shortage of oncologists. Pharmacists as well as other healthcare providers can assist with expanding patient access to cancer care. A pilot project was proposed to provide education, determine areas to expand pharmacy services in oncology, and recommend interventions at Tikur Anbessa Specialized Hospital and Addis Ababa University.

METHODS

A layered learning practice model comprising of a clinical pharmacist, a post-graduate year two oncology pharmacy resident, and two fourth-year student pharmacists was constructed for the experience. Through collaboration with the College of Pharmacy at Addis Ababa University, an international experience was developed to provide education and advance pharmacy practice at Tikur Anbessa Specialized Hospital.

RESULTS

Based on findings from a needs assessment, the participants collaborated with key stakeholders to develop practices and procedures for the implementation of high-dose methotrexate and for comprehensive chemotherapy order review. In addition, 17 didactic lectures were provided to nine students enrolled in the Master of Pharmacy in Pharmacy Practice at the College of Pharmacy at Addis Ababa University.

CONCLUSION

This experience provided educational and clinical impact using a layered learning practice model, consisting of a clinical pharmacist, pharmacy resident, and pharmacy students in an international setting. There is significant potential for clinical pharmacy to positively impact patient care in the oncology setting in Ethiopia. Future initiatives for advancement include the safe handling of hazardous agents, additional therapeutic drug monitoring, and outpatient oncology pharmacist practice.

Implementation and Evaluation of Near-Peer Facilitated Journal Club Activities in a Required MLE Course Series

Objective. To describe and evaluate the implementation of multiple, content-integrated journal club activities into a large, required medical literature evaluation (MLE) two-semester course series using near-peer student facilitators. Methods. Using near-peer, third-year (P3) students as a significant source of instructional personnel, 10 journal club activities were incorporated annually into the second-year (P2) MLE series. Activities included preparation, quiz, journal club, and debriefing. Each activity divided the P2s into groups of 8-12 students. In the fall semester, journal clubs were facilitated by faculty members and near-peers as P2s participated. In spring, P2s also facilitated, while faculty members' and near-peers' roles shifted to providing rubric-facilitated feedback and mentoring. Near-peers and P2s provided feedback on the experiences. Results. Over four years, two course faculty members and 62 near-peers facilitated (fall) or provided feedback/mentoring (spring) for 346 P2 MLE I/II students in 419 individual journal clubs. Course faculty members covered 80 journal clubs, while near-peers covered 339. Faculty and near-peer ratings of P2 facilitators demonstrated good P2 preparation. P2 facilitators were best at facilitating discussion of implications and results, while being most challenged by introduction and methods. P2 survey responses highly favored the addition of journal club activities and the use of P3 near-peer facilitators. Conclusion. The use of near-peers in the implementation of integrated journal club activities in a large, required MLE course series was successful. Future study will include refining formative feedback processes, exploring benefit to near-peers, and exploring near-peer use in other didactic settings.

Evaluation of a Newly Established Layered Learning Model in an Ambulatory Care Practice Setting

BACKGROUND AND PURPOSE

Given the need to accommodate overlapping longitudinal Introductory Pharmacy Practice Experience (IPPE) students and Advanced Pharmacy Practice Experience (APPE) students at regular intervals while meeting clinical demands, the opportunity to establish a layered learning model (LLM) became evident at University of Missouri - Kansas City School of Pharmacy. The purpose of this project was to establish an LLM at an ambulatory care site, observe the teaching-learning interactions between IPPE and APPE students, and evaluate student perceptions of the experience.

EDUCATIONAL ACTIVITY AND SETTING

The LLM was implemented over the course of three traditional semesters during Spring 2016 through Spring 2017. Clinical services were offered 2.5 days per week. Overlapping student instructional time was established in conjunction with the provision of clinical pharmacy services and the structure of each rotation type. Third-year (P3) IPPE and fourth-year (P4) APPE students, who participated in the LLM at this site, completed a course evaluation pertaining to their experiences. The evaluation focused on APPE and practice readiness, as well as strengths and limitations of the LLM.

FINDINGS

All 16 students completed the evaluation (100% response rate). All IPPE students indicated the LLM prepared them for APPEs in either an excellent (n=3, 37.5%) or above average (n=5, 62.5%) manner. Of the APPE students, most indicated the LLM prepared IPPE students for APPEs in an excellent (n=3, 37.5%) or above average (n=4, 50%) manner. Similarly, the majority of APPE students indicated the LLM prepared APPE students for practice in an excellent (n=3, 37.5%) or above average (n=5, 62.5%) manner. In addition, the following common themes developed, which highlight the benefits of the experience: reinforcement of knowledge through instruction, enhanced understanding of APPE expectations, exposure to multiple teaching styles, and creation of a comfortable learning environment. Students suggested the LLM include increased time for interaction with other learners.

SUMMARY

An LLM involving P3 IPPE and P4 APPE pharmacy students, in an ambulatory care practice setting, was associated with positive student perceptions. Student feedback was best utilized to generate the hypothesis that this LLM may increase both APPE and practice readiness. However, further study is needed to confirm direct cause and effect.

Promoting a growth mindset in pharmacy educators and students

COMMENTARY

Mindsets are implicit theories that influence how individuals think, act, and respond. Those with a fixed mindset tend to resist learning opportunities; those with a growth mindset embrace learning opportunities. It is important that pharmacy educators work to shift the mindsets of their students toward a growth mindset in order to promote resilience, improve personal outcomes, and enhance attitudes toward learning. Mindsets are not static, and with persistence and effort, can be modified.

IMPLICATIONS

Pharmacy educators can do much to influence the mindsets of their learners, and with purposeful effort, can help cultivate an environment that enhances a learner's growth mindset. If an educator is not deliberate, fixed mindsets can be inadvertently promoted to learners, which can result in diminished learning experiences for both student and educator. This commentary will inform pharmacy educators about mindsets and present several teaching and precepting techniques that can help promote a growth mindset among themselves and their learners.

Expediting Formulary Standardization in a Multihospital Health System Using Layered Learners

Drug formularies are a necessary part of medication management in hospitals and health systems. The system-level P&T committee at BJC HealthCare, a multihospital health system in St. Louis, Missouri, developed an approach to standardization of a system-wide formulary using available layered learners to complete the work in an expedited manner before implementation of a system-wide electronic medical record. The formulary standardization work was allocated to reviewers-including pharmacy students, residents, clinical pharmacy specialists, and pharmacy leadership-according to the complexity of the drug class under review, and a pharmacist was assigned to oversee and support the learner (student or resident) as class reviews were performed. The reviewer prepared a review of the drug class, developed recommendations for formulary agents and therapeutic interchanges, and presented recommendations to key stakeholder groups in the organization before a final decision by the system P&T committee. Using this approach, 27 therapeutic class reviews were conducted in 15 months, and 153 of 346 individual agents reviewed (44%) were retained on the formulary. The alignment of formulary medications and interchanges in the 27 classes resulted in an estimated $1.185 million savings in supply costs in the 12 months after implementing the changes. Standardization of the formulary and therapeutic interchanges can be expedited by using a layered learner model, and this model can be used in other health systems to accelerate the formulary review process.

Identifying the Presence of Cognitive Apprenticeship in the Layered Learning Practice Model

Objective. To identify the presence of cognitive apprenticeship themes in the layered learning practice model (LLPM). Methods. Attending pharmacists who had implemented an LLPM completed an individual 90-minute face-to-face semi-structured interview. Three researchers independently reviewed transcripts to identify cognitive apprenticeship themes according to the framework's dimensions and sub-dimensions. Results. Of 25 eligible attending pharmacists, 24 (96%) agreed to participate. All core dimensions of the cognitive apprenticeship framework emerged during the interviews; however, preceptors varied in how they used the framework in the training of pharmacy learners at different levels. This variability was especially apparent within the sub-dimensions of the content and method domains. Conclusion. This study demonstrates that all four cognitive apprenticeship principles are being used in the clinical environments operationalizing the LLPM. These findings suggest that cognitive apprenticeship is an applicable and relevant educational framework when engaging multiple learners in clinical education environments.

Expanding care through a layered learning practice model

PURPOSE

The outcomes of a patient-centered layered learning practice model (LLPM) in which the clinical specialist acted as the attending pharmacist and managed a pharmacy team to provide direct patient care were evaluated.

METHODS

Two 30-day evaluations were conducted on the acute care malignant hematology and medical oncology services of the University of North Carolina Medical Center in 2011. The primary objective of this study was to design an LLPM that used a team to expand the pharmacist care services offered. The primary outcome was the frequency of pharmacy team encounters at discharge (medication reconciliation and counseling), termed the discharge capture rate.

RESULTS

During the study months, 42 and 78 malignant hematology and medical oncology patients were eligible for study inclusion, respectively. The overall discharge capture rate was 51%. Sixty-one patients received discharge medication reconciliation services during patient counseling. Patients included in the malignant hematology group received a mean of 11 prescriptions at discharge, compared with 9.83 in the medical oncology group. Means of 1.26 and 2.1 medication-related problems per patient were identified in the malignant hematology and medical oncology studies, respectively, during discharge medication reconciliation. The overall mean face time spent per patient was 21.3 minutes.

CONCLUSION

Patients in malignant hematology and medical oncology services were counseled and provided discharge medication reconciliation by a pharmacy student or resident whose activities were managed and reviewed by an attending pharmacist using an LLPM, resulting in an improvement in all clinical outcomes and measures.