Report of the 2015-2016 Academic Affairs Standing Committee

Evaluating the Strengths and Barriers of Competency-Based Education in the Health Professions

OBJECTIVE

This study aimed to define competency-based education (CBE) for pharmacy education and describe how strengths and barriers of CBE can support or hinder implementation.

FINDINGS

Sixty-five studies were included from a variety of health professions in order to define competency based pharmacy education (CBPE) and identify barriers and benefits from the learner, faculty, institution, and society perspectives. From the 7 identified thematic categories, a CBPE definition was developed: "Competency-based pharmacy education is an outcomes-based curricular model of an organized framework of competencies (knowledge, skills, attitudes) for pharmacists to meet health care and societal needs. This learner-centered curricular model aligns authentic teaching and learning strategies and assessment (emphasizing workplace assessment and quality feedback) while deemphasizing time."

SUMMARY

This article provides a definition of CBE for its application within pharmacy education. The strengths and barriers for CBE were elucidated from other health professions' education literature. Identified implementation strengths and barriers aid in the discussions on what will support or hinder the implementation of CBE in pharmacy education.

The AACP Academic Affairs Committee's Final 2022 Curricular Outcomes and Entrustable Professional Activities (COEPA) for Pharmacy Graduates to Replace 2013 CAPE and 2016 EPAs

The American Association of Colleges of Pharmacy (AACP) Academic Affairs Committee was charged with revising both the 2013 Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes (EOs) and the 2016 Entrustable Professional Activities (EPAs). The Committee changed the document name from the CAPE outcomes to COEPA, (Curricular Outcomes and Entrustable Professional Activities) since the EOs and EPAs would now be housed together. A draft of the COEPA EOs and EPAs was released at the AACP July 2022 Annual meeting. After receiving additional stakeholder feedback during and after the meeting, the Committee made additional revisions. The final COEPA document was submitted to and approved by the AACP Board of Directors in November 2022. This COEPA document contains the final version of the 2022 EOs and EPAs. The revised EOs have been reduced to 3 domains and 12 subdomains (from 4 domains and 15 subdomains previously in CAPE 2013) and the revised EPAs have been reduced from 15 to 13 activities.

The AACP Academic Affairs Committee's Guidance for Use of the Curricular Outcomes and Entrustable Professional Activities (COEPA) for Pharmacy Graduates

The 2021-2023 American Association of Colleges of Pharmacy Academic Affairs Committee (AAC) was charged with and completed the revision of the 2013 Center for the Advancement of Pharmacy Education Outcomes and the 2016 Entrustable Professional Activity (EPA) statements for new pharmacy graduates. This work resulted in a new combined document, the Curricular Outcomes and Entrustable Professional Activities (COEPA) that was unanimously approved by the American Association of Colleges of Pharmacy Board of Directors and was published in the Journal. The AAC was also charged with providing stakeholders with guidance about how to use the new COEPA document. To achieve this charge, the AAC created example objectives for all 12 Educational Outcomes (EOs) and example tasks for all 13 EPAs. Although programs are asked to retain the EO domains, subdomains, one-word descriptors, and descriptions, unless they are adding more EOs or increasing the taxonomy level of a description, colleges and schools of pharmacy can expand or edit the example objectives and example tasks to meet local needs, as these are not designed to be prescriptive. This guidance document is published separately from the COEPA EOs and EPAs to reinforce the message that the example objectives and tasks are modifiable.

Finalizing the Work Related to the Curriculum Outcomes and Example Objectives and Entrustable Professional Activities (COEPA) Document: The Report of the 2022-2023 Academic Affairs Standing Committee

The 2022-2023 Academic Affairs Committee (AAC) was charged to (1) complete the Center for the Advancement of Pharmacy Education Outcomes and Entrustable Professional Activities (EPAs) revisions (now renamed as COEPA - Curriculum Outcomes and Entrustable Professional Activities) after receiving feedback at the 2022 American Association of Colleges of Pharmacy (AACP) Annual Meeting; (2) offer guidance on how the revised COEPA education outcomes and EPA statements should be used by member institutions, faculty, preceptor, and students; (3) guide input into the ongoing revision of the Accreditation Council for Pharmacy Education (ACPE) standards for the Doctor of Pharmacy program. The published report of the 2021-2022 AAC outlines the work of the Committee through the spring of 2022.1 This 2022-2023 AAC report focuses on the work related to finalizing the COEPA educational outcomes, EPAs, preamble, and glossary and formally receiving approval from the AACP Board of Directors.2 This report also describes the creation of a COEPA guidance document, including educational outcomes example learning objectives, and EPA example tasks for the Academy, however, the actual guidance document will be published separately. Finally, this current report outlines the feedback the AAC sought, received, synthesized, summarized, and prioritized from key interested and affected parties about the ACPE 2016 standards revisions for the ACPE 2025 draft standards.3 The Committee offers revisions for 1 AACP policy statement pertaining to diversity, equity, inclusion, accessibility, justice, and anti-racism. One new policy statement is also offered that urges ACPE to create accreditation standards for pharmacy education that support diversity, equity, inclusion, accessibility, justice, and anti-racism, despite presence of laws, executive orders, and policies that oppose these concepts.

A consortium's approach to developing an EPA-based community IPPE curriculum

INTRODUCTION

Currently, there are limited data on the use of entrustable professional activities (EPAs) within introductory pharmacy practice experiences (IPPEs). The objective of this study was to identify supporting EPA tasks community IPPE students should perform at the "Competent with Support" level to prepare them for advanced pharmacy practice experiences (APPEs).

METHODS

The Southeastern Pharmacy Experiential Education Consortium utilized a modified Delphi process to incorporate EPAs into community IPPE curricula to mirror the consortium's community APPE curricula. Community IPPE and APPE preceptors (N = 140) were invited to participate in focus groups and two surveys to identify and build consensus on EPA-based activities community IPPE students should perform to prepare them for APPEs. The primary outcome was development of an EPA-based community IPPE curriculum.

RESULTS

Nine preceptors (6.43%) participated in a focus group, 34 preceptors completed survey one (24.29%), and 20 preceptors completed survey two (14.29%). The initial list of 62 tasks for 14 EPAs was tailored to reflect an IPPE student skill set. Survey consensus led to a community IPPE curricula with 12 required EPAs and 54 tasks (40 required and 14 suggested).

CONCLUSIONS

The modified Delphi process provided a mechanism for preceptor collaboration with experiential programs to build consensus on community IPPE curricula redesigned around EPAs and supporting tasks. A unified IPPE curriculum adds value to colleges and schools of pharmacy with shared preceptors by improving continuity of experience, expectations, and evaluation of student learners and allows for targeted regional preceptor development.

Which Entrustment-Supervision Scale is Right for Pharmacy Education?

Entrustable professional activities (EPAs) are an outgrowth of the competency-based educational model to support workplace-based learner assessments and evaluation. A learner's performance of EPAs is assessed by the degree of provided entrustment and required supervision rather than by a score, percentage, or letter grade typically assigned in traditional academic coursework. Entrustment-supervision (ES) scales are used to document learner progression and steer learner development over time. The purpose of this article is to critique various ES tools in health professions education for utilization within an EPA framework for learner assessment in workplace-based settings and to determine which will best suit pharmacy education. Exploring the advantages and disadvantages across all types of ES scales is a critical step in determining the most useful ES tool for use within a specific pharmacy institution and across the Academy. An ES scale with the traditional 5 levels, a prospective assessment frame, and increased stratification at lower levels should be recommended by the Academy and utilized in workplace-based settings for formative and summative assessment to provide more valid assessment of learners, support the ideal of life-long learning, and give more meaning for pharmacy faculty and learners within assessment.

Successes and challenges in implementing specifications grading in skills-based laboratory courses: Experiences at two colleges of pharmacy

BACKGROUND AND PURPOSE

Specifications grading, a grading schema focused on mastery of skills, may provide an alternative to traditional grading. Specifications grading uses three components (pass/fail grading, bundles, and tokens) to allow students to demonstrate competency in specific areas as part of competency-based education. The purpose of this article is to outline specifications grading and review its implementation at two colleges of pharmacy.

EDUCATIONAL ACTIVITY AND SETTING

Two colleges of pharmacy used specifications grading within a first-year skills-based laboratory course. Instructors identified key skills for each course and the minimum performance levels for each grade (A, B, C, etc.). Each college evaluated skills that aligned with course learning objectives.

FINDINGS

Incorporating specifications grading helped better align assignments and assessments to course learning objectives. Instructors felt specifications grading introduced more rigor into the course. Instructors identified four challenges when implementing specifications grading, including: (1) lack of integration into the learning management system, (2) initial student confusion, (3) modifications needed due to unforeseen circumstances, and (4) logistical issues when implementing token exchange. Many of these challenges can be overcome with instructor tracking of passed assignments and earned/redeemed tokens, periodic reinforcement of the grading schema with students, and creating flexibility within the course, especially the first time the schema is implemented.

SUMMARY

Specifications grading was successfully implemented in two skills-based courses. Challenges encountered with implementing specifications grading will be continually addressed. Implementation of specifications grading in other forms of course deliveries (e.g., electives, didactic) may require adjustment and further evaluation.

Revising the Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes and Entrustable Professional Activities (EPAs): The Report of the 2021-2022 Academic Affairs Standing Committee

EXECUTIVE SUMMARY. The 2021-22 Academic Affairs Committee was charged to 1) Update the Center for the Advancement of Pharmacy Education (CAPE) Outcomes and Entrustable Professional Activity (EPA) statements for new pharmacy graduates; 2) Nominate at least one person for an elected AACP or Council Office; and 3) Consider ways that AACP can improve its financial health. This report primarily focuses on the process undertaken by the committee to revise the CAPE Educational Outcomes and EPAs. Proposed changes to the current outcomes are discussed and the reasoning behind these revisions are described. AACP members will have the opportunity to provide feedback prior to the final document being approved and published later this year.

A Call for Simplification and Integration of Doctor of Pharmacy Curricular Outcomes and Frameworks

Pharmacy education faces an upcoming revision of accreditation standards designed to outline degree program requirements for training the next generation of pharmacists. At the same time, pharmacy educators are increasingly expected to integrate multiple other educational frameworks and recommendations from distinct groups into their curricula. With this list of expectations constantly expanding and changing, education leaders are forced to spend valuable time and resources trying to satisfy "checklists" instead of enhancing their programs. The following commentary discusses concerns about the growing complexity of the standards and frameworks used in the accreditation process, overlap and redundancy in these various requirements, and relevant comparisons between pharmacy and medical education. We outline recommendations regarding purposeful integration of frameworks with the goal of simplifying accreditation requirements and enhancing program flexibility to deliver innovative, high-quality curricula.

Development of Entrustable Professional Activities for Specialist Hospice and Palliative Care Pharmacists

CONTEXT

Entrustable professional activities (EPAs) translate competencies into explicit, practical terms that clearly state the expected roles and responsibilities of clinicians who have achieved proficiency and expertise in a field. EPAs are defined for Hospice and Palliative Medicine physicians but not for other members of Hospice and Palliative Care (HAPC) interprofessional teams, including pharmacists.

OBJECTIVES

The objective of this study was to develop EPAs for HAPC pharmacists.

METHODS

An 11-member workgroup of HAPC pharmacists was convened to develop candidate EPAs using nominal group and modified-Delphi methods. Content validity index was used as a measure of consensus, defined a priori at ≥ 60%. Vetting occurred via intra- and interprofessional stakeholder reactor groups and a national survey of HAPC pharmacists.

RESULTS

Following an iterative process of workgroup and stakeholder consensus-building, 15 HAPC pharmacist EPAs were developed. Among the workgroup, all 15 EPAs reached ≥ 70% consensus, indicating appropriate internal validity. In a national survey of 185 HAPC pharmacists with a 20% response rate, 13 EPAs were rated by most respondents as "essential" and 2 were rated by most respondents as "important but not essential." Respondents indicated the 15 EPA set represented the core professional activities of HAPC pharmacists well (median rating of 5 on a Likert-like scale, IQR 1).

CONCLUSION

Fifteen consensus EPAs describe essential activities of HAPC pharmacists in direct patient care, leadership, education, and scholarship. These EPAs will further guide pharmacist training programs, HAPC services seeking to incorporate a specialized pharmacist on the team, and currently practicing HAPC pharmacists.

Development of an Entrustment-Supervision Assessment Tool for Pharmacy Experiential Education Using Stakeholder Focus Groups

Objective To devise a pharmacy-specific, expanded entrustable professional activities (EPA) entrustment-supervision scale that would frame preceptor ratings in a prospective and retrospective manner for use in experiential learning settings.Methods A series of focus group sessions were conducted to solicit expert opinion on how to develop and refine two entrustment-supervision scales. Purposive sampling was used to identify experts from different professional groups (physicians, pharmacy experiential administrators, and pharmacy practice faculty) who had extensive knowledge regarding EPAs and at least one publication related to EPAs. Panelists were invited to participate via email. Three focus sessions were conducted via videoconferencing between June and September 2019. The primary outcome was development of a pharmacy-specific EPA entrustment-supervision assessment tool. Secondary outcomes were individual entrustment-supervision statements across five levels of the entrustment-supervision scale.Results The focus group consisted of four pharmacy practice faculty, two experiential administrators, and one academic physician. Four concepts emerged from the focus group discussion: need for more granularity in entrustment-supervision scales; limitations due to differences in licensure requirements across the United States; present and ongoing use of expanded scales by schools and colleges of pharmacy; and uncertainty regarding how to rate entrustment-supervision when a student exhibits unprofessional behavior.Conclusion A pharmacy-specific, expanded EPA entrustment-supervision scale will be useful to support longitudinal assessment of learners in experiential settings where an EPA framework is utilized. Determining when to use a prospective versus retrospective perspective requires further evaluation.

Design, implementation and evaluation of novel work-based clinical assessment tool: An e-portfolio with embedded Entrustable Professional Activities

BACKGROUND

A new concept in work-based assessment, Entrustable Professional Activities (EPAs) describe key activities a work-ready practitioner can perform independently. EPAs are widely used in medicine to support competency-based education and are gaining acceptance in other professions such as nursing, pharmacy and dietetics. There is currently no widely accepted work-based assessment tool for student clinical placement assessment in dietetics and EPAs offer potential to address this gap.

OBJECTIVES

To design, implement and evaluate a work-based assessment tool using EPAs embedded in an e-portfolio for use in clinical dietetics.

SETTING

An accredited dietetic training program in Australian university and affiliated metropolitan and rural hospitals.

PARTICIPANTS

Three consecutive cohorts of final year dietetic students (n = 126) and their professional placement supervisors (n = 101).

METHODS

A working party consisting of dietetic academics with experience in clinical dietetics and education developed clinical dietetic EPAs and milestones that were mapped to the National Competency Standards for Dietitians in Australia. A design model incorporating multiple rounds of user feedback was used to create an e-portfolio with the EPAs embedded. Students and supervisors were invited to complete anonymous on-line surveys with Likert responses (1 = highly dissatisfied, 5 = highly satisfied) to evaluate the face validity, acceptability and feasibility of the tool.

RESULTS

A total of 37 EPAs were developed with an accompanying four-point entrustment scale to measure performance. Evaluation survey response rates were high and ranged from 35 to 45% for students and 57-83% for supervisors across the study period. Both students and supervisors evaluated the tool positively with a mean overall satisfaction of 4.12 ± 0.69 and 4.03 ± 0.68, respectively. Survey items evaluating face validity, feasibility and acceptability scored >3.75 for both groups of users.

CONCLUSIONS

The EPA based e-portfolio demonstrated face validity, feasibility and acceptability and offers potential for a widely accepted tool for work-based assessment of clinical dietetic students.

Entrustable professional activities in entry-level health professional education: A scoping review

Entrustable professional activities (EPAs) are a recent enhancement to competency-based health professional education that describe the observable work done by a competent health professional. Through defining education outcomes in a work-based context, EPAs offer potential to identify skill gaps in individual or student cohorts and focus improvements. Entrustable professional activities have been pioneered and gained rapid acceptance in postgraduate medical education; however, less is known about their application and use in undergraduate or entry-level health professional education. The Joanna Briggs Institute scoping review methodology was used to explore how and in what context EPAs are being used in entry-level health professional education. Databases searched include CINAHL, EMBASE, MEDLINE, Web of Science and PsycINFO. A total of 748 abstracts were returned after duplicates removed, and 127 full-text articles were screened with 30 included for data extraction. Publications in this area have recently accelerated with disciplines of professions of medicine, pharmacy, dietetics and physician assistants reporting on EPA development, implementation and evaluation. EPA use has been reported in the United States, Canada, Europe Australia and Central America. Major motivation reported for EPA use is to improve patient safety by aligning performance and expectations and to improve student assessment. Several studies report on the use of EPAs to evaluate different curriculum models or identify curriculum gaps representing potential application in education research.

Assessment of preceptor understanding and use of levels of entrustment

INTRODUCTION

This study determined the need to calibrate preceptors' use of levels of entrustment (LOE) in the evaluation of students performing entrustable professional activities (EPAs).

METHODS

Two introductory and four advanced pharmacy practice experience-focused cases were developed which described a fictional student, a practice site, and timing of a rotation. The cases included EPA-based tasks assigned to the student. Participants were to assign a LOE to the student for each EPA-based task.

RESULTS

Sixty of 317 preceptors participated in the study. Statistically significant differences in mean assigned LOE were found between preceptors by age (P < .05); between preceptors with differences in residency training (P < .05); and between preceptors who spent differing amounts of time with experiential students daily (P < .05).

CONCLUSIONS

Differences in assigned LOE were found based upon preceptor age, completion of a residency, and daily hours spent with experiential students. However, these differences did not result in changes to whether the student would pass or fail the rotation. Findings suggest that preceptors are consistent in assigning LOE to EPA-based tasks performed by students. In addition, preceptor development programming appears to be effective in establishing a standardized understanding of LOE among preceptors.

Entrustable professional activities for pharmacy students: A primer for solid organ transplant preceptors

DISCLAIMER

In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

The role of a solid organ transplant pharmacist is multifaceted and translates to diverse experiential and elective learning experiences that can be provided to pharmacy learners. Here we provide a guide to integrating pharmacy students into patient care and other pharmacist activities in solid organ transplantation.

SUMMARY

Thoughtful incorporation of learners into clinical practice and clinical research creates a positive learning environment for pharmacy students that can foster the development of core skills necessary for students to become "practice-ready" and "team-ready" pharmacy graduates and can equip them with valuable skills to incorporate into the specialty practice areas and careers they pursue. To help develop these educational experiences, attention to the list of core entrustable professional activities (EPAs) established by the American Association of Colleges of Pharmacy can help create a rich environment of learning with carefully cultivated tasks. Furthermore, learners can serve as transplant pharmacist extenders to assist in overall patient care and multidisciplinary involvement on the transplant team. This article serves as a "how-to" guide for applying the EPA framework to integrating pharmacy students in patient care and other pharmacist activities in solid organ transplantation and other specialty practice areas.

CONCLUSION

As pharmacy preceptors design and operationalize their teaching to incorporate EPAs, they can benefit from recommendations tailored to specialty practice areas such as solid organ transplantation. Students may start and finish these experiences at different EPA levels, but continuance of training will allow them to achieve the final EPA level across the 6 EPA domains.

Simulation Design, Findings, and Call to Action for Managing Difficult Patient Encounters

Objective. To implement and evaluate a laboratory simulation for teaching difficult patient encounter skills to pharmacy students to improve their self-assessed communication abilities and skills in the affective domain.Methods. Twelve simulation scenarios that represented difficult patient encounters in a variety of practice settings were developed. All students completed a self-assessment of their ability to communicate during difficult patient encounters before and after the simulations, and wrote a guided reflection afterward. The impact of the simulation was evaluated using quantitative and qualitative methodology. Three student cohorts were analyzed to determine whether significant change occurred in students' self-perceived communication abilities. Thematic analysis of the qualitative reflection responses was performed.Results. Over three years, three student cohorts of third-year professional students participated in the simulations (n=236). Students self-rated their ability to communicate on a 0-100 scale. Mean self-rating of ability prior to the simulation was 57.7 (SD=15.9) and after was 79.2 (SD=15.2). This mean difference of 21.5 points equates to an approximate 20% increase in self-rated ability. Variability in self-ratings between the cohorts was not significant. Qualitative analysis revealed that the simulation identified for student areas needing further development which in turn promoted self-awareness. Students expressed that learning in the safe, formative environment provided by the simulation contributed to their professional growth and was relevant to their future practice of pharmacy.Conclusion. This simulation fills a gap in skills-based education, addresses the affective domain of the Accreditation Council for Pharmacy Education (ACPE) Standards, transfers easily to schools and colleges of pharmacy. This supports a call to action for pharmacy educators to provide purposeful opportunities for students to practice communicating with patients during difficult encounters.

A Modified Delphi Involving Laboratory Faculty to Define Essential Skills for Pharmacy Graduates

Objective. To define essential skills for Doctor of Pharmacy (PharmD) graduates that are needed in the four most common sectors of pharmacy practice as determined by expert faculty who instruct within pharmacy skills laboratories.Methods. A three-round Delphi method was used to establish consensus. In the first round, participants were asked what skills were needed by students at entry to practice in community, health-system, ambulatory care, and managed care pharmacy settings. In rounds two and three, participants were asked to rate each skill with a level of importance using a 10-point Likert scale (1=not important to 10=very important).Results. In round one, participants produced a collective list of 289 essential skills. These skill statements were sent to participants in rounds two and three to assign a level of importance. After the third round, participants reached consensus using a mean level of importance for a final list of 69 community pharmacy skills, 47 health-system, 60 ambulatory care, and 15 managed care skills. These skills were then mapped to entrustable professional activities domains for schools and colleges pharmacy to use as a resource when assessing core competency development in the curriculum.Conclusion. The Delphi technique was used successfully with expert pharmacy skills laboratory faculty to identify laboratory-focused essential skills that recent PharmD graduates should have prior to entering community, health-system, ambulatory care, or managed care pharmacy practice. These essential skills can be used to guide curriculum development, develop milestone markers, and help ensure students are practice ready.

Appraisal of the entrustable professional activities interprofessional team member domain performed by North Dakota pharmacists

OBJECTIVE

To quantify the use of the interprofessional team member (ITM) domain of entrustable professional activities (EPAs) by North Dakota pharmacists across practice sites, roles in practice, and by preceptor status.

METHODS

Survey methods were used to characterize the self-reported frequency with which pharmacists undertake core EPAs and supporting tasks in the ITM domain. The survey was administered to registered pharmacists practicing in North Dakota (n=990) during the fall of 2018, of which 457 (46.1%) responded. After eliminating responses with incomplete or missing information, 119 responses were available for analysis.

RESULTS

For the overall EPA ITM domain, "Collaborate as a member of an interprofessional team population" pharmacists reported performing these activities an average (mean) of 3.3 times per month (SD=2.3). Within this domain, the highest reported example activity was "Use setting appropriate communication skills when interacting with others" (mean=4.1, SD 1.8), followed by "Communicate a patient's medication-related problem(s) to another health professional" (mean=3.3, SD 2.0), and "Contribute medication-related expertise to the team's work" (mean=3.1, SD=2.2). ITM domain and supporting example activities were performed at a greater rate in hospitals, community health centers and long-term-care facilities. For most items, preceptors reported a greater use of activities, than did non-preceptors.

CONCLUSIONS

North Dakota pharmacists currently complete tasks outlined in the ITM domain of the EPAs, although their contributions are varied by task, role, and preceptor status.

A Curriculum Crosswalk of the Core Entrustable Professional Activities for New Pharmacy Graduates

Objective. To cross reference the core entrustable professional activities (EPAs) to a complete set of educational guidance documents for the Doctor of Pharmacy (PharmD) curriculum to create a map for pharmacy educators.Methods. The Mapping EPAs Task Force consisted of nine members who first worked independently and then together in small working groups to map five assigned educational guidance documents (eg, Center for the Advancement of Pharmacy Education [CAPE] Outcomes, Accreditation Council for Pharmacy Education [ACPE] Standards 1-4, and the Essential Elements for Core Advanced Pharmacy Practice Experiences [APPEs]) to the Core Entrustable Professional Activities for New Pharmacy Graduates. Four working groups completed the mapping process during phases 1 and 2, which was followed by an independent quality assurance review and consensus in phase 3.Results. All 15 core EPA statements were mapped to one or more of the educational documents. One item from the CAPE Outcomes could not be mapped to a core EPA statement. The first five EPA statements mapped directly to the five elements of the Pharmacists' Patient Care Process: collect, assess, plan, implement, and follow-up: monitor and evaluate.Conclusion. This comprehensive EPA map is the first curriculum crosswalk that encompasses a complete set of educational guidance documents including the Essential Elements for Core APPEs for the Doctor of Pharmacy curriculum. If adopted by the Academy, this curriculum crosswalk will provide pharmacy schools with a common interpretation of important educational guidance documents; serve as the foundation for curricular development, revision, and assessment; and ensure student pharmacists are prepared to enter the pharmacy profession.

Evaluating Practice Readiness of Advanced Pharmacy Practice Experience Students Using the Core Entrustable Professional Activities

Objective. To evaluate levels of entrustability and practice readiness in advanced pharmacy practice experience (APPE) students using a pilot instrument designed to assess their competency in performing the entrustable professional activities (EPAs) expected of new pharmacy graduates. Methods. A pilot instrument was developed directly from EPAs to measure entrustability levels on a scale of one to five. Five APPE preceptors from several different practice areas participated. Fourth-year students used the instrument to self-evaluate their knowledge and skills at the beginning, midpoint, and end of the APPE. The preceptors evaluated students using the same instrument at APPE midpoint and end. The instrument had assigned weights for each EPA and entrustability level for a score of 100 if all items were marked five. If a rating of non-applicable was chosen, score adjustments were made. All students in the graduating class of 2018 were invited to perform a self-evaluation at the end of the fourth (APPE) year using the same instrument that study participants used. Results. Twenty-eight students and five preceptors completed evaluations during the APPE year. Overall scores from both preceptor evaluations of students and student self-evaluations increased significantly from pre-APPE to midpoint to final. Student self-evaluations were only slightly higher than preceptor evaluations. The mean (SD) preceptor scores for students and student self-assessment scores at the end of each APPE were 85.4% (7.1) and 87.2% (10.3), respectfully. One practice manager EPA and three population health EPAs were considered to not be applicable by preceptors on ≥50% of evaluations. Approximately 94% of all graduating students completed the year-end self-evaluations, with a mean (SD) score of 89% (8.6) and no EPAs marked as not applicable. Conclusion. Pharmacy students' proficiency in EPA improved during individual APPEs. According to preceptors, students' greatest improvement in entrustability was in educating patients and colleagues regarding appropriate use of medications and collecting information to identify medication-related problems.

Developing and Implementing an Entrustable Professional Activity Assessment for Pharmacy Practice Experiences

Objective. To develop, implement, and validate an entrustable professional activity (EPA) assessment tool that could be used to calculate course grades for experiential students in all practice environments. Methods. An EPA assessment tool was developed and directly mapped to 18 EPAs, and a criterion, or passing score, for each EPA was established for all practice experiences. The EPA assessment tool was implemented in the college's experiential program during summer 2018 and comparative outcomes and reliability of the EPA assessment tool were assessed within the core advanced pharmacy practice experiences (APPEs). Results. The EPA assessment tool reliability was strong (Cronbach's alpha=0.93), with preceptor-suggested grades and grades calculated using the EPA assessment tool equivalent in 95% of completed APPEs. All nonequivalent calculated-preceptor grade pairs were evenly split between one grade higher than scored and one grade lower than scored. Conclusion. The EPA assessment tool is a reliable and valid instrument for assessing EPA achievement in the APPE year. Future work should focus on determining the longitudinal utility of the EPA tool by comparing outcomes in introductory and advanced pharmacy practice experiences.

Competency-based education in pharmacy: A review of its development, applications, and challenges

RATIONALE, AIMS, AND OBJECTIVES

There has been a resurgence of interest in the application of competency-based education (CBE) in health care professionals' education in recent years, including the pharmacy profession. This model strives to prepare a competent pharmacy workforce to help meet societal needs for effective, safe, and economical health care services. The aim of this narrative review is to provide an overview of the applications of CBE in the education and training of pharmacists, the process for constructing a competency-based pharmacy curriculum, and the potential advantages and challenges associated with its implementation.

METHOD

A comprehensive literature review was conducted via PubMed and Scopus databases using a variety of keywords related to the topic (from 1975 to 2019). Other electronic resources (Google Scholar and the Education Resources Information Center) were searched to identify educational outcomes of pharmacy programmes emphasizing competency development and competency frameworks/standards for the pharmacy profession that were published up to 2019.

RESULTS

CBE has been increasingly adopted in pharmacy education, mainly in developed countries. A number of competency frameworks have been advanced to support the design of CBE curricula, accreditation standards of pharmacy programmes, and professional pharmacy registration/licensure. Several examples of the application of competency-based pharmacy education (CBPE) were identified at undergraduate, postgraduate, and professional development levels. Transforming a traditional pharmacy programme into CBPE offers several potential benefits but can also be associated with significant challenges. Successful implementation of CBPE programmes requires strong and supportive institutional leadership; proper curricular design, implementation, and management; and focus on faculty training and development.

CONCLUSION

The adoption of CBPE can enhance the ability of pharmacy education to meet the rapidly evolving societal health care needs. This model has been applied in developed countries at different levels throughout the pharmacist's learning continuum. It has also been investigated in some developing regions.

Engaging student pharmacists to improve Hospital Consumer Assessment of Health Care Providers and Systems scores

INTRODUCTION

Student pharmacists have historically served in shadowing roles for their experiential training at our institution. However, engaging students through active learning assignments has the potential to benefit both the student and the institution. The purpose of this project was to evaluate the impact of student pharmacists on Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) scores, a direct reflection of patient satisfaction within the hospital.

METHODS

In a four-month quality-improvement pilot project, student pharmacists were given active learning assignments directed at helping patients understand the purpose and side effects of their medications. Patients with hospital-initiated medications were provided with medication cards via student pharmacist-run counseling programs. The primary outcome was top response ("always") in medication-related HCAHPS scores. Secondary outcomes included scores on individual questions, number of medication education encounters, number of interventions, cost savings, and student feedback.

RESULTS

There were 482 medication education encounters. The top response for all medication-related HCAHPS scores improved by 14% (49% to 63%). Top response regarding medication indication increased 23% (63% to 86%). There were 552 interventions accepted, projecting a savings of $135,658. The top score on student evaluations of the practice site increased 20% (69% to 89%).

CONCLUSIONS

Student pharmacists can have a meaningful impact on medication-related HCAHPS scores. Additionally, student pharmacists benefit from active learning opportunities by providing and improving patient care leading to a more meaningful experience.

Assessment of Practice Management Entrustable Professional Activities by Pharmacists in North Dakota

Objective. To quantify the use of core entrustable practice activities (EPAs) in contemporary pharmacy practice in North Dakota. Methods. Given the large number of core EPAs, this study focused on those supporting tasks categorized within the practice manager domain. The survey instrument was sent to all registered pharmacists living and practicing in North Dakota (n=990). This manuscript reports on the practice manager domain and the activities and examples of supportive tasks in this domain. Results. Four hundred fifty-seven (46.1%) of the pharmacists responded; however, only 102 survey instruments were fully completed and usable. Respondents rated the "fulfill a medication order" activity the highest EPA overall (mean=9.1, SD=2.7). The "oversee the pharmacy operations for an assigned work shift" activity (mean=7.8, SD=3.9) was also rated highly. Responses to "oversee the pharmacy operations for an assigned work shift" were significantly different between independent practice settings and all other practice settings. The manager was more likely than other pharmacy positions to report performing seven of the nine tasks within this EPA. Significant differences in five of nine tasks were found across pharmacies located in rural or more urban communities, including "assist in the evaluation of pharmacy technicians" and "identify pharmacy service problems and/or medication safety issues." Conclusion. This study provides empirical evidence suggesting that EPAs can be a useful means to assess outcomes in pharmacy education.

Faculty Perceptions of Entrustable Professional Activities to Determine Pharmacy Student Readiness for Advanced Practice Experiences

Objective. To quantify pharmacy faculty members' perceptions of the importance of entrustable professional activities (EPAs) and the expected level of entrustment that should be achieved to determine APPE readiness. Methods. Entrustable professional activities define the core skills and tasks expected of new pharmacy graduates and may serve as a logical framework for determining pharmacy student readiness to begin advanced pharmacy practice experiences (APPEs). A five-question survey was distributed to all faculty members, staff members, and administrators at Ferris State University College of Pharmacy. Respondents were asked to rate 18 statements mapped to 12 EPAs on the perceived importance of each statement and the expected level of entrustment students should achieve to determine readiness for APPEs. Thresholds were used to determine consensus for importance and level of entrustment for each statement. Results. Of the 44 faculty members surveyed, 28 (63.6%) responded. A strong consensus was reached on the level of importance for 16 of 18 statements (89%), while two statements demonstrated moderate consensus (11%). No strong consensus was identified on levels of entrustment. Seven (39%) of 18 statements demonstrated moderate entrustment consensus and 11 (61%) statements demonstrated little consensus. Conclusion. Strong consensus was identified regarding which EPAs are important to determine students' APPE readiness; however, no strong consensus was found when evaluating levels of entrustment. Lack of consensus regarding entrustment raises several questions that require further study and clarification as the implementation of EPAs continues throughout the Academy.

Pharmacy Student Perceptions of the Entrustable Professional Activities

Objective. To determine pharmacy students' perceptions and self-reported preparedness to perform the 15 core entrustable professional activities (EPA) established by the American Association of Colleges of Pharmacy for new pharmacy graduates. Methods. A random sample of Doctor of Pharmacy (PharmD) students from all four professional years at four universities were asked to indicate whether each of the 15 EPA statements was relevant to the practice of pharmacy and whether pharmacists were expected to perform the activity in multiple practice settings. Participants rated their self-perceived level of entrustability for each activity and indicated which three EPAs they felt most and least prepared to perform. Results. Four hundred twenty-three usable responses were received. The majority (≥85%) of students rated all of the EPA statements as relevant and ≥67% indicated that pharmacists were expected to perform them in multiple practice settings with a high percentage of agreement. Students' perceived need for supervision decreased from the P1 to P4 years. These data suggest that students' confidence to perform some activities grew as they gained experience and knowledge. However, in some cases, the self-perceived need for supervision regressed as students better understood the complexity of the activity. The EPA statements students felt most and least prepared to perform varied by year in the program. Conclusion. The core EPA statements were consistently rated by pharmacy students as relevant to pharmacy practice and as an expectation in multiple settings. Students perceived that they require less supervision when performing EPA activities as they progressed through the curriculum.

Appraisal of the entrustable professional activities (EPAs) patient care provider domain by North Dakota pharmacists

BACKGROUND

Entrustable Professional Activities (EPAs) are the latest addition to a list of professional competencies that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy.

OBJECTIVE

The study's objective is to assess the use of Core EPAs in the patient care domain (by practice setting, position, and preceptor status) in contemporary pharmacy practice.

METHODS

This survey assessed the EPA activities of pharmacists practicing in North Dakota. The pharmacists were asked "how many times in the past 30 days have you delivered the following services in your practice setting?" Response options were: 0, 1, 2, 3, 4, and 5 or more times.

RESULTS

Of 990 potential respondents, 457 pharmacists (46.1%) returned a survey, and 107 (10.8%) answered every survey item in the patient care domain. Respondents reported that the highest rated activity items "Collect information to identify a patient's medication-related problems and health-related needs," and "Analyze information to determine the effects of medication therapy, identify medication-related problems, and prioritize health-related needs" were performed an average of 3.9 times per week (SD=1.8), and 3.8 times per week (SD=2.0), respectively. Both of these items, were reported for 70% of the respondents at 5 or more times per week. For these items, the highest reported practice setting was 'other' practice settings (e.g., long-term care, community health centers) followed by chains, hospitals, and independent pharmacies. By position, clinical pharmacists and preceptors reported the highest activity levels for most EPAs and supportive example tasks.

CONCLUSIONS

This study provides empirical evidence suggesting (but not proving) that EPAs have potential as a means to assess outcomes in pharmacy education and practice. Our study sets the stage for future work that further refines and assesses core EPA activities and supportive example tasks to measure the impact of how this process relates to outcomes of care.

Entrustable professional activities in health care education: a scoping review

CONTEXT

The shift in medical education from time-based learning to outcome-based learning has drawn much attention to entrustable professional activities (EPAs) as an ideal assessment framework to translate competencies into clinical practice. Given the relative novelty of EPAs, this review aims to highlight research gaps and explore and consolidate available evidence pertaining to the development and implementation of EPAs in health care.

METHOD

Arksey and O'Malley's scoping review framework was used to present the findings. The authors performed a systematic search of PubMed, Embase, CINAHL, Scopus, MedNar, OpenGrey and ProQuest Dissertation and Theses for English articles published from the inception of each database to May 2018. A manual search of the reference lists of the included studies was conducted and an expert panel was consulted. Two reviewers screened the articles for eligibility using the inclusion criteria. All authors extracted key data and analysed the data descriptively. Thematic analysis was used to categorise the results into themes.

RESULTS

Eighty articles were included in the review. All articles were published between 2010 and 2018. Three major themes and eight sub-themes were generated: (i) development of EPAs (frameworks for EPA development and implementation, identifying core or specialty-specific EPAs, and EPAs for faculty development), (ii) evaluation of EPAs and EPA entrustment factors (revised curriculum, entrustment decisions for professional activities, and feedback on implemented EPAs and the development process), and (iii) future directions and recommendations for EPAs (implementation of EPAs in undergraduate medical education and specific disciplines, and other criticisms and recommendations for EPAs).

CONCLUSIONS

Entrustable professional activities are an essential means to translate competencies into observable and measurable clinical practice. However, high-level evidence-based research on the efficacy, development and implementation of EPAs for specific target groups (i.e. undergraduates and staff) and geographical regions (i.e. Asia and Africa) is still lacking, which suggests a direction for future research.

The Report of the 2017-2018 Professional Affairs Standing Committee: The Development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Graduates

The 2017-2018 AACP Professional Affairs Committee addressed the charges of (1) developing a self-reflection/self-assessment tool for pharmacy faculty and preceptors to allow them to assess their capability and confidence with Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes, the Pharmacists' Patient Care Process (PPCP), and the Entrustable Professional Activities (EPAs) for New Pharmacy Graduates and (2) creation of a plan for AACP to utilize in the development of preceptor continuing education and training programs. This report describes the framework, rationale and process for the development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Pharmacy Graduates (PSAE Tool), the pre-test for the PSAE tool, and the online pilot test and its results for the PSAE Tool. The committee provides recommendations for AACP in the continued development and distribution of the PSAE Tool to the schools of pharmacy. Considerations for AACP and the schools of pharmacy to consider in the continuing professional development (CPD) for all preceptors are also discussed. The committee provides a policy statement, adopted by the AACP House of Delegates, regarding the commitment of AACP regarding the CPD for all preceptors. The committee also provides several recommendations to AACP and suggestions to schools of pharmacy and other stakeholder groups pertaining to the committee charges.

Entrustable Professional Activities as a Novel Framework for Pharmacy Education

Entrustable professional activities (EPAs) are units of measure for a particular profession that describe the professional's unique abilities and work. EPAs can be used in two ways: as a link between individual competencies for mastery and overall professional responsibilities in practice; and as a mechanism for faculty to assess the student's progression using levels of decreasing supervision. Currently used in medical education, implementation and utilization of EPAs within pharmacy education has potential benefits and challenges. This article will describe, highlight benefits of, and share mitigation strategies for implementing EPAs within pharmacy education.

Report of the 2016-17 Academic Affairs Standing Committee: Entrustable Professional Activities Implementation Roadmap

The purpose of this report is to: 1) Identify linkages across the EPA statements, Center for the Advancement of Pharmacy Education 2013 Educational Outcomes (CAPE 2013) and the Joint Commission of Pharmacy Practitioners' Pharmacist Patient Care Process (PPCP); 2) Provide ways EPA statements can be used to communicate core skills that are part of the entry-level pharmacist identity; 3) Suggest a potential roadmap for AACP members on how to implement EPA statements.