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.

Design and Evaluation of an APPE Readiness Dashboard Tool

OBJECTIVE

To describe the design and evaluation of a dashboard tool to assess the readiness for advanced pharmacy practice experiences (APPEs).

METHODS

The investigators developed a dashboard tool for the appraisal of APPE readiness consisting of indicators of pharmacy student knowledge, skills, and noncognitive attributes. For the 2018-2019 and 2019-2020 rotation years, a panel of stakeholders used the dashboard to evaluate APPE readiness. Students deemed not ready (5 or more dashboard indicators) had a remediation experience before the APPEs. The investigators monitored the students who were deemed ready but at risk for substandard performance (3 or 4 indicators or completion of remediation experience) and tracked the incidence of substandard performance for all APPE students. The outcomes were presented using descriptive statistics. Performance of the tool between years was compared using the χ2 test.

RESULTS

For 2 APPE rotation cycles, the investigators evaluated readiness in 499 students. A total of 3 students were deemed not ready, and 78 students were considered at risk for substandard performance. The tool predicted 52.1% of students who experienced a substandard performance. It had a negative predictive value of 93.6% and a positive predictive value of 38.5% for substandard performance. The predictive value was similar across the risk categories of knowledge, skills, and noncognitive attributes.

CONCLUSION

A dashboard tool facilitating holistic evaluation of APPE readiness was helpful in identifying students who were not ready for APPEs or at risk for substandard performance. The next steps include refinement of the tool through the evaluation of characteristics of students who experienced substandard performance and were not identified by the tool.

Strengths and limitations of a novel "Flip the Pharmacy" practice transformation coach advanced pharmacy practice experience

BACKGROUND AND PURPOSE

Flip the Pharmacy (FtP) helps community pharmacies "flip" from dispensing- to patient-centered care models with assistance from practice transformation coaches ("coaches"). Purdue University College of Pharmacy created a novel advanced pharmacy practice experience (APPE) positioning students to serve as FtP coaches with oversight from four faculty coaches. This communication describes the APPE's design, characterizes preliminary student coaching outcomes, and identifies the APPE's strengths and limitations.

EDUCATIONAL ACTIVITY AND SETTING

Twelve pharmacies were coached by APPE students. The APPE was designed to enhance student knowledge and skills in the scaled implementation of advanced patient care services through structured weekly activities: Week 1, student orientation and training; Week 2, preparing for pharmacy visits; and Weeks 3 and 4, conducting pharmacy visits. Students also performed recurring tasks each week, including managing social media accounts.

FINDINGS

Twenty-eight students completed the APPE. Students conducted 81 in-person and 105 virtual visits. Faculty coaches were estimated to need 40 to 50  hours each month for coaching-related activities; involving student coaches reduced faculty coach time by approximately 50%, with faculty spending 20  hours on average per month vs. students spending 50.84  hours. APPE strengths included intentional weekly structuring and oversight and careful student transitions; limitations included minimal pharmacy vendor knowledge and limited rapport-building with pharmacies.

SUMMARY

Early experiences demonstrated several benefits, including optimized faculty coach time and student exposure to practice transformation. Future endeavors to implement similar APPEs should incorporate strategies to enhance pharmacy vendor knowledge and strengthen relationship-building with participating pharmacies.

Objective structured clinical examination as a competency assessment tool of students' readiness for advanced pharmacy practice experiences in South Korea: a pilot study

BACKGROUND

The assessment of pharmacy students' readiness to begin the education of an advanced pharmacy practice experience (APPE) in clinical pharmacy settings continues to gain increasing attention. This study aimed to develop an objective structured clinical examination (OSCE) in the core domains acquired through an introductory pharmacy practice experience (IPPE), for evaluating its appropriateness as a tool of assessing clinical pharmacist competency for APPEs in Korean pharmacy students throughout a pilot study.

METHODS

OSCE's core competency domains and case scenarios were developed through a literature review, ideation by researchers, and external experts' consensus by a Delphi method. A prospective single-arm pilot test was conducted to implement the OSCE for Korean pharmacy students who completed a 60-h course of in-class simulation IPPE. Their competencies were assessed by four assessors in each OSCE station with a pass-fail grading system accompanied by a scoring rubric.

RESULTS

OSCE competency areas including patient counseling, provision of drug information, over-the-counter (OTC) counseling, and pharmaceutical care services were developed with four interactive and one non-interactive cases. Twenty pharmacy students participated in the OSCE pilot test, and their competencies were evaluated by 20 assessors. The performance rate was the lowest in the area of patient counseling for a respiratory inhaler (32.1%) and the highest (79.7%) in OTC counseling for constipation. The students had an average performance rate of 60.4% in their communication skills. Most participants agreed on the appropriateness, necessity, and effectiveness of the OSCE in evaluating pharmacy students' clinical performance and communication skills.

CONCLUSIONS

The OSCE model can be used to assess pharmacy students' readiness for off-campus clinical pharmacy practice experience. Our pilot study suggests the necessity of conducting an OSCE domain-based adjustment of difficulty levels, and strengthening simulation-based IPPE education.

Promoting continuing professional development (CPD) through a novel CPD advanced pharmacy practice experience

BACKGROUND AND PURPOSE

The Accreditation Council for Pharmacy Education Standards 2016 and the Entrustable Professional Activities highlight the importance of continuing professional development (CPD) in pharmacy education. Furthermore, pharmacy graduates must self-direct their learning to sustain professional knowledge, skills, and practice. An advanced pharmacy practice experience (APPE) dedicated to CPD can help meet standards of pharmacy education and prepare students for a career of lifelong learning.

EDUCATIONAL ACTIVITY AND SETTING

An innovative CPD APPE centered on the CPD framework and student self-directed learning was developed and implemented by three colleges of pharmacy. Students enrolled in the new CPD APPE were introduced to the CPD framework, engaged in reflection, developed personalized learning objectives, and participated in self-directed learning activities to meet identified educational needs.

FINDINGS

Student performance outcomes were assessed via written reflections, portfolio documentation, and attendance records. The novel CPD rotation showed positive findings regarding student-perceived satisfaction, achievement of learning outcomes, and foundational lifelong learning habits. As soon-to-be graduates and practicing pharmacists, final-year pharmacy students are well poised to learn and apply the CPD framework and develop the skills needed to become lifelong learners.

SUMMARY

Experiences across three colleges of pharmacy demonstrated that a CPD APPE is feasible, valuable, and effective to integrate comprehensive CPD training within pharmacy education. Other programs within the academy may utilize this scalable model to prepare APPE students to engage in self-directed CPD and lifelong learning as health professionals.

Evaluation of pharmacy student empathy scores before and after a geriatrics advanced pharmacy practice experience (APPE)

INTRODUCTION

Empathy from healthcare providers is associated with improved patient care and satisfaction, resulting in increased emphasis on empathy in pharmacy school curricula. Previous studies showed improvement in pharmacy student empathy after older adult-specific simulation activities in the didactic setting, but no such data exist for the practice environment. This study's purpose was to evaluate the impact of a geriatrics advanced pharmacy practice experience (APPE) on pharmacy student empathy toward older adults.

METHODS

All fourth-year pharmacy students in a geriatrics APPE at one of four participating sites were offered to participate in the study at the beginning of the rotation. Empathy was measured at baseline and end of the rotation using the Kiersma-Chen Empathy Scale (KCES). Wilcoxon matched-pairs signed-ranks test was used to test differences from pre- to post-rotation.

RESULTS

Fifty-four of the 110 eligible students opted to participate in the study, and 46 completed both the pre- and post-surveys. Most students were female (55.6%), and the average age was 27.3 years. Mean empathy scores for all students increased significantly by 4.89 points (z = 4.17, P < .001, d = 0.97). Specific KCES items related to handling other's feelings and viewing another person's perspective also significantly improved.

CONCLUSIONS

Empathy is a key component to professional development in healthcare students, and a geriatrics APPE provides an opportunity for students to grow this soft skill. Although further study is warranted, older adult focused rotations may be considered by schools of pharmacy to aid in preparing "graduate-ready" pharmacists.

Implementation and impact of a fourth-year student pharmacist wellness series pilot on perceived stress and support

BACKGROUND AND PURPOSE

A wellness program was piloted for student pharmacists in their advanced pharmacy practice experience (APPE) year. The purpose is to describe the program implementation and its impact on APPE students' perceived stress and perception of support by school personnel.

EDUCATIONAL ACTIVITY AND SETTING

A three-session virtual wellness program was designed for APPE students. Attendance was optional for the pilot year. An online survey assessing demographics, perceived stress (measured by the validated Perceived Stress Scale [PSS]), factors contributing to stress, and perceived support before the first session and after the third session was sent to all APPE students.

FINDINGS

Twenty (37%), 13 (24%), and 10 (18.5%) students attended the first, second, and third session, respectively. A total of 49 students completed the post-program survey. Of these, ten (20.4%) attended one session, ten (20.4%) attended two sessions, and two (4.1%) attended three sessions. Students reported moderate stress. Female students endorsed higher PSS scores and career-related stress. PSS scores were lower among students who attended at least one session vs. those who did not attend any sessions and were negatively correlated with total sessions attended. Attendees were likelier to feel supported by staff and preceptors and perceived that concerns were heard by administration and preceptors.

SUMMARY

An APPE wellness program was successfully developed. Students who attended at least one session reported less stress and greater support from school personnel vs. those who did not attend any sessions. These findings are promising as wellness efforts are integrated into pharmacy training.

Implementation and evaluation of a student scholarship program to increase care initiatives in rural pharmacies

INTRODUCTION

Availability of patient care services in rural areas is often lacking, which can reduce access to care for patients living in these areas. Patient care within community pharmacies is vital to care access in rural areas, but expanding pharmacy services can often be challenging. Pharmacy students, especially those on advanced pharmacy practice experiences, are positioned to make an impact on sites.

METHODS

The objective of this study was to describe the implementation, evaluation, and impact of a student scholarship program designed to increase patient care initiatives in rural community pharmacies. Scholarships were provided to students to expand patient care initiatives targeting chronic disease in select rural community pharmacies. Before and after participating in the scholarship program, students completed a survey assessing their perceived ability and confidence to initiate new patient care activities. In addition, patient care services provided by students were tracked and reported cumulatively.

RESULTS

During the first year of implementation, 24 student scholarship rotations were completed. Throughout the 24 rotations, 369 patients were screened for prediabetes, 391 were screened for hypertension, and 552 patients were screened for immunizations. Of the 27 items presented in the survey, 20 items showed a mean statistically significant change indicating an increase in student confidence in leading, developing, and performing patient care activities.

CONCLUSIONS

A student scholarship program designed to increase patient care initiatives in rural community pharmacies led to new patient care services in rural areas and increased student confidence in leading, developing, and expanding upon patient care activities.

Implementation and evaluation of a practice transformation advanced pharmacy practice experience

BACKGROUND AND PURPOSE

Advanced entrepreneurship opportunities are important to consider as entrepreneurial skills become increasingly important to develop in pharmacy students. This institution implemented a new practice transformation advanced pharmacy practice experience (APPE), pairing students with community partners to implement and/or evaluate pharmacy services, network with pharmacists, and receive mentorship. The purpose of this article is to describe the APPE and students' outcomes during this first pilot year.

EDUCATIONAL ACTIVITY AND SETTING

A faculty preceptor mentored and oversaw all APPE activities. Students were selected through an application process, and community partners were recruited based on alignment with students' goals and need for student assistance. Community partners prepared a list of practice transformation activities needed at their sites, and progress was tracked during weekly virtual meetings. APPE students completed a pre-APPE questionnaire, collecting background information and predictors of entrepreneurship: proactive personality, entrepreneurial self-efficacy, and individual entrepreneurial orientation (IEO). At the end of the APPE, IEO was measured again, and students reflected on what skills were developed.

FINDINGS

Three students participated in the first year and were paired with various community partners. IEO baseline scores ranged from 24 to 28 (mean = 25.3, SD = 2.3), and follow-up scores increased to 28 to 30 (mean = 29.0, SD = 1.0). Students reported development in both soft and technical skills.

SUMMARY

The practice transformation APPE offered students a unique opportunity to develop a diverse set of skills during a focused five-week experience. Based on positive feedback from students, this institution plans to continue to expand this APPE.

A team-led remote ambulatory care rotation: Creating efficiency without sacrificing quality

BACKGROUND AND PURPOSE

Advanced pharmacy practice experiences (APPEs) are a highly anticipated part of the doctor of pharmacy program. Traditionally, these rotations are offered as full-time, onsite experiences. However, there are situations in which geography, transportation, and housing requirements limit the accessibility of these experiences. Additionally, unexpected changes in rotation schedules or resource limitations may leave students in a difficult situation when completing their rotation hours. Having the ability to provide a remote APPE that results in similar student learning outcomes provides flexibility to experiential directors and ensures students' continued progression towards graduation.

EDUCATIONAL ACTIVITY AND SETTING

A group of faculty members and post-graduate trainees collaborated to create a remote, one-month ambulatory care experience for 18 students over three months. Students had access to the electronic health record (EHR) from their homes through a partnership with a local federally qualified health center. Access to the EHR enabled the students to participate in telehealth visits and have meaningful interactions with patients as if they were on-site. Students were also able to participate in topic discussions, answer drug information questions, complete a literature evaluation series, and work on projects remotely through this rotation.

FINDINGS AND SUMMARY

This remote rotation allowed preceptors to meet the educational needs of students while allowing them to provide patient care through telehealth. Data from summative student evaluations, student evaluations of preceptor and site, and a supplemental survey demonstrate that this remote rotation is a meaningful learning experience for students and is comparable to similar in-person rotations.

Redefining 'advanced': Supporting and promoting practice change through community advanced pharmacy practice experiences

INTRODUCTION

Community pharmacy practice in the United States (US) has faced several external pressures, threatening traditional practice models. Schools and colleges of pharmacy (S/COP), particularly through experiential rotations, are perfectly poised to help these practices create new sustainable business models. The purpose of this article is to highlight demonstrated, reproducible successes of community advanced pharmacy practice experience (APPE) advancement initiatives.

PERSPECTIVE

Despite community pharmacists being highly-trained health care providers with roughly equivalent educational backgrounds, community-based practices in the US are not all the same. Student pharmacists can contribute to the design and implementation of revenue-generating services helping individual pharmacies elevate their practice. Doing so involves new models for staffing, workflow, billing, and documentation. Students can help support practice change by focusing on implementation and sustainability. Example APPE integrations focused on community pharmacy practice transformation are described in detail from the University of Arkansas for Medical Sciences College of Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Idaho State University.

IMPLICATIONS

Establishing intentional connections that focus on new sustainable community business models is a responsibility for S/COP. The examples provided serve to demonstrate the feasibility of these partnerships. Training students on innovative practice models and utilizing them is critical in moving community practice forward. As academicians, we must prepare students to be agents of change for the profession and intentionally integrate them into a systematic plan to help promote and change practice activities wherever possible, but especially in community practice.

Evaluation of student-perceived growth in entrustable professional activities after involvement in a transitions-of-care process within an adult medicine advanced pharmacy practice experience

BACKGROUND AND PURPOSE

Involvement of pharmacists and trainees in care transitions reduces medication-related problems. Participation in the transitions-of-care (TOC) process may impact self-perceived growth of autonomy within selected entrustable professional activities (EPAs).

EDUCATIONAL ACTIVITY AND SETTING

A student-driven TOC documentation process was implemented within an inpatient family medicine advanced pharmacy practice experience. During the month-long rotation, students rounded with an interdisciplinary care team. Responsibilities included ensuring accurate medication reconciliation at care transitions throughout hospitalization and prior to discharge as well as medication optimization during hospitalization. Another responsibility was completing a medication-specific TOC note in the clinic-based electronic health record at discharge for patients receiving primary care from the associated clinic. The note was available to the outpatient interdisciplinary care team during the hospital follow-up appointment. Student-perceived growth in autonomy within selected EPAs was determined through an online anonymous survey.

FINDINGS

Ninety percent (n = 18) of eligible students completed the survey. For specific EPA statements (collecting information, establishing patient-centered goals and establishing a care plan, implementing a care plan, collaborating as an interdisciplinary team member, and ensuring immunization), student-perceived autonomy increased after involvement in this student-driven TOC process. During the study period, 215 notes were generated by student pharmacists and included interventions/recommendations within the following themes: evidence-based changes in therapy, patient counseling, and medication access.

SUMMARY

The importance of pharmacist and pharmacy trainee involvement in the TOC process has been well-documented. Involving students in student-driven TOC documentation processes serves to facilitate student-perceived growth in autonomy within selected EPAs.

Use of an objective structured clinical examination (OSCE) to assess intern performance in an advanced pharmacy practice experiences (APPE) Ambulatory Care rotation

Purpose

Intern assessment during advanced pharmacy practice experiences (APPEs) are generally based upon each individual preceptor's perceptions without an objective measurement of intern understanding and performance. Therefore, we sought to determine whether a pre- and post-OSCE could be used to confirm that interns achieved the goals and objectives of the Ambulatory Care rotation. The aims of this study were to determine whether a pre-rotation OSCE can help pharmacy interns self-assess their clinical strengths and weaknesses and assess whether their knowledge and skills improved after completing a post-rotation OSCE.

Methods

Pharmacy interns undergoing APPE Ambulatory Care rotations from September 2018 to March 2020 participated in a pre- and post-rotation OSCE to assess their knowledge of various chronic disease states. Interns completed pre- and post-OSCE surveys to assess their perceptions about their knowledge and the OSCE experience.

Results

Pharmacy intern knowledge about diabetes, hypertension, dyslipidemia, and atrial fibrillation significantly improved post-OSCE compared to their pre-OSCE scores (p < 0.001). The mean post-OSCE scores for diabetes (p < 0.001), dyslipidemia (P = 0.046), anticoagulation (P = 0.006), and the overall mean post-OSCE scores (P = 0.005) were significantly higher compared to interns' pre-OSCE scores. Students believed that the post-OSCE significantly highlighted their strengths and weaknesses in skills and knowledge compared to the pre-OSCE (P = 0.008).

Conclusion

Pre- and post-APPE OSCE assessments are important tools that can provide interns and preceptors with objective evaluations of student performance. OSCEs can either be used as an alternative to perception-based assessments or integrated into existing preceptor evaluations. Furthermore, OSCEs can help preceptors identify areas that require more emphasis in their rotations.

Team feedback: A missing piece of the interprofessional education puzzle

INTRODUCTION

The ambulatory care practice model has long embraced interprofessional collaboration, well before it was formalized by the Interprofessional Education Collaborative. Establishing a mechanism to gather insight from other members of the interprofessional team may facilitate further development of interprofessional education (IPE).

COMMENTARY

There is limited evidence investigating non-pharmacy trainees and medical provider perceptions of advanced pharmacy practice experience (APPE) student involvement in IPE. Most available evidence evaluates the satisfaction of non-pharmacy trainees and other health care professionals with APPE student recommendations.

IMPLICATIONS

Emphasis on IPE, such as formalizing feedback from other health care professionals during experiential rotations, may assist preceptors in adapting interactions, strengthening interprofessional collaborations, and ensuring that students are valued team members who contribute to providing quality patient care.

Developing an international industrial advanced pharmacy practice experience in Brazil

INTRODUCTION

In this commentary, we advocate for implementing international industry-focused advanced pharmacy practice experiences (APPEs) that engage pharmacy students and schools with the pharmaceutical industry to develop products for the global market to broaden pharmacy student experiences in non-patient care electives.

COMMENTARY

Our five-year experience suggests the following structural components are essential to the success of the APPE: (1) identification of suitable international industry partners through non-traditional methods, such as the local, United States (US) chamber of commerce; (2) commitment by the company and educational institutions to develop key personnel to work with international students in the host country; (3) development of a global regulatory affairs course and workshops that target the product development stage; (4) development of student experiences based on projects directly linked to a new product(s); (5) use of technology platforms to support weekly video conferencing and translation; (6) engagement of students in community service; (7) cooperative evaluation of students and the program. The aggregate of student projects led to the development of a line of dietary supplement products introduced to the US market.

IMPLICATIONS

The implementation of this APPE benefits pharmacy students but also the academic and industry hosts. Pharmacy students obtained global manufacturing experience, an appreciation for a different culture, and supported commercial product development. The educational institutions developed joint courses and workshops. Students were embedded into various departments, carried out Food & Drug Administration regulations research, prepared comparative regulatory process maps, and provided company employees with an understanding of American consumers.

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.

Use of a script concordance test to evaluate the impact of a targeted educational strategy on clinical reasoning in advanced pharmacy practice experiential students

BACKGROUND AND PURPOSE

It is unclear how clinical reasoning is impacted by a single advanced pharmacy practice experience (APPE) and how preceptors can further develop these skills.

EDUCATIONAL ACTIVITY AND SETTING

Students completing an APPE within four sites were invited to participate. To assess clinical reasoning skills, students completed a 30 item script concordance test (SCT) during week 1 and week 5 of a rotation. Students were divided into control and intervention groups. The intervention group participated in a clinical reasoning discussion, during which students presented a case and led a discussion on how to reason through treatment options.

FINDINGS

Change in mean SCT scores between week 1 and week 5 were 0.84 (2.8%) and 1.23 (4.1%) in the control (n = 15) and intervention groups (n = 28), respectively. There was no significant change in scores in the control group (P = .07, CI -0.34, 2.01). The change in scores was statistically significant in the intervention group (P = .02, CI 0.23, 2.23). An independent samples t-test comparing the SCT score change for the control and intervention group showed no significant difference (P = .62, CI -1.18, 1.96).

SUMMARY

This study demonstrated the feasibility of implementing a SCT in experiential education. SCT scores did not significantly improve beyond the standard APPE in response to the focused educational intervention, but investigators found that the discussion facilitated rich conversations about patient cases and was valuable for assessing a student's thinking pattern.

Impact of a novel preceptor collaborative advanced pharmacy practice experience curriculum on student-perceived ability and confidence

BACKGROUND AND PURPOSE

A novel teaching collaborative for acute care medicine advanced pharmacy practice experiences (APPEs) was formed by five faculty preceptors. The primary goal of the collaborative model was to ensure that acute care medicine APPEs provided students with opportunities to achieve Accreditation Council of Pharmacy Education Standards 2016, including strengthening students' ability to be practice- and team-ready.

EDUCATIONAL ACTIVITY AND SETTING

The collaborative model included group discussions, video modules, patient cases, journal scans, and case presentations among student pharmacists completing an adult or pediatric acute care APPE. Anonymous, voluntary pre-/post-surveys were completed by a cohort of students who participated in the collaborative model from May 2018 to April 2019. Survey questions assessed student-perceived ability/confidence related to interprofessional (IP) relationships and decision-making skills for adult and pediatric patients, as well as value of activities.

FINDINGS

From the cohort of 67 students, 54 pre-survey and 45 post-survey responses were obtained. Post-rotation, students showed an increase in confidence to practice pharmacy on an IP team (39% vs. 100%, P < .001). Significant increases were also found for therapeutic decision-making regarding antibiotics, anticoagulants, and pharmacokinetics for adult and pediatric patients. Among students completing the post-survey, video modules were the most valued component of the model.

SUMMARY

A collaborative APPE model resulted in consistent increases in student-perceived ability and confidence related to care of adult and pediatric patients. This APPE model could be adapted within different care settings and pharmacy curricula.

Evaluation of social phobia, comfort in communication, and interprofessional value during advanced pharmacy practice experiences: A focus on pharmacy student and medical resident interprofessional education

BACKGROUND

We implemented and evaluated communication and interprofessional socialization after a unique rotation between final year pharmacy students and medical residents.

INTERPROFESSIONAL EDUCATIONAL ACTIVITY

Pharmacy students on an advanced pharmacy practice experience (APPE) in pediatric critical care completed a standard experience with (i.e. intervention group) or without (i.e. control group) a medical resident as part of the pharmacy team. The objectives of this study were to evaluate pharmacy student social phobia, communication apprehension, interprofessional socialization, value placed on interprofessional teams, and comfort interacting with a physician as a result of the APPE. Practicality and sustainability were also evaluated.

DISCUSSION

Forty-six students participated (28 control, 18 intervention). Both groups had similar baseline characteristics and measure scores. No changes were observed in social phobia or communication apprehension. Both control and intervention groups showed improved scores in interprofessional socialization and valuing. Scores on the Self-Perceived Ability subscale of the Interprofessional Socialization and Valuing Scale increased for the intervention group, but not for the control group. Comfort interacting with a physician was higher in the intervention than the control group. Minimal changes to the APPE were made during the six-year study, and practicality and sustainability were positive.

IMPLICATIONS

Limited data describe interactions between pharmacy students and medical residents on APPEs. Participating students increased their comfort and self-perceived ability in interacting with a physician. Due to the limited need for extra time or financial resources, this experience could be applied and studied in additional settings to assist in preparing practice ready pharmacists.

Implementation and evaluation of a virtual learning advanced pharmacy practice experience

BACKGROUND AND PURPOSE

The novel severe acute respiratory syndrome coronavirus 2 restricted student involvement in direct patient care. Virtual learning is an effective education strategy in pharmacy curriculums. This study aimed to evaluate student perceptions of virtual learning advanced pharmacy practice experiences (APPE) utilizing an electronic 12-question survey.

EDUCATIONAL ACTIVITY AND SETTING

Virtual learning was developed and implemented, and students were surveyed at the end of the APPE. The survey was comprised of one open-ended and 11 Likert scale questions. It assessed implementation and use of virtual learning in place of a standard on-site APPE.

FINDINGS

Responses were attained from 19 students. Questions regarding resources provided and virtual learning enabling autonomous, independent learning had the highest percent of strong agreement. No responses indicated strong disagreement. Three questions solicited >10% response rate of somewhat disagree, 16% associated with virtual learning helping the student become a better member of the healthcare team after graduation. Open-ended responses acknowledged appreciation of the virtual APPE and presented material. One in six students commented on the ability to apply the learned information to direct patient care. Feedback was delivered on consideration for increased utility of patient care-orientated applications to facilitate simulation of real-life patient cases.

SUMMARY

Students who completed the virtual APPE were satisfied overall. Virtual teaching modalities may be incorporated into APPEs, particularly when direct patient care access is limited, but should not be used to completely replace the experience gained during direct patient care.

Teaching advanced pharmacy practice experience students to be effective teachers of second-year pharmacotherapy students

INTRODUCTION

Academic advanced pharmacy practice experiences (APPEs) are unique elective opportunities for student pharmacists to engage with and learn about academia. The purpose of this research was to determine the impact of second-year (PY2) student participation in fourth-year (PY4) academic APPE student-delivered review sessions on individual pharmacotherapy examination scores.

METHODS

The PY2 cohort was evaluated by comparing their performance against the class average when they did and did not attend a review session. Utilizing a t-test, we sought to determine if there was a significant change in student performance. Qualitative evaluations were also performed on the PY4 students experience during their rotation.

RESULTS

A total of 28 PY2 student pharmacists took a total of 140 exams during the study period. Of the 140 exams taken, 54 individual exams were taken after attending a review session created and led by PY4 student pharmacists and 86 exams were taken in the absence of attending a review session. Analysis showed that student performance on exams after attending a review session was 0.4 SD above the class average, while performance was very close to the class average at 0.05 SD above the class average when review sessions were not attended.

CONCLUSIONS

PY4 student pharmacists trained on an academic APPE can improve PY2 student pharmacists' pharmacotherapy exam scores. APPE students also self-reported positive learning experiences while participating in this teaching.

Faculty preceptors' strategies for teaching clinical reasoning skills in the advanced pharmacy practice experience setting

INTRODUCTION

Clinical reasoning is essential to providing quality patient care. However, advanced pharmacy practice experience (APPE) students may struggle with the real-life aspects of patient care, and it may be difficult to quickly identify these students in order to make meaningful interventions. The purpose of this study was to explore pharmacy faculty preceptors' strategies for identifying gaps and teaching clinical reasoning in the APPE setting.

METHODS

A qualitative study utilizing 30-min, one-on-one phone interviews was conducted with faculty members from two schools of pharmacy. Faculty participants were invited based on their APPE preceptor role and expertise in adult general medicine. Interview questions collected faculty demographics and reflections on evaluation and instruction of clinical reasoning skills. Demographics were analyzed using descriptive statistics. Thematic analysis was completed to identify themes from qualitative interview data.

RESULTS

Fifteen faculty preceptors participated. The cohort had an average of 17.1 pharmacy practice years and an average of 11.9 faculty member years. Interviews yielded a 7735-word document for data analysis, which resulted in 11 themes.

CONCLUSIONS

This study explored pharmacy faculty preceptors' strategies for identifying gaps in clinical reasoning and their instructional methods to improve those skills, which resulted in 11 themes. Future directions include implementation of a standardized clinical reasoning assessment tool in the APPE setting and exploration of targeted educational interventions.

Impact of community paramedicine program on APPE student skillsets

BACKGROUND AND PURPOSE

This article describes the clinical and educational impact resulting from interprofessional (IP) collaboration between fourth-year advanced pharmacy practice experience (APPE) pharmacy students and community paramedics within a community paramedicine (CP) program.

EDUCATIONAL ACTIVITY AND SETTING

The Manatee County, Florida CP program partnered with Lake Erie College of Osteopathic Medicine School of Pharmacy faculty to reduce 911 calls, emergency room visits, and hospital readmissions for underserved populations. The CP-pharmacist partnership optimized medication therapy, chronic disease management, and access to care through scheduled in-home visits with an IP team. With guidance from the pharmacist, APPE student responsibilities included comprehensive medication review, medication action plan development, communication with providers, and patient counseling to resolve medication issues.

FINDINGS

Survey data demonstrated this approach to APPEs increased student confidence in optimizing care plans (100%), assessing vitals (76%), identifying medical emergencies (84%), and communicating with patients (96%). Student incorporation into a CP program augmented the pharmacist's ability to successfully correct medication use errors and improve nonadherence through patient counseling. Medication interventions were successful in 693 of 799 scenarios, for a success rate of 86.7%.

SUMMARY

Results from this analysis reinforced prior research indicating pharmacy students can be successfully incorporated into a CP program, with resulting improvement in student clinical skills, communication strategies, and successful medication intervention outcomes.

Rebooting a sports pharmacy advanced pharmacy practice experience: Utilizing medicinal chemistry as a foundational approach to get pharmacists back in the game

BACKGROUND AND PURPOSE

To implement a sports pharmacy advanced pharmacy practice experience (SP-APPE) utilizing medicinal chemistry as a foundational approach.

EDUCATIONAL ACTIVITY AND SETTING

A student-pharmacist and medicinal chemistry faculty member collaborated to reboot a SP-APPE. Approached from a medicinal chemistry perspective and tailored to the infrastructure of the university, three fourth-year student-pharmacists piloted the SP-APPE (fall 2017 to fall 2018). Various performance enhancing drugs (PEDs) and supplements were investigated. Student-pharmacists evaluated general knowledge of PEDs along with the perceived value of pharmacists in sports among student-athletes, athletic personnel, and pre-APPE students.

FINDINGS

By demonstrating how legitimate medications were chemically similar to substances banned by sports governing agencies, comparing chemical structures/pharmacophores of PEDs to those of various prescription drugs, and comprehending athletes' misuse of PEDs, student-pharmacists educated student-athletes and athletic personnel on pertinent topics spanning pharmacy and sports (e.g., marijuana, medication sharing, deciphering supplement labels). Laboratory analytical methods that detect PEDs and educational points regarding potential adverse health risks posed by PED usage were also reviewed. Survey participants (approximately 75%, n = 134) perceived pharmacists as valuable to student-athletes and athletic personnel. Student-pharmacists indicated that medicinal chemistry knowledge was strengthened by completing the APPE and relevant to their pharmacy careers.

SUMMARY

Based on medicinal chemistry principles, the SP-APPE provided a venue for student-pharmacists to interact with athletics, assist with drug information education, and identify drugs or supplements as chemically related to those banned by sports governing agencies. Confident in medicinal chemistry concepts, student-pharmacists translated their expertise to benefit the patient/student-athlete.

Addressing challenges to precepting advanced pharmacy practice experience students in the community setting

BACKGROUND AND PURPOSE

An advanced pharmacy practice experience (APPE) in a community pharmacy setting is required in all accredited doctor of pharmacy program curricula in the United States. This setting often presents unique challenges to precepting students that may hinder the development and availability of robust learning experiences. This qualitative review discusses perceived challenges and potential solutions to maintaining a meaningful community rotation experience for students based on published literature and reported preceptor experiences. It also explores the clinical impact of APPE students in community pharmacy.

EDUCATIONAL ACTIVITY AND SETTING

St. Louis College of Pharmacy (STLCOP) provides a systematic approach to student orientation and evaluation for community pharmacy APPEs. This allows all pharmacy students to be held to the same educational outcome standard. Site preceptors are responsible for communicating site-specific expectations and providing frequent formative feedback to students throughout the five-week rotation.

FINDINGS

Community rotation students spent approximately 6400 hours providing almost 30,000 patient interventions over two years, indicating a potential benefit in quality of care at student-hosted sites. Despite evidenced benefits of the presence of pharmacy students in community pharmacies, some pharmacists hesitate to precept students due to anticipated obstacles of this additional responsibility.

SUMMARY

This review explored the community practice APPE structure offered at STLCOP and describes the patient impact that students have made during this clinical rotation. Data seem to indicate a positive return on investment for having APPE students in community pharmacy.

Comparing faculty evaluations of student journal club presentations with student self- and peer evaluations during advanced pharmacy practice experiences

BACKGROUND AND PURPOSE

Self-evaluation is a critical step in professional development. Peer evaluation may enhance student learning and help peer evaluators recognize their own limitations. However, these evaluations may not accurately assess performance. This study's purpose is to evaluate differences between faculty, self-, and peer evaluations of student journal club (JC) presentations during advanced pharmacy practice experiences (APPEs).

EDUCATIONAL ACTIVITY AND SETTING

Student JC presentations for three APPE sites were identified between May 2015 and April 2018 and included if at least one faculty, self-, and peer evaluation were complete. Overall grades and individual rubric ratings were compared.

FINDINGS

Seventy-four students had complete data sets. The mean overall scores for JC presentations were 82.72%, 86.05%, and 91.01% for faculty, self-, and peer evaluations, respectively. Self-evaluation ratings were significantly higher than faculty on each domain, except for "presentation and communication skills" (mean difference: -0.2, p = .034) and "ability to answer questions" (mean difference: -0.1, p = .247). Linear regression showed a statistically significant relationship between self-evaluation and faculty evaluation ratings for ability to answer questions (beta = 0.5, p < .001). Peer evaluation ratings were significantly higher than faculty and self-evaluations (p < .05).

SUMMARY

Faculty scores on JC presentations completed during APPEs were lower compared to student evaluations of themselves and their peers. Further incorporation of self- and peer evaluation throughout pharmacy school curricula may improve student competence in performing these evaluations. Formal training is needed to improve students' ability to complete self and peer evaluations.

Addressing preceptor shortages with a novel structure of blended ambulatory care rotations

INTRODUCTION

Schools of pharmacy are challenged to ensure sufficient full-time ambulatory care advance pharmacy practice experiences (APPEs). University of Maryland designed an innovative solution to create additional rotations utilizing faculty with part-time ambulatory care practices, by combining two rotation blocks into a 10-week "blended" ambulatory care/community pharmacy experience. The objective of this study is to characterize perceptions and impact of this format on student and preceptor skills, performance, and overall satisfaction, compared with the traditional five-week ambulatory care rotation.

METHODS

Ambulatory care preceptors were surveyed regarding student skills in interviewing, documentation, patient assessment, building pharmacist-patient relationships, and mentorship opportunities. Students were surveyed regarding the number of preceptors and patient interactions/week, rotation hours, clinical abilities developed, patient relationships, patient population diversity, preceptor mentorship, clinical track participation, rotation expectations, professional benefit, career development, overall satisfaction, and likelihood to recommend the rotation. Chi-square test was used to evaluate statistically significant differences in cohort responses.

RESULTS

Survey responses from 74 students (49%) and 21 preceptors (46%) were included. Student perceptions were generally positive and comparable between groups. Statistically significant differences were observed between groups in students' perception of "patient diversity" and preceptors' perception of "patient-pharmacist relationship".

CONCLUSION

The 10-week blended format provides a unique and viable option that offers a solution to shortages of preceptor availability for ambulatory care APPEs by providing a rotation format that is more conducive to clinical practice faculty part-time ambulatory clinic schedules.

Self-perceived knowledge and confidence regarding infectious diseases of advanced pharmacy practice experience students

INTRODUCTION

Knowledge in infectious diseases (ID) pharmacotherapy and antimicrobial stewardship is becoming increasingly important for pharmacists. Pharmacy schools utilize multiple methods to teach ID pharmacotherapy including advanced pharmacy practice experiences (APPEs).

METHODS

An internet-based survey was sent to students currently on APPEs at four colleges/schools of pharmacy. The primary study objective was a comparison of self-perceived ID knowledge and confidence prior to starting and during APPEs. The secondary objectives were to determine the level of self-perceived knowledge and confidence of students who have completed an ID APPE to those who have not, as well as the level of interest in postgraduate year 1 (PGY-1) and ID-specific postgraduate year 2 (PGY-2) residencies.

RESULTS

All statements revealed a statistically significant increase in self-perceived ID knowledge and confidence for students during APPEs compared to before starting rotations (p-values < 0.001). Students who completed an ID APPE had an overall increase in both self-perceived knowledge and confidence for all aspects. Completion of an ID APPE enhanced self-perceived knowledge in basic microbiology fundamentals, antimicrobial stewardship principles, and overall ID knowledge. Completion of an ID APPE created a higher level of confidence regarding selecting appropriate antimicrobial therapy, interpreting cultures and susceptibilities to de-escalate, and communicating with other healthcare professionals.

CONCLUSIONS

Students who completed an ID APPE had a higher level of self-perceived knowledge and confidence than those who had not. Recent increases in demand for antimicrobial stewardship positions warrants maximization of ID and non-ID APPEs to enhance students' knowledge and confidence in infectious diseases.

An interprofessional clinical toxicology advanced pharmacy practice experience

BACKGROUND AND PURPOSE

Clinical toxicology is a blend of science, research, and patient management practices involving human poisonings from exposure to natural and synthetic toxins. The objective of this study was to describe the components of an elective advanced pharmacy practice experience (APPE) in clinical toxicology at California Poison Control System (CPCS).

EDUCATIONAL ACTIVITY AND SETTING

The APPE requirements included a mix of active participation in case management and supplemental educational exercises, case presentations and consultations, and a structured self-study component consisting of readings and on-line modules. In addition, there were two active learning activities, high acuity poisoning simulation scenarios utilizing a high-fidelity mannequin, and an antidote tasting session.

FINDINGS

From April 2012 to October 2017, 82 student pharmacists completed this APPE. Pharmacy students completed 85 pre-simulation surveys and 80 post-simulation surveys. Survey results showed an increase in pharmacy student beliefs that a clinical pharmacist should be involved in the differential diagnosis and management of patients (60% pre-simulation vs. 78.8% post-simulation, p = 0.009). APPE pharmacy students completed an evaluation of the preceptors(s), site, and learning experience. The average score for all areas on the preceptor and site evaluations was >4.5 on a 5-point Likert scale. Qualitative data themes included student satisfaction with opportunities, feedback, and the interprofessional and collaborative environment.

SUMMARY

An APPE in the CPCS was successfully designed and implemented. The APPE provides an interprofessional collaborative learning environment that allows student pharmacists to understand the unique role of the pharmacist in this setting.

Assessment of a didactic ambulatory care pharmacy elective on student perceptions and subsequent performance in an ambulatory care advanced pharmacy practice experience

INTRODUCTION

This study assessed student perception in treating chronic disease states before and after taking an ambulatory care didactic elective and the impact on performance within a fourth-year ambulatory care advanced pharmacy practice experience (APPE).

METHODS

Assessment of student perceptions was evaluated in students taking the Fall 2016 and Spring 2017 elective offering by completing an 11-item electronic survey prior to the first lecture of the course and after the last lecture of the course. A retrospective assessment of student performance in the APPE compared students that had taken the elective to those that had not over a two-and-one-half year period. Data collected included the students' final APPE experiential and required examination grade.

RESULTS

In all but one survey question, student perceptions significantly improved upon completion of the elective. Student ambulatory care APPE final experiential grades were higher in students who had taken the elective compared to those that had not (90.3% vs. 88.9%, respectively, p = 0.04) as were APPE examination scores (78.0% vs. 74.0%, respectively, p = 0.01).

DISCUSSION AND CONCLUSIONS

Student perception in key ambulatory care concepts, disease states, and drug knowledge improved after taking the ambulatory care elective. Student ambulatory care APPE performance was also mildly improved as a result of taking the elective compared to those who did not take the course. This is the first study to evaluate subsequent performance in an APPE as a result of taking an elective ambulatory care course and can serve as a template for other research in elective assessment.

"How do I say that?": Using communication principles to enhance medication therapy management instruction

BACKGROUND AND PURPOSE

Medication therapy management (MTM) is a comprehensive, patient-centered approach to improving medication use, reducing the risk of adverse events and improving medication adherence. Given the service delivery model and required outputs of MTM services, communication skills are of utmost importance. The objectives of this study were to identify and describe communication principles and instructional practices to enhance MTM training.

EDUCATIONAL ACTIVITY AND SETTING

Drawing on formative assessment data from interviews of both pharmacy educators and alumni, this article identifies and describes communication principles and instructional practices that pharmacy educators can use to enhance MTM training initiatives to develop student communication strategies.

FINDINGS

Analysis revealed five key communication challenges of MTM service delivery, two communication principles that pharmacy teachers and learners can use to address those challenges, and a range of specific strategies, derived from communication principles, that students can use when challenges emerge. Implications of the analysis for pharmacy educators and researchers are described.

SUMMARY

Proactive communication training provided during MTM advanced pharmacy practice experiences enabled students to apply the principles and instructional strategies to specific patient interactions during the advanced pharmacy practice experiences and in their post-graduation practice settings.

Preliminary findings from a student pharmacist operated transitions of care pilot service

BACKGROUND AND PURPOSE

Student pharmacists are well equipped to complete transitions of care (TOC) activities. This communication describes the implementation of a student-operated TOC pilot service at a community hospital and explores the clinical and educational findings of such a service.

EDUCATIONAL ACTIVITY AND SETTING

Patients admitted to the hospital were included in the service if they had a primary care provider from an affiliated ambulatory care office. The TOC student pharmacist verified the medication history upon admission, reviewed the inpatient chart during the hospitalization, assessed medication adherence, provided discharge counseling, and prepared a TOC document to share with the patient's ambulatory care office.

FINDINGS

Forty-one patients were followed in the TOC pilot service. Student pharmacists identified 208 medication discrepancies between hospital and ambulatory care medication lists upon admission for 35 of the patients. Review of the discharge medication reconciliation was performed for 31 (75.6%) of the patients prior to discharge. The Adherence Estimator^® was performed for 32 (78%) of the patients, with a mean score of 2.2. Student pharmacists anecdotally reported satisfaction with their involvement, and preceptors felt confident that the students were able to serve as an extension of the TOC service.

DISCUSSION AND SUMMARY

Implementation of a student pharmacist-operated TOC service broadened student involvement on advanced pharmacy practice experience (APPE) and improved patient care through resolution of medication discrepancies, reinforcement of adherence, and communication with primary care providers.

Community education by advanced pharmacy practice experience students: Increasing electronic cigarette awareness amongst teens

BACKGROUND AND PURPOSE

An electronic cigarette (e-cigarette) is a device used to mimic the experience of smoking tobacco cigarettes. Considering their growing popularity amongst adolescents, it is imperative that education surrounding e-cigarettes be provided. The purpose of this project is to describe the development and delivery of a pilot interactive presentation and survey tool by doctor of pharmacy (PharmD) candidates to gauge the use and understanding of e-cigarettes amongst teens.

EDUCATIONAL ACTIVITY AND SETTING

An interactive presentation providing information on e-cigarettes was created by a PharmD candidate, and presented to 357 high school students in Massachusetts and New Hampshire. An anonymous survey tool was administered after the presentation to evaluate students' perception, use, and knowledge of e-cigarettes.

FINDINGS

When asked which is safer, an e-cigarette or a tobacco cigarette, most students (84%) responded "neither," and most stated that they learned something new from the presentation. Of the 96% of students that indicated they had heard of e-cigarettes, 27% of them had tried one. PharmD candidates reported increased confidence in public speaking and preparation of patient-suitable material.

DISCUSSION

This pilot project provided both education to adolescents and insight into their experience and understanding of the potential harms of e-cigarettes. Having a PharmD candidate deliver the presentation may have increased the students' level of comfort.

SUMMARY

An interactive, PharmD candidate-delivered presentation about e-cigarettes is an innovative method to both provide education about e-cigarettes, and ascertain information about knowledge and use in adolescents. Facilitating presentations like this could be successful in other settings or topics.

Development of a capstone course to improve student confidence and pharmacotherapy knowledge prior to advanced pharmacy practice experiences

OBJECTIVE

To describe a capstone course designed to improve student confidence with clinical skills, improve confidence with providing medication therapy, and evaluate student knowledge.

DESIGN

A 2-week capstone course was incorporated into the third-year pharmacotherapy course in a Doctor of Pharmacy program. Students evaluated complex patient cases and developed pharmacotherapy care plans. Pre- and post-capstone course survey results were used to assess change in student confidence using clinical skills and providing medication therapy, and quiz and exam results were used to assess student knowledge.

RESULTS

Student confidence significantly improved from baseline for clinical skills (p < 0.02 across all clinical skills domains) and providing medication therapy (p < 0.01 across all disease states). Students reported the largest improvement in confidence for the clinical skill of creating a Subjective/Objective/Assessment/Plan (SOAP) note on a patient with multiple disease states (p < 0.001). Students reported the highest confidence increase for acute kidney injury (p < 0.001). The average written exam score was 87.2% (standard deviation ± 8.0) and the average verbal exam score was 79.1% (standard deviation ± 15.7).

CONCLUSION

A 2-week capstone course can be valuable to improve confidence and assess student knowledge prior to advanced pharmacy practice experiences (APPEs).