A collaborative approach to improving and expanding an experiential education program

Optimizing optimization: A six-year quality improvement project focused on students' APPE preferences

PROBLEM DESCRIPTION

The advanced pharmacy practice experience (APPE) component of the entry-level doctor of pharmacy degree program is essential in contributing to student pharmacists' education. Establishing an optimization process to assist students in matching to their highest preferred clinical sites is extremely important.

QUALITY IMPROVEMENT METHODS

The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences uses a fourth year APPE match process designed to yield the best possible matches for the entire class while being perceived as fair and relatively easy to navigate. This article describes the evolution of this process.

RESULTS OF CQI INQUIRY

Across six years of data, satisfaction with the match process has been rated consistently high by students. Fairness with the process is also rated highly. Changes to the process have resulted in students receiving higher ranked preferences in more recent years. This was achieved while still following institution requirements for rural rotations and pre-matching.

INTERPRETATION AND DISCUSSION

The APPE year yields a tremendous amount of learning for students as a culminating experience applying skills and knowledge to actual patients. Improving students' ability to customize their own schedule allows them to optimize these learning opportunities.

CONCLUSIONS

A robust match process has been established and refined to meet the needs of the student pharmacists as they approach their fourth year of the curriculum. This process has been perceived as fair and relatively easy to navigate. Achievement of higher overall student rankings has been accomplished.

Experiential Education in Pharmacy Curriculum: The Lebanese International University Model

Experiential education is an essential component of pharmacy education in order to allow intern students to experience real conditions and training opportunities in different inpatient and outpatient settings. This paper provides a description of the pharmacy practice experiences (PPEs) in the Lebanese International University (LIU) 5-year bachelor of pharmacy (BPharm) and postgraduate doctor of pharmacy (PharmD) programs; focuses on the opportunities and challenges encountered; and presents a model for experiential education in Lebanon. Learning outcomes and thus students’ acquisition of predefined competencies are evaluated in actual practice settings through assessment tools. Our experiential education program aligns with the accreditation/certification criteria set by the Accreditation Council for Pharmacy Education (ACPE) and equips future pharmacists with the knowledge and skills to become major components in the healthcare team.

Strategies to optimize implementation of novel preceptorship models: Peer-assisted learning and near-peer teaching

INTRODUCTION

Hospital experiential placements have traditionally used a 1:1 (student to preceptor) ratio. Two models, peer-assisted learning (PAL) and near-peer teaching (NPT), have been described in the literature for education of health professions. This research explored the use of PAL and NPT, as well as advantages, challenges, and strategies to address challenges for implementation.

METHODS

This study used an anonymous survey to solicit feedback from staff pharmacists and pharmacy leaders about their use of PAL and NPT models in hospital settings in Alberta, Canada. Using closed and open-ended questions, experience with each model and implementation considerations were explored.

RESULTS

The survey was completed by 115 hospital pharmacists (11% response rate). PAL and NPT were utilized by 25% and 8% of respondents, respectively, and 10% had experience with both models. Advantages of these models include promoting teamwork and clinical independence, learners supporting each other, and fostering active learning. The highest ranked challenges were space/technology/computer access limitations and additional time to complete learner assessments. Many strategies were provided to address challenges, and facilitate implementation and utilization.

CONCLUSION

In the hospital setting, pharmacists used PAL more commonly than NPT. Feedback from pharmacists and leaders affirmed the advantages and challenges associated with use of these precepting models. Strategies to facilitate and optimize use were provided, which will guide faculty, pharmacy leaders, and preceptors in efforts to support implementation to increase capacity and expand the practice of precepting.

Perceived value of partnerships between schools of pharmacy and health systems

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Student perceptions of an experiential education clinic within a pharmacy school

BACKGROUND AND PURPOSE

Pharmacy schools would benefit from new models of experiential education. The University of Saskatchewan (Canada) recently opened a patient care clinic called the Medication Assessment Centre (MAC) as new experiential education model. The purpose of this paper is to describe the structure and function of the MAC and to report program evaluation data.

EDUCATIONAL ACTIVITY AND SETTING

The MAC is a unique application of an existing experiential education model in that it is an pharmacist-run ambulatory clinic (which is common) that is physically located on campus amongst the classrooms and supervised by pharmacy faculty (which is unique). Students are all required to participate in the clinic on a regular basis, in between lectures, throughout the four years of the pharmacy program.

FINDINGS

Students were invited to participate in one of five focus groups to assess the value of the experience. Transcripts were analyzed using thematic analysis, and the results identified strong satisfaction amongst students. The overall themes fell into three categories: (1) aspects that students liked, (2) aspects that students found challenging, and (3) positive impact on student learning. Previously published studies have found strong support for the MAC amongst patients and physicians.

SUMMARY

Students felt that a faculty supervised experiential education clinic that is physically located within their pharmacy school was a valuable learning experience. This paper provides a description of how the MAC has been integrated into an existing pharmacy curriculum, which may be valuable to schools contemplating a similar addition to existing experiential learning.

Curriculum renewal: Alignment of introductory pharmacy practice experiences with didactic course content

BACKGROUND AND PURPOSE

The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) used the opportunity of curriculum renewal to integrate knowledge and skills learned from didactic courses into the introductory pharmacy practice experiences (IPPEs) occurring simultaneously. This paper describes and evaluates the meaningful application of course content into IPPEs, and evaluates the success using qualitative feedback.

EDUCATIONAL ACTIVITY AND SETTING

Students entering the renewed curriculum starting in fall 2012 were provided a list of pharmacy skills and activities from didactic course directors that reinforced course content for that semester. The skills and activities were to be completed during the students' IPPE visits in the community or health systems settings, depending on the program year and semester.

FINDINGS

Students successfully completed course assignments during their IPPE course program. Not all activities could be completed as designed, and many required modification, including simulated experiences. Feedback from faculty and preceptor members of the school's experiential education committee demonstrated that these activities were valuable and improved learning of course material, but were challenging to implement.

DISCUSSION AND SUMMARY

A renewed curriculum that mapped course assignments for completion in experiential settings was successfully established, after some modifications. The program was modified at regular intervals to improve the ability of preceptors to complete these activities in their individual practice environment. A balance between the school providing guidance on what activities students should perform and allowing unstructured independent learning with the preceptor is needed for an optimal experience.

Learner : preceptor ratios for practice-based learning across health disciplines: a systematic review

CONTEXT

Practice-based learning is a cornerstone of developing clinical and professional competence in health disciplines. Practice-based learning systems have many interacting components, but a key facet is the number of learners per preceptor. Different learner : preceptor ratios may have unique benefits and pose unique challenges for participants. This is the first comprehensive systematic review of the topic. Our research questions were: What are the benefits and challenges of each learner : preceptor ratio in practice-based learning from the perspectives of the learners, preceptors, patients and stakeholder organisations (i.e. the placing and health care delivery organisations)? Are any ratios superior to others with respect to these characteristics and perspectives?

METHODS

Qualitative systematic review of published English-language literature since literature database inception, including multiple health disciplines.

RESULTS

Seventy-three articles were included in this review. Eight learner : preceptor ratio arrangements were identified involving nursing, physiotherapy, occupational therapy, pharmacy, dietetics, speech and language therapy, and medicine. Each arrangement offers unique benefits and challenges from the perspectives of learners, preceptors, programmes and health care delivery organisations. Patient perspectives were absent. Despite important advantages of each ratio for learners, preceptors and organisations, some of which may be profession specific, the 2 : 1 and 2+ : 2+ learner : preceptor ratios appear to be most likely to successfully balance the needs of all stakeholders.

CONCLUSIONS

Regardless of the learner : preceptor ratio chosen for its expected benefits, our results illuminate challenges that can be anticipated and managed. Patient perspectives should be incorporated into future studies of learner : preceptor ratios.

Using Text Analytics of AJPE Article Titles to Reveal Trends In Pharmacy Education Over the Past Two Decades

Objective. To identify trends in pharmacy education during last two decades using text mining. Methods. Articles published in the American Journal of Pharmaceutical Education (AJPE) in the past two decades were compiled in a database. Custom text analytics software was written using Visual Basic programming language in the Visual Basic for Applications (VBA) editor of Excel 2007. Frequency of words appearing in article titles was calculated using the custom VBA software. Data were analyzed to identify the emerging trends in pharmacy education. Results. Three educational trends emerged: active learning, interprofessional, and cultural competency. Conclusion. The text analytics program successfully identified trends in article topics and may be a useful compass to predict the future course of pharmacy education.

Increasing Capacity for Experiential Rotations for Pharmacy Learners: Lessons Learned from a Multisite Teaching Hospital

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Identifying factors which enhance capacity to engage in clinical education among podiatry practitioners: an action research project

Background

Health profession students develop practical skills whilst integrating theory with practice in a real world environment as an important component of their training. Research in the area of practice placements has identified challenges and barriers to the delivery of effective placement learning. However, there has been little research in podiatry and the question of which factors impact upon clinical educators’ capacity to engage with the role remains an under-researched area. This paper presents the second phase of an action research project designed to determine the factors that impact upon clinical educators’ capacity to engage with the mentorship role.

Methods

An online survey was developed and podiatry clinical educators recruited through National Health Service (NHS) Trusts. The survey included socio-demographic items, and questions relating to the factors identified as possible variables influencing clinical educator capacity; the latter was assessed using the ‘Clinical Educator Capacity to Engage’ scale (CECE). Descriptive statistics were used to explore demographic data whilst the relationship between the CECE and socio-demographic factors were examined using inferential statistics in relation to academic profile, career profile and organisation of the placement.

Results

The survey response rate was 42 % (n = 66). Multiple linear regression identified four independent variables which explain a significant proportion of the variability of the dependent variable, ‘capacity to engage with clinical education’, with an adjusted R₂ of 0.428. The four variables were: protected mentorship time, clinical educator relationship with university, sign-off responsibility, and volunteer status.

Conclusion

The identification of factors that impact upon clinical educators’ capacity to engage in mentoring of students has relevance for strategic planning and policy-making with the emphasis upon capacity-building at an individual level, so that the key attitudes and characteristics that are linked with good clinical supervision are preserved.

Pharmacy Student and Preceptor Impressions of Faculty Liaison Visits to Experiential Training Sites

OBJECTIVE

To characterize preceptor and student views about and experiences with faculty liaison visits to practice sites during clinical internships.

METHODS

A survey was administered at the conclusion of each of the first 3 academic years of a new postbaccalaureate doctor of pharmacy (PharmD) program.

RESULTS

Preceptors were satisfied overall with faculty liaison visits, while students initially were not; however, their perception increased in subsequent years. Students felt development of their patient care skills benefited, but less so their interpersonal communication skills. Each year, almost all preceptors indicated faculty liaison visits were helpful in developing and refining their mentorship skills.

CONCLUSION

Faculty liaison visits provided a valuable opportunity to interact and support preceptors and students during advanced pharmacy internships in a nascent PharmD program.

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

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

Canadian educational approaches for the advancement of pharmacy practice

Canadian faculties (schools) of pharmacy are actively engaged in the advancement and restructuring of their programs in response to the shift in pharmacy to pharmacists having/assuming an advanced practitioner role. Unfortunately, there is a paucity of evidence outlining optimal strategies for accomplishing this task. This review explores several educational changes proposed in the literature to aid in the advancement of pharmacy education such as program admission requirements, critical-thinking assessment and teaching methods, improvement of course content delivery, value of interprofessional education, advancement of practical experiential education, and mentorship strategies. Collectively, implementation of these improvements to pharmacy education will be crucial in determining the direction the profession will take.

Introduction of a continuing professional development tool for preceptors: lessons learned

Accreditation Council for Pharmacy Education (ACPE) guidelines state that preceptors should "have a systematic, self-directed approach to their own continuing professional development (CPD)." The objective of this study was to encourage preceptors to take advantage of the ACPE CPD resources and implement the concept of CPD (reflect, plan, act, evaluate, record) as a framework for guiding individual preceptor's continuing development as educators and to determine their opinion regarding the usefulness, effectiveness, and obstacles to implementation of this approach. A total of 3713 preceptors from the participating schools were encouraged to undergo CPD training and invited to respond to a series of questions. Of the initial respondents, 48% represented health system/hospital preceptors, followed by community/independent pharmacists (64 of 236, 28%). Preceptor respondents often train students from multiple schools/colleges (average = 1.9 schools/colleges per preceptor) and 90% agreed or strongly agreed with the statement, "the CPD model, as learned in the webcasts, is beneficial for ongoing preceptor development." The general consensus was that the preceptor portfolio provided motivation to reflect, plan, and set more defined and realistic goals for students, residents, and themselves as educators and could be a valuable starting point for promoting preceptors' reflection, planning, and action related to rotation management, professional teaching, and student learning goals.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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