Navigating power dynamics between pharmacy preceptors and learners

Pharmacy preceptors are crucial in pharmacy experiential education. They help develop learners during didactic learning, experiential learning, and post-graduate training. Preceptors hold a position of authority over learners as they are responsible for providing feedback and ultimately completing evaluations that determine whether the student passes or does not pass the rotation. Preceptor status, behavior, and communication style may cause students to feel intimidated. Preceptors should be aware of this power differential and keep generational, gender, cultural, and other factors in mind when providing feedback. Preceptors should also receive training and be open to constructive feedback from learners to ensure the experience meets the needs of the learner and allow for adjustments on the experiential rotation. Students should be empowered to provide open and honest feedback to preceptors in a psychologically safe environment without fear of repercussions.

Prior Pharmacy Work Experience as a Predictor of Clinical and Didactic Performance for Admissions Committees

OBJECTIVE

To investigate prior pharmacy work experience (PPWE) in admissions to predict clinical and didactic performance.

METHODS

In this retrospective study, data from 3 cohorts, classes of 2020-2022, were collected. Multivariate regressions were conducted to determine the impact of PPWE on performance in first-year pharmacy (P1) Community Introductory Pharmacy Practice Experience (IPPEs), second-year pharmacy (P2) institutional IPPEs, P2 & third-year pharmacy (P3) Observed Structured Clinical Examinations (OSCEs), Drug Information class and P1, P2, P3 grade point averages (GPAs).

RESULTS

Of 329 students, those who had PPWE (n = 210) worked as pharmacy technicians (78%), clerks, cashiers, drivers (10%), or other (12%). The majority worked in community settings (86%) and worked an average of 24 h weekly. PPWE was not associated with any pharmacy school GPAs. Those with PPWE scored 2.17 out of 100% points higher in Drug Information than those who did not. They also scored higher on P1 IPPE performance in communication and pharmacy operations skills; however, these notable differences did not continue in P2 IPPEs or OSCEs. Total hours worked in higher quartiles were also associated with increased scores in P1 IPPE communications skills, P1 IPPE pharmacy operations skills, and Drug Information course scores.

CONCLUSION

Prior pharmacy work experience modestly improved pharmacy school performance in selected areas in the P1 year, but the effect did not continue in later years. Students who had PPWE performed better in Drug Information and P1 IPPE communication and pharmacy operations skills.

Indicators, influences, and changes in professional identity formation in early experiential learning in community pharmacy

BACKGROUND

Experiential education is a key area in the pharmacy curriculum that professional identity formation (PIF) occurs. However, little is known about PIF influences and supports for pharmacy students during early experiential placements. The study aimed to explore pharmacy student PIF in an early experiential rotation in community pharmacy using reflective writing.

EDUCATIONAL ACTIVITY AND SETTING

First-year pharmacy students completed written reflections describing their professional identity and influencing experiences, before and after a four-week community introductory pharmacy practice experience. Qualitative content analysis of the written reflections was performed using three analytical approaches: (1) deductive coding based on professional identity indicators; (2) inductive coding to identify influences; and (3) inductive coding of field notes to identify changes between pre- and post-written reflections.

FINDINGS

Twelve students participated. All participants described discrete professional attributes and behaviors and valuing a patient-centered approach as part of their professional identity. Participants reported observation of pharmacists, the curriculum, and previous work experience influenced PIF prior to the experiential rotation. A strong influencer of PIF during the rotation was observation of pharmacist preceptors, whereas participants' own experiences were described less often. Changes in professional identity among participants were subtle and categorized as affirmation, acquisition, and growth.

SUMMARY

Pharmacy students' markers and influencers of PIF should be considered when developing curricular experiences and preceptor development that support PIF. The use of professional identity indicators and analysis of written reflections as a method to uncover PIF, shows promise and warrants further investigation.

Activities to enhance introductory pharmacy practice experiences

INTRODUCTION

The goal of this initiative was to provide a meaningful introductory pharmacy practice experience (IPPE) to third-year students when opportunities for direct patient interaction are limited.

METHODS

A single, pretest/posttest quasi-experiment was used to evaluate the impact of a structured pharmacy-based education series (intervention 1) and an interprofessional simulation (intervention 2) during combined internal medicine (IM) and infectious diseases (ID) IPPEs. Intervention 1 consisted of five, three-part pharmacy-based educational sessions, while intervention 2 consisted of an interprofessional simulated rounding experience. Pre- and post-rotation examinations were given to evaluate the impact of the interventions on student knowledge. Confidence was measured in 11 or 12-question pre- and post-surveys using a four-point Likert scale: strongly disagree, disagree, agree, strongly agree.

RESULTS

Thirty-six students (30 in intervention 1 and six in intervention 2) were included. In intervention 1, there was a 19% improvement in IM knowledge (45% vs. 64%) and 10% improvement in ID knowledge (40% vs. 50%). In intervention 2, there was a significant improvement in both IM (30% vs. 40%) and ID (50% vs. 65%) and knowledge questions (10% and 15% improvements, respectively). In both interventions, most students reported increased confidence.

CONCLUSIONS

Knowledge and confidence improved in both intervention groups, demonstrating that there are ways to enhance IPPEs without direct patient interaction.

Standardizing and improving the education of pharmacy students in a large health system

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these 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.

Implementing a high-risk medication education introductory pharmacy practice experience

BACKGROUND AND PURPOSE

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

EDUCATIONAL ACTIVITY AND SETTING

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

FINDINGS

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

SUMMARY

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

Pharmacy students' satisfaction with Introductory Pharmacy Practice Experiences (IPPE) at community pharmacy: The case of Saudi Arabia

OBJECTIVE

To assess pharmacy students' satisfaction with introductory pharmacy practice experiences (IPPE) at community pharmacy and the impact of the training on their future career.

METHODS

A self-administered questionnaire was made available to 74 male pharmacy students who completed 4 weeks community pharmacy IPPE. The questionnaire consists of 24 questions that were organized into 5 domains with a scale of six options were used to answer each question.

RESULTS

A total of 43 students completed the survey (58%). Most of them evaluated their training experience as either as good (41.86%) or excellent (41.86%). One third of students (34.88%) were very satisfied about the clarity of the community pharmacy IPPE goals and objectives given prior to the training period. About half of students (51.6%) received a good direction and feedback from their preceptors. Regarding the contact with the patient or guardian, (39.53%) of the students chose neutral while (25.58%) of the students were very satisfied. The learning environment was satisfactory for (32.56%) of students. Regarding skills domain, students strongly agreed that their skills were improved; Communication skills as reported by (48.84%) of students, documentation skills as reported by (34.88%) of students, and clinical skills as reported by (34.88%) of students.

CONCLUSION

Surveyed male students were in general satisfied with their training experience at community pharmacy. Providing an orientation to the community pharmacy preceptors and granted electronic access of necessary information to the students might increase their satisfaction.

Assessment of factors that impact performance in a year-long Top 200 Drug course

BACKGROUND AND PURPOSE

Knowledge of commonly used medications ("Top 200") is a common component of pharmacy curricula. This study assessed the impact of pre-pharmacy grade point average (GPA), timing of students' community introductory pharmacy practice experience (C-IPPE), C-IPPE practice location, completion of practice quizzes (PQs), and campus attended on Top 200 performance.

EDUCATIONAL ACTIVITY AND SETTING

Top 200 Drugs is a two-part series offered during the first professional (P1) year of the program. Students concurrently complete their C-IPPE during either the fall or spring semester. A retrospective review was completed to assess factors associated with student performance during the 2016-2017 academic year.

FINDINGS

Higher fall course grades were associated with higher pre-pharmacy GPA, active C-IPPE enrollment, and completion of >80% of PQs. Higher spring course grades were associated with higher pre-pharmacy GPAs, completion of >80% of PQs, satellite campus attendance, C-IPPE completion at a grocery store/mass merchant, and higher fall semester performance.

SUMMARY

A retrospective review of factors associated with student performance allowed the course coordinator to create further learning opportunities based on the findings. Since practice quizzes were associated with higher performance, these self-directed learning opportunities were expanded in the subsequent course offering. Student completion of the C-IPPE in the fall improved performance in the fall, and C-IPPE location may have impacted performance as well. Further investigations are warranted to better understand the impact of C-IPPE semester and C-IPPE location on Top 200 performance so these can be maximized to support student performance.

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

BACKGROUND AND PURPOSE

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

EDUCATIONAL ACTIVITY AND SETTING

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

FINDINGS

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

SUMMARY

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

Survey highlights the need to expand offerings of introductory pharmacy practice experiences in psychiatry and neurology: Benefits and example experiences

Introduction

Introductory pharmacy practice experiences (IPPEs) are 1 requirement schools and colleges of pharmacy must fulfill to meet accreditation standards. The purpose of this manuscript is to report existing IPPEs in psychiatry and neurology across the United States.

Methods

Two separate electronic surveys were administered to individual College of Psychiatric and Neurologic Pharmacists members with board certification in psychiatric pharmacy with an academic affiliation and academic institutions in the 2014-15 academic year to assess the neuropsychiatric curriculum in pharmacy programs. Results focusing on IPPEs were summarized using descriptive statistics.

Results

Academic institutional data reveal only 37.3% offered IPPEs in psychiatry, and 6.7% offered neurology. The number of available IPPEs is low even if a program offered an available rotation. The majority of College of Psychiatric and Neurologic Pharmacists member respondents (69.9%) did not offer IPPEs in psychiatry in the 2014-15 academic year, and none offered an IPPE in neurology. More than half of individual respondents feel their institution should increase IPPEs in psychiatry and neurology in order to enhance their curriculum.

Discussion

To expand IPPE availability, pharmacy programs should increase early exposure of pharmacy students to patients with psychiatric and neurologic conditions. Longitudinal experiences may allow students to engage in hands-on experiences, which may impact future career aspirations and reduce stigma. Current example IPPEs at the authors' institutions are included to stimulate discussion and action among readers on how IPPEs in these practice areas may be developed. Implementation of IPPEs in psychiatry and neurology is needed for students to gain experience working with these patients.

Assessing experiential education factors contributing to a PGY1 residency match: Pharmacy residency program director and comparative student survey

OBJECTIVE

To compare and contrast experiential education perceptions of pharmacy residency program directors (RPDs) and doctor of pharmacy students in their last year of the curriculum for residency application considerations.

METHODS

The New England Regional Departments of Experiential Education (NERDEE) consortium developed a 17-question survey to assess residency factors, including those related to experiential education. The survey was dispersed to advanced pharmacy practice experience (APPE) students from six colleges/schools of pharmacy and RPDs nationwide.

RESULTS

Students have different values on experiential preferences compared to RPDs. Sample findings include internal medicine and specialty clinical elective experiences prior to American Society of Health-System Pharmacists (ASHP) Midyear were extremely important to important for students, while RPDs viewed these experiences as somewhat important at best (p < 0.02). The majority of RPDs (67%) have no APPE schedule preference, while most students (77%) feel that certain APPE schedules may influence acceptance into residency.

CONCLUSION

Based on findings, information outlined can be used to dispel and/or validate common beliefs held by students regarding experiential factors that help or hinder a successful postgraduate year 1 (PGY1) residency match.

Preceptor's grading scale preference for student pharmacy practice experience and assessment of the common grading scale among US schools of pharmacy

INTRODUCTION

The objective of this study was to gain an understanding of preceptors' grading scale preferences for introductory and advanced pharmacy practice experiences (IPPE/APPE). Secondarily, assess if there is a common grading scale for IPPE/APPE rotations among US pharmacy programs.

METHODS

An online, 22-item survey questionnaire was sent to all preceptors at a fully accredited school of pharmacy. The survey instrument assessed preceptor attitudes toward the effectiveness of the primary grading scales, letter or pass/no pass. Demographic variables were also assessed, including gender, age, practice setting, years as a preceptor, and annual number of students precepted. In addition, a phone survey was conducted with all pharmacy programs in the United States at the time to assess grading scales used for introductory and advanced pharmacy practice experiences (IPPE/APPEs).

RESULTS

Three hundred sixty-five preceptors responded to the survey questionnaire. Overall, preceptors had more favorable attitudes toward the letter grade system as opposed to the pass/no pass system, and when asked specifically which they preferred, approximately 70% preferred the letter grading system. The phone survey of different pharmacy programs grading systems revealed most use the letter grading system. Fifty-six of 87 responding schools (64%) reported use of a letter grading system, compared to 26 of 87 (30%) using a pass/no pass system and five using 'other variations' (6%).

CONCLUSION

The majority of preceptors preferred the letter grading system over the pass/no pass system. Familiarity with this system was a contributing factor, as a significant number of preceptors preferred the grading scale they had as a pharmacy student - the letter grade system. This trend mimics current pharmacy school's grading system, as approximately 2/3 currently use a letter grading system to evaluate IPPE/APPEs.

Reassessment of Health-System Capacity for Experiential Education Requirements

Objective. To provide an update to the 2007 ASHP-AACP survey by examining the current capacity of hospitals/health systems' ability to conduct experiential education for doctor of pharmacy students. Methods. Pharmacists identified as pharmacy directors were sent an invitation to participate in an online survey tool. The survey tool asked IPPE- and APPE-specific questions, the nature of support provided by colleges/schools of pharmacy, the types of experiences available for students, and the factors influencing the quality, value, and challenges of experiential education. Results. Four hundred sixty five of the 2,911 surveys sent were completed yielding a response rate of 16%. Respectively, 45.1% and 28.5% of respondents believe that the capacity for APPE and IPPE will increase in the next five years. Overall, respondents believe that students receive a high-quality experiential education (91.4%). Conclusion. The results of this survey provide insight to the capacity, benefits and challenges of experiential education from the perspective of hospitals/health systems.

Using a community theatre as a self-directed introductory pharmacy practice experience (SD IPPE) site

OBJECTIVE

To describe a novel setting and method for self-directed introductory pharmacy practice experiences (SD IPPE).

METHODS

Students presented health care information relative to the plot of a production at a local community theater throughout the season. Students developed a poster and handout that were presented in the theater lobby prior to each production.

ASSESSMENT

A six-question survey was provided to students after each presentation that identified their perceived benefit to play patrons and their overall experience using a 5-point Likert scale.

IMPLICATIONS

Completing SD IPPE in a theater is a novel and innovative concept. Data suggest that students prefer presenting information in non-traditional settings. Students felt their work enhanced the theatrical experience of patrons. Results demonstrate that the theater is a viable setting for future presentations that benefit both students and public.

Using reflection to evaluate student learning in ambulatory care IPPEs

PURPOSE

Gather insight from student pharmacists about what they learned and whether objectives of an introductory pharmacy practice experience (IPPE) were achieved in an academic-based ambulatory care site.

METHODS

Students wrote post-reflective essays after their first ambulatory care-site visit. They reflected upon their previous assumptions of ambulatory care, and the roles and skills required of pharmacists in this setting. Additionally, students ranked their interest in ambulatory care pre- and post-IPPE. Post-reflection essays were analyzed for recurring themes using a constant comparison method and a respondent validation method was employed to confirm these findings. Wilcoxon signed-rank sum test was used to analyze student interest in ambulatory care and descriptive statistics were used, as appropriate.

RESULTS

Overall, 70 reflection articles were analyzed. Assumptions of ambulatory care were either incorrect or proved to be more than what was expected for 60% of students. Based on the themes identified, students learned most about the collaborative practice model, chronic disease state management, and the time commitment necessary for outcomes. Regarding skills required of a pharmacist, students discussed the need for a strong knowledge base, communication, and ability to transfer these skills from one setting to another. Interest in ambulatory care increased after the site visit (p <0.01) and 90% of students who wrote these reflections strongly agreed or agreed with the above findings.

CONCLUSIONS

With intentional reflection, ambulatory care IPPEs can serve as a meaningful outlet for learning while also achieving IPPE objectives.

Sequencing of Simulation and Clinic Experiences in an Introductory Pharmacy Practice Experience

Objective. To examine how the intrasemester sequencing of a simulation component, delivered during an ambulatory care introductory pharmacy practice experience (IPPE), affects student performance on a series of 3 assessments delivered during the second professional (P2) year. Design. At the Jefferson College of Pharmacy (JCP), P2 student pharmacists were randomly assigned to 6 weeks of simulation activities, followed by 6 weeks on site at an ambulatory care clinic or vice versa during either the fall or spring semesters. At the end of each semester, these students completed 3 skills-based assessments: answering a series of drug information (DI) questions; conducting medication adherence counseling; and conducting a medication history. The 2 groups' raw scores on assessment rubrics were compared. Assessment. During academic years 2011-2012 and 2012-2013, 180 P2 student pharmacists participated in the required ambulatory care IPPE. Ninety experienced simulation first, while the other 90 experienced the clinic first. Students assessed over a 2-year time span performed similarly on each of 3 skills-based assessments, regardless of how simulation experiences were sequenced within the IPPE. Conclusion. The lack of significant difference in student performance suggests that schools of pharmacy may have flexibility with regard to how they choose to incorporate simulation into clinical ambulatory care IPPEs.

Survey of Emergency Medicine Pharmacy Education Opportunities for Students and Residents

BACKGROUND

Pharmacy services in the emergency department (ED) have been shown to decrease medication adverse events and improve patient outcomes. Anecdotally, there has been expansion of emergency medicine (EM) educational opportunities for pharmacy students and postgraduate year 1 (PGY1) pharmacy residents, however the extent of this expansion is currently unknown.

OBJECTIVE

The objective of this survey study is to determine the prevalence and nature of EM pharmacy training available to pharmacy students and residents.

METHODS

Electronic surveys were distributed to chairs of departments of pharmacy practice and experiential education representatives at Accreditation Council for Pharmacy Education-accredited colleges or schools of pharmacy as well as residency program directors at American Society of Health-System Pharmacists-accredited postgraduate year 1 (PGY1) programs. Questions were asked related to demographics, EM introductory or advanced pharmacy practice experiences (IPPE or APPE), and PGY1 and non-EM postgraduate year 2 (PGY2) rotations. Five reminder e-mails and weekly and grand prize drawings were offered. Data that were gathered are presented utilizing descriptive statistics.

RESULTS

Overall, 57/110 (52%) colleges or schools of pharmacy representatives and 286/831 (34%) residency program representatives completed the survey. Colleges or schools of pharmacy reported EM IPPEs and APPEs at 12/57 (21.1%) and 44/53 (83%), respectively. EM pharmacy rotations were available for PGY1 and non-EM PGY2 residents at 212/286 (74.1%) and 83/157 (52.9%) of institutions, respectively.

CONCLUSIONS

Survey results represent the prevalence and characteristics of EM-related education opportunities for pharmacy students and residents.

Comparison of Introductory Pharmacy Practice Experiences Among US Pharmacy Programs

OBJECTIVE

To identify the various IPPE designs utilized by US pharmacy programs.

METHODS

A 20-question survey was developed and distributed to experiential affairs professionals at 129 pharmacy institutions nationwide addressing school demographics and IPPE design. Results were analyzed in aggregate.

RESULTS

Ninety-three schools responded (72%). Eighty-nine percent of those reported beginning IPPE experiences in the first professional year, although there was a great variation regarding whether the IPPE was held while didactic classes were in session or during school breaks. The number of required practice experiences varied. Institutions prohibited students from completing rotations in the same pharmacy chain (72%) or hospital (70%) where employed, and from completing 2 rotations at the same site (62%). Fifty-seven percent utilized faculty members as preceptors. 51% allowed a maximum of 2 students per preceptor per practice experience.

CONCLUSION

While clear trends existed in IPPE curricula, institutions incorporated aspects that addressed unique needs. Further research can determine the benefits and drawbacks of different IPPE designs.

Effect of pharmacy practice program on pharmacy student learning, satisfaction, and efficiency: assessment of introductory pharmacy practice course

INTRODUCTION

The Lebanese American University (LAU) offers first-year pharmacy students with Introductory Pharmacy Practice Experience (IPPE) courses comprising various activities that provide students with direct patient contact so that they can be geared up for "real-world" pharmacy practice. Routine assessment and improvement in these courses are imperative to ensure efficiency of these courses. This study was conducted to evaluate the quality of our IPPEs courses, determine its impact on student learning and satisfaction, and identify shortcomings in the program for quality improvement purposes.

METHODS

A literature review-based questionnaire, consisting of 76 questions with a response options following a 4-point scale (strongly agree = 4 to strongly disagree = 1), was completed by 92 first professional year pharmacy students who finished their hospital and community IPPE at LAU.

RESULTS

The students reported a high degree of satisfaction in community and hospital sites in terms of site selection, program schedule, site and school preceptors, and overall satisfaction with the experience. Compared to the hospital setting, students practicing in the community reported significantly higher scores in overall satisfaction. Besides the high satisfaction rate, our results identified improvement measures in some aspects of the program.

CONCLUSION

Our IPPE program serves as a successful experiential learning for pharmacy students.