lea bonner, pharm.d. appe director mercer university lindsey welch, pharm.d. appe director...

LEA BONNER, PHARM.D.A P P E D I R E C T O R

M E R C E R U N I V E R S I T Y

LINDSEY WELCH, PHARM.D.A P P E D I R E C T O R

U N I V E R S I T Y O F G E O R G I A

Best Practices for Precepting Student

Pharmacists

Learning Objectives

1. Identify the needs of student pharmacists during pharmacy practice experiences

2. Outline best practices for precepting pharmacy practice experiences

3. Identify effective and objective student performance assessment techniques

Disclosures

The presenters have no conflict of interest or relevant financial relationships with commercial interests to disclose.

Student Curricular Needs

Guided by Accreditation Standards and Guidelines published by the Accreditation Council for Pharmacy Education (ACPE)• Version 2.0 adopted 2007, revised January 2011• Standards 2016, released February 2, 2015

Revision of Accreditation Standards

Feb 2014 •ACPE released Draft Standards 2016 and accompanying Guidance Document•ACPE open for public comment

Jan 2015 •Draft Standards adopted at ACPE Board Meeting

Jul 2016 •Standards 2016 become effective July 1

https://www.acpe-accredit.org/deans/StandardsRevision.asp

Outcome expectations of Pharm.D. graduates

Emphasis on being practice-ready and team-ready

Prepared to directly contribute to patient care working in collaboration with other healthcare providers

Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree. Standards 2016. Released February 2, 2015. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf

PPE Requirements

Defined objectivesSpecified responsibilities of student,

preceptor, and siteStudent performance and achievement of

objectives must be documented and assessed

Purpose of PPEs

Enhance student:• Practice skills• Professional judgment• Behaviors• Attitudes • Values• Confidence• Sense of personal and professional responsibility


Pharmacy practice experiences (PPEs)

Introductory pharmacy practice experiences (IPPEs)• Occur during first 3 years of curriculum• Should be interfaced with didactic work and continue

in a progressive mannerAdvanced pharmacy practice experiences

(APPEs)• Final year clinical rotations• Should build upon IPPEs

Introductory Pharmacy Practice Experiences (IPPEs)

Minimum of 300 hours• 150 hours should be balanced between community

and institutional settings

• Activities should ensure readiness to enter APPEs• “APPE-ready”• Ex: Exposure to interprofessional practice vs. in-depth experience during APPEs


Pre-APPE Domains

Patient safety-accurately dispense medications

Basic patient assessment

Medication information

ID, assessment, and resolution of drug-related problems

Mathematics applied to clinical environment

Ethical, professional, and legal behavior

General communication abilities

Patient education

Drug info analysis and literature research

Health and wellness-public health

Insurance/prescription drug coverageAccreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree. Standards 2016. Released February 2, 2015. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf

Advanced Pharmacy Practice Experiences (APPEs)

Minimum of 1440 hours (36 weeks)• Required experiences: community, hospital/health-

system, ambulatory patient care, inpatient/general medicine care

• Minimum of 160 hours in each of the required settings • Emphasis on interprofessional team-based care

delivery• Majority of time should involve direct patient care• Opportunities for elective rotations to explore various

practice areas


APPE Learning Activities

Direct patient care Consulting and advising patients on self-care products Ensuring continuity of quality of care as patients

transition between healthcare settingsInterprofessional interaction and practice

Collaborative patient care decision-making


APPE Learning Activities

Medication dispensing, distribution, administration, and systems management Participating in discussions regarding human

resources management, medication resources management, and pharmacy data management systems

Professional development Emphasize the tenets of continuing professional

development


Pharmacist’s Patient Care Process

http://www.accp.com/docs/positions/misc/JCPP_Pharmacists_Patient_Care_Process.pdf. Accessed July 16, 2014

Increasing Need for PPEs

130 U.S. Colleges/Schools of Pharmacy (full or candidate accreditation status)• Another 4 with pre-candidate status• Increase in alternate campus locations among

accredited schools• Expanding class sizes

40% increase in Pharm.D. degrees conferred between 2004-2013• 7,770 to 13,207

https://acpe-accredit.org/shared_info/programsSecure.asp accessed June, 8, 2015http://www.aacp.org/resources/research/institutionalresearch/Pages/TrendData.aspx. Accessed July 16, 2014

Quantifying the Need

4 accredited Pharm.D. programs in state of Georgia

~500 Pharm.D. graduates/year

x 8 rotations= 4,000 APPEs/year

SPEEC

• Southeastern Pharmacy Experiential Education Consortium

• Currently includes all GA and AL colleges/schools

• Mission to promote advancement of pharmacy experiential education through synchronization of procedures, providing and standardizing preceptor training, and participating in scholarly activities

Discussion

How many of you currently serve as a preceptor for a College/School of Pharmacy?

Name some benefits you’ve experienced from precepting student pharmacists.

A Winning TeamMentor

shipLearns from those with

clinical experti

seDirect patient

careUnders

tand practic

al aspect

s of patient

careGives

confidence to apply

knowledge later

Experience in starting/runni

ng a clinical service

Give back to profess

ionStay “on

their toes”

Mentoring

future colleag

uesUse as

a recruit

ing tool

Developing and

maintaining

clinical service

sCost

savings

(FTEs)Quality improvementIncrea

sed patient satisfaction

Student Pharmacist

Standard 20: Preceptors

Sufficient numberQuality criteria for recruitment, orientation,

performance, evaluationStudent:preceptor ratio allows for

individualized mentoring (3:1 IPPE, 2:1 APPE)

Preceptor education/developmentPreceptor engagement is solicited


Standard 20: Preceptors

Positive role model with following attributes

Practicing ethically and with compassion for patients Accepting personal responsibility for patient outcomes Having professional education, experience, and competence commensurate with their

position Utilizing clinical and scientific publications in clinical care decision-making and evidence-

based practice Desiring to educate others (patients, caregivers, other healthcare professionals, students,

residents) Demonstrating the willingness and ability to advocate for patients and the profession Demonstrating creative thinking that fosters an innovative, entrepreneurial approach to

problem solving Having an aptitude for facilitating learning Being competent in the documentation and assessment of student performance Having a systematic, self-directed approach to their own continuing professional

development and actively participate in self-directed lifelong learning. Collaborating with other healthcare professionals as a visible and contributing member of a

team Being committed to their practice organization, professional societies, and the community

(20.1)

Student Perceptions of Preceptor Excellence

Students evaluated preceptors post-APPEPreceptors defined as “excellent” if rated

excellent ≥80% of time in a 3 year periodPreceptor excellence highly associated with:

Serving as a role model Showing interest in teaching Relating to student as individual Encouraging discussion/problem-solving Readily available for question Giving good direction/feedback Well-organized experience Spending time with students

Preceptor of the Year

Young S, Vos SS, Cantrell M, Shaw R; Factors Associated with Students’ Perception of Preceptor Excellence. AJPE 2014; 78 (3) Article 53.

Getting started: the Basics

Preceptor requirements• Criteria may differ by school/college• Application

Site requirements• Written affiliation agreements• Evaluated by college/school initially and at regular

intervals • Quality assurance

• Determine need for student background checks, drug screens, other clearance requirements

Organizing the experience

Syllabus• Template from college/school• Objectives, assignments, grading criteria• Set clear expectations both verbally and in related

syllabus

Orientation• Physical space• Key contacts and other staff• Expectations and guidelines for grading• Pharmacist’s role and value of services to both

patients and institution as a whole

Developing New Pharmacy Services

Identify and research serviceEvaluate need for education/trainingDevelop a process for patient careRevise workflow to accommodate the serviceConsider need for billing/documentationDevelop a marketing planImplement and evaluate the service

Precepting in the Hospital Pharmacy Part 3: Incorporating APPE Students into the Development and Implementation of Pharmacy Services. Volume 2012, Course No. 224. www.pharmacistsletter.com. Accessed June 24, 2014.

http://www.pharmacistsletter.com/

Incorporating Students into Pharmacy Services

Set clear expectations and responsibilitiesConsider oversight/supervisionProvide adequate training for tasks to be

completedConsider student time involved in service• Whole rotation vs. incorporation into another

• Develop a plan for continuation of the service

Real Preceptor Statistics

UGA 2014-2015 APPE preceptor evals: 1-4 Likert (1=Strongly disagree, 2=Disagree, 3=Agree,

4=Strongly Agree) Reviewed grading process for rotation

Average= 3.41 Used guided questions to help me identify and solve drug-

related problem when I could not do this independently Average=3.47

Mercer 2014-2015 APPE site surveys: 93.8% of students report their typical day is filled with

meaning activities 84% of students report the course syllabus and grading

methodology was presented during orientation

Structuring the Experience

Calendar• Time for training (start low and go slow)• Various levels of independence• Day-to-day schedule and/or weekly responsibilities• Student activities/responsibilities• Special projects

Topic discussions, in-services, journal clubs• May vary depending on time of year (e.g.

immunizations during flu season, etc.) • Dedicated time for formative and summative

feedback*Increases student satisfaction with experience*

Sample daily APPE calendar (outpatient)

7:30-9am: Assign patient load, gather relevant lab, assessment, diagnostic, and micro results9-10am: Consult charts if needed10am: Present patients to preceptor11am: IV to PO

11:30-1:30pm: lunch/work up new patients1:30-until: Change needed abx to PO, intervene on changes to therapy, follow-up on drug information questions

Sample weekly APPE calendar (outpatient)

Patient care doesn’t just happen from 8am-5pm…neither do learning

opportunities

●All shifts can provide valuable educational experiences Differences in workload Adjustments made to workflow May allow opportunities not available when fully staffed

Valuable learning opportunities Providing a sufficient degree of challenge Sink or swim mentality Students value opportunities to be allowed a reasonable

amount of independence, to have ownership in patient care, and to feel accountable for patient outcomes

Other Scheduling Options

“Student sharing”• Works best with a structured schedule• Must ensure student has a known point-of-contact• Ensure preceptors communicate about individual

student development and aid in progression

Real Preceptor Perspectives

“By having the students work up a combined 20-30 patients a day and see all of the charts I am saved a LOT of time than if I had to do all of that by myself. I have found that by doing this it gives time to have sit-down rounds about all of the patients that they see (which I consider to be the trade-off because the time they save me enables me to be able to discuss and review each patient with them). The usual first question I get is how can you trust students to do all of this without making mistakes or missing things. The answer I always give back is of course students will make mistakes and miss things----they are students. As a clinician it is still my responsibility to see my patients and look at their information on a daily basis.”

Real Preceptor Perspectives

We have a structured syllabus where they spend one week with each preceptor and during that time, they are assigned patient cases. The student works up the case, interviews the patient if possible and follows the patient for 2-3 days. During this time, the preceptor for the week will guide them and answer any questions (for a designated time slot in the morning). The rest of the day, the student is working independently on the formal oral patient case presentation. This presentation requires the student to research the published guidelines for each of the patient's disease states and assess whether the pharmacotherapy is appropriate or not. The cases are presented to the entire clinical staff - so questions are asked and the student gets experience expressing themselves and working under pressure.

In addition to oral cases, the student is assigned a written case, DI questions and a short Power point presentation (called a clinical pearl that is done on the last week). The student does a lot of this work independently - but still has the teaching and mentoring that they need.

Discussion

How many of you have precepted: 1-5 students 5-10 students >10 studentsDiscuss a time when you precepted a student

with knowledge or skill deficiencies. How/when did you address with the student?

Discuss a time when you precepted a student with a professionalism issue. How/when did you address with the student?

The Need for Feed….back

Verbal feedback as often as possible

“If you didn’t document it, it didn’t happen”Written documentationConstructive and honestMandatory midpoint and final evaluationsConsistent format created by SPEEC

Preceptor

Student

Exp Ed faculty

Perspectives of Feedback

Feedback must be provided to students At a minimum, performance competence must be

documented midway through the experience and at its completion

Should be objective in nature Feedback should be immediate, promote

improvement, and relate to specific actions Evaluations should be scheduled, promote

improvement, relate to global performance and grading

Pharmacist’s Letter. Giving Effective Feedback. www.pharmacistsletter.com. Accessed June 9, 2015.

Perceptions of Feedback

Students Receiving feedback improves the development of

clinical skills, patient care, and professionalismPreceptors

Receiving feedback increases teaching satisfaction Giving feedback gets easier with experience

Strategies for Assessing Students’ Skills

Student skills may be assessed by the preceptor using: “Active observation” “Questions” to evaluation students’ knowledge “See one, do one, teach one”


Communicating Effective Feedback

Partner with the student to improve learningLimit feedback to behaviors that can change

Knowledge vs. personalityLabel discussions as providing feedback

“Let me provide you with feedback…”Prioritize feedback providedDevelop a plan for improvement


lea bonner, pharm.d. appe director mercer university lindsey welch, pharm.d. appe director...

Documents

ippes slide

doctor of pharmacy degree

draft standards

appes accreditation

interprofessional practice

professional program

responsibilities of

precepting student pharmacists