preceptor development aahp 2014 heldenbrand

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9/30/2014 1 Preceptor Development Changes In Experiential Education: Tips for Today and Tomorrow Seth Heldenbrand, Pharm.D. Assistant Dean for Experiential Education, Associate Professor UAMS College of Pharmacy Disclosure I am employed by the UAMS College of Pharmacy I have no financial relationships to disclose Objectives 1. Review the role and structure of the UAMS experiential program 2. Discuss Domain 4 of the CAPE outcomes for assessing students 3. Summarize the student protections provided by the Family Educational Rights and Privacy Act (FERPA) 4. Review preceptor resources 5. Describe best practices for experiential learning

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9/30/2014

1

Preceptor Development Changes In Experiential Education: Tips

for Today and Tomorrow

Seth Heldenbrand, Pharm.D.Assistant Dean for Experiential Education, Associate Professor

UAMS College of Pharmacy

Disclosure

• I am employed by the UAMS College of

Pharmacy

• I have no financial relationships to disclose

Objectives

1. Review the role and structure of the UAMS

experiential program

2. Discuss Domain 4 of the CAPE outcomes for

assessing students

3. Summarize the student protections provided

by the Family Educational Rights and Privacy

Act (FERPA)

4. Review preceptor resources

5. Describe best practices for experiential learning

9/30/2014

2

UAMS Office of Experiential

Education

• Seth Heldenbrand, Pharm.D.—Assistant Dean

• Nicole Avant, Pharm.D.—Director

• Eric Crumbaugh, Pharm.D.—Director (part-time)

• Ellie Dickinson—Administrative Assistant (she

runs the show)

Experiential Goals/Mission

• Provide structured, practical and supervised

professional program experiences

• Enable the student to develop and apply skills

and knowledge gained in formal course work

• Provides opportunity to assume his/her role as a

pharmacist

• Professional judgment

• Practice competency

• Technical skills

What is Experiential Education?

• “A philosophy that informs many methodologies

in which educators purposefully engage with

learners in direct experience and focused

reflection in order to increase knowledge,

develop skills, clarify values, and develop

people's capacity to contribute to their

communities.”

Association for Experiential Education, http://www.aee.org/about/whatIsEE

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Experiential Structure

• IPPE - Introductory Pharmacy Practice Experiences

• ≥ 300 hours

• Spread over the first 3 professional years • P1 summer, P2 summer, P3 longitudinal IPPEs

• APPE - Advanced Pharmacy Practice Experiences

• ≥ 1440 hours (36 weeks)

• During the last academic year

• After IPPEs & required didactic courses are completed

IPPEs

• Minimum 150 hours balanced experience

• Community

• Institutional

• Permit students, under appropriate supervision to

assume direct patient care responsibilities.

• IPPEs should:

• begin early

• interface with didactic course work

• continue in a progressive manner leading to APPEs

IPPE examples

• processing & dispensing new/refill medication orders

• conducting patient interviews to obtain patient

information

• creating patient profiles using information obtained

• responding to drug information inquiries

• interacting with other health care professionals

• participating in educational offerings designed to

benefit the health of the general public

• interpreting & evaluating patient information

ACPE Standards and Guidelines, v. 2.0, 2011

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APPEs

• Experience of adequate intensity, duration, & breadth to

enable achievement of competency.

• Full-time, provide continuity of care, conducted under

pharmacist-preceptor supervision & monitoring

• Required APPEs develop pharmacist-delivered patient

care competencies for patients of all ages.

Types of Care Settings

Primary Community

Acute Hospital or health-system

Chronic Ambulatory

Preventive Inpatient/acute care general medicine

APPE examples

• identifying, evaluating, & communicating to the patient & other health

care professionals the appropriateness of the patient’s specific

pharmacotherapeutic agents, dosing regimens, dosage forms, routes

of administration, & delivery systems

• recommending prescription & nonprescription medications, dietary

supplements, diet, nutrition, traditional nondrug therapies, &

complementary & alternative therapies

• recommending appropriate medication dosing utilizing practical

pharmacokinetic principles

• identifying & reporting medication errors & adverse drug reactions

• managing the drug regimen through monitoring & assessing patient

information

ACPE Standards and Guidelines, v. 2.0, 2011

Competency Areas

IPPE

1. Professionalism

2. Drug Referencing

3. Communication

4. Prescription

Competency

5. Pharmacy Operations

APPE

1. Patient Care

2. Documentation

3. Medication Distribution,

Processing, & Dispensing

4. Resource Management

5. Communication

6. Public Health

7. Drug Information &

Evidence-Based Medicine

8. Professionalism

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Practice-Based Learning

• Active not passive

• Repetition

• Reinforcement

• Understanding

• Relevance

• Organization

• Choice

• Purposes & Goals / Individualization

� What is the ENDPOINT?

� Knowledge

� Skill

� Attitude

�Performance

standard

Practice Based Objectives

KNOWLEDGE

SKILLSATTITUDES

How is Precepting Different

from Teaching?• Teaching

• Impart skills or knowledge

• Gradually impart action or attitude

• Precepting

1. Determine learning needs

2. Plan experiences and expectations

3. Assess performance

4. Provide performance-based feedback

5. Repeat 3&4

6. Provide summative feedback

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Clinical Teaching

Environment

• Define role for student

• Integrate student into current patient

care opportunities

• Use student interest to enhance patient

care

• Identify new opportunities

The Balancing Act

Site Needs

Learning Needs

Patient Needs

Preceptor (HCP and Teacher)

What Students Need to Grow

• Effective mentorship

• Challenge growth

• Foster trust

• Feedback

• Focused vision

• Observe and allow autonomy

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Teaching By Example

• Role modeling

• Coaching and observation

• Supervision with autonomy

• Constructive feedback

• Positive recognition of achievements

First Day of Rotation

1. Orient the student to the site, practice, and staff

2. Review expectations for the rotation

3. Review the learning objectives and activities

4. Review the student's work during the experience

5. Review a planned schedule of rotation hours

6. Discuss expectations and due dates for special

projects, reports, presentations and meetings

7. Identify an alternate supervisor for instances when

the primary preceptor is unavailable

Assessing Experiential Students• Scoring

• 5 Meets requirement at a level beyond that expected for a new graduate

• 4 Meets requirement with minimal or no prompting and intervention from the preceptor

• 3 Meets requirement with moderate prompting and intervention from the preceptor

• 2 Meets requirement with extensive prompting and intervention from the preceptor

• 1 Does not meet requirement even with prompting and intervention from the preceptor

• 0 Though opportunities existed, student did not engage in requirement; therefore not able to assess

• NA Not applicable to experience or not observed

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UAMS COP Competencies

• Domain 1: Patient Care-Ensuring Appropriate Pharmacotherapy and Therapeutic Outcomes

• Patient Care

• Documentation

• Domain 2: Dispensing and Pharmacy Resource Management

• Medication distribution, processing and dispensing

• Resource management

• Communication

• Domain 3: Health Improvement, Wellness, and Disease Prevention

• Public health

• Drug information and EBM

• Multiple Domains

• Professionalism

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Questions about the current

system

1. Do you like the current evaluation?

2. What would you change about the

current evaluation?

Why Am I Asking You This?

• We will be updating the student evaluation

forms

• Harding and UAMS will be using the same forms

• New outcomes have been released

• Our goals

• Make the process simpler

• Less evaluation points

• Easier for preceptors to apply to their students

regardless of practice location

CAPE OutcomesCenter for the Advancement of Pharmacy Education

2013 Educational Outcomes

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CAPE Outcomes

4 Domains

1. Foundational knowledge integrated

throughout pharmacy curricula

2. Essentials for practicing pharmacy and

delivering patient-centered care

3. Effective approaches to practice and care

4. Ability to develop personally and

professionally

Domain 4: Personal and Professional

Development (affective domain)

1. Self-awareness

2. Leadership

3. Innovation and Entrepreneurship

4. Professionalism

Self-awareness

• Regulates own thinking and learning

• Maintains motivation, attention, and interest

• Engages in personal and professional development for the purpose

of individual growth

• Approach tasks with a desire to learn

• Demonstrates persistence and flexibility in all situations

• Engages in help seeking behavior when appropriate

• Strives for accuracy and precision

• Recognizes, corrects, and learns from errors

• Use constructive coping strategies to manage stress

• Seek personal, professional, or academic support to address

personal limitations

• Has positive self-esteem and confidence when working with others

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Leadership

• Identifies traits that reflect leadership versus

management

• Identifies the history of a team before implementing

changes

• Develops relationships, values diverse opinions, and

understands individual strengths and weaknesses to

promote teamwork

• Persuasively communicate goals to the team

• Empowers team members by actively listening, gathering

input or feedback, and fostering collaboration

Innovation and Entrepreneurship

• Demonstrate initiative when confronted with challenges

• Develop new ideas and approaches to improve quality or

overcome barriers to advance the profession

• Demonstrate creative decision making when confronted with

novel problems or challenges

• Assess personal strengths and weaknesses in entrepreneurial

skills

• Apply entrepreneurial skills within a simulated

entrepreneurial activity

• Conduct a risk-benefit analysis for implementation of an

innovative idea or simulated entrepreneurial activity

Professionalism

• Demonstrates altruism, integrity,

trustworthiness, flexibility, and respect

• Display preparation, initiative, and accountability

commitment to excellence.

• Delivers care that is legal, ethical, and

compassionate

• Recognizes professionalism is constantly

evaluated by others

• Engages in the profession of pharmacy

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Assessment Revision

• Dr. Jeff Mercer and I will be working on revising

our IPPE and APPE evaluations

• If you are interested in serving on a preceptor

focus group please contact me

Student Rights to Privacy:

FERPA

Family Educational Rights and

Privacy Act

• Federal law that protects the privacy of

student education records

• Right of the parents when child is <18 or

still in high school

• Transfers to student when > 18 or pursuing

education > high school

• Applies to all pharmacy students

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FERPA

• Gives eligible students the right to inspect and

review education records maintained by the

school

• Gives the students the right to request that a

school correct records they believe to be

inaccurate or misleading

• Requires schools to have written permission

from the student to release any information in

the school’s records

FERPA

• Applies to any documented student record maintained

by the school

• Students federal FERPA privacy rights extend to:

1. Poor overall performances on rotation

2. Specific instances of underperformance

3. Midpoint grades

4. Final grades

5. Instances of remediation

6. Instances of unsuccessful completion of your

rotation

FERPA

• Things to consider

• Do you have student employees?

• Are you technicians and staff aware of the

students rights?

• Protecting a student’s privacy takes effort

• HIPAA/FERPA ≈ Patient/Student

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FERPA

• Exceptions

1. School officials with educational interest;

2. Other schools (in the case of a transfer);

3. Official audit or evaluation purposes;

4. Financial aid organizations;

5. Organizations conducting certain studies for or on behalf

of the school;

6. Accrediting organizations;

7. Judicial order or lawfully issued subpoena;

8. Appropriate officials in cases of health and safety

emergencies; and

9. State and local authorities, within a juvenile justice

system, pursuant to specific State law.

FERPA

• Any documented student outcome

• Any documented student performance

maintained by the school

• Any disciplinary action by the school

• All grades

• Failure to progress

Preceptor Requirements

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Preceptor Requirements

1. Pharmacist license in good standing

2. Professional competency

3. Desire to educate

4. Minimum of one year practice experience in your area

5. Preceptor training

6. Professional membership

7. Communicate effectively (meaningful feedback to

students)

8. Avoid relationships with students that jeopardizes

learning

9. Not reimburse students (direct or indirect)

AR State Board Requirements

• Be an Arkansas pharmacist, licensed for more than one year and actively engaged in the

practice of Pharmacy for the year immediately preceding the application for certification as

a preceptor.

• Be a pharmacist employed in a pharmacy which currently holds a Class A rating indicated by

the Inspection Sheet for pharmacies as outlined by the State Board of Pharmacy.

• For the initial application as preceptor, the applicant must satisfactorily complete a test on

requirements and responsibilities of a preceptor as developed and administered by the

Board of Pharmacy or its representatives.

• Have a pharmacy library (latest edition), which meets or exceeds the requirements of the

"Inspection Sheet" for pharmacies.

• At least one preceptor from the internship site shall be a member of an appropriate

national pharmaceutical organization. Preceptors shall be a member of at least one

professional state organization.

• Must not have been convicted of any violation of Arkansas Code §17-92-311, unless the

Board officially grants exception.

• Must have attended at least one professional meeting during each licensure biennium.

• Must agree to give immediate personal and direct physical supervision to the intern. A

preceptor cannot supervise more than one intern at any specified time.

• Preceptors must renew their certification every two years by application and payment of

fees specified in regulation 01-00-0007.

Preceptor Resources

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Preceptor Resources

1. Collaborative Education Institute (CEI link in e-value)

2. Continuing Education (deferred cost COP CPE)

3. UAMS Library Access

4. Pharmacists’ Letter: Preceptor Training & Resource

Network

5. Others (should be listed in the manual)

6. IPPE/APPE Manuals

7. Facility tools

8. Pharmacist tools

9. Student tools

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Pharmacist’s Letter

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UAMS Library Access

Tools and Forms

Tools and Forms

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Tools and Forms

Tools and Forms

Tools and Forms

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Tools and Forms

Tools and Forms

Tools and Forms

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Tools and Forms

Tools and Forms

Tools and Forms

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Tools and Forms

Best Practices for Experiential

LearningNew student orientation

• Welcome the student and introduce yourself

and other personnel

• Provide a tour of the facility

• Explain policy and procedures

• Describe the types of services you provide

• Help the student understand his/her role and

daily responsibilities at your facility

Provide a clear plan for assessment

expectations

• What do you expect the student to do?

• Responsibilities

• Learning Activities

• Requirements

• What opportunities will the student have to

practice the activity?

Best Practices for Experiential

Learning

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Provide a clear plan for assessment expectations

• How will you assess the student’s performance?

• Projects/activities

• Documentation

• Verbal and written feedback timing

• Self-assessment

• If the experience has multiple preceptors

• Who shares responsibility for the student?

• What activities they will have with each preceptor?

• What preceptors will assess student responsibilities?

Best Practices for Experiential

Learning

Assessing Experiential Students• Scoring

• 5 Meets requirement at a level beyond that expected for a new graduate

• 4 Meets requirement with minimal or no prompting and intervention from the preceptor

• 3 Meets requirement with moderate prompting and intervention from the preceptor

• 2 Meets requirement with extensive prompting and intervention from the preceptor

• 1 Does not meet requirement even with prompting and intervention from the preceptor

• 0 Though opportunities existed, student did not engage in requirement; therefore not able to assess

• NA Not applicable to experience or not observed

Why give feedback?

• Gives insight to students above how they may see

themselves

• Students want feedback

• Students who get regular feedback

• Perform better

• Learn more quickly

Best Practices for Experiential

Learning

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What is meaningful feedback?

1. Descriptive NOT Evaluative

2. Specific

3. Honest and sincere

4. Relevant

5. Timely

6. Desired by Receiver

Best Practices for Experiential

Learning

Meaningful feedback

• Weekly feedback (informal)

• Gives them time to improve before midpoint

• Student’s response to feedback will help future assessments

• Midpoint evaluation

• Student self-assessment

• Strengths and opportunities to improve

• Final evaluation

• Student self-assessment

• Strengths and opportunities to improve

• Review progress form midpoint

• Global plan for improvement on future experiences

Best Practices for Experiential

Learning

Learning Assessment

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FERPA scenario 1

A former student/employee who is now a

preceptor calls to ask about a student’s

performance at your site. The student performed

poorly and as a result did not graduate.

Would disclosing this information be a FERPA

violation?

FERPA scenario 2

You often take handwritten notes on student performance at

your site. You use these to help you complete midpoint and

final evaluations. Again you are asked about a students

performance.

Would reviewing these files and discussing a student’s

performance violate FERPA?

Is it acceptable to select N/A on

the Experiential Student

Evaluation form?

a. Yes, but only when the student refused to

perform the activity

b. Yes, specifically when the opportunity did not

present itself during the experience

c. Yes, especially when a student performed the

task but it was observed by another pharmacist

d. No, what does it mean anyway?

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Student X has been exceptional all month.

They have consistently taken the initiative and

exceed expectations in all categories

• Score this student

a. 5

b. 4

c. 3

d. 2

e. 1

f. 0

g. N/A

Student Y has done a good job. You have only

had to tell them/show them something once.

They have worked independently and you

have enjoyed having them on rotation.

• Score this student

a. 5

b. 4

c. 3

d. 2

e. 1

f. 0

g. N/A

Student Z has been a pain all month and has

required repetitive instruction. They have

occasionally showed up late and could have

responded to feedback more appropriately.

• Score this student

a. 5

b. 4

c. 3

d. 2

e. 1

f. 0

g. N/A

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Which feedback statement is the most

meaningful to an experiential student?

a. “Good job!”

b. “Student rounded on all patients in the ICU today.“

c. “Student needs to ask, “Do all of the patient’s

medications have an indication?" for every patient the

student is assigned.

d. “Student specified INR target based on consideration of

patient’s indication & risks & justified recommended goal

using Chest guidelines."