A Pharmacotherapy Capstone Course to Advance Pharmacy Students�� Clinical Documentation Skills

Objective. To implement and assess the effectiveness of a capstone pharmacotherapy course designed to integrate in-class curriculum using patient cases and drug-information questions. The course was intended to improve third-year doctor of pharmacy (PharmD) students'' clinical documentation skills in preparation for beginning advanced pharmacy practice experiences (APPEs). Design. This 2-credit, semester-long course consisted of 6 patient cases and 12 drug-information questions posted electronically on an Internet-based medical chart, a public health presentation, a knowledge examination, and an objective standardized performance assessment. In class, students engaged in active-learning exercises and clinical problem-solving. Students worked outside of class in small groups to retrieve and discuss assigned articles and review medication information in preparation for in-class discussions.Assessment. A rubric was used to assess the patient cases and questions that students completed and submitted individually. Data for 4 consecutive course offerings (n=622) were then analyzed. A significant improvement was found in the “misplaced” but not the “missing” documentation ratings for both assessment and plan notes in the final assessment compared with baseline. In course evaluations, the majority of students agreed that the course integrated material across the curriculum (97%) and improved their clinical writing skills (80.5%).Conclusion. A capstone pharmacy course was successful in integrating and reviewing much of the material covered across the PharmD curriculum and in improving students’ clinical documentation skills.     

Measuring PreAdvanced Practice Experience Outcomes as Part of a PharmD Capstone Experience

Objective: To describe a capstone experience to: 1) assess student preparedness for Advanced Pharmacy Practice Experiences (APPE) and 2) provide program-level assessment data.Design: A capstone course was added immediately prior to APPEs. All capstone activities emphasized application and integration and were mapped to ACPE Appendix D, which details performance abilities expected of students prior to APPEs. Eleven learning activities comprising 20 assessments were created. Each assessment was pass/fail; students had to pass 15 of 20 assessments to pass the capstone course. Evaluation rubrics emphasized formative feedback for students.Assessment: The capstone experience was delivered 4 times over 4 consecutive years. One student did not pass; 55-68% of the students passed all activities. Program-level assessment data provided details on individual student preparedness prior to APPE, important information for accreditation, and basis for curriculum revisions.Conclusion: A capstone experience can be a valuable addition to a PharmD curriculum. Capstone activities incorporating authentic assessments provide important program-level assessment data for colleges/schools of pharmacy.     

Sterile Compounding Knowledge,Skills, and Confidence Among Graduating Doctor of Pharmacy Students

Objective. To determine whether the exposure to sterile compounding in the pharmacy curriculum produces Doctor of Pharmacy graduates who are both competent and confident in the area of sterile compounding, and to identify additional variables that may predict student performance.Methods. Participants were recruited from the fourth-year pharmacy class of 2018 at one university. The students were asked to complete a questionnaire assessing the following domains: demographics, confidence in compounding performance, prior experience, and theoretical knowledge. A written assessment was followed by a faculty-evaluated practicum in which the students were required to prepare two sterile products using a standardized rubric. Results were analyzed with a Student t test and linear regression to determine differences in performance based upon prior experience, confidence, and theoretical knowledge.Results. Overall, the 158 students performed well on the knowledge and skill examination, achieving an average total score of 89.8%. Of the 158 total participants, the 122 survey respondents had an overall mean confidence score of 2.9 on a four-point Likert scale, with 40.2% of students scoring in the confident or very confident range of the survey. In our analysis, we found that neither prior compounding experience or self-rated confidence were predictive of students’ total score.Conclusion. The results of this study suggest that the inclusion of sterile compounding education and training in all four years of the pharmacy curriculum produces PharmD graduates who are competent, with varying levels of confidence in the area of sterile compounding.     

Progress Examination for Assessing Students' Readiness for Advanced Pharmacy Practice Experiences

Objectives

To create a valid assessment tool to evaluate the readiness of pharmacy students for advanced pharmacy practice experiences (APPEs).

Design

The Triple Jump Examination (TJE) was tailored to the 4-year, 2-plus-2 curriculum of the College. It consisted of (1) a written, case-based, closed-book examination, (2) a written, case-based open-book examination, and (3) an objective structured clinical examination (OSCE). The TJE was administered at the end of each 4 academic semesters. Progression of students to APPEs was dependent on achieving a preset minimum cumulative (weighted average) score in the 4 consecutive TJE examinations.

Assessment

The predictive utility of the examination was demonstrated by a strong correlation between the cumulative TJE scores and the preceptor grades in the first year (P3) of APPEs (r = 0.60, p > 0.0001). Reliability of the TJE was shown by strong correlations among the 4 successive TJE examinations. A survey probing the usefulness of TJE indicated acceptance by both students and faculty members.

Conclusion

The TJE program is an effective tool for the assessment of pharmacy students'' readiness for the experiential years. In addition, the TJE provides guidance for students to achieve preparedness for APPE.     

Design and Implementation of a Laboratory-Based Drug Design and Synthesis Advanced Pharmacy Practice Experience

Objective. To provide students with an opportunity to participate in medicinal chemistry research within the doctor of pharmacy (PharmD) curriculum.Design. We designed and implemented a 3-course sequence in drug design or drug synthesis for pharmacy students consisting of a 1-month advanced elective followed by two 1-month research advanced pharmacy practice experiences (APPEs). To maximize student involvement, this 3-course sequence was offered to third-year and fourth-year students twice per calendar year.Assessment. Students were evaluated based on their commitment to the project’s success, productivity, and professionalism. Students also evaluated the course sequence using a 14-item course evaluation rubric. Student feedback was overwhelmingly positive. Students found the experience to be a valuable component of their pharmacy curriculum.Conclusion. We successfully designed and implemented a 3-course research sequence that allows PharmD students in the traditional 4-year program to participate in drug design and synthesis research. Students report the sequence enhanced their critical-thinking and problem-solving skills and helped them develop as independent learners. Based on the success achieved with this sequence, efforts are underway to develop research APPEs in other areas of the pharmaceutical sciences.     

Pharmaceutical Care Plan Examinations to Identify Students at Risk for Poor Performance in Advanced Pharmacy Practice Experiences

Objectives

To evaluate early predictors of advanced pharmacy practice experience (APPE) performance using either timed pharmaceutical care plan (TPCP) reports of 4 case histories or traditional lecture-based pharmacotherapy course examinations.

Methods

Statistical process control (SPC) methods were used to identify a group of third-year pharmacy students “at risk” for poor APPE performance (defined as an APPE grade point average of < 3.0). Examination scores from an integrated lecture-based pharmacotherapy sequence were used for comparison.

Results

TPCP scores but not lecture-based examination scores successfully identified 6 of 10 students who ultimately performed poorly in their APPEs.

Conclusion

Adaptation of SPC methods to assess student performance during problem-based learning (PBL) case reports is a useful technique for identifying students “at risk” for poor APPE performance.     

Web-based Portfolios for Pharmaceutical Care Plans During Advanced Pharmacy Practice Experiences

Objective

To implement and assess a Web-based patient care portfolio system for development of pharmaceutical care plans by students completing advanced pharmacy practice experiences (APPEs) throughout a statewide preceptor network.

Design

Using a Web database, students in APPEs documented 6 patient cases within 5 disease state categories. Through discussion of the disease states and inclusion of patient information such as problems, desired outcomes, and interventions, a complete pharmaceutical care plan was developed for each patient.

Assessment

Student interventions were compared by geographical regions to assess continuity of patient care activities by students. Additionally, students completed an evaluation of the portfolio course to provide feedback on the portfolio process. Students documented an average of 1.8 therapeutic interventions per patient case and documented interventions in all geographical regions. The majority of students indicated that the portfolio process improved their ability to develop a pharmaceutical care plan.

Conclusion

The Web-based patient care portfolio process assisted with documentation of compliance with Accreditation Council of Pharmacy Education (ACPE) standards and College of Pharmacy Competency Statements. Students indicated the portfolio process was beneficial in developing skills needed for creating pharmaceutical care plans.     

Accommodating Pharmacy Students With Physical Disabilities During the Experiential Learning Curricula

Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).     

An Integrated Course in Pain Management and Palliative Care Bridging the Basic Sciences and Pharmacy Practice

Objective. To describe the development of an integrated pain and palliative care course and to investigate the long-term effectiveness of the course during doctor of pharmacy (PharmD) students’ advanced pharmacy practice experiences (APPEs) and in their practice after graduation.Design. Roseman University College of Pharmacy faculty developed a 3-week elective course in pain and palliative care by integrating relevant clinical and pharmaceutical sciences. Instructional strategies included lectures, team and individual activities, case studies, and student presentations.Assessment. Students who participated in the course in 2010 and 2011 were surveyed anonymously to gain their perception about the class as well as the utility of the course during their APPEs and in their everyday practice. Traditional and nontraditional assessment of students confirmed that the learning outcomes objectives were achieved.Conclusions. Students taking the integrated course on pain management and palliative care achieved mastery of the learning outcome objectives. Surveys of students and practicing pharmacists who completed the course showed that the learning experience as well as retention was improved with the integrated mode of teaching. Integrating basic and clinical sciences in therapeutic courses is an effective learning strategy.     

Use of Capstone Experiences in Pharmacy Education to Synthesize and Apply Students’ Knowledge and Skills

Objective. To investigate capstone experiences in pharmacy education with the broad aim of better understanding how they are designed, used, and sustained.Methods. Capstones were defined as culminating experiences that required Doctor of Pharmacy (PharmD) students to apply their knowledge and skills and demonstrate their ability to integrate, extend, and apply multiple components of their academic experience. This study was conducted in two phases. Phase one was a mapping review, which provided insight into the design of pharmacy capstone experiences, including the purpose they served and their associated outcomes. Phase two consisted of conducting follow-up interviews to explore the current status and sustainability of those capstone experiences. Qualitative methods with multiple coders were used to analyze the data.Results. Five distinct purposes for capstone experiences were identified: preparation for advanced pharmacy practice experiences (APPEs), pharmacotherapy education, research, reflection on pharmacy school experiences, and immersive learning through an external organization. Wide variability was found in the design, purpose, and outcomes of capstone experiences. Study authors described the capstone experiences at their institution in terms of the viability, feasibility, desirability, and challenges faced.Conclusion. Capstones can play an important role in assessing student progress and practice readiness in pharmacy education. The findings of this study can be used to help pharmacy schools design capstone experiences that are effective and sustainable.     

Cost Savings Associated With Pharmacy Student Interventions During APPEs

Objective. To quantify the impact of pharmacy students’ clinical interventions in terms of number and cost savings throughout advanced pharmacy practice experiences (APPEs) using a Web-based documentation program.Methods. Five hundred eighty doctor of pharmacy (PharmD) students completing ten 4-week APPEs during the final year of the curriculum were asked to document all clinical interventions they made using a Web-based documentation tool. Data were collected over 4 academic years.Results. The total number of interventions made was 59,613, the total dollars saved was $8,583,681, and the average savings per intervention was $148. The top 3 categories of interventions made by students were identifying dosing issues, conducting chart reviews, and recommending appropriate therapy. The top 3 intervention types made by students that resulted in the most dollars saved per intervention were identifying potential allergic reactions, identifying drug interactions, and resolving contraindications.Conclusions. Pharmacy students made important and cost-effective clinical interventions during their APPEs that resulted in significant savings. Documentation programs can track the number, type, and value of the interventions that pharmacy students are making.     

Independent Community Pharmacists' Perspectives on Compounding in Contemporary Pharmacy Education

Objectives

To identify compounding practices of independent community pharmacy practitioners in order to make recommendations for the development of curricular objectives for doctor of pharmacy (PharmD) programs.

Methods

Independent community practitioners were asked about compounding regarding their motivations, common activities, educational exposures, and recommendations for PharmD education.

Results

Most respondents (69%) accepted compounding as a component of pharmaceutical care and compounded dermatological preparations for local effects, oral solutions, and suspensions at least once a week. Ninety-five percent were exposed to compounding in required pharmacy school courses and most (98%) who identified compounding as a professional service offered in their pharmacy sought additional postgraduate compounding education. Regardless of the extent of compounding emphasis in the practices surveyed, 84% stated that PharmD curricula should include compounding.

Conclusions

Pharmacy schools should define compounding curricular objectives and develop compounding abilities in a required laboratory course to prepare graduates for pharmaceutical care practice.     

A Curriculum Crosswalk of the Core Entrustable Professional Activities for New Pharmacy Graduates

Objective. To cross reference the core entrustable professional activities (EPAs) to a complete set of educational guidance documents for the Doctor of Pharmacy (PharmD) curriculum to create a map for pharmacy educators.Methods. The Mapping EPAs Task Force consisted of nine members who first worked independently and then together in small working groups to map five assigned educational guidance documents (eg, Center for the Advancement of Pharmacy Education [CAPE] Outcomes, Accreditation Council for Pharmacy Education [ACPE] Standards 1-4, and the Essential Elements for Core Advanced Pharmacy Practice Experiences [APPEs]) to the Core Entrustable Professional Activities for New Pharmacy Graduates. Four working groups completed the mapping process during phases 1 and 2, which was followed by an independent quality assurance review and consensus in phase 3.Results. All 15 core EPA statements were mapped to one or more of the educational documents. One item from the CAPE Outcomes could not be mapped to a core EPA statement. The first five EPA statements mapped directly to the five elements of the Pharmacists’ Patient Care Process: collect, assess, plan, implement, and follow-up: monitor and evaluate.Conclusion. This comprehensive EPA map is the first curriculum crosswalk that encompasses a complete set of educational guidance documents including the Essential Elements for Core APPEs for the Doctor of Pharmacy curriculum. If adopted by the Academy, this curriculum crosswalk will provide pharmacy schools with a common interpretation of important educational guidance documents; serve as the foundation for curricular development, revision, and assessment; and ensure student pharmacists are prepared to enter the pharmacy profession.     

Assessment of Cultural Competence in Pharmacy Students Prior to Advanced Pharmacy Practice Experiences

Objective. To assess various aspects of cultural competence in second year Doctor of Pharmacy students’ and investigate the relationship between cultural competence and students’ demographics, work experience, and prior education.Methods. A 63-item survey modified from the Clinical Cultural Competency Questionnaire (CCCQ) and comprising four domains (knowledge, skills, encounters or situations, and attitudes towards cultural competency) was administered to second year pharmacy students before they started their advanced pharmacy practice experiences (APPEs). Additional questions regarding their ability to identify and recognize elements of cultural competence were asked. The effects of demographics, work experience, and education on cultural competence also were assessed.Results. Ninety-seven students (86.6%) participated in the study. The majority of participants were Asian, female, and in their late 20s. Most students agreed or strongly agreed that they could identify and recognize elements of cultural competence. However, participants indicated they were only a little or somewhat comfortable when asked questions about knowledge, skills, and comfort. Students indicated they had “quite a bit” of competence regarding attitudes towards other cultures. Previous cultural diversity training in undergraduate studies and pharmacy school were associated with higher scores on the modified CCCQ.Conclusion. The findings emphasize the importance of schools providing training in the didactic and experiential portion of the pharmacy curriculum to increase pharmacy students’ knowledge, skills, comfort, and attitudes towards other cultures.     

基层药学服务能力本位下的高职药学专业课程体系构建Δ

目的:构建更好的高职药学专业课程体系,培养适应基层的药学服务型人才。方法:通过对基层卫生单位进行走访、调研,分析我国基层药学服务现状和高职药学教育存在的问题,对高职药学专业课程体系进行有目的性的优化与构建。结果:在理论课程体系方面,我院重构了专业基础课程体系,完善了人文社会类公共课程的设置,并调整了专业核心课程设置;在实践课程体系方面,优化整合了实验教学内容,以多样化、多方位的形式开展实训项目和顶岗实训。结论:我院高职药学专业重构了全新课程体系的培养目标、框架与内容。通过4年的跟踪调查以及根据与我院合作的企业反映,构建的全新课程体系更适应基层药学服务的需要,学生的文化素养和职业技能得到大幅的提升。     

Practice Experiences at a Single Institutional Practice Site to Improve Advanced Pharmacy Practice Examination Performance

Objective. To determine whether sequential assignment of students to the same facility for institutional practice experiences improves their advanced pharmacy practice experience (APPE) examination scores.Design. Student volunteers were assigned to the same healthcare facility for all institutional introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs). Other students completed institutional IPPEs and APPEs at separate healthcare facilities, ranging from 2 to 4 different facilities per student. APPE examination scores of students assigned to the same facility for all institutional learning experiences were compared with those of students assigned to more than 1 institutional practice site.Assessment. Holding grade point average constant, students assigned to the same facility for institutional IPPEs and APPEs scored 3 percentage points higher on the APPE institutional examination compared with students assigned to separate facilities for these experiences.Conclusion. Assigning students to the same facility for both institutional IPPEs and APPEs positively influenced knowledge-based APPE examination performance.     

Pharmacy Student Learning During Advanced Pharmacy Practice Experiences in Relation to the CAPE 2013 Outcomes

Outcomes from The Center for Advancement of Pharmacy Education (CAPE) are intended to represent the terminal knowledge, skills, and attitudes pharmacy students should possess and have guided delivery of pharmacy education for more than two decades. Advanced pharmacy practice experiences (APPEs) are the endpoint of pharmacy curricula where demonstration and assessment of terminal learning occurs. This review examines published literature in relation to the most recent CAPE outcomes to determine the extent to which they have been addressed during APPEs since 1996. Details related to the APPE focus, intervention(s)/learning setting(s), and assessments are summarized according to the 15 CAPE outcomes. Further, the assessments are categorized according to the level of learning achieved using an available method. Common CAPE outcomes are highlighted, as well as those for which published reports are lacking for APPEs. The range and quality of assessments are discussed and emphasize the need for continuous improvement of scholarly design and assessment.     

Role of Pharmacy Education in Growing the Pharmacy Practice Model

The Director’s Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on pharmacy academia’s (“Academy”) role in transforming an organization’s pharmacy practice model. Pharmacy students can assume an integrated and accountable role in the practice model by having defined responsibilities for patient care. This role will produce students who are best trained to meet the challenges of pharmacy practice and health care reform. To make the students successful in this role, the pharmacy director must have a specific plan for integrating pharmacy students into the model and establishing relationships with Academy leadership, most importantly with the dean of the school or college of pharmacy. If successfully executed, the relationship between the Academy and the pharmacy department will enhance the mission of developing patient-centered pharmacy services.Since 1960, costs of health care exceed the growth in the US gross domestic product (GDP) by an average of 2.5 percentage points per year.¹ This growth in health care expenses is not sustainable; recent health care reform requires insurance coverage for all people, which further strains the economic system. To address rising costs in most hospitals, pharmacy departments are being asked to improve their efficiency and effectiveness because medications represent almost 7% of a hospital’s expenses.² In addition, because of concerns with quality and safety in health care, pharmacists are being required to develop systems to prevent harm in health care (eg, preventing serious medication errors). The American Society of Health-System Pharmacists’ (ASHP) Pharmacy Practice Model Initiative (PPMI) was created to assist hospital pharmacy leaders in managing the consequences of limited resources and providing safer expanded services.Many stakeholders were engaged in creating the PPMI, and a critical component of the recommendations was pharmacy education. During the November 2010 meeting of the PPMI Summit, participants discussed the role of pharmacy education in advancing practice models. The Summit recommended that the pharmacy education academic community (“Academy”) prepare students for a contemporary role in drug therapy management.³ This role requires that the students have a grasp of skills in communication, clinical reasoning, time management, and the technical aspects of health-system pharmacy practice. Further, the PPMI suggested that the Academy implement curricular changes to prepare students for a larger (both integrated and accountable) role in health-system pharmacy practice.While the PPMI recommended changes in pharmacy curriculum to best prepare student, the Accreditation Council on Pharmacy Education (ACPE) also revised its standards to require expanded experiential education. The Introductory and Advanced Pharmacy Practices Experiences (IPPE, APPE) changed in 2010 to provide for a more aggressive introduction of students to pharmacy practice. These changes include increasing the number of required rotations for fourth-year students and increasing the students’ exposure in their first 3 professional years to both community and hospital practice.⁴The changes in the IPPE and APPE requirement have been met with some resistance; the logistics of providing expanded experiential education can be difficult given the limited pharmacy preceptor resources and training sites. We suggest that these requirements be used to further enhance the pharmacy practice model. Pharmacy directors should be planning for pharmacy students to be an integral and accountable part of the practice model.The goal of this article is to provide a framework for pharmacy directors to incorporate pharmacy students into their practice model. The article will discuss (1) the need for educating students in direct patient care activities, (2) examples of patient care roles filled by pharmacy students, (3) strategies for working with colleges or schools of pharmacy to enhance student engagement, (4) programs to integrate pharmacy students into patient care, and (5) keys to successful integration of pharmacy students into patient care. Transforming pharmacy students’ experiential education to an integrated and accountable role as part of a patient care team has many benefits for both the department and the student. It is yet another strategy for developing patient-centered services in the pharmacy department.     

Resilience and First-Year Pharmacy Students’ Academic Performance in a Pharmacy Math Course

Objective. The purpose of this study was to examine the relationship between academic resilience and academic success in Doctor of Pharmacy (PharmD) students.Methods. A cross-sectional survey using the Academic Pharmacy Resilience Scale (APRS-16) was conducted in two cohorts of first year pharmacy (P1) students (n = 374) during fall orientation in 2019 and 2020. The following data were also collected from student records: demographics, pre-pharmacy grade point average (GPA), Pharmacy Math outcome (passing or failing the course), and Pharmacy Math final numerical grade. Academic success was defined as achieving a passing grade in a Pharmacy Math course. Correlational, multiple logistic regression, and multiple linear regression analysis were conducted.Results. The survey response rate was 98.1%, and approximately 95% of participants passed Pharmacy Math. No significant correlations were found between Pharmacy Math final pass/fail outcome or Pharmacy Math final numerical grade and APRS-16 overall and subscale scores. In multiple logistic regression, neither pre-pharmacy GPA nor APRS overall scale or subscale scores were significantly associated with final Pharmacy Math outcome (passing/failing). In multiple linear regression, pre-pharmacy GPA was significantly associated with Pharmacy Math final numerical grade, but APRS-16 overall score and subscale scores were not.Conclusion. First-year pharmacy students’ performance in Pharmacy Math was not influenced by academic resilience. Studies like this one examining the relationship between pharmacy students’ resilience and academic performance are lacking. Future studies should assess whether academic resilience may affect performance in other courses as well as performance in the PharmD curriculum.