Simulation and introductory pharmacy practice experiences

This paper reviews the literature on the various types of simulation and their incorporation into health professions curricula, describes how simulation training is recognized in other professions, and evaluates the feasibility of integrating simulation into experiential education programs of colleges and schools of pharmacy. The Accreditation Council for Pharmacy Education (ACPE) Board of Directors develop standards and guidelines on the use of simulation as part of introductory pharmacy practice experiences within the doctor of pharmacy (PharmD) curriculum.     

The role of colleges and schools of pharmacy in the advent of Healthy People 2020

As the need for more experiential sites increases, colleges and schools of pharmacy should consider innovative and strategic approaches to expansion including adding programs that would address the target areas emphasized by Healthy People 2020. Healthy People 2020 encompasses the following areas: adolescent health, early and middle childhood, genomics, global health, health information technology, healthcare-associated infections, hearing and other sensory or communicating disorders (ear, nose, throat-voice, speech and language), weight status, older adults, quality of life and well-being, and social determinants of health. Academic leaders should consider what role exists for pharmacy practice in these areas and focus future program and curriculum development on Healthy People 2020 topic areas.     

High-fidelity patient simulation series to supplement introductory pharmacy practice experiences

Objective

To introduce a high-fidelity simulation series into a 5-year doctor of pharmacy (PharmD) curriculum to demonstrate a hybrid model for introductory pharmacy practice experience (IPPE) delivery.

Design

Fourth-year pharmacy students at a satellite campus participated in a 6-week high-fidelity patient simulation series in which small groups of students worked with members of a patient care team to care for patients in the following scenarios: asthma exacerbation, acute decompensated heart failure, and infective endocarditis with a subsequent anaphylactic reaction to the antibiotic. Fourth-year pharmacy students at the main campus who did not participate in the simulation served as a comparator group.

Assessment

Students'' scores on a knowledge-based post-simulation quiz were significantly higher than scores on the presimulation quiz (p < 0.05). Knowledge retention was significantly higher among the simulation participants than students in the comparator group (p = 0.004). The majority (76%) of students felt more confident “making clinical recommendations to a healthcare provider” after completing the simulation series (p = 0.01).

Conclusion

High-fidelity patient simulation is an effective active-learning strategy to augment IPPEs that allows students to apply clinical skills in a realistic but low-risk patient care setting.     

Reinforcing cultural competency concepts during introductory pharmacy practice experiences

Objectives

To incorporate cultural competency concepts into various introductory pharmacy practice experiences (IPPE) at the University of Missouri - Kansas City, School of Pharmacy.

Design

A 6-week series, titled “Becoming a Culturally Competent Provider” was developed to provide IPPE students with the opportunity to apply theory regarding cultural competency in a clinical context.

Assessment

Pre- and post-intervention attitude survey instruments were administered to 25 students in the spring semester of 2009. Several activities within the series were associated with reflection exercises. Student presentations were evaluated and formal feedback was provided by faculty members. A course evaluation was administered to evaluate the series and determine areas of improvement.

Conclusion

A special series on cultural competency resulted in positive changes in students'' attitudes, highlighting the importance of reinforcing cultural competency concepts during IPPEs.     

Integration of an introductory pharmacy practice experience with an advanced pharmacy practice experience in adult internal medicine

Objective. To describe the development, implementation, and assessment of an internal medicine introductory pharmacy practice experience (IPPE) that was integrated with an existing advanced pharmacy practice experience (APPE) in internal medicine.Design. A structured IPPE was designed for first-, second-, and third-year pharmacy (P1, P2, and P3) students. Activities for the IPPE were based on the established APPE and the individual learner''s educational level.Assessment. Students reported a greater understanding of clinical pharmacists’ roles, increased confidence in their clinical skills, and better preparation for APPEs. Peers viewed the approach as innovative and transferable to other practice settings. Participating faculty members provided a greater number of contact hours compared to traditional one-time site visits.Conclusions. Integrating an IPPE with an existing APPE is an effective and efficient way to provide patient care experiences for students in the P1-P3 years in accordance with accreditation standards.     

Portfolio use and practices in US colleges and schools of pharmacy

Objectives. To identify the prevalence of portfolio use in US pharmacy programs, common components of portfolios, and advantages of and limitations to using portfolios.Methods. A cross-sectional electronic survey instrument was sent to experiential coordinators at US colleges and schools of pharmacy to collect data on portfolio content, methods, training and resource requirements, and benefits and challenges of portfolio use.Results. Most colleges and schools of pharmacy (61.8%) use portfolios in experiential courses and the majority (67.1%) formally assess them, but there is wide variation regarding content and assessment. The majority of respondents used student portfolios as a formative evaluation primarily in the experiential curriculum.Conclusions. Although most colleges and schools of pharmacy have a portfolio system in place, few are using them to fulfill accreditation requirements. Colleges and schools need to carefully examine the intended purpose of their portfolio system and follow-through with implementation and maintenance of a system that meets their goals.     

Sustainability of a Practice-based Interprofessional Introductory Pharmacy Practice Experience Course

Objective. To describe a successfully sustained interprofessional introductory pharmacy practice experience (IPPE) in which third-year pharmacy students were paired with nonpharmacist practitioners.Methods. Course data were retrospectively reviewed and analyzed to reveal details about the program. Provider participant numbers and student perception data were reviewed and reported on.Results. The number of students and providers participating increased during the 13 years of the program. On average, preceptors participated for 3 years and hosted 4 pharmacy students. Students consistently agreed the course helped increase student communication competencies and integration into interdisciplinary practice (mean agreement of 88.4% and 91.6%, respectively).Conclusion. A required interprofessional IPPE course designed to develop students’ self-confidence working and communicating with nonpharmacist practitioners has been successfully sustained for more than a decade. Students report improvements in self-confidence and achievement of the course’s primary outcomes.     

An introductory pharmacy practice experience providing pharmaceutical care to elderly patients

Objective. To develop, integrate, and assess an introductory pharmacy practice experience (IPPE) in providing pharmaceutical care to patients at senior centers (Silver Scripts).Design. First-year pharmacy students learned and practiced the pharmaceutical care process in the classroom to prepare for participation in the Silver Scripts program, in which the students, under faculty mentorship, conducted comprehensive medication reviews for senior citizens attending senior centers in Pittsburgh, Pennsylvania.Assessment. Students, preceptors, and senior center staff members indicated the experience was positive. Specifically, first-year students felt they gained benefit both from an educational standpoint and in their own personal growth and development, while staff contacts indicated the patients appreciated the interaction with the students.Conclusion. The Silver Scripts experience is a model for linking classroom experiences and experiential learning. The cycle of experiencing, reflecting, and learning has provided not only a meaningful experience for our P1 students but also a worthwhile focused review of seniors’ medication use. This experience could be used as a model for other colleges and schools of pharmacy and their communities.     

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy

Objective. To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload.Methods. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes).Results. APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes.Conclusion. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.     

An introductory pharmacy practice experience on improving medication adherence

Objective. To evaluate the impact of a medication adherence activity on introductory pharmacy practice experience students’ perceptions of patient adherence as well as student development of empathy and confidence in patient counseling.Design. Students participated in a personal medication simulation using an automated medication dispenser. Students then identified a patient with nonadherence and provided counseling on use of the dispenser. After 4 to 6 weeks, students interviewed the patient about their experience with the dispenser and assessed changes in adherence.Assessment. One hundred fifty-three students completed the assignment and 3 surveys instruments. Following the experience, the majority of students agreed or strongly agreed that they developed more empathy for patients with multiple medications and felt confident counseling a patient in the use of a dispenser (92.0% and 88.2%, respectively). Most students (91.4%) reported feeling that their patient education session was successful.Conclusion. An introductory pharmacy practice experience involving an automated medication dispenser and patient counseling to improve medication adherence resulted in the development of empathy and improved student confidence.     

Integration of First- and Second-Year Introductory Pharmacy Practice Experiences

Objectives

To describe the integration of a first- and second-year introductory pharmacy practice experience (IPPE) involving direct patient contact in hospitals and clinics as a means of more efficiently using academic and preceptor resources.

Design

Two IPPE courses were integrated in fall 2004 to accomodate increasing enrollment in classes and limited clinical practice sites and preceptors, as well as to meet the increased need for students and clinicians to practice principles of self-education. P1 and P2 students interviewed patients and presented patient cases; preceptor expectations were structured by instructional objectives. Student and preceptor course evaluations were assessed from survey data.

Assessment

During the assessment period, all students passed the courses. Following integration of the IPPEs, both courses received positive evaluations from students and preceptors. Initial advanced pharmacy practice experience (APPE) grades for students completing the courses further suggests that the integrated IPPEs were beneficial to students.

Conclusion

The successful integration of first- and second- year IPPE courses resulted in more efficient use of academic and preceptor resources and created a model for other colleges of pharmacy to consider.     

Establishment of a multi-state experiential pharmacy program consortium

In 2002, a regional consortium was created for schools and colleges of pharmacy in Georgia and Alabama to assist experiential education faculty and staff members in streamlining administrative processes, providing required preceptor development, establishing a professional network, and conducting scholarly endeavors. Five schools and colleges of pharmacy with many shared experiential practice sites formed a consortium to help experiential faculty and staff members identify, discuss, and solve common experience program issues and challenges. During its 5 years in existence, the Southeastern Pharmacy Experiential Education Consortium has coordinated experiential schedules, developed and implemented uniform evaluation tools, coordinated site and preceptor development activities, established a work group for educational research and scholarship, and provided opportunities for networking and professional development. Several consortium members have received national recognition for their individual experiential education accomplishments. Through the activities of a regional consortium, members have successfully developed programs and initiatives that have streamlined administrative processes and have the potential to improve overall quality of experiential education programs. Professionally, consortium activities have resulted in 5 national presentations.     

Geriatric care as an introductory pharmacy practice experience

Objective. To describe the design, delivery, and impact of a geriatric introductory pharmacy practice experience (IPPE) to develop students’ skills related to consultant pharmacists’ roles and patient care responsibilities.Design. A required 2-unit geriatric IPPE, involving 40 hours in a geriatric-care facility, 5 reflection hours, and 12 classroom-discussion hours, was developed for first- and second-year pharmacy students. Students interviewed patients and caregivers, reviewed patient charts, triaged patient needs, prepared care plans, and performed quality-assurance functions.Assessment. After completing the IPPE, students’ geriatric- and patient-care abilities were enhanced, based on review of their interactions, care plans, reflections, and examinations, and they demonstrated cognitive, affective, and psychomotor-domain learning skills. Students’ care plans and quality assurance activities revealed positive patient outcomes, opportunities for measurable patient health improvement, and a positive impact on quality assurance activities. Student evaluations and feedback from health workers at the facilities also were positive.Conclusions. This geriatric IPPE in which students cared for a specific patient and interacted with other health care providers is an innovative approach to enhancing students’ abilities to serve the growing geriatric population.     

The capacity ratio as a measure of solvency in experiential education

Objective. To determine the utility of the capacity ratio to measure and compare solvency in experiential education in 6 colleges and schools of pharmacy in the Northwestern United States.Methods. The 6 colleges and schools of pharmacy combined data on student placements needed, site availability, and changes made to placements during the 2009-2010 and 2010-2011 academic years and calculated capacity ratios for the advanced and introductory experience programs in the region. Comparisons also were made to previously published capacity results to determine whether the capacity ratio was useful in identifying trends and guiding preceptor and site development.Results. Capacity ratio calculations were successful in facilitating comparison of capacity within and across regions. Experiential education is solvent in the Northwest overall, but specific parts of experiential programs were found to have more capacity than others. Trends in the Northwest were consistent with capacity in other regions.Conclusions. The capacity ratio can determine and facilitate comparison of solvency within and across colleges and schools of pharmacy and thereby inform decisions about resource management in experiential education.     

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.     

Use of online modules to enhance knowledge and skills application during an introductory pharmacy practice experience

Objectives. To implement and assess the effectiveness of online instructional modules to increase the consistency of learning outcomes related to students’ patient-care practice knowledge and their skills application and confidence across introductory pharmacy practice experience (IPPE) sites.Design. Twenty online modules were created to provide uniform delivery of instructional content that complemented classroom instruction and to introduce students to common pharmacy-practice skills in the patient-care arena.Assessment. Quantitative data were collected by means of a survey and pre- and post-module quizzes, which were completed by students to assess knowledge. More than 85% of students applied the IPPE skills. During the course, students’ confidence increased significantly in all areas. For all but 1 of the 13 competencies, more than 70% of students agreed or strongly agreed that the competencies were met.Conclusions. Online instructional modules in patient care can effectively increase students’ knowledge, skills application, and confidence, and improve the consistency of achieving outcomes for instructional content and activities across diverse practice settings.     

Science of safety topic coverage in experiential education in US and Taiwan colleges and schools of pharmacy

Objective. To compare the science of safety (SoS) topic coverage and associated student competencies in the experiential education curricula of colleges and schools of pharmacy in the United States and Taiwan.Methods. The experiential education director, assistant director, or coordinator at a random sample of 34 US colleges and schools of pharmacy and all 7 Taiwan schools of pharmacy were interviewed and then asked to complete an Internet-based survey instrument.Results. Faculty members in both countries perceived that experiential curricula were focused on the postmarketing phase of the SoS, and that there is a need for the pharmacy experiential curricula to be standardized in order to fill SoS coverage gaps. Inter-country differences in experiential SoS coverage were noted in topics included for safety biomarkers that signal potential for drug-induced problems and pharmacogenomics.Conclusions. Experiential SoS topic coverage and student ability gaps were perceived within and between US and Taiwan colleges and schools of pharmacy.     

An introductory pharmacy practice experience based on a medication therapy management service model

Objective. To implement and evaluate an introductory pharmacy practice experience (IPPE) based on the medication therapy management (MTM) service model.Design. Patient Care 2 is an IPPE that introduces third-year pharmacy students to the MTM service model. Students interacted with older adults to identify medication-related problems and develop recommendations using core MTM elements. Course outcome evaluations were based on number of documented medication-related problems, recommendations, and student reviews.Assessment. Fifty-seven older adults participated in the course. Students identified 52 medication-related problems and 66 medical problems, and documented 233 recommendations relating to health maintenance and wellness, pharmacotherapy, referrals, and education. Students reported having adequate experience performing core MTM elements.Conclusion. Patient Care 2 may serve as an experiential learning model for pharmacy schools to teach the core elements of MTM and provide patient care services to the community.