Relationship between advanced pharmacy practice experience grading schemes and pharmacy residency match rates.

PURPOSE: To determine the relationship of advanced pharmacy practice experience (APPE) grading schemes and other pharmacy program variables (ie, program age and funding) with pharmacy residency match rates. SUMMARY: A 12-question survey was disseminated to experiential administrators of pharmacy programs in October 2018. Respondents identified their program's APPE grading scheme (pass/fail, letter grades, or other) and associated pros and cons. Responding programs were categorized by age and funding status. Survey responses were correlated with the American Society of Health-System Pharmacists residency match rates for 2016 through 2018. Data were analyzed using descriptive statistics and logistic regression models as well as by attributes via thematic analysis. Most pharmacy programs (62%) reported using letter grades for APPEs compared to pass/fail (30%) or other (8%) schemes. Pharmacy programs using pass/fail grading were more likely to have students match to postgraduate year 1 (PGY1) (P < 0.001) and postgraduate year 2 (PGY2) (P = 0.0074) residencies. Older pharmacy programs for each grading scheme were more likely to have higher match rates; however, for PGY1 match rates, older programs utilizing letter grades correlated to lower match rates than those utilizing pass/fail grading (P < 0.0001). Likewise, both public and private pharmacy programs using pass/fail grading had higher PGY1 match rates than those using letter grades (P = 0.0006 and P = 0.0014). CONCLUSION: Pass/fail grading in APPEs does not hinder PGY1 or PGY2 residency placement compared to other grading schemes both overall and in combination with certain pharmacy program variables. Grading scheme strengths and weaknesses should be considered when deciding on optimal assessment strategies for APPEs and when evaluating candidates for residencies.

Establishing an Experiential Liaison Position to Increase IPPE and APPE Capacity and Preceptor Satisfaction in the Health System Environment.

Description of the problem: Providing experiential experiences for student pharmacists within health systems can be challenging for schools of pharmacy. Establishing clinical faculty practices within health systems enables schools to increase student placements, however the clinical faculty typically prioritize experiential education within their individual clinical practice and may not be positioned to develop experiential education opportunities across the site. Description of the innovation: A novel clinical faculty position, the experiential liaison (EL), established at the school's largest health system partner to focus on improving the quality and quantity of experiential education across an academic medical center (AMC). Critical analysis: University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science (SSPPS) identified interested preceptors, recognized and coordinated preceptor development, and facilitated development of quality experiential activities within the site through the establishment of the EL position. Since the establishment of the EL position, student placement at the site increased to 34% of SSPPS's experiential placements in 2020. A high number of preceptors answered "strongly agree or agree" to understanding SSPPS's curriculum, expectations from the school, how to utilize assessment tools to measure student performance on rotation, and how to provide feedback to the school. Preceptor development opportunities are routine and effective, and the relationship between the school and hospital is collaborative. Implications: Establishing an experiential liaison clinical faculty position within a health system is a feasible strategy for schools to further increase experiential education placements in health systems.

A longitudinal quality improvement program to optimize experiential education's ability to develop trusted independent pharmacist practitioners.

PROBLEM DESCRIPTION: To meet the evolving role of today's pharmacist, student pharmacists need to be given independent responsibilities that increase in rigor as they advance through the curriculum and be able to practice both autonomously and as part of an interprofessional team. Quality improvement methods: The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) experiential programs office undertook a 20-year process of developing independence for students. Students faced increasing challenges and responsibilities as they moved through experiential practice settings, with constant, cyclic adjustments made in response to feedback. RESULTS OF CQI INQUIRY: The continuous focus on developing independence in students has established a culture of trust in the Colorado pharmacy practice community. Students are allowed autonomy, and are challenged with increasing rigor as they advance. Graduates are well-prepared to perform both independently and as part of a team. INTERPRETATION AND DISCUSSION: The curricular framework based on trust and independent learning has helped the SSPPS train student pharmacists to meet the demands of current pharmacy practice, as well as expected roles in the future. Requiring increasing responsibilities from students as they move through the curriculum allows them to move along the spectrum set up through the entrustable professional activity (EPA) assessments to achieve high ratings for an individual skill. Continuous feedback and adjustments are necessary to identify what can be accomplished in pharmacy practice settings. CONCLUSIONS: This 20-year approach to curricular design and modifications within experiential education has produced independent pharmacy practitioners upon graduation.

A 3-Year Chronic Disease Public Health Intervention Focused on a Network of Rural Pharmacies Supported by Student Pharmacists.

OBJECTIVE: To retrospectively analyze and report various tracked outcomes of a 3-year collaboration offering chronic disease management services in diabetes and cardiovascular disease in pharmacies across 12 rural communities supported year-round by fourth-year student pharmacists. METHODS: Individualized medication therapy management services were provided to patients with cardiovascular disease and diabetes in a 6-month series based upon national guidelines standards of care. Objective laboratory measurements, adherence rates, goals set for patients, vaccination rates, and routine maintenance examinations were all tracked as part of the program. Provider acceptance of recommendations from student pharmacists were tracked, and patients completed a 3-question survey regarding satisfaction with services. RESULTS: A total of 430 student pharmacists rotated through these pharmacy sites providing care to 779 unique patients across 3 years. Statistically significant improvements in A1C (-0.8%, P < .001) and systolic and diastolic blood pressure (5 mm Hg, 3 mm Hg, respectively, P < .01) were associated with the pharmacy care. Adherence issues were identified and addressed with 44% of these patients. In all, 70% of patients reported successful goal attainment of >50% from baseline. Providers accepted student therapy change recommendations 56% of the time. Patients reported satisfaction with services provided in the pharmacies (average scores of 4.22-4.67 on a 1-5 Likert-type scale). CONCLUSIONS: A 3-year pharmacy intervention in 12 rural areas made positive impacts on patients' adherence rates and self-management in diabetes and cardiovascular disease and was associated with statistically significant improvements in A1C and blood pressure while challenging fourth-year student pharmacists to perform at a high level on community pharmacy rotations.

A multimethod evaluation of an interprofessional IPPE in an underserved clinic.

INTRODUCTION: To evaluate the design of an interprofessional introductory pharmacy practice experience (IP-IPPE) designed to integrate third-year pharmacy students in patient care workflow under the direct supervision of non-pharmacist practitioners in a federally qualified health center. METHODS: Data was gathered to evaluate the success of the IP-IPPE from the students', providers', and clinic's perspectives. Preceptors completed a mixed-methods survey to determine satisfaction and value of the IP-IPPE. Students completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) post-IP-IPPE to assess change in interprofessional outcomes. Student performance and competency demonstration was assessed using a modified interprofessional professional assessment scoring tool. Finally, a retrospective patient chart review was conducted to determine student value to the clinic. RESULTS: During a 12-week period at the studied clinic, 32 students were supervised by eight primary care providers (PCPs) and cared for 516 patients. Six providers (75%) endorsed students' ability to provide value-added interventions during clinical care. A chart review of 200 patient records indicated students provided medication education to 12% of patients engaged with, in addition to other contributions. Students' ICCAS self-assessments indicated significant improvement across all outcomes following the IP-IPPE. Qualitative provider responses indicated meaningful investment into the IP-IPPE and appreciation for pharmacy student's collaboration during patient care. CONCLUSION: All 32 students in this study were able to earn the trust of their assigned PCP preceptors. The IP-IPPE design created value for learners, patients, and providers.

Cultivating a Culture of Reflection Among Pharmacy Students Through Storytelling.

Objective. To hold a storytelling event and assess its effect on Doctor of Pharmacy (PharmD) students' perspectives on and attitudes toward reflection. Methods. Story Slam, a four-hour storytelling competition, was incorporated into the spring semester of the first professional year of a PharmD program. The event featured short first-person stories told by faculty members as well as students. Students were invited to participate in a pre- and post-intervention survey and focus group. An inductive qualitative analysis of the resulting data was conducted using textual and audio artifacts. Results. All 136 first professional year (P1) students participated in the 2019 Story Slam. Eleven students submitted qualitative pre- and post-intervention survey instruments and participated in a semi-structured recorded focus group. Thematic analysis revealed nine themes. Students' perspectives regarding the importance of self-reflection changed after participating in Story Slam, with students expressing a greater willingness to engage in self-reflection in the context of professional practice following the event. Students believed Story Slam created an environment conducive to reflection and engagement, resulting in strengthened relationships with peers and faculty members. Students expressed feeling a wide range of emotions as they shared their story and listened to the stories of others. Conclusion. Story Slam is an effective strategy for introducing P1 students to reflection, while also strengthening the school's reflective culture. Additionally, sharing stories may foster positive relationships and cultivate trust and respect between students and faculty members.

Design and Content Validation of Three Setting-Specific Assessment Tools for Advanced Pharmacy Practice Experiences.

Objective. To develop and validate three assessment tools to measure student performance in clinical settings during required advanced pharmacy practice experiences (APPEs). Methods. Each assessment tool was developed by subject-matter experts and validated using three sources of evidence. Proposed content underwent a job-task analysis by external APPE preceptors, evaluating each outcome in terms of importance and frequency of opportunity for student demonstration. After implementation, tool performance was evaluated using a measure of item applicability and student achievement. Finally, a two-step grade verification process was developed and grade acceptance by preceptor was determined. A priori benchmarks for acceptable tool performance were established for each strategy. Results. The job-task analysis was completed by 131 preceptors (52% response), with items achieving a composite score from 1.08 to11.83 (possible range: 1=most valuable, 25=least valuable). The mean item applicability ranged from 91.3% to 94.1% (n=849 student assessments) during the first year. Preceptors accepted the tool-generated grade in 798 (94%) assessments. Conclusion. Data from three evaluation strategies provide evidence of effective design and use of three unique APPE setting-specific student assessment tools. Pharmacy programs can adopt similar methodologies to develop and validate their assessment tools.

Assessing a Longitudinal Reflection Curriculum: A Case Study Of Student Self-Awareness Expressed Through Rotation Goal Achievement.

The Center for the Advancement of Pharmacy Education 2013 Affective Domain mandates students develop self-awareness of personal attributes affecting professional growth. Students should self-identify needs, create and implement goals, and evaluate success. This case study describes the qualitative and quantitative findings of an intentional reflection assignment prompting students to engage in a cycle of goal writing - monitoring - reflection - new goal writing, during an immersive clinical practice experience. A blinded review of 144 student assignments is presented in the context of a curricular review of the Reflective Practitioner Program (RPP), a longitudinal reflective thread spanning four years of professional pharmacy training. Evidence gathered in the assignment review indicates that students are sufficiently capable of establishing meaningful goals and describing why the goal is important to their professional development. In contrast, students struggle with articulating strategies for goal achievement and emotions experienced during goal monitoring. In consideration of these findings, RPP faculty identified three major themes when discussing key aspects of the RPP curricular design: 1) students need to articulate strategies for goal achievement in addition to stated aims, 2) students hesitate to identify emotions when reflecting, and 3) reflection needs to be both retrospective and prospective in nature. This case study has resulted in meaningful changes to RPP curricular design and illustrates how programs may approach assessment of the Affective Domain via common curricular elements.

Curriculum renewal: Alignment of introductory pharmacy practice experiences with didactic course content.

BACKGROUND AND PURPOSE: The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) used the opportunity of curriculum renewal to integrate knowledge and skills learned from didactic courses into the introductory pharmacy practice experiences (IPPEs) occurring simultaneously. This paper describes and evaluates the meaningful application of course content into IPPEs, and evaluates the success using qualitative feedback. EDUCATIONAL ACTIVITY AND SETTING: Students entering the renewed curriculum starting in fall 2012 were provided a list of pharmacy skills and activities from didactic course directors that reinforced course content for that semester. The skills and activities were to be completed during the students' IPPE visits in the community or health systems settings, depending on the program year and semester. FINDINGS: Students successfully completed course assignments during their IPPE course program. Not all activities could be completed as designed, and many required modification, including simulated experiences. Feedback from faculty and preceptor members of the school's experiential education committee demonstrated that these activities were valuable and improved learning of course material, but were challenging to implement. DISCUSSION AND SUMMARY: A renewed curriculum that mapped course assignments for completion in experiential settings was successfully established, after some modifications. The program was modified at regular intervals to improve the ability of preceptors to complete these activities in their individual practice environment. A balance between the school providing guidance on what activities students should perform and allowing unstructured independent learning with the preceptor is needed for an optimal experience.

Pharmacy student perspectives regarding curricular renewal with experiential alignment.

BACKGROUND AND PURPOSE: To evaluate pharmacy students' ability to perform and perspectives regarding a purposeful mapping of curricular content into experiential settings for application. EDUCATIONAL ACTIVITY AND SETTING: Students were given a list of activities developed by their curricular course directors that were to be completed during their introductory pharmacy practice experiences (IPPEs). Students were tasked with completing each assignment at their community or health system pharmacy site, and verify completion with their preceptor. Students were surveyed regarding their completion of these activities, who the tasks were performed on, and the value students perceived from the exercises. FINDINGS: Students ranked that the curricular mapping to experiential courses were successful. Average student responses reflected that the activities had value and positively impacted their learning. Many students struggled to find specific patient examples to complete the activities the way the course designed them. Changes to the structure of these activities was necessary for student success. DISCUSSION AND SUMMARY: Students felt that the curricular mapping of assignments into IPPEs was meaningful and improved their learning. Not all students were able to complete assignments as described.

Design and activity evaluation of an Advanced-Introductory Pharmacy Practice Experience (aIPPE) course for assessment of student APPE-readiness.

BACKGROUND AND PURPOSE: The newly implemented Advanced-Introductory Pharmacy Practice Experience (aIPPE) course at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences was designed to assess student readiness for Advanced Pharmacy Practice Experience (APPE) and provide formative feedback regarding skills and abilities needed to be successful during subsequent coursework and practice experiences. EDUCATIONAL ACTIVITY AND SETTING: The aIPPE is a full-time, six week (240hours) direct patient care rotation occurring in the spring semester of the third-professional year following a longitudinal integrated IPPE program. Required aIPPE course elements mimic the activities and expectations students should anticipate encountering during APPE training. FINDINGS: All students participating in the initial aIPPE course offering were described as APPE-Ready. Students and preceptors described the aIPPE course as successful in achieving the primary outcome of preparing students for improved downstream performance. SUMMARY: The aIPPE provided students opportunities to demonstrate readiness to enter advanced pharmacy practice experience.

Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience.

Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students' self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services.

Discovering eHealth Technology: An Innovative Interprofessional Graduate Student Learning Experience.

The use of eHealth has grown in recent years and is projected to continue to increase exponentially. In order to empower and prepare advanced practice providers to integrate eHealth into their clinical practice, curricular changes need to occur. The iTEAM grant provides a unique opportunity to prepare advanced practice disciplines to provide collaborative care using eHealth. Through the integration of a simulated telehealth using a standardized patient, Doctor of Pharmacy and Advanced Practice Registered Nursing students learned how to apply health information technology and coordinate care in an interprofessional manner. Opportunities and challenges to guide future efforts to integrate eHealth-learning experiences into the curriculum are identified.

Preparing the Next Generation of Advanced Practice Nurses for Connected Care.

The health care delivery system in the United States is transforming at a rapid pace. Several trends, including the emergence of a Connected Health care system, will require advanced nurse practitioners to have new knowledge, skills and competencies to practice in the future. This paper describes the redesign of coursework and the development of a Connected Care Framework to guide the learning needs of nurse practitioners. A Connected Care Quotient consisting of ten relevant questions and learning activities will serve as a guide for the future development of competencies for advanced practice nurses.

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.