Predictors of student preparedness for advanced pharmacy practice experiences.

BACKGROUND: A capstone course often serves as the final checkpoint of student readiness before the commencement of experiential training. The purpose of this study was to determine if the assessment components from the capstone course can serve as predictors of student performance during their Advanced Pharmacy Practice Experiences (APPEs). METHODS: Student data was analyzed to observe the correlation between performance in the Pharmacy Curriculum Outcomes Assessment (PCOA), student performance in the capstone course, and the overall grade point average (GPA) earned during APPEs. Spearman rank correlation analysis, multiple linear regression, and Mann-Whitney U test were used for statistical analysis. RESULTS: A statistically significant positive correlation was observed between the overall APPE GPA and students' capstone course grade, top drug competency exam score, pharmacy calculation competency exam score, and PCOA exam score. A significant regression equation was obtained during the analysis: (F(5, 97) = 5.62, p < 0.001), with an R2 = 0.225 (adjusted R2 = 0.185). In the linear regression model, capstone GPA emerged as a significant predictor (ß = 0.155; p = 0.019) of APPE GPA amongst the tested variables. Additionally, students scoring < 73% on the top drug competency exam in the capstone course or less than the reference group in the PCOA exam were found to have significantly lower GPA during their APPEs compared to other students. CONCLUSION: Performance on the top drug competency exam and the PCOA exam can serve as potential predictors of success during APPEs.

Exploring practice site contributions and professionalization impact of engaging student pharmacists on hematology-oncology advanced pharmacy practice experience rotations.

INTRODUCTION: Student pharmacists contribute meaningfully to patient care during Advanced Practice Pharmacy Experiences (APPEs) in varied settings. We aimed to characterize and evaluate the impact of student participation in hematology-oncology (hem-onc) APPEs on the practice site, and on student professionalization. METHODS: For students completing hem-onc APPEs during 2016-2019, rotation activities and post-APPE self-reflections describing meaningful impact were reviewed; activities were categorized into direct and indirect patient care, and up to three reflection themes of professionalization impact were extracted from each self-reflection. Hem-onc preceptor cohort was surveyed to assess impact of student contributions on the practice site. RESULTS: 171 students completed hem-onc APPEs in ambulatory care (133) and/or inpatient (38) settings. Of 932 student-reported activities, the most common were: evaluating patient pharmacotherapy (209), providing education to medical staff (132), patient counseling [non-chemotherapy (99); chemotherapy (82)], and providing drug information (96); 89% involved direct patient care/education. Survey results from 16 of 33 preceptors identified the most impactful student activities as evaluating pharmacotherapy, medication education/adherence resources, and in-service presentations. Of 392 student self-reflections, themes of impact focused on professionalization/self-awareness (39.3%), counseling/communication skills (27.8%), practice skills development (20.4%) and collaborative teamwork (12.5%). CONCLUSION: Pharmacy students make significant direct patient care contributions to hem-onc practice settings by evaluating pharmacotherapy and providing education to patients and healthcare personnel. Participation in hem-onc APPEs is highly influential to the professionalization of students, particularly in developing skills in oncology practice, patient interactions/communications, and developing self-awareness.

Survey of Emergency Medicine Pharmacy Education Opportunities for Students and Residents.

BACKGROUND: Pharmacy services in the emergency department (ED) have been shown to decrease medication adverse events and improve patient outcomes. Anecdotally, there has been expansion of emergency medicine (EM) educational opportunities for pharmacy students and postgraduate year 1 (PGY1) pharmacy residents, however the extent of this expansion is currently unknown. OBJECTIVE: The objective of this survey study is to determine the prevalence and nature of EM pharmacy training available to pharmacy students and residents. METHODS: Electronic surveys were distributed to chairs of departments of pharmacy practice and experiential education representatives at Accreditation Council for Pharmacy Education-accredited colleges or schools of pharmacy as well as residency program directors at American Society of Health-System Pharmacists-accredited postgraduate year 1 (PGY1) programs. Questions were asked related to demographics, EM introductory or advanced pharmacy practice experiences (IPPE or APPE), and PGY1 and non-EM postgraduate year 2 (PGY2) rotations. Five reminder e-mails and weekly and grand prize drawings were offered. Data that were gathered are presented utilizing descriptive statistics. RESULTS: Overall, 57/110 (52%) colleges or schools of pharmacy representatives and 286/831 (34%) residency program representatives completed the survey. Colleges or schools of pharmacy reported EM IPPEs and APPEs at 12/57 (21.1%) and 44/53 (83%), respectively. EM pharmacy rotations were available for PGY1 and non-EM PGY2 residents at 212/286 (74.1%) and 83/157 (52.9%) of institutions, respectively. CONCLUSIONS: Survey results represent the prevalence and characteristics of EM-related education opportunities for pharmacy students and residents.

The Divergence between Self- and Preceptor-Assessments of Student Performance during Advanced Pharmacy Practice Experiences.

(1) Objectives: A divergence in self- and preceptor-evaluations of clinical skills has been noted during Advanced Pharmacy Practice Experiences (APPEs). The goal of this study was to determine the domains of overestimation of clinical skills by students during their APPE rotations. (2) Methods: Preceptor-assigned grades for APPE rotations from 2017-2022 were analyzed to identify instances of letter grade B or lower. The self- and preceptor-evaluations of APPE rotation were compared to determine the domains of divergence in evaluation between students and preceptors. (3) Results: Between 2017 and 2022, 305 student APPE rotations were graded as B or lower (~14%) by the preceptors. A statistically significant difference was noted between self- and preceptor-assigned letter grades across all practice settings including ambulatory patient care, community pharmacy, general medicine patient care, hospital/health system pharmacy, and special population patient care APPE rotations. In addition, examining the self- and preceptor evaluation rubric for these rotations revealed a statistically significant overestimation of clinical skills by students in all 9 domains of APPE evaluation. Finally, the divergence in the rating of clinical skills between student- and preceptor evaluation was found to be highest in the domains of planning and follow-up of patient care, disease knowledge, and communication with patients. (4) Conclusions: Students who fail to exhibit exemplary practice readiness during APPEs tend to overestimate their clinical skills in all domains of APPE evaluation. The results from our study support the need for additional avenues to assist in the identification of deficits in student learning before APPEs to increase their self-awareness (metacognition).

A scoping review of advanced pharmacy practice experience readiness assessment measures across schools of pharmacy.

BACKGROUND: The development and implementation of Advanced Pharmacy Practice Experience (APPE) readiness assessments has been an area of increased interest to the academy since the publication of the Accreditation Council for Pharmacy Education (ACPE) standards in 2016. This scoping literature review aims to provide an updated summary of current APPE readiness assessment practices among ACPE-accredited institutions in the United States (US). METHODS: A literature search was conducted between 2022 and 2024 using the terms "APPE student readiness," "APPE readiness assessment," "APPE preparedness," "APPE student preparedness," "pharmacy" AND "readiness assessment", "pharmacy" AND "practice readiness," and "pharmacy" AND "student practice readiness" in Pubmed and Embase. The websites for the American Journal of Pharmaceutical Education and Currents in Pharmacy Teaching and Learning were also searched using these terms. Abstracts for all results were reviewed. Abstract only and poster presentations were excluded, as well as articles centered on non-US and/or non-ACPE-accredited institutions. Data was collected regarding the outcomes assessed, type of assessment activity, and how the assessment was implemented. Results were reviewed by a second author to ensure consistency in reporting. RESULTS: A total of 289 unique abstracts were reviewed by author pairs for inclusion based on relevance to the review objectives. A total of 13 articles were included in the final analysis. Each institution measured different knowledge areas, abilities, and entrustable professional activities (EPAs). Most programs had a summative component, with APPE readiness being primarily assessed in the final didactic year of the pharmacy curriculum. Most programs report at least one source of validity. IMPLICATIONS: Given the lack of specific APPE readiness assessment requirements in the ACPE Standards 2016, the different assessment methods among programs were not surprising. However, the commonalities identified can be leveraged with the release of the Curricular Outcomes and Entrustable Professional Activities (COEPA) 2022 to promote a standardized definition of APPE readiness. Future research should focus on formative assessment methods embedded throughout the didactic curriculum to identify "at-risk" students prior to a "high-stakes" summative assessment at the end of the didactic curriculum that impedes student progression to the APPE year.

Process and outcomes from systemization of a longitudinal advanced pharmacy practice experience (LAPPE) program.

PURPOSE: Longitudinal models for completing advanced pharmacy practice experiences were implemented to enhance experiential training efficiency through extracurricular experiences and to offer high-quality learning continuously. Through multihospital expansion of an established single-site longitudinal advanced pharmacy practice experience (LAPPE) program, the expanded collaborative opportunities support the development of new concepts that enhance integrated learning. METHODS: An observational study was designed to describe the approach for constructing a LAPPE program integrated across a multihospital system, to assess the professional skills gained by the program graduates, and to evaluate program impact on graduates' professional career. A questionnaire was developed for current students to assess the program's impact across 5 domains. Value-added benefits for the health system and challenges to implementation of a systemized program were reviewed as guidance for institutions interested in implementing such a model. RESULTS: Expansion of a single-site LAPPE program across a multihospital health system requires significant coordination from leadership, especially during the recruitment and interview process. Additionally, integration of preceptors across sites bolsters student experiences for various professional activities offered in a LAPPE program. This program's questionnaire results pointed toward an increase in students' knowledge and skills in preparation for postgraduate training. For students entering the ASHP Resident Matching Program, there was a 100% residency match rate before and after program systemization. CONCLUSION: The expansion of a LAPPE program across a multihospital system offers intangible benefits to an institution, expands self-reported competencies, and establishes a foundation for postgraduate success. This model may be utilized at institutions with similar interest to implement, expand, or systemize a LAPPE program.

A Systematic Review of APPE Readiness Assessments Utilized by US Schools of Pharmacy.

OBJECTIVE: The 2016 Accreditation Council for Pharmacy Education standard 25.8 requires schools of pharmacy to assess student readiness for Advanced Pharmacy Practice Experiences (APPEs). We performed a systematic review to identify how schools of pharmacy in the United States assess student readiness for APPE rotations in accordance with Accreditation Council for Pharmacy Education accreditation guidelines. FINDINGS: From a search of 6 databases, we identified 1053 unique studies, of which 11 were eligible for inclusion in our review. The most commonly reported assessment method was the use of a capstone course; however, these courses varied significantly from school to school in duration, resources used, and content. Regardless of the specific approach used, first-time and overall pass rates were high. SUMMARY: We found that while most studies reported using some type of capstone course for APPE readiness assessment, there was variability in how these courses were structured and the assessment methods used within the courses. The future 2025 standards may dictate a more uniform structure for readiness assessments; however, further research is needed to identify best practices regarding the assessment of APPE readiness.

Assessing Cognitive Apprenticeship Impact on Clinical Reasoning in Third-Year Student Pharmacists.

OBJECTIVE: The objective of this study was to evaluate the impact of implementing a cognitive apprenticeship theory (CAT) model into a Doctor of Pharmacy course in improving clinical reasoning skills of third-year student pharmacists over time and preparing them for Advanced Pharmacy Practice Experiences (APPEs). METHODS: This was a single center, nonrandomized, observational before-and-after study from January 2022 through May 2022. Third-year student pharmacists enrolled in the Critical Care Integrated Drugs and Disease pharmacotherapy course at the University of Kentucky College of Pharmacy were administered a well-established and nationally recognized clinical patient case assessment on weeks 1 and 15 of the course. Students were asked to prioritize patient problems and provide recommendations for therapy, goals, and monitoring. Responses were then scored using a predefined case key. In addition, student pharmacists were asked to self-evaluate their confidence in APPE readiness on a 5-point Likert scale. RESULTS: Of the 136 student pharmacists enrolled in the course, 92 (68%) student pharmacists completed both week 1 and week 15 clinical cases and self-assessment surveys, provided informed consent, and were included. Cumulative clinical case scores were significantly increased from week 1 to week 15 (34.8 vs 39.7). In addition, significant improvement was seen in overall problem prioritization, overall recommendations, and self-perceived preparedness for APPE rotations. CONCLUSION: The use of a CAT model into a 15-week pharmacotherapy course improved comprehensive scores of clinical reasoning assessment in third-year student pharmacists and was associated with increased self-perceived confidence and readiness for APPEs.

Pharmacy students' interprofessional experience and performance in advanced pharmacy practice experience rotations amid COVID-19 pandemic.

Introduction: Interprofessional education (IPE) is essential in pharmacy training, providing students with vital collaborative skills for real-world healthcare. Advanced Pharmacy Practice Experience (APPE) is integral to IPE, allowing students to apply their knowledge in diverse healthcare settings. The COVID-19 pandemic has disrupted healthcare education and raised concerns about its impact on IPE during APPE rotations. Our study investigates the pandemic's influence on pharmacy students' interprofessional interactions and APPE performance. Objective: To assess the interprofessional experiences of fourth-year pharmacy students before and during the COVID-19 pandemic in the context of APPE. Methods: This retrospective observational study examined the experiences of P4 pharmacy students in the United States during APPEs before and during the pandemic. We employed electronic surveys with 21 questions to gauge interactions and interprofessional team effectiveness, employing Likert scale response options. We compared responses between the 2019-2020 and 2020-2021 APPE rotations using statistical tests. Results: Our study encompassed 83 and 86 students for the 2019-2020 and 2020-2021 APPE rotations, respectively, achieving a 100% response rate. Amid the pandemic, written communications between pharmacy students and healthcare providers in general medicine rotations increased, while in-person engagement decreased. Pre-COVID, students reported higher colleague referrals and greater interprofessional utilization during ambulatory care rotations. Conclusion: COVID-19 shifted interactions from in-person to written communication between pharmacy students and healthcare providers. Students reported decreased satisfaction with their interprofessional experiences. This research offers insights into the changing landscape of pharmacy education, helping students prepare for evolving challenges in healthcare delivery and education.

Correlating Advanced Pharmacy Practice Experience Exam Scores and Pharmacist Licensure Status in a Single Program.

OBJECTIVE: Pharmacist licensure exam first-time pass rates have declined for several years. Predictors of licensure exam performance, including the Pharmacy College Admission Test, are no longer required, necessitating alternative strategies. Our aim is to assess the relationship between numerical scores on advanced pharmacy practice experience (APPE) exams and pharmacist licensure exams first-time pass rates. METHODS: We conducted a single-center, retrospective, observational analysis. APPE examination results between May 2020 and November 2023 were analyzed for association with licensure information from the Texas State Board of Pharmacy. Exam scores were collected for student cohorts graduating from 2021 to 2022 as study cohort data. Correlation between exam scores and probability of successful licensure was assessed using logistic regression. A classification and regression tree analysis identified the most significant threshold. Predictive ability of the best-fit model was prospectively validated using the 2023 graduate cohort. RESULTS: The overall licensure success rate was 80.6% for the study cohort (2021-2022, n = 206). Exam scores were well correlated to the likelihood of licensing success. The most significant threshold was 77.8%. The success rate was 82.5% vs 16.7% for those scoring above and below the threshold, respectively. The observed and predicted licensure success rates were 91.0% and 88.8%, respectively, in the validation cohort (2023, n = 89). The positive and negative prediction values were 94.9% and 40.0%, respectively. CONCLUSION: The performances on APPE exams were reasonable in predicting the first-time licensure success rate for a graduating class. Our assessment appears promising as a risk-stratification tool for students in gaining successful pharmacist licensure.

Navigating power dynamics between pharmacy preceptors and learners.

Pharmacy preceptors are crucial in pharmacy experiential education. They help develop learners during didactic learning, experiential learning, and post-graduate training. Preceptors hold a position of authority over learners as they are responsible for providing feedback and ultimately completing evaluations that determine whether the student passes or does not pass the rotation. Preceptor status, behavior, and communication style may cause students to feel intimidated. Preceptors should be aware of this power differential and keep generational, gender, cultural, and other factors in mind when providing feedback. Preceptors should also receive training and be open to constructive feedback from learners to ensure the experience meets the needs of the learner and allow for adjustments on the experiential rotation. Students should be empowered to provide open and honest feedback to preceptors in a psychologically safe environment without fear of repercussions.

Students empowering pharmacist provided contraception services: An APPE student perspective on service development.

PURPOSE: This reflection aims to highlight the ambulatory care setting and its impact on pharmacy student experiential education through student involvement in developing a contraception pharmacy service. Although pharmacist-prescribed contraception has been permitted through collaborative practice agreements (CPA) for some time, the recent enactment of Indiana House Bill 1568 has sparked interest amongst students in promoting this service and enhancing accessibility.1. DESCRIPTION: This manuscript invites readers into the dynamic experience of two Advanced Pharmacy Practice Experience (APPE) students engaged in developing and implementing a pharmacist-prescribed contraception service within an ambulatory care clinic. They address the creation, implementation, and feedback of students participating in developing this service throughout their four-week rotation. ANALYSIS/INTERPRETATION: Their experience contributes valuable insights into the evolving field of ambulatory care and its educational potential for student pharmacists. CONCLUSIONS AND IMPLICATIONS: This reflection is a testament that such initiatives have valuable benefits not only for students but also for health systems, clinics, and the broader community. In the future, the authors hope to see more students collaborating with experienced preceptors to design ambulatory practice protocols and services across various fields of expertise.

You'll have to call the attending: Impact of a longitudinal, "real-time" case-based infectious diseases elective on entrustable professional activities to enhance APPE readiness.

BACKGROUND AND PURPOSE: Transitioning from the didactic to experiential setting is challenging for student pharmacists, perhaps due to lack of experiences providing "real-time" clinician interaction. We describe findings from a semester-long infectious diseases (ID) didactic elective that utilized a national cohort of preceptors and faculty across the United States to mimic clinician interaction and "real-time" ID management of various disease states. The mechanics of this elective provide a framework for others to implement to enhance advanced pharmacy practice experience (APPE) readiness. EDUCATION ACTIVITY AND SETTING: Students enrolled in an ID elective course at a school of pharmacy participated in "real-time" acute care scenarios. They assisted in multidisciplinary management of a patient's infection, mimicking "rounds" on an APPE, via interaction with external pharmacist volunteers (playing the roles of other healthcare personnel). Additionally, students formally presented and discussed their cases within the class, further promoting learning while optimizing presentation skills. Pharmacist volunteers were surveyed to assess student performances as measured by four entrustable professional activities (EPAs). FINDINGS: A total of 48 volunteer opportunities occurred during two course offerings. Results from 43 surveys were analyzed (90% response rate). Of those responses, 22/24 (92%) played the role of attending physician, and 19/24 (79%) played the role of technician. Volunteers agreed that students met the four EPAs evaluated (agreement was 85-100%). SUMMARY: This semester-long elective provided "real-time" experience and feedback for pre-APPE students to enhance APPE readiness and reinforce EPAs. Students are likely to benefit from mimicked intra-professional interaction and augmented critical thinking skills that could be adapted to various disease states within pharmacy curricula.

APPE unreadiness - The other side of the coin.

INTRODUCTION: Student readiness for Advanced Pharmacy Practice Experiences (APPEs) has not been explicitly defined in literature or standards. Readiness for APPEs is a programmatic requirement of all schools and colleges of pharmacy (schools), leaving schools to determine their own assessments of APPE readiness. Current literature provides no consensus on the definition of APPE readiness nor the assessments or benchmarks used to evaluate APPE readiness. Schools have an opportunity to improve efforts to identify students at risk for poor APPE performance and provide early intervention. COMMENTARY: Due to a lack of consensus, it may be easier to describe students who are not ready for APPEs than it is to describe students who are APPE ready. APPE unreadiness is defined by the authors as those who require significant preceptor instruction on foundational competencies such as knowledge, skills, and/or attitudes and therefore are unable to meaningfully engage in application-based patient care activities. By adding focus to APPE unreadiness within APPE readiness programs, pharmacy schools may be able to more readily identify and remediate students who are at risk of failing one or more APPE rotations. IMPLICATIONS: We provide four recommendations for schools to consider. These are focused on assessing APPE readiness to qualify and quantify APPE unready students. By assessing APPE unreadiness, schools can make continuous quality improvement to ensure that preceptors, sites, students, and faculty can have the ongoing confidence that APPE students are all ready to meaningfully engage on rotation.

Preceptor Feedback on Utilization and Pre-APPE Performance Expectations of Pharmacy Practice Skills.

OBJECTIVE: This study aimed to determine the frequency with which preceptors perform skills in their practice setting and the degree of competency that preceptors expect from students to perform those skills upon starting their advanced pharmacy practice experiences (APPEs). METHODS: A survey assessing skill utilization and expected pre-APPE student competency level upon entry to APPEs was developed by pharmacy practice faculty and distributed to preceptors. Preceptors were asked to rank their utilization of skills and expected pre-APPE student competency of each skill. Investigators assigned each skill a categorical ranking of high, moderate, or low priority. RESULTS: The survey was completed by 448 pharmacy preceptors. Skills related to communication, patient education, documentation, collecting medication histories, and drug therapy review/reconciliation were the most utilized. Skills related to physical assessment and point-of-care testing were the least utilized, and the expected student competency level was also low. Skills identified as highest-priority included those related to patient counseling/education, problem-solving/critical thinking, and information gathering and management. CONCLUSION: The results of this survey suggest that the frequency with which preceptors perform specific skills in practice and their corresponding competency expectations for APPE students vary and are skill-dependent, allowing for prioritization. Stratifying individual skills according to how commonly they are encountered in practice and the competency levels expected by APPE preceptors can assist institutions in prioritizing skills-based laboratory content and assessment and in addressing curricular bloat and hoarding.

Preceptors' perceptions of an entrustable professional activities-based community introductory pharmacy practice experience curriculum.

INTRODUCTION: In 2021, the Southeastern Pharmacy Experiential Education Consortium implemented Entrustable Professional Activities (EPAs) into the community introductory pharmacy practice experience (IPPE) curriculum at five colleges/schools of pharmacy. The objective of this study was to evaluate community IPPE preceptors' perceptions regarding the newly implemented EPA-based community IPPE curriculum and corresponding preceptor training. METHODS: Community IPPE preceptors who precepted first-year student pharmacists in the EPA-based curriculum during the 2021 and 2022 community IPPE cycles were invited to complete a voluntary electronic survey. The survey collected preceptor feedback regarding the required EPA tasks, assessment tool, and preceptor development module. RESULTS: Eighty-eight preceptors began the survey, and approximately half completed the entire survey. Greater than 92% of preceptors surveyed agreed or strongly agreed EPA domain tasks were developed at an appropriate level for a student to complete by the end of the community IPPE, and ≥ 94% agreed or strongly agreed tasks prepared a community IPPE student for the community advanced pharmacy practice experience (APPE). Overall, most preceptors agreed or strongly agreed that the assessment tool was easy to navigate and effective at evaluating students' performance. All preceptors who viewed the recorded preceptor development module found it helpful to their understanding of the new assessment tool. CONCLUSIONS: Preceptors' feedback supports the use of an EPA-based community IPPE curriculum to assess student performance and prepare students for community APPEs. Preceptor involvement is valuable in the evaluation of a revised experiential curricula to assure IPPE expectations are appropriate and align with contemporary pharmacy practice.

Frequency of essential elements in required advanced pharmacy practice experiences (FEER - APPE).

INTRODUCTION: This study evaluated student reported achievement of essential elements (EE) across three required advanced pharmacy practice experiences (APPEs) to identify differences in the frequency of each EE during different delivery modalities. METHODS: APPE students from three different programs were assigned a self-assessment EE inventory after required acute care, ambulatory care, and community pharmacy APPEs between May 2018 and December 2020. Using a four-point frequency scale, students reported exposure to and completion of each EE. Pooled data were analyzed to compare differences in frequencies of EE during standard and disrupted delivery. All standard delivery APPEs were in-person, but during the study period APPEs shifted to a disrupted delivery using hybrid and remote formats. Frequency changes were reported as combined data and compared between programs. RESULTS: A total of 2191 of 2259 (97%) evaluations were completed. Acute care APPEs had a statistically significant change in frequency of evidence-based medicine elements. Ambulatory care APPEs had a statistically significant decrease in the frequency of reported pharmacist patient care elements. Community pharmacy had a statistically significant decrease in frequency in each category of EE except practice management. Statistically significant differences between programs were observed for select EEs. CONCLUSIONS: The frequency of EE completion during disrupted APPEs revealed minimal change. Acute care was the least impacted whereas community APPEs experienced the greatest change. This may be attributable to shifts in direct patient interactions during the disruption. Ambulatory care was impacted to a lesser degree, potentially due to utilization of telehealth communications.

Optimizing optimization: A six-year quality improvement project focused on students' APPE preferences.

PROBLEM DESCRIPTION: The advanced pharmacy practice experience (APPE) component of the entry-level doctor of pharmacy degree program is essential in contributing to student pharmacists' education. Establishing an optimization process to assist students in matching to their highest preferred clinical sites is extremely important. QUALITY IMPROVEMENT METHODS: The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences uses a fourth year APPE match process designed to yield the best possible matches for the entire class while being perceived as fair and relatively easy to navigate. This article describes the evolution of this process. RESULTS OF CQI INQUIRY: Across six years of data, satisfaction with the match process has been rated consistently high by students. Fairness with the process is also rated highly. Changes to the process have resulted in students receiving higher ranked preferences in more recent years. This was achieved while still following institution requirements for rural rotations and pre-matching. INTERPRETATION AND DISCUSSION: The APPE year yields a tremendous amount of learning for students as a culminating experience applying skills and knowledge to actual patients. Improving students' ability to customize their own schedule allows them to optimize these learning opportunities. CONCLUSIONS: A robust match process has been established and refined to meet the needs of the student pharmacists as they approach their fourth year of the curriculum. This process has been perceived as fair and relatively easy to navigate. Achievement of higher overall student rankings has been accomplished.

Validation of Longitudinal Progression Examinations for Prediction of APPE Readiness.

OBJECTIVE: To study curricular outcomes for the purpose of holistic improvement of the curriculum. METHODS: A single-institution retrospective cohort study evaluated 3 cohorts of Doctor of Pharmacy students entering the program through performance in Advanced Pharmacy Practice Experience (APPE) rotations. Assessment scores and pass/fail outcomes were collected from the 3 examinations to use as predictors, and the numbers of "needs improvement" (NI) and "unsatisfactory" (U) ratings from preceptors during the APPE rotations served as outcome measures. RESULTS: Pharmacy mathematics competency and Milemarker 1 (MM1) examination first-time scores, but not those from Milemarker 2 (MM2), were significantly associated with NI or U scores on required APPE rotations. Significant correlations for all examinations (pharmacy mathematics competency, MM1, and MM2) were found for the Acute Care/Inpatient APPE rotation for each cohort and the combined cohorts. Significant correlations were also found between all examinations and the APPE rotation courses Advanced Hospital and Ambulatory Care, with the exception of the 2021 cohort. Performance in the Advanced Community rotation was not associated with any of the examinations. MM1 and MM2 are both reliable measures of competence in our didactic curriculum and predictive of scoring an NI or U rating in the APPE Acute Care/Inpatient rotation. CONCLUSION: The longitudinal milestone examinations used in our institution provide a mechanism to identify students likely to struggle in required APPE rotations and target them for remediation activities.

Determining preceptor perceptions of APPE readiness through the use of entrustable professional activities.

INTRODUCTION: Pharmacy programs are required to demonstrate that students are advanced pharmacy practice experience (APPE) ready, but neither a professionally recognized definition of nor a consistent approach to assess APPE readiness exists. METHODS: APPE preceptors were surveyed about the relationship of EPAs to APPE readiness in three domains, including: (1) each EPA's relative importance, (2) indicators that a student is not ready to begin APPEs, and (3) each EPA's expected level of entrustment on the first day of the first APPE. We determined consensus of EPA importance and expected level of entrustment by adapting previously published thresholds. We analyzed the association between preceptor or practice setting characteristics with ranking of EPA importance. RESULTS: Of the 431 preceptors queried, 31% responded. Ten EPAs, primarily those reflecting the first three steps of the Pharmacists' Patient Care Process (PPCP), were identified as important with strong consensus. Ambulatory care preceptors placed higher importance on EPAs, primarily in the final steps of the PPCP and within the public health domain. Professionalism issues were most often cited as reasons for a lack of APPE readiness. There was considerable variability (weak or moderate consensus) in preceptors' expected level of entrustment per EPA. CONCLUSIONS: Pharmacy programs can consider prioritizing EPAs in the domains of patient care and information master when developing APPE readiness plans; professionalism should also be emphasized. Further work is needed to better understand what level of entrustment preceptors expect of an APPE ready student.