The Intersection of Growth Mindset and Accreditation in Pharmacy Education.

OBJECTIVES: To describe existing growth mindset literature within pharmacy and health care education, describe how a growth mindset can be beneficial in the accreditation process, and propose potential ways to promote a growth mindset in faculty, preceptors, students, and staff within pharmacy education. FINDINGS: To help pharmacy learners develop a growth mindset, existing literature emphasizes the need for a shift toward and aligning assessment with a growth mindset, helping to create self-directed adaptive learners, leading to health care providers who can adjust their practice to tackle expected and unexpected challenges throughout their careers. Strategies to create a culture of growth mindset identified include training faculty and learners on growth mindset and developing new assessments that track a learner's growth. Recommendations for pharmacy educators include encouraging educators to assess their own growth mindset and use a variety of teaching methods and provide feedback on learner effort that encourages the process of learning rather than focusing on individual attributes, traits, and results. SUMMARY: Growth mindset intersects with accreditation standards for both professional degree programs and providers of continuing pharmacy education. Continuing professional development process is one way to encourage faculty, staff, and students to develop a growth mindset. While a growth mindset can have many positive impacts on pharmacy accreditation, it is essential to recognize that achieving and maintaining accreditation is a multifaceted process involving numerous factors. A growth mindset can positively influence pharmacy education accreditation by fostering a culture of continuous improvement, innovation, resilience, student-centeredness, data-driven decision-making, collaboration, and effective leadership.

Preceptor Development: Using the American Nurses Credentialing Center Outcome-Based Continuing Education Model©.

Preceptors play a vital role in shaping the growth of every nurse. Effective preceptors lead to better patient outcomes as new nurses are better equipped to deliver high-quality care under the guidance of experienced mentors. Providing a supportive preceptor experience increases job satisfaction and retention rates among new and tenured nurses, ultimately benefiting health care organizations. When designing preceptor development programs, health care institutions should incorporate the Outcome-Based Continuing Education Model© (OB-CE Model©) from the American Nurses Credentialing Center. This column explores how to use the OB-CE Model© to enhance the competency and human skills of preceptors as learners, thereby fostering their development effectively. [J Contin Educ Nurs. 2024;55(5):212-216.].

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.

A longitudinal exploration of perceptions of pharmacy practice preparedness among graduating pharmacy students and preceptors.

Graduating student pharmacists who are practice-ready is an essential responsibility of pharmacy programs and heavily emphasized by Accreditation Council of Pharmacy Education (ACPE), pharmacy education's accrediting body. Although several studies have examined students' readiness to engage in advanced pharmacy practice experiences (APPE), few studies examine graduating students' readiness to practice. The objective of this study was to examine national trends in graduating pharmacy students' and preceptors' perceptions of students' pharmacy practice preparedness across a six-year time frame (2016-2021) and trends in graduating students' overall impressions of their program and the pharmacy profession across the same time period. A longitudinal descriptive study to examine trends in graduating student and preceptor perception was conducted utilizing data from the 2016-2021 American Association of Colleges of Pharmacy (AACP) Graduating Student Surveys (GSS) (n = 65,461) and Preceptor Surveys (PS) (n = 41,951). Over six years of survey data analyzed, a large percentage of students at both public and private institutions reported they felt prepared for practice (96.5% vs 95.5% respectively, p < 0.001). There was overall agreement (>90%) among preceptors that graduating students were prepared to enter pharmacy practice based on responses, although preceptors had lower levels of agreement compared to students on most statements. Based on the findings, both graduating pharmacy students and preceptors feel that graduates are prepared to practice pharmacy, with consistent trends in perceptions over the last six years. However, results also indicate that a consistent downward trend in students' willingness to pursue pharmacy again, indicating decreased optimism of graduating students for the profession.

Empowering early career pharmacists: Unleashing non-clinical competencies through pharmacy residency.

INTRODUCTION: Pharmacy residency programs traditionally prioritize clinical skills development. However, non-clinical competencies, such as leadership, conducting education, and innovation, are now emerging as pivotal factors in propelling pharmacists toward excellence in practice. The extent to which these non-clinical skills are effectively fostered by residency programs remains unclear. This study aims to explore how residency programs propel the development of crucial non-clinical competencies such as leadership, conducting education, and innovation. METHODS: Pharmacists who completed a pharmacy residency program and their preceptors from a tertiary teaching hospital took part in semi-structured interviews. Thematic analysis, employing an inductive approach and aided by NVivo software, was used to identify recurrent themes in the interview responses. RESULTS: Competency development was shaped by four key themes: system-dependent facilitators, system-dependent barriers, individual resident attitudes, and pharmacy department influences. The structure of the residency program was perceived to strongly support competency development in conducting education. The impact on the leadership and innovation competencies development was comparatively lesser. CONCLUSION: Pharmacy residency is perceived as effective in supporting non-clinical competency development when there is a clear structured framework with objectives and guidance for pre-defined activities and tasks known to support competency development. Ambiguity and a lack of standardized guidance in developing specific competencies were identified as factors that diminish their relevance for both residents and preceptors. To enhance residency programs, it is essential to establish clear frameworks, with pre-defined objectives and activities known to support competency development and supplement them with the necessary skills-building courses where appropriate.

Next steps for workplace-based assessments of entrustable professional activities.

BACKGROUND: Florida International University Herbert Wertheim College of Medicine (FIU-HWCOM) participated in the AAMC Core Entrustable Professional Activities (EPA) implementation pilot. Entrustment decision processes based on data from workplace-based assessments (WBAs) were piloted. Outcomes illustrated challenges including variability across EPAs with regards to learner level alignment and feasibility of data collection in the form of WBAs. In addition, students reported discomfort requesting WBA completion by preceptors and dissatisfaction with associated feedback. APPROACH: To guide future directions, we conducted a survey of third-year students to better understand their experience with and perceptions of WBAs used to evaluate EPAs at FIU-HWCOM. EVALUATION: Survey response was 96% (n = 107/112). Most (84%) reported that WBAs were not valuable to their development and that preceptors often did not complete WBAs in a timely fashion. Many (47%) reported not receiving verbal feedback. Most students (78%) used language in written responses demonstrating confusion between the EPAs and the WBAs used to assess them. IMPLICATIONS: The use of WBAs to assess EPAs did not have its intended impact at FIU-HWCOM. For future classes, WBA forms will consist of paper cards with questions directly assessing performance of skills aligned with EPAs 1, 5 and 6 only. To continue to promote feedback, students will be required to collect WBAs on all clerkships, but the number of required WBAs will be less than prior and no entrustment decisions will be made.

Entrustable Professional Activities: Can this Framework be Applied to Nurse Anesthesia Education to Assist in the Transition to Competency-Based Teaching?

Entrustable professional activities (EPAs) are the tasks or responsibilities which can be entrusted to a learner competent in that task to allow for unsupervised practice. The concept of EPAs is well documented in medical education literature, but only recently in nursing education. A paucity of literature exists on the application of an EPA framework specifically in nurse anesthesia. Based on the successful application of EPAs in competency-based medical and nursing education, we are of the opinion that this framework may also be utilized in the transition to competency-based education for nurse anesthesia learners. Many certified registered nurse anesthetists clinical preceptors lack training in competency-based education and teaching. The concept of EPAs may assist clinical preceptors in the translation of competencies and performance evaluation of learners. EPAs are defined for the nurse anesthesia clinical education setting. Examples of EPAs specific to nurse anesthesia include anesthesia machine checks, intubation, invasive line placement, regional anesthesia blocks, and preoperative assessment. Criteria of EPAs, barriers to use, and concrete examples are provided. Deliberate use of the EPA framework by clinical preceptors may lead to a more effective evaluation of the learner, thus resulting in purposeful progression to competence.

Does surgical observed structured clinical exam (OSCE) predict clerkship grade, shelf exam scores, and preceptor clinical evaluation?

BACKGROUND: Clinical evaluation of medical student performance has been criticized as variable and subjective. The aim of this study was to assess the correlation of a summative surgical OSCE exam to clinical faculty evaluations as well as surgery shelf exam score and final grades. METHODS: The performance of 392 students who completed the surgical clerkship between 2017 and 2019 was assessed via Pearson Coefficients comparing OSCE grades, clinical evaluations of Medical Knowledge and Patient Care, Communication and Professionalism, the National Board of Medical Examiners (NBME) shelf surgical subject exam, and final clerkship grade. RESULTS: Results demonstrate a statistically significant positive relationship between the OSCE, Shelf score and grade, final clerkship grade, and all clinical evaluations except Communication skills. The greatest correlation occurred between OSCE and shelf scores and grades. Although significant, the degree of correlation with clinical observation was significantly less. CONCLUSION: This study demonstrates that a surgical OSCE has a small positive correlation with clinical knowledge as measured by the NBME shelf exam. There is also an equal correlation with medical knowledge standards, with the OSCE better predicting NBME shelf outcome. This lower correlation to clinical assessment suggests that either the clinical grades contain elements not detected on an OSCE exam but could also support the hypothesis that variability in clinical grades do contain a significant degree of subjectivity.

Feedback in clinical settings: Nursing students' perceptions at the district hospital in the southern part of Namibia.

BACKGROUND: Feedback was the backbone of educational interventions in clinical settings. However, it was generally misunderstood and demanding to convey out effectively. Nursing students were not confident and did not feel free to practise clinical skills during practical placements because of the nature of the feedback they received whilst in these placements. Moreover, they experienced feedback as a barrier to completing practical workbooks. OBJECTIVE: The purpose of this article was to report on a qualitative study, which explored nursing students' perceptions of the feedback they received in clinical settings, at a district hospital. METHOD: This study was conducted at a district hospital located in southern Namibia. An explorative qualitative design with an interpretivist perspective was followed. A total of 11 nursing students from two training institutions were recruited by purposive sampling and were interviewed individually. All interviews were audio recorded with a digital voice recorder followed by verbatim transcriptions, with the participants' permission. Thereafter, data were analysed manually by qualitative content analysis. RESULTS: Themes that emerged as findings of this study are feedback is perceived as a teaching and learning process in clinical settings; participants perceived the different nature of feedback in clinical settings; participants perceived personal and interpersonal implications of feedback and there were strategies to improve feedback in clinical settings. CONCLUSION: Nursing students appreciated the feedback they received in clinical settings, despite the challenges related to group feedback and the emotional reactions it provoked. Nursing students should be prepared to be more receptive to the feedback conveyed in clinical settings.

Improving Nurse Preceptor Competence With Clinical Teaching on a Dedicated Education Unit.

BACKGROUND: Nurse preceptors have varying backgrounds of teaching experience and often cite insufficient preparation as a common reason for difficulties transitioning from the role of clinician to educator. This project evaluated an online education program for nurse preceptors of prelicensure students. METHOD: Nurse preceptors received online instruction and howto examples in the form of clinical teaching vignettes to improve the teaching component of their role. Pre- and postsurveys were used to help determine program effectiveness. RESULTS: After the training, nurse preceptors indicated they felt more competent when teaching students, and likewise, students reported increased satisfaction with the quality of teaching. CONCLUSION: There are numerous roles assumed by nurse preceptors. Although many nurse preceptors are expert clinicians, they may lack expertise in the teaching role. Preceptor preparation programs that provide practical examples through the use of vignettes can contribute to the development of teaching competencies. [J Contin Educ Nurs. 2021;52(5):226-231.].

Clinical Scholar Preparation: An Approach That Works.

The Colorado Center for Nursing Excellence established a formal didactic course in 2005 to deliberately prepare clinical faculty using expert clinical nurses. Independently, the National League for Nursing, in 2018, established criteria for certification for clinical nurse educators. The content of this course content closely mirrors those competencies and provides preparation for the exam. As a result, Clinical Scholars have established themselves as important players in nursing education in Colorado.

Best Practices in Facial Nerve Monitoring.

OBJECTIVES/HYPOTHESIS: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. STUDY DESIGN: Literature review and expert opinion. METHODS: Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. RESULTS: Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. CONCLUSIONS: We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:S1-S42, 2021.

Academic-practice collaboration in clinical education: A qualitative study of academic educator and clinical preceptor views.

Academic-practice collaborations between academic educators and preceptors are important to ensure the success of clinical education. This study explored the perceptions of academic educators and preceptors on their collaborations in a transition-to-practice program for nursing students. A qualitative exploratory study was undertaken with a purposive sample of 12 preceptors and 13 academic educators across three hospitals and one university in Singapore. Individual interviews were conducted. Four main themes emerged from the thematic data analysis: "hierarchical communication" that prevents academic educators and preceptors from communicating directly with each other, "uncertainty about learning objectives" among preceptors, "discrepancies in clinical assessments" due to a lack of support for preceptors in the assessment process, and "not knowing each other's practice," which could result in theory-practice gaps. The findings reflect the need to strengthen collaborations between academic educators and preceptors through joint teaching and assessments in clinical or simulated settings. This will provide opportunities to learn from each other's practice as well as build rapport, which are critical elements in reducing theory-practice divides and decreasing hierarchical levels between academic educators and preceptors.

Predictors and Motivation of Preceptors' Interest in Precepting of Pharmacy Interns-Do We Have a Useful Questionnaire?

PURPOSE: To determine the potential value of an adapted questionnaire to discover the predictors of preceptors' higher interest in precepting pharmacy interns and to evaluate preceptors' motivational factors and incentives for teaching as well as their professional satisfaction. METHOD: A link to the survey study of adapted questionnaire (JSAMPPP) was e-mailed to all pharmacists registered with the Pharmaceutical Chamber of the Republic of Srpska. Pharmacists' demographic and work experience characteristics, their attitudes related to motivation for precepting, value of incentives for precepting, job satisfaction, and influence of interns on pharmacists' professional practice were obtained. RESULTS: Half of the preceptors who reported feeling satisfied with their professional life also showed interest in teaching. In addition, teaching pharmacy students positively contributed to the overall job satisfaction of the preceptors. Pharmacy preceptors were found to be most motivated by intrinsic factors. The most valued incentives reported were those related to continuing education. CONCLUSIONS: The adapted questionnaire has potential value and it revealed the following predictors of preceptors' higher interest in precepting: enjoyment of teaching, satisfaction with professional life, satisfaction as a pharmacy preceptor, and interns' influence on preceptors. These identified predictors can be emphasized to improve pharmacy students' internship experiences, thereby reinforcing the pharmacy profession.

Teaching in health residencies: knowledge of preceptors under Shulman's analysis.

OBJECTIVES: to understand how the pedagogical knowledge that integrates the basic knowledge of teaching is perceived by preceptors in residents' teaching-learning process. METHODS: a qualitative research conducted by semi-structured interview from December 2013 to July 2014, with 31 preceptors of residency programs of three university hospitals in northeastern Brazil. For analysis, the Grounded Theory's proposal was used and supported by Atlas ti(r) 7.0 software. RESULTS: preceptors integrate preceptorship with basic teaching knowledge proposed by Lee Shulman, with emphasis on General Pedagogical Knowledge when seeking strategies to better work on specific and disciplinary content, and Pedagogical Content Knowledge when adapting content to make it comprehensible to residents. FINAL CONSIDERATIONS: the study allowed us to understand how Shulman's basic knowledge of teaching is perceived by preceptors. It is recognized that they integrate knowledge into the preceptorship, highlighting the General and Pedagogical Content Knowledge.

Nurse practitioner students' observations of preceptor engagement in obesity management and weight bias: A mixed-methods approach.

BACKGROUND: Obesity is considered a growing epidemic in the United States. Nurse practitioners (NPs) have the opportunity to serve as leaders in addressing concerns related to disease management, particularly obesity. Currently, we lack an awareness of how NP students are learning obesity management from their preceptors. PURPOSE: Thus, the current study sought to explore how NP students perceive preceptors' behaviors when managing patients with obesity. METHODOLOGICAL ORIENTATION: This study used a mixed-methods design. Participants were asked to report how often they observed their preceptors engage in different strategies when interacting with patients with obesity (e.g., calculate body mass index, identify goals). Students were then asked to respond to the statement: "share observations you made of how patients with obesity were treated in this environment." Students completed 2 clinical rotations during this period and, thus, were asked to answer the questions twice to capture experiences at both clinical sites. SAMPLE: Researchers surveyed 225 NP students completing clinical rotations in 3 settings (Family Practice, Pediatrics, and Obstetrics/Gynecology). CONCLUSIONS: Quantitative results revealed significant differences in the frequency of observed obesity management behaviors by all preceptors. Qualitative results revealed that NP students most often observed preceptors displaying interpersonal warmth without weight bias when working with patients with obesity. Contrary to current literature, this sample of NP students observed their preceptors engaging in positive interactions with individuals with obesity. IMPLICATIONS FOR PRACTICE: Educators must continue to teach students to engage in unbiased behavior toward patients. It is critical to continue to improve obesity management content offered in NP programs.

Addressing challenges to precepting advanced pharmacy practice experience students in the community setting.

BACKGROUND AND PURPOSE: An advanced pharmacy practice experience (APPE) in a community pharmacy setting is required in all accredited doctor of pharmacy program curricula in the United States. This setting often presents unique challenges to precepting students that may hinder the development and availability of robust learning experiences. This qualitative review discusses perceived challenges and potential solutions to maintaining a meaningful community rotation experience for students based on published literature and reported preceptor experiences. It also explores the clinical impact of APPE students in community pharmacy. EDUCATIONAL ACTIVITY AND SETTING: St. Louis College of Pharmacy (STLCOP) provides a systematic approach to student orientation and evaluation for community pharmacy APPEs. This allows all pharmacy students to be held to the same educational outcome standard. Site preceptors are responsible for communicating site-specific expectations and providing frequent formative feedback to students throughout the five-week rotation. FINDINGS: Community rotation students spent approximately 6400 hours providing almost 30,000 patient interventions over two years, indicating a potential benefit in quality of care at student-hosted sites. Despite evidenced benefits of the presence of pharmacy students in community pharmacies, some pharmacists hesitate to precept students due to anticipated obstacles of this additional responsibility. SUMMARY: This review explored the community practice APPE structure offered at STLCOP and describes the patient impact that students have made during this clinical rotation. Data seem to indicate a positive return on investment for having APPE students in community pharmacy.

Measuring and assessing the competencies of preceptors in health professions: a systematic scoping review.

BACKGROUND: In healthcare, preceptors act as a role model and supervisor, thereby facilitating the socialisation and development of the preceptee into a professional fit to practice. To ensure a consistent approach to every preceptorship experience, preceptor competencies should be measured or assessed to ensure that the desired outcomes are achieved. Defining these would ensure quality management and could inform development of an preceptor competency framework. This review aimed to evaluate the evidence for preceptor competencies and assessment in health professions. METHODS: This study followed the PRISMA ScR scoping review guidelines. A database search was conducted in Embase, Medline, CINAHL and IPA in 2019. Articles were included if they defined criteria for competency, measured or assessed competency, or described performance indicators of preceptors. A modified GRADE CERQual approach and CASP quality assessment were used to appraise identified competencies, performance indicators and confidence in evidence. RESULTS: Forty one studies identified 17 evidence-based competencies, of which 11 had an associated performance indicator. The competency of preceptors was most commonly measured using a preceptee completed survey (moderate to high confidence as per CERQual), followed by preceptor self-assessment, and peer-assessment. Preceptee outcomes as a measure of preceptor performance had good but limited evidence. CONCLUSIONS: Competencies with defined performance indicators allow for effective measurement and may be modifiable with training. To measure preceptor competency, the preceptor perspective, as well as peer and preceptee assessment is recommended. These findings can provide the basis for a common preceptor competency framework in health professions.