Preceptor perceptions of a redesigned entrustable professional activity (EPA) assessment tool in pharmacy practice experiences.

INTRODUCTION: The purpose of this study was to determine pharmacy preceptor perceptions of an entrustable professional activity (EPA) evaluation tool redesigned in 2019 and launched for use in May 2020. METHODS: Participants received an optional survey in June 2021 regarding their perceptions of the redesigned EPA assessment tool. The survey used a combination of open- and closed-ended questions regarding preceptor perceptions of the revised form, including perceptions of accuracy, usability, ease of use, grading, EPAs, and form layout. Preceptor perceptions were measured using seven-point Likert-type items and analyzed with descriptive statistics. Open-ended items were coded by at least two faculty members using qualitative content analysis. RESULTS: We received 106 responses (19.5% response rate) and analyzed a total of 91 responses. Most questions related to perceived accuracy were rated positively, and preceptors indicated it was easier to assign grades and provide feedback on EPAs using the new form. Preceptors agreed that EPAs indicated when students on clinical rotations excel and when they need to improve. Preceptors reported they could effectively evaluate students and do so in a way that saves them time. Overall, preceptors agreed that the form instructions helped them accurately assess student performance, and the new narratives helped them remember the assessment standards. CONCLUSIONS: Overarchingly, preceptors perceived that the new EPA assessment tool allowed them to provide feedback and grades more accurately, efficiently, effectively, and easily. This information will assist our institution in determining next best steps for EPA assessment tool updates.

An Exploration of Preceptor-Provided Written Feedback on Entrustable Professional Activities During Early Practice Experiences.

Objective. To explore and evaluate open-ended feedback on entrustable professional activities (EPAs) provided by preceptors to Doctor of Pharmacy (PharmD) students completing their first practice experience.Methods. A retrospective review was conducted of qualitative data collected from preceptor evaluations of student pharmacists who had completed a two-month practice experience in either community or health-system pharmacy at the end of their first professional year. Preceptors had used a validated EPA framework to assess students. A codebook was developed around the EPA framework and sub-coding was used to indicate positive, negative, or neutral assessment within each EPA. After several rounds of coding, consensus was reached for all codes by two investigators. A dependability audit was implemented to ensure the trustworthiness of the findings.Results. Preceptor evaluations of 153 student pharmacists were included in the study. Eighty students (52.3%) had completed a community experience and 73 (47.7%) had completed a health-system experience between May and August 2018. The preceptors at both practice settings provided overwhelmingly positive feedback on all EPAs. Opportunities to optimize preceptor-provided feedback were identified. The feedback provided by the preceptors in health-system and community practice settings focused on knowledge and behavior, respectively, with both emphasizing students' skill-based performance.Conclusion. This study provides valuable insight into optimizing preceptor-provided written feedback on EPAs. Conducting deeper analysis of preceptor feedback using focus groups or structured interviews is suggested to further explore preceptors' provision of EPA assessment to student pharmacists practicing in real-world settings.

Impact of an innovative partnership in patient care between an academic medical center department of pharmacy and a school of pharmacy.

PURPOSE: Pharmacy departments and schools of pharmacy have long held professional affiliations. However, the success of each entity is often not interdependent and aligned. In 2010, our institutions found ourselves in a position where the complementary motivations of each aligned to support a more meaningful and committed engagement, leading to the development of the Partnership in Patient Care. The impact of the partnership was evaluated 7 years postimplementation, and both the successes realized and the lessons learned are described. SUMMARY: The partnership provided many advantages to our pharmacy department and the school of pharmacy. This initial iteration of the partnership was a strong proof of concept that an intentional approach to the relationship between a school of pharmacy and a pharmacy department can lead to substantive improvements in a wide array of meaningful outcomes. We experienced an increase in the number of student rotation months completed, growth in the American Society of Health-System Pharmacists-accredited residency programs, and enhanced clinical services. However, the partnership was not without challenges. For instance, lack of a formalized tracking method made certain outcomes difficult to track. CONCLUSION: The purposeful establishment of the Partnership in Patient Care, built on the needs of a school of pharmacy and an academic medical center pharmacy department, allowed our institutions to develop an intertwined mission and vision. Over the initial years of the partnership, many successes were realized and lessons were learned. Both the successes and the challenges are serving as the foundation for future iterations of the partnership.

Implementation of the flipped residency research model to enhance residency research training.

PURPOSE: The attainment of fundamental research skills to create and disseminate new knowledge is imperative for the advancement of pharmacy practice. Research training is an important component of postgraduate residency training; however, the traditional model of performing residency research has several limitations that have hindered the ability of residents to complete high-quality research projects. Therefore, our institution developed and implemented the flipped residency research model with the 2013-2014 pharmacy practice residency class. SUMMARY: The flipped residency research model modifies the research timeline to better align research activities with residents' abilities at specific time points during the year. In the 4 years following implementation of the flipped residency research model, our institution found improvements in a number of areas pertaining to the research process compared with an evaluation of the 7 years prior to implementation. A decrease in the number of reviews required from institutional review boards was observed, resulting in improved institutional review board efficiency. The flipped residency research model also addressed limitations surrounding manuscript development and submission, as demonstrated by an improved publication rate. Additionally, residents who participated in the flipped residency research model self-reported increased comfort with research-related abilities associated with study design, implementation, manuscript development and submission, and biostatistics. CONCLUSION: The modified research timeline of the flipped residency research model better aligns research activities with resident experiences and abilities. This realignment has translated to demonstrable impact in the success of residency projects and dissemination of results. Research is needed to investigate the impact of the flipped residency research model on longer term scholarly success.

Exploratory Analysis of Entrustable Professional Activities as a Performance Measure During Early Pharmacy Practice Experiences.

Objective. To examine entrustable professional activities (EPAs) as an assessment tool for student pharmacists completing early practice experiences. Methods. Students completed a 2-month practice experience upon conclusion of their first year. Student performance on EPAs was assessed by preceptors and students at the midpoint and conclusion of the experience using a scale that ranged from dependent (1.0) to independent (5.0). Wilcoxon Signed-Rank Test assessed for differences between the midpoint and final evaluations on student self-evaluations and between the midpoint and final evaluation on preceptor-student evaluations. Cronbach's α assessed reliability of the EPAs. Results. From May to August 2016, 147 students completed a practice experience. Student-self and preceptor-student evaluations at the midpoint and final approximated a median score of 3.0 (IQR 2) and 4.0 (IQR 3), respectively, on EPAs 1-14. Analyses revealed statistically significant increases from midpoint to final evaluation for all constructs on both evaluations. Cronbach's α yielded scores of 0.98 for the preceptor evaluations and 0.95 for the student self-evaluation. Conclusion. There was an increase in student performance over time. The EPA statements may be a reliable assessment tool for student performance in pharmacy education.

Patient engagement in first cycle comprehensive chemotherapy consultation pharmacist services and impact on patient activation.

BACKGROUND: Healthcare systems and policy makers worldwide are demonstrating interest in shared decision making, which requires patient activation. Patient activation can be measured using a validated tool called the patient activation measure-10. First cycle comprehensive chemotherapy consultation services (3CS) is provided by an oncology pharmacy team member during a patient encounter at the beginning of the patient's treatment for cancer. METHODS: This was a single center, prospective, non-randomized, observational clinical study in patients with cancer who required a new chemotherapy plan. A baseline patient activation measure-10 survey was administered and a pharmacy team member met with the patient to complete the first cycle 3CS encounter. Within two business days of that encounter, a second patient activation measure-10 survey was administered, and thus, patients served as their own control. RESULTS: Forty-nine patients who met the inclusion criteria were enrolled, of which 36 completed the study. Mean patient activation measure-10 scores measured at baseline and two business days after the 3CS encounter were significantly different (68.5 ± SD 14.7 vs. 75.0 ± SD 14.3, p = 0.001). This difference persisted when evaluated by gender (female: 70.0 ± SD 14.8 vs. 81.6 ± SD 10.5, p = 0.001; male: 66.1 ± SD 14.8 vs. 70.8 ± SD 14.7, p = 0.022). CONCLUSION: This study demonstrates that cancer patients had significantly increased patient activation scores after engagement in a 3CS encounter provided by an oncology pharmacy team. Further studies are needed to verify these data in a larger population, different healthcare settings, and to evaluate for patients who have solid tumor malignancies.

The Importance of Authentic Leadership to all Generations Represented within Academic Pharmacy.

Academic pharmacy spans several generations including traditionalists, baby boomers, Generation X, and Generation Y, commonly referred to as millennials. It has been suggested that leadership styles must change to accommodate these generational differences in academic pharmacy, yet there are no data of which we are aware, that support this assertion. We contend that leadership styles are derived from one's authentic self and are based on core beliefs and values; therefore, leadership styles must not change to accommodate a specific generation or other subset of academic pharmacy. Instead, effective leaders must change tactics (ie, methods or processes) to reach and influence a specific cohort. This article develops and supports the argument that leadership styles should not change to accommodate generational differences in academic pharmacy.

Educational outcomes associated with early immersion of second-year student pharmacists into direct patient care roles in health-system practice.

BACKGROUND AND PURPOSE: To assess the educational impact of engaging second professional year student pharmacists in active, direct patient care experiences in health system practice. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists in their second professional year completed a redesigned, skill-based four-week introductory pharmacy practice experience in health system practice. The immersion consisted of experiences in both operational and clinical pharmacy environments. Students were assessed with skill development checklist assessments. Pre-post surveys were also collected. Data were analyzed using a mixed methods approach. FINDINGS: Twenty-eight student pharmacists were included; of those, 26 completed both surveys (92.9% response rate). Survey results revealed significant increases in 81.8% of operational and 100% of clinical self-efficacy statements (p<0.05) and positive perceptions of the program overall. Overall, findings suggested that student pharmacists developed skills in health system practice while identifying additional areas for emphasized learning. SUMMARY: Student pharmacists engaged in early, hands-on, direct patient care experiences enhanced their skill development in operational and clinical pharmacy practice.

Intentional Interprofessional Experiential Education.

The experiential component of a doctor of pharmacy curricula is an ideal, yet underutilized vehicle to advance interprofessional education (IPE) initiatives. To date, most experiential-based IPE initiatives occur in a naturally occurring, non-deliberate fashion. The American Association of Colleges of Pharmacy (AACP) Experiential Education Section formed the Task Force on Intentional Interprofessional Education in Experiential Education in academic year 2015-2016 to explore the issue. This commentary describes the work of the task force, including the following elements: defining intentional interprofessional experiential education as "the explicit effort by preceptors and practice sites to create/foster educational opportunities or activities designed specifically to achieve interprofessional educational competencies;" conducting a systematic literature review to identify examples of intentional interprofessional experiential education in the published literature; surveying faculty with oversight of experiential education programs and preceptors within those programs; and generating recommendations to stakeholders including AACP, pharmacy schools, and experiential education administrators.

Identifying the Presence of Cognitive Apprenticeship in the Layered Learning Practice Model.

Objective. To identify the presence of cognitive apprenticeship themes in the layered learning practice model (LLPM). Methods. Attending pharmacists who had implemented an LLPM completed an individual 90-minute face-to-face semi-structured interview. Three researchers independently reviewed transcripts to identify cognitive apprenticeship themes according to the framework's dimensions and sub-dimensions. Results. Of 25 eligible attending pharmacists, 24 (96%) agreed to participate. All core dimensions of the cognitive apprenticeship framework emerged during the interviews; however, preceptors varied in how they used the framework in the training of pharmacy learners at different levels. This variability was especially apparent within the sub-dimensions of the content and method domains. Conclusion. This study demonstrates that all four cognitive apprenticeship principles are being used in the clinical environments operationalizing the LLPM. These findings suggest that cognitive apprenticeship is an applicable and relevant educational framework when engaging multiple learners in clinical education environments.

Post-Hospital Discharge Care: A Retrospective Cohort Study Exploring the Value of Pharmacist-Enhanced Care and Describing Medication-Related Problems.

BACKGROUND Medication-related problems occur at high rates during care transitions. Evidence suggests that pharmacists are well-suited to identify and resolve medication-related problems during hospital admission and at discharge. Additional evidence is needed to understand the impact of face-to-face pharmacist visits in primary care after discharge. The purpose of the study was to describe medication-related problems found during face-to-face pharmacist visits in a medical home after hospital discharge.METHODS A retrospective cohort study was conducted within an academic primary care center staffed by family medicine trained physicians that evaluated patients who attended a hospital follow-up visit with pharmacist-enhanced care (N = 86) versus usual care (N = 86). The primary objective was to describe medication-related problems identified by pharmacists using a modified individualized Medication Assessment and Planning tool for patients receiving pharmacist-enhanced care. Secondary analyses were also conducted to compare 30-day and 60-day hospital readmission and emergency department visit rates in those exposed to pharmacist-enhanced care versus those who were not.RESULTS At baseline, the mean hospitalizations in the prior year were 1.1 ± 1.7 (pharmacist-enhanced care) and 0.76 ± 1.2 (usual care), indicating a low initial readmission risk. Of patients receiving pharmacist-enhanced care, 97.7% were found to have at least 1 medication-related problem, with an average of 4.36 medication-related problems per patient. The 30-day readmission rate was lower, but not significantly different between groups (8.1% for pharmacist-enhanced care versus 12.8% for usual care; adjusted odds ratio (OR), 0.47; 95% confidence interval (CI), 0.16-1.36).LIMITATIONS Limitations include the retrospective cohort study design and small sample size. Medication-related problems were identified and collected prospectively during pharmacist visits.CONCLUSION Medication-related problems are ubiquitous after hospital discharge. Larger prospective studies will be needed to understand the potential value of pharmacist-enhanced care during hospital follow-up visits on readmission rates in low-risk patient populations receiving care within a primary care medical home.

Accountable Care in Transitions (ACTion): A Team-Based Approach to Reducing Hospital Utilization in a Patient-Centered Medical Home.

BACKGROUND: There is limited data describing the role of the patient-centered medical home (PCMH) in successful transitions programs and more information is needed to determine the transition points where pharmacist involvement is most impactful. METHODS: A family medicine center developed a multidisciplinary outpatient-based transitions program focused on reducing emergency department (ED) and hospital use in medically complex patients. Key team members were a medical provider, clinical pharmacist practitioner (CPP), and care manager. The objective was to evaluate the impact of the program by comparing utilization before and after the intervention and to identify patient and process characteristic predictors of 30-day rehospitalizations. RESULTS: Of the 268 patients included, the mean time to follow-up appointment attended was 11.6 (11.8) days after discharge. The majority of patients (72%) saw their primary care provider at follow-up. Patients experiencing the multidisciplinary intervention had lower 30-day rehospitalizations at 7, 14, and 30 days postdischarge with significance achieved at 14 and 30 days. Compared to before the intervention, reductions in both ED visits and hospitalizations as well as increases in clinic visits were seen at 1, 3, and 6 months. CPP involvement was associated with lower rehospitalizations (7.7% vs 18.8%; P = .04). CONCLUSION: A multidisciplinary outpatient-based transitions program embedded in the PCMH increased access to primary care and reduced hospital and ED utilization. Face-to-face CPP involvement significantly lowered rehospitalizations. This program describes a standardized approach to complex care needs with defined roles, a model that may be generalizable and reproduced in other medical homes.

Continuous Care Provided Through Comprehensive Medication Management in an Acute Care Practice Model.

BACKGROUND: Pharmacy practice models that foster pharmacists' accountability for medication-related outcomes are imperative for the profession. Comprehensive medication management (CMM) is an opportunity to advance patient care. OBJECTIVE: The objective of this study was to evaluate the impact of a CMM practice model in the acute care setting on organizational, patient, and financial outcomes. METHODS: Three adult service lines focused on at-risk patients identified using internal risk stratification methodology were implemented. Core CMM elements included medication reconciliation, differentiated clinical pharmacy services, inpatient MTM consultations, discharge services, and documentation. Mixed methods compared the effect of the CMM model before and after implementation. Historical patients served as comparative controls in an observational design. Pharmacists completed a 60-minute interview regarding their experiences. Qualitative data were analyzed using thematic coding to characterize perception of the model. RESULTS: Three pharmacists implemented the model on cardiology, hematology/oncology, and surgery transplant services and provided services to 75 patients during the study. A total of 145 medication-related problems were identified and resolved. CMM was associated with a nonsignificant reduction of 8.8% in 30-day hospital readmission rates ( P = 0.64) and a 24.9% reduction in 30-day hospital utilization ( P = 0.41) as well as a significant reduction of 86.5% in emergency department visits ( P = 0.02). Patients receiving discharge prescriptions from our outpatient pharmacies increased by 21.4%, resulting in an 11.3% increase in discharge prescription capture and additional revenue of $5780. Themes identified from qualitative interviews included CMM structure, challenges, value, and resources. CONCLUSION: This study demonstrated successful implementation of a CMM model that positively affected organizational, patient, and financial outcomes.

Student pharmacist experiences as inpatient psychiatry medication education group leaders during an early immersion program.

BACKGROUND AND PURPOSE: While research suggests that pharmacists generally hold positive attitudes toward consumers of psychiatric medications, they often feel less comfortable talking about these medications and providing services for patients with mental illness. The purpose of this program was to train second and third year student pharmacists as psychiatry medication education groups leaders and to examine resulting student self-efficacy and mental health stigma. EDUCATIONAL ACTIVITY AND SETTING: In partnership with the University of North Carolina (UNC) Eshelman School of Pharmacy, the inpatient psychiatry service at UNC Medical Center expanded weekly medication education groups with the help of trained student pharmacists. All second- and third-year student pharmacists were invited to participate. Pre/post surveys and reflection statements were collected from 13 students that received training, provided informed consent, and participated in one or more medication education groups. Data were analyzed with a mixed methods approach. FINDINGS: Student responses revealed an increase in student self-efficacy (p < 0.05), improved understanding of mental illness, and new strategies for engaging in direct patient care. DISCUSSION AND SUMMARY: Results from this study suggest that students gained an appreciation for pharmacists and the workplace while developing self-efficacy and strategies for engaging with patients with mental illness as a part of medication education groups.

Exploring the Requisite Skills and Competencies of Pharmacists Needed for Success in an Evolving Health Care Environment.

Objective. To identify and describe the core competencies and skills considered essential for success of pharmacists in today's rapidly evolving health care environment. Methods. Six breakout groups of 15-20 preceptors, pharmacists, and partners engaged in a facilitated discussion about the qualities and characteristics relevant to the success of a pharmacy graduate. Data were analyzed using qualitative methods. Peer-debriefing, multiple coders, and member-checking were used to promote trustworthiness of findings. Results. Eight overarching themes were identified: critical thinking and problem solving; collaboration across networks and leading by influence; agility and adaptability; initiative and entrepreneurialism; effective oral and written communication; accessing and analyzing information; curiosity and imagination; and self-awareness. Conclusion. This study is an important step toward understanding how to best prepare pharmacy students for the emerging health care needs of society.

Organizational readiness for change: Preceptor perceptions regarding early immersion of student pharmacists in health-system practice.

PURPOSE: To examine preceptors' perceptions regarding readiness for change pre- and post-implementation of a pilot early immersion program engaging student pharmacists in direct patient care. METHODS: Student pharmacists enrolled in the second professional year of a Doctor of Pharmacy degree program completed a four-week health-system introductory pharmacy practice experience (IPPE) which was modified to include direct patient care roles in operational (drug preparation and dispensing) and clinical (comprehensive medication management) pharmacy environments. Pharmacy preceptors with direct oversight for program implementation completed a pre/post Organizational Readiness for Implementing Change (ORIC) survey and a 50-min interview or focus group post-experience. The ORIC survey evaluates two dimensions of organizational readiness for change - change commitment and change efficacy. Additional items assessed included implementation needs, support, and perceived value of the change. ORIC survey constructs were compared before and after the experience. Interviews and focus groups were audio recorded, transcribed, and evaluated by constant comparative analysis. A mixed methods approach was used to triangulate findings and develop greater understanding of the ORIC survey results. RESULTS: Twenty pharmacy preceptors (37 ± 8 years of age, 60% female, 65% clinical pharmacist position, 70% prior preceptor experience) participated in the study. There were no significant changes in pre/post survey constructs, except for a decline in the perception of organizational change commitment (p < 0.001). Sub-analyses indicated the decline was associated with items assessing individual dedication and individual commitment to the change (p < 0.05 for both). Primary emerging themes from interviews included concerns about implementation requirements, contextual factors of the experience that affected implementation, and varying perceptions about the value of early immersion across preceptor roles. CONCLUSION: As pharmacy curricula immerse student pharmacists in practice earlier in their education, pharmacy departments can utilize the ORIC survey to identify preceptors' commitment and concerns to support the necessary changes for student pharmacist engagement.

Improved Organizational Outcomes Associated With Incorporation of Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center.

PURPOSE: To assess the feasibility of engaging second professional year student pharmacists in the medication reconciliation process on hospital and health system pharmacy practice outcomes. METHODS: Student pharmacists in their second professional year in the Doctor of Pharmacy degree program at our institution were randomly selected from volunteers to participate. Each participant completed training prior to completing three 5-hour evening shifts. Organizational metrics, student pharmacist perception regarding quality of interactions with health care professionals, and pharmacist perceptions were collected. RESULTS: A total of 83 medication histories were performed on complex medical patients (57.0 ± 19.2 years, 51% female, 65% Caucasian, 12 ± 6 medications); of those, 93% were completed within 24 hours of hospital admission. Second professional student pharmacists completed on average 1.9 ± 0.6 medication histories per shift (range 1-3). Student pharmacists identified 0.9 medication-related problems per patient in collaboration with a pharmacist preceptor. Student pharmacists believed the quality of their interactions with health care professionals in the Student Medication and Reconciliation Team (SMART) program was good or excellent. The program has been well received by clinical pharmacists involved in its design and implementation. CONCLUSION: This study provides evidence that second professional year student pharmacists can assist pharmacy departments in the care of medically complex patients upon hospital admission.

The Arab American experience with diabetes: Perceptions, myths and implications for culturally-specific interventions.

AIMS: Culturally-specific lifestyle diabetes prevention programs require an assessment of population disease perceptions and cultural influences on health beliefs and behaviors. The primary objectives were to assess Arab Americans' knowledge and perceptions of diabetes and their preferences for a lifestyle intervention. METHODS: Sixty-nine self-identified Arab or Arab Americans ≥30 years of age and without diabetes participated in 8 focus groups. RESULTS: Emerging themes from the data included myths about diabetes etiology, folk remedies, and social stigma. The main barrier to healthcare was lack of health insurance and/or cost of care. Intervention preferences included gender-specific exercise, group-delivered education featuring religious ideology, inclusion of the family, and utilization of community facilities. CONCLUSION: Lifestyle interventions for Arab Americans need to address cultural preferences, diabetes myths, and folk remedies. Interventions should incorporate Arabic cultural content and gender-specific group education and exercise. Utilization of family support and religious centers will enable culturally-acceptable and cost-effective interventions.

The layered learning practice model: Lessons learned from implementation.

PURPOSE: Pharmacists' views about the implementation, benefits, and attributes of a layered learning practice model (LLPM) were examined. METHODS: Eligible and willing attending pharmacists at the same institution that had implemented an LLPM completed an individual, 90-minute, face-to-face interview using a structured interview guide developed by the interdisciplinary study team. Interviews were digitally recorded and transcribed verbatim without personal identifiers. Three researchers independently reviewed preliminary findings to reach consensus on emerging themes. In cases where thematic coding diverged, the researchers discussed their analyses until consensus was reached. RESULTS: Of 25 eligible attending pharmacists, 24 (96%) agreed to participate. The sample was drawn from both acute and ambulatory care practice settings and all clinical specialty areas. Attending pharmacists described several experiences implementing the LLPM and perceived benefits of the model. Attending pharmacists identified seven key attributes for hospital and health-system pharmacy departments that are needed to design and implement effective LLPMs: shared leadership, a systematic approach, good communication, flexibility for attending pharmacists, adequate resources, commitment, and evaluation. Participants also highlighted several potential challenges and obstacles for organizations to consider before implementing an LLPM. CONCLUSION: According to attending pharmacists involved in an LLPM, successful implementation of an LLPM required shared leadership, a systematic approach, communication, flexibility, resources, commitment, and a process for evaluation.

A Study of Layered Learning in Oncology.

Objective. To explore use of pharmacy learners as a means to expand pharmacy services in a layered learning practice model (LLPM), to examine whether an LLPM environment precludes achievement of knowledge-based learning objectives, and to explore learner perception of the experience. Design. An acute care oncology pharmacy practice experience was redesigned to support the LLPM. Specifically, the redesign focused on micro discussion, standardized feedback (eg, rubrics), and cooperative learning to enhance educational gain through performing clinical activities. Assessment. Posttest scores evaluating knowledge-based learning objectives increased in mean percentage compared to pretest values. Learners viewed the newly designed practice experience positively with respect to perceived knowledge attainment, improved clinical time management skills, contributions to patient care, and development of clinical and self-management skills. A fifth theme among students, comfort with learning, was also noted. Conclusion. Layered learning in an oncology practice experience was well-received by pharmacy learners. Data suggest a practice experience in the LLPM environment does not preclude achieving knowledge-based learning objectives and supports further studies of the LLPM.