Advanced Pharmacy Practice Experience Rotations Research Articles

An Online, Multi-institutional Debate on Diabetes Medications by Advanced Pharmacy Practice Experience Students

Objective. The purpose of this study was to evaluate changes in advanced pharmacy practice experience (APPE) students' knowledge and to measure student perceptions of an online, multi-institutional debate curriculum as an alternative to a journal club to improve critical thinking skills related to diabetes medications.Methods. All APPE students assigned to four faculty (n=37) at three different colleges during the 2020-2021 academic year received instruction on diabetes medication classes and their cardiovascular outcome trials. Students debated via the Lincoln-Douglas format whether the preferred second-line therapies for patients with type 2 diabetes mellitus are either glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors. Matched pre- and post-APPE knowledge scores were measured using a seven-item assessment tool. A 22-item post-debate survey measured student perceptions of the activity.Results. Pre- and post-APPE knowledge scores were compared in 32 students, yielding an 86% response rate. Knowledge scores improved 32% (59% pre vs 87% post). Thirty-three students completed the perceptions survey, yielding an 89% response rate. Students reported that the debate activity was beneficial (100%) and rated it more effective than a journal club at improving critical thinking skills and knowledge retention.Conclusion. Preliminary results suggest that incorporating an online, multi-institutional debate as an alternative to journal clubs during APPE rotations was well received. Further research is warranted on the impact of the multi-institutional debate and how to best deliver it during the APPEs of a pharmacy curriculum.

Clinical Advanced Pharmacy Practice Experience Rotations During COVID-19: Evaluation of a Transition to Virtual Learning

Background All Advanced Pharmacy Practice Experience (APPE) pharmacy rotations at a large academic medical center were converted to virtual experiences during the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Objective: This study aimed to describe information obtained through pre- and post-rotation surveys, implemented to improve experiences for future students who may be required to complete virtual APPE pharmacy rotations. Methods: A single-center, descriptive study was conducted at a 1382-bed academic medical center. A pre- and post-rotation survey was sent to 32 students, and a post-rotation survey was sent to 38 preceptors via email to assess newly implemented virtual rotations. Results: Students’ response rate for pre- and post-rotation surveys was 59% and 41%, respectively, and the preceptors’ response rate for the post-rotation survey was 37%. A statistically significant improvement in videoconferencing abilities after the rotation was found for students but no differences in other skills were noted. In the post-rotation survey, students rated all of the following areas as being “effective”: rotation as a whole, virtual topic and patient discussions; but were “neutral” regarding the utility of the introductory training guide. In the post-rotation survey, preceptors rated all of the following areas as being “effective”: rotation as a whole, virtual topic and patient discussions. Conclusion: Abrupt shifts to virtual pharmacy clinical rotations due to COVID-19 have led to many challenges. Both students and preceptors felt that virtual rotations were an effective alternative to in-person experiences; however, further studies are warranted to evaluate actual performance compared to perceived effectiveness.

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

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. 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. 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%). 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.

Assessment of pharmacy student attitudes and beliefs toward patients with mental illnesses on inpatient psychiatric units.

IntroductionPeople with mental illness continue to face stigma, despite these illnesses being common. Previous studies have demonstrated reduced stigma in pharmacy students after various exposures and education, although results have been mixed. The primary objective of this study was to evaluate the effects of an advanced pharmacy practice experience (APPE) in psychiatric pharmacy on students' stigma toward patients with mental illness using the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) at 2 psychiatric hospitals.MethodsThis was a prospective, multicenter survey study of pharmacy students on an APPE rotation at an inpatient psychiatric hospital conducted during 3 academic years. Prior to starting and upon completion of their rotation, participants completed the OMS-HC and provided demographic and rotation information.ResultsA total of 26 students participated in the prerotation survey, with 88.5% (n = 23) completing the postrotation survey. The primary outcome showed a significant decrease in total OMS-HC score (Z = −2.376, P = .017), indicating a decreased level of stigma at rotation completion. Analysis of the OMS-HC subscales for attitudes toward people with mental illness and attitudes toward self-disclosure of a mental illness also yielded significant decreases (Z = −2.425, P = .015; Z = −2.462, P = .014, respectively).DiscussionThis study showed that APPE rotations at inpatient psychiatric hospitals may help reduce stigma among pharmacy students. Pharmacy schools should consider increasing access to and encouraging completion of psychiatric pharmacy rotations to help reduce stigma prior to graduation.

Identification of essential knowledge for inpatient general medicine advanced pharmacy practice experiences

AbstractObjectiveWith diversity in advanced pharmacy practice experience (APPE) preceptors, rotation options, and site characteristics, inpatient general medicine (IGM) APPEs provide varied experiences for students. There is a concern for continuity of essential knowledge standards across experiences. To identify essential knowledge for students to learn during an IGM APPE.MethodsExpert pharmacists in acute care and/or student precepting in an inpatient setting participated in a three‐round modified Delphi process to build consensus. Through three rounds of survey consensus building, experts designated 143 pharmacotherapy topics as essential or non‐essential for an IGM APPE. Topics that achieved 80% or more agreement met consensus as essential. Topics that achieved less than 80% agreement by the end of the surveys were considered non‐essential.ResultsTwenty‐eight experts reached consensus on 70 (49%) topics as essential, 40 (28%) topics as non‐essential, and 33 (23%) topics as indeterminate after round one. Three additional topics suggested by the experts were included with the 33 indeterminate topics for round two considerations. At the conclusion of round three, 73 total topics met consensus as essential for IGM APPE students. Essential topics aligned with the categories of renal, cardiovascular, gastrointestinal, and neurologic disorders as well as infectious diseases. Non‐essential topic categories consisted of oncologic, dermatologic, and gynecological/obstetric disorders.ConclusionIdentified essential knowledge, as found in this study, may serve as a guide for preceptors and afford students the opportunity of consistent experiences across varying IGM APPEs. Validation with pharmacy curriculum and postgraduate competency recommendations support many of these consensus findings. More research is needed to identify the appropriate number of topics addressed during APPE rotations and how to assess that knowledge.

A Pharmacist's Role in a Dental Clinic: Establishing a Collaborative and Interprofessional Education Site.

Dental patients often have comorbidities and take multiple medications, some of which could impact their dental health and treatment. A pharmacist in a dental clinic can assist with the gathering, documentation and evaluation of a dental patient's medication history as it pertains to their dental visit and overall health. To develop and implement a collaborative and interprofessional education program with a pharmacist providing services in a dental school clinic. Creighton University School of Dentistry, a student-operated dental clinic located in Omaha, Nebraska, provides dental care by student dentists, faculty and staff to the surrounding community in a learning-focused environment. A pharmacist was incorporated into the dental clinic to create and establish an interprofessional relationship with both dental students and faculty beginning August 2014. Pharmacy students on an ambulatory care advanced pharmacy practice experience rotation were eventually added to the team. The pharmacy team provided medication therapy management services including disease state and medication counseling, medication reconciliation, identifying drug-related problems and dental implications of medications, and recommendations for prescribed medications. The pharmacy team's presence was largely accepted by dental faculty, staff, dental students, and patients. Pharmacists can play an important role in a dental clinic by performing thorough health and medication histories and communicating with dental and medical providers involved in a patient's care.

Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced Pharmacy Practice Experience Students

Background: Older adults with cognitive impairment may have difficulty understanding and complying with medical or medication instructions provided during hospitalization which may adversely impact patient outcomes. Objective: To evaluate the prevalence of cognitive impairment among patients aged 65 years and older within 24 hours of hospital admission using Mini-Cog™ assessments performed by advanced pharmacy practice experience (APPE) students. Methods: Students on APPE rotations were trained to perform Mini-Cog™ assessments during routine medication education sessions from February 2017 to April 2017. The primary end point was the prevalence of cognitive impairment indicated by a Mini-Cog™ score of ≤3. Secondary end points were the average number of observed Mini-Cog™ practice assessments required for APPE students to meet competency requirements, caregiver identification, and 30-day hospital readmissions. Results: Twelve APPE students completed the training program after an average of 4.4 (standard deviation [SD] = 1.0) graded Mini-Cog™ assessments. Of the 1159 admissions screened, 273 were included in the analysis. The prevalence of cognitive impairment was 55% (n = 149, 95% confidence interval [CI]: 48%-61%). A caregiver was identified for 41% (n = 113, 95% CI: 35%-47%) of patients, and 79 patients had a caregiver present at bedside during the visit. Hospital readmission within 30 days of discharge was 15% (n = 41, 95% CI: 11%-20%). Conclusion: Cognitive impairment could substantially impair a patient’s ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary.

Description of a pediatric degree option program in a doctorate of pharmacy curriculum and its impact on pediatric-focused advanced pharmacy practice experience rotations and faculty scholarly productivity

PurposeTo describe the development of a Pediatric Degree Option program and its impact on pediatric-focused advanced pharmacy practice experiences (APPEs) and faculty scholarly productivity. Educational activityThe Pediatric Degree Option program was established in 2011 and requires 16 h of didactic coursework and APPEs. The number of pediatric-focused APPEs and mean number of APPEs per pediatric faculty per year was compared pre- (2005–2010) and post-implementation (2011–2016). In addition, the median number of scholarship activities per student pre- and post-implementation was compared. The initial position obtained by graduates completing the degree option was collected. FindingsThirty students have completed the program. There were 146 pediatric-focused APPEs for the pre-implementation period and 259 post-implementation. However, there was an increase in pediatric faculty during the post-implementation, so there was no difference in the mean number of pediatric-focused APPEs per pediatric faculty in the pre- versus post-implementation period, 8.4 + 2.7 versus 6.9 +1.0, p = .224. A significant increase in the median number of pediatric-focused scholarly activities per student was observed pre-versus post-implementation, 3 (2–5) versus 5 (3–7), p = .005. Twenty-six (86.7%) students in the post-implementation period participated as a research assistant or coauthor in an original research or manuscript writing project. Students accepted a variety of positions after graduation including twelve (40%) accepting a PGY1 residency and eight (36.7%) as community pharmacists. SummaryAlthough the number of pediatric-focused APPEs increased in the post-implementation, this did not result in an increase in the mean number of mean pediatric-focused APPEs per pediatric faculty member. However, it did allow a unique opportunity for 30 students with interest in pediatrics and allowed for content and skill development. The Pediatric Degree Option program allowed students to gain experience with pediatric-focused scholarly activities that also enhanced faculty productivity in scholarship and research.

Pharmacy preceptors views of pharmacy students’ competency in pharmacy informatics

IntroductionThis study aimed to survey Advanced Pharmacy Practice Experience (APPE) preceptors’ perception of students’ competency in pharmacy informatics during their APPE rotations or experiences based on the Accreditation Council for Pharmacy Education (ACPE) version 2.0 accreditation standards. MethodsAll APPE preceptors associated with the University of Cincinnati were emailed a link to the survey. Follow-up interviews were conducted on pharmacy preceptors to identify reasons for nonresponse. ResultsIn total, 33 surveys were returned from the 288 preceptors contacted. Respondents believed the pharmacy students displayed the highest levels of competency in domain four regarding the benefits and current constraints in using information and communication technology in health care. However, respondents believed pharmacy students had the lowest competency on items included in domain three regarding data in continuous quality improvement initiatives. Half of the respondents believed the students’ knowledge was inadequate on all items included in this domain. This corresponds with nearly half of the respondents also rating pharmacy students as having inadequate knowledge of unified medical language system and meaningful use in domain one. Follow-up interviews identified that some preceptors did not feel comfortable with pharmacy informatics themselves. ConclusionsThis preliminary study showed that the majority of responding pharmacy preceptors believed pharmacy students had a reasonable understanding of the reasons for systematic processing of data, information, and knowledge in health care and the benefits, current constraints in using information, and communication technology in health care. However, they felt their knowledge was inadequate surrounding some basic terminology and use of data in continuous quality improvement initiatives.

Using institutional track programs and block scheduling to help students prepare for postgraduate residency training.

The development and implementation of institutional track programs and block scheduling to help students prepare for postgraduate residency training are described. Institutional track and block scheduling models were implemented into advanced pharmacy practice experience rotations to provide students with several of these experiences at the same practice site. Students at Purdue University College of Pharmacy (PUCOP) and Butler University College of Pharmacy and Health Sciences (BUCOPHS) can apply for an institutional track or block schedule. The application process for the institutional track and block scheduling programs provides students with an opportunity to refine written and oral skills that are necessary for residency applications and interviews, since the process mimics that of the ASHP Resident Matching Program. Students are frequently provided with mentors to assist in the residency or fellowship preparation, curriculum vitae or cover letter design, and career planning. Students at the site may also be paired with pharmacy residents enrolled in blocked rotations to serve as mentors. The top students are matched with a practice site and then assigned to five consecutive patient care rotations. Since 2011, a total of 71 students have participated in institutional tracks at PUCOP or block scheduling at BUCOPHS. Most institutional track students (83%) and block scheduling students (81%) were successful in matching to residency programs or hospital pharmacy positions after graduation. Block scheduling and institutional track programs were offered to students at two colleges of pharmacy interested in pursuing postgraduate residency training. Most institutional track students and block scheduling students successfully matched to residency programs or hospital pharmacy positions after graduation.

The Impact of a Student-Run Journal Club on Pharmacy Students' Self-Assessment of Critical Appraisal Skills.

After attending an educational session on hosting journal clubs at the 2013 Annual Meeting & Exhibition, American Society of Consultant Pharmacists, Seattle, Washington, two third-year professional pharmacy students created a student-run journal club through the University of Rhode Island's ASCP student chapter. Three journal club sessions were held during the spring semester and were open to all pharmacy students. Students completed an anonymous pre- and post-survey to assess confidence in evaluating medical literature. Of the 18 participants, 5 were lost to follow-up. Significant improvements were found among all participants in their confidence in critically evaluating clinical research, interpreting statistical methods, and completing a journal club during Advanced Pharmacy Practice Experience rotations. This activity can be replicated in academic settings as well as workplace environments where pharmacy students are involved.

APhA–APPM recipients honored for a lifetime of work

The APhA Academy of Pharmacy Practice & Management (APhA–APPM) recognizes the achievements of individuals who have made significant or sustained contributions to pharmacy practice. This year's winners shared their thoughts and insights with Pharmacy Today .

Living in an Older Adult Community: A Pharmacy Student's Experience

Interacting with older adults is a daily practice for pharmacists. It is important to understand how medications affect their wellbeing, but there are many other factors that affect quality of life. To truly understand some of the challenges facing older adults, Emily Anastasia, a sixth-year pharmacy student at the University of Rhode Island, moved into South Bay Retirement Living, a senior living community, for an eight-day immersion experience as a special project within one of her advanced pharmacy practice experience rotations. During her stay, she did not attend classes nor leave the facility unless on the South Bay bus with the other assisted living residents. She lived with a 92-year-old roommate, developed close friendships with many of the residents, and kept a detailed journal of her experience. The purpose of this reflection is to share her experience and recognize lifestyle as well as social and physical environment as factors in understanding the aging process. Immersing a pharmacy student within an assisted living community provides a unique opportunity to observe and appreciate characteristics of older adults that cannot be learned within a classroom setting.

An interdisciplinary approach to determine schistosomiasis prevalence and administer praziquantel to school-age children in Tanzania

Four students at the James L. Winkle College of Pharmacy, accompanied by a faculty member, traveled to Tanzania on an elective ambulatory care advanced pharmacy practice experience rotation to learn, provide care, and implement a schistosomiasis project in the village of Burere. We were part of a

Assessment of web-based training modules on learning facilitation for advanced pharmacy practice experiences in pediatrics.

To assess the effectiveness of web-based training (WBT) modules to enhance and facilitate student pharmacists' learning and their ability to provide pharmaceutical care to children during a pediatric advanced pharmacy practice experience (APPE). Pediatric-specific WBT modules were developed for completion by APPE students during a 4-week rotation. Pediatric modules covered developmental pharmacology; antimicrobial use and monitoring; fluids, electrolytes, and dehydration; and drug information. Students were responsible for completing all modules within the first week of the APPE. Preassessments and postassessments consisted of 8 to 10 multiple-choice questions, with scores ranging from 0 to 100 points. Data were analyzed using descriptive statistics and paired t tests. Statistically significant improvements in postassessment scores were achieved for 3 of the 4 modules. Significant improvements were not observed in the antimicrobial use and monitoring module. Most student pharmacists either somewhat or strongly agreed that the modules improved their understanding of pharmaceutical care for children. WBT modules, taken during an APPE rotation, may expand and improve student pharmacists' understanding of pharmaceutical care in pediatric patients.