Advanced Pharmacy Practice Research Articles

Creation of a Pharmacy Student Longitudinal Rotation to Expand the Scope of an Antimicrobial Stewardship Program.

Allergy assessments and penicillin skin testing have emerged as a vital intervention for Antimicrobial Stewardship Programs (ASPs). Investment and involvement in such programs by ASPs, however, are often limited due to resources, time, and personnel constraints. Harnessing an underutilized resource, 4th-year advanced pharmacy practice experience (APPE) students, allows for expanded ASP involvement and scope of practice. We aim to outline and provide insight on how 4th-year APPE students serve as an asset to an ASP. Through our novel longitudinal rotation experience, APPE students complete penicillin allergy assessments, patient education, and work alongside a clinical pharmacist to refer patients for penicillin skin testing if appropriate. Students also achieve many of the education standards required by the Accreditation Counsel for Pharmacy Education (ACPE) for graduation within the Doctor of Pharmacy degree while developing a strong foundation in antimicrobial stewardship and gaining invaluable knowledge for their future. The addition of APPE pharmacy students to our ASP has also enabled our program to achieve its goals and expand involvement and reach within our facility.

Student-Led discharge counseling program for High-Risk medications in a teaching hospital in Saudi Arabia: A pilot study

Discharge counseling by pharmacists reduces adverse medication events, emergency department visits, and readmissions. Studies indicate that pharmacy students in advanced pharmacy practice experiences (APPE) can deliver effective medication-related activities.An open label randomized controlled trial was conducted in adults discharged on warfarin, insulin, or both. Pharmacy students performed medication reconciliation, structured medication counseling, and follow-up calls 72-hours post-discharge. The usual care arm received traditional education. The primary outcome was the 30-day readmission rate post-discharge. Ninety-eight patients on high-risk medications were randomized to intervention (n = 51) or usual care (n = 47). The 30-day hospital readmission rate was lower in the intervention group (8/51, 15% vs. 11/47, 23%); (p = 0.48). There was no statistical difference in the time to first unplanned health care use (hazard ratio = 0.49 (95 %CI, 0.19–1.24), or the time-to-first clinic visit post-discharge (p = 0.94) between the two arms. Students identified 26 drug-related problems during reconciliation. Patients in the intervention arm reported high satisfaction with the service (mean 3.94; SD 0.11).Involving APPE students in the transition of care activities presents an excellent opportunity to minimize pharmacists' workload while maintaining patient care services.

Evaluation of a novel process for selecting advanced pharmacy practice experiences

IntroductionMatching an increasing number of pharmacy students with a limited number of advanced pharmacy practice experience (APPE) sites has become challenging for pharmacy schools. Selective tiered optimization (STO), a process for matching students with competitive APPE electives, was implemented by The University of Mississippi School of Pharmacy (UMSOP) in 2015 to address these concerns. This pilot study sought to evaluate student and preceptor satisfaction with the process. MethodsElectronic surveys were sent to students enrolled in APPEs and individuals who precepted APPE students at the UMSOP from 2016 to 2019. The surveys were designed to gauge satisfaction with STO's process, goals, utility, and fairness. ResultsThere were 63 responses from 149 preceptors (42% response rate) and 70 respondents from 314 students (22% response rate). Overall, both students and preceptors expressed satisfaction and found value in participating in STO. Both groups indicated that the benefit they received from participating in STO outweighed the extra effort required. Preceptors indicated that students who participated in STO were of higher quality and more focused, hardworking, and interested than those who did not participate. ConclusionsRespondents were satisfied with the STO process and experience. The process was perceived by preceptors to be fair for all students and worthwhile for its participants. Our results also demonstrated that this process is effective for easing the competitive APPE selection process. Schools and colleges of pharmacy should consider utilizing this process to alleviate applicable challenges with APPE selection.

Developing an international industrial advanced pharmacy practice experience in Brazil

IntroductionIn this commentary, we advocate for implementing international industry-focused advanced pharmacy practice experiences (APPEs) that engage pharmacy students and schools with the pharmaceutical industry to develop products for the global market to broaden pharmacy student experiences in non-patient care electives. CommentaryOur five-year experience suggests the following structural components are essential to the success of the APPE: (1) identification of suitable international industry partners through non-traditional methods, such as the local, United States (US) chamber of commerce; (2) commitment by the company and educational institutions to develop key personnel to work with international students in the host country; (3) development of a global regulatory affairs course and workshops that target the product development stage; (4) development of student experiences based on projects directly linked to a new product(s); (5) use of technology platforms to support weekly video conferencing and translation; (6) engagement of students in community service; (7) cooperative evaluation of students and the program. The aggregate of student projects led to the development of a line of dietary supplement products introduced to the US market. ImplicationsThe implementation of this APPE benefits pharmacy students but also the academic and industry hosts. Pharmacy students obtained global manufacturing experience, an appreciation for a different culture, and supported commercial product development. The educational institutions developed joint courses and workshops. Students were embedded into various departments, carried out Food & Drug Administration regulations research, prepared comparative regulatory process maps, and provided company employees with an understanding of American consumers.

Implementing Student Pharmacist- Led Health Outreach Events at Long-term Care Facilities in a Medically Underserved Community.

To describe the process of creating precepted, student pharmacist-led health outreach events at long-term care facilities and to describe the lessons learned during the implementation process. Yakima, Washington, a medically underserved area. Pharmacy students, supervised by pharmacist preceptors, conducted health outreach events at local long-term care facilities on a rotating monthly basis. These students provided comprehensive medication reviews, blood pressure screenings, and blood glucose screenings. Pharmacists providing medication reviews at long-term care facilities where residents manage their medications can address polypharmacy by identifying medication discrepancies, determining the effectiveness of treatment, and improving patient outcomes. Conducting health outreach events with pharmacy-student involvement includes the added benefit of providing students with the opportunity to gain hands-on experience before beginning their clinical Advanced Pharmacy Practice Experience (APPE) rotations and practice skills described in the American Society of Consultant Pharmacists Geriatric Pharmacy Curriculum Guide and Pharmacist's Patient Care Process. Nineteen health outreach events at long-term care facilities were held, and more than 100 residents participated annually. Students coordinated events successfully after developing a standardized set of questions, which was necessary for planning, and identifying someone to act as an event coordinator, recruiting students and ensuring they were appropriately trained, and creating a monitoring form to be filled in and shared with the participant. Students learned key lessons including naming the events appropriately to avoid confusion, understanding that not all long-term care facilities are alike, deciding how many students to recruit from each cohort to participate in events, optimizing the preceptor-to- student ratio, and ensuring preceptors were thorough in their oversight of students. This work described the implementation of health outreach events conducted by supervised student pharmacists at long-term care facilities. Health outreach events could be conducted by other colleges or facilities to provide important medication review and health screening services for long-term care facilities' residents, as well as providing student pharmacists with opportunities to learn and practice patient-care related skills.

Electronic Health Records in Pharmacy Skills-based Curricula

Electronic health records (EHRs) are integral to contemporary pharmacy practice. The use of EHRs and associated skill development in curricula across pharmacy education is variable. Skills-based courses in the Doctor of Pharmacy curriculum are ideal areas to develop these competencies' and integrate EHR use and skills with the Pharmacists' Patient Care Process. Consideration should be given by each school and college of pharmacy for having an EHR curriculum embedded within skills-based courses to prepare students for advanced pharmacy practice experiences as well as professional practice after graduation. A consensus on what skills or competencies should be consistently included in pharmacy curricula should be developed across pharmacy education to increase consistency in the delivery of EHR skills education and assessment. Emphasis on EHR skills and incorporation of them into national pharmacy education standards would help further guide development and assessment, as well as ensure new pharmacists are on the cutting edge of patient care and technology.

The role of technology in assessment, documentation, and tracking of clinical competencies in radiography education

The role of technology in assessment, documentation, and tracking of clinical competencies in radiography education

Strategies for Students to Optimize Their Learning Experience in Virtual Patient-Care Settings

Authors respond to the article by Dr. Karaoui and colleagues from the November issue of volume 35 in this journal that describes challenges in pharmacy education due to the COVID-19 pandemic. The authors are students who provide strategies for student success while on virtual introductory or Advanced Pharmacy Practice Experiences during COVID-19.

Strategies for Students to Optimize Their Learning Experience in Virtual Patient-Care Settings.

Authors respond to the article by Dr. Karaoui and colleagues from the November issue of volume 35 in this journal that describes challenges in pharmacy education due to the COVID-19 pandemic. The authors are students who provide strategies for student success while on virtual introductory or Advanced Pharmacy Practice Experiences during COVID-19.

Implementation of a capstone course with Formative OSCEs to evaluate preparedness for Advanced Pharmacy Practice Experiences (APPE)

Background: Capstone courses are well documented in pharmacy programmes, but vary in content, methods, and assessment. Aim: To describe the development and implementation of a capstone course for pharmacy students. Description: Components of the capstone course included clinical reviews, pre-tests, calculations, cases, and formative and summative objective structured clinical examinations (OSCEs). Formative OSCEs were a unique aspect of this capstone course, and were used to help students identify clinical strengths and recognise areas of weakness prior to advanced pharmacy practice experiences (APPE). Evaluation: A total of 72 students completed the capstone course in spring 2018. Student survey data indicated that the format of the course was conducive to learning, particularly the use of formative OSCEs. Conclusion: A capstone course was successfully designed and implemented that assessed a variety of pharmacy knowledge and skills prior to APPE. Student feedback and performance in the course provided insight that led to revisions in the pre-APPE curriculum.

Impact of a novel preceptor collaborative advanced pharmacy practice experience curriculum on student-perceived ability and confidence

Background and purposeA novel teaching collaborative for acute care medicine advanced pharmacy practice experiences (APPEs) was formed by five faculty preceptors. The primary goal of the collaborative model was to ensure that acute care medicine APPEs provided students with opportunities to achieve Accreditation Council of Pharmacy Education Standards 2016, including strengthening students' ability to be practice- and team-ready. Educational activity and settingThe collaborative model included group discussions, video modules, patient cases, journal scans, and case presentations among student pharmacists completing an adult or pediatric acute care APPE. Anonymous, voluntary pre−/post-surveys were completed by a cohort of students who participated in the collaborative model from May 2018 to April 2019. Survey questions assessed student-perceived ability/confidence related to interprofessional (IP) relationships and decision-making skills for adult and pediatric patients, as well as value of activities. FindingsFrom the cohort of 67 students, 54 pre-survey and 45 post-survey responses were obtained. Post-rotation, students showed an increase in confidence to practice pharmacy on an IP team (39% vs. 100%, P < .001). Significant increases were also found for therapeutic decision-making regarding antibiotics, anticoagulants, and pharmacokinetics for adult and pediatric patients. Among students completing the post-survey, video modules were the most valued component of the model. SummaryA collaborative APPE model resulted in consistent increases in student-perceived ability and confidence related to care of adult and pediatric patients. This APPE model could be adapted within different care settings and pharmacy curricula.

Development of a laboratory-based pharmacogenomics independent study and advanced pharmacy practice experience: Connecting basic science to clinical application

Background and purposeThe role of pharmacists in pharmacogenomics (PGx) use clinically is expanding, leading to increased pharmacy education requirements. Current reports indicate that PGx is primarily taught through didactic courses, indicating a need for applied coursework in pharmacy curricula, including laboratory exercises and clinical experiences. Such courses are instrumental in helping students connect the science of PGx to patient care. Educational activity and settingAn advanced PGx independent study and a similar advanced pharmacy practice experience (APPE) were developed. These courses included personal genetic testing, raw genetic sequence data analysis, and wet-laboratory genetic testing. The APPE included sessions with clinical pharmacists who use PGx and a genetic counselor, as well as a visit to a genetic reference laboratory. A pre−/post-examination and survey were used to measure the courses' effectiveness and student perceptions of their abilities, PGx, and course components. For this pilot study one student per course was evaluated. FindingsEach student completed all components of the courses successfully, supporting the feasibility of their implementation. Examination scores increased for both students with improvement in knowledge from basic genetics to clinical application. Both students also had a more positive perception of PGx after the courses and valued the various course components. SummaryThrough this unique course format, pharmacy students developed expertise in understanding and implementing PGx which allowed them to gain skills that go beyond an introductory course. Our experience may provide guidance to other pharmacy programs in adding more applied PGx education to their curricula.

Use of a script concordance test to evaluate the impact of a targeted educational strategy on clinical reasoning in advanced pharmacy practice experiential students

Background and purposeIt is unclear how clinical reasoning is impacted by a single advanced pharmacy practice experience (APPE) and how preceptors can further develop these skills. Educational activity and settingStudents completing an APPE within four sites were invited to participate. To assess clinical reasoning skills, students completed a 30 item script concordance test (SCT) during week 1 and week 5 of a rotation. Students were divided into control and intervention groups. The intervention group participated in a clinical reasoning discussion, during which students presented a case and led a discussion on how to reason through treatment options. FindingsChange in mean SCT scores between week 1 and week 5 were 0.84 (2.8%) and 1.23 (4.1%) in the control (n = 15) and intervention groups (n = 28), respectively. There was no significant change in scores in the control group (P = .07, CI -0.34, 2.01). The change in scores was statistically significant in the intervention group (P = .02, CI 0.23, 2.23). An independent samples t-test comparing the SCT score change for the control and intervention group showed no significant difference (P = .62, CI -1.18, 1.96). SummaryThis study demonstrated the feasibility of implementing a SCT in experiential education. SCT scores did not significantly improve beyond the standard APPE in response to the focused educational intervention, but investigators found that the discussion facilitated rich conversations about patient cases and was valuable for assessing a student's thinking pattern.

Assessment of preceptor understanding and use of levels of entrustment

IntroductionThis study determined the need to calibrate preceptors' use of levels of entrustment (LOE) in the evaluation of students performing entrustable professional activities (EPAs). MethodsTwo introductory and four advanced pharmacy practice experience-focused cases were developed which described a fictional student, a practice site, and timing of a rotation. The cases included EPA-based tasks assigned to the student. Participants were to assign a LOE to the student for each EPA-based task. ResultsSixty of 317 preceptors participated in the study. Statistically significant differences in mean assigned LOE were found between preceptors by age (P < .05); between preceptors with differences in residency training (P < .05); and between preceptors who spent differing amounts of time with experiential students daily (P < .05). ConclusionsDifferences in assigned LOE were found based upon preceptor age, completion of a residency, and daily hours spent with experiential students. However, these differences did not result in changes to whether the student would pass or fail the rotation. Findings suggest that preceptors are consistent in assigning LOE to EPA-based tasks performed by students. In addition, preceptor development programming appears to be effective in establishing a standardized understanding of LOE among preceptors.

Evaluation of social phobia, comfort in communication, and interprofessional value during advanced pharmacy practice experiences: A focus on pharmacy student and medical resident interprofessional education

BackgroundWe implemented and evaluated communication and interprofessional socialization after a unique rotation between final year pharmacy students and medical residents. Interprofessional educational activityPharmacy students on an advanced pharmacy practice experience (APPE) in pediatric critical care completed a standard experience with (i.e. intervention group) or without (i.e. control group) a medical resident as part of the pharmacy team. The objectives of this study were to evaluate pharmacy student social phobia, communication apprehension, interprofessional socialization, value placed on interprofessional teams, and comfort interacting with a physician as a result of the APPE. Practicality and sustainability were also evaluated. DiscussionForty-six students participated (28 control, 18 intervention). Both groups had similar baseline characteristics and measure scores. No changes were observed in social phobia or communication apprehension. Both control and intervention groups showed improved scores in interprofessional socialization and valuing. Scores on the Self-Perceived Ability subscale of the Interprofessional Socialization and Valuing Scale increased for the intervention group, but not for the control group. Comfort interacting with a physician was higher in the intervention than the control group. Minimal changes to the APPE were made during the six-year study, and practicality and sustainability were positive. ImplicationsLimited data describe interactions between pharmacy students and medical residents on APPEs. Participating students increased their comfort and self-perceived ability in interacting with a physician. Due to the limited need for extra time or financial resources, this experience could be applied and studied in additional settings to assist in preparing practice ready pharmacists.

Health outcomes and policy in pharmay curricula among Arab countries: An evaluation of 191 academic institutions

IntroductionHealth outcomes and policies is a growing areas that is needed in the healthcare culture. This study aimed to examine the availability, extent and type of teaching curricula (pharmacoeconomics, pharmacoepidemiology, pharmacovigilance, patient safety) in Arab countries. MethodsA retrospective observational study was conducted during the period of November 2019 to January 2020. The collection strategy was performed by listing of pharmacy colleges in each country and then reviewing the institutions’ websites that met the inclusion criteria. Five criteria were utilized to assess the availability of these courses: full-time mandatory, full-time elective, partial mandatory, partial elective, and not offered. ResultsOne hundred ninety-one academic institutions were screened during the study period. Of those, 151 (79.1%) institutions were included in the study and their curricular descriptions were retrieved from their electronic websites. Pharmacoeconomics was the most taught subject among the four subjects. It was offered in 89/151 of the colleges among Arab countries. Among these 89 colleges that offered pharmacoeconomics, 74/89 offered it as a mandatory. While, Pharmacoepidemiology was offered in 51 colleges, with 44/51 offering the subject as a mandatory, and 6 out of those 44 list it as a full-time mandatory, while 38 out of those 44 offer it as a partially mandatory. Only 22 of the colleges offered pharmacovigilance, with 14/22 offering the subject as a mandatory. Finally, there was only one institution that offers the subject of patient safety. Moreover, most of the four courses investigated are only taught in the final two years of study. ConclusionsThe study found a clear shortcoming in the teaching pharmaceutical outcomes. More efforts are needed by academic institutions to adopt and teach these subjects to ensure they meet the work needs and advanced pharmacy practice transformation.

Attitudes, barriers and facilitators of hospital pharmacists conducting practice‐based research: a systematic review

AbstractIntroductionPractice‐based research is essential in enhancing medication knowledge, quality use of medicines, the scope of the pharmacy profession and improving patient outcomes. This systematic review aims to uncover the attitudes of hospital pharmacists towards practice‐based research and their perceptions of the barriers and facilitators to undertaking practice‐based research.MethodsA systematic search of MEDLINE, Embase, International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature databases from 1 January 2000 to 11 March 2021 was conducted. Peer‐reviewed empirical studies exploring hospital pharmacists’ perceptions of – as well as barriers and facilitators to – practice‐based research were included and a descriptive synthesis used to identify common themes.ResultsNine studies were included in this review. Barriers and facilitators across four broad themes were related to pharmacist capacity and capability, workplace environment, research resources, and research culture. Hospital pharmacists had a high interest in conducting research, but limited research experience. Common barriers identified were lack of time, workplace support, funding, research culture, and competing priorities. Having a post‐graduate qualification and a positive attitude towards research facilitated research participation. Departmental support, designated research time and creation of research networks and forums were seen as facilitators for practice‐based research.ConclusionHospital pharmacists recognise the importance of practice‐based research in improving knowledge, patient care and advancing pharmacy practice. However, large variation has been reported for their confidence and experience in practice‐based research. Building research capacity and capability by supporting post‐graduate research qualification, providing designated time and creating research networks may strengthen the research culture amongst hospital pharmacists.

Oncology boot camp: A preparatory curriculum for advanced pharmacy practice experience students.

The primary objective of this study was to evaluate the effectiveness of an autonomous oncology boot camp on Advanced Pharmacy Practice Experience (APPE) student knowledge. Secondary objectives included assessing student perception of the virtual learning experience and overall comfort level with the material. APPE students rotating through our institution between November 2019 and March 2020 were voluntarily enrolled in a 4-hour oncology-focused boot camp, which included five PlayPosit (Denver, CO, USA) interactive video lectures embedded with case-based application questions followed by one comprehensive web-based Quandary (Victoria, BC, Canada) action-maze case. Student learning was measured by a pre- and post-intervention exam. A web survey tool (Qualtrics, Provo, UT, USA) collected student perceptions evaluating their comfort with oncology-specific drug knowledge and APPE rotations tasks. Fifty students enrolled in the oncology boot camp, with 100% completing the pre- and post-intervention assessments. Overall, pre-intervention exam scores (mean: 55.4%, SD: 21.8%) improved by 23.2% following the boot camp (mean: 78.6%, SD: 19.2%; p < 0.001). Students performed better on all 10 exam questions, with 6 questions showing a statistically significant improvement (p < 0.05). Forty-five students (90%) completed the perception surveys. Of those, 93% agreed that it effectively reinforced important oncology knowledge, 91% supported the autonomous design, and 82% would recommend the oncology boot camp for future students. The boot camp proved to be a beneficial educational tool that enhanced student knowledge and confidence in navigating common oncology concepts. Students valued the ability to independently complete the activities and supported its continuation.

Adapting pharmacy experiential education during COVID-19: Innovating remote preceptor resources, tools, and patient care delivery beyond virtual meetings.

PurposeTo describe the innovative teaching practices, tools, and resources for remote learning developed by a school of pharmacy with a decentralized experiential program to empower and support preceptors in response to the coronavirus disease 2019 (COVID-19) pandemic.SummaryAs the pandemic has continued, there have been significant shifts in pharmacy workflow, staffing, and patient care delivery. Pharmacy students are slowly being reintegrated into these learning environments. Although preceptors are willing and eager to teach, many lack the resources, tools, and support to create remote learning experiences at their facilities. The University of the Pacific Thomas J. Long School of Pharmacy has a decentralized experiential education model in which faculty regional coordinators with clinical practices and diverse expertise are disseminated throughout California. This model allowed us to collaborate and understand preceptor needs from a local level. We created a preceptor COVID-19 guidance document, introduced innovative virtual playbooks to pivot up to 100% remote rotations, and promoted the layered learning model to integrate pharmacy residents into the remote teaching space. Communication and flexibility are key to ensure student and preceptor safety while maintaining high-quality advanced pharmacy practice experiences and preserving patient-student relationships in telehealth.ConclusionOverall, we successfully created innovative solutions and leveraged our decentralized experiential model to meet the teaching and learning demands during an unanticipated crisis. We continue to adapt and plan to assess the effectiveness of the tools by administering surveys of preceptors and pharmacy students.

Student and educator perspectives on virtual institutional introductory pharmacy practice experience (IPPE)

BackgroundThe COVID-19 pandemic has required governments around the world to suspend face-to-face learning for school and university students. Colleges of pharmacy are faced with the challenge of training students in hospitals that are under considerable pressure at this time. The government of Saudi Arabia has moved all classes and training online to limit the spread of the virus. This study describes the experience of the Introductory and Advanced Pharmacy Practice Experience (IPPE and APPE) students and preceptors engaged in the virtual IPPE training.MethodsA cross-sectional study was conducted to describe and appraise the implemented virtual IPPE training from the experiences of IPPE and APPE students, and their preceptor. The IPPE students described their experiences in close-ended questionnaires, while APPE students in open-ended questionnaires, and the preceptor described the experiences in narrative. The study focused on highlighting the advantages, opportunities, challenges, and shortcomings of the virtual training.ResultsTwo preceptors and seven APPE students participated in the preparation and administration of the virtual training. The IPPE students’ experiences, based on 87 respondents, were mostly positive. Although IPPE students enjoyed the time flexibility that allowed the learning of new skills and reflection on previous experiences, 15% experienced difficulty finding quiet places with a reliable internet connection or had difficulty working on team-based activities. Moreover, some were anxious about the lack of adequate patient-care experience. On the other hand, the APPE students found the experience enriching as they gained experience and understanding of academic workflow, gained skills, and overcame the challenges they faced during this virtual training experience.ConclusionsFuture training programs should be organized to overcome the challenges and to maximize the benefits of training experiences. Schools of pharmacy may benefit from the training materials constructed, prepared, and administered by APPE students to improve IPPE students’ learning experiences and outcomes.