Ambulatory Care Advanced Pharmacy Practice Experiences Research Articles

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

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

Implementation of the Individual Teamwork Observation and Feedback Tool to Evaluate Pharmacy Student Performance

Objective. To determine the appropriateness and feasibility of implementing the Individual Teamwork Observation and Feedback Tool (iTOFT) in advanced pharmacy practice experiences (APPEs) to allow direct observation and rating of students' interprofessional teamwork skills.Methods. In the academic year 2018-2019, preceptors administered iTOFT at least once during required acute care and ambulatory care APPEs. After administration, which involved direct observation of students' behavior on an interprofessional team, preceptors evaluated iTOFT results and offered feedback to students. To determine implementation success of the iTOFT activity, an implementation satisfaction survey was administered to preceptors and students, which included questions on appropriateness and feasibility.Results. The iTOFT activity was completed 149 times each during required acute care and ambulatory care APPEs. Results demonstrated positive teamwork behaviors, eg, no students received an "inappropriate" rating on any iTOFT item. The implementation survey response rate was 33% (34/102) for preceptors and 40% (50/125) for students. Both groups reported that the iTOFT activity was feasible. Respondents also reported that completing the iTOFT activity did not interfere with workflow and that it was not difficult to find opportunities to complete it. Per preceptor report, mean time to complete the iTOFT activity was 37.7 minutes, but there were concerns identified regarding fidelity with all iTOFT steps.Conclusion. Incorporation of the iTOFT activity into the required acute and ambulatory care APPEs at a school of pharmacy was feasible. Future directions include determining ways to increase iTOFT fidelity.

Addressing practical challenges with entrustable professional activities in ambulatory care experiential education

Background and purposeEntrustable professional activities (EPAs) have been adopted and endorsed by the American Association of Colleges of Pharmacy as an assessment strategy. Application of EPAs in ambulatory care advanced pharmacy practice experiences (APPEs) has demonstrated potential internal grading consistency challenges and warrants further guidance. Educational activity and settingWithin a required ambulatory care APPE, a rubric was developed using purposeful and convenience sampling of preceptors, faculty, and students to concretely delineate expected EPA level progression from week one to week four based on setting specific activities. FindingsThe rubric was perceived to be accurate and useful as a tool for improving expectations of progression in the respective roles on ambulatory care APPEs. SummarySpecifying performance of common clinical activities by weekly EPA level progression within an ambulatory care APPE was perceived to address some of the challenges in APPE grading consistency. Research for determining appropriate progression within an APPE and progression context within graduate and post-graduate training is needed. As more pharmacy training programs implement EPAs, collaboration in applying core EPAs into experiential education will be needed. This example of a setting specific progression rubric may serve as a useful tool for preceptors and students during their APPEs.

Comparison of full-time faculty preceptor and volunteer preceptor evaluations of experiential students

IntroductionOftentimes, students believe that faculty preceptors have different expectations than volunteer preceptors during experiential rotations. Despite this perception, there is no published data reporting the actual differences in volunteer and faculty evaluations. This study determined if students placed with volunteer preceptors experience a different level of evaluation rigor than students placed with full-time faculty preceptors on advanced pharmacy practice experiences (APPEs). MethodsA retrospective analysis of preceptor evaluations of student pharmacists enrolled in acute care or ambulatory care APPEs from June 2016 to May 2019 was completed to determine differences between full-time faculty preceptors and volunteer preceptors. Results were analyzed using Fisher's exact testing. ResultsWhen comparing evaluation results from volunteer and full-time faculty preceptors, a statistically significant difference was demonstrated in both acute care and ambulatory care for two of ten questions on APPE formative evaluations. No difference was observed when comparing faculty and volunteer preceptor ratings across five summative assessments. ConclusionsPreceptor evaluations of APPE students in acute care and ambulatory care settings revealed limited statistically significant differences on formative assessment over three years, while required summative assessments showed no statistically significant differences between pharmacy practice faculty and volunteer preceptors. This indicates that any difference in rigor regarding APPE student performance between volunteer and faculty preceptors is limited.

Facilitation of a multisite student topic discussion series using web-based conferencing technology

IntroductionWhile technology's use and impact in the classroom setting is well-documented in literature, use during experiential education is less defined. Our objectives were to assess the change in clinical knowledge and application skills following a multisite topic discussion (TD) series using web-based conferencing technology during ambulatory care advanced pharmacy practice experiences (APPEs) and to assess student perceptions of learning through use of this modality. MethodsA multisite TD series was created using web-based conferencing technology for students assigned to a clinical faculty member's ambulatory care APPE. Five topic discussions were conducted during each five-week rotation block covering disease states integral to ambulatory care practice. Pre- and post-assessments were administered to assess student learning and a survey was administered to assess student perceptions of learning. ResultsA total of 151 students were invited to participate in the study with 114 (75.5%) included in the final analysis. Overall student performance improved significantly from 53.3 ± 12.7% on the pre-assessment to 65.8 ± 14.3% on the post-assessment, with student performance on the post-assessment improving significantly in all topic areas. Students perceived that the TD series enhanced their learning and ability to apply clinical information while creating an online learning community. ConclusionsThe addition of a multisite TD series using web-based conferencing technology successfully enhanced student knowledge. Student perceptions of this new web-based learning community were positive overall, despite some technological limitations. The results of this study support the use of web-based conferencing technology to enhance student learning during APPEs.

Ambulatory care preceptors’ perceptions on SOAP note writing in advanced pharmacy practice experiences (APPEs)

IntroductionDescriptions of SOAP note requirements and assessment methods used during advanced pharmacy practice experiences (APPEs) are limited in the literature. This study aimed to gather information from preceptors regarding SOAP note writing and assessment methods utilized during ambulatory care APPEs. MethodsA survey was developed and distributed to ambulatory care preceptors with data collected via Qualtrics and analyzed using descriptive statistics, Fisher's exact test to assess the significance for associations between dependent and independent variables, and the Gamma test to assess dependent variables in grading habits and feedback types. ResultsThe survey response rate was 62% with 75% of preceptors having students write SOAP notes during APPEs. A majority of preceptors (84%) do not formally grade SOAP notes with full-time faculty being more likely to grade and provide written feedback. Half of the preceptors perceived students as either prepared or very prepared to write SOAP notes but the majority felt that students struggle with the assessment portion of the note. There were significant differences between schools in the percentage of preceptors that formally grade SOAP notes, ranging from 2 to 45%. ConclusionsPreceptors’ perception of student preparedness to write SOAP notes on ambulatory APPEs was similar, despite assessment methods varying widely.

Impact of a simulated electronic health record on pharmacy students’ perceptions of preparedness for clinical practice

Background and purposeThe growing use of electronic health records (EHRs) in clinical practice highlights the need to incorporate simulated EHRs into the curriculum of healthcare professions. The purpose of this study was to evaluate the impact of a simulated EHR on student performance and to describe students’ perceptions of preparedness to use an EHR in clinical practice. Educational activity and settingA simulated EHR was introduced to third-year pharmacy students in a practice lab and case studies course series. The impact of the simulated EHR was measured by comparing student grades from acute patient care and ambulatory care advanced pharmacy practice experiences (APPEs) before and after EHR implementation. Data on students’ perceptions of preparedness to use an EHR was collected by means of a questionnaire. FindingsThere was no significant difference between groups on student performance from the acute patient care APPE (p = 0.522) or from the ambulatory care APPE (p = 0.936). Questionnaire responses showed statistically significant improvements in students’ perceptions of preparedness to use an EHR in clinical practice. DiscussionPositive findings related to students’ perceptions of preparedness to use an EHR in clinical practice were used to guide expansion of the simulated EHR throughout the didactic curriculum at the Philadelphia College of Pharmacy. SummaryImplementation of a simulated EHR at the end of the PharmD didactic curriculum did not show a difference in student performance on select APPEs, but did show improvements in students’ perceptions of preparedness to use an EHR in clinical practice.

Limited Predictive Utility of Admissions Scores and Objective Structured Clinical Examinations for APPE Performance

To examine the relationship between admissions, objective structured clinical examination (OSCE), and advanced pharmacy practice experience (APPE) scores. Admissions, OSCE, and APPE scores were collected for students who graduated from the doctor of pharmacy (PharmD) program in spring of 2012 and spring of 2013 (n=289). Pearson correlation was used to examine relationships between variables, and independent t test was used to compare mean scores between groups. All relationships among admissions data (undergraduate grade point average, composite PCAT scores, and interview scores) and OSCE and APPE scores were weak, with the strongest association found between the final OSCE and ambulatory care APPEs. Students with low scores on the final OSCE performed lower than others on the acute care, ambulatory care, and community APPEs. This study highlights the complexities of assessing student development of noncognitive professional skills over the course of a curriculum.

Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students

Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP) during their Advanced Pharmacy Practice Experience (APPE) in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP's and used for this purpose with participating students on their ambulatory care APPE.
 Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18) at the start of their ambulatory care APPE. The test was designed to assess both the students' baseline knowledge regarding MRP's, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest) to complete to assess if their knowledge had increased from baseline.
 Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP's. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students' knowledge or ability to properly identify and classify medication related problems (MRP) after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884). However, a statistically significant decline in students' knowledge occurred on one specific question, which tested their ability to classify MRP's (p = 0.029).
 Conclusions: Based on the results of the pre-test, students at our institution enter their APPE year with limited baseline knowledge of medication safety within the ambulatory care setting. Results from the posttest indicate potential ineffectiveness of a written document in providing effective education on MRP's to students in the experiential setting. Education may be made more effective with a hands-on, active learning approach that overcomes the limitations of other passive forms of learning.
 
 Type: Student Project