Ambulatory Care Advanced Pharmacy Practice Research Articles

Impact of removing group SOAP note writing from a problem-based learning course series on documentation performance during experiential rotations

Background and purposeDocumentation is a key component of pharmacy education, and SOAP (subjective, objective, assessment, plan) notes are a common framework. Learners must receive feedback, but the amount needed to achieve desired outcomes on experiential rotations is unknown. This study assessed the impact of discontinuing group-written SOAP notes in a four-course problem-based learning (PBL) series on note scores in experiential rotations. Educational activity and settingThree cohorts across five graduating classes were compared; group-written SOAP notes in four, two, and no PBL semesters. Note writing scores on inpatient medicine and ambulatory care introductory and advanced pharmacy practice experiences (IPPEs and APPEs) were compared using logistic analysis. The odds ratio (OR) of writing a “high performance” note was determined compared to the reference of zero semesters of PBL note writing. FindingsAdditional PBL SOAP note writing did not impact inpatient medicine IPPE scores; however, four semesters of note writing significantly lowered internal medicine APPE note writing scores (OR = 0.51, 95% CI = 0.31–0.84, P = .008). In contrast, two and four semesters of SOAP note writing improved ambulatory care IPPE note writing (OR = 2.33, 95% CI = 1.17–4.65, P = .02 and OR = 2.48, 95% CI = 1.47–4.16, P < .001, respectively) but there was no difference in ambulatory care APPE note scores. SummaryRemoving opportunities for group-written SOAP notes in a PBL course series minimally impacted students' performance on APPEs. Institutions may consider if current SOAP note feedback is effective in preparing learners for APPEs.

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.

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

Comparing perceptions of student abilities in diabetes self-management education and support among students, faculty and patients

Background and purposeDiabetes self-management education and support (DSMES) equips patients with diabetes with the knowledge needed for appropriate management. The purpose of this study was to compare perceptions of student confidence/aptitude held by students, pharmacy faculty preceptors, and patients regarding student teaching of a DSMES class. Educational activity and settingThe study was a prospective assessment of fourth-year ambulatory care advanced pharmacy practice experience students. Students taught a single DSMES class and evaluated their confidence using a 14-item survey before and after the class. Patients who participated in the class and a pharmacy faculty observer completed the same instrument. Responses were compared using Friedman and Wilcoxon signed-rank tests, as appropriate. FindingsTwenty-six students completed the survey. Overall, students’ self-perceived confidence scores significantly increased for all questions after teaching the DSMES class (P < .001 for all questions). Confidence scores among students and faculty preceptors were similar with no significant differences in perceived confidence. There were some significant differences found among student and patient scores, with patients assessing student’s perceived self-confidence higher than the students on three items (P < .05). SummaryStudent pharmacists’ perceptions of their own confidence and abilities improved from before to after teaching a DSMES class. Student and faculty preceptor confidence scores were similar. There were few differences between student and patient confidence scores, with patients rating students highly on their perceived confidence in teaching a DSMES class. Patient feedback is important to consider when evaluating student confidence and abilities.

Ambulatory care practice in the COVID-19 era: Redesigning clinical services and experiential learning.

The coronavirus disease (COVID‐19) has created a variety of challenges for health care professionals, including ambulatory care clinical pharmacists. High‐quality remote and minimal‐contact care has become a necessity. Ambulatory care clinical pharmacists around the nation have adjusted their practice. In many cases, this included implementation of telehealth programs for comprehensive medication management. The redesign of ambulatory care Advanced Pharmacy Practice Experiences (APPE) also required quick adaptation. In this paper, we describe the clinical practice and experiential education challenges encountered by an ambulatory care clinical pharmacist workgroup in a COVID‐19 “hotspot,” with an emphasis on solutions and guidance. We discuss how to adapt ambulatory care clinical pharmacy practices including methods of minimal‐contact care, reimbursement opportunities, tracking outcomes, and restructuring ambulatory care APPE. As ambulatory care clinical pharmacists continue to expand the services they provide in response to COVID‐19, we also describe opportunities to promote pharmacists as providers during times of pandemic and into the future.

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.

Educational Prescriptions to Document Evidence-Based Medicine Questions in Ambulatory Care Advanced Pharmacy Practice Experiences

Objective. To design, implement, and assess the use of "educational prescriptions" or Education Rx assignments in advanced pharmacy practice experiences (APPEs) in ambulatory care, and to assess the impact of the assignments on Doctor of Pharmacy (PharmD) students' self-efficacy to practice evidence-based medicine (EBM). Methods. Students enrolled in select ambulatory care APPEs completed up to four Education Rx assignments. The assignments required students to report the context of the question, source of information, results, appraisal of validity, and relevance of the evidence, and to answer the clinical question. A rubric was used that contained three subparts: a patient/population, intervention, comparison, outcome (PICO) conformity score (8 points), presence of answer to the PICO (1 point), and quality of answer to the PICO (6 points). Demographic information was collected and students were surveyed at the end of the APPE to rate their self-efficacy executing seven evidence-based medicine (EBM) skills. Results. Thirty students completed 110 Education Rxs. The average score (SD) was 13.6 (2.2) with a PICO conformity subsection score of 7.3 (1.3), and quality of answer subsection score of 5.3 (1.2). Only one Education Rx did not have an answer. Students consulted point-of-care references for a majority of the answers (65%). Sixteen (53%) students completed the self-assessment survey, and all strongly agreed or agreed that the Education Rx activity improved their ability to formulate a well-constructed clinical question and evaluate and apply the evidence. Conclusion. Through Education Rxs, PharmD students' self-confidence and their skills in finding answers to clinical questions increased.

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.

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.

Assessment of a didactic ambulatory care pharmacy elective on student perceptions and subsequent performance in an ambulatory care advanced pharmacy practice experience

IntroductionThis study assessed student perception in treating chronic disease states before and after taking an ambulatory care didactic elective and the impact on performance within a fourth-year ambulatory care advanced pharmacy practice experience (APPE). MethodsAssessment of student perceptions was evaluated in students taking the Fall 2016 and Spring 2017 elective offering by completing an 11-item electronic survey prior to the first lecture of the course and after the last lecture of the course. A retrospective assessment of student performance in the APPE compared students that had taken the elective to those that had not over a two-and-one-half year period. Data collected included the students’ final APPE experiential and required examination grade. ResultsIn all but one survey question, student perceptions significantly improved upon completion of the elective. Student ambulatory care APPE final experiential grades were higher in students who had taken the elective compared to those that had not (90.3% vs. 88.9%, respectively, p = 0.04) as were APPE examination scores (78.0% vs. 74.0%, respectively, p = 0.01). Discussion and conclusionsStudent perception in key ambulatory care concepts, disease states, and drug knowledge improved after taking the ambulatory care elective. Student ambulatory care APPE performance was also mildly improved as a result of taking the elective compared to those who did not take the course. This is the first study to evaluate subsequent performance in an APPE as a result of taking an elective ambulatory care course and can serve as a template for other research in elective assessment.

Impact of Instruction and Feedback on Reflective Responses during an Ambulatory Care Advanced Pharmacy Practice Experience

Objective. To investigate whether instruction and feedback on reflective responses are beneficial in developing pharmacy students to become more reflective practitioners. Methods. Students on an advanced pharmacy practice experience answered weekly reflection questions and were randomly assigned to either an intervention (received instruction and feedback on reflection) or control group. The final week's responses were de-identified and two blinded faculty members independently categorized them as reflective or nonreflective. The primary outcome measure was comparing the number of "reflective" responses in each group. Results. The responses were classified as reflective in 83.3% of students in the intervention group (n=18) compared to 37.5% of the control group (n=16). The odds that the response was categorized as reflective were 8.3 times higher in the intervention group. Conclusion. Providing instruction and feedback to students improved the likelihood that their work was reflective.

Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences

To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students' competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs.

Assessment of core knowledge during ambulatory care advanced pharmacy practice experiences using online modules and pre- and post-testing

ObjectivesTo evaluate whether knowledge on core ambulatory care topics, as measured by pre- and post-testing, improved during ambulatory care advanced pharmacy practice experiences (APPEs) after completing online modules and topic discussions individualized to specific student needs. MethodsPreceptors for eight ambulatory care APPE sites developed a 54 question pre-post-test and online modules for 10 knowledge areas, which include guidelines, algorithms, literature, clinical pearls, special populations, lecture handouts, patient education resources, and a self-assessment quiz. Online modules and individualized learning experiences were required for content areas with a score of <60% on the pre-test. ResultsOverall, 70 students were evaluated. The mean overall pre- and post-test scores were 65.1% and 86.3%, respectively [mean change 21.2% (p < 0.0001)], and improvement in each content area was significant. ConclusionThe use of individualized online modules and topic discussions based on pre-test scores significantly improved student knowledge in core ambulatory care content areas during APPEs.

A Multipreceptor Approach to Ambulatory Care Topic Discussions

To assess the impact of a multipreceptor approach to facilitating topic discussions on students' knowledge and confidence in clinical decision-making during an ambulatory care advanced pharmacy practice experiences (APPEs). Faculty members with relevant expertise and experience facilitated discussions with fourth-year doctor of pharmacy (PharmD) students regarding 7 ambulatory care topics. A student self-assessment survey and knowledge-assessment instrument was administered before and after discussions. Students' examination scores increased significantly from 59.1% ± 13.9% at baseline to 76.5% ± 12.6% at the end of the 5-week experience (p<0.001). The majority of participants were comfortable making therapeutic decisions regarding medication use as it related to all discussion topics except heart failure. Participation in topic discussions led by faculty members with expertise and experience for each ambulatory care topic was associated with a significant improvement in knowledge-assessment scores.

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

Assessing student knowledge using pre- and postrotation testing on an ambulatory care advance pharmacy practice experience and the use of interactive disease state discussions

ObjectiveTo describe the use of pre- and postrotation testing to objectively measure student knowledge during an ambulatory care advanced pharmacy practice experience (APPE) that used interactive disease state discussions. MethodsStudents on an ambulatory care APPE with select faculty preceptors at a school of pharmacy completed a pretest at the beginning and posttest at the end of the rotation that focused on common disease states in an ambulatory setting. Students were not aware of when assessments would occur. Throughout the APPE, the students participated in disease state discussions and applied the information in patient care encounters during the APPE. The tests were used to assess the students' knowledge of key therapeutic concepts. ResultsStudent knowledge improved as measured by a significant improvement in posttest scores from pretest scores. However, a satisfactory score of 70% correct was not uniformly attained and, in analyzing specific questions, key concepts on the disease states were missed by students despite the overall improvement in test scores. ConclusionsDisease states discussions augmented an ambulatory care APPE and played a significant role in improving student knowledge on core disease concepts. Although a posttest was useful in assessing therapeutic information gained through an APPE, only 60% of students achieved a satisfactory level of performance. Incorporation of a formalized assessment at the end of an APPE as an objective means of determining minimum pharmacotherapy competency would be beneficial.

Multi-site Heart Disease Risk Assessment Service Provided by Pharmacy Students

To evaluate a pharmacy student service focused on patient coronary heart disease (CHD) risk assessment. Fourth-year pharmacy students offered a CHD risk assessment service at 5 physicians' offices as part of ambulatory care advanced pharmacy practice experience (APPE). Patient acceptance of the service was assessed using a satisfaction survey instrument. Fifty-seven students educated 311 patients about CHD risk. Of the 258 patients who completed the satisfaction survey, 245 (95%) reported that the service was helpful in understanding CHD risk, and 79 (31%) learned of a personal CHD risk factor of which they were not previously aware. Student knowledge was assessed using a multiple-choice pretest and posttest focused on CHD knowledge recall. Students' test scores improved from pretest to posttest (mean 51.6 % +/- 1.1 vs. 64. 8% +/- 1.0. respectively; p = 0.01). A CHD risk assessment service provided by APPE students in ambulatory care settings was educational for both students and patients.

Resident Physicians’ Acceptance of Pharmacy Students’ Pharmacotherapy Recommendations During an Ambulatory Care Advanced Pharmacy Practice Experience

To compare the acceptance rates of written versus verbal pharmacotherapy recommendations made by pharmacy students on an ambulatory care advanced pharmacy practice experience (APPE). Fourth-year pharmacy students made written and verbal pharmacotherapy recommendations to resident physicians in an internal medicine clinic at an urban, teaching hospital over a 10-month period. The types of recommendations and outcomes of the interventions were recorded using a data collection form to determine differences in acceptance rates for written versus verbal recommendations. The recommendation types and corresponding acceptance rates were also compared. Of 542 pharmacotherapy recommendations made by 14 APPE students during the 10-month study period, 65.1% were written and 34.9% were verbal. Of the 189 verbal recommendations, 97.9% were accepted, compared with 83.6% of written recommendations (p < 0.0001). The most frequent types of recommendations and overall rates of acceptance were dosage change (87.0%), laboratory monitoring (85.8%), and medication initiation based on evidence-based medicine guidelines (79.3%). Verbal pharmacotherapy recommendations made by pharmacy students were accepted by resident physicians at a significantly higher rate than written recommendations in an outpatient internal medicine clinic.

ANY QUESTIONS

<b>Objective</b>. To evaluate a pharmacy student service focused on patient coronary heart disease (CHD) risk assessment. <b>Design</b>. Fourth-year pharmacy students offered a CHD risk assessment service at 5 physicians9 offices as part of ambulatory care advanced pharmacy practice experience (APPE). Patient acceptance of the service was assessed using a satisfaction survey instrument. <b>Assessment</b>. Fifty-seven students educated 311 patients about CHD risk. Of the 258 patients who completed the satisfaction survey, 245 (95%) reported that the service was helpful in understanding CHD risk, and 79 (31%) learned of a personal CHD risk factor of which they were not previously aware. Student knowledge was assessed using a multiple-choice pretest and posttest focused on CHD knowledge recall. Students9 test scores improved from pretest to posttest (mean 51.6 % ± 1.1 vs. 64. 8% ± 1.0. respectively; <i>p</i> = 0.01). <b>Conclusions</b>. A CHD risk assessment service provided by APPE students in ambulatory care settings was educational for both students and patients.