Care Advanced Pharmacy Practice Experience Research Articles

The Divergence between Self- and Preceptor-Assessments of Student Performance during Advanced Pharmacy Practice Experiences.

(1) Objectives: A divergence in self- and preceptor-evaluations of clinical skills has been noted during Advanced Pharmacy Practice Experiences (APPEs). The goal of this study was to determine the domains of overestimation of clinical skills by students during their APPE rotations. (2) Methods: Preceptor-assigned grades for APPE rotations from 2017-2022 were analyzed to identify instances of letter grade B or lower. The self- and preceptor-evaluations of APPE rotation were compared to determine the domains of divergence in evaluation between students and preceptors. (3) Results: Between 2017 and 2022, 305 student APPE rotations were graded as B or lower (~14%) by the preceptors. A statistically significant difference was noted between self- and preceptor-assigned letter grades across all practice settings including ambulatory patient care, community pharmacy, general medicine patient care, hospital/health system pharmacy, and special population patient care APPE rotations. In addition, examining the self- and preceptor evaluation rubric for these rotations revealed a statistically significant overestimation of clinical skills by students in all 9 domains of APPE evaluation. Finally, the divergence in the rating of clinical skills between student- and preceptor evaluation was found to be highest in the domains of planning and follow-up of patient care, disease knowledge, and communication with patients. (4) Conclusions: Students who fail to exhibit exemplary practice readiness during APPEs tend to overestimate their clinical skills in all domains of APPE evaluation. The results from our study support the need for additional avenues to assist in the identification of deficits in student learning before APPEs to increase their self-awareness (metacognition).

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.

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.

A classroom-based patient case activity as a potential formative indicator of pre-advanced pharmacy practice experience readiness

Background and purposePharmacy programs must assess student readiness for advanced pharmacy practice experiences (APPEs). This study evaluated: (1) if a relationship exists between student performance on a classroom-based patient case activity (Rx Review) and (2) performance on direct patient care and perceptions of the transferability of Rx Reviews to the APPE setting. Educational activity and settingRx Reviews are timed, independent, prospective reviews of a patient's medical record intended to simulate pre-rounding activities common in acute and ambulatory care settings. Students complete 12 Rx Reviews across a skills laboratory course sequence. Rx Review scores were compared to performance on acute care and ambulatory care APPEs for students in the Class of 2019 using descriptive statistics for student scores and bivariate logistic regression for the association between Rx Review scores and performance outcomes on patient care APPEs. Student perceptions of the Rx Reviews were assessed through a survey. Descriptive statistics and qualitative responses were used to analyze responses to the multiple-choice survey questions and open-ended question, respectively. FindingsOne hundred twenty-two students participated in the study. A relationship was found between students' Rx Review scores and performance in certain direct patient care APPEs, with students performing in the bottom 50% on Rx Reviews being more likely to perform poorly on those APPEs. Over 93% of students identified Rx Reviews as at least somewhat helpful in preparing them for APPEs. SummaryThis study indicated that a classroom-based patient case activity could be used as a formative measure of APPE readiness.

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.

Performance on advanced pharmacy practice experiences after implementation of mock acute care patient simulations

IntroductionWe sought to compare student performance on acute care advanced pharmacy practice experiences (APPEs) pre- and post-incorporation of mock acute care patient simulations into the curriculum. MethodsA series of mock acute care APPE simulations (MACAS) were developed and incorporated into Touro University California College of Pharmacy curriculum for first- and second-year pharmacy students. Results for student performance on Acute Care I and Acute Care II APPEs were collected for students who received none, one year, or two years of the MACAS. Student admission characteristics and didactic academic performance (grade point average [GPA]) were also gathered. Student characteristics and APPE performance were compared across cohorts of students who received none, one year, and two years of MACAS. Multivariate models were created to measure the impact of the MACAS while controlling for student characteristics. ResultsThe final cohort included 394 students. In unadjusted analyses, students with one or two years of MACAS received significantly higher preceptor acute care APPE evaluations for communication, professionalism, and patient scores vs. students who received no MACAS. In multivariate models controlling for age, gender, and undergraduate GPA, one year of MACAS increased student acute care APPE communication, professionalism, and patient care scores, relative to no MACAS. Similar increases in acute care APPE scores were seen for students who received two years of MACAS. ConclusionsMACAs significantly improved acute care APPE scores relative to students with no MACAS. This improvement in acute care APPEs occurred after students received a single year of MACAS.

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.

Examining student self‐awareness of performance on entrustable professional activities given context of preceptor evaluations

AbstractIntroductionIn experiential learning, student self‐evaluation is used to determine students' self‐awareness. At our institution, we ask students to self‐assess their performance on Entrustable Professional Activities (EPAs) on Direct Patient Care rotations.ObjectivesThe purpose of this study is to investigate if students can accurately self‐evaluate performance on EPAs during patient care practice experiences and if their accuracy and therefore, self‐awareness, improves over time.MethodsThis is a retrospective study using data that was collected from both student and preceptor final evaluations at three time points: T1 or Direct Patient Care Introductory Pharmacy Practice Experience (IPPE) (second or third year), T2 or the First Direct Patient Care Advanced Pharmacy Practice Experience (APPE) (fourth year), and T3 or the Last Direct Patient Care APPE (fourth year). The primary end point examined change in accuracy over time across all EPAs (global accuracy). The secondary end point examined bias or the under‐/overconfidence. The tertiary end point examined if student accuracy for individual EPAs changes over time.ResultsFor the primary end point, global accuracy, accuracy significantly improved over time (P &lt; .001) with time point one (T1 = 0.52) being more inaccurate than time point two (T2 = 0.26) and time point three (T3 = 0.027). For the secondary end point, bias (degree of under‐/overconfidence), there was no significant difference over time. When examining each individual EPA for changes in accuracy over time, we found individual EPAs showed the same significant trend (P &lt; .001) as global scores.ConclusionStudents' self‐assessment accuracy and therefore self‐awareness of their performance on EPAs improves over time. In all EPAs, the significant improvement in accuracy occurs between the students' Direct Patient Care IPPE (T1) and their first Patient Care APPE (T2). This evidence suggests the importance of early exposure of students to direct patient care activities, and that self‐evaluation of EPAs is beneficial to student development and leads to improved self‐awareness of their performance over time.

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.

Development of self-directed activities and a validated exam for primary care advanced pharmacy practice experiences

IntroductionThe impact of required self-directed activities (SDAs) measured by written exam on advanced pharmacy practice experiences (APPEs) has not been reported. The primary objective of this study was to determine the validity and reliability of a pre/post exam to measure knowledge when SDAs are incorporated into primary care APPEs. Secondary objectives included assessment of pre/post exam scores and students' perceptions of their learning through SDAs. MethodsTwo faculty implemented required SDAs and a pre/post-exam in their APPEs. Face and content validity were assessed using expert consensus. A retrospective exam of student performance from May 2016 to April 2018 was performed (n = 42). Additional APPE assessment scores were also collected to determine correlations and establish criterion validity. Students who completed the APPE during May 2016 to February 2017 (n = 17) were invited to complete an anonymous, 15-item cross-sectional survey to assess student perceptions of the activities. Differences in self-rated knowledge before and after the rotation were assessed. ResultsPre-exam and post-exam scores positively correlated with journal club and the APPE grading rubric and final scores. Overall, interrater reliability was excellent. Significant improvement was seen between pre-/post exam scores with a mean (SD) change of 21.5% (9.4%). Thirteen (77%) students completed the anonymous survey and rated their perceived knowledge significantly higher after completing the SDAs. ConclusionsThe pre/post exam was valid, reliable, and positively correlated with other graded assignments. Significant improvements in exam scores and survey results support SDAs as an effective teaching method on primary care APPEs.

Scalability of a remote advanced pharmacy practice experience with post‐graduate year one pharmacy resident preceptors

AbstractIntroductionDue to suspension of onsite clinical instruction due to the coronavirus disease 2019 (COVID‐19) pandemic, a remote acute care rotation was created to provide students with an Advanced Pharmacy Practice Experience (APPE) and post graduate year one (PGY‐1) pharmacy residents with an opportunity to gain experience in precepting roles.ObjectiveThe objectives of this study were to evaluate student knowledge, clinical skills, communication, student satisfaction, and PGY‐1 pharmacy resident acceptance of this remote rotation and fulfillment of residency precepting objectives.MethodsA five‐week remote acute care APPE rotation was created with pharmacy residents serving as co‐preceptors. A written evaluation and intermittent clinical examination (ICE) were deployed at baseline and conclusion to assess student knowledge, clinical skills, and communication. Student surveys assessed perceived skill improvement, satisfaction, and assessment of rotation and resident preceptors. Surveys were also utilized to evaluate resident perceived attainment of precepting objectives and residency program fulfillment of precepting requirements.ResultsThirty‐four students and 10 residents participated in the rotation. Student knowledge and clinical skills increased from baseline (41 out of 60 [31‐52] vs 50 [43‐55]; P &lt; .001) and the ICE (36 out of 70 [18‐55] vs 59.5 [43‐70]; P &lt; .001). There was a statistically significant increase at rotation conclusion in resident rating of extreme competence or extreme comfort in 45% of domains assessed.ConclusionA remote APPE rotation is an effective approach to deliver an APPE rotation and can be successfully used to further student knowledge and provide PGY‐1 pharmacy residents a precepting opportunity to advance their precepting skills when onsite experiences are limited.

Implementation of general medicine topics for acute care inpatient advanced pharmacy practice experiences

IntroductionThe purpose of this study was to describe the development of a general medicine student workbook to standardize acute care inpatient fourth-year pharmacy rotations among faculty with varied pharmacy practice sites. MethodsFour faculty designed an advanced pharmacy practice experience (APPE) student workbook on general medicine topics consisting of short answer and multiple-choice questions to ensure standardization by exposing all students to the same topics. A pre- and posttest was administered on the first and last day of the five-week rotation block to evaluate the effects of the APPE workbook on student understanding of general medicine topics. A paired t-test was used to evaluate the significance of the difference in test scores. ResultsThe average of the posttest exam was found to be significantly higher after the completion of the student workbook. The average grade on the pre-rotation 30-item exam was 22.8 (76.73%) and the post-rotation 30-item exam was 25.7 (86.26%), with a difference of 9.53% (P < .001, 95% CI = 7.11 to 11.96). ConclusionsCreating a standardized student workbook for an inpatient acute care rotation was a valuable addition. All students assigned to the faculty involved were exposed to the same topics despite variability in preceptors and practice sites. Overall the verbal feedback from the students was positive about the student workbook and discussions, especially since the information was applicable to their patients on rotation. Faculty will continue to use this workbook as a tool to teach various inpatient general medicine topics during the acute care APPE.

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.

Assessing student confidence in interprofessional communication during primary care advanced pharmacy practice experiences (APPEs)

Background and purposeStudents must have experience communicating and interacting with healthcare professionals throughout pharmacy school curricula to effectively develop interprofessional communication abilities and confidence. This study’s purpose was to assess student confidence in interprofessional communication utilizing a rubric and checklist inspired by the situation-background-assessment-recommendation (SBAR) technique throughout five-week primary care advanced pharmacy practice experiences (APPEs). Educational activity and settingA six-item rubric was created for student self-evaluation of interprofessional communication throughout their APPE. Students completed the rubric twice to evaluate change in confidence. Additionally, a pre-post rotation survey was developed to assess students’ comfort level rounding with healthcare professionals and interacting/intervening with other healthcare professionals to address a medication-related problem. A paired t-test was used to evaluate changes in perceived student confidence in rubric self-evaluations and pre- and post-APPE surveys. FindingsFrom May 2017 to April 2019, 93 students completed primary care APPEs with faculty authors, and 181 encounters were self-evaluated using the rubric. Forty-eight students completed all rubric sections twice; their mean self-evaluation score increased significantly from 15.25/18 to 17.10/18 (P < .001). Self-evaluation scores increased significantly on all rubric sections (P < .05) except professional language (P = .133). Student comfort level rounding with healthcare professionals and interacting/intervening with healthcare professionals to address a medication-related problem increased significantly (P < .001). SummaryInterprofessional communication practice, preceptor observations and feedback, and utilization of an interprofessional SBAR-inspired communication rubric contributed to improved student confidence in making patient care recommendations to physicians.

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.

A Modeling Exercise to Identify Predictors of Student Readiness for Advanced Pharmacy Practice Experiences

Objective. To model the relationship of common pharmacy education assessment data including student demographics, pre-pharmacy performance, core didactic performance, and external testing measures to identify predictors of student readiness for advanced pharmacy practice experiences (APPEs). Methods. The associations between 23 predictive covariates from 226 graduating students from 2015-2018 (5786 observations) and APPE readiness as measured by midpoint core APPE scores were modeled. Multiple linear and Poisson regression models with backward selection were used. A selection criterion of p >.10 was used for covariate elimination from the model. Three models were evaluated: average of all midpoint core APPE rotation scores; average of midpoint acute care pharmacy practice and ambulatory care APPE rotation scores; and number of midpoint core clerkship failing scores. Results. The average age of the population at admission was 25.4±4.5 years, 47% were female, and 75.2% had prior degrees. Across the three prediction models, knowledge-retention covariates were the strongest predictors. Total score on the Pharmacy Curriculum Outcomes Assessment was a modest yet consistent predictor across the models. All other significant predictors were unique to the various models. Conclusion. This four-year, population-based modeling study of the relationship of common pharmacy education assessment data to APPE midpoint scores shows a modest correlation with knowledge-based measures. There is a need for greater innovation in this area of research.

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.

Implementation of Mock Acute Care Advance Pharmacy Practice Experience Simulations and an Assessment Rubric

Objective. To implement a mock acute care advanced pharmacy practice experience series into the didactic training of second-year pharmacy students and validate an accompanying assessment rubric. Methods. Three 90-minute acute care patient simulation laboratory sessions were developed with input from clinical specialists, preceptors, students, and faculty members. An accompanying student evaluation rubric was also developed. The assessment rubric was validated using pairs of preceptor raters to determine inter-rater reliability, along with predictive validity on advanced pharmacy practice experience (APPE) acute care scores. A student survey was also conducted. Results. The mock acute care APPEs were successfully implemented into the didactic curriculum. The assessment rubric had good inter-rater reliability and good predictive validity with acute care APPEs. Survey results indicated that students found the mock acute care APPE simulation laboratories useful. Conclusion. Other schools seeking to enhance their students' preparedness for and performance in acute care APPEs should consider implementing acute care APPE simulations in the didactic curriculum.

Tracked Patient Encounters During Advanced Pharmacy Practice Experiences and Skill Self-assessment Using Entrustable Professional Activities

Objective. To determine if the number of patient encounters during advanced pharmacy practice experiences (APPEs) relates to student self-assessment of patient care skills using entrustable professional activities (EPAs). Methods. During 12-week acute care/institutional (AC/INST) APPEs, 15-week combined community pharmacy and ambulatory care (CPAC) APPEs, and three 5-week AC/INST or CPAC elective APPEs, fourth-year pharmacy students completed patient tracking surveys. Students documented the number of encounters, type of care provided, primary and secondary diagnoses, and special dosing/population considerations. Students completed self-assessment surveys for 12 EPAs. Students rated their ability to perform each EPA using a four-point scale (1=still developing this skill; 4=can do this independently) at the start and after each APPE semester. Results. Data were collected from May 2016 through April 2017. During this time, 165 students completed APPEs. Students reported 79,717 encounters. There was no significant correlation found between total number of encounters and EPA scores. The baseline EPA mean score was 3.1 and semester 3 EPA mean score was 3.7. The mean student-reported EPA scores did increase over time, some more quickly than others. Conclusion. Tracking student patient encounters provided insight into the quantity and variety of patients and conditions seen and level of care provided by students during APPEs. Mean scores on EPAs increased over time with increased exposure to patients. Patient tracking can be used to inform the curriculum by identifying potential gaps in both didactic and experiential education.