Introductory Pharmacy Practice Experience Research Articles

Students' attitudes and perceptions of a structured longitudinal introductory pharmacy practice experience (IPPE) medicine rotation

Objectives To implement a structured, longitudinal introductory pharmacy practice experience (IPPE) that provided real practice experiences, increased students' understanding of clinical pharmacy, and addressed accreditation standards. Methods A quasi-experimental design was used. Students completed a month-long IPPE structured around an established advanced pharmacy practice experience (APPE) with participation in activities based on learner level. Matched surveys of students' attitudes and perceptions before and after the IPPE were compared. Students' attitudes and perceptions on this IPPE approach were also compared with a traditional shadowing approach (controls). Results Thirty students completed the IPPE. After completion, students had increased confidence in skills practiced during the IPPE and improved understanding of the pharmacist's role compared with responses before completion and control student responses. Conclusion This innovative IPPE approach represents an efficient way to provide patient care experiences to IPPE students in accordance with accreditation standards. Because IPPE activities were layered on established APPE activities, this model could be adapted to other clinical settings that provide APPEs.

A novel approach to Introductory Pharmacy Practice Experiences: an integrated, longitudinal, residence-based program

Objective Introductory pharmacy practice experiences (IPPEs) became part of accreditation standards for schools of pharmacy in 2004. However, a novel practice experience program that places students in the community visiting patients began at Auburn University Harrison School of Pharmacy in 1997. This article will describe the structure and success of our IPPE program. Methods This IPPE is a longitudinal program that spans the first three professional years and focuses on patient care in residential settings. Student pharmacists and faculty collaborate in managing a patient caseload. During patient visits, student pharmacists conduct interviews and assessments that are then presented at weekly team meetings. Faculty members provide supervision and guidance to students during these meetings. Students document patient interactions in an electronic record. Teams meet to discuss patient status and explore patient care issues. Student pharmacists, faculty mentors and the IPPE coordinator make interventions on behalf of the patient if needed. Results Over the past four academic years, almost 97% of students have received grades of either satisfactory or excels. Student pharmacists' success in the course has been high and positive student feedback has been expressed through course evaluations and student focus groups. Conclusion This IPPE program is part of the culture of Harrison School of Pharmacy and provides student pharmacists with relevant, real-life pharmacy care responsibilities. The program teaches communication, patient and drug therapy assessment, health care issues, and promotes professional socialization. The program's design is a unique method for providing introductory pharmacy practice experiences.

High-Fidelity Patient Simulation Series to Supplement Introductory Pharmacy Practice Experiences

To introduce a high-fidelity simulation series into a 5-year doctor of pharmacy (PharmD) curriculum to demonstrate a hybrid model for introductory pharmacy practice experience (IPPE) delivery. Fourth-year pharmacy students at a satellite campus participated in a 6-week high-fidelity patient simulation series in which small groups of students worked with members of a patient care team to care for patients in the following scenarios: asthma exacerbation, acute decompensated heart failure, and infective endocarditis with a subsequent anaphylactic reaction to the antibiotic. Fourth-year pharmacy students at the main campus who did not participate in the simulation served as a comparator group. Students' scores on a knowledge-based post-simulation quiz were significantly higher than scores on the presimulation quiz (p < 0.05). Knowledge retention was significantly higher among the simulation participants than students in the comparator group (p = 0.004). The majority (76%) of students felt more confident "making clinical recommendations to a healthcare provider" after completing the simulation series (p = 0.01). High-fidelity patient simulation is an effective active-learning strategy to augment IPPEs that allows students to apply clinical skills in a realistic but low-risk patient care setting.

Reflections on a Decade of Progress in Pharmacy Education: Reasons for Celebration

The profession of pharmacy recently passed a historic milestone that merits recognition, discussion, and celebration. I am referring to July 2010, which marked the passage of 10 years since all entry classes of pharmacy students were enrolled in doctor of pharmacy (PharmD)-only programs. Driven by the profession's aspirations for a larger role in health care, the Accreditation Council for Pharmacy Education (ACPE), a decade ago, began accrediting only pharmacy education programs that met its standards for the PharmD degree. The successful transformation of pharmacy education over the past 10 years is a tribute to the leadership of the administrators and faculty members at accredited colleges of pharmacy, the dedication of practitioners who take students under their wings for experiential instruction, the support of ACPE's 3 sponsors (American Association of Colleges of Pharmacy, American Pharmacists Association, and National Association of Boards of Pharmacy), the guidance and advice of other pharmacy organizations, and the work of the board of directors, other volunteers, and staff members of ACPE. All of the colleges and schools of pharmacy in operation 10 years ago met the deadline for conversion from the bachelor of science (BS) degree to the PharmD entry-level (first professional) degree. This was an enormous achievement. It involved marshalling resources for an additional year of instruction and making significant changes in the content and structure of the curriculum, including the addition of introductory pharmacy practice experiences (IPPE) and expanded advanced pharmacy practice experiences (APPE). Demonstrating immense ingenuity, many colleges and schools of pharmacy during this period pioneered new ways of applying their resources to meet the challenge of preparing new pharmacists for an expanded role in health care. These innovations included: Distance education, both synchronous and asynchronous Creation of branch campuses (with or without distance education) 3-calendar-year curricula 2-plus-2 curricula Modular curricula organized by body organ system/disease states Integrated instruction in the biomedical, pharmaceutical, social/behavioral/administrative, and clinical sciences Team-based instruction Problem-based learning initiatives Service-learning initiatives Expanded use of high-tech simulation in teaching Facilitated dual-degree curricula (PharmD with master of business administration [MBA] degree, master of public health [MPH] degree, doctorate [PhD] degree, etc) This spirit of innovation among colleges and schools of pharmacy was supported by the revisions in the standards for pharmacy education that ACPE adopted in 2007. Examples of that support through revised standards include: Required interviews of student applicants as part of the admission process Greater use of active-learning techniques Outcomes-based assessment of student learning and curricular effectiveness Outcomes-based programmatic assessment Greater interprofessional instruction More curricular emphasis on medication safety, cultural competence, professionalism, and research principles Higher expectations for quality IPPEs and APPEs Accommodation of new areas of science in pharmacy, including pharmacoeconomics and pharmacogenomics Expanded use of portfolios to document faculty member and student progress and competencies Improved preparation of preceptors as educators, assessors of student competence, and innovators in practice Improved awareness of practice issues among science faculty members (stemming from shadowing experiences, increased dialogue with clinical colleagues, etc) More student involvement in college operations (committees, interviews, admissions process, etc) Notably, the ACPE now includes the Joint Commission of Pharmacy Practitioners (JCPP) Vision for Pharmacy Practice in 2015 in the accreditation standards for both the evaluation of pharmacy degree programs and continuing education providers. The JCPP vision is: “Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes.” Everyone in the profession can take pride in the remarkable progress in pharmacy education over the past decade. The changes we have witnessed were anchored in standards, and the standards were linked to a vision of the future in which patients have improved health outcomes because pharmacists were there—with the necessary knowledge, skills, and abilities—to help them. Let us pause to reflect and celebrate a decade of progress in pharmacy education. Our work is not done, of course, but our momentum is moving us in the right direction.

Education…A Must in All Levels of Pharmacy Practice

Public perception of a profession is extremely important, but even more vital is the actual worth the profession provides to those who partake of its services. As pharmacy recreates itself as a consultative profession, many changes are occurring in the college of pharmacy students' education. The onset of the Introductory Pharmacy Practice Experience (IPPE), the continued rotations in the Advanced Pharmacy Practice Experience (APPE), and the proposal to have mandatory residencies occurring by 2020 show the steps that pharmacy will take to move forward. But pharmacy continues to miss the first rung of the ladder as the profession climbs to its future success by not addressing the mandatory education of the primary workforce in day-to-day activities: that of standardized education and training of pharmacy technicians. While IPPE, APPE, and residencies will strengthen the pharmacy "dwelling," its foundation does not have solid ground. A deadline needs to be established for mandatory education, training, and certification for all technicians entering the profession today and, only after achieving these goals, should the pharmacy technicians be licensed to practice. With even more forethought, pharmacy might require that potential college of pharmacy students, as well as those not fortunate enough to be admitted to a college of pharmacy, become pharmacy technicians first. Only then can the pharmacy profession conquer the top rung of the ladder in a strong, upright fashion.

Reinforcing Cultural Competency Concepts During Introductory Pharmacy Practice Experiences

To incorporate cultural competency concepts into various introductory pharmacy practice experiences (IPPE) at the University of Missouri - Kansas City, School of Pharmacy. A 6-week series, titled "Becoming a Culturally Competent Provider" was developed to provide IPPE students with the opportunity to apply theory regarding cultural competency in a clinical context. Pre- and post-intervention attitude survey instruments were administered to 25 students in the spring semester of 2009. Several activities within the series were associated with reflection exercises. Student presentations were evaluated and formal feedback was provided by faculty members. A course evaluation was administered to evaluate the series and determine areas of improvement. A special series on cultural competency resulted in positive changes in students' attitudes, highlighting the importance of reinforcing cultural competency concepts during IPPEs.

Car Keys, House Keys, Easter Eggs, and Curricula

The hidden curriculum has become a topic of high concern within our colleges of pharmacy. Despite our efforts to map the curriculum to competency statements and our painstaking development of lectures and syllabi, students probably learn more about becoming a pharmacist from the unplanned, hidden curriculum than from our carefully designed formal presentations. It has been said that “The hidden curriculum is not simply found, one must go looking for it.”1 My efforts to go “looking for it,” lead me to conclude that our hidden curriculum is found in ways similar to how we find everyday things. Portions of the hidden curriculum might be compared to a misplaced set of car keys. Undoubtedly we have all spent time searching for car keys. In our hurry through our daily routine, we unconsciously drop our keys in unlikely places. In our curricula the “car keys” are passing conversations and nonverbal cues. Often our interactions with each other and our nonverbal communication are inconsistent with our more formal messages. Students receive didactic lectures espousing the importance of interprofessional teamwork. When they hear pharmacists belittle the efforts of other team members, they are unlikely to retain the right “take away” message. White coat ceremonies focused on the importance of core values, including respect for others and empathy, are unlikely to have the lasting impact we desire, if followed by an introductory pharmacy practice experience (IPPE) during which students hear health care professionals make derogatory remarks about a patient. Role modeling plays a critical part in developing future practitioners. Students learn by example. They not only learn specific skills, but also “cultural norms.” Faculty members who support each other, show empathy for patients, and create an inviting learning environment are likely to foster the development of future colleagues who are supportive, empathetic, and lifelong learners. On a different note, the hidden curriculum might be compared to house keys hidden under the doormat. The house keys are purposefully hidden, but their location may be more obvious than intended. The house keys in our curriculum are the powerful messages sent by our institutional policies and the allocation of our resources. Policies that allow students to attend professional meetings and funds that support their travel send messages that the institution values their participation in professional organizations. Promotion and tenure guidelines that reward excellence in teaching imply that the organization values teaching. Flexible work schedules for faculty and staff members may send the message that the organization is family friendly. These “keys” may not be in plain view, but their effect is evident. Finally, the hidden curriculum might be compared to an Easter egg hunt. Some messages we send in our curricula are expertly hidden, disguised in ways that one might never find without continually hunting. These are messages about our own shortcomings that we hide from our students, hoping that they will not be discovered. Perhaps we do not want students to realize that we do not have all the answers or that we make mistakes. We may worry that our students will recognize that transformation from resident or postdoctoral fellow one day to faculty member the next does not make us expert teachers overnight. We may avoid discussions that make us uncomfortable. After all, how do we teach a student how to deal with the death of a patient for whom he/she cared? How do we explain that the profession can evolve in the setting of health care reform legislation that we do not completely understand? Indeed, these Easter eggs in our curricula may pose the greatest challenges. It would be a productive exercise for faculty members within all of our colleges to examine their own personal curricula for hidden messages. Are we effective role models? What messages do our institutional policies convey? Does our allocation of resources reflect our values? And finally, what messages lurk in our silences?

Promoting a Culture of Academic Integrity

Promoting a Culture of Academic Integrity

111th Annual Meeting of the American Association of Colleges of Pharmacy, Seattle, Washington, July 10–14, 2010

111th Annual Meeting of the American Association of Colleges of Pharmacy, Seattle, Washington, July 10–14, 2010

A Hand and Glove Approach to Pharmacy Experiential Education and Residency Training

A Hand and Glove Approach to Pharmacy Experiential Education and Residency Training

Assessment of Pharmacy Student Professionalism Across a Curriculum

To evaluate changes in professionalism across the curriculum among pharmacy students in different classes. A professionalism instrument was administered early in the first (P1) year, upon completing the introductory pharmacy practice experiences (IPPE) near the end of the second (P2) year, and upon completing the advanced pharmacy practice experiences (APPE) at the end of the fourth (P4) year. The professionalism scale and its subscales were compared for the 3 time points for the class of 2009. Significant differences were noted in professionalism scores between the P1 and P4 years and for altruism, accountability, and honor/integrity subscale scores for the class of 2009. No significant differences were noted when the scores for 4 P1 classes, and 3 P2 classes were compared. An increase in professionalism scores and altruism, accountability, and honor/integrity scores was demonstrated, providing evidence that the curricular and co-curricular activities in the school of pharmacy helped develop professionalism in the class of 2009 students.

Using the three e’s (emphasis, expectations, and evaluation) to structure writing objectives for pharmacy practice experiences

While many educators debate the new introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs) requirements of the Accreditation Council for Pharmacy Education’s (ACPE’s) accreditation standards and guidelines for the professional program in pharmacy

Learning Bridge: Curricular Integration of Didactic and Experiential Education

To assess the impact of a program to integrate introductory pharmacy practice experiences with pharmaceutical science topics by promoting active learning, self-directed learning skills, and critical-thinking skills. The Learning Bridge, a curriculum program, was created to better integrate the material first-year (P1) students learned in pharmaceutical science courses into their introductory pharmacy practice experiences. Four Learning Bridge assignments required students to interact with their preceptors and answer questions relating to the pharmaceutical science material concurrently covered in their didactic courses. Surveys of students and preceptors were conducted to measure the effectiveness of the Learning Bridge process. Feedback indicated the Learning Bridge promoted students' interaction with their preceptors as well as development of active learning, self-directed learning, and critical-thinking skills. Students also indicated that the Learning Bridge assignments increased their learning, knowledge of drug information, and comprehension of relevant data in package inserts. The Learning Bridge process integrated the didactic and experiential components of the curriculum, enhancing student learning in both areas, and offered students educational opportunities to interact more with their preceptors.

Enhancing an Introductory Pharmacy Practice Experience at free medical clinics

The aim of the study was to assess and improve first-year student pharmacists' satisfaction and learning experience in a Student-Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population. Two consecutive classes of first-year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter-professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self-assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self-assessment survey instrument were compared between years 1 and 2. Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non-pharmacy-related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience. Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.

Impact of an Introductory Pharmacy Practice Experience on Students' Performance in an Advanced Practice Experience

To determine the impact of an introductory pharmacy practice experience (IPPE) on students' clinical skills during their initial advanced pharmacy practice experience (APPE). A 4-week First Steps course that focused on students developing pharmacy practice skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs. During the third week of the first APPE, faculty members rated students' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01). Completion of an IPPE course that focused on critical pharmacy practice aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE.

Background checks for experiential education could get centralized

A new service in which pharmacy schools obtain criminal background checks on applicants through a single screening company may help hospitals that serve as sites for experiential education—at least the introductory type. Pharmacy schools need the background checks in part because of the Accreditation Council for Pharmacy Education and the Joint Commission, said Jennifer Athay of the American Association of Colleges of Pharmacy (AACP). At least 30% of the Pharm.D. degree program must consist of practice experiences, preferably starting early in the curriculum. This accreditation requirement went into effect in mid-2007. Athay said the result is that first-year pharmacy students, through enrollment in what are known as introductory pharmacy practice experiences, are going to hospitals and other practice sites. The Joint Commission compels accredited hospitals—“when required by law and regulation and organization policy”—to verify criminal background checks on students who work in the same capacity as hospital staff members who provide care, treatment, and services.

Integration of First- and Second-Year Introductory Pharmacy Practice Experiences

To describe the integration of a first- and second-year introductory pharmacy practice experience (IPPE) involving direct patient contact in hospitals and clinics as a means of more efficiently using academic and preceptor resources. Two IPPE courses were integrated in fall 2004 to accommodate increasing enrollment in classes and limited clinical practice sites and preceptors, as well as to meet the increased need for students and clinicians to practice principles of self-education. P1 and P2 students interviewed patients and presented patient cases; preceptor expectations were structured by instructional objectives. Student and preceptor course evaluations were assessed from survey data. During the assessment period, all students passed the courses. Following integration of the IPPEs, both courses received positive evaluations from students and preceptors. Initial advanced pharmacy practice experience (APPE) grades for students completing the courses further suggests that the integrated IPPEs were beneficial to students. The successful integration of first- and second- year IPPE courses resulted in more efficient use of academic and preceptor resources and created a model for other colleges of pharmacy to consider.

Impact of Hybrid Delivery of Education on Student Academic Performance and the Student Experience

To compare student academic performance and the student experience in the first-year doctor of pharmacy (PharmD) program between the main and newly opened satellite campuses of the University of Maryland. Student performance indicators including graded assessments, course averages, cumulative first-year grade point average (GPA), and introductory pharmacy practice experience (IPPE) evaluations were analyzed retrospectively. Student experience indicators were obtained via an online survey instrument and included involvement in student organizations; time-budgeting practices; and stress levels and their perceived effect on performance. Graded assessments, course averages, GPA, and IPPE evaluations were indistinguishable between campuses. Students' time allocation was not different between campuses, except for time spent attending class and watching lecture videos. There was no difference between students' stress levels at each campus. The implementation of a satellite campus to expand pharmacy education yielded academic performance and student engagement comparable to those from traditional delivery methods.

Barriers to Expanding Advanced Pharmacy Practice Experience Site Availability in an Experiential Education Consortium

To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability. Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes. Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118. The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources.

Preceptor Perceptions of Pharmacy Student Team Quality Assurance Projects

To assess preceptors' opinions of the impact of quality assurance projects. Students were given the opportunity to directly apply material learned in class in a "real world" environment by completing a quality assurance project in a community or health-system pharmacy. All preceptors (n = 38) were contacted via telephone and given the opportunity to respond to open-ended questions concerning their experience with student-team quality assurance projects. Preceptors indicated the quality assurance projects benefited their practice sites by providing additional resources (53%, n = 19), decreased medication errors (22%, n = 8), and increased awareness of the importance of quality assurance (22%, n = 8). Ninety-four percent of respondents (n = 34) perceived the projects had a positive impact on patient care and 92% (n = 33) perceived a positive impact on themselves. Preceptors felt that quality assurance projects performed by pharmacy-student teams were beneficial to patient care, the practice site, and themselves. The quality assurance projects have broad applications and can be added to a medication safety class or to the introductory pharmacy practice experience (IPPE) sequence.