Medicine Advanced Pharmacy Practice Experience Research Articles

Examining Delineated Competencies within Blended Hospital/Health System Pharmacy and General Medicine Advanced Pharmacy Practice Experiences.

In the United States, Doctor of Pharmacy (PharmD) programs are required to provide advanced pharmacy practice experiences (APPEs) in the core inpatient rotation areas of hospital/health system pharmacy and inpatient general medicine patient care. Colleges and Schools of Pharmacy (C/SOPs) nationwide are increasingly utilizing blended or longitudinal APPE models to offer experiential opportunities; however, there is a gap in the literature to support programs with delineating rotation-specific competencies when integrating two or more rotations together. Utilizing a survey instrument, PharmD students at two C/SOPs reported their onsite inpatient rotation sub-competency activities achieved within the four competency areas of Hospital/Health Pharmacy Systems, Medication Safety and Quality, Clinical Applications, and Professional Practice, which are listed in Appendix C of the 2016 Accreditation Council for Pharmacy Education Standards Guidance Document. Unpaired two-sample t-tests were performed to compare proportions of sub-competency activity occurrence in the two rotation settings. In total, 168 students reported inpatient activities related to the four competency areas, with 95-100% reporting their involvement in one or more sub-competency opportunities within each area. Of the 26 sub-competencies compared, 73% significantly facilitated the development of competency to a greater extent for one APPE inpatient rotation type over the other (p < 0.05). The findings can be utilized by C/SOPs to support the delineation of rotation-specific competencies when blending inpatient experiential opportunities.

Comparison of Clinical Interventions between Student Pharmacists on Advanced Pharmacy Practice Experiences in Indianapolis, Indiana versus Eldoret, Kenya

Student pharmacists can have a positive impact on patient care. The objective of this research was to compare clinical interventions made by Purdue University College of Pharmacy (PUCOP) student pharmacists completing internal medicine Advanced Pharmacy Practice Experiences (APPE) in Kenya and the US. A retrospective analysis of interventions made by PUCOP student pharmacists participating in either the 8-week global health APPE at Moi Teaching and Referral Hospital (MTRH-Kenya) or the 4-week adult medicine APPE at the Sydney &amp; Lois Eskenazi Hospital (SLEH-US) was completed. Twenty-nine students (94%) documented interventions from the MTRH-Kenya cohort and 23 (82%) from the SLEH-US cohort. The median number of patients cared for per day was similar between the MTRH-Kenya (6.98 patients per day, interquartile range [IQR] = 5.75 to 8.15) and SLEH-US students (6.47 patients per day, IQR = 5.58 to 7.83). MTRH-Kenya students made a median number of 25.44 interventions per day (IQR = 20.80 to 28.95), while SLEH-US students made 14.77 (IQR = 9.80 to 17.72). The most common interventions were medication reconciliation/t-sheet rewrite and patient chart reviews for MTRH-Kenya and the SLEH-US, respectively. This research highlights how student pharmacists, supported in a well-designed, location-appropriate learning environment, can positively impact patient care.

Pharmacy student self-assessment of interprofessional behaviors in inpatient general medicine advanced pharmacy practice experiences

IntroductionThe World Health Organization defines interprofessional education (IPE) “as an experience where students from two or more professions learn about, from, and with each other to…improve health outcomes.”1 Recent studies have demonstrated that IPE experiences can produce positive outcomes, and the Accreditation Council for Pharmacy Education Accreditation Standards require IPE experiences to be incorporated in both didactic and experiential components of pharmacy curricula. The purpose of this study was to measure the impact of required rotation interprofessional activities on fourth-year pharmacy students' self-assessment of interprofessional collaboration behaviors. MethodsThis was an ambidirectional cohort study conducted among students enrolled in their inpatient general medicine advanced pharmacy practice experience (APPE) at the University of Texas at El Paso School of Pharmacy during academic year 2020–2021. Students completed the Interprofessional Education Collaborative (IPEC) competency self-assessment instrument at the beginning and end of their six-week APPE. The survey instrument assessed IPEC competencies in the four IPE domains. ResultsDuring the 2020–2021 academic year, 29 APPE pharmacy students completed the pre- and post-assessment during their inpatient general medicine APPE. There was a significant increase (P < .001) in IPEC scores from baseline to post-assessment in each domain. ConclusionsStudents had a positive change in interprofessional collaboration behaviors after completing the required IPE on their inpatient general medicine APPE, which is consistent with prior studies.While students' perceived IPE behaviors improved, further research is needed to elucidate the value of IPE learning activities and impact on learning outcomes.

Evaluation of student-perceived growth in entrustable professional activities after involvement in a transitions-of-care process within an adult medicine advanced pharmacy practice experience

Background and purposeInvolvement of pharmacists and trainees in care transitions reduces medication-related problems. Participation in the transitions-of-care (TOC) process may impact self-perceived growth of autonomy within selected entrustable professional activities (EPAs). Educational activity and settingA student-driven TOC documentation process was implemented within an inpatient family medicine advanced pharmacy practice experience. During the month-long rotation, students rounded with an interdisciplinary care team. Responsibilities included ensuring accurate medication reconciliation at care transitions throughout hospitalization and prior to discharge as well as medication optimization during hospitalization. Another responsibility was completing a medication-specific TOC note in the clinic-based electronic health record at discharge for patients receiving primary care from the associated clinic. The note was available to the outpatient interdisciplinary care team during the hospital follow-up appointment. Student-perceived growth in autonomy within selected EPAs was determined through an online anonymous survey. FindingsNinety percent (n = 18) of eligible students completed the survey. For specific EPA statements (collecting information, establishing patient-centered goals and establishing a care plan, implementing a care plan, collaborating as an interdisciplinary team member, and ensuring immunization), student-perceived autonomy increased after involvement in this student-driven TOC process. During the study period, 215 notes were generated by student pharmacists and included interventions/recommendations within the following themes: evidence-based changes in therapy, patient counseling, and medication access. SummaryThe importance of pharmacist and pharmacy trainee involvement in the TOC process has been well-documented. Involving students in student-driven TOC documentation processes serves to facilitate student-perceived growth in autonomy within selected EPAs.

Enhancing advanced pharmacy practice experiences through the use of Web 2.0 technologies

Background and purposeWeb 2.0 technologies have been leveraged to enhance learning experiences. However, limited data exists about implementing Web 2.0 into pharmacy education and within experiential learning. Educational activity and settingTwo adult internal medicine advanced pharmacy practice experiences (APPEs) applied Web 2.0 technologies including Google (Alphabet, Inc.), Dropbox (Dropbox, Inc.), Facebook (Facebook, Inc.), WordPress (WordPress Foundation), and ClassDojo (ClassDojo, Inc.) with the primary purpose of enhancing student learning, with specific purposes for each technology including improvements in writing, reflection, and time-management skills. An analysis of the use of Web 2.0 technologies included comparing student and preceptor evaluations, mapping learning outcomes to assessments, and evaluating student engagement with the technologies, blog statistics, survey data, and application utilization. FindingsFrom 2017 to 2019, 40 students were engaged with Web 2.0 technologies as a component of their APPE. Student and preceptor evaluations remained relatively unchanged compared to evaluations before using Web 2.0. Students maintained high levels of engagement across applications including 2928 Facebook comments, 4016 “likes", 280 blog posts, and 158 blog comments. Survey results revealed that students perceived that Facebook and blogging helped improve overall learning and communication skills meeting important learning outcomes. SummaryThe integration of two APPEs with Web 2.0 technologies enhanced learning and achieved learning outcomes for students on their adult acute care rotation.

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.

Identification of essential knowledge for inpatient general medicine advanced pharmacy practice experiences

AbstractObjectiveWith diversity in advanced pharmacy practice experience (APPE) preceptors, rotation options, and site characteristics, inpatient general medicine (IGM) APPEs provide varied experiences for students. There is a concern for continuity of essential knowledge standards across experiences. To identify essential knowledge for students to learn during an IGM APPE.MethodsExpert pharmacists in acute care and/or student precepting in an inpatient setting participated in a three‐round modified Delphi process to build consensus. Through three rounds of survey consensus building, experts designated 143 pharmacotherapy topics as essential or non‐essential for an IGM APPE. Topics that achieved 80% or more agreement met consensus as essential. Topics that achieved less than 80% agreement by the end of the surveys were considered non‐essential.ResultsTwenty‐eight experts reached consensus on 70 (49%) topics as essential, 40 (28%) topics as non‐essential, and 33 (23%) topics as indeterminate after round one. Three additional topics suggested by the experts were included with the 33 indeterminate topics for round two considerations. At the conclusion of round three, 73 total topics met consensus as essential for IGM APPE students. Essential topics aligned with the categories of renal, cardiovascular, gastrointestinal, and neurologic disorders as well as infectious diseases. Non‐essential topic categories consisted of oncologic, dermatologic, and gynecological/obstetric disorders.ConclusionIdentified essential knowledge, as found in this study, may serve as a guide for preceptors and afford students the opportunity of consistent experiences across varying IGM APPEs. Validation with pharmacy curriculum and postgraduate competency recommendations support many of these consensus findings. More research is needed to identify the appropriate number of topics addressed during APPE rotations and how to assess that knowledge.

Evaluation of pharmacy student perceptions and stereotypes of healthcare professionals before and after an internal medicine advanced pharmacy practice experience

BackgroundA focus of delivering effective patient-centered care is working as an interprofessional team. Pharmacy students may harbor stereotypes of other healthcare professions that could impede collaboration. The objective of this study was to assess pharmacy student ratings of pharmacists and other healthcare professionals' characteristics before and after their internal medicine advanced pharmacy practice experience (APPE) to determine if the APPE altered their stereotypes. A pre- and post-survey utilizing the Student Stereotypes Rating Questionnaire (SSRQ) was used to carry out the study goals. ImpactStudents had more interactions with pharmacists, physicians, and nurses than with other professionals. Pharmacy students' perceptions of their own profession (autostereotypes) were higher compared to the other disciplines, with a movement towards equality following APPE completion. Students also rated professionals lower if they completed the survey in earlier APPE blocks. These results are limited by the lack of coupling between surveys, a low response rate, and incomplete surveys. RecommendationsMethods that would have strengthened results include focusing on the healthcare professionals that students interacted with most, quantifying the number of experiences they had with each group before and after the rotation, requiring answers to all survey questions, and a strategy to match pre- and post-survey results. DiscussionDespite the limitations of the study, the experiences gained during the APPE positively impacted student perceptions and attitudes towards other healthcare disciplines. This experience type may be a key component to producing pharmacy graduates who are prepared to work collaboratively with other professionals.

Successful Remediation of an Advanced Pharmacy Practice Experience for an At-risk Student

Objective. To describe a successful remediation for an Acute Care Medicine advanced pharmacy practice experience (APPE) in a student with multiple learning deficits. Methods. A literature review of pharmacy and medical experiential remediation was conducted to identify best practices to implement prior to designing the remediation for our student case. Based on this search and experience as preceptors, a three-phase remediation was designed: one week for assessment, two weeks for development of learning skills and strategies and six weeks for an on-campus APPE. Success of the remediation was determined by student performance, as defined by the APPE preceptor, in all relevant 2013 Center for the Advancement of Pharmacy Education (CAPE) educational outcomes. Results. Baseline assessment indicated that the student was below minimal competency in six of 13 relevant 2013 CAPE educational outcomes. Upon completion of the three-part remediation, the student repeated the Acute Care Medicine APPE, achieving better than minimal competency in all 13 outcomes. The student demonstrated significant improvement in nine of 13 CAPE educational outcomes. Conclusion. This student case provides a novel and successful blueprint for remediation of APPE. However, more evidence-based literature is needed to guide educators in experiential remediation.

A Qualitative Study Identifying Key Components to Standardize Across Inpatient General Medicine Advanced Pharmacy Practice Experiences

Objective. To identify common components of inpatient general medicine advanced pharmacy practice experiences (APPEs) across sites, determine which components were important to standardize, and distinguish a benchmark of each component that would indicate standardization. Methods. In-depth interviews about the student experience were conducted with two students and one or more preceptors at each of 12 inpatient general medicine sites in the greater Seattle metropolitan area. Data from transcribed interviews were analyzed, then collapsed into a single spreadsheet for comparison. Overall themes for component groups were identified and components within each theme tested for importance in overall quality of the student experience. Components important for quality of the student experience were deemed "key components" and component metrics were developed for benchmarking. Results. Three themes were essential in the quality of the learning experience at inpatient general medicine sites: welcoming of the student by the preceptors, integration of the student into the site, and student interaction with patients and other health care providers. Key components to be standardized across sites were a structured orientation, written site-specific student guidelines and performance expectations, regular and meaningful student-preceptor interactions, identified performance competency standards, clear delineation of student patient care load and responsibilities, and daily interactions with patients and other health care providers. Conclusion. Qualitative evidence from sites can be used to identify key components to standardize across practice sites offering the same experiential course. These key components aid in the welcoming of the student to the site, integration of the student into the workflow, and daily opportunities for the student to interact with patients and with health care providers.

Analysis of the Student Experience in an Attending Pharmacist Model General Medicine Advanced Pharmacy Practice Experience

Objective. To characterize and determine the quality of the student experience in an attending pharmacist model (APM). Methods. In-depth interviews were conducted with students completing an advanced pharmacy practice experience (APPE) at two general medicine services using the APM over a 2-year time period. Quantitative information about student learning and interprofessional interactions were extracted from student evaluations of the site. Data from the mixed model were analyzed to identify strengths of the APM and areas needing improvement. Results. Strengths of the APM included positive student interaction with the pharmacy resident and more students reporting full integration in and accountability to the interprofessional team for patient outcomes compared to students in non-teaching models. A few students at one site reported a need for greater delineation of expectations, more initial support from preceptors, and initial responsibility for fewer patients. These factors were modified before the second APM year and subsequent reports from students at this site were uniformly positive. Students at the second site did not note areas needing improvement. The APM increased student capacity at both sites. Conclusion. The attending pharmacist model provided a high quality learning experience for students, particularly with regard to integration into and accountability for patient outcomes to the interprofessional team. Qualitative research methods enabled precise detection of areas needing improvement at one site and confirmed that changes made at that site improved the student experience.

Evaluation of focused teaching compared to usual teaching on Advanced Pharmacy Practice Experiences

ObjectiveTo determine the impact of focused teaching (FT) methods during an Advanced Pharmacy Practice Experience (APPE) on student pharmacist knowledge compared to usual teaching (UT). MethodsStudent pharmacists completing a five-week Ambulatory Care or Acute Care/General Medicine APPE from January 2011 to December 2012 were randomized to receive either UT or FT. Each student pharmacist completed a pre-rotation and post-rotation assessment. The absolute change in assessment scores between the groups was evaluated. ResultsA total of 34 and 44 student pharmacists were included in the UT and FT arms, respectively. Overall, the mean pre-rotation assessment score was 42/75 (56%) and mean post-rotation assessment score of 46/75 (61%) (p ≤ 0.001). The absolute change in assessment score was 4.03 ± 6.30 and 4.84 ± 6.65 (p = 0.586) for the UT and FT groups, respectively. ConclusionDuring a five-week APPE, FT had a similar influence on student pharmacist knowledge as UT when evaluating pre- and post-rotations assessments.

Use of web-based learning modules for a general medicine advanced pharmacy practice experience

ObjectiveTo implement and assess web-based learning modules on baseline pharmacy student knowledge prior to a general medicine advanced pharmacy practice experience (APPE). MethodsThree web-based learning modules were developed for use prior to a general medicine APPE. Students completed pre- and post-assessments specific to each learning module. Additionally, students completed perception surveys at the conclusion of the APPE to determine the utility of these modules and the impact on student learning experiences. ResultsUse of the web-based training (WBT) modules resulted in a statistically significant improvement in post-assessment scores for two of the three modules (p < 0.001). Student participants found the modules easy to use and helpful in APPE preparation. ConclusionsUtilization of a WBT module prior to a general medicine APPE improves baseline knowledge among pharmacy students.

Providers' Perceptions of Student Pharmacists on Inpatient General Medicine Practice Experiences

To assess health care providers' perceptions of student pharmacists involved as members of a general medicine team. A brief, anonymous, online survey instrument was distributed to 134 health care providers at 4 major medical centers in Massachusetts who interacted with Northeastern University student pharmacists during inpatient general medicine advanced pharmacy practice experiences beginning in March 2011. The survey instrument assessed health care provider perception of student pharmacists' involvement, preparedness, clinical skills, and therapeutic recommendations. Of the 79 providers who responded, 96.2% reported that student pharmacists were prepared for medical rounds and 87.3% reported that student pharmacists were active participants in patient care. Also, 94.9% and 98.7% of providers indicated that student pharmacist recommendations were appropriate and accurate, respectively. The majority (61.8%) of providers believed that student pharmacist involvement on internal medicine teams was beneficial. Provider perceptions regarding student pharmacist participation on general medicine practice experiences were mostly positive.

Development and Implementation of a Novel Lifestyle Medicine Advanced Pharmacy Practice Experience Elective

Objective: To develop and implement an Advanced Pharmacy Practice Experience (APPE) to increase student's awareness and use of lifestyle modifications in chronic disease prevention and management.&#x0D; Design: A five-week APPE was developed that utilized a wide variety of activities, including direct patient care, patient education, case studies, journal clubs and reflective assessment and writing to explore various lifestyle modifications and their relation to chronic disease prevention and management.&#x0D; Conclusion: The novel lifestyle medicine APPE provides students a unique opportunity to advance their knowledge in therapeutic lifestyle changes and expand their understanding of the pharmacist's role in chronic disease prevention and management.&#x0D; &#x0D; Type: Idea Paper

Evaluation of pharmacy students' clinical interventions on a general medicine practice experience.

As colleges of pharmacy prepare a new generation of practitioners, it is important that during practice experiences students learn the impact of clinical interventions. For over ten years, pharmacy students have been a vital part of the multidisciplinary team at the military treatment facility. The overall impact of the student interventions on patient care has not been evaluated. To evaluate the impact, the students began documenting their clinical interventions in Medkeeper RxInterventions™, an online database. The program is used to document faculty and fourth year pharmacy students' pharmaceutical interventions. The objective of this study was to analyze the interventions completed by fourth year pharmacy students during a general medicine advanced pharmacy practice experience at a military treatment facility. The students completing their general medicine advanced pharmacy practice experience at the military treatment facility are responsible for self reporting all interventions made during clinical rounds into the Medkeeper RxIntervention™ database. The researchers retrospectively collected and analyzed interventions made from June 2008 to June 2009. The total number of interventions recorded by 8 fourth year pharmacy students was 114. Students averaged a number of 14.3 interventions during an eight week practice experience. Students spent an average of 5 minutes per intervention. Ninety- five percent of the interventions were accepted. Fourth year pharmacy students' recommendations were accepted at a high rate by resident physicians. The high acceptance rate may have the ability to positively impact patient care.

An Elective Course in Adult Acute Care Medicine Using a Hybrid Delivery System

To develop and assess the effectiveness of an elective course modeled after activities students encounter on internal medicine advanced pharmacy practice experiences (APPEs). This hybrid elective course used a Web-based course management system linking pre-class lectures and assignments, classroom discussions, and projects to promote active student learning. Assessment of student performance was based on assignments, quizzes, and participation in classroom discussions. Students were surveyed to ascertain their opinion of the elective. This elective in adult acute care medicine increased student exposure to inpatient settings and provided students additional opportunities to communicate effectively, evaluate medical literature, and think critically.

Pharmacy Students' Perspectives on the Value of Taking Call During Acute Care Practice Experiences

Objectives. Determine graduates' perceptions of the benefits and limitations of taking call with the medicine team while in the experiential portion of the doctor of pharmacy (PharmD) degree program. Methods. Survey questionnaires were mailed to graduates who completed a medicine advanced pharmacy practice experience offering an on-call experience. Data collected included on-call requirements, participation, and perceptions of the benefits and limitations of participating in on-call activities. Results. Respondents generally agreed that they learned more about disease states and healthcare logistics during on-call experiences. Respondents also agreed it was a teambuilding experience and would encourage other students to take call. Conclusions. Taking call as a pharmacy student provides a unique opportunity to learn about disease states and build professional relationships with other healthcare professionals. This initial survey suggests that the perceived benefits of taking call outweigh the limitations, ...