A Comparison: Australian and American Pharmacy Internship

Programs Sally Haack, PharmD, BCPS Drake University College of

Pharmacy and Health Sciences Des Moines, Iowa USA

Background

Population • Iowa (3 million) • Des Moines metro area (560,000)

• Private university • 3500 undergraduate

students • 2100 graduate students • College of Pharmacy and

Health Sciences – PharmD – Bachelor of Science

• Clinical and Applied • Health Services Management • Pharmaceutical Sciences

Objectives • Compare and contrast pharmacy education in

Australia and the United States • Explore student and preceptor views of

community pharmacy internships and residencies

• Discuss aspects of community pharmacy practice experiences which lead to high levels of satisfaction for those involved

• Evaluate strategies to attract the brightest students to community pharmacy practice

B.Pharm. • Pharmacy Degree at a

University – 4 years

• Pharmacy Board of Australia – Internship for 10-12 months – Intern course (“approved

program of study”) – Board exam

• Clinical and Legal – Oral registration exam

Pharm.D. • Pharmacy Degree at a

University – 6 years – Includes 1 year internship

• State Board of Pharmacy – Proof of 1500 hours of

internship • 1250 hours from P4

rotations • 250 hours from a separate

internship (summer…) – Board Exam

• Clinical and Legal

Drake University: PharmD General Curriculum • 2 years of pre-pharmacy courses

– Chemistry, Biology, Statistics, Microbiology, etc. – Liberal Arts: Engaged Citizen, Written

Communication, History, Multicultural Understanding

• 3 years of pharmacy courses – Didactic along with experiential learning

• 1 year of pharmacy rotations – Experiential learning

Accreditation Council for Pharmacy Education

• New Guidelines for Colleges of Pharmacy – Adopted Jan 2006 – Effective Feb 2011

• Drastically increased the amount of experiential hours required to achieve a PharmD – 300 hours required in professional program

before rotations https://www.acpe-accredit.org/pdf/FinalS2007Guidelines2.0.pdf

Early Experiential Education Year Experience Type Location Hours

P1 Geriatric Service Learning Core Long-Term Care Facility 20

Pharmacy Distribution Core Community or Hospital Pharmacy

40

TOTAL P1 Hours 60

P2 Sterile Training Core Hospital 8

Diversity Service Learning Core Various (…) 40-50

Patient Care Services Elective Professional Elective 40-50

TOTAL P2 Hours 90

P3 Continuity of Care Core Home Health Care, Ambulatory Care, Hospital

40

Drug Therapy Problem Solving Core Medication Therapy Management or Long-Term Care Consultant

40

Patient Care Services Elective Professional Electives 40

TOTAL P3 Hours 120

P1-P3 Attending professional meetings, reflections/discussion, shadowing

36

TOTAL Early Experiential Hours 306+

Advanced Experiential Education Year Experience Type Hours P4 Acute Care Core 200

Ambulatory Care Core 200 Hospital Practice Core 200 Community Practice Core 200 Specialty Care Elective (complete up to 4) 600-800 Non-patient Care Elective (may complete 1) 0-200

Students complete 8 rotation blocks in the final year of the curriculum. — 40 hours/week x 5 weeks — Pay tuition to university — College Experiential Department is responsible for making site arrangements — Completed all across US and internationally — Required to complete one rotation outside the Des Moines area (>1 hour)

Pharmacy Climate in USA • Shortage of pharmacists due to increasing

needs for medication in general population – 1998-2008

• Rapid expansion of Colleges of Pharmacy (~130) – Concern over rapid expansion of programs – Many graduates having difficulty finding jobs

• Increase in graduates pursuing residencies

Pharmacy Residencies • Advanced training program

– Most are 1 year (specialty areas require 1 extra year)

– Typically begin immediately following graduation & boards

– Accreditation standards set by national practice organizations

– National match process to assist with securing positions

– Salary is <50% of a new community pharmacist – Most commonly in health systems/hospitals

• Some offered in community pharmacies

Community Practice Residencies • Attract leaders and innovators in community

pharmacy practice • Brings more clinical services to community

pharmacies; progressive clinical practice • Training focused in:

– Medication Therapy Management – Point-of-care testing – Immunizations – Collaborative Practice Models – Medication Reconciliation – Business plans for patient care services

Growth of Accredited Community and Total PGY-1 Residencies (2000-2011)

= Total Residency Positions = Community Residency Positions

Am J Pharm Educ 2011; 75(8): 160

Advanced Patient Care Services

Benefits • Keeps pharmacy site progressive • Attracts new patients to pharmacy and promotes

patient loyalty • Enhances public’s perception of pharmacist’s skills

and knowledge • Improves patient health outcomes Challenges • Time to develop, plan, implement, & evaluate services • Patient perceptions of already receiving adequate care • Appropriate pharmacists and staff; restricted roles? • Financial investment and sustainability J Pharm Pract Res 2009;39:207-210.

Views of Internship in Community Pharmacy

• “I trained in retail. Retail pharmacy gives you the best training especially with a good tutor. My tutor taught me independence, to think about treatments for situations which occurred in the day to day. Suggest that the majority do at least some retail experience.”

• “Pre-registration year was not very exciting. I worked

in a very busy shop and thus spending all my time in the dispensary. No experience on OTC selling or counseling, never involved in stock purchasing. Rules should be set up for pharmacists employing pre-registered graduates to ensure that experience in all facets of pharmacy is dealt with.”

Australian Journal of Hospital Pharmacy 1991; 21(1):31-7.

A Good Preceptor is ________ . • Address difference between theory and practice

• Characteristics of preceptor are of greater

significance in enhancing clinical experience than characteristics of site

• Survey of 56 preceptors – Benefits

• Personal satisfaction, increase in knowledge (up to date), opportunity to promote the profession, potential for staff recruitment

– Barriers • Need to have time to fulfill work responsibilities AND student

responsibilities, adequate resources (activities for student and knowledge at desired level), time, workload, insufficient resources/support

Pharmacy Education 2006;6(4):245-252

Job Satisfaction

Intrinsic Factors • Achievement potential • Perception of status • Self-satisfaction • Meaningfulness of work • Degree to which one’s

education is used in work • Recognition by others

Extrinsic Factors • Salary • Benefits • Advancement potential • Job security • Working conditions

(environment/hours/co-workers)

Am J Health-Syst Pharm 2010;67:1093-1100

Job Satisfaction

% time engaged in clinical activities Institution is inadequately staffed Am J Health-Syst Pharm 2010;67:1093-1100

Job Satisfaction Dimensions of Australian Community Pharmacists

• Questionnaire to assess job satisfaction – Mailed to 2017 pharmacists in NSW and ACT – 67% response rate

• Most important job characteristics: – Ability to work accurately – Need for work to be interesting

• Dissatisfaction with: – Government prescription system – Professional image – Financial pressures

J Soc Admin Pharm 1992;9(4):149-158

Practice Change in Community Pharmacy

• Identified 7 facilitators of practice change 1. Relationship with physicians 2. Remuneration 3. Pharmacy layout 4. Patient expectation 5. Manpower/staff 6. Communication and teamwork 7. External support and assistance Ann Pharmacother 2008;42:861-8

Intern Pharmacists as Change Agents

• Salbutamol supplied without prescription • Compulsory components of accredited training

course – Health promotion

• Campaign for consumers aimed at improving inhaler technique

– Staff education activities • How to appropriately supply inhaler medication

• A simulated patient presented to pharmacies requesting Ventolin – Referral to GP for poorly controlled asthma – Correction of poor inhaler technique

Ann Pharmacother 2010;44:1319-26

Results • Appropriate outcome of medical referral for poor

asthma control – Intervention group = 40% – Control group = 19% p=0.001

• Correction of poor inhaler technique – Intervention group = 3% – Control group = 0% p=0.12

• “Intern pharmacists were able to contribute to practice improvement in community pharmacy…”

Ann Pharmacother 2010;44:1319-26

http://www.apesma.com.au/media/releases/?id=1613. Accessed on 9.11.12

Annual Salaries

Interns: $35,000 Staff pharmacist: $50-65,000 Manager: $60-80,000

Rotations: $0 (pay tuition) Resident: $40,000 Staff pharmacist: $90-110,000 Manager: $115-130,000

http://www.jobs4careers.com.au/job/salary.php www.salary.com www.guild.org.au www.payscale.com

Final Thoughts

• Differences in pharmacy curricula present challenges and opportunities to recruit community pharmacists

• Need for work to be interesting (clinical activities) has a high correlation with job satisfaction in community pharmacy

• Serving as a preceptor for an intern in the community setting could have many benefits

Questions?

Sally Haack, PharmD sally.haack@drake.edu