Precepting Early Pharmacy Learners: Expectations ...

Precepting Early Pharmacy Learners:

Expectations, Assessment, and Practical Application

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Objectives

● Describe transformation of the professional curriculum at the

UNC Eshelman School of Pharmacy

● Summarize the steps for designing an Immersion Experience

● Design strategies to effectively integrate early pharmacy

learners into your practice site

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Speaker

Nicki Pinelli Reitter, PharmD, MS, FCCP, CDEAssistant Dean of Experiential Programs

Associate ProfessorUNC Eshelman School of Pharmacy

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Pre-Requisites

2+ years

Traditional PharmD Progression Overview

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Pre-Requisites

2+ years

PY1

ca. 40% repeats pre-requisite content

point of admission


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Pre-Requisites

2+ years

PY1


PY2-PY3

largely didactic lecture

2 x 4-wk IPPEs ORLongitudinal IPPEs

point of admission


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Pre-Requisites

2+ years

PY1


PY2-PY3



PY4

APPEs

point of admission point of licensure


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Pre-Requisites

2+ years

PY1


PY2-PY3



PY4

APPEs

Post-Graduate Training

point of admission point of licensure


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Early, continual immersion in patient care complemented

by contextual pharmacotherapy

Defining Elements from Guiding Principles

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Evidence-based inquiry: hands-on pharmacy innovation

& real-world problem solving


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Reflection on experiential learning, advanced &

emerging topics, electives


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Foundational courses emphasizing higher-order thinking

and problem solving


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Foundational courses emphasizing higher-order thinking

and problem solving

Re-engineer admissions process to consider non-cognitive & meta-cognitive skills


Doctor of Pharmacy (PharmD) Curriculum

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ACPE Accreditation

Standards

UNC Eshelman School of Pharmacy

Introductory PharmacyPractice Experiences(IPPE, Immersion Experiences)

300 hours 960 hours

Advanced Pharmacy Practice Experiences(APPE, Advanced Immersion Experiences)

1,440 hours 1,440 hours

Total 1,770 hours 2,400 hours

ACPE = Accreditation Council for Pharmacy Education

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“Immersion”

\i- ‘mər- shən\

• The act of putting someone or something completely in a liquid or

the state of being completely in a liquid.

• Complete involvement in some activity or interest.

• A method of learning a foreign language by being taught entirely

in that language.

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Why Immersion?● To give life to concepts and theories learned.

● To enrich students’ perspectives for next year’s topics.

● To let students practice using knowledge, skills, and abilities in a

real-world environment.

● To allow students to develop as professionals.

● To learn by doing.

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Experiential Nomenclature● Immersion Experiences (IPPEs)

○ Types■ Community Pharmacy■ Health Systems■ Direct Patient Care (e.g. inpatient clinical or ambulatory care)

○ Duration■ Two calendar months, 320 hours per experience

○ Timeline■ Summer after PY1■ Spring PY2■ Fall PY3

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Experiential Nomenclature● Advanced Immersion Experiences (APPEs)

○ Types■ Required by the Accreditation Council for Pharmacy Education (n=4)

● Health Systems● General Medicine● Community Pharmacy● Ambulatory Care

■ Required by the UNC Eshelman School of Pharmacy (n=3)● Clinical I, II, & III

■ Electives (n=2)● Patient Care Elective I, II● Non Patient Care Elective I, II

○ Duration■ One calendar month, 160 hours per experience

○ Timeline■ PY4 year

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Speaker

Kathryn Fuller, PharmDDirector of Practice Experiences: Health Systems

Assistant ProfessorUNC Eshelman School of Pharmacy

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Designing Your Experience• Step 1: Review syllabus and evaluations provided by the

school/college to determine required learning goals and assessments for your experience type

• Step 2: Determine how you will assess the student on the required learning goals

• Step 3: Determine practice activities and align them with required learning goals

• Step 4: Plan to implement your experience

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Entrustable Professional Activities

Units of professional practice, defined as tasks or responsibilities that trainees are entrusted to perform unsupervised once they have

obtained sufficient competence.

EPAs are independently executable, observable, and measurable in both process and outcome.

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Entrustable Professional Activities

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Professionalism and Competencies

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Evaluation Do’s

• Complete a sit-down midpoint and final evaluation

• Document in writing key actions/behaviors

• What should the learner stop, start or continue doing?

• Ensure written comments match ratings

• Contact the School for progression guidance

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EPA Functions

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Implementing Students into Practice

• Transforming pharmacy students’ experiential education to an integrated role has many benefits

• Defined responsibilities for patient care• Expand the breadth of direct patient care services and continue to

meet the demand for experiential education without taxing the limited resources of health systems

• Pharmacy students need to be viewed and utilized as an asset to the health system

Kennerly J and Weber R. Hosp Pharm. 2013 Apr; 48(4): 338–342.

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Speaker

Ian B. Hollis, PharmD, BCPS – AQ CardiologyClinical Specialist, Cardiac Surgery & Advanced Heart Failure

UNC Medical CenterChapel Hill, North Carolina

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Advanced Heart FailureRotation EPAsStep 1: Review syllabus and evaluations provided by the school/college to determine required learning goals and assessments for your experience type

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EPA Activities and Evaluation Rubric

EPA Statement Associated Activities EvaluationProvide medication education to patients are/or caregivers

- Prior to speaking with patient/caregiver, articulate to resident/preceptor intended content to be delivered and the order of priority

- Speak to patient/caregiver clearly, confidently, and in appropriate language, avoiding medical jargon

- Assess understanding through follow-up questioning and respond to questions with accurate information

- Assess the student’s ability to prepare for a counseling session in terms of planned focus areas, scope of content, completeness of content.

- Number of times in a counseling session the student uses medical jargon (goal zero by the last week of the rotation)

- By the end of the rotation, the student should be able to answer 75% or greater of patient-generated questions within a counseling session.

Implement a patient-centered care plan in collaboration with the care team

- Prior to an interaction with the interprofessional care team, articulate assessment and plan to resident/preceptor (i.e., layered learning model).

- Communicate verbally to the interprofessional care team the previously discussed plan in such a manner so as to achieve agreement/consensus.

- Respond to challenges to the proposed plan and reformulate a rationale or the plan itself so as to achieve agreement/consensus.

- Assess how well the student’s plan (e.g., priority of problems, evidence basis for intervention, quality of the intervention) matches more senior team members’ plan (e.g., resident/preceptor).

- The number of interventions accepted on an initial recommendation. Goal 50% of accepted interventions.

- The number of reformulated interventions accepted following rebuttal/discussion. Goal 25% of accepted interventions.

Step 2: Determine how you will assess the student on the required learning goals

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Step 3: Determine practice activities and align them with required learning goals

Pharmacist Activities Student Resident

Medication histories X X

Admission medication reconciliation X

Discharge medication reconciliation X

Discharge medication counseling X X

Warm “hand off” notes to outpatient providers X X

Pharmacy documentation in the EMR X X

Completion of pharmacy “sign out” mechanisms X X

Attendance at patient care rounds/clinic visits X X

Response to need for medication information X X

Prescription order verification X

Participation in medical emergency events X

Medication preparation/packaging X

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Step 4: Plan to implement your experience

- Survey of UNC acute and ambulatory care pharmacists- Key attributes of an effective LLPM:

Shared leadershipSystematic approachGood communicationFlexibility for attending pharmacistAdequate resourcesCommitmentEvaluation

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My clinical responsibilitiesPrecepting opportunities

Advanced Heart Failure

4-6 CICU patients

6-8 step-down/floor

patients

Cardiac Surgery

2-4 TICU patients

6-8 step down/floor

patients

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Building Your Learning ExperienceDiscuss and clarify learner expectations

- Ideally prior to or on day 1 of the experience- Ensure younger learner views senior learner(s) as a resource

“Senior” learner precepting expectations- Agree upon precepting goals for the experience- Responsibilities may shift over the course of the year

- Early year: “logistical” preceptingStudent direction: minute to minute “check box” activities

- Late year: Increased clinical preceptingStudent instruction: topics, patient care discussions

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Building Your Learning Experience

Prepare your multidisciplinary team- Orient them to expectations and capabilities of each level of learner

Triage your patients to learners by acuity, location- Devise a “when and where” approach to employing learners to extend your

“reach”

Meet to debrief before patient care is delivered- “Proof” their planned interventions- Plan the interaction with the provider in question

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Team rotation calendar- Highly effective in coordinating learning activities- Review the “plan” with learners at the beginning of each day- Identify times where the attending pharmacist will not be available

Establishing time expectations/boundaries- Schedule structured Rx team interactions- Learners as no worse than “zero sum” time commitment- “Potency” in interactions with attending pharmacist

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Rotation Team Calendar

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Utilize communication technology!- GroupMe, Slack, WhatsApp, group SMS chats- Enforce HIPPA compliance

Image from: https://www.master-computing.com/2017/01/24/businesstexting/

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Integrating Early Pharmacy Learners

Learner interactions – group vs. individualized

Group time – Discussion of patient care issues; problem-based learning

Senior learner precepts younger learner in the presence of the

attending pharmacist

Younger learner observes “modeling” of performance

expectations during targeted precepting of senior learner by

attending pharmacist

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Integrating Early Pharmacy Learners

Learner interactions – group vs. individualized

Individualized time – tailor discussion to specific performance areas

Enable the early pharmacy learner to be vulnerable in a

“safe” setting

Accelerate learning for senior learners

Can be a time when senior learner precepts junior learner without attending

pharmacist

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Early Immersion Pharmacy StudentsWhat Should I Expect?*

PY2 PY3 PY4

SOAP note/clinicalmonitoring

Introductory Moderate Advanced

Clinical documentation Moderate Advanced Advanced

Clinical decision-making Introductory Moderate Advanced

Multi-disciplinary interactions

Introductory Moderate Advanced

Patient counseling Moderate Advanced Advanced

Patients followed 2-4 4-6 6-8

*based on past rotation-based performances, as precepted by IBH

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Take Home Points

• Pharmacy school curriculums are evolving

• Resulting in a change in preceptor roles and responsibilities

• Designing a student experience requires understanding of assessments and learning goals

• This will help define learning activities

• Successful integration of early pharmacy learners into practice requires detailed planning of learning activities

Precepting Early Pharmacy Learners:

Expectations, Assessment, and Practical Application

Precepting Early Pharmacy Learners: Expectations ...

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