NOTES Pharmacy practice experiences
Sequential advanced pharmacy practice experiences at one institution for students from three pharmacy schools Rebecca A. Taylor, S. Scott Wisneski, Megan A. Kaun, Patricia Parteleno, Jonathan Williams, and Morton P. Goldman
E
nrollment at schools of pharmacy in the United States has increased at a rapid rate since the early 1990s, with an estimated 14,000 students currently enrolled in first-degree doctor of pharmacy programs. 1 Couple the increased number of pharmacy students with standards of the Accreditation Council for Pharmacy Education (ACPE) for introductory pharmacy practice experience (IPPE) and advanced pharmacy practice experience (APPE) rotations, and the strain on academic medical centers is apparent.2 ACPE Standard 10 states that IPPE rotations should constitute at least 5% of the curriculum and be balanced between community and institutional settings; APPE rotations should constitute a minimum of 25% of the curriculum.2 There is great need for creative approaches to student rotation design if the number of pharmacy students continues to rise. The security requirement for student practitioners
Purpose. The structure and implementation of an advanced pharmacy practice experience (APPE) that was sequential in nature are described. Summary. In early 2008, the pharmacy department of the Cleveland Clinic began conversations with three partner pharmacy schools in the surrounding area to accommodate rotations for advanced practice experiences pharmacy students. The resulting sequential APPE (SAE) program is offered at each school for four or five months and incorporates a longitudinal student project component to be completed over the SAE’s duration. Program coordination and scheduling are unique to this program, where rotations are set up outside of the typical rotation selection. Since 2009, 23 students have completed the program, and 10 are currently enrolled. The SAE program was implemented in 2009 and continues to provide a depth of experience for pharma-
involved in direct patient care has also increased the strain of paperwork for school of pharmacy and
Rebecca A. Taylor, Pharm.D., M.B.A., BCPS, is Pharmacy Manager, Cleveland Clinic Marymount Hospital, Garfield Heights, OH; at the time of writing she was Education Manager, Department of Pharmacy, Cleveland Clinic, Cleveland, OH. S. Scott Wisneski, Pharm.D., M.B.A., is Director of Experiential Education, Assistant Professor of Pharmacy Practice, Northeast Ohio Medical University. Megan A. Kaun, Pharm.D., BCPS, is Director of Advanced Pharmacy Practice Experiences, College of Pharmacy, University of Toledo, Toledo, OH. Patricia Parteleno, Pharm.D., is Director of Experiential Education and Associate Professor, Raabe College of Pharmacy, Ohio Northern University, Ada. Jonathan Williams, Pharm.D.,
140
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
cy students. Preceptors have reported that SAE students are more motivated, have goals that fit with the institution, and offer decreased orientation burden compared with traditional APPE students. Students report a maximum of 19 hours gained per month in decreased orientation time to the computer system and site, allowing them to focus more time on patient care. Over a five-month period, a student could gain 76 hours in clinical experience over the traditional APPE student due to the decreased orientation burden. Conclusion. SAEs at one institution have proven advantageous to preceptors, students, and the site. SAEs have provided enriching student rotations while increasing site efficiencies, allowing longitudinal projects, and enhancing the site’s exposure to students as potential residency candidates. Am J Health-Syst Pharm. 2014; 71:140-4
hospital personnel. Each student must show proof of immunizations, have background checks, and com-
M.S., is Assistant Director, Pharmacy Operations, Cleveland Clinic. Morton P. Goldman, Pharm.D., FCCP, BCPS, is Consultant, American Pharmacotherapy, Cleveland; at the time of writing he was System Director, Academic Affairs and International Business Development, Department of Pharmacy, Cleveland Clinic. Address correspondence to Dr. Taylor ([email protected]). The authors have declared no potential conflicts of interests. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0102-0140$06.00. DOI 10.2146/ajhp130139
NOTES Pharmacy practice experiences
plete regulatory training dealing with the Health Insurance Portability and Accountability Act and the Occupational Safety and Health Administration. Sites may also require proof of intern licensure, proof of medical insurance, and documentation of hospital policy review. While many of these items are completed in an online course format, the administrative burden on schools and sites is increasing. Most practitioners agree on the importance of providing enriching student rotations. In addition, there is a desire to utilize students more effectively and creatively in new pharmacy practice models. It is often beneficial for hospitals to offer the same number of rotations but change the mix of rotations to allow for a more-comprehensive experience for fewer students. Examples of longitudinal or sequential APPE experiences (SAEs) can be found in abstract form3 as well as in professional circles among experiential directors. This article describes one such program at an academic medical center in cooperation with three schools of pharmacy. While the availability of such programs has grown through networking and discussions among colleagues, the literature on SAE programs is scarce. SAE program description In early 2008, the pharmacy department of the Cleveland Clinic began conversations with three partner pharmacy schools in the surrounding area. There had been a long-standing relationship with two of the schools, and a new relationship had formed with a school in precandidate status (i.e., pending accreditation by ACPE) to begin APPEs in the 2009–10 academic year. In Ohio, all schools of pharmacy have agreed that APPEs will last one calendar month, beginning the first Monday and ending the last Friday of the month. Cleveland Clinic typically accommodated 60 students per academic year from the
two existing programs and occasionally some students from other colleges. In order to incorporate this new group of students (yielding an addition of 24 student rotation months per academic year), the site’s pharmacy education manager arranged various meetings to brainstorm the SAE with the experiential directors. The resulting SAE program would be offered at each school for four or five months and incorporate a longitudinal student project component to be completed over the SAE’s duration. The goal of the program was to attract high-quality, motivated students who were expected to apply for a pharmacy residency or a hospital pharmacy job. Two schools chose the four-month-long program that included one rotation each in advanced hospital practice and internal medicine and two electives. The other school chose a five-month-long program that included advanced hospital practice, leadership, internal medicine for two months, and one elective. The experiences had staggered the months when they would begin to allow for maximum capacity in advanced hospital practice and internal medicine rotations at the site. Table 1 illustrates the 2009–10 SAE template. Two schools agreed to pilot test the program with two or three students for the first year, for a total of five SAE students scheduled in 2009–10. Students were also assigned a longitudinal project to complete throughout the program with a designated preceptor (similar to a residency project but smaller in scope). Of note, the academic medical center is a one-hour drive from one school and two- and five-hour drives from the other two schools. Students are responsible for their own transportation and other traveling expenses during APPEs. Student selection Each school selects the students for its program through an internal review process. Experiential direc-
tors may ask for letters of intent with or without an interview. Grades and evaluations from faculty may be incorporated into or decision. There have been three or four applicants per SAE slot, depending on the school of pharmacy. Pharmacy department personnel declined the offer to interview interested students due to work volume and timing. The academic medical center still offers non-SAE rotations for other APPE students in specialized practice areas such as oncology, transplantation, nutrition, ambulatory care, research, drug information, informatics, pediatrics, and critical care. Program outcomes Preceptors at the academic medical center were sent a survey via e-mail in 2012 to retrospectively gather information regarding the SAE program. Preceptors were asked to evaluate current and previous SAE students as part of the survey. Of the 30 preceptors to whom the survey was sent, 21 (70%) responded. Preceptors were asked questions regarding advantages of the program, suitability of SAE students for internal or external residency recruitment, interactions of students with pharmacy residents, and project participation. Preceptors were also asked to estimate the time saved by each student per rotation by choosing an SAE. Results are summarized in Table 2. Preceptors believed that SAE students had a slight advantage in applying for residencies at the site and other programs. When asked to indicate advantages to having SAE students versus traditional APPE students, preceptors responded that (1) they spend less time orienting SAE students, (2) SAE students are more motivated, (3) SAE students are residency bound, and (4) the sequence of SAE rotations is conducive to learning. Preceptors estimated that most students spend 4–6 hours per rotation learning a new computer system and 1–2 hours familiarizing
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
141
142
School 1— Student A School 2— Student A School 1— Student B School 3— Student A School 1— Student A School 2— Student A Electives (various)
Internal medicine
School 1— Student A School 2— Student A
School 1— Student B School 3— Student A
October
School 2— Student C School 3— Student C School 3— Student D School 1— Student C School 2— Student B School 3— Student B School 1— Student B School 3— Student A
September
School 1— Student C School 2— Student B School 3— Student B Off Off
August July
School 1— Student B School 3— Student A
June
School 1— Student A School 2— Student A
Rotation
Advanced hospital practice
Template Schedule for Three Schools of Pharmacy in Sequential APPE Experiences
Table 1.
November
School 2— Student C School 3— Student C School 3— Student D School 1— Student C School 2— Student B School 3— Student B
January
School 1— Student C School 2— Student B School 3— Student B School 2— Student C School 3— Student C School 3— Student D
February
School 2— Student C School 3— Student C School 3— Student D
NOTES Pharmacy practice experiences
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
themselves with the institutional site (locating work units and meeting rooms, paging preceptors, navigating parking) (Table 3). This is in addition to 8 hours that would be spent for formal orientation to a new site. Thus, after the first month, SAE students could save up to 16 hours per month by not having to become acquainted with a new computer system and site, and this time could be spent on patient care. Preceptors estimated that a student could potentially gain a full week of rotation experience over a five-month SAE. Preceptors reported benefitting from SAE students’ involvement in projects as well. Project examples included drug-use evaluations, time and efficiency studies, workflow streamlining, trigger-tool methodology for medication safety, and an institutional review board-approved study comparing pharmacist management of hypertension versus the standard of care as part of a collaborative practice agreement. Many research projects were presented as posters at professional meetings at the local, state, and national levels. Since the inception of the program in 2009, 23 students have completed SAEs; at the time of writing, 10 students were currently enrolled. An anonymous survey was sent to all current and former students to assess program outcomes from the student’s perspective. Of the 33 students to whom the survey was sent, 14 (42%) responded. This rate may have been this low due to the possibility of obsolete e-mail addresss for former graduates. Of the 14 respondents, 7 were currently enrolled, and 7 had graduated from the program. Students estimated a longer time to become familiar with the computer system and site than did preceptors (Table 3). If students spent an average of 8 hours to learn the computer system, 3 hours to become familiar with the site, and 8 hours for each orientation day, they could gain 57 hours of meaningful rotation time over a four-month
3.8
4.1 4.4
1
0 0
0
1 0
2
0 2
2
3 5
3
3 7
On the Likert scale, 5 represented a very positive response (e.g., large advantage, high quality, very valuable or influential) while 1 represented an absent or low effect (e.g., no advantage, low quality, not valuable or influential). Many preceptors had not supervised a project for an SAE student. b
a
3.9 4.0 3.7 4.1 0 0 0 0 1 1 0 0 4 3 7 2 13 12 13 4
Preceptor’ Survey Do SAE students hold a competitive advantage in applying for a residency at our site? (n = 21) Do SAE students hold a competitive advantage in applying for other residencies? (n = 21) How would you rate the quality of SAE students compared with non-SAE students? (n = 21) How valuable was the SAE student’s contribution to a project? (n = 9)b Student Survey If you have graduated, how influential was the SAE on your decision to complete a residency? (n = 8) If you have graduated, to what extent did the SAE provide you with a competitive edge as a residency candidate? (n = 7) How would you rate your relationship with preceptors during your SAE? (n = 14)
1 2 3 4 Question
5
No. Respondents Providing Likert-Scale Scorea
Responses to Preceptor and Student Surveys About the Sequential Advanced Pharmacy Practice Experience (SAE)
Table 2.
Challenges The major challenges to the SAE program are scheduling and assigning rotations with each school of pharmacy. The SAE program’s open months for the following year are discussed
Mean LikertScale Score
SAE and 76 hours over a five-month SAE (after the first month) versus the traditional APPE. These estimates represent almost an additional week to two weeks of meaningful rotation time per student. Students reported other advantages, such as the increased exposure to pharmacy residents, the ability to work on sophisticated projects, and the building of relationships with preceptors, colleagues, and other allied health personnel at the facility. Overall, 11 (48%) of the 23 students gained residency or postgraduate training placement. Of note, the rate of placement in a residency or postgraduate education program for the 2011–12 SAE class was 87% (7 of 8 students). Based on National Matching Service statistics for the American Society of Health-System Pharmacists, the overall placement rate of students into postgraduate year 1 programs was 61% (2268 of 3706 students) in 2012.4 Since 2009, 5 of 23 SAE students have been accepted as internal residency candidates, 2 of whom returned after working as a pharmacist for some time. The administrative burden that encompasses student enrollment in rotations has also decreased. Previously, the site would accept 60 students for rotations, many of whom stayed only 1 month. Currently, the site has enrolled 48 students for 89 months of APPE rotations, decreasing the enrollment burden by at least 50%. The downstream effects of this are fewer identification badges, fewer security system requests and removals, decreased demands on the information technology security team, and less time spent overseeing this process.
3 5 1 3
NOTES Pharmacy practice experiences
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143
NOTES Pharmacy practice experiences
Table 3.
Estimates of Time Required for Students to Complete Tasks Associated With an Advanced Pharmacy Practice Experience (APPE) No. (%) Respondentsb Estimated Time Required (hr)a Learning new computer system 4–6 7–9 10–12 13–15 >15 Familiarization with institutional site 1–2 3–4 5–6 7–8 9–10
Students (n = 14)
Preceptors (n = 21)
12 (57) 6 (29) 3 (14) 0 0
2 (14) 5 (36) 4 (29) 2 (14) 1 (7)
11 (52) 5 (24) 5 (24) 0 0
0 6 (43) 4 (29) 2 (14) 2 (14)
Applies to a traditional one-month APPE or an entire four- or five-month sequential APPE. The preceptor and student questionnaires did not offer exactly the same multiple-choice options.
a
b
with preceptors. Schools of pharmacy interview student candidates from October through December. Rotations are selected in communication with the schools of pharmacy and the site’s education manager before open availability is submitted for the remainder of rotations. It is ideal to start the SAE before December, considering that many of these students apply for residencies. This practice limits the overall number of students who can complete the SAE based on
144
site capacity. The site has determined that 10 students per academic year is appropriate. Two students start in June, 2 start in July, none start in August, 3 start in September, and 3 start in October. The influx of students must also be balanced with new hires in the department (pharmacy practice residents, newly hired pharmacists), so capacity and space are true challenges. SAE programs provide higher quality rotation experiences but sac-
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
rifice the quantity of students who can participate. The focus moves from recruiting a large pool of students with mixed career interests to building relationships with selfselected students. The site’s education manager oversees the experiences and meets with students at least monthly to ensure a smooth transition and project progress. Conclusion SAEs at one institution have proven advantageous to preceptors, students, and the site. SAEs have provided enriching student rotations while increasing site efficiencies, allowing longitudinal projects, and enhancing the site’s exposure to students as potential residency candidates. References 1. Brown D. From shortage to surplus: the hazards of uncontrolled academic growth. Am J Pharm Educ. 2010; 74:article 185. 2. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. Effective July 1, 2007. www.acpe-accredit.org/pdf/ACPE_ Revised_PharmD_Standards_Adopted_ Jan152006.pdf (accessed 2012 Aug 25). 3. Carr-Lopez SM, Ferrill MJ, Blalock SJ et al. Innovative clerkship design: impact on student development. Paper presented at the AACP Annual Meeting. Toronto, Canada; 2001 Jul 8–11. 4. National Matching Services. ASHP resident matching program: for positions beginning in 2012. www.natmatch.com (accessed 2013 Jun 17).
Sequential advanced pharmacy practice experiences at one institution for students from three pharmacy schools Rebecca A. Taylor, S. Scott Wisneski, Megan A. Kaun, Patricia Parteleno, Jonathan Williams, and Morton P. Goldman
E
nrollment at schools of pharmacy in the United States has increased at a rapid rate since the early 1990s, with an estimated 14,000 students currently enrolled in first-degree doctor of pharmacy programs. 1 Couple the increased number of pharmacy students with standards of the Accreditation Council for Pharmacy Education (ACPE) for introductory pharmacy practice experience (IPPE) and advanced pharmacy practice experience (APPE) rotations, and the strain on academic medical centers is apparent.2 ACPE Standard 10 states that IPPE rotations should constitute at least 5% of the curriculum and be balanced between community and institutional settings; APPE rotations should constitute a minimum of 25% of the curriculum.2 There is great need for creative approaches to student rotation design if the number of pharmacy students continues to rise. The security requirement for student practitioners
Purpose. The structure and implementation of an advanced pharmacy practice experience (APPE) that was sequential in nature are described. Summary. In early 2008, the pharmacy department of the Cleveland Clinic began conversations with three partner pharmacy schools in the surrounding area to accommodate rotations for advanced practice experiences pharmacy students. The resulting sequential APPE (SAE) program is offered at each school for four or five months and incorporates a longitudinal student project component to be completed over the SAE’s duration. Program coordination and scheduling are unique to this program, where rotations are set up outside of the typical rotation selection. Since 2009, 23 students have completed the program, and 10 are currently enrolled. The SAE program was implemented in 2009 and continues to provide a depth of experience for pharma-
involved in direct patient care has also increased the strain of paperwork for school of pharmacy and
Rebecca A. Taylor, Pharm.D., M.B.A., BCPS, is Pharmacy Manager, Cleveland Clinic Marymount Hospital, Garfield Heights, OH; at the time of writing she was Education Manager, Department of Pharmacy, Cleveland Clinic, Cleveland, OH. S. Scott Wisneski, Pharm.D., M.B.A., is Director of Experiential Education, Assistant Professor of Pharmacy Practice, Northeast Ohio Medical University. Megan A. Kaun, Pharm.D., BCPS, is Director of Advanced Pharmacy Practice Experiences, College of Pharmacy, University of Toledo, Toledo, OH. Patricia Parteleno, Pharm.D., is Director of Experiential Education and Associate Professor, Raabe College of Pharmacy, Ohio Northern University, Ada. Jonathan Williams, Pharm.D.,
140
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
cy students. Preceptors have reported that SAE students are more motivated, have goals that fit with the institution, and offer decreased orientation burden compared with traditional APPE students. Students report a maximum of 19 hours gained per month in decreased orientation time to the computer system and site, allowing them to focus more time on patient care. Over a five-month period, a student could gain 76 hours in clinical experience over the traditional APPE student due to the decreased orientation burden. Conclusion. SAEs at one institution have proven advantageous to preceptors, students, and the site. SAEs have provided enriching student rotations while increasing site efficiencies, allowing longitudinal projects, and enhancing the site’s exposure to students as potential residency candidates. Am J Health-Syst Pharm. 2014; 71:140-4
hospital personnel. Each student must show proof of immunizations, have background checks, and com-
M.S., is Assistant Director, Pharmacy Operations, Cleveland Clinic. Morton P. Goldman, Pharm.D., FCCP, BCPS, is Consultant, American Pharmacotherapy, Cleveland; at the time of writing he was System Director, Academic Affairs and International Business Development, Department of Pharmacy, Cleveland Clinic. Address correspondence to Dr. Taylor ([email protected]). The authors have declared no potential conflicts of interests. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0102-0140$06.00. DOI 10.2146/ajhp130139
NOTES Pharmacy practice experiences
plete regulatory training dealing with the Health Insurance Portability and Accountability Act and the Occupational Safety and Health Administration. Sites may also require proof of intern licensure, proof of medical insurance, and documentation of hospital policy review. While many of these items are completed in an online course format, the administrative burden on schools and sites is increasing. Most practitioners agree on the importance of providing enriching student rotations. In addition, there is a desire to utilize students more effectively and creatively in new pharmacy practice models. It is often beneficial for hospitals to offer the same number of rotations but change the mix of rotations to allow for a more-comprehensive experience for fewer students. Examples of longitudinal or sequential APPE experiences (SAEs) can be found in abstract form3 as well as in professional circles among experiential directors. This article describes one such program at an academic medical center in cooperation with three schools of pharmacy. While the availability of such programs has grown through networking and discussions among colleagues, the literature on SAE programs is scarce. SAE program description In early 2008, the pharmacy department of the Cleveland Clinic began conversations with three partner pharmacy schools in the surrounding area. There had been a long-standing relationship with two of the schools, and a new relationship had formed with a school in precandidate status (i.e., pending accreditation by ACPE) to begin APPEs in the 2009–10 academic year. In Ohio, all schools of pharmacy have agreed that APPEs will last one calendar month, beginning the first Monday and ending the last Friday of the month. Cleveland Clinic typically accommodated 60 students per academic year from the
two existing programs and occasionally some students from other colleges. In order to incorporate this new group of students (yielding an addition of 24 student rotation months per academic year), the site’s pharmacy education manager arranged various meetings to brainstorm the SAE with the experiential directors. The resulting SAE program would be offered at each school for four or five months and incorporate a longitudinal student project component to be completed over the SAE’s duration. The goal of the program was to attract high-quality, motivated students who were expected to apply for a pharmacy residency or a hospital pharmacy job. Two schools chose the four-month-long program that included one rotation each in advanced hospital practice and internal medicine and two electives. The other school chose a five-month-long program that included advanced hospital practice, leadership, internal medicine for two months, and one elective. The experiences had staggered the months when they would begin to allow for maximum capacity in advanced hospital practice and internal medicine rotations at the site. Table 1 illustrates the 2009–10 SAE template. Two schools agreed to pilot test the program with two or three students for the first year, for a total of five SAE students scheduled in 2009–10. Students were also assigned a longitudinal project to complete throughout the program with a designated preceptor (similar to a residency project but smaller in scope). Of note, the academic medical center is a one-hour drive from one school and two- and five-hour drives from the other two schools. Students are responsible for their own transportation and other traveling expenses during APPEs. Student selection Each school selects the students for its program through an internal review process. Experiential direc-
tors may ask for letters of intent with or without an interview. Grades and evaluations from faculty may be incorporated into or decision. There have been three or four applicants per SAE slot, depending on the school of pharmacy. Pharmacy department personnel declined the offer to interview interested students due to work volume and timing. The academic medical center still offers non-SAE rotations for other APPE students in specialized practice areas such as oncology, transplantation, nutrition, ambulatory care, research, drug information, informatics, pediatrics, and critical care. Program outcomes Preceptors at the academic medical center were sent a survey via e-mail in 2012 to retrospectively gather information regarding the SAE program. Preceptors were asked to evaluate current and previous SAE students as part of the survey. Of the 30 preceptors to whom the survey was sent, 21 (70%) responded. Preceptors were asked questions regarding advantages of the program, suitability of SAE students for internal or external residency recruitment, interactions of students with pharmacy residents, and project participation. Preceptors were also asked to estimate the time saved by each student per rotation by choosing an SAE. Results are summarized in Table 2. Preceptors believed that SAE students had a slight advantage in applying for residencies at the site and other programs. When asked to indicate advantages to having SAE students versus traditional APPE students, preceptors responded that (1) they spend less time orienting SAE students, (2) SAE students are more motivated, (3) SAE students are residency bound, and (4) the sequence of SAE rotations is conducive to learning. Preceptors estimated that most students spend 4–6 hours per rotation learning a new computer system and 1–2 hours familiarizing
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
141
142
School 1— Student A School 2— Student A School 1— Student B School 3— Student A School 1— Student A School 2— Student A Electives (various)
Internal medicine
School 1— Student A School 2— Student A
School 1— Student B School 3— Student A
October
School 2— Student C School 3— Student C School 3— Student D School 1— Student C School 2— Student B School 3— Student B School 1— Student B School 3— Student A
September
School 1— Student C School 2— Student B School 3— Student B Off Off
August July
School 1— Student B School 3— Student A
June
School 1— Student A School 2— Student A
Rotation
Advanced hospital practice
Template Schedule for Three Schools of Pharmacy in Sequential APPE Experiences
Table 1.
November
School 2— Student C School 3— Student C School 3— Student D School 1— Student C School 2— Student B School 3— Student B
January
School 1— Student C School 2— Student B School 3— Student B School 2— Student C School 3— Student C School 3— Student D
February
School 2— Student C School 3— Student C School 3— Student D
NOTES Pharmacy practice experiences
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
themselves with the institutional site (locating work units and meeting rooms, paging preceptors, navigating parking) (Table 3). This is in addition to 8 hours that would be spent for formal orientation to a new site. Thus, after the first month, SAE students could save up to 16 hours per month by not having to become acquainted with a new computer system and site, and this time could be spent on patient care. Preceptors estimated that a student could potentially gain a full week of rotation experience over a five-month SAE. Preceptors reported benefitting from SAE students’ involvement in projects as well. Project examples included drug-use evaluations, time and efficiency studies, workflow streamlining, trigger-tool methodology for medication safety, and an institutional review board-approved study comparing pharmacist management of hypertension versus the standard of care as part of a collaborative practice agreement. Many research projects were presented as posters at professional meetings at the local, state, and national levels. Since the inception of the program in 2009, 23 students have completed SAEs; at the time of writing, 10 students were currently enrolled. An anonymous survey was sent to all current and former students to assess program outcomes from the student’s perspective. Of the 33 students to whom the survey was sent, 14 (42%) responded. This rate may have been this low due to the possibility of obsolete e-mail addresss for former graduates. Of the 14 respondents, 7 were currently enrolled, and 7 had graduated from the program. Students estimated a longer time to become familiar with the computer system and site than did preceptors (Table 3). If students spent an average of 8 hours to learn the computer system, 3 hours to become familiar with the site, and 8 hours for each orientation day, they could gain 57 hours of meaningful rotation time over a four-month
3.8
4.1 4.4
1
0 0
0
1 0
2
0 2
2
3 5
3
3 7
On the Likert scale, 5 represented a very positive response (e.g., large advantage, high quality, very valuable or influential) while 1 represented an absent or low effect (e.g., no advantage, low quality, not valuable or influential). Many preceptors had not supervised a project for an SAE student. b
a
3.9 4.0 3.7 4.1 0 0 0 0 1 1 0 0 4 3 7 2 13 12 13 4
Preceptor’ Survey Do SAE students hold a competitive advantage in applying for a residency at our site? (n = 21) Do SAE students hold a competitive advantage in applying for other residencies? (n = 21) How would you rate the quality of SAE students compared with non-SAE students? (n = 21) How valuable was the SAE student’s contribution to a project? (n = 9)b Student Survey If you have graduated, how influential was the SAE on your decision to complete a residency? (n = 8) If you have graduated, to what extent did the SAE provide you with a competitive edge as a residency candidate? (n = 7) How would you rate your relationship with preceptors during your SAE? (n = 14)
1 2 3 4 Question
5
No. Respondents Providing Likert-Scale Scorea
Responses to Preceptor and Student Surveys About the Sequential Advanced Pharmacy Practice Experience (SAE)
Table 2.
Challenges The major challenges to the SAE program are scheduling and assigning rotations with each school of pharmacy. The SAE program’s open months for the following year are discussed
Mean LikertScale Score
SAE and 76 hours over a five-month SAE (after the first month) versus the traditional APPE. These estimates represent almost an additional week to two weeks of meaningful rotation time per student. Students reported other advantages, such as the increased exposure to pharmacy residents, the ability to work on sophisticated projects, and the building of relationships with preceptors, colleagues, and other allied health personnel at the facility. Overall, 11 (48%) of the 23 students gained residency or postgraduate training placement. Of note, the rate of placement in a residency or postgraduate education program for the 2011–12 SAE class was 87% (7 of 8 students). Based on National Matching Service statistics for the American Society of Health-System Pharmacists, the overall placement rate of students into postgraduate year 1 programs was 61% (2268 of 3706 students) in 2012.4 Since 2009, 5 of 23 SAE students have been accepted as internal residency candidates, 2 of whom returned after working as a pharmacist for some time. The administrative burden that encompasses student enrollment in rotations has also decreased. Previously, the site would accept 60 students for rotations, many of whom stayed only 1 month. Currently, the site has enrolled 48 students for 89 months of APPE rotations, decreasing the enrollment burden by at least 50%. The downstream effects of this are fewer identification badges, fewer security system requests and removals, decreased demands on the information technology security team, and less time spent overseeing this process.
3 5 1 3
NOTES Pharmacy practice experiences
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
143
NOTES Pharmacy practice experiences
Table 3.
Estimates of Time Required for Students to Complete Tasks Associated With an Advanced Pharmacy Practice Experience (APPE) No. (%) Respondentsb Estimated Time Required (hr)a Learning new computer system 4–6 7–9 10–12 13–15 >15 Familiarization with institutional site 1–2 3–4 5–6 7–8 9–10
Students (n = 14)
Preceptors (n = 21)
12 (57) 6 (29) 3 (14) 0 0
2 (14) 5 (36) 4 (29) 2 (14) 1 (7)
11 (52) 5 (24) 5 (24) 0 0
0 6 (43) 4 (29) 2 (14) 2 (14)
Applies to a traditional one-month APPE or an entire four- or five-month sequential APPE. The preceptor and student questionnaires did not offer exactly the same multiple-choice options.
a
b
with preceptors. Schools of pharmacy interview student candidates from October through December. Rotations are selected in communication with the schools of pharmacy and the site’s education manager before open availability is submitted for the remainder of rotations. It is ideal to start the SAE before December, considering that many of these students apply for residencies. This practice limits the overall number of students who can complete the SAE based on
144
site capacity. The site has determined that 10 students per academic year is appropriate. Two students start in June, 2 start in July, none start in August, 3 start in September, and 3 start in October. The influx of students must also be balanced with new hires in the department (pharmacy practice residents, newly hired pharmacists), so capacity and space are true challenges. SAE programs provide higher quality rotation experiences but sac-
Am J Health-Syst Pharm—Vol 71 Jan 15, 2014
rifice the quantity of students who can participate. The focus moves from recruiting a large pool of students with mixed career interests to building relationships with selfselected students. The site’s education manager oversees the experiences and meets with students at least monthly to ensure a smooth transition and project progress. Conclusion SAEs at one institution have proven advantageous to preceptors, students, and the site. SAEs have provided enriching student rotations while increasing site efficiencies, allowing longitudinal projects, and enhancing the site’s exposure to students as potential residency candidates. References 1. Brown D. From shortage to surplus: the hazards of uncontrolled academic growth. Am J Pharm Educ. 2010; 74:article 185. 2. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. Effective July 1, 2007. www.acpe-accredit.org/pdf/ACPE_ Revised_PharmD_Standards_Adopted_ Jan152006.pdf (accessed 2012 Aug 25). 3. Carr-Lopez SM, Ferrill MJ, Blalock SJ et al. Innovative clerkship design: impact on student development. Paper presented at the AACP Annual Meeting. Toronto, Canada; 2001 Jul 8–11. 4. National Matching Services. ASHP resident matching program: for positions beginning in 2012. www.natmatch.com (accessed 2013 Jun 17).
