This semester, we will be profiling several projects from colleagues at the MN-COP, highlighting each for its contributions to innovation in pharmacy education. We begin with an experiential elective for first-year student pharmacists: The Pharmaceutical Care Experience directed by Anita Sharma, PharmD (HealthEast) and Keri Hager, PharmD (MN-COP).
Getting Their Feet Wet: Early Involvement in the Pharmacists’ Patient Care Process
With the national shortage of primary care providers, pharmacists are seeking national provider status recognition and pursuing expanded scope of practice at state and local levels.
Prior to the introduction of this elective at the MN-COP, students typically had their first experiential exposure to ambulatory care pharmacy practice while on advanced pharmacy practice experiences (APPEs) in their fourth professional year. Sharma, course director on the Twin Cities campus, believes we could be doing more to prepare our students for practice:
“The landscape of healthcare is changing. If we are asking our students to be leaders of patient care, then they need to have authentic exposure to patient care in the ambulatory care setting earlier in the curriculum.”
Testing the Waters: Highly Supported and Focused Direct Patient Care Opportunities
To this end, the Pharmaceutical Care Experience builds on the first-year didactic course, Foundations of Pharmaceutical Care, by providing an early opportunity for first-year students (n=6) to assess each patient’s unique medication experience and drug-related needs through patient interviews and shared-decision making in a primary care clinic. Then, students develop a patient-centered care plan under the guidance of a practitioner mentor. Student performance is evaluated through new practitioner mentors’ assessment of entrustable professional activities (EPAs), as well as captured through qualitative reflection data from both the students and the practitioner mentors.
Starting Small & Working Up to the High-Dive
Intentional design was important for success in the first offering of this elective. Starting the elective with a smaller enrollment (n=6) was crucial for scheduling. It was also beneficial to begin this work with a health system (HealthEast) which has has an established relationship with the MN-COP; this made it easier to find engaged practitioner mentors who were willing to pilot the course and helped to ensure that students were exposed to a consistent patient care process as desired. Future efforts can be focused on expansion after initial successes.
Taking the Plunge with EPAs
Pittenger and colleagues describe EPAs as a way to “creat[e] performance statements regarding knowledge, skills, and attitudes assessed by the educator/preceptor and measured using a scale that describes various levels of trust.” The MN-COP employs EPAs as a way to assess confidence in graduates’ abilities to translate didactic and experiential learning into practice-readiness.
Within the Pharmaceutical Care Experience, practitioner mentors (n=5) were relatively new to formal precepting roles. They noted challenges of setting appropriate expectations for learning due to lack of familiarity with the first-year Pharm.D. didactic coursework. More practitioner mentor feedback revolved around being new to assessing students with EPAs. It was mentioned that the ability to assess certain EPAs largely relied upon the medical conditions or unique patient cases encountered, which could vary from day-to-day or clinic-to-clinic. Additionally, some EPAs were not expected to move levels over the course of the experience, while attainment of some EPAs was expected to move from Level 1 (“Trusted with observation only, even with direct supervision”) to Level 2 (“Trusted to perform with direct, proactive supervision”). Practitioner mentors also commented that it was difficult at times to review EPA ratings of 1 or 2 with students because students might be discouraged seeing a lower numbered rating. In forthcoming offerings, course directors want to spend more time in orientation with both students and practitioner mentors to increase familiarity with EPAs.
Taking like a Duck to Water
Students commented that the most valuable experiences from the course are the opportunities to discuss real-life patient cases with practitioners actively doing this work. They also found it beneficial to see how other members of the healthcare team interact with a pharmacist in primary care. One student reflected that her confidence and communication skills during patient encounters are improved; she sees this when she volunteers at a University of Minnesota-affiliated student-run free clinic. She attributes this confidence to the opportunity this elective afforded first-year students to put pharmaceutical care skills into practice.
The Pharmaceutical Care Experience will be open for its second offering in the summer of the 2017-2018 school year. Course co-director Keri Hager (Duluth campus) also directs Foundations of Pharmaceutical Care in the didactic curriculum and is pleased with how this has helped to coach early learners in preparation for real patient encounters.
When asked about building upon successes of the first offering, she states:
“Going forward, we will incorporate an enhanced preceptor orientation and plan to invest further in the development of our preceptors. We will also be integrating more purposeful midpoint and final debriefing sessions as these held high value for the students. Additionally, we will need to revisit how to assess this introductory exposure to ambulatory care with EPAs.”
Sharma is also encouraged by early findings of the elective:
“All students said that if they had the opportunity to do it all over, they would choose to take the course again.”
In addition to maintaining the seminal components of early exposure to a consistent patient care process and direct patient care experiences with pharmacy practitioner mentoring, the course is looking to open more opportunities for students. Says Sharma, “We hope to increase our enrollment over both campuses and expand our sites into other health systems in future offerings.”