By Andrew Bzowyckyj, PharmD
In my previous post in this series, I discussed some barriers that can prevent student pharmacists from developing their sense of accountability to the patient, and the remainder of the health care team during their experiential training. Realizing there is no perfect, “one size fits all” solution, it will be necessary for preceptors to identify how to instill these skills into their students within their specific IPPE or APPE. Schools and Colleges of Pharmacy may also need to play a role in helping preceptors identify these learning opportunities and develop their abilities to instill these skills in student pharmacists.
Proposed Strategies for Developing Student Pharmacists into Accountable Practitioners in the Experiential Setting
- Utilize APPE orientation to clearly set role expectations: Since prior experiences shape student pharmacists’ perceptions of the role of the pharmacist in providing patient care, it is important to spend some time during APPE orientation to discuss your expectations of the student in regard to the patient care process. In my syllabus, I include the definition of pharmaceutical care,1 discuss with students on the first day what it means for my practice, and how it relates to them during this APPE. I also remind students that they are less than a year from graduation, and this APPE is the time for them to fully embrace the opportunity to practice their full range of skills before the “dress rehearsal” is over.
- Integrate collaborative practice agreements (CPAs): The use of CPAs can be especially helpful to practice implementing and following-up on a therapeutic plan, as it puts the responsibility of these actions entirely within the purview of the pharmacist, and therefore, the student pharmacist. When possible, implementing a CPA and reviewing it with students at the beginning of the APPE will provide them with a better understanding of their role on the care team and describe expectations within the scope of practice.
- Write out prescriptions and/or laboratory orders: Regardless of the existence of a CPA, a tangible way to make the actions of implementation and follow-up more tangible to students is having them write it out. A simple low-tech solution is to provide the student with a fake prescription pad (while keeping it as “life-like” as possible) and/or laboratory order sheet and have the student write out the orders that he or she would like to request. A high-tech solution would include providing students access to propose orders for co-signature by the preceptor. Any activity that increases the “realness” of the situation would likely increase the student’s perception of their role in the patient care process.
- Develop longitudinal or consecutive APPEs: Although harder to implement from the perspective of an individual preceptor, utilizing a longitudinal structure for your APPE can be a potential opportunity for students to increase the likelihood that they will follow-up with patients at a subsequent visit, especially for ambulatory chronic care experiences. Similarly, providing students with 2-3 consecutive APPEs at a particular site or within the same health-system can decrease the amount of time needed to orient them to site-specific aspects, increase the students’ familiarity with the site, and help them better fully integrate into the pharmacist workflow. However, simply being at the same site for several APPEs consecutively does not guarantee that students are developing these essential skills. Individual APPE curricula must be intentionally designed in such a way that students have repeated experience with implementation and follow-up while participating in the PPCP.
With pharmacists’ roles continually evolving, it is essential that graduates are able to fully embrace and be comfortable with all steps of the PPCP, not just the first few. Potential barriers encountered by students in the experiential setting may prevent them from developing their sense of accountability to patient care, thereby keeping the profession from advancing. To maintain the positive trajectory of the pharmacy profession, preceptors should work diligently on potential solutions to overcome these barriers.
What barriers have you identified in your practice setting and what strategies have been effective for helping students overcome them in developing their sense of professional accountability?
- Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management. 3rd ed. Chicago, IL: McGraw Hill; 2012.
Andrew Bzowyckyj is a Clinical Associate Professor at the University of Missouri-Kansas City in Kansas City, MO. Educational scholarship interests include student leadership development, reflection and reflective practice, and professional development of students into practitioners. In his free time, Andrew enjoys running, traveling and being a genuine foodie.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning