By Craig D. Cox, PharmD
The 2016 Accreditation Council for Pharmacy Education standards state students must be “team ready” and “practice ready” at graduation.1 I would argue students should also be “precepting ready”. With graduates becoming preceptors early in their career, either during residencies or as clinical practitioners, shouldn’t they be more prepared?
Approximately one-third of pharmacy curricula consist of both introductory (IPPE) and advanced pharmacy practice experiences (APPE) supervised by preceptors. In a survey by Danielson and colleagues, experiential administrators reported “finding and maintaining rotation sites” as their greatest concern, which has remained unchanged over the past 10 years.2 Preceptor development was also listed as a top 5 challenge.
If finding and training preceptors are major issues facing experiential education, shouldn’t we focus on building the preceptor pipeline?
Wouldn’t it make sense to start with our pharmacy students? Many schools of pharmacy have their students recite the Oath of Pharmacist in their first year and again at graduation, which they state “I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists”.
Haines and colleagues asked schools what programs they offered to prepare students for academic careers.3 A diversity of activities related to teaching, scholarship, practice, and service were discovered. However, of the 94 institutions that responded, only 15% provided students with the opportunity to serve as preceptor of IPPE and APPE students under the supervision of their preceptor. Additionally, these academic activities are often elective and few students have the chance to experience them. Although I’m not proposing all students need to complete a formal teaching certificate program, I would challenge the academy to consider requiring all students to be trained for future precepting roles.
What could be done to prepare students to be preceptors?
Many of the strategies used to train residents, volunteers, and full-time faculty to be preceptors could work for students. A diversity of preceptor development programs such as live lectures, webinars, simulations, videos, and online modules exist that are generally high quality and required a significant amount of time and resources to develop. Why not use them for students? Why not train students, residents, and pharmacy practitioners together? Or take it a step further and train all health professionals together to be future preceptors?
Be innovative, be creative and students will get interested…
I have been fortunate to lead the development of two innovative mini-series movie programs that were intentionally designed to train both students and preceptors representing a diversity of health care professions in an interprofessional environment.
- Change of Heart: An Interprofessional Mini-Series (Movie Trailer)
- The Reason I Jump: An Interprofessional Mini-Series (Movie Trailer)
Creative modalities like the mini-series can help excite students about their future rotations, but also learn about the role of a preceptor.4
What would an IPPE or APPE preceptor experience for a student look like?
For inspiration, we can look at concepts of “peer to peer” and “near-peer” mentoring.5 “Peer to peer” involves students of the same academic year (eg. APPE with APPE student) working together, while the latter involves students at different levels (eg. APPE and IPPE student). Over the past 17 years on my adult medicine rotation, I routinely take two IPPE and two APPE students (4 students:1 preceptor ratio) and employ the near-peer mentoring philosophy. Students are assigned in pairs (IPPE with APPE student) to different teaching teams, which provides the opportunity for the students of different years to learn from one another and practice their precepting skills. For peer-to-peer, I set aside time for the two IPPE or two APPE students to collaborate on different types of assignments (e.g. chart reviews, SOAP notes, drug information).
In advance of groups of students working together, I do the following for each activity:
- Describe the purpose / student role
- Model the activity
- Review the details of the assessment form
Students are assigned specific activities and given a deadline. Orienting students to activities, providing formative feedback, and performing a summative evaluation are three preceptor skills I aim to accomplish through peer mentoring activities. Although much of the activity is done outside my supervision, I require the formal feedback and evaluation sessions between the students to occur in my presence.
Trying to utilize this model can have challenges. Not all experiential rotations have ratios of 2:1 (students to preceptor) or greater to allow for these experiences. In addition, students have varying degrees of interest in being a preceptor. Certainly, preparing all students to be “precepting ready” is not an easy proposition that can be implemented overnight. However, given the model is promising, devoting more time to experimentation in this area is warranted as the profession’s future is heavily reliant on the quality and quantity of our preceptors.
- Accreditation Council for Pharmacy Education. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree (“Standards 2016”). Published 2015. Available at: https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed August 4th, 2017.
- Danielson J, Craddick K, Eccles D, et al. A qualitative analysis of common concerns about challenges facing pharmacy experiential education programs. Am J Pharm Educ 2015;79(1):Article 6.
- Haines SL, Dy-Boarman EA, Clifford KM, et al. Methods used by colleges and schools of pharmacy to prepare student pharmacists for careers in academia. Am J Pharm Educ 2017;81(1):Article 6.
- Cox CD, Samuel NG. Utilizing an innovative preceptor video mini-series to prepare students for experiential rotations: Does it work? Innov Pharm 2017;8(2):Article 20.
- Bene KL, Bergus G. When learners become teachers: a review of peer teaching in medical student education. Fam Med 2014;46(10):783-7.
Craig D. Cox is an Associate Professor and Vice Chair of Experiential Programs at Texas Tech University Health Sciences Center School of Pharmacy. Educational scholarship interests include preceptor development and quality assurance/improvement in experiential education. In his free time, Craig enjoys attending sporting events and traveling the world.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning
Great start to a very interesting discussion, Craig! Not all students may be ready or interested in the preceptor path, but as you pointed out, they may have to possess some basic skills in this area as part of their contribution to the profession.