Overview of Experiential Education Gerald E. Meyer, PharmD, MBA, FASHP Associate Professor and Director of Experiential Education Jefferson School of Pharmacy

Objectives Describe the driving forces behind changes in pharmacy experiential education

The Roadmap to Change – What is driving us? JCPP Future Vision of Pharmacy Practice CAPE Educational Outcomes 2004 IOM: Health Professions Education ACPE Standards 2007

Joint Commission of Pharmacy Practitioners – 2007 Position Statement Vision: Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes Pharmacy Practice in 2015 Foundations of Pharmacy Practice How Pharmacists Will Practice How Pharmacy Practice Will Benefit Society Foundations: Pharmacy Education will prepare pharmacists to provide patient care…(so this is about “us”). Need to develop and maintain a commitment for and about patients, an-in-depth knowledge base and the ability to apply evidence to decision making. How Pharmacists will practice. Pharmacists will have authority and autonomy to manage medication therapy and will be accountable for outcomes. Benefits: Will achieve public recognition that they are essential to the provision of effective health care.

AACP: Center for the Advancement of Pharmaceutical Education (CAPE) Provide Pharmaceutical Care Interprofessional, Evidence-based… Patient-centered or Population based Manage and Use Resources of the Health-Care System Human, medical, informational Medication use systems Promote Public Health

Institute of Medicine (IOM) Health Professions Education: A Bridge to Quality Core Competencies Provide patient centered care Work in interdisciplinary (Interprofessional) teams Employ evidence-based practice Apply quality improvement Utilize informatics

ACCREDITATION COUNCIL FOR PHARMACY EDUCATION ACCREDITATION STANDARDS AND GUIDELINES FOR THE PROFESSIONAL PROGRAM IN PHARMACY LEADING TO THE DOCTOR OF PHARMACY DEGREE ADOPTED: JANUARY 15, 2006 RELEASED: FEBRUARY 17, 2006 EFFECTIVE: JULY 1, 2007

ACPE Standard 14: Curricular Core- Pharmacy Practice Experiences … must provide a continuum of required and elective pharmacy practice experiences throughout the curriculum, from introductory to advanced, of adequate scope, intensity and duration to support the achievement of the PROFESSIONAL COMPETENCIES presented in Standard 12.

ACPE Standard #10 The Curriculum “… required & elective courses and experiences must effectively facilitate student development and achievement of professional competencies” Introductory pharmacy practice experiences (IPPEs): 5% of curriculum Advanced pharmacy practice experiences (APPEs): 25% of curriculum

Standard 14: Preceptors Guideline 14.1 “… must insure preceptors receive orientation…, ongoing training, and development” “Preceptors should provide close supervision of and significant interaction with students.” “The student-to-preceptor ratio for the pharmacy practice experience should be adequate to provide individualized instruction, guidance, supervision, and assessment.”

Standard 11: Teaching and Learning Methods “… produce graduates who become competent pharmacists by ensuring achievement of the stated outcomes, fostering…. critical thinking and problem-solving skills… and enabling students to transition from dependent to active, self-directed, lifelong learners.”

Provided by and used with permission of Peter Vlasses: ACPE

Preparing for A Student

Preparing for a Student Experiential Manual / Preceptor Orientation Create a schedule for the individual student THINK of ways to integrate student into site/practice/duties WIN-WIN Student gains practical knowledge/skill, Preceptor/Site gains value of the task or result

Preparing for a Student Gather other orientation materials Organizational charts, maps, required readings, policies and procedures, computer training, etc Help make student feel comfortable and welcome

Preparing for a Student Assessing student’s prior experience Resumé Student’s own verbalization Student portfolio Especially important in later rotations Faculty rotations completed – key information!

Preparing for a Student Set clear expectations Learning contract General description of activities Clear breakdown of grading Other important documentation, such as confidentiality Signed by preceptor and student Day 1

Preparing for a Student Types of learners Auditory Visual Somatic (tactile, kinesthetic) Motivating factors

Giving Feedback and Conducting Evaluations

Evaluations Informal vs. Formal Based on expectations which have been clearly articulated

Informal Evaluations Generally Verbal Should be: Continuous and Ongoing After presentation End of project Constructive

Formal Evaluations Types Should be: Project-related (journal club, cases, pt interviews) Summative Should be: Written - using form(s) Routine (at least twice per rotation for summative) Direct and Succinct Honest Specific Meaningful (include a plan for improvement)

Evaluation Instrument Provided by SOP Linked to outcomes Prone to subjectivity and bias Need to evaluate not only knowledge and skills but also attitude.

6 Step Approach to Completing Evaluation Form Observe – Need to observe several times during period. Ask others. Record – Use index cards or PDA. Retrieve – Organize all documents Analyze – Look for patterns of performance (consistency, assistance needed?, prompting needed?) Self-Assessment Evaluate

Pitfalls in Evaluations Harshness or Leniency based on personal relationships Central Tendency Proximity Error Contrast Error Grading on improvement/effort Grade Inflation

How to Deliver Evaluation Have documentation ready (including a review of the student’s self-assessment) Use quiet private place for evaluation Review comments and ratings Provide examples from documentation Highlight strengths and areas for improvement Identify improvement plan

Difficult Students Why are Students Difficult? What are the indicators of the difficulties?

Difficult Students: Things for Preceptor to Consider Were objectives and expectations clearly outlined? Is patient care potentially compromised? Is this the first time for the student in this practice environment? Is this a first rotation? Has feedback been given to the student? Am I approachable? Have other members of the staff been helpful to the student?

Strategies for Dealing with Difficult Students Conduct self-assessment (preceptor) Determine the underlying problem Document problem Inform the student Outline a plan Communication ! With student With site With school

Meeting with a Problem Student Agree on a private time – inform the student about the nature of the meeting. Be objective and clear about your assessment of the problem Let student know about the seriousness of the problem (to patients, to grade) Give the student an opportunity to present their views. Is there something you are unaware of? Don’t interrupt or get defensive. Document and Communicate!

Students Can Fail Preceptors do not assign failing grades – students earn them! Often very difficult situation. Ask yourself? Would I want this individual working in my environment? Providing patient care? Could a pharmacist get fired for such behavior (tardiness, absences, unprofessionalism, major medication error)