Discover, Learn, Care...Improve Health Status of Pharmacy Education in the US George E. MacKinnon III, Ph.D., R.Ph., FASHP Vice President of Academic Affairs American Association of Colleges of Pharmacy

Guiding Principle: High Standards of Academic Excellence Outstanding students come to universities where they can study with outstanding faculty Outstanding faculty pursue careers at universities where they can work with outstanding students If excellence is lost in one, then a decline in the other can be expected to follow LeslieSW. Pharmacy faculty workforce: Increasing the numbers and holding to high standards of excellence AmJPharmEduc. 2005;69(5)1-2. Paraphrasing former President of the University of Texas-Austin, QUALITY

Today’s Challenges Require Studied Action Key challenges in 21st Century Pharmacy Education  Sufficient qualified applicants  National shortage of pharmacists  Leaders for existing and emerging schools  Quantity and quality of experiential education sites  Sufficient faculty for expansion and retirement positions; need for practice plan revenue  Meaningful metrics for objective quality assessment in education  Student and faculty professionalism  Resources, resources, resources!

Resources, Resources, Resources  Students  Faculty  Experiential  Research

Mission of Pharmacy Education … to prepare graduates who provide patient- centered care that ensures optimal medication therapy outcomes and provides a foundation for specialization in specific areas of pharmacy practice; to participate in the education of patients, other healthcare providers, and future pharmacists; to conduct research; and to provide service and leadership to the community. (Adopted by AACP HOD July 2007)

Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes  Pharmaceutical Care Provide patient-centered as well as population-based care  Systems Management Manage human, physical, medical, informational, medication use systems and technological resources  Public Health Assure the availability of effective health and disease prevention services and policy (Adopted by AACP 2004)

Health Professions Education: A Bridge to Quality (2003 IOM) All Health Professionals Should Be Able To:  Deliver patient-centered care  Work in interdisciplinary teams  Employ evidence-based practice  Apply quality improvement approaches  Utilize informatics Health Professions Education: A Bridge to Quality (2003) Institute of Medicine (IOM Health Professions Education: A Bridge to Quality (2003) Institute of Medicine (IOM). National Academy of Sciences.

Characteristics of the Pharmacy Education Enterprise  Approximately 110 colleges/schools of pharmacy (COP/SOPs) Some existing programs are expanding class sizes Some programs are developing satellite campuses 7-10 programs are year-round (“accelerated”) 10 programs earlier than pre-candidate status  Doctor of Pharmacy (PharmD) enrollment of 50,667 (Fall 2007) and 9,790 graduates in 2007  By 2015 number of graduates could be 14,000

Today’s PharmD Graduate “Engineering Degree of the Health Sciences”  Pharmacy Applicants: 15,652 applicants (PharmCAS,2008), 12,500 applicants for a total of about 28, ,463 applications received by COP/SOPs (2006)  Pharmacy Matriculates: 75% have > 3 years education, about 50% have a baccalaureate degree Majority (67%) are women, Mean age increasing  Pharmacy Graduates: Elimination of post-graduate internship requirements Enter the profession as a generalist practitioner

Pharmacy School and Residency Graduation Trends Source: AACP & ASHP Data

Pharmacy Faculty  AACP Institutional Research Briefs* 4,340 full-time, 534 part-time at 92 COPs (2006) 595 vacant and/or lost positions in (39% increase n=429) 49% were existing positions, 42% new positions 51% of vacancies are in the area of Practice Top reason for vacant position = move to another COP  Impact of future retirements  Academics devoid of pharmacy experience  Extent of adjunct faculty in Academy is unknown  Campus-based appointments in Health Sciences *Source: AACP Institutional Research Brief #8: Vacant Budgeted and Lost Faculty Positions – Academic Year (94 of 97 COP/SOP reporting)*

Resources to Meet our Challenges: Faculty  Education Scholar TM  American Foundation for Pharmaceutical Education ( AFPE) Program Support AACP New Investigators Program (Faculty) Gateway Research Scholarships (Students)  Wal-Mart Scholarship Program  Academic Leadership Fellows Program  President Raehl’s 2007 Challenge  2008 AACP Institute

Taxonomy of Learning Knowledge Skills Abilities Attitudes Behaviors Post- Graduate Experiential Learning Service Learning Workshops PBL Labs Didactics

Why Pharmacy Preceptors?  Total number of pharmacy preceptors is unknown  100 COP/SOP’s with 100 students at 10 placements/year = 100,000 placements/annually  5 placements/preceptor/year = 20,000 Preceptors  No process has been used to describe on a national level preceptors’ characteristics, perceptions, and needs/wants  Preceptors maybe under-served/under-recognized  AACP is a logical “home” for their educational needs/wants  Opportunity to provide products & services for preceptors  Creation of an Academy of Preceptors  Preceptors are “self-selected” individuals  Logical group to engage in practice improvement initiatives

Benefits to Engaging Pharmacy Preceptors  Focus on the Individual (Preceptor) not the Site  Providing standardization in many areas to preceptors (that are mobile themselves)  Follow through on APPI Summit recommendations  Pooling of the limited resources (human, financial, intellectual, technological) to develop/maintain programming for preceptors  Attract “non-traditional” hires to the academic pharmacy community

Resources to Meet our Challenges: Experiential Education  Academic Practice Partnership Initiative (2005) Library of resources (N>400 items) Site profiling tools - Crystal APPLE Awards  AACP Institute (2006)  Experiential Education Administrators Workshop (2007)  National Capacity Analysis with ASHP (2007)  More Products and Services

Academic Practice Partnership Initiative (APPI) This Initiative identifies strategies and resources to:  increase capacity and  enhance quality, efficiency, and effectiveness of professional experience programs Goals were to improve pharmacy education and practice by:  enhancing opportunities for pharmacists to become partners of schools and colleges of pharmacy;  enabling colleges and schools of pharmacy in their efforts to assist practitioners and organizations to advance patient care services;  assist administrators at colleges and schools as well as in pharmacy organizations to enhance experiential education.

Purpose of the award:  To recognize the successful partnerships between academia and practice that lead to enhanced quality in practice and education;  To recognize excellence in practitioners’ participation in doctor of pharmacy education by providing exemplary patient care sites that support educational outcomes of advanced practice experiences;  To identify and profile exemplary patient care practices delivered by pharmacists in a variety of settings considered benchmarks of excellence in advanced clinical education programs Crystal APPLE Award  Univ of Florida College of Pharmacy & Shands Jacksonville Medical Center  The Univ of Iowa College of Pharmacy & Osterhaus Pharmacy  Northeastern Univ School of Pharmacy & Harbor Health Services Inc. (AmCare)  The Univ of Mississippi School of Pharmacy & North Mississippi Medical Center  Univ of Missouri—Kansas City School of Pharmacy & Branson Drug  The Ohio State Univ College of Pharmacy & Kroger Patient Care Center  Univ of Oklahoma College of Pharmacy & Valu-Med Pharmacy  Texas Tech Univ Health Sciences Center School of Pharmacy & North Texas Veterans Administration Medical Center (AmCare)

AACP Portfolio of Products and Services: Experiential Education AACP Benefits to Preceptors Benefits to College/Schools Benefits to Employers National Preceptor Profile National Preceptor Develop Program Exper Education Adminis Workshop Universal Compet Assessment Universal Compet Assessment Universal Compet Assessment National Preceptor Develop Program Universal Documentation Sys Universal Documentation Sys Universal Documentation Sys Developed In Progress Proposed

Action Plan & Status Update: Portfolio of Products and Services Advice and Feedback from Key AACP Constituents Approval from AACP Board of Directors Created an EE Advisory Group to the Portfolio Deliverables to date:  Experiential Education Administrator’s Workshop  Fall of 2007 attended by 23 EEAs, 2008 Program  Preceptor Profiling to begin in early 2008  Universal Competency Assessment  Proof-of-concept for Competency-based Student Performance Assessment Program for APPE’s by Scholar in Residence  Universal Documentation System  Discussion with FDA & AHRQ, and MTM vendors in 2007

Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q Preceptor Profile Universal Competency Assessment Preceptor Development Program Experiential Education Administrators Workshop Preceptor Profile Universal Documentation System AACP—Experiential Education Portfolio Timeline

Experiential Education Administrator’s Workshop GOAL:  Provide essential information and resources to new administrative support personnel for experiential education (EE) programs. OBJECTIVES:  Discuss the ACPE Standards 2007;  Provide information on key resources;  Describe relevant operational procedures; and  Create a support network of contacts and peers  Including AACP, ACPE, and EE contacts

Preceptor Profile GOAL:  Describe on a national level the characteristics of pharmacy preceptors engaged in experiential education. OBJECTIVES:  Capture the demographic characteristics of preceptors;  Describe the contributions by preceptors to experiential education;  Explore the development interests of preceptors;  Engage the preceptor community with AACP

GOAL:  Create a development program for clinical instructors (i.e., preceptors) by assisting them in their quest for self-improvement/continuing professional development (CPD) OBJECTIVES:  Utilize and pool resources (human, intellectual, technological, financial) to develop/maintain a preceptor development program:  maintained on a national basis  delivered, supported, and supplemented on a state/regional basis  Provide standardization to preceptor training  Recognize the significant role that pharmacist preceptors by:  employers; students and the academic pharmacy community;  professional practice communities; and State Boards of Pharmacy  Establish a framework for further collaboration on a national scale among the academic and professional practice communities Preceptor Development Program

Universal Competency Assessment Competency Assessment of Pharmacy Practice Experiences (CAPPE) GOAL:  Employ an evidenced-based approach to student performance assessment during experiential education that is meaningful and provides useful information. OBJECTIVES:  Promote consistent student performance assessments to a cadre of predominately volunteer preceptors;  Reduce the redundancy experienced by preceptors  Create a psychometrically sound clinical performance assessment tool;  Standardization for State Boards of Pharmacy  Provide meaningful information about student performance during experiential education  Formative and Summative assessments will require students to take responsibility for their learning and CPD

Universal Documentation System GOAL:  Employ a universal approach to document and characterize the contributions that pharmacy students provide in the care of patients in a multitude of practice settings. OBJECTIVES:  Indoctrinate the skills, attitudes, and behaviors in pharmacy students to document “patient pharmacy care plans”;  Document and characterize the interactions of students in achieving optimal outcomes of medication therapy;  Assess students contributions to assuring medication safety in patients and groups of patients;  Document specific clinical encounters (patient-types) that may be required for licensure, post-graduate training, or board-certification;  Potential revenue streams in conducting naturalistic studies and patient reported outcomes by having a process in place

Traditional View of the Academic Triad of Responsibilities for Faculty Teaching Research Service

Scholarship Reconsidered From: Scholarship Reconsidered: Priorities of the Professoriate, Boyer I. Discovery II. Application IV. Dissemination III. Integration

An Alternative View of Research for Clinical Faculty Teaching Scholarship Service Patient Care Administrative Didactic Experiential CE/CPD

Research – Scholarship by Clinical Scientists Practice-Based Research Network (PBRN) The Agency for Healthcare Research and Quality (AHRQ) defines a practice-based research network (PBRN) as a group with at least 15 ambulatory practices and/or 15 clinicians devoted principally to the primary care of patients, affiliated with each other (and often with an academic or professional organization) in order to investigate questions related to community based practice. Types of research conducted by PBRNs  the treatment or prevention of common diseases and symptoms;  continuity and coordination of care;  the nature, characteristics and organization of prescription drug distribution and use;  the interface between pharmacy practice and other healthcare providers;  decisions made by patients about healthcare and health practices for themselves, their families, and the community.

Compelling Facts - Embracing the PBRN Model to Improve Medication Use  Medications are the most commonly used treatment modality in medicine.  Roughly 80% of prescription drugs go to outpatients; 20% are distributed in acute care.  Each American uses an average of 12.3 prescriptions (new and refill) annually.  Persons 55 years and older visit a pharmacy twice a month on average.  The National Institutes of Health (NIH) and AHRQ have come to regard Practice-Based Research Networks (PBRNs) as an important complement to traditional research.  PBRNs are grounded in the proposition that “if we want more evidence-based practice, then we need more practice-based evidence”

Efficacy Effectiveness Efficiency Use in Controlled Clinical Practice? N= 100s-1,000s Randomized clinical trials (RCTs), Phase III Adverse Drug Event (ADEs/ADRs) Reports Use in “Real life” Clinical Practice? N=10,000s Post-Marketing Observational Studies (PMOS) Phase IV Studies Ongoing Surveillance Impact on health care resources? N=100,000s Registries Naturalistic Studies PBRN Studies From Clinical Study (drug) to Clinical Practice (medication) DrugMedication Does it work in controlled practice? Does it work in wide spread clinical practice ? Does it contribute to more efficient resource use?

Approaches to Surveillance Prospective Based Electronic Medical Records (EMR)  Pharmaceutical, Medical, Hospital Lab data more often linked to actual clinical results  What the clinician ordered and results of the patient  Data maybe accessible instantaneously  A “real life registry” or “naturalistic” PMOS Prescription Profiles  Advantage of seeing patient monthly (chronic Rxs)  Assessment of adherence/compliance  Potential surveillance of ADE’s  Electronic messaging with providers (tie into an EMR)

Elements of a Safe and Effective Medication Use System  Prompt and accurate response to signs and symptoms  Safe and efficacious medicines  Prescribing for definite objectives  Dispensing and tailored patient advice  Active patient/caregiver cooperation  Monitoring (problem detection and resolution)  Documentation and communication system  A management system (with performance indicators, thresholds, etc.) Grainger-Rousseau TJ, et al. Therapeutic outcomes monitoring: application of pharmaceutical care guidelines to community pharmacy. J Am Pharm Assoc (Wash).1997 Nov-Dec;NS37(6):

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