1. EXPERIENTIAL UPDATES FROM UAMS AND HOW TO CREATE MOMENTS FOR STUDENT PHARMACISTS ON ROTATION
Lindsey Dayer, PharmD, BCACP
Associate Professor
UAMS College of Pharmacy

2. OBJECTIVES
Review recent changes to the UAMS College of Pharmacy Experiential Program.
Describe the importance of heightened ‘moments’ in education and a student’s career.
Discuss how the contributions of others can create satisfaction in students.
Give examples of how improving shared meaning can increase personal connection regarding student interaction.

3. EXPERIENTIAL GOALS/MISSION
Provide structured, practical and supervised pharmacy experiences
Enable students to develop and apply skills in a real world practice environment
Students can assume role of a practicing pharmacist
Professional judgment
Practice competency
Technical skills
Structured, supervised, relevant, practical practice experiences
Students should be able to develop and apply skills gained in the classroom
We want students to develop professional judgment, as well as technical skills to become competent pharmacists

4. APPE CHANGES THIS YEAR (MAY 2018)
APPE ≥ 1440 hours
(36 weeks)
APPE ≥ 1600 hours
(40 weeks)
9 month-long rotations
10 month-long rotations
Off May and December
May rotations!
December as an option
5 Direct patient care rotations
2 Indirect patient care rotations
2 Electives
7 Direct patient care rotations
1 Indirect patient care rotation
More direct patient care

5. 2018 APPE CHANGES Health-system changes
Students can select to the level of the site and preceptor
Students may select 1 more Acute/AmbCare rotation
up from 4 required to 5
7 possible if all electives used for Acute/AmbCare
Google doc of all rotations and rotation descriptions sent to students

6. 2018 APPE CHANGES Community Rotation Changes
Students can select to the level of site/preceptor
Can have up to 4 community experiences
Community Management will become an elective known as Community Ownership/Management
MTM and OTC direct patient care rotation will be folded into a new Enhanced Pharmacy Services (EPS) direct patient care rotation
All community pharmacies will be visited/contacted to determine
What Enhanced Pharmacy Service they offer
If they want to continue to be a site that offers Community Management/Ownership

7. SO WHAT ARE ENHANCED PHARMACY SERVICES? (NOT AN ALL INCLUSIVE LIST)
Adherence Packaging
Collection of Vital Signs
Compounding (sterile/non-sterile)
Comprehensive Medication Reviews
CMR with chronic care management
Medication Synchronization Program
Clinical Medication Synchronization Program
Point of Care Testing (A1c, Strep, Flu, Hep C)
Smoking Cessation program
Home Visits/Delivery
Naloxone Dispensing
Standardized assessments (PHQ-9, Med adherence Morisky Scale, pain assessment)
Nutritional Counseling
Disease State Management and Education Programs 
Medication Reconciliation
Immunization screening and administration
Travel Vaccines
Transitions of Care 
DME
In depth counseling/coaching
Care plan development and reinforcement
Pharmacogenomics Testing

8. SO WHY DID WE CHANGE APPE STRUCTURE FOR 2018?
Years of preceptor/site feedback
Changes in the NAPLEX exam
Increased items from 185 to 250
Increase in clinically-based and patient-centered items
Possibly moving to a Pass/Fail exam
Drop in NAPLEX pass rates for GY2016
PCOA (Pharmacy Curriculum Outcomes Assessment)
Given near or at the end of the didactic curriculum
Lets COPs benchmark themselves with other comparator schools
Clinical and basic science questions
We benchmarked near the 50th percentile

9. THE PHARMACY SCHOOL CURRICULUM
It is changing
Curriculum 2025
Integrated curriculum
LOTS of working groups
We see the changes in practice and the changes in the licensure exam

10. Intuitive interface
Preceptor availability is gathered electronically (computer, phone, tablet)
Evaluations may be filled out by a variety of devices
More functionality and easier to use than e-value (for students and preceptors)
Meets more of the experiential office needs than e-value

11. ROTATION SELECTIONS
P3 students get to select to the level of the preceptor
Rank specific preceptors for acute, ambulatory care, hospital management, community EPS
Selectives
Electives
A change from previous years when could only rank the city
CORE does a lot of cool stuff!!
Impact of student word of mouth on next year (if you are an ass to your students not many will choose you the next year)

12. WHAT IS THE IMPACT OF STUDENT WORD OF MOUTH? IT DEPENDS…

13. WHAT KIND OF PRECEPTOR DO YOU WANT TO BE?

14. SO, HOW DID THESE NEW CHANGES GO?
Preceptor/site selection
Went well!!
Students received ~6/10 rotations in their top 5 rankings
Out of 329 rotations that went through the lottery
150 were #1 preferences
87 were #2 picks
44 were #3 picks
Others were hand placed based on other circumstances
Distant sites
~30% students were placed at a distant site
Changes for next year
Selectives (less specific)
Google docs sheet-REMOVE
Students can view site descriptions in CORE
Seemed to be high satisfaction

15. FUTURE DIRECTIONS
Education about the Pharmacists’ Patient Care Process (PPCP)
Rotations Fair
Preferences released to preceptors
Other?
Implement the Pharmacist Patient Care Process into the experiential curriculum (e.g. rubric, education, etc)

16. SURVEY How to play: Go to kahoot.it Enter in game PIN: 613057
Create your name
My Login:
UserName: ldayer
Password: UAMS22

17. STUDENT EVALUATIONS

19. TIPS FOR READING STUDENT EVALUATIONS
First off, don’t ignore them.
They may be trying to tell you something
Look for themes and patterns
I didn’t get proper orientation/know what to expect
Schedule
I didn’t see my preceptor much
No feed
Consider “studying” your evaluations with someone you trust (experienced preceptor) or having someone read over them
Do your research
Ask others questions
Read a book about precepting
Experience…
Take more students ☺
Evaluations are anonymous, but can still be personal
Explain material well? Explain expectations? Orient the students to your site?

20. TIPS FOR “DEALING WITH” STUDENT EVALUATIONS
Eliminate inappropriate/just plain mean comments
Look for outliers and eliminate those
Look for your strengths and positive comments and dwell on these too
Be proactive
Give students clear expectations on day 1
Evaluations are anonymous, but can still be personal
Explain material well? Explain expectations? Orient the students to your site?

21. THE POWER OF MOMENTS IN EDUCATION

22. Modeler Socializer Educator
Preceptor = Teacher
A practicing pharmacist who gives personal instruction, training, and supervision to a pharmacy student
Modeler Socializer Educator
Modeler: demonstrates how competent staff perform their job
Socializer: integrates student into the unit culture, helps student feel comfortable in an uncomfortable environment
Educator: assists student to assess learning needs, plan learning experiences, implement the plan, evaluate performance

23. This book with it’s stories and examples can help you (and me) as a teacher, a mentor, a preceptor, a leader, and a student

24. BOOK TAKEAWAYS Defining moments shape our lives
We don’t have to wait to make them happen
We can create them

25. KEY POINTS Elevate the ordinary by creating peaks in the moment
Seek insight by seeking the truth and looking deep into the moment
Create pride by seeing the contributions of others in the moment
Develop connections by reflecting on the meaning of the moment

26. DEFINING MOMENTS
“Our lives are measured in moments, and defining moments are the ones that endure in our memories”
Recall moments based on peaks, pits, and transitions
Scientific reason for remembering these moments
Unique and extraordinarily unexpected
Four components (EPIC): Elevation, Pride, Insight, Connection
We all have defining moments in our lives…meaningful experiences that stand out in our memory.
Elevation – a moment that rises above all others in a day
Pride – a moment that happened while we are at peak
performance
Insight – a moment that changes how we see our environment
Connection – a moment that is part of our cultural fabric
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

27. THINKING IN MOMENTS
“Transitions should be marked, milestones commemorated, and pits filled.”
If you want to lead people differently, you have to be aware of your ability to change the ordinary
Example: what if you treated the student’s first day of rotation like a first date? You worked hard to find out their interests, their goals, their learning style?
G.L.E.A.M tool
End of rotation “moments” (e.g. coffee, lunch, workplace announcement to highlight the student’s month, other?)
People crave unique experiences
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

28. G.L.E.A.M. TOOL
Goals: what are your goals and expectations for this rotation? What are your goals and expectations for your career?
Learning: How do you learn most effectively? What has helped you succeed in other rotations? What did you find challenging? How do you like to receive feedback? What is your learning style?
Experiences: What previous patient experiences have been meaningful to you? What have other clerkships been like? Which patient experiences/interactions have been most challenging for you? Are there particular patient groups or medical conditions that have been more challenging for you? Have the students share a story. If there have been no challenges so far, encourage them to talk with you when such challenges arise during your time together
Activities: what activities are you involved in outside of school?
More: what more do I need to know about you to make this an optimal learning experience? What have a forgotten to ask you? Do you have any questions for me?
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

29. BUILDING PEAKS
“To elevate a moment, do three things: First, boost sensory appeal. Second, raise the stakes. Third, break the script.”
Highschool students log more time in classrooms than anywhere else. Yet most adults will not recall learning experiences. What if we could design an academic experience that was as memorable as prom?
Consider designing instructional methods that drive emotional connection and memory to the experience in order to increase student retention of knowledge
Experiential rotations might be a key place to practice this concept
“Peaks don’t just happen. They take energy and effort.”
When investing in increasing your customer satisfaction, there is
a greater return on investment when you spend money on moving
people from an eight to a nine. • “There is nine times more to gain by elevating positive customers than
by eliminating negative ones.”
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

30. BREAK THE SCRIPT “Breaking the script is a strategy”
We can create more peaks by disrupting routines
Must be a surprise, not an expectation
Example: if you give something away every Friday, it becomes routine, and when you stop doing it, it creates a disappointment
Spontaneity in every aspect of your life will create lasting moments at home, with friends, and at work
What area of your work could you ”break the script”?
ACH emergency department allows students to ride Angel One helicopter for a day
Get people out of their traditional environments and mix it up. Move your classroom for a day, take the leadership “planning” day to an unexpected environment, get people talking about the environment and moving to increase creativity and memory.
We are most likely to recall our youth and life cycle rituals because they
are all firsts.
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

31. RECOGNIZE OTHERS “Being grateful to others elevates your own spirits”
Educators have great influence on the direction of life and learning
”Of all of the ways we can create moments of pride for others, the simplest is to offer them recognition.”
We need more strategies and development in order to increase our ability to create moments for students.
Surveys have found that “the top reason people leave their jobs is a lack of praise and recognition.”
Praise should always be unique and personal – not a process or “programmatic.”
Make recognition spontaneous.
The most important message is: “I saw what you did and I appreciate it.”
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

32. MULTIPLY MILESTONES
”A common trait you will observe in accomplished people is an obsession with completion. Once a project falls into their horizon, they crave almost compulsively to finish it.”
Multiply milestones (progress, success) by breaking larger tasks into smaller pieces.
When there is a BIG project, it is often difficult to see the incremental change; celebrate small successes to increase the power of moments.
People love milestones in their live.
Youth sports offer great examples of breaking down skills into smaller parts. Over the course of the season there are many milestones and successes. First goal, first steal, first win, etc. Break down life like this to increase milestones, recognition, and motivation.
People love milestones in their lives – 10,000 steps on the pedometer is an example. People who track their steps are obsessive about making certain that they hit their daily milestone.
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

33. PRACTICE COURAGE
“People almost always know the right thing to do. They just lack courage because they have not practiced or experienced the results of taking the risk to be brave.”
Have a plan and practice courage.
“Implementation intentions” Ex. “I am going to eat a cookie; if I crave a second cookie, I’m going to eat an apple”
Without implementation intentions, we end up defaulting to the path of least resistance because we didn’t have a plan.
Take small steps.
In didactic curriculum- we have OSCE simulations to practice real-world scenarios
Rehearse with kids what to do when they face peer pressure. Talk about ways to get out of the situation and practice the situation by role-playing.
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

34. CREATE SHARED MEANING
“If you want to be a part of a group that bonds like cement, take on a really demanding task that’s deeply meaningful. All of you will remember it the rest of your lives.”
If you expect customers (or students) to have great experiences, it begins with the employees having great experiences.
Create connections with people by doing it in person…you don’t feel ‘meaning’ in an .
Discover your “why”
People in every organization need to understand or discover their “why.”
Why they clean the floors. Why they teach. Why they work in customer
service.
When people understand their role in the work it leads to “innovation and improvisation.” This builds meaning and ownership.
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

35. DEEPEN TIES
“If we can create the right kind of moment, we can change relationships in an instant.”
Be genuine in how you respond and give feedback.
Processes and checklists to determine the progress of others/students do not build genuine connections.
Be intentional .
“If we want more moments of connection, we need to be more responsive to others.”
“Relationships don’t deepen naturally. In the absence of action, they will stall.”
One school system did home visits to parents who were disconnected from the school and found that when they went in without scripts, clipboards or notecards and simply talked with parents, there was a gigantic increase in engagement from those who would have been traditionally disengaged.
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

36. MAKING MOMENTS MATTER
“ A bit of attention and energy can transform an ordinary moment into an extraordinary one.”
Too often we focus on the wrong things. Fixing problems, looking for solutions and we fail to recognize the opportunity to reinforce the moment. Bring attention to the struggle, recognize the courage and reinforce the relationships that are getting the outcomes. That’s what making moments is all about.
HEATH, C AND DAN HEATH. THE POWER OF MOMENTS.

37. THINGS TO THINK ABOUT…
What ordinary moments in your day (in the students day) could be extraordinary?
List ways that you can support others to build courage
Review your willingness to support others finding the importance in the moment
Describe how you utilize collaborative practice in order to make moments matter
List your strategies for recognizing others
Evaluate your own ability to deepen the purpose of work for others or yourself.

38. WHY SHOULD WE CARE ABOUT HEIGHTENED ‘MOMENTS’ IN EDUCATION AND A STUDENT’S CAREER?
Increased appreciation for the profession
Increased ownership in the profession
Increased student engagement
Improving shared meaning can increase personal connection regarding student interaction and engagement
These moments matter! We never forget them!
I think most of us want to make a difference

39. HOW CAN THE CONTRIBUTIONS OF OTHERS CREATE SATISFACTION IN STUDENTS?
When students and staff feel valued, respected, and supported their satisfaction increases.
This can be hard to do consciously demonstrate these matters
Create space and conditions for students to discover and wrestle with new ideas
Give them the opportunity to work through a problem and come up with a solution

40. CELEBRATE THE ORDINARY
This book increases optimism, it makes you look at others with greater empathy, and will have you doing your life work with more passion.
It provokes a little bit of guilt, which may encourage us all to change how they approach instruction, leadership, and customer experience.

41. ASSESSMENT QUESTIONS How to play: Go to https://kahoot.it
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42. REFERENCES
Heath, C and Dan Heath. The Power of Moments. London, Transworld Publishers, 2017