Creating Meaningful International Pharmacy Experiences

by Katherine Baker, Pharm.D., PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

International pharmacy experiences are increasingly popular. Today, students are eager to see the world and compare their learning environments to those of other students around the globe. In 2010, a survey of 114 pharmacy schools in the United States revealed that 40 had an active global/international program.¹ Having completed a global pharmacy experience during pharmacy school, I can speak to their value. I was fortunate to spend 5 weeks in Phitsanulok, Thailand at Naresuan University teaching hospital. What seemed like a distant dream soon became a reality when I found myself in rural Thailand with one of my best pharmacy school friends relying on the Google translator application to help us communicate. While international experiences have important benefits simply from “being there,” it is equally important to know how to design these experiences to maximize learning.

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First, it important to ensure that international experiences foster the development of the competencies required for graduation. Second, that there should be policies in place to ensure that the international site and faculty are qualified.² To address these requirements and the increasing demand for global health experiences, several initiatives have sought to improve the quality of international pharmacy rotations. Indeed, the American Association of Colleges of Pharmacy developed a special interest group that includes a dedicated team of individuals who discuss topics and ideas related to global healthcare.¹  

Prior to establishing an international experience and sending student pharmacists across the globe, great attention should be paid to ensuring that both the student and the host site are prepared for the visit. The planning period for my international rotation was stressful due to unknowns that come with living and learning in a foreign country. These stresses were alleviated when the host site sent me documents with helpful information about our living arrangements and coordinated everything before arrival. A number of articles have explored important considerations that must be taken into account before developing a Global/International Advanced Pharmacy Practice Experience (G/I APPE). These considerations include host country, home institution, host institution, faculty/preceptors, and student issues.² 

The host country is an important factor to consider before establishing an international rotation. While having a well-thought-out curriculum is necessary, ensuring a safe and functional learning environment in a foreign country is even more important. Pharmacy schools need to ensure that students are well informed about the country they will be traveling to.  Students should try to learn about the local culture(s) and basic parts of the native language. This will help them while navigating abroad as well as improving patient interactions during the experience. While in Thailand, I worked in an anticoagulation clinic and was asked to interview and counsel patients. I struggled to communicate and had to rely on my preceptor. This particular experience would have been much more meaningful had I learned the language ahead of time. Logistics of the rotation such as visas, living arrangements, transportation, and financial considerations should also be addressed well in advance. 

Equally important are the host institution and the curriculum. To justify an international experience, the host institution should be vetted and deemed an appropriate pharmacy experience. It is recommended that the host and home institutions have a designate representative. These designated faculty members will be responsible for communicating student educational needs, learning outcomes, and detecting any red flags.¹  In addition, a thorough and thoughtful syllabus must be drafted and approved. Just like any other course or experience in pharmacy school, the syllabus should lay out expectations, goals, objectives, and grading criteria.¹    

Student interaction while on rotation is another important consideration to create a meaningful experience abroad. For students to take full advantage of their international pharmacy experience, they should be meaningfully engaged and aware of what they are learning. One descriptive study discusses the importance of reflective writing while on rotation. Based on student reflections, the authors noted a pattern to student learning while on a G/I APPE. Students use “communication, problem-solving, and adaptability”³ skills while on rotation and then reflect on the major differences between their home and host country. There a couple of ways to get students to reflect about their experiences.  One method is to ask students to keep a personal journal and regularly writing entries.  Another way to encourage reflection is to require students to give a presentation to peers after completing the experience. My pharmacy school required each student to create a weekly travel blog reflecting on their experiences (check out our blog: Thailand Adventures - Two Pharmacy Students Finding Their Way Through Thailand). This exercise helped us to reflect and translate what we learned abroad and apply it to our lives in the United States. Our blog essays were also useful to future participants. Indeed, many of our weekend excursions were based on blog posts from previous students!

Global pharmacy experiences are not only an adventurous, once-in-a-lifetime experience, they also enhance a pharmacy student’s professional advancement. In a world that is becoming smaller and more connected through technology, a G/I APPE will give students an opportunity to grow their perspective and sensitivity towards people from other cultures.¹ Students who have participated in a global pharmacy rotation are more likely to be culturally aware and “demonstrate increased interest in volunteerism, humanitarianism, and public health.”² Moreover, international experiences often help students improve their communication skills, problem-solving skills, and adaptability.³  

Having participated in an international rotation myself, I can attest to many of these benefits. If I could give any piece of advice, I would encourage students heading into an international experience to learn some of the host country’s language and keep a travel journal or blog. It’s also important to give both the host and home sites feedback. The home institution often go to great lengths to ensure that the rotation will be maximally beneficial but the best information is feedback based on personal experience. The host institution that I completed my rotation at required students to complete an in-depth exit survey. The institution wanted an honest review of the experience and it was important to openly discuss any concerns to better serve students for the future.

International pharmacy experiences are a once-in-a-lifetime opportunity that I would recommend to all pharmacy students. If the experience is well planned and executed by both the host and home institutions and if the student approaches the experience with enthusiasm and an open mind, it will be a personal and professional growth experience the student will never forget.

References:

1. Steeb DR, Overman RA, Sleath BL, Joyner PU. Global Experiential and Didactic Education Opportunities at US Colleges and Schools of Pharmacy. Am J Pharm Educ. 2016;80(1): Article 7. doi:10.5688/ajpe8017
2. Alsharif NZ, Dakkuri A, Abrons JP, et al. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations. Am J Pharm Educ. 2016;80(3): Article 38. doi:10.5688/ajpe80338.
3. Steeb DR, Miller ML, Schellhase EM, et al. Assessment of Global Health Learning Outcomes on International Experiences. Am J Pharm Educ. 2019. doi: 10.5688/apje7586

Is There a Perfect Late Work Policy?

by Kaitlyn Dupuis, PharmD, PGY-1 Pharmacy Resident, North Mississippi Medical Center, Tupelo, MS

When it comes to teaching, there are several logistical issues that people often overlook — like dealing with students who do not turn-in assignments on time.  When assignments are submitted late, it often creates additional work for the teacher and inequities with other students who did not have the benefit of extra time.  It’s difficult to develop a completely fair and consistent “late work policy.”  Some teachers choose to accept late work within a few days of the assignment’s due date for full credit.  While others will accept late work with points deducted. And still others do not accept late work at all.  Some teachers believe that if the work is assigned, it is important to the student’s education. Therefore, they accept late work to encourage students to complete all assignments.

The majority of teachers understand that there are certain circumstances when students simply can’t finish their assignment by the due date.  Sometimes things pop-up in life that nobody has control over.  While some excuses are valid, there are times when students lie or use excuses that really did not prevent them from submitting their assignment on time.  It’s very difficult to determine which excuses are valid and which excuses just don’t “add-up.”   While teachers want to be compassionate and understanding, it is also in their job description to prepare students for the future in a world where deadlines matter and there are consequences.

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In a recent article posted on the Faculty Focus website entitled A Headache-Free Late Work Policy by Dr. Laura Schisler, the author proposes a “make-up day.”¹ The “make-up day” allows for students to turn-in they missed assignments throughout the semester on the make-up day to receive partial or full credit.  This removes the need to determine the validity of each student’s excuse.  This provides everyone the same opportunity to submit missed assignments, no matter the reason.  This policy makes it harder to miss multiple assignments, because students must turned-in all assignments on the predetermined make-up day at the end of the semester. The student either has to complete the assignment near the initial due date and hold-on to it until the end of the semester or complete the assignment at the end of the semester when there is typically an overwhelming number of tests and assignments.

In her essay entitled It’s Time to Ditch Our Deadlines, Dr. Ellen Boucher writes about her experience with a rigid late work policy.²  She states that early in her career students would lose one-third of their grade for an assignment for every day that passed without turning in the work.  In her experience, because the consequences were so severe, students were turning in work just to say that they were turning it in.  Other students would not submit anything and simply disappear because there was no way to pass the class.  Dr. Boucher began to realize that anxiety and burnout were a problem, so she then adopted a policy where students could submit their assignments two-days late for full credit.  Even after the two-day grace period, she would allow the student to meet with her to discuss a plan to turn-in the assignment.  Dr. Boucher saw that her students were working diligently to turn-in quality assignments rather than turning-in assignments simply for completion.  Dr. Boucher saw the level of anxiety and burnout decrease and felt this compassionate approach benefited her students. While it is true that anxiety and burnout are on the rise among students in both college and high school, allowing students to freely turn assignments in, beyond the deadline, can teach students bad habits.^3,4

While researching late work policies, I came across a few articles regarding “No zero policies.”  There are several schools that are transitioning to policies that don’t allow grades lower than 50%.  If the student refuses to turn-in his or her assignment, they still receive a 50%.  The philosophy behind this approach is that a zero is simply impossible to “bounce back” from.  One zero in a semester can cause a student to fail the entire class.  People in favor of the “no zero policy” argue that punishing the student with a zero is not actually assessing their knowledge.  While some people are very much in favor of a no zero policy, some people think it’s ridiculous.  The article cites a Facebook Post called “Is Our Grading System Fair” that asked 300 members Edutopian Innovative Teachers of English to comment.  Many people disagreed with the policy, simply because it requires students to do very minimal work in order to pass a class.³ 

I think that late work policies should vary, depending on the student age and nature of the course.  When teaching elementary school kids, late work policies should be more lenient.  Children in lower grade levels do not have control of their home life and aren’t always responsible enough to get their school work done without parental guidance.  I believe that it is appropriate for teachers to allow students to turn-in late work with minimal consequences when they are in lower grade levels.  As students age, they should become more responsible and should know that school is a priority. While life can still get in the way of older students, I believe that there should be consequences for late work the majority of the time.  Of course, there should be exceptions for unforeseeable life events, like an serious illness or death in the family, but students must learn that there are consequences in life when things aren’t done by their deadline. College professors should have a more stringent late work policy.  I know that burnout and anxiety are very real, but deadlines are deadlines and the consequences should be bad enough to create strong incentives to turn assignments in on time.  Indeed, a study done at Illinois Wesleyan University actually showed that students think that late work penalties are fair.⁵

There probably is no perfect “late work policy.”  I believe that there are times that deadlines should be extended — so I disagree with “zero tolerance policies.”  I also believe that students should meet deadlines.  While I agree that teachers should be compassionate and understanding, I also believe that they are doing students an injustice by allowing them a two-day grace period on every assignment or by giving them 50% even if they fail to submit anything.  I really like having a “make-up day” at the end of the semester.  This allows for students to still receive credit for missed assignments but doesn’t require the teacher to create a policy about "acceptable excuses" for late work.  The “make-up day” is usually during a very busy and stressful point in the semester which should encourage students to turn in their work by the due date.  The major drawback to a “make-up day” is that it signals to students that it’s “ok” to not meet deadlines.  Important life skills are learned in school and one is time-management.  If you fail to meet deadlines in life, you will find yourself without a job … and maybe without electricity.

References:

1. Schisler L. A Headache-Free Late Work Policy. Faculty Focus. Faculty Focus - Higher Ed Teaching & Learning. August 22, 2019.
2. Boucher E. It's Time to Ditch Our Deadlines. ChronicleVitae for higher ed jobs, career tools and advice. September 2, 2016.
3. Minero E. Do No-Zero Policies Help or Hurt Students? Edutopia. https://www.edutopia.org/article/do-no-zero-policies-help-or-hurt-students. July 3, 2018.
4.  Center for Collegiate Mental Health. 2018 Annual Report (Publication No. STA 19-180).
5. Lui M and Nillas L. Late Work Policies: Their Impact on Student Achievement. John Wesley Powell Student Research Conference, 2015. Abstract 8.