Bridging the Gap: From the Classroom to Practice

Cody Taylor, PharmD, PGY2 Critical Care Pharmacy Practice Resident, University of Mississippi Medical Center

It’s 06:00 and a nervous pharmacy student anxiously waits to begin his first Advanced Pharmacy Practice Experience (APPE) in the cardiac intensive care unit. He takes a moment to look around the unit hoping to calm his nerves but to no avail. The scene unfolding before him consists of nurses running from room to room, a patient in critical condition, and medical residents asking for drugs he only vaguely remembers from his second year in pharmacy school. It’s day 1 of his final year of pharmacy school and he already feels defeated. This is my story and one that is similar to that of many pharmacy students across the nation.

APPEs are designed to provide students with daily opportunities to assess and monitor patients, interact with other healthcare professionals, improve literature evaluation, and enhance many other skills including giving presentations and educating patients.  These experiences often provoke stress and anxiety for students. For me, it was a combination of my first experience with critically ill patients, a lack of knowledge regarding critical care practice, the pressure to remember everything from the previous three years of pharmacy school, navigating an unfamiliar electronic medical record, and learning to cope with difficult situations.

Student pharmacists are expected to master various core competencies during their final year of APPEs. While each college of pharmacy has their own set of competency statements, they generally revolve around: developing and applying foundational knowledge, promoting safe and evidence-based patient care, contributing to interprofessional teams, and engaging in professional development. Some colleges of pharmacy have begun assessing their students’ preparedness to meet these competencies. Student pharmacists have reported less preparedness in areas such as recommending medications and doses, evaluating laboratory test results, assessing medication appropriateness, and discussing pharmacotherapy recommendations during interprofessional team rounds.¹  Preceptors have also weighed in.  Students do not seem to be able to integrate foundational knowledge from all academic disciplines when discussing a patient problem.  Moreover, students have difficulty performing pharmaceutical calculations and critiquing primary and tertiary literature.² These topics are discussed throughout the pharmacy curriculum, but many factors can influence why pharmacy students may feel unprepared and anxious. In addition to the fact that these topics were often covered in class two or three years ago, some students are innately prone, based on their personality and previous experiences, to anxiety, fear, or low self-esteem.

So, what can we do to help prepare pharmacy students to transition from the classroom to clinical practice? The Accreditation Council for Pharmacy Education (ACPE) accreditation standards now require colleges to assess student readiness to enter APPEs.³ Since the release of these standards, colleges/schools of pharmacy have increasingly implemented objective structured clinical examinations (OSCEs), simulations, and authentic patient cases in their curriculum.

Tchen and colleagues at the University of British Columbia took a different approach to prepare their students for APPEs.⁴ They received feedback from both students and preceptors that students were not adequately ready for their inpatient APPEs. To address this problem, they developed a series of online, self-paced modules.  They used focus groups consisting of preceptors, faculty, pharmacy residents, and recent alumni to develop these modules. Modules focused on common terminology, processes, and procedures in the inpatient setting; how to effectively use a patient’s chart to identify pertinent information; and how to perform a patient workup and assessment. Post-module survey results indicated just under 70% of students felt the modules improved their performance during their inpatient APPEs. However, only 25% of students believed it helped reduce their anxiety. This is not surprising as many people experience anxiety when experiencing new, unfamiliar circumstances and this feeling likely cannot be completely mitigated through didactic instruction. Preceptors also perceived a benefit to the modules, stating that there was more time to focus on student-centered learning versus orienting the student to the practice environment.

This is an interesting approach to increasing APPE readiness among pharmacy students. Gathering feedback from faculty, preceptors, and alumni to create these modules enabled a multidimensional approach to fill the gaps between the classroom and practice. Allowing students to progress through the modules at their own pace is also helpful as this allows each student to review the material at a time when they are most motivated to learn and immediately before starting the rotation.  This is a great example of “just in time” learning.

It is difficult to change curriculums based on one college of pharmacy’s experience, but I believe Tchen and his colleagues at the University of British Columbia describe an effective way to increase pharmacy students’ readiness for their APPEs.

References:

1. Scott DM, Friesner DL, Miller DR. Pharmacy students’ perceptions of their preparedness to provide pharmaceutical care. American Journal of Pharmaceutical Education.74(1) Article 8.
2. Lundquist LM, Hogan S. Evaluating preceptors’ perceptions of student preparedness for advanced pharmacy practice experiences. Journal of Pharmacy Teaching. 14(1);19-32.
3. 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). 2015.
4. Tchen P, Leung L, Simpson F, et. al. Bridging the gap: An evaluation of self-paced online transition modules for advanced pharmacy practice experience students. Currents in Pharmacy Teaching and Learning 2018; 10:1375-1383.