Erie County Pharmaceutical Association
internship program by Martin Rein nternship in the practice of pharmacy has long been a subject of considerable oontroversy within the profession. The basic objective of an internship program--as outlined in the Pharmacy Preceptor's Guide-is to provide a planned program of supervised professional training for the intern in order to help him become a competent practitioner of pharmacy. While some states have moved toward establishing programs designed to meet this objeotive, in most other states little has been done. Several years ago, members of the Erie County (New York) Pharmaceutical Association and the State University of New York at Buffalo school of pharmacy recognized that most graduates were gaining little from their internship in community pharmacy and set out to do something about it. An internship study committee consisting of practitioners, faculty members and other interested parties met to formulate a plan for establishment of a meaningful internship program in ,community pharmacy. The committee chairman was Martin Rein. From the initial meetings, there emerged the fallowing set of guidelines-
I
(1) There should be specific requirements for both the preceptor and the pharmacy in which the training was to be taken. (2) A definite curriculum should be established in which all topics were presented in logical sequence. (3) The internship should begin after the second year of college and extend, summers only, until three months after graduation. (4) There was a, need for a text in addition to the Pharmacy Preceptor's
(4) participate in continuing education programs (5) agree to cooperate with the administrators of the progra'm (6) have not been found guilty or have had his license suspended or revoked for any drug or narcotic violation (7) see to it that the intern handed in a,1I ,a ssignments promptly (8) be deemed qualified to participate in the program by the 'i nternship study committee
Requirements for the participating pharmacy were that it must(1) be operating under the same management for at least one ye'a r (2) dispense at least 6,000 new prescription orders per year (3) be free of any state board owner connected violation for whioh ,a penalty has been imposed for the previous three years (4) be open for practice at least 48 hours a week (5) have an adequate library (6) have a representa,t ive inventory of sick room, inva'l idand nursing supplies (7) either have or establish, within a year, a family or individual prescription order record system (8) be deemed a qualified pharmacy by the internship study committee
The topics to be covered in the curriculum were organized in a logical sequence and a text was written covering these topics. The currioulum was divided into three phases-elementary, intermediate and advance. Some examples of topics covered in each phase are given belowphase I specific duties of intern
patient-pharmacist relationshipelementary interior arrangement of pharmacy pricing and arranging merohandise inventory turnover labeling opening and closing procedure dermatologic agents equipment ·and arrangement ethics ·a nd conduct filing prescription orders record-keeping third-party paying Rx's professional organizations phase ,II biologicals and dated products n.arcotics, exempt narcotics legal responsibilities relationshi,ps with colleagues unauthentic Rx's drug information services I'a ws-poisons, na'rcotics, stimul,a nts and depressants non-prescription drugs surgkal supplies visits to other pharmacies and health fa,cilities phase III addi'c ts evaluation of products prescription orders-notations, renewals, copies, pricing professional services to profession and to public stock solutions delegation of responsibilitie's patient-pharmacist relationship-advanced prescription orders-checking, dispensing, compounding, inventory control purchasing a pharma1cy visits to physicians
Assignments followed each topic or ( continued on page 516)
Guide.
(5) Each intern should complete a set of assignments based on the text and his experience. (6) Supervision and evaluation of the program was essenti.al.
Based on the guidelines, a pilot program was initiated in 1967 with five interns participating. Requirements for the preceptor w'e re that he must(1) be licensed in the state of New York and actively engaged in pr:actice for the previous three years (2) be free of any state board viol:ation for which a penalty was imposed for the previous three years (3) belong to the county and state pharmaceutical associ.ations and have attended at least half of the looal meetings
A community pharmacist in Buffalo, New York, Martin Rein al.so is a part-time instructor in pharmacy administration at the State University of New York at Buffalo. He is chairman of the internship study committee and president-elect of the Erie County Pharmaceutical Association and cochairman of the New York state internship committee. Besides being active in the state pharmaceutical association and the Erie County Pharmaceutical Association, Rein is a member of APhA. Rein was the 1967 Bowl of H ygeia award recipient for New York state.
Vol. NS9, No. 10, October 1969
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Your written guarantee of quality Each prescription you fill i.s an exercise of your professional judgment. The drug you dispense may be vital to your customer's health and well-being. Minor differences in dosage form, particle size, solubility, rate of absorption, or hardness of tablet can make major differences in therapeutic efficacy. -When the choice is yours, you want to dispense the best.
- - - - - - Eli Lilly and Company • Indianapolis, Indiana 46206
jnternship program ( continued from page 513)
group of topics and with each assignment, both intern and preceptor were asked for a ,c omment and criticism. During the internship period, several meetings were held which were attended by the interns, preceptors and members of the internship study committee. During the meetings, further comment 'a nd criticism were heard and discuss'e d. The assignments and meetings provided not only a means of evaluating the intern's progress,. but also an important feedback mechanism for oonsistently improving the program. The assignments included daily w'Ork sheets, progress reports showing the actual number of prescription 'Orders dispensed by the intern, number of narcotics and !poisons handled, experi,e noes encountered, journal articles read, meetings attended, etc. Some examples of assignments are( A)
visits to physicians
(1) Report on your visit to a physician. What was discussed? What are appropriate a'r eas of discussion? What advantages and disadvantages a're inherent in such a, practice? (2) How are new products brought to the ·a ttention of the physicians in your area?
(B) ship
physician-pharmacist relation-
(1) Record the contacts that physiciansand other practitioners made with the pharmacist for the purpose of seeking advice.
( C)
new products
(1) Discuss all new drugs that have appeared in the I,a,s t six menths. Show their chemical structure and evaluate their therapeutic actions in comparison with some other products. (2) Compare eight antibiotics as to efficacy of action, spectrum covered, therapeutic indications and contraindications.
(D)
narcotics, exempt narcotics
(1) Can the following pa'c kage of tabs be sold without an Rx? aspkin gr 3.5 caffeine gr .5 codeine phose gr 1/30 phenacetin gr 2.5 excipients qs gr 16 such tablets #24 (2) A pharmacist can sell over the counter a medical preparation that contains in one fluid ouncenot more than grains of opium not more than - grains of dionin not more than - grains of hycodan not more than =grains of dolophine not more than _ gliains of ,cocaine (3) Classify the following as to type of na'rcotic A, B, X, Mclassification telephone apomorphine ETH and C papaverine ASAand Cod #1 _ __ Robitussin AC
(E )
non-prescription drugs
(1) Discuss five cases where the intern cautioned the patron in the proper use of a non-presoription drug. (2) oUst the active ingredient in each of the following-
For the year 1968 This Pharmacy has been designated as a
TRAINING AREA fur PHARMACY INTERNS nam e
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address
Thi s PhaTm~cy h~ s me~ u..'ilh all req~i:ements as set forth by the Int ernship Study Co mmitt ee. Bo th th e Pharmac .v and th e Prec eptors have c~m.p!ted tnth a ri gid set 0/ minimum quali fi cat ions u'hic h autho riz es th e area as being among those se rvin g tb e pro fessio n in the tramIng of Pharmacy Intern s . Participating as Prece ptors in thi s Pharmac \ and al so comply ing u'ith a set 0/ minimum s tandards u·i// be Ii cf!. fls ed Pharmaci s ts : .
- - - - - - - - - - - -_ _ _ _ _ _ _ _ _ __ ____ and _ _ _ __ __ _ _ _ _ _ _ _ _ __ _ _ _ _ __ _ _ __ nam e of Preceptor
nam e
0/
Precep t or
_ _ _ __ _ _ _ _ _ _ _ Cha irman InJerns.hip S tudy Co mmiJtee
ERIE COUNTY PHARMACEUTICAL ASSOCIAT ION and
ANNUAL PARTICIPATING FUND FOR PHARMACEUTICAL EDUCATION
Figure I-A sample of the certificate issued to the approved pharmacies for display. 516
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
Vicks 44 cough syrup Sominex COlltac Desitin Desenex
Compoz Tylenol Infra-Rub Preparation H SUppOSe
The assignments were reviewed by a committee member for coverage and returned to the intern with comments. Upon completion of the pilot program, the interns and preceptors were asked. to evaluate each other by completion of a questionnaire designed by the internship study committee. This was an important means of evaluation of the program and the preceptors. Our evaluation 'Of the initial pilot study led us to conolude that it was an unqualified suocess and sihould definitely be continued in the future. Both interns and preceptors found that they gained much from the program that they would not have gained otherwise, the interns particularly being highly enthusiastic. The preceptors found that a considerable amount of time was required for proper supervision of the intern's training. A key factor in the success of the program was the close supervision provided by the internship study committee. As a result of the initial pilot program, text material and assignments w'e re revised to a considerable extent for the following year. In the seoond year, the same basic procedures were followed with 13 interns participating. This time, each pharmacy designated two preceptors so that the intern would be working with one of them at all times. Included were three interns outside Erie County in an attempt to expand the program. All of the approved pharmacies were issued a certificate for display (figure I) and at the completion of the program, each intern was awarded a ,c ertificate (figure II) in a public presentati'On at a meeting of the Erie County Pharmaceutical Association. A copy of the certificate also was sent to the New York State Boa.rd of Pharmacy. The second year of the pilot program was considered to be even more suocessful than the first and will be continued in the future in Erie County and hopefully expanded further throughout New York state. From this pilot study, we have been able to derive some very important conclusions. The pI1eceptor, for instance, is a very capable and productive teacher. He must, however, have guidance. The intern participating in our program receives a composite of information which another cannot possibly obtain. Since many procedures and many methods are integrated into the text, the intern who does, not participate in our program at best, can obtain only a portion of the material from his preceptor. Although the ,oommunity pharmacy
owner is rather reluctant to share his procedures and ideas with others, especially in the field of education, he is more than willing to cooperate with another community pharmacist. Pharmacy students somehow feel that they would rather work in a place where they can earn more money than in a pharmacy. However, through pallticipation in a controlled program, the intern very shortly becomes more valuable tD his preoeptor. Through proper training and intense participation, the intern's capabilities soon command him a higher hourly wage so that it soon surpasses the wage he would get in anothte r field. To enhance the situation, the employer is now "happy" to pay the higher wage. With'Out the program, the employer feels to SDme extent that having an intern is somewhat of a burden. On the oontrary, when our intern proficiently dispenses every prescription order that enters the pharmacy-and our method of teaching affords him just that in a very short time-the preceptor is free to spend more time with the patients. He can, because of this intern, better perform his function in the communi-
ty. The internship program is capable of providing the training the intern requires on a high professional plane. Therefore, the school of pharmacy has been in full support of our endeavors. The program also thoroughly oovers the economic aspects 'Of the profession. As a result, we have 'a ttracted interested preceptors, without whom an internship cannot be carried out. Our interns fared much better than interns downstate on the practical portion 'Of the state board exams. In fact~ one of our interns, when he received his license, was hired to manage a pharmacy while his employer tonk an extended vacation. The intern felt completely confident and attributed his ability to participation in the ECPA internship program. In every single case, where a preceptor for some reason-other than a physical defect-did not initially qualify for the program, he chos:e to raise his standards of practice in order to participate. The prestige involved in displaying a certificate also was a motivation towards raising standards of praotice. After all, a pharmacy designated as a Certified Training Area is certainly one of which a patron can be proud. As mentioned earlier, an important feature of the program was the close supervision by the committee. The supervision of an internship program by a local association is probably unique and suggests what we think is an excellent method fDr overcoming what has been one of th,e most difficult problems in establishing such pro-
l7ertlficate
Of
InternshijJ
Th is is to certify that - - - - - - - - o! ------c:-:;add7:,e-=-=ss- - - - - -- -----:c=ily-----:- - - - h a s successfully completed INTERNSHIP under the pers onal sup erv ision of registered Pharmacists Preceptor
J
Preceptor 2
Th e above person has participat ed in all required proc edures and has satis f a ctorily comple t ed all assignmen ts. Trainin !!. was
COrl.
dueled under the s lrict g u ida nee of the Intern ship Study Comm ittee wbicb U'a s res p 0 n sib I e lor th e aut h 0 r i z a I ion 01 -
-
_ _ _ _ _ _ __ nam e
_ _ _ as a t rain ing ar ea.
0/ Pharma cy -
_
_ _ _ __
_
_ _ Chairman
Inte rn shi p St udy Committ ee
ERIE COUNTY PHARMACEUTICAL ASSOCIATION and ANNUAL PARTICIPATING FUND FOR PHARMACEUTICAL EDUCATION
Figure II-At the completion of the internship program, each intern received a certificate from the Erie County Pharmaceutical Association in a public presentatiOn.
grams in the past. Who better than local society leaders are better acquainted with ,t he area pharmacies and practitioners? Who is in a better position to maintain close contact with participants? Furthermore, the utilization of the local society is a good example of self-policing which is sorely needed in our profession. Finally, we found ,t hat it was indeed possible to conduct the program on a larger scale than originally envisioned. Interns participated in other areas of the state with all controls, material and instructions emanating from Erie County. Methods were developed whereby all assignments were checked from all interns in a short period of time with ease. Progress reports were scrutinized and problems which 'Occurred-such as an intern not dispensing enough 'Of the pharmacy's prescription orders-were easily spotted and rectified. Regarding the future of our pro-
gram, we in Erie County feel that we have the most comprehensive internship program in the country. The committee has made great progress and we feel that our years of experience have been valuable in helping us to make decisions. Of course, we feel that for the good of the profession, future pharmacists, pharmacists already in practioe and the public, the ECPA internship program could-indeed should be-implemented throughout the state. With a few minor adjustments, .the program oould be utiliz:ed in its entirety on a statewide 'basis. Of course, this would entail the extensive participation 'of the state and county societies, the colleges of pharmacy, the state board of pharmacy and the pharmacists of the state. It is our h'Ope that pharmacists everywhere will aocept their responsibilities and, perhaps using our program as a model, initiate the needed improvem·e nts in their own areas. •
FIGHT
THEM ALL. •• Heart Attack Stroke Hig'h Blood Pressure Rheumatic Fever
GIVE ··~~LM~~~ HEART FUND Vol. NS9, No. 10, October 1969
517