- Email: [email protected]
Future direction of program influenced by student pharmacist voices
DEPARTMENTS N. Olenik et al. / Journal of the American Pharmacists Association 56 (2016) 487e490
be able to provide a quality education as new institutions when existing institutions are struggling to keep up with practice changes? Just in 2015-2016, four new pharmacy schools opened in Texas, Florida, North Carolina, and California.2 Assuming that there is a fixed pool of applicants academically who can do professional school work and that there are more schools trying to keep their seats full for survival, will standards fall at a time of great change and practice expansion, to produce an inferior practitioner at a time in history when we need better and more adaptable clinicians? The U.S. Bureau of Labor Statistics reported that pharmacist jobs will grow by 3% from 2014 to 2024, which is slower than average for all occupations. It also reports that employment of pharmacists in traditional pharmacies is projected to decline slightly.3 The Accreditation Council for Pharmacy Education (ACPE) recently finalized new Doctor of Pharmacy standards. The aim of these standards is to ensure that graduates of accredited schools of pharmacy are “‘practice-ready’ and ‘teamready,’ that is, prepared to directly contribute to patient care working in collaboration with other health care providers.”4 These standards, originally created in January 2014, have since been revised and finalized. Beginning in Fall 2016, all pharmacy schools undergoing accreditation will be assessed with the use of these new standards. One could argue that student pharmacists are prepared in the realm of didactic knowledge, given the high national pass rate of the North American Pharmacist Licensure Examination (92.64% first-attempt pass rate in 2015 graduates).5 However, when students participate in experiential rotations, being able to convey knowledge clinically on an interdisciplinary team and to effectively influence recommendations regarding patient care becomes increasingly important. With the changing atmosphere of the pharmacist's role on the health care team, incorporation of interprofessional education (IPE) into the curriculum is becoming critical. Working on interprofessional teams is listed as one of the 5 core competencies that all health care professionals should attain during their education.6 It is also a requirement of the new ACPE Standards. How are students being prepared to interact effectively with other health
488
care providers? One particular focus included in the Purdue University College of Pharmacy's most recent strategic initiatives has been to embed IPE experiences throughout the PharmD curriculum. This can be a challenge for many schools of pharmacy, such as Purdue, who are not paired with a teaching hospital. Finding creative ways to implement team care into the didactic curriculum becomes increasingly important to prepare students for experiential rotations. This year, Purdue introduced an IPE event for students on experiential rotations to be held between the Indiana University School of Medicine and Purdue College of Pharmacy, consisting of a full day series of workshops and presentations. Another push in the standards comes from the Center for the Advancement of Pharmacy Education (CAPE) 2013 Outcomes, focusing on leadership as a goal for pharmacy students throughout the curriculum. This idea of leadership is beyond that of participating on a committee or in a professional organization, but about instilling the intrinsic ability as a student pharmacist (and eventually a pharmacist) to lead others. Some of the CAPE Outcomes identified by Janke et al.7 related to leadership include: foundational knowledge; medication use systems management; patient advocacy; interprofessional collaboration; communication; self-awareness; innovation and entrepreneurship; and professionalism.8 To keep up with the evolving role of pharmacists in the health care field, creating capable leaders is vital. The ideal pharmacy graduate of today should possess a strong background in clinical knowledge, but must also be equipped with proficiency in communication and leadership skill sets. A valuable contribution that one can make is being a preceptor on the front lines. Preceptors can help shape the next generation of pharmacists during experiential rotations. Where does one start? APhA offers an Advanced Preceptor Training course with 4 tracks that include Getting Started as a Preceptor, Working Effectively with Student Pharmacists, Building Clinical Confidence, and Cultivating Interprofessional Education. If you are a preceptor, seek interprofessional opportunities to shape this next generation of student pharmacists into leaders that are highly skilled in communication and collaboration.
References 1. NASPA/NABP. Convened meeting on statewide protocols for pharmacist prescribing; June 15, 2016. Available at: http://naspa.us/wp-content/ uploads/2016/06/SWP-Meeting-Report-Final. pdf. Accessed July 19, 2016. 2. Barker A. The pharmacy job crisis: blame the pharmacy school bubble. Pharmacy Times; May 26, 2015. Available at: http://www. pharmacytimes.com/contributor/alex-barkerpharmd/2015/05/the-pharmacy-job-crisis-blamethe-pharmacy-school-bubble. Accessed July 19, 2016. 3. Bureau of Labor Statistics, US Department of Labor. Occupational outlook handbook, 201617 edition, pharmacists. Available at: http:// www.bls.gov/ooh/healthcare/pharmacists.htm. Accessed July 19, 2016. 4. 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”); February 2, 2015. Available at: https://www. acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed July 19, 2016. 5. National Association of Boards of Pharmacy. NAPLEX® passing rates for 2013-2015 graduates per pharmacy school. Available at: http://www. nabp.net/system/rich/rich_files/rich_files/000/ 001/276/original/naplex-passrates-2015.pdf. Accessed July 19, 2016. 6. Greiner AC, Knebel E. Health Professions Education: A Bridge to Quality. Washington: National Academies Press; 2003. 7. Janke KK, Nelson MH, Bzowyckyj AS, et al. Deliberate integration of student leadership development in Doctor of Pharmacy programs. Am J Pharm Educ. 2016;80(1):2. 8. Medina MS, Plaza CM, Stowe CD, et al. Center for Advancement of Pharmacy Education 2013 Educational Outcomes. Am J Pharm Educ. 2013;77(8):162. Nicole L. Olenik, PharmD, CDE, BC-ADM, Clinical Assistant Professor of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN Michael J. Schuh, BSPharm, PharmD, MBA, Ambulatory Pharmacist, Assistant Professor of Family Medicine, Palliative Medicine, and Pharmacy, Mayo Clinic, Jacksonville, FL
APhAeASP Future direction of program influenced by student pharmacist voices Within my first few weeks in the PharmD program at the Ohio State University (OSU) College of Pharmacy, I was elected PharmD representative for the class of 2017. In that role, I have served for 3 years on 2 committees: our curriculum committee, known as the PharmD Program Committee, which works to improve the structure of the current program; and the Curriculum Change Task Force, which designed the new
DEPARTMENTS N. Olenik et al. / Journal of the American Pharmacists Association 56 (2016) 487e490
Doctor of Pharmacy program that OSU is implementing this academic year. The committees are composed of faculty, staff, administrators, and student representatives from each PharmD class. Feedback from students is very highly valued, because it helps shape policies that will ensure that graduates of the program are prepared to flourish in the rapidly evolving realm of pharmacy practice. As voting members, the PharmD representatives on these committees have an important role in voicing the student perspective when discussing topics such as academic progression Swinger guidelines, exam scheduling policies, elective course approvals, and program prerequisites. Faculty members have described student involvement as a major strength of the PharmD Program Committee. In almost every meeting I have attended, if the PharmD representatives do not speak up on a topic, someone invariably pauses the conversation to say, “I want to know what the students think about this.” In my time on these committees, there have been 2 occasions in which advocacy by student members has had a substantial impact. Exam scheduling policies tend to be a matter of contention, largely because students don't fully understand the challenge of arranging exam times and locations, and faculty may not always fully appreciate the stress that goes along with having 3 or 4 exams in 1 week. Student representatives requested adding exam scheduling to the committee agenda, and, as a result of the discussion, a committee leader now gathers exam dates and other noteworthy occasionsdsuch as the APhA Annual Meetingdinto a single spreadsheet and distributes it before each semester. In this way, any concerns may be addressed well ahead of time. Although it isn't a perfect solution, it does help student pharmacists anticipate difficult weeks and manage time so as not to fall behind in their learning. The second topic that PharmD representatives were quick to weigh in on was proposed changes to the PharmD program prerequisites. The committee as a whole generally supported the suggestion to reduce the physics requirement to 1 semester and to add a semester of
physiology, but many students strongly rejected the idea of dropping the requirement of a bachelor's degree for entry into the program. The bachelor's degree prerequisite is held by fewer than a dozen colleges of pharmacy across the country. Many students feel that it is a distinguishing feature of the OSU program and that it holds pharmacists to the same standards of other health care professionals, which can only be beneficial as we work to attain provider status. Others accept the proposal in the interest of reducing the financial burden on students and potentially shortening the length of time spent in education. Hearing these arguments from my classmates, I created an online survey to gather the opinions of student pharmacists in all 4 classes in the program regarding the proposed changes, and I presented the data at a committee meeting. Feedback gathered from 71 respondents was sharply divided and generated more careful consideration of the benefits and drawbacks of removing the bachelor's degree prerequisite. At this time it is not clear whether the requirement will change or not, because the proposal has not yet been set in stone. Creating a new PharmD curriculum for the incoming class of 2020 was a process that took a little over 2 years and is still a work in progress. Substantial time was devoted to crafting a needs assessment, vision statement, guiding principles, and ability-based outcomes early on. Preparing graduates for the changing atmosphere of pharmacy practice was a major focus of our goals, because we intend OSU graduates to be “exemplary patient care providers who … will be exceptionally well prepared for entry-level pharmacy practice and advanced pharmacy education.” The curriculum itself was reorganized into a block structure to facilitate horizontal and vertical integration among various modules. The pharmacy practice lab, which was formerly held only during the P2 year, was expanded to all 3 years of the didactic education and revitalized as a setting to apply lessons from the classroom. In the first year, foundational pharmaceutical sciences were rearranged into a single integrated block, and more concepts in patient care and nonprescription therapeutics were incorporated to better prepare students for community rotations. We pushed for a shift in teaching
methodology to a more active learning approach, acknowledging that a significant part of student learning comes from a hidden “cocurriculum” through volunteering at free clinics, employment in pharmacy internships, and involvement in professional organizations such as APhAeASP. As a student representative, some of my contributions included meeting with an external site review team, discussing new accreditation standards, and providing input on the general structure of the curriculum as well as course syllabi for the program's first year. In both maintaining an existing Doctor of Pharmacy program and rolling out an entirely new one, it is essential to have an ongoing process for review and assessment, and student inclusion should be a key component of that process. OSU has accomplished this by placing student members on the curriculum committee, gathering feedback through surveys and course evaluations, and holding focus groups and town hall meetings where we can voice our concerns. In this way, student pharmacists are actively engaged in their own education and are better prepared to step into the ever-expanding role of the pharmacist as a member of the health care team. Paul Swinger, final-year PharmD candidate, Ohio State University College of Pharmacy, The Ohio State University, Columbus, OH
APhAeAPRS Pharmacy school: The training ground for building research skills The Institute of Medicine has set a goal that “by the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up-to-date clinical information and will reflect the best available evidence.”1 Providing team-based patientcentered care that incorporates patient preferences, evidence, and clinical expertise is the future of health care. As crucial members of the health care team, pharmacists must acquire skills needed to provide patient-centered care, such as the ability to obtain evidence and evaluate the literature. Pharmacy school is an ideal time to build these skills, and both the
489
be able to provide a quality education as new institutions when existing institutions are struggling to keep up with practice changes? Just in 2015-2016, four new pharmacy schools opened in Texas, Florida, North Carolina, and California.2 Assuming that there is a fixed pool of applicants academically who can do professional school work and that there are more schools trying to keep their seats full for survival, will standards fall at a time of great change and practice expansion, to produce an inferior practitioner at a time in history when we need better and more adaptable clinicians? The U.S. Bureau of Labor Statistics reported that pharmacist jobs will grow by 3% from 2014 to 2024, which is slower than average for all occupations. It also reports that employment of pharmacists in traditional pharmacies is projected to decline slightly.3 The Accreditation Council for Pharmacy Education (ACPE) recently finalized new Doctor of Pharmacy standards. The aim of these standards is to ensure that graduates of accredited schools of pharmacy are “‘practice-ready’ and ‘teamready,’ that is, prepared to directly contribute to patient care working in collaboration with other health care providers.”4 These standards, originally created in January 2014, have since been revised and finalized. Beginning in Fall 2016, all pharmacy schools undergoing accreditation will be assessed with the use of these new standards. One could argue that student pharmacists are prepared in the realm of didactic knowledge, given the high national pass rate of the North American Pharmacist Licensure Examination (92.64% first-attempt pass rate in 2015 graduates).5 However, when students participate in experiential rotations, being able to convey knowledge clinically on an interdisciplinary team and to effectively influence recommendations regarding patient care becomes increasingly important. With the changing atmosphere of the pharmacist's role on the health care team, incorporation of interprofessional education (IPE) into the curriculum is becoming critical. Working on interprofessional teams is listed as one of the 5 core competencies that all health care professionals should attain during their education.6 It is also a requirement of the new ACPE Standards. How are students being prepared to interact effectively with other health
488
care providers? One particular focus included in the Purdue University College of Pharmacy's most recent strategic initiatives has been to embed IPE experiences throughout the PharmD curriculum. This can be a challenge for many schools of pharmacy, such as Purdue, who are not paired with a teaching hospital. Finding creative ways to implement team care into the didactic curriculum becomes increasingly important to prepare students for experiential rotations. This year, Purdue introduced an IPE event for students on experiential rotations to be held between the Indiana University School of Medicine and Purdue College of Pharmacy, consisting of a full day series of workshops and presentations. Another push in the standards comes from the Center for the Advancement of Pharmacy Education (CAPE) 2013 Outcomes, focusing on leadership as a goal for pharmacy students throughout the curriculum. This idea of leadership is beyond that of participating on a committee or in a professional organization, but about instilling the intrinsic ability as a student pharmacist (and eventually a pharmacist) to lead others. Some of the CAPE Outcomes identified by Janke et al.7 related to leadership include: foundational knowledge; medication use systems management; patient advocacy; interprofessional collaboration; communication; self-awareness; innovation and entrepreneurship; and professionalism.8 To keep up with the evolving role of pharmacists in the health care field, creating capable leaders is vital. The ideal pharmacy graduate of today should possess a strong background in clinical knowledge, but must also be equipped with proficiency in communication and leadership skill sets. A valuable contribution that one can make is being a preceptor on the front lines. Preceptors can help shape the next generation of pharmacists during experiential rotations. Where does one start? APhA offers an Advanced Preceptor Training course with 4 tracks that include Getting Started as a Preceptor, Working Effectively with Student Pharmacists, Building Clinical Confidence, and Cultivating Interprofessional Education. If you are a preceptor, seek interprofessional opportunities to shape this next generation of student pharmacists into leaders that are highly skilled in communication and collaboration.
References 1. NASPA/NABP. Convened meeting on statewide protocols for pharmacist prescribing; June 15, 2016. Available at: http://naspa.us/wp-content/ uploads/2016/06/SWP-Meeting-Report-Final. pdf. Accessed July 19, 2016. 2. Barker A. The pharmacy job crisis: blame the pharmacy school bubble. Pharmacy Times; May 26, 2015. Available at: http://www. pharmacytimes.com/contributor/alex-barkerpharmd/2015/05/the-pharmacy-job-crisis-blamethe-pharmacy-school-bubble. Accessed July 19, 2016. 3. Bureau of Labor Statistics, US Department of Labor. Occupational outlook handbook, 201617 edition, pharmacists. Available at: http:// www.bls.gov/ooh/healthcare/pharmacists.htm. Accessed July 19, 2016. 4. 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”); February 2, 2015. Available at: https://www. acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed July 19, 2016. 5. National Association of Boards of Pharmacy. NAPLEX® passing rates for 2013-2015 graduates per pharmacy school. Available at: http://www. nabp.net/system/rich/rich_files/rich_files/000/ 001/276/original/naplex-passrates-2015.pdf. Accessed July 19, 2016. 6. Greiner AC, Knebel E. Health Professions Education: A Bridge to Quality. Washington: National Academies Press; 2003. 7. Janke KK, Nelson MH, Bzowyckyj AS, et al. Deliberate integration of student leadership development in Doctor of Pharmacy programs. Am J Pharm Educ. 2016;80(1):2. 8. Medina MS, Plaza CM, Stowe CD, et al. Center for Advancement of Pharmacy Education 2013 Educational Outcomes. Am J Pharm Educ. 2013;77(8):162. Nicole L. Olenik, PharmD, CDE, BC-ADM, Clinical Assistant Professor of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN Michael J. Schuh, BSPharm, PharmD, MBA, Ambulatory Pharmacist, Assistant Professor of Family Medicine, Palliative Medicine, and Pharmacy, Mayo Clinic, Jacksonville, FL
APhAeASP Future direction of program influenced by student pharmacist voices Within my first few weeks in the PharmD program at the Ohio State University (OSU) College of Pharmacy, I was elected PharmD representative for the class of 2017. In that role, I have served for 3 years on 2 committees: our curriculum committee, known as the PharmD Program Committee, which works to improve the structure of the current program; and the Curriculum Change Task Force, which designed the new
DEPARTMENTS N. Olenik et al. / Journal of the American Pharmacists Association 56 (2016) 487e490
Doctor of Pharmacy program that OSU is implementing this academic year. The committees are composed of faculty, staff, administrators, and student representatives from each PharmD class. Feedback from students is very highly valued, because it helps shape policies that will ensure that graduates of the program are prepared to flourish in the rapidly evolving realm of pharmacy practice. As voting members, the PharmD representatives on these committees have an important role in voicing the student perspective when discussing topics such as academic progression Swinger guidelines, exam scheduling policies, elective course approvals, and program prerequisites. Faculty members have described student involvement as a major strength of the PharmD Program Committee. In almost every meeting I have attended, if the PharmD representatives do not speak up on a topic, someone invariably pauses the conversation to say, “I want to know what the students think about this.” In my time on these committees, there have been 2 occasions in which advocacy by student members has had a substantial impact. Exam scheduling policies tend to be a matter of contention, largely because students don't fully understand the challenge of arranging exam times and locations, and faculty may not always fully appreciate the stress that goes along with having 3 or 4 exams in 1 week. Student representatives requested adding exam scheduling to the committee agenda, and, as a result of the discussion, a committee leader now gathers exam dates and other noteworthy occasionsdsuch as the APhA Annual Meetingdinto a single spreadsheet and distributes it before each semester. In this way, any concerns may be addressed well ahead of time. Although it isn't a perfect solution, it does help student pharmacists anticipate difficult weeks and manage time so as not to fall behind in their learning. The second topic that PharmD representatives were quick to weigh in on was proposed changes to the PharmD program prerequisites. The committee as a whole generally supported the suggestion to reduce the physics requirement to 1 semester and to add a semester of
physiology, but many students strongly rejected the idea of dropping the requirement of a bachelor's degree for entry into the program. The bachelor's degree prerequisite is held by fewer than a dozen colleges of pharmacy across the country. Many students feel that it is a distinguishing feature of the OSU program and that it holds pharmacists to the same standards of other health care professionals, which can only be beneficial as we work to attain provider status. Others accept the proposal in the interest of reducing the financial burden on students and potentially shortening the length of time spent in education. Hearing these arguments from my classmates, I created an online survey to gather the opinions of student pharmacists in all 4 classes in the program regarding the proposed changes, and I presented the data at a committee meeting. Feedback gathered from 71 respondents was sharply divided and generated more careful consideration of the benefits and drawbacks of removing the bachelor's degree prerequisite. At this time it is not clear whether the requirement will change or not, because the proposal has not yet been set in stone. Creating a new PharmD curriculum for the incoming class of 2020 was a process that took a little over 2 years and is still a work in progress. Substantial time was devoted to crafting a needs assessment, vision statement, guiding principles, and ability-based outcomes early on. Preparing graduates for the changing atmosphere of pharmacy practice was a major focus of our goals, because we intend OSU graduates to be “exemplary patient care providers who … will be exceptionally well prepared for entry-level pharmacy practice and advanced pharmacy education.” The curriculum itself was reorganized into a block structure to facilitate horizontal and vertical integration among various modules. The pharmacy practice lab, which was formerly held only during the P2 year, was expanded to all 3 years of the didactic education and revitalized as a setting to apply lessons from the classroom. In the first year, foundational pharmaceutical sciences were rearranged into a single integrated block, and more concepts in patient care and nonprescription therapeutics were incorporated to better prepare students for community rotations. We pushed for a shift in teaching
methodology to a more active learning approach, acknowledging that a significant part of student learning comes from a hidden “cocurriculum” through volunteering at free clinics, employment in pharmacy internships, and involvement in professional organizations such as APhAeASP. As a student representative, some of my contributions included meeting with an external site review team, discussing new accreditation standards, and providing input on the general structure of the curriculum as well as course syllabi for the program's first year. In both maintaining an existing Doctor of Pharmacy program and rolling out an entirely new one, it is essential to have an ongoing process for review and assessment, and student inclusion should be a key component of that process. OSU has accomplished this by placing student members on the curriculum committee, gathering feedback through surveys and course evaluations, and holding focus groups and town hall meetings where we can voice our concerns. In this way, student pharmacists are actively engaged in their own education and are better prepared to step into the ever-expanding role of the pharmacist as a member of the health care team. Paul Swinger, final-year PharmD candidate, Ohio State University College of Pharmacy, The Ohio State University, Columbus, OH
APhAeAPRS Pharmacy school: The training ground for building research skills The Institute of Medicine has set a goal that “by the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up-to-date clinical information and will reflect the best available evidence.”1 Providing team-based patientcentered care that incorporates patient preferences, evidence, and clinical expertise is the future of health care. As crucial members of the health care team, pharmacists must acquire skills needed to provide patient-centered care, such as the ability to obtain evidence and evaluate the literature. Pharmacy school is an ideal time to build these skills, and both the
489