Peer Review: Integration of Pharmacy Students

INTEGRATION OF PHARMACY STUDENTS INTO CLINICAL INTERNSHIPS IN THE WORKPLACE

AUTHOR

Lucia A. Ernst

ACKNOWLEDGEMENTS Jennifer Morris, PharmD, MBA Stacy Livingston, PharmD Jamie S. Sinclair, M.S., RPh, FASHP, FMSHP

There are no conflicts of interest relating to the subject matter of this manuscript.

ABSTRACT

Integrating pharmacy students in a meaningful way to bring better care to patients, and creating competent, caring pharmacy providers for the future.

The practice of pharmacy is continuously evolving and advancing; with these changes, many pharmacy students feel the pull to pursue diverse work experiences to prepare themselves for future goals. These experiences may include a mix of research, non-traditional job opportunities, hospital pharmacy or community pharmacy. Pharmacy students have recognized the importance of having a well-rounded CV to set themselves apart in the highly competitive post-graduate world, both in pharmacy residency programs and the job market. This has led to pharmacy students juggling multiple employments in a variety of pharmacy avenues. This contributes to complex scheduling, burnout, and grief for students and employers. Although a multitude of internships held may indicate a wide breadth of experiences to draw from, it may conversely impede the ability to foster depth of experience and development of rich relationships and mentorships with one employer.

Given this reality, Mercy Medical Center (MMC) Pharmacy in Cedar Rapids, IA looked to retool the existing internship program to better meet the needs of both interns and pharmacy department operations. The goal was complex: develop an integrated internship program that would offer students experience in a multitude of areas, prepare interested students for PGY-1 pharmacy residency programs, offer a diverse set of working experiences and skills at one place of employment, and support the operational needs of the pharmacy department. The undertaking started with an assessment of all the workplace experiences MMC Pharmacy could provide and pharmacy students sought: experience in hospital, community and ambulatory care practice, clinical skills development, research, and professional development. Staff pharmacists, interns, and technicians were interviewed to identify areas for improvement within the program. Subsequently, the identified areas were targeted with the development of four objectives and associated activities to meet the expressed needs of all parties and create mutual goals. Changes were discussed extensively with the pharmacy leadership team, and the final version was presented to all department staff to maximize buy-in and engagement of existing team members. Four core objectives and activities were developed: clinical skills and decision making, soft skills and communication, an independent research project and a service staffing component. Each objective was structured similarly to the Mercy Medical Center PGY-1 Pharmacy Residency program, with specific activities required to both remain in and successfully complete the internship program. Evaluation of each intern is completed on an on-going basis to ensure competency and accuracy in skills development. The new program structure naturally lends to more meaningful mentorships with pharmacy staff and leadership, and in turn provides interns with a competitive advantage in future career opportunities, including residency. Leaders discussed the revised program with current interns and applicants with the understanding that active participation in all components of the program was required. The benefit of access to the variety of experiences includes the expectation that each intern is fully invested in the entire program. If an intern fails to meet required program elements, they may be removed from all non-staffing components.

Enhancement of clinical skills and decision-making is achieved primarily through completion of inpatient medication education for patients newly started on warfarin or direct-acting-oral-anticoagulants, as well as education following open heart surgeries such as coronary artery bypass grafting. In addition to medication education, interns complete medication histories and medication reconciliations in the Emergency Department. These activities provide opportunities for the intern to develop interview and communication skills, discuss patients’ experiences with medications, and work to prevent medication errors with a focus on ensuring proper care transitions for the patient. Interns also gain experience working in the ambulatory care setting at Mercy’s Anticoagulation Clinic where they interpret lab results and accordingly adjust anticoagulation therapy and dosing at the discretion and direction of a supervising pharmacist. These shifts are key in developing clinical skills and provide a foundation for the second objective of the program: soft skills and communication.

Effective communication with patients, interdisciplinary care team members, and other professionals such as administrators or policymakers is critical to ensuring successful patient outcomes and highlighting the role of the pharmacist on the care team. Interns join the pharmacy residents for half of the year in monthly soft skills training with a residency preceptor, where interns improve upon their communication, listening, and problem-solving skills through discussion of actual situations at work. Interns are expected to practice these skills outside these trainings, during clinical and central distribution shifts as well as the third objective of the program, an independent research or quality improvement project. These projects range from medication use evaluations, antimicrobial stewardship initiatives, and pharmacy informatics. These projects allow the intern to gain real-world experience in research and quality improvement needed for future residency and work

experiences. Dedicated staffing hours working central distribution shifts for the inpatient pharmacy with opportunities to staff in the outpatient pharmacy to explore community practice is also required and rounds out the program objectives. These shifts create a foundational understanding of the technical and workflow systems necessary to operationalize the ultimate goal of medications reaching the patient in a timely and safe manner and are critical to understanding the important role of central pharmacy distribution chains. This understanding is foundational for success in future residency or career endeavors. The staffing role is a necessary component to the internship, particularly as pharmacies around the country are experiencing workforce shortages. According to ASHP, “a majority of pharmacy administrators in a recent survey reported turnover rates of at least 21% in 2021, and nearly 1 in 10 noting they had lost 41% or more of their technicians.” (1)

The integrated pharmacy internship program described above lays the foundation for how workplaces can engage and utilize the skill set of pharmacy interns in a unique and meaningful way. As the vast majority of pharmacy students seek employment experience during their professional education, it is critical that employers develop opportunities that provide benefit to both the employer and the intern to maximize the experience for both. With the implementation of the new program structure and maximizing pharmacy interns’ unique skill set, support of Mercy Medical Center’s mission to provide the best patient care is achieved, while significantly contributing to creating competent, engaged, caring pharmacist professionals for the future.

References: 1. Hospitals and health systems experiencing severe shortage of pharmacy technicians. ASHP. (2022, March 15). Retrieved July 25, 2022, from https://www.ashp. org/news/2022/03/15/hospitals-and-health-systems-experiencing-severe-shortage-of-pharmacy-technicians?loginreturnUrl=SSOCheckOnly