Let's Think About It

LET’S THINK ABOUT IT V O L U M E

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Let’s Think About It is published three times a year by the Center for the Advancement of Teaching and Learning (CATAL) in Mercer University’s College of Pharmacy and Health Sciences. The purpose of CATAL is to support and promote effective and innovative teaching that enhances learning at the College. CATAL’s vision is to create a learning-centered community that promotes a culture of excellence in teaching and learning.

Evaluation of Institutional Introductory Pharmacy Practice Experiences at Area Hospitals Nicole L. Metzger, Pharm.D., Angela O. Shogbon, Pharm.D., Pamela M. Moye, Pharm.D., Phillip S. Owen, Pharm.D., Melissa M. Chesson, Pharm.D., and Bobby C. Jacob, Pharm.D.

Leisa L. Marshall, Pharm.D.

This Issue Let’s Think About It

is the newsletter for Mercer University’s Center for the Advancement of Teaching and Learning (CATAL) in the College of Pharmacy and Health Sciences.

Pharmacists are widely regarded as medication experts and can provide evidence-based, cost-effective patient care. The Accreditation Council for Pharmacy Education (ACPE) describes their vision of future pharmacy practice as one where pharmacists ensure optimal medication therapy outcomes for patients.

They further recommend that pharmacy

ing designs and structure, but all with a goal to

education prepares students for the delivery

increase students’ preparedness for Advanced

of patient-centered care that optimizes medica-

Pharmacy Practice Experiences (APPE). Some

tion use, improves therapeutic outcomes, and

institutional IPPE programs have involved

Let’s Think About It provides a forum for College

promotes public health initiatives. However,

students working with interprofessional patient

of Pharmacy and Health Sciences faculty to

along with recognition of the pharmacist as

care teams, while others have incorporated

share reports of their scholarship of teaching

a medication expert comes the additional

direct patient care activities such as patient

and learning. At present, I serve as editor and

accountability for patient health outcomes;

interviews and medication reconciliation

Dr. Ajay Banga as associate editor. We encour-

and, hopefully, public recognition of the phar-

services.2-4 Assessment of IPPE is also varied,

age you to submit reports of your pedagogical

macist’s ability to manage medications, improve

including students’ perceptions of IPPE and

research or innovative teaching techniques and

cost-effectiveness and patient outcomes.1

knowledge gained, faculty’s assessment of

approaches that facilitate learning in the class-

As a result, ACPE has increased emphasis

students’ performance, and students’ readi-

room or practice site. We would also invite you

on experiential education, specifically Intro-

to submit short summaries of books or arti-

ductory Pharmacy Practice Experiences (IPPE).

In an assessment of a direct patient care in-

cles that you have found useful in your teach-

In January 2011, ACPE updated their 2007 stan-

stitutional IPPE program focused on providing

ing, as we would like to include these types

dards to include guidelines 14.4 and 14.5 which

medication reconciliation services at a local

of articles in the newsletter. Each submission is

clarify requirements for IPPE.1 Guideline 14.4

health-system, preliminary data showed

reviewed by the editors and selected members

recommends that IPPE include a total of 300

students had positive attitudes about medica-

of CATAL, and we provide feedback to authors

hours, of which 150 hours be equally divided

tion reconciliation and an awareness of its

within 60 days. Please consult the CATAL Web-

between community (75 hours) and institution-

importance.3 Students’ understanding of and

site for previous issues of Let’s Think About It to

al settings (75 hours).1 While community hours

their abilities to perform medication reconcilia-

review the manuscripts published in the past.

are relatively easy to obtain, institutional IPPE

tion improved after IPPE.3 In another longi-

The Web site also contains information about

hours are much more difficult to secure due to

tudinal IPPE program described by Chisolm

(Continued on page 2)

the smaller number of hospitals.

et al, students worked with faculty and APPE

There are several descriptions of institutional IPPE programs in the literature, each with vary-

ness for experiential rotations.2-5

students to interview patients, evaluate and (Continued on page 2)

(This Issue – Continued from page 1)

(IPPE Study – Continued from page 1)

conclusion of their IPPE block. The differences

programs offered by CATAL, such as the

present patient cases.4 A list of 21 competencies

in the assessment tools between year one and

Journal Club and Colloquy meetings.

was developed by the school’s curriculum com-

year two are described in Table 1.

This issue of the newsletter features two

mittee, and students were surveyed before and

Tests were graded by IPPE faculty using

projects highlighting teaching and learning in

after IPPE to assess their perceptions of the ex-

a standardized key and each open-ended

practice experience settings in the pharmacy

perience and their attainment of each competen-

knowledge-based question was assigned a

program. The first article, authored by

cy. Overall, the investigators found that students

point-value. The primary objective of the study

Dr. Nicole Metzger and five other faculty members,

enjoyed IPPE and it resulted in learning.4

was to compare the difference in students’

provides an evaluation of Introductory Practice

Mercer University College of Pharmacy and

performance on the pre-test and post-test

Experiences at local hospitals. It includes an

Health Sciences (Mercer COPHS) developed a

assessment tools. Secondary objectives in-

explanation of the Accreditation Council for

unique approach to securing institutional sites

cluded: assessing baseline hospital experience,

Pharmacy Education standards for these prac-

for APPE and IPPE, which included strategical-

determining the impact of IPPE on students’

tice experiences. The second article, authored

ly placing pharmacy practice faculty members

confidence in basic hospital pharmacy practice

by Dr. Angela Shogbon and Dr. Lisa Lundquist,

at four local hospitals (Atlanta Medical Center,

and their likelihood of pursuing a career in hos-

discusses the impact of Advanced Practice

DeKalb Medical, Emory Healthcare, and Grady

pital pharmacy, and whether previous hospital

Experience pharmacy students at a local com-

Health System) to facilitate these experiences.

experience resulted in higher post-test scores.

munity hospital. This is our first issue in which

During the 2009 and 2010 academic years,

Students’ responses to demographic questions

both articles focus on practice experiences,

institutional IPPE at Mercer COPHS was con-

were analyzed using descriptive statistics and

and we hope you enjoy it.

ducted longitudinally during the third profes-

the Wilcoxon Signed Rank test. Comparison

Thank you and please do not hesitate to

sional year. Groups of 4 to 6 students came

between students’ pre-test and post-test scores

contact me or other members of CATAL if

to the four hospitals once a week for 4 hours

was done by paired t-test. Scores across the

you would like to discuss possible manuscript

per week, for 4 consecutive weeks. An assess-

institutions were analyzed using ANOVA. The

submissions to the newsletter.

ment tool was designed to evaluate students’

study was approved by Mercer University’s

acquisition and application of basic hospital

Institutional Review Board, and a waiver of

Leisa L. Marshall, Pharm.D.

pharmacy practice knowledge. The purpose

informed consent was granted.

Clinical Professor

of this study was to quantitatively assess the

Department of Pharmacy Practice

effectiveness of institutional IPPE at meeting

results

Editor

instructional objectives.

Eighty-eight (98.9%) students completed the

marshall_l@mercer.edu

2

pre-test and post-test at four faculty-facilitated Methods

IPPE institutions in year one (EUH n=30, Grady

In order to evaluate students’ performance

n=29, AMC n=15, DeKalb n=14) and a total of

on core competencies derived from the ACPE

84 (86.6%) students at three faculty-facilitated

standards, a written assessment tool that

IPPE institutions in year two (EUH n=43, AMC

provides both qualitative and quantitative

n=19, DeKalb n=22). Baseline characteristics

measurements was designed by IPPE faculty.

revealed that 58 (66%) students in year one

Students were asked about their baseline

and 46 (54.8%) students in year two reported

hospital pharmacy experience, confidence

a prior visit to a hospital pharmacy. Of those,

in knowledge of hospital pharmacy practice,

only 26 (30%) students in year one and 20

and likelihood of pursuing a career in hospital

(23.8%) students in year two reported volun-

pharmacy practice in the qualitative questions.

teering, interning, or working in a hospital

The quantitative section included questions

pharmacy. For the primary endpoint, overall

that were developed to assess students’

student performance on the quantitative

comprehension of objectives in line with

assessment improved in both years (p<0.01).

ACPE standards and competencies for IPPE.

Figure 1 illustrates the differences between the

Questions developed assessed knowledge in

mean pre-test and post-test scores for years

the following competency areas: decentral-

one and two. Students reported improved

ized pharmacy model, USP 797 standards,

confidence in their knowledge of hospital

automated distribution systems, drug informa-

pharmacy practice at the conclusion of IPPE

tion references, anticoagulation management,

(p<0.001 in both years), and their likelihood to

medication reconciliation, and pharmacy calcu-

pursue a career in hospital pharmacy practice

lations. Students were administered the same

did not significantly change by the conclusion

IPPE assessment tool as a pre-test prior to

of IPPE (p=0.184 in year one, p=0.075 in year

the institutional IPPE and as a post-test at the

two). Figures 2 and 3 illustrate the breakdown

Table 1: Comparison of Year One and Year Two Assessments Year

Assessment Type

Number of quantitative questions

Sites included

1

Likert scale demographic questions; Multiple choice content questions

12

N=4: AMC, DM, EUH, GHS

2

Likert scale demographic questions; A combination of multiple choice and short answer content questions

14

N=3: AMC, DM, EUH *GHS excluded due to lack of a faculty facilitator and missing data

AMC= Atlanta Medical Center; DM=DeKalb Medical; EUH= Emory University Hospital; GHS= Grady Health System

of student responses regarding their confi-

information, identification and assessment of

order entry and verification, drug information

dence in hospital pharmacy practice for both

drug related problems, dose calculation, drug

inquiries, medication therapy management,

years. Prior hospital pharmacy experience re-

information analysis and literature search.1 The

dose calculations, intravenous compounding,

sulted in higher pre-test scores (p<0.01) in year

institutional IPPE program at Mercer COPHS

among others, in order to enhance students’

one but there was no significant difference in

was designed to meet objectives in line with

learning. At the conclusion of these experi-

year two (p=0.525). There was no significant dif-

these standards, and students’ acquisition

ences, students reported improved confidence

ference in post-test scores at the conclusion of

of knowledge at the end of this program was

in their knowledge of basic hospital pharmacy

IPPE in both years between students with prior

evident through their performance on the post-

practice. Prior hospital pharmacy practice

hospital pharmacy experience and those with-

test assessment tool. After our assessment

experience did not have a significant impact

out (p=0.183 in year one, p=0.542 in year two).

tool was designed, the American Society of

on the extent of knowledge gained at the end of

Figure 4 illustrates the differences between

Health-System Pharmacists (ASHP) and ACPE

the institutional IPPE as evidenced by students’

the mean pre-test and post-test scores in both

jointly developed a task force to describe com-

performance on the post-test assessment tool.

years stratified by prior work experience.

petencies necessary for entry-level pharmacy

There are some limitations to this study. Stu-

practice in hospitals and health-systems. The

dents’ performance on the assessment tool in

Discussion

institutional IPPE program at Mercer COPHS

both study years could not be combined and

This study demonstrated measurable improve-

is instrumental in ensuring students achieve

jointly analyzed due to the significant revisions

ment in students’ knowledge of hospital phar-

many of these competencies.

made to the assessment tool in the second

macy practice after completion of a 4-week

The institutional IPPE program at Mercer

year of study. In the first year, the quantita-

long institutional IPPE program. The Accredi-

COPHS involved students working with faculty,

tive portion of the assessment tool utilized

tation Standards and Guidelines put forth by

pharmacists, pharmacy residents, pharmacy

multiple choice questions, and in year two, that

ACPE highlights the IPPE core domains and

interns and technicians, and some APPE

section was revised to include a combination

ability performance statements that students

students to learn objectives set forth for the

of short answer and multiple choice questions.

must demonstrate abilities and competency in,

IPPE program. The institutional IPPE program

This was done to better assess students’ ability

to ensure their optimal preparation for APPEs.1

provided students with experiential training

to apply and synthesize knowledge acquired

Some of these core domains are patient

and included active learning strategies, such as

during IPPE. In addition, we had to exclude

safety, basic patient assessment, medication

patient case discussions, simulated medication

(Continued on page 4)

6

3

Figure 1. Overall Performance Across All Institutions: Year 1 & 2

Conclusions Institutional IPPE plays a key role in preparing pharmacy students to evaluate, interpret, and accurately dispense prescribed medications, and to provide optimal patient care in the hospital environment. The institutional IPPE program at Mercer COPHS was successful at improving students’ knowledge and confidence in basic hospital pharmacy practice. Colleges of Pharmacy should continually strive for ways to enhance IPPE programs in order to develop confident, competent, and well-rounded pharmacy practitioners. acknowledgement Kathryn Momary, Pharm.D., for her aid in statistical analysis References 1. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional degree program in

Figure 2. Confidence in Knowledge of Hospital Pharmacy Practice: Year 1

pharmacy leading to the doctor of pharmacy degree. 2.0 Adopted January 15, 2006. Revised January 23, 2011. Accreditation Council for Pharmacy Education. Chicago, Illinois 2011.

2. Ma CS, Holuby RS, Bucci LL. Physician and pharmacist collaboration: The University of Hawaii Hilo College of Pharmacy – JABSOM experience. Hawaii Med J. 2010;69(6 Suppl 3):42-4.

3. Walker PC, Kinsey KS, Kraft MD, Mason NA, Clark JS. Improving student education and patient care through an innovative introductory pharmacy practice experience. Am J Health-Syst Pharm 2011;68:655-660.

4. Chisholm MA, DiPiro JT, Fagan SC. An innovative introductory pharmacy practice experience model. Am J Pharm Educ.

2003;67(1):171-178.

5. Wuller WR, Luer MS. A sequence of introductory pharmacy practice experiences to

(IPPE Study – Continued from page 3)

in confidence scores and performance on the

address the new standards for experiential

one of our sites (Grady Health System) in year

post-test was solely due to the 4-week long

learning. Am J Pharm Educ. 2008;72(4):

two because the faculty member at that institu-

institutional IPPE experience or, if additional

Article 73.

tion relocated and the data set from their

learning took place in other didactic courses

6. ASHP-ACPE Task Force. Entry-level

students was incomplete. Additionally, it is

and patient care experiences during the time

competencies needed for pharmacy practice

difficult to determine if students’ improvement

between the pre-test and post-test.

in hospitals and health-systems. Fall 2010.

Available at http://www.ashp.org/DocLibrary/MemberCenter/Entry-level-Competencies.aspx. Accessed August 1, 2011.

4

Figure 3. Confidence in Knowledge of Hospital Pharmacy Practice: Year 2

Figure 4. Performance Based on Prior Work Experience: Year 1 & 2

5

Impact of Pharmacy Students on Advanced Pharmacy Practice Experiences at a Community Non-teaching Hospital Angela O. Shogbon, Pharm.D., BCPS, and Lisa M. Lundquist, Pharm.D., BCPS

The Accreditation Council for Pharmacy Education (ACPE) requires that the curriculum of Colleges of Pharmacy leads to the development of graduates who are able to contribute to patient care in collaboration with patients, prescribers and other members of the health care team.1 ACPE highlights several aspects of students’

of Pharmacy and Health Sciences students.

estimated cost savings, intervention types,

contribution to patient care in preparation

These APPEs provide students with op-

and acceptance rates.

for their role as future pharmacists, including

portunities for patient care interactions and

providing patient education, optimizing the

collaboration with healthcare providers as

methods

part of their experiential education process.

This study involved a retrospective review

municating with other healthcare providers.

A component of the learning objectives for

of clinical interventions by APPE students

ACPE also recommends the documentation

all APPE students at DeKalb Medical is to

on their Advanced Institutional, Medication

and assessment of the nature and extent

engage in site specific clinical activities, under

Safety, and Internal Medicine APPEs over

of students’ interactions with patients and

the supervision of a preceptor, in order to

a 2 year period (June 2009 to July 2011),

health care professionals.

increase students’ contribution to patient

excluding April and May 2010. As part of the

pharmaceutical care of patients, and com1

1

Advanced pharmacy practice experiences

care, in line with ACPE standards. These clini-

expectations of their APPE at DeKalb Medi-

(APPE) are a component of students’

cal activities include intravenous to oral (IV to

cal, students in these 3 practice experiences

experiential education and provide students

PO) drug therapy screening and conversions,

participate in clinical activities to optimize the

with multiple opportunities to interact with

adverse drug event screening and reporting,

medication therapy and medication safety of

patients, and collaborate with different mem-

and patient education on warfarin therapy.

patients, as well as to improve their health lit-

bers of the health care team in optimizing the

In addition, students participate in the drug

eracy on certain medication therapies. In the

pharmaceutical care of patients. Several stud-

information service and provide health

process, students learn how to interact with

ies have evaluated the impact of pharmacy

information to various healthcare providers

other healthcare professionals and improve

students on experiential rotations in different

and patients. Another APPE objective is to

their communication skills by making verbal

health care settings in relation to the types

aid students in the development of written

and written recommendations regarding

and significance of clinical interventions,

and verbal communications skills and to learn

medication therapy. Students also develop

as well as on cost savings to the institu-

how to work with a multidisciplinary group of

their patient education skills. These activities

tion

These studies have demonstrated the

healthcare providers. Students’ participation

are all performed under the supervision of

significant impact pharmacy students have

in these activities and other APPE specific

the site preceptors. Part of the requirement

in improving patient care and in increasing

functions such as medication reconciliation,

of these APPEs is that students document

cost savings to the institution. Most pub-

drug therapy monitoring and optimization,

the clinical activities they perform in order to

lished studies report the impact of pharmacy

teaches students how to contribute to patient

keep track of their activities at the site and

students in teaching institutions while some

care in collaboration with other health care

progress through the APPE. It also serves as

others do not specify the teaching status of

providers, which is in line with ACPE objectives.

a learning tool on how pharmacists document

the site.

clinical interventions.

.2-7

2-7

DeKalb Medical is a community non-

This study assessed the impact of phar-

macy students on APPEs at this community

teaching hospital that offers Advanced

non-teaching hospital during their completion

with other health care professionals, patients

Institutional, Medication Safety, and Internal

of competencies in-line with ACPE standards

and caregivers, and were documented on a

Medicine APPEs to Mercer University College

by evaluation of clinical interventions for

data collection form for the first 1.5 years of

6

Clinical interventions involved interactions

the study. All data collected were subsequent-

mentation of clinical interventions and were

practice setting still had multiple opportuni-

ly entered into an internet-based documen-

included in this study. Clinical interventions

ties to impact the care of patients through

tation system from Pharmacy OneSource,

from these students on Medication Safety

participation in a variety of clinical activi-

Quantifi, (Pharmacy OneSource, Bellevue, WA)

(n=13), Advanced Institutional (n=17) and Inter-

ties, thus meeting key objectives in line with

for analysis of intervention types, accep-

nal Medicine (n=39) APPEs were collected and

ACPE standards. The quantity of each type

tance rates and estimated total cost savings.

analyzed. APPE students reported a 96.5% ac-

of clinical intervention attempted varied by

Beginning in January 2011, students directly

ceptance rate (972 accepted/1007 attempted)

type of APPE, based on the requirements of

entered their interventions into Quantifi.

for clinical interventions with an estimated

each APPE. Overall, the most common types

Interventions were classified into the following

total cost savings of $119,401. Table 1 high-

of interventions reported were information/

areas: therapeutic (antibiotic recommenda-

lights the number of attempted and accepted

education and IV to PO therapeutic conver-

tions, medication initiation/discontinuation),

clinical interventions and Table 2 highlights

sions. The increased number of these types of

safety (dose evaluation, drug interactions,

the estimated cost savings associated with ac-

clinical interventions was due to the stu-

allergy information clarification, lab evalua-

cepted clinical interventions. The most com-

dent’s weekly participation in specific clinical

tion), quality assurance (medication history, du-

mon types of interventions performed were

activities at this practice site including IV to

plicate avoidance), IV to PO, and information/

information/education (patient education, drug

PO screening and conversions per hospital

education (drug information, patient educa-

information, drug therapy consultations) and

protocol, and warfarin education.

tion, drug therapy consultation). Students were

IV to PO screening and conversions.

8

In addition to the experiential educa-

educated on how to appropriately document

tion gained through students’ involvement

clinical interventions and each intervention was

in clinical activities at practice sites, other

reviewed by a pharmacist.

discussion

additional teaching and learning benefits

Pharmacy students on various APPEs at

can be observed. DiVall et al reported on

lizing the variables and assumptions made by

DeKalb Medical had over 1000 opportunities,

the implementation of a school-wide clinical

Quantifi which was based on literature evalu-

over a two year period, to impact the care of

intervention database to document pharmacy

ation and cost-savings calculations to derive

patients through interaction with other health-

students’ impact on patient care. The authors

hard and soft cost savings for each type of in-

care providers, patients and caregivers, and

highlighted that clinical interventions can

tervention. Hard cost savings includes actual

through medical chart review. These clinical

be incorporated into student portfolios to

costs saved based on a clinical intervention

interventions were well received with an ac-

highlight their impact on patient care, thus

made and applies to interventions such as IV

ceptance rate of 96.5% and an estimated total

helping students build up their professional

to PO therapeutic conversion and antibiotic

cost savings of $119,401 over a two year period.

development portfolios.2 It can also serve

recommendations. Hard cost savings ranged

The estimated total cost savings included both

as an assessment tool for site preceptors to

from $17 to $214. Soft cost savings refers to

hard/actual cost savings, and soft cost sav-

document the APPE competencies students

cost avoidance from the prevention of a po-

ings/avoidance from prevention of a potential

meet. 2 The authors also highlight the impor-

tential adverse drug event when an interven-

adverse event when an intervention is made.

tance of assessment of the most commonly

tion is made, for example, allergy information

This approach to evaluation of clinical interven-

observed drugs and conditions documented

clarification, and were assigned a cost savings

tions has also been utilized by similar studies

in these clinical interventions, for curriculum

of $153.

evaluating clinical interventions of pharmacists

assessment to ensure pharmacy training is in

and pharmacy students.

line with trends in practice. 2

versity’s Institutional Review Board. Descrip-

tive statistics were utilized to analyze data

tive impact of pharmacy students in various

faculty members precept the Internal Medi-

obtained.

clinical settings and their associated cost

cine APPE at DeKalb Medical, while non-facul-

savings and in most of these studies, the

ty site-based preceptors oversee the Medica-

Estimated cost savings were calculated uti-

This study was approved by Mercer Uni-

6,7

Previous studies have described the posi-

2-7

This study had several limitations. Mercer

impact in teaching institutions is described. In

tion Safety and Advanced Institutional APPEs.

results

non-teaching community hospitals like DeKalb

However, faculty members supervise all of the

A total of 69 fourth professional year pharma-

Medical, the interaction with the medical

APPE students’ completion of general clinical

cy students who completed their Advanced

team is not made on formal teaching rounds

activities including IV to PO conversions, warfa-

Institutional, Medication Safety, or Internal

and interaction mainly occurs on a one-to-

rin education, and drug information, and could

Medicine APPEs at DeKalb Medical over the

one basis with attending physicians, nurse

therefore follow-up to ensure interventions

two year study period were trained on docu-

practitioners, physician assistants and other

performed where documented by students. In

healthcare providers. APPE students in this

addition, since faculty reviewed and 7

Table 1. Attempted Clinical Interventions and Acceptance Rates Advanced Institutional n (% accepted)

Internal Medicine n (% accepted)

Total Attempted n (%)

Therapeutic Antibiotic recommendation Medication initiation/discontinuation Therapeutic interchanges

Medication Safety n (% accepted)

3 (100)

2 (100)

124 (90.3)

129 (12.8)

Safety Dose evaluation Lab evaluation Allergy information clarified Drug Interactions

5 (80)

2 (100)

129 (87.6)

136 (13.5)

0

3 (100)

84 (96.3)

87 (8.6)

IV to PO

38 (100)

53 (100)

115 (100)

206 (20.5)

Information/education Drug information Patient education Drug therapy consultation

80 (100)

81 (100)

288 (98.9)

449 (44.6)

126 (99.2)

141 (100)

740 (95.4)

1007 (100)

Quality assurance Medication history Duplicate avoidance

Overall (Continued on page 8)

to those that were not accepted. This may

mendations to the clinical team through

(AAPE Study – Continued from page 7)

have underestimated the total number of

either verbal or written means, and teaches

approved their Internal Medicine students’

clinical interventions performed and inflated

them how to document such activity. This pro-

clinical recommendations prior to students’

the number of accepted interventions. In

cess also helps the student realize the impact

discussion with the healthcare team, they

this study, there was no specific assessment

they have on patient care and may provide a

could also follow-up on if certain interven-

of students’ verbal communication skills to

better understanding of an interdisciplinary

tions were documented. This intervention

other healthcare providers, but interventions

approach to patient care through interactions

documentation follow-up by preceptors may

were discussed with a site preceptor prior to

with other healthcare providers. Student

not have been the case with the Medication

implementation.10 Lastly, even though cost

interventions during their APPEs will continue

Safety and Advanced Institutional students

savings have been calculated and reported,

to be collected with potential incorporation

for their other APPE specific interventions. In

it is unknown if the accepted interventions

of a student survey to assess their perceived

this regard, students on the Internal Medicine

reduced length of stay or overall healthcare

impact on patient care.

APPE may have been more likely to document

costs.7

interventions compared with students on

may help to justify the impact and presence of

other APPEs. In addition, students may have

clinical interventions by students helps to

pharmacy students at practice sites and may

been more likely to document only interven-

contribute to their active learning process and

justify increasing the number of students at

tions they recollected based on its perceived

preparation as future pharmacists. It helps

these sites in order to increase the potential

favorable impact on patient care. They may

them identify what a clinical intervention is

impact on patient care and cost savings to

also have been more likely to document the

and the various types, it provides them with

the hospital.

interventions that got accepted as opposed

an opportunity to communicate the recom-

9

8

The performance and documentation of

The estimated cost savings documented

June 26, 2010.

2004;38:574-8.

conclusion

2. DiVall MW, Zikaras B, Copeland D, et al.

8. Pharmacy OneSource®, Quantifi®. Available

Pharmacy students on APPEs at a community

School-wide clinical intervention system to

from http://www.pharmacyonesource.com/ap-

non-teaching hospital had over 1000 opportu-

document pharmacy students’ impact on

plications/quantifi. Accessed December 1, 2011.

nities within a two year period to participate

patient care. Am J Pharm Educ. 2010;74(1):

9. Pound MW, Miller SW. Written versus

in clinical activities, interact and collaborate

Article 14.

oral recommendations made by pharmacy

with other health care professionals, and im-

3. Taylor CT, Church CO, Byrd DC. Documen-

students during internal medicine rotations.

pact the care of patients, while also contribut-

tation of clinical interventions by pharmacy

Ann Pharmacother 2007;41:772-6

ing to pharmacy cost savings. These activities

faculty, residents, and students. Ann Pharmaco-

10. Lundquist LM, Moye PM. Resident physi-

provided students with the opportunity to

ther. 2000;34:843-7.

cians’ acceptance of pharmacy students’

learn and demonstrate ACPE competencies

4. Pham DQ. Evaluating the impact of clinical

pharmacotherapy recommendations during

in experiential education, specifically in con-

interventions by PharmD students on internal

an ambulatory care advanced pharmacy prac-

tributing to patient care in collaboration with

medicine clerkships: the results of a 3 year

tice experience. Am J Pharm Educ. 2009;73(8):

patients, prescribers and other members of

study. Ann Pharmacother. 2006;40:1541-5.

Article 145.

the health care team.

5. Slaughter RL, Erickson SR, Thomson PA. Clinical interventions provided by doctor

References

of pharmacy students. Ann Pharmacother.

1. Accreditation Council for Pharmacy Educa-

1994;28(5):665-70.

tion (ACPE). Accreditation standards and

6. Stevenson TL, Fox BI, Andrus M, Caroll D.

guidelines for the professional program in

Implementation of a school-wide clinical

pharmacy leading to the doctor of pharmacy

intervention documentation system. Am J

degree. Available at: http://www.acpe-ac-

Pharm Educ. 2011;75(5):Article 90

credit.org/pdf/ACPE_Revised_PharmD_Stan-

7. Condren ME, Haase MR, Luedtke SA,

dards_Adopted_Jan152006.pdf. Accessed

Gaylor AS. Clinical activities on an academic pediatric pharmacy team. Ann Pharmacother.

Table 2. Accepted Clinical Interventions and Estimated Cost Savings Advanced Institutional (n=125)

Medication Safety (n=141)

Internal Medicine (n=706)

Total Accepted (n=972)

Therapeutic

$459

$306

$17,724

$18,489

Safety

$612

$306

$17,289

$18,207

$0

$459

$12,393

$12,852

$646

$901

$1,904

$3,451

Information/education

$11,934

$12,087

$42,381

$66,402

Estimated Total Cost Savings

$13,651

$14,059

$91,691

$119,401

Intervention Class

Quality assurance IV to PO

9

From the Literature: Lecture Capture, Attendance and Learning

by J. Grady Strom, Ph.D. Students in a course have been audio record-

Their study was designed to address the fol-

sures from students with no-webcast access;

ing lectures since the invention of the tape

lowing five research questions:

and webcast viewing appeared to neutralize

recorder. Technology to record lectures digi-

• How does webcasting affect students’ actual

the negative effect being absent from class can

tally and post the resulting files on the web for

class attendance, when other factors, such

have on student performance.

all students to download has been available

as GPA, gender, reason for taking course,

There are at least two ideas that are suggest-

for more than 10 years. PowerPoint slides al-

and other online resources, that could affect

ed by these findings. There obviously are sev-

low the voice of the instructor to be included

attendance are taken into consideration?

eral factors that control classroom attendance

as part of the slide deck. Recent advances in

• How does webcasting affect students’

and all of these should be considered when

technology have created the ability to capture

performance when attendance is taken into

supplying resources to students. This study

and synchronize the class lecture with slides,

account?

suggests that the availability of other online

what is written on a whiteboard or through a

• How effective do students perceive

resources suppresses classroom attendance

document camera, or sometimes even a video

webcasts to be for learning?

more than webcasting. Also, the study findings

recording of the instructor. These are referred

• Why do students use webcasts?

imply that students may have learned as well

to as podcasts, lecture capture, webcasts or

• How do students use webcasts?

using webcasts as they would have attending

screencasts.

lectures. Absenteeism may not have a negative

The availability of various technologies is

The study was conducted in a large enrollment

effect on learning when webcasting is avail-

rapidly evolving and is increasingly being used

geology course with two course sections. Stu-

able and viewed by students. From the study

in higher education. Factors such as lower cost

dents in one section were allowed access to

surveys, many students agreed that webcasts

of the technology and greater student access to

lecture webcasts while students in the other

can replace being in class (55%) and lecture

computers and smart mobile devices have prob-

section were not allowed webcast access. Data

webcasts are as good as going to class (66%).

ably made implementation a more viable op-

were collected through attendance counts,

We should remember that attendance in

tion. A study from the E-Business Institute at the

by performance on examinations, through an

class is not a learning outcome, however, face-

University of Wisconsin-Madison found that 82%

end of semester survey administered to all

to-face contact is valuable for a number of

of students surveyed said that they preferred

students, and by recording access by students

reasons. Technology should be viewed for the

classes with lecture capture as a complement to

to webcasts.

ways that it can contribute to positive student

classroom delivery. Additionally, the students

Based on analysis of these data, the authors

outcomes and experiences. There are many

perceived a number of benefits from lecture

concluded the following related to attendance:

questions remaining to be answered related to

capture, including (in order of importance) mak-

students with webcast access attended class

lecture capture/webcasting. For example, what

ing up for a missed class, watching lectures on

less frequently than students without access;

types of content are best suited to this format?

demand for convenience, improving retention

students who viewed webcasts more frequent-

What is the optimum length for the webcast

of class materials, improving test scores, and

ly were absent more often; and the availability

and could summaries be more effective than

reviewing material before class.

of additional course materials online (e.g.,

full lectures using webcasting? Could webcast-

As a relatively new technology, very little re-

Power Point slides, lecture notes) had a greater

ing be used to give feedback to students?

search targeted to the educational advantages

negative impact on classroom attendance than

Do webcasts potentially facilitate learning in

and disadvantages of lecture capture or pod-

webcasting. Findings related to the impact on

large lecture courses by providing students

casting has been published. A recent report by

student performance included the following:

increased control over their own learning pro-

Traphagan, Kucsera, and Kishi was designed to

for those students with access to webcasts,

cesses?

answer some of these questions. In particular,

more webcast viewing was associated with

It seems to me that there is an important

they observed the impact of integrating lec-

higher performance; after controlling for GPA

implication from this study based on the evi-

ture capture on learning and attendance in a

differences and absences, students with web-

dence that webcasts lectures could be as effec-

course.

cast access did not differ on performance mea-

tive as in-class lectures. This technology may

1

2

10

be used to transform teaching and learning by “flipping” the classroom. The lecture, presented to students before class, would allow class time for hands-on activities and more personal interaction with the instructor.

As faculty members, we must continually reevaluate what we teach and how we teach.

We exist to move students to their highest potential. We need to find the best way to do that, including the appropriate use of technology.

References 1. Veeramani R, Bradley S. Insights regarding undergraduate preference for lecture capture University of Wisconsin-Madison; Sept 23, 2008. documents.scribd.com.s3.amazonaws. com/docs/2l8qp0ru2o11am87.pdf (accessed 2012 May 24).

2. Traphagan T, Kucsera JV, Kishi K. Impact of class lecture webcasting on attendance and learning. Education Tech Research Dev 2010;58:19–37.

Dr. J. Grady Strom is vice chair of the Department of Pharmaceutical Sciences and director of the Center for the Advancement of Teaching and Learning in the College of Pharmacy and Health Sciences at Mercer University.

Publisher Hewitt “Ted” Matthews, Ph.D. Dean and Vice President for the Health Sciences

Editor Leisa L. Marshall, Pharm.D.

Associate Editor Ajay Banga, Ph.D.

Editorial and Production Manager David Hefner

Graphic Design Jenifer Cooper, CooperWorks Inc.

11

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Letâ&#x20AC;&#x2122;s Think About It A Newsletter by Mercer Universityâ&#x20AC;&#x2122;s College of Pharmacy and Health Sciences

inside Evaluation of IPPEs at Area Hospitals P. 1 Impact of Pharmacy Students on APPEs at a Community Non-Teaching Hospital P. 6 From the Literature: Lecture Capture, Attendance and Learning P. 10