SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
Spring Preceptor Workshop
Step 1 and Step 2 Rotations Most preceptors spend some time with their students on the first day to find out their career goals, prior rotations, and work history. Do your expectations change when you realize the student has vast work experience? Or when he/she has had several rotations similar to yours (like Colby in the cartoon)? The Accreditation Council for Pharmacy Education (ACPE) is interested in having preceptors increase the rigor of an APPE when it is the student’s second (or third!) rotation in that same type, such as acute care. For some rotations, this may mean more independence providing patient care (rounding on patients, delivering MTM services, making recommendations to a provider). For others, this may be more projects or assignments. This can also impact how you grade your student, based on these expectations.
The Spring Preceptor Workshop (March 28, 2019) will address the topic of progressively harder APPEs. Preceptors will be divided into smaller workgroups based on their APPE/IPPE types to develop activities for “Step 1” and “Step 2” rotations. The next steps will be to decide what type of rotation you offer (only Step 1, only Step 2, or some combination of both?) and then strategize the best times of year to offer these. Following the session, you will have ready-to-use resources to better evaluate your students and hold them to the correct expectations.
Required vs. Elective Rotations Now that our updated APPE evaluation has been in use for over a year, our preceptors have noticed that required APPE rotation evaluations do not allow a “not applicable” option when grading on the Presbyterian 10 competencies. Do you find that there are some competencies that are more difficult to evaluate? Acute care preceptors have reported difficulty grading “Promotion of Health and Public Welfare” and “Dispensing of Pharmaceuticals,” while many advanced community preceptors report struggling with true activities for “Ethical and Legal Decisions.”
At the workshop, preceptor workgroups will identify these “problem competencies” for their specific rotations. The attendees will identify specific barriers and brainstorm creative solutions to each one. By the end of the session, you can determine if your rotation is best categorized as required or elective and will develop activities for each competency on the evaluation.
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
Spring Preceptor Workshop APPE Readiness Sometimes you may precept a student who doesn’t seem ready for APPEs. He/she may have difficulty navigating the patient chart, providing sound evidence-based decisions, or communicating with other health care professionals. Whether you precept IPPE students, APPE students, or both, there is opportunity to help prepare students for APPEs by reinforcing the knowledge, skills, and attitudes required to be APPE-ready. The final portion of the preceptor workshop will focus on APPE-readiness. Once again in preceptor
workgroups, attendees will answer the question, “What
are the essential knowledge, skills, and attitudes needed by students prior to starting their APPEs?”
Once the statement has been answered, video vignettes of preceptor-student interactions will be shared. The group must determine, “Was the student APPE-ready?” If they answer no, the group will determine the next steps in order to get the student up to speed. Answers from the groups will be shared, so different perspectives can be collected.
NEW THIS YEAR! Students and preceptors have requested this for many years! We are pleased to offer a coffee and dessert reception following the preceptor workshop (3pm, student café) where preceptors and students can meet and mingle! Hope you’ll plan on joining us!
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
What we’ve been up to… SITE VISITS Prisma Health Midlands Richland Hospital, Columbia, SC Walmart Clinical Services, Greenville, SC Walgreens Pharmacy, Greenville, SC Lexington Medical Center, West Columbia, SC New Horizon Family Health Services, Greenville, SC Fred’s Pharmacy, Honea Path, SC Self Regional Healthcare, Greenwood, SC Prisma Health Upstate - Greenville Memorial Hospital, Greenville, SC
Pre-Clinical IPPE
Preceptor Pins
In order to better prepare P3s for APPEs, we are ensuring that all P3s complete at least 1 case presentation and 2 oral presentations during each IPPE segment (fall and spring). If you precept P3 IPPE students, please work with your student on these presentations and give feedback that can prepare him/her for the APPE year. Just as PCSP students have class pins for their white coats, we now have preceptor pins for our preceptors. Pins may be received after completion of the new preceptor modules (pcspoee.com).
IPPE Case Presentation This assignment can be completed in every setting – inpatient and outpatient. Even if the full patient chart is not available, the student, should, at a minimum, discuss the disease state and potential treatment plans. The case presentation should include: o Pathophysiology of the disease state o Medications used to treat the disease o Evaluation of the drug therapy of the case
IPPE Oral Presentation The preceptor can determine the guidelines, audience, and presentation details for the oral presentation. Suggested topics are listed on page 11 of the P3 IPPE workbook.
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019 There’s a lot in the literature about trends and improvements in experiential education. So we’ve created an easy way for you to keep up: The Journal Monitor. In each preceptor newsletter, we’ll provide you a brief look at some current articles. And we’ll provide the source information as well so you can take a look at the entire article yourself.
Assessment of SOAP note evaluation tools in colleges and schools of pharmacy Currents in Pharmacy Teaching and Learning 2017; 9 (576-584).
OBJECTIVE: Describe current practices in assessing SOAP notes within skills laboratory courses at colleges and schools of pharmacy. COMPARISON OF DOCUMENTING PHARMCEUTICAL CARE SERVICES: The American Society of Health SystemPharmacists (ASHP), the American College of Clinical Pharmacy (ACCP), and the American Pharmacists Association (APhA) each provide guidelines for the documentation of pharmaceutical care services (table below from article).
Sando, KR et al. Curr in Pharm Teach Learn. 2017;(9): 576-584
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
(continued)
Assessment of SOAP note evaluation tools in colleges and schools of pharmacy Currents in Pharmacy Teaching and Learning 2017; 9 (576-584).
RESULTS & DISCUSSION: Thirty-nine SOAP note assessment tools were collected from 25 different colleges and schools of pharmacy in the US. The most variability existed in the subjective and objective sections of the tools. For example, only 8% of evaluation tools included documentation of the patient’s medication history in the subjective section. The lack of consistency in SOAP note assessment tools can lead to variability in documentation when students enter APPEs and, later, practice. As the profession moves towards more consistency in pharmacist care, a need for uniformity in documentation will also follow. When designing a SOAP note assessment tool, inclusion of specific elements should be drawn from literature as well as recommendations of national pharmacy organizations. Educators (and preceptors) should also include the Pharmacists’ Patient Care Process to improve the transition to real-life practice settings.
Sando, KR et al. Curr in Pharm Teach Learn. 2017;(9): 576-584
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
Evaluation of a Longitudinal Advanced Pharmacy Practice Experience American Journal of Pharmaceutical Education 2017; 81 (3) Article 52.
OBJECTIVE: To describe satisfaction and career path of students who participated in the longitudinal advanced pharmacy practice experience (APPE) BACKGROUND: Several health-systems have begun implementing a longitudinal APPE, both across the US and in SC. The goal is to minimize orientation time, maximize time for direct patient care, and projects that require a longer time period, such as in depth evaluations of medical therapies. A collaboration between New York-Presbyterian Hospital (NYP) and St. John’s University College of Pharmacy and Health Sciences (SJU) was investigated in this study. PROGRAM DESCRIPTION: Interested students applied for the APPE “block” that included five rotations at NYP (general hospital, internal medicine, and three acute care electives). The student application included a letter of intent, curriculum vitae, and pharmacy school transcripts. RESULTS AND DISCUSSION: More than 90% of the respondents believed that the NYP-SJU program provided them a better learning experience compared to rotations at multiple institutions. Students gained approximately 76 hours of additional clinical experience in the longitudinal program. 38% of students completed research during the longitudinal rotation, and 20% published a manuscript that they reported would not have been able to complete in a single rotation block. Following the program, 67% of the respondents accepted a pharmacy residency after graduation.
BY THE NUMBERS
53 students enrolled in the NYP-SJU longitudinal program (January 1, 2010-December 31, 2013) 45 students completed the 3-part survey 76 hours of additional clinical experience (assumed an average of 8 hours for orientation, 8 hours for computer training, and 3 hours to become familiar with the institution) 38% completed a research project and presented their findings as a poster at a national conference
24% published a manuscript with an NYP preceptor
100% of respondents would recommend the NYP-SJO program to a peer 100% of respondents agreed that rotations at NYP allowed for critical evaluation of medication therapy and development of interventions
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
IPPE Workbook Tip: P1 Workbook The P1 IPPE workbook includes an activity intended to expose students to healthcare systems and how community pharmacists manage financial burdens of patients (page 10). The activity, shown below, recommends reviewing a Medicare or Medicaid plan and discussing the impact that covered and non-covered services have on the enrollees. If you struggle with completing this activity with your students, here is some helpful guidance:
• Help guide the student to a SC Medicaid plan website (such as https://www.absolutetotalcare.com/) • Direct the student to find the preferred drug list document (For Members – Medicaid Plan – Pharmacy – Preferred Drug List (PDF file) • Allow the student to review the document and discuss the following: • How the preferred drug list is developed • The pharmacy benefit manager’s role in processing Medicaid/Absolute Total Care claims • Dispensing and quantity limits • Prior authorizations • Step therapy • Age limits • Medical necessity requests • For students with prior work experience, you can also review the PDL and consider what barriers exist for certain medication classes and how that impacts patient access to medications • For example: different age restrictions on certain antidepressant medications Excerpt from https://pharmacy.envolvehealth.com/content/da m/centene/envolve-pharmacysolutions/pdfs/PDL/FORMULARYAbsoluteTotalCare_SouthCarolina.pdf
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
Preceptor Spotlight
Joycely M. Bowens, RPh Pharmacist, G. Werber Bryan Psychiatric Hospital Pharmacy Columbia, South Carolina Joycely was born and raised in Columbia, SC. She graduated from the University Of South Carolina in 1986 where she earned a bachelor of science degree in pharmacy. Her career began as a retail pharmacist with the Rite Aid Corporation for 10 years. As a community pharmacist, she dispensed medications and counseled patients to help them improve their overall health and wellness on a daily basis. In 1996, Joycely became interested in ambulatory care so she joined the pharmacy team at Palmetto Health Richland 14 Medical Park Outpatient Pharmacy. During her 14 years there, she provided services for patients in the hospital and at home as well as those enrolled in the Palmetto SeniorCare PACE Program. She also filled prescriptions for employees and provided distributive and consulting services for Palmetto Health outpatient clinics. Joycely started working at G. Werber Bryan Psychiatric Hospital Pharmacy in April 2010. At G. Werber Bryan, she is a part of a multidisciplinary team that takes care of the psychiatric and medical needs of hospitalized patients. She offers an introductory pharmacy practice experience (IPPE) for second-year students. During the IPPE, students learn about various psychiatric disorders such as schizophrenia, depression, bipolar disorder, and substance abuse along with their various drug treatments. Students also participate in this multidisciplinary approach to patient care, process and dispense medication orders, learn how medication errors and adverse drug reactions are reported, monitor clozapine and lithium levels, and learn about the many aspects of managing a hospital pharmacy. 1. What are the most difficult aspects of being a preceptor? And how do you overcome these barriers?
The most difficult aspect of being a preceptor is preparing weekly assignments that will not only interest students, but also challenge them to ensure that they have a quality educational experience. I overcome these barriers by coordinating with other pharmacy staff so that students will have opportunities to observe and participate in the multidisciplinary approach to patient care. 2. What do you value most about being a preceptor? I value the opportunity to shape students’ foundations in order to benefit the future of our profession of pharmacy. 3. How do you judge a student's success on your rotation? I love students who show an interest and are curious about what we do, so I judge a student’s success based on the student’s interest, curiosity, weekly progress, and achievement of weekly set goals.
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
Student Spotlight Angela Winkler, P3 student Angela is originally from Somerset, Kentucky and received a bachelor of science in forensic chemistry from Eastern Kentucky University in 2006. She currently works as a pharmacy intern for Fred’s Pharmacy in Ware Shoals, SC. She is involved in Christian Pharmacist Fellowship International (CPFI) and the College of Psychiatric and Neurologic Pharmacists (CPNP) and serves as the treasurer for both student organizations. She is also working on two research projects with faculty. Following graduation, Angela wants to pursue a residency and desires to use her patient care knowledge to help the underserved patient population.
1. What has been your most valuable rotation so far and why? My most challenging, but also most fulfilling rotation so far, has been at Laurens Family Medicine with Dr. Jennifer Clements. She pushed me beyond what I thought I was capable of learning. She was also readily available to help me with any questions on assignments during my rotation. To enrich my learning experience, Dr. Clements worked with me to understand the statistical values of a study and how I could apply it in treating patients in my future practice. She was incredibly patient with me during this process! 2. How do you balance the demands of your rotations with your school work? Time management and prioritizing tasks is essential. If I didn’t place these in the forefront of my mind at the beginning of the day and utilize my to-do list, I would not survive pharmacy school! 3. What is something you have learned about yourself on rotation? Every rotation has had its unique demands and rewards. These rotations have built upon and reinforced several areas to make me a better pharmacist and person. One of the most important things I have learned is to adapt and be flexible with preceptors and their staff. While on rotation, I always try to absorb the best take-home point offered from preceptors and learn as much as possible, while also trying to be helpful.
SCHOOL OF PHARMACY
pharmacy.presby.edu | 864.938.3900
February 2019
Master Preceptor Recognition
Master Preceptor requirements are due in November each year and the spring and summer is an ideal time to complete any outstanding requirements to submit in the fall. If you have any questions about the items to be completed, please contact Alyson Wilder (awilder@presby.edu). Master Preceptors are recognized at the White Coat Ceremony annually and are eligible for adjunct faculty appointment.
New (and seasoned) Preceptor Training