Experiential Education: Stepping Up to the Plate

For almost 2 decades, I have encountered colleagues in hospital and community practice who complain about providing experiential rotations for professional students. While there are many organizations and preceptors that warmly embrace experiential education, far too many continue to decline participation. Most of the complaints relate to the resources and time students require of the pharmacy and its staff. Some preceptors and/or their institutions expect financial support from the school for assuming responsibility for providing rotations.

I’ve been a preceptor for hundreds of students and a director of pharmacy at 2 academic medical centers that enabled my pharmacy staff to offer scores of rotations annually, so I know the issues and understand the challenges that providing experiential education experiences represents. Nevertheless, I firmly believe that it is the practice community’s responsibility to offer these educational experiences.

Until the early 20th century, when pharmacy schools began to open, individuals became pharmacists after completing an apprenticeship. The Merriam-Webster online definition of apprentice is “one who is learning by practical experience under skilled workers a trade, art, or calling.” Clearly, experiential education had its roots in the apprenticeship era. Apprenticeships were abandoned as suboptimal with the evolution of colleges of pharmacy, boards of pharmacy, and curricular enhancement. Until pharmacy curricula were changed when the doctor of pharmacy degree became the entry level degree, most boards of pharmacy required 6 to 12 months of “internship” or “externship” experiences to qualify for licensure.

These internship experiences were of inconsistent quality and focus and usually consisted of students performing technical functions that were subsequently verified by licensed pharmacists. Common functions were prescription filling, unit dose cart filling, label generation, answering the phone, and other “nonjudgmental” functions. Aligning students with preceptors was dependent on the efforts of the preceptor and the student, with little or no input from academia, and had little relationship to what was being taught in the schools. These experiences were mandated to be offered during the summer and after graduation, when students were not in class. Variances in both content and quality were commonplace.

I can remember when employers frequently complained that students were not prepared to practice after passing the boards without supervision, and a tailored orientation and training period to familiarize the student with the roles, responsibilities, and expectations of their first employer was needed. At both Duke and UNC Hospitals, we developed checklists of skills and capabilities that required validation by an experienced pharmacist before they could assume independent responsibility for staffing. It should also be noted that employers offering internship and externship experiences actually paid students for their efforts!

Introductory Pharmacy Practice Experiences

Introductory pharmacy practice experiences (IPPEs) are usually of short duration, frequently scheduled with multiple students simultaneously, and consume limited resources, since they usually include shadowing experiences, meeting and lecture time, tours, and similar activities. IPPEs provide the opportunity to familiarize the student with pharmacist roles and responsibilities and enable the evaluation of the student for advanced practice rotations and potential recruitment into residencies or entry-level practice.

Despite its short duration, an IPPE rotation represents our best opportunity to convince a student that practice in our environments (hospital, community, etc.) best meets their needs and interests when they become a licensed pharmacist. Regrettably, some students have developed an aversion to a given practice environment based on a disorganized and suboptimal IPPE experience. Since this perspective and attitude often closes the door to recruit students into specific pharmacy practice, we need to understand the importance of an IPPE and appreciate how it can affect students negatively for a long time. If we cannot put our best foot forward, we should not offer IPPEs.

Advanced Pharmacy Practice Experiences

Advanced pharmacy practice experiences (APPEs) are usually month-long rotations and should consume more resources than IPPEs, but these can be successfully offset by student contributions to providing service to the pharmacy and the patients they serve. APPEs require a qualified preceptor who supervises and assesses the student in achieving educational and training outcomes established by the school, the preceptor, and the organization. APPEs require that the school and preceptors (with their employers) plan, collaborate, and cooperate effectively on behalf of the profession, the practice of pharmacy, and the students. As experiential education evolves and improves, all parties must be entrepreneurial to accomplish educational, institutional, and individual goals of all those involved.

I believe the partnership between academia and the practice community frequently has considerable room for improvement in terms of planning and collaboration.

Why Should Preceptors and Institutions Support Experiential Education?

Pharmacy leaders, preceptors, and their institutions should enthusiastically support and provide APPEs for a variety of reasons, including:

• Our individual responsibility to “pay it forward.” All of us were “touched” by a preceptor, mentor, or practitioner who helped us understand the importance of what we do, motivated us to continuously improve, and gave us hope for becoming a valued pharmacist. The admiration and satisfaction preceptors derive from such relationships are often enduring. Don’t all of us have an obligation to pay it forward?

• Through APPEs we are more influential in supplementing the student’s education with skills and experiences needed to practice pharmacy in our environments.

• Ten months of APPEs should provide a level of practice maturity that is impossible to achieve in an academic environment alone. This translates to preparing pharmacy students for a more rapid and effective assimilation into the workforce and earlier productivity with limited oversight.

• Exposure of students to potential role models by our most effective practitioners, which should guide students in adopting a healthy, committed practice philosophy.

• Students on APPE rotations give potential employers an opportunity to observe and assess students’ interests, skills, and suitability as potential recruits for residency or staff positions. Multiple rotations at the same site enable the potential employer to provide a more tailored experience that makes them more valuable, and likely better prepared, for their first position.

• APPEs should motivate and excite students about their future practice. Frequently students develop an appreciation for their academic experience that now makes sense and can be applied to practice. They should also recognize the dynamic nature of practice evolution and their need to develop a lifelong learning personal philosophy.

Institutions and their pharmacy leaders have additional reasons to support and encourage experiential education rotations, including:

• Motivating practitioner preceptors. I always felt that preceptors would strive to do their best and be at the top of their practice if they were teaching others.

• Preceptor satisfaction and recognition. As the departmental leader, I did everything possible to recognize the efforts of preceptors, but usually the students themselves held their best preceptors in very high regard and expressed their appreciation continuously, including after the rotation was concluded.

• Recruitment and retention. Extremely positive APPE experiences help in recruitment, but the familiarity of the institution and preceptors promote an understanding of performance expectations and thus ensure a better fit between the institution and the employee.

• Student contributions to the clinical enterprise.

Student Contributions to the Clinical Enterprise

Students can contribute to the pharmacy by providing necessary work while learning, but care needs to be taken not to abandon their educational outcome expectations. Student assumption of technical and professional responsibilities, with supervision, can reduce staff time in selected situations. Such assignments must be carefully planned and are dependent on the student’s background and experience. Offering multiple rotations to a single student in the same pharmacy significantly enhances their potential contributions. These contributions may include:

• Unit dose drug distribution technical functions

• IV compounding

• Inventory control and management

• Conducting drug utilization reviews

• P&T Committee monograph development

• Responding to drug information requests

• Researching projects to investigate an institution-specific issue

• Taking admission histories

• Providing discharge counseling

• Initial clinic patient assessments

Entrepreneurial Programs

Almost 10 years ago, a collaborative effort between the UNC School of Pharmacy and UNC Hospitals launched a program to provide 10 rotations to each of 10 selected students. The “Clinical Scholars Program” was wildly successful at UNC and now almost half of each class is enrolled in similar programs offered by hospitals, ambulatory clinics, and community pharmacies across the state.

Other colleges of pharmacy have developed similar entrepreneurial programs, including the University of Florida’s block program. These initiatives minimize orientation and student logistics, engender camaraderie and collegiality among students, faculty, and preceptors, and enable efficient student learning, productivity, and contributions. I suspect many other creative approaches to experiential education are available across the country. Collaboration, cooperation, and planning ensure program success, so we just need to start.

Summary

I have tried to present an argument for practitioners to offer experiential rotations and identified some of the services that students can provide. Students, preceptors, institutions, and colleges of pharmacy can all benefit from experiential education when they are planned appropriately and collaboratively.

Practitioners now have an active role in planning experiential education, our new graduates are better prepared for practice, and we don’t have to pay students for their efforts! What’s all the complaining about? PTHS

Mr. McAllister earned his bachelor’s and master’s degrees in pharmacy from the University of North Carolina (UNC) at Chapel Hill and completed his pharmacy administrative and clinical practice residency at Duke University Medical Center. Mr. McAllister held numerous positions at Duke University Health System, including director of pharmacy and associate chief operating officer. He served as director of pharmacy at UNC Hospitals and assistant and associate dean for clinical affairs at the UNC School of Pharmacy until he retired in 2007 and formed a consulting company, InvictusRx. He was recently named clinical professor and regional experiential education program coordinator for the University of Florida College of Pharmacy. He served the American Society of Health-System Pharmacists in numerous capacities for more than 30 years as a member of the board of directors and as president. He has been the recipient of many awards including the United Kingdom’s Clinical Pharmacy Lecture Award and pharmacy’s highest honor, the Harvey A. K. Whitney Lecture Award. Mr. McAllister is married to a pharmacist, Anita Groves McAllister, who is a pharmacy consultant with Huron Healthcare Consulting. He has 3 children, including a son Jim IV who is an assistant director of pharmacy at Shand’s at the University of Florida.