Great Expectations: Preparing for Your First Job in Pharmacy

Get to know the competencies and skill sets required for practice in different settings and stay on track.

Pharmacy schools are graduating more students than ever before, preparing the next generation of health care professionals to tackle patient care in an evolving health care landscape.

But are these students ready for their first pharmacy position when they leave school?

To answer that question, the board of directors of the Accreditation Council for Pharmacy Education (ACPE) teamed up with the American Society of Health-System Pharmacists (ASHP) to create a joint task force to determine the skills expected of new PharmD graduates.

“We heard from many members that new graduates had excellent clinical training, but often didn’t have other skills required for an entry-level position,” said Douglas Scheckelhoff, MS, vice president of professional development at ASHP, in an interview with Pharmacy Times. “We approached ACPE and decided to identify those skills students needed.”

Members from both organizations involved in hiring new graduates came together in 2009 to determine the competencies expected for first-year residency positions, forming the ASHP-ACPE task force. In addition to the task force, a survey was sent to hospital pharmacy directors and residency program directors. The final list of competencies was formed combining the guidance from the task force and the results from the survey and was published in the fall of 2010.

“We got a lot of feedback that the information was very helpful,” Scheckelhoff said. “The list provided valuable information, so the ACPE developed similar projects for other areas of practice.”

The ACPE then partnered with the National Community Pharmacists Association (NCPA) and the National Association of Chain Drug Stores Foundation (NACDSF) to identify the competencies needed for community pharmacy, as well as with the Academy of Managed Care Pharmacy (AMCP) to determine those required for managed care pharmacy.

Although the information gathered from the task forces was primarily intended to help the ACPE revise the PharmD program standards and assist pharmacy schools in revising their curricula, the competency lists can also be useful to pharmacy students. Students who understand what will be expected of them after graduation will be better prepared for a successful career, no matter which area of pharmacy they choose to practice in.

Community Pharmacy

The competency list developed by the ACPE, NACDS, and NCPA task force, published in 2012, identified skill sets in 7 areas that are essential to community pharmacy practice. These are:

• Pharmacist-delivered patient care
• Public health
• Communication
• Dispensing systems management
• Business management
• Pharmacy law
• Leadership

In the pharmacist-delivered patient care category, students “often have a gap in their ability to apply their skills in community settings and be practical with the information they have learned in school and how that information translates to a specific patient,” the report notes. Students should be able to use their clinical knowledge to effectively provide a variety of services such as medication therapy management, counseling, providing medication education, resolving medication safety issues, and removing barriers to medication adherence.

Communicating effectively, both verbally and in writing; managing dispensing; compounding; business operations management; and understanding legal and ethical standards were also considered to be essential to community practice. In addition, community pharmacists are also expected to be strong leaders. “All pharmacy graduates should be self-directed, lifelong learners who are motivated to embrace emerging clinical services,” the task force report suggests.

Managed Care Pharmacy

Students preparing for a career in managed care pharmacy “must be competent clinicians, strong communicators, good managers, and reliable team players,” the AMCP-ACPE task force writes. The managed care pharmacy list of competencies includes 44 skills separated into 3 categories:

• Cognitive or knowledge-based
• Psychomotor or skills-based
• Affective or value-based competencies

New graduates should understand differences in health care delivery models; the provisions of Medicare Parts A, B, C, and D; the development of formulary systems; concepts related to the benefit structure of a health plan; and other concepts of managed care pharmacy. Students also need to possess strong clinical, communication, problem-solving, and computer skills. Value-based competencies include respect for employers, honesty, respect for patient privacy, punctuality, and professional dress.

Health-System Pharmacy

Similar to the lists developed for community and managed care pharmacy, the competencies identified for hospitals and health-system pharmacy are separated into specific categories:

• Pharmacy systems
• Medication safety and quality
• Clinical applications
• Professional practice

“It’s important to be aware of the multiple aspects that go into health-systems practice,” Scheckelhoff said. “Students need to understand that the practice has many unique elements, and what they are.”

One of the many facets central to health-system practice is working alongside other health care professionals.

“The ability to work in a team-based care environment is essential,” Scheckelhoff said. “Being able to work with other caregivers is one of the most important skills needed for health systems pharmacy, and it doesn’t always come naturally.”

Other competencies include contributing to the establishment of medication use policies; medication reconciliation; understanding national standards, guidelines, and best practices of safe medication use; understanding of the basic drug procurement process; and supervising pharmacy technicians.

Preparing for the Future

Although different skills may be required for each sector of pharmacy practice, the same high level of competency is expected in each field. A study published in the American Journal of Pharmaceutical Education on February 12, 2013, surveyed pharmacists in different practice settings to determine whether they varied in their expectations of entry-level pharmacists.

The results indicated that regardless of practice setting, most pharmacists expressed similar expectations for new graduates and rated certain competencies as important. The ability to evaluate contraindications, duplications, and interactions in medication therapy; accuracy in pharmaceutical calculations; the management of adverse reactions; patient assessment; and recommendations for appropriate therapy were considered to be the most critical competencies across all practice settings.

These results highlight the importance of viewing the entire scope of pharmacy when preparing for a career, instead of limiting goals and skill sets to just 1 area.

“The chances of working in the same area of pharmacy for an entire career are slim,” Scheckelhoff said. “So prepare yourself to evolve and to be productive throughout your career. Be aware that these lists exist and use them to broaden your skills.”

Well-rounded students will be ready to meet the expectations they face after graduation.

Table 2: Comparison of Competencies Across Practice Settings

Entry-level Competency

Community Pharmacy

Hospital and Health-System Pharmacy

Managed Care Pharmacy

Drug information (DI) skills

Access and utilize appropriate DI resources and provide an accurate and credible solution in both written and oral forms.

Access appropriate DI resources for patient education.

Given a DI question, access appropriate DI resources, including primary literature, and provide an accurate and credible answer in both written and oral forms.

Drug utilization review (DUR)

Understand and communicate drug coverage policies, purpose/function of a pharmacy benefit manager (PBM), and benefit structure of a health plan.

Discuss the concept of DUR management and define associated key elements. Conduct DUR and evaluate medication-use patterns in a specified patient population.

Health care delivery systems

Understand and communicate drug coverage policies, purpose/function of a pharmacy benefit manager (PBM), and benefit structure of a health plan.

Outline

Medicare Parts A to D and Medicaid, including enrollment

and other payment programs, and provide guidance in patient assistance programs.

Describe the differences between health care delivery models.

Outline Medicare Parts A to D and Medicaid, including drug coverage.

Discuss the benefit structure of a health plan and PBM programs.

Managed care

Understand and communicate managed care. Explain its purpose, function, and general concept.

Explain the general concept of managed care.

Pharmacy law and policies

Understand regulations and laws that impact pharmacy practice and legal operations.

Identify issues, pending legislation, and regulations across all levels of government and how to make a positive impact.

Understand and apply legal and ethical aspects of pharmacy practice required to evaluate a patient care decision.

Describe the need for a Clinical Laboratory Improvement Amendments (CLIA)-waiver and documentation of testing done in the community pharmacy.

Evaluate prescriptions for legitimate medical use and appropriate dose.

Proactively perform counseling and education compliant with the Omnibus Budget Reconciliation Act of 1990 (OBRA-90).

Identify major factors that contribute to drug-related fraud and abuse.

Discuss the requirements for patient confidentiality under the 1996 Health Insurance Portability and Accountability Act and professional practice guidelines.

Identify several major factors that contribute to drug-related fraud and abuse.

Specialty pharmaceuticals

Demonstrate knowledge of

specialty pharmaceuticals and support patient adherence and administration.

Explain the term specialty pharmaceuticals, give examples, and describe how they are procured, stored, and dispensed to patients.

Computer Skills

Demonstrate strong computer skills and apply those skills in analyses, presentations, and communications.

Drug approval process

Identify and explain the steps involved in the drug approval process in the United States.

Immunization

Be a certified immunizer.

Describe the vaccine information statement, adverse events reporting system, and registries.

Leadership skills

Identify and manage conflict at all levels, supervise and motivate employees, delegate appropriate tasks, effectively articulate team objectives, and measure and report team performance.

Display confidence in patient care skills learned in pharmacy school.

Public Health

Discuss the pharmacist’s role in education and intervention in public health initiatives applicable to pharmacy practice.

Proactively promote healthy lifestyle and nutrition and describe how it impacts drug therapy and overall health.

Source: American Journal of Pharmaceutical Education