How Pharmacy Schools and Students Are Handling COVID-19

Aislinn Antrim: Hi, this is Aislinn Antrim from Pharmacy Times. Before we get started today, one of our top stories is about the annual Albert Ebert lecture given this year by Suzanne Solomon, founder of the Pharmacist Moms Group. Solomon spoke last week about the power of social media in the field of pharmacy, so there's more about that on Pharmacy Times. Today, I'm speaking with Dr. Foote, dean of the Philadelphia College of Pharmacy at the University of the Sciences, about how COVID-19 has affected students and how schools are educating the next generation of trusted health care professionals. So, Dr. Foote, can you just give us an overview of how this semester has been affected for your students?

Edward Foote, PharmD, FCCP, BCPS: Sure, thanks for having me. So, you know, our changes have been nothing less than profound. Our students really had to adapt very quickly to a whole new learning environment in a very, very brief period of time. In fact, we made the changes over the weekend. Some universities were doing, you know, taking a spring break or extending spring break to adjust, but our students and faculty really had to adjust very, very quickly. And so, it's really been so different in that [there’s] a lot of online learning, but even more importantly, I think it's where they're learning. For many of them, they had to leave their dorms, they may have been in an apartment, so I would say the vast majority of our students are actually in a different environment. They went home, basically, and so we certainly do have some commuters that, you know, continue to learn and study where they were living, but most of them have actually moved. And talking to a lot of students, some of the biggest challenges in terms of just a new environment are where they're studying. And in addition to the different learning environments, I think the biggest thing that they would tell about their habits at home is that loss of social interaction and not just, you know, socially hanging out with each other. But it’s that professional interaction that they really feel that they've missed, so I can't underestimate how big of a change this has been for our students. But they're doing well.

Aislinn Antrim: Certainly, lots of resiliency going on. Absolutely. What solutions have you come up with? You mentioned lots of commuter learning and computer learning.

Edward Foote, PharmD, FCCP, BCPS: So, we moved over to online learning. I think our faculty really adapted because all those other things, I think, really affected our students. The first week was rough. I mean, our pharmacy students by definition are very stressed group of individuals and I talked to some students who I consider very level-headed and they were really [stressed]. It was over the top; it was really over the top. They were so stressed out, and so what we did right after the first week—well, I think Saturday—I had a series of open forums for our students. So we broke it up by different classes and we also did it with faculty, and I hadn't been able to work with some of our students in PCP Student Council and so they were able to kind of give me a little bit of a kind of idea what was going on. So, I think the biggest thing is we just listened, and we affirmed, kind of, some of the things that were going on. And so, specifically, some of the things that that we did was, testing was a big issue, so our students were very frustrated because PCP had decided that we would use a monitoring system. So, they're taking their exams at home on a computer system and we were going to use a monitoring system where, essentially, their cameras were monitoring their movements, so they weren't allowed to leave, it was basically like being in class. And they really, really pushed back. They'd heard that all the other pharmacy schools in their area are going to open book and, you know, they're going to have it so easy. So, I did some homework, I called the other deans, and it simply wasn't the case. You know, they would do it, just doing things differently, and we were the only school to use a monitoring system. But what happened with this monitoring system, for instance, students can't use calculators so we had to have them use the calculator on the computer, which would slow them down. So, one of the things we did, is students were really stressed about these two-hour class exams and so we gave everybody an extra 50%. And it was dramatic, how just giving them a little extra time to take these exams made a difference. The reality is many of them don't use that extra time but just knowing that because of the newness of the assessment that they had some extra time to take the exam, I think really made big a big difference. They certainly wanted some more clarity on, kind of, the must-knows. I will say we pretty much gave the same exam but I think faculty were much more likely to give like study guides and, you know, where we have maybe broad objectives and electives, faculty kind of rewrote them some and really helped guide students in terms of really understanding, not what they need to know for the exam—that was certainly important to students, too—but really what are the important things they need to know as a student pharmacist. So, I think it really gave us all a sense of understanding each other. I said it a number of times to both the students and faculty, that we need to manage expectations. And I was, you know, very direct with the students that, you know, they need to understand that faculty are pivoting on a dime over the weekend, and the faculty, again, did well, but we weren't perfect. And I asked them to give us a break and I said the same thing to faculty and, you know, and it wasn't like I had to talk them into something but, you know, just having that conversation about the struggles that students have going on and to understand, you know, that we might have to give them a little more. We relaxed our attendance, since we have a pretty strict attendance policy here and so we have certain lectures that go on, and normally students have to go, and they could, you know, [points] could be docked. And so we decided we were going to relax attendance, so if there's active learning going on or certainly assessments or quizzes they have to be there, but since we record everything online now we’re allowing students to not go to class, kind of. Most of them still do, but some of them who have family issues, some of them have kids, some of them have parents that are sick they're taking care of. We've been able to kind of loosen that that rein, and I think that made a lot of difference. I think it made a lot of difference. So, you know, again, I think the students have done really well and I think it's because both sides—if you think about a side for the students and faculty—have really understood each other and I think worked well. The other thing—and a lot of universities are doing this, and this is quite a big thing that was done at the university level—we've gone to a credit/no credit option, and this is really widespread throughout higher education now. Students can either take the grade that they earned in the class or they could choose to just take credit, so if I was a student and I was doing a 4.0 and I really struggled, maybe I was sick or maybe the new learning environment, I pulled a B in a class, well, I could actually just take that credit. It's almost like a pass, and so it would not affect my GPA. And, again, the thought is we're giving students a little leeway, we're being a little more generous. And then if a student failed a course, rather than actually failing course they could just choose not to take credit, so a failure doesn't show up on their transcript on their course. And then they would certainly have to retake the course, you know, but that has certainly helped a lot, too. And so, I think those things small and big have really made a difference.

Aislinn Antrim: That's all wonderful to hear. In addition to the classroom aspect, rotations and hands-on experience is vital, obviously. How has that been affected and what's been going on around that?

Edward Foote, PharmD, FCCP, BCPS: So, like all schools, that's been the challenge, a big challenge, actually. For our fourth-year students who are in their advanced pharmacy practice experience, or their APPEs, we had a lot of changes. So, we were moving people around a lot, as hospitals would essentially just call us and say, “Well, we can't take your students anymore” because either this, that, their staff are so busy or, as you probably have heard, there's a shortage of PPE or protective equipment. But other hospitals weren't, and so we would shift people, you know. And then whenever possible we would help the students. So, we had a number of students who were going to a local hospital in New Jersey that had to tell us they couldn't go, and, luckily, Johns Hopkins in Maryland was able to take them. That's a wonderful experience, a wonderful hospital and health system. Well, that’s housing for four or five weeks and students, you know, may not have had the money. So, luckily, we were able to adapt. I've got a fund due to the generosity of some of our alumni, so it's actually able to pay for their housing for those five weeks, and I think the students really, really appreciated that. And I want to say it was kind of least we can do, because we gave them 48 hours’ notice. Do you want to move to Maryland, or you want us to keep looking? And so, again, they're really resilient. So, all our students will finish on time, and that's been a problem at some schools is they've been so shut out that they haven't been able to finish. So, we have a strong network of alumni and strong network of rotation, so we were able to finish everybody on time. Maybe not in the exact same hospital or rotation they thought they would be in, but they are finishing on time. And then we have these introductory pharmacy practice experiences, so those are the IPPEs, and they occur P1 through P3 year. And at Philadelphia College of Pharmacy at the University of the Sciences, those occur during the semester. Some of them occur in the summer, but most of them are during the semester. And we had issues with those, as well, so those would be a little more creative. Students have been doing some on-campus activities—oh, I should say will be doing some on-campus activity when they come back. And then we've been doing some distance learning. Luckily, our accreditation agency, the ACPE, has been very accommodating to us and they've really encouraged us to be—the words they used are “creative”—and they've allowed us some flexibility. We’re still required to meet the basic standards of accreditation, but they've given us some leeway in terms of how we meet those standards. So, it's been some work but our students are on track. But it's been a fun challenge.

Aislinn Antrim: [It’s] certainly a challenge. And speaking of graduating, I know many pharmacy schools have explored the option of having their students graduate early in order to go into the workforce. What are the logistics of that decision, and how does that work?

Edward Foote, PharmD, FCCP, BCPS: So, I wouldn't say we seriously considered that option. We talked about it very briefly, I think, but we didn't really see the point of it. So, what it would mean is some students, all students, get usually one rotation block off, and this is at most pharmacy schools. And so we had had a quite large cohort of students that were really done with their rotations in March and then really were off for six or seven weeks, and then they came back for a very, kind of, summery course—a one week long summary course. But for all intents and purposes, they were done. So, theoretically, I suppose we could have moved some things around and graduated those students early. However, we were concerned for a number of different reasons. First of all, the testing sites to take the boards in were not open, and then even if they were and they could go out of state to get tested, we were too concerned they were going to rush it. So, we chose not to. And I will say, I did not get one phone call from, you know, a director of pharmacy or chain pharmacy or anybody saying, “We need work force.” They know they are depending on our students, so our students who are now home and studying, they're still working. They're going into hospitals and in retail and community pharmacies as interns, but I'm not sure there's a huge shortage of licensed pharmacists. So, we really did not consider that, and, again, we were worried that it might be detrimental to our students.

Aislinn Antrim: Certainly. So, you mentioned the downsides to it. I mean, it's not necessarily a need at the moment. For schools that have considered that, are there concerns that that could limit the scope of their education? Being so focused on COVID right now, how does that affect the educational aspect?

Edward Foote, PharmD, FCCP, BCPS: I'm not sure it really would, because the reality is the ones that have graduated early, basically what they did is—as far as I know—I don't think they could have just dropped people out of rotations. I mean, we still have a minimum, all these kids would be on rotation and all APPEs. Their students are required to do a minimum of 1440 hours, and accreditation did not release us from those hours. So, students really had the full experience. I'm not sure it would have limited their education. Like, I don't think these programs are being allowed to cut off their rotations to my knowledge, so it's more like they probably just fast-tracked the graduation. So, for instance, for our students who are done with rotations, our graduation does not occur for three weeks. Well, you could shorten that, like you could theoretically just turn the paperwork around quick and essentially confer the degrees. So that could be done, but, again, we didn't see that three-week rush would really make a difference. So, I don't think it really would have affected them if we had done it, and I don't think that the schools that chose to do that have really made any significant short cuts or maybe a cuts into the quality of the education.

Aislinn Antrim: Okay. What should students learn from the situation? Obviously, this is hopefully a once-in-a-lifetime situation, but what could they be learning from this?

Edward Foote, PharmD, FCCP, BCPS: So much, right? How to adapt to rapid change, you know. Really, if I ever once said, “Let's go online,” it would have taken me five years to get this done, and not just from a resistance. We were just forced into doing this so quickly and adapting to change so quickly, and I think everybody—students, faculty—we are surprised at how well we did with this. It was really, frankly, amazing. I think the other thing is, I think we learned a deeper appreciation for each other, meaning the two groups: faculty and students. You know, I think faculty really got a sense of the amount of pressure student pharmacists are under academically and how this has become worse. And I think the students really understand how much work we put into making this program work, even before COVID. And so, I think that we've had these kinds of conversations, some of them more subtle than others, some of them like an open forum. We talked about that, where students and faculty are actually able to kind of share some of their challenges. Both groups have learned to problem-solve very quickly and I think it put so many things into perspective, right? Because we have faculty, but certainly many students, who have been affected directly by COVID. They have family who's been sick, very sick, such that some students had to take some time off. The students are going into work, into pharmacies, you know, the health system or in communities, and taking care of patients who are potentially exposing themselves. Maybe we're not as frontline as some nurses are, but we're really there, right? We're really there, especially in community pharmacy, right? And I think they realize the sacrifices we have to make sometimes as health professionals, that we have to be there. And that's one of the reasons that we went into this allowing some sense of flexibility about attending class at times, is because faculty have to understand that there's some more important things sometimes than getting to class, right? And if there's a shortage of a technician at a hospital or a community pharmacy, that's patients that are being affected, and so our students may be needed. And so, I think it put a lot of things in perspective. So, I really think they've learned a lot, and it's a subtle thing. I actually surveyed some students and it's all over the place, because I try to get a sense of, “have you learned more, do you think your learning is actually better this way or less.” And it was a beautiful bell-shaped curve. Some students are not feeling like they're really not learning like they should be. There's a whole bunch that said, you know, in terms of content, they feel like they’ve learned the same. And then there's others who said, “Boy, I really flourished, I think this is better.” But the majority of them have really adopted really well, and I think, when you talk about, you know, what have they learned, they've learned how quickly they can adapt. I think it's really amazing.

Aislinn Antrim: It’s definitely important for pharmacists. Sort of switching gears, we've spoken to pharmacists about expanding their scope of practice and that ongoing push for that. How are you educating students to take on these practices should they happen in the future?

Edward Foote, PharmD, FCCP, BCPS: Sure. So, yes, absolutely, expanding scope of practice—the ability to bill for services, you know, having provider status—is really critical to the future of our profession. So, we now have that, we have a new curriculum. It was just launched two years ago, so actually our first class is still in the implementation phase. It's called a competency-based curriculum and so, essentially, what we really do is we focus on those competencies that pharmacists need to be able to demonstrate to be to be high quality health care providers. And so, our students learn about, for instance, point-of-care testing. So maybe we're sort of limited, we're starting to see that now with COVID, right? Some pharmacists got permission to do that testing, but other point-of-care testing, as well, for things like diabetes and things like that. So, we trained them in that as well because in Pennsylvania, for instance, we don't have as many liberties in terms of our practice models as there are in other states, but we don't know where students are going to go. And as you mentioned, the future is going to be different, so we need to train in those areas. And some of the basic things are things like communication skills, basic physical assessment skills, the ability to make decisions and to stand by them. So, you know, many times pharmacists—certainly when I was a pharmacy student— really making a medication decision really wasn't in our purview, right? Most would make a recommendation and hope somebody took it. And I think moving forward we're going to see—in fact, we are seeing now—the pharmacists more and more making those decisions, and they need to have the confidence of the skills and the attitudes to be able to do that. So, yeah, lots and lots of things I think we do in terms of preparing our students.

Aislinn Antrim: Excellent. Well, lastly, can you just discuss the overall importance of pharmacists and the value that they bring to healthcare, especially during COVID-19?

Edward Foote, PharmD, FCCP, BCPS: Sure, I think a couple things. One is I think we know and we've seen how pharmacists are an integral part of that team, and we'll see more and more. For instance, when they talk about essential businesses, right, its grocery stores and pharmacies, right? And I don't know if, really, the public knows. Maybe we've taken pharmacists for granted in the community practice, that we are essential personnel, health care personnel, that need to be there to support patients, certainly to provide a product but also educate patients, train them on how to use some of their medications and those devices. So, I think it's definitely given us more ability to do that. I think you're seeing more and more states now starting to expand, even if for a short period of time, a scope of practice where pharmacists are not only doing point-of-care testing but potentially administering medication. So, in Pennsylvania and almost all 50 states now, pharmacists can administer immunizations. Well, besides treatment of COVID, you know, it's the ability to immunize against this terrible virus. It’s going to be really critical and pharmacists are going to be in the forefront of that. We are going to be the immunizers for COVID, I promise you that, and so we need to be prepared to take that role on. And luckily, you know, over the last 10 or 20 years we've done that, you know, with more standard immunizations. But I think we're going to have more of a role. You know, there's a lot of changes in our profession going on, and so I think we're going to see more and more pharmacists involved in the ambulatory care setting and population health. You know, this is a population health issue, you know, and pharmacist are in a terrific place to be able to provide input and guidance to how we deliver care at that population level, when we think about preventing mass infections like this.

Aislinn Antrim: Absolutely. Well, thank you so much for joining us. Now we're going to hear from some of our other MJH Life Sciences Brands on their latest headlines.