Practice Experiences at a Single Institutional Practice Site to Improve Advanced Pharmacy Practice Examination Performance

Article excerpt

INTRODUCTION

The American Council on Pharmaceutical Education (ACPE) Accreditation Standards requires all pharmacy students to complete both IPPEs and APPEs in institutional settings. (1) Changes in these standards have further defined that a minimum of 75 IPPE hours is required in institutional settings. Challenges to providing a sufficient number and quality of experiences in institutional practice have been previously noted, (2) and suggested entry-level competencies have also been published. (3) Institutional pharmacy practice environments are heterogeneous and complex, and fewer pharmacy students have existing work experience in such environments. Because of structural and procedural differences in the delivery of pharmacy services, the institutional environment is more challenging for students, requiring preceptors to invest more time in orientation before students are able to develop and contribute in meaningful ways. Accomplishing learning objectives in these complex institutional environments within the limited time available makes an intentional design even more important to maximize the return on efforts invested by students and preceptors.

Pharmacy student contributions in institutional environments have been documented in medication education, (4) medication reconciliation, (5-10) cost avoidance, (11) clinical interventions, (12-14) clinical practice guideline development, (15) and support of a venous thromboembolism prophylaxis program. (16) In 1 published report, a small group model was designed to integrate a 2-course series with IPPE learning. In this model, first- and second-year doctor of pharmacy (P1 and P2) students shared responsibilities of completing instructional objectives such as patient interviews and patient presentations in hospitals and clinics. (17) Student and preceptor responses on a survey instrument about the model were positive, but continuity of learning at the same site was not specified and no comparison group of students was available to enable measurement of subsequent differences in APPE performance. Another study involved implementation of dedicated, midsemester scheduling blocks for P1 and P2 students to accomplish IPPE learning objectives outside of classes as well as to meet the intent of using geographically diverse practice sites and sequencing to minimize overlap of P1 vs P2 learners. (18) This experiential design included hospital observations for all P1 students and hospital experiences for some P2 students, but neither reported sequential placement of students at the same sites nor evaluated impact on APPE performance. These existing reports show efforts to integrate IPPE learning across a course series and/or maximize efficiency of site/preceptor resources, but have neither studied continuity of learning within the same facility over time nor evaluated the impact on student learning relative to other experiential designs. Thus, it is unclear whether fostering continuity of a learning environment through sequential assignment of pharmacy students to the same institution affects learning outcomes.

To evaluate the feasibility of assigning the same students to the same institution for all required IPPE and APPE institutional placements, the University of Oklahoma Health Science Center, College of Pharmacy partnered with the pharmacy administration of Mercy Health Center (MHC), a local institution. With a goal of maximizing efficiency by increasing student familiarity with the institution over time, student performance was expected to improve as well. This study hypothesis was that promoting continuity of learning through assignment of students to the same facility for institutional IPPEs and APPEs would improve performance on a required APPE institutional examination. Basic structure of the IPPE program and the institutional IPPE component, as well as the process by which students were assigned for learning experiences are described; details related to the required APPE examination and the assessment methods used to compare student groups are provided; and findings and additional information from relevant publications that have examined longitudinal experiential designs in medical education are discussed. …