Academic journal article American Journal of Pharmaceutical Education

Integration of an Introductory Pharmacy Practice Experience with an Advanced Pharmacy Practice Experience in Adult Internal Medicine

Academic journal article American Journal of Pharmaceutical Education

Integration of an Introductory Pharmacy Practice Experience with an Advanced Pharmacy Practice Experience in Adult Internal Medicine

Article excerpt


Traditional introductory pharmacy practice experiences (IPPEs) offered by faculty members practicing in the internal medicine service at the University of Oklahoma College of Pharmacy (OUCOP) consisted of the student making a single visit to the practice site where they primarily observed patient care activities. While faculty members felt that even this minimal exposure to internal medicine pharmacy practice was valuable, the limited time spent at the practice site did not allow opportunities for students to be involved in patient care. Additionally, the experience was not progressive in nature and seemed unlikely to prepare students for advanced pharmacy practice experiences (APPEs). According to the Accreditation Council for Pharmacy Education (ACPE), IPPEs should involve actual practice experiences and permit students to assume direct patient care responsibilities. (1) The Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes place an emphasis on student provision of patient-centered care in collaboration with patients, prescribers, and other healthcare professionals. (2) Furthermore, in 2007 ACPE standards increased the required number of IPPE contact hours to at least 300. (1)

Colleges and schools of pharmacy have taken different approaches to address the required increase in IPPE hours. (3-5) One such approach was a longitudinal experience that spanned the first 3 years of a PharmD program and focused on caring for patients in residential settings. (3) Students' level of involvement in patient care progressively increased from the P1 to the P3 year. Students established relationships with actual patients, assessed medication therapy, developed care plans, and mentored students in earlier classes. Ninety-seven percent of students received grades of "satisfactory" or "excels" based on their performance in patient care. Overall, students provided positive feedback regarding the course.

A second approach to increasing IPPE hours involved offering a 4-week IPPE course that took place at the end of the P3 year, just prior to the beginning of APPEs in the fourth (P4) year. (4) The experience focused on application of previously learned information to patient care, potentially providing a seamless transition to APPEs. There were activities in both community and hospital settings that included medication counseling, developing patient care plans, presenting a journal club, and responding to drug information questions. Faculty members assessed students' performance of clinical skills during the first week of APPEs. Students who completed the IPPE demonstrated better performance of clinical skills than the class prior to implementation. Authors noted that while this approach required significant time and resources, students were able to transition more quickly into APPEs and potentially perform at a higher level.

In a third approach, first- and second-year IPPEs focusing on direct patient care were integrated in order to use academic and preceptor resources most efficiently. (5) The integrated IPPE included a combined recitation session where students completed activities such as reviewing medical records and presenting patient cases. Following the recitation session, students were assigned to clinical sites where they interviewed patients and presented patients cases to preceptors. Working in small groups at the sites, P2 students mentored P1 students. Preceptors and students evaluated the IPPE positively and preliminary data suggested a benefit to APPE performance.

At OUCOP, faculty members practicing in internal medicine redesigned the existing internal medicine IPPE into a structured, innovative experience designed to meet ACPE and CAPE requirements, increase the number of contact hours, and maximize faculty resources. In fall 2008, the redesigned adult internal medicine IPPE was implemented. The overarching goals of the redesigned IPPE were to provide direct patient care opportunities to IPPE students and provide more IPPE contact hours than previously offered. …

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