Metacognition or "thinking about thinking" is valued in educational and workplace settings as a way for individuals to improve future performance through reflection and self-assessment of past performance. (1) Within healthcare professions, reflection and reflective writing about practice experiences are valued, as these skills can be used to develop lifelong learning strategies. Also, healthcare licensing and accrediting bodies have implemented standards for reflection and reflective writing. (1) With respect to pharmacy, reflection improves students' critical-thinking skills, while reflective writing allows pharmacy students to document achievement of multiple ability-based outcomes. (2,3) The Accreditation Council for Pharmacy Education encourages students to assume responsibility for their own learning including self-assessment of knowledge, skills, attitudes, and values, together with development of personal learning plans and maintenance of student portfolios. (4)
If pharmacy graduates are expected to use reflection and reflective writing as lifelong learning strategies then it is reasonable that pharmacy students should learn and practice these skills throughout pharmacy school as a way to ingrain them as behaviors. However, reflection is not an intuitive skill (1,5) so students need to receive appropriate mentoring and feedback to develop it. (1,6-10) The need for large classes of students to receive detailed and individualized feedback on their reflective writing necessitates the use of large numbers of writing preceptors.
To address these challenges, in 2004, the Skaggs School of Pharmacy & Pharmaceutical Sciences developed a required 3-year reflective writing program and integrated it into a sequence of 6 introductory pharmacy practice experience (IPPE) courses. A group of writing preceptors to sustain the writing program each year for 3 classes of 160 students were recruited. In this paper, we describe the program and report on the writing preceptors and student opinions regarding the program's value and the preceptors' reasons for participating.
The primary goal of the reflective writing program was to develop students' lifelong learning skills. The primary strategy used to achieve that goal was to develop students' ability to self-assess their competency to care for patients in experiential practice sites. Students were required to use self-assessment skills to identify learning opportunities and to act on and evaluate the outcome of those learning opportunities. Restated with reference to Bloom's taxonomy, students were tasked with integrating And applying didactic knowledge and skills in the practice setting, forming strategies to improve this performance based on their reflection, and evaluate how these strategies impacted their patient care performance. (11)
When the Skaggs School of Pharmacy and Pharmaceutical Sciences implemented its PharmD degree program in 1999, 6 IPPE courses were included in the curriculum (1 per semester for the first 3 years) to provide students with 3 contact hours per week in which to apply newly acquired knowledge and skills in community, hospital, and other practice settings. The 6 IPPE course syllabi included reflective writing assignments, but the IPPE writing program was limited in its initial years because of logistical issues. Students in the IPPE program were paired with practitioners in a variety of practice settings for periods of up to 2 years. This extended pairing allowed preceptors to form mentor/mentee relationships with the students and customize their teaching approach according to each student's needs. This long-term association allowed preceptors to identify students' strengths and weaknesses over time and produced insightful feedback to course directors with respect to individual student performance. Because of workplace pressures, however, this feedback was focused more on select aspects of patient care than on a comprehensive analysis of students' use of pharmacy practice competencies. …