Academic journal article American Journal of Pharmaceutical Education

Impact of Instruction and Feedback on Reflective Responses during an Ambulatory Care Advanced Pharmacy Practice Experience

Academic journal article American Journal of Pharmaceutical Education

Impact of Instruction and Feedback on Reflective Responses during an Ambulatory Care Advanced Pharmacy Practice Experience

Article excerpt


One of the key elements of developing as a health care professional is having the ability to be a reflective practitioner. (1-4) Being a reflective practitioner means critically evaluating experiences in practice to improve actions in the future. By initiating this process of reflection, a practitioner is more mindful of previous knowledge, the impact of tacit understandings, and has the awareness of novel approaches to patient care. (5) A reflective practitioner will gain confidence in expertise and develop into a more competent member of the health care team. (1)

Incorporating reflection into pharmacy education can foster the development of life-long learners and graduates who demonstrate patient-centered care. (6-8) In addition, it can potentially produce graduates who are more advanced professionally, which may lead to them more readily securing employment. (9) The Accreditation Council for Pharmacy Education (ACPE) recognizes this skill of reflective practice as being critical to the development of successful pharmacy school graduates and included it in the 2016 Standards for professional programs in pharmacy. (10) Standard 3.1 describes a pharmacy graduate's ability to problem solve and to critically evaluate varied patient care scenarios, and Standard 4.1 discusses self-awareness and reflection on personal knowledge, experiences, biases, and their impact on professional growth. (10)

Reflection exercises have been readily implemented into doctor of pharmacy (PharmD) curricula, but challenges and questions still need to be answered regarding the effectiveness of such activities in developing reflective practitioners. (11-14) One commonly cited difficulty with these exercises is the challenge of assessing the quality and/or level of the reflection. (14) Commonly, the literature describes reflection activities compiled in a portfolio and some level of assessment and feedback given to students, typically in the form of a structured rubric that rates the general quality of the work. (8,13) Such summative feedback is beneficial, but more specific and routine feedback targeting the assessment of the students' reflective skills may be needed to further their development as reflective practitioners. Previous research demonstrated the feasibility of using assessment measures to rate the quality of pharmacy student reflections, but did not address methods to improve the students' reflective skills. (8,15) Thus, a paucity of data demonstrates educational methods successful in improving the reflective skills of pharmacy students when measured by validated assessment measures.

The objective of this study was to investigate whether instruction and feedback on reflective responses completed during an ambulatory care advanced pharmacy practice experience (APPE) are beneficial in helping pharmacy students become more reflective practitioners.


From July 2012 to April 2013, fourth-year pharmacy students at three different ambulatory APPE locations in Omaha, NE were asked to answer specific reflection questions after the first through fourth weeks of their 5-week APPE (Table 1). The students submitted answers to the weekly questions via Google Doc (Google Inc., Mountain View, CA) and shared online access to this document with their preceptor and the Creighton University School of Pharmacy and Health Profession's chaplains. The chaplains were included in this activity because of their role in the development of students' reflection abilities at the school throughout the curriculum. Reflection activities are completed most often following an experiential activity or service learning opportunity with general feedback given to students for some reflections.

Students were randomized to either the intervention group or the control group at the beginning of the APPE. Students assigned to the intervention group received specific instructions and guidance on how to compose reflective responses and also received weekly feedback on their responses to the reflection questions. …

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