3/23/2017 1 Layered Learning/Utilization of Students and Residents as Pharmacy Extenders: Panel of Experts Spencer Pummel, Pharm.D., BCPS Christina Graham, Pharm.D., BCPS Linda Radke, Pharm.D., BCPS, FASHP Jill T Robke, Pharm.D.,BCPS, FASHP Objectives • Be able to describe the concepts of layered learning and practicing at the top of one’s license. • Explain concepts used to overcome challenges faced in using students and residents in a wide variety of practice situations/settings. • Discuss how some of these principles might be applied to more effectively use students/residents in your practice setting. Teaching Pharmacy Students/Residents – Pre‐2010 Am J Pharmaceutical Edu. 2007;71(2):1‐2. • Restricted to big teaching medical centers • Students are passive observers in a clinical pharmacist‐centric practice model • Learning is primarily through lecture/discussion • Residents are “super‐students” and staffing is a necessary evil • Teaching activities are of little value; a luxury when viewed from an organizational standpoint • Schools of pharmacy engaged in rapid expansion of capacity; leads to students foraging for rotation sites
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Layered Learning/Utilization of Students and Residents as Pharmacy Extenders:
Saint Luke’s Hospital400 bed tertiary care hospital located in Kansas City, MO
Research and academic institution
Services include Critical CareNeurology and Neurosurgery Cardiology and Cardiac SurgeryNephrology and Renal TransplantNeonatologyOncologyInpatient rehab
6 PGY1 residents1 PGY2 Health System Pharmacy Practice Administration
1 PGY2 Critical Care42 APPE rotations (4 Schools of Pharmacy)
17 IPPE rotations
Overnight StaffPharmacists (4 FTE)12 hour shifts; 7 on, 7 off3 residency trained3 board certified pharmacotherapy specialists2 residency teaching certificatesActive in department operations, department research and advancement
Technicians (6 FTE)Experienced groupAll nationally certifiedViewed as experts by their Saint Luke’s peers
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Why not take IPPE students overnight?Experienced and residency trained pharmacists
Experienced pharmacy technicians
Extensive operational and clinical activities
Time for projects to advance our department’s mission
Why not take IPPE students overnight?Hours‐8 PM to 7 AM
All 12 hour shifts
No overlap with students from other shifts
Number of students to take
Integration into workflow
Inexperienced preceptors
Are we starting from scratch?Established residency and student programs
Great resources, including other experienced preceptors that assisted us with:Recruitment
Orientation/administrative activities
Project ideas/organizationTopic discussion ideas
Basic curriculum provided by school
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Example ScheduleTime Activities completed
2000 Triage phone callsComplete assigned tasks from workbookWork on presentation/research projectCheck sterile IV batch production
2200 Order verificationReview completed work from student workbook
0000 Shadow nursing
0100 Work with technician staff‐Sterile Compounding‐Non‐sterile compounding‐ADC restock‐Central pharmacy automation‐Unit dose packaging
0500 Order verificationTopic discussion
Did we satisfy the needs of the students?Flexible learningshadowing, topic discussions, presentations, operational and clinical functions
Common feedback from students included:Higher percentage of time with preceptor than their day shift counterparts
Appreciated individualized rotation structureStill able to work their paid intern jobRotation completion in 2 weeks
Did we satisfy the needs of the department?Department quality improvementData collection for Alaris pump integration research
Completion of technical work
Engage evening/night staff in learning opportunities
Positive perception of pharmacy and hospital staff
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Can we improve the experience next year?Enhance our practice site and student resources
Increase patient interaction
Increase face‐to‐face interaction with other hospital providers
173-bed not-for-profit community hospital– Average Census: 100 patients– 10 bed ICU– 27 bed emergency department– 13+ Ambulatory Clinics
Main Pharmacy– 24:1 pharmacist to patient ratio or less
• Accommodates personalized patient‐centered care
– 24/7 pharmacist service• Including code blue/trauma/stroke response
Health-System Pharmacy– Employee (Self-Insured) & Meds 2 Beds Service– Transitions of Care
Oncology Satellite
Create More Internships!
“Never give up
on what you really want to do.
The person with the
big dreams
is more powerful
than one with all the facts.”
‐Albert Einstein
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Structure
ASHP Foundation Pharmacy Forecast 2017
When building pharmacy practice models for health systems, forethought should be given to how students will be incorporated as productive members of the pharmacy team.
Students should not simply be layered on top of existing operations without clearly defining how they will contribute to the work of the pharmacy department.
Pharmacy Practice AdvancementPharmacy Practice Advancement
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Community Impact
LMH Alumni Perspective
Clinical Intern – Class of 2008
“As a faculty member at University of Southern California, I work closely with hundreds of students each year. I ask them about their internship experiences and have been shocked to learn that none of their internships are even half as advanced as the LMH clinical intern program. LMH is at the cutting edge of clinical pharmacy."
“As a faculty member at University of Southern California, I work closely with hundreds of students each year. I ask them about their internship experiences and have been shocked to learn that none of their internships are even half as advanced as the LMH clinical intern program. LMH is at the cutting edge of clinical pharmacy."
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Clinical Intern – Class of 2009
"My time at LMH helped to shape the clinician that I am. My love for patient care and developing a relationship
with the patient started as a clinical intern at LMH.”
"My time at LMH helped to shape the clinician that I am. My love for patient care and developing a relationship
with the patient started as a clinical intern at LMH.”
Clinical Intern – Class of 2013
“Sometimes, looking back, I feel like I learned more about medications and treatment at LMH than from pharmacy school. It was having the chance to apply what was being taught to us that really had an impact on my learning. The
experiences I gained prepared me, beyond my imagination, for a PGY1 residency.”
“Sometimes, looking back, I feel like I learned more about medications and treatment at LMH than from pharmacy school. It was having the chance to apply what was being taught to us that really had an impact on my learning. The
experiences I gained prepared me, beyond my imagination, for a PGY1 residency.”
Future Directions
“Celebrate what you accomplish BUT raise the bar each time you succeed.”-Mia Hamm
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SWOT Analysis – To be completed by Intern Leadership