Overview of Experiential Education Gerald E. Meyer, PharmD, MBA, FASHP Associate Professor and Director of Experiential Education Jefferson School of Pharmacy.

Overview of Experiential Overview of Experiential EducationEducation

Gerald E. Meyer, PharmD, MBA, FASHPGerald E. Meyer, PharmD, MBA, FASHPAssociate Professor and Director of Associate Professor and Director of

Experiential EducationExperiential EducationJefferson School of PharmacyJefferson School of Pharmacy

ObjectivesObjectives

• Describe the driving forces behind Describe the driving forces behind changes in pharmacy experiential changes in pharmacy experiential educationeducation

The Roadmap to Change – The Roadmap to Change – What is driving us?What is driving us?

• JCPP Future Vision of Pharmacy JCPP Future Vision of Pharmacy PracticePractice

• CAPE Educational Outcomes 2004CAPE Educational Outcomes 2004

• IOM: Health Professions EducationIOM: Health Professions Education

• ACPE Standards 2007ACPE Standards 2007

JJoint oint CCommission of ommission of PPharmacy harmacy PPractitioners – ractitioners – 2007 Position Statement2007 Position Statement

• Vision: Pharmacists will be the health Vision: Pharmacists will be the health care professionals responsible for care professionals responsible for providing patient care that ensures providing patient care that ensures optimal medication therapy outcomesoptimal medication therapy outcomes

• Pharmacy Practice in 2015Pharmacy Practice in 2015– Foundations of Pharmacy PracticeFoundations of Pharmacy Practice– How Pharmacists Will PracticeHow Pharmacists Will Practice– How Pharmacy Practice Will Benefit SocietyHow Pharmacy Practice Will Benefit Society

AACP: Center for the AACP: Center for the Advancement of Advancement of Pharmaceutical Education Pharmaceutical Education (CAPE)(CAPE)

• Provide Pharmaceutical CareProvide Pharmaceutical Care– Interprofessional, Evidence-based…Interprofessional, Evidence-based…– Patient-centered or Population basedPatient-centered or Population based

• Manage and Use Resources of the Health-Manage and Use Resources of the Health-Care SystemCare System– Human, medical, informationalHuman, medical, informational– Medication use systemsMedication use systems

• Promote Public HealthPromote Public Health

Institute of Medicine (IOM) Institute of Medicine (IOM) Health Professions Education: A Health Professions Education: A Bridge to QualityBridge to Quality

Core CompetenciesCore Competencies• Provide patient centered careProvide patient centered care• Work in interdisciplinary Work in interdisciplinary

(Interprofessional) teams(Interprofessional) teams• Employ evidence-based practiceEmploy evidence-based practice• Apply quality improvementApply quality improvement• Utilize informaticsUtilize informatics

ACCREDITATION COUNCIL FOR PHARMACY EDUCATION

ACCREDITATION STANDARDS AND GUIDELINES FOR THE

PROFESSIONAL PROGRAM IN PHARMACY LEADING TO

THE DOCTOR OF PHARMACY DEGREE

ADOPTED: JANUARY 15, 2006RELEASED: FEBRUARY 17, 2006

EFFECTIVE: JULY 1, 2007

ACPE Standard 14ACPE Standard 14: Curricular : Curricular Core-Core-Pharmacy Practice Pharmacy Practice ExperiencesExperiences

… … must provide a continuum of must provide a continuum of required and elective pharmacy required and elective pharmacy practice experiences throughout the practice experiences throughout the curriculum, from curriculum, from introductory to introductory to advancedadvanced, of adequate scope, , of adequate scope, intensity and duration to support the intensity and duration to support the achievement of the achievement of the PROFESSIONAL PROFESSIONAL COMPETENCIESCOMPETENCIES presented in presented in Standard 12. Standard 12.

ACPE Standard #10ACPE Standard #10The CurriculumThe Curriculum• “… “… required & elective courses and required & elective courses and

experiences must effectively facilitate experiences must effectively facilitate student development and achievement student development and achievement of professional competencies”of professional competencies”

• Introductory pharmacy practice Introductory pharmacy practice experiences (IPPEs): 5% of curriculumexperiences (IPPEs): 5% of curriculum

• Advanced pharmacy practice Advanced pharmacy practice experiences (APPEs): 25% of curriculumexperiences (APPEs): 25% of curriculum

Standard 14: PreceptorsStandard 14: Preceptors

Guideline 14.1Guideline 14.1“… “… must insure preceptors receive must insure preceptors receive

orientation…, ongoing training, and orientation…, ongoing training, and development”development”

““Preceptors should provide close supervision Preceptors should provide close supervision of and significant interaction with students.”of and significant interaction with students.”

““The student-to-preceptor ratio for the The student-to-preceptor ratio for the pharmacy practice experience should be pharmacy practice experience should be adequate to provide individualized adequate to provide individualized instruction, guidance, supervision, and instruction, guidance, supervision, and assessment.”assessment.”

Standard 11: Teaching and Standard 11: Teaching and Learning MethodsLearning Methods

“… “… produce graduates who become produce graduates who become competent pharmacists by ensuring competent pharmacists by ensuring achievement of the stated outcomes, achievement of the stated outcomes, fostering…. critical thinking and fostering…. critical thinking and problem-solving skills… and enabling problem-solving skills… and enabling students to transition from students to transition from dependent to active, self-directed, dependent to active, self-directed, lifelong learners.”lifelong learners.”

Provided by and used with permission of Peter Vlasses: ACPE

Preparing for A StudentPreparing for A Student

Preparing for a StudentPreparing for a Student

• Experiential Manual / Preceptor Experiential Manual / Preceptor OrientationOrientation

• Create a schedule for the individual Create a schedule for the individual studentstudent– THINK of ways to integrate student into THINK of ways to integrate student into

site/practice/dutiessite/practice/duties•WIN-WIN Student gains practical WIN-WIN Student gains practical

knowledge/skill, Preceptor/Site gains value knowledge/skill, Preceptor/Site gains value of the task or resultof the task or result

Preparing for a StudentPreparing for a Student

•Gather other orientation Gather other orientation materialsmaterials– Organizational charts, maps, Organizational charts, maps,

required readings, policies and required readings, policies and procedures, computer training, etcprocedures, computer training, etc

•Help make student feel Help make student feel comfortable and welcomecomfortable and welcome

Preparing for a StudentPreparing for a Student

•Assessing student’s prior Assessing student’s prior experienceexperience– ResuméResumé– Student’s own verbalizationStudent’s own verbalization– Student portfolioStudent portfolio

•Especially important in later rotationsEspecially important in later rotations

•Faculty rotations completed – key Faculty rotations completed – key information!information!

Preparing for a StudentPreparing for a Student

•Set clear expectationsSet clear expectations– Learning contractLearning contract

•General description of activitiesGeneral description of activities

•Clear breakdown of gradingClear breakdown of grading

•Other important documentation, such Other important documentation, such as confidentialityas confidentiality

•Signed by preceptor and student Day Signed by preceptor and student Day 11

Preparing for a StudentPreparing for a Student

•Types of learnersTypes of learners– AuditoryAuditory– VisualVisual– Somatic (tactile, kinesthetic)Somatic (tactile, kinesthetic)

•Motivating factorsMotivating factors

Giving Feedback and Giving Feedback and Conducting EvaluationsConducting Evaluations

EvaluationsEvaluations

• Informal vs. FormalInformal vs. Formal

• Based on expectations which have Based on expectations which have been clearly articulatedbeen clearly articulated

Informal EvaluationsInformal Evaluations

• Generally VerbalGenerally Verbal

• Should be:Should be:– Continuous and OngoingContinuous and Ongoing

•After presentationAfter presentation

•End of projectEnd of project

– ConstructiveConstructive

Formal EvaluationsFormal Evaluations

• TypesTypes– Project-related (journal club, cases, pt interviews)Project-related (journal club, cases, pt interviews)– SummativeSummative

• Should be:Should be:– Written - using form(s)Written - using form(s)– Routine (at least twice per rotation for summative)Routine (at least twice per rotation for summative)– Direct and SuccinctDirect and Succinct– HonestHonest– SpecificSpecific– Meaningful (include a plan for improvement)Meaningful (include a plan for improvement)

Evaluation InstrumentEvaluation Instrument

• Provided by SOPProvided by SOP

• Linked to outcomesLinked to outcomes

• Prone to subjectivity and biasProne to subjectivity and bias

• Need to evaluate not only knowledge Need to evaluate not only knowledge and skills but also attitude.and skills but also attitude.

6 Step Approach to 6 Step Approach to Completing Evaluation FormCompleting Evaluation Form• Observe – Need to observe several times Observe – Need to observe several times

during period. Ask others.during period. Ask others.• Record – Use index cards or PDA. Record – Use index cards or PDA. • Retrieve – Organize all documentsRetrieve – Organize all documents• Analyze – Look for patterns of performance Analyze – Look for patterns of performance

(consistency, assistance needed?, (consistency, assistance needed?, prompting needed?)prompting needed?)

• Self-AssessmentSelf-Assessment• EvaluateEvaluate

Pitfalls in EvaluationsPitfalls in Evaluations

• Harshness or Leniency based on Harshness or Leniency based on personal relationshipspersonal relationships

• Central TendencyCentral Tendency

• Proximity ErrorProximity Error

• Contrast ErrorContrast Error

• Grading on improvement/effortGrading on improvement/effort

• Grade InflationGrade Inflation

How to Deliver EvaluationHow to Deliver Evaluation

• Have documentation ready (including a Have documentation ready (including a review of the student’s self-assessment)review of the student’s self-assessment)

• Use quiet private place for evaluationUse quiet private place for evaluation

• Review comments and ratingsReview comments and ratings

• Provide examples from documentationProvide examples from documentation

• Highlight strengths and areas for Highlight strengths and areas for improvementimprovement

• Identify improvement planIdentify improvement plan

Difficult StudentsDifficult Students

• Why are Students Difficult? What are Why are Students Difficult? What are the indicators of the difficulties?the indicators of the difficulties?– – – – –

Difficult Students: Things Difficult Students: Things for Preceptor to Considerfor Preceptor to Consider

• Were objectives and expectations clearly Were objectives and expectations clearly outlined?outlined?

• Is patient care potentially compromised?Is patient care potentially compromised?• Is this the first time for the student in this Is this the first time for the student in this

practice environment? Is this a first rotation?practice environment? Is this a first rotation?• Has feedback been given to the student?Has feedback been given to the student?• Am I approachable?Am I approachable?• Have other members of the staff been helpful to Have other members of the staff been helpful to

the student?the student?

Strategies for Dealing with Strategies for Dealing with Difficult StudentsDifficult Students

• Conduct self-assessment (preceptor)Conduct self-assessment (preceptor)• Determine the underlying problemDetermine the underlying problem

• Document problemDocument problem• Inform the studentInform the student• Outline a planOutline a plan• Communication !Communication !

– With studentWith student– With siteWith site– With schoolWith school

Meeting with a Problem Meeting with a Problem StudentStudent• Agree on a private time – inform the student Agree on a private time – inform the student

about the nature of the meeting.about the nature of the meeting.• Be objective and clear about your assessment Be objective and clear about your assessment

of the problemof the problem• Let student know about the seriousness of the Let student know about the seriousness of the

problem (to patients, to grade)problem (to patients, to grade)• Give the student an opportunity to present their Give the student an opportunity to present their

views. Is there something you are unaware of?views. Is there something you are unaware of?• Don’t interrupt or get defensive.Don’t interrupt or get defensive.• Document and Communicate! Document and Communicate!

Students Can Fail Students Can Fail

• Preceptors do not assign failing grades – Preceptors do not assign failing grades – students earn them!students earn them!

• Often very difficult situation.Often very difficult situation.

• Ask yourself?Ask yourself?– Would I want this individual working in my Would I want this individual working in my

environment? Providing patient care?environment? Providing patient care?– Could a pharmacist get fired for such behavior Could a pharmacist get fired for such behavior

(tardiness, absences, unprofessionalism, major (tardiness, absences, unprofessionalism, major medication error)medication error)