An Accelerated,Practice-Based Model for Fostering Precepting Skills in Pharmacy Residents

Sound precepting skills are vitally important for all pharmacists and for the future of our profession. Residency training provides a fertile environment for the resident to learn and foster new skills. This article outlines an accelerated model for developing precepting skills in residents and provides helpful advice for residents seeking to gain experience as a preceptor.Key Words: resident, preceptor development, practice modelResidency training is a special experience in the life of a pharmacy professional. It is the one time in the residents’ pharmacy career when they are able to demonstrate and develop clinical knowledge, time management skills, and interpersonal communication techniques while practicing pharmacy, all under the watchful eye of an experienced preceptor. Preceptors give valuable feedback and advice that mold the residents as practitioners and prepares them for the next step in their career. This is an opportune time for the skills of effective preceptors to be passed down to preceptees. The American Society of Health-System Pharmacists (ASHP) requires residents to use the 4 preceptor roles that are employed in practice-based teaching to complete residency expectations.¹ Residents are extremely talented, highly motivated individuals. New residency graduates often accept jobs that require a portion of their time be dedicated to pharmacy students or residents on rotation. This may be their first experience acting as a primary preceptor. Residency programs should incorporate a structured model for developing preceptor skills for residents.The American College of Clinical Pharmacy recently released guidelines for resident teaching experiences.² This article expands on these recommendations and outlines an accelerated model that has worked at one institution and provides helpful advice for residents seeking to gain experience as a preceptor.     

A needs assessment study of hospital pharmacy residency preceptors

Background:

Canadian pharmacy residency programs rely on preceptors to support the growing demand of graduates wishing to pursue hospital residencies. Understanding the educational needs of these preceptors is important to ensure that they are well prepared to deliver successful programs.

Objective:

To determine what new and experienced residency preceptors self-identify as learning needs in order to become more effective preceptors for pharmacy residents.

Methods:

A needs assessment of preceptors from the 31 accredited Canadian general hospital pharmacy residency programs was conducted. The study had 4 key components: interviews and focus group discussions with key informants, a pilot study, an online survey, and member checking (seeking clarification and further explanation from study participants). The residency coordinators and a convenience sample of 5 preceptors from each program were invited to participate in the survey component.

Results:

Of a possible 186 participants, 132 (71%) responded to the survey. Of these, 128 (97%) were confident that they met the 2010 standards of the Canadian Hospital Pharmacy Residency Board (CHPRB). Preceptors ranked communication skills, giving effective feedback, and clinical knowledge as the most important elements of being an effective preceptor. Managing workload, performing evaluations, and dealing with difficult residents were commonly reported challenges. Preceptors expressed a preference for interactive workshops and mentorship programs with experienced colleagues when first becoming preceptors, followed by 1-day training sessions or online learning modules every other year for ongoing educational support. The most beneficial support topics selected were providing constructive feedback, practical assessment strategies, small-group teaching strategies, effective communication skills, and setting goals and objectives.

Conclusions:

This study identified several learning needs of hospital residency preceptors and showed that preceptors would appreciate educational support. Utilization of these results by residency program administrators, the CHPRB, and faculties of pharmacy could be beneficial for residency programs across Canada.     

Embracing Challenges When Co-Precepting Pharmacy Students

Many residency programs have adopted formal training in clinical preceptorship as an additional opportunity for professional development. However, a balance must be struck between acting as a co-preceptor for pharmacy students and as a learner being precepted by a more experienced practitioner. A commonly utilized method for demonstrating skill in the 4 preceptor roles (direct instruction, modeling, coaching, and facilitating) is to co-precept students during a learning experience with the support of a preceptor or experiential mentor. The transition from learner to teacher can present many challenges. Awareness of some of the more common challenges and a review of hypothetical scenarios may promote proactive dialogue with the experienced preceptor and promote confidence as the resident embarks on a co-precepting assignment. The objective of this article is to present scenarios a resident may encounter when co-precepting students, focusing on professionalism, patient care, providing feedback, planning, and communication, and strategies for addressing potential challenges.Key Words: co-preceptor, pharmacy student, precepting, residency trainingTell me and I forget. Teach me and I remember. Involve me and I learn. If we take these instructions for educating to heart, we realize that teaching others requires determination and commitment. Many residency programs have adopted formal training in clinical preceptorship as an additional opportunity for professional development. However, a balance must be struck between acting as a co-preceptor for pharmacy students and as a learner being precepted by a more experienced practitioner.¹Postgraduate year 1 (PGY1) residency objective R5.1.3 requires the resident to demonstrate skill in the 4 preceptor roles employed in practice-based teaching: direct instruction, modeling, coaching, and facilitating.²A commonly utilized method for achieving this objective is for the resident to co-precept students during a learning experience with the support of a preceptor or experiential mentor.^3,4The experienced practitioner will facilitate the co-preceptor’s growth and self-awareness by observing his or her preparation, performance, and interactions during the experience.⁵The transition from learner to teacher can present many challenges.⁶An awareness of common challenges and a review of hypothetical scenarios may promote proactive dialogue between the experienced preceptor and resident and promote confidence in the resident as he or she embarks on a co-precepting assignment. The objective of this article is to present scenarios a resident may encounter when co-precepting students and strategies for addressing potential challenges.     

Factors that influence residency applicants in the selection of a specific program

The relative importance of factors that influenced residency applicants in the selection of a specific program was determined through a national survey. A four-page questionnaire was developed through a series of focus groups with current and former pharmacy residents. A total of 370 questionnaires were mailed to the preceptors of all residencies participating in the 1987 ASHP Resident Matching Program; the preceptors were instructed to forward the questionnaires to all first-year residents in their programs. Respondents were asked to provide demographic information and to rate (using a seven-point Likert scale) the importance of 19 factors that might have influenced their choice of residency program. The respondents also were asked to list which 4 of the 19 factors had been most important to them in their choice. Most of the 243 respondents had entered the residency programs with little or no postgraduate pharmacy experience. The average residency candidate applied to 2.8 programs; approximately half of the respondents had accepted a residency position in the state in which they currently lived. The reputation of the residency program as a good learning program was rated most important by all groups. ASHP accreditation was rated slightly higher by residents in general programs, whereas the type of medical services provided by the hospital and the university teaching affiliation were rated slightly higher by respondents in clinical and specialty programs. Factors with low importance ratings included desirable climate and total number of residency hours worked. Residency preceptors can use the results of this study to focus their marketing and recruiting strategies.     

Practice Management Training in the PGY1 Residency Year: Best Practices From Two Nationwide Surveys

Purpose:

The development of future pharmacy leaders is vital to the advancement of our profession. Postgraduate year 1 (PGY1) residency training requires residents to exercise leadership and practice management skills. Two national surveys were conducted to describe the current state of practice management experiences and elucidate best practice recommendations.

Methods:

The surveys, online multiple choice and free response, queried American Society of Health-System Pharmacists (ASHP)–accredited residency program practice management preceptors (survey 1) and PGY1 residents (survey 2) and were distributed via the ASHP residency program directors’ listserv. Responses were reviewed and analyzed by members of the University HealthSystem Consortium Pharmacy Council Strategic Initiatives and Programming Committee.

Results:

Survey 1, completed by 240 institutions, identified that a combination of concentrated and longitudinal practice management experiences were used most frequently (47%), followed by concentrated alone (33%). Universally noted activities included meeting attendance (98%), projects (94%), and committee involvement (92%). Sixty-seven percent of the programs changed the experience in the previous 3 years, with 43% planning changes in the coming year. Survey 2 was completed by 58 PGY1 residents from 42 programs. Most (80%) residents stated they had enough time with their preceptors, and 55% rated their enjoyment of the rotation as 4 or 5 on a 1 to 5 scale (5 = most enjoyed)

Conclusion:

Our findings suggest that there is not a best practice for the structure or content of the PGY1 practice management experience. These results highlight key recommendations, including the need for practice management-specific preceptor development, incorporation of longitudinal experiences, and more practice management and leadership activities.Key Words: administration, leadership, residency, training     

Educational Games as a Teaching Tool in Pharmacy Curriculum

The shift in the pharmacist’s role from simply dispensing medications to effective delivery of pharmaceutical care interventions and drug therapy management has influenced pharmacy education.^1-3 The educational focus has shifted from basic sciences to clinical and integrated courses that require incorporating active-learning strategies to provide pharmacy graduates with higher levels of competencies and specialized skills. As opposed to passive didactic lectures, active-learning strategies address the educational content in an interactive learning environment to develop interpersonal, communication, and problem-solving skills needed by pharmacists to function effectively in their new roles.^4-6 One such strategy is using educational games. The aim of this paper is to review educational games adopted in different pharmacy schools and to aid educators in replicating the successfully implemented games and overcoming deficiencies in educational games. This review also highlights the main pitfalls within this research area.     

Assessment of factors influencing community pharmacy residents' pursuit of academic positions

Objectives

To determine the percentage of residents accepting faculty positions following completion of a community pharmacy residency program (CPRP) and identify influences to pursue/not pursue an academic career.

Methods

CPRP directors and preceptors across the United States were contacted and 53 community pharmacy residents were identified. The residents were invited to participate in surveys at the beginning and end of the 2005-2006 residency year.

Results

Forty-five residents (85%) completed the preliminary survey instrument and 40 (75%) completed the follow-up survey instrument. Of these, 36 completed both survey instruments. Initially, 28 (62%) respondents indicated a faculty position as one of their potential job preferences. After completing their residency program, 3 (8%) residents accepted faculty positions; and 3 (8%) others were awaiting offers at follow-up. Reasons for accepting a faculty position were positive teaching experiences and the influence of a mentor or preceptor. Reasons for not pursuing a faculty position included lack of interest, geographic location, disliked teaching experiences, lack of preparedness, and non-competitive salary.

Conclusion

Many community pharmacy residents consider faculty positions early in their residency but few pursue faculty positions. CPRPs and colleges of pharmacy should work together to enhance residents'' experiences to foster interest in academia.     

Improving communication skills of pharmacy students through effective precepting

Pharmacy students should be given opportunities to learn and practice interpersonal communication skills during their community advanced pharmacy practice experience (APPE). Preceptors have the responsibility of setting the stage for the pharmacy students during their initial encounter. During this orientation to the site, students should become familiar with the history of the practice, the types of services provided, and the staff members. Once the orientation is completed, preceptors can develop strategies for incorporating the students into the practice's patient care activities. Students should participate in patient counseling, interviewing, and educational sessions. Also, students should participate in collaborative work with other health care providers. To ensure the development of communication skills in pharmacy students, preceptors can incorporate the teaching process "see one, do one, teach one" into their teaching activities. By following these strategies, preceptors can effectively and positively impact the communication skills of their students.     

Evaluation of clinical research knowledge and interest among pharmacy residents: survey design and validation.

PURPOSE: The development and validation of a survey to describe the research knowledge, attitudes, and skills of pharmacy practice residents are described. SUMMARY: A survey was drafted to determine if pharmacy practice residency experience and the American Society of Health-System Pharmacists (ASHP)-required project improve the residents' objectively and subjectively assessed research knowledge, to determine if the residency experience and the ASHP-required project affect the residents' attitudes regarding research as a component of their future professional practice, and to subjectively assess the effect of the residency experience and the ASHP-required project on other essential skills, such as problem solving, critical thinking, and time management. An initial questionnaire was developed and underwent content validation testing by clinical pharmacists and faculty, residents, and research fellows. Following content validation, the questionnaire underwent construct validity testing (for discriminative validity and responsiveness) in students, residents, and clinical pharmacists and faculty. Reliability was tested in a subgroup of subjects who completed the questionnaire twice within two to four weeks. From the content validation phase, average scores for individual questions ranged from 1.00 to 2.00. Discriminative validity testing of the revised questionnaire demonstrated the instrument's ability to discriminate between groups expected to differ. Effect-size and mean-knowledge score differences indicated high levels of responsiveness, signifying the instrument's ability to detect change over time or after an intervention. CONCLUSION: A survey questionnaire developed to measure research knowledge and interest among pharmacy practice residents demonstrated its validity and reliability with significant sensitivity and responsiveness.     

Assessment of Volunteer Preceptors at Colleges and Schools of Pharmacy in the United States

Objective. To identify the way colleges and schools of pharmacy in the United States assess the performance of volunteer preceptors who precept students in advanced pharmacy practice experiences (APPEs).Methods. In the summer and fall semesters of 2018, directors of experiential education were invited to complete an online, self-administered questionnaire that included questions dealing with assessment of APPE volunteer preceptors related to promotion and reappointment procedures, abilities and attributes assessed, methods of assessment, and frequency of conducting such assessments. Several attempts were made via email and phone to encourage participation.Results. Eighty-one of 132 (61.4%) fully accredited programs responded with all but one reporting that they evaluated the performance of APPE volunteer preceptors. Forty-one of these 80 (51.3%) indicated that preceptors cannot be promoted in rank, while 47 (58.8%) had a process for preceptor reappointment. The most commonly assessed preceptor abilities and attributes were accessibility, ability to provide feedback to students, communication skills, and professional demeanor. The most reported assessment strategies were summative student evaluations and on-site evaluation of the preceptor by college or school personnel. The frequency of assessments varied based on the assessment method the institution used.Conclusion. Assessment of APPE volunteer preceptors was an integral component of the quality assurance process at almost all responding US pharmacy colleges and schools. The institutions evaluated various preceptor abilities and attributes and used multiple assessment strategies. Findings from this study may help programs review their existing assessment practices, implement new ones, and help to standardize preceptor assessment.     

An Observational Case Study of Near-peer Teaching in Medical and Pharmacy Experiential Training

Objective. To compare peer teaching in a medical and a pharmacy clinical teaching unit and to provide suggestions for future research in pharmacy near-peer teaching.Methods. This exploratory observational study used principles of ethnographic methodology for data collection and analysis. Observations were collected in a large downtown teaching hospital. An average of 4-6 hours per day were spent observing a team of medical trainees from the Faculty (School) of Medicine in the general internal medicine (unit for two weeks, followed by a team of pharmacy trainees in an ambulatory hemodialysis (HD) unit for two weeks. Data was collected through field notes and informal interviews that were audiotaped and subsequently transcribed. Data was interpreted by the observer and reviewed weekly by two impartial pharmacists.Results. Five major themes emerged: (1) influence of peer teaching hierarchy; (2) educational distance between peer learners and teachers; (3) effect of the clinical teaching unit size on peer learning; (4) trainees’ perception of their teaching role in the clinical teaching unit; and (5) influence of daily schedule and workload on peer teaching. As opposed to pharmacy, a hierarchy and pyramidal structure of peer teaching was observed in medical experiential training. There appeared to be no effect of educational distance on near peer teaching; however, perception of teaching role and influence of daily schedule affected near-peer teaching.Conclusion. Through initial comparisons of medical and pharmacy clinical teaching units, this study provides a reflection of elements that may be necessary to successfully implement near-peer teaching in pharmacy experiential training. Future studies in this area should assess learning outcomes and participant satisfaction, preceptor workload, and impact on patient care.     

Assessment of teaching experiences completed during accredited pharmacy residency programs

Objectives

To examine teaching experiences in residency programs accredited by the American Society of Health-System Pharmacists (ASHP) and how they relate to career choices of residents.

Methods

An online survey instrument was developed that asked former residents about the type of teaching experiences they completed during their residency and the effect of these experiences on the decision to pursue an academic career. Our target population was pharmacists completing accredited residencies from 2003-2006.

Results

Four hundred fifty-five (11% of the target population) pharmacists who had completed a residency responded. Former residents who completed 2 years of postgraduate training were significantly more likely to participate in all teaching experiences identified by this survey (p < 0.008). Former residents in college- or school-affiliated programs were significantly more likely to participate in all of the teaching experiences identified (p < 0.003). Former residents who went on to take a faculty position were more likely to have given lectures, participated in problem-based learning (PBL) or small group seminars (SGS), and served as a primary preceptor (p < 0.008) during their residency.

Conclusions

Residents who eventually became faculty members were more likely to have acquired training and experience in teaching during their residency programs.     

Evaluating the preceptor–preceptee relationship among Pharm D students at the King Saud University School of Pharmacy

Objective

To evaluate preceptee satisfaction concerning preceptorship and the preceptor–preceptee relationship among pharmacy students.

Impact and Application of Material Learned in a Pharmacy Residency Teaching Certificate Program

Objective. To describe the impact and application of material learned in a pharmacy resident teaching certificate program on the career experiences of alumni 1 to 11 years after completion of the program.Design. A teaching certificate program was established in 2001 that brought together residents from various training programs throughout Wisconsin to discuss essential educational skills in a dynamic learning environment. The purpose of the program was to teach participants the fundamental skills to continue to develop as a pharmacy educator throughout their career.Assessment. An electronic survey instrument was sent to alumni of the program. Greater than 70% of respondents agreed that the teaching certificate program reinforced their desire to teach in practice and that the program helped qualify them for their current or previous practice position. Alumni in academic positions more strongly agreed that the program changed their career interest to include academia and qualified them for their position in academia.Conclusions. A teaching certificate program can reinforce or stimulate interest among pharmacy residents in pursuing an academic career and prepare them for this role. Completion of the program led to a high level of confidence among the majority of alumni in their ability to precept students and residents and influenced some alumni involved in the hiring of pharmacists.     

Harvey A.K. Whitney lecture. Intimations on a profession: retrospect and prospect

The evolution and development of institutional pharmacy and its pathfinders are discussed, and future directions for the profession are suggested. From the Bulletin of the American Society of Hospital Pharmacists to the American Journal of Hospital Pharmacy, hospital pharmacy literature has helped the profession evolve by providing specialized information while continuing to meet practitioners' changing needs over time. Editorials help to establish unity of purpose among members by encouraging consensus development. Other publications and programs of ASHP extend its mission into institutions nationwide. To achieve unity of purpose, the profession relies on the formal organization (ASHP and its chapters) for providing order and the informal organization (meetings) for exchanging information and providing motivation. Pharmacy "trains its own" via residency programs, whose prototypes, nonacademic internships, were designed by pathfinder preceptors like Harvey A. K. Whitney. These programs have ensured continuity in improving practice standards and a source of skilled professionals. Women have been leaders in the history and development of hospital pharmacy. The sound economic management of the Society has led to accelerated developments for institutional pharmacy. In the future, ASHP should seek to become more involved in public policy issues concerning health care in general; develop a written set of ethical standards to guide institutional practitioners; and prepare an updated history of ASHP and the hospital pharmacy movement, including an interpretation of events, or a cultural perspective. ASHP has established a strong foundation for hospital pharmacy as envisioned by the early pathfinders; young pharmacists are the pathfinders for future progress.     

College of pharmacy-teaching hospital relationships: report of a survey

The results of surveys conducted by the American Association of Colleges of Pharmacy (AACP) and the American Society of Hospital Pharmacists (ASHP) to investigate the extent and causes of problems in relationships between colleges of pharmacy and the pharmacy departments in their affiliated teaching hospitals are presented. For the AACP study, questionnaires were mailed to either the dean or the pharmacy practice department chairman of all 72 colleges, and a telephone interview was subsequently conducted with most of them. For the ASHP study, interviews were conducted with 67 directors of pharmacy in the colleges' principal affiliated teaching hospitals. Problems identified by the colleges related to quality or extent of services and finances. Most directors of pharmacy stated that they derived benefit from their affiliation with a college of pharmacy. The relationship between colleges of pharmacy and their teaching hospitals is relatively healthy and generally better than expected.     

Providing clinical pharmacy services in an AIDS--oncology ambulatory-care clinic

The activities of a pharmacist in an ambulatory-care AIDS-oncology clinic are described. In December 1984, the chief of the AIDS Activities Division of San Francisco General Hospital's Department of Medicine hired a clinical pharmacist to develop the pharmacokinetics sections of investigational drug protocols, provide drug therapy consultations, and supervise the reorganization of the drug storage and inventory system. Since joining the clinic staff, the pharmacist has become active in a variety of clinical, research, and educational activities. The pharmacist conducts weekly medication refill clinics and developed drug information sheets for clinic patients and health-care professionals. The pharmacist also supervises timely collection of blood samples for serum drug concentration determinations and helps to prepare the investigational drugs for dispensing. The pharmacist developed policies and procedures for the safe handling of antineoplastic agents and standardized the accountability procedures for investigational drugs. The pharmacist also serves as a liaison between the clinic and the hospital's department of pharmacy and as a preceptor of pharmacy students and residents. A clinical pharmacist can make an important contribution to the research and patient-care activities in an AIDS-oncology clinic.     

Mirror to ASHP: 1942-1992.

Highlights from the history of ASHP are presented on the occasion of the Society's 50th anniversary. Efforts to organize a formal group representing hospital pharmacists, begun in the 1920s, resulted in the formation of a subsection on hospital pharmacy of the American Pharmaceutical Association in 1936. In 1942, ASHP became a distinct organization affiliated with APhA. The body's goals were to establish minimum standards for pharmaceutical services, ensure a supply of well-qualified hospital pharmacists by providing hospital internships, facilitate information exchange, and foster cost-effective use of medicines. The development of practice standards and periodic surveys of hospital pharmaceutical services, educational efforts and accreditation programs, publications, and ASHP's role in the development of principles for hospital formulary systems are described. ASHP's endorsement of unit dose drug distribution and systems for preparation of intravenous admixtures is discussed. The evolution of pharmacists' clinical roles, their increased involvement in drug therapy decisions and the provision of drug information to patients, and the expanded responsibility implicit in the pharmaceutical care concept are traced. Today's ASHP members can build on the work of yesterday's members to provide better pharmaceutical care.