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Preceptor Development Changes In Experiential Education: Tips
for Today and Tomorrow
Seth Heldenbrand, Pharm.D.Assistant Dean for Experiential Education, Associate Professor
UAMS College of Pharmacy
Disclosure
• I am employed by the UAMS College of
Pharmacy
• I have no financial relationships to disclose
Objectives
1. Review the role and structure of the UAMS
experiential program
2. Discuss Domain 4 of the CAPE outcomes for
assessing students
3. Summarize the student protections provided
by the Family Educational Rights and Privacy
Act (FERPA)
4. Review preceptor resources
5. Describe best practices for experiential learning
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UAMS Office of Experiential
Education
• Seth Heldenbrand, Pharm.D.—Assistant Dean
• Nicole Avant, Pharm.D.—Director
• Eric Crumbaugh, Pharm.D.—Director (part-time)
• Ellie Dickinson—Administrative Assistant (she
runs the show)
Experiential Goals/Mission
• Provide structured, practical and supervised
professional program experiences
• Enable the student to develop and apply skills
and knowledge gained in formal course work
• Provides opportunity to assume his/her role as a
pharmacist
• Professional judgment
• Practice competency
• Technical skills
What is Experiential Education?
• “A philosophy that informs many methodologies
in which educators purposefully engage with
learners in direct experience and focused
reflection in order to increase knowledge,
develop skills, clarify values, and develop
people's capacity to contribute to their
communities.”
Association for Experiential Education, http://www.aee.org/about/whatIsEE
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Experiential Structure
• IPPE - Introductory Pharmacy Practice Experiences
• ≥ 300 hours
• Spread over the first 3 professional years • P1 summer, P2 summer, P3 longitudinal IPPEs
• APPE - Advanced Pharmacy Practice Experiences
• ≥ 1440 hours (36 weeks)
• During the last academic year
• After IPPEs & required didactic courses are completed
IPPEs
• Minimum 150 hours balanced experience
• Community
• Institutional
• Permit students, under appropriate supervision to
assume direct patient care responsibilities.
• IPPEs should:
• begin early
• interface with didactic course work
• continue in a progressive manner leading to APPEs
IPPE examples
• processing & dispensing new/refill medication orders
• conducting patient interviews to obtain patient
information
• creating patient profiles using information obtained
• responding to drug information inquiries
• interacting with other health care professionals
• participating in educational offerings designed to
benefit the health of the general public
• interpreting & evaluating patient information
ACPE Standards and Guidelines, v. 2.0, 2011
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APPEs
• Experience of adequate intensity, duration, & breadth to
enable achievement of competency.
• Full-time, provide continuity of care, conducted under
pharmacist-preceptor supervision & monitoring
• Required APPEs develop pharmacist-delivered patient
care competencies for patients of all ages.
Types of Care Settings
Primary Community
Acute Hospital or health-system
Chronic Ambulatory
Preventive Inpatient/acute care general medicine
APPE examples
• identifying, evaluating, & communicating to the patient & other health
care professionals the appropriateness of the patient’s specific
pharmacotherapeutic agents, dosing regimens, dosage forms, routes
of administration, & delivery systems
• recommending prescription & nonprescription medications, dietary
supplements, diet, nutrition, traditional nondrug therapies, &
complementary & alternative therapies
• recommending appropriate medication dosing utilizing practical
pharmacokinetic principles
• identifying & reporting medication errors & adverse drug reactions
• managing the drug regimen through monitoring & assessing patient
information
ACPE Standards and Guidelines, v. 2.0, 2011
Competency Areas
IPPE
1. Professionalism
2. Drug Referencing
3. Communication
4. Prescription
Competency
5. Pharmacy Operations
APPE
1. Patient Care
2. Documentation
3. Medication Distribution,
Processing, & Dispensing
4. Resource Management
5. Communication
6. Public Health
7. Drug Information &
Evidence-Based Medicine
8. Professionalism
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Practice-Based Learning
• Active not passive
• Repetition
• Reinforcement
• Understanding
• Relevance
• Organization
• Choice
• Purposes & Goals / Individualization
� What is the ENDPOINT?
� Knowledge
� Skill
� Attitude
�Performance
standard
Practice Based Objectives
KNOWLEDGE
SKILLSATTITUDES
How is Precepting Different
from Teaching?• Teaching
• Impart skills or knowledge
• Gradually impart action or attitude
• Precepting
1. Determine learning needs
2. Plan experiences and expectations
3. Assess performance
4. Provide performance-based feedback
5. Repeat 3&4
6. Provide summative feedback
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Clinical Teaching
Environment
• Define role for student
• Integrate student into current patient
care opportunities
• Use student interest to enhance patient
care
• Identify new opportunities
The Balancing Act
Site Needs
Learning Needs
Patient Needs
Preceptor (HCP and Teacher)
What Students Need to Grow
• Effective mentorship
• Challenge growth
• Foster trust
• Feedback
• Focused vision
• Observe and allow autonomy
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Teaching By Example
• Role modeling
• Coaching and observation
• Supervision with autonomy
• Constructive feedback
• Positive recognition of achievements
First Day of Rotation
1. Orient the student to the site, practice, and staff
2. Review expectations for the rotation
3. Review the learning objectives and activities
4. Review the student's work during the experience
5. Review a planned schedule of rotation hours
6. Discuss expectations and due dates for special
projects, reports, presentations and meetings
7. Identify an alternate supervisor for instances when
the primary preceptor is unavailable
Assessing Experiential Students• Scoring
• 5 Meets requirement at a level beyond that expected for a new graduate
• 4 Meets requirement with minimal or no prompting and intervention from the preceptor
• 3 Meets requirement with moderate prompting and intervention from the preceptor
• 2 Meets requirement with extensive prompting and intervention from the preceptor
• 1 Does not meet requirement even with prompting and intervention from the preceptor
• 0 Though opportunities existed, student did not engage in requirement; therefore not able to assess
• NA Not applicable to experience or not observed
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UAMS COP Competencies
• Domain 1: Patient Care-Ensuring Appropriate Pharmacotherapy and Therapeutic Outcomes
• Patient Care
• Documentation
• Domain 2: Dispensing and Pharmacy Resource Management
• Medication distribution, processing and dispensing
• Resource management
• Communication
• Domain 3: Health Improvement, Wellness, and Disease Prevention
• Public health
• Drug information and EBM
• Multiple Domains
• Professionalism
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Questions about the current
system
1. Do you like the current evaluation?
2. What would you change about the
current evaluation?
Why Am I Asking You This?
• We will be updating the student evaluation
forms
• Harding and UAMS will be using the same forms
• New outcomes have been released
• Our goals
• Make the process simpler
• Less evaluation points
• Easier for preceptors to apply to their students
regardless of practice location
CAPE OutcomesCenter for the Advancement of Pharmacy Education
2013 Educational Outcomes
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CAPE Outcomes
4 Domains
1. Foundational knowledge integrated
throughout pharmacy curricula
2. Essentials for practicing pharmacy and
delivering patient-centered care
3. Effective approaches to practice and care
4. Ability to develop personally and
professionally
Domain 4: Personal and Professional
Development (affective domain)
1. Self-awareness
2. Leadership
3. Innovation and Entrepreneurship
4. Professionalism
Self-awareness
• Regulates own thinking and learning
• Maintains motivation, attention, and interest
• Engages in personal and professional development for the purpose
of individual growth
• Approach tasks with a desire to learn
• Demonstrates persistence and flexibility in all situations
• Engages in help seeking behavior when appropriate
• Strives for accuracy and precision
• Recognizes, corrects, and learns from errors
• Use constructive coping strategies to manage stress
• Seek personal, professional, or academic support to address
personal limitations
• Has positive self-esteem and confidence when working with others
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Leadership
• Identifies traits that reflect leadership versus
management
• Identifies the history of a team before implementing
changes
• Develops relationships, values diverse opinions, and
understands individual strengths and weaknesses to
promote teamwork
• Persuasively communicate goals to the team
• Empowers team members by actively listening, gathering
input or feedback, and fostering collaboration
Innovation and Entrepreneurship
• Demonstrate initiative when confronted with challenges
• Develop new ideas and approaches to improve quality or
overcome barriers to advance the profession
• Demonstrate creative decision making when confronted with
novel problems or challenges
• Assess personal strengths and weaknesses in entrepreneurial
skills
• Apply entrepreneurial skills within a simulated
entrepreneurial activity
• Conduct a risk-benefit analysis for implementation of an
innovative idea or simulated entrepreneurial activity
Professionalism
• Demonstrates altruism, integrity,
trustworthiness, flexibility, and respect
• Display preparation, initiative, and accountability
commitment to excellence.
• Delivers care that is legal, ethical, and
compassionate
• Recognizes professionalism is constantly
evaluated by others
• Engages in the profession of pharmacy
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Assessment Revision
• Dr. Jeff Mercer and I will be working on revising
our IPPE and APPE evaluations
• If you are interested in serving on a preceptor
focus group please contact me
Student Rights to Privacy:
FERPA
Family Educational Rights and
Privacy Act
• Federal law that protects the privacy of
student education records
• Right of the parents when child is <18 or
still in high school
• Transfers to student when > 18 or pursuing
education > high school
• Applies to all pharmacy students
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FERPA
• Gives eligible students the right to inspect and
review education records maintained by the
school
• Gives the students the right to request that a
school correct records they believe to be
inaccurate or misleading
• Requires schools to have written permission
from the student to release any information in
the school’s records
FERPA
• Applies to any documented student record maintained
by the school
• Students federal FERPA privacy rights extend to:
1. Poor overall performances on rotation
2. Specific instances of underperformance
3. Midpoint grades
4. Final grades
5. Instances of remediation
6. Instances of unsuccessful completion of your
rotation
FERPA
• Things to consider
• Do you have student employees?
• Are you technicians and staff aware of the
students rights?
• Protecting a student’s privacy takes effort
• HIPAA/FERPA ≈ Patient/Student
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FERPA
• Exceptions
1. School officials with educational interest;
2. Other schools (in the case of a transfer);
3. Official audit or evaluation purposes;
4. Financial aid organizations;
5. Organizations conducting certain studies for or on behalf
of the school;
6. Accrediting organizations;
7. Judicial order or lawfully issued subpoena;
8. Appropriate officials in cases of health and safety
emergencies; and
9. State and local authorities, within a juvenile justice
system, pursuant to specific State law.
FERPA
• Any documented student outcome
• Any documented student performance
maintained by the school
• Any disciplinary action by the school
• All grades
• Failure to progress
Preceptor Requirements
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Preceptor Requirements
1. Pharmacist license in good standing
2. Professional competency
3. Desire to educate
4. Minimum of one year practice experience in your area
5. Preceptor training
6. Professional membership
7. Communicate effectively (meaningful feedback to
students)
8. Avoid relationships with students that jeopardizes
learning
9. Not reimburse students (direct or indirect)
AR State Board Requirements
• Be an Arkansas pharmacist, licensed for more than one year and actively engaged in the
practice of Pharmacy for the year immediately preceding the application for certification as
a preceptor.
• Be a pharmacist employed in a pharmacy which currently holds a Class A rating indicated by
the Inspection Sheet for pharmacies as outlined by the State Board of Pharmacy.
• For the initial application as preceptor, the applicant must satisfactorily complete a test on
requirements and responsibilities of a preceptor as developed and administered by the
Board of Pharmacy or its representatives.
• Have a pharmacy library (latest edition), which meets or exceeds the requirements of the
"Inspection Sheet" for pharmacies.
• At least one preceptor from the internship site shall be a member of an appropriate
national pharmaceutical organization. Preceptors shall be a member of at least one
professional state organization.
• Must not have been convicted of any violation of Arkansas Code §17-92-311, unless the
Board officially grants exception.
• Must have attended at least one professional meeting during each licensure biennium.
• Must agree to give immediate personal and direct physical supervision to the intern. A
preceptor cannot supervise more than one intern at any specified time.
• Preceptors must renew their certification every two years by application and payment of
fees specified in regulation 01-00-0007.
Preceptor Resources
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Preceptor Resources
1. Collaborative Education Institute (CEI link in e-value)
2. Continuing Education (deferred cost COP CPE)
3. UAMS Library Access
4. Pharmacists’ Letter: Preceptor Training & Resource
Network
5. Others (should be listed in the manual)
6. IPPE/APPE Manuals
7. Facility tools
8. Pharmacist tools
9. Student tools
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Tools and Forms
Best Practices for Experiential
LearningNew student orientation
• Welcome the student and introduce yourself
and other personnel
• Provide a tour of the facility
• Explain policy and procedures
• Describe the types of services you provide
• Help the student understand his/her role and
daily responsibilities at your facility
Provide a clear plan for assessment
expectations
• What do you expect the student to do?
• Responsibilities
• Learning Activities
• Requirements
• What opportunities will the student have to
practice the activity?
Best Practices for Experiential
Learning
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Provide a clear plan for assessment expectations
• How will you assess the student’s performance?
• Projects/activities
• Documentation
• Verbal and written feedback timing
• Self-assessment
• If the experience has multiple preceptors
• Who shares responsibility for the student?
• What activities they will have with each preceptor?
• What preceptors will assess student responsibilities?
Best Practices for Experiential
Learning
Assessing Experiential Students• Scoring
• 5 Meets requirement at a level beyond that expected for a new graduate
• 4 Meets requirement with minimal or no prompting and intervention from the preceptor
• 3 Meets requirement with moderate prompting and intervention from the preceptor
• 2 Meets requirement with extensive prompting and intervention from the preceptor
• 1 Does not meet requirement even with prompting and intervention from the preceptor
• 0 Though opportunities existed, student did not engage in requirement; therefore not able to assess
• NA Not applicable to experience or not observed
Why give feedback?
• Gives insight to students above how they may see
themselves
• Students want feedback
• Students who get regular feedback
• Perform better
• Learn more quickly
Best Practices for Experiential
Learning
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What is meaningful feedback?
1. Descriptive NOT Evaluative
2. Specific
3. Honest and sincere
4. Relevant
5. Timely
6. Desired by Receiver
Best Practices for Experiential
Learning
Meaningful feedback
• Weekly feedback (informal)
• Gives them time to improve before midpoint
• Student’s response to feedback will help future assessments
• Midpoint evaluation
• Student self-assessment
• Strengths and opportunities to improve
• Final evaluation
• Student self-assessment
• Strengths and opportunities to improve
• Review progress form midpoint
• Global plan for improvement on future experiences
Best Practices for Experiential
Learning
Learning Assessment
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FERPA scenario 1
A former student/employee who is now a
preceptor calls to ask about a student’s
performance at your site. The student performed
poorly and as a result did not graduate.
Would disclosing this information be a FERPA
violation?
FERPA scenario 2
You often take handwritten notes on student performance at
your site. You use these to help you complete midpoint and
final evaluations. Again you are asked about a students
performance.
Would reviewing these files and discussing a student’s
performance violate FERPA?
Is it acceptable to select N/A on
the Experiential Student
Evaluation form?
a. Yes, but only when the student refused to
perform the activity
b. Yes, specifically when the opportunity did not
present itself during the experience
c. Yes, especially when a student performed the
task but it was observed by another pharmacist
d. No, what does it mean anyway?
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Student X has been exceptional all month.
They have consistently taken the initiative and
exceed expectations in all categories
• Score this student
a. 5
b. 4
c. 3
d. 2
e. 1
f. 0
g. N/A
Student Y has done a good job. You have only
had to tell them/show them something once.
They have worked independently and you
have enjoyed having them on rotation.
• Score this student
a. 5
b. 4
c. 3
d. 2
e. 1
f. 0
g. N/A
Student Z has been a pain all month and has
required repetitive instruction. They have
occasionally showed up late and could have
responded to feedback more appropriately.
• Score this student
a. 5
b. 4
c. 3
d. 2
e. 1
f. 0
g. N/A
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Which feedback statement is the most
meaningful to an experiential student?
a. “Good job!”
b. “Student rounded on all patients in the ICU today.“
c. “Student needs to ask, “Do all of the patient’s
medications have an indication?" for every patient the
student is assigned.
d. “Student specified INR target based on consideration of
patient’s indication & risks & justified recommended goal
using Chest guidelines."