Cognitive Apprenticeship in a Long-Term Care

Pharmacy

Maria MillerClemson University

Green Pharmacy dispenses prescriptions to residents of long-term care facilities

Problem: packaging mistakes leading to potentially harmful or fatal patient outcomes

– Wrong medication

– Wrong strength

– Wrong quantity

Adverse outcomes to medication errors can produce serious results

Sub-theraputic or overdosing Patient harm or death

Legal action Fines

Loss of licensure

Green Pharmacy went on a Performance Improvement/Root Cause Analysis journey to determine the cause of packaging errors

The analysis determined that the performance gap was due to training issues

Pharmacy technicians spend 9 months in a classroom-based vocational training program

New technicians begin work without much hands-on experience

They learn the trade by being paired with an experienced technician

The Apprenticeship Model

• Modeling: the instructor demonstrates and narrates how to perform a task

• Coaching: the student performs the task while the instructor watches and coaches

• Scaffolding: as the student becomes increasingly more competent, the instructor pulls away support

• Instructors would explain how to perform tasks, but not necessarily why a task needed to be performed a particular way

• The work was not organized in a way conducive to training a new technician

• Having multiple instructors made it difficult for trainees to see the ‘big picture’ view

• Sometimes trainees picked up bad habits

The downside to the apprenticeship model

The Cognitive Apprenticeship Model

Adds these features

• Articulation: the trainer questions the student and also stimulates the student to ask questions

• Reflection: encouraging the student to be aware of his/her own strengths and weaknesses

• Exploration: encouraging students to formulate and

pursue learning goals

The cognitive apprenticeship model bridges the gap between schooling and work by helping students use the information learned in school within the context of the work setting

Knowledge + Appropriate Training = Success

Conclusion

Green Pharmacy has adopted the cognitive apprenticeship model to training new pharmacy technicians with the expectation that better trained technicians will make fewer errors