Evaluating Experiential Learning

Written by:

Lauren Grecheck, Pharm.D.

PGY-2 Ambulatory Care Pharmacy Resident

University of Maryland School of Pharmacy

Students graduating from Schools of Pharmacy will enter into the workforce at different perceived and actual readiness and competency levels.^1,2 It is our responsibility as educators to ensure students are provided with experiences to prepare them for pharmacy practice. We do this through didactic and experiential education. While the didactic learning is generally uniform from student to student, it is more challenging to achieve uniformity for experiential learning.

         

Lounsbery et al described a tracking tool for Ambulatory Care Advanced Pharmacy Practice Experiences (APPE) that aimed to determine the number of patient encounters needed for a specific medical condition and the number of times a clinical skill needs to be performed for the student to be considered competent in that area.³ This study of fourth year pharmacy students focused on ten medical conditions (anticoagulation, asthma, infectious disease, chronic obstructive pulmonary disease [COPD], diabetes, lipids, hypertension, mental health, smoking, and women’s health), as well as nine skills (asthma action plan, asthma education, diabetes education, pain assessment, primary literature search, drug consult/information, motivational interviewing, presentation to another healthcare provider, and care coordination).³ The preceptor evaluations employed the use of the Dreyfus Model, which breaks skill acquisition and learning into five stages: (1) novice, (2) advanced beginner, (3) competence, (4) proficiency, and (5) expertise.⁴ Using this model for the forty-six APPE students allowed the preceptors in the study to objectively grade the students’ competency levels. Students were considered competent if they were graded per the Dreyfus model as stage 3 or higher, and students were classified as not competent if graded as stages 1 or 2.³ Students ranked as competent had an overall higher mean number of patient encounters compared to students ranked as not competent (5.1 vs. 4.3, p=0.01).³ There was no statistically significant difference between the individual medical conditions and competency levels.³ Overall, the students who were ranked as competent in regards to skill performance had a higher mean number of times the skill was performed compared to students rated as not competent (3.8 vs. 2.7, p=0.0009).³ Asthma education was the only skill to show a statistically significant difference independently (4.5 vs. 2.6, p=0.05).³ Tracking of patient care experiences and skills will allow preceptors to quantitatively evaluate the experiences a student is offered. Using this information on rotations can serve as a method for tailoring experiences during the rotation, as well as to set up rotation experiences to meet objectives set forth by the Accreditation Council for Pharmacy Education (ACPE) for pharmacy education.⁵

          

Recognizing that not all ambulatory care rotations offer the same experiences, Schools of Pharmacy can still provide continuity of experiences by creating guidelines for expected experiences. For example, performing the asthma education skill 4.5 times facilitated competency compared to only performing the skill 2.6 times.³ This information can be used to create a suggested number of experiences the students should engage in. Currently, many evaluation methods or learning experiences do not state exact numbers of experiences; instead, learning descriptions usually loosely state that a student should be exposed to a particular experience. For preceptors who are not directly affiliated with the university, they may have trouble determining what a sufficient experience is for the student; therefore, creating guidelines with specific expectations of what should be achieved in a rotational experience will help these preceptors ensure they are providing an adequate learning experience for the student. These guidelines could be used by the preceptor when creating their syllabus or learning description for the rotation, which can then be directly referenced in the evaluation. Additionally, this guideline should serve as an extension of the guidance provided by ACPE by incorporating specific examples of skills, as well as quantitative set points for each skill that is expected to be performed.⁶ Furthermore, providing the preceptor with the Dreyfus model examples of how the student should be performing for each stage of learning will allow the preceptor to demonstrate concrete behaviors that the student should be able to replicate to achieve the goals of the rotation. This is important to ensure continuity of experiences in preparing the next generation of pharmacy professionals.

         

 To further tailor the rotation experience for the student based on his or her stage of learning, a baseline competency for each individual student should be obtained. One limitation of the Lounsbery et al study was that baseline competencies were not completed; therefore, achievement of competency cannot be directly linked to that particular rotation experience and/or the number of patient encounters from that rotation. To bridge the gap from the start of the rotation to the end of the rotation, another goal for rotations should be to show individual progression. To accomplish this, baseline competency is essential. Creating mock ambulatory cases for the students to complete that combine interview skills, counseling, drug information, and SOAP note writing on the disease states that will be seen in that clinic will allow the preceptor to target student-specific areas for improvement. A strong correlation between low performers on an Objective Structured Clinical Examination and low performance on an APPE rotations has been demonstrated.⁷ Unfortunately, most preceptors do not have data about a student’s performance in pharmacy years one through three; therefore, they are unable to tailor the complexity of their rotation to that student’s ability level. The baseline competency allows each preceptor to learn about the student as an individual and ensure the learning environment they create fosters the skill level the student presents with, thus enabling focused rotation experiences to address the student’s deficiencies.

         

 Continuity of rotation experiences is essential for preparing pharmacy students to become effective practitioners. One way to ensure competencies are met is to provide further guidance to preceptors regarding specific examples of what activities a student should be able to perform, as well as how much the student has advanced throughout the rotation. To achieve this goal during short APPE rotations, students must perform baseline competencies, so their experiences can be tailored to where they would benefit the most.

References:

1.    Truong et al. Factors Impacting Self-Perceived Readiness for Residency Training: Results of a National Survey of Postgraduate Year I Residents. Journal of Pharmacy Practice. 2015;28(1):112-118.

2.    National Association of Boards of Pharmacy. North American Pharmacist Licensure Examination®: Passing Rates for 2014-2016 Graduates Per Pharmacy School. Published February 15, 2017. Website: https://nabp.pharmacy/wp-content/uploads/2017/02/2016-NAPLEX-Pass-Rates.pdf. Accessed on May 1, 2017.

3.    Lounsbery JL et al. Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences. Am J Pharm Educ. 2016;80(1):Article 14.

4.    Dreyfus SE. A Five-Stage Model of Adult Skill Acquisition. Bulletin of Science, Technology & Society. 2004;24(3):177-181.

5.    Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree (“Standards 2016”). Website: https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed March 16, 2016.

6.    Accreditation Council for Pharmacy Education. Guidance for the accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree (“Guidance for Standards 2016”). Website: https://www.acpe-accredit.org/pdf/GuidanceforStandards2016FINAL.pdf. Accessed March 16, 2016.

7.    McLauglin JE, Khanova J, Scolaro K, Rodgers PT, Cox WC. Limited Predictive Utility of Admissions Scores and Objective Structured Clinical Examinations for APPE Performance. Am J Pharm Educ. 2015;79(6):Article 84.

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