The Layered Learning Practice Model

Lauren Antal, PharmD

PGY-1 Pharmacy Resident

Holy Cross Hospital

As a newly licensed pharmacist in a residency program, each day brings new opportunities and challenges to me. My pharmacy school education gave me a good solid background for tackling most of these challenges, including an understanding of how to manage medically complex ICU patients and making therapy recommendations to providers. I have an idea where to begin to start to solve the problem and the next steps I should take to reach a solution. One of the areas that I do not feel as prepared for is precepting students. I am interested in becoming a preceptor for pharmacy students in the future and possibly even teaching some lectures at a school of pharmacy. However, before I tackle those challenges, I would like to gain additional experience and skills. As a resident, I will be given the opportunity to precept a student who is on rotation at my hospital.

The Layered Learning Practice Model is a model that was developed and implemented at University of North Carolina.¹ This model is also known as the Attending Model.² It is a teaching model that teaches residents how to precept student pharmacists or other pharmacy residents under the supervision of an experienced clinical pharmacist. This model allows residency programs to develop precepting opportunities for their residents. The Layered Learning Practice Model sets up opportunities to effectively utilize multiple learners at various stages into a practice setting.³

The Layered Learning Practice Model utilizes at least 3 layers. These first of the 3 layers is the primary preceptor who is the preceptor on file for the school or pharmacy program or the residency program. The second layer is the resident. This layer may include PGY-1 and/or PGY-2 residents. PGY-2 residents may precept PGY-1 or student pharmacists and PGY-1 residents may precept student pharmacists. The third and final layer of the Layered Learning Practice Model is the student pharmacist.^1,2,3 The roles and responsibilities of each layer are clearly delineated.³

The primary preceptor has the responsibility of orienting both the resident(s) and student(s) to the Layered Learning Practice Model. They are also responsible for creating/obtaining syllabuses for the resident and student. The primary preceptor is expected to outline responsibilities and set expectations for the resident and student. The primary preceptor assists the resident in providing constructive feedback to the student. They must also evaluate the resident’s performance. The primary preceptor has the responsibility of overseeing all the patient care activities’ as well as the pharmacy education.³

The resident has many roles and responsibilities too. They are expected to meet with the primary preceptor prior to the first day in order to discuss the learning experience. The resident must help develop the student’s rotation calendar and activities.³ They are expected to serve as a mentor to the student pharmacist.¹ The resident takes on the role of orienting the student to the practice site, establishing goals, and incorporating the student into patient care activities. The resident is expected to supervise the student during the patient care activities. They must provide constructive feedback to the student regularly. The resident is responsible for leading topic discussions and other activities. They must evaluate the performance of the student.³

The student has the responsibility of participating in the patient care activities as well as the other rotation activities. The student should report to the resident preceptor. They should provide feedback about the resident as a preceptor. They should also provide feedback on the Layered Learning Practice Model.³

There is a four-step process that allows the Layered Learning Practice Model to be successfully implemented. The first step is Orientation. This step can include primary preceptors as well as residents who are unfamiliar with the Layered Learning Practice Model. It serves to familiarize new preceptors to the model. Orientation also familiarizes the resident to the model and sets expectations for the rotation. Orientation can provide resources for preceptor development and provide evaluation tools. The next step is the pre-experience planning where the primary preceptor and resident meet to review and finalize any material for the student’s rotation and set expectations. The resident takes on the responsibility of communicating with the students prior to the rotation beginning. The implementation step is the first day of the student’s rotation where the primary preceptor and the resident provide an orientation to the rotation and the Layered Learning Practice Model. This meeting sets the precedent that the resident will serve as the student’s primary preceptor and the resident will be giving the student feedback and their evaluation. The final step is the post experience evaluation where both the resident and student pharmacist are given written and verbal evaluations. Feedback about the Layered Learning Practice Model is solicited and ways to improve the learning experience are looked at.³

This model provides the framework to successfully set up a resident to precept a student pharmacist with supervision from a senior preceptor. It allows the resident to gain experience precepting under the supervision of an experienced preceptor. This allows the resident to gain additional knowledge from a preceptor while they are actively precepting a student pharmacist.  It will also allow residents who may be more hesitant to take on precepting a student to gain confidence under the oversight of their primary preceptor. This model allows for multiple pharmacists and student pharmacists to participate in patient care together.

While the Layered Learning Practice Model provides many benefits, there are also challenges along with the model. One of these challenges is coordinating multiple people’s schedules. The resident and the student’s schedules may start and end at different times. This model can also create more work for the senior preceptor. Every person’s role in the model must be clearly understood as well. Residents may also receive less attention because the senior preceptor has a resident as well as student to focus on. Residents must also have good time management skills in order to balance all of their responsibilities. While there are challenges associated with the model, these can be overcome.³

References:

1.       Pinelli NR, Eckel SF, Vu MB, Weinberger M, Roth MT. The layered learning practice model: Lessons learned from implementation. American Journal of Health-System Pharmacy. 2016;73(24):2077-2082. doi:10.2146/ajhp160163. https://academic.oup.com/ajhp/article-abstract/73/24/2077/5102177?redirectedFrom=fulltext

2.       Sarigianis J. The Layered Learning Practice Model. Regional Preceptor Development Network. Sept 28, 2018. https://ce.pharmacy.uconn.edu/wp-content/uploads/sites/2102/2019/01/HO-6-per-page-Layered-Learning-final.pdf

3.       Loy BM, Yang S, Moss JM, Kemp DW, Brown JN. Application of the Layered Learning Practice Model in an Academic Medical Center. Hospital Pharmacy. 2017;52(4):266-272. doi:10.1310/hpx5204-266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424830/