Layered Learning Model

Olyad Begna
PGY1 Pharmacy Resident
Holy Cross Hospital

The layered learning practice model (LLPM) involves training pharmacy residents to precept pharmacy students under the supervision of a clinical pharmacist.¹ The model is used by many residency programs to provide teaching experience for new residents. The layered learning model is being routinely utilized as the need for pharmacy practice experiential sites increases with the increase in the number of pharmacy schools. The number of pharmacy schools increased by 65% between 2000 and 2015 from 80 to 132.² According to the American Association of Colleges of Pharmacy (AACP), as of January 2021, there are 140 pharmacy schools across the nation and the demand for experiential sites continues to increase. Moreover, the increase in the number of pharmacy students graduating has led to an increase in the number of applicants seeking post-graduate residency training who need preceptorship experience. Due to the primary departmental responsivities of clinical pharmacists, accommodating an increasing number of pharmacy students is becoming challenging for institutions. LLPM is one approach that can be implemented to meet the increase in the demand for preceptorship. Some studies at community teaching hospitals have demonstrated that LLPM can increase medication reconciliation rates, discharge counseling, and the overall number of pharmacy interventions. ^(3,4) In addition, learners have reported an overall positive experience with LLPM.⁵

The LLPM model involves a minimum of three layers consisting of a senior preceptor, a pharmacy resident, and a pharmacy student.¹ The senior preceptor oversees the entire rotation experience with responsibility for the submission of evaluations and patient care. The second level of precepting consists of the pharmacy resident, who serves as the primary preceptor for the pharmacy student. Pharmacy students are incorporated into the third level of the learning model with active involvement in patient care activities. Loy et al reported on the implementation of the LLPM at a tertiary medical center with a 4-step process which includes orientation, pre-experience planning, implementation, and postexperience evaluations.¹ There are various benefits to implementing LLPM in teaching medical institutions which include maximizing the number of learners, improving efficiency, and enhancing quality improvement opportunities.¹ For the resident, the LLPM provides teaching experiences at different learning levels, enhances leadership skills, and increases clinical and teaching decision-making. For health care institutions, even though there is not enough data to support improved patient outcomes, implementation of LLPM may increase pharmacy presence in clinical practice and can lead to an increase in pharmacist interventions and improve medication safety and patient satisfaction.³

Integration of LLPM into a residency program helps to encourage team-based learning between residents and pharmacy students and helps residents expand their roles as practitioner learners.¹ The LLPM also allows residents to engage in precepting other residents by participating in a teaching certificate program to fulfill the American Society of Health-System Pharmacists (ASHP) requirements. ASHP developed the Pharmacy Practice Model to expand pharmacist care for patients by capitalizing on the pharmacists' role in patient care teams, encouraging pharmacist training and board certification, expanding the use of technology, as well as promoting leadership roles in medication management and outcomes.⁶ With pharmacy residents sharing precepting duties with clinical pharmacists via LLPM, senior pharmacy clinicians may not have to compromise on their patient care responsibilities and have more time to actively participate in patient care tasks as well as continuing education programs. In addition, the American College of Clinical Pharmacy (ACCP) also encourages residency programs to incorporate a teaching experience component for pharmacy residents to develop as competent clinicians.⁷ Moreover, LLPM can help residents grow their leadership skills as they precept pharmacy students and directly get involved in patient care teams. Feedback from senior clinical pharmacists, residents and pharmacy students should regularly be assessed to continuously improve the learning experience. Feedback and evaluation can also be used to implement changes in applying the LLPM, such as improving orientation structure and updating objectives and expectations.  

There are some limitations to the LLPM, which include not being adopted at all practice sites and lack of enough data supporting the quality of learning for the pharmacy resident and student.¹ In addition, there need to be more studies conducted to compare LLPM to traditional precepting models head-to-head in evaluating learning and other outcomes. To be successful, the LLPM relies on the participation of all three levels, and a deficit in any of the layers of teaching can negatively affect the outcome for learners.

References

1. Loy BM, Yang S, Moss JM, Kemp DW, Brown JN. Application of the Layered Learning Practice Model in an Academic Medical Center. Hosp Pharm. 2017;52(4):266-272. doi:10.1310/hpj5204-266.

2. American Association of Colleges of Pharmacy. Academic pharmacy's vital statistics. http://www.aacp.org/about/pages/vitalstats.aspx. Accessed November 12, 2021. [Ref list]

3. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Delgado O, Kernan WP, Knoer SJAm J Health Syst Pharm. 2014 Nov 1; 71(21):1871-6. [PubMed] [Ref list]

4. Expanding care through a layered learning practice model. Bates JS, Buie LW, Amerine LB, Savage SW, Eckel SF, Patel R, Valgus JM, Rao K, Daniels R Am J Health Syst Pharm. 2016 Nov 15; 73(22):1869-1875. [PubMed] [Ref list]

5. A Study of Layered Learning in Oncology. Bates JS, Buie LW, Lyons K, Rao K, Pinelli NR, McLaughlin JE, Roth MT Am J Pharm Educ. 2016 May 25; 80(4):68. [PubMed] [Ref list]

6. American Society of Health-System Pharmacists. Pharmacy Practice Model Summit: Executive summary. Am J Health Syst Pharm. 2011; 68: 1079– 1085. [Google Scholar]

7. Havrda DE, Engle JP, Anderson KC, et al. Guidelines for resident teaching experiences. Pharmacotherapy. 2013; 33: e147– 161. [PubMed] [Google Scholar]