Just as face-to-face encounters can teach students and residents clinical and professional skills, incorporating learners into telehealth pharmacy practice can offer an experience that is unique, robust, and clinically challenging. Pharmacy-led telehealth patient encounters draw on different communication skill sets and allow students to engage in patient care remotely. Though challenging, adjusting or designing an experiential learning site to accommodate telehealth pharmacy practice models can be rewarding for preceptors, patients, and learners.
Training expectations and learning strategies for telehealth pharmacy practice rotations may differ based on whether the experience is an introductory pharmacy practice experience, an advanced pharmacy practice experience, or a postgraduate residency training experience.
INTRODUCTORY PHARMACY PRACTICE EXPERIENCES
Introductory pharmacy practice experiences (or IPPEs) generally consist of first-, second-, and even third-year pharmacy students seeking baseline exposure to general pharmacy practice. They may vary, however, depending on specific program duration and curriculum. Through short-term and long-term experiential opportunities, students can observe pharmacists and other members of the pharmacy team apply a wide variety of skills in different practice settings. IPPE rotations are structured to provide opportunities for career exploration across inpatient, outpatient, and specialized settings, as well as opportunities for student reflection, discussion, and professional development. Moreover, IPPE rotations allow student pharmacists to safely model techniques and practices under preceptor supervision. In 1997, the Accreditation Council for Pharmacy Education (ACPE) required experiential hours as part of a doctor of pharmacy (PharmD) degree. In this first reference, pharmacy students are generally required to complete at least 300 hours of IPPE experience divided between community and institutional practice settings.1 However, due to some of the inherent ambiguity in ACPE standards, significant variation in IPPE rotational design has been noted between pharmacy programs. Although each pharmacy program and state may have its own IPPE requirements for successful graduation and licensure, the overarching structure is intended to be roughly similar across the country. This chapter is not intended to provide an in-depth review of IPPE requirements; the reader is encouraged to reference the individual requirements of their pharmacy program and state.
In response to COVID-19 and its impact on didactic and experiential education opportunities, ACPE and the American College of Clinical Pharmacy (ACCP) released a joint statement to pharmacy programs across the country, declaring that “student opportunities using telehealth may count for ambulatory care or IPPE hours if they meet the competencies developed for your ambulatory care/IPPE rotations.”2 This signifies that educational organizations recognize that telehealth can serve an invaluable role in helping rotation sites meet curricular objectives and deadlines.2 In addition, ACPE and ACCP do not give specific guidance on how to conduct telehealth rotations. Innovation is encouraged, as long as standards and curriculum objectives are met.2
ADVANCED PHARMACY PRACTICE EXPERIENCES
Conversely, advanced pharmacy practice experience (APPEs) feature student pharmacists prior to graduation, seeking more intensive and complex pharmacy practice opportunities. In general, rotations tend to be longer than those of IPPE students, and experiences tend to have elevated complexities that are more akin to what is seen in practice. Although student pharmacists still require supervision by a pharmacy preceptor, far greater autonomy is expected and given. Each program and state may have its own APPE requirements for graduation and licensure; interested readers are encouraged to reference the individual requirements of their pharmacy program and state. According to Danielson et al.,3 the essential elements of core APPE experiences should include the following:
Inpatient General Medicine and Ambulatory Care APPE rotations:
Pharmacist patient care
Communication and education
Evidence-based medicine (EBM)
Practice-specific responsibilities (PSR)
Community Pharmacy APPE rotations:
Pharmacist patient care
Communication and education
Dispensing system and safety management
In a recent presentation, the executive director of ACPE wrote that while “the majority of APPE hours must involve direct patient-care … telehealth can be direct-patient care if designed appropriately.” This again demonstrates that, with enough creativity and innovation, any APPE rotation can utilize telehealth to provide a challenging and personally rewarding experience for student pharmacists.4
Following graduation, many pharmacy students choose to complete postgraduate training. Residencies are traditionally classified as either postgraduate year 1 (PGY1) or postgraduate year 2 (PGY2), and residents can opt to pursue training in areas ranging from population-focused (e.g., pediatrics or geriatrics), disease-focused (e.g., oncology, cardiology, or others), or specialized settings (e.g., critical care, ambulatory care, pharmacogenomics, management). The American Society of Health-System Pharmacists (ASHP) maintains specific accreditation standards for both PGY1 and PGY2 residencies. Successful completion of an ASHP-accredited PGY1 program or a PGY1 program in candidacy status seeking accreditation is often required to progress to an ASHP-accredited PGY2 program. In general, the ASHP-required competency areas and goals for PGY1 residencies are available at https://www.ashp.org.5 While they will not be listed in full here, several observations can be made.
For one, there is significant overlap in several of the core competency areas and goals for residency training. While evaluation criteria are subject to change with time, a number of principles relating to patient care, education, leadership, and practice management are timeless and are not easily rooted out. It is important for preceptors, given the inherent ambiguity and subsequent variation found between IPPE, APPE, and resident rotations among programs, to identify and develop rotational experiences that draw on these core skill sets, especially when creating telehealth-based rotations.
Additionally, when reviewing the individual components of each competency area for both PGY1 and PGY2 residencies, two competencies have opportunities for telehealth: R1: Patient Care and E3: Initiating an Advanced Practice Area-Related Service. R1: Patient Care, for example, entails interacting with patients and caregivers, ensuring continuity of care between different settings, and collecting information on which to base safe and effective therapy.5 Conversely, by designing, implementing, and assessing a new telehealth-based service (as outlined in E3), residents can develop the skill sets needed to fully utilize this treatment modality.
The core elements of each level of pharmacy learner experience are required to transition with the learning site as patient care pivots to pharmacy telehealth practice. Developing innovative learning opportunities and activities that continue to allow mastery of essential pharmacy skill sets will ensure successful telehealth pharmacy practice teaching and learning. Telehealth can be incorporated into each of the five pieces of the Joint Commission of Pharmacy Practitioners Pharmacists’ Patient Care Process (Figure 15.1).6 In the Practitioners Pharmacists’ Patient Care Process, essential skills for pharmacy graduates and postgraduates are identified by preceptors to include areas of entrustability, including communication, teamwork, and professionalism.7 Once essential skills have been identified, preceptors can follow the guidance from ACPE and ACCP to create innovative telehealth rotations that meet competencies and standards.
Tool for Critical Skill Coverage in Pharmacy Telehealth Practice
Identified Elements of Essential Pharmacy Practice Skills for Pharmacy Graduates:
Patient-Centered Care, Pharmacists’ Patient Care Process (see Figure 15.1)
Communication with patients, preceptors, and healthcare team
Vital signs and laboratory value evaluation and assessment
FrenzelJ, EukelH, NevilleM, et al.Essential skills for pharmacy graduates reported by advanced pharmacy practice experience preceptors. Curr Pharm Teach Learn. October 2015;700-704. doi: 10.1016/j.cptl.2015.06.005.
FrenzelJ, EukelH, NevilleM, et al.Essential skills for pharmacy graduates reported by advanced pharmacy practice experience preceptors. Curr Pharm Teach Learn. October 2015;700-704. doi: 10.1016/j.cptl.2015.06.005.)| false