Priming the Preceptor Pipeline: Collaboration, Resources, and Recognition

Background and Charges

According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Professional Affairs Committee is to study issues associated with the professional practice as they relate to pharmaceutical education, and to establish and improve working relationships with all other organizations in the field of health affairs. The Committee is also encouraged to address related agenda items relevant to its Bylaws charge and to identify issues for consideration by subsequent committees, task forces, commissions, or other groups.

President Cynthia Boyle established the theme of “Capitalizing on Foundations of Citizenship” for the 2015-2016 standing committees.¹ According to President Boyle, as the academy prepares our nation’s future pharmacists and scholars, the academy is leveraging all of the stakeholders who invest in academic pharmacy.¹ A key group of stakeholders in our academy are pharmacy preceptors. Our preceptors are one group of citizens that bears responsibility for a significant portion of the preparation of practice-ready graduates. Estimated to be approximately 30,000 pharmacists strong, most accept responsibility for precepting Advanced Pharmacy Practice Experiences (APPE) [and often Introductory Pharmacy Practice Experience (IPPEs) as well] with little or no direct compensation. The 2015-16 Professional Affairs Committee is charged to:

• (1) Study the current relationship between the colleges/schools of pharmacy, our volunteer preceptors, and the organizations that employ them. The focus will be defining the needs of this population of practitioners for continuing professional development, recognition and support to assure that they are prepared to assume increasing responsibility for assuring that Doctor of Pharmacy graduates are both practice- and team-ready; and

• (2) Assess the unique demands of precepting in an interprofessional care environment.

Members of the 2016 PAC include faculty representing multiple disciplines from various schools/colleges of pharmacy and professional staff representation from the American Pharmacists Association (APhA), the American College of Clinical Pharmacy (ACCP), the American Society of Health-System Pharmacists (ASHP) and the National Association of Chain Drug Stores (NACDS). Prior to any in-person meetings of the committee, pertinent background information and resource materials were distributed. The professional staff representatives met on September 21, 2015 to discuss their programs, initiatives and services involving preceptors and their development, as well as the role(s) that national pharmacy organizations can have with preceptors and their employers. A conference call was held with the entire committee to develop a strategy for addressing committee charges as they pertain to volunteer pharmacy preceptors—those preceptors who are not full-time employees of a school/college of pharmacy. The academic members of the 2016 PAC met for a day and a half, with the other 2015-16 standing committees, on November 11-12, 2015 in Toronto, Canada to discuss the various facets related to this issue, as well as to develop a process and strategies for addressing the charges. Following the process development and delegation of assignments related to the committee charges, the PAC communicated via electronic communications as well as through personal exchanges via telephone and email.

In developing the strategy to address their charges, the PAC considered numerous factors that contribute to the training and continuing development for volunteer preceptors. The Accreditation Council for Pharmacy Education (ACPE) release of Standards 2016 influences all aspects of pharmacy education, including preceptors and experiential education.² Previous professional affairs committee reports pertaining to preceptor training and recognition,.³ the role of experiential education in practice⁴ and the collaboration of academic pharmacy and pharmacy practice⁵ were reviewed. The importance of preceptor training on the evolving developments in pharmacy, including Entrustable Professional Activities (EPAs) for pharmacy being developed by the 2016 AACP Academic Affairs Committee, the Pharmacist Patient Care Process,⁶ and interprofessional precepting⁷ were also discussed. Finally, a review of current AACP policy was conducted and one policy was found which pertains to the 2016 PAC charges:

AACP encourages employers and stakeholders to identify and develop potential preceptors in their organizations and provide performance evaluation which incentivizes and recognizes preceptors’ contributions to pharmacy education. (Source: Experiential Education Section, 2008).

The result is the following report, which explores the role of academic pharmacy in preceptor continuing professional development, as well as the need for academic pharmacy to work with the practice community with regards to preceptor training and development. The PAC identified the following areas related to their charge which serve as the framework for the report as well as the generation of proposed policy statements, recommendations to AACP and suggestions to schools/colleges of pharmacy:

• • The Value of Precepting

• • The Continuing Professional Development (CPD) of Volunteer Preceptors

• • Academic Pharmacy and Practice Collaboration: The Case for Volunteer Preceptors

• • The Recognition of Volunteer Preceptors

• • Interprofessional Education/Practice and the Volunteer Preceptor

The Value of Precepting

Experiential education is a major component of schools/colleges of pharmacy curricula and an integral part of the pharmacy profession. The experiential component of education became an academic requirement by the ACPE standards of 1974⁸ and has evolved to comprise almost 30% of the pharmacy education requirements as mandated by the current IPPE and APPE components found in Standards 2016.² The National Association of Boards of Pharmacy (NABP) acknowledges experiential education as part of the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (Model Act) which provides boards of pharmacy with model language that may be used when developing state laws or board rules.⁹ The Model Act provides guidance on pharmacy interns, preceptors, pharmacy practice experience programs, and the evidence of completion of pharmacy practice experience credit under the instruction and supervision of a preceptor. Precepting is an integral part of experiential education which promotes the competence, familiarity, confidence and security of student pharmacists in a new environment.

Standards 2016 has a specific standard pertaining to preceptors. Standard 20 states that the college or school must have a sufficient number of preceptors (practice faculty or external practitioners) to effectively deliver and evaluate students in the experiential component of the curriculum.² Key elements within the preceptor standard provide guidance on preceptor criteria, student-to-preceptor ratio, preceptor education and development, preceptor engagement and experiential education administration. Preceptor education and development mandates that schools/colleges of pharmacy orient preceptors to the program’s mission, the specific learning expectations for the experience outlined in the syllabus, and effective performance evaluation techniques before accepting students and also foster the professional development of its preceptors commensurate with their educational responsibilities to the program.²

Academic pharmacy and other health professions institutions have implemented a diverse array of programs to meet the preceptor development requirement for experiential education. Vos and Trewet outline a comprehensive development program, which includes a combination of live sessions, online presentations, newsletters and onsite visits, which can be used to provide initial and continual training to preceptors.¹⁰ The overall reaction from preceptors to the preceptor development activities was positive, with preceptors perceiving enhanced attitudes, skills and knowledge.¹⁰ Other preceptor development programs implemented by schools/colleges of pharmacy include experiential education consortia utilizing an online preceptor development program,¹¹ a continuing education home study course,¹² the creation of an academy of preceptors,¹³ and a training program comprised of two 6-hour sessions which included lectures, discussion groups, hands-on activities and role-playing exercises.¹⁴ In 2011, the Nebraska Medical Center implemented a multi-faceted program to develop the teaching and clinical skills of pharmacy residency preceptors, which could serve as a model for other institutions in planning and evaluating programs to ensure the continued skills and knowledge needed for pharmacy residency training.¹⁵

A survey by Hartzler, et al., sent to pharmacy residency coordinators and preceptors indicated that 50% of preceptors reported self-study and continuing education sessions at professional meetings as their primary methods of preceptor development and over 90% of respondents felt they could benefit from continuing education tailored for residency preceptor development.¹⁶ Kassam, et al., developed an interprofessional web-based teaching module program for preceptors called E-tips for Practice Education which is comprised of eight modules focused on various aspects of precepting.¹⁷ The preceptor ratings on the modules were high with more than 80% rating each of the eight modules as “very applicable” or “extremely applicable” and future studies examining the benefits of these modules into various health professions practice setting is warranted.¹⁷ Texas Christian University developed an interdisciplinary preceptor team (IPT) model, which involved various health professionals including social workers, pharmacists, and physicians coming together to precept clinical nurse learner (CNL) students due to the lack of CNLs trained to serve as preceptors.¹⁸ Ratings of the preceptor model by preceptors and students were all satisfactory.¹⁸ Overall, schools/colleges of pharmacy and other health professions utilize a variety of formats to educate and train preceptors initially and continually over the course of service to the institution.

Although schools/colleges of pharmacy play a significant role in the initial and continual training of preceptors to be effective drivers for experiential education, other organizations such as national pharmacy associations also acknowledge the value of precepting by providing education and training for preceptors. The four national pharmacy associations represented on the 2016 PAC have an established commitment to providing preceptor training and development in various formats (i.e., meetings, online, webinars, continuing education [CE] programs) on a variety of topics (Table 1 provides some of the preceptor activities for each association). The 2016 PAC invited the other national pharmacy organizations to respond to a series of questions regarding their training/continuing development for preceptors. Of the fourteen organizations invited, there were responses from seven organizations that provided information regarding preceptor development training (Table 2 provides a summary of this information). The majority of these associations, as well as all four of the national pharmacy associations, agree that there is a need for the national pharmacy organizations to work together in the area of preceptor development especially in the areas that are germane to all pharmacy preceptors regardless of practice setting.

Preceptors are an important facet for the experiential education (learning) experience as they assist student pharmacists in actualizing didactic material and related concepts in a real-world setting. With the precepting responsibility, preceptors operationalize the statements “I will accept the lifelong obligation to improve my professional knowledge and competence” and “I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists” which are included in the Oath of a Pharmacist.¹⁹ Preceptors are part of the Value Proposition of pharmacy education and pharmacy practice⁴ and should be provided with continual training and development. This training and development does not only encompass how to provide an effective experience or how to manage conflicts with a student pharmacist, but also involves learning and applying evolving elements pertaining to pharmacy, health care and experiential education. For example, once the EPAs for pharmacy are developed, preceptors will have to know them, be able to apply them to their practice setting and be able to utilize them to assess student pharmacists on experiential rotations.

Precepting can be viewed as a highly transactional aspect for pharmacy education. Schools/Colleges of pharmacy pay, in some manner, for preceptors to educate students via experiential education IPPEs and APPEs. A recent study by Danielson, et al., revealed that payments to sites, preceptors (stipends) and sites/preceptors (on a per rotation basis) from schools/colleges of pharmacy accounted for over one-half of the total cost for experiential education (excluding costs for supplies and equipment).²⁰ The questions of how precepting funds could and should be spent are important ones and the 2016 PAC spent consideration time discussing this issue. Based on the constantly evolving changes in education and practice and the need for preceptors to be current in the diverse aspects that affect experiential education, the PAC believes that the academy should transition away from paying experiential education sites and preceptors on a per rotation or per student basis to paying to support the professional development for the advancement of preceptors (i.e., provide CPD avenues, support/supplement board certification). Sites that continue to be paid for experiential education should be encouraged to utilize the funds for preceptor CPD and schools/colleges of pharmacy can be involved to develop the programming/support to be available to preceptors for their continual development. The future of the profession is highly dependent on preceptors and the profession must work together to provide the necessary tools to have preceptors be the most effective teachers and practitioners available for student pharmacists.

Policy Statements (Adopted by the AACP House of Delegates July 28, 2016), Recommendations and Suggestion:

Policy Statement 1: AACP encourages pharmacists in all practice settings to be a preceptor to contribute to the future of the profession and the evolving health care system.

Policy Statement 2: AACP encourages members of the academy that use the traditional transactional model of experiential education (i.e., payment to an experiential preceptor/site per student per rotation) to transition to a model that reinvests experiential education resources to support the professional development/advancement of preceptors.

Recommendation 1: AACP should collaborate with other national pharmacy organizations to identify and disseminate modules for baseline preceptor training to schools/colleges of pharmacy.

Recommendation 2: AACP should collaborate with other national pharmacy organizations to develop and disseminate best practices regarding precepting across all phases of pharmacy education.

Suggestion 1: Schools/colleges of pharmacy should work with their board of pharmacy to reduce the barriers faced in experiential education.

The Continuing Professional Development (CPD) for Volunteer Preceptors

The Continuing Professional Development (CPD) of preceptors is both an education and practice consideration and, therefore, is a potential area of collaboration between academic pharmacy and pharmacy practice. CPD is defined by ACPE as a self-directed, ongoing, systematic and outcomes-focused approach to lifelong learning that is applied into practice.²¹ CPD involves the process of active participation in formal and informal learning activities that assist individuals in developing and maintaining continuing competence, enhancing professional practice, and supporting achievement of career goals.²¹ CPD involves an ongoing cycle of reflecting, planning, learning, and evaluating, while recording and reviewing all of these aspects for continued development. Precepting student pharmacists and other learners could be a vital part of CPD for health care professionals. Tofade, et al, encouraged preceptors from seven schools/colleges of pharmacy to utilize the CPD resource provided by ACPE to guide their development as educators.²² Although the response rate from the invited preceptors was low, those who responded by receiving information about CPD and answering questions provided important information. The respondents indicated that the preceptor CPD portfolio provided motivation to reflect, plan and set more defined and realistic goals for student pharmacists, pharmacy residents and themselves as educators and could be a valuable starting point for promoting preceptors’ reflection, planning and action related to rotation management, professional teaching and student learning goals.²²

To date, there is no standardized method by which each school selects preceptors and the recruitment is generally based on preceptors’ interest or recommendations from the practice site. In general, pharmacists enter the role of preceptorship without formal teaching experience or knowledge in the art of precepting. Therefore, schools establish preceptor development programs (PDPs) which typically accompany credits for continuing education and address topics relevant to teaching and learning, especially targeting adult learning.^10,12,23 To date, there is no standardization of PDPs with regard to learning objectives, outcomes, and platform/delivery of education. Additionally, few programs incorporated online-based PDPs for their preceptors which would better suit the needs of the practicing preceptor. There are several descriptions in the literature about the development and implementation of PDPs in different preceptor cohorts, with outcomes such as feasibility, participant satisfaction, and challenges; however, few programs have evaluated the effectiveness of their PDPs both at the preceptor and student levels.

A few studies have addressed the needs for preceptor development in pharmacy education. Sonthisombat²⁴ demonstrated that preceptors tend to overestimate the quality of their performance in teaching compared with students’ evaluations and concluded that PDPs are needed for pharmacy preceptors. Paravattil²⁵ evaluated preceptors’ perception of their ability to a given set of learning objectives and found that most of them rated their ability as high. Another study demonstrated that pharmacy residency preceptors expressed having learning and educational support needs in the areas of communication skills, giving effective feedback, clinical knowledge, and mentorship programs.²⁶ The preceptors also preferred 1-day training sessions or online learning modules every other year for ongoing educational support. As mentioned previously, Vos and Trewet¹⁰ developed and implemented a comprehensive PDP that included live and recorded online programming, a preceptor manual, a preceptor newsletter, live events, and one-on-one practice site visits; they also collected over 5,000 evaluations of preceptor performance by students.

There are several papers discussing preceptor development and assessment via an online platform. Romanick²⁷ developed a pilot PDP using virtual communities and networks via computer-mediated conferencing, and evaluated preceptors’ satisfaction with the approach. The responses from 39 preceptors (66% response rate) found that the program received positive feedback and participation rates; however, the program had challenges related to technology and inconvenience with timing of sessions. Davison, et al.²⁸ developed an electronically available preceptor-training video and assessed preceptors’ training preferences. The investigators found that a majority of respondents (1) preferred electronic versus live training program regardless of age, (2) would participate in future electronic training programs, and (3) have the available resources to participate in electronic training. Kassam, et al.²⁹ developed an online, self-directed training program for preceptors and evaluated their confidence in teaching and the helpfulness of the training for their teaching. The results demonstrated that the PDP improved the preceptors’ confidence and knowledge in patient care; however, this study did not investigate the impact of the training at a higher level. The flexibility of PDPs to accommodate preceptors’ preferences would be important for the success of preceptor development overall.

The PAC recommends that a preceptor self-assessment tool be developed to assist in the continuing professional development of preceptors. The following areas should be investigated in the development of a preceptor self-assessment tool:

• • Determine the purpose and focus areas of a preceptor self-assessment tool

  • a. Purpose of self-assessment tool

    • a. Accurate self-assessment of teaching abilities

    • b. Career development/progression

    • c. Requirement by standards of the affiliated programs

    • d. Self-efficacy

  • b. Focused areas

    • a. Building portfolio

    • b. Current knowledge in teaching

    • c. Current style of teaching

    • d. Demonstration of critical thinking skills

    • e. Knowledge of ACPE standards for students

    • f. Management of challenging students

    • g. Mentoring

    • h. Providing feedback

    • i. Recognition of students’ learning style

    • j. Student evaluation

    • k. Time management

• • Determine the areas that should be germane to all preceptors regardless of the learner (Preceptor 101 information or Standards for Preceptors)

  • . ACPE standards for Doctor of Pharmacy students

  • a. Cultural competency

  • b. Demonstrating mentorship and leadership

  • c. Different instructional strategies

  • d. Effective integration of students in practice

  • e. Effective written and oral communication

  • f. Learner assessment

  • g. Pedagogical knowledge (effective teaching)

  • h. Providing meaningful and constructive feedback

  • i. Setting appropriate expectations

  • j. Time management

  • k. Understanding and teaching in an interprofessional setting

• • Develop training areas related to preceptors working across different learner groups

  • a. Cultural differences or barriers

  • b. Different competency levels among learners

  • c. Different schools with different schedules, forms, evaluations

  • d. Effectiveness of layered learning model

  • e. Having a different preceptor than assigned (e.g., technician, nurse)

  • f. Motivating and challenging learners

  • g. Online vs. in-person instruction

Recommendations

Recommendation 3: AACP should collaborate with other national pharmacy organizations to develop and disseminate best practices in preceptor development, including a preceptor self-assessment tool, across all phases of pharmacy education.

Recommendation 4: AACP should add questions to the required preceptor surveys regarding self-efficacy and CPD needs.

Academic Pharmacy and Practice Collaboration: The Case for Volunteer Preceptors

Academic pharmacy must work effectively with employers from the pharmacy profession to enhance the training of student pharmacists while helping the industry meet its production and patient outcome needs. The needs of the pharmacy industry to train student pharmacists are varied, and may reflect the perspectives of the individuals within the organization. Pharmacists who staff the pharmacy and are directly involved with patient care and drug distribution may be advantaged by having student pharmacists work by their side, learning through hands-on experience, and helping to process the daily workflow. However, if having the trainee interferes with the workflow, and slows down the normal work productivity of the staff pharmacist, there may be a reluctance to participate in experiential education.

Mid-level managers may see student pharmacists as additions in manpower to the workforce, and depend on the added productivity of the trainee to meet production requirements and patient care needs. Student pharmacists may extend the patient care services of the pharmacy and allow for services such as medication reconciliation or medication education to be consistently provided. In a review of studies examining the value of the student pharmacist to experiential practice sites, student pharmacists were found to confer economic and clinical benefits that may exceed the costs associated with their supervision and training.³⁰

There are excellent examples of the integration of students into the workflow such that the students provide manpower and expanded provision of services in otherwise busy retail and health-system environments. The use of block-scheduling^31,32 and layered learner models³³ in experiential education have generated optimal outcomes for the student pharmacist, practice site and preceptor.

To better understand how to best engage student pharmacists in hands-on learning that is meaningful for and challenging for the learner, it would be advantageous to identify and communicate these and other best practice models for student pharmacist experiential learning in both community and institutional pharmacy settings, with specific interest in identifying student output (activities and other services provided), cost savings or billable services associated with student pharmacist work, and assess the optimal student-to-pharmacist ratios. AACP has collaborated with MedHub LLC (through its online software E*Value), the University of Buffalo Health Sciences and Texas Tech University Health Sciences Center School of Pharmacy to measure student pharmacist contributions in both inpatient and outpatient practice settings during APPE rotations.³⁴ This study will also explore the value and purpose of the student pharmacist intervention documentation process, as any student pharmacist completing an APPE rotation can participate utilizing a specific data entry template to document their interventions. The data collection period is the 2015-16 and 2016-17 academic year, with study results anticipated in fall 2017.

AACP conducts annual surveys of preceptors, in addition to other curriculum quality surveys, to assist member schools/colleges in continuous program improvement and accountability (accreditation) purposes.³⁵ The preceptor survey, which has been administrated each year since 2008, contains a demographic section as well as questions regarding experiential education communication, pharmacy school curriculum and student preparation and resources/support for preceptors. Table 3 provides information on the resources/support questions from the preceptor survey for the years 2008 through 2015. While the majority of preceptors either strongly agree or agree with the resources/support questions, the highest of these responses have been for the questions “The student-to-preceptor ratios at my site are appropriate to maximize learning” and “There are adequate facilities and resources at the practice site to precept students.” The lowest percentage of responses of strongly agree and agree have been to the questions “The college/school has an effective continuing professional development program for me that is consistent with my preceptor responsibilities” and “The college/school provides me with access to library and educational resources” which suggests that there are opportunities for additional preceptor support.

It’s important to articulate mutually beneficial outcomes from the student pharmacist experiential learning experience, and conducting a series of focus groups or surveys with pharmacist managers and academic deans or experiential directors to identify the outcomes that meet the corporate needs of both entities may be an ideal manner of obtaining these data. Senior management in pharmacy organizations may envision the relationship between the business and colleges of pharmacy as a fruitful relationship that allows the training and selection of future employees, while receiving modest revenue for the student pharmacist opportunity to engage with the organization’s patients and systems.

To better understand the complex relationship between academic pharmacy and the pharmacy businesses that serve as educational extenders, several information gathering tasks should be explored, including:

• • Gather unpublished work, data, or perceptions from other national association efforts through discussion with organizations offering preceptor programing;

• • Conduct a series of focus groups or surveys with pharmacist preceptors from community and institutional settings (these should include chain and independent community pharmacy, and small, mid-size, and large institutional settings);

• • Conduct a series of focus groups or surveys with senior student pharmacists or recent pharmacy school graduates to identify pharmacist preceptor development needs;

• • Conduct a series of focus groups or surveys with experiential directors to identify pharmacist preceptor development needs; and

• • Conduct a series of focus groups or surveys with mid-level pharmacy managers to identify the deficits or deficiencies in first-time pharmacist employees.

In an effort to examine this issue during the 2015-16 academic year, the 2016 PAC conducted two focus groups during the 2016 APhA Annual Meeting in Baltimore, MD on March 5, 2016. One group was comprised of pharmacist preceptors and the other was comprised of pharmacy employers. Focus group invitations were sent out to APhA Annual Meeting attendees in mid-February 2016, with two additional reminder notices following the initial invitation. Information on both focus groups is provided in Table 4, and the focus group guides utilized for both groups can be found in Appendix 1. Due to the small number of focus group participants and the small number of pharmacy practice areas represented in the focus groups, the PAC encourages additional avenues to gather input on these issues from preceptors and pharmacy employers in order to add to this preliminary examination of the issues regarding preceptor continuing professional development needs.

Pharmacy Preceptor Focus Group

Four current preceptors participated in the PAC pharmacy preceptor focus group held during the 2016 APhA Annual Meeting. The following elements were expressed and/or agreed upon by the majority of the pharmacy preceptor focus group participants:

• • The decision for them to become a preceptor was based on them wanting to have a positive impact on the future of pharmacy;

• • A standardized program for the training of preceptors, including the expectations of preceptors, would be beneficial;

• • Avenues for both new and established preceptors to chat and share information would be very useful;

• • A common evaluation form for rotations, with elements that can be customized for a particular site or schools, would reduce the administrative burden for preceptors (especially for those who precept for more than one school/college of pharmacy);

• • Preceptors need more hands-on training, especially in the area of working with difficult students and how to provide effective feedback;

• • Preceptor development opportunities should include attending national, regional, state, and/or local professional meetings and having training opportunities available virtually and on-demand;

• • Preceptor support that would be of benefit includes library access from schools/colleges of pharmacy, being subsidized for attending preceptor training (either by being granted the time off with pay or receiving money to assist with attending a meeting); and

• • Overall, student pharmacists are adequately prepared for and exhibit professionalism during their rotations

None of the focus group preceptors receives payment or stipends for being a preceptor. When asked about the proposed PAC policy statement regarding transitioning from paying sites or preceptors on a per student/per rotation basis to utilizing such funds to focus on preceptor development and advancement, everyone in the focus group agreed with the proposed policy statement and its intended purpose.

The focus group participants agreed that having student pharmacists on rotation year-round is very beneficial for preceptors, their practice sites and ultimately patients. These preceptors expressed interest in having better communication with schools/colleges of pharmacy (especially on pharmacy curriculum changes) and having more opportunities to practice the skills needed to be good preceptors. The detailed notes from the preceptor focus group are included in Appendix 2.

Pharmacy Employer Focus Group

Seven staff members representing six national community (retail) pharmacy organizations participated in the PAC pharmacy employer focus group held during the 2016 APhA Annual Meeting. The following elements were expressed and/or agreed upon by the majority of the pharmacy employer focus group participants:

• • Precepting is viewed in a positive manner by the companies represented, as it provides leadership opportunities, the ability to develop future leaders and allows student pharmacists to experience community pharmacy in a “real-world” setting;

• • It would be beneficial for the employers/supervisors of preceptors to have access to preceptor training (or the training received by their preceptors);

• • It would be beneficial to have more consistency for rotation logistics, including rotation schedules, rotation objectives, and student evaluation rubrics;

• • Pharmacy employers would like to have more control over the sites and preceptors that schools/colleges of pharmacy place students, as they know the best locations for a rotation experience in their company;

• • Preceptors need more training on how to work with the “marginal” student on rotation, which includes how to evaluate students and how to have difficult conversations;

• • Preceptors need more opportunities for continuing education on new areas of pharmacy, hands-on training on coaching and giving feedback to experiential education students and training on how to be organized to be more effective in precepting;

• • Preceptor training needs to be available for the needs of the preceptor (i.e., offer multiple “live” training days, offer webinar on-demand training); and

• • Leadership, clinical and management skills are needed by community pharmacists and pharmacist preceptors in the community setting.

None of the participating companies represented in the pharmacy employer focus group receives payment or stipends for being a preceptor. In fact, the few that have received payment for students being on rotation at one of their stores said that they returned the payment to the school/college of pharmacy. When asked about the proposed PAC policy statement regarding transitioning from paying sites or preceptors on a per student/per rotation basis to utilizing such funds to focus on preceptor development and advancement, everyone in the focus group agreed with the proposed policy statement and its intended purpose.

The focus group participants believe that there needs to be more community pharmacy representation at the table(s) of influence at schools/colleges of pharmacy (i.e., curriculum committee, curricular review committees) and there needs to be more community pharmacy-focused faculty so that this practice setting can have more of an influence during didactic and service learning. They also expressed interest in developing additional partnerships between community practice and academic pharmacy to ensure that preceptors optimally integrate with the learning and training of future pharmacists. The detailed notes from the pharmacy employer focus group are included in Appendix 3.

Recommendations and Suggestion:

Recommendation 5: AACP should institute a national advisory board of pharmacy employers and national pharmacy organizations to collaborate with AACP on preceptor and other educational and practice issues.

Recommendation 6: AACP should lead the development and implementation of standardized assessments for all required APPEs.

Suggestion 2: Schools/colleges of pharmacy should work directly with pharmacy employers to recognize pharmacy preceptors.

The Recognition of Volunteer Preceptors

The 2016 PAC discussed the importance of recognizing volunteer preceptors for their work and service to the schools/colleges of pharmacy. While some colleges provide direct compensation to preceptors for taking IPPE and APPE students, others do not. Alternately, they may compensate practice sites which may or may not have a direct benefit to the individual preceptor. Regardless of remuneration methods, recognition of preceptors in other, more prestigious ways, was something the committee members agreed was an important initiative.

Credentialing

A credential is documented evidence of professional qualifications.³⁶ Credentialing refers to one of two processes: the process of granting a credential or the process by which an organization or institution obtains, verifies, and assesses an individual’s qualifications to provide services.³⁶ Credentialing in precepting should be developed for preceptors who have completed specified training programs developed by national pharmacy organizations such as AACP, ASHP, and APhA. AACP should include an item in the AACP annual preceptor survey to determine the value preceptors see in this type of offering. A universal credentialing process could create a way to nationally recognize fully trained preceptors. This could benefit preceptors who take students from multiple schools/colleges and would decrease the number of site-specific preceptor training programs the preceptors need to complete. It could also serve as a national database for outstanding preceptors that could be recognized by multiple schools/colleges. The credentialing process for preceptors should be different than current board certification programs. Volunteer preceptors should not be charged a fee to participate, as they are acting in a service role and supporting the schools/colleges of pharmacy. The cost of such a program should be offset by the schools/colleges and the funds that may be utilized to pay preceptors could be utilized for the development and maintenance of this program.

Awards

Many schools/colleges of pharmacy offer awards to outstanding preceptors. These often come in the form of Preceptor of the Year awards, which are sometimes further classified by length of time in practice (new and veteran preceptors) or by practice setting (inpatient versus outpatient). Schools/colleges of pharmacy should continue to grant these awards, and should consider optimizing the number of awards given to provide recognition and praise to multiple qualified preceptors. AACP instituted the annual Master Preceptor Recognition Program in 2014 to recognize volunteer preceptors who have demonstrated sustained commitment to excellence in experiential education and professional practice.³⁷ Schools should consider nominating their own preceptor award winners for a national award such as the Master Preceptor Recognition Program to further promote the preceptor’s efforts and accomplishments. National pharmacy organizations such as AACP, ASHP, and APhA should consider holding events during the annual meetings that recognize outstanding preceptors. These events could also recognize volunteer preceptors for their number of years of service to the profession as a preceptor (i.e., 5 years, 10 years, etc.).

Other Forms of Recognition

Preceptors can be offered affiliate faculty appointments within the schools/college of pharmacy. These appointments should have meaning, be clear in the appointment letter, and be reviewed by the school/college annually. The title should be clearly explained and should recognize the pharmacist as a preceptor. Promotion guidelines (if applicable to the position) should be clearly delineated. Preceptors should also be recognized by the state pharmacy organizations. AACP can work with the National Alliance of State Pharmacy Associations (NASPA) and the individual state pharmacy organizations on this initiative and could provide programming at the National Pharmacy Preceptors Conference for IPPE and APPE preceptors. Special recognition should be given to those preceptors who are promoted through the schools/colleges of pharmacy.

Outstanding preceptors should be entitled to discounts on state and national pharmacy organizations’ programming. They should also receive discounts on board certification memberships and schools/colleges of pharmacy should promote their outstanding preceptors to external constituents. Having posters or electronic boards posted throughout the college that display the current outstanding preceptors is a way to inform visitors to the college, prospective students and current students, how important it is to serve as a preceptor. At the local level, press releases should be sent out to all forms of public media. The preceptor’s employer should be made aware of the accomplishments of the preceptor, as this may lead to positive outcomes on future performance evaluations.

Preceptors who are recognized in the ways mentioned above should be invited to serve on panels at local and national pharmacy meetings and asked to participate in focus groups designed to enhance experiential learning across the country. They should be held up to the masses as role models for the profession and their methods and strategies for mentoring students should be glorified and shared with others within and outside of pharmacy.

Recommendations and Suggestions:

Recommendation 7: AACP should collaborate with other national organizations to recognize institutions and organizations who excel in precepting.

Recommendation 8: AACP should invite the AACP Master Preceptors to the AACP annual meeting to be recognized by the academy.

Suggestion 3: Schools/colleges of pharmacy should develop new ways to recognize preceptors, including those who have been preceptors for many years.

Suggestion 4: Schools/colleges of pharmacy should recognize institutions and organizations who excel in precepting.

Interprofessional Education/Practice and the Volunteer Preceptor

Interprofessional Education (IPE) has become a focus and expectation in health professions education over the past several years. Although at varying degrees, IPE is mandated in the accreditation standards for most of the health professions.^2,38 The World Health Organization (WHO) framework for action on IPE and collaborative practices states that IPE occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.³⁹ While the Interprofessional Education Collaborative (IPEC) has contributed to several key resources for IPE and competencies for Interprofessional Collaborative Practice,^40,41,42 there is limited information regarding the extent to which volunteer preceptors are knowledgeable and competent about IPE and interprofessional practice. This provides a tremendous opportunity for the health professions to collaborate in this effort.

There are several resources that have been established to assist preceptor development related to IPE and interprofessional practice. To assist with the assessment of the IPEC Competencies, the Canadian Academic Health Council developed an Interprofessional Collaborator Assessment Rubric.⁴³

The National Center for Interprofessional Practice and Education has established a Nexus Learning Toolkit that has elements designed to support preceptors in any healthcare profession who wish to precept interprofessional practice and education at their practice site.⁴⁴ The toolkit provides online modules and tools available in a variety of formats including web-based modules for preceptor development, active-learning materials and facilitator guides for face-to-face workshops for preceptor development, interprofessional education materials to be used with learners to enhance their practice experiences and interprofessional collaborative practice materials and other resources being used across the country. These resources are divided into three areas: those designed for (1) the preceptor as a learner of inteprofessional practice and education, (2) the preceptor as an Interprofessional Educator and (3) the preceptor as an Interprofessional Champion. The University of Washington’s Center for Health Sciences Interprofessional Education, Research and Practice founded in 1997 is one of the first collaborative centers for IPE and since 2010 has provided resources for educating faculty to be leaders and facilitators in IPE.⁴⁵ There are many other IPE centers throughout the country who have resources for faculty (including preceptors) interprofessional education and development.^{46,47,48,49,50,51,52,53}

Academic pharmacy has begun to examine IPE in experiential education. The AACP Experiential Education Section has a task force examining Intentional Interprofessional Education (IPE) in Experiential Education (EE). The task force has proposed the following definition of intentional IPE within EE:

• • “Intentional inteprofessional education in experiential learning is the explicit effort by preceptors and practice sites to create/foster educational opportunities or activities designed specifically to achieve interprofessional educational competencies.” ⁵⁴

This task force through it is activities during the 2015-16 academic year, which includes quantifying the amount of and characterizing the types of intentional IPE occurring within the EE section, will provide important baseline information that the section and the academy can utilize to build on future communications and collaborations within and outside of the academy to build resources and tools that can assist in developmental needs for preceptors and experiential education sites.

Recommendation:

Recommendation 9: AACP should advise the National Center for Interprofessional Education and other interprofessional education and practice groups to examine issues related to precepting in an interprofessional care environment.

Policy Statements, Recommendations and Suggestions

Policy Statements (Adopted by the AACP House of Delegates July 27, 2016).

Policy Statement 1: AACP encourages pharmacists in all practice settings to be a preceptor to contribute to the future of the profession and the evolving health care system.

Policy Statement 2: AACP encourages members of the academy that use the traditional transactional model of experiential education (i.e., payment to an experiential preceptor/site per student per rotation) to transition to a model that reinvests experiential education resources to support the professional development/advancement of preceptors.

Recommendations

Recommendation 1: AACP should collaborate with other national pharmacy organizations to identify and disseminate modules for baseline preceptor training to schools/colleges of pharmacy.

Recommendation 2: AACP should collaborate with other national pharmacy organizations to develop and disseminate best practices regarding precepting across all phases of pharmacy education.

Recommendation 3: AACP should collaborate with other national pharmacy organizations to develop and disseminate best practices in preceptor development, including a preceptor self-assessment tool, across all phases of pharmacy education.

Recommendation 4: AACP should add questions to the required preceptor surveys regarding self-efficacy and CPD needs.

Recommendation 5: AACP should institute a national advisory board of pharmacy employers and national pharmacy organizations to collaborate with AACP on preceptor and other educational and practice issues.

Recommendation 6: AACP should lead the development and implementation of standardized assessments for all required APPEs.

Recommendation 7: AACP should collaborate with other national organizations to recognize institutions and organizations who excel in precepting.

Recommendation 8: AACP should invite the AACP Master Preceptors to the AACP annual meeting to be recognized by the academy.

Recommendation 9: AACP should advise the National Center for Interprofessional Education and other interprofessional education and practice groups to examine issues related to precepting in an interprofessional care environment.

Suggestions

Suggestion 1: Schools/colleges of pharmacy should work with their board of pharmacy to reduce the barriers faced in experiential education.

Suggestion 2: Schools/colleges of pharmacy should work directly with pharmacy employers to recognize pharmacy preceptors.

Suggestion 3: Schools/colleges of pharmacy should develop new ways to recognize preceptors, including those who have been preceptors for many years.

Suggestion 4: Schools/colleges of pharmacy should recognize institutions and organizations who excel in precepting.

Conclusion and Call to Action

Preceptors are a key group of stakeholders that bear significant responsibility for ensuring practice-ready, team-ready pharmacy graduates. Academic pharmacy and the national pharmacy organizations play a critical role in preceptor training and development. AACP should collaborate with these organizations to ensure consistency in areas of preceptor development that are common to all pharmacy preceptors regardless of practice setting. A standardized program for baseline preceptor training should be developed and disseminated to all schools/colleges of pharmacy. Best practices in preceptor development should be disseminated to all stakeholders (schools/colleges of pharmacy, pharmacist preceptors and employers). Schools/colleges of pharmacy should evaluate the effectiveness of their preceptor development programs focusing on both preceptor and student educational outcomes. Financial resources that support experiential education should be redirected toward advancing the professional development of preceptors to ensure quality preceptors and practice sites for student experiential education. National and state pharmacy organizations and schools/colleges of pharmacy should collaborate to recognize preceptors, institutions and organizations that excel in precepting.

Academic pharmacy must collaborate with pharmacist employers to ensure optimal outcomes for students, practice sites and patients. Best practice models that yield mutually beneficial outcomes in both inpatient and outpatient practice settings must be shared with all stakeholders in experiential education. AACP should conduct additional focus groups with student pharmacists, pharmacist preceptors, experiential directors and pharmacy managers to better define preceptor development needs. Finally, AACP should spearhead a national advisory board of pharmacy employers and the national pharmacy organizations to foster an open dialogue regarding student, preceptor and practice site issues.