Longitudinal Outcomes of an Elective Academic and Administrative Advanced Pharmacy Practice Experience

INTRODUCTION

Outcome 3.2 of the CAPE 2013 Educational Outcomes and Standard 3 of the 2016 Accreditation Council for Pharmacy Education Standards require schools and colleges of pharmacy to develop students as educators who can demonstrate effective teaching skills including preparing relevant content, selecting appropriate teaching methods, tailoring instruction, and assessing learning.^1,2 Although the main purpose of these guidelines may be for pharmacy students to learn to educate patients, additional intended audiences are peers and other health care professionals. The educator subdomain was included in CAPE 2013 to highlight the importance of training students how to teach patients rather than present to patients.^1,3 Teaching is patient-centered and includes adapting content and assessing understanding. Presenting content is pharmacist-centered and focuses on delivering scripted content within a required timeframe and assuming patient comprehension.^3,4

Colleges and schools of pharmacy may address the educator outcome in the didactic curriculum by embedding it into laboratories and skills-based courses such as a pharmacy practice course, a clinical communication laboratory, or a senior capstone or seminar course.^5,6 Some programs also may address the educator standard in the experiential curriculum by offering an academic and administrative advanced pharmacy practice experience (APPE). As previously described in the literature, it is offered as an elective APPE to students who are interested in academic and administrative careers.^7-9 The academic and administrative APPE typically covers topics such as instructional design, the science of teaching and learning, curriculum development, and assessment and feedback strategies, all of which are included in the educator subdomain.^9-20 The benefit of an APPE dedicated to the educator standard is that it allows higher-level evaluation and application of teaching skills, which may not be available elsewhere in the curriculum. Educators have suggested that academic and administrative APPEs should be reserved for residency training because there is no evidence in the literature that the APPE increases the pursuit of faculty positions.²¹ However, the metric of pharmacy graduates pursuing faculty positions should not be limited to full-time appointments and should include adjunct faculty appointments, as more students may become preceptors rather than full-time faculty members.²² As such, an academic and administrative APPE may help students become “preceptor ready,”²² thereby benefitting a potentially larger cohort of students.

Our study was designed to address elements of this debate about the long-term outcomes of academic and administrative APPEs, which is important because the number of these APPEs is growing.^21,22 The study objectives were to evaluate participants’ perceptions of the academic and administrative APPE and its impact on career choice, as well as long-term retention of their teaching knowledge related to the educator outcome; compare the number of APPE participants to nonparticipants who accepted a full-time faculty position as a first job upon completion of postgraduate work (residency or graduate school); and compare the number of eligible participants to nonparticipants who became preceptors after graduation. We hypothesized that students who completed the academic and administrative APPE would perceive that the APPE would be beneficial to them in future faculty positions and that they would remember a majority of the teaching-related content. We also hypothesized that a significantly higher percentage of academic and administrative APPE participants would pursue a faculty position after graduation. If similar materials and activities are included in academic and administrative APPEs at other pharmacy schools and the students are similar to those who completed this APPE, then it would seem that the results of our study would be generalizable.

METHODS

Since 2009, the University of Oklahoma Health Sciences Center College of Pharmacy (OUHSC COP) has offered an elective, four-week academic and administrative APPE, co-precepted by the college’s CEO dean and the associate dean for assessment and evaluation and teacher preparation and development, who also serves as the director of preparing future faculty for the campus. Fourth-year students with an interest in academic career paths are encouraged to enroll in the APPE, which is offered in the spring semester each year to two to four students. Prior to data collection, the study was granted exemption by the OUHSC Institutional Review Board. Responses were kept confidential and participants were informed that the results only would be reported in aggregate.

Students enrolled in the academic and administrative APPE from 2009-2015 completed five modules (Pharmacy Curricula, Academic Pharmacy, Instructional Design, Delivering Feedback, and Academic Administration), each of which included relevant content, activities, and assessments (Table 1). Seventeen academic and administrative APPE students from the years of 2009 to 2016 were invited via email in August 2016 to participate in the study and complete a questionnaire consisting of 24 Likert-type items and one open-ended question about the experience, nine demographic items, and a locally developed 20-item test (Table 2) that aligned with the APPE’s objectives.

To identify the first job of all pharmacy graduates who pursued postgraduate training and had or had not completed the academic and administrative APPE, we conducted a retrospective review of an OUHSC College of Pharmacy database from the years 2009 to 2013. Only these years were included because no students completed the APPE in 2014 and students from 2015 and 2016 were still in training at the time of the study.

To determine the percentage of pharmacy graduates from 2009 to 2015 who had served or were serving as preceptors, we conducted a search of the Oklahoma State Board of Pharmacy preceptor database and then compared the number of OUHSC COP alumni serving as preceptors who had completed the APPE to the number who had not. Two groups of alumni were excluded from the review: those who graduated in 2014 when the APPE was not offered, and those from the class of 2016 as they were not eligible for a preceptor’s license until one year after graduation. The Oklahoma State Board of Pharmacy records were chosen because historically 70% of students stayed in Oklahoma after graduation (as determined by the college’s annual career placement survey).

Descriptive statistics were used to summarize the findings from the survey. The instrument used a 5-point Likert scale to rate agreement with items. Results from this section were presented as (frequency) percent for individual items as well as by CAPE 2013 domain and subdomain.¹ Percent correct scores were calculated for each question on the Teaching Knowledge and Skill Retention multiple-choice assessment. In addition to item analysis, questions were grouped by APPE modules to determine overall content area retention. Pearson Χ² and Fisher’s Exact tests were used to determine differences between the percent of students on post-graduation statuses and academic and administrative APPE status. Each of these tests examined if the percent of academic and administrative APPE obtaining the post-graduation status was greater than nonparticipants. Results were summarized using frequency (percent). Statistical significance was set at p<.05. All analyses were conducted using SAS software v9,4 (SAS Institute, Cary, North Carolina).

RESULTS

DISCUSSION

The results from this study provide longitudinal data regarding academic and administrative APPEs. Similar to previous publications, the participants in this study agreed that the APPE impacted their career path and offered them a better understanding of faculty roles and responsibilities. Learning about an academic career path may demystify the expectations and help participants view it as an achievable goal. One limitation of our findings is that there may have been a selection bias as students interested in an academic career were also those most likely complete the academic and administrative APPE. In addition to pursuing an academic career, the study also found that the APPE participants retained core academic and administrative knowledge over time. This result suggests that the APPE participants will be able to apply their knowledge to future teaching encounters because they have remembered the content after several years.

There were two test items that participants scored poorly on: online testing and classroom management. This result was expected as online proctoring of examinations and classroom management strategies were not added to the APPE training until 2016. The finding also highlights two important areas for continuing professional development for faculty members. One limitation of this knowledge retention result is that the knowledge test only contained 20 items and 13 of the items were related to the teaching module specifically. The same results may not have been found if more test questions had been asked because a greater percentage of APPE content would have been covered. However, all the test questions that were developed were aligned with objectives that were associated with each APPE module.

Another significant finding was that a greater percentage of students who completed the academic and administrative APPE pursued postgraduate training upon graduation compared to their peers, which is important as completion of postgraduate training is a requirement for obtaining most faculty positions. For those who pursued postgraduate training, significantly more academic and administrative APPE participants obtained full-time faculty positions compared to nonparticipants. This finding provides longitudinal data that were previously missing from the literature and offers support for continuing the availability of academic and administrative APPEs during the Doctor of Pharmacy program as a way to increase pursuit of a faculty position upon completion of postgraduate training. One limitation of this finding was that the academic and administrative APPE participants may have gotten the test questions correct and had more positive perceptions about teaching if they also completed postgraduate training that included a teaching certificate program(s).

The data also revealed that 71% of participants in the academic and administrative APPE and over 50% of nonparticipants obtained a preceptor’s license, although it is not known if the nonparticipants were actively serving as preceptors. These findings support commentary by Cox²² advocating for graduates to be “preceptor ready.” Completing an academic and administrative APPE can help students achieve this outcome. Preparing students for a future preceptor role can benefit colleges and schools of pharmacy that need effective preceptors to train their students. It can also help students learn how to become effective preceptors so they can better fulfill the role. Knowing that more than 50% of graduates become preceptors suggests that more students should complete an academic and administrative APPE to prepare them to serve in this important role.

The content covered in the five academic and administrative APPE modules supports teaching in the didactic or experiential settings, as evidenced by survey results from participants who agreed that the rotation helped encourage them to become a preceptor. The APPE also encouraged them to use effective strategies to deliver feedback, which is a frequently used preceptor skill.

Offering academic and administrative APPE content to an entire class of students through an APPE may be logistically difficult. An alternative solution may be to deliver the APPE content in a senior level capstone course or through self-study coupled with feedback from and discussion with a preceptor during a required APPE. Offering the academic and administrative APPE content to all students is one way to achieve domain 4 (personal and professional development) of the CAPE 2013 outcomes and the educator subdomain in domain 3 (approach to practice and care). The APPE is also a way to ensure that students establish a foundation of effective precepting skills.

CONCLUSION

Longitudinal analysis of an academic and administrative APPE found that a majority of participants were pursuing careers in academia upon postgraduate training of residencies and graduate (PhD) programs and that the rotation helped them understand the roles and responsibilities of a faculty member. Participants retained the knowledge they gained from the APPE over time, suggesting that the content can be applied to future teaching encounters. The results also revealed that over half of all graduates (both APPE participants and nonparticipants) obtained preceptor licenses. This suggests that the academic and administrative APPE content should be offered to all senior level students in some format, whether as an APPE or as course work in a senior level capstone course to systematically prepare students to serve as preceptors in the future.