Abstract
Objective. To review the published literature describing and evaluating pharmacy student and resident preceptor development.
Findings. Database searches yielded 32 published articles on pharmacy preceptor development: 22 for experiential preceptors, eight for resident preceptors, and two encompassing both experiential and resident preceptors. The identified articles covered a variety of preceptor development strategies, including live, web-based, and multifaceted approaches, which were disseminated via analytical studies, needs assessment surveys, and descriptive reports. In analytical studies, the evaluation methods most commonly used were preceptor pre- and post-perception surveys.
Summary. Preceptor development strategies vary among pharmacy schools and residency programs. The evaluation methods used also varied, and there is a lack of evidence-based practices related to preceptor development. Preceptor development should be tailored based on preceptor type and program needs. An opportunity exists to further evaluate which strategies are most effective for improving precepting techniques, with an ultimate goal of delineating best practices for pharmacy preceptor development.
INTRODUCTION
Preceptors are essential stakeholders in Doctor of Pharmacy (PharmD) programs accredited by the Accreditation Council for Pharmacy Education (ACPE) and pharmacy residency programs accredited by the American Society of Health-System Pharmacists (ASHP).1-3 Preceptors must have credentials and expertise in accordance with their roles and responsibilities, similar to the expectations for pharmacy faculty members.1 The ACPE’s Standards 2016 recommend that colleges and schools of pharmacy include preceptors in critical areas such as strategic plan development, curriculum delivery, and fostering a culture of collaboration and professionalism.1 Preceptor education, development, and engagement are also emphasized as key elements of a successful experiential education program.1 Guidance on qualifications, credentials, and development for pharmacy resident and student preceptors is further elaborated in the American College of Clinical Pharmacy (ACCP) white paper, “Quality Experiential Education.”4 Both documents emphasize the importance of preceptor development support by schools and colleges of pharmacy.1,4
Preceptor challenges associated with experiential education programs are well described in the pharmacy literature.5-7 In a survey by Danielson and colleagues of 78 experiential directors, preceptor development was identified as one of eight common concerns.7 Specific examples of this concern included training preceptors and adjunct faculty members to assess student outcomes, coordinating preceptor education, and advancing practice sites. The identification of this concern was consistent among both private and public institutions regardless of student class size. The 2015-2016 American Association of Colleges of Pharmacy (AACP) Professional Affairs Standing Committee (PAC) reported similar needs after surveying representatives from nine national and state pharmacy organizations.8 Additional considerations included managing students of different learner levels, facilitating resident preceptors, and creating preceptor development plans. The 2015-2016 AACP PAC recommended that national pharmacy organizations disseminate best practices for preceptor development, which presently remains undefined.
Although numerous modalities for preceptor development exist, there is a lack of consensus among professional organizations and state boards of pharmacy in the United States regarding requirements for preceptor development.8,9 For example, some states mandate a specific number of preceptor continuing education (CE) hours for licensure as a pharmacist preceptor.10 Additionally, it is unclear whether certain training modalities (eg, live, online, print) are more effective than others. The characterization of best practices for preceptor development would be beneficial given the variability of prior education and training among volunteer and non-volunteer preceptors. Pharmacy schools may have criteria for preceptor eligibility but largely recruit preceptors based on preceptor interest or practice site. Furthermore, the use of preceptor self-assessment tools to assist with continued professional development may not be widespread among pharmacy programs. A study at one pharmacy program in Thailand found that preceptors overestimated the quality of their teaching compared to student evaluation ratings.11 This highlights the necessity of robust preceptor development programs since preceptor teaching behaviors may impact student performance on clinical competencies.12
Preceptor development for pharmacy residency programs is also a significant area of need. In a survey of 1437 pharmacy residency preceptors and residents, only 55.9% of respondents believed that their institution provided ample opportunities for preceptor development.13 The ASHP accreditation standards for pharmacy residency programs address two skillsets of preceptor development: teaching and professionalism.2,3 Often, it is the responsibility of the residency program director or program leadership team to evaluate preceptor teaching skills, provide opportunities for preceptor development, and implement a plan for teaching quality improvement.2,3 Pharmacy residency programs must have the resources and evidence-based approaches to train residency program directors and preceptors in the aforementioned areas.
There is a lack of uniformity within preceptor development expectations, requirements, and outcomes despite the inclusion of preceptor development in pharmacy education and residency program accreditation standards. The objective of this review was to identify best practices for pharmacy preceptor development by summarizing relevant existing literature.
METHODS
An English-language PubMed and MEDLINE search was conducted for 1964 through April 2020 using the following search terms alone or in combination: preceptor development, preceptor training, preceptor education, experiential education, pharmacy, residency preceptor, resident preceptor, and pharmacy preceptor. Two of the authors reviewed the articles to determine which to include and also reviewed the references used in these articles to identify other relevant sources. The third author adjudicated any discrepancies over whether to include an article. All articles that described and/or evaluated methods of pharmacy preceptor development, either for introductory pharmacy practice experience (IPPE) or advanced pharmacy practice experience (APPE) students or pharmacy residents, were included in the literature review. Teaching certificate programs not focused solely on preceptor development were excluded from this analysis.
RESULTS
Thirty-two articles were identified for inclusion in the review, with the subject of the articles divided between pharmacy student preceptor development and pharmacy resident preceptor development. The inclusion and exclusion of literature is highlighted in Figure 1.
Study Design Flow Chart
Pharmacy Student Preceptor Development
Twenty-four articles regarding preceptor development related to pharmacy student experiential training were identified for inclusion (Table 1). Nineteen were analytical studies and five were descriptive in nature.9,14-36 The delivery methods used for the majority of the preceptor development programs described were either live, web-based, or multifaceted (eg, web-based and live delivery).
Findings From a Review of the Literature on Pharmacy Student Preceptor Development
A cross-sectional analysis of an experiential education administrator’s survey reported on preceptor orientation and development data from 85 respondents.36 Globally, about two thirds of schools offered some type of live preceptor development programming, and 75% of schools contracted with an outside vendor to deliver preceptor continuing education, such as the Pharmacist’s Letter. The cost of the preceptor development program was also reported, with the majority of respondents spending more than $2500. Outcomes of the strategies used by schools was not collected.36
A multifaceted approach to preceptor development was undertaken in five studies.9,18,30,32,33 Most incorporated some live and/or printed preceptor development component, as well as web-based modules. Boyle and colleagues described development of but did not evaluate an “academy of preceptors,” which involved increased preceptor of the year recognition, networking, and development, and emphasized the value of the role that preceptors play in pharmacy education.33 Another article described a longitudinal professional development program offered to pharmacists and residents, a quarter of which was focused specifically on precepting.30 In addition to in-person modules, participants had take-home assignments and were assigned a specific teaching mentor to guide them. Although multiple delivery methods were used in these studies, only Davison and colleagues investigated preceptors’ preferences regarding delivery methods for training and discovered that the majority of respondents preferred online or web-based training compared with a yearly live development session.18
Six studies describe implementation of standalone live preceptor development sessions that ranged from three to 20 hours of contact time.14,15,17,22,23,31 Three were focused not only on preceptor development, but also on elevating the skills and patient care capabilities of outpatient pharmacists.14,15,17
Program evaluation methods varied among the studies. In one program described by Kassam and colleagues, after preceptors had undergone training, the school developed an enhanced advanced community experience and compared student evaluations of the enhanced experience with evaluations by a control group of students (the only study to do so). The authors found significant improvement in students’ skills and attitudes compared to those of students in the control group who had completed traditional community experiences and whose preceptors had not received additional training.17 The Birkman Method training was employed in another study which sought to improve faculty and preceptor self-awareness and confidence, and to apply these skills to communication with students during experiential activities. While faculty and non-faculty preceptors were analyzed separately, improvements in confidence in numerous areas were seen in both groups.31
Six studies described using only web-based modules for preceptor development, two of which were collaborations between multiple schools.16,20,21,24,27,28 One of the studies used an already existing ACPE continuing professional development webcast for their preceptors, while others created their own material, providing anywhere from one to 11 modules for preceptor home use.24,28 Inconsistent outcomes were investigated in these analyses, and reported participation ranged from 32 to 444 pharmacy preceptors.
Notably, four articles focused on preceptor development in interprofessional education (IPE).25,26,29,35 McCutchen and colleagues used a unique method of an interprofessional objective structured teaching exercise (iOSTE) to train 23 community pharmacy preceptors in interprofessional practice and precepting.26 Cox and colleagues also implemented a novel approach by creating a mini-series of videos screened as a feature length film for preceptors to learn interprofessional precepting skills.25 Finally, Tanzer and colleagues created an interprofessional precepting dashboard from survey results to inform specific preceptor development recommendations.35 Both McCutchen, Cox, and Fusco demonstrated significant improvements in preceptor confidence after implementation of their preceptor development strategy or program.25,26,29
Pharmacy Residency Preceptor Development
Ten articles on pharmacy residency preceptor development were identified (Table 2), including two analytical studies, three needs assessment surveys, and five descriptive publications.13,22,34,37-43 In-person training, either through concentrated or longitudinal timeframes, was described in five of ten articles and preceptor mentorship was described in four of ten articles. No studies that compared delivery modalities for preceptor development programming were found. Additionally, only the two analytical students provided any assessment data, highlighting a gap in the literature22,37 Remaining literature mainly describe the structure of preceptor development programs.
Findings From a Review of the Literature on Pharmacy Resident Preceptor Development
Three articles on pharmacy residency needs assessments within Canada and the United States were found.13,38,39 These articles highlight the importance of including mentorship as well as internal and external preceptor training programs. However, one survey included preceptors as well as residents and did not include a response rate, while another study had a small sample and low response rate.13,39 The survey by Bolt and colleagues identified a lack of standardization within programming for pharmacy residency preceptor development.39
DISCUSSION
We found that preceptor development strategies vary among pharmacy schools and residency programs, with some commonality in themes. Although preceptor development is a required portion of accreditation for both pharmacy schools and residency program, the literature does not support any one approach to providing it.1-3 The majority of literature pertains to development of preceptors to train pharmacy students, with both individual schools and consortiums reporting on small- and large-scale programs. Residency program preceptor development, on the other hand, is less frequently evaluated and appears to follow a more individualized approach.
No standard method for preceptor development was identified among pharmacy school or residency programs. A 2015 analysis of challenges facing pharmacy experiential programs highlighted preceptor development and quality assurance as a concern for programs, especially among large and very large colleges of pharmacy.7 Given that adult learning styles and preferences vary, particularly among different generations, there may not be a best way to deliver preceptor development.44,45 Online delivery may be preferred by most pharmacy student preceptors as it was the most commonly used modality either alone or in combination.18 Additionally, needs assessments of residency preceptors have identified that there is a desire for preceptor development which may include individual mentorship or workshops and modules.13,37
Most pharmacy schools and residency programs target preceptor development individually; however, one national effort has been described. The Canadian Experiential Education (CanExEd) Project for Pharmacy, a project through the Association of Faculties of Pharmacy, has published articles on their determination of best practices and recommendations for experiential education preceptor development in Canadian colleges of pharmacy.46-48 The resulting national preceptor development prototype encompassed three driving principles, including the importance of preceptor competencies throughout the program, strategies for preceptor engagement, and a design that allowed for continuous quality improvement and assurance measures. The web-based platform prototype allows for demographic collection followed by institution specific learning, rotation-specific training, and preceptor self-directed continuous professional development. While the final design of the described prototype has yet to be reported, this represents a step towards streamlined preceptor development that has not been described elsewhere.
Most preceptor development delivery methods have included web-based and in-person training. The ACCP white paper on quality experiential education recommends the development of web-based training programs tailored to school needs and objectives, especially as a means to standardize preceptor training.4 Both web-based and in-person training are convenient to deliver, but it is also important for pharmacy schools and residency programs to think innovatively when targeting development opportunities. There is a need within the Academy for empiric studies comparing delivery methods for preceptor development. With an increasing focus of all health professions on interprofessional education and care, the importance of preceptor development in these areas has grown. Several colleges of pharmacy have integrated interprofessional practice into preceptor development using skills-based practice, such as an interprofessional objective structured teaching exercise.25,26,29,35 Other novel methods of development included having preceptors attend a screening of a videotaped mini-series, Adventures in Interprofessional Precepting.25 Outside of standard lectures and workshops, individual mentorship of new preceptors has been described by residency programs and within a formal teaching certificate-like program for pharmacists.30,34,41-43 While this may not be practical for colleges of pharmacy on a broad scale, it does highlight a targeted approach to preceptor development that allows programs to focus on preceptors’ specific areas of need.
In addition to delivery, it is important to identify the impact of preceptor development strategies. Articles reporting on evaluation-related outcomes varied; however, the majority used preceptor pre- and post-program evaluations or perceptions surveys. Preceptor evaluations of development programs are vital as preceptors are the consumer; however, they tell us little about the impact on precepting skills or the impact on pharmacy learners. Unfortunately, little is known regarding the impact of pharmacy preceptor development on learner outcomes. Kassam and colleagues investigated student evaluation of rotations, finding that students’ attitudes about and skills learned during a community APPE improved significantly after the preceptors attended a one-day workshop compared to a control APPE.17 Vos and colleagues also investigated student evaluations of preceptors, finding that mean student evaluations of preceptors improved following preceptor development.9 The scholarship related to preceptor development is lacking, and this is a major need for the Academy to address to enable pharmacy schools and residency programs to implement evidence-based precepting practices. Gathering more data on experiential endpoints, including student outcomes and preceptor evaluations, will help to further assess the impact of preceptor development initiatives.
Challenges that may exist for programs providing quality and wide-reaching preceptor development include preparation of and delivery time for content, geographic limitations to live delivery, cost for CE accreditation, cultivation of preceptor engagement and interest, and varied levels of preceptor experience, among others. While no “magic bullet” has been discovered, many of these challenges may be overcome through methods described in the literature and reported in this paper. Web-based approaches allow preceptors to access content at their convenience, regardless of their geographic location, and to learn at their own pace. Though not specifically reported here, the web-based approach also provides a time-efficient method for those delivering the preceptor development as modules may be reused for many years and accessed “on demand” and updated as needed. Multi-university consortiums or regional preceptor development is another way to pool resources and maximize personnel time.32 Preceptor development may also be focused by skill level, including development of targeted workshops for less experienced preceptors or modules on basic precepting techniques versus focusing on specific needs for more advanced preceptors, such as expanding interprofessional education.14,16,25,26
CONCLUSION
A wide array of development strategies exist for pharmacy student and resident preceptors, spanning from individual preceptor mentorship and in-person lectures and workshops to web-based modules. No specific method of delivery is recommended by accreditation bodies, allowing for flexibility and customization by pharmacy schools and residency programs. Limited evidence exists pertaining to learner outcomes, and no single strategy has emerged as superior from the varied evaluation methods reported. Schools and colleges of pharmacy and residency programs should consider resources, preceptor needs, and desired outcomes when designing preceptor development. Additionally, further assessment of the impact of preceptor development on IPPEs and APPEs, as well as on residency learning experiences, learning outcomes, and precepting skills is needed.
- Received January 17, 2020.
- Accepted May 17, 2020.
- © 2020 American Association of Colleges of Pharmacy
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