Challenges to Pharmacy School Enrollment Management Caused by a Global Pandemic

Recruitment

Priority 1 of the 2018-2021 Strategic Plan issued by the American Association of Colleges of Pharmacy (AACP) is to “enrich the applicant pipeline” to ensure that the appropriate numbers of diverse, qualified students are recruited and trained to meet society’s needs for pharmacists.¹ While some online recruitment resources exist (eg, Pharmacy Is Right For Me), many programs rely heavily on recruitment strategies that involve direct human interaction.² As preparation for the next academic cycle begins, recruiters must consider how they will navigate the challenges presented by the pandemic, since physical distancing and stay-at-home orders may be in place through the summer and fall semesters. In addition to advising students via videoconferencing platforms, remote recruitment strategies could include the use of social media, mobile apps, interactive websites, software platforms, direct and personalized email communication, and free promotional gifts sent through the mail. Digital campus tours may replace traditional tours for students and their families.

Schools may find unforeseen benefits to remote recruitment. For example, the substantial amount of time and expense previously dedicated to travel could be spent on developing innovative remote recruitment strategies. Perhaps it is time to explore new forms of social media, or rethink how alumni, preceptors, and/or students might be utilized in recruitment efforts. Positive messaging about a pharmacy school from pharmacists and other health care professionals working in the community provides legitimacy to advertising.

Admissions

The Chronicle of Higher Education and The Wall Street Journal have described many challenges related to COVID-19 within areas of enrollment management.^3,4 For example, the inability of students and/or parents to maintain employment will have a lasting impact on the affordability of higher education.^3,4 Both the financial and cultural impact from COVID-19 will likely result in decreased international student populations in US colleges and universities.^5,6 Potential pharmacy students may wonder if now is the right time to begin their college education and whether they will have the same “return on investment” from learning in a remote environment rather than in classrooms, laboratories, and experiential sites where they could interact in person with professors, fellow students, and preceptors. After all, the campus experience, which also includes social and cultural activities, adds value.

The diminishing applicant pool and subsequent smaller class sizes were already of utmost concern to pharmacy programs.⁷ The COVID-19 pandemic added to these woes. For example, by mid-March 2020, some schools had closed or were short staffed and therefore unable to supply transcripts to the PharmCAS application system. This slowed admissions processes and caused frustration for applicants. PharmCAS rallied by accepting unofficial transcripts for review. Admissions committees increased informal communication with applicants, enhanced transparency of processes, and provided flexibility by extending deadlines and communicating the likelihood of an interview prior to the delayed processing.

Even after students’ information was verified in PharmCAS, other data used to make admission decisions were unavailable. In addition to school closures, Pearson VUE test centers, which administer the Pharmacy College Admissions Test (PCAT), were closed through April 30, 2020. Hence, PCAT scores were temporarily unavailable. In addition, many undergraduate programs allowed students to change their grade mode for prerequisite courses to pass/fail because of inequitable learning conditions. This made it difficult for admissions committees to evaluate student performance in prerequisite courses. Likewise, many schools were in the process of conducting in-person admissions interviews when the virtual world became the only interview option. Team-based interviews were suddenly difficult to conduct, and in some cases, eliminated. In response to these challenges, admissions committees implemented innovative interview processes and reevaluated admissions criteria. Committees found they could extrapolate important information about candidates from other sources. Some began reviewing students’ course loads, evaluating the academic rigor of previous institutions they had attended, and scrutinizing the number of courses repeated or for which a grade of C or below was received. Others schools placed greater emphasis on students’ cultural, healthcare, leadership, volunteer, community, customer service, and employment experiences. Some began to assess candidates’ personal characteristics, such as growth mindset and resilience, while other schools gleaned information from students’ letters of recommendation. The pandemic stimulated admissions committees to reexamine their admissions processes and take unprecedented steps to ensure that pharmacy education and the next class of pharmacy students would be ready to move forward when the crisis has passed.

Student Orientation and Retention

The 2018-2019 Student Affairs Standing Committee Report highlighted the importance of technology for iGeneration program delivery and recommended that schools conduct online or hybrid (online and in-person) orientation programs to support students’ development of self-directed learning skills.⁸ An orientation model presented at the 2016 annual AACP meeting received high student satisfaction scores and was associated with improved first-year grade point averages.⁹

The authors suggest that student onboarding be implemented now for longitudinal delivery through the summer months. Existing course management systems can deliver a variety of information through self-directed learning modules. Content could include financial aid, campus safety, school policies, professional expectations, study skills, stress management, team development, and many other topics. Online longitudinal modules can be paired with high-frequency, high-touch, peer-to-peer and/or student-advisor meetings via video conferencing. Virtual breakout sessions, remote team-building activities, online scavenger hunts, and social trivia games can be employed for larger group activities.

Programs are exploring hybrid content delivery, holding small-group sessions with frequent offerings rather than large class sessions, and other systems that will ensure safe delivery of content with social distancing in place. With the increase in online content, there will be greater focus on the issue of accessibility. Faculty members must ensure new content is inclusive, functional, equitable, and sustainable for students with disabilities who need special accommodations.

The sudden move to remote teaching resulted in a plethora of unexpected issues for students. For example, moving traditional content and assessment processes to online modes at breakneck speed resulted in system failures - many related to technology. In some cases, the technology simply did not work and students were unable to submit assignments. Students were suddenly relocated and differences in time zones caused confusion about when assignments were due and when tests would open or close. In addition to technology issues, many students moved home and encountered personal issues, such as loss of daily structure and peer support. Many found themselves with no private space to study. Others had to share their computer, time online, and bandwidth with family members. Some were forced to leave their campus job and find employment to support themselves and family members. Many were scared for family members who were front-line healthcare workers. Students were suddenly suffering from isolation, depression, and anxiety. Students’ test scores declined. Some students were reported as “missing in action.” Student retention rates within programs may ultimately be affected.

The emotional, physical, and financial toll on students prompted many schools to relax academic policies. They extended course withdrawal dates, allowed grade mode changes to pass/fail, relaxed rules for incomplete grades, and eliminated probation and dismissal for professional students during the COVID-19 crisis. Schools proactively solicited student concerns and provided emergency financial aid, computers, and free software to students. They increased touch points with students through virtual town hall meetings and daily/weekly communications. Some schools used virtual check-in processes, increased the frequency of grade monitoring, and followed-up with students who were not participating. Instructors found ways to keep students engaged by conducting online quiz bowls, trivia tournaments, and other forms of gaming. Likewise, a variety of online wellness strategies emerged, with content on exercise strategies, healthy eating, maintaining connections with friends and family, mindfulness, and meditation.

Many students prefer the brick-and-mortar academic experience. They miss their friends, autonomy, campus-based activities, and amenities like high-speed internet access. When students return, the campus experience will likely be different. Instructors should brace for a heavier teaching load with multiple, small groups of students, variations in content delivery, an extended workweek, and competition for classroom space. Safety training for students and instructors will likely be mandated, and self-care kits with masks and gloves and/or hand sanitizer will be distributed to students before class. Instructors and students will enter and exit rooms strategically and avoid congregating before and after class.

Graduation and Licensure

The COVID-19 pandemic forced pharmacies and other healthcare facilities to reduce their workforce to essential personnel. As such, students on advanced pharmacy practice experience rotations were released early, resulting in the inability to demonstrate that students met competencies, hour requirements, and/or the minimum number of discrete experiences required by the Accreditation Council for Pharmacy Education. Graduation ceremonies were delayed, cancelled or held remotely. Capacity to administer state and national licensing examinations was limited. Nevertheless, schools found a variety of innovative ways to deliver simulated and remote experiential content and move their students forward to licensure.

The anticlimactic end to the academic year intensified student loneliness, anxiety, and depression, especially for graduates. Schools understood the significance of graduates sharing their achievements with peers, family, friends, faculty and staff members. Many schools responded by holding festive, virtual graduation ceremonies through web-based platforms where honors were awarded, screen shots captured attendees, slideshows touted memories, faculty reminisced, peer awards provided humor, and post-graduation plans were revealed. Many schools reported after-hour virtual parties. Remote ceremonies and celebrations provided students with the sense of accomplishment and the finality they needed and deserved. Many students and their families traveled back to campus to take graduation photos in cap and gown. Commencement awards for professional, academic, and leadership achievements were mailed to students. Some schools will host live reunions in the fall or offer students the option to participate in live commencement exercises when safe to do. Nothing will stop our Academy from celebrating our students’ accomplishments.