Addressing the Challenges of Precepting Students Enrolled in Remote Research Advanced Pharmacy Practice Experiences

Precepting a Short-Duration Research Project

A research project can take months to years from conceptualization to manuscript publication. Therefore, implementing a four- to six-week research-focused APPE can be challenging for researchers who must sufficiently involve the student pharmacists in a project intended to give them an understanding of what a career in research would be like. Giving students a role in writing a research paper helps them develop the essential skills needed to incorporate research into evidence-based pharmacy practice while providing a competitive advantage to those applying to residences or other postgraduate clinical opportunities.¹⁰ To address this challenge, our laboratory required each APPE student to complete one well-defined small research deliverable, such as the protocol for a literature review, the introduction section to a full manuscript, or a short commentary. For example, one of our APPE students drafted the background of a clinical research manuscript, while another created a protocol for a scoping review on diabetes medications. We recommend developing an optional plan for APPE students to contribute to a larger research deliverable (eg, a peer-reviewed research manuscript) if they wish to continue volunteering with the research team after they transition to other APPEs.

Scoping reviews are larger research deliverables that can be completed by APPE students, as they require students to learn literature review methodology but do not require substantial statistical knowledge or critical appraisal to complete.¹¹ During an APPE, students can complete and register a scoping review protocol. Students may wish to continue with the lab as a volunteer, which will give them more time to gain the knowledge needed to make further contributions to the project, such as publish the protocol, complete article screening, and write parts of the manuscript. An alternative to assigning independent research deliverables to APPE students is to involve them in the data collection or data analysis for an ongoing project. In these scenarios, students should also be given opportunities to understand the background of the project and present the results to have sufficient exposure to a broad range of skills required in pharmacist-researcher careers.

Student Pharmacists with Limited Research Experience

Students entering a research-focused APPE may have little or no previous research experience. To gauge an APPE student’s baseline knowledge, a pre-assessment can be assigned that requires students to leverage skills applicable to the research project. For example, if the student will be conducting a literature review, they may be asked to compose a one-page summary of papers that relate to one of the laboratory’s focus areas. Through this assessment, students will begin to familiarize themselves with relevant literature while providing the preceptor with insight into their baseline critical appraisal and communication skills. Importantly, the pre-assessment can help align the expectations the preceptor and APPE student have for the APPE as a shared understanding of expectations helps to facilitate productivity and minimize misunderstandings.¹²

We also encourage preceptors to provide APPE students with learning materials that can provide them with basic knowledge of the research field. These materials may include pre-made lecture slides, recorded lectures, and guidance for relevant training (eg, ethics requirements). We recommend that preceptors distribute foundational materials before the APPE begins and any other documents once the student has officially started the APPE to avoid overwhelming students with pre-reading material. Given the remote nature of the APPE, students may be reluctant to reach out to preceptors when they have questions. Therefore, researchers should meet regularly with the student to answer questions about the learning materials. Specifically, preceptors should schedule virtual meetings, provide clear expectations about which learning materials should be reviewed in advance, and ask students to be prepared with well-defined questions for the preceptor to address. In our experience, these regular meetings encourage APPE students to read with intent, as they have set opportunities to discuss concepts that are not clear before applying the acquired knowledge and skills to their research project. Other opportunities for learning introductory research include journal clubs, professional development sessions, and presentation skills assessments.

Maintaining Consistent Communication in a Virtual Environment

Reliable modes of communication are important when preceptors cannot regularly see students in person. Providing APPE students with a summary of the laboratory’s communication platforms helps to prevent confusion and increase student comfort level. For example, our team used different platforms for different types of communication: Slack (Slack Technologies, Inc) for quick messaging, Basecamp (Basecamp) for disseminating project documents, and Microsoft Teams (Microsoft Corporation) for meetings. In the case of internet connectivity issues, we recommend that students also have access to at least one non-internet (ie, cellular) mode of communication.

To provide structure, we recommend creating a long-term, tentative schedule for virtual meetings to maintain communication throughout the APPE. An established schedule allows students adequate time to prepare for meetings and, in our experience, helps to set expectations for the student and alleviate stress. Additionally, students should be aware of the preceptor’s expectations of the student regarding document turnaround times and response times, especially for evenings and weekends. Preceptors should acknowledge that APPE students’ daily schedules have likely been impacted by the pandemic and should take into account the students’ specific situations when scheduling and setting deadlines. Overall, if detailed guidelines about communication are explained at the beginning of the APPE and enforced consistently throughout it, students tend to be more comfortable and more likely to actively participate in communication with both the preceptor and the team.

One way in which preceptors and APPE students can formally establish these communication preferences and expectations is through a research learning contract.¹³ These contracts help team members to collaboratively articulate short-term and long-term goals, schedules, resources, communication protocols, responsibilities, tasks, outcomes, and more.¹³ When discussed and created together, these research learning contracts help to encourage mutual understanding, trust, accountability, and partnership.

Balancing Mentoring Time Between Graduate Students and APPE Students

Many preceptors for research-based APPEs are also supervisors of graduate trainees, and therefore must balance their time between several students. To reduce the workload of the preceptor and provide valuable mentorship experience for graduate students, preceptors can provide senior graduate students with the opportunity to mentor APPE students by overseeing certain aspects of their learning.^14,15 Additionally, multiple mentor interactions during the APPE can provide new insights and experiences for student pharmacists, allowing them to form more connections, develop more skills, and keep the experience engaging.^14,15 Preceptors should, however, clarify what the graduate student’s role will be and delineate which responsibilities fall to the preceptor alone. For example, graduate students can supervise APPE students completing smaller steps of a project; however, the midpoint and final APPE assessments must be conducted by the preceptor, with input from graduate trainees if needed. Additionally, precepting two APPE students simultaneously can provide the student pharmacists with a partner with whom they can collaborate, discuss ideas, and exchange feedback. However, a maximum student-to-faculty ratio of 10:1 should be maintained to facilitate the provision of individualized student feedback based on their contributions to a project to ensure that each student is fairly assessed.⁶

Keeping APPE Students Engaged and Motivated

Staying focused and on schedule while working from home during a pandemic can be a significant challenge for students who are used to working with peers and directly interacting with patients. Aligning the APPE project with students’ interests and career goals can help improve their engagement. Advanced pharmacy practice experiences have predefined educational outcomes; however, at the beginning of the experience, students should reflect on their personal learning objectives and how the APPE can help them achieve their career goals.¹⁰

Preceptors can not only cater the research project to students’ interests but also reach out to their network of colleagues and past alumni who can provide APPE students with insights into different fields and career paths. The APPE students assigned to our laboratory virtually met alumni in government and industry careers who spoke with the students about their day-to-day job responsibilities and career paths, and provided general advice. In our experience, an advantage of working in a virtual environment is that many people are using an online platform in some form, facilitating discussions with those who would normally not have the time or means to commute and participate in in-person talks.

Preceptors can apply several other strategies to help improve student engagement. First, setting an inviting tone at the beginning of the APPE by holding a virtual orientation in which the students are introduced to the research team and their projects may help students feel less isolated and establish themselves as team members. A brief daily check-in where preceptors and APPE students discuss tasks can provide the extra guidance students may need to complete their projects on time. Preceptors should also stay connected with students to discuss their thoughts and concerns during what is likely a stressful time for both parties. Additionally, preceptors should share impromptu opportunities with APPE students to get involved in non-project specific activities. For example, our laboratory invited APPE students to participate in webinars that were part of a university-wide Undergraduate Summer Research Program. Finally, the preceptor should invite feedback from APPE students throughout the rotation and adapt the experience in ways that consider students’ suggestions and address students’ concerns.