Inclusion of the Pharmacist Patient Care Process in Doctor of Pharmacy Curricula

DISCUSSION

This study was the first national assessment of integration of the PPCP into pharmacy school curricula, which is a required element as part of the ACPE Standards 2016.² The PPCP was integrated into 96% of all responding institutions, with most having an intentional teaching and assessment plan incorporated into multiple courses and across different professional years. The extent of collaborative teaching varied, with pharmacy practice faculty being the most frequent teachers of the PPCP. While programs are assessing the PPCP, few schools had made changes to the curriculum based on the data.

There is high value placed on the PPCP by the profession; thus, it is important to accurately assess and utilize the data to inform student outcome attainment. While most institutions that participated in the study were mapping or tagging the PPCP in their assessment data, there was considerable variability in their approaches to tagging. Mapping is an important element in assessing adherence to educational standards and accreditation standards, as well as in determining curricular improvements.¹⁰ Mapping also allows faculty to engage with assessment data, particularly if an electronic system is used, and for the institution to engage in continuous quality improvement.^11,12 Researchers have incorporated mapping into examinations and quizzes, rubric-based assessments, and practical examinations.^6,9,13 - Responsibility for oversight of PPCP integration often falls on the faculty members providing instruction in addition to the assessment office or team. Proactive approaches to identifying curricular gaps, whether through committees, faculty members, or committee-faculty partnerships, are important.

Given the nature of the PPCP and its inherent relationship to practice, it is not surprising to see that the PPCP is taught by pharmacy practice faculty at nearly all institutions. While one-third of institutions have foundational and social/administrative sciences (SAS) faculty teaching the PPCP, there is certainly room for growth. The PPCP has many areas for integration of foundational science and SAS faculty. Each stage of the PPCP contains elements that are clearly linked to key SAS concepts, such as the social determinants of health, clear communication principles, and medication adherence.¹ For foundational sciences faculty, chemical and pharmacokinetic differences between agents used for the same condition could be linked to the assess and plan steps, when students need to choose between therapeutic options and defend their choice with reasoning. Alsharif and Faulkner provide an example of integrating the PPCP into a medical chemistry course, which was positively received and improved student understanding of the PPCP.⁸ Other basic science faculty could consider similar approaches. Few programs indicated that they integrated faculty development related to the PPCP; perhaps development efforts could aid nonpractice faculty in determining their “fit” with the PPCP. Furthermore, while nearly all institutions have pharmacy practice faculty teaching the PPCP, it does not mean that all pharmacy practice faculty teach it. This would be an interesting area for further exploration.

The PPCP was also heavily integrated in experiential programs, particularly in IPPE and APPE evaluations. While 78% of institutions indicated that the preceptors are teaching the PPCP, there is clearly room for expanding the PPCP in experiential education. Another future area to examine will be whether the preceptors are teaching/modeling the PPCP or focusing on assessment of the PPCP. It is also unclear whether programs are using data from the APPE performance assessments to identify student knowledge, skills, or behavioral gaps that could be addressed on the curricular level. Research has found that pharmacists believe that the PPCP accurately reflects their practice, and intentional assessment of the PPCP in IPPE experiences can be successful.^7,14 Preceptor development may be a successful avenue to promote intentional integration and assessment. For example, Hagel and colleagues integrated a case-based webinar which improved preceptor confidence in integrating the PPCP and assisted them in identifying methods for incorporating it.¹⁵

For most institutions, students receive repeated exposure to the PPCP through different courses, pharmacy practice laboratories, case-based learning, and experiential learning. Assessment is often occurring alongside teaching, but there are instances where it is being taught without formal assessment. The bigger challenge for institutions is using the data from assessment to drive competency attainment. At the time of survey distribution, 17% of respondents had made changes to the curriculum as a result of competency assessment, and another 34% were in the process of making changes. It seems that institutions are making a concerted effort to utilize the data and determine if and when it should drive change. There is less information on how experiential learning assessment data are being utilized, which could be a worthwhile area for future examination.

Interestingly, there is limited incorporation of the PPCP into interprofessional learning. While the PPCP is specific to pharmacy, the application is relevant to producing team-ready, practice-ready pharmacists. Given that a goal of implementing the PPCP is to consistently provide care, demonstrate our value, and effectively communicate how pharmacists contribute to patient care,³ integrating the PPCP as part of interprofessional learning could be a valuable educational tool. This is particularly relevant when discussing the roles and responsibilities of pharmacists with other members of the team, which is a key element of interprofessional learning. The ACPE Standards further reinforce the need for interprofessional, collaborative care in Standard 10.8, where the curriculum should prepare students “to provide patient-centered collaborative care” as part of the PPCP. Further research efforts could focus on approaches to integrating and assessing the PPCP as part of interprofessional learning as well as the perceptions of other professions related to elements of the PPCP.

Our study has a number of limitations. The survey collected data only as a snapshot in time during the first part of 2020; thus, the data may not reflect current practices. This is particularly true considering changes that may have been necessary as part of the transition to online and hybrid learning because of the COVID-19 pandemic. Second, one survey per school was completed. The survey was sent to the assessment lead at each institution with a request to forward to the most appropriate person who is most familiar with PPCP integration into the curriculum. In some cases, the individual completing the survey may not have known all current practices related to the PPCP at the program. While the survey was pretested, items may not have been as clear to the respondents as the research team. For example, objective structured clinical examinations (OSCEs) were included in teaching and assessment columns as some institutions may integrate teaching OSCEs.²² However, this could have been confusing to participants at institutions without an OSCE program. Finally, not all institutions responded to the survey, and this may have been because of challenges respondents faced with completing the survey in the midst of the COVID-19 pandemic.