INTRODUCTION
This is a summary of the June 2-3, 2022 Bridging Pharmacy Education and Practice (BPEP) Summit that was designed to achieve consensus and provide action-oriented recommendations to address what pharmacy workforce optimization would look like and the changes that are needed to achieve this. Addressing pharmacy workforce optimization is crucial to help steer the future of pharmacy education and enhance the pharmacy profession’s capacity to improve health outcomes and reduce health disparities. The conference was organized by the new AACP Center to Accelerate Pharmacy Practice Transformation and Academic Innovation (AACP Transformation Center), in partnership with six national pharmacy organizations (Table 1). Background on creation of the AACP Transformation Center, the rationale for the summit, and the structure of the event was published in a recent AJPE commentary.1
Organizations that Collaborated with AACP in Planning the Summit
The summit was attended by approximately 300 individuals, including pharmacists from academia and other sectors of pharmacy (Table 2), pharmacy students, and other healthcare professionals, at six regional host sites spread across the United States (Table 3). Attendees were invited through a purposeful, collaborative approach, with input from AACP leaders and other national pharmacy organizations, which resulted in a pool of subject-matter experts with diverse experiences.1 Plenary lectures and panel discussions, which were telecast to each host site, focused on four topics: (1) competency-based education; (2) professional identity formation; (3) optimizing the continuum of learning: PharmD through postgraduate education; and (4) continuing professional development. Participants at each host site divided into three breakout groups to brainstorm ideas for moving forward in each of these areas. The diverse group of attendees brought passion, experience, and insights from various facets of the pharmacy workforce and beyond, resulting in rich, open discussion and recommendations.
Primary Areas of Professional Engagement of Summit Participantsa
Regional Host Sites for the Summit
After the summit, the takeaways from the breakout discussion groups were recast as recommendations that would lend themselves to actions by the AACP Transformation Center and its collaborators. Summit participants were asked to identify, via a web-based survey, the recommendations that have the greatest potential for enhancing pharmacy’s capacity to improve health outcomes of all people over the next five years. Participants were also asked to rank the four domains of the summit with respect to impact and effort required for implementation. The full list of recommendations from the Summit and complete post-summit survey results can be found on the AACP Transformation Center webpage, along with recordings of all the keynote and panel sessions.2 A graphic recorder, Jo Byrne, created a visual map of the BPEP Summit to bring to life the purpose of the summit and the conversations regarding themes of lifelong learning, interprofessional collaboration, adaptability and inclusivity that emerged during the summit (see Figure 1).
Bridging Pharmacy Education and Practice Summit Visual Map.
PRE-SUMMIT SURVEY
A pre-summit survey was developed by two members of the planning committee. It was piloted with the full committee and finalized. The survey was completed by 219 attendees (a 72% response rate); 47% of the pharmacist respondents indicated they had been licensed for more than 15 years, 8% indicated they had been licensed for 11 to 15 years, and less than 10% indicated either they had been licensed for less than 10 years or were not a licensed healthcare provider.
The survey items were developed to obtain information from summit participants about bridging pharmacy education and practice by listing areas of practice informed by Core Entrustable Professional Activities for New Pharmacy Graduates.3 For each activity statement, participants were asked to select from the following responses: gap in education, gap in practice, gap in both, no gap. In response to this list of pharmacist activities, participants indicated “no gap” in education or practice in two areas: (1) ability to prepare and dispense medication and (2) ability to use general drug knowledge (e.g., indications, dosing, side effects). Gaps were perceived in both education and practice in several areas, including:
Ability to promote population and public health measures
Ability to recognize and provide recommendations for social determinants of health barriers to address health equity
Ability to apply cultural competency skills within interactions with patients and fellow members of the healthcare team
Ability to effectively address the impact of personal, professional, and employer-related demands on personal wellbeing
Ability to implement expanded pharmacy care models and services
Ability to innovate, adapting practice with new therapies and technologies
Additionally, participants were asked to rate each of the four topic areas of the summit on both impact and effort using the following responses: no impact/effort, low impact/effort, moderate impact/effort, or high impact/effort. All four topic areas of the summit were rated by participants as having moderate to high impact on achieving an optimized pharmacy workforce. Competency-based education was viewed by respondents as requiring a high degree of effort to develop strategies for enhancing the capacity of the pharmacy workforce; the other three domains (professional identity formation, the continuum of learning, and continuing professional development) were rated as requiring moderate effort. As discussed below, a similar impact/effort question was asked in the post-summit survey of summit participants.
OPENING THE SUMMIT
Russell B. Melchert, AACP President-Elect, speaking from the University of Texas at Austin venue, opened the summit with a warm welcome to attendees and appreciation for those involved in planning and conducting the event. These remarks strongly encouraged attendees to think outside the box about the future of the profession of pharmacy and the strategies to reach an optimized pharmacy workforce.
Stuart T. Haines, AACP President, in a video-recorded message, stated two key questions the summit was designed to help answer: (1) How should the pharmacy workforce be deployed to ensure the optimal use of medications in all settings? (2) What changes in pharmacy education and practice are needed to achieve an optimized pharmacy workforce?
COMPETENCY-BASED EDUCATION
Keynote Lecture
Melissa S. Medina (College of Pharmacy, The University of Oklahoma Health Sciences Center) reviewed the fundamentals of competency-based education (CBE) and the factors that are generating heightened interest in CBE. (Reference 4 is an article by Dr. Medina on CBE.)
Reflecting deliberations of the AACP Competency-Based Education Task Force, Dr. Medina defined CBE as outcomes-based education that (1) focuses on the abilities of the student to do job-related tasks, (2) de-emphasizes a time-based approach to training, (3) allows students to move at their own pace, and (4) requires students to demonstrate what they know. An overarching objective of CBE in pharmacy is to improve the profession’s capacity to meet healthcare and societal needs. Dr. Medina contrasted CBE with traditional instruction in terms of structure, teaching mode, pace, assessment method, and program completion time (see Figure 2).
Comparison of traditional vs. competency-based education (from reference 4).
Current interest in CBE is driven by rising tuition costs, the desire of older students to fit education around the demands in their lives, and the desire of educators and others to be more confident that graduates have attained the expected level of competence before graduating.
Dr. Medina discussed the advantages of CBE from four perspectives: (1) the patient/society (e.g., improving medication-use safety), (2) the learner (e.g., minimizing student debt), (3) the healthcare system (e.g., fostering interprofessional collaboration), and (4) the academic institution (e.g., attracting applications for admission). She reviewed the history of educational standards in pharmacy and commented on the prominent CBE movement in medical education.
Dr. Medina discussed opportunities for advancing CBE in pharmacy education in three areas: research (e.g., identifying content areas that lend themselves to CBE), skills development (e.g., identifying skills common to all pharmacists), and assessment (e.g., evaluating the feasibility of an integrated approach to performance assessment).
Panel Discussion
A panel discussion on CBE was moderated by Daniel P. Zlott (American Pharmacists Association); the panelists were Zubin Austin (Leslie Dan Faculty of Pharmacy, University of Toronto), Dorothy Andriole (Association of American Medical Colleges), and Denise Rhoney (Eshelman School of Pharmacy, University of North Carolina). They commented on the challenges that educators are trying to solve with CBE and elaborated on the implications of adopting CBE in pharmacy. Of note, Dr. Austin brought an international perspective on CBE to this discussion. Panelists discussed the relationship between CBE and (1) life-long learning, (2) professional-role expansion, (3) building both competence and confidence in learners, (4) adaptability to changes in practice expectations, and (5) requirements for broad-based stakeholder support (e.g., by employers and regulators).
Panelist Denise Rhoney chaired the recent AACP Competency-Based Education Task Force, which was charged to (1) explore the advantages and disadvantages of advancing a competency-based approach to pharmacy education and (2) determine ways to create more flexibility within pharmacy curricula to be able to allow for the offering of competency-based education (i.e., be less bound by standard, time-based curricular requirements). The CBE Task Force will be publishing multiple papers in AJPE over the coming months to share their findings and recommendations.
Top-Rated Recommendations from Discussion Groups
In the area of CBE, the highest rated general recommendations indicate a demand for establishing the need for and feasibility of CBE for the pharmacy profession and clarifying the problems or issues that CBE would address. Logically, this should occur prior to development of “practice-ready” competencies, strategies for addressing the content-delivery and assessment challenges, or a comprehensive teaching and learning model, which were other highly rated items in the post-summit survey. Determining need and feasibility of this model will be necessary moving forward (including assessment of the effect on education infrastructure and related costs, which was the highest rated recommendation related to educators and students). (See Table 4 for all top-rated recommendations related to CBE.)
Post-Summit Top-Rated Recommendations Related to Competency-Based Education (CBE)a
PROFESSIONAL IDENTITY FORMATION
Keynote Lecture
Jamie Kellar (Leslie Dan Faculty of Pharmacy, University of Toronto), a Canadian pharmacist and researcher, presented the keynote lecture related to professional identity formation (PIF), a topic that has been under formal study by the 2019-2020 and 2020-2021 AACP Student Affairs Standing Committees and a subsequent Council of Faculties Task Force.5-6 The 2020-2021 standing committee noted that “professional identity involves internalizing and demonstrating the behavioral norms, standards, and values of a professional community, such that one comes to ‘think, act and feel’ like a member of that community.”6 Further, “… a strong professional identity is needed in this era of practice transformation and expansion of the pharmacist’s roles.”6
Dr. Kellar cautioned that “professional identity alone is not likely to transform practice on the scale we are hoping for, nor on the timelines we desire.” She encouraged investment in research that can guide strategies for pursuing change in pharmacy practice. She challenged the notion that there is a need for a single, unified identity for the profession and encouraged consideration of the possibilities that could result from supporting multiple professional identities.
According to Dr. Kellar’s historical critical discourse analysis of pharmacy education, five professional discourses—apothecary, dispenser, merchandiser, expert advisor, and healthcare provider—were exhibited over the past century. (See reference 7 for background on discourse analysis.) She noted that the top-down promotion of the healthcare provider role has had the unintended consequence of marginalizing other relevant identities of pharmacists, such as dispenser and merchandiser. The pile-up of and dissonance among professional identities puts learners at risk because they cannot reconcile the ideal conception of a pharmacist and the roles they are frequently called upon to perform in experiential education. If pharmacy educational programs are not equipped to help learners navigate the discrepant messages between the classroom and experiential learning, students are left to negotiate the identity dissonance on their own and may choose to avoid positions that curtail their ability to practice as healthcare providers.
As an alternative to advocating and training for a unified identity, Dr. Kellar said, “We can choose to accept that there is no permanent identity to be achieved or to be set by the academy and shift to the idea that identities are fluid and determined by individual students.” She acknowledged that this philosophy may be difficult for pharmacy educators to accept because it is counter to the notion of standardized student outcomes. (See also an article on some of Dr. Kellar’s research8 and an article about professional identity formation in medical education.9)
Panel Discussion
William M. Ellis (Board of Pharmacy Specialties) moderated the discussion of a panel consisting of Kristin Janke (College of Pharmacy, University of Minnesota), Vickie L. Powell (Pharmacy Department, New York-Presbyterian Hospital), and Carolyn M. Clancy (Veterans Health Administration). The topics covered included (1) the importance of PIF in workforce optimization and practice transformation, (2) current and future aspirational identities of pharmacists (e.g., compounders, clinical pharmacists, quality-of-care leaders, regulatory and policy leaders, change agents), (3) how early student experiences can help form professional identity, (4) what the profession needs to do to advance professional identity, (5) how the employment forecast for pharmacists should be considered in PIF, (6) whether it is desirable to link professional identity with place of practice, (7) how to reflect PIF in accreditation standards, (8) PIF for pharmacy technicians, (9) the role of professional organizations in PIF, (10) balancing one’s preferred professional identity with that of the employer, (11) the role of interprofessional education in identity formation, and (12) how to reconcile pharmacy-specific PIF versus healthcare-team PIF.
Top-Rated Recommendations from Discussion Groups
The highest rated PIF general recommendation relates to the need to develop a consistent message about the role and value of a pharmacist, while the third-highest-rated item highlights the importance of developing and communicating a primary identity for pharmacists that could still be individualized. These results suggest the need to create consensus on a pharmacist identity that conveys the role and value of a pharmacist, which can be individualized for any given pharmacist in the profession, regardless of career path or specialization. Also highly rated: (1) the need to conceptualize PIF as a continuous process that begins early in PharmD education and extends throughout a pharmacist’s career and (2) that tools should be provided to faculty and practitioners to ensure positive role modeling and mentoring related to PIF. (See Table 5 for all top-rated recommendations related to PIF.)
Post-Summit Top-Rated Recommendations Related to Professional Identity Formation (PIF)a
OPTIMIZING THE CONTINUUM OF LEARNING: PHARM.D. THROUGH POSTGRADUATE EDUCATION
Keynote Lecture
Alison J. Whelan (Association of American Medical Colleges) opened this segment of the summit with a broadly focused lecture on “Opportunities in Health Professions Education: How To Evolve as Health Educators.”
The need to establish a “growth mindset” in learners (including critical thinking, adaptability, being open to change, and self-reflection) was discussed as an approach to optimize the continuum of learning. This would also ensure that health practitioners continuously meet the needs of the public. Medical education has approached this through identifying competencies across the learning continuum and in new and emerging areas such as quality improvement and patient safety; telehealth; and diversity, equity, and inclusion.
During the covid-19 pandemic, medical residents and faculty members have sometimes been redeployed to patient care areas they are not familiar with to meet public health needs. This requires better assessment of competency in the interest of patient safety, practitioner confidence, and practitioner well-being. The competency-based approach also facilitates pursuance of new skills or passions throughout a practitioner’s career and can allow students to move through training more quickly to better support the workforce.
Medical educators and pharmacy educators have identified some of the same core competencies for their students. There would be merit in assessing the degree to which true overlap exists among the respective target competencies, which might suggest opportunities for sharing teaching resources and learning from each other in the practice environment. Cross-training between various health professions during the covid-19 pandemic was essential, and this could serve as a model for more cross-training in the future.
Each profession is working to diversify its future workforce in various ways to better address the needs of a diverse patient population while simultaneously supporting a more diverse and inclusive workforce. Development of greater diversity among health profession educators requires recruitment for diversity, learner retention and engagement, and career promotion—all supported by appropriate training, education, policy, procedures, culture, and community. Increased career planning support, specifically through matching individuals’ passions with their pursuits, can help with retention and satisfaction. A more diverse and more satisfied workforce contributes to well-being for all.
Dr. Whalen advocated that educators engage students in developing curricular changes because students have good ideas, and they will be more satisfied with changes that they had a voice in creating. (For a related article about medicine’s acceleration of the transition to medical residencies, see reference 10.)
Panel Discussion
Amie D. Brooks (American College of Clinical Pharmacy) moderated the discussion of a panel consisting of Janet A. Silvester (American Society of Health-System Pharmacists), Todd D. Sorensen (College of Pharmacy, University of Minnesota), and Sharon L. Youmans (School of Pharmacy, University of California San Francisco).
The topics covered included (1) the need for a fresh, holistic approach for determining (a) which competencies are best developed in which stage of the education continuum and (b) the time required for achieving those competencies; (2) the need for better coordination between PharmD programs and residencies with respect to target competencies; (3) learning from the changes made in education during the pandemic; (4) the major changes in the PharmD curriculum at the University of California San Francisco, which focused on moving to a pass/no pass three-year, integrated curriculum; (5) how to teach learners about making constructive change in pharmacy practice; (6) the need for non-residency flexible, learner-centric postgraduate programs for developing specific competencies; (7) the need for better methods of assessing practice readiness; (8) the prospect of incorporating the concept of entrustable professional activities into residencies; (9) collaboration between PharmD programs and residency programs in preceptor development; and (10) enhancing pharmacy intraprofessional collaboration through the learning continuum.
Top-Rated Recommendations from Discussion Groups
The highest rated recommendations suggest the need to improve communication and alignment across the pharmacy continuum of learning and to harmonize accreditation standards for interprofessional education. Attendees indicated the need to focus more on skill development in critical thinking, problem solving, and continuous learning through more practicums, labs, and simulations. Also rated highly was the desirability of exposing students to successful practitioners who pursued various career paths to reinforce the value of life-long learning and adaptability. Multiple highly rated recommendations suggest synergy between continuum-of-learning optimization, CBE, and continuing professional development (CPD). While consensus about CBE and CPD in pharmacy education and the profession has not yet been reached, these survey results support investigation of how these models may contribute to optimizing the continuum of learning. (See Table 6 for all top-rated recommendations related to optimizing the continuum of learning.)
Post-Summit Top-Rated Recommendations Related to Optimizing the Continuum of Learninga
CONTINUING PROFESSIONAL DEVELOPMENT
Keynote Lecture
Michael J. Rouse (Accreditation Council for Pharmacy Education) began his keynote lecture on pharmacists’ continuing professional development (CPD) by tracing the history of continuing education (CE) and CPD in pharmacy. It is generally recognized that mandatory CE has not adequately supported the advancement of pharmacy practice.
CPD has been conceptualized as “an ongoing learning and development cycle in which individual learners reflect on their practice, assess their knowledge and skills, identify learning needs and goals, create a personal learning plan, implement the plan, apply the learning in practice, and evaluate the effectiveness of the plan and the outcomes and impact of learning.”11 Employers (rather than state boards of pharmacy) are probably in the best position to encourage adoption of a CPD model for ensuring continuing competence of practitioners.
Mr. Rouse called for a profession-wide strategic approach in supporting CPD as a means of advancing pharmacy practice. Among his specific recommendations toward this end were to (1) recognize self-directed lifelong learning as a competency that must be developed throughout the continuum of learning, (2) develop and deliver innovative models for CE/CPD, (3) give more attention to application of learning and commitment to change, (4) measure outcomes and impact of learning rather than CE credits earned, (5) align credentialing requirements with specific goals related to advancing team-delivered patient care, and (6) align practitioners’ learning needs and goals with the needs and goals of patients, employers, and society. Mr. Rouse urged that every educational activity in pharmacy be focused on preparing and motivating pharmacists to improve the safety and effectiveness of drug therapy and patients’ quality of life.
Panel Discussion
Brian Lawson (Board of Pharmacy Specialties) moderated the discussion of a panel consisting of Kate Gainer (Iowa Pharmacists Association), Anne Y. Lin (School of Pharmacy, Notre Dame of Maryland University), and Lee C. Vermeulen (American Association of Colleges of Pharmacy).
Topics discussed included (1) the role of pharmacy organizations, academic pharmacy, and health-system settings in fostering CPD, (2) aligning CPD plans with the goals of employers, (3) the relationship between CPD and practitioner resiliency and satisfaction, (4) techniques for shifting from CE to CPD, (5) the return on investment of CPD, (6) the positive aspects of preparing practitioners through CPD to advance within their current organizations, (7) explaining the value of CPD, (8) CPD requirements for pharmacists who are not involved in direct patient care, (9) the relationship between CPD and professional identity formation, (10) documentation of improved patient care as a motivator for adopting CPD, and (11) how to train student pharmacists to become lifelong learners.
Top-Rated Recommendations from Discussion Groups
Similar to the CBE recommendations, highly rated CPD recommendations indicate a need to establish the value of CPD for various stakeholders before determining if implementation is appropriate across pharmacy education and practice. This and other highly rated recommendations suggest that consensus across the profession, from pharmacy schools to pharmacist employers, is required to have a common understanding of the objectives and methods to successfully transition from the current CE model to CPD, if this is determined to be desired and feasible. Additional top recommendations represent actions related to implementation and could be considered more closely when consensus is achieved with respect to moving forward with CPD. (See Table 7 for all top-rated recommendations related to pharmacists’ continuing professional development.)
Post-Summit Top-Rated Recommendations Related to Continuing Professional Development (CPD)a
POST-SUMMIT SURVEY
At all six regional host sites, immediately following the panel discussion of each summit topic, three breakout groups convened to formulate key takeaways related to the respective topic. Hence, there were 72 small-group discussions during the summit as a whole. After combining related points and recasting the remaining takeaways as recommendations, 142 items were included in the post-summit survey (38 items related to competency-based education, 27 to professional identity formation, 42 to optimizing the continuum of learning, and 35 to continuing professional development).
Within each domain, the recommendations were clustered into two or three distinct categories. For example, the 38 items related to competency-based education were divided into 12 general recommendations, 16 related to educators and students, and 10 related to practitioners and employers. For each cluster, survey respondents were asked to select one to three recommendations that they believed would have the most significant impact on enhancing pharmacy’s capacity to improve health outcomes for all people over the next five years.
The post-summit survey (with a 36% response rate) was sent electronically to all summit participants approximately two weeks after the conclusion of the event. Tables 4-7 show the top items selected by the 109 survey respondents. The highest number of votes for any recommendation was 84 (see Table 4). The lowest number of votes for any top-rated recommendation was 27 (one item in Table 5 and one in Table 7). The median number of votes for top-rated recommendations was 39.
The post-summit survey also asked respondents to again rate the four domains of the summit on two measures: “level of impact on achieving an optimized pharmacy workforce” and “level of effort to develop strategies that will be needed to achieve an optimized pharmacy workforce.” All domains were rated as having high to moderate impact and as requiring moderate to high effort. Professional identity formation was rated as having somewhat higher impact than the other three domains and as requiring somewhat less effort. Competency-based education was at the other end of the spectrum, rated as having somewhat lower impact than the other three domains and as requiring substantially more effort.
NEXT STEPS: FULFILLING THE PROMISE OF THE SUMMIT
The energy and enthusiasm of those who planned the summit and of those who participated in this landmark event bode well for what will follow. This optimism is supported by the passion for professional renewal and alignment we have observed among a wide swath of pharmacy educators and practitioners. Renewal in the sense of making innovations in how the pharmacy workforce is educated for the challenges it faces. Alignment in the sense of making innovations in practice that will enhance pharmacy’s effectiveness in promoting responsible use of medicines. The summit has pointed the way toward the constructive changes that are needed to achieve these ends.
Follow-up on the recommendations of the summit will be a major focus of the AACP Transformation Center. The Center will review all 142 recommendations from the summit (available on the AACP Transformation Center webpage2) and will be particularly guided by the top-rated recommendations when setting its priorities (Tables 4-7). An expert advisory council will be appointed and convened in Fall 2022 to assist the Center in this discernment process. Among other key activities, the Center will publicize constructive innovations in pharmacy practice and education and will seek to foster wider adoption of those innovations.
All stakeholders related to the mission of pharmacy are encouraged to assess how their strategic priorities and activities align with the recommendations of the summit. As the AACP Transformation Center plans how to pursue these recommendations, it will identify opportunities to collaborate with stakeholders, including administrative leaders and faculty members of colleges and schools of pharmacy, national and state pharmacist associations, pharmacy employer organizations, individual pharmacy practitioners and trainees, pharmacy technician organizations, credentialing and regulatory bodies in pharmacy, patients and patient advocacy groups, interprofessional educators, and others.
Broad-based and synergistic collaboration will be required to build a stronger culture of community, innovation, and transformation in pharmacy that ultimately results in greatly improved health for individuals and the population as a whole. That is the promise of the summit and the goal of all those who are inspired by the recommendations of the summit.
ACKNOWLEDGEMENTS
Our dedicated organizational planning partners included Ruby Singh (AMCP), Mary E. Kiersma (ACPE), Amie D. Brooks (ACCP), Lindsay L. Kunkle (formerly of APhA), Daniel Zlott (APhA), Douglas J. Scheckelhoff (ASHP), Kasey K. Thompson (ASHP), William M. Ellis (BPS), and Brian Lawson (BPS). In addition to those listed as authors of this report, AACP staff members who made significant contributions include Michelle Assa-Eley, Lynette R. Bradley-Baker, Jasey Cárdenas, Thomas Maggio, Sibu Ramamurthy, and Sarah P. Shrader.
William A. Zellmer, BSPharm, MPH, President, Pharmacy Foresight Consulting, was retained to work with the AACP staff on the creation of the BPEP Summit summary.
- © 2022 American Association of Colleges of Pharmacy
In this issue
Jump to section
- Article
- INTRODUCTION
- PRE-SUMMIT SURVEY
- OPENING THE SUMMIT
- COMPETENCY-BASED EDUCATION
- PROFESSIONAL IDENTITY FORMATION
- OPTIMIZING THE CONTINUUM OF LEARNING: PHARM.D. THROUGH POSTGRADUATE EDUCATION
- CONTINUING PROFESSIONAL DEVELOPMENT
- POST-SUMMIT SURVEY
- NEXT STEPS: FULFILLING THE PROMISE OF THE SUMMIT
- ACKNOWLEDGEMENTS
- REFERENCES
- Figures & Data
- Info & Metrics
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