Lynette R. Bradley-Baker

Pharmacy Residencies and Dual Degrees as Complementary or Competitive Advanced Training Opportunities

The impact of pharmacy practice has been enhanced through additional graduate training opportunities, such as pharmacy residencies and dual-degree programs. This article compares and contrasts key aspects of pharmacy residencies and dual-degree programs, as well as examines the efforts of US colleges and schools of pharmacy in promoting these advanced training opportunities on their Web sites. Pharmacy residencies and dual-degree programs are complementary opportunities that allow student pharmacists to gain advanced knowledge and specialized skills beyond the traditional Doctor of Pharmacy (PharmD) degree. The combination of these credentials can be highly advantageous in a variety of practice settings. As pharmacists collaborate with healthcare providers and professionals from other disciplines, more support is needed to expand the availability and use of these cross-profession, advanced training opportunities to enhance the future of the pharmacy profession.

Report of the 2011-2012 AACP Professional Affairs Committee: Addressing the teaching excellence of volunteer pharmacy preceptors

issuesassociatedwiththeprofessionalpracticeastheyrelate to pharmaceutical education, and to establishand improve working relationships with all other or-ganizations in the field of health affairs. The Commit-teeisalsoencouragedtoaddressrelatedagendaitemsrelevanttoitsBylaws chargeandtoidentifyissuesforconsideration by subsequent committees, task forces,commission, or other groups.

Historical Development and Emerging Trends of Community Pharmacy Residencies

Clinical pharmacy services necessitate appropriately trained pharmacists. Postgraduate year one (PGY1) community pharmacy residency programs (CPRPs) provide advanced training for pharmacists to provide multiple patient care services in the community setting. These programs provide an avenue to translate innovative ideas and services into clinical practice. In this paper, we describe the history and current status of PGY1 community pharmacy residency programs, including an analysis of the typical settings and services offered. Specific information on the trends of community programs compared with other PGY1 pharmacy residencies is also discussed. The information presented in this paper is intended to encourage discussion regarding the need for increasing the capacity of PGY1 community pharmacy residency programs.

Report of the 2010-2011 Professional Affairs Committee: Effective partnerships to implement pharmacists' services in team-based, patient-centered healthcare.

According to the Bylaws of the AACP, the Professional Affairs Committee is to study: issues associated with the professional practice as they relate to pharmaceutical education, and to establish and improve working relationships with all other organizations in the field of health affairs. The Committee is also encouraged to address related agenda items relevant to its Bylaws charge and to identify issues for consideration by subsequent committees, task forces, commission, or other groups. COMMITTEE CHARGE President Rodney A. Carter charged the 2010-2011 American Association of Colleges of Pharmacy (AACP) Professional Affairs Committee with: Examining how AACP and its members can most effectively partner with a variety of key stakeholders to accelerate the implementation of pharmacist services (e.g., MTM, primary care) as the standard for team-based, patient-centered care. Members of the 2010-2011 Professional Affairs Committee include faculty from various colleges and schools of pharmacy as well as pharmacy practice association representatives from the American Pharmacists Association (APhA), the American Society of Health-System Pharmacists (ASHP), the National Association of Chain Drug Stores (NACDS), and the National Community Pharmacists Association (NCPA). In order to fulfill the Committee charge, the Committee members met for a day and a half in Arlington, Virginia in October 2010 to discuss the committee charge and develop a plan of action to address the charge. Following this meeting, the Committee communicated via a series of conference calls as well as personal exchanges via telephone and email. The result is the following report which is positioned to discuss various models of care, challenges and opportunities pertaining to the charge, successful practices of AACP members and multiple pharmacy practice organizations, and recommendations to AACP in response to the Committee charge. BACKGROUND The pharmacy profession has been intransition from a product-based to a patient-centered care model since the introduction of the pharmaceutical care philosophy in the 1990s. (1) This transition has been accomplished to varying degrees in different pharmacy practice settings and has been influenced by a variety of factors including the transition to the clinically-focused Doctor of Pharmacy (Pharm.D.) degree as the entry level degree and the increasing recognition that medication-related problems pose a significant threat to public health. (2) The Centers for Medicare and Medicaid Services (CMS) recognized the importance of medication therapy management (MTM) services by requiring all Medicare Part D plans to provide MTM as part of their programs. Recent healthcare reform (HCR) legislation includes provisions for MTM and pharmacist-provided services as part of integrated team-based care models designed to improve the quality of healthcare delivered in the United States. (4) Pharmacists are well-positioned to serve as the medication therapy expert on the healthcare team. (5) Currently, MTM services are not offered to all patients in all settings. This creates a situation of inequality and fragmentation of pharmacy services. It is imperative that the profession and the Academy accelerate the implementation of patient-centered, team-based care as the standard of pharmacy practice with the availability of MTM services to all patients. This vision has been clearly articulated in the Joint Commission of Pharmacy Practitioners (JCPP) vision for pharmacy practice. (6) Identification of the factors that are impeding the realization of this vision and the development of strategies to accelerate its adoption as the standard of pharmacy practice in 2015 are the focus of this report. With the current HCR legislation, increasing the momentum for implementation of medication management services and chronic disease management services provided by pharmacists is a critical issue for pharmacy practice and education. …

Leadership Development of Student Pharmacists

Redesigning the health system model(s) to provide improved access, coordination, and utilization of resources, and quality of care is an important step towards achieving better health for all. This will require the work of many creative and forward-thinking individuals who collaborate effectively with others and are capable of generating successful organizational change in complex, high pressure, and challenging environments. To ensure the continued expansion and success of these efforts, schools, colleges, and universities must develop and sustain high-impact learning environments and curricula that foster the ability to positively influence this process. The AACP 2008-2009 Argus Commission examined issues related to building a sustainable system of leadership development for pharmacy, and student pharmacists were a focus in their report.1 One of the proposed policy statements from that report, “curricular modifications should occur such that competencies for leading change in pharmacy and health care are developed in all student pharmacists, using a consistent thread of didactic, experiential and co-curricular learning opportunities,” clearly indicates the need for the curricula at all colleges and schools of pharmacy to have a focus on developing leadership skills. Many change leadership competencies can and should be reflected throughout the core curricular components, via lecture-based courses (required and elective), practice laboratories, small-group discussions and projects, case studies, and introductory and advanced pharmacy practice experiences (IPPEs and APPEs). In addition, extracurricular activities, service learning, and other experiences provided to student pharmacists throughout their formal professional education can serve to instill and promote change leadership attributes. Continued study of the impact of PharmD curricula is also needed. Applying Kirkpatricks Model of Evaluation,2,3 programs appear to have made steady progress towards evaluating the reaction (satisfaction and perceived value of training) and learning (development of knowledge, skills, abilities) of student pharmacists. It is the behavior (transfer of the learning to the practice or other settings) and results (the impact on individual patients, health care settings, population, and community health) that need further study through enhanced partnerships among academia, practice, and other organizations. The editors of this issue also reconnected with several of the student pharmacists (now pharmacists) who participated in the Argus Commission Report and recent graduates from 4 pharmacy practice organizations. Their viewpoints, many of which reinforce the Argus Commission’s original recommendations, are summarized below: (1) Colleges and schools should strive to create an environment where leadership is not only recognized but valued. Faculty members who are actively involved in professional organizations, policy development, and everyday practice as change agents themselves send a strong message to students of the importance they place on these types of activities. In addition, encouraging and providing financial support for student pharmacists to attend professional meetings raises awareness of new and emerging pharmacy roles and networking opportunities. (2) Creating a supportive network of role models and mentors (faculty members, peers, and practitioners) is important to professional growth. Mentors are needed who encourage student pharmacists to see not only the challenges but also the possibilities, who spark curiosity, and in the words of one of the pharmacists interviewed, “not necessarily provide the right answer, but help frame the question.” Providing multiple levels of involvement and the encouragement of mentors who have achieved a healthy balance between their work (or school, if peer mentors) and their personal life has increased student engagement for those “on the fence” and prevented burnout for those already involved. (3) Providing multiple opportunities for learning outside of the classroom with multiple professions is essential. Applying previous learning to new, unscripted, and sometimes ambiguous situations creates the courage to test novel solutions, build team and coalitions, and challenge the status quo. Identifying needs and innovative approaches to addressing those needs (eg, coordinating health promotion/disease prevention and early detection activities in the community), capitalizing on the profession’s strengths, and embracing new roles are examples of ways student pharmacists can promote better health as leaders and change agents. Embedding opportunities to expand pharmacy services, conduct research, and participate in policy development or advocacy in IPPEs and APPEs and intern experiences, allow student pharmacists to practice skills they can carry forward in their careers. Active involvement in professional organizations and co-curricular activities are strongly encouraged. The critical issue of professional practice development in the AACP strategic plan addresses creating change agents and leaders in student pharmacists and graduates.4 The idea for a theme issue focused on student leadership development to be published in the Journal was developed by several faculty members who have worked and published in the area of student leadership and the AACP Director of Professional Alliance Development. The primary objectives for the issue were to promote awareness of the need for a focus on student leadership development, disseminate guidance documents for use by AACP member colleges and schools and the broader Journal readership, and facilitate implementation of educational programs to achieve competencies related to student leadership and change agent development. All AACP members were invited to submit manuscript proposals. Authors submitted an abstract and detailed outline within a predetermined set of themes: (1) research-focused work in areas of student leadership development; (2) the role of classroom, experiential, co-curricular, international/global, or interprofessional education in leadership development; (3) the role of student organizations in leadership development; (4) best practices in leadership instruction, including outcomes and quality indicators; and (5) the role of leadership abilities in the recruitment, selection, progression, and/or graduation of student pharmacists. Sixty-two proposals from 59 different colleges and schools of pharmacy were received. A committee of 17 members from the AACP Leadership Development Special Interest Group was formed to review the proposals. An evaluation rubric was developed based on the manuscript proposal’s abstract and scholarly contribution. Six manuscripts were selected, and the non-selected submissions were encouraged to seek publication in the future. The articles contained within this theme issue represent a diverse collection of information on student leadership development. The report of a 2010 AACP Council of Faculties Task Force examines how colleges and schools of pharmacy are preparing pharmacy faculty and student pharmacists to be leaders and advocates for the profession.5 Using a modified Delphi process, Traynor, Janke, and Boyle provide the academy with valuable information in 2 articles regarding student pharmacist leadership competencies and guidelines regarding student leadership development in the curricula.6,7 Patterson and colleagues provide an innovative method to offer formal leadership instruction to second- and third-year PharmD students with the assistance of graduate students and faculty members.8 Sucher and colleagues provide another example of using an elective course for student pharmacist development.9 Using various mechanisms to encourage student reflection, this course exposes student pharmacists to multiple facets, techniques, and tools used to develop and assess leadership. Chesnut and Tran-Johnson describe a student leadership development series that uses a longitudinal, co-curricular approach to emphasize the application of leadership concepts.10 This series has been available for 6 years and provides student pharmacists the opportunity to participate in multiple leadership platforms and activities as well earn points that can lead to the award of travel funds to attend a conference or meeting to further enhance their leadership skills. Developing effective leaders and change agents is an important step in addressing the current and emerging challenges of the US healthcare system. Colleges and schools of pharmacy have a responsibility to incorporate leadership development opportunities throughout their curriculum in order to provide future practitioners with the knowledge, attitudes, and skills needed to implement positive change. The Leadership Development Special Interest Group formed in 2011 is creating a toolkit that can be shared among colleges and schools and other organizations based on a recommendation from the 2008-2009 Argus Commission Report. We hope that the articles in this theme issue will also provide helpful strategies in addressing academic pharmacy’s important charge of leadership development.

Pharmacists' Assessment of Facets of Health Literacy in Pharmacy Practice Settings

Background: There is limited research on the scope of health literacy practices employed by front-line providers such as pharmacies. Given the challenge of health literacy aspects in todays society, an analysis of health literacy practices provided in pharmacy settings is warranted. Objective: To investigate how pharmacists assess their primary practice setting for attributes related to health literacy. Methods: An invitation to complete an online survey was sent to a random sample of 1,000 pharmacists practicing in ambulatory-based practice settings in Maryland. A follow-up reminder postcard was sent a month after the initial invitation. The online survey was available for 3 months. The survey instrument was based on the Agency for Healthcare Research and Quality (AHRQ) Pharmacy Health Literacy Assessment Tool. The health literacy areas explored in this study include print materials, verbal communication techniques, and sensitivity to health literacy-related issues. Results: Of the 1000 pharmacists sent the survey, 160 responded to the survey invitation; 113 were able to complete the entire survey. Most (56%) of the respondents were older than 40 years and 68% worked in community pharmacy settings. Pharmacists who completed formal health literacy training and those in community pharmacy practice appeared to provide greater access to easy-to-read printed materials in their health-care settings and were willing to provide competent verbal consultation about medications. Such services are specifically amenable to patients with limited health literacy. This study is limited by the low response rate and by not being generalizable to ambulatory pharmacy settings throughout the US. Conclusions: This study provides insight into the potential for health literacy issues to impact care provided in ambulatory pharmacy practice settings. Pharmacists need additional training regarding health literacy, such as methods to improve communication with patients who have limited health literacy.

The Report of the 2017-2018 Professional Affairs Standing Committee: The Development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Graduates

EXECUTIVE SUMMARY The 2017-2018 AACP Professional Affairs Committee addressed the charges of (1) developing a self-reflection/self-assessment tool for pharmacy faculty and preceptors to allow them to assess their capability and confidence with Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes, the Pharmacists’ Patient Care Process (PPCP), and the Entrustable Professional Activities (EPAs) for New Pharmacy Graduates and (2) creation of a plan for AACP to utilize in the development of preceptor continuing education and training programs. This report describes the framework, rationale and process for the development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Pharmacy Graduates (PSAE Tool), the pre-test for the PSAE tool, and the online pilot test and its results for the PSAE Tool. The committee provides recommendations for AACP in the continued development and distribution of the PSAE Tool to the schools of pharmacy. Considerations for AACP and the schools of pharmacy to consider in the continuing professional development (CPD) for all preceptors are also discussed. The committee provides a policy statement, adopted by the AACP House of Delegates, regarding the commitment of AACP regarding the CPD for all preceptors. The committee also provides several recommendations to AACP and suggestions to schools of pharmacy and other stakeholder groups pertaining to the committee charges.

Reassessment of Health-System Capacity for Experiential Education Requirements

Objective. To provide an update to the 2007 ASHP-AACP survey by examining the current capacity of hospitals/health systems’ ability to conduct experiential education for doctor of pharmacy students. Methods. Pharmacists identified as pharmacy directors were sent an invitation to participate in an online survey tool. The survey tool asked IPPE- and APPE-specific questions, the nature of support provided by colleges/schools of pharmacy, the types of experiences available for students, and the factors influencing the quality, value, and challenges of experiential education. Results. Four hundred sixty five of the 2,911 surveys sent were completed yielding a response rate of 16%. Respectively, 45.1% and 28.5% of respondents believe that the capacity for APPE and IPPE will increase in the next five years. Overall, respondents believe that students receive a high-quality experiential education (91.4%). Conclusion. The results of this survey provide insight to the capacity, benefits and challenges of experiential education from the perspective of hospitals/health systems.

The Report of the 2016-2017 Professional Affairs Standing Committee: Formally Embracing and Engaging Preceptors in the Academy — The Time Has Come

EXECUTIVE SUMMARY The 2016-2017 AACP Professional Affairs Committee (PAC) was charged to examine strategies to include adjunct/affiliate preceptors as AACP members and to determine the value proposition of AACP membership for this group of educators. The PAC defined adjunct/affiliate preceptors as preceptors who are neither full-time employees nor have a primary employment commitment (≥50% of the preceptor’s work salary) at a school/college of pharmacy. Specific charges to the PAC included: recommend an approach to increase the number of adjunct/affiliate preceptors as AACP members, examine AACP membership from an adjunct/affiliate preceptor value perspective, and prepare a concise summary of available literature describing value-added contributions of student pharmacists and pharmacy preceptors to pharmacy practice models, interprofessional education (IPE) and interprofessional practice (IPP). The summary of the plan developed by the PAC to address the charges is presented in the following report, which includes three sections: the value proposition of AACP membership for adjunct/affiliate preceptors, expansion of the presence of adjunct/affiliate preceptors in AACP, and the value of student pharmacists in experiential education settings. The value proposition of AACP membership for adjunct/affiliate preceptors section describes results of surveys and focus groups conducted by the PAC. The PAC surveyed experiential education directors at schools/colleges of pharmacy, adjunct/affiliate preceptors (from a request via the experiential education directors), and new pharmacy practice faculty members in order to determine current resources available for adjunct/affiliate preceptor development, as well as explore potential resources AACP could provide for adjunct/affiliate preceptor development. Focus groups were held with adjunct/affiliate preceptors and experiential education faculty/staff to explore some of the results and concepts generated from the surveys. The PAC developed three recommendations for AACP as a result of the surveys and focus groups. The report also describes various factors that should be considered by AACP in developing a membership category for adjunct/affiliate preceptors, including potential membership models, establishment of an advisory board, and collaboration with other stakeholder groups. The final section of the report provides an executive summary and detailed table, which summarizes available literature on the value of student pharmacists in experiential education. The brief literature review reinforces that there are many different practice settings where student pharmacists add value to patient care and the practice site. This information is significant for experiential education faculty/staff, as well as adjunct/affiliate preceptors, and serves as an example of best practices which document the value experiential education provides to patient care and practice sites. The final section of the report provides a policy statement that was adopted by the 2017 AACP House of Delegates and one suggestion to schools/colleges of pharmacy. The report concludes with a call to action regarding the formal involvement of adjunct/affiliate preceptors by AACP and the academy.

Which Comes First—Credentialing and Privileging in Pharmacy or Pharmacist Provider Status?

The “which came first, the chicken or the egg?” causality dilemma can be applied to many situations in the advancement of health care and pharmacy practice. Whether the universal acknowledgment and application of credentialing and privileging in pharmacy should precede pharmacists being granted provider status is an issue that the profession should consider during this time of practice evolution. The pharmacy profession has the opportunity and responsibility to proactively ensure that credentialing and privileging are addressed in all pharmacy practice settings. The Council on Credentialing in Pharmacy (CCP), a coalition of 10 national pharmacy organizations committed to providing leadership, guidance, public information, and coordination for credentialing programs in or relevant to the profession of pharmacy, recently published a resource paper on pharmacist credentialing and privileging.1 The CCP defines credentialing as the process of granting a credential (a designation that indicates qualifications in a subject or area), and (2) the process by which an organization or institution obtains, verifies, and assesses an individual’s qualifications to provide patient care services. The council defines privileging as the process by which a health care organization, having reviewed an individual health care provider’s credentials and performance and found them satisfactory, authorizes that individual to perform a specific scope of patient care services within that organization.2 Thus, credentialing and privileging are distinct but related processes. Health care providers participating in health plans are required to undergo both a credentialing and privileging process to qualify for participation and payment for services. Pharmacists and pharmacist patient care services are currently not included in key sections of the Social Security Act (such as Medicare Part B), which determines eligibility for health care programs. Their absence from Medicare Part B can result in patients not being eligible to use pharmacists’ patient care services. As the profession pursues provider status and the role of the pharmacist on the health care team continues to expand into patient care, there is an increasing need to verify pharmacists’ ability to provide certain services. One way to achieve this is for organizations to develop a process for pharmacist credentialing and privileging. Aligning patient services with credentialing and privileging is a current method used to determine the ability and competency of other types of health care practitioners.3 The pharmacy profession has a tremendous opportunity to be prepared in the area of credentialing and privileging by defining our processes in the various settings where pharmacists practice and provide patient care. Credentialing and privileging in pharmacy will contribute to the benefits provided by these processes currently in place in other aspects of health care such as patient safety, quality improvement, and advancing the health care experience. This aspect of pharmacy practice does not have to be an example of “which came first?” as the profession can and should be prepared in this important and integral step in providing quality health care services to patients.