Introductory Experiential Education: A Means for Introducing Concepts of Healthcare Improvement

In June 2006 the Accreditation Council for Pharmacy Education approved new standards which will be implemented in 2007. Among the most problematic to implement is the requirement for many hours (5% of the curriculum) to be spent in introductory pharmacy practice experiences, supervised by a preceptor pharmacist. Most faculty members and colleges agree with the need for pharmacy students to be involved with the profession from the beginning of their curriculum. While there is little hard evidence, most accept the premise that students who understand what they are aiming for in their education will be more motivated and better able to understand the rationale for the components of the pharmacy education. Difficulties arise, however, when schools attempt to define the outcome competencies that should result from the experience. If the goal is simply exposure to the profession as it is practiced in its various venues, it does not take 5% of the curricular hours to accomplish that. If the goal is to learn dispensing and communication skills, the goal may be better achieved in simulated environments. Also, a substantial number of first-year pharmacy students have worked as pharmacy technicians and those skills are already in place. A goal of having the students actually practicing patient care probably is not realistic for first-year students. So, what do we do with introductory pharmacy practice experiences to make them worthy of 5% of the curriculum? I maintain that the early pharmacy experience can be used to reorient our students' education to introduce systems improvement thinking and hopefully, to produce graduates who are able to play a major role in improving the health care system or at least the microsystem in which they participate. I find that our students are often frustrated by the distance between what they are being taught as the ideal practice of pharmacy, ie, pharmaceutical care (or medication therapy management) and what they actually see in practice. This frustration leads to cynicism in some and a curbing of practice ambitions in others. Some will maintain their optimism and idealism throughout the curriculum only to emerge from the program into a practice setting without the skills to create the changes in that setting so they can serve patients the way they want to. There are not enough patient-care-providing practices available to accommodate all our students in experiential education, much less to hire all of our graduates. Clearly our students and our graduates must be part of a practice change and practice improvement process if we have any hope of meeting the needs of society for medication therapy management. They must be taught the principles and process of health care improvement and be prepared to be change agents as they graduate from our schools. We have an important stake in this change effort as the window of opportunity to prove what pharmacists can contribute to health care is opening now (with reimbursement for medication therapy management becoming more available). But that window may not remain open long if we fail to deliver the care we have said we can deliver and achieve the benefits we have promised. The 2004 Center for the Advancement of Pharmaceutical Education outcomes embrace this systems thinking as one leg of the 3 component education recommended for our students, yet few programs have figured out how to implement the competencies needed to engage in healthcare improvement. Introductory pharmacy practice experiences can be the beginning of educating our students with the skills to change practice. Let's place our students in the best environments we can identify (those with patient-centered care and team practices; those engaged in medication therapy management) as well as in the more typical dispensing settings. Let's ask them to identify the differences and talk with the pharmacists in the patient care providing sites about how they changed their practices. Let's teach our students to document and discuss practice improvements and the improved outcomes that result. This early investment in learning what is and what can/should be can be further developed with didactic and experiential educational experiences throughout the curriculum and into the advanced practice experiences. Perhaps each student could engage in a healthcare improvement project during their last year of practice experience. Maybe they will help our preceptor pharmacists improve their practices, creating better sites for our students to learn in. As an aside, I believe that we should teach the dispensing, distribution, and communication skills, and even early patient care skills, in simulation laboratories that are becoming such a central part of education of other health care professionals. That does not need to be done in our valuable volunteer experiential sites. Perhaps with competencies well defined, we will be able to then reduce the number of hours required for early experiences. In conclusion, I encourage all programs to consider using the introductory experiential education for a distinct and valuable purpose, which is providing the basis for students to become active change agents. We can build upon that basis during subsequent educational experiences and the pharmacists we graduate will be prepared to improve practice on the local, microsystem, and system levels to help us achieve our professional goals of helping patients achieve the optimum benefit from the medications they take.