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Pharmacy Schools In Colorado

An Innovative Clerkship in Pharmacy Education'2

The objective was to offer a comprehensive, elective, six-week clerkship experience in pharmacy education for PharmD students to develop their skills and stimulate their interest in the teaching and service aspects of academic life. The methods used included students participating in this rotation to meet the following outcomes through a wide variety of activities. These were: (i) creating and delivering an instructional module; (ii) assessing the learning value of that module or other instructional activity; (iii) participating in school committees and describing the committees' impact on the educational process; (iv) analyzing a variety of instructional methodologies and assessments used by faculty members; (v) discussing changes in pharmaceutical education over the last three decades; (vi) identifing, evaluating and discussing references and resources for pharmacy faculty to aid in their teaching; (vii) evaluating and discussing specific education journal articles of interest to the student; (viii) analyzing the role of specific national associations that impact pharmacy education; (ix) completing and presenting an education-related project; and (x) creating a portfolio to demonstrate achievement of rotation outcomes. Participant feedback and evaluations of the rotation were very positive. Student portfolios reflected their understanding of pharmacy education and the challenges and rewards of faculty life. Undergraduate students value the instructional activities of and interaction with these clerkship students. With continued success of this model, the rotation may become required for all students, as well as stimulate more of them to pursue academic careers.

INTRODUCTION

The recruitment of pharmacy students into academic careers has been discussed at length in the last decade(1-8). Questions and concerns have been raised that with the advent of the PharmD degree as the sole entry-level practice degree, fewer students will opt to pursue post-graduate training to prepare for careers in academia(9,10). Additionally, while most clerkship rotations give students patient-centered practice experience in a variety of settings, very few focus on "academic practice." Recommendations have been made to involve students in experiences that may interest them in academic careers( 11). A number of schools offer clerkship and residency rotations in education/teaching/faculty life to help prepare graduates for academic careers(12-18).

At the University of Colorado Health Sciences Center School of Pharmacy, students in the "track-in" PharmD program (to be phased out as of May 2002) complete seven sixweek clerkship rotations in their final year of the program. Of these seven rotations, two are community-practice based, one is inpatient-based, one is in ambulatory care, one is in a specialty practice (e.g., psychiatry, oncology, geriatrics), and the two remaining are elective rotations. Students select two clerkships of interest from a list of elective rotations ranging from manufacturing to research to education.

The clerkship rotation described in this paper is an education-based elective rotation. It focuses on the service as well as teaching aspects of academic positions and provides students with numerous hands-on opportunities in both areas. The rotation culminates in students' completion of a timely educationrelated project and a comprehensive self-reflective portfolio of their experiences to demonstrate achievement of rotation outcomes. The two primary preceptors for this rotation allow one or two students per six-week rotation during the fall and spring semesters to participate. The specific student-focused outcomes for this rotation are:

1. discuss changes in pharmaceutical education over the last three decades;

2. analyze the role of specific national associations that impact pharmacy education;

3. identify, evaluate and discuss references and resources for pharmacy faculty to aid in their teaching;

4. evaluate and discuss specific education journal articles of interest to the student;

5. analyze a variety of instructional methodologies and assessments used by faculty members;

6. participate in school committees and describe the committees' impact on the school's educational process;

7. create and repeatedly deliver an instructional module;

8. assess the learning value of that module or other instructional activity;

9. complete and present an education-related project; and

10. create a comprehensive portfolio to demonstrate achievement of rotation outcomes.

The rotation employs a wide variety of activities to help students meet all of the specified outcomes. Weekly meetings help preceptors to determine students' progression toward meeting all outcomes. Students' schedule for the rotation mimics daily activities of the faculty preceptors. During unstructured, unscheduled time, students work independently toward achievement of outcomes. More specific details of the rotation follow.

METHODS

This section describes the primary activities of the rotation:

* Initial meeting between students and preceptors for discussion of:

1. students' and preceptors' expectations for the rotation,

2. the syllabus and its use as a learning tool, and

3. the students' schedule

* Participation in weekly preceptor-student meetings to discuss assigned/selected readings and determine progress toward achieving rotation outcomes,

* Attendance and appropriate participation in a variety of school committee meetings,

* Creation, delivery, and assessment of an instructional module for the PI or P2 Professional Skills Development (PSD) course,

* Observation/facilitation/instruction in other courses,

* Facilitation and completion of a selected education-related project.

* Development and completion of a comprehensive reflective rotation portfolio.

Initial Meeting

* A week prior to the start of the rotation, students are emailed a copy of the rotation syllabus (Appendix A), rotation calendar (one week of the six-week calendar shown in Appendix B), and a list of assigned readings for discussion in the initial student-preceptor meeting (Appendix C - Part I of the Week 1 reading list). Students are asked to create a list of expectations for the rotation prior to reading the syllabus, email those to the preceptors, and come prepared to discuss them at the initial preceptor-student meeting. Additionally, students are asked to read the other documents and come prepared to discuss them at the initial meeting. In this meeting, the following elements are discussed:

* Student and Preceptor Expectations for Rotation: Similarities and differences between students' and preceptors' expectations are discussed. At this time, minor modifications in the students' schedule and/or activities are made to ensure fulfillment of their expectations. Preceptors discuss with the students their role as "junior faculty" members. As such, "student" confidentiality, analogous to patient confidentiality, is discussed as these clerkship students will become privy to grades and possibly other student-sensitive information of those students whom they instruct. The importance of maintaining their professionalism as junior faculty members by keeping this information confidential is emphasized.

* Syllabus: The rotation syllabus was designed using a template from the preceptors' Professional Skills Development course sequence. It is comprehensive in nature and is not only discussed with the students pointby-point, but also used as an example of how to create a course syllabus. The syllabus contains specific information regarding each major aspect of the rotation: development and delivery of an instructional module, completion of an independent project, achievement of outcomes and compilation of a portfolio, weekly meetings with preceptors and review of assigned readings, and the students' calendar. Following discussion of the syllabus, students sign a Statement of Understanding at the end of the document and submit it to the preceptors. This document is considered a contract between the student and preceptors that the student understands and is willing to abide by the syllabus as a guide for the rotation.

* Time Mangement: The students' calendar is discussed with the caveat that activities, times, or locations may change, so they need to be "flexible." Students are required to wear a pager and check their email daily. They are also encouraged to utilize their time between courses and meetings to work on their modules, projects, and portfolios, thereby reinforcing efficient time management skills.

* Logistics - Office Space, Computer, Copy Charges: Students are given keys to a graduate student office that they are allowed to use during the rotation. The office has several computers, printers, a small library and a phone. Students are also trusted with copy machine access codes that directly bill either of the school's departments or the Professional Skills Development courses.

* Week 1, Part 1 Readings: Students are asked to read the preceptors' article and syllabi regarding the Professional Skills Development courses in which they will be involved(19). These documents are discussed with the clerkship students in detail, as they will be spending the majority of their time as teaching assistants and instructors in the PSD courses for the duration of their rotation. They did not participate in these same courses during their PI and P2 years (new entry-level PharmD program vs. trackin PharmD program).

Weekly Preceptor Student Meetings

These meetings are led by the-clerkship students where they are asked to come prepared with an agenda. Normally 90 minutes in length, the meetings allow for discussion of students' modules, projects and portfolios. Additionally, educational philosophies and many esoteric topics are often discussed. It is during these sessions that the students can express to the preceptors their accomplishments and frustrations with their roles as junior faculty members. These discussions are extremely valuable for both students and preceptors; the "a-ha" experience occurs many times as the students begin to understand why faculty members and the educational process as a whole function as they do. Assigned weekly readings are also discussed in any manner the students so choose; some write formal reports on which to base their discussion, while others prefer to base their discussions from their highlighted notes directly from an article. During weeks 3 and 6 of the rotation, evaluations of the clerkship students for the school's Office of Experiential Programs are conducted and discussed during these meetings. Although students are provided feedback with regard to their performance on a continual basis, these periods designate a more formal time to discuss and document students' performance in the rotation.

School-wide Committee Meetings

Clerkship students are asked to attend and participate in, when appropriate, in a number of school-wide committee meetings. Examples of these include curriculum committee, assessment committee, clerkship committee, committee on instructional technology, post-graduate professional education committee, and P1 and P2 Course Directors' meetings. During these meetings, students are expected to either take minutes of the meeting or take notes for their own use to provide evidence of achievement for rotation outcome #6. At the end of the rotation, students are expected to discuss the role of each of these committees in the school and their impact on its educational processes.

Instructional Module

Clerkship students create, repeatedly deliver (three times), and assess the learning value of learning activities in a course module. The module is delivered in either the PI or P2 Professional Skills Development course for one week (three, three-hour class sessions). Since these courses are primarily conducted as small group, active learning sessions, methodologies usually include pre-assigned readings, mini-presentations, case studies, participant role-play, and class/group discussions. Preceptors provide each clerkship student with a predetermined topic. They then design appropriate instructional methodologies for the topic with the help of the preceptors. They create learning outcomes for the module, as well as design and conduct an assessment of the real/perceived learning value of the instructional activities. They also assess their students' assignments (grade and provide written feedback) produced by the instructional activities. During the first session that the instructional module is delivered, the clerkship students are videotaped for the purpose of self-assessment and subsequent improvement for the next two sessions. They have at least two but not more than four weeks to create their instructional modules. They develop a timeline to facilitate module completion and provide preceptors with progress updates. They then present a "dress rehearsal" of the instructional module to preceptors and/or other interested parties, at least one day prior to the first delivery of the module.

Observation/Facilitation/Instruction in Other Courses

To observe and/or serve as a facilitator in faculty members' courses (other than the preceptors'), students attend other courses periodically. This provides them the opportunity to more critically analyze the teaching styles of other faculty members and learn different instructional methodologies. Examples of this activity include facilitating discussion groups in courses such as Introduction to Pharmacy, Pharmacy Law, and Humanistic Issues in Illness and Wellness, observing small group debates in an interdisciplinary Health Care Ethics course, observing active learning in large, lecture-based courses of Science Foundations I and Integrated Organ Systems III, and supervising P2 students as they conduct patient consultations at a publicly funded addiction recovery center as part of an experiential course.

Education-Related Project

The purpose of completing an education-related project is to expose students to, and have them gain experience in, a project not directly related to teaching. Clerkship students select a project from a list of ideas submitted by numerous faculty members. The selection is done in coordination with the preceptors. They have the entire rotation to work on the project so that it is complete by the end of the rotation. They develop a timeline to facilitate completion of the project and provide the preceptors with progress updates. After its completion they then present a verbal or written synopsis of the project to the preceptors and/or other interested parties. Past examples of projects include designing and conducting an on-line student assessment of the Introduction to Pharmacy course, participating in and evaluating an Advanced Cardiac Life Support (ACLS) preparation course for health care professionals, conducting a survey to evaluate participants' perceptions of a Drug Information clerkship versus a Drug Information portfolio, and helping to design the school's representative poster for the 2001 AACP Annual Meeting.

Rotation Portfolio

The purpose of having students compile a portfolio over the course of the rotation is threefold: (i) collect and present evidence to demonstrate achievement of rotation outcomes; (ii) create a "teaching portfolio;" and (iii) review all of their accomplishments achieved during the rotation. The portfolio can be completed in a number of ways, such as using an organized paper-based notebook or an electronic portfolio system. Clerkship students could potentially use these teaching portfolios - a professional, documented record of education/teaching related experiences and expertise - for residency, fellowship or job interviews. The portfolios include, but are not limited to a table of contents, an introduction, student's baseline expectations prior to the rotation, evidence of achievement of each outcome organized by outcome, and conclusion/reflections. One student who created her portfolio on a CD-rom included a video clip of her teaching as well as text-based links to other documents and sections on the CD.

Assessment of the portfolio is conducted formatively and summatively by the preceptors. The formative process includes students providing the preceptors with periodic progress reports and asking questions about the appropriateness of certain pieces of evidence for inclusion in their portfolios; in turn, the preceptors provide students with constructive comments toward completion of the portfolios. Summative assessment of the portfolio is completed by preceptors at the end of the rotation; determinations are made whether all criteria for completion of the portfolio have been met and about the professional appearance, organization, and writing quality of the portfolio. At this time, a standardized portfolio evaluation tool has not yet been developed.

Additional Rotation Activities

In addition to all of the activities described above, there are optional activities in which clerkship students can participate during the rotation. Some students choose to attend faculty development workshops offered by the campus Office of Education. Others have created helpful learning tools for the first and second year students with whom they interact, such as a "therapeutics study guide" and "list of common sigs and medical abbreviations." These activities go beyond the expectations of the rotation.

RESULTS AND DISCUSSION

Although only five students have completed the clerkship thus far, all have found their six-week introduction to faculty life to be a valuable learning experience. The only formal tools that the preceptors have used thus far to have students assess the rotation is the standard evaluation form supplied by the school's Office of Experiential Education. Unfortunately, most of the items on this form do not apply to this rotation, but responses to two open-ended questions at the end of the form provided valuable information to the preceptors (Table I). Additionally, students' summaries and reflections of the clerkship in their portfolios have also provided the preceptors with insight as to what the students have accomplished and learned. All students have passed the rotation with "flying colors" and achieved the rotation outcomes beyond the expectations of the preceptors. Their success and encouragement has prompted additional students to participate in the rotation in upcoming semesters. It is most exciting when these clerkship students interact with first and second year students, and several of the latter have decided that they would like to participate in the rotation in their (P4) fourth year. The first and second year students have expressed their appreciation and enjoyment of having interacted with and been instructed by these clerkship students.

REFLECTIONS AND IMPLICATIONS

This section describes the innovative nature of the clerkship, rationale for its implementation, successes and pitfalls, and rationale for planned modifications.

Innovative Nature of the Clerkship

Although a number of schools offer clerkship and residency rotations in education/teaching, there are a few items in the rotation described in this paper that make it somewhat unique: 1) the high level of involvement in hands-on teaching experiences and educational service activities, 2) the emphasis on national pharmacy education through reading and discussion, and 3) the compilation of a comprehensive rotation portfolio. Fortunately for the preceptors, the students participating in this rotation have already successfully completed a course in Instructional Methods, which focuses primarily on creating objectives, handouts, slides, and delivering a formal presentation. Thus, the preceptors only need to provide some educational background and theory at the beginning of the rotation; much of what the students actually learn occurs through observation and participation in many types of courses. They also research, read and discover the history of pharmaceutical education, current influential organizations and other factors that impact the current and future delivery of pharmacy education. Additionally, having them participate in a number of education-related committee meetings helps them see "the big picture" of how these committees support the educational processes of the school and its curricula. Lastly, the documentation of their rotation activities in a portfolio format with a comprehensive summative reflection develops their ability to organize and reflect on a set of activities - these skills are transferable to many different career paths.

Rationale for Implementation

This elective clerkship was created to provide PharmD candidates with teaching and service experience as if they were junior faculty members. Participation in this clerkship is hoped to inspire them to pursue academia as a career path, as well as develop their appreciation for the teaching and service aspects of faculty life. Additionally, the practical skills learned in this rotation, especially those related to teaching/learning and creating a comprehensive portfolio should help them to be better professionals, practitioners, and educators in whatever career path they choose. Regardless of whether they choose to pursue a career in academia or not, a framework is set for developing future preceptors who fully comprehend the educational outcomes of the school's curricular programs.

Successes and Pitfalls

Although it is unknown at this time if any of the five participants will choose a career in academia, the preceptors feel that the six-week experience has had a profound impact on them thus far. These students now feel confident about delivering a quality learning experience - they have the skills to effectively create, administer, and assess activities they may develop. They have gained a broad appreciation for the rewards and challenges of the teaching and service aspects of faculty life and the complexities of pharmaceutical education. They have also demonstrated the capacity to create high quality, comprehensive portfolios of their work. These have been the greatest successes of the clerkship thus far. Additionally, the first and second year students with whom the clerkship students interact have benefited greatly. These early students enjoyed learning new concepts and skills from PharmD candidates and found the candidates' teaching to be very effective. They enjoyed interacting with these "role models" and learning about what lies ahead for them in the curriculum, clerkship rotations, and pharmacy practice. This interaction may also aid the clerkship students to transition from student to faculty/ preceptor.

One of the areas that could be improved in this rotation is the formative assessment process of the portfolio. Currently, students are so busy in the clerkship that they usually compile their portfolios during the last week of the rotation. Unfortunately, this leaves the preceptors with little time to critically assess the students' work and provide constructive feedback. Although the quality of the students' portfolios has been exceptional thus far, future participants in the rotation may not always perform at a similar level. The system for portfolio development described in the syllabus reflects periodic formative assessment, but thus far it has been difficult to adhere to the timing of this system. The preceptors are working to devise better methods in which to increase their and the students' adherence to those guidelines.

Planned Modifications and Rationale

With continued success, consideration will be given to transforming this clerkship from an elective to required status for all PharmD candidates. If this were to occur, some major modifications would take place. Most obvious is the need for more preceptors and "sites." Additional faculty members could precept students and have students teach in their courses, observe others' courses, and participate in their service activities. As an example, the faculty member who directs our postgraduate professional education programs (external PharmD and continuing education programs) could involve students in those aspects of pharmacy education. A few community preceptors could also be identified who work in education programs, whether they are the education of patients, health professionals, or others. It would also be important to create a set of standardized assessment instruments to evaluate student performance in these differing education rotations in order to ensure that all participants are achieving the outcomes of the rotation. To this end, the outcomes of the rotation may need to be modified for specific "practice sites," or become more broad in nature so that they apply to many different experiences.

CONCLUSION

Although much time and energy have been expended into the design, implementation and maintenance of this rotation, the preceptors feel that they are "doing the right thing" with regard to pharmacy education in the 21 st century. They desire continued improvement of what has begun and involvement of additional faculty members and preceptors in the process. They also want to share their successes and pitfalls with national colleagues who are conducting or planning to implement similar endeavors. Finally, consistent collection of longitudinal data could help preceptors determine if these experiences are making a difference in pharmacy education and recruiting students to pursue careers in academia.

Acknowledgments. The authors would like to thank those students who have enthusiastically participated in the rotation thus far and are letting us share their work: Norwan Moaleji, Mistie Hien Nguyen, Neal Schmidt, Laurie Schmitt, and Melissa Selby. We would also like to thank our colleagues who have been involved in helping to precept the rotation: Drs. Ralph Altiere, Laura Borgelt, Cathy Jarvis, Joe Saseen, David Thompson, Chris Turner, and Rob Valuck.

1 Manuscript based on the portfolio submitted to the 2001 Council of Faculties Innovations in Teaching Competition.

2Clerkship described is offered at the University of Colorado Health Sciences Center School of Pharmacy.

References

(1) Gerald, M.C., "Impact of the all-PharmD degree on graduate studies in pharmacy," Pharm. Bus., 2, 20, 30(1991).

(2) Gerald, M.C., "Chair report of the Academic Affairs Committee," Am. J. Pharm. Educ., 55, 12S-16S(1991).

(3) Cassady, J.M., "Chair report for the Research and Graduate Affairs Committee," ibid, 55, 24S-25S(1991).

(4) Mauger, J.W., "Chair report of the Research and Graduate Affairs Committee," ibid, 56, 22S-27S(1992).

(5) Brouwer, K.L.R., "Chair report for the Research and Graduate Affairs Committee," ibid., 58, 27S-29S(1994).

(6) Stavchansky, S.A., "Chair report of the Research and Graduate Affairs Committee," ibid, 62, 21S-26S(1998).

(7) Penna, R.P., "A new future. Report of the Executive Vice President," ibid., 64, 1S4S(2000).

(8) Holdford, D.A. and Stratton, T.P., "A marketing plan for recruiting students into pharmacy-school-based graduate programs. A report," ibid., 64, 41 S-47S(2000).

(9) Ueda, C.T., "Chair report for the Research and Graduate Affairs Committee," ibid., 57, 25S-29S(1993).

(10) Speedie, M.K., "Chair report for the Research and Graduate Affairs Committee," ibid., 58, 19S-23S(1995).

(11) Roche, VF., "Chair report of the Academic Affairs Committee," ibid., 60, SS-9S(1996).

(12) Selander, L.K and Bjornson, D.C., "Description of an elective PharmD teaching clerkship," ibid., 59, 273-278(1995).

(13) Waite, N.M. and Hobson, E.H., "Training future faculty members: Additional of a teaching/learning component to a residency program," ibid., 63, 74S(1999).

(14) Tonino, R., et al., "Teaching rotation in a nontraditional PharmD program," ibid., 63, 74S(1999).

(15) Hobson, E.H. and Briceland, L.L. "Integrated pharmacy education PharmD clerkship: Preparing for academic pharmacy practice," ibid, 63, 76S(1999).

(16) Brandt, B.F., et al., "Development of a teaching certificate program for pharmacy residents and graduate students," ibid., 64, 11 OS-1115(2000). (17) Page, R., Hammer, D. and Morris, K., "Development of a pharmacy resident faculty rotation," ibid., 64, 96S-97S(2000).

(18) Bongiorno, R.A., et al., "Implementation of a teaching rotation for Doctor of Pharmacy students," ASHP Midyear Clinical Mtg., 33(Dec.), P-551)(1998).

(19) Purkerson Hammer, D. and Paulsen, S.M. "Strategies and processes to design an integrated, longitudinal professional skills development course Sequence," Am. J. Pharm. Educ., 65, 77-85(2001).

Dana P Hammer

School of Pharmacy, University of Washington, H-375 Health Science Center, Box 357630, Seattle WA 98195

Susan M. Paulsen3

School of Pharmacy, C238, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver CO 80262-0238

3Corresponding author.

Am. J. Pharm. Educ., 65, 284-293(2001); received 7/13/01, accepted 8/27/01.

Copyright American Association of Colleges of Pharmacy Fall 2001
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