Quality Experiential Education
American College of Clinical Pharmacy
Krystal K. Haase, Pharm.D., FCCP, Maureen A. Smythe, Pharm.D., FCCP,
Patricia L. Orlando, Pharm.D., FCCP, Beth H. Resman-Targoff, Pharm.D., FCCP, and
Lisa S. Smith, Pharm.D.
Contributors: Sheryl J. Herner, Pharm.D., S. Dee Melnyk, Pharm.D., Nicole M. Paolini, Pharm.D.,
Kalen B. Porter, Pharm.D., Phillip T. Rodgers, Pharm.D., FCCP, and Avery L. Spunt, M.S.
The 2007 Accreditation Council for Pharmacy Education (ACPE)
Accreditation Standards and Guidelines for the Professional Program in
Pharmacy delineate new expectations for experiential education within
curricula and include guidance on the development and conduct of Pharmacy
Practice Experiences. The American College of Clinical Pharmacy (ACCP)
Educational Affairs Subcommittee C developed a position statement to further
delineate the views of ACCP on factors necessary to meet contemporary
standards for doctoral education in pharmacy and to provide guidance to our
membership on how to implement the new standards. This White Paper
provides explanation and supporting documentation for positions on
quantitative and qualitative aspects of experiential education, as well as
requirements for practice sites, preceptor roles, qualification, credentialing,
and development and assessment of student performance.
Key Words: pharmacy curricula, experiential education, preceptor
qualifications
(Pharmacotherapy 2008;28(10):219e–227e)
The Accreditation Council for Pharmacy
Education (ACPE) adopted revised Accreditation
Standards and Guidelines for the Professional
Program in Pharmacy in January 2006.
1
These
standards, effective July 2007, provide
considerable delineation of the expectations for
experiential education within curricula and
include guidance on the development and
conduct of Pharmacy Practice Experiences. The
most notable changes to the standards include a
specification that curricula must include a
minimum of 5% introductory pharmacy practice
experiences (IPPE) and 25% advanced pharmacy
practice experiences (APPE) based upon a 4-
academic-year program. Standardization of
experiences based upon outcomes is also
required, with training encompassing the
knowledge, skills, and attitudes to prepare
students to enter pharmacy practice in any
setting.
Investment in the future practice of pharmacy
requires a dedicated interest in the educational
foundations that undergird that future. The
American College of Clinical Pharmacy (ACCP),
as a member of the Joint Commission of
Pharmacy Practitioners (JCPP), endorses a
common vision for the future of the profession.
2
This document was written by the 2006 ACCP
Educational Affairs Subcommittee C: Krystal K. Haase,
Pharm.D., BCPS, Chair; Maureen A. Smythe, Pharm.D.,
FCCP, BCPS; Patricia L. Orlando, Pharm.D.; Beth H.
Resman-Targoff, Pharm.D., FCCP; Lisa S. Smith, Pharm.D.;
Sheryl J. Herner, Pharm.D., BCPS; S. Dee Melnyk,
Pharm.D.; Nicole M. Paolini, Pharm.D.; Kalen B. Porter,
Pharm.D., BCPS; Phillip T. Rodgers, Pharm.D., FCCP,
BCPS; Avery L. Spunt, M.S. Approved by the American
College of Clinical Pharmacy Board of Regents on April 19,
2007; final revision received on May 10, 2007.
Address reprint requests to the American College of
Clinical Pharmacy, 13000 W. 87th St. Parkway, Suite 100,
Lenexa, KS 66215; e-mail: accp@accp.com; or download
from http://www.accp.com.
ACCP WHITE PAPER
PHARMACOTHERAPY Volume 28, October 2008
The Future Vision of Pharmacy Practice describes
both how pharmacists will practice in the year
2015 and how pharmacy practice will benefit
society. The vision also delineates the
foundations of pharmacy education that are
necessary to prepare future “pharmacists to
provide patient-centered and population-based
care.” The knowledge, skills, attitudes, and
beliefs associated with this vision of practice
should be a primary focus for experiential
training. A summary of the Vision is included in
Appendix 1.
To further define educational outcomes related
to the Vision, ACCP recently published a
commentary on the educational outcomes that
should be met for all pharmacy graduates.
3
The
combination of curricular requirements in
experiential education, increased pharmacy
student enrollment, and an anticipated shortage
of qualified preceptors bring us to a pivotal
crossroad.
4, 5
In light of current and anticipated
resource constraints, ensuring a consistent level
of quality experiential education for all
graduating pharmacists is essential.
The 2006 ACCP Educational Affairs
Subcommittee C was charged to develop a
Position Statement on Quality Experiential
Education.
6
This White Paper further delineates
the views of the College on factors necessary to
meet contemporary standards for doctoral
education in pharmacy. This White Paper also
provides guidance to our membership on how to
implement the new standards in a manner that
ensures the educational outcomes achieved are
reflective of both the current practice of
pharmacy and anticipated future practice roles.
Finally, the document should serve as a tool for
schools to assess the quality of their experiential
education programs.
Section I: Experiential Education: Quantitative
and Qualitative Aspects
Experiential education is defined as a
methodology in which educators engage learners
in direct experience and targeted reflection in
order to increase knowledge and to develop skills,
behaviors, and values.
7
Experiential education
should be utilized throughout all years of the
pharmacy curriculum, typically culminating in
the last professional year. Outcomes should be
carefully designed and integrated within the
curriculum as a whole such that each experience
builds upon previous experiences.
8
Experiential
education is an ideal training medium for
application and reinforcement of information
learned through didactic coursework. This form
of active learning targets adult learning styles and
promotes learner-centered and lifelong learning.
8, 9
Quantity of Experience
The revised ACPE Standards now provide
guidance on the amount of experiential
education that is required. The IPPE should
encompass no less than 5% of curricular content,
while the APPE should comprise a minimum of
25% of a 4-academic-year program.
1
Interpretation of this standard will be difficult.
The total semester credit hours required for
graduation vary among pharmacy schools.
Variation also exists across schools in the
identification of curricular components that
qualify as experiential education. Given the
existing variation in the number of weeks of
required APPE among schools (range 26–48,
average 36.9 ± 6.4),
1
0
further delineation of the
requirements in the standard is warranted.
ACCP interprets this recommendation as a
minimum of 36 weeks of structured APPE based
upon a standard 4-academic-year program.
Incorporation of additional elective experiences
is encouraged to provide flexibility for career-
based training. Though IPPE are also difficult to
quantify, 5% is interpreted as the equivalent of
300 hours of structured experiential activities.
In addition to overall time spent in experiential
education time, guidance is warranted regarding
the types of experiences required to meet the
desired educational outcomes. ACPE requires
direct patient care experiences in multiple
practice settings. This requirement supports the
JCPP Vision Statement that states direct patient
care skills will be essential to the future of
pharmacy practice.
2
ACPE and JCPP agree that
schools of pharmacy must prepare pharmacy
graduates to enter practice in any setting.
1, 2
In
medicine, the medical school curriculum outlines
a specific list of required training experiences in
order to prepare a generalist practitioner who can
enter into any area of graduate medical
education.
11
The profession of pharmacy will
benefit from a similar outline of expectations for
preparation of entry-level pharmacists. The
guideline below lists suggested requirements for
the minimum types of experiences that should be
required within pharmacy curricula. Pharmacy
faculty must maintain authority for curricula,
including the development of experiential
programs. That authority must come with a level
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QUALITY EXPERIENTIAL EDUCATION ACCP
of accountability to ensure that each student who
completes the experiential training program has
demonstrated proficiency in all areas of entry-
level practice. Recommended required
experiences include the following:
• Community Practice Management:
Distributive functions, medication
counseling, patient education and relations,
managing pharmacy operations, personnel
management, retrieval and evaluation of drug
information, monitoring and evaluating drug
therapy, and direct patient care experience
(e.g., administration of immunizations,
health-related screenings, medication therapy
management services, and collaborative
practice) where allowed by state regulation.
• Health-Systems Practice Management: Broad
range of distributive functions, experience in
resource management (e.g., formulary
development and management, protocol
development and utilization, medication use
evaluation, personnel management),
population-based care activities, and use of
technology to advance patient care.
• Direct Patient Care: Multiple direct patient
care experiences should be included in the
inpatient, ambulatory, and community
environments. Approximately two-thirds of
the experiences should include direct patient
care, specifically in the areas of acute care
medicine, ambulatory care, community
practice, and specialized training experiences.
Qualifying experiences should include face-
to-face contact with patients and health care
providers as well as active participation in
patient care decision-making. Through the
sum of experiences, students should be
exposed to a variety of disease states as well as
diverse patient populations (i.e., patients from
a variety of age groups, gender, race,
socioeconomic, and educational levels).
While different practice models have relative
strengths and weaknesses, the inclusion of
multiple experiences should provide balance.
Standard knowledge sets, including specific
medication therapies and disease states,
should be defined for each experience.
• Electives: Opportunities should be available
for students to explore different career tracks
through a variety of electives. Availability of
electives should reflect current practice and
career trends. In particular, advanced or
specialty electives in community settings
should be available as the majority of
students enter that area of practice. Other
potential career tracks include patient care
subspecialties, research, academia,
administration, drug information, and
industry. Electives should be scheduled
logically based upon career interests, with
prerequisite experiences defined when
necessary. Regardless of elective type, all
should have established standards with clear
objectives, assessment, and outcomes.
Quality of Experiences
Delineating quantity is not useful if the
experiences are not of sufficient quality. A
quality experience is broadly defined as a well-
planned, outcomes-focused training experience
with adequate supervision and assessment by a
qualified preceptor within a learning-rich
practice environment. These characteristics are
further defined within subsections of the White
Paper. The responsibility for achieving quality
resides with schools of pharmacy. Faculty
ownership of curricular design and delivery is
important given the unique opportunities and
resources of each school. Curricular autonomy
allows for innovation to develop unique
educational models that will, in turn, further
advance the practice of pharmacy. However, a
minimum basic template for the structure of
experiential clerkships across all schools of
pharmacy is warranted to ensure consistent
outcomes. Key recommendations related to the
development of experiential education within
pharmacy school curricula include the following:
• IPPE should begin early, ideally during the
first professional year, and should involve
actual practice experiences and service
activities focusing on proficiency in meeting
core competencies that are clearly articulated.
Mock or case-based scenarios may play a
limited role in introductory training, but are
not a substitute for hands-on practice
experiences.
12
Direct involvement of students
in patient care activities at all stages is
essential for reinforcement of didactic
coursework early in the curriculum and
enhancement of student motivation and
learning skills.
13
These activities should build
upon one another in preparation for the
APPE and are ideal for development of
fundamental skills and attitudes such as
professionalism, communication with
patients and health care professionals, and
problem-solving.
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PHARMACOTHERAPY Volume 28, October 2008
• Direct patient care experiences, including
IPPE and APPE, should reflect specific
measurable outcomes and should include
appropriate evaluation techniques.
Outcomes must include knowledge (e.g.,
commonly encountered pharmacotherapy,
including reinforcement/learning of basic
sciences, therapeutic principles, and practice
management); skills (e.g., demonstration of
direct patient care, patient assessment,
communications); and attitudes and beliefs
(e.g., demonstration of concern for patient
welfare, demonstration of self-learning
behaviors).
1
Measurable outcomes, learning
activities, and assessment methods for each
individual experience need to be well defined
and consistent across all sites where the
experience is offered. Development of novel
experiences or more rigorous outcomes is
encouraged, but the minimum educational
outcomes for each required experience
should ultimately be consistent from one
school of pharmacy to another.
• Innovative training models are encouraged.
For example, a comprehensive patient care
experience is envisioned by this committee as
one where the student would be involved in
distributive functions as well as direct patient
care functions for targeted patients, providing
continuity of care across multiple
environments (e.g., the student is responsible
for a given patient whether seen in an acute
care or clinic setting). This particular model
espouses several of the more challenging
outcomes, including the acceptance of
responsibility for patient care and outcomes
across the continuum of care. Innovation
and flexibility in design of experiences may
alleviate resource constraints. Caution
should be taken, however, to ensure that
innovations involve realistic practice
opportunities that result in an improvement
in educational outcomes.
Section II: Practice Sites
Program Oversight
The structure of all experiential educational
experiences should be clearly defined by each
school. Schools should have a dedicated faculty
member (i.e., Director of Experiential Education)
who is responsible for oversight of the school’s
experiential education program. On a routine
basis, the school should actively assess whether
the experiential components of the curriculum
are effective in achieving their desired outcomes.
Practice Site Requirements
Each experiential site should be licensed and
should maintain accreditation as appropriate to
the practice areas covered. In general, sites
should provide routine access to patient medical
records. Sites that provide direct patient care
experiences should provide students the
opportunity for face-to-face interaction with
patients on a daily basis and for routine
communication with health care professionals.
Sites should allow comprehensive assessment and
contribution to patient drug therapy and should
allow preceptors and students to document
written communication through medical records.
Practice sites generally should have a diverse
patient population, as previously described, for
student exposure; qualified preceptors to serve as
role models for patient care; and adequate drug
information resources. Each site should outline a
specific communication network for use by the
school, preceptors, students, and other health
care professionals. Students should be oriented
to the entire scope of pharmacy services provided
at each practice site in order to better understand
how their experience fits into the practice model.
The ideal practice site should provide
opportunities for both introductory and
advanced practice experiences. Site-specific
deficiencies should be identified and addressed
through the selection of other required
experiences. For example, a student exposed to a
narrow patient population during one experience
should have the opportunity to interact with
other, more diverse patient populations during
other experiences. Because the requirements for
individual sites vary, recommended practice
model requirements for each individual
experience type are delineated in Appendix 2.
Practice Site Assessment
Performing quality assurance evaluations of the
practice site, preceptor, and student’s delivery of
care is required to adequately assess each
experience. Quality assessments should focus on
site qualifications and resources, preceptor
performance, and student outcomes (i.e., do
students who rotate through the site achieve all
established objectives for a given experience).
Quality assurance evaluations should be ongoing,
with direct observation/assessment at the practice
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QUALITY EXPERIENTIAL EDUCATION ACCP
site occurring no less than every 3 years.
Section III Precepting Requirements
Supervision
In general, student activities should take place
under the supervision and monitoring of a
qualified preceptor who is, in most cases, a
licensed pharmacist. When the primary
preceptor is not available, alternate supervision
and support must be clearly defined. Whenever
feasible, pharmacy residents are encouraged to be
actively integrated into the experiential teaching
model in order to begin developing individual
precepting skills. In this instance, the primary
preceptor should be readily accessible to the
pharmacy resident and pharmacy student and
should provide specific direction, assessment,
and feedback for all resident precepting activities.
Other health care professionals may be utilized
for elective experiences. However, non-
pharmacist-precepted experiences must have a
well-defined structure and support system,
including availability of pharmacist consultants.
Level of Interaction
The primary preceptor should treat the student
as a colleague-in-training and directly interact
with the pharmacy student at least daily, with
more frequent interaction as necessary. The
knowledge and skill level of the student and the
nature of the practice site should determine the
length and frequency of interactions. The
preceptor should regularly assess if the
interaction frequency needs adjustment.
Methods of interaction should be site specific in
order to meet educational goals and outcomes,
and tailored to meet the needs of the student.
Interactions should challenge the student,
encourage self-directed learning, and provide
ongoing constructive feedback.
Student-to-Preceptor Ratio
The Boards of Pharmacy for many states
provide limitations for student-to-preceptor
ratios. However, data are lacking to support an
optimal number of students within a learning
experience. The student-to-preceptor ratio at
each practice site should be carefully considered
in order to ensure adequate individualized
instruction, guidance, supervision, and
assessment for each student assigned to the site.
Practice site demographics, including the number
of pharmacists and technicians, workflow and
facility design, and types and numbers of patients
cared for, are important factors. Pharmacy
resident and physician support may also impact
the number of students that can be effectively
precepted. Finally, consideration should also be
given for the amount of time a preceptor is able
or required to dedicate to precepting activities
versus other roles.
Individuals whose primary responsibility is
student precepting may be able to effectively
manage more students than would an individual
who has less time allocated for precepting
activities. Based upon this factor, a 2:1 student
preceptor ratio is suggested for advanced practice
experiences precepted by non-full-time faculty.
The scheduling of two students concurrently
with one preceptor can enhance the learning
experience, especially in situations that are
advantageous for student-to-student mentorship
and collegiality. A student-to-preceptor ratio as
high as 4:1 may be justified for full-time faculty
who have significant time allocated for practice-
based teaching as long as no other resource
constraints exist. Recognizing that preceptors are
often responsible for other learners such as
residents, trainees, or non-pharmacy health
profession students, the total learner-to-
preceptor-ratio should be considered for each
experience and should not be greater than 4:1.
In situations where larger student-to-preceptor
ratios are utilized, appropriate documentation
must be maintained to demonstrate that students
attain all of the required learning outcomes for
the experience.
In addition to the student-to-preceptor ratio,
the annual cumulative number of students per
preceptor should be assessed. Infrequent (once
or twice per year) or excessive precepting may
result in less than optimal preceptor
performance. Student-to-student interaction may
be beneficial and should be considered when
evaluating the optimal number of students per
experience.
Section IV: Preceptor Qualifications,
Credentials, Development
Preceptor Qualifications
Schools are striving to increase the number of
preceptors involved in the provision of
experiential training. Care must be taken to
ensure that new preceptors, as well as existing
preceptors, meet professional standards endorsed
223e
PHARMACOTHERAPY Volume 28, October 2008
by the school. Preceptors must have a valid
professional license and meet requirements
designated by the Board of Pharmacy. Preceptors,
regardless of level of affiliation with the school,
should have appropriate credentials for their level
of practice. Suggested credentials by experience
type are outlined in Appendix 2. Preceptors of
direct patient care experiences should maintain
an active patient care practice. Of equal weight
with credentials are the more intangible
attributes of an effective preceptor. These
include mentorship, professionalism, and
demonstration of empathy and caring for
patients. Schools are encouraged to adopt or
adopt with modification the Preceptor Criteria
defined by ACPE.
1
Preceptors should be required
to submit their curriculum vitae and a detailed
description of their current practice site for
review by the school. Teaching evaluations
should be reviewed by the school on an annual
basis in order to identify any potential concerns
with individual preceptors. If identified, the
school should have a process in place to correct
the deficiencies. Evaluations should not be
punitive, but rather, should be utilized for all
preceptors as a method of ongoing professional
development leading to quality improvement.
Schools should develop criteria for review and re-
appointment of preceptors. Re-appointment
should be based on the demonstration of effective
teaching evaluations over several years in
conjunction with a re-evaluation of the practice
site and documentation of ongoing professional
development.
In order to continue to attract highly qualified
preceptors, schools should ensure that adjunct
faculty and volunteer faculty are provided
incentives for supporting the experiential
component of their curriculum. Schools should
recognize adjunct/volunteer faculty on an annual
basis for excellence in teaching and practice.
Offering incentives to individual preceptors
should assist schools in retaining highly qualified
preceptors. Example incentives include travel
support to attend professional meetings; payment
of professional membership dues, specialty
certification fees, and fees to participate in
professional development programs; purchase of
textbooks and electronic resources; and advanced
faculty appointments if certain performance
levels are met. Volunteer and adjunct faculty
should be actively engaged in the school’s
ongoing efforts to develop, restructure, or assess
the experiential program and should have
significant input in the structure of individual
experiences.
Preceptor Training / Credentialing/ Development
With approximately 30% of the pharmacy
curriculum being experiential, preceptors
involved in this portion must have appropriate
training prior to precepting students. Thus, there
is an immediate need for schools to establish a
training program for preceptors. ACCP endorses
the development of a universal training program
for all preceptors. However, there is still a need
to individualize training to the mission and goals
of the school.
Each school should start by identifying the
desired components of their initial
comprehensive preceptor training program. The
program may need to incorporate individual
modules, each with its own objectives. Schools
224e
Appendix 2: (continued)
Direct Patient Care: Advanced Community
• Preceptors should have a minimum of 1 year of
residency or equivalent experience in direct patient
care activities. Additional certification is strongly
encouraged and is particularly encouraged in sites that
also conduct accredited residency programs
1
4
or in
specialized practice environments. Preceptors should
optimally spend at least 30% of time in direct patient
c
are activities.
• Site should establish a structure that includes a
minimum of 30% direct patient care activities (outside
of limited prescription counseling) in addition to
practice management/operations, personnel
management, and well-defined project related
activities. Activities should ideally include
administration of medications (immunizations),
comprehensive patient education, disease-focused
group classes, and patient assessment (such as
screenings) with implementation of patient care plans.
Health-Systems Practice Management
• Preceptors should have 1 and ideally 2 years of
residency training or equivalent experience consistent
with their respective position. Preceptors should have
training and job responsibilities commensurate with
most required objectives for the experience and should
orchestrate and supervise activities mentored by other
pharmacists. Additional mentors should be utilized for
structured segments of the experience to meet
objectives as needed.
• Students should gain an understanding of the drug
distribution system and departmental structure,
participation in the activities of relevant institutional
committees (e.g., Pharmacy and Therapeutics
Committee, Institutional Review Board, quality
improvement), working with pharmacists in a variety
of settings, and interaction with pharmacy
administrators.
QUALITY EXPERIENTIAL EDUCATION ACCP
should consider the development of web-based
training programs or CD-ROM-based training
programs. After completion of an initial
preceptor training program, ongoing preceptor
development should be required of preceptors
every 1–2 years. Schools that share preceptors
should try to standardize preceptor training and
requirements for those preceptors to eliminate
redundancy. Schools should consider
incorporating the following components into
preceptor training:
• Orientation to the school’s mission, goals,
and values
• A review of the professional pharmacy
curriculum
• A review of the overall goals of experiential
training and the structure of the school’s
experiential training program
• An understanding of the student
requirements that must be completed prior to
site/experience assignment
• Techniques for effective experience design
• Information about effective learning
techniques/strategies
• Effective strategies for resolving difficult
student issues, motivating students, and
changing student behavior
• A review of the overall assessment program
(process for student evaluation, requirements
for filing grades, preceptor evaluation, etc)
• Suggested approaches for individualization of
experience based upon the background of the
student
The Director of Experiential Education should
ensure that all preceptors have completed the
appropriate training prior to being scheduled for
their first student. Schools should consider
encouraging new preceptors to co-precept with a
more experienced colleague for their first 1 or 2
experiences.
Schools must provide support for the continual
professional development of all preceptors
involved in experiential training. Preceptors
should have access to current literature through
the school or another academia-based library
system. Ongoing preceptor development in the
area of instruction may be met through live
preceptor training programs held at Schools of
Pharmacy and state or national organization
meetings. Alternate formats for offering
professional development programs should be
explored to ensure all preceptors have an
opportunity to participate. Effective
communication mechanisms must exist between
preceptors and the school. Schools should
consider developing an experiential education
newsletter that addresses timely issues in
experiential education (and provides recognition
to deserving preceptors). Documentation of
ongoing professional development related to the
area of experiential instruction should be a part
of annual preceptor review. Such documentation
should be a required component for re-
appointment or promotion. Schools should
promote their professional development program
as a benefit/incentive to becoming an adjunct or
volunteer faculty member.
Section V: Mechanisms for Effective and
Consistent Assessment of Student Performance
There are three areas of student performance
that should be assessed: knowledge, skills, and
attitudes. Assessments need to determine not
only the quality of student performance in the
different areas, but also that the required quantity
of experiences and proficiencies (as outlined in
Section I) have been accomplished and are
consistent for each student. Student portfolios
can be used to assist in this process. The
portfolios can include checklists of required
elements, records of skills and activities
performed during the experiences, logs of topics
discussed and types of patients seen, and
examples of written work such as drug
information questions or selected notes from
medical records. Portfolios should also include
assessments by preceptors and self-assessments
by students. Self-assessment is particularly
useful when conducted during the early and
middle stages of an experience. These portfolios
provide a continuum for the assessment process.
They can be used throughout the entire
experiential education program by both students
and preceptors to determine and document areas
of deficiency that may be provided or remedied
during subsequent experiences.
Assessments should be standardized so that all
students completing a specific experience will be
assessed in the same fashion. Assessments
should be both formative and summative.
Formative assessments help to guide the students
through the learning process by providing
constructive criticism that molds their
performance to that which is desired. Summative
assessments provide an evaluation at the
completion of an experience or program.
15
Students should be specifically assessed on
knowledge. Core knowledge competencies and
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PHARMACOTHERAPY Volume 28, October 2008
related assessment measures should be included
for each experience rather than just providing an
overall subjective assessment of quality of
knowledge base. This principle increases student
responsibility for outcomes and promotes self-
learning. The mastery of this knowledge can be
assessed through written and verbal
examinations.
With the expanding roles of pharmacists, there
is an increasing need to assure the competency of
pharmacy graduates. Competency (or per-
formance) skills and attitudes are assessed through
observation of students. A form for uniform
assessment of 19 competencies was developed at
Virginia Commonwealth University.
16
These
competencies were evaluated on a 5-point scale
and were classified as communication/ education,
pharmacy care plan, professionalism, or practice-
specific competencies.
Another type of assessment that has been
proposed is a “high-stakes” comprehensive
examination at the end of the pharmacy program.
This may take the form of an objective structured
clinical examination (OSCE). This type of test
assesses both practice knowledge and
performance using standardized patients.
15
Problems with the use of a comprehensive
examination include difficulty in validating the
examination, and determining how to remediate
students who have passed all their courses but
fail the examination.
Care must be taken when redesigning
assessment methods to ensure that they can be
efficiently conducted by preceptors. Schools can
assist preceptors by collaborating to develop
similar assessment methods and tools when
practice sites are used by more than one school.
Summary
ACCP members, regardless of role as
academician, preceptor, or practitioner, should
each play an active role in defining and
implementing standards for quality experiential
education. Standardization in experiential
education will produce pharmacy graduates with
a consistently high level of knowledge and skills
that will provide society with highly competent
pharmacists. Quality experiential training with
an emphasis on direct patient care will prepare
graduates for the type of practice envisioned for
2015 and will better position the profession as a
whole for attainment of this vision.
References
1. American Council on Pharmaceutical Education.
Accreditation standards and guidelines for the professional
program in pharmacy leading to the doctor of pharmacy
degree, adopted January 15, 2006. Chicago, Illinois, 2006.
2. Joint Commission of Pharmacy Practitioners. JCPP future
vision of pharmacy practice. November 10, 2004. Available
from www.aacp.org/Docs/MainNavigation/ Resources/
6725_CPPFutureVisionofPharmacyPracticeFINAL.pdf.
Accessed June 2, 2006.
3. American College of Clinical Pharmacy. Utilization of the
Center for the Advancement of Pharmaceutical Education
educational outcomes, revised version 2004: report of the 2005
ACCP educational affairs committee. Pharmacotherapy
2006;26:1193–1200.
4. American Association of Colleges of Pharmacy. Academic
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characteristics. September 1, 2005. Available from
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6. American College of Clinical Pharmacy Educational Affairs
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Inc., 2001:227–248.
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226e
QUALITY EXPERIENTIAL EDUCATION ACCP 227e
Appendix 2: Recommended Practice Model and Preceptor
Qualifications for Select Experiences
Direct Patient Care: Acute Care (includes Adult Medicine,
Surgery, Pediatrics, and Inpatient Subspecialty)
• Preceptors should have 1 and ideally 2 years of
residency training or equivalent experience
c
ommensurate with their respective position. Board
certification is strongly encouraged, in particular at
sites that also conduct accredited residency programs.
14
Preceptors should maintain an active practice site.
• Site should provide daily opportunities for students to
engage in direct patient care, including active
participation in daily patient rounds with a practice
team or individual physician. Where the traditional
academic model is not available, frequent face-to-face
communications with other health care professionals
must be assured. The site should provide resources for
comprehensive assessment and monitoring of patients,
including access to patients, patient medical records,
and drug information resources. Pharmacists should
have access to medical records and should have a
defined mechanism for documenting activities and/or
recommendations in the patient record. The site
should guarantee appropriate quantity and diversity of
patient exposure as required for each specific
experience. The site should engage and support
preceptors and students in population-based activities
(e.g., adverse drug event and medication error
reporting, medication use evaluation, development and
use of protocols and guidelines). Finally, patient care
practice should be supported by appropriate clinical
evidence.
Direct Patient Care: Ambulatory / Primary Care
• Preceptors should have 1 and ideally 2 years of
residency training or equivalent experience
commensurate with their respective position.
Additional certification (e.g., BPS certification in a
recognized specialty, Certified Diabetes Educator,
Certified Geriatric Pharmacist) is strongly encouraged,
particularly for sites that also conduct accredited
residency programs
14
or in specialized practice
environments. Preceptors should engage in direct
patient care activities on a daily basis.
• Ideally, students should be exposed to different models
of ambulatory practice. “Collaborative” models should
include daily interaction with patients and
participation in patient care decision-making with
other health care professionals. “Primary care” models
should include daily interaction with patients,
including comprehensive assessment, clinical decision-
making, and implementation of drug therapy plans.
Regardless of model, students and preceptors should
routinely document patient care activities in the
medical record. Experiences may involve multiple sites
if necessary to ensure that students gain proficiency
across multiple areas of ambulatory care (e.g.,
anticoagulation, diabetes, dyslipidemia, hypertension,
cardiovascular disease, women’s health) as defined by
individual experience standards.
Appendix 1: The JCPP Future Vision of Pharmacy
Practice
2
The Foundations of Pharmacy Practice. Pharmacy education
will prepare pharmacists to provide patient-centered and
population-based care that optimizes medication therapy; to
m
anage health care system resources to improve therapeutic
outcomes; and to promote health improvement, wellness,
and disease prevention. Pharmacists will develop and
maintain:
• A commitment to care for, and care about, patients
•
An in-depth knowledge of medications and the
biomedical, sociobehavioral, and clinical sciences
• The ability to apply evidence-based therapeutic
principles and guidelines, evolving sciences and
emerging technologies, and relevant legal, ethical,
social, cultural, economic, and professional issues to
contemporary pharmacy practice
How Pharmacists Will Practice. Pharmacists will have the
authority and autonomy to manage medication therapy and
will be accountable for patients’ therapeutic outcomes. In
doing so, they will communicate and collaborate with
patients, caregivers, health care professionals, and qualified
support personnel. As experts regarding medication use,
pharmacists will be responsible for:
• Rational use of medications, including the
measurement and assurance of medication therapy
outcomes
• Promotion of wellness, health improvement, and
disease prevention
• Design and oversight of safe, accurate, and timely
medication distribution systems
Working cooperatively with practitioners of other
disciplines to care for patients, pharmacists will be:
•The most trusted and accessible source of medications
and related devices and supplies
•The primary resource for unbiased information and
advice regarding the safe, appropriate, and cost-
effective use of medications
•Valued patient care providers whom health care systems
and payers recognize as having responsibility for
assuring the desired outcomes of medication use
