Introductory clinical clerkship during the first and second professional years: Emphasis in clinical practice and writing

American Journal of Pharmaceutical Education,  Spring 1998  by Vrahnos, Dimitra,  Madduz, Michael S

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An introductory clinical clerkship course was developed to involve students in patient care activities early in their college experience, introduce students to clinical communication and organizational skills in preparation for future clerkships, better relate early didactic curricular content and principles to the practice of pharmaceutical care, provide students with opportunities to practice clinical and scientific writing skills, and assist students in evaluating future professional training and practice options. The clerkship is a two or three credit-hour professional elective offered to first and second professional year pharmacy students. Each student is required to develop a "Clerkship Portfolio" that allows both the student and his/her preceptor to track clerkship performance throughout the rotation. The portfolio includes consultation notes, a case presentation handout, a drug information paper, a disease monograph, and a patient counseling guide. Throughout the clerkship, students practice patient presentation skills, formulate answers to drug information inquiries, and develop professional writing skills. Results of student course evaluations indicate that the clerkship introduces effectively the process of rendering pharmaceutical care. Instructor assessments indicate that first and second professional year students are capable of conducting direct patient care activities under the guidance of a preceptor. All students indicated that the course helped them relate didactic curricula to the practice of pharmaceutical care. The majority of students who completed the clerkship suggested that this experience should be a curricular requirement.

BACKGROUND

Introductory practice experiences early in the pharmacy curriculum are recommended by the new American Council of Pharmaceutical Education Accreditation Standards and Guidelines(1). Early practice experiences can assist students in gaining an understanding of the basic principles learned in the classroom and demonstrate how these principles apply to the "real" patient care environment(2). Such "introductory clerkships" may also allow early opportunities to practice the clinical skills necessary to render pharmaceutical care. Moreover, professionalization of students during the early years may be facilitated by faculty rolemodeling and mentoring. However, there are limited published reports detailing the methods or results of such early clinical experiences in the pharmacy literature(3-7). The sole exposure to the patient care environment that most pharmacy students obtain early in the curriculum consists of written and/or verbal patient case scenarios introduced in the classroom setting. Until recently, students at the St. Louis College of Pharmacy could participate in clinical clerkships only during their final academic year.

Background Paper II from the Commission to Implement Change in Pharmaceutical Education suggests that pharmacy students should be "effectively sending and responding to communications for varied audiences and purposes including writing, reading, speaking, listening, and using data..." In order to address this educational outcome, ample opportunities to practice verbal and written communication abilities in the clinical setting are required(8).

Hence, an experiential course entitled "Introductory Clinical Clerkship with Emphasis on Clinical Practice and Writing" was developed to: (i) involve students in patient care activities as a member of an interdisciplinary health care team in a patient-care environment; (ii) introduce students to clinical communication and organizational skills in preparation for future clerkships; (iii) better relate early didactic curricular content and principles to the practice of pharmaceutical care; (iv) provide students with opportunities to practice clinical and scientific writing skills; and (v) assist students in evaluating future professional training and practice options.

COURSE DESCRIPTION

The clerkship is a two credit-hour (nonwriting emphasis) or three credit-hour (writing emphasis) professional elective offered to pharmacy students in their first or second professional year. Each student is assigned to an inpatient medicine or outpatient ambulatory care site with a clinical faculty preceptor. In addition, at least one sixth year (senior) pharmacy student and/or postgraduate doctor of pharmacy resident serves as a co-mentor and role model during portions of the clerkship.

The practice component of the clerkship requires six contact hours (at the practice site) weekly for 14 weeks. The first two weeks are devoted to site orientation. This includes introduction to medical, nursing, pharmacy, and other allied health professionals; and orientation to patient care wards/ clinics, patient medical charts, monitoring forms, the laboratory ordering process, and other aspects of daily patient care activities. The remaining 12 weeks involve completion of a variety of clinical tasks that provide continuous practice of the designated course outcomes (Appendix A). The writing emphasis version of the clerkship includes at least five writing assignments and meets institutional requirements for writing emphasis courses (Table I)(9).