Evaluation of a pilot clinical skills workshop series for community pharmacists

American Journal of Pharmaceutical Education, Summer 1998 by Mehra, Ila V, Wuller, Cynthia A

Clinical clerkship sites are needed in community pharmacies to prepare students to assume new roles as pharmaceutical care providers. A series of six clinical skills workshops were developed to train community pharmacists to become preceptors for students during clinical community pharmacy rotations. Learning was assessed by a final practicum. A self-assessment tool evaluated perceived improvement in attitude and clinical skills. A majority of the respondents reported positive changes in their daily practice, increased knowledge and confidence in all areas discussed in the workshops, and increased motivation/desire to counsel patients. All feel prepared to precept students in the near future; however, one-half think they first need additional instruction on precepting. A clinical skills workshop series is an effective method to begin preparing community pharmacists to become clinical role models and preceptors for community pharmacy clerkship rotations.

INTRODUCTION

The role of the community pharmacist is evolving from that of a medication dispenser to one of a pharmaceutical care provider. Although most practitioners and educators agree that the preparation of pharmacy graduates for this evolving role is essential, opportunities for students to develop and practice clinical skills in the community environment remain limited. The majority of contemporary community pharmacy experiential rotations still emphasize the practice of traditional pharmacy dispensing and managerial tasks. While valuable, these experiences alone are insufficient in preparing students for future community-based pharmaceutical care roles. Therefore, colleges of pharmacy should seek to collaborate with community pharmacists in the development of clinical practice roles in the retail setting(1,2).

The evolution of the practice of pharmacy has resulted in re-engineering, which is quickening the change in pharmacist roles. Principles of practice for pharmaceutical care have been developed by the American Pharmaceutical Association (APhA) as a proposed standard of care(3). The American Society of Health-System Pharmacists (ASHP) has also proposed guidelines on a standardized method for pharmaceutical care(4). Both of these guidelines focus on responsibility for patient outcomes. The redirection of clinical pharmacy in a community setting and redefinition of practice must be combined with retraining/support for pharmacists cognitive activities. The Iowa Center for Pharmaceutical Care (ICPC) has developed curricula to support evolving cognitive practice roles, and now serves as the template for the newly created American Center for Pharmaceutical Care(5). These training-based models focus on work patterns, job responsibilities, store layout, communication, marketing and reimbursement(6). Other innovative efforts to facilitate implementation of clinical activities include the Indian Health Service practice models(7) and collaborative drug therapy management initiative(8). The pharmacist care model, developed by the National Community Pharmacists Association (NCPA) (formerly the National Association of Retail Druggists) focuses on disease state management (for diabetes, respiratory care and cardiovascular care) and pharmacist care skills(6). Several software-based training models of pharmaceutical care are also available (e.g., MedOutcomes, CarePoint. Encounter)(6).

The focus of these pharmaceutical care training programs was on retraining practicing pharmacists. Unfortunately, training pharmacists to precept students and demonstrate the skills they need to assume new roles of pharmaceutical care providers when they graduate were not included in these programs. In addition, many of these programs focus on a process and not on skills. Pharmacists must first learn basic clinical skills and implement a clinical practice model before they can become preceptors and role models for students. A three-part program was created to meet these goals, and is currently being implemented. Phase I is a series of clinical skills workshops designed to introduce pharmacists to the management, monitoring and patient education of common chronic disease states. Phase II is also a series of workshops incorporating additional common chronic diseases and including more ways to precept students on clinical clerkships. Phase III is the actual precepting of clerkship students at the pharmacist's site with guidance from a clinical faculty member at St. Louis College of Pharmacy. Phase I of the program will be described in this paper.

OBJECTIVES

The overall goal of the program was to train community pharmacists to serve as clinical clerkship preceptors and role models in the experiential program at St. Louis College of Pharmacy. The specific objectives for phase I of this program were to: (i) increase community pharmacists' clinical skills;(ii) increase community pharmacists' knowledge base in chronic disease state management of diabetes, asthma and hypertension: and (iii) to train community pharmacists to be providers of quality pharmaceutical care to their patients. The specific disease were selected because they are common chronic conditions that pharmacists can easily monitor and teach patients to self-monitor at home.