PEP-SIG task force chair report: PharmD clerkship students as resources

American Journal of Pharmaceutical Education,  Winter 2000  by Abel, Steven R,  Garzynski, Ellen,  Easterday, Tiffany L

• E-mail
• Print
• Link

PEP-SIG Task Forces Chair Report: PharmD Clerkship Students as Resources

BACKGROUND

As the profession of pharmacy adopts the PharmD as the entry-level degree and integrates more widely throughout the health care system to provide pharmaceutical care services, demand for experiential training of students has increased dramatically. In a majority of PharmD programs, students are required to complete approximately one year of clinical rotations. This has lead to a great demand for sites to provide this clinical training.

Competition among sites is intense, especially in the hospital. Hospitals provide the foundation for training in the health profession due to the controlled patients in a rich, multidisciplinary environment where the clinical skills learned can be transferred to other environments. Administrators have been forced to reduce staff, document the value of services, increase productivity, and maximize their resources in response to the downsizing of hospitals. This has increased the pressure to justify clinical teaching programs. Due to the high demand being placed on different clerkship sites, monetary reimbursement from schools is becoming a means of justifying the training of students and the student's value to the site.

The AACP Professional Experiential Programs - Special Interest Group (PEP-SIG) Committee formed a task force to evaluate clerkship students as resources. The task force identified four key issues to address. The first issue was to evaluate the curricula to determine which elements provide students with skills that are an immediate value to an affiliated site. The curriculum may need to be modified (to prepare students with the basic skills) in order to make the students most desirable to the sites. Preceptors have certain expectations of student ability based on their didactic training. These skills obtained from didactic experience need to be uniform among students as well as perfected. This will allow students to concentrate on clerkship activities that cannot be learned through didactic work and to better contribute to the host environment.

The second issue to evaluate is the model for experiential training. The task force should focus on the "employee model" of training. In this model, both the preceptor and student produce output, which should be most contributory to the training site. The student produces output independent of the preceptor. Only if the student is fully trained will they have a positive effect on output. This model assumes that the student acts as an employee and if they are not present output will be decreased. It assumes that the student can provide services which the practitioner would provide if the student was not actively participating in these services while on their clinical rotations. In the "nonemployee model" the student can have a positive impact on output, but not independent of the preceptor. The student only increases the preceptor's output. The student cannot be considered an employee.

The third issue was to evaluate block training for students at experiential sites, including identification of the optimal length of training which provides return to the site. Many students are exposed to multiple practice sites that require orientation at each site. This increases training time and decreases productivity for host staff. If a student is trained at one site and continues to do rotations at that site, then training would only need to be performed once, and the potential contributions of the student might be greater.

The fourth issue involved evaluating the published literature to prepare a reference list which contains specific examples describing utilization of students within practice sites. Issue four is the focus of this report. The objective of this literature review was to determine how a pharmacy student could be an asset versus a liability to the clerkship site during experiential training.

METHODS

A MEDLINE search was performed that gathered published articles dealing with pharmacy clerkships. Each article was reviewed, and the content dealing with each of the Task Force issues was extracted from the literature. A table was for-matted for guidance when reviewing the literature that included the following elements: evaluation of curricula, evaluation of the application of the "employee model", evaluation of block training, and evaluation of student contributions. The information was sorted in a useful, organized manner that could later be summarized.

RESULTS

Overall, no specific conclusions could be drawn from review of the literature. The optimal length of a clerkship could not be determined. The length of various clerkships cited in the literature ranged from four weeks to fourteen weeks. Four weeks was the most common length of a clerkship experience. Forty-three percent of the rotations were four weeks in length. Nineteen percent were five weeks, 20 percent were six weeks, one percent were seven weeks, nine percent were eight weeks, and four percent were greater than eight weeks (See Figure 1). The rotations were all inpatient rotations completed by PharmD students. At two clerkship sites that involved four week long rotations, the preceptors expressed an interest in increasing the rotation to six weeks. One site determined it took four weeks for the student to perform at the specified level. Another required a minimum of 18 weeks at an institution, but all rotations were six weeks long. One site determined that the student's contributions were greater in week five than week one of a five-week rotation.