Evaluation of student performance in an immunization continuing education certificate program incorpated in a pharmacy curriculum

American Journal of Pharmaceutical Education, Summer 2000 by Hak, Emily B, Foster, Stephan L, McColl, Maureen P, Bradberry, J Christopher

According to Tennessee Board of Pharmacy regulations, pharmacists participating in influenza immunization programs must complete the American Pharmaceutical Association (APhA) Pharmacy-Based Immunization Delivery certificate program. Our objective was to incorporate this program into The University of Tennessee College of Pharmacy curriculum so graduates would be able to administer immunizations following licensure. Pharmacy faculty trained as APhA faculty modified the course for pharmacy students. Lecture time was decreased and information previously presented in lecture was presented in cases that were evaluated by small groups of students and then discussed with faculty facilitators. Faculty supervised small groups of students practicing injection technique on each other. The self study test grade ( SD) was 95 t 4 (78 - 100) and post test score was 94 5 (73 - 100) with a score of 70 required for passing. All second and third year students successfully completed the program and 53 percent of fourth-year students elected to take and successfully completed the course. Beginning in 2000, all graduates will be recognized by the Tennessee Board of Pharmacy as immunization providers.

INTRODUCTION

Tennessee is among at least 30 other states whose pharmacy practice act has been changed to allow pharmacists to administer medications and to develop collaborative practice agreements with physicians. The rules promulgated by the Tennessee Board of Pharmacy recognized the American Pharmaceutical Association (APhA) certificate program entitled Pharmacy-Based Immunization Delivery as providing the appropriate education and training for pharmacists to conduct an influenza immunization program. While the University of Tennessee College of Pharmacy curriculum contained lectures on immunizations and a laboratory on immunization technique, this did not satisfy the board requirement for immunization competency. Therefore, to graduate students who could practice to the extent of the new practice act, it was decided to explore the possibility of integrating the APhA certificate program into the curriculum. Additionally, we wanted to implement this project by the Fall of 1998 so pharmacy students could provide immunizations during the campus influenza immunization initiative. The activities and the month prior to implementation of the course are shown in Table I.

PREPARATION OF FACULTY

The APhA licensed their program to our college and eight of our faculty completed the certificate program and were trained to be instructors. APhA provided all supporting materials for the course including self-study test, post test, answer keys, audiovisual materials, supporting resource materials, and course evaluation forms.

ADAPTATION OF TEACHING MATERIALS

To maintain the integrity of the program, all of the APhA program materials were used (including the self study manual, Centers for Disease Control book entitled "Epidemiology and Prevention of Vaccine-Preventable Diseases," local information, and supporting documents). These course materials were purchased by the Association of Students of Pharmacy (ASP) at cost and then sold to the students. ASP also conducts annual Cardiopulmonary Resuscitation (CPR) training, another requirement for successful completion of the immunization program.

The primary consideration for the placement of the course was the campus influenza immunization initiative that is held one day during the last two weeks of October each year. To insure the availability of large number of pharmacy students as immunizers, they would need to complete the course prior to that time. Second- and third-year students are available on campus, but many of our fourth-year clerkships are away from campus. Therefore, the program was placed in the parenterals course that is offered early in the fall semester of the second professional year insuring that approximately 200 certified pharmacy students would be available to participate in the fall influenza immunization clinic. For the first year, a separate course was provided early in the fall for the third- year class and just prior to graduation for the fourth-year students.

In addition to the self study, the APhA certificate program consists of lectures on diseases, immunizations, reimbursement, obtaining a Medicare provider number, claims submission, marketing strategies, and emergency management of complications. The technique for subcutaneous and intramuscular injections is practiced on a partner and every participant is required to administer and receive three injections. The original college curriculum contained two hours of lecture that provided an overview of routine pediatric and adult immunizations and four hours of immunization technique with practice on a dummy model in a clinical laboratory setting.

The current teaching philosophy in our college is to minimize formal lectures and use small group, case-based discussions. The content of the APhA program was reformatted to be consistent with this philosophy. The program information and slides were reviewed and the key points were organized into a lecture format that was covered in three hours and forty minutes. Two hours were allotted to specific immunization information; one hour and ten minutes to legal issues, marketing strategies, and reimbursement. Forty-five minutes were allotted to emergency management and injection technique demonstration. Two and one-half hours were allotted for seven case scenarios that covered didactic material from all aspects of immunizations, including adult and pediatric schedules, vaccine related adverse effects, vaccine relative and absolute contraindications, and emergency management of allergic reactions. In order for students to solve the cases, they were required to recall facts, consider patient specific data, and apply immunization principles. An example of a case with the solution is shown in the Appendix.