1

P4 - ADVANCED PHARMACY PRACTICE EXPERIENCE

(APPE)

PRECEPTOR MANUAL

2017-2018

2

APPE General Descriptions .......................................................................................................................... 7

Goals, Objectives and Activities ................................................................................................................... 9

PRECEPTOR STANDARDS ....................................................................................................................... 9

STUDENT STANDARDS ......................................................................................................................... 10

PRECEPTOR GUIDELINES ..................................................................................................................... 11

3

4

APPEs are designed to enhance the knowledge base and skills students need in order to

fulfill the competencies required for the professional pharmacy degree. Students should further

develop their skills in patient care, critical thinking, decision making, ethical judgment and

This preceptor manual is a guide for preceptors to utilize in one’s development and

throughout a student’s APPE. We have included information on APPE policies, procedures,

objectives, and assessments. You are making an enormous contribution to individual students,

NEOMED and the profession of pharmacy. Please do not hesitate to contact the college if you

have any questions; we are more than willing to assist you.

Best wishes for a rewarding experience!

Updated 02/27/2017

5

6

P4 year. There are no rotations scheduled for the months of December and May.

7

APPE GENERAL DESCRIPTIONS

Clinical - (Acute Care Internal Medicine, Ambulatory Care, Clinical Selective)

Palliative care). Students are exposed to diverse patient populations with a broad range of acute

professionals and patients. These experiences may include medication order processing,

dispensing, sterile product preparation, clinical services, inventory management, and

administration.

8

Underserved

These experiences take place primarily in ambulatory settings (e.g. Federally Qualified

Health Centers, charitable pharmacies, hospital-based ambulatory clinics) which provide

pharmaceutical care services to those who face barriers to timely access to health services. These

experiences focus on identification, resolution and prevention of drug related problems in the

underserved patient. Students may participate in activities such as dispensing, patient counseling,

medication therapy management, disease state management, adherence monitoring, development

experience. Activities a student may perform on these experiences include spending time with a

manager or director of pharmacy services, attend administrative related meetings, and develop

Electives

Elective APPEs may be either patient-care or non-patient care experiences. These rotations

provide students with an adequate breadth of knowledge in areas of interest and should

complement the required APPEs to develop the student pharmacist into a competent and mature

professional. Elective experiences give students the opportunity to gain insight in areas such as

academia, research, drug information, compounding, and professional association management

among others. Students may also take additional clinical selective rotations, community, or

hospital rotations as elective experiences.

9

Goals, Objectives and Activities

goals and objectives for their rotations. Students should also work with preceptors to incorporate

his or her interests or areas of needed skill improvement into the goals and objectives of the

rotation.

PRECEPTOR STANDARDS

The Preceptor shall:

1. Recognize that the relationship with the student is one of preceptor-student rather than

employer-employee.

2. Recognize that learning requires mutual respect, courtesy and communication between him

or herself and the student.

goals and objectives, review of assessment forms, develop a schedule of activities for the

student, and notify staff of their responsibilities when working with a student.

6. Give the student a thorough orientation to the site and experience early in the rotation to

facilitate a smooth transition and an optimal use of available resources.

7. Clearly outline expectations of the student regarding professional dress, conduct,

scheduling of hours/activities, assignments, and performance.

8. Afford the student sufficient time, preparation and patience for the learning experience.

9. Do not assume the student’s level of competence but determine this by discussing previous

16

Students should not make any travel arrangements until they have received approval from

their preceptor to be absent. The signed absence form should be forwarded to the Director

of Experiential Education for review.

6. Students are authorized specific holidays off from rotation (refer to the P4 APPE Academic

Schedule for a list of approved student holidays). Preceptors should allow students to be

off for these approved holidays.

7. In the case of personal illness or emergency, the student is required to notify the preceptor

or his /her designee as soon as possible prior to the scheduled arrival time to the site. The

method of notification (i.e. email, phone call) shall be predetermined by the preceptor and

communicated to the student at the start of the rotation. If the student is absent for more

than TWO (2) days from the rotation due to illness or emergency, both the preceptor and

the student must notify the Director of Experiential Education. The “Request for Approval

of Absence from APPE Activities Form” must be completed upon the student’s return to

the rotation.

8. Time off for religious reasons is allowed in accordance with NEOMED policy. Students

Experiential Education TWO (2) months prior to the start of the time off. The student is

absence that was not approved by the preceptor. Unexcused absences will not be tolerated

and jeopardize the student’s successful completion of the program. Any unexcused

absence may result in failure of the rotation in which it occurred. Preceptors should

immediately notify the Director of Experiential Education if such absences occur.

10. Time off requests for travel to or from a distant rotation is to be arranged only within that

rotation at the discretion of the preceptor. Generally, no more than ONE (1) business day

should be taken for travel.

11. Preceptors should consult with the Director of Experiential Education regarding any

concerns surrounding a student’s absence from a rotation.

17

Evaluations and Grading

as they would any other course. Preceptors monitor student performance, identify strengths and

weaknesses and provide necessary feedback to ensure student development in established

competency areas. Preceptors must complete a student evaluation in E*Value for each student

Section 5: Interprofessional Collaboration

Section 7: Administrative Skills

• Midpoint Evaluation: The preceptor is strongly encouraged, by the university and ACPE,

to complete a student evaluation at the midpoint of the rotation. The midpoint evaluation

is required if the student is not meeting rotation expectations or performing at an

unsatisfactory level. The evaluation should be discussed with the student and submitted to

the college via E*Value. If a student is not meeting performance expectations at the

midpoint, the preceptor should contact the Director of Experiential Education to discuss

the issues and discuss a plan for improvement.

• Final Evaluation: The preceptor is required to complete a final student evaluation during

accomplished during past rotations and build in activities during subsequent rotations to

fulfill all the expectations of a student’s APPE rotations.

• Preceptors are encouraged to comment on student needs to improve for subsequent

rotations. (Note: Preceptors are able to view Overall Comments and Areas for

Improvement sections of earlier APPE evaluations of the students they are precepting.

Information on how to view these evaluations is in the E*Value instruction guide)

• The final evaluation should be reviewed and discussed directly with the student at the

end of the rotation. It is important to complete the evaluation in a timely manner so the

18

Final grades for rotations will be based on an average score of all the components of the

evaluation using the following scale:

Feedback

student. Effective feedback provides positive reinforcement for what the student is doing

Without appropriate feedback, students may miss crucial skills development and/or

feedback:

1. Students want to receive feedback on their performance - Students desire and expect

preceptors to provide them feedback on their performance whether it is positive or

negative. One can only improve or change if they are provided honest, specific, and

discussing individual performance with a student. Some find it effective to “sandwich”

negative feedback between positive feedback given at the beginning and the end.

provide feedback immediately after a task, patient-counseling session or other activity. As

this is not always possible, a time should be determined for providing feedback to the

student, once a week for example “Feedback Friday”. Preceptors should take notes as

soon as possible after observing students and not rely on memory to ensure accurate and

helpful feedback. Preceptors might find the Journal Club Evaluation, Case Presentation

(see Appendix) helpful for recording observations.

5. Feedback should focus on remediable behavior and should offer suggestions for

improvement – Feedback should focus on behaviors that can be corrected. Feedback

should not deal with assumed intentions or preceptor interpretations. Preceptors should

19

Student Performance during the Rotation

acceptable level of competence in the practice and clinical skills necessary to becoming a

licensed pharmacist. Successful completion of the rotations goals and objectives is a

reliable measure of one’s performance during a rotation. Since a student’s level of

competence in any specific skill may vary from their peers it is important that preceptors

identify and work with their student on those skills needing improvement. Identifying

those areas for improvement and discussing with the student as early as possible into the

rotation will allow opportunity for the student to show improvement. The preceptor and

student developing a plan with specific, measurable, attainable, relevant, and timely

(S.M.A.R.T) goals is an ideal approach to help one meet the expectations of the rotation.

This may require the student spending additional time mastering a particular activity or

task (e.g. counseling patients, dispensing, reviewing patients drug therapy, answering drug

information questions, etc.) rather than activities one is comfortable doing. Providing

effective feedback (see above) throughout this time is vital. Ideally the student should be

allowed the time to demonstrate a progressive improvement in one’s performance needed

to successfully pass the rotation. The preceptor should consider the student’s effort and

degree of progression in mastering a skill when completing the midpoint or final

evaluation.

Preceptors who are having difficulty with a student’s performance, developing a plan for

improvement, or believe improvement is not being achieved should contact the Director of

Experiential Education for assistance as soon as possible.

In instances of unacceptable professional behavior or performance, the preceptor should

but not limited to a greater amount of independence, mentoring/training other learners, and

completion of special projects or research. In these situations, a preceptor should not feel

limited by the established list of rotation objectives when working with high performing

students. Providing feedback to the high-performers is also essential during this time.

Student Evaluation of Preceptor

• Following the completion of an APPE, the student is required to complete an assessment

of their preceptor, the rotation, and the site (see appendix). The student will also provide

a self-assessment following each rotation.

should be utilized as a tool to make potential enhancements to their program.

• Preceptors who have a concerns or questions about the evaluations submitted by their

student can contact the college.

20

21

complete all activities in a professional manner under the facilitation of a preceptor.

• Demonstrate the ability to transfer a prescription to and from another pharmacy

• Demonstrate the ability to perform any necessary pharmaceutical calculations

22

• Effective verbal communication when advising, counseling, and educating patients

• Clarify proper medication dosing

IV. Participate when applicable in services provided by a pharmacist to include but not limited to:

• Medication Therapy Management Service (MTMS)

• Collaborative Practice Agreements

• Chronic Disease State Management

• Adherence Counseling

• Immunization services

• Disease Screening/Health and Wellness programs

• Community health fairs

• Patient home visits

• MD office visits

• Screening and Brown Bag programs

• Other community outreach programs such as presentations to nursing homes

• Marketing presentations to employer and payor groups

• Allergies (to include description of the reaction)

23

• Medication history (including previous treatments and nonprescription products)

• Available past medical, family, social, and surgical history

• Immunization history

• Adherence to a medication regimen

• Physical assessment

• Measure basic physical assessment data (i.e. blood pressure, lipid panel,

glucose, weight, height, etc.) where available and when appropriate

• Obtain physical assessment and lab data from patient health record when

record is available

• Insurance/healthcare coverage

• Lifestyle factors unique to the patient

VII. Identify and prioritize a patient’s problems including the following drug related problems:

• Unnecessary drug therapy (i.e. duplicate therapy, no indication)

• Additional drug therapy needed (i.e. untreated indication)

• Effectiveness

• Different product required (i.e. superior product available, therapy is not

• Dose too low [inadequate dosing frequency or duration, drug interaction

• Safety

• Compliance

• Concern about adverse effects

• Cost

• Patient forgets to take

• Patient cannot tolerate dosage form

24

• Pharmacokinetics

• Dose and routes of administration

• Contraindications and precautions

• Adverse reactions

• Monitoring parameters for efficacy and toxicity

• Key patient education talking points

• Include a drug therapy monitoring plan that states the parameters to be measured and

• Be communicated to the patient and other members of the health care team in an

X. Demonstrate the ability to measure and document patient outcomes.

• Implement the pharmaceutical care monitoring plan to determine the outcome(s) of

• Measure, record, and appropriately track the therapeutic response and toxicity

• Create an audience-appropriate response and communicate this in a timely manner.

• Document the question, response, and resources/references used on an appropriate

XII. Demonstrate the ability to effectively communicate, both in writing and verbally, with health

• Medication and disease education

• Responses to drug information requests either verbally or in writing

• Documentation of interventions

25

• Communication to patients summarizing their prescription coverage if applicable

• Journal club

• Maintaining confidentiality regarding patient information and displaying honesty and

• Mentoring pharmacy students currently on an early experiential site visit if applicable

• Arriving on time and prepared for all rotation activities

• Demonstrating the ability to complete assignments in an accurate and timely manner

• Developing the habits consistent with life-long learning

I. Review the mission statement, strategic plans, and management plans for the pharmacy

• Quality control

• Inventory control

• Budgeting and financial management

• Record keeping

• Theft reporting

IV. Review the process by which the pharmacy meets and maintains compliance with all

V. Review key components of human resource management, including but not limited to:

32

IV. Develop a pharmaceutical care plan to manage a patient’s identified health/medical problems

• State the desired and achievable pharmacotherapeutic goals for each identified problem

• Include a drug therapy monitoring plan that states the parameters to be measured and

V. Exhibit a firm understanding of drug therapy. For each pharmacotherapeutic option the

• Pharmacokinetics

• Adverse reactions

• Interactions (drugs, dietary supplements, food, laboratory, disease)

• Monitoring parameters for efficacy and toxicity

• Key patient education talking points

• Cost of therapy

• Implement the pharmaceutical care monitoring plan to determine the outcome(s) of

• Measure, record, and appropriately track the therapeutic response and toxicity

• Identify, assess, and report adverse drug reactions and medication errors using the

VII. Educate patients, caregivers, and health care professionals regarding the appropriate use of

• Implement patient-specific education plans. These plans should include purpose,

• Educate professional colleagues, including pharmacists, physicians, and nurses regarding

VIII. Demonstrate the ability to use the most appropriate resources to respond to drug information

• Identify the specific question using appropriate techniques

33

• Create an audience-appropriate response and communicate this in a timely manner

• Where applicable document the question, response, and resources/references used

IX. Demonstrate the ability to effectively communicate, both in writing and verbally, with health

• Responses to drug information requests either verbally or in writing

• Communication to the health care professionals regarding medication therapy plans and

• Demonstrating courtesy and respect towards others and exhibiting self-control in all

• Maintaining confidentiality regarding patient information and displaying honesty and

• Demonstrating the ability to complete assignments in an accurate and timely manner

• Developing the habits consistent with life-long learning

34

• Depression