62: 6 tips to incorporate precepting advanced pharmacy practice experience students into your workflow

In this episode I’ll share my top 6 tips to incorporate precepting advanced pharmacy practice experience (APPE) students into your workflow.
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I look at precepting as providing a student the opportunity to develop and apply the art and science of pharmacy in a practice setting.

It is the responsibility of us, as a profession, to provide these opportunities and guidance to the next generation of pharmacists.

I’ve been precepting 6 to 8 advanced pharmacy practice experience (APPE) students per year for over 10 years.

Here are my top 6 tips:

#1 Set expectations

Set expectations for how you want the rotation to go on day 1, and immediately address anything that is not up to your expectations.

It has been a long time since I had a student that wasn’t able to meet expectations for the rotation. I attribute this both to the quality of the students the college sends my way and my ability to recognize and immediately correct when things are not going according to expectations.

Despite the discomfort that comes from explaining to someone you want them to change their behavior, it is so much easier to address things the moment they happen rather than days or weeks later.

#2 The student doesn’t need (or want) to be attached to your hip for 100% of the rotation

Once I realized this concept, much of the stress of balancing precepting with my other duties vanished. Here are 2 ways that I make sure this happens:

1. I arrive at work 1 hour or more before my student does. Pharmacy Joeism #4 is that 1 minute before 9am = 2 minutes after noon. By getting a head start on my day before my student arrives I make sure I don’t start off behind. This also gives the student an hour at the end of the day to work on assignments and projects without me interrupting them with new assignments and projects.

2. I spend time away from the student midday. Unless there are unstable ICU patients that need my attention, I’ll spend some time after lunch in my office without the student while I catch up on emails and projects.

#3 Build a database of references and practice resources for your student to independently review

I’ve assembled a collection of over 70 references and practice resources. I have these resources loosely organized and linked on an internal Sharepoint site accessible on my institution’s network.  You download this list of resources inside the free Pharmacy Nation Community.

If your institution does not have a system such as Sharepoint for you to use to organize your practice resources, consider some of these other options:

A shared Evernote folder
A shared Google Drive folder
A Trello Board
A shared Dropbox folder

Remember to keep in mind “fair use” and copyright when compiling your resources.

Now that I have created this database of resources, I am able to instruct my student to skim the titles and review something that interests them whenever there is downtime or if I get called to an unexpected meeting.

#4 Experiment with a “flipped classroom”

According to Wikipedia:

Flipped classroom is an instructional strategy and a type of blendedlearning that reverses the traditional educational arrangement by delivering instructional content, often online, outside of the classroom. It moves activities, including those that may have traditionally been considered homework, into the classroom.

The most basic type of ‘flipped classroom’ approach is to give a student an article and say “go read this article and then we’ll talk about it”.

My podcast can be used to facilitate flipped classroom discussions. I’ll often have my student listen to an episode, read the references, then we’ll discuss the topic afterwards.

I’m experimenting with making the process a little more formal. For sepsis, I’ve packaged episode 42 with the surviving sepsis guidelines into an ‘online course’ format. I’m asking my student to review the ‘course’ material in preparation for a time we set aside to discuss any questions the student has about the care of septic patients.  You can access the same course by clicking here.

#5 Get other health care professionals engaged in training your students

I have my student purposefully develop relationships with the nursing staff and physicians by doing things like answering drug information questions, taking medication histories, and providing IV compatibility. Staff in turn include the student in beside procedures and offer to teach the student about the different monitoring devices or other ICU related topics.

#6 Ease the student into the patient workup process

I’ve found that if I slowly ease a student into the process of evaluating critically ill patients, by the 2nd week they become a ‘pharmacist extender’ and the remaining weeks of the rotation go smoothly.

Here is how I ease students into the rotation:

– I’ll have them watch me as I do a complete patient work-up, explaining my thought process along the way.
– I make sure the student has institutional guidelines on basic things like stress ulcer, VTE, and VAP prophylaxis.
– I ask the student to do a patient workup, and I give them unlimited time to do so. I’ll explain “I’d rather you workup one patient thoroughly than 5 patients haphazardly”.
– I review the student’s work and provide them feedback, repeating the process for another patient.

By the 2nd week of the 6 week rotation, most students are able to do a high quality workup of 4-5 patients in the 2 hours before ICU rounds start.

If you have any precepting tips you would like to add please contact me!

Pharmacy Nation member Anthony has offered 4 documents that he uses to facilitate precepting APPE students:

Anthony’s Pharmacy Progress Note

Anthony’s ICU Data Collection Form

Anthony’s Survival Guide to ICU Rounding by Systems

Anthony’s APPE Clinical Syllabus

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If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.

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