Summer 2019

Director’s Corner: Precepting Millennials

By Dr. Kimberly Stulz

Much has been written about the Millennial workforce, individuals born between 1981-1996 (23-38 years old). For preceptors, it is important to understand that Millennials value open communication, flat organizational structure and a flexible schedule. Therefore, preceptors should set clear expectations on the first day regarding:

• Frequency of formal and informal communication

• Hierarchy of reporting concerns and asking questions

• Flexibility/rigidity of rotation schedule

Millennials have grown up with instant communication. Consequently, these students desire frequent brief meetings to ensure clear direction and quick decision making. They also seek out additional validation and praise during these interactions. To avoid frustration for both preceptor and student, explain how often you will provide feedback in both formal and informal ways. Preceptors may also require that students write down instructions to avoid repeating information throughout the rotation.

Further, preceptors may notice this generation displays an indifference to rank. If your practice site is organized in a pyramidal fashion, it is important to explain why and how this works for students. Provide examples and guidelines regarding who they should talk to and when would be most appropriate.

Lastly, Millennials do not live to work, which may lead preceptors to think they have a poor work ethic. Yet, don’t we all want to shift toward a better work-life balance? In reality, Millennials are found to be very loyal, innovative and responsible when engaged with work activities. Ensure students understand that their schedule has been drafted to meet patient needs and how they should report tardies and request absences. For example, indicate whether you prefer a phone call, email, text or a combination of these methods and how much advance notice is expected.

Preceptors can connect well with Millennial students by understanding their work place values. For more strategies on precepting Millennials, preceptors are encouraged to view the CEImpact module titled Generational Shift: Why We Should Modify our Instructional Strategies for the Next Generation of Pharmacists. (If you are in need of the CEI access code, please email your Regional Coordinator)

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Experiential Update

Summer has arrived which means our new rotation year is officially underway! During the Spring semester, our Hospital and Community Pharmacy Advisory Boards met to provide feedback on our experiential program. The information gathered has been used to improve our experiential curriculum.  The IPPE workbook has been updated with new calculations and additional inventory management activities to ensure students are keeping up with current practice.

We appreciate your valuable insight into how we are preparing the next generation of Gator pharmacists. If you would like to offer feedback regarding the experiential program, please contact our office or your Regional Coordinator.

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Entrustable Professional Activities

Entrustable professional activities (EPAs) are key responsibilities performed by pharmacists during their daily work. Another way to define EPAs is essential tasks and activities that new pharmacy graduates should be able to perform without direct supervision when they enter the practice of pharmacy.

What are the core EPAs for pharmacy?

Please click here for a list of the 15 core EPAs for pharmacy. The 15 core EPAs are categorized into six key professional roles or domains: 1) Patient Care Provider, 2) Interprofessional Team Member, 3) Population Health Promoter, 4) Information Master, 5) Practice Manager, and 6) Self-Developer, with each domain encompassing one or more entrustable professional activities. For instance, the Interprofessional Team Member Domain contains one EPA - Collaborate as a member of an interprofessional team. In contrast, the Patient Care Provider Domain contains five EPAs: 1) Collect information to identify a patient’s medication-related problems and health-related needs, 2) Analyze information to determine the effects of medication therapy, identify medication-related problems, and prioritize health-related needs, 3) Establish patient-centered goals and create a care plan for a patient in collaboration with the patient, caregiver(s), and other health professionals that is evidence-based and cost-effective, 4) Implement a care plan in collaboration with the patient, caregivers, and other health professionals, and 5) Follow-up and monitor a care plan. The five EPAs within the Patient Care Provider Domain align nicely with the steps in the Pharmacists’ Patient Care Process (Collect, Assess, Plan, Implement, and Follow-up).

Why does pharmacy need EPAs?

Thus far in pharmacy education, core competencies have centered on what students should know (drug and disease state knowledge) and how students should act (professional behaviors). However, many preceptors have seen the student who is very “book smart” and can meet all the knowledge competencies, but doesn’t have the soft skills or professional behaviors needed to practice effectively. Conversely, we have seen students who have outstanding interpersonal and team skills, but cannot assimilate the clinical knowledge and apply it in practice. The advantage of EPAs is that they surpass what our students should KNOW and how they should BEHAVE. EPAs outline what new pharmacy graduates should be able to DO. In other words, EPAs outline a basic set of pharmacist tasks and activities which are considered the baseline minimum expectation for a pharmacy graduate. The EPAs provide another way for us to ensure practice readiness in our graduates, in addition to traditional standardized knowledge exams such as NAPLEX and MPJE.

How do I assess EPAs?

Each of the 15 EPAs is connected with a set of supporting tasks that the preceptor should keep in mind when assessing the EPA. For example, for the EPA “Implement a care plan in collaboration with the patient, caregivers, and other health professionals”, a supporting task is Educate a patient regarding the appropriate use of a new medication, device to administer a medication, or self-monitoring test. For a summary of the EPAs and examples of supporting tasks which can be used when evaluating each EPA, please click here.

EPAs are assessed on the level at which the preceptor “trusts” a student to perform the EPA (i.e., what is the level of entrustability?). There are five levels of entrustability (see below). When evaluating the EPA, the preceptor should think “I trust the student to….”

Level 1 – Observe the activity only

Level 2 – Act with direct supervision present in the room

Level 3 – Act with supervision available within minutes

Level 4 – Act with intermittent supervision available within hours

Level 5 – Act independently to decide what activities to perform; direct and supervise activities of others

For instance, in the example provided above, the preceptor might ask themselves, “How much do I trust the student to educate a patient on the appropriate use of a new medication?  Do I trust them to educate only if I am right there watching them (level 2), or do I trust them to educate when I am down the hall and can be called in for any questions (level 3)?” Students who are earlier in rotations or in very complex patient care environments may only achieve a level 1 or level 2 for some EPAs, and that is perfectly acceptable.

What level should students achieve for each EPA?

Remember that EPAs outline baseline minimum expectations for practice. Therefore, each graduate should be able to achieve each EPA at a level 3 (i.e., without direct supervision) upon entering practice. Level 5 should be assigned rarely – this level of performance is more appropriate for a higher level learner such as a PGY-1 or PGY-2 resident.

Do EPAs affect the student’s grade?

EPAs do not affect the rotation grade. They are a way for you to give honest feedback on how well the student is able to perform basic pharmacist functions and suggest strategies to achieve greater independence as they move toward entry into the profession.

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APPE Required Activities and Portfolio

 “How do I know what my students are required to do on rotation?” With so many moving parts it can be challenging to know what is required of students, why, and how best to comply.

What is required?

The University of Florida College of Pharmacy has required activities that are mapped to ACPE accreditation standard requirements. Each rotation type has its own set of required activities. These can be found in the syllabus templates used by the college of pharmacy. Preceptors must provide opportunities for students to complete these activities and they may require additional activities if desired.

Why is it required?

ACPE accreditation standards require that the college show evidence that they are providing experiences which enable students to meet required standards. In addition, the college has to provide evidence that these standards have been achieved.

How does the college provide evidence of standard achievement?

The college documents evidence of achievement in a variety of ways. One of the ways is through a student portfolio. This is a set of evidences submitted, by the students, to PharmAcademic which highlights their best work in some key experiential areas.

What is in the portfolio and what do I have to do?

The portfolio contains 16 examples representing 6 types of activities required across the 6 rotation types. (4 Pharmacy Notes, 2 Literature Evaluations, 4 Drug Information Questions, 1 Drug Utilization Review, 4 Formal Presentations, and 1 Project Evidence). You, as a preceptor, only need to provide the opportunity to complete the activity, if required by your rotation type. It is the student’s responsibility to submit the evidences and the college checks and verifies the submissions.

How do I comply?

The best way to comply is to provide students with the opportunities to complete the required activities. A full list of required activities is available in the syllabus template for your rotation type. If you need an updated syllabus template, please reach out to your regional coordinator. They can assist you with updating your syllabus. If you do not feel you can provide one of the experiences, reach out to your regional coordinator as well. In almost all cases we have been able to work with the site to identify a process to meet the requirements.

We recently held preceptor forums regarding portfolios. If you were unable to attend and would like more information click Here to go to the forum archives and review the material.

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Student Honors Projects

Honors Projects - University of Florida College of Pharmacy students have the opportunities to complete research or non-research projects while a student in the program. GPA permitting, these projects may qualify the student to graduate with honors. There are specific requirements and some do’s and don’ts. Because it is not uncommon for students to work with preceptors on these projects, we recently conducted preceptor forums to explain the process and answer questions you may have.  Additional information on honors requirements can be found at https://curriculum.pharmacy.ufl.edu/curriculum-courses/pharmd-research/academic-honors/ For more information on the regulatory requirements associated with honors research projects go to https://ssc.pharmacy.ufl.edu/regulatory-compliance/

If you were not able to attend the preceptor forums, the slides and a Q&A sheet can be accessed at https://oep.pharmacy.ufl.edu/preceptor-resources/preceptor-orientation-development/preceptor-town-hall-sessions/

We will be working on a new preceptor forum series. If there is something with regard to the college or working with our students that you would like to know more about, please share your ideas with Carinda Feild (cfeild@cop.ufl.edu). 

Look for more information to come regarding our future forums.

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Congratulations to our 2018-2019 outstanding UF preceptors!

New Inpatient Preceptor of the Year - James Morales, Pharm.D., of UF Health Jacksonville

New Outpatient Preceptor of the Year - Kyle Thorner, Pharm.D., of Advent Health Orlando

Inpatient preceptor of the Year- Christine Corsberg, Pharm.D. of North Florida Regional Medical Center

Outpatient Preceptor of the Year - Roger Accardi, Pharm.D., of Accardi Clinical Pharmacy

Distinguished Inpatient Preceptor of the Year - Ben Bato, Pharm.D., of UF Health Jacksonville

Distinguished Outpatient Preceptor of the Year - Mark Percifield, Pharm.D., of Walgreens Pharmacy

Click Here for more details and pictures of our award-winning preceptors. 

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Continuing Education Updates

The Collaborative Education Institute (CEI) - Preceptors for the University of Florida are eligible for free continuing education and resources from the CEI. For access to the offerings, you will need to contact your regional coordinator for a pass code. There are updated codes for 2019 so be sure to reach out for the new information. Then click here to access the CE offerings. Please note that the CEI site contains a section specifically with content related to precepting. Other resources available via the link are journal clubs, and other general CE subject areas.

Regional Coordinator Programs-The office of experiential programs is currently offering 1 hour of live CE for our program entitled "the ABCs of EPAs for Preceptors". If you are interested in this program for your site, please contact your regional coordinator.

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News Flash!

As a benefit to our preceptors we are pleased to be able to provide The Pharmacist's Letter. Preceptors will be able to access this publication from our experiential website in the coming days. Be on the look out for this new benefit. Click Here to access our preceptor benefits.

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Mark Your Calendar

July 1 – APPE Rotation 1 Final Grades Due

July 12 - FPA Gator reception 5:30 - 7:00 Marriot harbor Beach Resort  - Salon A -  Click Here to RSVP

July 15 - CIPPE / HIPPE Rotation 2 Final Grades Due

August 2 - FSHP Gator Reception 6:00 - 7:30 Hilton Orlando Bonnet Creek  - Click Here to RSVP

August 12 – APPE Rotation 2 / CIPPE & HIPPE Rotations 3/3a Final Grades Due

August 16  - HIPPE  Rotation 3b Final Grades Due (note this is the last day of the rotation)