1 Tracy S. Hunter, RPh, MS, PhD Assistant Dean, Experiential - - PDF document

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Tracy S. Hunter, RPh, MS, PhD

Assistant Dean, Experiential Education UNM College of Pharmacy October 2016

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I do NOT have, nor does my family have, financial interests to disclose.

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Organization of Discussion

Vision External Forces S trategies

3 Vision 4

Prepare UNM S tudent Pharmacists to be Leaders in Pharmacy Practice Today & Tomorrow

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Vision 5

Design experiences that benefit both the preceptor and student pharmacist.

Organization of Discussion

Vision External Forces S trategies

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Converging Forces

Health Care Environment Health Care Environment ACPE 2016 Standards ACPE 2016 Standards ASHP Residency Standards ASHP Residency Standards NAPLEX Blueprint NAPLEX Blueprint EPAs EPAs

7 Changes in Health Care Environment

Expanding role of Pharmacists on Health Care Team Expanding role of Pharmacists on Health Care Team Reimbursement Changes Reimbursement Changes Patient expectations & access to information Patient expectations & access to information Aging of the population Aging of the population Bottom line Bottom line

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Changes in Health Care Environment

Expanding role of Pharmacists on Health Care Team Expanding role of Pharmacists on Health Care Team Reimbursement Changes Reimbursement Changes Patient expectations & access to information Patient expectations & access to information Aging of the population Aging of the population All doing more with less All doing more with less

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Forces on Education: ACPE Outcomes: 2016

The curriculum prepares all students to provide entry-level, patient-centered care in a variety of practice settings as a contributing member of an interprofessional team. Team exposure includes prescribers as well as

• ther healthcare professionals.

The curriculum prepares all students to provide entry-level, patient-centered care in a variety of practice settings as a contributing member of an interprofessional team. Team exposure includes prescribers as well as

• ther healthcare professionals.

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The ACPE Outcomes: 2016

• Provide direct patient care in a

variety of healthcare settings

Practice- ready Practice- ready

• Contribute as a member of an

interprofessional collaborative patient care team

Team-ready Team-ready

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Focus on Experiential learning

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Doing is primary focus Knowing

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IPPEs: Pre-Advanced Pharmacy Experience Curriculum

Prepares for APPE Prepares for APPE IPPE exposure to contemporary practice models: IPPE exposure to contemporary practice models:

• Interprofessional shared patient care decision making
• Professional ethics
• Expected behaviors
• Intentionally structured sequenced “ …

purposely integrated into didactic curriculum”

13 IPPEs: Pre-Advanced Pharmacy Experience Curriculum

P1: Community in S ummer P1: Community in S ummer P2: Institutional in S ummer P2: Institutional in S ummer

P3: Concurrent Transitions of Care 2016 P3: Concurrent Transitions of Care 2016

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New Postgraduate Y ear One (PGY1) Residency Accreditation S tandards 15

• Purpose of revision:
• Align standards to current pharmacy practice trends
• Global changes:

Design and Conduct of the Residency Program

• NEW statement: 3.3.a.(6)
• “ Residents must spend two thirds or more of the

program in direct patient care activities”

• NEW preceptor qualifications (“ 6 of 6” vs. “ 4 of 7” )
• NEW designation of “ Preceptors-in-Training”

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NAPLEX Blueprint: 2 Areas

Ensure S afe & Effective Pharmacotherapy & Outcomes Ensure S afe & Effective Pharmacotherapy & Outcomes S afe & Accurate Preparation, Compounding, Dispensing, & Admin of Meds & Provision of Health Care Products S afe & Accurate Preparation, Compounding, Dispensing, & Admin of Meds & Provision of Health Care Products

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http:/ / www.nabp.net/ programs/ examination/ naplex/ naplex-blueprint

NAPLEX Blueprint 18

:Ensure Safe & Effective Pharmacotherapy & Outcomes

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NAPLEX Exam November 2016 19

• Increase in length for clinical cases
• 185 to 250 items
• 4.25 to 6 hours time

Which of the following most closely matches your knowledge of EP As?

• I am Well-versed about what EPAs are & how to

use them?

• I have some understanding of what EPAs are

and & how to use

• I have very minimal understanding of what EPAs

are or how to use them

• This is my first time learning about EPAs

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What are EP As?

• Entrustable Professional Activities
• EP

As -- units of practice or descriptors of work.

• Defined as specific task or responsibilities that

trainees are “ trusted” to perform with direct supervision

• Independently executable, observable &

measurable in their process & outcome

21 What are EP As?

• EP

As for New Pharmacy Graduates

• discreet,
• essential activities & tasks
• that ALL new graduates Must be able to

perform without direct supervision upon entering practice or graduation. 22

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Entrustable Professional Activities

• Patient Care Provider Domain

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• Population Health Promoter Domain

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• Information Master Domain

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• Practice Manager Domain

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• S

elf-Developer Domain

5 23 EP A Example: Patient Care Provider Domain

Collect information to identify a patient’s medication related problem Collect information to identify a patient’s medication related problem

Analyze info. to determine effects of med therapy, identify med- related problems, & prioritize health- related needs. Analyze info. to determine effects of med therapy, identify med- related problems, & prioritize health- related needs. Establish patient- centered goals, create a plan for a patient with patient, caregiver(s), &

• ther hps that

is evidence- based & cost- effective. Establish patient- centered goals, create a plan for a patient with patient, caregiver(s), &

• ther hps that

is evidence- based & cost- effective. Implement care plan in collaboration with the patient, caregivers, &

• ther health

professionals Implement care plan in collaboration with the patient, caregivers, &

• ther health

professionals

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Converging Forces

Health Care Environment Health Care Environment ACPE 2016 Standards ACPE 2016 Standards ASHP Residency Standards ASHP Residency Standards NABPLEX Blueprint NABPLEX Blueprint EPAs EPAs

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Vision External Forces S trategies

Organization of Discussion 26

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Qualified Preceptors

Demonstrate expertise Demonstrate expertise Enthusiastic for Teaching Enthusiastic for Teaching S trong communication skills S trong communication skills Willingness to provide feedback Willingness to provide feedback Willingness to receive feedback Willingness to receive feedback

27 How many Preceptor roles & Responsibilities can you name? 28

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Preceptor Roles & Responsibilities

Teacher/ educator Teacher/ educator S killed Communicator S killed Communicator Facilitator -- Motivator Facilitator -- Motivator S

• cializer

S

• cializer

Role Model Role Model Expert patient care provider Expert patient care provider

29 Teacher educator roles Assessor Assessor Planner Planner Implementer Implementer Evaluator Evaluator 30

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Assessor Role

Determine current level Determine current level Determine Learning needs Determine Learning needs Assess early: EDOC Assess early: EDOC Listen Listen 31 Assessment Activities

Diagnose S tudent deficits and strengths Diagnose S tudent deficits and strengths Determine what works well or not for you Determine what works well or not for you Develop & implement a assessment system for competency development over the experiences Develop & implement a assessment system for competency development over the experiences Chart student progress Chart student progress

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Planner: Preventative Care

Design Orientation Design Orientation S elect learning activities S elect learning activities Create learning contract Create learning contract 33

Vision External Forces S trategies

Organization of Discussion 34

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Concrete S teps: The preceptor’s role & tasks

S etting suitable experiences S etting suitable experiences Posing problems to solve Posing problems to solve S etting boundaries S etting boundaries S upporting learners S upporting learners Insuring physical & emotional safety Insuring physical & emotional safety Facilitating the learning process Facilitating the learning process

Gass MA, Gillis HL, Russell KC (2012)

35 The preceptor’s role & tasks

S triving to be aware of our: S triving to be aware of our: Biases Biases Judgments Judgments Pre-conceptions & Pre-conceptions & How these influence the learner. How these influence the learner.

Gass MA, Gillis HL, Russell KC (2012)

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The preceptor’s role & tasks

Recognize & encourage spontaneous opportunities for learning Recognize & encourage spontaneous opportunities for learning Design of experience to include the possibility to learn from natural consequences, mistakes & successes Design of experience to include the possibility to learn from natural consequences, mistakes & successes

Gass MA, Gillis HL, Russell K.C (2012)

37 Concrete Tasks: Preceptor development

Increase sense of worth & confidence Increase sense of worth & confidence Competent in at least one model Competent in at least one model Common models include Common models include

• The one-minute preceptor
• Pimping

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S teps to Making Precepting a j oy

The Teachable

moment

The Teachable

moment 1-minute Preceptor 1-minute Preceptor S NAPPS S NAPPS Aunt Minnie Aunt Minnie 2-minute Observation 2-minute Observation Activated

Demonstration

Activated

Demonstration S ee One, Do One, Teach One S ee One, Do One, Teach One

Teaching

S cripts

Teaching

S cripts

Ask-tell ask Ask-tell ask “ Pimping” “ Pimping”

39 One Minute Preceptor

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The One Minute Preceptor

• https:/ / www.youtube.com/ watch?

v=hmKvei3thwQ

41 How would you apply this in your practice?

• JS

, a 48 yo woman with a history of T2D, obesity, HPT , & migraine headaches is admitted for S yncope work up. Her recent A1c is 7.4% .

• S

he was diagnosed with microalbuminuria (1945mg/ dl) [Jan. 2015].

• Last 3 reading: BP 154/ 86 mmHG pulse 78bpm
• Med list: Metformin 1000 BID
• Glyburide 10 mg BID
• Lisinopril 20 QD
• Ibuprofen 200mg prn

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SNAPPS

• S Summarize the client history & current status
• N Narrow the hypotheses to 2-3 relevant possibilities
• A Analyze the issues by comparing & contrasting possible

hypotheses

• P Probe preceptor -- ask questions about uncertainties, difficulties
• r alternative approaches
• P Plan intervention approach
• S S

elect a case-related issue for self-directed learning

43 S NAPPS : Learner-Centered Model

• Facilitates active learning conversation
• Research proven
• S

hared responsibility

• Described as “ cognitive dance”
• Learner initiates – not passive
• Focus on “ Learnable Moments”
• S

tudent probes preceptor for relevant information

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Pimping: Rounding with the Team

“ Rounded with Osler today. Riddles house officers with questions. Like a Gatling gun. Welch says students call it ‘ pimping.’ Delightful.” Abraham Flexner “ Rounded with Osler today. Riddles house officers with questions. Like a Gatling gun. Welch says students call it ‘ pimping.’ Delightful.” Abraham Flexner

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Rounding with the Team

“ I must say that pimping accomplished only four things for me: “ I must say that pimping accomplished only four things for me: establishment of a pecking order among the medical staff; establishment of a pecking order among the medical staff; suppression of any honest and spontaneous intellectual question or pursuit; suppression of any honest and spontaneous intellectual question or pursuit; creation of an atmosphere of hostility and anger; & creation of an atmosphere of hostility and anger; & perpetuation of the dehumanization for which medical education has been criticized.” perpetuation of the dehumanization for which medical education has been criticized.”

S tanton C. LetterJAMA 262(1989):2541-2 [pubmed]

47 Practice Reflection

What key ideas did you encounter that build on, or conflict with your practice? What key ideas did you encounter that build on, or conflict with your practice? What ideas do you commit to implementing? What ideas do you commit to implementing? What connections with others can you develop to help you accountable to change? What connections with others can you develop to help you accountable to change?

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Key Takeaways

What are your key Takeaways? What are your key Takeaways?

49 Key Takeaways

Prepare early Prepare early S et expectations early S et expectations early Assess early Assess early Give feedback early & often Give feedback early & often Evaluate and document Evaluate and document Find techniques that works for you Find techniques that works for you

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Making Pr Making Prece ecepting a jo ting a joy

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TSHunter@salud.unm.edu

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Green GM, Chen EH. Top 10 ideas to improve your bedside teaching in a busy emergency

• department. EMJ 2015;32(1):76-77.

Gass MA, Gillis HL, Russell KC (2012). Adventure therapy: Theory, Research, and Practice. New York, NY: Routledge. http://www.aee.org/what-is-ee Cunningham AS. Blatt SD, Fuller PG. Weinberger HL. The Art of Precepting. Socrates or Aunt Minnie. Arch Pediatr Adolesc Med. 153. Feb 1999 O’Neil TO, Aust MP. HealthStream Onboarding Series: Essential Best Practices in Preceptor Training. A White Paper accessed 08.20.2016 at: www.healthstream.com Lindsey ED, etal . Constructive ways to prevent, identify,, & remediate deficiencies of “challenging trainees” in experiential education. AM J Health-Syst Pharm. 2016;73(13):9961009.

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Obj ectives

Identify best practices and approaches to your clinical teaching environment -- One Minute Preceptor model Identify best practices and approaches to your clinical teaching environment -- One Minute Preceptor model Articulate learning expectations – EP As and ACPE S tandards -- in clinical teaching Articulate learning expectations – EP As and ACPE S tandards -- in clinical teaching Define significance of Entrustable Professional Activities (EP A) Define significance of Entrustable Professional Activities (EP A) Discuss ways to implement 1 Minute Preceptor model Discuss ways to implement 1 Minute Preceptor model Constructively address ways to prevent, identify, & address KS A issues in experiential education Constructively address ways to prevent, identify, & address KS A issues in experiential education

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At the end of this presentation, pharmacists will be able to:

Obj ectives for Technicians

Explain the benefits of a Pr66872ecepting program to your career and your place of practice Explain the benefits of a Pr66872ecepting program to your career and your place of practice Define Entrustable Professional Activities (EP A) Define Entrustable Professional Activities (EP A) List the process of One Minute Preceptor model List the process of One Minute Preceptor model

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At the end of this presentation, technicians will be able to: