AACP Academic Affairs Committee. Stakeholder Feedback DRAFT Entrustable Professional Activities (EPAs) for New Pharmacy Graduates

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1 AACP Academic Affairs Committee Stakeholder Feedback DRAFT ntrustable Professional Activities (PAs) for New Pharmacy Graduates In 2013, the Center for the Advancement of Pharmacy ducation (CAP) panel generated a list of outcome statements (competencies) 1 which are now included as Standards 1-4 in the Accreditation Council for Pharmacy ducation (ACP) accreditation standards 2 (effective Fall 2016). These statements articulate the general abilities needed by all pharmacists at the completion of the Doctor of Pharmacy degree and describes the qualities required to be a competent pharmacy practitioner. Competencies integrate multiple components such as knowledge, skills, values, and attitudes. The CAP outcome statements guide educational institutions but may be too theoretical to guide training and assessment activities in daily practice. ntrustable professional activities (PAs) are intended to translate competency statements to practice. 3 Trust is a central concept in healthcare delivery. Patients and healthcare providers must trust pharmacists to perform a number of essential tasks to ensure the safe and effective use of medications. During advanced pharmacy practice experiences and following licensure, preceptors and supervisors decide when and what tasks they entrust trainees and new practitioners to assume. Building on this concept, PAs are units of professional practice, specific tasks or responsibilities, to be entrusted to the unsupervised execution by a trainee or pharmacist once she or he has sufficient competence. PAs are independently executable, observable, and measurable in both process and outcome. 4 PAs are not an alternative for competencies, but a means to translate competencies into practice. 3 Competencies are descriptors of pharmacists; PAs are descriptors of work. PAs usually require multiple competencies employed in an integrative, holistic nature. Thus, PAs often require proficiency in several competency domains. The AACP Academic Affairs Committee was charged by AACP President Cynthia Boyle to identify the PAs for pharmacy graduates as they transition from completion of the Doctor of Pharmacy degree into practice and post-graduate opportunities such as residency training. Attached are a series of DRAFT entrustable professional activity (PA) statements that the AACP Academic Affairs Committee believes all pharmacy graduates should be able to perform at the time of licensure, either without supervision or with reactive supervision. The level to which trainees can be entrusted to perform PA tasks develops over time and should be based on the depth and maturity of each trainee s knowledge, skills, and attitudes. Trainees who have very limited knowledge and lack experience should first observe exemplary performances before attempting PA tasks. As their knowledge and skills evolve, trainees can then be entrusted to perform these tasks under direct observation with immediate, face-to-face supervision. With feedback and additional practice, trainees should be able to move from direct

2 supervision to indirect supervision. In this document, we refer to this level of performance as pre-entrustable where only reactive supervision is needed from a supervisor in close proximity. The Committee believes that all tasks outlined in this document should no longer require direct supervision at the time of graduation. PA tasks that the Committee believes should be fully entrustable without supervision under most conditions at the time of graduation are designated ( = entrustable) in the attached tables. Those tasks/activities that will likely require reactive supervision with a knowledgeable and experienced supervisor in close proximity have been designated P (P = pre-entrustable). While they should be knowledgeable and have some experience performing P tasks, recent graduates are unlikely to have mastered them. The Committee also believes that recent graduates should be entrusted to perform some tasks under relatively straightforward conditions that are commonly encountered in practice. However, in more complicated patient populations or practice environments, these same tasks would require indirect and perhaps even direct supervision. These tasks have been labeled + P, signifying our belief that recent graduates should have sufficient knowledge and experience to perform these tasks without supervision under conditions of low complexity (see Figure 1). Only with additional experience, supervised practice, and training should pharmacists be entrusted to perform + P tasks under more complex conditions. The AACP Academic Affairs Committee is seeking feedback from a variety of stakeholders regarding the PA task statements, the conditions under which these activities would be performed, and the level of performance ( vs. P vs +P ) that should be expected at the time of graduation. Please submit written comments to the AACP Academic Affairs Standing Committee using the following link: by March 15, References 1. Medina MS, Plaza CM, Stowe CD, et al. Center for the Advancement of Pharmacy ducation (CAP) ducational Outcomes Am J Pharm duc. 2013; 77(8): Article Accreditation Standards and Key lements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree ( Standards 2016 ). Chicago, IL: Accreditation Council for Pharmacy ducation, Ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med duc 2013; 5(1): Core ntrustable Professional Activities for ntering ntering Residency: Faculty and Learners Guide. Washington, DC: Association of American Medical Colleges, 2014.

3 1. When a specific tool or technique (e.g., motivational interviewing) is proposed in an PA statement, is the tool or technique commonly used and relevant in most practice settings? Are there additional tools or techniques that should be specifically mentioned in these statements? 2. Is there pharmacy-specific jargon that should be clarified or defined in a glossary? xamples might include adherence and drug use behaviors. Are there others? 3. Are there any style considerations (using the term drug versus medication)? Is there prefered terminology? Are there specific words or phrases that should be used or avoided? 4. Figure: PA Development with Training and xperience. Are specific examples needed with regard to what comprises a low complexity patient versus high complexity patient AND a low complexity environment versus a high complexity environment? Or is the figure self-explanatory and sufficient as is? 5. Are the PA role descriptors appropriate? Are they the most effective ways to describe the role aligned with the task statements underneath? 6. From your perspective, are there any tasks that are missing from the PA statements that every pharmacy graduate should be able to do? Are there any statements that should not be included? 7. Taken as a whole, do these statements represent what pharmacists do?

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5 Consider the task statements below. Should we trust a new pharmacy graduate at the time of licensure to perform these tasks? Patient Care Provider Draft PA Statements Use health records to determine a patient s health-related needs relevant to setting of care and the purpose of the encounter. Collect a medical history from a patient, family member or caregiver. Collect a medication history from a patient, family member or caregiver. Determine a patient s medication adherence and other medication use behaviors. Assess a patient s signs and symptoms to determine whether the patient can be treated within the scope of practice or requires a referral. Measure an adult patient s vital signs and interpret the results (eg, body temperature, pulse rate, respiration rate, and blood pressure). Perform a comprehensive medication review (CMR) for a patient. Reconcile a patient s medication list and communicate discrepancies to stakeholders involved in the patient s care. Compile a prioritized health-related problem list for a patient stablish patient-centered goals and then create and implement a therapeutic plan for a patient. valuate an existing drug therapy regimen and modify/adjust plan based on patient response. Follow an evidence-based disease management protocol Refer a patient, when needed, to other healthcare providers who can best meet the patient s needs. Create and implement a patient specific education plan Assess a patient s health literacy using a validated screening tool. ducate a patient on a new medication. ducate a patient on the use of medication adherence aids. Develop a self-care treatment plan with a patient. ducate a patient on a self-care product. Assist a patient with behavior change (eg, motivational interviewing strategies). Write a note that documents the findings and recommendations from a patient encounter. * = ntrustable (Unsupervised execution; supervision at a distance and/or post hoc) + P + P + P + P + P + P

6 * P = Pre-entrustable task under all conditions (Indirect supervision; execution of task with supervision close by or reactive supervision (i.e. on * + P = may be either entrustable or pre-entrustable but depends on the conditions From your perspective, are there any tasks that are missing from the Patient Care Provider PA statements that every graduate should be able to do? Are there any statements that should not be included? As a whole, do these represent what pharmacist do in the role of a Patient Care Provider?

7 Consider the task statements below. Should we trust a new pharmacy graduate at the time of licensure to perform these tasks? Inter-Professional Team Member PA Statements Facilitate a team (group) discussion to develop a shared plan of action Communicate a patient s medication-related problem(s) to another health professional Communicate a patient case to a colleague to ensure an effective handoff or during a transition of care xplain the pharmacist s role/responsibilities to health professional colleagues and patients. * = ntrustable (Unsupervised execution; supervision at a distance and/or post hoc) P + P * P = Pre-entrustable task under all conditions (Indirect supervision; execution of task with supervision close by or reactive supervision (i.e. on * + P = may be either entrustable or pre-entrustable but depends on the conditions From your perspective, are there any tasks that are missing from the Inter-Professional Team Member PA statements that every graduate should be able to do? Are there any statements that should not be included? As a whole, do these represent what pharmacist do in the role of an Inter-Professional Team Member?

8 Consider the task statements below. Should we trust a new pharmacy graduate at the time of licensure to perform these tasks? Population Health/Care Provider Draft PA Statements Perform a screening assessment to identify patients at risk for highly prevalent diseases in a population (e.g. hypertension, diabetes, depression) Report adverse drug events and medication errors to stakeholders. Perform a medication use evaluation Determine whether a patient is eligible for and has received CDC recommended immunizations. Administer and document CDC recommended immunizations to an adult patient Perform basic life support during a simulated medical emergency. * = ntrustable (Unsupervised execution; supervision at a distance and/or post hoc) P * P = Pre-entrustable task under all conditions (Indirect supervision; execution of task with supervision close by or reactive supervision (i.e. on * + P = may be either entrustable or pre-entrustable but depends on the conditions From your perspective, are there any tasks that are missing from the Population Health/Care Provider PA statements that every graduate should be able to do? Are there any statements that should not be included? As a whole, do these represent what pharmacist do in the role of a Population Health/Care Provider?

9 Consider the task statements below. Should we trust a new pharmacy graduate at the time of licensure to perform these tasks? Practice Manager Draft PA Statements Oversee the pharmacy operations for an assigned work shift Fulfill a medication order. nter patient-specific information into an electronic health or pharmacy record system Prepare commonly prescribed medications that require basic sterile compounding (eg, [give examples]) or basic non-sterile compounding (eg, [give examples]) prior to patient use. Determine if a medication is contraindicated for a patient. Identify and manage drug interactions. Determine the acquisition cost and patient co-pay or price for a prescription. Obtain authorization for a non-preferred medication. Assist a patient to acquire medication(s) through support programs * = ntrustable (Unsupervised execution; supervision at a distance and/or post hoc) P * P = Pre-entrustable task under all conditions (Indirect supervision; execution of task with supervision close by or reactive supervision (i.e. on * + P = may be either entrustable or pre-entrustable but depends on the conditions What are the essential drugs or products that every graduate should be able to compound? What are the graduation expectations regarding compounding? From your perspective, are there any tasks that are missing from the Practice Manager PA statements that every graduate should be able to do? Are there any statements that should not be included? As a whole, do these represent what pharmacist do in the role of a Practice Manager?

10 Consider the task statements below. Should we trust a new pharmacy graduate at the time of licensure to perform these tasks? Information Master Draft PA Statements Lead a discussion regarding a recently published research manuscript and its application to patient care Develop and deliver a brief (less than 1 hour) educational program regarding medication therapy to a health professional audience Retrieve and analyze scientific literature to make a patient-specific recommendation. Answer a drug information request from a healthcare professional or patient Retrieve and analyze scientific literature to answer a drug information question. * = ntrustable (Unsupervised execution; supervision at a distance and/or post hoc) + P + P + P + P * P = Pre-entrustable task under all conditions (Indirect supervision; execution of task with supervision close by or reactive supervision (i.e. on * + P = may be either entrustable or pre-entrustable but depends on the conditions From your perspective, are there any tasks that are missing from the Information Master PA statements that every graduate should be able to do? Are there any statements that should not be included? As a whole, do these represent what pharmacist do in the role of an Information Master?

11 Consider the task statement below. Should we trust a new pharmacy graduate at the time of licensure to perform this task? Self-Developer Draft PA Statements Create a written plan for continuous professional development * = ntrustable (Unsupervised execution; supervision at a distance and/or post hoc) P * P = Pre-entrustable task under all conditions (Indirect supervision; execution of task with supervision close by or reactive supervision (i.e. on * + P = may be either entrustable or pre-entrustable but depends on the conditions From your perspective, are there any tasks that are missing from the Self-Developer PA statements that every graduate should be able to do? Are there any statements that should not be included? As a whole, do these represent what pharmacist do in the role of a Self-Developer?