Jean M Scholtz, PharmD, BCPS, FASHP Philadelphia College of Pharmacy/USciences October 30, 2015 j.scholtz@usciences.edu Learning Objectives Recognize individuals who were instrumental in building our current pharmacy foundation. Review the transition from dispensing to direct patient care. Describe changes in pharmacy education and practice in the last 40 years. Discuss future opportunities and direction for pharmacy students, pharmacy technicians, and pharmacists. Hospital Pharmacy in the 60 s Main focus manufacturing and dispensing 1963 - one of the first certificates of accreditation for a pharmacy residency program issued to Bronson Methodist Hospital 1965 - creation of Medicare 1966 ASHP had their 2 nd Special Conference on Hospital Residency Training in Columbus, Ohio Paul Parker reported that many wanted to offer a hospital pharmacy residency but not all were qualified 1968 - Congress extended the Health Manpower Act Capitation grants to colleges of pharmacy Goal was to increase in education in clinical pharmacy, drug use and abuse, and clinical pharmacology 1
Flack s Goals for Hospital Pharmacists Active ASHP members should act as an individual recruiting service Establishment of a formal standard to provide a Hospital Pharmacy Orientation to pharmacy students Revision of Minimum Standard for Pharmacy Internship in Hospitals Specialists in hospital pharmacy should obtain a six-year degree Pharmacy & Therapeutics Committee should represent all services Operation of a hospital formulary system Establishment of minimal standards for each affiliated chapters of ASHP Creation of ASHP Fellows Herbert L. Flack, 1961 2
Commitment and Involvement By teaching students about drugs in real life, i.e., in the hospital, schools of pharmacy will educate every student so that he will be able to practice in any environment he chooses. This means that all schools will have a clinical facility as a laboratory and a clinical faculty composed primarily of experienced hospital pharmacists. The professional doctor of pharmacy degree will be standard for those who plan to become practitioners. As pharmacy continues to shift emphasis to the patient as well as the product and as the body of knowledge of the physician becomes increasingly specialized, the pharmacist will be accepted as the drug expert on the health team and he will exert a profound influence on the prescribing of drugs, particularly in hospitals. Hospital Pharmacy in the 70 s 1970 ASHP Accreditation Standard for Pharmacy Residency Revised and approved Requirement for clinical services in patient care areas 84 programs accredited by 1976 Pharmacist participation with physicians in making therapeutic decisions Paul Parker residency training to acquire knowledge and practice skills Expansion of pharmacy services Unit-dose packaging Patient profiles (cardexes) Poison information centers 3
Sister Gonzales Key Points Pharmacists are overeducated to do count and pour jobs Evolution of pharmacist -in-the patient-care areas Patient-pharmacist relationship Patient interviews Discharge interviews Frightening things emerge when the patient tells all to the pharmacist Interim visits with the patient allow us the opportunity to assess response Patient feels this hospital is concerned about me 4
Sister Mary Gonzales Duffy, RSM (1909 85) Hospital Pharmacy in the 80 s Satellite pharmacies Specialization Drug information Pharmacokinetic services Nutrition consults Oncology pharmacy ASHP s Hilton Head Invitational conference in 1985 to assess progress of hospital pharmacy in implementing clinical pharmacy Clinical pharmacy should not be thought of as something separate from pharmacy practice as a whole 5
Leadership in a Clinical Profession Residency programs and the accreditation process have been key in bringing about change in hospital pharmacy Primary value is to supply the profession with mature, highly skilled clinical and managerial practitioners ASHP must foster the advancement of specialty practice and encourage the development of training programs Explore ideas for the necessary education and experiential training that we are going to need as we grow and mature as a clinical profession Hospital Pharmacy in the 90 s Continued expansion of clinical services Pharmacy-board certification Increased number of residencies Computerization Automation Medication safety One degree for pharmacists Doctor of Pharmacy degree 6
Hospital Pharmacy in the 90 s 7
Prescription for Safety in Health Care Accountability for error prevention Equally shared among all health care stakeholders Root-cause analysis Embrace a culture of safety Required CQI activities USP ISMP Medication Error Reporting Program reveal that medication-related problems are repetitive in nature Harvey A. K. Whitney Lecture Permission Granted Daniel M. Ashby 2011 Ashby s Key Points Pharmacists should spend the majority of their time in direct patient care for all patients Pharmacy department practice model should be comprehensive assurance of the competency of each provider Licensed pharmacy technicians should perform drug distribution activities Technology is needed to support a safe, effective, and efficient medication use system Activities for pharmacy students and pharmacy residents should support the educational goals for both groups though their active involvement in the care of patients Team-based practice models with specialist and generalist pharmacists, pharmacy residents, pharmacy students, and pharmacy technicians are required to achieve desired outcomes 8
Ashby s Key Points Groundwork for future success Redesign of the pharmacy residency model Competence and quality of the pharmacist work force Role of students and the need to make students indispensable Daniel M. Ashby, June 14, 2011, Harvey A.K. Whitney Lecture Award What was Sister Gonzales Duffy's key point in her Harvey AK Whitney lecture? A) Pharmacists are educated to do count and pour jobs B) Frightening things emerge when the patient tells all to the pharmacist C) Interim visits with the patient allow us the opportunity to assess patient response D) B and C E) All of the above Whose Harvey AK Whitney lecture focused on the role of students and making students indispensable? A) Herbert L. Flack B) Joseph A. Oddis C) Joe E. Smith D) Daniel M. Ashby 9
10
11
Management Learning Systems 12
13
STUDENTS AT DIFFERENT LEVELS CONCRETE EXPERIENCE What if? Why? ACTIVE EXPERIMENTATION TYPE 4 ACCOMMODATORS e.g., Education TYPE 3 CONVERGERS e.g., Engineering TYPE 1 DIVERGERS e.g., Social Science, Humanities TYPE 2 ASSIMILATORS e.g., Physical Sciences REFLECTIVE OBSERVATION How? What? ABSTRACT CONCEPTUALIZATION Learning Styles and Learning Cycle Based on Kolb s Model 14
ACCOMMODATORS What if? Faculty as Evaluator/Remediator FACTS & DATA DIVERGERS Why? Faculty as Motivator DOING Open ended problems Student presentations Design projects Subjective exams Simulations CONVERGERS How? Faculty as Coach Motivational stories Group discussion Group projects Subjective tests Field trips ASSIMILATORS What? Faculty as Expert WATCHING Homework problems Computer simulations Field trips Individuals reports Demonstrations Lectures Textbook reading Demonstrations by instructor Independent research Objective exams SYMBOLS Sample Activities and Role of Faculty for Each Kolb Learning Style Style Characteristics Classroom preferences Competitive Compete with other students Teacher-centered, class activities Collaborative Share ideas with others Student-led small groups Avoidant Uninterested, non-participant Anonymous environment Participant Eager to participate Lectures with discussion Dependent Seek authority figure Clear instructions, little ambiguity Independent Think for themselves Independent study and projects Characteristics of Grasha-Riechmann Learning Styles 15
Mobile Response Devices Teacher Learner Outcome Curriculum materials Teaching methods Assessment methods Learning experiences Knowledge Skills Attitudes Best practices with patients Improved patient outcome Clinical settings 16
NEW ACCREDITATION STANDARDS Standards become effective July 1, 2016 and will be utilized in accreditation reviews beginning in the Fall of 2016. https://www.acpe-accredit.org/deans/standardsrevision.asp Changes in the ACPE Standards Institute of Medicine (IOM) Report (www.iom.edu) noting needed changes in our healthcare system to improve medication safety and patient outcomes, including the five competencies that all healthcare professionals should attain during their education: Provide patient-centered care Work in interprofessional teams Employ evidence-based practice Apply quality improvement Utilize informatics Revision of the AACP s Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes in 2013, which are intended to be the target toward which the evolving pharmacy curriculum should be aimed. CAPE* Educational Outcomes 2013 Function collaboratively as members of an interprofessional team Advocate for patients Demonstrate leadership Provide care for diverse patient populations Contribute to the health and wellness of individuals and communities Educate a broad range of constituents Manage a highly technical workplace *Center for Advancement of Pharmacy Education http://www.aacp.org/resources/education/cape/pages/default.aspx 17
Changes in the ACPE Standards Expansion of the scope of pharmacy practice in state laws and regulations to include collaborative practice with prescribers. Joint Commission of Pharmacy Practitioners Vision of Pharmacy Practice, accepted by the governing boards of 10 pharmacy organizations, including ACPE, and released in 2013 Health Professionals for a New Century: Transforming education to strengthen health systems in an interdependent world http://www.thelancet.com/journals/lancet/article/piis0140-6736(10)61854-5/fulltext Core Competencies for Interprofessional Collaborative Practice http://www.aacn.nche.edu/educationresources/ipecreport.pdf ACPE 2016 Standards Graduating students are practice-ready and team-ready Prepared to directly contribute to patient care working in collaboration with other healthcare providers. Greater emphasis on critical educational outcomes and focus on development of students professional knowledge, skills, abilities, behaviors, and attitudes, including scientific foundation, knowledge application, and practice competencies manner in which programs must assess students acquisition of knowledge mastery of skills and achievement of competencies importance of both curricular and co-curricular experiences in advancing the professional development of students What key changes are occurring in the accreditation requirements for schools of pharmacy? A) Interprofessional education is required. B) Live experiences must replace all simulation activities. C) Graduating students should be practice-ready and team ready. D) A and B E) All of the above 18
Teacher Learner Outcome Curriculum materials Teaching methods Assessment methods Learning experiences Knowledge Skills Attitudes Best practices with patients Improved patient outcome Clinical settings Key Points to Remember About Andragogy (Adult Learning) Adults are independent and self directing. They have accumulated a great deal of experience, which is a rich resource for learning. They value learning that integrates with the demands of their everyday life. They are more interested in immediate, problem centered approaches than in subject centered ones. They are more motivated to learn by internal drives than by external ones. 19
Andragogy/Adult Learning Principles Must want to learn Will only learn what they feel they need to learn Learn by doing Learning focuses on problems and the problems must be realistic Experience affects adult learning Learn best in an informal situation Want guidance Quality Professionalism Community Outstanding Patient Care Education is the kindling of a flame, not the filling of a vessel. 20
Tell me and I forget. Teach me and I remember. Involve me and I learn. 21