IPPE’s, APPEs, and Service
Learning
Ruth E Nemire, B.S.Ph., Pharm.D., EdD
Associate Dean for Professional Education and Community Engagement
Professor Pharmacy and Health Outcomes
Touro College of Pharmacy, New York
ruth.nemire@touro.edu
212-851-1192 x 2115
Education vs. Training
„
Ironically, as society places more and more importance on
shortshort-term metrics, also at stake is the quality of the
concrete preparation for life we offer our students…
students…. it is
increasingly clear that an overemphasis on vocational
training is wrong and potentially disastrous in a world
where the generations we are training will go through
several careers in a lifetime…
lifetime… The strange truth is that just
as we enter a time when it is fundamental to train people
for life rather than simply for jobs, our universities…
universities…..
long expert in elevating our capacity to live a full,
meaningful, and useful life…
life…..are being pressured to
narrow their focus to job placement.
http://www.insidehighered.com/views/2006/09/18/sexton
Halting the Race to the Bottom
Goals
• Discuss Definitions for Introductory Pharmacy
Practice Experiences (IPPE), Advanced Pharmacy
Practice Experiences (APPE)
– Where does service-learning fit
• Plan opportunities for Introductory Practice
Experiences
• Plan opportunities for Advanced Practice
Experiences
Defining Educational Experience Courses
• Introductory Practice Experience: Early experience
exposure to the practice of pharmacy outside the
walls of the college of pharmacy.
• Advanced Practice Experience: Experiential
education for students building on previous IPPE
and didactic courses with a goal to establish
practitioners and expose students to the wide world
of practice.
• Service-Learning: A teaching methodology for use
in courses. Service meets the learning needs of
students and community defined needs by mutual
agreement
ACPE Standard 14
Experiential Education
The pharmacy practice experiences must
include
•direct interaction with diverse patient
populations in a variety of practice settings
•involve collaboration with other health care
professionals.
•Most pharmacy practice experiences must be
under the supervision of qualified pharmacist
preceptors licensed in the United States.
http://www.acpeaccredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152
006.DOC
Introductory Practice (IPPE)
STANDARD 14.4
• Actual practice in community + institutional
(5%)
• Assume direct patient care responsibilities.
• Other types of practice settings may be used.
• IPPEs begin early and interface with didactic
course work
• Didactic course work should not be counted
toward the curricular requirement
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.DOC
IPPE
• The introductory pharmacy practice
experiences may use various formats,
including:
– shadowing of practitioners or students on
advanced pharmacy practice experiences
– interviews with real patients
– service learning
– real practice experiences in community,
institutional, long-term care pharmacies,
etc.
Appendix C Additional Guidance on Pharmacy Practice Experiences
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.DOC
IPPEs should consistently expose students to
allow participation in activities such as, but not
limited to: Appendix C
• processing and dispensing new/refill medication
orders
• conducting patient interviews to obtain patient
information
• triaging and assessing the need for treatment or
referral,
• identifying patient-specific factors that affect health,
• assessing patient health literacy and compliance
• providing point-of-care and patient-centered services
• conducting physical assessments
• preparing and compounding extemporaneous
preparations and sterile products
Appendix C Additional Guidance on Pharmacy Practice Experiences
http://www.acpeaccredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.DOC
Introductory Pharmacy
Practice Experiences
• Time for Participant ?
– Concerns about IPPEs
– Where should students be placed?
– Innovative ideas?
Advanced Practice
ACPE Standard 14.5
Advanced Pharmacy Practice Experiences should:
• Provide balanced required (the majority) and elective
experiences
• Enable achievement of stated competencies as
demonstrated by assessment of outcome
• Include primary, acute, chronic, and preventive care
among patients of all ages
• Develop pharmacist-delivered patient care
competencies in the following settings:
–
–
–
–
community pharmacy
hospital or health-system pharmacy
ambulatory care
inpatient/acute care general medicine
http://www.acpeaccredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.
DOC
APPE
• Most of the time should involve direct patient care
• Must be 1440 hours (25% of curriculum)
• Require active participation and patient care
responsibilities, in a progressive fashion
• General objectives as well as site-specific learning
objectives should be established for all of the
pharmacy practice experiences
• Assessed through mapping objectives back to
competency (expected outcomes) requirements
Appendix C Additional Guidance on Pharmacy Practice Experiences
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.DOC
Advanced Pharmacy Practice
Experience Courses
• Time for Participant ?
– Concerns about APPEs
– Where should students be placed?
– Innovative ideas?
ACPE Guidelines: S-L
Service learning experiences although
beneficial in developing desirable
pharmacist student attitudes and values, do
not necessarily qualify as introductory
pharmacy practice experiences unless they
specifically include activities that are directly
related to medicine and pharmacy. (See
Guidelines page
Appendix C Additional Guidance on Pharmacy Practice Experiences
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.DOC
Building Service-Learning as part
of Experiential Education Course
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„
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Establish relationships
Build trust
Work with the formal and informal
leadership
Seek commitment from community
organizations
Accept that community selfself-determination is
the responsibility and right of all people
http://www.health.state.mn.us/communityeng/disparities/principles.html
http://www.cdc.gov/phppo/pce/part2.htm
Service-Learning in the
curriculum
• Time for Participant ?
– Concerns about service-learning
– Where should students be placed?
– Innovative ideas?
– What counts as IPPEs
• Only those service-learning experiences that
can provide activities listed in the ACPE
guidelines
Conclusion: IPPE
• Must be 5% of curriculum (300 hours)
• Majority- community and institutional
• May include other sites related to the practice
of pharmacy.
• Reflection and Case presentation on campus
time used minimally.
• Advancing to greater responsibility in APPE.
• Service-learning can be used but must meet
guidelines
Conclusion: APPE
• 25% of the curriculum (1440 hours)
• Required and Elective mostly direct patient
care
• Advanced opportunities consistent with
patient care, team interaction, professional
behavior
• Software system for managing practice
experiences
• Quality assurance of preceptors, sites and
student achievement a requirement
Conclusion:
Service-Learning
• Methodology that does not meet IPPE
guidelines if not direct patient care oriented
(Guideline Appendix C page xv)
• Encouraged to be implemented throughout
the curriculum
• Differentiation of service-learning and clinical
experiences often difficult to discern. Use the
phrase “community defined needs” to help.
Appendix C Additional Guidance on Pharmacy Practice Experiences
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.DOC
Conclusion:
Leading Innovation
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One size doesn't fit all
Develop a community of higher practiced
creativizers
The 20/80 rule (Its easier to change 20% of
the faculty by 80% than to change 80% of
the faculty by 20%)
Innovation only pays in the future
Degraff, J., & Quinn, S., E. (2007). Leading Innovation. New York, NY; McGraw Hill.