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7/22/2004

Experiential Education Requirements Squeeze Schools, Rotation Sites

Kate Traynor

Kathy Besinque, director of experiential programs at the University of Southern California (USC) School of Pharmacy in Los Angeles, has been placing pharmacy students in experiential rotations for about a dozen years.

Besinque said the pace of placements has picked up now that the nation's pharmacy schools have phased out the baccalaureate degree program in pharmacy in favor of the all-Pharm.D. curriculum.

"We have between 180 and 200 students per class," Besinque said. "I do 1100 clerkship placements, 400 externship placements, and 190 i.v. [specialty rotation] placements a year."

"It used to be really simple," she said about placing students at experiential learning sites. "We used to just send students off. I'd call my friends, and they'd say, 'sure, I'll take a student.' And it was very informal."

"Now," she said, "it's not."

Besinque described some of the administrative issues that she addresses when placing pharmacy students at experiential sites. "I have to verify that all of my students are in good standing with the board of pharmacy," she said. "They all need to be licensed [as intern pharmacists] and functioning under scope of practice."

In addition, she said, students need to undergo a physical examination that includes testing for tuberculosis exposure and obtaining titers for hepatitis, measles, and rubella.

"We have to train students in universal precautions, CPR—just like an employee," Besinque added. "They have to have liability insurance. We have to have HIPAA training, we have to have legal contracts for the students to be in the sites."

"I'm like a little personnel office," she said, adding that she thrives on the sometimes-chaotic atmosphere. "I like my job, but it's not for everyone."

Former ASHP President Steven L. Sheaffer, vice chair for experiential learning at the University of the Sciences in Philadelphia (USP), said that pharmacy schools must now compete with each other to place students at experiential rotation sites.

Sheaffer explained that the Accreditation Council for Pharmacy Education has mandated the use of experiential training early in the pharmacy student's education. Consequently, he said, "there's an increasing demand for sites because of growing needs to meet the requirement for early experiential education."

Sheaffer noted that a pharmacy student's final year of school consists almost entirely of experiential rotations, which adds to the need for rotation sites. In addition, he said, "many colleges of pharmacy, due to the pharmacist shortage and other financial considerations, have increased the number of students enrolled per class."

"The net result is that the demand to place students for experiential education has markedly increased," he said.

As a former director of pharmacy at Mercy Fitzgerald and Mercy Community hospitals in Philadelphia, Sheaffer is familiar with the challenges faced by hospitals that accept students on rotation as well as pharmacy schools that place students at the sites.

Staffing shortages at hospitals and the resulting increase in demands placed on pharmacy staff, he said, are "making it more and more difficult for the hospitals . . . to be able to precept students at the level and in the way that students expect and, certainly, the colleges would like."

To offset some of this burden, some sites, such as the Albert Einstein Medical Center in Philadelphia, charge pharmacy schools for students' experiential rotations.

Clinical pharmacist Rahit Moghe, Einstein's clerkship coordinator, said that fees received from pharmacy schools help fund his position and ensure that the students receive high-quality, hands-on training during rotations.

Moghe said that before he came on board, Einstein hosted "one or two students" at a time, mostly from USP.

"We saw that if we created a position for a clerkship preceptor who directed the program, we could open up students to a greater number of rotations," Moghe said. Now, he added, "we have about 15 students a month."

Moghe said that Einstein hosts pharmacy students mainly from USP and Wilkes University in Wilkes-Barre and takes students from other schools "on an as-needed basis." Because Einstein requires "some level of monetary compensation," he said, placing students at Einstein is problematic for state-funded schools.

"Our institution loves education, but nobody is going to educate without a proper amount of compensation," Moghe said.

Besinque said that payment for the sites is not as big an issue in California as it is in the eastern portion of the country.

"We don't do it," she said about site payments. "We're not involved, as they are in some other parts of the country, in the $125-a-week-per-student or similar type arrangements—at least not yet."

Beverly A. Talluto, assistant director for experiential education at Creighton University in Omaha, Nebraska, said that the issue of paying sites to host students "can be a problem because there is no standard amount of money that is paid to institutions."

"Sometimes it's minimal," Talluto said about site fees. "It can be up to $300 per rotation per student. Some go up to $1000. This is prohibitive to some schools who just don't have that cash flow. And it seems unreasonable for the profession to charge exorbitant amounts because it reflects back on the students' tuition."

Instead of paying rotation sites a per-student fee, Besinque said, USC provides other types of compensation to the people who host experiential programs.

"If they need to attend meetings, we fund that. We sometimes place a person, subsidize the cost of an onsite coordinator. We buy books, supplies, things like that; we have done training for their residents," she said.

Talluto likewise emphasized the collaborative nature of the relationship between rotation sites and the pharmacy schools they serve.

"When you start a college of pharmacy, you get contracts between some of your larger institutions that form the foundation of rotations, because they are large teaching hospitals and they have a large number of clinicians."

Pharmacy schools, Talluto said, will cofund staff positions at hospitals and long-term-care and ambulatory care clinics that "solidify that relationship between the school and the site" and guarantee students placement at rotation sites.

Talluto said she is aware of the issues experiential sites face when they accept students on rotation. "I owned my own stores for approximately 18 years, and I was a site for advanced community rotations," she explained.

"One of the problems that the preceptors face is that they do take students from multiple universities and colleges," she said. "They start at different times, they are on different lengths of time, they have different expectations, so that it makes it very difficult for the preceptors to coordinate" students' training.

Moghe said that he works to accommodate the different start times and training levels of pharmacy students who come to Einstein on rotation.

"My job is to divide their mornings into the clinical work," he said. "The afternoon is usually spent with me, talking about various different cases and case studies and . . . journal clubs, presentations."

Moghe said experiential rotations are an important way to expose students to "the real world" of hospital pharmacy practice.

"A lot of students who are coming for their first rotation don't know what to expect. Some of them don't have any hospital experience whatsoever, because they either work in retail or other pharmacy environments," he said. "A lot of students are very intimidated by the fact that they are going to be physically on the floor with the physicians and helping manage drug therapy right off the bat."

Talluto said that working with students is "a huge responsibility for the preceptors, because they want to give quality rotations."

"We put a lot of responsibility on the preceptors because of what we're required to do as colleges to prepare the students," she said.

The best preceptors, she added, are those who "truly want to work with the students. And that supersedes the workload, the levels of work that they have to do, the pressures they're under."

"It's the love of teaching" that drives these preceptors, Talluto said. "It's very rewarding."