Back to Pharmacy School, Part 1: What's Being Taught Now?

JANUARY 26, 2018
This is part 1 of a series on how pharmacy school has changed in the past couple of decades.

Have you ever heard of a flipped classroom or an advanced pharmacy practice experience (APPE)? For students attending pharmacy school now, these are some common terms that may be foreign to those of us who graduated years ago. Recently, I was thinking about how much technology has advanced since I graduated from the University of Pittsburgh School of Pharmacy in 2001, and that made me wonder what it is like to be a pharmacy student today. I reached out to Terry Schwinghammer, PharmD, FCCP, FASHP, FAPhA, BCPS, 1 of my favorite professors. He has been teaching and mentoring pharmacy students for 40 years, and is an author of the Pharmacotherapy Casebook and Pharmacotherapy Principles & Practice (McGraw Hill-Education, 2017). He is a chairman and professor at the West Virginia University (WVU) School of Pharmacy in Morgantown.

Because there is so much information to cover, this will be a 3-part article. This first part will cover the first 3 years of pharmacy school. The second part will cover the Pharmacy Curriculum Outcomes Assessment exam, the APPE, the North American Pharmacist Licensure Examination(NAPLEX)/Multistate Pharmacy Jurisprudence Examination, and residencies. And the third part will be an interview with a current PharmD student.
Many major changes have taken place in pharmacy education over the past several decades in response to changes in medical care, advances in educational strategies, and new accreditation standards set by the Accreditation Council for Pharmacy Education (ACPE), Dr. Schwinghammer said. 

Here are some highlights:
1. Teaching and learning methods: Students review the course material before class and come arrive ready to discuss, as well as practice skills and work together.
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2. Practical examinations: In addition to multiple-choice exams, students are tested on their ability to review and verify prescriptions, counsel patients, interact with other health care professionals, and perform calculations.

3. Simulation-based experiences: Some schools have an affiliated simulation center used to give students experience with patient assessment with manikins (life-sized models) and counseling with live people who play the role of patients (“standardized patients”). At WVU, students participate in the WV STEPS Simulation Center during the first 3 years of the pharmacy school curriculum. 

4. Co-curricular activities: In addition to classroom instruction, there is also learning that happens outside the classroom, such as participating in community service activities and health fairs, and attending professional presentations.

5. Interprofessional education and team-based care: Students must graduate practice-ready and team-ready. While students learn, they must have opportunities to study with other members of the health care team. When they graduate, they must be ready to provide entry-level, patient-centered care as part of a team. 

6. CAPE Outcomes: The Center for the Advancement of Pharmaceutical Education (CAPE) educational outcomes of the American Association of Colleges of Pharmacy are the target at which the curriculum is aimed. The CAPE outcomes focus on the attitudes, knowledge, and skills, that entry-level graduates should possess. 

7. The Joint Commission of Pharmacy Practitioners' (JCCP) pharmacist’s patient care process (PPCP): The JCPP published a process that should be followed when pharmacists deliver direct patient care. Historically, every other health care profession follows a standard patient care process for each patient, but pharmacy does not. Accreditation standards now require that students learn how to implement the PPCP.

8. Introductory pharmacy practice experience (IPPE) requirements: During the first 3 years of curriculum, IPPE experience of at least 300 hours is required. Dr Schwinghammer gives an example that is done at WVU-community and hospital rotations of 2 to 4 weeks after the second and third years of pharmacy school.

9. APPE preparedness: The first 3 years of the curriculum must ensure that students are ready for APPE rotations. Students must have a minimum level of knowledge and practice experience so that they will succeed in their fourth year.

So, what goes on in pharmacy schools? Although there are differences among schools, most are moving toward a focus on student-centered learning. Dr. Schwinghammer's students have a full schedule. They spend about 16 to 20 hours a week in the required pharmacy curriculum, plus a total of 8 professional elective credit hours in the second and third years. “Class release" time is also scheduled for students to work on activities outside the school of pharmacy. One morning a week, students have service learning site visits. They are assigned to a community partner, such as a nursing home, and they develop a health-related project to benefit that partner during the year. One afternoon a week is also scheduled for IPPE time. There is not really a "typical" day in pharmacy school, as each is different and consists of a mix of large-group classroom sessions and small-group activities, Dr. Schwinghammer said. Some classes may meet 4 or 4 times weekly, and there is also practicum time, where one-third of the class at a time participates in a patient case discussion or another learning activity for 2 hours. Exams are not held during regular class times but instead are scheduled as a block once weekly, ie, exams may be given on Fridays from 3 p.m. to 5 p.m. for a given class. Because students are expected to come to class prepared, they must spend a lot of time outside the class reviewing material. Because students have such full schedules, which often include outside work on nights and/or weekends, many students struggle to achieve a balance with school and work time.
There is a big focus on the "flipped classroom," which means that students are expected to do some initial learning on their own before class, such as by reading a textbook chapter or reviewing a video. Then, classroom time is not a traditional lecture. Instead, students work in groups of 5 or 6 to do calculations, medicinal chemistry exercises, or patient case studies. One form of the flipped classroom is called team-based learning (TBL). At the beginning of a TBL class, students taken an individual quiz on their computers, and then the same quiz is given to students in small groups. The idea is for students to discuss the course material and work together to arrive at the correct answers. The average score on the group quiz is generally higher than the individual quiz scores because everyone's knowledge is brought to the table. Then during the rest of class, students work on applying the material (“application exercises”) rather than listening to a lecture.
Simulation centers use high-fidelity pediatric or adult manikins that can mimic many human physiologic responses. These manikins can sweat, have seizures, have an increased heart rate, etc. There is also a standardized patient program. Usually, participants are retired community members who receive a modest hourly rate to play the role of a patient using a script. For example, a "patient" may have chest pain, and the student pharmacist must assess the nature of pain, decide whether to recommend an OTC medicine, and then counsel the patient. The patient plays the same role for every student, and the experience must feel real to the student. T scenarios aim to "suspend disbelief," so, students should feel like it is a real situation, Dr. Schwinghammer said. This is more effective than counseling fellow students because students do not know the standardized patients.
 
Students still write subjective, objective, assessment, and plan (SOAP) notes after patient encounters, because SOAP notes are still the standard among health care professionals 
 
There is a real focus on practicing skills, not just memorizing content but being able to apply the knowledge and provide patient care. The curriculum at many schools even provides American Pharmacists Association certifications, such as diabetes, immunization, and medication therapy management.

Most classrooms sessions are now recorded and are made available to students via electronic course management software on websites such as Blackboard, Dr. Schwinghammer said. Students can then review lectures and clarify notes later. This also presents a problem: Because the course material is available online, some students think that it is not necessary to attend class. As a result, professors must find ways to make class time meaningful for students. In addition to facilitating learning, technology can also present a distraction in the classroom, as students are frequently seen texting, viewing social media, and even shopping. Dr. Schwinghammer said that it is tough for students to use electronic devices for learning without distractions, as they think that they can multi-task and still participate in class. But studies show that this kind of activity can be distracting and interfere with learning.

When I went to pharmacy school, our research was done by finding our references via computer and then photocopying pages out of massive binders of journals. Now many journals are available online through school libraries, Dr. Schwinghammer said. There are many more journals than there used to be, and they vary in quality. The APhA and the American Society of Health-System Pharmacists sell subscriptions for packages of reference materials to schools, which are available to students on that school's Intranet. Accesspharmacy.com is another subscription-based service that contains McGraw Hill publications, such as Goodman and Gilman’s Pharmacology, Harrison’s Principles of Internal Medicine, NAPLEX study guides, and Pharmacotherapy. 
I also wondered how exams are given now. When I was in school, we automatically went to a large auditorium and sat every other row, every other seat, and filled in bubbles with our No. 2 pencils, then anxiously awaited results several days later. Exams are very different now, Dr. Schwinghammer said. Traditional exams are all given electronically on secure platforms, which students take on laptops. Exams are on a secure website that students cannot exit: a lockdown browser. Instructors can monitor the exam and see the running average score while students are still taking their exams. Results are available immediately, and instructors can determine if their questions were good or should be thrown out based on statistical evaluation. These exams are easier and faster, as well as more reliable. Some exams also include a lab set-up, where student pharmacists go to different stations to review and verify prescriptions, counsel patients, review patient cases, and make recommendations.
 
Hearing about pharmacy school almost makes me want to go back and do it again. Stay tuned for part 2, where we learn more about what comes after the third year of pharmacy school.

Karen Berger, PharmD
Karen Berger, PharmD
Karen Berger, PharmD, graduated from the University of Pittsburgh School of Pharmacy in 2001. She has worked in community pharmacies for over 16 years as a Pharmacist in Charge, staff, and floater pharmacist for a large chain. Currently, she is a pharmacist at an independent pharmacy in Northern NJ. She can be reached at karenmichelleberger@gmail.com
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