Better Teaching Through Collaboration

Pharmacy practice has changed since its origins in the dim days of human history, but one aspect has remained constant. As long as there have been pharmacists, there have been pharmacy preceptors: working professionals who transfer their knowledge, insights, and professional standards to the novices following in their footsteps.

This tradition is alive and well at the University of Michigan College of Pharmacy, remarks Nancy Mason, BSPharm’76, PharmD’81, acting director of the College’s Experiential Training Program.

“The basic educational goal of our PharmD program is to graduate generalist practitioners who have the skills, knowledge, and clinical judgment to succeed as entry-level professionals in any setting they choose,” explains Mason. “Our Experiential Training Program enables us to achieve that goal by matching PharmD students with working pharmacists in a wide variety of practice settings. It’s a collaborative model that works, and works well.”

To open as wide a field of career options as possible, every P-4 is required to complete at least one, four-week rotation in ambulatory care practice, community practice, drug information, general inpatient clinical practice, institutional practice, specialized inpatient clinical practice, and a non-traditional practice setting. (Students may waive a required rotation if they’ve amassed a comparable number of hours in an identical setting, as sometimes happens with students who’ve worked steadily in a pharmacy prior to their P-4 year.)

“With over 300 preceptors offering more than 175 different practice experiences, our preceptors are one of the great strengths of our professional degree program,” Mason says. “When you consider that the whole fourth year of the PharmD curriculum is based upon a continuous, 40-week experience of direct contact with practicing pharmacists, you appreciate just how significant a role preceptors have in the education of our P-4 students.”

But that’s only part of the picture, Mason notes.

“When we revised our PharmD curriculum a few years ago, we built in earlier clinical experiences because students wanted more direct patient contact and earlier practice exposure, and because faculty felt that earlier experiences would strengthen the curriculum by allowing students to apply what they’ve just learned in the classroom and lab,” she says. “Those changes have amplified the role of preceptors in our curriculum.” In the P-1 year, for example, students interview working pharmacists to gain insights into their practice. P-1 students are also required to shadow P-4 students on clinical rotations. As P-3s, students must spend a minimum six hours per week in a community pharmacy and six hours per week in a hospital pharmacy in consecutive academic terms. P-3 experiences introduce students to both the dispensing functions of a pharmacist and the pharmaceutical aspects of patient care.

These practice exposures are in addition to students’ non-College-affiliated part-time and/or seasonal employment where they are working under the supervision of a licensed pharmacist.

“Every direct exposure students have to pharmacy practice and working pharmacists contributes to the goal of graduating entry-level pharmacists who can start contributing from day one on the job,” Mason adds.

Whatever their practice environment, preceptors all have one important trait in common, Mason says: they teach aspects of their profession that no amount of classroom discourse, reading, or simulated experience can replicate.

“As working professionals, preceptors know how to apply clinical reasoning to every patient encounter,” says Mason. “They are skilled in the techniques of evidence-based medicines, which they use in the assessment and pharmaceutical management of patients. They know how to get to the core of a problem and devise a solution, quickly, and often under pressure. They work with and understand practice-specific systems and protocols. They are invaluable role models.”

While the majority of experiential training practice sites are located within driving distance of Ann Arbor, the College also offers learning experiences at sites throughout the continental U.S.

“If students can afford to live at other locations or, as sometimes happens, are able to secure financial assistance from a distant site sponsor, there’s almost no limit to where students can have an externship experience.”

Although the majority of experiential training sites are in community and hospital practice settings, the College also provides a wide range of other learning experiences — in industry, with professional organizations, with managed care and insurance companies, with governmental agencies, and many other venues. If there’s a type of pharmacy practice, chances are that it’s represented in the College’s network of preceptors or on the College roster of experiential training sites.

“Students have a fantastic range of people and places to choose from,” notes Mason. “Our educational philosophy is to expose students to as many pharmacy career paths as possible, and then let them choose the one that best fits their interests, talents, personality, work style, and professional goals. In the end, that freedom to choose will make them better professionals and more productive employees.”

Recruiting New Preceptors, a Never-ending Mission

The quest to recruit more preceptors and to increase both the number and variety of experiential training sites is never-ending. In fact, it’s essential in order to keep the PharmD program robust, Mason says.

“We are luckier than many pharmacy schools in that our professional degree program is affiliated with a major teaching hospital and health system,” she explains. “The University of Michigan Health System provides a majority of our clinical faculty and clinical rotation sites for our students. But experiential training is not a static system. As our PharmD program evolves, so do our experiential training needs. We have a growing demand for new, more, and different experiential learning opportunities.”

One reason for the increasing demand for preceptors and training sites is that the College has boosted its PharmD enrollment by about 16 percent over the past four years. Another reason, as previously mentioned, is that the College has introduced more clinical and patient-oriented material earlier in the curriculum, with a corresponding need for more preceptor contact time.

Adding to the recruitment challenge: the continuing national shortage of pharmacists.

“In our contacts with other colleges of pharmacy around the country, we find that the shortage of pharmacists is hurting experiential training programs just about everywhere,” Mason says. “The challenge grows when you are trying to provide learning experiences that are within driving distance of Ann Arbor and to offer a variety of choices, which is what we’ve historically attempted to do.”

Top Preceptor Requirements: Enthusiasm and a Willingness to Teach

Asked what qualities define a good preceptor, Mason says it comes down to a few essentials.

“We want people who are good at what they do, who are enthusiastic about the profession of pharmacy and their own practice, and who can pass this enthusiasm on to students — in other words, good role models,” states Mason. “Previous teaching experience is not required, but a desire to teach is a must.”

To help preceptors learn how to teach, the U-M College of Pharmacy is teaming up with the Michigan Pharmacists’ Association and the state’s other two pharmacy schools. This spring, the consortium will launch a small-scale preceptor training program. The plan is to learn from the pilot program and implement it on a wider basis thereafter.

With 10 rotations of four weeks each, preceptors have about 20 contact days to impart a specific body of knowledge. “Twenty days are just enough for students to get a general feel for an area of practice,” Mason notes.

Preceptors choose how many of the four-week, August-to-May experiential training rotations they will commit to. Because planning for the coming year’s experiential training cycle begins during winter term, the College must know in February of each year which preceptors will host students for which rotations. Having preceptor commitments pinned down by February allows Experiential Training Program personnel to build a rotation schedule and have it approved before the annual rotation cycle begins.

“We do not prescribe what preceptors should do on a daily basis,” explains Mason. “Rather, the College works with preceptors to develop a set of general learning objectives tailored to each experiential training site, and then Experiential Training Program personnel help preceptors develop performance measurements to ensure that the learning objectives are met.

“Preceptors know their own practice best, so we leave it up to them to match projects and activities to learning objectives,” Mason says. “Probably the hardest part of being a preceptor is balancing what you would like students to learn with the amount of time you have to teach it. You want the rotation to be challenging, but not so difficult that students are overwhelmed by the experience. We want our preceptors to succeed and to enjoy the precepting experience, and we will support them in every way we can. If they need help, we’re ready to step in at any time and lend a hand.”

Why do preceptors precept? That varies from person to person, Mason says.

“For some of us, it’s the joy of passing the torch to a new generation. For others, it’s a mutual learning experience: in the dialogue that takes place as students learn about your practice, you are learning what they’ve just learned at school or in a practice setting that is very different from your own. Some preceptors use the opportunity as a recruitment tool: to evaluate a student’s work ethic, attitudes, and competencies over four weeks at no risk to themselves.

“Personally, I find the experience rejuvenating,” Mason reflects. “Students are at an exciting stage in their personal and professional development. They are young and energetic and want to make a difference in the world. It’s infectious because they cause you to see your job, your profession, from a fresh perspective. They remind you why it was that you chose the profession of pharmacy. Students are a tonic for the spirit.”

To learn more about becoming a University of Michigan College of Pharmacy preceptor, contact Nancy Mason at nmason@umich.edu. Or call 734-763-0091 or 734-763-4981.