Have you ever been curious as to what a day in the life of an AACP APPE student is like? So have we!
The American Association of Colleges of Pharmacy is proud to announce that they are now accepting applications for APPE students who wish to complete a rotation and find out more about association work. Dr. Jennifer Adams, Senior Director of Strategic Academic Partnerships at AACP, is the primary preceptor for student pharmacists for the duration of their APPE rotation. Please email firstname.lastname@example.org with any questions you may have about the AACP APPE or related topics.
*For rotations occurring in the fall 2016 and spring 2017 time frame, AACP will accept applications until Dec. 1, 2015. All applicants will be notified by Jan. 30, 2016 of their acceptance status.
This blog will serve as an innovative forum for students to post their weekly reflections about their experiences at AACP and provide unique insight into the great work that the association does for academic pharmacy. Feel free to post your comments/feedback/suggestions and we look forward to sharing our journey with you!
Week 4: When Knowledge is No Longer Sufficient
February 2, 2015 – February 6, 2015
The summer after my P1 year I read an article by Miller et al. titled “Beyond Flexner: A New Model for Continuous Learning in the Health Professions” published in the February 2010 edition of Academic Medicine discussing the need to change medical education. (Ref. 1) (By way of background, Abraham Flexner’s 1910 report resulted in the medical education model still in use today.) Miller et al. says, “One hundred years after Flexner, despite numerous calls for reform, medical education seems to be clinging once more to models that no longer respond to the health care needs of the community. And although our educational system is now highly regulated, it is not yet accountable for the most important of outcomes—the health of the public.”
While the article is primarily talking about physician education, it strongly emphasizes interprofessional collaboration, and I believe it is applicable to all health professions education. The authors suggest change is needed for the following reasons: (1) the ever-increasing volume of biomedical knowledge is impossible for any person to know, (2) many factors other than biomedical science influence health outcomes in patients, (3) the work environment of health care professionals today requires a different set of skills largely involving interprofessional teamwork, and (4) the current educational models do not sufficiently prepare students to be lifelong learners capable of adapting to patient needs over time.
Numerous discussions I heard at the 2015 AACP Interim Meeting have addressed this idea of leading educational changes that prepare students to be practice-ready upon graduation and nimble in skills and attitude to be successful as practice changes in the future. The conversations reminded me of this article, which I believe is still relevant. The Accreditation Council for Pharmacy Education (ACPE) released the new Standards 2016 this week specifying what pharmacy schools must do to obtain and retain accreditation. This document is what every pharmacy school uses as the basis for designing its curriculum so that it can prepare its students to be excellent pharmacy practitioners. It contains a controversial requirement that schools assess the content of their curricula using a standardized test administered to students at the end of the didactic portion of the program.
Herein lies the problem. If what Miller et al. suggests is true (and I believe it is), we need health professions education that focuses on developing different kinds of students, and that didactic content-based knowledge is only a small fraction of what students need as a basis for graduation. Does it make sense today to still put such an emphasis on the content in education? Does it make sense in preparing students to be practitioners of the future to continue down this path?
Please do not misunderstand my argument: I believe content is extremely important. Content is foundational. But with the accessibility of information today, knowing content by rote is not sufficient to make successful health professionals. We are not like Watson, the computer that resoundingly beats humans on Jeopardy, with its virtually limitless storage and recall capacity for information.
Our value as health care professionals comes from our human processes of gleaning the relevant from the vast reservoir of possible inputs, analyzing the information, creating an individualized plan that incorporates our patient’s health goals with the best evidence, and adjusting the plan as things change with our patient over time. This is what clinicians provide that computers do not. While we cannot fully learn or utilize cognitive processes without the appropriate foundational content, I believe that learning the processes is actually more important to our success as clinicians than learning the content. Having useful, reliable methods for assessing student’s capabilities regarding these processes is an essential component of determining whether a student is practice-ready.
Some of my friends have struggled to obtain residency interviews this year. I understand that applications to programs have almost overwhelmed programs’ abilities to evaluate candidates. I know my friends have excellent knowledge and will make great clinicians because I have worked with them in class, but it makes me wonder whether the way we are assessed in school adequately captures the skills we have gained in a way that is meaningful to residency directors and employers. Is the information we convey on a CV, through a transcript, or from various recommendations adequate to attest to the true learning that has occurred through the curricula? I think we do learn processes and skills such as leadership through curricular activities—though sometimes not overtly—but I am not sure that we have enough meaningful assessments of that type of learning or that we have methods to convey that information when it comes time to apply for jobs and residencies.
I have been incredibly impressed by the discussions I have heard from the deans and faculty leaders at the AACP Interim Meeting. The literature and conversations mentioned suggest that pharmacy educators acknowledge the need for different models that embrace and teach skill-based competencies with at least equal emphasis as content-based knowledge. They are hungry for more types of assessments of process and skills-based learning than those available today to ensure graduates meet the needs of the profession and can demonstrate their workforce readiness. Dr. Rae Matsumoto, Dean of Touro University California College of Pharmacy, told me about a new personal and career development program they will be implementing for their students in the near future. This is an exciting endeavor that shows that members of the academy “get it.” It demonstrates how progressive leadership is moving education in a meaningful direction.
I think my challenge in the next few months before graduation is to continue to reflect on what I have learned both inside and outside the classroom and to compare my answers with those of my peers. Then, as I continue into the next phase of my career, I can determine the most valuable aspects of my learning and what may not have been as applicable. I want to encourage my peers to do the same so that we can share this information with our schools in a constructive manner. I know there are surveys I will complete to help provide data, but as the keynote speaker of the AACP Interim Meeting said, stories enable leaders to inspire change and can be even more meaningful than data. Perhaps by sharing my development story as it unfolds over the next few years I can provide some substance and imagery that will enable deans and faculty to implement the changes they know are needed.
Image from http://assessment.uconn.edu/images/cartoon.jpg.
Ref. 1: Miller BM, Moore DEJ, Stead WW, Balser JR. Beyond Flexner: a new model for continuous learning in the health professions. Acad Med. 2010;85(2):266–72. doi:10.1097/ACM.0b013e3181c859fb.
Week 3: The New Old World of Gaming
January 26, 2015 – January 30, 2015
I am not a gamer. In fact, my mother did not allow video games in our house when I was growing up. My exposure to the world of Mario Brothers and Zelda occurred in short bursts when visiting friends’ houses, and I was so bad at playing that I lost interest quickly and returned to my world of books. I have little personal knowledge of online multiplayer role playing games like World of Warcraft and Final Fantasy, though I have quite a few friends who actively play. I recently read a fiction detective novel that intrigued me where the main suspect in the story was a teenage gamer. The book spent some time explaining how characters interacted inside the game and how those online behaviors translated to real life actions. I became intrigued and curious.
Fast forward a few weeks to my rotation at AACP where I came face-to-face with a reinvention of video games, and my curiosity exploded. I had the opportunity this week to visit Professions Quest, a new company created by AACP in partnership with George Mason University’s Simulation and Game Institute. This collaboration is taking gaming to a new “serious” level.
Video games have been used as simulators for teaching technical job-based skills such as flying aircraft for many years. The multiplayer role playing games allow individual players, via their avatars, to interact in real time. Sometimes the characters fight each other, but sometimes they collaborate for a common goal based on the unfolding scenario. Professions Quest is bridging these two concepts by intentionally teaching and assessing communication and teamwork skills through interactive online games specifically designed for health professional students.
Ruth Nemire, Associate Executive Vice President of AACP, is one of the driving forces behind Professions Quest. She envisions a change in health professions education with an increasing focus on the skills necessary for interprofessional practice and co-opted video games as an innovative delivery platform. Serious games are about more than entertainment; they are deliberately designed to teach knowledge and skills by using the game as a vehicle for learning. Critical competencies for healthcare professionals include teamwork and collaboration outside of one’s own profession, but these are some of the most challenging competencies to incorporate into traditional curricula. Many schools lack the professional diversity on one campus to build effective teams. Even schools with the diversity often lack sufficient experiential education sites and resources for groups of students to learn together. Other challenges include the lack of student engagement in developing improved non-cognitive (e.g., communication and teamwork).
Professions Quest overcomes some of these barriers by using virtual interactions between the players in the video game to teach specific skills built into each quest. For example, one of the skills might pertain to integrity in communication. One player may receive a piece of information about a patient that other players do not have. That player then has an opportunity to share that information, keep it secret, or share misinformation. Each of these actions causes the player to gain or lose points according to their choice, so students learn that their choices have consequences within the game, just as they will have consequences in real life.
I was intrigued not only by the potential implications of using games to teach health professions students but also by the innovation in thinking required to take one thing—the video game—and apply it to another purpose—health professions education. While contemplating this idea of repurposing something, images of HGTV shows popped into my head where completely dysfunctional rooms are transformed into beautiful, livable spaces. Then I wondered what other kinds of inventions had been repurposed for other uses, so I asked my friend Google. I found a plethora of answers including drugs such as Viagra® (originally designed for hypertension and angina but repurposed as an erectile dysfunction drug thanks to one of its side effects),1 household items like bubble wrap (this crazy-addictive product was originally marketed as trendy wallpaper), and WD-40 (created to prevent rust on ballistic missiles).2 What all of these examples have in common is that someone looked at something that already existed and asked, “What else can we do with this?”
Reimagining what exists today into future applications is an essential component of innovation. Sometimes things need be designed from the ground up, but sometimes repurposing a tool for a different function can lead to amazing results. I am confident that the innovations that Professions Quest will bring to interprofessional health professions education will have far reaching impacts beyond just health professions students. What if we can eventually adapt this new model of “serious” video games to teach patients to better manage their own diseases? What if someone with newly diagnosed diabetes could manipulate things like diet and exercise and the amount of insulin injected in a game to understand what happens to their body in both the short and long term? Maybe that would be a powerful enough tool to spur some people to make lasting life changes to avoid the long term sequelae of diabetes by controlling it early.
One of my strengths is looking to the future and thinking about how things could be. Sometimes, though, I think creating a better future requires creating completely new ideas. My experience at Professions Quest reminded me that innovation is not always about making something from scratch but rather looking at the tools we have today and re-envisioning them in a different way to make them work for the future. I believe I can be a better futurist by allowing my creativity to be inspired by the present rather than kicking it to curb in favor of something shiny and new. When I think about the future now, I have new questions I can deliberately ask about how things in existence today can be modified for new purposes in the future. As I continue my pharmacy career, ideally as a health system pharmacy administrative resident, perhaps I will be able to use my past experiences working for a wholesale distribution company in training and development to help my new organization. Workforce development can be a challenge to pharmacy departments that may lack dedicated resources for this purpose. Rather than immediately suggesting new programs and initiatives, I can take the time to thoughtfully consider what already exists and then brainstorm creative ways to build upon the foundation and take it to a new level. Maybe my institution will have important, specific content that is currently presented in a boring or time-intensive manner. Maybe I could even take that content, match it to relevant job skills, and partner with Professions Quest to develop workforce games that would be engaging, efficient, and effective. I may not know exactly what the future holds, but I do know that reinvention and innovation will make it exciting.
Image from https://professionsquest.com/products.
Week 2: The Power of Waiting
January 19, 2015 – January 23, 2015
Prior to my rotation at AACP, I have never lived in a place where walking is the primary means of transportation. I am admittedly terrified of driving in the northern Virginia/Washington D. C. area. So when I was planning this rotation, I looked for housing in a strategic location: within walking distance of the AACP office. I decided somewhere between ten and fifteen blocks was a reasonable distance. I could then park my car and not need it for daily use. The prospects of extra daily exercise and having a new life experience were enticing.
One of the most impressive things to me about this new living situation is that cars wait for pedestrians! In Richmond, where I live and attend school normally, every time I step off a curb, even in a crosswalk with the light in my favor, I still feel like I’m gambling with my life. Are the cars even paying attention to me at all? Old Town Alexandria, Virginia where AACP is headquartered is different. When I approach the crosswalks—cautiously, mind you, as I’m still from Richmond—the cars stop at the four-way stops and wait for me to cross. They stop at red lights and do not make right turns on red until I am across the entire street. Mind blown.
However, I noticed something on Wednesday of my second week of rotation. I was headed to the gym around 8:00 pm, which was quite a bit later than normal. I was not comfortable with the prospect of walking home alone after 9:00 pm so I decided to drive. (Not that I was planning on taking short cuts through dark alleys, but I have taken far too many martial arts and self defense classes in my life to take unnecessary risks.) I am rather embarrassed to admit this, but I drove like Richmonders. I was anxious to get through the stops and tended to start across the intersection as soon as the pedestrians were out of my lane rather than waiting for them to cross the entire street. If I thought I could take the right on red before the pedestrian was halfway across, I took the turn rather than waiting. My driving behavior is completely unacceptable.
What I realized is that I felt valued as a human being when the cars waited for me. I felt like the drivers respected me, my time, and my need to get to my destination just as much as they recognized their own needs. I also felt safe in my choice to be a pedestrian because I could rely on that respect. Are there many things better for the psyche than feeling safe and valued? Those two states of being are high on my list.
So how does this apply to AACP? AACP is a member-driven organization made up of deans, faculty members, and students who all have thoughts and opinions about the state of pharmacy today and the direction the profession should move in the future. My experiences thus far with this organization have shown me a culture that creates a safe space for creativity and vision where individuals and groups are valued for their contributions. Staff members have solicited my opinions and feedback about a number of topics and genuinely want to use that information to improve their programs and services. This is the kind of environment that should be a model for all workplaces. I am sure there are times when things are not completely smooth and feathers get ruffled, but the culture is one that sees those times as learning experiences. The core values of AACP guide the actions of employees and the strategic plan and vision for the organization.
I believe my challenge is to take this experience and use it as a model for my own behavior in both my work and personal lives. If I interact with my coworkers, peers, mentors, students—really everyone—in a way that makes them feel valued as a person, that makes them feel like their opinions matter and can make a difference, and that makes them feel like they have a safe space for sharing openly and honestly, I can help create the environment in which I want to work. I have worked in companies before where it was difficult to see the values posted on the wall in their daily operations. I know that I allowed my own negativity, my own need to get through the day so I could leave, to contribute to this failure to create a thriving value-driven culture. I also know that I have new opportunities each and every day to do something different, to act in ways consistent with my personal values, and to be a leader who shows others how to do the same. I need to be—will be—a driver who waits for pedestrians.
Image from http://images.trvl-media.com/hotels/1000000/690000/688000/687916/687916_76_b.jpg