Research Article
The Redesign of a Community Pharmacy Internship Program
Journal of Pharmacy Practice 1-4 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190014566305 jpp.sagepub.com
Anthony J. Pattin, PharmD1, Sarah E. Kelling, PharmD, MPH, BCACP2, Jim Szyskowski, BSPharm, RPh3, Michelle L. Izor, PharmD3, and Susan Findley, BSPharm, RPh3
Abstract Background: Pharmacy internships provide students with practical experiences that lead to enhancement of clinical skills and personal growth. Objective: To describe the design and implementation of a structured 10-week summer pharmacy internship program in a supermarket chain pharmacy. Methods: The pharmacy leadership team developed and piloted a new format of the pharmacy internship during the summer of 2013. Pharmacy students in professional year 1 (P1), 2 (P2), and 4 (P4) were invited to apply for a paid internship. Pharmacy students were recruited from all colleges of pharmacy in the state of Michigan. The goal of the new program was to create a focused learning opportunity that encouraged students to develop knowledge, skills, and abilities about patient care, pharmacy management, and working within a team. Results: A total of 19 interns were recruited (P1 ¼ 7, P2 ¼ 7, and P4 ¼ 5). Students practiced 40 hours per week and participated in the medication dispensing process and employee biometrics screening program. Interns provided approximately 500 assessments on pharmacy employees and all P1 and P2 interns completed a patient care project. Conclusions: The restructured internship program provided pharmacy students with a 10-week program that exposed them to many aspects of community pharmacy practice. The program needs future refinement and assessment measures to verify interns improve skills throughout the program. Keywords pharmacy internship, community pharmacy, student pharmacists
Introduction Although Doctor of Pharmacy education provides many opportunities for experiential learning, students continue to seek pharmacy internship programs for more exposure to the profession. Internship programs have been shown to maximize learning opportunities by fostering relationships between mentors and students that lead to personal growth.1,2 Furthermore, the longitudinal nature allows concepts to be reinforced in real-world practice settings. Several hospital practice sites described models of structured internship programs for students. Skledar and colleagues created a 3-year pharmacy internship program at the University of Pittsburgh Medical Center (UPMC) to enhance active learning and application of clinical skills.1 A summer program was developed at Johns Hopkins Hospitals, which aimed to expose pharmacy students to various practice settings within a health system.3 Outcomes reported include improved internship satisfaction with experiences, knowledge of health care system processes, and learning of pharmacy practice skills and abilities. These programs provide a model for community pharmacies interested in developing a similar internship program. Historically, the Michigan division of The Kroger Company has offered a traditional internship where students practiced
longitudinally throughout the year. Interns often performed dispensing tasks similar to pharmacy technicians and worked infrequently due to hectic school and examination schedules. Due to inadequate intern experiences, graduate interns and newly licensed pharmacists were not prepared to operate the pharmacy at a high level. This was evident by former interns and newly licensed pharmacists requesting additional time to learn pharmacy processes beyond licensure. It was expected that interns would be comfortable in transitioning to the role of pharmacist since they spent time in the pharmacy during a 2- to 3-year internship; however, interns expressed a lack of comfort and confidence operating the pharmacy. The
1 Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA 2 Department of Clinical, Social, and Administrative Sciences, College of Pharmacy, The University of Michigan, Ann Arbor, MI, USA 3 The Kroger Company of Michigan, Novi, MI, USA
Corresponding Author: Anthony J. Pattin, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, 259 Mack Avenue, Detroit, MI 48201, USA. Email: [email protected]
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
2
Journal of Pharmacy Practice
Table 1. Overview of Key Activities. Activity
P1
P2
P4 graduate intern
Prescription processing functions and patient care services Preparation of medications X X OTC counseling X X Weekly screening day X X Prescription counseling X Patient care assessment Project management Intern project X X Pharmacy management Laws and ethics X X Inventory X X Audits X Record keeping X Team building Orientation X X Daily store huddle X X Weekly pharmacy conference call X X Interorganization communication
a
X X X X
X X X X X X X X
Abbreviation: OTC, over the counter. a All P4 students were considered graduate interns and offered staff pharmacist positions after passing board examinations.
recognition of this gap resulted in an interest in restructuring the program in order to improve the internship experience and outcomes. With input from Kroger leadership and academic stakeholders, the internship was modified with the goal of increasing knowledge, skills, and abilities after participation in the program. In this first article, we describe the redesign of an internship program in the grocery store chain setting. In subsequent articles, we plan to report data on outcomes from the interns that matriculate through the program. To the author’s knowledge, there have been no other published works that describe the intentional restructuring of a community pharmacy internship program.
Methods Program Structure In the original version of the internship program, interns were required to practice a minimum of 1 day per month, and many were not interested in working beyond that threshold. The revised internship program was structured to allow the student pharmacist to perform a variety of activities during the summer months and required 40 hours a week to participate. An overview of key aspects of the program is included in Table 1. The new internship program took place during a 10-week block beginning May 28, 2013. Orientation was provided for the group of interns during the first 2 days of the internship. The first day focused on human resource topics, including company policies and procedures. The second day of orientation focused on patient care processes, including how to use point of care testing systems (ie, glucometers and cholesterol machines) and interpret test results. Interns practiced entering clinically related information into the prescription processing system.
Additionally, interns were trained on all elements of the employee biometric screening program, which involves the assessment of body mass index, tobacco use, blood pressure, cholesterol, and blood glucose. After the orientation process, each intern was assigned to a home store. This was the location where they were to learn the basics of how to operate a pharmacy. Interns were matched to a particular site depending on the pharmacists’ ability to mentor others, including pharmacy technicians, the volume of prescriptions dispensed by the pharmacy, and the level of clinical services offered at the pharmacy. Students were preferentially placed at pharmacies that offered biometric screening services to employees. This provided ample experiences for interns to learn the pharmacy processes, both related to dispensing functions and other patient care services. The pharmacy managers supplied the intern with a weekly schedule that emphasized specific learning activities, such as working in the pharmacy, biometric wellness screenings, and project management on specific days. At various points during the program, the interns met with pharmacy managers and coordinators to learn about human resource responsibilities and management tasks. Although many experiences took place at the home store, students were also assigned to visit different stores to perform biometric screenings. This gave the students an opportunity to work with other pharmacists and to see a variety of ways of approaching patient care in the community pharmacy setting.
Internship Recruitment In the previous version of the internship program, pharmacy students were recruited in a similar fashion to pharmacy technicians. This included recruiting students based on the business needs of a particular location. In the revised program, the recruitment process was modified to attract high-quality students interested in community pharmacy. The business needs of the organization was not a factor in the decision process as a preselected number of positions were created prior to beginning the recruitment process. Students from all colleges of pharmacy in Michigan were invited to apply for a position in the internship program. Recruitment flyers were sent to experiential directors describing the program and the application process. Experiential directors were asked to distribute the flyers to students in the P1, P2, and P4 class. P3 students were excluded as they were completing their Advanced Pharmacy Practice Experience (APPE) rotations during the time of the internship program. Applicants were asked to complete an online application and supply their curriculum vitae that described all previous school, work, and professional experience. Managers used a 2-interview process to select the final candidates. During the interview process, students were asked about their previous work history and interest in community pharmacy practice. After the interview process, pharmacy management convened to select the most appropriate candidates for a position in the program. After students accepted a position as an intern, they completed processes to become an employee of the company.
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
Pattin et al
3
Discussion Program Activities Students were expected to continually develop their skills throughout the internship in order to be prepared for entrylevel practice in a community pharmacy setting. A variety of skills were introduced and subsequently reinforced throughout the program. For example, P1 students were first introduced to over-the-counter (OTC) medication selection and counseling during week 6 of the program. Throughout the remaining weeks, students were expected to review specific groups of OTC products and make recommendations to patients under the direct supervision of their pharmacy preceptor. P2 students were reintroduced to OTC counseling during week 2 of the internship. The following week, prescription counseling was introduced. Students were then expected to work with the pharmacy preceptor to provide counseling related to OTC and prescription medications throughout the remaining weeks. Graduate interns were expected to provide counseling regarding all therapies with minimal intervention by the precepting pharmacist. Interns were also expected to develop their patient care assessment skills throughout the internship program. P1 and P2 interns conducted blood pressure and blood glucose screenings at their store 4 hours every week. Approximately 2500 screenings were provided during the first summer. P2 and graduate interns were also integral components of the employee biometric screening program. During the 10-week program, interns conducted and provided education (and referrals when necessary) to approximately 500 patients. P1 and P2 interns were required to develop and execute a plan to increase business at 1 pharmacy location. Through this process, students practiced their project management skills, including creating a business plan, developing a realistic timeline, identifying project goals, implementing a project, overcoming unanticipated barriers, and assessing program outcomes. Students also developed practice management skills, such as in the areas of law and ethics, inventory, audits, and record keeping. The program was designed to slowly introduce students to the regulatory aspect of pharmacy. For example, topics discussed with P1 interns included pseudoephedrine sales, controlled substance class V requirements, and refill limits. P2 interns learned about standard operating procedures put forth by the Drug Enforcement Agency (DEA), including short and long audits, and reporting requirements. Inventory control was more fully explored, including returning medications, assessing known loss, and determining physical inventory requirements (which included controlled substances). During the graduate intern period, each intern was required to demonstrate competency in ordering medications and supplies. Additional topics reviewed include inventory goals, pharmacy audits, and workforce scheduling. Finally, students were expected to develop their teamwork skills. This included the ability to interact with other health care professionals as well as coworkers outside the pharmacy department. For example, students participated in daily store
huddles (which included representatives from various departments within the store) and weekly pharmacy manager conference calls. Additional means of communication such as the use of company e-mail and online resources were integrated, particularly during the graduate intern period.
Feedback From Interns Interns were asked to provide feedback about the program. Many mentioned that they would recommend the program to others. They expressed positive remarks about working with the preceptors, learning about the responsibilities of pharmacists and pharmacy managers, and participating in an organized program that provided full-time employment. They also mentioned that they found value in completing biometric screenings and learning about business goals. To improve the program, interns requested more orientation time to learn how to use point of care testing machines and interpret laboratory data. Interns also suggested that internship preceptors undergo training prior to initiating the next class of summer interns. The consistency of experiences varied depending on the interest level of the precepting pharmacist and the level of engagement provided. To increase consistency among preceptors, interns recommended developing a list of OTC topics so all preceptors review similar topics with each intern. Preceptors and management personnel involved in the development, delivery, and assessment of the program plan to incorporate these suggestions in order to improve the program moving forward.
Limitations Limitations were identified during the development and the initiation of the redesigned program. Due to the nature of providing a paid internship experience, the program accepted a limited number of interns. We hope to expand the program in the future to provide the experience for more pharmacy students throughout the state. Because the internship is offered during a limited time on a yearly basis, there is no guarantee that students will return to participate in the program during subsequent summers. Some may choose to seek employment during the school year at another pharmacy, which may limit retention of interested candidates in the grocery store chain. The interest level may decrease if there are no new experiences to offer returning interns. Furthermore, authors lack data that show improvement in knowledge, skills, and attitudes of students from the revised program compared to the original program. After implementing the modified program, authors began to track outcomes and intends to publish these results at a later time.
Next Steps Several steps are planned in order to continue to develop the revised internship program. One concern was whether students would reapply for subsequent summers. As a result, a new
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
4
Journal of Pharmacy Practice
focus for the management project was developed to entice previous interns to reapply for a position. Of note, 6 of the 7 P1 interns from the summer of 2013 returned the following summer as P2 students. Finally, there is lack of a formalized approach to assessment. The literature describes institutional internships that use various assessment techniques such as use of competency checklists, rubrics to evaluate development of assignments, incorporation of a case presentation evaluation tool, and self-reflection.1,4 To improve assessment of our interns, preceptors will be provided a list of competencies at the start of the program and asked to complete it as interns work through learning activities. Participants in the program will be surveyed about their confidence and perceptions of the program at the start of the program and during the conclusions of the program to measure whether the program is effective in this area. Authors also plan to assess and provide feedback on learning throughout the program by holding journal clubs, patient case presentations, and small quizzes during the internship experience. All responses and work completed by the interns will be evaluated to determine the success of the program. The goal is to improve students’ knowledge, skills, and abilities in community pharmacy practice and intern assessment and feedback is a key component to ensure effectiveness of the program for the future.
Conclusion During the summer of 2013, the Michigan division of Kroger implemented a redesigned pharmacy internship program. The new program incorporated a variety of patient care opportunities as well as a consistent schedule so students could learn about pharmacy prescription processing, patient care services,
pharmacy management, project management, and team building in the community pharmacy setting. Future plans include developing assessment tools to evaluate student learning during and at the end of the program. Acknowledgments The contribution of Jim Szyskowski, BSPharm, to the original design of the internship program is acknowledged.
Declaration of Conflicting Interests The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors were employed by the Kroger Company at the time of publication of the article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Skledar SJ, McKaveney TP, Ward CO, et al. Advanced practice internship: experiential learning in a drug use and disease state management program. Am J Pharm Educ. 2006;70(3):68. 2. Nguyen KA, Hart SR, Pidcock KN, et al. Creating learning opportunities for pharmacy students through an observership program. Am J Health Syst Pharm. 2012;69(21):1905-1909. 3. Clark JS. Developing the future of pharmacy through healthsystem pharmacy internship program. Am J Health Syst Pharm. 2007;64(9):952-954. 4. Wallman A, Lindblad AK, Hall S, et al. A categorization scheme for assessing pharmacy student’s levels of reflection during internships. Am J Pharm Educ. 2008;72(1):5.
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
The Redesign of a Community Pharmacy Internship Program
Journal of Pharmacy Practice 1-4 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190014566305 jpp.sagepub.com
Anthony J. Pattin, PharmD1, Sarah E. Kelling, PharmD, MPH, BCACP2, Jim Szyskowski, BSPharm, RPh3, Michelle L. Izor, PharmD3, and Susan Findley, BSPharm, RPh3
Abstract Background: Pharmacy internships provide students with practical experiences that lead to enhancement of clinical skills and personal growth. Objective: To describe the design and implementation of a structured 10-week summer pharmacy internship program in a supermarket chain pharmacy. Methods: The pharmacy leadership team developed and piloted a new format of the pharmacy internship during the summer of 2013. Pharmacy students in professional year 1 (P1), 2 (P2), and 4 (P4) were invited to apply for a paid internship. Pharmacy students were recruited from all colleges of pharmacy in the state of Michigan. The goal of the new program was to create a focused learning opportunity that encouraged students to develop knowledge, skills, and abilities about patient care, pharmacy management, and working within a team. Results: A total of 19 interns were recruited (P1 ¼ 7, P2 ¼ 7, and P4 ¼ 5). Students practiced 40 hours per week and participated in the medication dispensing process and employee biometrics screening program. Interns provided approximately 500 assessments on pharmacy employees and all P1 and P2 interns completed a patient care project. Conclusions: The restructured internship program provided pharmacy students with a 10-week program that exposed them to many aspects of community pharmacy practice. The program needs future refinement and assessment measures to verify interns improve skills throughout the program. Keywords pharmacy internship, community pharmacy, student pharmacists
Introduction Although Doctor of Pharmacy education provides many opportunities for experiential learning, students continue to seek pharmacy internship programs for more exposure to the profession. Internship programs have been shown to maximize learning opportunities by fostering relationships between mentors and students that lead to personal growth.1,2 Furthermore, the longitudinal nature allows concepts to be reinforced in real-world practice settings. Several hospital practice sites described models of structured internship programs for students. Skledar and colleagues created a 3-year pharmacy internship program at the University of Pittsburgh Medical Center (UPMC) to enhance active learning and application of clinical skills.1 A summer program was developed at Johns Hopkins Hospitals, which aimed to expose pharmacy students to various practice settings within a health system.3 Outcomes reported include improved internship satisfaction with experiences, knowledge of health care system processes, and learning of pharmacy practice skills and abilities. These programs provide a model for community pharmacies interested in developing a similar internship program. Historically, the Michigan division of The Kroger Company has offered a traditional internship where students practiced
longitudinally throughout the year. Interns often performed dispensing tasks similar to pharmacy technicians and worked infrequently due to hectic school and examination schedules. Due to inadequate intern experiences, graduate interns and newly licensed pharmacists were not prepared to operate the pharmacy at a high level. This was evident by former interns and newly licensed pharmacists requesting additional time to learn pharmacy processes beyond licensure. It was expected that interns would be comfortable in transitioning to the role of pharmacist since they spent time in the pharmacy during a 2- to 3-year internship; however, interns expressed a lack of comfort and confidence operating the pharmacy. The
1 Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA 2 Department of Clinical, Social, and Administrative Sciences, College of Pharmacy, The University of Michigan, Ann Arbor, MI, USA 3 The Kroger Company of Michigan, Novi, MI, USA
Corresponding Author: Anthony J. Pattin, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, 259 Mack Avenue, Detroit, MI 48201, USA. Email: [email protected]
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
2
Journal of Pharmacy Practice
Table 1. Overview of Key Activities. Activity
P1
P2
P4 graduate intern
Prescription processing functions and patient care services Preparation of medications X X OTC counseling X X Weekly screening day X X Prescription counseling X Patient care assessment Project management Intern project X X Pharmacy management Laws and ethics X X Inventory X X Audits X Record keeping X Team building Orientation X X Daily store huddle X X Weekly pharmacy conference call X X Interorganization communication
a
X X X X
X X X X X X X X
Abbreviation: OTC, over the counter. a All P4 students were considered graduate interns and offered staff pharmacist positions after passing board examinations.
recognition of this gap resulted in an interest in restructuring the program in order to improve the internship experience and outcomes. With input from Kroger leadership and academic stakeholders, the internship was modified with the goal of increasing knowledge, skills, and abilities after participation in the program. In this first article, we describe the redesign of an internship program in the grocery store chain setting. In subsequent articles, we plan to report data on outcomes from the interns that matriculate through the program. To the author’s knowledge, there have been no other published works that describe the intentional restructuring of a community pharmacy internship program.
Methods Program Structure In the original version of the internship program, interns were required to practice a minimum of 1 day per month, and many were not interested in working beyond that threshold. The revised internship program was structured to allow the student pharmacist to perform a variety of activities during the summer months and required 40 hours a week to participate. An overview of key aspects of the program is included in Table 1. The new internship program took place during a 10-week block beginning May 28, 2013. Orientation was provided for the group of interns during the first 2 days of the internship. The first day focused on human resource topics, including company policies and procedures. The second day of orientation focused on patient care processes, including how to use point of care testing systems (ie, glucometers and cholesterol machines) and interpret test results. Interns practiced entering clinically related information into the prescription processing system.
Additionally, interns were trained on all elements of the employee biometric screening program, which involves the assessment of body mass index, tobacco use, blood pressure, cholesterol, and blood glucose. After the orientation process, each intern was assigned to a home store. This was the location where they were to learn the basics of how to operate a pharmacy. Interns were matched to a particular site depending on the pharmacists’ ability to mentor others, including pharmacy technicians, the volume of prescriptions dispensed by the pharmacy, and the level of clinical services offered at the pharmacy. Students were preferentially placed at pharmacies that offered biometric screening services to employees. This provided ample experiences for interns to learn the pharmacy processes, both related to dispensing functions and other patient care services. The pharmacy managers supplied the intern with a weekly schedule that emphasized specific learning activities, such as working in the pharmacy, biometric wellness screenings, and project management on specific days. At various points during the program, the interns met with pharmacy managers and coordinators to learn about human resource responsibilities and management tasks. Although many experiences took place at the home store, students were also assigned to visit different stores to perform biometric screenings. This gave the students an opportunity to work with other pharmacists and to see a variety of ways of approaching patient care in the community pharmacy setting.
Internship Recruitment In the previous version of the internship program, pharmacy students were recruited in a similar fashion to pharmacy technicians. This included recruiting students based on the business needs of a particular location. In the revised program, the recruitment process was modified to attract high-quality students interested in community pharmacy. The business needs of the organization was not a factor in the decision process as a preselected number of positions were created prior to beginning the recruitment process. Students from all colleges of pharmacy in Michigan were invited to apply for a position in the internship program. Recruitment flyers were sent to experiential directors describing the program and the application process. Experiential directors were asked to distribute the flyers to students in the P1, P2, and P4 class. P3 students were excluded as they were completing their Advanced Pharmacy Practice Experience (APPE) rotations during the time of the internship program. Applicants were asked to complete an online application and supply their curriculum vitae that described all previous school, work, and professional experience. Managers used a 2-interview process to select the final candidates. During the interview process, students were asked about their previous work history and interest in community pharmacy practice. After the interview process, pharmacy management convened to select the most appropriate candidates for a position in the program. After students accepted a position as an intern, they completed processes to become an employee of the company.
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
Pattin et al
3
Discussion Program Activities Students were expected to continually develop their skills throughout the internship in order to be prepared for entrylevel practice in a community pharmacy setting. A variety of skills were introduced and subsequently reinforced throughout the program. For example, P1 students were first introduced to over-the-counter (OTC) medication selection and counseling during week 6 of the program. Throughout the remaining weeks, students were expected to review specific groups of OTC products and make recommendations to patients under the direct supervision of their pharmacy preceptor. P2 students were reintroduced to OTC counseling during week 2 of the internship. The following week, prescription counseling was introduced. Students were then expected to work with the pharmacy preceptor to provide counseling related to OTC and prescription medications throughout the remaining weeks. Graduate interns were expected to provide counseling regarding all therapies with minimal intervention by the precepting pharmacist. Interns were also expected to develop their patient care assessment skills throughout the internship program. P1 and P2 interns conducted blood pressure and blood glucose screenings at their store 4 hours every week. Approximately 2500 screenings were provided during the first summer. P2 and graduate interns were also integral components of the employee biometric screening program. During the 10-week program, interns conducted and provided education (and referrals when necessary) to approximately 500 patients. P1 and P2 interns were required to develop and execute a plan to increase business at 1 pharmacy location. Through this process, students practiced their project management skills, including creating a business plan, developing a realistic timeline, identifying project goals, implementing a project, overcoming unanticipated barriers, and assessing program outcomes. Students also developed practice management skills, such as in the areas of law and ethics, inventory, audits, and record keeping. The program was designed to slowly introduce students to the regulatory aspect of pharmacy. For example, topics discussed with P1 interns included pseudoephedrine sales, controlled substance class V requirements, and refill limits. P2 interns learned about standard operating procedures put forth by the Drug Enforcement Agency (DEA), including short and long audits, and reporting requirements. Inventory control was more fully explored, including returning medications, assessing known loss, and determining physical inventory requirements (which included controlled substances). During the graduate intern period, each intern was required to demonstrate competency in ordering medications and supplies. Additional topics reviewed include inventory goals, pharmacy audits, and workforce scheduling. Finally, students were expected to develop their teamwork skills. This included the ability to interact with other health care professionals as well as coworkers outside the pharmacy department. For example, students participated in daily store
huddles (which included representatives from various departments within the store) and weekly pharmacy manager conference calls. Additional means of communication such as the use of company e-mail and online resources were integrated, particularly during the graduate intern period.
Feedback From Interns Interns were asked to provide feedback about the program. Many mentioned that they would recommend the program to others. They expressed positive remarks about working with the preceptors, learning about the responsibilities of pharmacists and pharmacy managers, and participating in an organized program that provided full-time employment. They also mentioned that they found value in completing biometric screenings and learning about business goals. To improve the program, interns requested more orientation time to learn how to use point of care testing machines and interpret laboratory data. Interns also suggested that internship preceptors undergo training prior to initiating the next class of summer interns. The consistency of experiences varied depending on the interest level of the precepting pharmacist and the level of engagement provided. To increase consistency among preceptors, interns recommended developing a list of OTC topics so all preceptors review similar topics with each intern. Preceptors and management personnel involved in the development, delivery, and assessment of the program plan to incorporate these suggestions in order to improve the program moving forward.
Limitations Limitations were identified during the development and the initiation of the redesigned program. Due to the nature of providing a paid internship experience, the program accepted a limited number of interns. We hope to expand the program in the future to provide the experience for more pharmacy students throughout the state. Because the internship is offered during a limited time on a yearly basis, there is no guarantee that students will return to participate in the program during subsequent summers. Some may choose to seek employment during the school year at another pharmacy, which may limit retention of interested candidates in the grocery store chain. The interest level may decrease if there are no new experiences to offer returning interns. Furthermore, authors lack data that show improvement in knowledge, skills, and attitudes of students from the revised program compared to the original program. After implementing the modified program, authors began to track outcomes and intends to publish these results at a later time.
Next Steps Several steps are planned in order to continue to develop the revised internship program. One concern was whether students would reapply for subsequent summers. As a result, a new
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
4
Journal of Pharmacy Practice
focus for the management project was developed to entice previous interns to reapply for a position. Of note, 6 of the 7 P1 interns from the summer of 2013 returned the following summer as P2 students. Finally, there is lack of a formalized approach to assessment. The literature describes institutional internships that use various assessment techniques such as use of competency checklists, rubrics to evaluate development of assignments, incorporation of a case presentation evaluation tool, and self-reflection.1,4 To improve assessment of our interns, preceptors will be provided a list of competencies at the start of the program and asked to complete it as interns work through learning activities. Participants in the program will be surveyed about their confidence and perceptions of the program at the start of the program and during the conclusions of the program to measure whether the program is effective in this area. Authors also plan to assess and provide feedback on learning throughout the program by holding journal clubs, patient case presentations, and small quizzes during the internship experience. All responses and work completed by the interns will be evaluated to determine the success of the program. The goal is to improve students’ knowledge, skills, and abilities in community pharmacy practice and intern assessment and feedback is a key component to ensure effectiveness of the program for the future.
Conclusion During the summer of 2013, the Michigan division of Kroger implemented a redesigned pharmacy internship program. The new program incorporated a variety of patient care opportunities as well as a consistent schedule so students could learn about pharmacy prescription processing, patient care services,
pharmacy management, project management, and team building in the community pharmacy setting. Future plans include developing assessment tools to evaluate student learning during and at the end of the program. Acknowledgments The contribution of Jim Szyskowski, BSPharm, to the original design of the internship program is acknowledged.
Declaration of Conflicting Interests The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors were employed by the Kroger Company at the time of publication of the article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Skledar SJ, McKaveney TP, Ward CO, et al. Advanced practice internship: experiential learning in a drug use and disease state management program. Am J Pharm Educ. 2006;70(3):68. 2. Nguyen KA, Hart SR, Pidcock KN, et al. Creating learning opportunities for pharmacy students through an observership program. Am J Health Syst Pharm. 2012;69(21):1905-1909. 3. Clark JS. Developing the future of pharmacy through healthsystem pharmacy internship program. Am J Health Syst Pharm. 2007;64(9):952-954. 4. Wallman A, Lindblad AK, Hall S, et al. A categorization scheme for assessing pharmacy student’s levels of reflection during internships. Am J Pharm Educ. 2008;72(1):5.
Downloaded from jpp.sagepub.com at UCSF LIBRARY & CKM on January 22, 2015
