What does it really mean to be “APPE ready?” 

By: Kylie Lang, PharmD Candidate 2024, Lindsey Ferraro, PharmD, BCPS, and David Nau, PhD, RPh, FAPhA 

Are students truly ready for APPEs?

Many Colleges of Pharmacy determine a student’s “Advanced Pharmacy Practice Experience (APPE) readiness” by performance on knowledge-based assessments, such as the Pharmacy Curriculum Outcomes Assessment (PCOA), the forthcoming North American Pharmacist Licensure Examination (NAPLEX) Advantage, or course grades. While these standards have been the mainstay of assessment, the question arises, is performance on multiple choice exams a true representation of APPE readiness?  Should greater emphasis be placed on “soft skill” assessments? In this article, we discuss limitations of knowledge-focused evaluations of readiness and call for greater attention to skills assessments.  

What’s the problem?

From a pharmacy student’s perspective, APPEs are exciting yet many students fear being underprepared.  A recent study in the American Journal of Pharmaceutical Education (AJPE) examined student perspective on readiness. Preceptors found variable levels of student confidence in their interpersonal and interprofessional knowledge and skills prior to starting APPEs across three themes:  

• Learner characteristics: incorporates personal characteristics and foundations in clinical knowledge; student’s ability to complete tasks and communicate with others; self-awareness and professionalism
• Relationship-building: student’s ability to engage in relationships with patients, health care providers and preceptors 
• Participation in workplace activities: encompasses workplace environment behavior, expectations, and engagement; recognition of their role as a student in the workplace

The challenge becomes how to best incorporate and assess these themes in the curriculum prior to APPEs.¹ 

Why should skills be evaluated?

Many skills are required to be an effective and attentive pharmacist, yet some may be harder to measure on a multiple choice exam. An example is empathy in communication (ACPE Standard 3.6). One study showed a positive correlation between empathy and patient satisfaction, adherence and treatment outcomes.² Students’ levels of empathy can be influenced by pharmacy education interventions incorporated into the curriculum.²  A second example is personal and professional development, especially self-awareness (ACPE Standard 4.1). A study published in AJPE found that students tend to underestimate their own knowledge and academic performance. Self-assessment is necessary for students to better understand their strengths and weaknesses related to clinical and interpersonal skills.³ We believe pharmacy curricula should allow the flexibility to focus more heavily on interpersonal skills as a measure of  APPE preparedness. 

Next steps:

During my tenure at ONU, I have had the opportunity to engage in “assessment days” each semester that are specifically focused on skills such as communication, problem solving, and self-awareness. Assessment days are structured similarly to an Objective Structured Clinical Examination (OSCE) and focus on the evaluation of clinical skills. They occur alongside the curriculum and are not a graded activity for any particular course, rather they provide students with formative feedback in the fall and summative feedback in the spring. During our assessment days, students are placed in a simulated pharmacy situation wherein an evaluator assesses their performance on different key elements. These assessment days have allowed me to practice applying my skills in scenarios that I may be faced with during APPEs, while also allowing me to self-reflect on areas of improvement. Assessment scenarios may range from direct physical assessment skills to patient interactions focused on communication to interprofessional team based interactions. We believe these assessment day activities, OSCEs, select entrustable professional activities (EPAs), or other situational judgment tests (SJTs), are a more realistic and accurate portrayal of APPE readiness. From a student perspective, I believe the elements in Table 1 should be evaluated through skill-based assessments every semester to complement the knowledge-based multiple choice exams. 

ACPE Key Elements5	Potential Assessment Components
Problem Solving (3.1)	Identify problems, develop a solution, create a plan of action
Patient Advocacy (3.3)	Listen with a goal to understand, acknowledge a patient’s feelings, set a best course of action based on patient preference
Communication (3.6)	Self-Introduction, effective listening, appropriate response
Self awareness (4.1)	Assess challenges, reflect on positives and negatives of interaction, develop a plan for future interactions.
Professionalism (4.4)	Professional dress, professional tone of voice, professional demeanor

Final Remarks:

Assessment of interpersonal and clinical skills can lead to a better evaluation of APPE readiness. With the evaluation of five key elements, students can have a better perception of their own readiness and be able to reflect on their own skills gaps. The addition of simulations for skills assessments will allow students to more realistically practice and build common workplace skills such as their learner characteristics, relationship-building, and participation in workplace activities to ensure APPE readiness. So, how are you currently assessing these 5 key elements in your pharmacy curriculum? Are they skill-based assessments? Are your students truly ready for APPEs?

References

1. Gruenberg, K., Hsia, S., O’Brien, B., & O’Sullivan, P. (2021). Exploring Multiple Perspectives on Pharmacy Students’ Readiness for Advanced Pharmacy Practice Experiences. American journal of pharmaceutical education, 85(5), 8358. https://DOI: https://doi.org/10.5688/ajpe8358
2. Ratka A. (2018). Empathy and the Development of Affective Skills. American journal of pharmaceutical education, 82(10), 7192. https://doi.org/10.5688%2Fajpe7192
3. Abeyaratne, C., Nhu, T., & Malone, D. (2022). Self-Assessment of Therapeutic Decision-Making Skills in Pharmacy Students. American journal of pharmaceutical education, 86(4), 8696. DOI: https://doi.org/10.5688/ajpe8696
4. Andrews, L. B., Cardinale, M., & Dixit, D. (2020). Integrating high fidelity patient simulation into a skills-based doctor of pharmacy curriculum: A literature review with focus on the bedrock pilot course. Currents in pharmacy teaching & learning, 12(11), 1320–1328. https://doi.org/10.1016/j.cptl.2020.06.008
5. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the Doctor of Pharmacy degree: “Standards 2016”. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf 

---

Author Bio(s): 

---

Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning