Introductory Pharmacy Practice Experiences (IPPE)

Level 1: Learner is permitted to observe only. Even with direct supervision, the learner is not entrusted to perform the activity or task.

Level 2: Learner is entrusted to perform the activity or task with direct and proactive supervision. Learners must be observed performing tasks in order to provide immediate feedback.

Level 3: Learner is entrusted to perform the activity or task with indirect and reactive supervision. Learners can perform task without direct supervision but may request assistance. Supervising pharmacist is quickly available on site. Feedback is provided immediately after completion of an activity or task.

Level 4: Learner is entrusted to perform the activity or task with supervision at a distance. Learners can independently perform tasks. Learner meets with supervising pharmacist at periodic intervals. Feedback is provided regarding overall performance based on sample work.

Level 5: Learner is entrusted to independently decide what activities and tasks need to be performed. Learner is entrusted to direct and supervise the activities of others. Learner meets with supervising pharmacist at periodic intervals. Feedback is provided regarding overall performance based on broad professional expectations and organizational goals.

1. Collect information necessary to identify a patient's medication-related problems and health-related needs.
a. Example Tasks:
i.      Collect a history from a patient or caregiver.
ii.     Collect a medication history from a patient or caregiver.
iii.    Collect a patient's experience with medication.
iv.    Collect information related to barriers for patients to take their medication(s).
v.     Collect objective information from the patient (e.g., physical exam, point of care testing).
vi.    Collect data from a patient's electronic health, digital health, or medication record.

2. Assess collected information to determine a patient's medication-related problems and health-related needs.
a. Example Tasks:
i.       Assess the indication of the medication treatment plan.
ii.      Assess the safety of the medication treatment plan including drug interactions.
iii.      Assess the effectiveness of medication treatment plans, including existing, previous, and new medications.
iv.      Assess the alignment of the medication plan with the patient's goals, needs, abilities, values, and beliefs.
v.       Assess the relative priority of each health-related need of the patient to create a prioritized problem list.
vi.      Assess if a patient requires a referral for their health-related needs.
vii.     Assess whether a patient is eligible for CDC-recommended immunizations.

3. Create a care plan in collaboration with the patient, others trusted by the patient, and other health professionals to optimize pharmacologic and nonpharmacologic treatment.
a. Example Tasks:
i.       Create person-centered treatment goals.
ii.      Create a prioritized list of evidence-based and patient-centered treatment options to discuss with members of the healthcare team/patient/caregiver(s).
iii.      Create a person-centered treatment plan.
iv.      Create a plan to mitigate the risk of drug interactions and polypharmacy.
v.       Create a treatment plan that incorporates potential strategies to minimize cost for the patient, such as formulary review, patient assistance programs, medication discount programs.
vi.      Create a plan to monitor the safety and efficacy of the treatment plan.
vii.     Create an individualized education plan for the patient and/or caregiver.

4. Contribute patient specific medication-related expertise as part of an interprofessional care team.
a. Example Tasks:
i.       Explain a pharmacist's role and responsibilities to a healthcare team.
ii.      Apply the PPCP as a member of an interprofessional team Communicate a patient's medication-related problem(s) to the healthcare team.
iii.     Provide recommendations to the health care team to resolve and/or monitor medication- related problems.
iv.     Provide evidence-based drug information to the health care team.

5. Answer medication related questions using scientific literature.
a. Example Tasks:
i.      Ask clarifying questions to identify and address the true question.
ii.     Perform a systematic search of tertiary, secondary, and primary resources.
iii.    Identify and retrieve high-quality scientific literature.
iv.    Analyze scientific literature.
v.     Provide a written or verbal response to the true question, including findings and recommendations.

6. Implement a care plan in collaboration with the patient, others trusted by the patient, and other health professionals.
a. Example Tasks:
i.      Initiate, modify, or discontinue medication therapy Present necessary information to a colleague during a handoff or transition of care.
ii.     Schedule follow-up care as needed (e.g., labs or tests, follow-up appointments).
iii.    Document the findings, recommendations, plan, and pharmacy services provided.
iv.    Discuss the care plan with a patient and/or others trusted by the patient.

7. Fulfill a medication order.
a. Example Tasks:
i.      Enter an order or prescription into an electronic health or pharmacy record system.
ii.     Perform calculations required to compound, dispense, and administer medications.
iii.    Perform a prospective drug utilization review.
iv.    Adjudicate a third-party claim.
v.     Identify and manage drug therapy problems.
vi.    Consider formulary preferred medications when making recommendations.
vii.   Complete an authorization process for a non-preferred medication.
viii.   Assist a patient to acquire medication(s) through support programs.
ix.     Prepare non-sterile and/or sterile medications.
x.      Perform a quality assurance check on prepared medications prior to dispensing.
xi.     Dispense and administer a product including injectable medications and immunizations.
xii.    Adhere to state and federal laws/regulations and site quality and safety procedures.

8. Educate the patient and others trusted by the patient regarding the appropriate use of a medication, device to administer a medication, or self-monitoring test.
a. Example Tasks:
i.       Provide education and self-management training to the patient or caregiver.
ii.      Assess the learning needs of a patient and others trusted by the patient.
iii.     Select a method for providing education in the given environment.
iv.     Actively engage the patient in the education session. Identify, select, or develop supportive education materials (e.g., written, models, demonstration devices, videos).
v.      Adapt the terminology and verbal delivery of information.
vi.     Determine the effectiveness of education provided by assessing a patient's understanding and/or their ability to demonstrate the technique.
vii.    Reinforce key points, correct misunderstandings, or address gaps with the patient as needed.

9. Monitor and evaluate the safety and effectiveness of a care plan.
a. Example Tasks:
i.     Collect monitoring data at the appropriate time interval(s).
ii.    Evaluate the selected monitoring parameters to determine the therapeutic and adverse effects related to the treatment plan.
iii.    Recommend modifications or adjustments to an existing medication therapy regimen based on patient response.

10. Report adverse drug events and/or medication errors in accordance with site specific procedures.
a. Example Tasks:
i.     Identify factors of system(s) (e.g., personnel, infrastructure, interfaces) associated with errors or risk of errors.
ii.    Determine points of intervention within system(s) to prevent or minimize medication- related errors.
iii.    Report and document adverse drug events and medication errors to stakeholders.

11. Deliver medication or health-related education to health professionals or the public.
a. Example Tasks:
i.      Lead a discussion regarding published primary literature and its application to patient care (e.g., journal club).
ii.      Develop and deliver a verbal, digital, or written medication or health-related educational program to health professional(s), a community, or other groups.
iii.     Give a brief (~ 10 minutes) drug presentation to the pharmacy and/or medical team. Consider using new drug information as the topic.

12. Identify populations at risk for prevalent diseases and preventable adverse medication outcomes.
a. Example Tasks:
i.      Perform a screening assessment to identify patients at risk for prevalent diseases in a population and triage, when needed.
ii.      Evaluate individual and/or aggregated patient data to determine patients or populations at risk for a disease.

13. Perform the technical, administrative, and supporting operations of a pharmacy practice site.
a. Example Tasks:
i.      Execute pharmacy policies and procedures.
ii.     Delegate work activities to pharmacy team members.
iii.    Provide formative feedback on pharmacy team dynamics, workflow, processes, and operations.
iv.    Manage pharmacy workflow to ensure efficiency and safety.
v.     Use technology to support the pharmacy workflow.
vi.    Execute pharmacy quality improvement activities.
vii.    Procure inventory to ensure continued pharmacy operations.
viii.    Prepare for regulatory visits and inspections.

IPPE Community, Hospital/Health Systems, and Ambulatory Care assess on Educational Outcomes 1-12.

1. Learner: Seek, analyze, integrate, and apply foundational knowledge of medications and pharmacy practice (biomedical; pharmaceutical; social, behavioral, administrative; and clinical sciences; drug classes; and digital health.

i. Foundational knowledge – outlined in ACPE Appendix 1 and include the biomedical, pharmaceutical, social/behavioral/administrative, and clinical sciences as they pertain to the practice of pharmacy.

ii. Biomedical sciences – the preprofessional sciences (e.g., chemistry, physics, biology) and biomedical (e.g., anatomy, physiology, biochemistry, immunology, biostatistics).

iii. Pharmaceutical sciences – The pharmaceutical sciences build on principles introduced in the preprofessional biomedical sciences including pharmaceutics/biopharmaceutics, pharmacokinetics, pharmacology, toxicology, pharmacogenomics, medicinal chemistry, clinical chemistry, pharmaceutical calculations, and pharmaceutical compounding, which are taught in the professional pharmacy curriculum and collectively explain drug and/or drug product formulation, delivery, stability and action.

iv. Social, behavioral, administrative sciences - the disciplines and concepts of public health, epidemiology, economics, financial management, health behavior, outcomes, research methods, law and ethics, healthcare administration, management, and operations, marketing, communications, medication distribution systems taught within the professional pharmacy curriculum.

v. Clinical sciences - the areas of the professional pharmacy curriculum focused on the integration and application of the biomedical, pharmaceutical, and social/behavioral/ administrative sciences to improve the human condition through the safe and efficacious use of medications.

vi. Digital health –digital technologies that improve health and includes categories such as mobile health, health information technology, wearable devices, telehealth and telemedicine, personalized medicine, and tools such as mobile health apps and software.

2. Problem solver: Use problem solving and critical thinking skills, along with an innovative mindset, to address challenges and to promote positive change.

i. Problem-solving skills: Identify and define problems that have multiple considerations (and possibly more than 1 viable solution); explore and prioritize potential strategies; compare and contrast potential solutions; design and evaluate implemented solutions using evidence and/or rationale and anticipate and reflect on outcomes.

ii. Critical thinking - evaluating conclusions by systematically examining the problem, evidence, & solution. It includes 6 core skills including interpretation, analysis, evaluation, inference, explanation, and self-regulation.

iii. Innovative mindset - a set of beliefs that includes being forward-thinking, creative, open to testing, comfortable making mistakes and trying again; collaborative and focused on progress that allows a person to generate creative or novel solutions to problems that result in improved performance.

3. Communicator: Actively engage, listen, and communicate verbally, nonverbally, and in writing when interacting with or educating an individual, group, or organization.

i. Communication: Communication is the exchange of information between patients, health care providers, and others that involves skills such listening, speaking, writing, observing nonverbal communication, decoding messages, giving and receiving feedback, and empathizing.

ii. Educating: Educating focuses how to package, deliver, coach, and assess individuals to increase their ability to learn, retain, access, and use knowledge. Educating involves teaching methods, instructional strategies, individual differences, and assessment techniques.

4. Ally: Mitigate health disparities by considering, recognizing, and navigating cultural and structural factors (e.g. social determinants of health, diversity, equity, inclusion, and accessibility) to improve access and health outcomes.

i. Cultural humility – Ability to recognize one's own limitation in order to avoid making assumptions about other cultures, admitting that one does not know and is willing to learn from patients/person/client/consumer/community about their experiences, while being aware of one's own embeddedness in culture(s).

ii. Structural humility - The capacity of health care professionals to appreciate that their role is not to surmount oppressive structures but rather to understand knowledge and practice gaps vis-a`-vis structures, partner with other stakeholders to fill these gaps, and engage in self-reflection throughout these processes.

iii. Health disparities - preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.

iv. Navigating – strategies provided by individuals or teams that reduce barriers to care.

v. Structures – The policies, economic systems, and other institutions (policing and judicial systems, schools, etc.) that have produced and maintain social inequities and health disparities, often along the lines of social categories such as race, class, gender, and sexuality.

vi. Structural competency – The trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication “non-compliance”, trauma, psychosis) also represent the downstream implications of several upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health.

vii. Social determinants of health – conditions in the environments where people are born, live, work, play, age, and worship that affect a wide range of health, functioning, and quality of life outcomes and risks. There are 5 key domains: social and community context, education, neighborhood and built environment, health and health care, and economic stability.

5. Provider: Provide whole person care to individuals as the medication specialist using the Pharmacists’ Patient Care Process.

i. Person-centered care – A holistic approach to use with patients to be more inclusive. A broadened definition of patient-centered care that extends the concept beyond clinical care where health‐care providers are encouraged to partner with patients, families, and caregivers, to co‐design and deliver personalized care, including prevention and promotion activities, that provides people with the high‐quality care they need and improves health‐care system efficiency and effectiveness.

ii. Whole person care- Whole person health involves looking at the whole person—not just separate organs or body systems—and considering multiple factors that promote either health or disease. It means helping and empowering individuals, families, communities, and populations to improve their health in multiple interconnected biological, behavioral, social, and environmental areas.

iii. Patient – An individual who interacts with a clinician either because of real or perceived illness, for health promotion and disease prevention and/or to meet social needs.

iv. Medication Specialist – During the PharmD program students develop specialized knowledge in the safe and effective use of medications. However, a PharmD curriculum does not provide sufficient deliberate practice with focused feedback to achieve expert- level performance. We expect they will continue to develop expertise after graduation.

v. Pharmacist’s Patient Care Process (PPCP) – a consistent process for the delivery of patient care across the profession that is applicable to any setting where pharmacists provide care and for any patient care service provided by pharmacists. The process includes collect, assess, plan, implement, and follow-up.

6. Advocate: Promote the best interests of patients and/or the pharmacy profession within healthcare settings and at the community, state, or national level.

i. Advocacy – The process by which the actions of individuals or groups attempt to bring about social and/or organizational change on behalf of a particular health goal, program, interest, or population.

7. Steward: Optimize patient healthcare outcomes using human, financial, technological, and physical resources to improve the safety, efficacy, and environmental impact of medication use systems.

i. Optimize medications - Occurs when there is a blend between: 1) developing an optimal medication regimen, that is appropriate for the patient, effective for the medical condition, evidence-based, cost effective, and safe for the patient to use; and 2) using shared decision making: a person-centered approach that incorporates the patient’s needs, abilities, values, and beliefs, and taking steps to ensure the medication can be properly used in the setting it will be administered.

ii. Medication Use System/Process - A complex process comprised of medication prescribing, order processing, dispensing, administration, and effects monitoring (e.g., intended or unintended effects).

8. Collaborator: Actively engage and contribute as a healthcare team member by demonstrating core interprofessional competencies.

i. Population-based care - A comprehensive care approach where practitioners assess the health needs of a specific population, implement, and evaluate interventions to improve the health of that population, and provide care for individual patients in the context of the culture, health status, and health needs of the populations of which that patient is a member.

9. Promoter: Assess factors that influence the health and wellness of a population and develop strategies to address those factors.

i. Population-based care - A comprehensive care approach where practitioners assess the health needs of a specific population, implement and evaluate interventions to improve the health of that population and provide care for individual patients in the context of the culture, health status, and health needs of the populations of which that patient is a member.

10. Leader: Demonstrate the ability to influence and support the achievement of shared goals on a team, regardless of one’s role.

i. Leadership - Leadership is a function of knowing yourself, creating a culture of trust and open communication, having a vision that is well communicated, empowering others, taking a broad view of situations, and forming strategic alliances. Leaders are compared to managers where there are some subtle differences. Managers are responsible for identifying, implementing, and overseeing resources to effectively accomplish specific projects or processes.

11. Self-aware: Examine, reflect on, and address personal and professional attributes (e.g., knowledge, metacognition, skills, abilities, beliefs, biases, motivation, help-seeking strategies, and emotional intelligence that could enhance or limit growth, development, & professional identity formation).

i. Metacognition – a type of cognition that regulates thinking and learning and consists of 3 self-assessment skills including planning, monitoring, and evaluating.

 ii. Help seeking – Assessing needs and finding assistance when a deficit is identified that is associated with academic success. Behaviors may include seeking professional counseling, meditating, exercising, or engaging in the arts.

iii. Emotional intelligence – The ability to identify and manage one’s own emotions, as well as the emotions of others. It includes the skills of emotional awareness, or the ability to identify and name one’s own emotions; the ability to harness those emotions and apply them to tasks like thinking and problem solving; and the ability to manage emotions, which includes both regulating one’s own emotions when necessary and helping others to do the same.

iv. Professional Identity Formation – Involves internalizing and demonstrating the behavioral norms, standards, and values of a professional community, such that one comes to “think, act and feel” like a member of that community. Professional identity influences how a professional perceives, explains, presents, and conducts themselves.

12. Professional: Did the student exhibit attitudes and behaviors that embody a commitment to building and maintaining trust with patients, colleagues, other health care professionals, and society.

i. Professionalism – Includes the elements of adherence to ethical principles, effective interactions with patients and with people who are important to those patients, effective interactions with other people working within the health system, reliability, and commitment to autonomous maintenance and continuous improvement of competence and citizenship and professional engagement.

 ii. Oath of a Pharmacist was revised in 2021.

13. Professional Skills and Attitudes: Activities and experiences, intended to advance professional, personal, and career development, are purposely designed and implemented to ensure an array of opportunities for students to document competency of advocacy, self-awareness, leadership, and professionalism. These activities complement and advance the learning that occurs within the formal curriculum and can occur, outside, alongside, and/or within the curriculum.

14.  Team: Demonstrates the ability to influence and support the achievement of shared goals with others or in a team.

15. Diversity: Develop strategies to actively promote inclusivity, equity, and social justice in academic and professional environments.

16. Outcomes: The student achieved the learning objectives and/or goals of the rotation that were discussed at the beginning of the rotation.

Does Not Meet Expectations (1): The performance falls significantly below the expected standards for the professional year. There are numerous errors or deficiencies in understanding, execution, or completion of the task. The work does not meet the basic requirements and demonstrates a lack of effort or comprehension.

Approaches Expectations (2): The performance partially meets the expected standards for the professional year. There are some errors or deficiencies in understanding, execution, or completion of the task. While aspects of the work may be satisfactory, overall, it falls short of meeting all requirements and demonstrates room for improvement.

Meets Expectations (3): The performance meets the expected standards for the professional year. It demonstrates a solid understanding and execution of the task with minimal errors or deficiencies. The work meets all requirements and may also include additional elements that enhance its quality and completeness.

Exceeds Expectations (4): The performance goes above and beyond the expected standards for the professional year. It demonstrates a thorough understanding and exceptional execution of the task with no significant errors or deficiencies. The work not only meets all requirements but also includes additional elements that significantly enhance its quality, creativity, and/or innovation.