Objective. To understand technicians’ attitudes toward teaching student pharmacists and students’ attitudes toward learning from technicians.
Methods. Survey data concerning technicians’ perceived importance of pharmacy skills and their confidence in teaching those skills to student pharmacists were collected, as was survey data concerning students’ comfort level with learning skills from technicians. Skills included in each survey aligned with common student pharmacist competencies and the pharmacy technician certification examination.
Results. Fifty-eight (92.1%) responses were received from technicians and 141(97.9%) student survey instruments were returned. The skills that pharmacy technicians perceived to be most important and felt most comfortable teaching included filling a prescription and communicating effectively with patients. With the exception of communication, these skills also aligned with what the students were most comfortable learning from technicians.
Conclusions. Student pharmacists have learning goals that align with the daily tasks of pharmacy technicians. The survey results highlight areas in which technicians could be used to educate student pharmacists.
Keywords: introductory pharmacy practice experiences, pharmacy technicians, survey
In 2007, the Accreditation Council for Pharmacy Education (ACPE) instituted new standards to guide pharmacy curricula, which included a minimum of 300 hours of introductory pharmacy practice experiences (IPPEs) to occur in the first 3 years.1 This new requirement significantly increased the number of student pharmacists doing early practice experiences in hospital and community pharmacies. The goal of IPPEs is to provide student pharmacists opportunities to explore different career paths, apply knowledge learned in the didactic setting to real-world situations, and increase their ability and confidence before entering advanced pharmacy practice experiences in their fourth year.
Several of the competencies from the Center for Advancement of Pharmacy Education for student pharmacist on IPPEs align with distributive functions (Table 1).2 As pharmacists move toward providing pharmaceutical care and spending more of their time identifying and resolving drug-therapy problems and counseling patients, pharmacy technicians are positioned to teach distributive competencies. Efforts are under way by the Pharmacy Technician Certification Board (PTCB), American Society of Health-System Pharmacists (ASHP), and many state boards of pharmacy to ensure consistent training among technicians. ASHP has developed a Model Curriculum for the training of pharmacy technicians, but it does not mention their role as educators and is not yet mandatory.3 Based on this model, we can justify that several of the competencies of early student experiences fall within the professional responsibilities of a technician; however, little of the professional literature assesses technicians’ motivation and confidence regarding teaching these skills or student pharmacists’ receptiveness to it.
Distributive Competencies From the Center for Advancement of Pharmacy Education2
The 55-item technician survey instrument was developed to gather data about demographics, working environments, technician-perceived importance of specific skills and tasks, and confidence in ability to teach those tasks to IPPE students. The 35-item student pharmacist survey instrument was designed to collect information pertaining to experience working as a technician, experience with technicians while on IPPEs, comfort level learning specific tasks from pharmacy technicians, and top items students would like to learn from a pharmacist while on IPPEs. To solicit the tasks that students had learned from technicians and what they would like to learn from pharmacists, the survey allowed them to manually enter up to 3 additional items.
For both survey instruments, items soliciting attitudinal information were collected using a 5-point Likert scale, ranging from strongly disagree to strongly agree.4 A 5-point scale was selected based on a consensus that having 5 response options allows respondents a sufficiently wide range of intensities from which to choose.5
Demographic variables were collected using dichotomous responses, multiple-response items, and fill-in-the-blank statements. Data included gender, age, experience as a technician, whether they were certified by PTCB, and for the technician survey, whether their worksites host pharmacy students.
On both survey instruments, the sections pertaining to specific skills and tasks mirrored the types of basic knowledge functions that are represented on the Pharmacy Technicians Certification Examination (PTCE).6 Variables were drawn from all 3 areas of this examination: assisting the pharmacist in serving patients, maintaining medication and inventory control systems, and participating in the administration and management of pharmacy practice.
After the first draft of the student survey instrument was created, a focus group of 5 students was convened to ensure the survey was clear, comprehensive, and acceptable. After the focus group had reviewed the survey instrument, several revisions were made before the final version was distributed. This study received institutional review board exemption prior to data collection.
Study participants were considered a convenience sample. Technicians attending the 2009 annual meeting of the American Association of Pharmacy Technicians were invited to participate. Paper survey instruments were distributed to the 43 attendees prior to a presentation on their role in experiential education. An additional 20 survey instruments were distributed to technicians in the community pharmacy environment to ensure this group was adequately represented. The student survey instrument was distributed during the fall 2010 orientation to 144 students starting their second or third year of the doctor of pharmacy (PharmD) degree program. At this point in the curriculum, the second-year students had completed 1 semester of IPPEs focusing on distributive functions in either the hospital or retail setting. The third-year students had completed 3 semesters: 2 in the community setting and 1 in the hospital setting. A response rate of at least 50% was desired.5
All analyses were done using SPSS,Version 15.0 for Windows. As a quality-control measure, a codebook was used for data entry and organization.5 After the data were collected, a randomly selected sample (10%) of the papers was checked for errors. Responses to open-ended questions were scanned to identify frequently recurring answers. In the codebook, major groups of responses were assigned a number. For responses that did not fall into 1 of the listed categories, a category of “other” was used. Frequencies were calculated for descriptive items. Variables that were measured as continuous data were converted to ordinal data because statistical procedures are not commonly used to compare an ordinal dependent variable with a continuous independent variable.7 Spearman's rho (ρ) was calculated to assess correlation between variables. To determine how much variance, r values were used to calculate the coefficient of determination for the 2 variables. The Mann-Whitney U test was used to compare mean rankings between groups. In these cases, z values were used to calculate an approximate value of r. R values were interpreted as follows: small correlation (0.10 – 0.29), medium correlation (0.3 – 0.49), and large correlation (0.5 – 1.0).8 These guidelines are also appropriate to interpret r values for mean differences.8 Significance was set a priori at <0.05.
For missing data, the SPSS option “excluded cases pairwise” was used so that survey instruments with missing data were excluded only if they were missing the data required for the specific analysis. To test the survey's internal consistency, the Cronbach α was calculated for each section of the survey instrument. A minimum level of 0.7 was considered an appropriate level of reliability.
On the technician survey instrument, the sections on working conditions, perceived importance of skill, and confidence to teach a specific skill achieved a Cronbach α of 0.899, 0.857, and 0.925, respectively. The Cronbach α for the section of the student survey pertaining to comfort learning specific tasks was 0.886. These results indicate that the items on both survey instruments measured the same underlying attribute and were internally consistent and reliable.
Fifty-eight (92.1%) of the 63 technician survey instruments distributed were returned. Demographic and work characteristics are provided in Tables 2 and 3, and frequencies calculated for responses in the 3 sections of the technician survey are presented in Tables 4, 5, and 6. There was a moderate positive correlation between perception of adequate training and overall comfort with teaching others in the workplace (ρ = 0.477, n = 56, P = 0.001). Perception of adequate training helps explain 23% of the variance in respondents’ rating of their level of comfort with teaching. There was either a moderate or large positive correlation between perceived level of importance of a specific task and the confidence to teach that task, except for filling a prescription (ρ = 0 .277, n = 53, P = 0.102).
Demographics of Pharmacy Technicians Who Responded to a Survey Regarding Their Role as Instructors for Student Pharmacists (n = 58)
Work History of Pharmacy Technicians Who Responded to a Survey Regarding Their Role as Instructors for Student Pharmacists
Pharmacy Technicians’ Perceptions of Working Conditions, No. (%)
Pharmacy Technicians’ Perceptions About the Importance of Specific Skills, No. (%)
Technicians’ Confidence in Teaching Student Pharmacists Specific Skills, No. (%)
One hundred forty-one (97.9%) of the 144 student survey instruments were returned (Table 7). The average student age was 26 years. For students with experience as a technician, 42 (56%) indicated that they played a role in educating student pharmacists during that time. One hundred thirty-three (94.3%) students believed that pharmacists need to have the knowledge and skills to perform distributive functions in the retail setting even if the profession moves toward an emphasis on providing pharmaceutical care.
Characteristics of Student Pharmacists Who Responded to a Survey Regarding Pharmacy Technicians as Instructors (N = 141)
Table 8 lists the top 5 tasks that students reported being most comfortable and least comfortable learning from pharmacy technicians. Students who had completed 3 semesters of IPPEs were more comfortable learning the following from technicians: how to fill a prescription (U = 1944, z = -0.606, P = 0.026, r = -0.05), determining prescription cost (U = 1974, z = -2.068, P = 0.039, r = -0.17), and taking a refill request from a patient (U = 2009, z = -2.395, P = 0.017, r =-0.20). There was no significant difference between the 2 classes’ comfort levels for other tasks.
Top 5 Tasks Student Pharmacists Were Most and Least Comfortable Learning from Technicians
There were no significant differences in comfort level associated with learning from a technician between students with experience as a technician and those with no experience, with the exception of operating a cash register (U = 1089, z = -2.068, P = 0.039, r = -0.17). Students who obtained certification from the PTCB were more comfortable learning how to take a refill request from a patient (U = 2000.5, z = -2.282, P = 0.023, r = -0.19) and how to solve conflicts with patients (U = 1636, z = -3.336, P = 0.001, r = -0.28) from technicians than were those who had technician experience but did not have PTCB certification.
Students who had spent a significant amount of time with technicians during the first semester of IPPE were more comfortable learning how to determine insurance eligibility (ρ = 0.211, n = 141, P = 0.012), inventory ordering needs (ρ = 0.226, n = 141, P = 0.007), and solving conflict with patients (ρ = 0.219, n = 140, P = 0.009) from technicians than were students who had spent little time with technicians.
Students who had spent a significant amount of time with technicians during the second semester of IPPE were more comfortable learning the following tasks from a technician: how to take a refill request from a patient, how to fill a prescription, how to determine prescription cost, how to determine ordering needs, how to check in an order once it was received, how to use the computer system, how to stock the shelves, and how to maintain inventory records.
Students were asked to list the most significant tasks they learned from technicians while on IPPEs. The top answers are provided in Table 9. Examples of comments that fell into the “other” category were operating the cash register, printing labels, and decreasing dispensing errors.
Most Significant Tasks Student Pharmacists Felt They Learned From Technicians While on Practice Experiences
Students with technician experience who had the responsibility of educating student pharmacists were no more comfortable learning from technicians than were those without that experience. Students who indicated that they did not feel comfortable learning from a technician cited the following reasons: they were training to become pharmacists and, therefore, felt they should learn from pharmacists (n = 59, 41.8%), they had reservations about technicians’ abilities (n = 52, 36.9%), and they felt the technicians would have a hard time adding teaching to their normal routine (n = 17, 12.8%).
In response to being asked which tasks they wanted to learn from a pharmacist while on IPPEs, a majority of students cited performing a drug-use review (n = 129, 91.5%), followed by verifying the correctness of a filled prescription (n = 112, 79.4%). Sixteen students entered additional tasks they wanted to learn, of which the most commonly cited were communication skills (n = 5, 31.3%) and how to conduct medication therapy management sessions (n = 2, 12.5%).
According to the technicians surveyed, the skills perceived to be the most important were filling prescriptions, entering a new prescription into the computer, and communicating effectively with patients. These skills coincide with those the technicians felt most comfortable teaching. A majority felt comfortable learning these tasks from technicians, with the exception of communication skills, which 25% reported they would not be comfortable learning from technicians. One reason for this difference may be the various types of information generally communicated by each. Technicians tend to focus on questions relating to prescription preparation and insurance, while pharmacists focus on medications and disease states.
The tasks technicians felt least comfortable teaching student pharmacists included communicating with insurance companies, determining cost and reimbursement, and clarifying a prescription with a physician. Possibly, this is because expertise in these tasks comes with time as one learns the nuances of the healthcare system. The nature of these tasks also makes it more difficult to provide a clear-cut description of how each situation could be handled. Conversely, students felt comfortable learning these tasks from technicians, perhaps because students do not view them as requiring clinical judgment.
There was no correlation found between technicians’ years of experience and their overall comfort with teaching others. This may be attributable to 52% of the respondents having more than 10 years of experience, suggesting that respondents with less experience were underrepresented in this survey.
When comparing the technicians’ perceived importance of a skill to the confidence to teach that skill, there was no correlation for filling a prescription. This finding may result from the fact that filling a prescription is possibly the most frequent activity performed by community pharmacy technicians, and therefore did not stand out to them as exceptionally important.
For technicians, the time in current position did not help to explain confidence in teaching. Although 64.3% of the respondents had been in their position for 5 years or less, they may have had experience from previous jobs.
The main tasks the students wanted to learn in IPPEs (performing a drug-utilization review and verifying the correctness of a prescription) require a higher level of drug knowledge than may be possessed by students beginning their second or third year of pharmacy school. However, shadowing a pharmacist performing these duties can be a significant component of IPPEs.
While these surveys serve as a good starting point for assessing technicians’ motivation and perceived abilities to teach student pharmacists as well as students receptiveness to being taught by technicians, there are some limitations to this study. The technician sample size was relatively small. This may be the reason that several of the analyses were not significant. Because the sample populations were obtained through nonprobability sampling, the results cannot be generalized beyond the sample. Another confounding factor may have been that the technicians in this survey were well established in their positions, possibly indicating a higher level of teaching confidence compared with that of other technicians.
Despite these limitations, the resulting data provide a preliminary understanding of some of the key issues underlying the educational relationship between pharmacy technicians and student pharmacists. Future studies should be conducted to refine the survey instrument and generate results that are more representative of the 2 populations.
One survey found that the most frequent factors that contribute to errors in medication preparation are interruptions and inadequate staffing, which is an important consideration to take into account when adding student pharmacist education to a technician's responsibilities.9 Although having an inexperienced student pharmacist at a site could lead to both of these conditions, there are ways to overcome these obstacles, such as providing student pharmacists with adequate site orientation and training. The survey also emphasized the importance of technicians buying into the educational process. As technicians are becoming more important players in pharmacy education, their contributions are invaluable. In addition to pharmacist training for preceptors, colleges and schools of pharmacy need to provide similar training targeted toward technicians.
With implementation of the 2007 accreditation standards requiring 300 IPPE hours, student pharmacists will be spending a significant amount of time in hospital and community pharmacy settings. While it is important for them to learn the tasks and responsibilities of the profession from pharmacists, there are some competencies that are appropriate for them to learn from pharmacy technicians. This study demonstrates that technicians feel they have the ability to educate and that student pharmacists are receptive to the idea. To ensure a successful exchange, technicians need to have clear expectations of their roles as educators and students need a clear understanding of the competencies they are expected to learn during their IPPEs.
The authors acknowledge Paul Henkel, DSocSc Candidate, for his assistance during the development of the technician survey instrument.
Articles from American Journal of Pharmaceutical Education are provided here courtesy of American Association of Colleges of Pharmacy
A pharmacist is a healthcare professional who is a expert on pharmaceutical drugs and how they act to fight disease and improve the heath of the patient. Pharmacists are responsible for the implementation of drug therapy with the intention of improving the quality of a patient’s life. Some examples of such improvements include curing diseases, reducing or eliminating a patient’s symptoms, slowing the process of a disease, and preventing disease. A pharmacist works with patients and other healthcare professionals in order to design, implement, and monitor a drug therapy plan specifically designed for that patient. Not only do pharmacists advise doctors and patients on prescription drugs, but they also provide information on the best medications that can be purchased “over the counter”.
The most common goal of pharmacists is to move beyond their traditional role of simply dispensing medication and deal with patients more directly and on a more personal level. They strive to be a source of advice on medications for both heath-care professionals and patients. They also are dedicated to providing individualized services to patients. Such services include consultations and providing more understandable information about the side effects of the medications that the patient is receiving.
More than 1,000 years ago, religious and magic practitioners controlled the medical aspects of people’s lives. They believed that many aspects of disease were beyond observation, explanation, and control. The oldest known application of pharmacy was in ancient India and China. They based healing on the belief that disease was caused by spirits in the body. In Babylonia, Assyria, Egypt, and parts of Greece the concept of purification from sin by a purgative existed. In second century Rome, Galen classified medicines by the affects that they had on the four humors of the body: blood, phlegm, yellow bile, and black bile. The systematic guide he created was, unfortunately, incorrect. Seventh century Arabs contributed a large amount of knowledge on the drugs available from that time through the Middle Ages. In 1240, the Holy Roman Emperor, Frederick II, made great advancements in pharmacy by: issuing three regulations that separate the profession of pharmacy, instituting governmental supervision over pharmacy, and producing an oath that pharmacists had to take promising to prepare drugs reliably. The 19th century brought major pharmacy development throughout the United States. Pharmacy organizations, formal education of pharmacists, official pharmacy books (pharmacopoeias), and setting standards for the identity and purity of drugs are some examples of such developments. Some pharmacy unions that were developed during this time included the American Pharmaceutical Association (1852), the Pharmaceutical Manufacturers Association (1958), and the Federation Internationale Pharmaceutique (1910) which is a worldwide organization base in the Netherlands. Major advancement has taken place in this field in the past 100 years, and pharmacists have started applying scientific method and principles to their work. Beginning in the 1960’s, pharmacists started to practice patient oriented functions, such as drug use review.
The job of a pharmacist consists of many roles. Specific duties vary according to the location of the job for example, community or retail pharmacists counsel patients, answer questions, provide information on over the counter drugs, make drug recommendations, provide advice medical equipment and home heath-care supplies, and, possibly, complete insurance forms and other paperwork. Community pharmacists may sell non-health related merchandise, and also hire and/or supervise other employees. Some community pharmacists provide specialized services such as helping patients with diabetes, asthma, smoking cessation, or high blood pressure. In hospitals and clinics, besides dispensing medications, pharmacists advise medical staff on selection of drugs, make sterile solutions, purchase medical supplies, counsel patients on drug use, and evaluate drug use patterns and outcomes. They are also responsible for assessing, planning, and monitoring drug therapy for patients. Pharmacists who participate in home healthcare are responsible for monitoring drug regimens and preparing infusions and other medications for home use.
Pharmacists are responsible for knowing how their patients manage their medication, they then analyze this regiment searching for problems. Next they determine and implement solutions for these problems and monitor their outcomes. Pharmacists are also responsible for dispensing drugs and providing information about them. Pharmacists must understand drug use, clinical effects, and drug composition (chemical, biological, and physical properties). The pharmacist’s role of making actual pharmaceutical agents is dwindling; and it is now a very small role due to pharmaceutical companies who make the drugs for them. Pharmacists are responsible for the accuracy of every prescription, lately they have been relying on pharmacy technicians and aides to assist them; pharmacists delegate tasks and supervise their outcomes. Finally, pharmacists are responsible for maintaining patient medication profiles in order to advise doctors on prescribing new medication.
Students who desire pursuing a career in pharmacy should achieve scientific aptitude, have good communication skills, a desire to help others, and conscientiousness. There are two entry-level degrees available for such students: a Bachelor of Science degree (BS) in pharmacy, or a PharmD. The BS takes five years to complete and will be obsolete after 2005. The PharmD is a six year program that makes the pharmacists most knowledgeable on medications and their use. The PharmD degree was designed for students with more laboratory and research experience. Many pharmacists who hold their master’s degree or Ph.D. work in research for drug companies or teach at universities. Pharmacists who own and run their own pharmacy may also obtain their MBA. Pharmacy colleges require two years of general pre-pharmacy education. These classes include mathematics and natural sciences such as chemistry, biology, and physics. Another requirement is courses in humanities and social sciences.
In 2000, the American Council on Pharmaceutical Education named 82 accredited colleges of pharmacy. Some of these colleges require that students take the Pharmacy College Admissions Test. All of these colleges offer courses in pharmacy practice in order to teach the dispensing of drugs, communication skills, and dealing with other health professionals. Such courses strengthen students understanding of professional ethics and practice managerial responsibilities. All pharmacists must know the drug laws, assessment skills, problem-solving approaches, and have managerial and communication abilities. Every pharmacist must obtain a license, however in order to do this they must serve under a licensed pharmacist, graduate form and accredited college, and pass a state exam. Some states require continued education for license renewal. For pharmacists there are many areas of graduate study such as pharmaceutics, pharmaceutical chemistry, pharmacology, and pharmacy administration. Some pharmacists specialize in specific drug therapy areas. These areas include intravenous nutrition support, oncology, nuclear pharmacy, and pharmacotherapy.
There are many different places where pharmacists are needed; community pharmacies, hospitals, long-term care facilities, pharmaceutical companies, mail service, managed care, and in government are a few. There are approximately 112,000 community pharmacists, 66,000 pharmacists in chain pharmacies and 46,000 in self-owned pharmacies. As for the rest of pharmacists, there are 40,000 in hospitals, 21,000 in consulting, government, academics, and industry (http://www.pharmacyandyou.org/about/pharmacyfacts.html). The median annual earnings for pharmacists in 2000 was $70,950. The middle 50% were between $61,860 and $81,690, the lowest 10 % earned less than $51,570, and the highest 10% made more than $89,010. Job location definitely effects earnings for pharmacists, the following are the median earnings in different locations: department store pharmacists earned $73,730, grocery store pharmacists earned $72,440, pharmacists in drug stores and proprietary stores made $72,110, and finally hospital pharmacists earned $68,760. The average starting base salary for full-time pharmacists was $67,824. Further compensation comes in such forms as bonuses, overtime, and profit sharing.
Working conditions for pharmacists are among the most favorable of all professions. Clean, well lit, ventilated areas are customary facilities. Pharmacists wear gloves and masks, along with other protective equipment on order to protect themselves. Although pharmacy may seem to be a good job with great benefits it does have its downfalls, for example, pharmacists are on their feet a lot, hours are unreliable, you may be required to work evenings, nights, weekends, and holidays, consultant pharmacists often travel on order to monitor patients, and the job of a pharmacist is mentally demanding. Pharmacists are required to know the properties of thousands of drugs and learn hundreds of new drugs which are introduced every year. One out of seven pharmacists only worked part time in 2000, full time pharmacists work approximately 40 hours per week. Pharmacists in privately owned pharmacies averaged 50 or more hours a week. Pharmacists held about 217,000 jobs on 2000. Six out of ten in community pharmacies, 21 % in hospitals, and all others in clinics, mail-order pharmacies, pharmaceutical wholesalers, home health agencies, or in government.
Room for advancement in the field of pharmacy is limited; it all depends on the location or site of each individual job. In community pharmacies, most new employees start on the “staff” level and can advance to the managerial, part owner, or owner status. In chain drug stores, pharmacists begin as staff, may become the pharmacy supervisor or manager at the store level, may obtain responsibilities at the district or regional level, and could possibly rise to an executive position within the headquarters of the company. The highest level of advancement for hospital pharmacists is supervisory or administrative positions. In the pharmaceutical industries, pharmacists can obtain positions in marketing, sales, research, quality control, production, or packaging.
The job outlook for pharmacists is very hopeful. Currently there are more job openings than degrees being granted. This is the case due to the increased needs of a growing older population, scientific advances, new developments in genome research and medication distribution system, and more sophisticated consumers. Due to declining dispensing fees, pharmacists are trying to increase prescription volume; automated drug dispensing will be implemented which will raise the demand for pharmacy technicians and aides. Due to the increasing number of chain drugstores, the need for community pharmacies is dwindling, therefore retail pharmacies are expected to have faster than average employment growth. The need for pharmacists in hospitals is expected to grow as fast as average although their services are shifting toward long-term, ambulatory, and home healthcare. New opportunities for pharmacists are developing rapidly, such opportunities exist in managed care organizations (analyzing trends and patterns in medication use), research, disease management, and pharmacoeconomics (determining costs and benefits of different drug therapies). According to the California projections of Employment, the estimated number of jobs for pharmacists in 2005 is 18,550 (in California). The role of the dispensing pharmacist is in most danger. Due to automated filling and the use of pharmacy technicians these pharmacy jobs are becoming obsolete.
Pharmacists play very important roles in the everyday lives of many people. From dispensing medications to advising consumers on the most effective products, pharmacists effect most every citizen’s life every day.
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