Completion Dates: March 22, 2021 to April 23, 2021
Description: This rotation was designed to introduce a 4th year PharmD candidate to managed care pharmacy in a remote setting. The student had the opportunity to participate in both clinical and managed care activities through telephonic patient care, meeting participation, and project management. Each week of the five week rotation was dedicated to a different aspect of clinical and managed care services offered at Evolent Health and offered interprofessional interactions with nurses, medical directors, and other pharmacy staff. Overall, the student gained a better understanding of managed care practices through prior authorization reviews, monograph and formulary development, and topic discussions, as well as furthered clinical knowledge through new start patient calls, medication therapy management (MTM), transitions of care, and pharmacotherapy presentations.
Activities Completed
New start calls: Resident Feedback
Patient case presentations: Medication Therapy Management and Transitions of Care
Care management pharmacotherapy drug reference: diabetes, hypertension, hyperlipidemia, heart failure
Care management presentation: Medication Treatment for Type 2 Diabetes
Topic discussions: 1 student-led on drug utilization reviews and 2 resident-led on payment models and career planning
Utilization management practice cases
Monograph: Tepmetko (tepotinib)
Journal club: Lee LA, Bailes Z, Barnes N ,et al. Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med. 2021;9(1):69-84.
Final presentation: PGx: A Solution for Depression: Resident Feedback
Evaluations
Resident Evaluation of Student at Midpoint
Strengths: XXX has been a pleasure to work with thus far in her rotation. Her greatest strengths include her desire to learn about managed care, asking thoughtful questions, time management skills, incorporating feedback, and having a professional demeanor. She has demonstrated these strengths by participating in training with a variety of team members, communicating her thought process in a utilization management case review, submitting assigned projects (e.g. drug therapy tables, drug monograph) in advance of deadlines, and adjusting her approach to patient care and updating assignments based on feedback provided.
Opportunities: XXX’s areas for improvement include continuing to use updated practice guidelines to advance patient care and applying evidence-based clinical knowledge from a managed care perspective. For the remainder of her clinical work during the rotation, I encourage XXX to continue using open ended questions, organizing her conversation points, and counseling in a concise manner.
Resident Evaluation of Student at Final
Strengths: XXX's greatest strengths include her desire to learn, asking thought-provoking questions, time management skills, incorporating feedback, collaborating effectively, and having a professional demeanor. She has demonstrated these skills by being able to manage multiple competing priorities (e.g., patient cases, topic discussions, presentations), collaborating with other pharmacists and patients to provide appropriate patient care, and incorporating feedback to produce quality work. I have really enjoyed working with XXX and seeing her grow throughout this rotation. I am confident that she will do well in her career as a pharmacist and wish her the best of luck on her journey!
Opportunities: XXX's areas for improvement include continuing to advance her skills in applying clinical knowledge from a managed care perspective, notifying managers well in advance if milestones cannot be met, and delivering effective presentations to a variety of audiences. As XXX transitions to a new practitioner, I encourage her to consider high value interventions in her patient care, work with managers to achieve shared goals, and speak with conviction during patient and provider interactions.
Student Evaluation of Resident: All in all, Tuesday was one of my favorite preceptors and it was honestly fun working with her.
Strengths
She did not micromanage me, but she was accessible when I needed her help
She was intentional and present during her time with me. When we had conversations or topic discussions, I could tell she was focused on our conversations and not thinking about her other responsibilities
She showed genuine interest in meeting my needs and challenging me while making sure I didn't feel burnt out
She helped me identify my own strengths and weaknesses with ways to improve
She was very encouraging and provided a safe learning environment
She challenged me in my thinking and experiences. Ex. she let me conduct a MTM session.
Opportunities
Providing direction as to how to work up a patient in a managed care role. I used an ambulatory care approach, so getting more direction behind what is important to a managed care pharmacist doing clinical sessions would have been helpful. This is specific to my experience with transitions of care and CMRs.
Asking those guiding, preceptor-like questions that encourage critical thinking (she did ask those questions but they weren't as tricky or broad as some of my other preceptors)
Allowing for a variety of approaches to advance my learning (this is challenging to incorporate but maybe something away from the generic PowerPoint presentation approach)
Being almost too kind! For example, when other pharmacists gave me negative feedback I felt as though Tuesday felt bad giving me that feedback. Maybe this was because she really didn't agree with it, but I personally believe that accepting negative feedback without a "grain of salt" allows for growth. This depends on the student, too.
Preceptor Evaluation of Resident
Midpoint: It was good that she asked her how she thought the week has gone. XXX self-identified some areas that were going to be discussed on the midpoint in advance of discussing the midpoint. She clearly defined competent as a good rating; good way to set expectation for the review. XXX will begin to ask a question and Tuesday will sometimes interrupt and answer before XXX finishes asking the question. While Tuesday has anticipated the question correctly, she's not allowing XXX to complete her thought. This also occurred when I inquired XXX about the duplicate member issue. She did a nice job balancing positive and constructive feedback and this was confirmed by XXX's response. She asked XXX her thoughts at the conclusion of the evaluation and she [the student] confirmed accuracy and fairness.
Formative (Feedback Friday): When discussing a challenging call, Tuesday provided an alternative way to address negativity, emphasizing not to use negatives but had trouble thinking of specific ways to state things but in the rest of the review she provided good concrete examples of how the conversation could've been managed differently. She caught herself interrupting as XXX started to answer a question I asked and let her answer the question!
Final: Tuesday provided a lot of very specific examples that tied to the objectives to justify the rating. She is really good at providing positive feedback, but less confident providing constructive feedback. She struggled with providing feedback about her presentation delivery and being able to provide feedback that was specific enough for XXX to learn from.
Self-evaluation
In March, I spent time preparing for precepting my first student. In particular, I arranged her schedule and coordinated activities for the five weeks that she will be with us. I never would have guessed how much goes into the preparation stage of precepting a student, albeit this probably gets easier with experience. I believe my biggest opportunity in precepting will be striking a balance between being a friend and being a teacher. On one hand, I want the experience to go well for the student and so I tend towards wanting to be the student's friend and mentor, however, I realize that this isn't always conducive to the holistic learning experience. While I hope to always strive towards promoting an open and honest communication pathway, it will be important for me to also provide constructive and actionable feedback to develop pharmacy professionals. At the same time, I hope to maintain engagement by providing activities that meet both the objectives of the rotation and interests of the student. Although I still have a lot to learn about how to be an effective preceptor, this experience has already challenged me and pushed me to grow into the preceptor that I ultimately want to be.
Overall, independently precepting a student was a very positive and rewarding experience, but I was fortunate that I had a student who was willing to learn and be engaged given it was her last rotation prior to graduation. I did find my precepting approach change throughout the 5 weeks to ensure the student was continuing to develop both soft skills and clinical knowledge. This included asking the student her thoughts on how the week went during Feedback Fridays (i.e., what went well, what didn't go well, what would you like to work on for next week) and providing additional feedback on clinical cases. Based on final feedback received from the student, I believe I was able to achieve my goals of promoting an open line of communication and a supportive environment, while also providing activities that met the objectives of the rotation and interests of the student. I also received feedback on areas of improvement, including using alternative activities to deliver topic discussions other than PowerPoint, asking more broad questions to allow for critical thinking, and providing additional background or direction on activities when the concept is unfamiliar. I complete agree with these comments and plan to adapt my style in future precepting experiences.
* XXX = student's name de-identified