key: cord-0844314-9oj9lt8y
authors: Norris, Melanie S; Steinmetz Pater, Karen; Berenbrok, Lucas A
title: Expanding remote ambulatory care learning environments from COVID-19 to beyond
date: 2021-12-03
journal: Am J Health Syst Pharm
DOI: 10.1093/ajhp/zxab463
sha: ab0314e1f0517b449169e6f9fdb565c01595326d
doc_id: 844314
cord_uid: 9oj9lt8y

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W e thank Dr. Anderson et al 1 for publishing "Adapting ambulatory care learning environments in response to the COVID-19 pandemic." Their work discussed the adaptations utilized in 2 unique ambulatory care practice settings to creatively and sustainably precept pharmacy learners during a period of physical distancing and infection control due to the coronavirus disease 2019 (COVID-19) pandemic. 1 While the authors discussed both student and resident training, we offer our personal experience with student training exclusively. We endorse the ideas and insights provided by the authors, and we offer additional considerations from the perspectives of an advanced pharmacy practice experience (APPE) student and 2 ambulatory care faculty preceptors.

At the beginning of the COVID-19 pandemic, ambulatory care pharmacists quickly adapted clinic workflows to maintain the provision of medication management services to their patients. An example is the utilization of telemedicine visits, which increased in frequency by 154% for 4 of the largest US telemedicine providers in early 2020, as compared to the same time period in 2019. 2 Such a rapid transition to remote patient care radically impacted how, when, and where pharmacist preceptors offered ambulatory care APPEs to student pharmacists during the COVID-19 pandemic. At our institution in Pittsburgh, PA, ambulatory care APPEs relied heavily on both synchronous and asynchronous activities, including journal club presentations, patient workup and case discussions, and answering drug information questions, which correspond to many of the activities outlined by Anderson et al. 1 From an APPE student perspective, students gained valuable experience from these synchronous and asynchronous activities in preparation for remote patient care, which will continue beyond the COVID-19 pandemic. From a pharmacist preceptor perspective, designing these experiences required innovation, patience, and time.

In our collective experiences completing and precepting ambulatory care APPEs during the COVID-19 pandemic, pharmacist preceptors adapted traditional in-person rotation activities using creative ideas and technology. One example was pooling ambulatory care APPE students for joint topic discussions and case presentations. When students were gathered remotely from diverse outpatient clinics, including departments specializing in anticoagulation, family medicine, outpatient cardiology, precision medicine, outpatient transplant, and underserved care, students contributed their unique perspectives and experiences providing patient care, which ultimately led to robust discussions focused on medication management services and practice development. We attribute this success to our organization's quick adoption of videoconferencing technology.

Despite challenges created by the COVID-19 pandemic, the Accreditation Council for Pharmacy Education (ACPE) has not relaxed minimum standards for experiential pharmacy education. According to an ACPE communication, students were expected to meet competency-based practice standards and complete the same requisite number of hours in core rotation areas as the graduating classes before them. 3 Remote learning has generated concerns about the readiness of student pharmacists as they plan to enter the workforce; however, in our experience, mastery of patient care skills was still feasible using synchronous, asynchronous, and remote patient care activities. 1 In addition to competency with remote patient care platforms, student pharmacists will be graduating with new skill sets, which include resiliency, adaptability, and innovation, as a consequence of training during a pandemic with constantly changing regulations and opportunities. We believe that the graduating class of 2021 may be better prepared than previous classes to care for patients AM J HEALTH-SYST PHARM | VOLUME XX | NUMBER XX | XXXX XX, 2021 using telemedicine and to reach patients in rural areas by telephone and other remote technology solutions. In further support of this, ACPE released a recommendation that programs encourage student development of remote interaction skills, as provision of remote care will likely continue to some degree in the future. 3 These newly developed skill sets will be invaluable as pharmacy practice continues to evolve and telemedicine is further adopted, encouraged, and reimbursed.

In response to Anderson et al, 1 our collective experiences living and precepting ambulatory care APPEs have demonstrated that ambulatory care learning opportunities conducted in remote settings are feasible and successful in cultivating student pharmacists who are practice ready upon graduation. We predict that remote rotation experiences will continue to expand, a shift that parallels the expansion of telemedicine services that emerged under the catalyst of the COVID-19 pandemic. Reliance on remote learning platforms developed out of necessity during the COVID-19 pandemic, but implementation of these strategies ultimately created new and meaningful APPEs for students who would not have otherwise been able to experience patient care outside of their home state or health education region. Further curation of remote experiences could create coast-to-coast learning opportunities without requiring the burden of travel and its associated costs. Maintenance of hybrid learning environments that combine in-person and remote patient care responsibilities beyond the COVID-19 pandemic may better serve and prepare student pharmacists as they become practitioners of the future.

Adapting ambulatory care learning environments in response to the COVID-19 pandemic

Trends in the use of telemedicine during the emergence of the COVID-19 pandemic-United States

Accreditation Council for Pharmacy Education. Recommendations for participation in experiential education activities during a national, regional, or local crisis