Pharmacy Internships: We Can Do Better.

The pharmacist's role in patient care is expanding, and the profession must prepare its graduates for direct patient care. Internships can help facilitate this training outside of the formal pharmacy curriculum. Intern roles can expand beyond distributive tasks to compliment the full range of pharmacist activities, providing value to the student and institution. Crucially, outcomes measured must not only be traditional measures of student and pharmacist output, but also the growth and success of the student within the program. Creative metrics (e.g. resilience or leadership development) should be considered when assessing programmatic outcomes. Programs already engaged in internship programs should assess their respective programs and report findings. © Individual authors.

Introduction

Doing more with less is an everyday mantra in healthcare, and pharmacy is no exception. Evaluation and justification for clinical services is an ongoing process. Direct patient care is in high demand, enabling pharmacists to break through the ceiling of traditional care and practice at the top of their license. Likewise, pharmacy organizations and leaders are rethinking what “top of license” means for all members of the pharmacy care team. As an educator, practicing pharmacist, and internship director, we view interns as one aspect in pharmacy that needs to advance. The pharmacist's role continues to transform and interns have a crucial role in supporting expansion of pharmacy services, as well as sustaining services in place, while achieving high priority goals.

The number of pharmacy graduates has grown from approximately 7000 in 2000 to over 14,000 in 2017. This expansion of graduates, coupled with the aging population, provides a timely opportunity for pharmacists to advance as direct patient care providers. The growing number of pharmacists, limited number of residency programs, and portion of unmatched candidates creates a gap of suitably trained pharmacists available to meet the demands of the evolving clinical role of pharmacists. Pharmacy internship programs are defined as compensated on-the-job training for students, typically completed during one or multiple years of the PharmD curriculum. Internship programs can help set apart graduates pursuing post-graduate training or prepare graduates for direct patient care roles. But diligence in training our pharmacy interns is critical!

Internship programs should enhance student learning experiences by developing competencies and skills necessary to be highly functional, competent pharmacists. Internships should serve as an apprenticeship to the profession, exposing the interns to all facets of pharmacy. Supplementing introductory (IPPE) and advanced pharmacy practice experiences (APPE) with internship programs can build skills in direct patient care, distributive tasks, and project management.[2-4] Pharmacy student internships provide comprehensive exposure to different aspects of pharmacy practice, serve as recruitment tools for institutions, and enhance students’ professional growth.

Too often, pharmacy interns primarily fill a technical or distributive need within the pharmacy department, simply shadow pharmacists, and fail to be utilized to their fullest potential. The complementary toolbox in this issue summarizes the sparse literature surrounding student internships and their role within the profession. We suggest the following considerations to utilize interns as pharmacist extenders, expand the reach of our profession, and build leaders.

Creative Utilization of Interns

Ideally, your internship program will have defined criteria for the roles and responsibilities of interns. These criteria should build on distributive and operational functions, while requiring continuous development of the intern. We owe it to our future professionals to deliver internship programs that push the student into activities beyond medication history attainment and medication delivery. Interns should participate in a comprehensive patient care delivery experience, understanding the importance of each step along the way. Alignment of patient care activities with the student interns’ professional curriculum will allow for thoughtful advancement of responsibilities. For example, second year pharmacy student interns covering diabetes in the therapeutics sequence may start completing medication education with new diabetics. This curricular partnership increases student intern exposure to various activities while targeting high risk patient populations and medications.

Likewise, creative leadership development could provide benefit to the institution and simultaneously develop student leaders. Instead of the orientation of the intern falling solely on the shoulders of pharmacist team members, training of incoming interns can be done by interns recently completing that curricular year. Utilization of a layered learning model could help provide mentorship training and close peer assessment of performance, allowing use of seasoned interns or residents to help mentor newer interns in developing skill sets pertinent for success.[6-7] Additional leadership development through a longitudinal leadership series, including seminars, book clubs, and discussions, will help cultivate those skills. Institutional benefit can be derived from staff educational seminars delivered by interns or minimized onboarding from hiring trained interns. Likewise, investment in professional development of intern and staff members, through a longitudinal seminar series, could create a culture of leadership development within the department.

Sites that have multiple learners can integrate interns into the existing educational activities to meet the intellectual development required for a successful internship. Interns should actively participate in formal and informal presentations alongside ongoing research at the institution. Alternative learning strategies (e.g. Jigsaw method) can provide structured support and integrate multiple layers of learners for key activities (e.g., journal club, topic discussion, learner debates). Integration into these activities builds marketable skills, such as communication, project and time management, and professionalism. When interns are integrated with other learners, they also gain awareness of the roles played by each member of the pharmacy team, and they can further advance this integrated model as they progress in their careers.

While creative use of interns may require more coordination throughout the year, this presents an ideal opportunity for leadership development with a chief intern or team of senior interns. Coordination, communication, and integration into site educational activities further develops these individuals as leaders in our profession. In whatever capacity utilized, student internships should be designed to meet the specific needs of the pharmacy department and institution while simultaneously developing the intern as a professional.

Continuous Quality Improvement

As with any learner-centered program, continuous quality improvement is mandatory. Measuring a cost-analysis for the program, tracking research accomplishments of participants, and identifying direct patient care activities completed are just a few examples of metrics highlighted in the toolbox provided in this issue. Additionally, analyzing direct patient care pharmacist activities that highly integrated interns are able to accomplish could showcase the downstream effects of a wellrun program. Whatever you define as outcomes for program success, make sure you capture those outcomes and reflect on needed changes. Likewise, unintended negative consequences should also be quickly detected and mitigated.

Tracking the aforementioned traditional metrics is necessary; however, we owe it to our profession to do more. What metrics measure the success of your interns during program completion? What about after leaving the program? Participation in these activities will also undoubtedly develop the intern as a professional, but how? Typically, residency attainment serves as the marker of a successful intern graduate. We ask that you consider more. Did your program develop and shape them as a professional? Are there metrics to measure growth of the intern directly? These could include changes in mindset, resilience, critical thinking, leadership, and motivation. The potential for these metrics is profound and the gap in our current understanding vast. Capturing metrics for success and disseminating this information is paramount in pushing the academy forward. Knowing what creates successful graduates can help us establish standards for pharmacy internships, a needed component as our profession continues to expand.

We challenge the academy to consider the following to develop our student interns as leaders in the profession:

Identify what is considered “top of license” for students in your state and explore changes to your student activities.

If you currently have an internship, do a quality assurance analysis and report those findings.

Commit to our professional future and develop all levels of learners to their highest potential.

Join the conversation. What can and should student interns be accomplishing? What standards should the academy have for current and future programs?

We hope you will develop, capture, and disseminate meaningful program metrics, as well as share the program design and utilization of student interns. It is our responsibility to shape future generations of pharmacists and creative student internships are one platform to nurture their development.