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Richard J. Silvia, PharmD, BCPP
Associate Professor of Pharmacy Practice
MCPHS University, School of Pharmacy – Boston

Maintaining a clinical practice as a pharmacist can be daunting at times. Between patient care and administration requirements, clinical education, and possibly student education, time management can be difficult. Student education in particular can be a significant time component if not managed well, as the requirements for clinical rotations are significant. Many pharmacists might feel this role is too much of a time consumer and elect to forego it as part of their role. However, pharmacy students do not need to be strictly a burden on the practitioner, but can instead be your “right hand” and help expand the capabilities of your practice.

Pharmacy students can provide a variety of services to the practice, depending upon the needs of the practice and the capabilities of the student. For example, students can contact patients in advance of a scheduled visit with the pharmacist to not only remind the patient of the visit, but to perform any advance screenings that might be needed for the visit. They can perform medication reconciliation and assess patient adherence to their medication through these pre-visit contacts as well as by contacting the patient’s pharmacy for confirmation. During the visits themselves, students can perform additional screenings that might be needed, such as symptom checklists, history taking, questionnaires, and similar activities. Some of these can likely be performed in the waiting area while the pharmacist is actively engaged with another patient, allowing for improved time efficiency for the clinic. Students can engage in patient education on medications, devices, and other areas that can help improve patient understanding and care. Student involvement with the patient can continue after the visit with similar post-visit calls being made to the patient to ensure they have started any new medications provided during the visit and to determine any initial adverse effects that might prevent continued adherence to the medication.

Within my own clinic, we have utilized students in these roles for nearly a year, and the response has been universally positive. The pharmacists and other providers the students have worked with appreciate the “extra hands” the students provide to their practice, especially the gathering of medication and symptom information prior to the visit, saving them time during the visit. The patients appreciate the pre- and post-visit calls as well, providing them with a sense of caring that someone contacts them to inquire about their medications and symptoms. We have collected anecdotal information that patient adherence to medications, especially newly prescribed medications, has improved as a result as well. Students also appreciate these opportunities to interact more directly with patients and utilize the skills they learned throughout their education.

Considerations When Implementing a Student Service Extension

What degree of student activity does your state or federal regulations allow?

While most states allow students to engage in a variety of activities while supervised by a pharmacist, there may be restrictions.

What does your pharmacy and medical leadership allow at the site?

Leadership should review these activities to ensure they approve of them and that they do not violate any contracts or other agreements the site has in place.

How do you handle the variability in student capabilities entering into the site?

While most students should be able to perform in these or other roles upon starting clinical rotations, this is not universal. Some students may present with communication concerns, low self-confidence, or other potential deficiencies that might hinder their performance in these roles. Each student should be assessed for their individual capabilities and provided with direct, straightforward expectations of their performance as a practice extender. Where needed, perform direct intervention to bring the student up to standard to engage in these roles. While this might involve some additional time at the start of the rotation, it will pay off over time as the student gains more independence which then allows the pharmacist to engage in other activities required for the practice. Regardless, all students should be supervised to some extent as they engage in these activities to ensure they are appropriately providing the services.

Pharmacists often comment how they are always short on time to do all the things expected of them and that they would like to do within their practice. Pharmacy students provide additional assistance to meet these practice responsibilities, and can provide services appropriate to their level of education and skills that can alleviate some of the burden on the pharmacist, allowing them to engage in other clinical activities. The potential benefits to the pharmacist, their patients, and the students themselves can be significant.

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