Structure of the Learning Environment

2.4.3.1 Orientation and Announcements

Student volunteers are required to independently complete a MAC orientation prior to volunteering for the first time. The orientation includes a YouTube video that describes and illustrates the patient care process that is used at the MAC. Student volunteers are also required to read and acquaint themselves with the MAC Learner Responsibilities and Expectations document that is in the MAC Policy and Procedures Manual (Appendix C). MSCL are provided additional training and orientation (e.g., how to use the patient chart). Prior to the first patient interaction, the MAC pharmacist also gives a brief introduction to the patient care process and the roles and responsibilities of the student. Students are notified of any updates or announcements regarding MAC student learner policies or procedures via email.

2.4.3.2 MAC Volunteer Responsibilities

All MAC volunteers are required to adhere to responsibilities and expectations as outlined in the MAC Learner Responsibilities and Expectations within the MAC Policy and Procedures Manual (Appendix C). These include signing and adhering to privacy and confidentiality agreements, protecting the anonymity and confidentiality of the patients, being on time for appointments, participation in pre and post patient

appointment discussions, and registering as a pharmacy Intern with the Saskatchewan College of Pharmacy Professionals (SCPP). The MAC pharmacist and director ensure all student learners are held accountable for their involvement and actions during and outside the patient care appointments.

2.4.3.3 Sign-up Process for Student Volunteers

Up to four students (typically two junior and two senior) are able to volunteer for each patient appointment. To facilitate the scheduling of student volunteers (i.e., early experiential education), a web-based sign up sheet was created using “Google Docs”. The sign up sheet identifies the type of patient appointment (e.g., initial assessment, follow up), but does not contain any patient information or identifiers to maintain the confidentiality of MAC patients. Therefore, students sign up for a certain type of MAC experience and not for a specific patient.

In order to allow equal opportunity for all students to participate, students are limited to volunteer for one patient appointment per week. Each MAC experience provides the opportunity for two senior or MSCL and two junior students to participate. However, to ensure all student volunteer opportunities are filled, any student (junior or senior) is allowed to sign up for any slot that remains unfilled within 24 hours of a patient appointment, even if that student had volunteered within the last week.

From September 2014 to November 2015, the sign up sheet was updated immediately after patient appointments were made and students were required to intermittently check for new volunteer opportunities. Starting in November 2015, the sign up sheet was updated regularly every Wednesday and Friday afternoon, to provide more predictability for students to check the schedule for new volunteer opportunities. 2.4.3.4 Pre Patient Interview Discussion

The MAC pharmacist takes responsibility for the entire patient care process as well as facilitating an enriched learning environment for the students present. Student volunteers are required to arrive fifteen minutes prior to the scheduled patient

appointment time for a brief pre-interview discussion. This includes an introduction to the patient case (e.g., reason for referral, chief complaint, progress from previous appointments) and a review of the patient care process. During this time, student

volunteer roles are also discussed and assigned (e.g., indirect observer, direct observer or patient interview leader).

2.4.3.5 Patient Interview

The MAC pharmacist and all students greet the patient prior to entering the patient interview room. At this time, verbal consent is obtained from the patient for students to be present. Students who directly observe are encouraged to ask questions or contribute to the patient interaction. To encourage more active participation from the students, the pharmacist leading the interaction may invite the student learners to ask additional questions of the patient or provide some patient education.

All patient interviews (i.e., initial assessments and follow up appointments) use a standardized systematic procedure to collect information and provide patient-centered education. Patients are encouraged to participate in the interview by asking questions, discussing concerns, and deciding with the pharmacist and/or learner which

recommendations they feel are appropriate and feasible for them. All patient appointments have a maximum 60-minute time limit that is not always used, but is strictly maintained.

2.4.3.6 Post Patient Interview Discussion

After the completion of the patient interview, learners are asked to stay for a reflective, debriefing group discussion. The discussions last 15-30 minutes and are lead by the MAC pharmacist, who engages students in a discussion that requires students to reflect on what happened during the interview, from both a clinical skills perspective (e.g., How could the pharmacist have been more empathetic? How could the interview have been better organized?) and a therapeutic knowledge perspective (e.g., What is an ACE inhibitor?). The pharmacist ensures that all students contribute to the

discussion and that each student is able to understand the topics. Since students with various levels of knowledge, skills and experiences are often involved in the same discussion, the MAC pharmacist typically has the more senior students play a “peer- mentorship” role by explaining key topics to the more junior students.

2.4.3.7 Care Plan Development and Implementation

Following the patient interview, the MAC pharmacist often collects additional patient history by accessing provincial electronic databases (e.g., laboratory results, prescription drug dispensing records) and by requesting it from the family physician, community pharmacist, and/or specialist physicians. Once a complete patient history is collected, the pharmacist uses this information to identify any drug therapy problems and to develop care plans to ensure the problems are managed. Student volunteers are generally not directly involved in these steps due to the large amount of time required. However, all students have the opportunity to participate in follow up patient

appointments when the care plan is discussed with the patient. These follow up appointments allow students to participate in presenting and negotiating the details of the care plan with the patient either through active participation or observation. 2.4.3.8 MSCL experiences

All patients receive at least one follow up phone call from a MAC team member (typically after a consultation letter has been faxed to their physician that includes recommendations to adjust drug therapy) to assess if the proposed recommendations were implemented and how they are tolerating the changes. When a MAC pharmacist completes this task, student volunteers are generally not involved as the phone calls are not scheduled and take place intermittently during the day. However, student volunteers are involved if the phone follow up is completed by a MSCL.

MSCL experiences began in October 2015 for the purpose of creating more

opportunities for student involvement, enhancing student active participation, and enhancing patient care. MSCL experiences are two hour sessions in which up to four student volunteers (two senior and two junior) can volunteer to participate in patient follow ups. MSCLs prepare and conduct unsupervised (i.e., the MAC pharmacist is not present, but is in the next room if needed) telephone-based follow-ups, complete

clinical documentation, update patient care plans, and debrief with the MAC pharmacist at the end of their session. In addition, they mentor the more junior students in

and conduct the patient interaction. MSCL have access to complete MAC patient charts and are held accountable for their contributions made to the care of the patient.

2.4.4 Evidence to Support the Value of a Patient Care Clinic Located Within a