Future pharmacists learn to deliver patient care during COVID-19

Pharmacists are often the health care providers that patients see first, last, and most frequently, making effective and compassionate communication a vital skill for the profession. Mastering such communication, as well as the skills required to work smoothly within the health care team, takes constant practice.

The COVID-19 pandemic has created new challenges for safely educating future pharmacists, but the UCSF School of Pharmacy’s doctor of pharmacy (PharmD) degree program has adapted. The program’s experiential education components, known as Introductory and Advanced Pharmacy Practice Experiences (IPPEs and APPEs), have acclimated especially quickly to the pandemic, creating new approaches to hands-on learning.

Nearly two years into the pandemic, with viral variants spreading in partially vaccinated communities, UCSF’s PharmD students continue to apply their knowledge to real-world pharmacy duties, counseling patients, presenting medication recommendations, and collaborating with health care colleagues, all while adhering to pandemic-safe practices. It has not been easy, but students are emerging with the skills needed to think, empathize, and practice effectively, no matter the circumstance.

Experiential education hits a roadblock

When the pandemic forced California into a lockdown in March 2020, students in the Class of 2022 were halfway through their yearlong community IPPEs, which typically occur at retail pharmacies in the Bay Area. With student safety in mind, the School decided to prematurely suspend the IPPEs.

“I definitely feel like at the time, the administration made the right choice in canceling [our IPPEs] because we didn’t know anything about COVID, like how serious it was going to be,” said Andrew Hean, Class of 2022. “They were doing the best with what they could go off of.”

To make up for the required clinical hours that were lost, students later completed learning “bundles” on the online platform MyDispense, which included simulations of typing up prescriptions and counseling virtual patients. But it was not a perfect substitute.

“It’s great that we had an opportunity to make something up at all,” said Cody Angerman, Class of 2022. “But [the online learning model] had holes. It can’t ever replace real human interaction and real pharmacy learning experiences, because it’s not a real scenario and it’s not as dynamic.”

The pharmacy preceptors who mentor students during experiential education also raced to adapt to the rising pandemic. Zlatan Coralic, PharmD, and his team, who oversee IPPE and APPE students, pharmacy residents, and emergency medicine physician residents in the UCSF Emergency Department, refrained from accepting student learners during the first few months of COVID-19, due to general uncertainty and limited personal protective equipment (PPE). Residents continued to practice, wearing N95s and eye protection, under the guidance of Coralic’s team.

“We still want to engage with students as much as possible, and introduce them to the clinical environment of the emergency department as much as we can,” said Coralic. “But we’ve stayed very mindful of the infectious risk and of not exposing students to unnecessary risk.”

A cautious return to in-person

As the initial surge of COVID-19 cases receded in June 2020, Coralic’s team slowly reintroduced students from the Class of 2022 back into the Emergency Department. All students were fitted with N95s and were only allowed to interact with confirmed COVID-negative patients.

The Class of 2023 was able to fully participate in their first-year retail IPPEs beginning in September 2020. Unfortunately, several sites were experiencing lower patient volume, creating fewer opportunities for patient interaction. Yet there were silver linings to the less hectic atmosphere.

“With the slower-paced environment, I could learn at my own speed,” said Teresa Mendoza, Class of 2023. “Since there was more downtime, my preceptor was able to give me her whole time anytime I had questions or needed practice with anything.”

Students were able to practice certain skills, like vaccine administration, and even contributed directly to UCSF’s COVID-19 vaccination effort. But with all large lecture sessions held virtually, and with students unable to gather as a class, it was difficult for them to connect with one another.

“I only had my [experiential] site and what I learned from there,” said Kelly Ching, Class of 2023. “So I wasn’t able to tap into that community knowledge pool that’s shared among students. I would have benefited a lot more from my IPPEs if I’d been able to talk to my classmates and share our experiences.”

After finishing their retail IPPEs in May 2021, the Class of 2023 went on to complete their two-week summer concentrated IPPEs at hospitals throughout the Bay Area, again only interacting with COVID-negative patients using appropriate PPE. Students participated in rounds and topic discussions, some of which were virtual. But it was still hard for some of them to feel completely at ease, especially as they received email updates on the confirmed COVID-19 exposures at their sites.

“I wasn’t seeing COVID patients, so it felt a little off-putting to see those emails every day,” said Angerman. “That was more alarming and scary to me, since I still felt a bit disconnected from it all.”

A few students noted that their preceptors worked from home during the majority of their rotations, limiting valuable opportunities for mentorship. Virtual rounds also made it difficult for some students to connect with the patients they were reviewing or with their colleagues.

“It’s hard when you’re just a blank face on a black screen,” said Angerman. “But navigating through this has taught us all a lot about resilience and how to make the best of our learning experiences while staying safe.”

Moving forward with resilience and empathy

Despite the challenges of completing experiential education during the pandemic, students were impressed by how seriously their rotation sites enforced COVID-19 safety guidelines and by the care that preceptors took to respect each student’s comfort level with in-person interactions.

The strain of living with COVID-19 for two years also gave students a new sense of empathy that translated into a higher standard of patient care.

“We all became more understanding during this pandemic and more aware of what other people are going through,” said Hean. “I’ve realized how to step into my patients’ shoes better. It’s helped improve my patient care skills, and made me feel more patient-centered as a whole.”

Today, experiential education in the School of Pharmacy marches on, giving future pharmacists the real world practice they need, but experiential coordinators and preceptors continue to keep a close eye on the status of the pandemic, ready to adjust to changes on the ground.

“With the delta variant rising, we’re rekindling all those earlier worries that we had,” said Coralic. “However, I feel we’re more prepared now to address some of those issues and to relieve some of that anxiety. So as of now, I do feel safe precepting students.”