Walking along the graveyard, cold wind in my face, I just couldn’t fathom what I was getting myself into and what I’m doing there. Then I remembered: it was just part of the hardships I had to go through to become a pharmacist. Thousands of students had gone through it before me, and I was no exception – if I wanted to get somewhere the road to it was unpleasant. But does it really have to be that way?
This is the first year that St. John’s is implementing the “IPPE” (Introductory Pharmacy Practice Experience) in its program of study for third year pharmacy students. We are the “test subjects,” if you will, for these introductory rotations that involve a number of challenges to the already demanding curriculum. The goal of these IPPEs is to introduce students to the common workplace of the pharmacist, which presumably the student had no prior contact with before choosing it as their desired career path. In any case, NYS requires that third years complete 100 hours of observation at these preliminary rounds in community and hospital pharmacies, before returning to similar sites as fifth year interns. While the idea behind getting to know your future workplace is a beneficial one, the means of its implementation may not be the most convenient or even logical ones. Many St. John’s students feel that the administration of IPPEs is unfounded and ineffective, from the level of the program’s organization in our University’s headquarters, all the way up to the idea behind these introductory rounds.
In the eyes of students, there are too many losses and not enough gains from the way these IPPEs have been set up. First of all, most students who are already in the program (and all 3rd years are already part of the professional program) have an idea of what their future jobs may entail. A lot of students work in pharmacies already, so the observational goal of IPPEs will be almost like a step backwards for them. Finally, students are losing out financially on these rounds because: they are not getting paid since they are only observing; they are missing a day of productivity if they are employed by a pharmacy; and they are not being reimbursed for traveling expenses (not to mention opportunity costs of spending time studying or working). In the end, the eight hours of every week spent at the site (and time spent commuting) will only add up to a pass/fail grade for a one credit course.
Aside from expected errors and mix-ups under normal administrative functions, a lot of misunderstandings students have faced with their IPPEs this semester are due to the newness of the program itself. Nonetheless, St. John’s staff has been working hard to fulfill its requirements as an accredited institution to educate their students by the means described by their superiors. Everything was in the works beginning from the fall 2009 semester, during which students had to submit multiple forms including updated medical records, HIPPA completion, OSHA training and background checks – for which there was a considerable fee. Having met the deadlines, students were assigned to locations based on the order in which they submitted their forms, preference (ranked 1-9, the boroughs and LI counties), address, and whether or not they had a means to travel, i.e. owned a car. Not only was this system imperfect in accommodating everyone, the administration repeatedly warned students that any requests to change the assigned site of rotation will not be honored. Granted, in doing so, they were protecting themselves from a lot of bombardment and complaints from students, but shouldn’t it be part of their job to look out for all their students and value their concerns? Perhaps 250 students are too many students to indulge, but I believe that each student deserves the best education St. John’s has to offer, and the best effort on the administration’s part to make that happen.
I myself, tried to switch my assigned rotation site but was told that nothing could be done for me. I handed every form in on time, I maintained a stellar GPA, I wrote on my form that I had no means to travel to my site; yet I still depended on the luck of the draw, and got assigned to a pharmacy surrounded by three cemeteries, to which I would need to commute with 3 train transfers and a bus transfer, taking two hours. My philosophy is this: the less time we spend traveling to the site, the more time we have to dedicate ourselves to the experience, and study for our other classes. I was told that if I switch my site to a more preferable one to me, it would be unjust and the same exception would have to be made to all students. Furthermore, I had done something totally unacceptable – I got directly involved in the fate of my IPPE rotations, and got permission from a preceptor in my area to complete my IPPE hours in that location. Apparently, this went against the entire system because in a way, I was going behind the administration’s back and put the preceptor in an uncomfortable situation, whereas he could not refuse the opportunity to help out a fellow St. John’s student. I was being lectured for trying to take my educational experience into my own [capable] hands. This was a complete 180 degree turn from my usual associations with administration; I’ve always been a straight A student, and the only other times I was in the dean’s office was to talk of my accomplishments and good things that are sure to come in the future. So I wondered, what does this advice say for the learning experience that St. John’s has an obligation to give me? Shouldn’t educators encourage students to seek the best for themselves, to think independently and to find solutions?
The whole mess of misunderstandings, complaints, and pleas for “exceptions” could be placated by assigning students to sites in a timely fashion. The rotation schedule and location was revealed to students less than a week before they had to go out on them! Perhaps this was due, again, to the fact that this is a new program, or perhaps to reduce the amount of complains or pleas to switch out; in either case, students should not be penalized for the inadequateness of this program’s administration. Since this program is brand new, perhaps some exceptions should be tolerated during the time of its introduction.
Even more helpful would be to avoid this tangle with students altogether. Instead of having St. John’s administrators as intermediaries in this entire process, it would be easier for all parties involved to have the students search for their own IPPE sites. This would not only save the administrators the hassle and pressure of trying to please the students and do their job for everyone justly, it would teach students the responsibility of being in the “real world” and making their own connections and choices. I even have a proposition for how this can work. A student with a site in mind can get the agreement of a potential preceptor, then report to the school to come evaluate the site and prepare the necessary paperwork and contracts if they deem it suitable. Yes, this would take potentially 250 visits if each student has their own individual site, but maybe it is worth the trips if all the aforementioned stress can be forgone. Or perhaps the documents proving the existence of the site and a phone call to the preceptor would be sufficient to deem the site suitable. As long as the student gains the required learning experience, then the goal of these IPPEs would be fulfilled. So far the evaluation process to this involves filling out a learning packet, putting in the required amount of hours at the site, and getting assessed by the preceptor based on our professionalism and aptitude. As long as these are all met, it shouldn’t matter who chose the preceptor site. For those students that cannot find their preceptor in the allotted time, the school should offer some of their affiliated sites.
One step further than that would be to have all the students that are already employed as pharmacy technicians to verify this by documentation, and being able to circumvent to the process altogether. If the issue here is distrust and cheating, all St. John’s has to do is check the reliability of the documents by contacting the preceptors themselves. I for one, am all for learning new things and getting hands-on experience (or in this case, observation only) with something concretely related to my chosen career. I just think there is an easier way to go about it, and just because it hasn’t been done before, it should not be ruled out as impossible. My other suggestion was to switch my day of rotation to a weekend day, and I was immediately reproached for this as well, since it was not part of the policy.
IPPEs do not have to bring about a collective groan from students and administrators alike. We don’t have to shake our heads and slump our shoulders in defeat at the start of each rotation. Instead, we can make this a positive experience to look forward to by having a more active role in its management. The worst feeling is that of helplessness: trapped with no alternatives. Students should be encouraged to go out and make their own choices regarding their education. St. John’s has already given us the background, but we should slowly take the reins into our own hands. This will not only simulate practice in the real world, but will allow students to feel in control of their destiny and thus be willing and proactive in their IPPEs. Furthermore, it would alleviate some administrative responsibilities and stresses, since they would not be liable for the students’ decisions.
We live in a free country where anything is possible, so I think students should take more responsibility for themselves. Treating all students with equal respect is one thing, but running a policy of “no exceptions whatsoever” sounds dangerously close to socialism. If everyone was made to conform, no great people would ever stand out. We should not be afraid to think creatively. In fact we should be encouraged to look for solutions outside the box, and not only make life easier on everyone, but create better experiences in doing so.