Advanced Pharmacy Practice Experiences (APPE) make up a major portion of the pharmacy school curriculum, and are an opportunity for pharmacy students to see the practical application of what they have learned in their classroom coursework. Most schools require a total of one year of APPE, although some schools may require more or longer rotations. APPE rotations provide students with opportunities for active learning through exposure to actual pharmacy practice settings and allow students to refine and reinforce their knowledge and skills in patient care, problem solving and decision making.
Choosing your rotations
When choosing APPE rotations, there are a few things to keep in mind. Although each college of pharmacy has its own system for selecting APPE rotations, most allow students some degree of choice and input in the process. To maximize the educational experience, you should choose a variety of rotations, and try to explore one or more areas of study that provide you with the chance to broaden your knowledge base and improve your skills. Try to explore areas of study that interest you, regardless of whether you think those areas have potential as a career choice. One educator suggests that students should, “try to see things on APPE that they may never see again.” Indeed, APPE rotations give you the chance to truly broaden your horizons and explore unfamiliar areas of the profession.
Many schools allow or require students to complete rotations outside of the school’s geographic area, in another state or even in a foreign country. These experiences can be an opportunity for you to see firsthand the differences in healthcare delivery in different parts of the country or the world. Students from rural areas might benefit from a rotation in a large metropolitan area, and vice versa.
If you are interested in exploring this type of rotation, often called an “away rotation,” a good place to start is with your experiential education office. The school may already have away rotations in place that you can select. School policy about away rotations may vary, so it is always good to ask before committing to a site. Be sure to consider the cost of doing a rotation far from home, including travel, lodging and meals, car rental, insurance and other costs. Find out if the site provides any assistance with these expenses and budget accordingly.
The most important thing to remember when selecting rotations is that these experiences prepare you to become the most competent pharmacist that you can be. While it might be tempting to select rotations that allow for convenient scheduling or lots of free time, the tradeoff is reduced knowledge gained from practical experience. It’s not necessary to remove all fun from the rotation experience, or to only select very difficult rotations, but it’s important to challenge yourself and make the most of the many opportunities for professional enrichment and learning that will be presented throughout the year.
Start off on the right foot
First impressions are very important. You should follow your school’s policy for contacting preceptors in advance of rotations. Most schools recommend contacting the preceptor one or two weeks prior to the scheduled first day of the rotation. The school should be able to tell you whether a phone call or email is preferred, and provide contact information. You should greet your preceptor as “Ms. Smith” or “Dr. Lake,” and treat email correspondence with the same formality as you would a written communication. It is best to use a school email address or, if a personal email account is used, make sure the address is appropriate. Don’t email a preceptor from an account like [email protected] or toosexyPha[email protected] – this will not make a good first impression!
When contacting a preceptor, ask about the time they want you to arrive at the rotation, dress code, parking, intern licenses, ID badges, background checks, drug screens and any documentation the site might require. If you know in advance that there are days that you might need time off for medical appointments, conferences or professional meetings, this may be an appropriate time to ask the preceptor. For major life events that aren’t easily rescheduled, such as a wedding, it may be prudent to contact your preceptor as soon as you are assigned the rotation. Being proactive will allow you time to rearrange your rotation schedule in the event that a required rotation activity conflicts with attending an important life event.
Please don’t be overly demanding about scheduling or make excessive requests for time off; this will only start things off on the wrong foot. Time off during a rotation can be requested, but remember that the site is not obligated to accommodate your schedule. Schools may have policies about time off as well, so be sure to familiarize yourself with the school’s policy prior to the start of rotations and be prepared to propose a plan to make up any time missed.
On the first day of the rotation, the most important task is to arrive on time! If the rotation is in an unfamiliar area, above all, make sure you have the correct address and directions and plan for enough driving time. On the first day, try to arrive a little bit early, introduce yourself and provide any documentation that was requested by the site. The preceptor should discuss his or her expectations for the rotation with you and orient you to the site. If you have school projects or assignments that must be completed during the rotation period, let your preceptor know in case the preceptor wants to reschedule projects and assignments for the rotation itself.
If you have a portfolio, it can be presented for a preceptor’s review on the first day of the rotation. Above all, be polite and unobtrusive while learning the ropes at a new site. Remember staff members still have to do their jobs and take care of patients while incorporating a new student into the routine. Don’t be afraid to ask questions as needed, but also make an effort to learn the basics on your own by observing and helping out when appropriate.
Think of each day at your rotation site as an opportunity to build a positive professional relationship with your preceptor and other pharmacists involved in your education. SDN members have frequently referred to rotations as “a series of month long job interviews.” This is an apt description, because every moment you spend at your rotation site is your chance to make a good impression.
Be punctual, be polite and be helpful. Be courteous to everyone at your rotation site, from the Director of Pharmacy to the housekeepers. Ask questions and take a genuine interest in the practice of pharmacy at your site. Even if you complete a rotation in an area of pharmacy you think you won’t pursue as a career, you can still learn valuable skills and competencies that will transfer to your eventual practice site.
The contacts you make on rotation may help you land your dream job someday. Make a great impression and you might end up with a great letter of recommendation for residency or reference for a job application. Never underestimate the value of developing contacts and networking. Rotations are a great opportunity to start building your professional network. Keep in touch with people you meet on rotations and begin cultivating those professional relationships. On the flipside, pharmacy is a very small world. If you fail to make a good impression on a preceptor or someone else at a rotation site, they can easily spread the word to colleagues and hinder your ability to find a position after graduation.
Make the most of your experience
APPE’s are about strengthening your areas of weakness and maintaining your strengths. You may end up being placed in a rotation you are not thrilled about, but always try to get the most out of the experience. You may even be surprised, and end up enjoying that pharmacy specialty. Keep an open mind and use each rotation as an opportunity to broaden your knowledge base and develop your professional skills.
APPEs are a great time to identify any area of weakness and find ways to improve upon them. For example, if you are uncomfortable with giving presentations, volunteer to give a nursing in-service about a class of medications you want to review. Or prepare a topic discussion on an unfamiliar disease state and present it to other students at your rotation site. They’ll probably appreciate the review as well. If you aren’t comfortable counseling patients, ask your preceptor for more opportunities to practice. If there is a skill you’d like to master, such as compounding, physical assessment or immunizations, talk to your preceptor. They should be happy to facilitate your learning.
Although working 40 hours/week with no pay can be stressful for any college student, work hard every day to gain as much experience as possible at your rotation sites. Keep a list of questions that came up throughout the day. When you have free time to work on projects or assignments, look up the answers. If you can look up at least one thing every day, you’ve learned 365 new things over the course of your last year of pharmacy school.
You certainly are not going to know everything as a student, and no preceptor expects you to. Asking questions is good and demonstrates to your preceptor that you are interested in the rotation. However, whenever possible, try to look the answers up yourself and if you still cannot find the answer, then ask. This is great preparation for becoming a self-sufficient pharmacist after graduation.
During rotations take your preceptors’ constructive criticism seriously and work to improve on the areas of weakness they identify. Use evaluations as a chance to self identify areas of strengths and opportunities for improvement. Discuss your self assessment with your preceptor and together you can develop a plan to address areas of need. Then, you can track your progress over the course of the year.
It may be helpful to sit down at the beginning of rotations and make a list of skills and competencies you already possess and think of ways you’d like to improve upon those and develop new ones. Then, chart your progress over the year. Keep copies of work product you generate (de-identified of course) and any presentations or written assignments you produce. These can be kept in a portfolio and shared with future preceptors and during residency or job interviews. It also keeps you from reinventing the wheel on future assignments. You never know when you’ll need to go back and refer to something you worked on previously.
After the rotation
Always make sure to thank your preceptor for the time they spent training you. Keep in mind, some schools utilize volunteer preceptors. They are taking on the extra responsibility simply for the love of teaching and especially deserve some words of appreciation. Taking on a student requires planning and significant effort on the part of the preceptor. Even those who are compensated for their time by the school typically put in effort far greater than the amount of the stipend. Be sure they know you appreciate the opportunity to work with and learn from them. A handwritten thank you note is always an appropriate way to express your gratitude.
If you would like your preceptor to write a letter of recommendation or provide a reference, the end of the rotation is a good time to ask them about it. Make sure you get their contact information you so you can follow up when the letter is needed. Tell your preceptor you’d like to stay in touch by email and send them a note as appropriate to let them know what’s going on with your education and career. Most will be delighted to hear about your successes as a student. Of course, if your preceptor writes you a letter of recommendation, provides a reference or assists you in some other way, make sure to write them a thank you note and send it promptly.
Good luck with rotations and the rest of your pharmacy career. For more tips on making the most of your APPE experience, check out the SDN Pharmacy Forums.