Addendum: Page 31 is where the detailed minutes are for the discussion of SB590:
http://www.pharmacy.ca.gov/meetings/agendas/2014/14_jun_lic_mat.pdf
Copy/pasted for your convenience (i'll format later, maybe):
Expert from the April 2014 Board Meeting
a. Summary of Presentation Made to Committee on Requirements for Intern Experience in ACPE Approved School of Pharmacy Curricula
The Licensing Committee was asked to review the requirements for reporting intern hours experience required of students enrolled in ACPE-approved schools of pharmacy. Chair Veale reported that on March 19th Dr. Vlasses provided a presentation on ACPE’s requirements for intern experience in ACPE-approved schools of pharmacy. Dr. Vlasses highlighted that ACPE accredited schools of pharmacy curricula must contain “real world” pharmacy experience. Dr. Vlasses also reviewed the process by which students shadow pharmacists and work in pharmacies to gain hands on practice experience.
Chair Veale stated that the committee was particularly concerned with the preceptor screening and evaluation process and the hands-on knowledge students gain while in pharmacy school.
Chair Veale explained that she would report on agenda item d before opening the floor to board and public comments under agenda item e.
b. Summary of Presentation by the California Schools of Pharmacy on the Intern Experience Earned by Students in California Schools of Pharmacy and the Reporting of Intern Hours to the California Board of Pharmacy
Chair Veale stated that over the years, the board has been asked to change the reporting of intern hours to eliminate the specific requirement that 900 hours be earned in a pharmacy. Historically, the board has not agreed that such a change is in the public interest.
Chair Veale provided that the committee heard testimony stating that it is difficult for students to gain additional intern hours outside of the curriculum, as many of the jobs historically held by interns are now being filled by technicians.
Chair Veale noted that deans from various schools of pharmacy asked the committee to change the intern requirement to deem any student who graduated from an accredited school of pharmacy after 2007 as having fulfilled his or her required intern hours.
Chair Veale reported that the committee asked legal counsel if a regulatory change would be required in order to accept the proposal as brought before the board. Mr. Santiago stated that a regulation change would be required to allow the schools to sign off on the entire 1500 hours. The committee also asked if the board could eliminate the 1500 hour requirement and simply require graduation from an ACPE accredited school. Mr. Santiago confirmed that the board could choose to go that avenue, and stated that doing so would require a statutory change.
c. Discussion and Possible Action to Update the Pharmacist Interns Hour Requirements from Business and Professions Code section 4209 and 16 California Code of Regulations Section 1728 and the Intern Hours Affidavit Form 17A-29
Chair Veale reported that at the committee meeting Jon Roth offered CPhA’s legislative support to make any statutory changes deemed necessary to change the reporting of pharmacy intern hours.
Chair Veale explained that it was the committee’s desire to ensure that intern hour requirements are the same for all graduates of an ACPE accredited pharmacy program. The committee asked board staff and counsel to ensure any statutory or regulatory changes made achieved equality in intern hour reporting requirements for both in-state and out-of-state applicants.
Chair Veale noted that at the committee meeting the comment was made that it is easier for an out of state graduate to receive approval to sit for the board’s exam. Mr. Santiago stated that at the committee meeting the comments were not addressed because there was no licensing staff present.
Ms. Herold responded that the board does not probe into if the out-of-state applicant was getting paid during their internship and staff validates that a pharmacist signed off on the hours.
Mr. Room asked if the committee envisioned that statute would require that as part of the application, and applicant would have to submit a form signed by the dean of the school certifying that they completed the intern hours required in the ACPE curricula.
Chair Veale responded that graduating from an accredited school essentially indicates that they completed the necessary intern hours, the committee was looking to staff to determine is a certificate from the dean was necessary.
Mr. Room warned that with compounding the board was previously willing to accept an accreditation body’s approval in place of a board license and the board has sense found that this was not sufficient.
Chair Veale responded that unlike compounding accreditation there is only one entity (ACPE) that accredits all schools of pharmacy. Additionally she stated that the committee felt that ACPE was better able to monitor the programs and preceptors.
Mr. Room expressed that the board must be willing to accept any changes to the hourly requirements they may deem fit in the future – for example if they lower the requirement to 500 hours.
Chair Veale agreed and commented that perhaps the board should create a floor that the hours could not go under.
Ms. Herold noted that the board would need to consider that there are foreign graduates who are currently required to complete a number of hours in the United States.
Chair Veale responded that the committee would not change that requirement. Ms. Herold asked to clarify it proof of graduation or a separate letter from the dean would be required to fulfill the intern hour requirement.
Chair Veale stated that those details could be sent back to the committee and staff to work-out.
President Weisser commented that he is uncomfortable handing over the process to ACPE and worries that the importance of gaining hands on experience may be lost.
Chair Veale commented that previously she felt the same way; however after hearing the various presentations she learned that ACPE really closely monitors the schools and the preceptors.
Mr. Law commented that the board needs to require that the schools meet a certain hour requirement so that the scenario that Mr. Room described earlier could not occur.
President Weisser remarked that over the years he has wondered how much of an emphasis the pharmacy schools place on graduating students who have an appreciation for practice in community pharmacies vs. clinical practice.
Mr. Law responded that in top pharmacy schools 30% of graduates work in clinical settings and 70% of graduates work in community pharmacies.
Ms. Butler commented that like President Weisser, she was previously concerned about students gaining experience in community settings. However after the committee meeting she felt assured that ACPE accredited schools give students experience in all settings.
Dr. Wong commented that knowledge gained in clinical settings can be used in community pharmacy settings.
President Weisser agreed. Steve Gray, representing CSHP, commented that there is a perceived discrepancy in the requirements for California applicants and out-of-state applicants. Currently California applicants must have their hours signed off by the pharmacist who did the training or PIC of the location where they worked, however out-of-state applicants do not have to submit the same documentation.
Dr. Gray clarified that even if the board does not choose accept graduation in place of intern hours; they should review the licensing processes to ensure that the requirements are being implemented equally for all applicants.
Dr. Gray also commented that CSHP is worried that current graduates of pharmacy schools are not entering the workforce practice ready and have a lack of maturity (no work experience). He noted that many schools use simulations rather than real experience.
Dr. Gray stated that ACPE is currently designing the new standards for accreditation and encouraged the board to participate in the process.
Dr. Gray concluded that it is very difficult for current students to gain intern hours outside of their school. Chair Veale asked Dr. Gray to clarify if CSHP supports the request made by the various schools of pharmacy to change the intern hour reporting.
Dr. Gray confirmed that CSHP was in support of the proposal. At the request of Mr. Schaad,
Dr. Gray provided an overview of the use of simulations used in schools of pharmacy. Ms. Herold clarified that every applicant, regardless of state, signs their application stating that they have completed 900 hours of practice experience under the direct supervision of a pharmacist.
Dr. Gray responded that the board requires California students to submit affidavits signed by the pharmacist that supervised them, while out-of-state applicants to not have to provide such documentation.
Dr. Gray clarified that the difference in documentation required by the board is why CSHP feels that California students are being held to higher standard.
Holly Strom, former board member, commented that many graduates leave school and are not ready for practice. She added that when she was a board member she attended an ACPE accreditation and was very impressed with the rigor that the schools are held to and encouraged current board members to attend them if possible.
Sam Shimomura, Associate Dean of Western University School of Pharmacy, commented that many times students go back to the location they completed the intern hours and the PIC or supervising pharmacist has left the pharmacy.
Dr. Shimomura added that Western University finds simulations to be a helpful educational tool and recommend that board consider adding a simulation portion to the CPJE. At the request of Mr. Law, Dr. Shimomura explained that of the approximately 140 graduates about 30-40 students choose to study clinical pharmacy and the rest study community pharmacy.
Dennis McAllister, representing ACPE, reported that the draft ACPE standards are now available for review online and they will be reviewed at the NABP meeting in Phoenix. Dr. McAllister explained that ACPE changed their standards to allow students have 30 of their experience hours to be gained via simulation; the remaining 1,710 must be done in a pharmacy.
President Weisser asked Dr. McAllister (who currently serves on the Arizona Board of Pharmacy) if they have issues with pharmacists not conducting patient consultations. Dr. McAllister responded lack of consultation is hard to quantify but seems to be a common problem in all states. He added that six or seven years ago the Arizona board took the stance that any issue that that resulted in the patient needed to file a complaint with the board or caused patient harm and could have been prevented by proper consultation, would result in an automatic fine.
Mr. Law asked Dr. McAllister thought that ACPE would ever lower the number of experience hours a student needs to complete prior to graduation.
Dr. McAllister responded that he does not anticipate ACPE would ever lower the hour requirement as they understand how important quality experience is to graduating practice ready pharmacists.
Representatives from the University of California San Francisco, University of San Diego, Touro University and the University of the Pacific expressed their support of the proposal to change the intern hour requirements as presented to the board. The representatives also provided the board with insight into the pharmacy experience gained while in the various schools.
John Garret, pharmacy student at the University of San Diego, provided the board with insight into the experience gained in school by current pharmacy students. He noted that students face new hardships including increase in tuition fees and a decrease in the number of jobs available.
Ms. Butler asked if the representatives felt that students left the schools ready to practice pharmacy. It was clarified that the students were ready to sit for the CPJE exam.
Sam Shimomura, Associate Dean of Western University School of Pharmacy, commented that their preceptors receive training and continuing education opportunities.
Dr. Shimomuro added that schools have been expanding the number of clerkship hours required for students.
Ms. Herold suggested that staff provide different options to the board at the next meeting.
Chair Veale asked that the board vote on the committee recommendation to change the requirements, and then if the motion passes board staff can provide options on how to implement the change.
Dr. Castellblanch commented that he would like to receive more options from board staff and discuss the item again at future meetings.
Chair Veale responded that members who would like to receive more options rather than accepting graduation from an ACPE accredited school should vote the motion down so that the discussion can go back to committee.
Committee Recommendation (Motion): Direct staff to work with counsel to develop any statutory and regulatory changes necessary so that graduating from an ACPE accredited school of pharmacy meets the intern hours requirement for the application to the CPJE exam. Support: 9 Oppose: 1 Abstain: 2
