Does an early longitudinal community practice placement for pharmacy students promote learning by establishing more opportunities for connection with patients, curriculum integration and professional engagement? A Mixed Methods Study

Introduction: Longitudinal clinical placements are defined as involving "a regular, recurrent placement in the same setting with the same supervisor over a period of time". The underlying mechanism promoting learning is "continuity" in its varying forms of patient, supervisor and longitudinal exposure. Longitudinal placements have been reported to promote learning by establishing more opportunities for connection with patients ("continuity of care"), integrating knowledge, skills and attitudes across science and practice ("continuity of curriculum") and enhancing supervision, role modelling and mentoring ("continuity of supervision")1. The longitudinal community pharmacy placement (LCPP) in the institution was designed for second year students to attend the same community pharmacy site for a half day each week for 12 weeks. Aim: This study sought to answer the question: Does an early longitudinal community practice placement for pharmacy students promote learning by establishing more opportunities for connection with patients, curriculum integration and professional engagement? Methods: This was an explanatory mixed methods study. Data for the quantitative before and after study were collected using a validated tool called the Student Pharmacist Inventory of Professional Engagement (SPIPE) 2 and the questionnaire, also contained questions related to connection with patients and curriculum integration. Qualitative semi-structured interviews, focussed on continuity of care, curriculum and supervision, with students, supervisors and practice-educators were conducted following the 12-week longitudinal placement. The interviews focused on continuity of care, curriculum and supervision and were thematically analysed. Results: 78% (n = 47/60) students completed the questionnaire. Significant increases in the sum scores for professional engagement (S-PIPE) and sub-scores for belonging, meaningful experience and connectedness were recorded post-placement. Some increases were recorded relating to connection with patients. The majority of students agreed that the placement helped them to contextualise and apply knowledge learned from modules. 13 students and 12 pharmacists were interviewed. Most participants described the placement supporting curriculum integration, considering the suggested learning activities very useful to promote integration of module content and practice. Continuity of care was not as widely discussed as some pharmacists had seen this as more of an observational placements and students saying they did not get the chance to speak to patients. However, some pharmacists allowed their students to serve customers and practice patient counselling, which from a student lens was very useful, particularly when they built relationships with patients they saw recurrently. Pharmacists and students felt that the longitudinal nature of the placement promoted building a professional working relationship over time. However, some pharmacists were not there on a number of student placement days, limiting the opportunity to build a relationship and students felt that days where locums were working were less beneficial. Conclusions: The LCPP promotes professional engagement through role modelling, professional working relationships and repeated supervisor interactions. Curriculum integration is promoted through learning activities, and the longitudinal nature of the placement allowed for opportunities to link to modules being studied at the same time and for linking to more modules. Patient-centred beliefs are promoted but issues including not seeing interaction to completion and inconsistences in level of interaction with patients, depending on placement. Possible issues to be addressed include reviewing the 3 hours' duration of the day and more guidance on the expected level of interaction with patients.