New APPE programs will bring pharmacy students to rural and underserved urban communities

Two new College of Pharmacy programs will place pharmacy students in both rural and underserved urban communities for extended work as part of their fourth-year Advanced Pharmacy Practice Experiences (APPE) rotations. The programs, called Rural Pharmacist Associate Program (R-RxAP) and Urban Underserved Pharmacist Associate Program (U2-RxAP), will immerse students in a single community for a 30-week, six-block series of APPE rotations. 

The college received a planning grant from the Minnesota Department of Health to fund the initial development phase of the program and studied different literature, schools, and health care fields to identify best practices. Early on in the process, the college began collaborating with the University of Minnesota Medical School’s Rural Physician and Metropolitan Physician Associate Programs (RPAP and MetroPAP) to leverage their successes and build a similar program for pharmacy students. The partnership will also aim to foster interprofessional collaboration; whenever possible, pharmacy students will be co-located in communities with medical students and other interprofessional learners. 

“When we met with [the medical school programs], it became apparent that they had a really successful model that they've been using in the medical school for quite some time,” said Dr. Maggie Ricco, residency program director. “It not only worked in terms of creating a really cool educational experience and exposure for med students, but it also worked in retaining people in rural communities.”

The rural and underserved urban pharmacy programs will be available starting with the PharmD class of 2027, who are currently second-year students. In the fall of their third year, they will apply to the programs and indicate a ranking of preferred communities prior to the beginning of the APPE scheduling process. 

“In those 30 weeks, the students are learning across the systems, working with the team, really building those meaningful relationships that normally start over every five weeks,” said Dr. Andrew Traynor, associate program director for PharmD experiential education. “We're looking for more meaningful learning activities that also include community engagement and really understanding what makes this community work. How do they serve people? How do people live here? How does healthcare interface with that beyond the patient presenting with a need?”

The extended community placement may reduce the cognitive burden for some students by eliminating the reset and adaptation periods between rotation sites. In a more traditional APPE model, students would be learning a new electronic health record system, meeting a new preceptor, and mapping the layout of the new site every five weeks— this model creates the opportunity for smoother transitions between blocks, Ricco noted. 

“When you think about it, there's a lot that you can learn from someone in a short period of time and think of how much you can learn from [a preceptor] when you really develop a deep relationship over time,” Traynor said. “We can cover a wider base of things than just knowledge and skills and really tap into who you are as a person to create holistic development.”

Particularly for the rural sites, this will mean students will likely live in or close to the community, resulting in a fully immersive experience of rural life and work, Traynor said. The college has a requirement for students to complete either a rural or underserved urban APPE rotation but has moved away from requiring all students to complete both APPEs. Instead, the focus is on attracting students who are interested in rural or urban underserved work (“moving from required to inspired”). Ideally, this model will encourage retention, causing students to consider returning to those communities and staying there long-term. While the college has long considered implementing a longitudinal APPE program, the COVID-19 pandemic put a pause on it, as it did for many projects. The silver lining is that it allowed the college time to be intentional about building the program and effectively engaging students.  

“We're moving away from putting students who may be reluctantly going [to specific communities], might just be doing it to check a box, to finding the ones for whom it's really a good fit, inspiring them and helping them to understand all the opportunities that exist, both professionally and personally,” Ricco said.

Addressing workforce shortages and the needs of underserved communities is a major priority of the college. Structurally, the parallel programs will be very similar, but will differ in terms of “the ways social determinants of health present and how systems of care and resources are used to address patient needs,” Traynor said.

“We have many different workforce challenges equally in rural and urban areas and it's about giving people the skills and experiences to feel confident in going to these settings,” he added.