A practicum problem: COVID-19 forces pharmacy students to weigh personal health, on-time graduation

Ada Mew was working at St. Paul’s Hospital when COVID-19 began to shut down the country.

The fourth-year student is in the Entry-to-Practice (E2P) PharmD program at UBC and was completing her practicum at the hospital.

On March 17, Mew was pulled out of her position and told her she wouldn’t be going back to work at the hospital. She was then reassigned to work in a community pharmacy, a Shoppers Drug Mart in Vancouver.

Her experience isn’t uncommon in the E2P PharmD program right now. As hospitals have kicked students out with the outbreak of novel coronavirus, students currently completing their hospital requirements have been sent to community pharmacies.

Students in the faculty have expressed concerns about the way UBC is dealing with practicums — namely in a hotly debated UBC Confessions post. Not only are students concerned for their personal health and the health of those around them, but they’re frustrated with the quality of education they’re receiving after being forced out of hospital practicums, and with UBC for not doing more to prevent students from having to delay their graduation if they choose to postpone their practicum.

‘Personal risk tolerance’

In third and fourth year, students in the program complete their practicums within hospitals, after two years in community pharmacies earlier in their degree.

Nick Pang, a pharmacy student senator and a student in the program, said that the health risks of practicums are going to depend on the “student’s personal risk tolerance.”

“For a majority of the people who are worried, it’s because of the people they might be in contact with … A lot of people are living with roommates. A lot of people are living with family, especially older family members, or perhaps parents with immunocompromised conditions,” he said.

Students have brought up health issues in a survey obtained by The Ubyssey. The survey — administered by students in the program between April 10 and 17 — collected the opinions of 120 class of 2021 students and 171 class of 2022 and 2023 students to “gather a brief overview of the current feelings of students regarding their upcoming Community Practicum Placements.”

Jason Schacher, one of the students involved in the creation of the survey, noted that the survey was intended to “facilitate students concerns” and provide the information from the survey to the Office of Experiential Education — the body that deals with everything practicum related within pharmacy — to “help in their decision making model.”

“Questions were made to address essential knowledge of the students going on practicum and provide an outlet to elaborate on specific worries that each graduation year had … Just as the experiences of each year were different, so were the opinions,” Schacher wrote in a message to The Ubyssey.

In response to the question, “Currently do you have any issues regarding your practicum site?” approximately 100 students surveyed noted safety concerns and a little over 80 students noted travel concerns. Other concerns included finances, housing and inadequate resources.

In the survey, around 25 respondents noted that they are in contact/live with someone who is immunocompromised and around 45 said they are in contact/live with someone who is over the age of 60.

The shortage of personal protective equipment is also an issue, especially in community pharmacies where Mew and many other students are now working.

“We … in the community don’t qualify as health care professionals so we ... have not been able to order those surgical masks and we’ve had to look for [them] and sew our own as well,” Mew said.

Dean of the Faculty of Pharmaceutical Sciences Michael Coughtrie wrote in a statement to The Ubyssey that the Office of Experiential Education "has spoken with numerous practice sites and practice educators … and is working closely with sites to ensure the safety of our students.”

He noted that community pharmacies have their own measures in place to protect those working there.

“Our pharmacy partners are working to ensure their practice sites are safe to provide care and academic instruction without an unreasonable burden of risk,” he wrote. “While on practicum, students are to follow the guidelines and recommendations provided by provincial Public Health officers and continue to adhere to all infection control policies as directed by the practice site and their practice educator.”

Due to COVID-19, however, the usual requirement that students complete their summer practicum before continuing with the fall term is not in place for this year. So, students who chose not to complete their practicum can continue their studies in the fall. However, they would still have to complete that practicum at a later date, postponing their graduation.

Coughtrie said this is the approach that will “enable the continuity of our E2P PharmD program while ensuring students have the ability to determine what is best for themselves and their families.”

Some students have called for the faculty to cancel practicums altogether for the time being due to the risks of COVID-19, but others, such as Mew, have expressed the desire to continue their practicums and contribute to the community effort.

According to Coughtrie, the faculty is not considering cancelling all practicums.

“The Faculty has an obligation to our profession and the communities we serve to ensure that students that have achieved the key competencies, as mandated by our accrediting organization and pharmacy regulatory authorities, are successfully graduated each year to meet the ongoing needs of the workforce,” he said.

Out of the faculty’s hands

As for adjusting graduation requirements, UBC can only do so much, as accreditation in Canada is determined by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP). The Council is the body that determines how many hours of practicum and of what type a student needs to graduate with a PharmD degree. To graduate as an accredited pharmacist, students have to complete 32 weeks (1280 hours) of practicum, with at least 24 weeks of full-time direct patient care.

“We’ve had meetings, spoken with the [CCAPP] and they are unwilling or not considering the change in the requirements needed for a school to graduate an accredited pharmacist,” Pang said.

K. Wayne Hindmarsh, CEO of CCAPP and dean emeritus at the Leslie Dan Faculty of Pharmacy at the University of Toronto, sent The Ubyssey part of a notice sent to Canadian deans of pharmacy in March.

“There was unanimous agreement today at the [CCAPP] Board meeting to empower and enable each institution to be innovative in identifying best practices to assist in your assessment of whether the students have met the competencies,” the statement reads.

“We believe that the Faculties/Colleges are best suited to determine which students are competent to graduate. This would include evidence of practice competency even though all the clinical hours have not been met.”

At UBC, this has resulted in community practicum essentially equating to hospital practicum for affected students.

“That’s, I think, the reason why people are being pulled out of hospitals and put into community [pharmacies] because that fulfills that requirement even though ... it’s not the same. But it’s similar enough that they will still be able to graduate,” Pang said.

Mew noted that the experience in community pharmacies isn’t the same as in hospitals — and that hospital experience is a major draw of the UBC program to begin with.

“A lot of people are very upset that hospital does not equate to community. The medicine is different. The speed in which you do things is different,” Mew said. “But at the same time, we can’t force health authorities and hospitals to take us when they’re not even taking doctors and nurses.”

Students have also struggled to find practicum sites in general — a problem that Pang said is not necessarily new for the program that has grown significantly since it began in 2015. However, the pandemic has intensified this.

“With COVID, a lot of practicum sites are closing their doors to students, especially all of the hospitals, and it’s quite difficult for the faculty to find any practicum site,” he said.

Pang said that students have asked the faculty to ask the Accreditation Board to make changes, but he said that no other schools have convinced the Board to lessen requirements either.

“It doesn’t seem like UBC is going to be an exception. So in that sense, there’s not much the faculty can do. I'm sure theoretically it’s possible for the faculty to fight much harder and try to get this exception,” Pang said.

“But in a more realistic sense, I don’t think they have the resources at this time to be able to do that.”

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