CEimpact Podcast

Teaching Future Pharmacists to Diagnose and Prescribe

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Diagnosis and prescribing are no longer on the margins for pharmacy practice, but explicitly called out in the ACPE Standards that guide pharmacy education. Once considered out of bounds for pharmacists, diagnostic reasoning is now central to preparing practice-ready graduates. This episode explores how preceptors can support learners in applying clinical decision-making frameworks, integrating shared decision-making, and navigating prescriptive authority across diverse practice settings—equipping the next generation of pharmacists for expanded patient care.

HOST
Kathy Schott, PhD
Vice President, Education & Operations
CEimpact

GUESTS
Jennifer Adams, PharmD, EdD
Associate Professor, Associate Dean for Academic Affairs
Idaho State University L.S. Skaggs College of Pharmacy

Rachel Allen
Associate Teaching Professor
University of Washington School of Pharmacy

Cherith Smith, PharmD
Clinical Assistant Professor and Director, Experiential Education
University of Montana – College of Health Skaggs School of Pharmacy

Kathy Schott, Jennifer Adams, Rachel Allen, and Cherith Smith have no relevant financial relationships with ineligible companies to disclose.

Get CE: CLICK HERE TO CPE CREDIT FOR THE COURSE!

CPE INFORMATION
Learning Objectives
At the end of this course, preceptors will be able to:
1. Describe key principles of diagnostic reasoning and prescribing within the context of pharmacy practice.
2. Identify evidence-based frameworks such as the One-Minute Preceptor and shared decision-making to support learner development in clinical settings.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-319-H99-P
Initial release date: 10/15/2025
Expiration date: 10/15/2028
Additional CPE details can be found here.

This program has been:
Approved by the Minnesota Board of Pharmacy as education for Minnesota pharmacy preceptors.

Reviewed by the Texas Consortium on Experiential Programs and has been designated as preceptor education and training for Texas preceptors.

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SPEAKER_03:

Welcome to Precept to Practice. I'm your host, Kathy Schott, and today we're continuing our conversations on developing clinical reasoning skills, but this time with a twist. With the new ACPE standards 2025 now in effect, pharmacy educators are tasked with equipping future pharmacists with diagnostic and prescribing skills. Once considered beyond the scope of pharmacists, diagnosis and prescribing are becoming more mainstream as state legislation is opening the opportunity for standard of care regulation and broader prescribing authority in areas such as infectious disease and contraception. We've long talked about clinical reasoning, and now it's time to take the next step. In this episode, I talk with representatives from three schools of pharmacy in the Pacific Northwest who are working with preceptors to ensure they feel equipped to teach diagnostic reasoning to their learners and equip them with the skills necessary to take advantage of expanding roles for pharmacists. Whether you're a seasoned preceptor or new to experiential education, today's conversation is full of practical takeaways you can start using immediately. Let's get started. Okay, well, welcome everyone. I am so glad to have you all here today. I know that coordinating three schedules from three academicians from three different institutions and the first couple weeks of school is not the easiest thing to do. So I really appreciate you being willing to join me. I'm super excited about today's conversation. It's I think a really timely topic and it's been something that's been in the back of my brain. So I was so happy, Jen, when you reached out and and offered this topic to to another uh team member, Josh. You know, it's timely for us. I'm in Iowa and we have just adopted standard of care. So we're really looking at how practice is changing or will change. I know that's our already been the standard for some years in Idaho, um, Jen. But you know, the question here today is how does that impact precepting? And there's just so much advocacy happening in other states in this space for expansion of scope for pharmacists that I think this is just a really great timing. Let's let's get started with just some quick introductions from each of you, a little bit about your background, um, but more importantly, what led you to focus on diagnostic reasoning and and pharmacist prescribing in experiential settings. So, Jen, let's start with you.

SPEAKER_02:

Well, thanks, Kathy. Happy to be here today and excited to talk about this topic and hopefully provide some education for preceptors so that they can feel comfortable with what's happening in pharmacy education that's supporting some of our practice advancement. Um, and so I'm Jen Adams. I'm the Associate Dean for Academic Programs and a tenured professor at Idaho State University. And I support our Office of Experiential Education predominantly working with them on their evaluation tools and making sure that when we're evaluating students on introductory pharmacy practice experiences and advanced pharmacy practice experiences, that that connects well with the overall curriculum and our overall goals of what we're trying to help train our future pharmacists to do.

SPEAKER_03:

Awesome. That's awesome. Rachel.

SPEAKER_01:

Hi everyone, I'm Rachel Allen. I'm an associate teaching professor at University of Washington School of Pharmacy. And there I'm assistant dean for professional affairs and practice. So experiential education is one of the areas under that umbrella, in addition to professional development and career readiness. I also teach in our second-year pharmacist provider series, and a lot of these skills with kind of thinking about diagnostic thinking is part of what I focus on in my teaching role as well. Thanks for having me.

SPEAKER_03:

Yeah, thank you for being here. Cherith, let's finish up the intros with you.

SPEAKER_00:

Hello, my name is Cherith Smith from the Skages School of Pharmacy at the University of Montana. I am the serving as a clinical assistant professor and the director of experiential education. I have been working with students for now it's been decades. I've been a preceptor since 2010 and started out in a teaching community-based pharmacy. Spent 10 years in retail pharmacy as a preceptor and then switched to 10 years in an ambulatory care setting. So I would share that precepting is near and dear to my heart. Being part of the experiential program helps me to interact and network with other schools of pharmacy within our consortium. And together we've been able to navigate some of these changing landscapes for our preceptors. Thank you so much for having me.

SPEAKER_03:

Yeah, yeah, absolutely. Chairs, could you, you and I were chatting before we hit the record button today. Could you just share a little bit about what brought you all together specifically around this topic? I know I kind of shared my why, but it would be good to hear, I think, from you all as to, you know, what put you all together under this uh uh under this space.

SPEAKER_00:

Sure. So we are all part of the Northwest Pharmacy Experiential Consortium, and that consortium includes Oregon, Washington, Idaho, Wyoming, and Montana. And as we've navigated through first, it was COPA 2022, we started to move forward in taking a look at preparing for and anticipating ACPE 2025 standards. In the last year, we then received some requests on how our programs were going to address some of the some of those upcoming standards changes. Included in that were the diagnostic reasoning and prescribing. And so we came together as a consortium and realized that all of us were navigating through this process, and there was a learning where our preceptors were really at and being able to embrace these changes. That's where we realized that we needed to do some education across our consortium to help prepare our preceptors as these new standards rolled out.

SPEAKER_03:

Right, right. Yeah, and here we are in 2025. So we're in it. Let's let's start by talking a bit about what diagnostic reasoning is. I mean, we uh we've talked for years about clinical reasoning, developing clinical reasoning skills in our students. Talk a little bit about what makes diagnostic reasoning maybe different in the context of pharmacy education. Jen, would you mind tackling that one?

SPEAKER_02:

Sure. I'm happy to. So there's probably folks out there listening that have that have heard me say, you know, we've actually been engaging in diagnosis and pharmacy through some of our clinical reasoning for years. We just haven't used the words to describe it in that way. So when you look at the diagnostic steps that apply to any health profession, so physicians, nurse practitioners, PAs, when they're determining a working diagnosis or a differential diagnosis, they're collecting information about the patient, they're assessing that information that they have and coming up with sort of a working diagnosis. And they may begin down the area of a plan where they're like, okay, we we have this plan that we're gonna begin to implement and see how it goes. And if things don't work, we're gonna come back and revisit and collect additional information. We're gonna then again assess that information. So what you're hearing are actually steps of the pharmacist patient care process, right? So we have been talking about these things in pharmacy for literally years, decades. We just haven't been calling it diagnosing. I've been a pharmacist for a few more than 20 years, but no one's no one's counting. No one's counting. No one's counting. No, I'm now Stephen's, I'm not young anymore. It's okay. I exactly. Um, but in thinking about my own pharmacy education, I was taught that there are other people in healthcare that figure out what's wrong. And then as pharmacists, we use our skills to fix what's wrong with medications, right? So I was taught all along the way, like we are not diagnosticians, but we were taught all of the diagnostic skills just not using those words. And we were taught advanced assessment or maybe just assessment. But pharmacists every day are confirming diagnoses. They're looking at that information that they have, making their own assessment to determine does this patient really have this disease state before I move down the path of, you know, confirming that we're in the right space and having the right medication for the therapy for this patient. Does this make sense that we are actually where we are? And there are stories upon stories of pharmacists who have said, hmm, maybe we need to relook at this patient. Maybe we aren't, maybe there's something else going on here. Before we go down this treatment route, why don't we gather a little bit more information? So that's really where things started to fully come together. And then in Idaho, as pharmacists obtain this advanced authority. So, yes, we have, you know, the standard of care model where we can regulate pharmacists and penalize their license if they go rogue and outside the standard of care. But at the same time, we also advanced our scope to allow pharmacists to have full practice authority. So pharmacists in Idaho now have the ability to diagnose and prescribe independently without being under the supervision of another practitioner. And so, because of that, we really had to look at what we were teaching in pharmacy education to make sure that we were clear you're gonna have this authority when you graduate. We wanted it to be really clear for the students that these are the skills that you're learning. And thankfully, and I'm sure you probably have more questions about this, but the pharmacist patient care process has now been updated to more intentionally include diagnosis and prescribing and and to be clear that that's what we were always talking about. Like the words are actually there. Um and the accreditation standards 2025 also include those words. So that's where it all started and where it all where it all came from.

SPEAKER_03:

Yeah, no, that's great. I mean, it's really just a it's a semantics. We it's it's been there. So we're calling it what it what it is. Yeah. Yeah. You you touched on Idaho, you know, as as you know, having full practice authority. Jen, what's the landscape, you know, in pharmacist prescribing authority in general? Can you talk, you know, obviously high level, but touch space a little bit about what's happening across the country with regard to prescriptive authority?

SPEAKER_02:

We're definitely starting to see a shift towards more independent authority as it relates to pharmacist prescribing. I think a lot of states, there's authority to prescribe vaccines, right? Like that's sort of where a lot of things started. And then we started to see some other things, whether it was for smoking cessation or hormonal contraceptives or opioid antagonists before nalaxone became over the counter. Like we started to see like some movements across the states. Um, there are now a handful of states, including Montana, where Sheriff is, where pharmacists are prescribing based on broad categories. So for things that are minor and self-limiting, things that can be diagnosed with a CLIA wave test, things where a pharmacist says this is an emergency and I need to be able to take care of this patient. Um, so we're seeing that in a handful of states like Montana, Colorado, Alaska has a little bit of a version of it. Idaho started, you know, with a list and then we moved to the categories, and now we just have this broad prescriptive authority, much like Iowa, who has also moved in that direction. And so we're beginning to see a shift and a recognition that pharmacists are trained in this way, um, and that pharmacists do have the skills to be able to practice independently and to be able to take on that authority in a way. And in some cases, you know, if you've been a pharmacist for a little while and you haven't, you know, aren't super comfortable thinking this way, there are definitely continuing education programs that help people feel more comfortable. Um, but that at least in in Idaho and Iowa, having that standard of care framework, making sure that pharmacists are not prescribing outside of their clinical ability, outside their education training, and experience. So in other states that are moving in that direction, or maybe that are allowing for prescribing under collaborative practice authority, that standard of care piece can absolutely still still be relevant for those folks, even if it's being guided by a protocol, like a statewide protocol, or a protocol that's determined between the prescriber and the pharmacist in the collaborative practice agreement. So all states now allow for collaborative practice agreements. So whether that prescribing is happening under delegated authority from another prescriber or whether it's happening independently, that prescribing is happening. And it's interesting, there's actually a really great opinion from the Washington Attorney General that talks about, you know, prescribing and diagnosing are so intimately connected that you can't have one without the other.

SPEAKER_03:

With a user.

SPEAKER_02:

What would you prescribe if there was no diagnosis or a reason to prescribe? So you have to have that diagnosis to determine what you're going to prescribe.

SPEAKER_03:

Yeah. No, that makes sense. Talk a little bit about, you know, obviously it's in, you know, the the terminology is now in the standards. Um, and but beyond that, maybe talk a little bit about why it's important for preceptors to understand these evolving responsibilities that they have, you know, as a result of a changing landscape and up and updated standards and a revised patient pharmacist patient care process. Can you talk a little bit about the role the preceptor needs to play in all of this?

SPEAKER_02:

Yeah, absolutely. So often when we define in pharmacy education the things we want to evaluate students on, we need to have somebody who's modeling that behavior for them, right? So having a preceptor modeling their thought processes, right? So a preceptor who's gonna say, okay, I just got this prescription in a community pharmacy. I'm gonna look through the information that I have and determine if this is the right drug for the right patient right now. So what are those things that are going through my mind as I'm making that decision? Or a pharmacist in an ambulatory care setting who is looking at a patient and looking at their labs and making a determination if this is the right course of action or treatment for a patient, is this the right diagnosis? And it might be that you are thinking through all of those diagnostic steps without realizing it. Um, and we found in our experience at Idaho State, but also I know Rachel can speak to what they found at the University of Washington, like how often preceptors didn't think they were doing those things. And so this is something that's important for us in pharmacy education to help preceptors recognize and identify when they're already doing these steps so that they can then model that behavior for our students and evaluate our students' ability to actually take those steps. Because at the end of the day, you know, you graduate from pharmacy school and you have that sort of minimum level of competency, right? Like that's what everybody says. You're gonna pass the Netflix and you're minimally competent, and then you're gonna gain experience and you're gonna get better at all the things. But what is that expectation of that minimum level of competence? And we need students to be able to demonstrate that minimum level of competence. And in the case of the accreditation standards, they need to have and be able to articulate their ability to diagnose or confirm a diagnosis and to prescribe the right therapy or treatment for a patient.

SPEAKER_03:

Yeah, yeah, yeah. Thanks for that. That is helpful. Rachel, maybe build on that a little bit. Um, you know, Jen referenced the work that you've done at UW to help preceptors sort of see their role in all of this. And then maybe maybe start start to, you know, walk us through what this looks like in, you know, in engaging students in in you know the diagnosis process in as part of their experiential uh work.

SPEAKER_01:

Absolutely. I think that's the piece that that we saw was that students sometimes weren't recognizing themselves in these roles and we asked them to reflect on how are you diagnosing? So so there's kind of this trickle-down effect if the preceptor isn't articulating it, the student isn't seeing it, and then it's it's not becoming kind of part of their professional identity and realizing, yes, I diagnose and I prescribe, and that's just who I am. So I think that's that's kind of the fun is knowing these things are happening, we just have to kind of change our wording a little bit to make it more explicit and clear to students. Yeah, so one thing we did is actually ask students, how are you sort of involved in diagnostic thinking? And we got some really fun responses because I think this reflects both ways that preceptors and students are engaging in diagnostic thinking. Um, so things like I just reviewed a patient's chart during Med rec and I happened to find an undiagnosed condition. So a student actually mentioned on their rotation that they found an elevated A1C with a patient with no diagnosis for diabetes. They saw no medications for diabetes and were able to work with the team and and kind of have this patient appropriately diagnosed with diabetes. So that's kind of one example that that we saw. Certainly in the diagnosis realm, identifying medication-related causes. So another example that was shared with us of a student having this happen on rotations was suspecting Steven Stevens-Johnson syndrome based on the way a patient was presenting and their recent medication exposure. So that was something the team was able to investigate further and confirm that that was what was happening. Um, so some really meaningful interactions, certainly interpreting labs and data to confirm a diagnosis. So we had a student share an example of hey, we were able to confirm that there was iron deficiency anemia before we moved forward with therapy and felt good about it. And then, yeah, so many great examples of ruling out differential causes for OTC recommendations. Like we ruled out it wasn't, you know, a migraine, it wasn't something that needed to be referred before we recommended an OTC therapy. So I think it's kind of fun to see what the the students are doing out in practice, and we certainly see that it's happening.

SPEAKER_03:

Yeah, yeah, yeah. That's great that they're able to identify all those things and start to make those connections. Um, Jareth, I think that we you have a couple of examples from a community practice perspective. And I'd I'd love to explore a couple of case case scenarios maybe a little more deeply just to make sure we're giving folks a real picture as to what this all can look like from a preceptor to preceptor's perspective.

SPEAKER_04:

Oh, I have you on mute. Yeah, Tiereth still.

SPEAKER_03:

There we go.

SPEAKER_00:

All right. So thank you so much. In working in both community pharmacy practice and in ambulatory care settings, there are some overlapping skills that we see not only our pre our students being able to engage in, however, these fit within the building blocks as we develop prescribing and diagnostic skill sets when we look at some of the activities already going on within a community pharmacy. If we were to look at a community pharmacy where we've seen a lot of strengths, we have the immunization programs, pharmacist-based immunizations. And every time that a patient is coming into the counter, there's a collection of information. And that collection of information then is assessed as it moves through that dispensing process, being able to help that student understand what information is important, how they're making the decision of whether or not that vaccine can be administered, and then administering the vaccine, counseling on that vaccine, there are a lot of different components in there that help a learner understand specific skill sets and steps within the whole diagnostic process, that diagnostic reasoning, and then being able to then dispense that prescription, what is entailed in creating that prescription from that prescribing standpoint. We also have a number of our community pharmacies across our region who are involved in tests to treat. And so if we are looking at CLIOVED tests and having a student understand the step-by-step processes, critical thinking, collection of information, all of that can help contribute to prescribing and diagnosis. So even if we are not thinking about something where a pharmacist is actually doing the actual diagnosis, they are involved in the steps and being able to assess and understand and examine what is going on in front of them. So a couple of the examples that we might think about include, and we've already talked about that, could also be, for instance, our community pharmacies may provide a blood pressure screening. If they're identifying an individual who is coming into the pharmacy and they just ask for a blood pressure screening, and that blood pressure is elevated, individual isn't on medication, uh, that offers an opportunity to provide education and some form of referral that also helps build those building blocks. But I also think about simple things that we've been doing forever and ever, and that is over-the-counter recommendations. So when we're thinking of over-the-counter recommendations, that can run from looking at how we're helping an individual select an antifungal cream. It could be how they are looking at selecting a supplement. There are a lot of different things that a pharmacist is already doing, but are we actually walking that student through those steps and how we're determining what we're going to help that customer or that patient choose? So there's a few examples there of what we see in community pharmacy.

SPEAKER_03:

Yeah, those are great examples. I'm thinking back to a continuing education program that we did not very long ago on probiotic selection. So when you mentioned the over-the-counter supplement, and it had a huge diagnostic component to it, really understanding what the issue was for the patient before recommending a product on a specific strain. So I can see, you know, how that really can play out in the community space. Um, other examples and maybe other practice environments. And I think earlier we talked about, you know, what about pharmacists who may be practicing in more of a clinic-based environment. Jen, is that something you you can maybe talk through?

SPEAKER_02:

Yeah. And just one other thing to add to, like on the community-based side, I'm very much a words matter kind of person in case people haven't picked up on that, right? Like, let's just use the words and stop making up things in pharmacy that other health professions don't use. But I did notice APHA just changed the name of their certificate training program to diagnose and treat instead of test and treat. You know, you're using the test as information to help form your diagnosis and treat. So just something that like related to what to what Sherith was explaining that I was like, oh, so excited to see, right? Like you're using the right words. It's great. But thinking too about like a clinic-based setting, this is another one of my words matter kind of things. I don't like to use ambulatory care because it's not often used anywhere else in healthcare except for ambulatory surgery centers, but that's a whole other whole other thing. I was in Iowa.

SPEAKER_03:

I was in the I was in the audience in Iowa. So I that stuck with me, Jen. Right. So when it says, yep, we're not talking ambulatory care.

SPEAKER_02:

So I'll give an example that includes my parents. So both of my parents are, you know, older, obviously, um, and they are over the age of 65. They're Medicare patients, and they both actually have diabetes. And so they are actually seen by a pharmacist much more often than they're seen by their primary care provider. They only see him about once a year, but they see their super fantastic pharmacist named Kaylee all the time. Um, and they message her all the time, you know, with questions about various different things. And there definitely have been times where because they had a pharmacist participating in their care, they actually were able to get to a space where like the most appropriate treatment. So, for example, my mom had COVID. My mom also has reduced kidney function, reduced liver function. And so in seeking out some treatment when she did have COVID, she confirmed to them that that she did have a positive COVID test and was asking about medication. And because there was a pharmacist that was involved in her care that had that information and looked at her as a whole complete patient, they said, You are not a candidate for Paxlovid, because my mom was like, I saw Paxlovid on the news, you know. Um, and they were like, No. So her super fantastic pharmacist said, No, absolutely not. We're not going to prescribe that for you, but we'll get you some molnupure because we know all of these things about you. So in a clinic-based setting, you might see something like that that all happened over telehealth, right? Um, my mom wasn't gonna go into the clinic when she had COVID. So you can see that sort of thing, you know, happening there. Um, but you can also see whether it's primary care or whether it's specialty care in a clinic-based setting, where if a pharmacist is somebody who is managing a patient's care much more closely than their primary care provider or the specialist is, that pharmacist might notice some things that are going on with a patient. And you might also see, like in this example with my mom, my mom reached out directly to the pharmacist, not to her primary care provider. So when she went into her MyCart, she was sending a message to her pharmacist. And so I think as we begin to see more of this take hold as there are more and more clinic-based pharmacists. It used to be the only way you did that was if you were affiliated with a pharmacy school, right? And now we're starting to see these types of jobs are out there all over the place, right? We've got healthcare systems that have embraced that. I think we're gonna start to see even more of that, you know, independent diagnosing that's coming from a pharmacist, regardless of what your state allows, right? So maybe you're practicing in a clinic under collaborative practice and you notice these things and you go back to the primary care provider and you're like, hey, I found this with this patient. Let's take a look and make some decisions together about the next next steps for this patient. So hopefully that gives at least a couple of examples. You know, we I know we're working on a a continuing education program for CE impact, and we'll definitely provide some some very specific, you know, clinic-based and community-based examples in that continuing education session, but that kind of gives you at least a little bit of a feel for, you know, what we're going to be talking about in our continuing education session.

SPEAKER_03:

Yeah, yeah. No, that's awesome. That's a great, that's a great foundation, I think. I I want to talk a little bit about how preceptors can sort of assess in students their thought process, you know, how they're working through some of these diagnostic processes. But before we do that, let's maybe shift gears and talk a little bit about some some of the more some of the strategies maybe preceptors can use and and you know, working to foster these skills in students. Jared, let's start with you and talk a little bit about shared decision making and patient-centered prescribing. Why is that such an important, you know, why is why is the shared decision-making component such an important part of patient-centered prescribing in the pharmacy space?

SPEAKER_00:

It's very timely as we think about this podcast, because we did have the publication of the 2025 new pharmacist patient care process that also integrated diagnostic reasoning and prescribing within their update. And when we look at that pharmacist patient care process wheel, you will see that there's a continuum of collaborate, communicate, encircling that patient-centered care right in the center of that model. And so shared decision making is a tool that helps a preceptor and a student understand that importance of how communication matters when working through caring for the people that we're serving. So if we were to look at shared decision making, thinking about it as a care approach to prescribing, where we include that patient, their family, their caregiver, and walking through with the student, being able to verbalize that process. Here is what we are looking at, here is what we are talking about. Because what we know is that when students are involved in that thinking process, when a preceptor is verbalizing, here is how they are navigating through communication with a preceptor by modeling it, that absolutely adds value to that teaching moment. So in looking at shared decision making, we're looking at where we're using evidence-based treatment options. And we know that there are several different reasonable options, but how are we helping the patient determine what's best for them? This is where I would share when we're thinking about the pharmacist realm. We know that it's embedded within that pharmacist patient care process. We can use a tool like shared decision making to walk the student through how to build communication skills, how to build decision-making skills and supportive skills and helping patients when there's multiple treatment options.

SPEAKER_03:

Yeah, yeah. Any thoughts from either of you, Rachel or Jen, on that topic of shared decision making or some of the strategies that you've seen preceptors use to you know engage students in that process?

SPEAKER_01:

I think the that you see it so so commonly, but maybe it's not seen as shared decision making and just helping students with the tools to incorporate the patient's thoughts and values. So the idea of kind of really helping them ask for their preferences first and then get to really what matters most is such a helpful framework. And our pharmacists are doing it all the time. I think it is just being explicit. This is shared decision making and really helps us to account for their values and preferences.

SPEAKER_03:

Right, right. Can you talk a little bit, and maybe Cherith, this is for you, the the three-talk model specific, you know, to the to the shared decision making, um, the shared decision-making process. How how how can a tool like that play in to the to the preceptors work with the with their with their learner?

SPEAKER_00:

What I think is most helpful is being able to provide tools that can fit into busy pharmacies, busy workflow, where preceptors have some sort of a framework of how to have the conversations with their learner. And if we look at that three-talk model, we break that down into being able to deliberate on a decision through a process where you're incorporating some team talk. Let's work together as a team to find a decision that's best for you. Okay. We're helping that learner to understand, okay, now we can consider the possible options and helping that student navigate through having those conversations. And then finally being able to narrow down to that decision talk, what matters most in the final decision. So that framework and being able to incorporate that into shared decision making provides preceptors with a tool that is tangible, that moves through step-by-step and skill building or the communication and conversations that are happening with that deliberation process.

SPEAKER_03:

Awesome. Yeah, great. Rachel, let's let's talk a little bit more about additional tools and and best practices. Um, you know, we we we lean on the one-minute preceptor model frequently, right? As preceptors. Can you can you talk about how that fits in here? Um where it, you know, how how it can help guide diagnostic reasoning.

SPEAKER_01:

Yeah, I think knowing that it's something that we're used to as preceptors and and do lean on, it's such a great tool to think about in this area, just to be more explicit and it's very efficient. So it makes a lot of sense to use. And largely for me, I think it's guiding my my prompting questions and the way I provide feedback. So just really that that piece of get a commitment that feels so appropriate for diagnosing, where we want students to feel comfortable kind of committing. So I think one key piece when we're getting that commitment is really feeling comfortable using the word diagnose and avoiding that passive language. So instead of what do you think is the most likely cause, instead, what do you think is the most likely diagnosis? Really using that word, feeling good about it, and then asking questions to learn the student's thought process, right? What other diagnoses did you consider and why'd you rule them out? And then what evidence do you have that supports your most likely diagnosis? So understanding their thought process, because we all know students sometimes can get to the right answer, but how they got there or all the reasons behind it, we want to make sure that's really solid. And I also think bringing in like what lab test would support your diagnosis. If you had one, what's one that would support it? That's kind of a fun question to bring in there. And then, of course, that that role of like guiding the learner if there's any kind of omissions in thinking, providing some alternate perspectives. I always think that's what we hear from students that they really appreciate, like, oh, I hadn't hadn't thought about it like that. The preceptor helped me think about it differently. So even as you're doing that, you're providing your experience, your wisdom as a preceptor, but maybe also asking the student, what would make you reconsider your diagnosis? Just to have them kind of be thinking about it. Yeah. And then ending on what they did well, I think that's always such an important piece of reinforcing what they want to take as they move forward. What made their thinking process sound, or what did they collect and bring into the their diagnostic process that that made it work? Yeah. So it's it's pretty simple, effective, efficient, and I think such a great way to think about diagnostic reasoning and providing feedback.

SPEAKER_03:

Right, right. Yeah, and having the student talk through their their thinking process or or their resident, or you know, for you know, we we can be talking about residents here too. Having them talk through their thinking process is like the best way to assess where they are, right? And and how they how they're and and and and sort of where they are in that in that process. I think we've kind of talked about this, but for for preceptors who are in states with more restrictive prescribing laws, these are all things that any preceptor can really do, right? I mean, it there doesn't have to be a prescription at the end of the road here that is signed by a pharmacist. This is really just work that, you know, as Den, you mentioned, we were doing every day. We just need to call it that. Yeah. Um, any other practical tools and and best practices from you, Charit or Jen, that you you could add into the mix?

SPEAKER_00:

I'll share that. We we already include tools like Scholar Mac when we're dealing with minor acute conditions. We're we're we're just needing to be more intentional on how those are supporting and leading to diagnosis or prescribing, especially as we see the landscape change. I really do think that the teaching tools that we already have, if we are more intentional about how those are applied, to be mindful that we are a part of that healthcare team already. And even if we are in a state where they are more restrictive, uh pharmacists have been involved in collaborative practice agreements. Uh, they have been involved in a lot of different levels where being a part of that team, you can use those same tools, but you're actually building in the technical words so that you're calling those supportive pieces, those skills, exactly what they are.

SPEAKER_03:

Yeah, yeah, great, great call out.

SPEAKER_02:

I think the only thing I would would add to that is for preceptors to keep an open mind, right? You know, when they see something on an evaluation tool that they're like, I don't do this, you know, and a that like to ask, right? So first come and ask us and say, what are your expectations as it relates to this? Like what, you know, I don't want to mark A every single time on every student that comes through. I want to know more so about what your expectations are and why this is here. I also think particularly too like our community-based pharmacists, for example, thinking of it on their end as well. I think sometimes that's a tendency of like, well, my setting is different. I'm not, I'm not inpatient, I'm not in a clinic, I'm not, you know, doing those things, right? I'm over here doing these things and I'm managing dispensing and I've got all these other things going on. And so I would say the only other piece I would add is just for particularly those community-based preceptors, to keep an open mind and to really think through like some of these examples that we've shared. There's plenty of times that a community-based pharmacist is that initial primary care provider for so many patients. And they're absolutely walking through those differential diagnostic steps in their head in trying to figure out like who do I need to treat, right? Like, who can I take care of right here in the community pharmacy versus who do I need to refer to a higher level of care? Um, there's a lot of places that patients access healthcare, and our community-based pharmacies are definitely one of them. And I honestly think the the more we can get some of our community-based preceptors to think differently about this, the better off the professional identity will be of our graduates and the better off the professional identity of those pharmacists will be.

SPEAKER_03:

Yeah, yeah, yeah. And what better navigators they can be for patients, you know, if they are going through those those steps. And yeah, yeah, yeah, 100%. Well, this has been a this has been a great conversation. I I'd like to kind of wrap up by asking each of you to to offer one thing that preceptors who are listening today could start doing right now, um, to begin, you know, shifting their own mindset, engaging their students in, you know, the in the in this in this reasoning process, encouraging them to use the right language, whatever that is. So, Rachel, how about I start with you?

SPEAKER_01:

I love just the simple question of what else could this be? And just really fostering that culture of curiosity and really kind of immersing in that landscape of diagnostic thinking.

SPEAKER_03:

Yeah, what a great question. And and love the I love the the call out to curiosity. That's awesome. How about you?

SPEAKER_00:

I think the biggest mind shift would be to ask the pharmacist, ask the preceptor, what am I already doing that is contributing to the diagnostic reasoning process and to prescribing.

SPEAKER_03:

Yeah. And Jen.

SPEAKER_02:

Gosh, they've taken all the good ones. I know. I I probably will come back to what I'm always saying. Words matter. Be intentional in the words that you use, especially with students. You are shaping the future of our profession. So the more you can be intentional with the words that you're using to shape the future, the better off we'll all be.

SPEAKER_03:

Love it. Well, thank you all for all the work that you're doing in this space to raise awareness for learners, for preceptors, for really everyone in the profession. I'm gonna pull a few resources to make sure we get into the show notes. Cherith, you talked about the three-talk model, certainly the one-minute preceptor. Um, and I might be pinging you all to see if there's other resources that you might have us include and point folks to down the road. So with that, thank you all so much and keep up the awesome work. Thanks for having us.

SPEAKER_00:

Thank you so much.

SPEAKER_03:

Thanks for joining us for this episode on diagnostic reasoning and prescribing in pharmacy education. As we discussed, pharmacists have always been engaged in the practice of clinical reasoning. What's changing now is the recognition of diagnosis as a formal part of our professional role, reflected in the ACPE standards. It's not so much a new skill as it is a shift in mindset and language for how we describe the clinical decisions we've been making all along. We hope this conversation gave you new tools and perspectives to bring into your precepting practice. If you found value in today's discussion, share it with colleagues and subscribe so you don't miss future episodes. And as always, thank you for the work you do every day to guide and inspire the next generation of pharmacists. Remember to check out previous episodes of this podcast and don't forget to visit the full library of preceptor by design courses available for preceptors on the CE Impact website. Be sure you ask your experiential program director or residency program director if you are a member so that you can access it all for free. And if you are a member, don't forget to claim your CE. Thanks again, and I'll see you next time on Precept Practice.