Revising the formula: a call to reassess the status of compounding education

By: Mohenad Rasoul, PharmD Candidate 2022, Taylor Craigo, PharmD Candidate 2022; Ashley Naccarato, PharmD Candidate 2022; Ronald Wheeler, PharmD Candidate 2022; Mary E. Fredrickson, PharmD, BCPS

Pharmacists play a crucial role in the creation of personalized medications for patients. Within institutional settings, competency in aseptic technique and compounding sterile preparations is a vital component of patient safety. The importance of these skills is recognized within licensure requirements, with Area Five of NAPLEX competency statements devoted to the compounding, dispensing, and administration of medications.¹ 

Accreditation standards also emphasize these skills, with requirements for students to prepare pharmaceutically accurate, safe, and effective products.² However, there is no consensus among PharmD programs as to the scope and design of compounding courses.³ While this allows for flexibility and creativity, it can present a challenge in determining the ideal depth and breadth of compounding education. Numerous factors may influence course design, including faculty interest and expertise and available monetary and facility resources.³ While repeated exposure and feedback is crucial for skill refinement, allocating appropriate curricular time can also prove difficult.⁴

The last formal assessment of compounding education occurred more than ten years ago.³ As pharmacy educators seek to develop learning experiences that will prepare graduates for practice while reducing curricular hoarding, now may be the time to reassess the status of compounding education. Skill instructors should consider analyzing curricula to ensure compounding education is timely, relevant, and outcome-based, and take advantage of opportunities to streamline this content via integration into other areas of the curriculum. 

We propose the following:

1. Establish minimum competencies  

Working with appropriate stakeholders, institutions should determine minimum compounding competencies based on contemporary needs. For example, what preparations should students be proficient in compounding? What skills related to calculations, documentation, assessment, and technique should be stressed?  Emphasis should be placed on determining competencies which best prepare students for experiential rotations, licensure exams, and practice in today’s current landscape, rather than relying on use of historical and potentially outdated proficiencies.  

2. Develop relevant learning experiences 

Reassessing and revising compounding education may involve adding, removing, or modifying content and should be conducted as part of a broader assessment of skills-based curricula. To incorporate more compounding training, instructors may consider removing outdated content from skill labs; if compounding content is removed, this may open curricular time to teach other essential skills.⁵  

Retained learning experiences should involve hands-on training and some level of direct observation. In an era of virtual education, use of simulations may assist programs with limited resources. Students should be provided with sufficient training opportunities to promote skill development, and an investigation into the optimal allocation of credit and contact hours would be beneficial. Overly complex or time-consuming activities may prevent students from becoming proficient in baseline competencies, and quality of activities should be prioritized over quantity. More advanced training could be allocated to elective courses or incorporated into experiential rotations. 

Through the process of streamlining, compounding content could be incorporated into other areas of the curriculum, potentially without affecting credit hours. This may provide a bridge between the basic and clinical sciences, helping students to better understand the relevance of this training while promoting skill development related to advances in technology, pharmaceutical calculations, critical thinking, literature evaluation, and interprofessional collaboration (Table 1). 

3. Validate assessment methods 

It would benefit the Academy to have validated assessment methods for non-sterile and sterile compounding training. Ideally, students should be directly observed and assessed by instructors well-trained in this area. Assessment strategies may involve self- and/or peer evaluations to prepare students for roles related to overseeing compounding processes. Students would benefit from multiple opportunities to demonstrate competency achievement, and those unable to meet minimum competencies should be provided with suitable remediation opportunities. Yearly assessments could help determine skill retention. 

Table 1. Suggested  Learning Experiences 

Area	Examples
Core curriculum	Activities within skill courses that parallel therapeutic topics (compounding chemotherapy preparations during an oncology module) or involve use of technology (electronic health records)         Inclusion of compounding-focused content into SOAP note writing exercises        Drug information questions focused on formulating patient-specific preparations or questions regarding compatibility or stability         Objective Structured Clinical Examinations that involve sterile or nonsterile compounding components
Interprofessional education	Cases or activities involving medicine or veterinary students focusing on the compounding triad and specialty areas like hormone replacement and veterinary medicine Activities with pharmacy technicians to compound and assess accuracy of nonsterile or sterile compounded preparations Activities with nursing students involving IV infusions (example: infusion rates, compatibility)
Experiential education	Verifying calculations and product labels Researching formulations Qualitative/quantitative product assessments Discussion of business and regulatory considerations Simulated IPPE hours involving compounding activities

Next Steps

Just as compounding standards are continually reviewed and updated, we believe components of compounding education should be frequently reassessed to ensure a well-balanced curriculum is delivered. 

Has your program reassessed or revised its compounding curricula recently?

References:

1.   NAPLEX competency statements. NABP.. 

2. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree “Standards 2016”. Published February 2, 2015. 

3. Shrewsbury R, Augustine S, Adams J. Assessment and recommendations of compounding education in AACP member institutions. Am J Pharm Educ. 2012; 76(7): S9. 

4. Dennis VC, Owora AH, Kirkpatrick AE. Comparison of Aseptic Compounding Errors Before and After Modified Laboratory and Introductory Pharmacy Practice Experiences. Am J Pharm Educ. 2015;79(10):158.

5. Porter AL, McKeirnan KC, Bottenberg MM. Evaluating A Skills Lab Curriculum: Determining Essential Skills for Pharmacists [published online ahead of print, 2021 Oct 25]. Am J Pharm Educ. 2021;8880. doi:10.5688/ajpe8880

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Author Bio(s):

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Pulses is a scholarly blog supported by a team of pharmacy education scholars.