Before they graduate: Challenge your APPE students with an ethics dilemma

In April many APPE students are completing final requirements and setting their sights on graduation, the board exams and entering professional practice after a very long educational journey.

As long as the students are able to maintain focus and finish strong, final rotations are often very rewarding for both the student and the preceptor. Every pharmacist remembers the excitement that this major milestone brings. These “nearly new” practitioners are at a time of great personal change as they entertain and accept positions or make plans to begin PGY-1 residency training programs.

April rotations are a time to challenge these students with higher levels of patient care expectations and to offer opportunities to test and solidify a personal process of using professional judgment.

Consider presenting your P4 rotation students with an ethical decision issue based on a situation you have encountered during your career. Begin by providing your student with only the initial facts related to the situation, saving your opinions and/or how the situation was resolved. Have the student quickly respond to the situation on the spot and provide the rationale for their professional decision if the board of pharmacy questioned the action taken. Discuss any differences in how the decision could have been handled and the possible or actual outcomes for the patient.

A potential scenario for discussion is below:

In July your student has just passed all licensing requirements and was lucky enough to get to work on the July 4 holiday, as the only pharmacist. The practice site is in a small rural community with limited healthcare resources and her pharmacy is the only one open with hours until 10 p.m. The nearest hospital is 40 miles away and an urgent care center is 25 miles away. Approximately 20 minutes before the store is scheduled to close, a 19-year-old male who has never used pharmacies in the chain appears at the pharmacy in-window in obvious distress. Although he is having difficulty speaking he is able to tell the technician that:

  1. He was visiting his family for the holiday and home is a nine-hour drive away
  2. He is extremely allergic to tree nuts
  3. He didn’t realize the cupcakes that were served had a peanut butter frosting
  4. He doesn’t have his Epi-Pen
  5. He doesn’t have a valid prescription or refill container that he can produce
  6. He hasn’t seen his family MD (from back at home) in more than 18 months
  7. He needs an Epi-Pen now
  8. His face and neck appear swollen

What will the new practitioner do?