Abstract
Background
Pharmacists and pharmacy interns were instrumental in vaccination efforts during the COVID-19 pandemic. Objectives: To identify pharmacy intern involvement in COVID-19 immunization practices in New York State (NYS) and explore interns’ perceptions of experiences.
Methods
A 34-item survey was developed and administered at 5 pharmacy programs in NYS. Data collected included: perceptions of immunization readiness, participation in immunizations, description of experiences, and perceptions on the role of pharmacists. Respondents also reported on their preparedness to participate in the immunization process and the types of questions received from patients. Data were analyzed using descriptive statistics and thematic analysis. Questions regarding student experiences before and after participating in immunization efforts were analyzed using a two-sample t test.
Results
A total of 460 interns participated in the survey with 398 (87%) reporting participation in COVID-19 immunizations. Of those, 231 (58%) participated at work, 146 (36.7) during experiential rotations, and 98 (24.6%) during volunteer experiences. Respondents participated in various components of vaccine delivery including administration (n = 246, 61.8%). Respondents administered an estimated 57,100 COVID-19 vaccines from December 2020 to April 2021 resulting in significantly higher mean scores for comfort level (5-point Likert scale) administering vaccines after participation (mean score 4.08 ± 1.31) compared to before (mean score 3.61 ± 1.42) (p < .0001). Themes which emerged regarding student perceptions of their experience are described.
Conclusion
Pharmacy intern involvement in NYS COVID-19 immunization practices contributed to public health vaccination efforts. Additionally, interns improved comfort levels with immunization administration and recognized pharmacists’ emerging roles within the U.S. healthcare system.
Keywords: pharmacy intern, COVID-19 vaccine, public health, immunization
Background
In New York State (NYS), the first case of coronavirus disease 2019 (COVID-19) was reported on March 1st, 2020, quickly leading to a state of emergency on March 7th. The outbreak of the virus was declared a pandemic by the World Health Organization (WHO) on March 11th, 2020.1 At that time, there were 245 new cases reported in the United States, a number that rapidly grew into the hundreds of thousands along with a drastic increase in hospitalizations and deaths.2 NYS implemented a number of restrictions and mandates including requirement for masks in public places, reduced workplace capacity, and limited public gatherings. By April 10th, 2020, NYS had one of the highest confirmed COVID-19 case counts worldwide.3 A variety of medical interventions were implemented and developed, among them the emergence of the COVID-19 vaccine, the first of which received emergency use authorization (EUA) from the Food and Drug Administration (FDA) on December 11th, 2020.4 It was during this time that pharmacists, and by extension student pharmacists, were called on in efforts to vaccinate the public to reduce the impact of COVID-19 across the United States (U.S.).5
Pharmacy schools incorporate student pharmacists into patient care throughout the professional phase of the program. This includes Introductory Pharmacy Practice Experiences (IPPEs) which are experiential courses students participate in during the earlier professional years and Advanced Pharmacy Practice Experiences (APPEs) which take place during the last professional year, just prior to graduation. According to the Accreditation Council for Pharmacy Education (ACPE), IPPEs (minimum of 300 hours) are designed to expose student pharmacists to the standards that constitute “exemplary pharmacy practice” in the United States.6 APPEs allow students to continue their hands-on learning in a variety of pharmacy practice environments for a minimum of 1440 hours during which all of the skills previously acquired are reinforced with the ability to apply core competencies in a more high intensity manner.6 Through both IPPE and APPE experiences, students have the opportunity to provide direct patient care and contribute to public health initiatives such as immunization of community members. These learning experiences and immunization training also help students apply the acquired skills and knowledge within their work settings and volunteer opportunities. In some states, student pharmacists are required to obtain an intern license which specifies the types of patient care activities a student may participate in under the supervision of a licensed pharmacist. Licensed pharmacists are individuals who have graduated from an approved educational program, passed the required licensing exams, and obtained a license to practice pharmacy. The intern license identifies students who are enrolled in or have completed specified coursework at a school/college of pharmacy and differentiates them from other individuals, such as pharmacy technicians, etc. who may be involved in limited aspects of patient care but do not have the expanded permissions granted by the intern license.7 While there is variation between states on whether student pharmacists need to obtain intern licenses prior to immunizing, this manuscript will refer to students with the ability to immunize as “interns” to reflect the regulations of NYS.8
In order for pharmacy interns to participate in immunization administration, they must undergo a certification program reviewing the core competencies of immunization techniques, indications and contraindications to vaccines, and emergency readiness.9 Doctor of Pharmacy (PharmD) programs may choose to incorporate immunization training and/or certification as part of their curricula. Before the pandemic, many pharmacy schools did not offer a vaccine certification program to students until their third professional year. In anticipation of the COVID-19 vaccine, pharmacy programs across the country increased opportunities for training and certification to be offered more frequently, and/or earlier in the curriculum.10,11 Once immunization certified, pharmacy interns in all fifty states are permitted to administer vaccines under the supervision of a licensed pharmacist.12 In NYS, pharmacy interns have been permitted to vaccinate since December 2018, just 2 years before the first COVID-19 vaccine became available.13 At that time, the vaccines that pharmacists and pharmacy interns were permitted to administer included seasonal influenza to patients 2 years and older, as well as pneumococcal, meningococcal, herpes zoster, tetanus, diphtheria, and pertussis vaccinations to adults 18 years and older.8 More recently, this list has expanded to allow the administration of all CDC recommended vaccines.13,14 In June of 2020, NYS permitted pharmacists and pharmacy interns to administer the COVID-19 vaccine upon availability.13,15 As soon as the first COVID-19 vaccine became available in December 2020, both pharmacists and pharmacy interns in NYS were ready to step up and begin administering vaccines to approved priority individuals.
It has been shown that pharmacy interns’ participation in vaccination clinics positively changes the patient’s perception of a pharmacists’ role in vaccinating, increases vaccine-related knowledge among patients, and provides an overall positive vaccination experience for the patient.16,17 Intern participation in vaccine clinics has proven to be vital in vaccinating the public against COVID-19. There has also been an increased demand for pharmacy intern immunizers.10,11 In a survey sent to pharmacy school deans, all respondents, representing about 30% of the country’s pharmacy programs, stated their students had been asked to participate in vaccination efforts in multiple capacities across various settings.18
The purpose of this study was to identify pharmacy intern involvement in COVID-19 immunization practices in the State of New York and explore intern perceptions of their experience.
Methods
Participation of NYS member programs of the Empire Experiential Education Consortium was solicited in March 2021. Interested members met and/or communicated via email. All eight NYS pharmacy programs were invited to participate, and 5 programs committed to administering the survey to their students. Participating programs included: Albany College of Pharmacy and Health Sciences (Albany, NY), D’Youville College School of Pharmacy (Buffalo, NY), Long Island University Arnold and Marie Schwartz College of Pharmacy and Health Sciences (LIU Pharmacy) (Brooklyn, NY), St John Fisher College Wegmans School of Pharmacy (Rochester, NY), and University at Buffalo The State University of New York School of Pharmacy & Pharmaceutical Sciences (Buffalo, NY). Institutional Review Board (IRB) approval was obtained by each program individually. Participating programs also compiled information regarding their respective immunization training requirements, experiential education program structure, and aggregate student demographics for the student cohorts to whom the survey was administered.
A 34-item survey was developed and administered by the primary investigator in each program to all students enrolled in their second, third, and fourth professional year of the 4-year PharmD program (P2, P3, P4 respectively) at the institution. Students in their first professional year (P1) were excluded as they were not eligible for pharmacy intern designation (based on NYS Office of the Professions regulations at the time of survey administration) and thus could not administer vaccines.8,19 This was the only exclusion criteria. Survey question formats included 5-point Likert (Strongly Agree to Strongly Disagree), multiple choice, and open ended/comments. Demographic/background questions were also included. Survey administration timelines varied by program and occurred on a rolling basis between February and July 2021. The survey was developed through a literature search on the role of student immunizers and piloted with 37 P4 students from LIU Pharmacy. No issues were identified or provided by sample. Minor school specific editing of items were based on variations in terminology for multi-center administration. Data collected included four main categories: perceptions of immunization readiness (seven questions), participation in immunization initiatives in various practice settings (five questions), description of immunization experiences (eleven questions), and perceptions on the role of pharmacists (three questions). Changes in student responses before and after participating in immunization initiatives were analyzed using a two-sample t test. Data were otherwise analyzed using descriptive statistics.
Qualitative analysis was used to identify emerging themes in free text survey items. Thematic analysis was conducted by 3 authors, as part of creation of the themes and in evaluation of the themes using inductive reasoning. The data were first reviewed by a student author to identify predominant themes using key words and phrases, followed by independent review by the 2 faculty authors to validate themes and expand or add as relevant. Any disagreements were further reviewed by a fourth author.
Results
Of the 460 survey respondents, 398 (87%) reported participation in COVID-19 immunizations (Table 1). Of the 398 who participated, the majority reported participating at work (58%, n = 231) followed by experiential rotations (36.7%, n = 146: IPPE 32.2%, n = 47, APPE 67.8%, n = 99) and volunteer experiences (24.6%, n = 98). Respondents participated through vaccine preparation (62.8%, n = 250), administration (61.8%, n = 246), counseling (59.5%, n = 237), registration (51%, n = 203), and monitoring for reactions (44.2%, n = 176). Respondents administered an estimated self-reported total of 57,100 COVID-19 vaccines from December 2020 to April 2021. Data specific to administration of vaccines are summarized in Table 1. Respondents commented on their preparedness to participate in the immunization process (Table 2) and reported on the types of questions they received from patients. Most commonly reported questions are presented in Table 3. Those respondents who administered vaccinations (n = 246) reported significantly higher mean scores for comfort level (5-point Likert scale with 1 = very uncomfortable and 5 = very comfortable) administering vaccines after participating in immunization efforts (mean score 4.08 ± 1.31) compared to before (mean score 3.61 ± 1.42) (P < .0001).
Table 1.
Pharmacy Intern Administration of COVID-19 Immunizations by Cohort Year.
| Total # of Respondents | Second professional year (P2) | Third professional year (P3) | Fourth professional year (P4) | |
|---|---|---|---|---|
| Respondents N (%)a | 460 (100) | 105 (22.8) | 193 (42) | 162 (35.2) |
| Caucasian | 216 (47) | |||
| African-American | 22 (4.8) | |||
| Latin/Hispanic | 14 (3) | |||
| Asian | 87 (18.9) | |||
| Other/Missing | 121 (26.3) | |||
| Respondents who administered vaccines N (% respondents)b | 246 (61.8) | 69 (28) | 80 (32.5) | 97 (39.4) |
| Setting of vaccine administration | ||||
| Work | 173 (70.3) | 50 (72.5) | 63 (78.8) | 60 (61.9) |
| Volunteer | 76 (30.9) | 35 (50.7) | 23 (28.8) | 18 (18.6) |
| IPPE or APPE | 93 (37.8)c | 21 (30.4) | 13 (16.3) | 59 (60.8) |
| Timing of vaccine administration | ||||
| December 2020 | 58 | 16 | 15 | 27 |
| January 2021 | 126 | 31 | 46 | 49 |
| February 2021 | 140 | 40 | 48 | 52 |
| March 2021 | 119 | 42 | 34 | 43 |
| April 2021 | 118 | 44 | 31 | 43 |
| Mean # vaccines administered per student (SD) | 247.4 (297.2)d | 264.7 (264.7) | 221.2 (289.2) | 256.7 (325.5) |
aBased on total number of survey respondents (n = 460).
bBased on number of survey respondents who indicated participation in immunization initiatives (n = 398).
cIPPE = 32 (34.4), APPE = 61 (65.6).
d14 Entries >1000 coded as 1000 out of n = 231 (15 did not respond to this question).
Table 2.
Perceived Immunization Preparedness Provided by the School (n = 412)*.
| Statements | Mean (SD) | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree |
|---|---|---|---|---|---|---|
| Overall the school prepared me to PROVIDE immunizations as a student pharmacist | 3.83 (0.97) | 16 (3.9) | 18 (4.4) | 86 (20.9) | 192 (46.6) | 100 (24.3) |
| The school prepared me to ADMINISTER immunizations as a student pharmacist | 3.83 (0.99) | 15 (3.6) | 25 (6.1) | 79 (19.2) | 191 (46.4) | 102 (24.8) |
| The school prepared me to MANAGE adverse events associated with immunizations as a student pharmacist | 3.35 (0.97) | 19 (4.6) | 49 (11.9) | 152 (36.9) | 151 (36.7) | 41 (10) |
Table 3.
Most Common Questions Received From Patients (n = 460).
| Questions/Inquiries | N (%) |
|---|---|
| Side effects/safety | 332 (72.1) |
| Will the vaccine make me sick? | 293 (63.7) |
| What’s the difference between the vaccines? | 248 (53.9) |
| How long until I get immunity? | 246 (53.5) |
| Interactions with other medications or health conditions | 242 (52.6) |
| Second dose timing questions | 239 (52) |
| Does this work if I already had COVID? | 216 (47) |
| Will I get COVID from the vaccine? | 211 (45.9) |
| How long does it work? | 210 (45.7) |
| Do I still need to wear a mask after I get vaccinated? | 205 (44.6) |
| What if I’m immunocompromised? | 171 (37.2) |
| Is it safe during pregnancy? | 166 (36.1) |
| Can you mix vaccines? | 152 (33) |
| Does this protect against mutated strains? | 151 (32.8) |
The cumulative survey response rate for the 5 participating schools was 24.8% (460/1854). The overall racial/ethnic demographics of survey respondents are reported in Table 1 and individually represented the pools of students sampled from each school. IPPE rotations at the 5 colleges are primarily concentrated in the summer and fall, although may have longitudinal or winter/spring components. Requirements included 120-160 hours of IPPE in the community pharmacy setting and more varied arrangements related to the institutional pharmacy setting, including 75 hours (n = 1), 120 hours (n = 1), 100 hours (n = 1), and 160 hours (n = 2). Two schools have a 10-20 hour IPPE requirement in long-term care facilities (LTCF). For APPEs, 3 schools offer rotations in 6-week blocks, 1 in 5-week blocks, and 1 in a combination of 6- or 4-week blocks depending on the rotation. All colleges, at minimum, require APPE rotations in the community, ambulatory care, inpatient, and institutional setting, which run simultaneously throughout the year. Immunization training through the American Pharmacists Association (APhA) Immunization-Based Delivery Certificate Program during the spring of the first professional year is additionally required by all schools, with 2 having made this requirement part of a specific course. All survey respondents (n = 460) reported receiving some type of immunization training with the majority receiving the APhA training through school (92.2%). No school had specific experiential or co-curricular requirements related to students administering or participating in immunization-related activities. Beyond incorporating COVID-19 topics into routine delivery of curricular content, 1 college required all students to complete a COVID-19 Collaborative Institutional Training Initiative (CITI) program training and another required students entering APPEs to participate in a four-part continuing education series delivered by faculty.
Four thematic findings from qualitative analysis of survey comments emerged and are presented in Table 4 with sample supporting quotes for each theme. Interns reported on the value of the pharmacist in providing information to the patient as the most accessible health care provider during the COVID-19 pandemic in a variety of communities. As vaccine hesitancy became a predominant barrier to COVID-19 immunization, interns observed the pharmacists’ ability to successfully combat misinformation. The pharmacists’ central role in immunization efforts led many interns to report experiencing and understanding, for the first time, the pharmacists’ contribution to public health. Similarly, interns identified an emerging role for the pharmacist as a result of their involvement in COVID-19 efforts and the need for continued advocacy to carry this momentum forward. As part of advocacy efforts, however, the potentially negative impact of incorporating COVID-19 immunizations into already heavy workloads of pharmacists in the community setting was also identified as a priority area. Finally, interns noted the benefit of real-life experience with administering COVID-19 vaccinations to improve their immunization skills and increase their comfort level.
Table 4.
Thematic Analysis for Role of the Pharmacist.
| Theme | Excerpt |
|---|---|
| Value of providing information to patient as most accessible health care provider | As a Spanish speaking future pharmacist I was able to answer patient question and educate patients about the mechanism of the vaccine and how it differs from other vaccines |
| Pharmacists have the closest access to communities, even communities not near larger population cities. Pharmacists can reach the most people with the most convenience for them. Pharmacists are so important to the vaccine effort and ending the COVID pandemic | |
| Throughout this pandemic I’ve gained an understanding of the role pharmacists should be playing in educating the public about the importance of vaccinations, and providing information to combat vaccine hesitancy | |
| Advocating for emerging role of the pharmacist | Pharmacists are essential for more than dispensing medication, pharmacists can provide other services and I think the pandemic has helped show how pharmacists can take a larger role in healthcare |
| Pharmacists were put at the forefront of vaccine administration during the past few months. While vaccinating at the hospital where I worked I met several physicians, nurses, etc. And I was able to discuss my role as a pharmacy intern, which I felt gave them greater respect about what we do | |
| It is expanding our field. However, in retail we’ve been pulled in so many directions. I Sometimes felt like I was in a vaccination center and not a pharmacy. We couldn’t do our normal tasks because it was so busy with vaccines and no help | |
| Contributor to public health | Pharmacists are an integral component of the health care field and they should also be public health advocates |
| It has shown me the impact that a community pharmacist can make in a community. The pharmacy I worked in served a small community in the bronx. The patients were extremely excited and grateful that we were able to secure vaccines and administer them to the elderly in the community | |
| Pharmacists are essential for more than dispensing medication, pharmacists can provide other services and I think the pandemic has helped show how pharmacists can take a larger role in healthcare | |
| Benefit of real-life experience | I Think that real life practice through immunization clinics was crucial to my comfortableness. I Would not have felt comfortable from just the APHA school provided training |
| My comfort in administering vaccines did not come from my training at school. It came from on-the-job experience |
Discussion
To date, this study is among the first to report on the statewide involvement of pharmacy intern immunization efforts during the COVID-19 pandemic. Based on the survey data presented, the sample of pharmacy interns represented from 5 colleges of pharmacy throughout NYS appear to have played a significant role in all aspects of COVID-19 immunization delivery, including directly administering over 50000 doses. Since data collection was based on voluntarily reported student data, it is likely that impact (number of students involved and/or doses administered) is underreported. Of the 14 participants who reported administering >1000 vaccines, most (n = 8) were by students at Albany College of Pharmacy and Health Sciences. This may be due to this college having several students assigned to vaccine clinics for a 40-hour Team Based Care IPPE experience where 100-200 vaccines were being administered during each clinic event.
The COVID-19 pandemic has been unique from pre-existing pharmacy immunization efforts in that organizations or local governments may have established specific immunization clinics in order to meet public health demand. Patanwala et al. recommended for these efforts to involve strong collaborative partnerships with schools/colleges of pharmacy in order to allow student pharmacists to serve as a surge workforce.20 The experience of one such hospital-based clinic in Brooklyn, NY, which heavily incorporated students from LIU Pharmacy, was described by Andrade et al.21 In the first 2 weeks of the pharmacist-run immunization clinic, 100% of the doses allotted to the institution were administered to the highest-risk hospital employees according to state protocol. The incorporation of APPE students into the staffing model for both clinical and administrative functions is cited as one of the key components for the clinic’s success.
Other novel programs incorporating the use of pharmacy interns nationwide include COVID-19 vaccination efforts in LTCFs through collaboration with West Virginia School of Pharmacy and a local independent community pharmacy. The program utilized pharmacy faculty, residents, and approximately 100 student volunteers to administer over 15000 doses of COVID-19 vaccine. The overall vaccination assessment was rated as very good or excellent by 93% of patients in a clinic feedback survey.22 Although the administration of immunization in LTCFs by pharmacy interns was not explicitly captured by this study, participation in this setting was reported by select survey respondents in line with the experiential components of participating colleges. The University of Connecticut School of Pharmacy partnered with the Connecticut Department of Public Health to create a vaccination training program which would allow any eligible health professional to administer the COVID-19 vaccine. Pharmacy interns (n = 106) were incorporated into the program, which required both didactic and in-person training, by supporting faculty during the in-person sessions. As a result of these efforts to expand eligible immunizers, 55% of Connecticut’s population had received at least 1 dose of the COVID-19 vaccine by April 30, 2021 compared to 44% nationally. Interns were also involved in efforts to battle misinformation by creating short YouTube videos to answer common questions about the COVID-19 vaccine. Several videos were translated into multiple languages, including Spanish, Mandarin, Cantonese, and Polish. The videos were reported to have almost 15000 cumulative views at the time of manuscript publication.23 The potential for vaccine misinformation illustrated a need for pharmacists and pharmacy intern preparedness to respond to emergency immunization efforts and be a valuable resource in educating the public (keeping public informed, prevention of spread, addressing questions/concerns, impact vaccine hesitation). Participants in this study played an integral role in responding to thousands of patient questions for a variety of COVID-19 vaccine related concerns and helping combat vaccine misinformation and hesitancy (Table 3).
Temporary state-based immunizer certification programs put into place specifically for COVID-19, such as that described by Doyno et al., are in contrast to the generally required immunization training which pharmacists and pharmacy interns must undergo in order to administer vaccinations. Pharmacy interns must complete a practical training program which includes hands-on injection techniques, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines. Among existing training programs is the commonly utilized APhA Pharmacy-Based Immunization Delivery Certificate Program.24 At the time of survey administration, all participating schools utilized the APhA training program for their students and required completion of this training program during the spring semester of the first professional year. This timeline allowed students to be properly trained by the time they received their intern permit, which then allowed them to administer vaccinations under the supervision of a pharmacist immunizer.8,19 It is important to note that while all the schools required this training, which prepared and enabled students to participate in vaccination opportunities, none of the schools’ curricula stipulated students participate in vaccine administration. This could be due to the fact that not all experiential sites participate in immunization initiatives and/or allow interns to participate in immunization efforts. Additionally, this could be a result of the delays associated with curricular updates/revisions which have not yet occurred in response to the 2018 NYS regulation updates allowing pharmacy interns to immunize.
Several studies have reported the positive impact of APhA immunization training on pharmacy students’ knowledge and skills, and in this study, approximately 71% of interns agreed or strongly agreed their school had prepared them to administer immunizations as a student pharmacist.25,26 Hands-on experience with vaccine administration was, however, found to be significantly associated with an increase in comfort level as 62% of interns reporting feeling comfortable or very comfortable with administration after training only, compared to 79% after actually participating in COVID-19 immunization opportunities. This is further supported by qualitative comments observed in the survey findings highlighting the benefit of practical experience outside of the classroom setting. These results are also comparable to previous studies evaluating the impact of hands-on immunization training for interns. Turner et al. reported on the impact of incorporating IPPE students into 90-minute, community pharmacy-based immunization clinics during their second and third years of the program after completing the APhA immunization-based course. Prior to participating in the clinic, students self-rated their confidence with administering immunizations as 4.6 on a scale of 10 (10 = maximum self-confidence).27 After participating for the second time, students reported a significant increase in their self-confidence with a self-rating of 8.8.27 DiDonato et al. similarly surveyed students participating in immunization opportunities through health fair vaccination events. Students at this school were required to complete both the APhA course and online learning modules and assessments designed to reinforce the APhA content. Although no statistically significant differences were identified before and after student participation in immunization opportunities, 52.8% of students reported themselves as very confident with vaccine administration prior to the event compared to 71.6% afterwards.28 While the APhA Pharmacy-Based Immunization Delivery Certificate Program is among the most utilized by schools/colleges of pharmacy across the country, others, like the Collaborative Education Institute Immunization Training and the Minnesota College of Pharmacy Immunization Delivery Program are also available in select states, and many pharmacy programs incorporate immunization education as part of their curriculum in addition to the certificate program offered.29
A potential gap in training currently offered by pharmacy colleges may be related to management of adverse drug events. In this study, only 47% of survey respondents felt their school had prepared them to manage adverse drug events associated with immunizations. DiDonato et al. also reported that only 15% of respondents rated themselves as very confident in managing vaccine-related adverse events, which increased to only 17% after health fair participation.28
Students in this study participated in vaccination efforts in a variety of settings and formats with more students participating at work, followed by IPPE/APPE, followed by volunteer experiences. One reason more students participated through work is likely because most students work in a retail/community pharmacy setting. Nationally, retail pharmacies have been a key driver of COVID-19 vaccination efforts due to the Federal Retail Pharmacy Program for COVID-19 Vaccination. The program, which authorizes certain retail pharmacies to receive a supply of COVID-19 vaccines directly from the federal government, has been implemented in over 41000 pharmacies across the U.S. and resulted in administration of approximately 216 million doses in these settings as of January 2022.30 Another reason could be that many institutions in NYS suspended or limited student educational experiences during the peak of the COVID-19 pandemic, thereby minimizing the opportunities available for interns in their IPPEs/APPEs. Other reasons could be that interns employed at a facility have a more longitudinal relationship and have established a higher level of entrustment compared to interns in IPPEs/APPEs who are only there for a specified amount of time. Interns on IPPEs/APPEs also have numerous educational requirements and expectations to achieve aside from vaccinations. When comparing intern involvement during IPPEs to APPEs, more interns participated in vaccination efforts during the advanced experiences. This could be a result of the timing of vaccine availability which occurred during the winter/spring months when fewer interns are scheduled for IPPEs across the schools/colleges of pharmacy participating in this study. Another reason could be that pharmacists supervising the interns may perceive more advanced students to have better/more developed skills. Lowest rates of intern participation were seen in December as compared to the later months. This is likely due to lack of access to vaccines during that time frame and eligibility restrictions for patient populations. With respect to IPPEs/APPEs, this could also be due to a lower number of total experience days during the month of December due to breaks and holidays.
Comments from interns working and participating in experiential courses throughout the pandemic highlighted the expanded scope of pharmacists’ roles and their increased recognition within the healthcare system. This is further recognized and supported through advocacy efforts by APhA in their December 17th, 2021 press release where they identify the need for pharmacists to be recognized as eligible providers under the Social Security Act and have the ability to bill Medicare for the clinical services they provide.31 APhA calls on the respective lawmakers and stakeholders to take appropriate action. Along with addressing the need for pharmacists’ billing privileges, is a need to address the current workload and staffing challenges that have become even more significant as a result of the pandemic and are leading to increases in burnout and well-being concerns among pharmacists.31 This, too, was identified by the participants in this study.
Limitations of this study include recall bias and non-response bias. Students who did not directly participate in vaccine administration may have been less likely to fill out the survey. Although the response rate is low, achievement of a specific sample size is not required as this is primarily a descriptive and qualitative study. Sampling bias was sought to be avoided in this study by surveying students at 5 colleges of pharmacy geographically distributed throughout NYS. The proportion of survey contributions from each of the sampling sites was comparable to the relevant student bodies. Additionally, the racial/ethnic breakdown of responding participants from each institution was compared to the institution’s overall demographics to avoid sampling error. Another limitation is that data regarding number of vaccines administered were self-reported by the students, and thus, may be over- or under-reported. Finally, as students may have completed the survey at varying times, it is possible that results were influenced by changes in vaccine hesitancy and/or spread of misinformation as the vaccine roll-out carried forward.
Conclusion
Pharmacy intern involvement in the COVID-19 immunization practices in the State of New York contributed to public health efforts by increasing the number of COVID-19 vaccinations administered and combating misinformation related to the virus and associated vaccines. Additionally, participation in vaccination efforts improved interns’ comfort levels associated with immunization administration, a skill necessary for practicing within the pharmacy profession, and highlighted the existing and emerging roles of pharmacists within the U.S. healthcare system.
Acknowledgments
The authors would like to acknowledge Dr. Karen A. Mlodozeniec for her contribution to the data collection.
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs
Jane Shtaynberg https://orcid.org/0000-0003-3623-1217
Rebecca Cope https://orcid.org/0000-0001-9962-0995
Katherine Maddox https://orcid.org/0000-0001-8774-7622
Keith DelMonte https://orcid.org/0000-0002-9345-3185
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