A new study by Chapman University School of Pharmacy reveals how pharmacy schools across the United States approach the transition from classroom to practice settings (Advanced Pharmacy Practice Experiences (APPEs)) differently, and findings reveal significant gaps in student preparedness.

Published in the American Journal of Pharmaceutical Education (Navigating the Transition to APPEs: A Survey of US Schools of Pharmacy), the authors surveyed 115 accredited [JG1] US pharmacy schools to understand how they transition students from didactic learning to hands-on patient care. The results leave more questions than answers in the pharmacy education system, notably, “What does it mean to be prepared for APPEs and clinical practice?”

The Challenge of Defining “APPE-Ready”

Since 2016, the Accreditation Council for Pharmacy Education (ACPE) has required schools to ensure students are prepared for APPEs before beginning their advanced-level rotations. Almost a decade later, there is not a consensus on what that truly means.

“Although ACPE Standards mandate that students be APPE-ready, there’s no specific guidance on how to deliver or evaluate readiness,” Laressa Bethishou, Pharm.D., associate professor and Director of Professional Education said. “That’s created significant variability in how schools approach this transition.”

The study found that 75.7% of pharmacy schools have an intentionally designed curriculum to support the transition to APPEs. More often than not, this takes the form of a specific course delivered immediately before students begin their rotations that typically run for a median of 22 hours over 13 weeks, covering professionalism, therapeutic knowledge, literature evaluation, and patient care documentation. Some schools integrate APPE preparation throughout the entire curriculum, and others rely on brief orientation sessions or “boot camp” style experiences. Nearly a quarter of schools reported having no formal transition curriculum at all.

What Students Learn, and what Schools Struggle to Address

Schools use diverse teaching strategies to prepare students, including simulations, therapeutic cases, reflections, and Objective Structured Clinical Examinations (OSCEs). The research revealed which topics schools prioritize as students prepare to care for real patients. Professionalism topped the list, covered by 91% of programs, followed closely by literature evaluation (88.9%), drug information (87%), and therapeutics (86.5%).

“These topics reflect what ACPE Standards have emphasized over the years,” said Albert Bach, Pharm.D., and associate professor and Director of Clinical Examinations and Simulations. “When standards highlight specific competencies, curricula adapt to reflect those priorities.”

Physical assessment skills were covered by only 59.3% of programs, despite the evolving role of pharmacists in diagnosis and prescribing. This gap is particularly noteworthy given that ACPE Standards 2025 place greater emphasis on these advanced clinical skills.

The study identified concerning gaps in topics critical to student success and well-being, where “wellness and well-being” were addressed by only 44.2% of programs. Professional identity formation, the process through which students internalize the values and culture of pharmacy practice, was covered by just 55.8% of schools.

“Research in medical students has shown that inadequate preparation for clinical transitions leads to anxiety, feelings of incompetence, and challenges with well-being,” Emmanuelle Schwartzman, Pharm.D., professor and Chair of Pharmacy Practice, said. “Properly preparing students for this transition may, in itself, support their wellness.”

The gap in professional identity formation is surprising, given recent attention to the topic in pharmacy education. The study suggests this may be due to a lack of clear guidance on how to teach and evaluate these less tangible competencies.

Law was another surprisingly underemphasized area, covered by fewer programs despite its importance in practice and ongoing regulatory changes. This gap may help explain challenges students face with pharmacy jurisprudence examinations.

How Schools are Assessing 

Therapeutics was the most commonly evaluated topic (86.5%), primarily through traditional examinations, therapeutic cases, patient care documentation, and performance-based OSCEs. Calculations were evaluated by 78.8% of programs, predominantly through exams.

Many schools still rely heavily on traditional exams over performance-based exams, which contradicts how they would be evaluated during APPEs in clinical environments, where they’ll be evaluated based on patient interactions, communication skills, and professional judgment.

Professionalism, taught by 91% of programs, was evaluated by only 71.2%, primarily using OSCEs, reflections, and professionalism assessments. It remains that soft skills are recognized as vital to a pharmacist, but remain difficult to measure.

The Resource Reality

Implementing a strong transition curriculum requires significant resources that schools may not be prepared to orchestrate. The study found that schools rely heavily on full-time clinical faculty (95.6%), followed by residents and fellows (58.2%), current APPE students (41.8%), staff (40.3%), and preceptors (37.3%) to prepare students for APPEs.

“The disproportionately heavy workload on clinical faculty may serve as a barrier to implementing a dedicated transition experience,” said Kathy Besinque, Pharm.D., and professor emerita. “But the value to students may support the need for this investment.”

Among schools that reported challenges with their transition curricula, 17% cited resource constraints as a primary concern. Another 23% noted that there’s no “one-size-fits-all” approach, as evidenced by the diverse course structures across institutions.

Findings and the Future of APPE Readiness 

The study’s findings have both encouraging progress and opportunities for improvement. While most schools have recognized the importance of intentionally supporting students through the transition to APPEs, the lack of consensus on definitions, content, and assessment creates challenges for ensuring that students at all institutions receive standard preparation.

“By describing the current landscape and strategies employed for content delivery and evaluation, schools can better understand how well they meet the needs of students as they transition from the classroom to clinical practice,” said Jeff Goad, Pharm.D., professor of pharmacy practice.

The team identified several areas where pharmacy education needs greater focus:

  • Standardized definitions: Pharmacy schools need consensus on what “APPE-ready” means, and how to distinguish between longitudinal APPE readiness and the specific transition period.
  • Assessment practices: Schools need better tools to evaluate soft skills like professionalism, communication, and professional identity in ways that reflect clinical practice, rather than classroom performance.
  • Wellness integration: Given the link between inadequate preparation and lack of student well-being, transition curricula should explicitly address coping strategies.
  • Physical assessment emphasis: As pharmacists take on expanded roles in diagnosis and prescribing, schools must prioritize teaching and evaluating physical assessment skills.
  • Resource allocation: Schools need strategies to support transition curricula without adding additional burden clinical faculty.

Chapman’s Commitment to Student Success

At CUSP, preparing students for APPEs and the realities of clinical practice is woven throughout the curriculum from day one. CUSP’s on-going commitment to understanding and improving APPE transitions is part of our institutional focus on student success.

The study represents one of the most comprehensive looks at APPE transition curricula to date, with an 80.9% response rate from accredited pharmacy schools. The findings provide a foundation for developing best practices and ensuring that all pharmacy students, regardless of where they study, receive the preparation they need to confidently care for patients.

Read the Navigating the Transition to APPEs: A Survey of US Schools of Pharmacy full findings here.