Exploring the problems and coping strategies of pharmacy internship in large general hospitals in China: from the perspective of preceptors.

OBJECTIVE: The role of the Hospital Pharmacy Preceptor (HPP) is pivotal in upholding the excellence of experiential training and fostering the professional growth of pharmacy interns. However, there is a lack of studies that provide an overview of pharmacy internships from the perspective of HPP. This study explores the experience and expectations of HPPs regarding existing problems and possible coping strategies in intern teaching. METHODS: This is a qualitative study that was conducted through individual interviews and focus group discussions. HPPs were invited as participants from large-scale tertiary hospitals in representative provinces of mainland China. Interview and focus group discussion data were analyzed using thematic analysis to see emerging themes from the data. Nvivo 12 was utilized for data management and processing. RESULTS: Eight individual interviews and two focus group discussions were conducted, involving 14 HPPs as participants. Upon the examination of the interviews and focus group data, four themes were summarized regarding HPPs' perceptions: 1) current presenting problems; 2) possible coping strategies; 3) something HPPs should do; 4) something interns should do. CONCLUSION: This study found that from the HPPs' perspective, the hospital-based pharmacy internship still has some problems from policy to practice, which need to be addressed by the joint efforts of the state, schools, internship bases, pharmacy preceptors, and students.

Reconsidering the residency training pathway for ambulatory care pharmacists.

Ambulatory care, commonly found in primary care settings, is a growing area of pharmacy practice supported by an expanding number of residency training opportunities in this setting. As this practice expands, the profession has chosen to adopt structures that define it as a specialty practice area, a departure from the medical profession. A key example of this definition is the profession's alignment of residency training for this setting within postgraduate year 2 standards. In this commentary, we explore the implications of this approach and share experience from more than 20 years of statewide ambulatory care residency training in Minnesota. We question whether current training expectations are rooted in an objective evaluation of the knowledge and skills required for ambulatory care pharmacy practice. Ultimately, we call on practice leaders to take account of the impact on current training expectations for learners and pharmacy workforce development and seek a rationalization of the training pathway for ambulatory care practice.

Development and implementation of an in-hospital pharmacist emergency response simulation training curriculum.

BACKGROUND: Medical simulation is an effective educational tool used to increase confidence, improve knowledge, and refine skills when responding to high-acuity situations. Despite established roles of the pharmacist on the hospital code team, most institutions lack formalized pharmacist training for code team responses. OBJECTIVE: This pre-post analysis aimed to evaluate the impact of a didactic and simulation-based code response training for pharmacists on self-perceived improvement and preparedness when responding to in-hospital medical emergencies. METHODS: An emergency response curriculum (ERC) was developed for pharmacists and pharmacy residents at our institution. The curriculum, led by 4 lead clinical pharmacy specialists, included a 60-minute didactic code competency lecture followed by 2 medical emergency simulations and a debrief after each scenario. After completion of the simulation portion of the ERC, participants were given a survey to complete that assessed their confidence using a 5-point Likert scale (1 = very unconfident to 5 = very confident) in completing the course objectives before and after the ERC. RESULTS: Seventy-two pharmacists completed the ERC and 60 completed the postcourse survey. Of those who completed the postcourse survey, 70% were pharmacy residents. Using a 5-point Likert scale (1 = very unconfident to 5 = very confident), median participant confidence rose from 3 (interquartile range [IQR] 2-4) before the session to 4 (IQR 3-5) after the session (P < 0.001). Of the participants, 95% believed the ERC training should be required annually or multiple times a year and 100% of respondents felt the ERC training was beneficial. CONCLUSION: Development of a pharmacist ERC including didactic and simulation-based learning improved the confidence and preparedness of pharmacists when participating as members of the hospital code team. Future studies should continue to evaluate pharmacist training and curriculum development in code team responses.

How to phase II: Timelines, perceptions, and suggestions from PGY-1 residency program directors.

BACKGROUND: Phase II was implemented in 2016 to provide structure for applicants and unmatched residency pharmacy programs to interact. Previous literature has provided some approaches for this process; however, clarification on navigating the phase II process to successfully match for applicants and their mentors is still needed. In addition, with phase II occurring for >6 years, there is a need for continual evaluation. OBJECTIVES: The objectives were to describe (1) program phase II structure and timelines, (2) program personnel demand, and (3) perceptions of and suggestions for phase II from postgraduate year (PGY)1 residency program directors (RPDs) to provide clarity to applicants, mentors, and residency stakeholders. METHODS: A 31-item survey was developed including 9 demographic items, 13 program-specific timeline-based items, 5 skip-logic items on screening interviews, and 4 qualitative questions on the benefits, drawbacks, and suggested changes to phase II. The survey was disseminated to PGY-1 RPDs participating in phase II with available contact information in June 2021 and May 2022, with 3 weekly reminders. RESULTS: The survey was completed by 180 of the 484 RPDs participating in phase II (37.2% response rate). Programs participating in the survey had an average of 1.4 positions (± 0.7) open in phase II and 31 applicants (± 31) per open position. The timelines for screening applications, contacting applicants, and conducting interviews were variable. For qualitative data, RPDs appreciated the structured process and noted high-quality and geographic diversity of applicants in phase II. However, challenges reported were the quantity of applications, lack of time to fully review applications, and technical issues. Suggested changes included an extended phase II timeline, universal application deadline, and technical improvements. CONCLUSION: The structured approach of phase II was an improvement compared with historical approaches; however, variability exists in timelines for programs. Respondents identified further opportunities to refine phase II to benefit residency stakeholders.

Learning on the run - a qualitative, longitudinal study of pharmacy educators' experiences implementing a hospital pharmacy residency program.

BACKGROUND: A hospital pharmacy foundation residency training program has been introduced in Australia, modelled on residency programs established in other countries. The program aims to support the professional development of early-career hospital pharmacists, in both clinical and non-clinical roles. Pharmacy educators are usually tasked with the implementation and maintenance of this program. This qualitative, longitudinal study aimed to investigate hospital pharmacy educators' expectations, perceptions and experiences with implementing and developing their residency program. METHODS: Qualitative data were collected at two timepoints, approximately 24 months apart, using either focus groups or interviews with pharmacy educators who were directly involved in the implementation of the residency program at their respective hospitals. During the early phases of implementation, and approximately 24 months later, participants were asked about their experiences and expectations of the residency program as well as any changes that had occurred within the residency program over time. RESULTS: Four focus groups and three semi-structured interviews were held with pharmacy educators and senior pharmacists from different hospital settings. These were audio recorded and transcribed verbatim. Transcripts were inductively analysed via thematic analysis. Fifteen hospital pharmacy educators and senior hospital pharmacists participated in the initial focus groups and interviews, and seven educators were retained for follow-up. Four main themes were established from the discussions: participants had great expectations of a positive impact of the residency on their workplace and residents' professional development; substantial effort, support and resources were needed to implement and maintain a residency program; self-motivation and engagement is needed by residents to succeed and experience timely completion and career acceleration; and lastly a balance between standardisation, consistency and flexibility in delivering the residency needs to be found. The role of educators changed with the implementation of a residency, with the addition of more managerial and supervisory aspects. CONCLUSION: The Australian hospital pharmacy foundation residency program is a complex workplace training program with multiple factors and prerequisites influencing its implementation, development and outcomes. Pharmacy educators are central to the successful implementation and ongoing sustainability of a residency program. They may benefit from formal training and qualifications to support their role.

Implementation of a novel learning experience in scientific writing, publishing, and peer review into a first year pharmacy practice residency.

BACKGROUND: Pharmacists with competency in writing, publishing, and peer review are essential to continue advancing the pharmacy profession, but structured training of these skills may vary. OBJECTIVE: The authors set out to implement and assess the impact of a structured learning experience into a postgraduate year 1 pharmacy residency training program that provides tangible experience in the processes of scientific writing, publishing, and peer reviewing. METHODS: A quarterly pharmacy newsletter process was augmented to include an editorial board that consisted of residency trained pharmacists with varying levels of experience in scientific writing, publishing, and peer reviewing. The process was designed to provide a structured writing learning experience, to reinforce important concepts and terminology, and to simulate the process of submitting a manuscript to a peer-reviewed publication. Impact of the learning experience on quality of article submissions was assessed by comparing first quarter and last quarter writing submission scores for residents between 2017 and 2020. RESULTS: A statistically significant difference was observed in both raw scores (27 vs. 42.5 points out of 50 points possible, P < 0.05) and the proportion of pass or fail when comparing writing submission scores from the first quarter of the learning experience to submission scores from the last quarter (25% passing rate vs. 83% passing rate, P = 0.007). CONCLUSION: This novel learning experience was successfully integrated into a quarterly pharmacy newsletter and resulted in improved writing scores. This structured writing learning experience can be readily integrated into pharmacy residency training programs, and it provides hands-on training in scientific writing, publishing, and peer review for both residents and preceptors.

Expansion of a postgraduate year 2 ambulatory care pharmacy residency program utilizing Medicare annual wellness visits within primary care.

BACKGROUND: Funding for pharmacy residency programs is traditionally allocated by the Centers for Medicare and Medicaid Services. In 2003, funding for postgraduate year 2 (PGY-2) was retracted. PGY-2 sites must develop additional funding methods to facilitate program expansion. OBJECTIVE: To describe the impact of expanding a PGY-2 ambulatory care pharmacy residency through an innovative funding model. PRACTICE DESCRIPTION: St. Joseph's/Candler Health System (SJC) employs pharmacists, including ambulatory care pharmacists, supported by revenue from Medicare annual wellness visits (AWVs) and pharmacy residents. PRACTICE INNOVATION: The PGY-2 ambulatory care program at SJC historically offered 1 position supported by SJC. The program expanded in 2020 to further patient outreach with disease state management by increasing the number of pharmacists providing comprehensive patient care. The additional position was primarily supported using funding from AWVs completed by pharmacy residents. To ensure adherence with the American Society of Health-System Pharmacists, residents were evaluated quarterly by preceptor based on feedback provided by clinicians at the practice site. EVALUATION METHODS: In addition to conducting AWVs, residents worked with physicians within the state-defined scope of practice to optimize medications, support office visits, promote medication adherence and antimicrobial stewardship improvement activities, and implement a blood pressure monitoring program. RESULTS: From July 15, 2020 to March 31, 2021, 407 AWVs were completed by SJC PGY-2 ambulatory care residents, and average AWVs per day increased from 4.5 to 6.9. As compared with the previous year, total AWVs at the primary clinic doubled after pharmacy resident addition, increasing from 251 to 550 (P < 0.001). CONCLUSION: Through an additional position fiscally supported by reimbursement from AWVs, SJC Ambulatory Care PGY-2 residents increased patient outreach to preventative services as compared with the previous year, expanded pharmacy practice to a new practice site, and generated revenue. This funding method is a viable option to expand postgraduate pharmacy training and ensure optimal patient care in the outpatient setting.

Rethinking residency recruitment, application, and interview processes to benefit applicants and programs long-term.

Pharmacy residency recruitment and interviews have been significantly impacted by the COVID-19 pandemic. Many traditional recruitment events and interviews were transitioned from in-person to virtual, and new approaches to recruitment, such as virtual open houses, were developed. There are limited data on how these changes impacted pharmacy residency applicants and programs, and the future of virtual events is currently unknown. We highlight recommendations for virtual recruitment and interviews and provide suggestions for residency programs and national organizations to improve virtual processes in the future.

Use of the Well-Being Index to identify pharmacy residents in distress.

OBJECTIVE(S): Identify current pharmacy residents' level of distress, likelihood of burnout, likelihood of severe fatigue, suicidal ideation, meaning in work, satisfaction with work-life balance, and overall quality of life. METHODS: A cross-sectional survey, conducted between February 1, 2020 and March 31, 2020. The pharmacist Well-Being Index (WBI) was used to collect data from first- and second-year pharmacy resident participants. A survey was sent to each residency program director (RPD) listed in the American Society of Health-System Pharmacist directory. RPDs were asked to forward the e-mail with information on the survey for the residents to complete. The e-mail contained a description of the research project and a link to the research survey. Respondents were asked to complete questions regarding their demographics in the research survey, including age, gender, ethnicity, marital status, commute time, type of residency, year of residency, etc. They were then asked to complete the WBI through the provided link and asked to enter their results from the WBI into the survey. RESULTS: Pharmacy residents are at high risk for developing burnout; 53% of the participants were considered to be high risk. Approximately 43% of the pharmacy residents were considered to have a moderate to high risk for developing severe fatigue, and 57% had poor work-life integration scores. Participants were found to have a high quality of life and high meaning in their work, 46% and 62%, respectively. CONCLUSION: The study identified that pharmacy residents who experienced great levels of distress were more likely to experience symptoms of burnout and more likely to experience fatigue. Pharmacy residents also experienced a high quality of life and high meaning in their work.

On-call duties in hospital pharmacies: National survey and elaboration of a training program for pharmacy residents.

OBJECTIVES: During their residency, pharmacy residents are required to attend a hospital on-call program in order to insure the continuum of care for inpatients. This activity is subject to risks, and requires a prior training. Our aim was to develop and to optimize such a training program. METHODS: To this end, we first established a baseline study of the existing training methods in our hospital and those in the different hospitals of France in which pharmacy residents realize in-house on-call duties, associated with an identification of both pharmacists and students' needs in our institution. These preliminary studies were used to create a transversal, structured and harmonized training program. RESULTS: The results of our national survey highlighted great disparities of training between the establishments and point out the lack of structure, organization and harmonization of the training, which residents expected to be improved. Our training program contains 3 parts: initial theoretical training, initial practical training and continuous training. Beyond the harmonization of the theoretical training's materials between the different sectors of the pharmacy, new tools were introduced like an in-house on-call duty notebook complementary to trainings adapted to note taking, simulation's workshops and interactive quizzes. The training was gradually implemented in our hospital pharmacy, in collaboration with the pharmacists of the different activity sectors. CONCLUSIONS: The next steps of our work will be to assess pharmacists and pharmacy residents' satisfaction about our program and its efficacy.

Coping with the residency program during COVID-19: Hematology oncology pharmacy residents' perspective.

INTRODUCTION: The COVID-19 pandemic has led to significant changes in all governmental activities in Saudi Arabia including training and teaching, with the majority of such activities suspended in response to the COVID-19 pandemic. We aim to share the challenges that Hematology Oncology Pharmacy (HOP) residents faced during the quarantine period and provide recommendations on how to cope with the residency journey. METHOD: We followed a qualitative methodological approach in March 2020 using a structured virtual group discussion for data generation. RESULTS: All six PGY2 hematology oncology pharmacy (HOP) residents were included in the group discussion. The group agreed that the need for HOP services during this pandemic is beyond the scope of oncology pharmacists' normal daily practice. The group recognized two fundamental points. First, the goal of the current training should be customized to the most pressing need and recognized at the national level. Second, the current training system should be improved to ensure efficient use of current resources. On this basis, the group developed six main recommendations for action. CONCLUSION: The current situation is a challenge for all healthcare providers, and the majority of the nation's current generation never dealt with such a situation in days gone by. This paper presents the challenges that should be addressed at the national level and provide a fundamental consensus recommendation for practical approaches to maximize learning and minimize disruption to trainees' progression while maintaining patient-pharmacy quality of care.

Virtually there: An innovative approach for training oncology pharmacy residents in gynecologic oncology.

OBJECTIVE: To develop an alternative approach to provide oncology pharmacy practice residents' education and training in the management of gynecologic malignancies in the absence of a specialist in this area at their institution. SETTING: Gynecologic oncology is a unique specialty in oncology. There is a need for more oncology clinical pharmacy specialists to participate in the care of patients with gynecologic malignancies as many do not have specific education in this area. PRACTICE DESCRIPTION: A virtual learning experience was developed that included all aspects of a typical experience with the exception of direct patient care. Postgraduate year 2 oncology pharmacy residents from 3 different programs were included. PRACTICE INNOVATION: Although the number of oncology clinical pharmacy specialists who are subspecialized in gynecologic oncology has grown, it is difficult to find experienced preceptors in gynecology oncology. We set to offer a virtual learning environment for programs that did not have a dedicated or highly specialized pharmacist in this area. EVALUATION: A pre- and postlearning assessment of the resident's knowledge of gynecologic malignancies was administered. Each trainee independently completed a validated 20-question gynecologic oncology knowledge assessment tool before and again after completion of all sessions. Midpoint and end-of-experience evaluations were completed via the phone with each resident. All evaluations were documented in PharmAcademic (McCreadie Group, Ann Arbor, MI), a required software program for postgraduate residency training programs. RESULTS: To date, 7 oncology pharmacy practice residents completed the virtual experience. A 42% improvement in scores pertaining to gynecologic oncology knowledge was identified. Residents were also satisfied with the overall virtual experience. Based on the assessment tool, all the residents gave positive evaluations with "always true" for 6 of the 7 questions. CONCLUSIONS: This pilot of a virtual experience was a successful platform to provide clinical knowledge and skills for oncology pharmacy residents in gynecologic oncology.

Advocating for the pharmacy profession through involvement in a type 1 diabetes day camp as a pharmacy residency learning experience.

OBJECTIVE: Diabetes summer camps have the common objectives of providing children with diabetes a safe environment to have fun and develop skills to manage diabetes in the presence of variable physical activity and nutritional intake. Historically, the American Diabetes Association (ADA) has relied on nurses, dietitians, and physicians to serve as medical staff, whereas pharmacists served in educational roles. This commentary describes the experience of postgraduate year-2 (PGY-2) ambulatory care pharmacy residents participating as medical staff in the management of children with type 1 diabetes (T1D) at a week-long, summer day camp in an elective learning experience. DESCRIPTION: Two PGY-2 residents volunteered at ADA-sponsored camps in July and August 2017, in which they were responsible for performing and documenting blood glucose measurements, dosing and administering insulin, overseeing the use of insulin pumps and continuous glucose monitors, and managing cases of hypo- and hyperglycemias in children aged 4-9 years. They facilitated interprofessional education of other medical staff members, including discussions regarding pharmacokinetic profiles and formulations of various insulin products and performing advanced insulin dosing adjustments. SUMMARY: The perceived benefits of this residency learning experience included increased self-confidence regarding the management of T1D, insulin administration techniques, and interprofessional collaboration. Performing advanced clinical management of children with T1D increased awareness of pharmacists' skill set in diabetes care. Demonstrating this value in nontraditional care settings may increase the likelihood that pharmacists are recruited to interdisciplinary health care teams to participate in autonomous direct patient care. CONCLUSION: The PGY-2 ambulatory care pharmacy residents autonomously practiced as recognized medical staff in the management of pediatric patients with T1D. This experience advocates for pharmacists' and their trainees' involvement in service-learning and team-based medical care outside the traditional health care setting.

Assessing an Interprofessional Polypharmacy and Deprescribing Educational Intervention for Primary Care Post-graduate Trainees: a Quantitative and Qualitative Evaluation.

BACKGROUND: Polypharmacy and potentially inappropriate medications (PIMs) are increasingly common and associated with adverse health effects. However, post-graduate education in polypharmacy and complex medication management for older adults remain limited. OBJECTIVE: The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE) polypharmacy clinic was created to provide a platform for teaching internal medicine (IM) and nurse practitioner (NP) residents about outpatient medication management and deprescribing for older adults. We aimed to assess residents' knowledge of polypharmacy and perceptions of this interprofessional education intervention. DESIGN: A prospective cohort study with an internal comparison group. PARTICIPANTS: IM residents and NP residents; Veterans ≥ 65 years and taking ≥ 10 medications. INTERVENTION: IMPROVE consists of a pre-clinic conference, shared medical appointment, individual appointment, and interprofessional precepting model. MAIN MEASURES: We assessed residents' performance on a pre-post knowledge test, residents' qualitative assessment of the educational impact of IMPROVE, and the number and type of medications discontinued or decreased. KEY RESULTS: The IMPROVE intervention group (n = 18) had a significantly greater improvement in test scores than the control group (n = 18) (14% ± 15% versus - 1.3% ± 16%) over a period of 6 months (Wilcoxon rank sum, p = 0.019). In focus groups, residents (n = 17) reported perceived improvements in knowledge and skills, noting that the experience changed their practice in other clinical settings. In addition, residents valued the unique interprofessional experience. Veterans (n = 71) had a median of 15 medications (IQR 12-19), and a median of 2 medications (IQR 1-3) was discontinued. Vitamins, supplements, and cardiovascular medications were the most commonly discontinued medications, and cardiovascular medications were the most commonly decreased in dose or frequency. CONCLUSIONS: Overall, IMPROVE is an effective model of post-graduate primary care training in complex medication management and deprescribing that improves residents' knowledge and skills, and is perceived by residents to influence their practice outside the program.

Using a multisite and multi-health system pharmacy resident program model for care documentation quality improvement.

OBJECTIVES: To implement and evaluate a pharmacy resident documentation peer review process. SETTING: The University of Minnesota Postgraduate Year One Pharmacy Residency Program is a multisite program with 25 residents across 16 different health care organizations. PRACTICE DESCRIPTION: Sites within the program provide comprehensive medication management (CMM) services to patients in ambulatory care settings, including participation in the full patient care process of assessment, care plan development, follow-up, and appropriate documentation. PRACTICE INNOVATION: In this innovative peer review process model, residents undergo a deidentified CMM documentation review process with residents from other practice sites, exposing them to different documentation templates and perspectives. EVALUATION: A workgroup of residency preceptors led by a research team developed a peer review process, which evolved through 3 phases over 2 years in response to resident, preceptor, and administration team feedback. Resident feedback was compiled and analyzed. RESULTS: Forty-two residents responded to the survey (67% response rate); 71% found the review process to be helpful. Residents reported that the process improved their understanding of how to improve patient care documentation (74%), how to provide peer feedback (90%), and the importance of effective interprofessional communication in clinical decision making (81%). DISCUSSION: The core perceived benefit of the peer review process was exposure to how other health systems and practitioners document CMM. Some residents participate in a peer review process at their home institutions, which may explain some of the lack of perceived benefit. Generalizability of this study is limited by being within a single residency program with a relatively small number of participants. CONCLUSION: Pharmacy residents found a peer review process of documentation to be helpful during their residency education. The process exposed residents to different documentation practices at various health care systems, which led to ideas of how to improve documentation and provided a foundation for how to provide peer feedback in practice.

Exploring the relationship between examination pass rates and eligibility pathways among pharmacist candidates for initial board certification.

OBJECTIVES: To compare examination pass rates among different eligibility cohorts for initial board certification in 6 recognized pharmacy practice specialties. DESIGN: Retrospective observational cohort study. SETTING AND PARTICIPANTS: Practicing U.S. pharmacists who were approved candidates for initial board certification examinations in the following Board of Pharmacy Specialties (BPS)-recognized specialties: ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy. OUTCOME MEASURES: The number and percentage of BPS-approved candidates that pass initial board certification examinations differentiated by specialty and eligibility pathway (i.e., completion of postgraduate residency training or demonstration of postlicensure specialized practice experience). RESULTS: Initial board certification examination outcome (i.e., pass or fail) was assessed for a total of 15,171 candidates from Fall 2015 to Fall 2018. Pass rates for that period based on eligibility pathway (e.g., completion of a PGY-2 specialty residency, completion of a PGY-1 residency plus 1-2 years of postlicensure specialized practice experience, or 3-4 years of postlicensure specialized practice experience) were, respectively as follows: ambulatory care pharmacy (n = 2081): 94%, 84%, and 55% (P < 0.0001); critical care pharmacy (n = 2111): 99%, 94%, and 79% (P < 0.0001); oncology pharmacy (n = 1195) 93%, 75%, and 50% (P < 0.0001); pediatric pharmacy (n = 1119): 87%, 73%, and 57%; (P < 0.0001); pharmacotherapy (n = 8368): 88%, 59% (P < 0.0001); and psychiatric pharmacy (n = 477): 93%, 72%, 49% (P < 0.0001). CONCLUSION: From 2015 to 2018, the percentage of BPS-approved candidates that passed initial board certification examinations in ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy was significantly higher for cohorts deemed to be board eligible based on completion of postgraduate residency training.

Professional responsibilities reported by pharmacists completing residencies in community-based settings.

OBJECTIVES: To evaluate the professional responsibilities of pharmacists who completed residencies in a community-based setting and to determine if there is a difference in responsibilities for pharmacists completing different types of PGY-1 residency and PGY-2 residency training. METHODS: A survey was designed by adapting questions from the 2014 Pharmacist Workforce Survey and creating other questions designed for this project. Surveys were distributed electronically to residency program directors of PGY-1 community-based pharmacy residencies, PGY-1 pharmacy residencies in ambulatory care environments, and PGY-2 ambulatory care residencies; program directors were asked to distribute the survey to all residency alumni of their program. RESULTS: A total of 450 programs were identified; 349 responses were received, with respondents having completed residency training from 1989 to 2016. Respondents represented at least 73 different residency programs across the country. More than 97% of respondents agreed or strongly agreed that their residency training prepared them to be successful in their career. Nondispensing patient care, ranging from 39.0% to 52.5%, represented the largest percentage of job responsibilities. Current job responsibilities contained a higher percentage of business or organization management compared with first job (17.7% vs. 5.8%; P < 0.001). CONCLUSION: Pharmacists completing residency training have a large percentage of their first jobs associated with patient care responsibilities, regardless of the type of training received or the type of setting.

The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model.

OBJECTIVES: To embed pharmacy residents in an interprofessional nephrology clinic to conduct medication reconciliation in targeted high-risk patients with nondialysis kidney disease. SETTING: This pilot was a prospective quality improvement initiative conducted in an interprofessional outpatient nephrology clinic. PRACTICE DESCRIPTION: The nephrology clinic team includes nephrology providers, a social worker, and a geriatrician. The team is responsible for the management of conditions such as nondialysis kidney disease, resistant hypertension, acute kidney injury, proteinuria, and nephropathy. EVALUATION: Primary outcomes included the number and type of medication discrepancies and drug therapy problems identified. Secondary outcomes included the changes in care process directly resulting from the pharmacy residents' recommendations. The perceived value of the pharmacy residents to the interprofessional team was assessed through postintervention anonymous surveys and semistructured interviews. RESULTS: The pharmacy residents conducted 118 visits for 87 unique patients (mean age 73 years, 97% male) with nondialysis kidney disease (89% stages III-V), polypharmacy (87% of patients taking > 10 medications), and a heavy comorbidity burden (85% hypertension, 80% dyslipidemia, 59% diabetes mellitus type II) from January to October 2017. Pharmacists identified 344 medication discrepancies and 301 drug therapy problems, resulting in 398 changes in care process. The most frequently identified discrepancies and drug therapy problems were the omission of an active medication from the medication list (86 of 344 discrepancies, 25%) and potentially inappropriate medications (106 of 301 drug therapy problems, 35%). Pharmacists recommended 228 medication changes, provided 76 adherence devices, facilitated 24 consults or referrals, and communicated with the primary care team on 70 occasions. The interprofessional team members all strongly agreed that patients and the team benefited from the pharmacists' involvement. CONCLUSION: Pharmacy resident-led medication reconciliation resulted in the identification and resolution of medication discrepancies and drug therapy problems, leading to changes in the care process.

Pharmacy interns' perceptions of knowledge and skills required for delivery of patient care services.

OBJECTIVES: To explore how pharmacy interns' training experiences during internship influence understanding and confidence about preparation for providing patient care services in a large community pharmacy chain. METHODS: A descriptive survey design using a census sample of the 98 pharmacy interns, aged 18 years and older, employed in 52 pharmacies of one community pharmacy chain was conducted. Training experiences influencing understanding and confidence were evaluated with the use of a 38-question survey instrument developed with a focus group of pharmacy interns and distributed via Qualtrics over a period of 12 weeks. Responses were stored in Qualtrics and analyzed with the use of SAS version 9.4. RESULTS: Thirty-four surveys were returned, for a response rate of 35%, with a 20% response rate for all of the questions. Pharmacy interns who completed the American Pharmacist Association "Delivering Medication Therapy Management Services" certificate training program were more likely to agree with statements evaluating understanding (P < 0.02) and confidence (P < 0.09) in completing a comprehensive medication review and less likely to indicate a need for training (P < 0.02). Pharmacy interns have a greater understanding and confidence incorporating immunizations into workflow (both 85%). They also have a greater understanding and confidence in using Advisory Committee on Immunization Practices/Centers for Disease Control and Prevention guidelines for immunization recommendations (90% and 85%, respectively). Pharmacy interns reported that they did not have a strong understanding of and confidence level in providing other patient care services, including medication therapy management services, clinical queue, and point-of-care testing. Survey respondents reported a desire for additional training in these areas. CONCLUSION: Although pharmacy interns have a greater understanding of how to incorporate immunizations into pharmacy workload and use immunization guidelines, levels of understanding and confidence in providing other patient care services were not as strong. Future development of training for patient care services may help to increase pharmacy intern understanding and confidence.

[Evaluation of knowledge and perceptions of pharmacists and residents pharmacists about bibliometric indicators applied to the scientific literature in pharmacy]. / Évaluation des connaissances et perceptions des pharmaciens et internes en pharmacie sur les indicateurs de notoriété appliqués à la publication scientifique en pharmacie.

OBJECTIVES: Evaluate the level of knowledge and perceptions of French and Quebec hospital's pharmacists/residents about bibliometrics indicators applied in pharmacy. Identify the determinants associated with this knowledge. METHODS: This is a descriptive cross-sectional study. An anonymous questionnaire of 17 questions answers was developed. The questionnaire was published on the SurveyMonkey site (www.SurveyMonkey.com, SurveyMonkey, Portland, OR, USA) and released from March 19 to April 9, 2018. We calculated and compared the proportion of respondents in Quebec and France by using a Chi2 test. A value less than 0.05 is considered statistically significant. RESULTS: A total of 899 pharmacists (646 in Quebec and 253 in France) and 147 residents (70 in Quebec and 77 in France) were contacted by email. The survey was completed by 401 respondents, e.g., 301 in Quebec (participation rate: 42%) and 100 in France (30%). Overall 26% (106/401) of respondents (67/301 in Quebec vs. 39/100 in France) reported having knowledge or good knowledge of those indicators. These data are corroborated by many other results. CONCLUSIONS: Small proportions are aware of those indicators. A good knowledge is associated with being a French pharmacist, working in a teaching hospital or university, having a professional experience of 10 years or more, be involved in a research project, having a scientific watch or having an online profile on database. It appears necessary to inform pharmacists and residents on notoriety indicators.