Empowering early career pharmacists: Unleashing non-clinical competencies through pharmacy residency.

INTRODUCTION: Pharmacy residency programs traditionally prioritize clinical skills development. However, non-clinical competencies, such as leadership, conducting education, and innovation, are now emerging as pivotal factors in propelling pharmacists toward excellence in practice. The extent to which these non-clinical skills are effectively fostered by residency programs remains unclear. This study aims to explore how residency programs propel the development of crucial non-clinical competencies such as leadership, conducting education, and innovation. METHODS: Pharmacists who completed a pharmacy residency program and their preceptors from a tertiary teaching hospital took part in semi-structured interviews. Thematic analysis, employing an inductive approach and aided by NVivo software, was used to identify recurrent themes in the interview responses. RESULTS: Competency development was shaped by four key themes: system-dependent facilitators, system-dependent barriers, individual resident attitudes, and pharmacy department influences. The structure of the residency program was perceived to strongly support competency development in conducting education. The impact on the leadership and innovation competencies development was comparatively lesser. CONCLUSION: Pharmacy residency is perceived as effective in supporting non-clinical competency development when there is a clear structured framework with objectives and guidance for pre-defined activities and tasks known to support competency development. Ambiguity and a lack of standardized guidance in developing specific competencies were identified as factors that diminish their relevance for both residents and preceptors. To enhance residency programs, it is essential to establish clear frameworks, with pre-defined objectives and activities known to support competency development and supplement them with the necessary skills-building courses where appropriate.

Impact of PhORCAS references on overall application score for postgraduate year 1 pharmacy residency candidates.

PURPOSE: The disparity between the number of applicants for postgraduate year 1 (PGY1) pharmacy residency positions and the number of available residency positions increases the need to optimize how applicants are evaluated. The purpose of the study described here was to evaluate the correlation of ratings of residency candidate characteristics by academic and professional references listed on residency applications with overall application score, applicant ranking, and the likelihood of candidates receiving an invitation to interview. METHODS: A multicenter, retrospective study was conducted to evaluate the correlation of reference writers' ratings of 13 candidate characteristics and their overall recommendations with program-determined outcomes (eg, final application score, applicant ranking, and invitation to interview) through analysis of PGY1 applications submitted through the Pharmacy Online Residency Centralized Application System (PhORCAS) from 2015 through 2018. Keywords and themes within the open-ended section of letters of reference were also analyzed for correlation with overall application score. RESULTS: A total of 5,923 references listed on 1,867 applications to 4 PGY1 pharmacy residency programs processed by PhORCAS were included in the analysis. For the majority of applicant characteristic ratings (ie, 74% of 56,872 ratings overall), reference writers rated candidates as exceeding expectations, and applicants were "highly recommended" by these evaluators in 91% of cases. References' average characteristic ratings and overall recommendations were poorly correlated with final application score (R2 = 0.12 [P < 0.0001] and R2 = 0.08 [P < 0.0001], respectively), final ranking (R2 = 0.02 [P < 0.0001] and R2 = 0.03 [P < 0.0001], respectively), and invitation to interview (R2 = 0.07 [P < 0.0001] and R2 = 0.04 [P < 0.0001], respectively). For the themes evaluated, references' use of teaching words best correlated with normalized final application score, although the correlation was poor (R2 = 0.007, P = 0.0001). CONCLUSION: Reference writers' ratings of PGY1 residency candidate characteristics in PhORCAS are poorly correlated with application score, applicant ranking, and invitation to interview. The results of this study suggest that the existing PhORCAS standardized form for submitting references is of limited utility in its current state.

Exploring pharmacy residency program director preference of pharmacy student organization membership and leadership involvement on residency candidate interview selection.

INTRODUCTION: Pharmacy student professional organization involvement and leadership are important qualifications of a pharmacy residency candidate. It is unknown if membership in specific student pharmacy organizations or types of leadership roles within these organizations are preferred by residency program directors (RPDs). The purpose of the study was to determine preference and importance of specific pharmacy student professional organization membership and leadership involvement when selecting residency candidates for an interview by RPDs. METHODS: A descriptive study was conducted using an online survey. Pharmacy RPDs with involvement in reviewing applicants for interviews were included. RPDs ranked the importance and preference of specific student professional organization membership, breadth versus depth of involvement, and leadership position held on selecting candidates for an interview. RESULTS: The survey was sent to 2084 RPDs. A total of 232 respondents met inclusion criteria and completed the survey. The majority (95.5%) of RPDs reported student membership as important, while 28.6% had preference for a specific organization. A total of 56.3% of RPDs reported student leadership as "very important" and 76.1% preferred depth over breadth of involvement. A total of 55.6% of RPDs preferred applicants with a high-level leadership position. CONCLUSIONS: Pharmacy student professional organization membership is important to RPDs when selecting residency candidates for an interview. The majority of RPDs have no preference for a specific organization, while 28.6% report a preference that affects interview selection. RPDs report leadership as important and place higher importance on depth versus breadth of involvement, with greater preference for a high-level leadership position.

Evaluation of pharmacy resident perceived impact of natural disaster on stress during pharmacy residency training.

INTRODUCTION: Natural disasters present unique challenges for healthcare training programs. Limited literature has been published regarding the impact of natural disasters on pharmacy residency training. The objective of this study was to determine the degree of perceived impact natural disasters have on pharmacy resident stress and which factors contribute to any perceived change in stress. METHODS: A cross-sectional study was conducted via a survey distributed to pharmacy residents whose program was located in an area potentially affected by natural disaster in the first six months of the 2017-2018 resident year. A modified Likert scale utilizing a 10-point scale was used to assess resident stress. Potential sources of stress were assessed via multiple-choice questions. The primary outcome was the degree of change in resident perceived stress compared to baseline during and after the natural disaster. RESULTS: One hundred twenty-nine pharmacy residents completed the survey. Stress increased from baseline during the natural disaster and remained elevated after compared to baseline. Main sources of stress were increased residency workload, natural disaster preparation and recovery, and concerns regarding friends and family. Half of residents reported their residency program did not have an established natural disaster policy in place. CONCLUSIONS: Improved planning and communication regarding workload expectations may minimize stress among residents balancing increased personal responsibilities during times of natural disaster.

The role of clinical pharmacist trainees in medication reconciliation process at hospital admission.

Background Medication discrepancies are a common occurrence following hospital admission and carry the potential for causing harm. However, little is known about the prevalence and potential risk factors involved in medication discrepancies in China. Objective To determine the frequency of medication discrepancies and the associated risk factors and evaluate the potential harmsof errors prevented by pharmacist trainees performing medication reconciliation process. Setting A tertiary hospital in Shanxi, China. Method Medication reconciliation was conducted at admission to four clinical departments including cardiology, nephrology, endocrinology and pneumology department between 2019 Feb 1st and 2019 Aug 31st by clinical pharmacist trainees. All unintentional medication discrepancies were presented to the expert panel to evaluate. Associations between unintentional medication discrepancies and various factors were examined. Main outcome measure The primary outcome was the prevalence of unintentional medication discrepancies as well as the associated risk factors. Results Overall, 331 patients were included (mean age 59.7 ± 15.2 years; 176 men). The reconciliation process identified 511 drug discrepancies, 98 of which were unintentional medication discrepancies; these occurred in 74 patients. The most common unintentional medication discrepancies type was omission (40.8%), followed by incorrect dose (25.5%), and 73.5% could have caused patients moderate to significant harm and complications. 5 or more drugs and 2 or more chronic diseases at admission associated with unintentional medication discrepancies in a logistic regression analysis. Conclusion Medication reconciliation performed by pharmacist trainees upon admission can reduce unintentional medication discrepancies. Patients taking 5 or more drugs and experiencing more than two chronic diseases were found to be particularly at risk.

Continuity of Specialty Pharmacy Practice: A Survey of PGY-2 Pharmacy Residency Graduates.

BACKGROUND: Literature regarding career trajectory for postgraduate year 2 (PGY-2) pharmacy residency specialty-trained pharmacists is limited. OBJECTIVE: The objective of our study is to describe PGY-2 pharmacy residency training on career practice and satisfaction. METHODS: A cross-sectional study surveyed graduates of PGY-2 pharmacy residency programs. Respondents were identified by current PGY-2 residency program directors requesting participation from their program alumni. The primary outcome was whether PGY-2 residency-trained pharmacists continued working within their specialty or not. Secondary outcomes included alternative specialty areas, current satisfaction with their specialty, and the necessity of completing a PGY-2. RESULTS: Among 647 respondents, 84% completed their program in the past 6 years. The top 3 represented pharmacy specialties were critical care (19%), ambulatory care (14%), and oncology (13%). Most respondents continue to practice in the same specialty as their PGY-2 residency program (n = 572, 87%) compared with pharmacists who currently practice in other clinical specialties or areas of pharmacy (n = 83, 13%). Critical care (n = 28, 33%) had the largest specialty response no longer practicing in their PGY-2 residency program specialty with 42% (n = 12) now practicing within the emergency medicine specialty. The average satisfaction for their current specialty was 4.7 ± 0.82 (Likert scale of 1 = extremely dissatisfied to 5 = extremely satisfied). CONCLUSIONS: The vast majority PGY-2 pharmacy residency-trained pharmacists experienced training-practice concordance and are satisfied with their trained specialty. Among those with specialty training practice discordance, critical care training was most prevalent.

An individualized approach to residency preparation for fourth professional year pharmacy students.

INTRODUCTION: The objective of this study was to evaluate the impact of an individualized residency preparation program and faculty mentorship on student preparedness for pursuing residency training and their ability to successfully match with a postgraduate year one (PGY1) residency position. METHODS: This prospective cohort enrolled fourth professional year pharmacy students from August 2016 to March 2017. Students participated in a faculty-designed residency preparation program, were assigned faculty mentors, and were provided with several residency preparation resources. The primary outcome was change in the median overall perceived level of preparedness, as measured by pre- and post-residency preparation program surveys. A key secondary end point was the correlation between obtaining a PGY1 residency position and the number of residency preparation sessions attended. RESULTS: Fifty-two students participated in the residency preparation program. The median overall perceived level of preparedness increased following the preparation program. Of the 52 students participating, 37 attended over half of the program sessions. Twenty-one of the 37 (56.8%) students participating in more than half of the sessions matched with a PGY1 program compared to three out of 15 (20%) students participating in fewer than half the sessions. Additionally, students reported value in mock interviews, faculty mentorship, and institution-specific residency preparation guidance delivered via a workbook. CONCLUSIONS: Participation in an individualized residency preparation program with faculty mentorship and institution-specific guidance improves the perceived level of preparedness for students pursuing residency training. High attendance at sessions, along with other factors, may contribute to a higher rate of success.

High-fidelity simulation increases pharmacy resident perceived competence during medical emergencies.

INTRODUCTION: Our objective was to assess postgraduate year one (PGY1) pharmacy resident perceived competence during medical emergencies before and after implementation of a longitudinal simulation training curriculum. METHODS: At the University of California San Francisco (UCSF) Medical Center, PGY1 pharmacy residents serve as primary code team responders for code blue, code sepsis, and code stroke, among other medical emergencies. In 2015, the UCSF Residency Training Program implemented a longitudinal simulation curriculum for PGY1 pharmacy residents. Throughout the residency year, residents participated in four simulation lab sessions that addressed various medical emergencies. To assess the impact that the simulation curriculum had on resident perceived competence during medical emergencies, a 19-question survey (13 clinical questions and six control questions) was distributed to the residents at the end of the residency year. Resident responses from the 2015 to 2016 and 2016 to 2017 surveys were compared to a control residency class from 2014 to 2015 who did not undergo the simulation curriculum. RESULTS: Simulation-trained PGY1 pharmacy residents reported significantly greater perceived competence in five of the twelve medical emergency scenarios (acute coronary syndromes, symptomatic bradycardia, supraventricular tachycardia, ventricular tachycardia, and cardiac arrest) as compared to non-simulation-trained controls. In addition, the PGY1 pharmacy residents felt that their performance as a clinical pharmacist would significantly improve as a result of the simulation curriculum. CONCLUSIONS: Incorporation of a longitudinal simulation curriculum into PGY1 pharmacy resident training can positively impact resident self-reported competence when performing essential pharmacist functions during medical emergencies.

A novel and comprehensive design of mock residency interviews for fourth-professional year doctor of pharmacy students.

BACKGROUND AND PURPOSE: To describe a comprehensive design of mock residency interviews intended to closely mimic the environment and variety of interview settings commonly seen in post-graduate year 1 (PGY-1) interviews. EDUCATIONAL ACTIVITY AND SETTING: Mock interviews were held during one evening where a total of 24 fourth-professional year doctor of pharmacy students each experienced seven different interview scenarios over the course of nearly three hours. Twenty-seven faculty members and pharmacists and 11 current pharmacy residents participated as interviewers. Students received individual written feedback after the conclusion of the event. FINDINGS: Duquesne University School of Pharmacy has successfully hosted this residency mock interview program for four consecutive years. After establishing a basic template for the interview format, we have been able to include more students, more interviewers, and a greater variety of interview scenarios. SUMMARY: This comprehensive approach to mock residency interviews has been successfully implemented to help prepare students at Duquesne University School of Pharmacy for PGY-1 residency interviews.

PGY1 resident research projects: Publication rates, project completion policies, perceived values, and barriers.

PURPOSE: To assess the publication rates of PGY1 pharmacy residents and to determine the beliefs of pharmacy residency program directors (RPDs) regarding PGY1 residency research projects, the residency-specific policies on publishing, and the perceived barriers to publishing for PGY1 residents. METHODS: The 2013 American Society of Health-System Pharmacists Midyear Clinical Meeting resident poster presentation roster was used to compile the list of PGY1 residents who submitted an abstract. The Web of Science database was searched using the PGY1 residents' name and research title to determine if a publication resulted from the abstract by December 2016. Publication rates were calculated using several demographic subcategories. The PGY1 RPDs identified from the ASHP website (n = 1220) were surveyed to determine how they value the research project, policies regarding publishing at their institution, and potential barriers to publication. RESULTS: Out of 1419 abstracts from PGY1 residents, 26 (1.8%) resulted in a publication by 2016. Of the 369 RPDs who responded, the majority complimented their programs as favorable environments for completing research, 55% stating that their institutions offered formal research training, 65% stating that they have preceptors specifically assigned for research, and 83% stating that they provide dedicated time to residents to complete their research. The common barriers to publication were difficulty in completing the project in one year and lack of continuity after residency completion. CONCLUSION: Despite pharmacy residency programs requiring residents to complete a research project, most residents end the residency without a publication. Further research is needed to identify the residents' barriers to publications and resources needed to publish the research projects.

Evaluating a measure of the research training environment in a sample of pharmacy residents.

INTRODUCTION: While an important predictor of future research involvement, formal assessment of the quality of the research training environment in pharmacy residency training has not been examined. The objective of this study was to evaluate the psychometric properties of a modified version of the shortened form of the revised Research Training Environment Scale (RTES-R-S) in pharmacy residents. METHODS: The original wording of the 18 items from RTES-R-S was modified to reflect pharmacy residency training. Data were collected as part of a larger study involving a random sample of pharmacy residents in the United States during the 2016-2017 residency year. Internal consistency was assessed with Cronbach's α. Confirmatory factor analysis was used to assess the fit of the factor structures examined previously during the original RTES-R-S development. RESULTS: Based on confirmatory factor analysis, the preferred model proposed a single, second-order factor predicting nine factors reflecting Gelso's previously described ingredients of the research training environment. This model had acceptable fit indices and was statistically better than models without second-order factors. Cronbach's α for the global scale was 0.86, with the two subscales >0.7. CONCLUSIONS: Minor rewording of an existing instrument to measure residents' perceptions of the quality of the research training environment demonstrated acceptable internal consistency. The factor structure of the recommended use proposed by the original developers of the RTES-R-S was supported in this sample of pharmacy residents. Continued work with additional samples is needed to generate additional validity evidence supporting the use of this tool in pharmacy residents.

Professional development series in postgraduate pharmacy residency training: Experiences and opportunities.

INTRODUCTION: The American Society of Health-System Pharmacists (ASHP) identifies competency areas that categorize clinical and non-clinical skills to develop during postgraduate residency training. To address the competency areas related to non-clinical skills, some residencies have developed programs to focus on interpersonal, leadership, and other professional skills. There is limited guidance in the literature regarding the development or impact of these programs. PERSPECTIVE: Professional development series have been implemented at two academic institutions to support the development of non-clinical skills during postgraduate residency training. While these programs address many of the non-clinical skills described in the competency areas, barriers such as program support, logistics, and need for assessment may impede the creation, growth, and success of similar programs. IMPLICATIONS: With the continued increase in the number of residency programs and trainees, scalability and sustainability are vital components for the success of professional development programs. Assessment of the impact of current programs and further guidance from pharmacy organizations regarding important aspects of professional development would help standardize this process.

Comparison of perceived personality traits between the pharmacy residents admitted through the match or scramble process.

INTRODUCTION: The purpose of this study is to determine whether certain personality traits are as prominent in pharmacy practice residents who obtain positions through the post-Match process, previously referred to as the Scramble, as compared to residents who match directly with programs. METHODS: Pharmacy residency program directors (RPDs) across the United States were asked to complete an electronic survey that gauged RPD perceptions of 13 personality traits commonly seen in pharmacy residents. RPDs were requested to separately evaluate residents who Scrambled and Matched to their respective programs. Exploratory factor analysis (EFA) was used to determine factor structure for the personality traits and to assess whether factors associate differentially between Matched and Scrambled residents. RESULTS: A total of 1876 RPDs of post-graduate year one (PGY1), post-graduate year two (PGY2), and combined PGY1 and PGY2 pharmacy residency programs were contacted for study participation with a response rate of 21 percent. Demographic variables related to program type and number of residents per class were similar between Scrambled and Matched groups. The EFA identified two factors across 13 traits: we termed them as traditional traits and grit-like traits, and they significantly differed between the Scramble and Match groups. RPD perception of traditional traits (nine traits) were significantly higher in the Match group (p < 0.05), whereas perceived grit-like traits (four traits) were significantly higher in the Scramble group (p < 0.0001). CONCLUSION: Residency candidates who Match versus candidates who Scramble are perceived to have unique and significantly different personality traits.

Post-graduate year two transitions of care pharmacy residencies no longer accredited.

INTRODUCTION: Literature supports pharmacist integration within transitions of care. A total of eight health-system pharmacies and colleges of pharmacy developed focused post-graduate year two (PGY2) training in this specialty. However, in fall 2016, ongoing accreditation of these PGY2 transitions of care programs was discontinued by the American Society of Health-System Pharmacists Commission on Credentialing. PERSPECTIVE: Healthcare relies on interprofessional collaborations and corresponding programs in order to improve patient care. Pharmacists who have completed specialized training in transitions of care are not only leaders in this realm but also ambassadors for interprofessional medicine. IMPLICATIONS: Rebranding transitions of care PGY2 programs fails to capture all the opportunities available to train and mentor new transitions of care pharmacists. Lack of consensual accreditation introduces variability within training. There may be opportunities to revisit transitions of care PGY2 accreditation in the future.

Outcomes of Student-Driven, Faculty-Mentored Research and Impact on Postgraduate Training and Career Selection.

Objective. To evaluate scholarly deliverables from student-driven research and explore the impact on postgraduate training placement rates, pharmacy faculty appointments and lifetime publications. Methods. A retrospective analysis of Doctor of Pharmacy graduates who conducted student research between the academic years of 2002 and 2015 was performed. Data were collected on research participation, abstracts, presentations, postgraduate training, full-time faculty appointments, and publications. Results. Of 1229 graduates, 300 participated in research during pharmacy school. Fifty-six percent (n=167) submitted at least one abstract and 68 students (23%) published their research. Research participation was associated with a significantly higher likelihood of postgraduate training and specialty training. Research participation positively affected the likelihood of faculty appointment and lifetime publication rate. Conclusion. Students who engaged in elective research had significant scholarly deliverables, including peer-reviewed publications, and were more likely to successfully match in a postgraduate position and achieve full-time academic appointments.

Rates of depressive symptoms among pharmacy residents.

PURPOSE: Results of a survey-based study assessing rates of depression and depressive symptoms among pharmacy residents are reported. METHODS: In a time-series study conducted during the 2015-16 residency year, pharmacy residents nationwide were invited to participate in a series of online surveys (administered in September and December 2015 and March 2016). Survey participants reported demographic data and provided information on residency characteristics and perceived family and program support; the survey incorporated the 9-item depression screening component of the Patient Health Questionnaire (PHQ-9). Descriptive statistics were used to estimate rates of depression and depressive symptoms. RESULTS: There were 633, 542, and 749 respondents to the September, December, and March surveys, respectively, for an overall response rate of 20.5%. The mean age of respondents was 26.9 years. Among respondents to the March survey, 39.9% (95% confidence interval, 36.2-43.2%) reported moderate-to-severe depressive symptoms. The rate of severe depressive symptoms (as measured by PHQ-9 scores) increased from 3.2% in the September survey to 7.8% in the March survey (p < 0.05); rates of self-reported low depressive symptoms decreased over the same time period (p < 0.05). By comparison, rates of depressive symptoms in medical residents have been reported to be in the range of 30%. CONCLUSION: A survey of pharmacy residents found that the rate of depressive symptoms, as measured by the PHQ-9, was higher than reported rates in the U.S. general population.

Improving Ambulatory Care Resident Training: Preparing for Opportunities to Treat Mental Illness in the Primary Care Setting.

PURPOSE: The development of an outpatient psychiatry clinical practice learning experience for PGY2 ambulatory care pharmacy residents in preparation for the treatment of psychiatric disorders in the primary care setting is described. SUMMARY: With the increased prevalence of psychiatric disorders, significant mortality, and limited access to care, integration of mental health treatment into the primary care setting is necessary to improve patient outcomes. Given the majority of mental health treatment occurs in the primary care setting, pharmacists in patient-centered medical homes (PCMHs) are in a unique position with direct access to patients to effectively manage these illnesses. However, the increased need for pharmacist education and training in psychiatry has prompted a large, Midwestern academic health system to develop an outpatient psychiatry learning experience for PGY2 (Postgraduate Year 2) ambulatory care pharmacy residents in 2015. The goal of this learning experience is to introduce the PGY2 ambulatory care residents to the role and impact of psychiatric clinical pharmacists and to orient the residents to the basics of psychiatric pharmacotherapy to be applied to their future practice in the primary care setting. CONCLUSION: The development of an outpatient psychiatry learning experience for PGY2 ambulatory care pharmacy residents will allow for more integrated and comprehensive care for patients with psychiatric conditions, many of whom are treated and managed in the PCMH setting.