Promoting diversity, equity and inclusion awareness in clinical documentation through postgraduate year one training.

BACKGROUND AND PURPOSE: As healthcare providers increasingly focus on emerging issues of diversity, equity and inclusion (DEI) in patient care, less is known about the training in postgraduate year one (PGY1) pharmacy residency on DEI clinical documentation considerations. This pilot project explored whether training, discussion and self-reflection within a peer review activity promoted DEI self-awareness in clinical documentation through a centralized curriculum of a multisite PGY1. EDUCATIONAL ACTIVITY AND SETTING: Building upon an established peer review of clinical documentation activity, PGY1 pharmacy residents practicing in ambulatory care settings received training on DEI considerations and completed small and large group discussions, a post-activity mixed methods survey with self-reflection prompts, and a three-month follow-up survey. FINDINGS: Twenty-two residents participated in the peer review of clinical documentation activity, DEI training and discussions. Twelve residents completed the post-activity survey with reflection prompts; 6 (50%) reported similar previous DEI training prior to residency. After the DEI training and discussions, 12 (100%) agreed or strongly agreed that their awareness of DEI documentation considerations increased; 10 (83%) would document their submitted notes differently, while one resident was unsure and one would not make changes. Twelve residents completed the follow-up survey three months following the activity. Themes from the free-text responses on key learnings collected post-activity and three-month post (respectively) included: 1) new knowledge, increased self-awareness, and intended action and 2) increased self-awareness and changes in note-making convention. SUMMARY: Integrating DEI training, discussion, and self-reflection prompts into a peer review clinical documentation activity increased self-awareness and knowledge of DEI considerations and promoted intended changes in patient care documentation for pharmacy residents. Regardless of previous training, residents reported continued self-awareness and changes in documentation conventions continued three months later.

Impact of Advanced Pharmacy Practice Experiences on Residency Interview Invitations.

Objective. To determine how postgraduate year one (PGY1) pharmacy residency program directors perceive factors related to advanced pharmacy practice experiences (APPEs) when selecting candidates for residency interviews. Methods. An online cross-sectional nationwide survey of 1,280 PGY1 residency program directors was conducted. Participants were asked to rank the overall influence of five APPE categories, including location, structure, elective type, timing, and preceptor references, as well as the desirability and necessity of APPE-related variables representing the five categories, in their assessment of residency candidates. Results. Program demographics and survey data were collected from 375 participants (29% response rate). The category most influential to program directors' decisions was APPE preceptor reference letters, while the category that was the least influential was APPE timing factors. An APPE's location, structure, and elective type ranked second, third, and fourth, respectively, as the most influential categories. Respondents perceived factors similar to their own residency environment as desirable, supporting the study's conceptual framework of person-environment fit. The variables that the majority of residency directors specifically desired were two reference letters from APPE preceptors and letter grades for each APPE completed. Completion of inpatient elective APPEs was considered more desirable than completion of a balanced mix of elective APPEs. Participants rarely indicated that a specific APPE variable was a necessity for a candidate to be considered. Conclusion. Applicants to pharmacy residency programs should consider the importance of person-environment fit when selecting APPEs and preparing applications as program directors desire candidates who possess attributes compatible with their organization and complete APPEs in settings similar to that of their organization. Conversely, the absence of desired APPE-related variables does not necessarily exclude an applicant from consideration.

Association between student characteristics and rankings when applying for a residency in health-system pharmacy administration.

PURPOSE: Results of a study to identify characteristics associated with pharmacy residency applicant success in obtaining an invitation to interview and a top candidate ranking are reported. Subsequent development and initial validation of a predictive model based on those characteristics are described. METHODS: Bivariable analyses were performed for planned stratifications of applicants to a health-system pharmacy administration residency program according to whether they were offered an on-site interview or were among the 8 top candidates by final candidate ranking. A Random Forest algorithm was created to identify predictors of the likelihood of an applicant being offered an on-site interview. RESULTS: Applicants who were offered interviews had a higher median pharmacy school grade point average (GPA) than those not invited to interview: 3.63 (interquartile range [IQR], 3.46-3.79) versus 3.35 (IQR, 3.2-3.49); p < 0.001. Invited applicants also received more scholarships during pharmacy school (median, 2 [IQR, 1-3) versus 1 [IQR, 0-2]; p = 0.002). Applicants with prior work experience as a hospital pharmacy intern were also more likely than those without such experience to be offered an interview (70.0% versus 37.8% were invited, p = 0.001), as were applicants who presented a poster at a national meeting during pharmacy school (80% versus 60%, p = 0.02) or who served in a national pharmacy organization leadership position (41.4% versus 20%, p = 0.03). Pharmacy school GPA was associated with final candidate ranking; top-ranked candidates had a significantly higher median GPA than lower-ranked applicants (3.68 [IQR, 3.51-3.8] versus 3.48 [IQR, 3.23-3.7]; p = 0.003). CONCLUSION: Objective criteria within the realms of academic performance and prior work experience may be used to streamline the applicant screening process when determining candidates to invite for an on-site interview. Pharmacy school GPA was the only characteristic found to be associated with applicant final ranking.

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.

Selecting candidates for pharmacy residencies: A national survey of residency program directors.

WHAT IS KNOWN AND OBJECTIVE: Due to advances in healthcare and treatment options, there is a need for pharmacists with additional post-graduate residency training. With the growing need for residency-trained pharmacists, obtaining a post-graduate pharmacy residency has become more competitive. The objective of this study was to capture the perspectives of post-graduate year 1 residency programme directors (RPDs) in the United States (US) regarding aspects of a candidate's application and interview they found most important when selecting future residents. METHODS: A cross-sectional, electronic survey was distributed via e-mail to PGY-1 pharmacy RPDs in the USA. RPDs were identified via the American Society of Health-System Pharmacists' pharmacy residency directory. Data related to programme demographics, candidate applications and interview evaluations were collected. RPDs' perceptions were captured via a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). RESULTS AND DISCUSSION: A total of 327 (26.6%) RPDs completed the survey. RPDs highly considered overall compatibility (mean Likert score: 4.9), letters of recommendation (4.6) and letter of interest (4.5) when inviting candidates for on-site interviews. Residency programmes focusing in acute care valued hospital pharmacy work experience more compared to non-acute care-focused residency programmes (4.2 vs 2.9). During the interview, critical thinking ability (4.8), verbal communication (4.8) and overall compatibility (4.9) were viewed as highly important when considering ranking of candidates. WHAT IS NEW AND CONCLUSION: Due to the competitive nature of obtaining a residency programme, insight from RPDs on factors they consider significant when assessing prospective residents is valuable. The results from this study show that a strong letter of intent, letters of recommendations and overall compatibility are considered important by RPDs and should be used by candidates to better prepare themselves for residency applications. Additionally, the candidate should remain knowledgeable about the residency programme and be able to respond to questions asked during the residency interview process.

Characterization of actions taken during the delivery of medication therapy management: A time-and-motion approach.

OBJECTIVES: To characterize actions performed by pharmacists and support staff during provision of medication therapy management (MTM) and to compare actions performed according to practice characteristics. METHODS: A purposeful sample of 7 MTM practices (2 call centers and 5 community practices) was identified and visited by investigators. Pharmacists and support staff were observed during their routine provision of MTM. Investigators characterized "major" (e.g., preparation for a comprehensive medication review) and "minor" (i.e., specific steps in overarching major action) actions with the use of a time-and-motion approach. RESULTS: A total of 32 major and 469 minor actions were observed. Practices were characterized as Later Maturity Level or Early Maturity Level on the basis of their self-reported MTM appointment volume, self-assessment of the extent of integration of chronic care model principles, and payer mix. Later Maturity Level practices were more likely to deliver follow-up medication therapy reviews and comprehensive medication reviews (CMRs) as opposed to targeted medication reviews (TMRs) and to receive physician referrals for MTM. Later Maturity Level practices were also more likely to use paid interns than pharmacy rotation students. CMR activities observed at Later Maturity Level practices lasted a median of 30.8 minutes versus 20.3 minutes for CMR activities at Early Maturity Level practices. Similarly, TMR activities observed at Later Maturity Level practices were longer: a median of 31.0 minutes versus 12.3 minutes. At Later Maturity Level practices, pharmacists spent a greater proportion of time providing patient education, while support staff spent a greater proportion of time on tasks such as capturing demographics and introducing or explaining MTM. CONCLUSION: MTM activities were longer at Later Maturity Level practices, and these practices were more likely to use paid pharmacy interns and to receive physician referrals for MTM. This work provides a foundation for future research.