Student Preparation for PGY1 Residency Training by US Colleges of Pharmacy: Survey of the Residency Program Director Perspective.

Purpose: To evaluate current residents' level of preparation by US colleges of pharmacy for postgraduate year 1 (PGY1) residency training from the perspective of residency program directors (RPDs). Methods: RPDs were asked in an electronic survey questionnaire to rate PGY1 pharmacy residents' abilities in 4 domains: communication, clinical knowledge, interpersonal/time-management skills, and professionalism/leadership. Results: One hundred ninety-seven RPDs of the American Society of Health-System Pharmacists (ASHP)-accredited PGY1 programs completed the survey. The majority of RPDs strongly agreed or agreed that residents were prepared as students to effectively communicate both verbally and nonverbally, were able to appropriately respond to drug inquiries using drug resources and literature searches, and consistently displayed professionalism. Respondents were more likely to disagree or give a neutral response when asked about residents' understanding of biostatistics and their ability to provide enteral and parenteral nutritional support for patients. Conclusion: Overall, RPDs agreed that residents were prepared to perform the majority of the tasks of each of the 4 domains assessed in this survey relating to PGY1 training. RPDs may use the results of this survey to provide additional support for their residents in the areas in which residents lack adequate preparation, while colleges of pharmacy may focus on incorporating more time in their curriculum for certain areas to better prepare their students for residency training.

Antibiotic dosing during sustained low-efficiency dialysis: special considerations in adult critically ill patients.

OBJECTIVE: To address issues of antibiotic dosing during sustained low-efficiency dialysis by using available pharmacokinetic data, intermittent and continuous renal replacement therapy dialysis guidelines, and our experience with sustained low-efficiency dialysis. DATA RESOURCES: Published clinical trials, case reports, and reviews of antibiotic dosing in humans during sustained low-efficiency dialysis. DATA EXTRACTION: A search of electronic databases (MEDLINE, PubMed, and Ovid) was conducted by using key words of extended daily dialysis, sustained low-efficiency dialysis, antibiotics, antimicrobial agents, and pharmacokinetics. MEDLINE identified 32 sustained low-efficiency dialysis articles, and PubMed identified 33 articles. All papers describing antibiotic clearance prospectively in patients were considered for this article. DATA SYNTHESIS: We identified nine original research articles and case reports that determined the impact of sustained low-efficiency dialysis on antibiotic clearance in patients. The blood and dialysate flow rates, duration of dialysis, type of filter, and the pharmacokinetic parameters were extracted from each article. If multiple articles on the same drug were published, they were compared for consistency with the aforementioned dialysis parameters and then compared with forms of continuous renal replacement therapy. Antibiotic clearance by sustained low-efficiency dialysis was determined to be similar or higher than continuous renal replacement therapy therapies. The estimated creatinine clearance during sustained low-efficiency dialysis was approximately 60 mL/min to 100 mL/min depending on the blood and dialysate flow rates and the type of filter used. CONCLUSIONS: The potential for significant drug removal during an 8-hr-or-longer sustained low-efficiency dialysis session is evident by the limited number of studies available. Because significant amounts of drug may be removed by sustained low-efficiency dialysis combined with altered pharmacokinetic variables in critically ill patients, the risk for suboptimal drug concentrations and pharmacodynamics must be considered. Appropriate dose and calculation of dosing intervals is essential to provide adequate antibiotic therapy in these patients. It is recommended that institutions who utilize sustained low-efficiency dialysis establish dosing guidelines for all pharmacists and physicians to follow to provide consistent delivery of antibiotics at adequate concentrations.

StrengthsFinder® signature themes of talent in pharmacy residents at four midwestern pharmacy schools.

BACKGROUND AND PURPOSE: StrengthsFinder® is a widely-used assessment that can be used to help student pharmacists discover their talents (i.e., signature themes [STs]) and develop their leadership skills. The assessment has also been used in pharmacy residents, but the prevalence of various STs in that group has not been compared to those in student pharmacists. EDUCATIONAL ACTIVITY AND SETTING: Residents from four midwestern pharmacy institutions completed StrengthsFinder® 2.0 and received their top five STs. STs were organized and examined by domains (executing, influencing, relationship building, and strategic thinking). StrengthsFinder® data on student pharmacists were obtained from a previously published study. The distribution of the themes and domains was compared between residents and student pharmacists. FINDINGS: Responses from 31 residency program cohorts, including 290 pharmacy residents from a pool of 304 (95.4%) possible respondents, were included in the study. The learner ST was more frequently reported in the top five in pharmacy residents versus student pharmacists (42.8% versus 35.5%, p = 0.022). The woo and communication STs were also more frequently reported in the top five, while the consistency ST was reported less frequently in the top five in pharmacy residents versus student pharmacists (p < 0.05). The executing and relationship building domains had the highest average number of STs (1.58 and 1.56, respectively). DISCUSSION AND SUMMARY: The ST profile of pharmacy residents at residency programs affiliated with four midwestern schools of pharmacy is generally similar to that of pharmacy graduates. However, several STs were more or less prevalent in pharmacy residents. Recognition of these differences may assist residency program directors in marketing and design of programs and ranking of candidates.

Residency application screening tools: A survey of academic medical centers.

PURPOSE: The current use and content of screening tools utilized by ASHP-accredited pharmacy residency programs were assessed. METHODS: A survey consisting of 19 questions assessing residency programs and the screening of pharmacy residency program applicants was e-mailed to residency directors of 362 pharmacy residency programs at 105 University HealthSystem Consortium (UHC)-member institutions. Questions gathered general program demographic information, data related to applicant growth from residency years 2010-11 to 2011-12, and information about the residency screening processes currently used. RESULTS: Responses were received from 73 residency program sites (69.5%) of the 105 UHC-member institutions to whom the e-mail was sent. Many sites used screening tools to calculate applicants' scores and then determined which candidates to invite for an onsite interview based on applicants' scores and group discussion. Seventy-eight percent (n = 57) of the 73 responding institutions reported the use of a screening tool or rubric to select applicants to invite for onsite interviews. The most common method of evaluation was individual applicant review before meeting as a group to discuss candidate selection. The most important factor for determining which residency candidate to interview was the overall impression based on the candidate's curriculum vitae (CV) and letters of recommendation. CONCLUSION: Most residency programs in UHC-member hospitals used a screening tool to determine which applicants to invite for an onsite interview. The most important factor for determining which residency candidate to interview was the overall impression based on the candidate's CV and letters of recommendation.

Residency scramble: program directors' experiences with the Pharmacy Online Residency Centralized Application Service.

PURPOSE: Residency program directors' perceptions of the scramble process in 2013 using the Pharmacy Online Residency Centralized Application Service (PhORCAS) were evaluated. METHODS: After the ASHP Resident Matching Program ("Match") results were released in 2013, programs were asked to not extend offers to applicants until the following Monday, allowing a week for programs and applicants to evaluate their options and make the best decisions. A survey consisting of open-ended and structured response questions was sent electronically to 1905 program directors. Adherence to the recommended one-week moratorium before extending an offer to applicants for unmatched positions was also assessed. RESULTS: A total of 531 completed surveys were returned (28.2% response rate). Programs with 119 of the 133 unmatched postgraduate year 1 positions were represented in the results. The ma jority of directors were satisfied with the use of PhORCAS overall, rating it easier (60.3%) or at least the same (24.8%) as processes used in the past. Programs with unmatched positions thought using PhORCAS made it easier to fill positions (64.5%). Sixty percent of program directors contacted applicants the week after the Match. Most directors (79%) followed the recommendation of waiting until April 1 or later to make offers; however, 49% thought others did not follow the guidelines. Program directors offered many concerns about the stressful nature of the scramble process and offered several recommendations for improvement. CONCLUSION: Residency program directors found that the use of PhORCAS and guidelines from the ASHP Commission on Credentialing improved the scramble process and facilitated the filling of unmatched residency positions.

IL6 plasma concentrations in patients with sepsis receiving SLED and antibiotics: a predictor for survival.

BACKGROUND: The present study evaluated interleukin-6 (IL6) as a predictor of mortality in patients and sepsis with acute kidney injury (AKI) receiving sustained low-efficiency dialysis (SLED) and antibiotic therapy. PATIENTS AND METHODS: Seven patients with sepsis receiving antibiotics and SLED for AKI were studied. Blood was obtained at baseline prior to SLED and antibiotics, during SLED, and then after stopping SLED. IL6 concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). RESULTS: Mean plasma IL6 concentrations ranged between 700 and 900 pg/ml for the first 8 h after starting SLED but was significantly lower after discontinuation of SLED (200-250 pg/ml) (p=0.0044). Three out of seven patients survived to be discharged from the hospital and all three had significantly lower concentrations of IL6 during the first 8 h compared to those who died in the hospital (p<0.0001). CONCLUSION: The combination of SLED and antibiotic therapy was unable to lower the initial high plasma IL6 concentrations, and high initial IL6 concentrations predicted in-hospital mortality.

Residency preceptor development and evaluation: a new approach.

PURPOSE: The design and implementation of a preceptor development program involving close collaboration by the pharmacy residency program director (RPD) and members of a residency advisory committee (RAC) are described. SUMMARY: In 2011 the Nebraska Medical Center (NMC) implemented a program to foster the development of preceptors' teaching and clinical skills, as required by accreditation standards of the American Society of Health-System Pharmacists (ASHP). The RPD and RAC worked closely to define expectations of resident preceptors and a pathway for their transition from "conditional" to "primary" status. Among other program requirements, prospective (and new incoming) preceptors must (1) submit to the RAC a letter of interest in becoming a resident preceptor accompanied by an academic and professional record, (2) complete a new preceptor orientation session in which teaching concepts and principles are presented and discussed, and (3) obtain 10 preceptor education (PE) credits every two years. PE credits are earned through defined preceptor development opportunities including a teaching core and a clinical core focused on enhancing skills such as the application of therapeutic knowledge and conduct of clinical research. All preceptors are required to submit updated academic and professional records to the RAC every two years. The RAC audits 25% of preceptors to document attainment of PE credits and also conducts annual reviews of ASHP Resi-Trak summary evaluations of all preceptors and learning experiences. CONCLUSION: The NMC program may serve as a model for other institutions in planning and evaluating professional development programs to ensure that preceptors maintain the skills and knowledge necessary to provide high-quality resident training.

Program for developing leadership in pharmacy residents.

PURPOSE: An innovative, structured approach to incorporating leadership development activities into pharmacy residency training is described. SUMMARY: The American Society of Health-System Pharmacists (ASHP) has called for increased efforts to make leadership development an integral component of the training of pharmacy students and new practitioners. In 2007, The Nebraska Medical Center (TNMC) took action to systematize leadership training in its pharmacy residency programs by launching a new Leadership Development Series. Throughout the residency year, trainees at TNMC participate in a variety of activities: (1) focused group discussions of selected articles on leadership concepts written by noted leaders of the past and present, (2) a two-day offsite retreat featuring trust-building exercises and physical challenges, (3) a self-assessment designed to help residents identify and use their untapped personal strengths, (4) training on the effective application of different styles of communication and conflict resolution, and (5) education on the history and evolution of health-system pharmacy, including a review and discussion of lectures by recipients of ASHP's Harvey A. K. Whitney Award. Feedback from residents who have completed the series has been positive, with many residents indicating that it has stimulated their professional growth and helped prepared them for leadership roles. CONCLUSION: A structured Leadership Development Series exposes pharmacy residents to various leadership philosophies and principles and, through the study of Harvey A. K. Whitney Award lectures, to the thoughts of past and present pharmacy leaders. Residents develop an increased self-awareness through a resident fall retreat, a StrengthsFinder assessment, and communication and conflict-mode assessment tools.

Value of pharmacy residency training: a survey of the academic medical center perspective.

PURPOSE: The results of a survey assessing the views of pharmacy directors, medical center executives, and pharmacists on the value of residency programs to their institutions are reported. METHODS: In a two-phase survey entailing face-to-face interviews and the use of an electronic questionnaire, representatives of the pharmacy departments and executive staffs of eight academic medical centers were asked to rate the impact of pharmacy residency programs in areas such as educational and research innovation, quality-of-care and cost outcomes, and opportunities for revenue generation. RESULTS: Seven hospital administrators, eight directors of pharmacy, 122 pharmacists serving as residency preceptors, and 91 nonpreceptor pharmacists participated in the survey. The survey responses indicated that hospital administrators view pharmacy residency programs as important contributors to their institutions' prestige, academic success, and capacity for delivering educational programs. All directors of pharmacy surveyed were in agreement that the costs associated with conducting a pharmacy residency program are outweighed by the cost savings achieved through resident contributions to patient care and medication error prevention. A large majority (90%) of preceptor pharmacists agreed or strongly agreed that residents help reduce medication errors by educating prescribers and other activities that promote rational medication use; only about half of nonpreceptor pharmacists shared that view, although 65% of nonpreceptors acknowledged the contributions of residents to overall pharmacy department success. CONCLUSION: All groups of survey respondents viewed residency programs as important assets to their institutions, especially in the areas of institutional prestige, staff recruitment, and professional development and education.