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.

Characterization of clinical knowledge and problem-solving assessments employed in postgraduate year 1 pharmacy residency interviews.

PURPOSE: Attainment of postgraduate year 1 (PGY1) residency positions has become increasingly competitive. Inclusion of clinical knowledge and problem-solving assessments in onsite interviews has increased in recent years. Characterization of these assessments is necessary for applicants to best prepare for interviews and for mentors to provide guidance. METHODS: An online survey was emailed to program directors of PGY1 pharmacy residency programs accredited by the American Society of Health-System Pharmacists (ASHP). Data were analyzed using descriptive statistics. Chi-square and Fisher's exact tests were used to compare categorical data. The Mann-Whitney U test was used to analyze nonparametric continuous data. RESULTS: Of the 221 respondents, most identified their programs as based at community (48%) or academic (39%) medical centers. Ninety percent of programs reported inclusion of clinical knowledge and problem-solving assessments in the onsite interview process. The most common assessments included asking clinical questions (70%), development of a SOAP (subjective, objective, assessment, plan) note or care plan (42%), and formal presentations that applicants prepared prior to arrival (39%). Most programs (71%) reported incorporating multiple assessments, with 2 assessments included most commonly (43%). Clinical assessment performance accounted for 10% to 25% of the overall interview score in approximately half of programs. CONCLUSION: During onsite PGY1 residency interviews, applicants must be prepared to participate in at least 1 clinical knowledge and problem-solving assessment, including answering clinical questions, developing a SOAP note or care plan, and/or delivering a presentation. Applicants should expect that these assessments will account for a substantial portion of the interview evaluation.

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.

Effect of a multimodal multidisciplinary training program on pharmacy residents' knowledge and confidence toward research and biostatistics.

INTRODUCTION: The optimal method to increase pharmacy resident knowledge and confidence toward research remains unknown. OBJECTIVE: This study evaluated the impact of a structured curriculum on pharmacy residents' knowledge, confidence and attitude toward biostatistics and research. METHODS: This prospective, multicenter study included pharmacy residents from 2016 to 2017. Residents underwent research training with (1) 60-hours of online modules delivered by multidisciplinary senior faculty (MD, PhD), (2) a 2-day interactive workshop delivered by experienced pharmacy researchers and (3) a mentored longitudinal research experience. Fifteen residents were invited to complete a questionnaire at baseline and again before graduation to measure knowledge, confidence and attitudes about research. Residents were followed for one additional year to measure peer-reviewed publications. RESULTS: Eleven (73%) residents provided complete responses to ≥1survey domain. At baseline, 27% of respondents reported being at least somewhat confident about their biostatistics and research skills (a favorable response for ≥5 of the 9 confidence items). At follow-up, 91% self-reported confidence. Self-reported familiarity with statistical terminology (a score of 4 or 5) increased from 19% at baseline to 82% at follow-up. The mean correct score on the knowledge items at baseline was 15 ±â€¯2.5 (total possible 28) and increased to 20 ±â€¯2.7 after training. By one year after graduation, 53% of residents published at least 1 peer-reviewed manuscript and 20 peer-reviewed publications as first or co-author with a median journal impact factor of 3.16 (IQR: 2.61-4.59). CONCLUSION: This study provides a framework for sustainable, multidisciplinary, multimodal research education that increased confidence and knowledge among pharmacy residents and resulted in tangible contributions to the scientific literature. Future studies should explore long-term knowledge gained and publications.

Identifying and evaluating gaps in knowledge, skills, and qualities necessary for a career in academia.

INTRODUCTION: Due to demands for qualified faculty and educators, more pharmacy residency programs have adopted resident teaching certificate programs (RTCP). There is a lack of standardization and published research on what should be included in these programs. The primary objective of this study was to utilize an online survey to identify and evaluate perceived gaps in skills, qualities, and knowledge needed for a successful career in academia. METHODS: An IRB-approved Qualtrics® survey was developed and emailed to faculty at Ohio colleges of pharmacy in January 2018. RESULTS: Eighty of 299 total surveys (26.8%) were completed by faculty with representation from all seven colleges in Ohio. When asked to select from a provided list, the top five self-identified gaps in knowledge at the beginning of their career were: accreditation (80.56%), institutional finance (79.17%), programmatic assessment (79.17%), admissions/marketing (77.78%), and experiential site recruitment/retention (77.78%). However, when asked to list five gaps as a free response, the most common themes were tenure, teaching, research, curriculum, and work life balance/time management. Additional questions assessed skills, qualities, resources, and faculty development techniques. CONCLUSIONS: There are many identifiable gaps that participants recalled experiencing in their early years as a faculty member. The number of RTCPs is growing and RTCPs are often the only training residents receive in direct relation to academia and pedagogy. It is critical that RTCPs cover consistent content to expose residents to a career in academia and teach skills that residents need to successfully educate others.

Resident perceptions of a resilience curriculum in a postgraduate year 1 (PGY1) pharmacy residency program.

BACKGROUND AND PURPOSE: Burnout is a growing concern among healthcare professions. Efforts to prevent burnout and promote wellbeing and resilience have been a focus of some medical training programs. Some interventions have been able to show a reduction in stress and burnout among residents. However, none have looked at specific factors that are considered most valuable to residents. This study addressed the gap in literature by evaluating the promotion of resilience in pharmacy residents and identifying valuable components of an implemented resilience curriculum. EDUCATIONAL ACTIVITY AND SETTING: Twenty-eight post-graduate year 1 pharmacy residents participated in a resilience curriculum including nine sessions throughout the residency year. Residents were surveyed at four points throughout the year on perceived value of the curriculum, most valuable components, factors to improve value and key takeaways from the sessions. FINDINGS: On the final survey, 90% of residents rated the resilience curriculum as highly or extremely valuable. Residents most frequently commented that a sense of community and taking time for reflection were the most valuable components of the curriculum. To improve the value of the curriculum, residents most frequently stated that increasing the opportunity to share thoughts and ideas, and more time dedicated to sessions would be beneficial. The most noted key takeaways from residents included self-care, balance, and knowing they were not alone as they moved throughout their residency year. SUMMARY: Pharmacy residents reported value in the resiliency curriculum. Further information on the benefit of specific topics and long-term influence of the program would be beneficial.

Establishing an investigational drugs and research residency at an academic medical center.

PURPOSE: The development, structure, and implementation of an innovative residency program designed to help meet a growing need for pharmacists with specialized expertise in investigational drug use and clinical research are described. SUMMARY: Clinical research has become an increasingly complex field, but prior to 2017 there were no U.S. specialty residency training programs focused on pharmacists' role in drug development and the care of patients enrolled in clinical trials. In 2016 Johns Hopkins Hospital (JHH) launched an initiative to develop residency training standards specific to the areas of investigational drug use and clinical research. The residency development process consisted of creation of a residency development committee; a needs assessment, including formation of a diverse panel of internal and external experts to guide identification of key competency areas and development of residency goals and objectives; design of the program's structure, including a framework for required and elective rotations; submission of an application for pre-candidate status to the ASHP Commission on Credentialing; and recruitment efforts. CONCLUSION: The JHH investigational drugs and research residency, a combined PGY1 and PGY2 program with 5 competency areas, 14 goals, and 49 objectives, was granted pre-candidate status by ASHP in November 2016. The first resident began the program in June 2017.

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.

A Screening Tool to Identify Qualified Pharmacy Residency Candidates.

Objective. To develop and evaluate the utility of a prescreening tool to assess candidates for PGY1 pharmacy residency programs. Methods. A scoring tool was developed to prescreen candidates who applied to two PGY1 pharmacy residency programs. The tool scored applicants based on six domains: community service, leadership experience, letters of intent, letters of recommendation, presentations/publication, and work experience. Results. Applicants who were chosen to interview based on results from the screening tool were those who had significantly higher scores for all domains except work experience, as compared to applicants who were not interviewed. Total scores were also significantly higher. The average overall scores for applicants increased each year. Conclusion. Each year, the competition for first-year pharmacy residency positions continues to increase. A tool that can assess and differentiate between candidates' strengths by screening their applications can be a valuable asset for program administrators when used correctly.

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.

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.

Evaluation of an elective course for preparing students to pursue postgraduate residency training.

BACKGROUND AND PURPOSE: To describe the effectiveness of an elective for preparing students to pursue postgraduate residency training (PGRT). EDUCATIONAL ACTIVITY AND SETTING: A prospective, observational study of students enrolled in the "Preparation for PGRT" elective conducted between January 2015 and December 2016 was conducted. Survey tools and assessments were developed to evaluate various aspects of the course. Curriculum vitae and letters of intent were evaluated using rubrics. A thematic analysis on students' reflections of mock interviews was performed using the copy-and-paste method in MAXQDA 12. Student demographics and survey and assessment results were characterized descriptively. Pre- and post-course responses on course content and PGRT intentions were compared using Wilcoxon signed rank and student t-tests. FINDINGS: Students' self-assessed understanding of all course objectives increased from pre- to post-course (p < 0.05). Students' self-assessments for the mock interviews and continuing education presentation revealed growth in abilities and recognition of challenges to address in the future. A significant number of students who were undecided about completing a fellowship (p = 0.0009) or graduate school (p = 0.014) after graduation prior to the course indicated they would not pursue these options. Pre- and post-course knowledge assessments were administered, which demonstrated an increase in knowledge in six of ten course focus areas and decrease in one (p < 0.05). SUMMARY: The elective improved students' confidence in achieving course objectives, clarified their intentions to pursue PGRT, and allowed for initial attempts at important skills (i.e., interviewing and providing a formal presentation) in a low stakes environment.

Publish or perish: Success with publication in pharmacy residency training.

BACKGROUND AND PURPOSE: Pharmacy residency training standards require development of medical writing skills. These skills are fundamental to pharmacy clinicians and scholars alike. Despite this requirement, new practitioners and seasoned clinicians frequently struggle with scholarly development and manuscript generation for a variety of reasons, ranging from lack of experience or familiarity with the process of peer-review submission to time constraints. EDUCATIONAL ACTIVITY AND SETTING: We describe a process for fostering pharmacy resident scholarship and publication utilized at Robert Wood Johnson University Hospital, including the stages of the project development process and corresponding responsibilities during each phase of the manuscript submission process. From identification of interest, to project and manuscript development, review, submission, revision, and reflection, our postgraduate pharmacy residents receive guidance and structure from a preceptor mentor to usher them through this experience for the first time. FINDINGS: The program has had success utilizing this structured approach to supporting residency publication efforts, with the preparation of 23 manuscripts that have resulted in peer-reviewed publications from 28 residents graduating between 2013 and 2017. This results in a resident authorship rate of 82%. SUMMARY: Although medical writing and manuscript development may not be an intuitive process, it is imperative that preceptors and individuals interacting with postgraduate pharmacy trainees consider exposing their trainees to this process, with foresight into thinking about a structured approach to publication at the onset of project development.

Development of pharmacy resident leadership skills through creation of a regional ambulatory care forum.

BACKGROUND AND PURPOSE: Action-based leadership activities help refine leadership skills. This paper describes an experiential, longitudinal leadership experience for post-graduate year two (PGY2) pharmacy residents in ambulatory care. EDUCATIONAL ACTIVITY AND SETTING: As part of a leadership and advocacy rotation, two PGY2 ambulatory care pharmacy residents collaborated with a state association, North Carolina Association of Pharmacists, to co-chair a newly formed regional ambulatory care forum in the western part of the state. The residents developed charges for the group, directed and organized the leadership team meetings, moderated the member events of approximately 30 participants, and served as liaisons to the state association and its members. Two residency preceptors who supervised the academic and leadership experiences for the residency program provided oversight for the residents with the forum. Residents completed written and oral self-reflections, received formative feedback from the forum's leadership team and leadership preceptor, participated in a 360-degree leadership evaluation, and received quarterly summative evaluations. FINDINGS: Skills developed included leading a group, event planning, advocacy, networking, communication, professional writing, creating a shared vision, teamwork, and collaboration. SUMMARY: Serving in leadership roles within professional organizations can provide PGY2 pharmacy residents with practical hands-on leadership opportunities to help prepare them for positional and non-positional leadership roles in the future.

Use and accessibility of health and medication information sources among pharmacy students during their community pharmacy internship.

INTRODUCTION: Evidence-based health and medication information (HMI) sources and databases have a growing importance in daily professional practice in community pharmacies. Previous research suggests that students learn practical skills at the workplace through self-directed learning and practical experience rather than formal training. Thus, pharmacy internship is a key in ensuring pharmacy students' competency to use HMI sources and databases. This study assessed what HMI sources pharmacy students had used and accessible during their first internship in community pharmacies in Finland. METHODS: The data were collected as part of the obligatory assignments of the second year pharmacy students at the University of Helsinki during their first three-month internship in a community pharmacy in 2013 (n = 152, response rate 100%). RESULTS: The most commonly used HMI sources during the first internship period were electronic product-specific databases assisting in medication counselling, such as the checklist type generic prescription medication information database integrated into pharmacy prescription processing system, used daily by 74% of the students having access to the database (n = 121). Databases assisting in medication reviews were less commonly used although they were available in the majority of the pharmacies. DISCUSSION AND CONCLUSION: Although the majority of students had access to a wide range of HMI sources and databases during their internship, the actual use of sources other than product-specific medication information was limited, particularly the use of databases in assisting in medication reviews. It is important to facilitate their use in the second internship to acquire competences needed for their further use after graduation.