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.

Survey of health-system pharmacy administration and leadership residencies.

PURPOSE: To perform an inquiry with response measurement from health-system pharmacy administration and leadership (HSPAL) residency program directors and residents to distinguish variances between the programs and identify enhancement opportunities for key stakeholders. METHODS: Members from the Pharmacy Administration Resident Collaboration Research Committee developed separate 20-question survey instruments to assess the strengths and areas of opportunity for HSPAL residency programs from the perspective of residency program directors and residents. The survey instruments were designed to evaluate the level of pharmacy service integration across HSPAL programs nationwide. RESULTS: Nearly half of the residency program directors within the listserv (40.74%, 33/81) participated in the survey. The recognized areas of opportunity by residency program directors include community pharmacy leadership, professional organization involvement, sterile compounding, and supply chain management. About a third (32.54%, 41/126) of the residents participated in the survey. Residents reported the least exposure to community pharmacy leadership, human resource management, informatics, professional organizations, and ambulatory care/specialty rotations. The overall recommendations for HSPAL residency programs are to incorporate C-suite-level experiences, improve alumni engagement, develop longitudinal human resource/financial experiences, and encourage resident credential obtainment. CONCLUSION: In order to foster professional and leadership growth for HSPAL residents, residency programs should consider incorporating C-suite-level experiences, longitudinal human resource/finance experiences, alumni engagement opportunities, rotation variety, professional organization involvement, and support in credential obtainment.

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.

Curricular Exposure to Postgraduate Residency Training Through an Introductory Pharmacy Practice Experience.

Objective. To evaluate the impact of a residency-focused introductory pharmacy practice experience (IPPE) on student perceived knowledge of and attitudes toward postgraduate residency training. Methods. Second- and third-year student pharmacists completed a required four-hour experience at a residency training site. Students completed a five-item survey before and after the experience, indicating their perceived knowledge of residency training components as well as their own postgraduate plans. Students also submitted a written reflection following the experience. Paired t tests were used to compare pre- and post-survey responses. Qualitative analysis was completed to identify common themes in student reflections and code for positive, neutral, or negative student experience. Results. A total of 276 students completed the Introduction to Postgraduate Residency Training IPPE in summer 2016. Post-experience survey responses indicated a significant increase in students' perceived knowledge of residency programs; however, plans to pursue residency training did not significantly change after completing the experience. Twenty-five independent themes were identified in reading student reflections, with the most common theme (included in 55% of reflections) being that the experience "clarified resident day-to-day responsibilities." The majority (95%) of students perceived the experience as valuable. Conclusion. A residency-focused IPPE increased student pharmacists' perceptions of knowledge about postgraduate residency training and was viewed by students as a beneficial experience.

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.

Professional Benefits of a Web-based Journal Club for Critical Care Residents and Their Mentors.

Objective. To identify the perceptions and benefits of participation in a web-based journal club by the critical care pharmacy residents who presented and their mentors. Methods. Former and current resident presenters and their mentors were invited to complete one of three electronic surveys created to assess their perceptions of their experiences with a web-based journal club sponsored by the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine (SCCM). Descriptive statistics were used to analyze the data gathered. Results. Thirty-eight (41%) former residents, 23 (72%) recent or current residents, and 32 (58%) presentation mentors responded to the survey. Residents in both groups indicated that participation was a beneficial educational and professional experience. Residents who more recently presented an online journal club reported improved confidence in critically evaluating research, determining clinical applications of published literature, developing evidence-based recommendations, and educating trainees on evidence-based medicine. Mentors believed their residents' journal club participation influenced their future involvement in both the SCCM and the CPP Section and were extremely likely to recommend their future residents participate in the web-based journal club. Conclusion. Participation in a web-based journal club provided professional benefits to participants and their mentors that extended beyond the presentation itself. Interaction with the organization through this experience may have encouraged these individuals to maintain their professional involvement in the organization after the web-based journal club experience was completed. Other professional organizations may benefit from implementation of a similar web-based journal club.

Influence of the Fear of Missing Out in Student Pharmacists' Decision to Pursue Residency Training.

Objective. To examine the influence of the fear of missing out (FOMO) on student pharmacists' postgraduate career decisions, specifically on whether to pursue a residency. Methods. A 14-item FOMO scale was designed to examine the influence of this factor on student pharmacists' residency decision. A survey was distributed to second-, third-, and fourth-year student pharmacists at four participating universities. Average FOMO scores were compared based on residency intentions. Logistic regression analysis was used to predict residency intentions based on students' average FOMO scores. Results. The survey response rate was 74%. Of the 833 respondents, 42% indicated an intention to pursue residency training. Students indicated the FOMO items were "slightly" true of them, as evidenced by the overall FOMO mean score of 2.0 on a 5-point scale. Comparison among classes revealed a higher mean FOMO score among students in the second year of the pharmacy curriculum than among students in the third and fourth years. Logistic regression analysis indicated that FOMO score can reliably distinguish between students with residency intentions and those without. Conclusion. This study supports the existence of FOMO in the decision to pursue a pharmacy residency, although more research and scale refinement is needed to better identify its impact.

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.

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.

Longitudinal Associations Between Grit, Academic Outcomes, and Residency Match Rates Among Pharmacy Students.

Objective. To characterize Grit-S scores in pharmacy students, determine whether Grit-S scores change within individual pharmacy students and cohorts over time, and investigate the relationship between Grit-S scores, academic outcomes, and professional outcomes. Methods. A survey was conducted in fall 2016 and again in fall 2017 to determine Grit-S scores in first- through fourth-year pharmacy students. Participant demographic variables, grade point average (GPA), advanced pharmacy practice experience (APPE) ratings, and residency match results were collected. Results. Over the study period, 852 survey responses were completed by 85% of students surveyed. The mean Grit-S scores of each cohort ranged from 3.5 to 3.7 (on a 5-point scale with 5 representing the highest level of grit). Underrepresented minorities had slightly higher Grit-S scores and first-generation college students had slightly lower Grit-S scores. Two hundred eighty-seven students responded to both the 2016 and 2017 surveys. Among these paired responses, small but significant changes in individual Grit-S scores over time that varied in direction and magnitude by school year were noted. Higher Grit-S scores were not associated with higher GPA or superior APPE performance, nor were they predictive of a student matching to a postgraduate pharmacy residency. Conclusion. Significant associations between grit and measures of academic or professional achievement were not detected in this pharmacy student cohort. The presence of small but significant changes in Grit-S scores over time, in the absence of any intervention, has implications that further research should be conducted in this area.

Effect of Advanced Pharmacy Practice Experience Grading Scheme on Residency Match Rates.

Objective. To examine the effect of advanced pharmacy practice experience (APPE) grading schemes on residency match rates. Methods. A cross-sectional survey was administered to U.S. pharmacy schools and colleges to determine an APPE grading scheme. Post-graduate year 1 residency match data for the years 2013-2015 was obtained from the American Society of Health-System Pharmacists. Additional variables thought to affect residency match rates were collected from publicly available sources and prior research. Unadjusted and adjusted multivariate logistic regression analysis was performed to compare 2013-2015 residency match rates between institutions using letter grading and those using pass/fail grading schemes. Potential confounders for incorporation into the adjusted model were identified by Chi-square or Fisher's exact test as appropriate. Results. There were 110 of 126 schools that responded to the survey. Of these, 100 schools reported using either letter grading or pass/fail grading schemes in APPE courses and were included in the study. Unadjusted analysis revealed no difference in match rates between letter grading and pass/fail grading schemes over the aggregated time frame or in individual years. After adjusting for potential confounders, pass/fail grading was associated with higher match rates in the aggregate analysis and in 2013. However, no association was observed in 2014 or 2015. Conclusion. This study demonstrates that there is limited difference in residency match rates between schools using pass/fail or letter grading schemes in APPEs.

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.

Characteristics of schools of pharmacy associated with a successful PGY1 residency match.

INTRODUCTION: The literature is limited related to school of pharmacy (SOP) characteristics that may impact a student's residency match success. Given the paucity of information, the aim of our study was to examine the association between multiple school specific characteristics and Post-Graduate Year 1 (PGY1) residency match rate. METHODS: PGY1 residency match data and SOP specific characteristics were obtained. The median aggregate match rate was used to categorize programs as high or low match rate. Univariate and multivariate analyses were conducted to assess the impact of SOP characteristics on match rate. RESULTS: Median match rates were 64% (2013), 63.25% (2014), and 64.25% (2015). Schools with >95% North American Pharmacist Licensure Examination® (NAPLEX®) pass rate and >15 funded faculty were more likely to have a high match rate. Private schools were less likely to have a high match rate when compared to public programs. CONCLUSION: SOP characteristics associated with a high likelihood of a successful PGY1 residency match were greater than 95% of NAPLEX® pass rate, more than 15 funded faculty members, and public school status.

Perceived Stress, Stressors, and Coping Mechanisms Among PGY1 Pharmacy Residents.

Objective. To evaluate perceived stress among postgraduate year 1 (PGY1) pharmacy residents and to examine relationships between perceived stress and certain demographic variables. Main stressors during residency training and coping mechanisms used were also determined. Methods. A link to a web-based survey was sent to 1128 pharmacy residency program directors who were asked to forward it to current PGY1 residents in their programs. The 22-item questionnaire included the 10-item Perceived Stress Scale (PSS-10), demographic information, number of working/sleeping hours, and major stressors and coping mechanisms. Results. There were 505 responses collected from PGY1 residents of community pharmacy, managed care, and pharmacy practice residency programs across the US. Females reported higher PSS-10 scores than males. Perceived stress scores were similar across age groups. Single residents and married residents exhibited similar PSS-10 scores. Residents with children had higher stress score compared to residents without children. Perceived stress scores were similar across types of PGY1 residency programs. A higher number of working hours was associated with a higher PSS-10 score. Time pressures, work overload, and fear of error were the top stressors reported. Spending time with family and friends, staying optimistic, and engaging in enjoyable activities were the top coping strategies employed by participants. Conclusion. Female gender, having children, working longer working hours, and desire to change residency program were associated with higher PSS-10 scores. Approximately a third of the participants associated perceived stress with activities related to residency training (time pressures, workload, fear of errors) and report the use of positive coping strategies to deal with stress.

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.

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.

Student and School-level Predictors of Pharmacy Residency Attainment.

Objective. To identify student and school level predictors of pharmacy residency attainment. Methods. Data were collected from the American Association of Colleges of Pharmacy (AACP) and the Carnegie Classification of Institutions of Higher Education. Logistic multilevel modeling was used to examine the effects of select student and school level characteristics on pharmacy residency attainment, as indicated by students on the AACP Graduating Student Survey (GSS) from 2013 to 2015. Results. The dataset included 24,351 graduating pharmacy students from 101 schools and colleges of pharmacy. Predictors of residency attainment included working in an institutional pharmacy, female gender, student age, school age, and Research I classification. Nonsignificant variables included curriculum type, class size, and institutional control. Conclusion. Student and pharmacy school characteristics impact the likelihood of pharmacy residency attainment. Further research is needed to understand the mechanisms associated with these effects.

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.