National Survey Regarding the Importance of Leadership in PGY1 Pharmacy Practice Residency Training

Background:

Leadership is considered a professional obligation for all pharmacists. It is important to integrate leadership training in residency programs to meet the leadership needs and requirements of the profession.

Objective:

To evaluate the importance of leadership development during postgraduate year 1 (PGY1) pharmacy practice residency training as perceived by new practitioners.

Methods:

A 15-question online survey was distributed to residency-trained new practitioners to assess (1) amount of time dedicated to leadership training during residency training, (2) different leadership tools utilized, (3) residents’ participation in various committees or councils, (4) perceived benefit of increased leadership training, (5) importance of having a mentor, (6) understanding of the residency organization’s strategic objectives, (7) discussion of Pharmacy Practice Model Initiative (PPMI) during residency training, and (8) adequacy of leadership training in preparation to become a pharmacy practice leader.

Results:

Although the majority of resident respondents had less than 20% of their residency devoted to leadership, nearly all survey participants acknowledged that leadership is an important component of PGY1 residency training. Residents agreed that their residency experience would have benefited from increased leadership opportunities. Most residents were knowledgeable about their organization’s strategic objectives but did not have a full understanding of pharmacy initiatives such as the PPMI.

Conclusion:

Feedback from residents indicates that an optimal dedication to leadership training would range between 20% and 30% of the residency year. Increased focus on PPMI, mentorship, and expanded use of leadership tools can serve as a way to help meet the future leadership needs of the pharmacy profession and help to better prepare residents to become pharmacy practice leaders.     

Practice Management Training in the PGY1 Residency Year: Best Practices From Two Nationwide Surveys

Purpose:

The development of future pharmacy leaders is vital to the advancement of our profession. Postgraduate year 1 (PGY1) residency training requires residents to exercise leadership and practice management skills. Two national surveys were conducted to describe the current state of practice management experiences and elucidate best practice recommendations.

Methods:

The surveys, online multiple choice and free response, queried American Society of Health-System Pharmacists (ASHP)–accredited residency program practice management preceptors (survey 1) and PGY1 residents (survey 2) and were distributed via the ASHP residency program directors’ listserv. Responses were reviewed and analyzed by members of the University HealthSystem Consortium Pharmacy Council Strategic Initiatives and Programming Committee.

Results:

Survey 1, completed by 240 institutions, identified that a combination of concentrated and longitudinal practice management experiences were used most frequently (47%), followed by concentrated alone (33%). Universally noted activities included meeting attendance (98%), projects (94%), and committee involvement (92%). Sixty-seven percent of the programs changed the experience in the previous 3 years, with 43% planning changes in the coming year. Survey 2 was completed by 58 PGY1 residents from 42 programs. Most (80%) residents stated they had enough time with their preceptors, and 55% rated their enjoyment of the rotation as 4 or 5 on a 1 to 5 scale (5 = most enjoyed)

Conclusion:

Our findings suggest that there is not a best practice for the structure or content of the PGY1 practice management experience. These results highlight key recommendations, including the need for practice management-specific preceptor development, incorporation of longitudinal experiences, and more practice management and leadership activities.Key Words: administration, leadership, residency, training     

Characteristics That Define a Successful Pharmacy Resident as Perceived by Residency Programs

Purpose:

To identify the subjective and objective characteristics that pharmacy residency programs use to define a successful resident and to determine what percentage of their 2009-2010 residency class they felt were successful.

Methods:

An electronic survey was sent via e-mail to all residency program directors (RPDs) of postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residency programs in the United States. A 3-part survey instrument was developed following validation of questions for clarity and reliability using a pilot survey. Respondents were asked to rank the importance of 20 subjective characteristics for a resident to possess in order to be considered successful and the importance of different objective measurements of accomplishment in the definition of a “successful” resident using a Likert scale where 1 = not at all important, 2 = some importance, 3 = very important, and 4 = critical.

Results:

Of the 1,081 surveys sent to RPDs, 473 respondents answered at least one question, yielding a response rate of 43.8%. The most critically important subjective characteristics in defining a successful resident as ranked among PGY1 residency programs are dependability, professionalism, self-motivation/initiative, and work ethic. PGY2 programs ranked clinical knowledge and skills, critical thinking, and dependability as the most important. The most critically important objective characteristic in defining a successful resident as ranked among both PGY1 and PGY2 programs is obtaining a clinical position. The majority of PGY1 and PGY2 respondents felt that 76% to 100% of their 2009-2010 residency class was successful based on the characteristics they rated most important.

Conclusion:

Identification of the characteristics that pharmacy residency programs use to define success will allow them to identify predictors of success and optimal methods of selecting residents who possess these characteristics.     

Pharmacy students' perceptions of a required senior research project

Objectives

To determine pharmacy students'' perceptions of a required research project in a doctor of pharmacy curriculum.

Methods

A survey instrument was administered to senior pharmacy students to determine their perceptions of the project advisor and overall project experience and their postgraduation employment plans.

Results

Two-hundred twenty-nine (81.5%) students completed a survey instrument. The majority agreed or strongly agreed that the project provided a valuable learning experience (88.2%), provided a competitive advantage for postgraduate job opportunities (73.2%), and should be a continued graduation requirement (74.2%). Respondents with plans for a residency or fellowship were more likely than those entering a community or hospital/institutional pharmacy to agree that completion of the project made them more qualified or marketable and should be continued as a graduation requirement (p < 0.05).

Conclusions

A required research project was perceived by pharmacy students to be a beneficial experience. Students pursuing residency or fellowship were more likely to feel the project was beneficial than students entering the workforce.     

Practice characteristics of bachelor of science and doctor of pharmacy degreed pharmacists based on the 2009 National Workforce Survey

Objective

To compare practice settings and activities of pharmacists with bachelor of science (BS) in pharmacy and doctor of pharmacy (PharmD) degrees.

Methods

Data from the 2009 National Pharmacist Workforce Survey instrument were analyzed. Multivariate regression was used to examine the association of the PharmD degree with time spent in dispensing and patient care.

Results

The survey response rate by pharmacists was 52%, and 562 usable responses met our inclusion criteria. Sixty-three percent of BS and 39% of PharmD pharmacists were employed in community pharmacies, compared with 21% of BS and 38% of PharmD pharmacists employed in hospital pharmacy settings. Practicing in a community setting had the strongest influence on time spent in dispensing and time spent in patient care. Among respondents with PharmD degrees, a residency was associated with less time in dispensing and more time in patient care.

Conclusion

Time spent in dispensing and patient care were influenced more by practice setting than by educational degree and residency training.     

Using human patient simulation to prepare student pharmacists to manage medical emergencies in an ambulatory setting

Objective

To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting.

Design

Second-year student pharmacists were assigned randomly to groups and played the role of pharmacists in a community pharmacy setting in which a simulated patient experienced 1 of 5 emergency scenarios: medication-related allergic reaction, acute asthma attack, hypoglycemia, myocardial infarction, and stroke. The students were expected to use patient assessment techniques to determine which emergency the simulated patient was experiencing and the appropriate intervention. Following each simulation, a debriefing session was conducted.

Assessment

Eighty-two student pharmacists completed the simulation activity. Ninety-three percent of student groups correctly identified the emergency. A post-activity survey instrument was administered, and 83% of responders indicated this activity was effective or very effective.

Conclusion

Simulation of emergencies seen in an ambulatory pharmacy setting allowed students to assert knowledge, practice communication skills, apply assessment techniques, and work as a team in a low-risk environment.     

Clinical pharmacy consultations provided by American and Kenyan pharmacy students during an acute care advanced pharmacy practice experience

Objective

To compare the clinical consultations provided by American and Kenyan pharmacy students in an acute care setting in a developing country.

Methods

The documented pharmacy consultation recommendations made by American and Kenyan pharmacy students during patient care rounds on an advanced pharmacy practice experience at a referral hospital in Kenya were reviewed and classified according to type of intervention and therapeutic area.

Results

The Kenyan students documented more interventions than American students (16.7 vs. 12.0 interventions/day) and provided significantly more consultations regarding human immunodeficiency virus (HIV) and antibiotics. The top area of consultations provided by American students was cardiovascular diseases.

Conclusions

American and Kenyan pharmacy students successfully providing clinical pharmacy consultations in a resource-constrained, acute-care practice setting suggests an important role for pharmacy students in the reconciliation of prescriber orders with medication administration records and in providing drug information.     

A needs assessment study of hospital pharmacy residency preceptors

Background:

Canadian pharmacy residency programs rely on preceptors to support the growing demand of graduates wishing to pursue hospital residencies. Understanding the educational needs of these preceptors is important to ensure that they are well prepared to deliver successful programs.

Objective:

To determine what new and experienced residency preceptors self-identify as learning needs in order to become more effective preceptors for pharmacy residents.

Methods:

A needs assessment of preceptors from the 31 accredited Canadian general hospital pharmacy residency programs was conducted. The study had 4 key components: interviews and focus group discussions with key informants, a pilot study, an online survey, and member checking (seeking clarification and further explanation from study participants). The residency coordinators and a convenience sample of 5 preceptors from each program were invited to participate in the survey component.

Results:

Of a possible 186 participants, 132 (71%) responded to the survey. Of these, 128 (97%) were confident that they met the 2010 standards of the Canadian Hospital Pharmacy Residency Board (CHPRB). Preceptors ranked communication skills, giving effective feedback, and clinical knowledge as the most important elements of being an effective preceptor. Managing workload, performing evaluations, and dealing with difficult residents were commonly reported challenges. Preceptors expressed a preference for interactive workshops and mentorship programs with experienced colleagues when first becoming preceptors, followed by 1-day training sessions or online learning modules every other year for ongoing educational support. The most beneficial support topics selected were providing constructive feedback, practical assessment strategies, small-group teaching strategies, effective communication skills, and setting goals and objectives.

Conclusions:

This study identified several learning needs of hospital residency preceptors and showed that preceptors would appreciate educational support. Utilization of these results by residency program administrators, the CHPRB, and faculties of pharmacy could be beneficial for residency programs across Canada.     

An Advanced Pharmacy Practice Experience in Inpatient Medication Education

Objective

To describe a unique advanced pharmacy practice experience (APPE) in which pharmacy students provided medication education to hospitalized patients.

Design

Students were trained to independently assess patients'' needs for education and identify drug-related problems. Students then provided medication education and performed medication therapy management under the supervision of clinical staff pharmacists. To assess the impact of the APPE, the number of hospitalized patients assessed and educated during the 3-month time period prior to student involvement was compared to the first 3 months of the APPE.

Assessment

Student participation increased the number of patients receiving medication education and medication therapy management from the hospital pharmacy. At the end of the APPE, students reported that the experience positively affected their ability to impact patients'' care and to critique their own learning and skills.

Conclusion

The inpatient medication education APPE provided students the opportunity to be responsible and accountable for the provision of direct patient care. In addition, the APPE benefitted the hospital, the school of pharmacy, and, most importantly, the patients.     

Analysis of cost avoidance from pharmacy students' clinical interventions at a psychiatric hospital

Objective

To analyze the cost avoidance resulting from clinical interventions made by pharmacy students completing an advanced pharmacy practice experience (APPE) at a psychiatric hospital.

Methods

A retrospective database review of documented clinical interventions by pharmacy students was conducted to classify interventions by type and significance. Interventions were assigned a cost avoidance value determined by an evaluation of the literature.

Results

Three hundred-twenty interventions were documented by 15 pharmacy students during the 1-year study period. The majority of interventions were related to psychiatric medication classes and most (n = 197; 61.6%) were classified as being of moderate significance. The most common interventions included patient education (13.1%), order clarification (11.6%), therapeutic dosing adjustments (10.9%), and laboratory order monitoring (8.8%). The estimated cost avoidance from all interventions made by pharmacy students was approximately $23,000.

Conclusions

Pharmacy students completing APPEs at a psychiatric hospital contributed to a variety of significant clinical interventions and provided considerable cost avoidance value to the institution.     

Assessment of factors influencing community pharmacy residents' pursuit of academic positions

Objectives

To determine the percentage of residents accepting faculty positions following completion of a community pharmacy residency program (CPRP) and identify influences to pursue/not pursue an academic career.

Methods

CPRP directors and preceptors across the United States were contacted and 53 community pharmacy residents were identified. The residents were invited to participate in surveys at the beginning and end of the 2005-2006 residency year.

Results

Forty-five residents (85%) completed the preliminary survey instrument and 40 (75%) completed the follow-up survey instrument. Of these, 36 completed both survey instruments. Initially, 28 (62%) respondents indicated a faculty position as one of their potential job preferences. After completing their residency program, 3 (8%) residents accepted faculty positions; and 3 (8%) others were awaiting offers at follow-up. Reasons for accepting a faculty position were positive teaching experiences and the influence of a mentor or preceptor. Reasons for not pursuing a faculty position included lack of interest, geographic location, disliked teaching experiences, lack of preparedness, and non-competitive salary.

Conclusion

Many community pharmacy residents consider faculty positions early in their residency but few pursue faculty positions. CPRPs and colleges of pharmacy should work together to enhance residents'' experiences to foster interest in academia.     

A Hospice-based Advanced Pharmacy Experience

Objective

To evaluate a hospice-based advanced pharmacy practice experience (APPE).

Design

Two years of data gathered from student evaluation forms and reflective journals were analyzed.

Assessment

Students completed reflective journals and expressed a high level of satisfaction with the hospice-based learning experience. They gained a better understanding of end-of-life care provided by a hospice and the pharmacist''s role in optimizing supportive care for patients receiving hospice care.

Conclusion

Hospice-based APPEs can provide a rich interdisciplinary learning environment for pharmacy students interested in developing knowledge, attitudes, and skills to effectively manage the pharmacotherapy of patients receiving end-of-life care.     

Factors That Influence the Career Goals of Pharmacy Students

Objectives

To identify pharmacy students’ short- and long-term career goals, including projected areas of practice, and evaluate the factors that influence these goals.

Methods

A 19-question survey instrument was administered to pharmacy students in each of the 4 professional pharmacy years. The results were analyzed to determine factors influencing students’ career goals and to compare choices among the different classes.

Results

The most important factor considered by pharmacy students was work environment. Their career goals upon graduation were predominantly in the retail chain setting. However, 5 years after graduation, their projected areas of practice were divided between retail and clinical settings.

Conclusions

Specific factors influence pharmacy students'' short- and long-term career goals and identifying these factors may provide insights to faculty members in planning the experiential curriculum and assist prospective employers in increasing job retention among new pharmacists and improving their overall job satisfaction.     

Practice Settings, Job Responsibilities, and Job Satisfaction of Nontraditional PharmD and BS Pharmacy Graduates

Objectives

To assess differences in the practice of pharmacy and in job satisfaction between graduates of a nontraditional doctor of pharmacy (PharmD) program and a bachelor of science (BS) in pharmacy program.

Methods

Two separate survey instruments were mailed to 293 PharmD graduates and 293 BS graduates.

Results

Two hundred fourteen (73.0%) of the 293 nontraditional PharmD graduates and 189 (64.5%) of the 293 BS graduates completed the survey instruments. Nontraditional PharmD graduates expressed greater satisfaction, both in their current position and with pharmacy as a career, compared to BS graduates. Nontraditional PharmD graduates were more likely than BS graduates to practice in a hospital and have more clinical responsibilities.

Conclusions

Nontraditional PharmD graduates are more likely to have greater satisfaction with their job and with pharmacy as a career compared to BS-trained pharmacists.     

An Advanced Pharmacy Practice Experience in Public Health

Objectives

To develop and implement an advanced pharmacy practice experience (APPE) that would increase students'' awareness of, acceptance of, and ability to apply public health concepts in pharmaceutical care.

Design

A 6-week APPE was developed that utilized a wide variety of activities including written assignments, role-play, direct patient care, reflective writing, and community outreach to explore various public health issues and their relation to the practice of pharmacy. To determine the students'' perception of learning, a 5-question survey instrument was sent to students upon completion of the experience

Assessment

The results of the survey indicated high satisfaction with the APPE in a variety of different domains including provision of pharmaceutical care, providing patient education, exercising cultural competency, referring to community resources, and utilizing medication assistance programs.

Conclusion

The advanced pharmacy practice experience (APPE) provides students a unique opportunity to develop skills important to the practice of public health and expand understanding of the role of pharmacist in the public health setting.     

Health Promotion Integrated Into a Thai PharmD Curriculum to Improve Pharmacy Practice Skills

Objective

To implement and evaluate 5 integrated teaching modules in the fifth-year doctor of pharmacy (PharmD) curriculum to increase students'' ability to promote patients'' health as part of their pharmacy practice.

Design

Activity-based learning was added to each module: (1) a practice experience in which students provided health information and counseling to the public; (2) academic debates on current issues in pharmacy (3) journal clubs on articles from the pharmacy literature; and (4) research projects relating to ongoing faculty research on diabetes. Students on 12-week practice experiences had visits to patients in inpatient wards, outpatient clinics, and either primary care units or community pharmacies.

Assessment

Practice examinations at the end of the first semester, the average student score was above 80% as determined by preceptors in experience sites and from faculty members. Group interviews found that students were positive about the benefits of integrated teaching.

Conclusion

The integration of the teaching between modules in the same semester is possible and greatly benefits student learning.     

Impact of an Introductory Pharmacy Practice Experience on Students' Performance in an Advanced Practice Experience

Objective

To determine the impact of an introductory pharmacy practice experience (IPPE) on students'' clinical skills during their initial advanced pharmacy practice experience (APPE).

Design

A 4-week First Steps course that focused on students developing pharmacy practice skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs.

Assessment

During the third week of the first APPE, faculty members rated students'' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01).

Conclusion

Completion of an IPPE course that focused on critical pharmacy practice aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE.