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.

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.

Relationship between publication of a postgraduate year 1 residency research project and subsequent career type at a large academic medical center.

PURPOSE: The study objectives were to (1) quantify the overall incidence of residency publications of postgraduate year 1 (PGY1) residency alumni; (2) evaluate annual fluctuations in publications over time; and (3) compare the career types of residency alumni who published their PGY1 residency research projects to those for alumni who did not. METHODS: A retrospective cohort study was performed among individuals who completed a PGY1 acute/ambulatory care residency between 2010 and 2021. A list of residency alumni was obtained along with the corresponding titles of their research projects. Each resident's name was entered into PubMed and Google Scholar to find the corresponding publication. LinkedIn and other publicly available resources were used to determine the career types of residents immediately after residency as well as their current career types. RESULTS: In total, 178 residency alumni completed an acute/ambulatory care PGY1 residency, of whom 16.7% (30/178) published their residency research project. Publication was associated with career type among those who pursued a postgraduate year 2 residency but was not associated with career type immediately after the PGY1 residency or current career type. The presence of an academic preceptor was associated with a higher probability of publishing compared to residents who did not have an academic preceptor (31.5% vs 10.5%; P < 0.01). CONCLUSION: The frequency of publications was within the range reported elsewhere, with fluctuations over time. Presence of an academic preceptor improved the probability of publication.

Pharmacy residency training program increases residents' confidence in inpatient medical emergency response.

PURPOSE: The benefits of pharmacists' involvement in medical emergencies are well established, but optimal methods of training pharmacists for emergency response are unknown. The primary objective of this report is to describe the design and evaluation of a pharmacy resident medical emergency response training (PR-MERT) program for preparing trainees to respond to hospital medical emergencies, including cardiac arrest and rapid sequence intubation (RSI). SUMMARY: The PR-MERT program was a year-long longitudinal experience designed to prepare postgraduate year 1 pharmacy residents for medical emergency response. During the first month, the residents completed an orientation session that encompassed several lectures, certification by the American Heart Association in basic life support and advanced cardiovascular life support, standardized simulation scenarios, and mock medical emergencies. The trainees continued to utilize these skills and clinical knowledge through a longitudinal didactic lecture series, resident case conferences, and practice-based application by responding to real-life medical emergencies. Residents were assessed and coached throughout the program by clinical pharmacy preceptors and a "code coach" with extensive medical emergency response experience. After the year-long training, residents completed an anonymous survey assessing self-confidence and the structure of the program. The results showed improved confidence in medication selection and dosing, as well as anticipating the needs of the team and speaking up in cardiac arrest and RSI situations. Residents were satisfied with the training offered and structure of the program. CONCLUSION: The development of a PR-MERT program at an academic medical center was successful in achieving longitudinal learning objectives and improving residents' confidence in responding to medical emergencies. The implementation of a similar medical emergency training curriculum in inpatient pharmacy residency programs may be beneficial.

Development and implementation of an in-hospital pharmacist emergency response simulation training curriculum.

BACKGROUND: Medical simulation is an effective educational tool used to increase confidence, improve knowledge, and refine skills when responding to high-acuity situations. Despite established roles of the pharmacist on the hospital code team, most institutions lack formalized pharmacist training for code team responses. OBJECTIVE: This pre-post analysis aimed to evaluate the impact of a didactic and simulation-based code response training for pharmacists on self-perceived improvement and preparedness when responding to in-hospital medical emergencies. METHODS: An emergency response curriculum (ERC) was developed for pharmacists and pharmacy residents at our institution. The curriculum, led by 4 lead clinical pharmacy specialists, included a 60-minute didactic code competency lecture followed by 2 medical emergency simulations and a debrief after each scenario. After completion of the simulation portion of the ERC, participants were given a survey to complete that assessed their confidence using a 5-point Likert scale (1 = very unconfident to 5 = very confident) in completing the course objectives before and after the ERC. RESULTS: Seventy-two pharmacists completed the ERC and 60 completed the postcourse survey. Of those who completed the postcourse survey, 70% were pharmacy residents. Using a 5-point Likert scale (1 = very unconfident to 5 = very confident), median participant confidence rose from 3 (interquartile range [IQR] 2-4) before the session to 4 (IQR 3-5) after the session (P < 0.001). Of the participants, 95% believed the ERC training should be required annually or multiple times a year and 100% of respondents felt the ERC training was beneficial. CONCLUSION: Development of a pharmacist ERC including didactic and simulation-based learning improved the confidence and preparedness of pharmacists when participating as members of the hospital code team. Future studies should continue to evaluate pharmacist training and curriculum development in code team responses.

Exploring the problems and coping strategies of pharmacy internship in large general hospitals in China: from the perspective of preceptors.

OBJECTIVE: The role of the Hospital Pharmacy Preceptor (HPP) is pivotal in upholding the excellence of experiential training and fostering the professional growth of pharmacy interns. However, there is a lack of studies that provide an overview of pharmacy internships from the perspective of HPP. This study explores the experience and expectations of HPPs regarding existing problems and possible coping strategies in intern teaching. METHODS: This is a qualitative study that was conducted through individual interviews and focus group discussions. HPPs were invited as participants from large-scale tertiary hospitals in representative provinces of mainland China. Interview and focus group discussion data were analyzed using thematic analysis to see emerging themes from the data. Nvivo 12 was utilized for data management and processing. RESULTS: Eight individual interviews and two focus group discussions were conducted, involving 14 HPPs as participants. Upon the examination of the interviews and focus group data, four themes were summarized regarding HPPs' perceptions: 1) current presenting problems; 2) possible coping strategies; 3) something HPPs should do; 4) something interns should do. CONCLUSION: This study found that from the HPPs' perspective, the hospital-based pharmacy internship still has some problems from policy to practice, which need to be addressed by the joint efforts of the state, schools, internship bases, pharmacy preceptors, and students.

Best practices for PGY1 letters of intent: Recommendations from a modified Delphi process.

PURPOSE: The aim of this study was to provide consensus recommendations from residency program leaders on letters of intent (LOIs) written by postgraduate year 1 (PGY1) pharmacy residency candidates. METHODS: A 3-round modified Delphi process was used to determine consensus among PGY1 residency program leaders across the country. A screening and demographic survey was utilized to ensure representation of panelists. The initial items for round 1 of the study were developed using existing published literature, with pilot testing by 2 residency program directors. For each round, respondents rated items on a 7-point Likert scale, with opportunities to provide qualitative feedback and modifications for lower-rated items. For future rounds, items were adjusted based on respondent feedback. Only items meeting predefined consensus were included in the final recommendations. RESULTS: A total of 254 pharmacists were invited to participate in the panel, with 41 completing the demographic and study consent survey. There were 35 participants in round 1, 34 of whom remained for rounds 2 and 3. The panel created 18 LOI recommendations for PGY1 residency candidates. Most recommendations were focused on the content of the LOI, while others were related to formatting. CONCLUSION: The recommendations from this study can be employed by PGY1 pharmacy residency candidates to enhance their likelihood of success in the residency application process.

Potential Impact of Race and Ethnicity on Pharmacy Residency Match Rate and Match Participation.

OBJECTIVE: The purpose of this study was to investigate if a correlation exists between a student's self-identified race or ethnicity and their rates of participating in the match or matching with a pharmacy residency. METHODS: This retrospective cohort study included pharmacy graduates from 2016 through 2021 at two schools/colleges of pharmacy, a Historically Black College or University and a non-Historically Black College or University. The primary outcome was to compare the percentage of underrepresented minority (URM) students and non-URM students who successfully matched with a postgraduate year 1 pharmacy residency. The secondary outcomes compared rates of participation in the match and the effects of student-related factors that influenced match success and participation rates between URM students and non-URM students. RESULTS: Of the 900 included students, 273 participated in the match. The match rate among students participating in the match was 53.5% (146 of 273) with 50.3% (84 of 167) in the URM group compared to 58.5% (62 of 106) in the non-URM group (P = .186) successfully matching. Rates of match participation were lower for students identified as URM (26% vs 39.3%, P < .001). When adjusting for previously published predictors of match success, URM status did not significantly affect match rates or match participation. CONCLUSION: At two schools of pharmacy, URM students were less likely to participate in the match but just as likely to match to an American Society of Health-System Pharmacists residency in the univariable analysis. However, when adjusting for other characteristics, there was no difference in match participation or match success in students who self-identified as URM.

Reconsidering the residency training pathway for ambulatory care pharmacists.

Ambulatory care, commonly found in primary care settings, is a growing area of pharmacy practice supported by an expanding number of residency training opportunities in this setting. As this practice expands, the profession has chosen to adopt structures that define it as a specialty practice area, a departure from the medical profession. A key example of this definition is the profession's alignment of residency training for this setting within postgraduate year 2 standards. In this commentary, we explore the implications of this approach and share experience from more than 20 years of statewide ambulatory care residency training in Minnesota. We question whether current training expectations are rooted in an objective evaluation of the knowledge and skills required for ambulatory care pharmacy practice. Ultimately, we call on practice leaders to take account of the impact on current training expectations for learners and pharmacy workforce development and seek a rationalization of the training pathway for ambulatory care practice.

Process and outcomes from systemization of a longitudinal advanced pharmacy practice experience (LAPPE) program.

PURPOSE: Longitudinal models for completing advanced pharmacy practice experiences were implemented to enhance experiential training efficiency through extracurricular experiences and to offer high-quality learning continuously. Through multihospital expansion of an established single-site longitudinal advanced pharmacy practice experience (LAPPE) program, the expanded collaborative opportunities support the development of new concepts that enhance integrated learning. METHODS: An observational study was designed to describe the approach for constructing a LAPPE program integrated across a multihospital system, to assess the professional skills gained by the program graduates, and to evaluate program impact on graduates' professional career. A questionnaire was developed for current students to assess the program's impact across 5 domains. Value-added benefits for the health system and challenges to implementation of a systemized program were reviewed as guidance for institutions interested in implementing such a model. RESULTS: Expansion of a single-site LAPPE program across a multihospital health system requires significant coordination from leadership, especially during the recruitment and interview process. Additionally, integration of preceptors across sites bolsters student experiences for various professional activities offered in a LAPPE program. This program's questionnaire results pointed toward an increase in students' knowledge and skills in preparation for postgraduate training. For students entering the ASHP Resident Matching Program, there was a 100% residency match rate before and after program systemization. CONCLUSION: The expansion of a LAPPE program across a multihospital system offers intangible benefits to an institution, expands self-reported competencies, and establishes a foundation for postgraduate success. This model may be utilized at institutions with similar interest to implement, expand, or systemize a LAPPE program.

Assessment of Longitudinal Advanced Pharmacy Practice Experience Programs in Preparing Pharmacy Students for Residency Training.

OBJECTIVE: This study aimed to determine whether postgraduate year 1 (PGY-1) pharmacy residents felt more prepared for residency training after having completed a Longitudinal Advanced Pharmacy Practice Experience (LAPPE) program during pharmacy school. METHODS: This was a multicenter, two-arm, cross-sectional study among PGY-1 pharmacy residents. The primary outcome was self-reported residency preparedness. Secondary outcomes included self-reported competency in key indicators for success during early residency and matching with a preferred residency program. A survey was developed to obtain these data and was sent via email to all residency program directors of qualifying programs, who then redistributed it to PGY-1 residents in their respective programs. RESULTS: A total of 960 PGY-1 residents were included in the study. Of these, 180 (19%) reported prior participation in a LAPPE program. Longitudinal Advanced Pharmacy Practice Experience participants reported increased preparedness for residency training as compared to nonparticipants (mean 6.18 vs 5.72 on a 7-point Likert scale; difference 0.46, 95% CI 0.309-0.618). Longitudinal Advanced Pharmacy Practice Experience participation was also associated with greater self-reported clinical knowledge and skills (mean 5.18 vs 4.95, difference 0.23, 95% CI 0.093-0.372). Self-reported matching with a preferred residency program was common and similar between cohorts. CONCLUSION: Postgraduate year 1 residents who had completed a LAPPE felt better prepared for residency than those who had not completed a LAPPE. Prior LAPPE participation was also associated with greater self-reported clinical knowledge and skills at the start of residency training.

Perceptions of PGY1 pharmacy resident research, final projects, and associated publication outcomes.

PURPOSE: To describe the publication rate and the research landscape of postgraduate year 1 (PGY1) pharmacy residency programs within the Great Lakes Pharmacy Resident Conference (GLPRC) region. METHODS: This study was comprised of two elements. The first was a retrospective cohort evaluation of previously presented GLPRC research abstracts and publication rates. The second was a 45-question survey of current GLPRC PGY1 residency program directors (RPDs). The primary objective of this study was to evaluate publication rates of PGY1 abstracts submitted to the GLPRC. Secondary objectives included describing RPD perceptions of the value of research, identifying perceived barriers to research completion, and characterizing current and ideal components of residency research programs. RESULTS: A total of 447 PGY1 abstracts were reviewed; 47 (10.5%) resulted in manuscript publication within a peer-reviewed journal. There was no significant difference in publication rates between years (9.5% in 2013 vs 13.8% in 2016 vs 7.4% in 2019, P = 0.166). One hundred ten PGY1 RPDs in the GLPRC region were invited to participate in the survey, with 33 (30%) responses received. The majority of programs (94%) required manuscript submission to the RPD prior to graduation; however, only 12% required submission for peer-reviewed publication. Major barriers to research completion included lack of preceptor time and knowledge regarding the research and publication process, as well as lack of resident interest and knowledge of the process. CONCLUSION: The current publication rate of PGY1 research abstracts presented at the GLPRC remains at approximately 10%, which is unchanged from a previous investigation. RPD perceptions of the research process and barriers also remain largely unchanged or less favorable.

Implementation and Evaluation of a Residency Preparation Program for Fourth-Year Doctor of Pharmacy Students.

OBJECTIVE: To describe the impact of a formal residency preparation program on student match rates, and to evaluate student-reported advisement activities and perceptions of the residency application process. METHODS: An optional, noncredit-bearing, residency preparation program was implemented in professional year 4 (PY4) of the Doctor of Pharmacy curriculum. The program consisted of 4 residency preparation presentations and/or workshops: curriculum vitae writing, navigating the residency application process and American Society of Health-Systems Pharmacy Midyear Clinical Meeting, letter of intent writing, and interview skills. Students attended either virtually or in person, with 3 of the 4 sessions including small group breakout sessions. The program also included dedicated, 1-on-1 residency advisement with residency-experienced advisors. RESULTS: Residency match rates following program implementation increased from 74.3% (comparison group) to 87.5% (intervention group). More students in the intervention group reported that their advisor assisted them with curriculum vitae review, letter of intent review, and interview skills. In addition, the intervention group reported significantly more time spent meeting with their advisor during PY4 than the comparison group. Students found the program to be beneficial to their professional development, indicated that it helped them to obtain a residency position, and expressed that they would participate in the residency preparation program again. CONCLUSION: Implementation of a formal residency preparation program for PY4 students that included 1-on-1 dedicated residency advisement increased match rates and interaction between students and their residency advisor.

Implementation of a pharmacy residency wellness program: Impact on burnout and mindfulness and lessons learned.

BACKGROUND AND PURPOSE: Attention to wellness in the pharmacy workplace is occurring. To maintain accreditation, pharmacy residency programs must incorporate wellness and resilience initiatives. EDUCATIONAL ACTIVITY AND SETTING: Orlando Health created a pharmacy residency wellness program for post-graduate year one (PGY-1) and post-graduate year two (PGY-2) pharmacy residents to address wellness and burnout. The wellness program included assignment of a mentor, development of a personal wellness plan, completion of monthly reflections, and wellness and resiliency training. FINDINGS: Pharmacy residents anonymously completed the Oldenburg Burnout Inventory (OLBI) and Mindful Attention Awareness Scale (MAAS) at the beginning and end of the residency year. A total of nine pharmacy residents were eligible to participate in the wellness program. Eight residents completed the pre-survey, and seven residents completed the post-survey. No change was observed in the overall median OLBI score (pre-program = 35 [IQR 31.5-37.3] and post-program = 36 [IQR 31-37.5]; P = .683). Similar results were found on the OLBI for disengagement and exhaustion, correlating with low burnout risk. There was no change in the overall median MAAS score (pre-program = 3.7 [IQR 3.6-4.1] and post-program = 3.8 [IQR 3.5-3.9]; P = 1.000). Overall, feedback from the pharmacy residents after program completion was positive. SUMMARY: Pharmacy residents participating in the wellness program at our institution had low risk for burnout and a high level of mindfulness pre- and post-program completion. Pharmacy residents enjoyed participating in the wellness program and found the program to be valuable, supporting its continued implementation.

Implementing and evaluating a diversity, equity, and inclusion resident recruitment strategy.

PURPOSE: A recruitment strategy was designed to increase the racial diversity of applicants to the postgraduate year 1 pharmacy program at University of Michigan Health, Michigan Medicine (MM). This article describes MM's diversity, equity, and inclusion (DEI) residency recruitment approach, from conceptualization through implementation, and includes an evaluation of its effectiveness. SUMMARY: The report of the American Society of Health-System Pharmacists (ASHP) Task Force on Racial Diversity, Equity, and Inclusion, published in January 2021, provided a foundation for our recruitment approach. The approach consisted of establishing a residency DEI subcommittee, conducting outreach to under-represented students, and reducing bias in the process by amending the application screening rubric. The combination of these efforts resulted in a 5% increase in applicants from pharmacy schools with a high proportion of under-represented minority students. CONCLUSION: A diverse residency program benefits patients, trainees, and the larger healthcare organization. In addition, incorporating DEI into resident recruitment is required by the new ASHP Accreditation Standard for postgraduate pharmacy residency programs effective July 1, 2023. Evaluation of our recruitment efforts demonstrated targeted recruitment as an effective strategy to increase the diversity of a residency program's applicants. There may be additional barriers not addressed by our interventions to be further explored.

An Exploration of the Relationship Between Pharmacy School Admission Variables and PGY1 Pharmacy Residency Program Match.

OBJECTIVE: To explore the relationship between pharmacy school admission variables and matching to a postgraduate year 1 (PGY1) pharmacy residency program. METHODS: Demographic data, academic indicators, and application review scores were collected for the 2017-2020 Doctor of Pharmacy (PharmD) graduating classes. Multiple mini-interview (MMI) scores were collected for the 2018-2020 PharmD graduating classes. Postgraduate year 1 matching data were collected for all students. Bivariate analyses were performed comparing students who matched to a PGY1 residency versus those who did not match versus those who did not pursue a residency. Logistic regression modeling was performed to explore predictors of matching to a PGY1 residency program. RESULTS: A total of 616 students were included. Bivariate analyses revealed that students who matched to a PGY1 had a higher undergraduate grade point average, higher pharmacy college admissions test composite score, were younger in age, and were more likely to identify as female. Students who matched also scored higher on MMI stations with constructs related to integrity, adaptability, critical thinking, and why pursuing our school. Logistic regression modeling found that an increase in age was associated with lower odds of matching to a PGY1 (0.88 [0.78-0.99]) and an increase in composite MMI station score was associated with higher odds of matching (1.8 [1.31-2.47]). CONCLUSION: Several pharmacy school admission variables were found to be associated with successful matching to a PGY1 residency. These findings have the potential for impact at a programmatic level when evaluating the weight of certain criteria for admission decisions and at the individual student level when providing career services support.

A Systematic Review of Interventions Implemented by Pharmacy Programs to Improve Postgraduate Residency Placement.

OBJECTIVE: This systematic review aims to identify the impact of interventions implemented by pharmacy programs to support students pursuing postgraduate residency training. METHODS: We conducted a literature search through March 8, 2022 to identify articles that studied an intervention made by a pharmacy program aiming to prepare students to qualify for a postgraduate residency position. Data were collected to describe each study's methods, the included population, and outcomes and to evaluate study risk of bias. FINDINGS: Twelve studies met our inclusion criteria. The evidence base is limited to observational data with significant risk of bias. Pharmacy programs use various strategies to deliver training to students opting for the residency application process: elective courses, multiyear curricular tracks, introductory pharmacy practice experiences (IPPEs), and organized professional development events. Participation in these interventions was found to be associated with higher residency match rates, with exception of IPPE where match rates were not evaluated as an outcome. Curricular tracks and multicomponent professional development events were found to be associated with the largest improvement in match rates. Participation in electives or multicomponent professional development was found to be associated with improved student knowledge and confidence in interviews. Multicomponent professional development was also found to be associated with student preparedness for the match process. Curricular tracks and IPPE were found to be associated with improved student knowledge, whereas mock interviews were associated with improved student confidence. SUMMARY: Pharmacy schools support preparation of students for the residency application and interview process in a variety of ways. The current evidence does not support one strategy to be more effective than another. Until additional evidence emerges to guide decisions, schools should select training programs based on balancing the need to support student professional development with resources and workload.