1. Developing an ASHP Approved Residency Program
Janet Teeters, M.S., R.Ph. Director of Accreditation Services American Society of Health System Pharmacists

2. Objectives
Provide examples of action you can take to develop a residency program.
Describe three factors that will help make your residency program a success.
Summarize the steps to have your residency program become accredited.

3. Questions to ask yourself?
Why do you want to start a residency? What does your site have to offer? Are you & your staff ready for a major commitment to the program? This is more than just taking pharmacy students on rotation….

4. Residency vs Experiential Training
Experience vs exposure
Integrating knowledge, skills, abilities & attitudes to gain confidence in practice
Repetition to reinforce development
Ability to develop skills progressively
Self selected group of individuals desiring to advance their skills

5. Residencies are the bridge between Education and Practice
Helping to develop clinical & professional maturity

6. How to begin? Initial assessment Costs of the program
Support for program
Justification
Program Design
Individuals Role
Recruitment
Accreditation

7. Initial assessment Philosophy Organization Department
Staff (experience, interest, commitment)
Services (scope & depth)
Resources available
Costs

8. Costs of a residency program
Preceptor and program directors time
Space and equipment
Salaries and benefits of residents
Travel
Recruitment expenses
Training of Preceptors
Accreditation Fees

9. Gathering support
Pharmacy
Physicians
Administration
Nursing

10. Justification Patient care services Projects & programs
Medicare Pass through for post graduate medical education (if accredited)
Recruitment and retention of staff
Keeps the department contemporary
Enhance credibility within an institution

11. Program Design Purpose # residents Structure
College affiliation, teaching opportunities
Utilization of outside experiences

12. Program Design Use a systematic approach Understand instruction
Focus on assessment & feedback
Roles & responsibilities

13. Systematic Approach to Training
Outcomes, Goals & Objectives Assessment Program Design Instruction

14. ASHP Residency Learning System “RLS”
Model for a systematic approach to training
Maximize learning experiences
Builds upon past experiences
Focuses on improving instruction & feedback
Provides consistency in assuring outcomes

15. Outcomes, Goals & Objectives
Outcomes: What resident graduate should be
capable of doing
Goals: What resident should learn to do
Objectives: Observable, measurable behavior
Criteria: Detail to evaluate performance related to
the objectives
Outcomes
Goal
Goal
Obj Obj Obj
C C C C C C C C C

16. Goal: Document patient care activities appropriately
Outcome: Provide patient centered care
Goal: Document patient care activities appropriately
Objective: Appropriate selection of activities Objective Effectively document appropriate information
Objective: Explain exemplary documentation
Criteria: Written in time to be useful
Criteria: Follows Hospital Policy
Criteria: Legible
Criteria: Only pertinent information included
Criteria: Accurate interpretation

17. Outcomes, G&O Selection Tips:
Include required outcomes, goals & objectives
Limit the total number of outcomes

18. Design Learning Experiences (rotations) Areas of expertise
Determine length, type, electives
Identify goals that match the experience
Identify goals to be evaluated during the experience
Identify learning activities to meet G&O

19. Design Tips:
Only offer rotations - good role models and adequate patient #s
Focus on the strengths of the site
Strong role models for early experiences
Limit the number of goals evaluated per rotation
Don’t repeat the evaluation of the same goals with every rotation if goal has been obtained
Develop effective communications between preceptors to avoid duplication of efforts

20. Provide Instruction Stage of Learning
Bloom’s – level of cognitive learning
Methods of Instruction
Foundation
Knowledge, skills
Knowledge
Comprehension
Reading, lecture
Guided discussion
Interactive lecture
Practical Application
Application
Analysis
Synthesis
Case presentation
Case based teaching
Simulation
Practice based teaching
Integration
Evaluation
Practice based facilitation

21. Preceptors Role Residents Learning
Facilitating Culmination & integration Coaching Practical Application Modeling Direct Instruction Foundation Skills & Knowledge

22. Instruction Tips
Educate preceptors on how resident training varies from student training
Provide forum for preceptors to discuss effective methods they have used to learn from each other
Provide development for preceptors

23. Assessment & Feedback Effectively “diagnose”
Provide effective guidance - criteria
Constructive criticism
Maximize residents progress
Improve programs performance

24. Assessment & Feedback Tips
Key area of focus
Can use a variety of methods to document feedback
Use tools already developed

25. “ You are unaware of the effect you have on others.”
Chinese fortune cookie

26. Residency Program Director Preceptors All staff
Key Individuals
Residency Program Director
Preceptors
All staff

27. Residency Program Director Role
Overall Champion for the program
Initial assessment of entering resident
Development of resident plan
Monitoring of resident over time
Assess preceptors & be a preceptor
Assess program performance
Improvement of the program

28. Preceptors Role Responsible for their experiences/rotation Instruction
Feedback
Formative - constructive ongoing
use snap shots/ criteria based checklists
Summative – at the end of an experience
Attainment of G&O assigned
Receive
Improve effectiveness
Communicate to other preceptors

29. Overall challenges of design & implementation
Understanding the systematic approach
RPh have not been trained in educational design
Focusing on paperwork vs concept
Need to involve all preceptors in design
Takes time
Everyone needs to be educated
New staff
CQI

30. If you build it they will come…….

31. not exactly…. Recruitment
Market yourselves!
ASHP Midyear Mtg
Students, Staff
Other residency programs in your area
Un-matched candidates post MATCH (March)
State, regional, college presentations
Brochures/ web pages
Seeking accreditation

32. “ If you always do what you have always done, you’ll always get what you always got.” anonymous

33. Accreditation
Acts as a catalyst to promote change and provide consistency in training
A voluntary process to show a program meets national standards
A means of self-regulation, using peer review

34. Why accreditation? Credibility Consistency Funding Recognition
Consumer protection
Fosters continuous improvement
Public relies on accreditation for
Credibility
Consistency
Funding
Recognition

35. What’s involved from the accreditation side?
Standard development
Measuring compliance
Review process
Education

36. What’s involved from your side?
Program development
Resident recruitment
Application/ Reapplication
Survey visits and reports
Meeting & keeping current with standards
Constantly improving your program
Keeping your information up to date with ASHP

37. Accreditation application process
Read the standards & regulations
Must have a resident
Fees begin as soon as you apply
Application includes program director information
Information goes live on web site
Site visit (after 9 months)
Accreditation is retroactive to application date
On going reports

38. What to expect after application
Set Survey date
Self- assessment
Site survey
Correspondence in response to report
ASHP Commission on Credentialing
ASHP Board of Directors

40. TOP Areas of Partial/Non-compliance in Pharmacy Practice
Residency training issues:
Preceptors’ Contribution to Profession 56% 67% 58% ----
Individualized Plan for Resident 50% 54% 47% 55%
Assessment of the Resident 44% 51% 44% 61%
Resident Self Evaluations 41% 44% 56% 61%
Progress over Time & Feedback % 44% 55%
Document/plan for leave & impact 59%
Based on 3/03, 3/04, 3/05, 3/06 COC

41. TOP Areas of Partial/Non-compliance in Pharmacy Practice
Pharmacy or service issues:
Sterile Products Area 66% 79% 51% 58%
Safe Drug System 63% 59% 65% 74%
Drug Information 47% 56% 49% 48%
Based on 3/03, 3/04, 3/05, 3/06 COC

42. TOP areas of Partial/Non-compliance in Specialized Programs
Residency training issues:
Individualized goals/objectives 67% 56% 97% 63%
Evaluations not routinely done 48% 52% 81% ----
Individual plan & monitored 52% 44% 94% 56%
Resident has not completed PGY1 54% 44% 32% 50%
Resident self evaluation % % 44%
Based on 3/03 , 3/04, 3/05, 3/06 COC

43. New Residency Accreditation Standards

44. Factors related to release of new Residency Accreditation Standards
IOM reports
JCAHO Roundtable/conference
Future of Residency Training Conference
ACCP/ASHP Partnership
Open Hearings & comment periods
ACPE standards

45. IOM - Core competencies for all health professionals
Patient-centered
Interdisciplinary teams
Evidence-based practice
Utilize informatics
Apply quality improvement

46. Residency Stakeholders Conference
Accreditation by one national body that includes key stakeholders
All residencies should be accredited
Residencies help develop innovative practices
Colleges provide knowledge; residencies are becoming necessary to integrate knowledge into practice

47. Residency Stakeholder Conference
↑ need for residency trained individuals by 2015
↑ need for community residencies
PGY1 & PGY2 is appropriate model
Terms and vision need to be consistent, defined, endorsed and embraced by the profession
Specialization in the profession needs clarity

48. New Standards: PGY1 Pharmacy Residency
Replaces Pharmacy Practice (2001)
PGY2 Pharmacy Residency
Replaces Specialized Pharmacy Practice (1994)
and all supplemental standards
(Goals & objectives remain)
Standards not altered at this time:
Managed Care Pharmacy Practice
Managed Care Systems Residency
Pharmacy Practice (with emphasis in Community Care)

49. Generalist Focused Practitioner Advanced Practitioner
PharmD
Graduate
Broad
Patient/Practice FOCUS
Narrow
A PGY1
Generalist
Wide variety of patients & diseases
PGY B
Generalist Focused Practitioner
Wide variety of diseases may be in a unique setting or population (e.g., pediatrics, geriatrics, ambulatory, managed care)
C PGY2
Advanced Practitioner
More experience, skill and ability developed in a broad set of patients
(e.g., pharmacotherapy)
PGY D
More experience, skill, and ability developed in a focused area of practice (e.g., oncology, critical care)
Basic
DEPTH of
knowledge, skills,
abilities, experience
Advanced

50. Principles of accreditation
Resident’s qualifications
Environment for learning
Resident’s responsibilities
Training program (systematic approach)
Residency Program Director & Preceptors
Organization
Pharmacy

51. New Standards
PGY1/PGY2
General training vs. advanced depth of training
Incorporates IOM core competencies
Duty hours
Participation in the match

52. PGY1 - 6 Core Competencies
Medication use process
Quality Improvement IOM
Patient-centered care IOM
Interdisciplinary Teams IOM
Evidence Based Practice IOM
Leadership and management
Project management
Education/training
Medical informatics IOM

53. PGY2 Residency Program Directors
PGY2 Residency & 3 years or 5 years of experience in the area BPS - Board Certification Nuclear Nutrition Oncology Psychiatry Pharmacotherapy + added qualifications Infectious Diseases Cardiology

54. Why is accreditation important to a resident?
Think of the residents expectations they are giving up a year of full salary, with college loans to do this program.
Accelerates development of their practice skills
Competitive advantage in the market place
Mentorship
Networking opportunities
Career planning
Shows that the site is committed to excellence
Ensures they are not used as cheap labor

55. Why is accreditation important to a site?
Funding – where applicable
Commitment to excellence
Means of self regulation
CQI
Helps advance the practice of pharmacy
Recruit and retain staff & residents
Enhanced credibility

56. Seek advice from others:
Other Residency Programs & preceptors
ASHP – Accreditation Services
ASHP Midyear Clinical Meeting – new and prospective residency program workshops and town hall meeting
ASHP National Residency Preceptors Conference
ASHP Residency Learning System – training programs
Colleges of pharmacy

57. STARTING YOUR RESIDENCY PROGRAM

58. Objective 1 Actions you can take to develop a residency
Assessment
Identify Costs
Justification
Learn about systematic approach
Design Program
Train & educate
Strategy for recruitment
Review ASHP accreditation standards

59. Objective 2 Factors to help make your residency program a success
Champion & commitment
Thorough education and preparation
Involve as many individuals as possible
Must realize this is about education and may need to learn new principles different then how you were taught
Realize this is not a short term process – it improves with time and continuous improvement
This involves the entire department, not just a few

60. Objective 3 Steps to have residency become accredited
Read standards & regulations
Begin design based on standards
Seek advise from others
Attend training programs
(RLS, new programs, NRPC/MCM)
Design program with involvement of many
Recruit a resident
Apply!

61. Just do it!