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

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Presentation on theme: "Developing an ASHP Approved Residency Program Janet Teeters, M.S., R.Ph. Director of Accreditation Services American Society of Health System Pharmacists."— Presentation transcript:

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

2 Objectives 1. Provide examples of action you can take to develop a residency program. 2. Describe three factors that will help make your residency program a success. 3. Summarize the steps to have your residency program become accredited. 2

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…. 3

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 4

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

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

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

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 8

9 Gathering support  Pharmacy  Physicians  Administration  Nursing 9

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 10

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

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

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

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 14

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 15 Goal Obj Obj Obj C C C C C C C C C Goal

16 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 16

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

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 18

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 19

20 Provide Instruction Stage of Learning Bloom’s – level of cognitive learning Methods of Instruction Foundation Knowledge, skills KnowledgeComprehension Reading, lecture Guided discussion Interactive lecture Practical Application ApplicationAnalysisSynthesis Case presentation Case based teaching Simulation Practice based teaching IntegrationEvaluation Practice based facilitation 20

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

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 22

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

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

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

26 Key Individuals Residency Program Director Preceptors All staff 26

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 27

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 28

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 29

30 If you build it they will come……. 30

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 31

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

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 33

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

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

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 36

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 37

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 38

39 39

40 TOP Areas of Partial/Non-compliance in Pharmacy Practice Residency training issues:2006200520042003 Preceptors’ Contribution to Profession 56%67%58%---- Individualized Plan for Resident50%54%47%55% Assessment of the Resident44%51%44%61% Resident Self Evaluations41%44%56%61% Progress over Time & Feedback----36%44% 55% Document/plan for leave & impact59% ------------ Based on 3/03, 3/04, 3/05, 3/06 COC 40

41 TOP Areas of Partial/Non-compliance in Pharmacy Practice Pharmacy or service issues: 2006200520042003 Sterile Products Area66%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 41

42 TOP areas of Partial/Non-compliance in Specialized Programs Residency training issues:20062005 20042003 Individualized goals/objectives 67%56%97%63% Evaluations not routinely done48%52%81%---- Individual plan & monitored52%44%94% 56% Resident has not completed PGY154%44%32%50% Resident self evaluation 52%----19% 44% Based on 3/03, 3/04, 3/05, 3/06 COC 42

43 New Residency Accreditation Standards 43

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 44

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

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 46

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 47

48 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) 48 New Standards:

49 PharmD Graduate Patient/Practice FOCUS Broad DEPTH of knowledge, skills, abilities, experience A PGY1 Generalist Wide variety of patients & diseases PGY1 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) PGY2 D Advanced Practitioner More experience, skill, and ability developed in a focused area of practice (e.g., oncology, critical care) Narrow Basic Advanced 49

50 Principles of accreditation 1. Resident’s qualifications 2. Environment for learning 3. Resident’s responsibilities 4. Training program (systematic approach) 5. Residency Program Director & Preceptors 6. Organization 7. Pharmacy 50

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

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 52

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 53

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 54

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 55

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 56


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 58

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 59

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! 60

61 Just do it! 61

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