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Developing an ASHP Approved Residency Program
Janet Teeters, M.S., R.Ph.Director of Accreditation ServicesAmerican Society of Health System Pharmacists
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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.
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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….
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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
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Residencies are the bridge between Education and Practice
Helping to develop clinical & professional maturity
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How to begin?
Initial assessment
Costs of the program
Support for program
Justification
Program Design
Individuals Role
Recruitment
Accreditation
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Initial assessment
Philosophy
Organization
DepartmentStaff (experience, interest,
commitment)Services (scope & depth)
Resources available
Costs
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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
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Gathering support
PharmacyPhysicians AdministrationNursing
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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
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Program Design
Purpose
# residents
Structure
College affiliation, teaching opportunities
Utilization of outside experiences
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Program Design
Use a systematic approach
Understand instruction
Focus on assessment & feedback
Roles & responsibilities
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Systematic Approach to Training
Outcomes, Goals & Objectives
Assessment Program Design
Instruction
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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
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Outcomes, Goals & ObjectivesOutcomes: 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
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Goal
Obj Obj Obj
C C C C C C C C C
Goal
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
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Outcomes, G&O Selection Tips:
Include required outcomes, goals & objectives
Limit the total number of outcomes
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DesignLearning 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
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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
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Provide Instruction
Stage of LearningStage of Learning Bloom’s – level of Bloom’s – level of cognitive learningcognitive learning
Methods of Methods of InstructionInstruction
FoundationFoundation
Knowledge, skills Knowledge, skills
KnowledgeKnowledge
ComprehensionComprehension
Reading, lectureReading, lecture
Guided discussionGuided discussion
Interactive lectureInteractive lecture
Practical ApplicationPractical Application ApplicationApplication
AnalysisAnalysis
SynthesisSynthesis
Case presentationCase presentation
Case based teachingCase based teaching
SimulationSimulation
Practice based Practice based teachingteaching
IntegrationIntegration EvaluationEvaluation Practice based Practice based facilitation facilitation
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Preceptors Role Residents Learning
Facilitating Culmination & integration
Coaching Practical Application
Modeling Direct Instruction Foundation
Skills & Knowledge
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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
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Assessment & Feedback
Effectively “diagnose”
Provide effective guidance - criteria
Constructive criticism
Maximize residents progress
Improve programs performance
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Assessment & Feedback Tips
Key area of focus
Can use a variety of methods to document feedback
Use tools already developed
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“ You are unaware of the effect
you have on others.”
Chinese fortune cookie
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Key Individuals
Residency Program Director
Preceptors
All staff
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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
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Preceptors Role
Responsible for their experiences/rotationInstructionFeedbackFormative - constructive ongoing
use snap shots/ criteria based checklistsSummative – at the end of an
experienceAttainment of G&O assigned
Receive Improve effectivenessCommunicate to other preceptors
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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
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If you build it they will come…….
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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
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“ If you always do what you have always done, you’ll always get what you always got.”
anonymous
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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
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Why accreditation?
Consumer protection
Fosters continuous improvement
Public relies on accreditation for
Credibility
Consistency
Funding
Recognition
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What’s involved from the accreditation side?
Standard development
Measuring compliance
Review process
Education
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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
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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
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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
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Residency Evaluation Process
PrePre--survey Self Evaluation Prepared by Site survey Self Evaluation Prepared by Site
ASHP Site Visit (every 6 years)ASHP Site Visit (every 6 years)
Report by Surveyors & Site Follow up to FindingsReport by Surveyors & Site Follow up to Findings
Review by Commission on Credentialing (meets 2/yr) Review by Commission on Credentialing (meets 2/yr) no, 1, 3, or 6 year Accreditationno, 1, 3, or 6 year Accreditation
Interim Reports Interim Reports
Next Site VisitNext Site Visit
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TOP Areas of Partial/Non-compliance in Pharmacy Practice
Residency training issues: 2006 2005 2004 2003• 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 ---- 36% 44% 55%• Document/plan for leave & impact 59% ---- ---- ----
Based on 3/03, 3/04, 3/05, 3/06 COC
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TOP Areas of Partial/Non-compliance in Pharmacy Practice
Pharmacy or service issues: 2006 2005 2004 2003
• 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
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TOP areas of Partial/Non-compliance in Specialized Programs
Residency training issues: 2006 2005 2004 2003• 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 52% ---- 19% 44%
Based on 3/03 , 3/04, 3/05, 3/06 COC
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New Residency Accreditation Standards
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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
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•Patient-centered
•Interdisciplinary teams
•Evidence-based practice
•Utilize informatics
•Apply quality improvement
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IOM - Core competencies for all health professionals
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
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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 professionSpecialization in the profession needs clarity
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PGY1 Pharmacy Residency
Replaces Pharmacy Practice (2001)
PGY2 Pharmacy ResidencyReplaces 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)
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New Standards:
PharmDGraduate
Patient/Practice FOCUS
Broad
DEPTH ofknowledge, skills, abilities, experience
A A PGY1PGY1
GeneralistGeneralist
Wide variety of patients & Wide variety of patients & diseasesdiseases
PGY1 PGY1 B B
Generalist Focused PractitionerGeneralist Focused Practitioner
Wide variety of diseases may be Wide variety of diseases may be in a unique setting or population in a unique setting or population (e.g., pediatrics, geriatrics, (e.g., pediatrics, geriatrics, ambulatory, managed care)ambulatory, managed care)
C C PGY2PGY2
Advanced PractitionerAdvanced Practitioner
More experience, skill and More experience, skill and ability developed in a broad ability developed in a broad set of patientsset of patients(e.g., pharmacotherapy)(e.g., pharmacotherapy)
PGY2 PGY2 D D
Advanced PractitionerAdvanced Practitioner
More experience, skill, and ability More experience, skill, and ability developed in a focused area of developed in a focused area of practice (e.g., oncology, critical practice (e.g., oncology, critical care)care)
Narrow
Basic
Advanced
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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
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New Standards
PGY1/PGY2
General training vs. advanced depth of training
Incorporates IOM core competencies
Duty hours
Participation in the match
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PGY1 - 6 Core Competencies
Medication use process Quality Improvement IOM
Patient-centered care IOM
Interdisciplinary Teams IOM Evidence Based Practice
IOMLeadership and managementProject managementEducation/trainingMedical informatics IOM
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PGY2 Residency Program Directors
PGY2 Residency & 3 years or 5 years of experience in the area
BPS - Board CertificationNuclearNutritionOncologyPsychiatryPharmacotherapy + added
qualificationsInfectious DiseasesCardiology
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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
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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
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Seek advice from others:
Other Residency Programs & preceptors
ASHP – Accreditation Services
http://www.ashp.org/rtp/index.cfmASHP 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
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STARTING YOUR RESIDENCY PROGRAM
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Objective 1Actions 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
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Objective 2 Factors to help make your residency program a success
Champion & commitment Thorough education and preparationInvolve as many individuals as possible Must realize this is about education and may need to learn new principles different then how you were taughtRealize this is not a short term process – it improves with time and continuous improvementThis involves the entire department, not just a few
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Objective 3 Steps to have residency become accredited
Read standards & regulationsBegin design based on standardsSeek advise from othersAttend training programs (RLS, new programs, NRPC/MCM)
Design program with involvement of manyRecruit a residentApply!
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Just do it!
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