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. 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

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. 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? • 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: 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

41. TOP Areas of Partial/Non-compliance in Pharmacy Practice Pharmacy or service issues: 200620052004 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

42. 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

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. PharmD Graduate Broad Patient/Practice FOCUS Narrow 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