Developing an ASHP Approved Residency Program

Janet Teeters, M.S., R.Ph.Director of Accreditation ServicesAmerican Society of Health System Pharmacists

1

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

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

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

Residencies are the bridge between Education and Practice

Helping to develop clinical & professional maturity

5

How to begin?

Initial assessment

Costs of the program

Support for program

Justification

Program Design

Individuals Role

Recruitment

Accreditation

6

Initial assessment

Philosophy

Organization

DepartmentStaff (experience, interest,

commitment)Services (scope & depth)

Resources available

Costs

7

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

Gathering support

PharmacyPhysicians AdministrationNursing

9

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

Program Design

Purpose

# residents

Structure

College affiliation, teaching opportunities

Utilization of outside experiences

11

Program Design

Use a systematic approach

Understand instruction

Focus on assessment & feedback

Roles & responsibilities

12

Systematic Approach to Training

Outcomes, Goals & Objectives

Assessment Program Design

Instruction

13

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

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

15

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

16

Outcomes, G&O Selection Tips:

Include required outcomes, goals & objectives

Limit the total number of outcomes

17

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

18

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

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

20

Preceptors Role Residents Learning

Facilitating Culmination & integration

Coaching Practical Application

Modeling Direct Instruction Foundation

Skills & Knowledge

21

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

Assessment & Feedback

Effectively “diagnose”

Provide effective guidance - criteria

Constructive criticism

Maximize residents progress

Improve programs performance

23

Assessment & Feedback Tips

Key area of focus

Can use a variety of methods to document feedback

Use tools already developed

24

“ You are unaware of the effect

you have on others.”

Chinese fortune cookie

25

Key Individuals

Residency Program Director

Preceptors

All staff

26

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

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

28

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

If you build it they will come…….

30

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

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

anonymous

32

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

Why accreditation?

Consumer protection

Fosters continuous improvement

Public relies on accreditation for

Credibility

Consistency

Funding

Recognition

34

What’s involved from the accreditation side?

Standard development

Measuring compliance

Review process

Education

35

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

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

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

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

39

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

40

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

41

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

42

New Residency Accreditation Standards

43

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

•Patient-centered

•Interdisciplinary teams

•Evidence-based practice

•Utilize informatics

•Apply quality improvement

45

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

46

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

47

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)

48

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

49

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

New Standards

PGY1/PGY2

General training vs. advanced depth of training

Incorporates IOM core competencies

Duty hours

Participation in the match

51

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

52

PGY2 Residency Program Directors

PGY2 Residency & 3 years or 5 years of experience in the area

BPS - Board CertificationNuclearNutritionOncologyPsychiatryPharmacotherapy + added

qualificationsInfectious DiseasesCardiology

53

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

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

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

56

STARTING YOUR RESIDENCY PROGRAM

57

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

58

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

59

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!

60

Just do it!

61

62