Developing an ASHP Approved
Residency Program
Janet Teeters, M.S., R.Ph.
Director of Accreditation Services
American Society of Health System Pharmacists
1
Objectives
1.
2.
3.
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.
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
Department
 Staff (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
 Pharmacy
 Physicians
 Administration
 Nursing
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 & 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
C
Obj
C CCC C CC
C
15
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
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
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
19
preceptors to avoid duplication of efforts
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
20
Preceptors Role
Facilitating
Residents Learning
Culmination
& integration
Coaching
Practical Application
Modeling
Direct Instruction
& Knowledge
Foundation Skills
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/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
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
Pre-survey Self Evaluation Prepared by Site

ASHP Site Visit (every 6 years)

Report by Surveyors & Site Follow up to Findings

Review by Commission on Credentialing (meets 2/yr)
no, 1, 3, or 6 year Accreditation

Interim Reports

Next Site Visit

39
TOP Areas of Partial/Non-compliance
in Pharmacy Practice
Residency training issues:
•
Preceptors’ Contribution to Profession
•
Individualized Plan for Resident
Assessment of the Resident
Resident Self Evaluations
Progress over Time & Feedback
55%
Document/plan for leave & impact
•
•
•
•
2006
56%
50%
44%
41%
2005
67%
54%
51%
44%
----
2004
58%
47%
44%
56%
36%
2003
---55%
61%
61%
44%
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:
• Sterile Products Area
• Safe Drug System
• Drug Information
48%
2006
2005
2004
2003
66%
63%
79%
59%
47%
51%
65%
56%
58%
74%
49%
Based on 3/03, 3/04, 3/05, 3/06 COC
41
TOP areas of Partial/Non-compliance
Specialized Programs
in
Residency training issues:
• Individualized goals/objectives
• Evaluations not routinely done
• Individual plan & monitored
56%
• Resident has not completed PGY1
• Resident self evaluation
44%
2006
67%
48%
2005
56%
52%
52%
2004
97%
81%
44%
2003
63%
---94%
54%
44%
52%
32%
----
50%
19%
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
IOM - Core competencies for all health
professionals
•Patient-centered
•Interdisciplinary teams
•Evidence-based practice
•Utilize informatics
•Apply quality improvement
45
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
profession
Specialization in the profession needs clarity
47
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)
48
PharmD
Graduate
Basic
Patient/Practice FOCUS
Broad
A
PGY1
Generalist
Wide variety of patients &
diseases
DEPTH of
knowledge,
skills,
abilities,
experience
C
PGY2
Advanced Practitioner
More experience, skill and
ability developed in a broad
set of patients
(e.g., pharmacotherapy)
Narrow
PGY1
B
Generalist Focused Practitioner
Wide variety of diseases may be
in a unique setting or population
(e.g., pediatrics, geriatrics,
ambulatory, managed care)
PGY2
D
Advanced Practitioner
More experience, skill, and ability
developed in a focused area of
practice (e.g., oncology, critical
care)
Advanced
49
Principles of accreditation
1.
2.
3.
4.
5.
6.
7.
Resident’s qualifications
Environment for learning
Resident’s responsibilities
Training program (systematic approach)
Residency Program Director & Preceptors
Organization
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
IOM
IOM
IOM
IOM
Improvement
 Patient-centered care
 Interdisciplinary
 Evidence
Teams
Based Practice
 Leadership and management
 Project management
 Education/training
 Medical informatics
IOM
52
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
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.cfm
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
STARTING YOUR RESIDENCY
PROGRAM
57
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
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
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
Just do it!
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