Pharmacy Residency Training Research Articles

Incidence of a negative hidden curriculum, cynicism, and burnout within pharmacy resident education: A nationwide survey

IntroductionThe term “hidden curriculum” (HC) is a set of ethical, moral, and value-based teachings communicated in a non-explicit manner. Recent literature has described increasing awareness of the prevalence of the HC and potential negative impact on medical learners; however, this information is lacking in pharmacy resident education. Consequently, we conducted a survey study of United States pharmacy residents to learn their perceptions concerning the HC in pharmacy residency training. MethodsA nationwide survey of pharmacy residents was conducted in June 2019. The survey assessed the following: presence of negative HC (score 0 to 80), cynicism (score 0 to 25), burnout via Maslach Burnout Inventory depersonalization (MBI-D) (range 0 to 30), and emotional exhaustion via Maslach Burnout Inventory emotional exhaustion (MBI-EE) (range 0 to 54). Higher scores represent increased occurrences of each domain. ResultsThe mean HC score was 20 (SD 14.7), mean cynicism score was 9 (SD 5.5), MBI-D was 5.5 (SD 4.5), and MBI-EE was 24.2 (SD 12.4). Of those completing an MBI score, 40.4% (82/203) reported burnout in one area, while 15.8% (32/203) reported burnout in both areas. Residents reporting burnout had higher mean HC and cynicism scores. ConclusionsAwareness to develop and grow cultures that minimize the presence of a negative HC is essential to improve postgraduate pharmacy training.

Enhancing pharmacy residency training program quality and efficiency through alignment of pharmacy residency programs within a multihospital health system.

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Impact of COVID-19 pandemic on training of pharmacy residents and fellows: Results from a national survey of postgraduate pharmacy trainees

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has impacted the activities of healthcare workers, including postgraduate pharmacy trainees. Quality training experiences must be maintained to produce competent pharmacy practitioners and maintain program standards.MethodsA cross-sectional survey of postgraduate pharmacy trainees in the United States was conducted to evaluate training experience changes and assess perceived impacts on residents and fellows following the COVID-19 pandemic’s onset.ResultsFrom June 4 through June 22, 2020, 511 pharmacy trainees in 46 states completed the survey. Participants’ median age was 26 (interquartile range [IQR], 25-28) years, with included responses from postgraduate year 1 residents (54% of sample), postgraduate year 2 residents (40%), and postgraduate fellows (6%). Compared to experiences prior to the onset of the COVID-19 pandemic, fewer trainees conducted direct patient care (38.5% vs 91.4%, P < 0.001), more worked from home (31.7% vs 1.6%, P < 0.001), and less time was spent with preceptors per day (2 [IQR, 2-6] hours vs 4 [IQR, 1-4] hours, P < 0.001). Sixty-five percent of respondents reported experiencing changes in their training program, 39% reported being asked to work in areas outside of their routine training experience, and 89% stated their training shifted to focus on COVID-19 to some degree. Most respondents perceived either major (9.6%) or minor (52.0%) worsening in quality of experience, with major and minor improvement in quality of experience reported by 5.5% and 8.4% of respondents, respectively.ConclusionPharmacy resident/fellow experiences were perceived to have been extensively impacted by the COVID-19 pandemic in varying ways. Our findings describe shifts in postgraduate training and may aid in the development of best practices for optimizing trainee experiences in future crises.

Addressing Burnout in Pharmacy Residency Programs

Addressing health care provider burnout has become a top priority for many health care systems. Unfortunately, a paucity of literature is available on preventing and managing burnout in pharmacy residents despite an increase in articles on the prevalence of pharmacy burnout. This limits the ability of pharmacy managers to understand and address burnout in this high-risk population. Until further investigation into the most beneficial, evidence-based strategies for managing burnout in this population is conducted, this commentary offers strategies to address and mitigate burnout in pharmacy residency training programs based on the available interdisciplinary literature.The authors have first-hand experience with burnout and aim to begin a paradigm shift to emphasize well-being and reshape the culture of postgraduate training. Dr. Potter has dedicated time to developing programming and founded an interprofessional well-being organization called Mindfulness in Newly Developing Students of Healthcare (MINDS) for health care students and providing recommendations for pharmacy residency programs. As a program director, Dr. Cadiz focuses on the development of realistic and effective strategies to eliminate burnout and foster well-being in her pharmacy residency training program.

A medication therapy management residency rotation adjusts to coronavirus disease 2019 constraints

The purpose of this commentary is to describe the Johns Hopkins Home Care Group’s (JHHCG) Community-based Pharmacy Residency Medication Therapy Management (MTM) rotation, summarize adjustments made to the rotation after the onset of the coronavirus disease 2019 (COVID-19) pandemic, describe key learnings from the adjustments, and provide a call to action for other residency programs seeking to improve their rotations amidst pandemic restrictions. MTM clinical pharmacists at JHHCG collaborate with patients to identify barriers to adherence, review medications, and develop plans for improvement. Through improved medication adherence, the goals for this program are to reduce adverse effects, patient cost, and medical visits or hospital admissions. Central to this practice is the belief that strong patient relationships are necessary to uncover the root cause of medication nonadherence. In Postgraduate Year-1 (PGY-1) community-based pharmacy residency training, new pharmacists learn the value of building relationships with patients and working through complex problems during this clinical experience. By assisting patients with complex medical conditions and social situations, new pharmacists gain skills in patient care, pharmacy operations, and medication access challenges. As the COVID-19 pandemic forced the discontinuation of face-to-face interactions in this setting, rotation experiences for residents were adapted with the goal of continuing high-impact patient interactions and keeping everyone involved safe. Although considerable changes were made to the MTM rotation because of the COVID-19 pandemic, residents were still able to provide meaningful clinical care telephonically and continued to learn valuable patient care skills. Most importantly, high quality care was still delivered to the patients despite considerable challenges. The major challenge for the residents’ clinical experiences as a result of the adjustments has been finding an impactful volume of complex patients to enhance their skills. Other residency programs are encouraged to consider three recommendations to improve their rotations moving forward.

Pharmacy residency directors' concerns with implementing in‐training examinations in pharmacy residencies

AbstractIntroductionThe use of in‐training examinations as formative assessment in graduate medical education is commonplace and performance has varying degrees of positive correlation with physician performance on future board certification examinations. Such a formative tool does not exist in graduate pharmacy education and may be a useful tool to consider developing and implementing into pharmacy residency programming.ObjectivesTo evaluate the concerns of residency program directors (RPDs) should they be faced with implementing an in‐training examination into their postgraduate year 1 (PGY1) pharmacy residency program.MethodsThe concerns‐based adoption model framework was used to conduct a mixed‐methods evaluation of RPDs' concerns about in‐training examinations in pharmacy residency training. RPDs from the eastern United States were invited to participate in a 35‐item survey, followed by a scripted interview to learn about their concerns with the idea of examination integration.ResultsTwenty‐four program directors completed the stages of concern (SOC) quantitative survey and seven continued on to complete the levels of use qualitative interview. Survey data identified that program directors were in the informational stage, requiring more information and understanding before implementing such an assessment tool. The qualification of their survey responses contained themes of equality and equity between participating programs, the difference between summative and formative assessment, and curriculum changes that would accompany such a programmatic change. All participants were in the early SOC and had not actively sought information about this practice before being part of this research.ConclusionSignificant efforts will be required to inform RPDs about in‐training examinations and formative assessment practices leading up to the implementation of such a practice in graduate pharmacy education.

A Research Partnership to Enhance Postgraduate Pharmacy Residency Training Outcomes.

Pharmacy residents must complete research as part of their program; however, challenges exist in providing experiences that result in successful research dissemination outcomes. A university-based research team, integrated into an ambulatory care pharmacy residency program aimed to improve presentation and publication rates of pharmacy resident research projects. Data on the number of postgraduate year-2 (PGY2) residents and their productivity were collected and summarized to assess progress. A total of 13 residents completed their residency over seven years. Each resident produced one regional presentation, and one national presentation beginning in year four. To date, three peer-reviewed papers have been published, with another one in-press. Responses from residents found lack of guidance, lack of data availability for projects and feedback fatigue were barriers to a positive research experience. To address these problems, a university-based research team was integrated to provide research mentor guided support, ensure study feasibility, and provide structured feedback. This program evaluation highlighted the integration of a PGY2 ambulatory care pharmacy residency with a designated, interprofessional university-based research team. Future work is warranted to reduce research-related barriers and formally evaluate resident post-program knowledge, skills, and subsequent dissemination rates.

Integrating simulation into advanced pharmacy practice experience curriculum: An innovative approach to training

BackgroundThe use of simulation-based education (SBE) in pharmacy education can help students acquire the essential clinical knowledge and skills for practice and can enhance patients' safety. Simulation-based training has been implemented in inter-professional education training, introductory pharmacy practice experiences, pharmacy residency training. Still, there is limited information in the literature that assesses the use of simulation in advanced pharmacy practice experience (APPE). ObjectiveTo evaluate the impact of integrating SBE into APPE on students' learning outcomes, training costs, and satisfaction. MethodThis study presents a new training model of a 5-week clerkship experience where sixth-year pharmacy students alternate between hospital wards and simulation rooms. Student assessment rubrics were used to measure students’ achievements and report faculty feedback. Students filled scenario evaluation forms to assess their simulation satisfaction rate. ResultsA total of 57 students completed a full block of simulation-based, followed by hospital-based blocks practicing in the same medical specialty in both blocks. This newly structured experience provided fourteen direct patient care training seats per rotation and saved around 25,000 Saudi Riyals per rotation. The mean grades in both simulation and hospital-based blocks were mostly above 90% in all learning outcomes. Cognitive skills and affect learning outcomes mean grades were higher in the simulation-based group—most of the students being satisfied with the simulation scenarios. ConclusionSBE integration into APPE can supplement hospital-based experiential training to achieve the best learning outcomes with improved students' satisfaction.

Evaluation of pharmacy resident perceived impact of natural disaster on stress during pharmacy residency training

IntroductionNatural disasters present unique challenges for healthcare training programs. Limited literature has been published regarding the impact of natural disasters on pharmacy residency training. The objective of this study was to determine the degree of perceived impact natural disasters have on pharmacy resident stress and which factors contribute to any perceived change in stress. MethodsA cross-sectional study was conducted via a survey distributed to pharmacy residents whose program was located in an area potentially affected by natural disaster in the first six months of the 2017–2018 resident year. A modified Likert scale utilizing a 10-point scale was used to assess resident stress. Potential sources of stress were assessed via multiple-choice questions. The primary outcome was the degree of change in resident perceived stress compared to baseline during and after the natural disaster. ResultsOne hundred twenty-nine pharmacy residents completed the survey. Stress increased from baseline during the natural disaster and remained elevated after compared to baseline. Main sources of stress were increased residency workload, natural disaster preparation and recovery, and concerns regarding friends and family. Half of residents reported their residency program did not have an established natural disaster policy in place. ConclusionsImproved planning and communication regarding workload expectations may minimize stress among residents balancing increased personal responsibilities during times of natural disaster.

A Pharmacotherapy Scholars Program to Provide Intensive Training to Enhance Pharmacy Students’ Postgraduate Readiness

Objective. To design, integrate the curriculum for, and evaluate an innovative program to facilitate placement of students into postgraduate pharmacy residency training programs involving direct patient care. Methods. The Pharmacotherapy Scholars Program (PSP) was designed to prepare fourth-professional year students to become highly proficient in a direct patient care role and to successfully match with postgraduate residency training programs. The following elements were included in the year-long curriculum: integrated synchronous advanced pharmacy practice experiences with personal advising, team-based mentoring, peer-to-peer learning, longitudinal research, and professional development. Program goals were modeled after the accreditation standards for postgraduate year one (PGY1) pharmacy residency programs. Program faculty members ensured that the PSP had a broad scope, included rigorous student assessments, had a strong research focus, and provided scholarship opportunities. Results. Sixty-eight students completed the program from fall 2013 through spring 2019. The overall residency match rate was 93%. Students' performance on both knowledge and clinical skills assessments significantly improved after completing the program. There was an approximately 15% increase in knowledge and a 30% improvement in clinical skills based on comprehensive readiness assessments and an intermittent clinical examination that used patient simulation, respectively. Conclusion. The Pharmacotherapy Scholars Program is an innovative training program designed to enhance PharmD students' preparation for advanced clinical training. Students who completed the PSP achieved a high PGY1 residency placement rate while demonstrating significant improvements in pharmacotherapy knowledge and clinical skills in direct patient care activities.

Impact of Incorporating Pharmacy Residents Into a Pharmacist-Managed Culture Review Service During Weekend Staffing Commitments

Background: Clinical pharmacy continues to rapidly evolve as does the need to incorporate unique learning opportunities in pharmacy residency training (eg, transitions of care). Objective: To describe the impact of incorporating pharmacy residents into a pharmacist-managed emergency department culture review service (CRS). Methods: This retrospective study included 500 cultures with positive results evaluated by a pharmacy resident during weekend staffing shifts for patients discharged from the emergency department or urgent care center (UCC). The primary outcome of this study was the number of interventions performed by pharmacy residents. Results: Of the 500 cultures evaluated, 275 (55%) required action by the pharmacy residents, resulting in 233 interventions. Modification of antimicrobial therapy occurred 70 times. When surveyed, a majority of residents strongly agreed that the CRS had a positive impact. Based on evaluations, residents achieved mastery of pertinent residency performance objectives. Conclusion: Incorporation of pharmacy residents into a pharmacist-managed emergency department CRS promotes safe and effective medication use to patients discharged from an emergency department or UCC while providing residents additional experience in designing a therapeutic regimen, providing education to patients, and communicating with health-care teams to manage medication therapy.

An opinion paper of the Cardiology Practice and Research Network of the American College of Clinical Pharmacy: Recommendations for training of cardiovascular pharmacy specialists in postgraduate year 2 residency programs

AbstractPharmacists in direct patient care settings are expanding their roles and responsibilities. These changes mandate a deeper and broader understanding of disease states, as well as influencing social, behavioral, and environmental factors. Existing guidelines and accreditation standards related to the training of graduate or cardiovascular pharmacist specialists (ie, Accreditation Council for Graduate Medical Education, American Society of Health‐System Pharmacists, American College of Clinical Pharmacy [ACCP]) provide some guidance on essential competencies. However, they stop short of providing recommendations for how to achieve all the objectives. The purpose of this paper is to build upon existing guidelines/standards, describing our recommendations for pharmacy residency training of a cardiovascular clinical specialist. The paper is broken down into the following sections: (1) Skills and Competencies (Building Clinical Skills, Application of Clinical Knowledge and Skills, Drug Information, Research and Scholarship, Teaching Skills, Interpersonal, Communication, and Presentation Skills), (2) Personal and Professional Growth (Growing Interpersonal Skills, Engaging with the Profession), (3) Program Design (Resident Selection, Preceptors and Mentoring, Expectations for Progress/Milestones, Program and Learning Experience Structure), and (4) Clinical and Therapeutic Content Expertise or Medical Knowledge. After each recommendation, specific details are provided to aid in conceptualizing how each can be achieved. Some recommendations are considered essential whereas others are designated as optional. This paper represents the opinion of the Cardiology Practice and Research Network of the American College of Clinical Pharmacy. It does not necessarily represent an official ACCP commentary, guideline, or statement of policy or position.

A marathon, not a sprint: Growth and evolution of community‐based pharmacy residency education and training

AbstractCommunity‐based pharmacy residency programs, which emerged over 35 years ago, have grown to 218 programs to be the second largest first‐year postgraduate pharmacy residency education and training program in the United States. This paper is intended to provide a history and current status of community‐based pharmacy residency education and training. Multiple major milestones and activities, including funding, advisory panels, training for meeting the Accreditation Standard and other resources have contributed to the evolution of community‐based pharmacy residency programs. Over the years, the community‐based residency program education and training guidelines and standards have changed to focus on the individual. This focus has resulted in the emergence of new practice sites for training such as health‐system community pharmacies and federally‐qualified healthcare centers. The longitudinal learning experiences of the Standard enable residency graduates to function as community‐based pharmacist practitioners (CPPs). CPPs provide leadership and patient care services to meet the needs of patients in the communities that they serve. The next generation of CPPs will lead the advancement and transformation of community‐based pharmacy practice and provide increased access to care and improved patient outcomes.

AJHP names Cesarz contributing editor.

AJHP welcomes Joe Cesarz, M.S., Pharm.D., director of ambulatory pharmacy services at UW Health in Madison, Wisconsin, as the journal’s first-ever contributing editor for specialty pharmacy. “I am honored and excited to serve the profession in this role,” Cesarz said. “Given the continued importance of specialty pharmacy to health systems, there is a need for resources and increased dialogue to support initiatives related to this area of practice.” Under Cesarz’s direction, UW Health’s specialty pharmacy team supports inpatient and ambulatory care throughout the integrated health system, including its community pharmacies, ambulatory care clinics, mail-order pharmacy, and infusion service. Cesarz led the establishment of UW Health’s postgraduate year 2 specialty pharmacy residency training program. He said creating the residency, achieving ASHP accreditation, and watching the program and its graduates develop has been highly rewarding personally and professionally. AJHP Editor in Chief Daniel J. Cobaugh said Cesarz’s appointment to the editorial board “is critical to the journal’s ongoing efforts to publish cutting-edge specialty pharmacy content, which supports ASHP members as they provide high quality care to their patients.”

Evaluating a measure of the research training environment in a sample of pharmacy residents

IntroductionWhile an important predictor of future research involvement, formal assessment of the quality of the research training environment in pharmacy residency training has not been examined. The objective of this study was to evaluate the psychometric properties of a modified version of the shortened form of the revised Research Training Environment Scale (RTES-R-S) in pharmacy residents. MethodsThe original wording of the 18 items from RTES-R-S was modified to reflect pharmacy residency training. Data were collected as part of a larger study involving a random sample of pharmacy residents in the United States during the 2016–2017 residency year. Internal consistency was assessed with Cronbach's α. Confirmatory factor analysis was used to assess the fit of the factor structures examined previously during the original RTES-R-S development. ResultsBased on confirmatory factor analysis, the preferred model proposed a single, second-order factor predicting nine factors reflecting Gelso’s previously described ingredients of the research training environment. This model had acceptable fit indices and was statistically better than models without second-order factors. Cronbach's α for the global scale was 0.86, with the two subscales >0.7. ConclusionsMinor rewording of an existing instrument to measure residents’ perceptions of the quality of the research training environment demonstrated acceptable internal consistency. The factor structure of the recommended use proposed by the original developers of the RTES-R-S was supported in this sample of pharmacy residents. Continued work with additional samples is needed to generate additional validity evidence supporting the use of this tool in pharmacy residents.

Publish or perish: Success with publication in pharmacy residency training

Background and purposePharmacy residency training standards require development of medical writing skills. These skills are fundamental to pharmacy clinicians and scholars alike. Despite this requirement, new practitioners and seasoned clinicians frequently struggle with scholarly development and manuscript generation for a variety of reasons, ranging from lack of experience or familiarity with the process of peer-review submission to time constraints. Educational activity and settingWe describe a process for fostering pharmacy resident scholarship and publication utilized at Robert Wood Johnson University Hospital, including the stages of the project development process and corresponding responsibilities during each phase of the manuscript submission process. From identification of interest, to project and manuscript development, review, submission, revision, and reflection, our postgraduate pharmacy residents receive guidance and structure from a preceptor mentor to usher them through this experience for the first time. FindingsThe program has had success utilizing this structured approach to supporting residency publication efforts, with the preparation of 23 manuscripts that have resulted in peer-reviewed publications from 28 residents graduating between 2013 and 2017. This results in a resident authorship rate of 82%. SummaryAlthough medical writing and manuscript development may not be an intuitive process, it is imperative that preceptors and individuals interacting with postgraduate pharmacy trainees consider exposing their trainees to this process, with foresight into thinking about a structured approach to publication at the onset of project development.

Professional development series in postgraduate pharmacy residency training: Experiences and opportunities

IntroductionThe American Society of Health-System Pharmacists (ASHP) identifies competency areas that categorize clinical and non-clinical skills to develop during postgraduate residency training. To address the competency areas related to non-clinical skills, some residencies have developed programs to focus on interpersonal, leadership, and other professional skills. There is limited guidance in the literature regarding the development or impact of these programs. PerspectiveProfessional development series have been implemented at two academic institutions to support the development of non-clinical skills during postgraduate residency training. While these programs address many of the non-clinical skills described in the competency areas, barriers such as program support, logistics, and need for assessment may impede the creation, growth, and success of similar programs. ImplicationsWith the continued increase in the number of residency programs and trainees, scalability and sustainability are vital components for the success of professional development programs. Assessment of the impact of current programs and further guidance from pharmacy organizations regarding important aspects of professional development would help standardize this process.

Continuity of Specialty Pharmacy Practice: A Survey of PGY-2 Pharmacy Residency Graduates

Background: Literature regarding career trajectory for postgraduate year 2 (PGY-2) pharmacy residency specialty–trained pharmacists is limited. Objective: The objective of our study is to describe PGY-2 pharmacy residency training on career practice and satisfaction. Methods: A cross-sectional study surveyed graduates of PGY-2 pharmacy residency programs. Respondents were identified by current PGY-2 residency program directors requesting participation from their program alumni. The primary outcome was whether PGY-2 residency–trained pharmacists continued working within their specialty or not. Secondary outcomes included alternative specialty areas, current satisfaction with their specialty, and the necessity of completing a PGY-2. Results: Among 647 respondents, 84% completed their program in the past 6 years. The top 3 represented pharmacy specialties were critical care (19%), ambulatory care (14%), and oncology (13%). Most respondents continue to practice in the same specialty as their PGY-2 residency program (n = 572, 87%) compared with pharmacists who currently practice in other clinical specialties or areas of pharmacy (n = 83, 13%). Critical care (n = 28, 33%) had the largest specialty response no longer practicing in their PGY-2 residency program specialty with 42% (n = 12) now practicing within the emergency medicine specialty. The average satisfaction for their current specialty was 4.7 ± 0.82 (Likert scale of 1 = extremely dissatisfied to 5 = extremely satisfied). Conclusions: The vast majority PGY-2 pharmacy residency–trained pharmacists experienced training-practice concordance and are satisfied with their trained specialty. Among those with specialty training practice discordance, critical care training was most prevalent.

Breadth of Statistical Training Among Pharmacy Residency Programs Across the United States.

Background: Pharmacy residents' knowledge of biostatistics is a self-identified deficit. Objective: To describe statistical training practices across postgraduate year 1 (PGY1) pharmacy residency programs and correlate training practices with residency program directors' (RPDs) confidence in their residents' statistical abilities. Methods: A 13-item survey was sent to PGY1 RPDs and included questions regarding respondents' institution, program characteristics, type and amount of statistical training offered and desired, as well as performance of statistics, resident project publication rates, and RPDs' confidence in residents' statistical abilities. Results: Of the 1054 RPDs invited to participate in the survey, 202 (19.7%) surveys were completed. Nearly 25% of PGY1 pharmacy residency programs in this sample offered no statistical training to their residents. The most common types of training were study design considerations/selecting statistical tests (64.9%), descriptive statistics (59.9%), and database development/data manipulation (46.6%). The majority (60.9%) of RPDs had low confidence in their residents' abilities to perform their own statistical analysis. After adjusting for significant covariates, residents receiving complex statistical training (odds ratio [OR]: 6.76; 95% confidence interval [CI]: 2.7-24.9) and a publication rate >50% (OR: 5.63; 95% CI: 1.61-19.69) were associated with higher RPD confidence in residents' abilities to perform statistical analyses. Conclusion: The sample of programs in this survey indicates that statistical training for many residents may be limited, and many RPDs are not confident in their residents' abilities to perform statistical analysis of research projects. Statistical training and opportunities to enhance research skills may be an area for future growth in pharmacy residency training programs.

Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience.

Purpose: The purpose of this study was to utilize lean process improvement principles to enhance the health-system pharmacy administration learning experience within a postgraduate year 1 (PGY1) residency program. Summary: The Richard L. Roudebush VA Medical Center adopted the use of lean to improve customer service and workplace efficiency. The Residency Advisory Council, overseeing the 6 pharmacy residency programs, felt that training residents in a proven process improvement technique would benefit the service and assist in developing problem-solving skills. Yellow Belt training was incorporated into the residency programs in 2012, and the Yellow Belt project for the 2014-2015 residency class was the modification of the PGY1 Health-System Pharmacy Administration learning experience. Residents focused on a few key areas as part of their completion plan: educating residents and preceptors on the importance of leadership activities, establishing a list of consistent topic discussions to be held during the administration learning experience, confirming a topic list for the pharmacy practice management and leadership seminars, piloting collaborative precepting for the administration experience, revising the staff development program, and increasing resident involvement in the PGY1 interview process. Two portions of the project lacked effective and timely communication, and as a result, those areas were not fully implemented. The remainder of the items achieved 100% completion. Conclusion: Lean techniques were effectively utilized within a residency program to enhance the health-system pharmacy administration learning experience. Successful implementation of lean requires engagement of stakeholders within the health-system, timely communication, frequent reassessments, and accountability.