Pharmacy Residency Research Articles

Building a robust pharmacy research program: Reflections from a large healthcare system not affiliated with a college of pharmacy

AbstractProfessional standards for academic health care system pharmacy departments and clinical pharmacists advocate for research and scholarly activities. Developing and sustaining a research program in a clinical pharmacy department is challenging. Over the span of a decade, a robust pharmacy research program was developed in an academic medical center not affiliated with a college of pharmacy. The aim of this manuscript is to provide a framework suitable for scaling research in pharmacy departments within an academic medical center. Objectives to accomplish the aim includes describing the structure and evolution of the clinical pharmacy department research program, listing measurable outputs and achievements of the pharmacists and the program and describing the barriers encountered and solutions that were enacted to overcome them. Elements critical to building and sustaining a research program in the pharmacy department included long‐term commitment from within the department, a departmental research infrastructure, support from institutional leadership, research funding from the institution, and a growth mindset in accordance with company initiatives to support evolving research needs. A research curriculum was developed for pharmacy residents and pharmacists, created electronic tools for research proposal scientific reviews and allocation of funds, and established departmental research career development awards that allowed for protected time to pursue research and professional development. Over the first 10 years of the program, publication rates grew more than three‐fold, faculty appointments and promotions increased approximately five‐fold, and pharmacist investigators obtained extramural federal funding. Further offsetting clinical workload relative to dedicated research time remains a challenge. The experience and success at this academic medical center suggest it is feasible to develop a robust, sustainable clinical pharmacy department research program.

Interprofessional Curriculum Delivery: Experience of a Primary Care Education Program.

Few post-graduate training programs offer a comprehensive curriculum that includes structured clinical experiences to teach interprofessional care. To address this need, the United States Department of Veterans Affairs, Office of Academic Affiliations funded the Centers of Excellence in Primary Care Education (CoEPCE) from 2011-2019 to provide interprofessional curricula for health profession trainees (HPTs), including physician residents, nurse practitioner residents, pharmacy residents, and psychology residents. We examined changes over time in curricular domains, system impacts, and program practices based on HPT survey data and the qualitative evaluation of narrative feedback. An annual survey was administered to participants. Indirect standardized ratios were calculated for interprofessional professional education (IPE) program domains, system impacts, and program practices. Qualitative responses were coded based on curricular domains and key program components. The study cohort included 369 HPTs. Site and profession standardized indirect ratios across all professions indicated improvements in curricular domains, system impacts, and program practices, with significant differences observed for associated health HPTs as compared to other HPTs for performance improvement. Qualitative data indicated that profession was associated with differences in perceptions of the curriculum. Although improvements occurred over time, our findings support the need for the thoughtful consideration of profession-specific identity characteristics when designing interprofessional curricula.

Promoting diversity, equity and inclusion awareness in clinical documentation through postgraduate year one training

Background and purposeAs healthcare providers increasingly focus on emerging issues of diversity, equity and inclusion (DEI) in patient care, less is known about the training in postgraduate year one (PGY1) pharmacy residency on DEI clinical documentation considerations. This pilot project explored whether training, discussion and self-reflection within a peer review activity promoted DEI self-awareness in clinical documentation through a centralized curriculum of a multisite PGY1. Educational activity and settingBuilding upon an established peer review of clinical documentation activity, PGY1 pharmacy residents practicing in ambulatory care settings received training on DEI considerations and completed small and large group discussions, a post-activity mixed methods survey with self-reflection prompts, and a three-month follow-up survey. FindingsTwenty-two residents participated in the peer review of clinical documentation activity, DEI training and discussions. Twelve residents completed the post-activity survey with reflection prompts; 6 (50%) reported similar previous DEI training prior to residency. After the DEI training and discussions, 12 (100%) agreed or strongly agreed that their awareness of DEI documentation considerations increased; 10 (83%) would document their submitted notes differently, while one resident was unsure and one would not make changes. Twelve residents completed the follow-up survey three months following the activity. Themes from the free-text responses on key learnings collected post-activity and three-month post (respectively) included: 1) new knowledge, increased self-awareness, and intended action and 2) increased self-awareness and changes in note-making convention. SummaryIntegrating DEI training, discussion, and self-reflection prompts into a peer review clinical documentation activity increased self-awareness and knowledge of DEI considerations and promoted intended changes in patient care documentation for pharmacy residents. Regardless of previous training, residents reported continued self-awareness and changes in documentation conventions continued three months later.

587 Pharmacy Residents Have a Significant Impact on Process Improvement at Verified Burn Center

587 Pharmacy Residents Have a Significant Impact on Process Improvement at Verified Burn Center

Perceptions, knowledge, and perceived barriers to practicing evidence‐based medicine among pharmacists in Japanese community hospitals: A cross‐sectional multicenter survey

AbstractIntroductionEvidence‐based medicine (EBM) skills are required for pharmacists. However, the current status of EBM skills and its education in Japanese pharmacists remains unknown.ObjectivesWe investigated the perceptions, knowledge, and barriers for EBM in Japanese pharmacists.MethodsWe conducted a cross‐sectional survey of pharmacists employed by four community hospitals in Japan. A questionnaire including 55 questions to evaluate pharmacists' perceptions, knowledge, exposure, access, terminology, and barriers for EBM was developed based on our previous research.ResultsThe questionnaire was provided to 70 pharmacists and the response rate was 90% (n = 63). Regarding the 5As (Ask, Acquire, Appraise, Apply, Assess) skills, only 30.2% of pharmacists were confident in their skills for Ask, 17.5% for Acquire, 19.0% for Appraise, 34.9% for Apply, and 25.4% for Assess. Additionally, although less than 20% of pharmacists felt comfortable teaching EBM to pharmacy residents and were confident to explain to others any EBM‐related terms, more than 90% of the pharmacists recognized the importance of EBM education for patient care. Furthermore, they reported many barriers to EBM, such as skills, statistical knowledge, training, English, and opportunities to practice EBM.ConclusionAlthough most Japanese pharmacists in this study were not confident in their EBM skills and in teaching them, they acknowledged the importance of EBM. Our study suggests that providing EBM training, and the clinical roles and responsibilities could address the identified barriers, such as, lack of skills, knowledge, and opportunities to practice EBM, and pharmacists could better embrace EBM in their practice to optimize patient care.

Comment on “Landscape of board certification preparation in pharmacy residency programs”

Comment on “Landscape of board certification preparation in pharmacy residency programs”

Clinical Pharmacist-Led Medication Review in Hospitalized Confirmed or Probable Patients with COVID-19 During the First Wave of COVID-19 Pandemic.

Drug-related problems (DRPs) result in serious problems among hospitalized patients, high rates of morbidity and mortality, and increased healthcare costs. This study aimed to identify DRPs by clinical pharmacist-led medication review in hospitalized probable patients with coronavirus disease-2019 (COVID-19) during the first wave of the COVID-19 pandemic. This retrospective cross-sectional study was conducted at the COVID-19 inpatient services of a tertiary university hospital in Türkiye for 3 months (between March 2020 and June 2020) and included hospitalized confirmed or probable COVID-19 patients. The World Health Organization and Turkish Ministry of Health Guidelines case definitions were used to define confirmed and probable COVID-19 patients. Six clinical pharmacy residents provided medication review services during their education and training. DRPs were classified based on the Pharmaceutical Care Network Europe V9.00. The physician's acceptance rate of clinical pharmacists' recommendations was assessed. Among 202 hospitalized patients with probable or confirmed COVID-19, 132 (65.3%) had at least one drug-related problem. Two hundred and sixty-four DRPs were identified. Drug selection (85.6%) and dose selection (9.2%) were the most common causes of these problems. Among the 80 clinical pharmacist interventions, 48.8% were accepted by the physicians. Clinical pharmacists identified a significant number of DRPs during the COVID-19 pandemic, particularly those related to drug interactions and drug safety, such as adverse drug reactions. This study highlights the importance of detecting and responding to DRPs in the COVID-19 pandemic.

Evaluation of a community-based pharmacy resident-led continuous glucose monitoring program within a family medicine clinic

BackgroundPharmacist-driven continuous glucose monitoring (CGM) is associated with reduced hemoglobin A1c (HbA1c) and achievement of daily glycemic goals. Community-based pharmacists are well-positioned to improve CGM uptake among patients with diabetes due to their accessibility and expertise. However, little data exists evaluating the outcomes of CGM services led by a community-based pharmacist. ObjectiveTo evaluate the impact of a community-based pharmacy resident-driven CGM service on HbA1c, revenue, and patient satisfaction. Practice DescriptionIndependent community pharmacy sharing a clinical services agreement with a primary care clinic for Postgraduate Year One (PGY1) Community-based Pharmacy Residents to provide patient care under general supervision of the physician. Practice innovationPatients were offered CGM services if they were 18+ years with an HbA1c > 7.0% and had insurance coverage for CGM. Enrolled patients engaged in three months of pharmacist-led appointments for CGM application, data interpretation, diabetes education, and lifestyle management. Current Procedural Terminology (CPT) codes 99211, 95250, or 95251 were billed based on each encounter. HbA1c values were collected at program enrollment and conclusion. Patients completed a satisfaction survey at program conclusion. Evaluation methodsDemographics and billed CPT codes were collected from the electronic health record. Descriptive statistics were used to analyze data. ResultsEighteen patients were included. A mean reduction of 1.2% occurred in HbA1c (n = 12; 9.7%−8.5%). Forty CPT codes were billed, generating $3671.40 of revenue. Satisfaction surveys were collected for 50% of participants (n = 9). Most were satisfied with the CGM service and its individual components (n = 8, 89%). Most were willing to continue using CGM devices and receive diabetes education from a pharmacist (n = 8, 89%). ConclusionA community-based pharmacist-led CGM service demonstrated a reduction in HbA1c and generated revenue for the clinic. Patients reported satisfaction and willingness to continue the service.

Publication of pharmacy resident research projects: A systematic review and meta-analysis.

Pharmacy residents often aspire to develop research skills through conducting a research project. Project publication rates among pharmacy residents are variable and at times low; however, previous studies have been limited to specific geographic regions and timeframes. This study sought to conduct a systematic review and meta-analysis to determine the proportion of pharmacy resident research projects published in the peer-reviewed literature. A systematic review of PubMed MEDLINE, Embase, and the Web of Science Core Collection was performed from database inception to May 25, 2023. Articles were included if they were full-text, peer-reviewed manuscripts of original research presenting observational data regarding pharmacy resident research project publication rates. Data extraction and assessment of risk of bias were conducted by 2 independent reviewers. A proportional meta-analysis using a random effects model of the included studies was conducted to generate a pooled, overall proportion. The search yielded 5,225 records and 12 articles that met the inclusion criteria. All studies were retrospective and observational. Risk of selection and cohort identification biases was "high," whereas that of detection and timeframe biases was "low." The included studies represented 6,990 resident research projects, 777 of which were published in the peer-reviewed literature. Publication rates across individual studies ranged from 1.8% to 36.2%. The pooled proportion (scale of 0 to 1) of projects published was 0.13 (95% CI, 0.09-0.19). Pharmacy resident research project publication rates are low at 13%. Furthermore, studies reporting project publication rates over time suggest a neutral or negative trend in publication rates despite an exponential increase in the number of pharmacy residents.

Implementation and evaluation of a learner-driven leadership initiative for pharmacy students and pharmacy residents.

Introduction: Leadership training is a crucial component of the pharmacy education curriculum. The Accreditation Council for Pharmacy Education (ACPE) emphasizes and encourages the use of different leadership initiatives, and universities employ tactics with varying levels of success to implement these initiatives. "Leadership theory" debates if leadership can be learned or if it is a natural-born skill. This article explores learned leadership and describes a small study deployed to different levels of pharmacy learners to foster leadership confidence and self-awareness. Educational Context and Methods: Second- and third-year didactic students in a leadership elective, voluntary fourth-year Advanced Pharmacy Practice Experience (APPE) students on an ambulatory care rotation, and first postgraduate year (PGY1) pharmacy residents were included in this initiative. Each cohort facilitated a leadership book club discussion and completed professional development activities over the course of their experience. Learners' perspectives on leadership were surveyed utilizing a pre-post survey study, administered prior to beginning the initiative and after completing the initiative. Findings and Discussion: Results demonstrated learners' perceived confidence and self-awareness in their leadership skills increased from pre-survey to post-survey. Evaluation of qualitative responses exhibited that participants found value in adding more leadership development to their pharmacy training. Most participants noted leadership book discussion facilitation as the most valuable part of the initiative and posited they would utilize skills gained through these discussions nearly every day in their careers. Results suggest PGY1 pharmacy residents showed the most significant increase in their scores from pre- to post-study, while didactic students showed the least significant increase. Implications: Our findings suggest learner-driven leadership initiatives, specifically learner-facilitated book club discussions, are beneficial to incorporate into both didactic and experiential coursework. Implementation of these discussions could be applied in many aspects of the curriculum with minimal resources and a reasonable expectation of perceived benefit to student leadership development.

Exploring the Value of Medical Affairs Learning Experiences for Pharmacy Students and Residents

The objective of this article is 3-fold: to strengthen the understanding of medical affairs (MA) among pharmacy professionals; to provide greater visibility into the value experienced by educators, learners, and the practice of pharmacy across the health care ecosystem when MA learning opportunities are available; and to provide a framework for organizations who seek to establish an MA experiential rotation. The authors collated information from published literature, anecdotal experience, and interviews with experiential education leaders from several colleges of pharmacy. As a result, the article summarizes the current perceptions of MA practice among educators and students and highlights how MA experiences may support pharmacy learners in the future.

Identifying factors that influence the selection of a postgraduate year 2 ambulatory care residency program

AbstractIntroductionStudies have been conducted to evaluate motivating factors for pharmacy students in pursuing a postgraduate year 1 (PGY1) residency program. Currently, no literature assesses the factors driving the selection of a specific PGY2 ambulatory care (AC) pharmacy program.ObjectivesThe primary objective of this study was to identify factors driving the selection of a specific PGY2 AC pharmacy residency program. Secondary objectives were to describe whether these driving factors have changed throughout the residency year, the impact of remote work in the selection of a PGY2 AC program, and the impact of resident well‐being in the selection of a PGY2 AC program.MethodsA questionnaire was electronically distributed to 199 American Society of Health‐System Pharmacists residency program directors (RPDs) of PGY2 AC programs in March 2023. The RPDs were asked to forward the questionnaire and reminder emails to their current PGY2 AC residents. The questionnaire included a combination of categorical, Likert‐type, open‐ended, and demographic questions. Descriptive statistics were used to analyze the results.ResultsIn total, 72 PGY2 AC residents responded, providing a response rate of 27%. The mean age was 26 (±1.30) years, 69% identified as female, and 57% practiced in an urban setting. The top three factors that influenced the selection prior to the ASHP Match were culture of the program, perceived positive resident morale, and mentorship provided by RPD and preceptors. These factors remained the most influential after being in residency for approximately 8–9 months. The ability to work from home or remotely, complete a teaching certificate program, and conduct telehealth visits were the least influential factors.ConclusionAn understanding of the factors that were most influential in the selection of a PGY2 AC program provides a unique resource to RPDs, allowing them to better position their program for future candidates.

Characterizing redundancy in pharmacy residency research projects.

Each year, roughly 5,000 residents conduct research on clinical and practice-based topics to meet the requirements of the ASHP residency standards related to research and project management. Several investigators have evaluated residency research project publication rates, but redundancy among projects has not been evaluated. The primary objective of this study was to determine the rate of redundancy among pharmacy residency research projects. This was a retrospective cohort analysis of abstracts accepted to various regional pharmacy residency conferences from 2017 through 2020. Each abstract was placed in a pharmacy domain by therapeutic area. The categorized data for each year were then further evaluated to identify clinical categories for the year. Topics were labeled as redundant if at least 10 projects fell into the same focus area within a clinical category. Descriptive statistics were used to quantify the incidence of redundancy each year. A total of 4,027 abstracts were included. The most common pharmacy domains were infectious disease, internal medicine, and benefit of pharmacy services. Overall, 8.2% projects (332 of 4,027) were categorized as redundant. The most common focus areas were rapid diagnostics, opioid reduction protocols, and vancomycin area-under-the-curve vs trough monitoring. Pharmacy residency research projects encompassed topics across a wide range of pharmacotherapy areas. Approximately 1 in 12 projects was redundant. This is likely because the project addressed a "hot topic" in practice and may represent an opportunity for institutions to collaborate to optimize project efficiency and impact.

Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback

Inpatient hyperglycaemia is associated with an increase in morbidity and mortality, number of rehospitalisations and length of hospitalisation. Although the advantages of proper glycaemic control in hospitalised patients with diabetes...

Development and implementation of an in-hospital pharmacist emergency response simulation training curriculum

BackgroundMedical simulation is an effective educational tool used to increase confidence, improve knowledge, and refine skills when responding to high-acuity situations. Despite established roles of the pharmacist on the hospital code team, most institutions lack formalized pharmacist training for code team responses. ObjectiveThis pre-post analysis aimed to evaluate the impact of a didactic and simulation-based code response training for pharmacists on self-perceived improvement and preparedness when responding to in-hospital medical emergencies. MethodsAn emergency response curriculum (ERC) was developed for pharmacists and pharmacy residents at our institution. The curriculum, led by 4 lead clinical pharmacy specialists, included a 60-minute didactic code competency lecture followed by 2 medical emergency simulations and a debrief after each scenario. After completion of the simulation portion of the ERC, participants were given a survey to complete that assessed their confidence using a 5-point Likert scale (1 = very unconfident to 5 = very confident) in completing the course objectives before and after the ERC. ResultsSeventy-two pharmacists completed the ERC and 60 completed the postcourse survey. Of those who completed the postcourse survey, 70% were pharmacy residents. Using a 5-point Likert scale (1 = very unconfident to 5 = very confident), median participant confidence rose from 3 (interquartile range [IQR] 2-4) before the session to 4 (IQR 3-5) after the session (P < 0.001). Of the participants, 95% believed the ERC training should be required annually or multiple times a year and 100% of respondents felt the ERC training was beneficial. ConclusionDevelopment of a pharmacist ERC including didactic and simulation-based learning improved the confidence and preparedness of pharmacists when participating as members of the hospital code team. Future studies should continue to evaluate pharmacist training and curriculum development in code team responses.

Factors associated with attaining a pharmacy residency interview: A scoping review

AbstractPostgraduate pharmacy residencies are essential in preparing graduates for pharmacy careers. Residencies are highly competitive and despite efforts to increase the number of residency programs in the United States, the demand still outweighs the supply. Attaining a residency interview is a critical step in securing a residency position. The objective of this scoping review is to describe the published literature on factors associated with attaining a pharmacy residency interview. The updated Arksey and O'Malley scoping review framework was followed for this scoping review. The review is reported according to The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Protocols and Scoping Reviews (PRISMA‐ScR). The search strategy contained a combination of medical subject headings (MeSH) and keywords from a review of article title and abstracts. The inclusion and exclusion criteria were created a priori. English language studies describing pharmacy residency interview, selection, rubrics, and descriptive, quantitative, or qualitative data were included. Title and abstracts were independently reviewed, followed by independent full‐text reviews. Covidence©, an online systematic review platform, was used in the screening, review, and selection process. Thirteen studies assessing factors associated with a residency interview met inclusion criteria. The majority of these studies (n = 7) analyzed data from residency program director (RPD) surveys. Most of these studies found that RPDs highly value letters of recommendation when evaluating a candidate's application. Three studies analyzed retrospective data. Several studies focused on letters of recommendation. The studies described letters of recommendation, letters of intent, grade point average, and leadership experience as factors associated with attaining a residency interview. Most studies had limitations in generalizability, study design, and heterogeneous data.

Pharmacy residency training program increases residents' confidence in inpatient medical emergency response.

The benefits of pharmacists' involvement in medical emergencies are well established, but optimal methods of training pharmacists for emergency response are unknown. The primary objective of this report is to describe the design and evaluation of a pharmacy resident medical emergency response training (PR-MERT) program for preparing trainees to respond to hospital medical emergencies, including cardiac arrest and rapid sequence intubation (RSI). The PR-MERT program was a year-long longitudinal experience designed to prepare postgraduate year 1 pharmacy residents for medical emergency response. During the first month, the residents completed an orientation session that encompassed several lectures, certification by the American Heart Association in basic life support and advanced cardiovascular life support, standardized simulation scenarios, and mock medical emergencies. The trainees continued to utilize these skills and clinical knowledge through a longitudinal didactic lecture series, resident case conferences, and practice-based application by responding to real-life medical emergencies. Residents were assessed and coached throughout the program by clinical pharmacy preceptors and a "code coach" with extensive medical emergency response experience. After the year-long training, residents completed an anonymous survey assessing self-confidence and the structure of the program. The results showed improved confidence in medication selection and dosing, as well as anticipating the needs of the team and speaking up in cardiac arrest and RSI situations. Residents were satisfied with the training offered and structure of the program. The development of a PR-MERT program at an academic medical center was successful in achieving longitudinal learning objectives and improving residents' confidence in responding to medical emergencies. The implementation of a similar medical emergency training curriculum in inpatient pharmacy residency programs may be beneficial.

Abstract WP75: Interprofessional Medical Education in a Stroke Escape Room to Improve Stroke Education and Communication Skills

Purpose: Acute stroke care requires a foundation of clinical knowledge to quickly recognize symptoms and facilitate rapid, safe treatment. Effective care requires a complex network of communication in a stroke response team. Simulation-based training provides a multimodal approach to learning that reinforces clinical knowledge of stroke and affords the opportunity to demonstrate effective communication skills in critical situations. An interprofessional scenario allows all participants to learn about the different roles required for effective care. Methods: Fifty new graduate nurses participated in a pilot model of a traditional didactic session on stroke knowledge, followed by an “escape room” incorporating this knowledge to solve puzzles. The second iteration was expanded to include incoming neurology PGY-2 residents, registered nurses, and pharmacy residents. After the lecture, participants formed teams including equal numbers of all provider roles. The teams were tasked to complete a timed version of the escape room by solving stroke-based puzzles. The escape room was followed by a debrief of communication skills modeled by TeamSTEPPS. Finally, the same teams were exposed to a simulated “stroke code," which included a focused assessment, interpretation of labs and imaging, and management of barriers to treatment with an end goal of collectively managing a suspected stroke. Results: A 5-point scale was used to assess level of comfort with leadership in initial stroke assessment, management, treatment, and communicating concerns. The average increase in numeric level of comfort was 0.9 (range 0.6 - 1.4). The benefit did appear greater for incoming neurology PGY-2 residents (average increase 1.3, range 0.6 - 1.6) compared to registered nurses (average increase 0.45, range 0.25 to 0.75). Conclusions: Use of an escape room during training for incoming neurology PGY-2 residents, registered nurses, and pharmacy residents provided a novel opportunity to facilitate application of clinical knowledge, leadership, teamwork, shared decision-making, and prioritization of patient safety. Providing interactive sessions in between didactic instruction increased participant engagement and level of comfort with roles in a stroke response team.

Best practices for PGY1 letters of intent: Recommendations from a modified Delphi process.

The aim of this study was to provide consensus recommendations from residency program leaders on letters of intent (LOIs) written by postgraduate year 1 (PGY1) pharmacy residency candidates. A 3-round modified Delphi process was used to determine consensus among PGY1 residency program leaders across the country. A screening and demographic survey was utilized to ensure representation of panelists. The initial items for round 1 of the study were developed using existing published literature, with pilot testing by 2 residency program directors. For each round, respondents rated items on a 7-point Likert scale, with opportunities to provide qualitative feedback and modifications for lower-rated items. For future rounds, items were adjusted based on respondent feedback. Only items meeting predefined consensus were included in the final recommendations. A total of 254 pharmacists were invited to participate in the panel, with 41 completing the demographic and study consent survey. There were 35 participants in round 1, 34 of whom remained for rounds 2 and 3. The panel created 18 LOI recommendations for PGY1 residency candidates. Most recommendations were focused on the content of the LOI, while others were related to formatting. The recommendations from this study can be employed by PGY1 pharmacy residency candidates to enhance their likelihood of success in the residency application process.

A framework for optimizing diversity, equity, inclusion, and belonging in pharmacy residency recruitment for underrepresented minorities.

In an effort to expedite the publication of articles, AJHP is posting 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.