A program of the University of Pittsburgh School of Pharmacy in collaboration with the University of Pittsburgh Medical Center

Inaugural Annual Program Report Fiscal Year 2014

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To: Patricia D. Kroboth, PhD, Dean, School of Pharmacy Susan M. Meyer, PhD, Associate Dean for Education, School of Pharmacy M. Beth Minnigh, PhD, Chair, Curriculum Committee, School of Pharmacy Albert Wright, PharmD, MHA, Vice President, Operations, UPMC Presbyterian cc: Pharmacotherapy Scholars Program Leadership Team, Preceptorship, and FY 14 Scholars

University of Pittsburgh School of Pharmacy Leadership Team, Curriculum Committee, Faculty, and Board of Visitors

RE: Pharmacotherapy Scholars Program Inaugural Annual Program Report, FY 14 December 11, 2013 Dean Kroboth, Drs. Meyer, Minnigh, Wright, and Colleagues, It is with great pleasure that we, the leadership team of the Pharmacotherapy Scholars Program, submit the inaugural annual program report for fiscal year 2014 herein. This comprehensive report describes significant improvement in both objective and subjective learner performance over the course of the program. Additionally, it describes the degree to which the learners were satisfied with the program, and their perception regarding their readiness to enter the field in pursuit of pharmacy residency training. Copies of each abstract and poster presented at the American Society of Health-System Pharmacists (ASHP) 2013 Midyear Meeting in Orlando FL are included. Lastly, reflection statements from both learners and preceptors are provided. This program has grown rapidly from inception to completion of the first class. We believe that we have built a sustainable, scalable, and successful program for mutual benefit of the University and our partner, the University of Pittsburgh Medical Center. To highlight one element, two of the four inaugural Pharmacotherapy Scholars were victorious in the regional ASHP clinical skills competition and placed 5th of 124 programs participating in the national ASHP clinical skills competition at the Midyear meeting in Orlando. We are exceedingly proud of our inaugural class and expect that they will continue their path to personal greatness and represent the School of Pharmacy well in their next endeavor. Respectfully submitted,

__________________________________ __________________________________ Christopher R. Ensor, PharmD, BCPS-CV James C. Coons, PharmD, BCPS-CV Assistant Professor; Program Co-Director Associate Professor; Program Co-Director enclosure

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Mission The joint mission of the University of Pittsburgh Pharmacotherapy Scholars Program is to prepare P4 pharmacy students to become highly proficient patient care providers and for a successful transition into competitive post-graduate residency training programs. Vision The Pharmacotherapy Scholars Program is an innovative training program that supports the advancement of student professionals as medication experts and patient care advocates. Students will engage as stakeholders in the medication use process and will be responsible for patient outcomes under the direction of pharmacist mentors. Table 1. Pharmacotherapy Scholars Program (PSP) Rotations

No. Credits Rotation Preceptorship

1 5 Health-System Pharmacy (HSP) Amanda Johnson, PharmDa Randall Smith, PhDb

2 5 Cardiology / Medicine (IMC) James Coons, PharmD, BCPS-CVb Nicholas Schwier, PharmDa Kate Hatfield, PharmDc

3 5 Solid Organ Transplantation (SOT) Christopher Ensor, PharmD, BCPS-CVb Heather Johnson, PharmD, BCPSb Gretchen Kipp, PharmD, BCPSc

4 5 Critical Care (CC)

Bonnie Falcione, PharmD, BCPSb Neal Benedict, PharmD, BCPSb Kris Poloyac, PharmD, BCPSc Lara Groetzinger, PharmD, BCPSc

5 5 Ambulatory Care (AC) Longitudinal Rotation (20 weeks)

Christine Ruby-Sclesi, PharmD, BCPSb Karen Steinmetz Pater, PharmD, BCPSb

a, PGY-2 resident preceptor. b, faculty preceptor. c, unit-based preceptor. Table 2. PSP Learning Domains

No. Domain

PS 1 Direct patient care

PS 2 Drug information

PS 3 Patient communication

PS 4 Medication therapy management

PS 5 Professional communication

PS 6 Knowledge and teaching

PS 7 Research and quality improvement

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Objective Knowledge Each clinical rotation experience in the PSP began with an objective timed 40-100 question multiple-choice readiness assessment designed to assess the learner’s entering knowledge on the core group of subjects covered. Mean performance on the readiness assessments were universally low (65.3%, SD 0.04), as shown by the ‘PSP pre’ value in Figure 1, panels A and B. The PSP concluded with an objective timed 240 question multiple-choice comprehensive examination which consisted of the readiness assessment questions grouped together; the performance on which is shown by the ‘PSP post’ value in Figure 1, panels A and B. As such, the performance of each learner on each rotation experience was compared (Figure 1, panels C-F). The performance of each learner increased by a mean of 10% (SD 0.01) to 75.3% (SD 0.03) by the conclusion of the PSP (Figure 1, panels A and B), a statistically significant change (p < 0.001). Performance on each individual rotation experience improved significantly (Figure 1, panels C-F) with the exception of the critical care rotation which trended strongly towards significance, but was seemingly influenced by one outlier whose performance did not improve. Figure 1. Readiness Assessments and Comprehensive Examination Scores

A/B. PSP, pharmacotherapy scholars program. C. AC, ambulatory care longitudinal. D. IMC, internal medicine / cardiology. E. SOT, solid organ transplantation. F. CC, critical care. p-value calculated by paired t-test.

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Objective Skills Integrated into the PSP were objective structured intermittent clinical examinations (ICE). These ICE were structured as a timed patient workup, problem identification, and presentation. Learners were given 30 minutes to review patient data, 30 minutes to speak with the patient and/or family, 10 minutes to present their assessment and plan to the assessing preceptor, and 5 minutes to debrief. Two variations of the ICE were employed: simulation and bedside scenarios. Learners took the first ICE at the patient simulator (SIM) in the first week of the program, and all others in the last week of each rotation experience. The SIM case was complex and was constructed to broadly cover the core topics of each rotation experience in the PSP. The same SIM case was then utilized again at the conclusion of the PSP; thus, these scores were directly compared. The bedside scenarios were handled similarly; though, a pertinent case to the rotation experience was pre-selected for each learner from the array of service patients. All scores were compared and the progression of performance over time was trended (Figure 2). Learner’s performance rose steadily by approximately 9% with each examination over the course of the PSP, a statistically significant change (p < 0.001, Figure 2). Additionally, the learners performance on the SIM case increased dramatically and significantly (p = 0.001) when evaluated at PSP entry and exit (Figure 2). This seems to indicate that the longitudinal nature of the program and evaluation techniques are of benefit to the learner’s performance. Figure 2. Intermittent Clinical Examination Scores

a. p-value calculated by paired t-test. b. p-value calculated by one-way analysis of variance (ANOVA).

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A. Preceptor completed evaluation of the learner. A1. Comparison of performance on each rotation. A2. Comparison of performance on HSP vs. all others. B. Learner self-evaluation. B1. Comparison of performance on each rotation. B2. Comparison of performance on HSP vs. all others. a. p-value calculated by one-way ANOVA. b. p-value calculated by paired t-test. Scale: 1-10 Likert, 1-5 needs improvement, 6-8 satisfactory progress, 9-10 achieved.

Figure 3. Rotation Evaluations

Figure 4. Ambulatory Care Evaluations

A. Preceptor completed evaluation of the learner. B. Learner self-evaluation. Scale: 1-10 Likert, 1-5 needs improvement, 6-8 satisfactory progress, 9-10 achieved.

Subjective Performance Assessments The PSP modeled the subjective individual rotation evaluation on the ASHP Residency Learning System (RLS) and contained seven learning domains (Table 3). This was done for three reasons, first, to better model the system that will be utilized during the scholars’ residency training, second, to bring an enhanced level of rigor to the P4 rotation evaluation process, and third, to track continuous progress over the course of the PSP on the same evaluation tool. Figure 3 (left) describes the mean assessment scores for all learners as determined by the preceptorship and the learner self-evaluation using the same tool designed to assess the learning domains found on page 3 of this report. The scale for this tool was a 1-10 Likert scale, which corresponded to a performance phenotype of needs improvement (1-5), satisfactory progress (6-8), and achieved (9-10). There is a clear and significant divergence between the performance assessed on the HSP rotation when compared to all others (Figure 3, panels A2 and B2). This is likely an artifact of the experience of the evaluator rather than a substantive difference. Subjective preceptor-assessed performance improvement on the remaining rotations trended strongly towards improvement over time (p = 0.107, Figure 3, panel A1). While encouraging, the magnitude of the subjective improvement is markedly less than the improvements seen on the objective assessment measures (pages 4 and 5 of this report). Learner Self-Assessment: The learner self-evaluation scores were generally lower by a mean of 0.44 (SD 0.08) points which reached statistical significance (p = 0.005). This indicates that learners in the program were significantly more demanding of their own performance than the perception of the evaluating preceptorship. However, the magnitude of this difference was small. Ambulatory Care Longitudinal Rotation: The PSP program included a 20 week longitudinal ambulatory care experience. Scholars spent 10 weeks in geriatrics and 10

weeks in the Matilda Theiss clinic for the underserved. Figure 4 (left) describes the preceptor and scholar completed evaluations, using the same scale described above. There were no significant differences between the scholar-generated vs. preceptor generated assessments.

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Subjective Scholar Satisfaction and Program Perception

The PSP program assessed learner satisfaction on three core elements: the PSP program, PSP preceptors, and PSP rotations. Learners were asked to rate their degree of satisfaction with each question on a 1-5 Likert scale, 1 indicating strong disagreement and 5 indicating strong agreement. Figure 5 (left) describes the mean satisfaction score with the PSP on the whole over time. Satisfaction rose over time; however, the greatest magnitude of effect came when the HSP rotation was compared with all others. Clearly, learners were significantly less-satisfied with the HSP rotation (p < 0.001, Figure 5, panel B) when compared with all others. In general, learners were satisfied with all of the following rotation experiences following the HSP rotation (p = 0.46, Figure 5, panel A). Similar dichotomous relationships were evident in each of the subset areas as described in Figure 6 (below).

To highlight two questions of significant importance that speak directly to the mission and vision of the PSP, learners were asked to rate the degree to which they felt prepared to enter PGY-1 pharmacy practice residency training and the degree to which they felt prepared to be a pharmaceutical care provider over the course of the program on the same Likert scale (Figure 6, panel A). The mean answer to these questions rose significantly over time (p = 0.017, Figure 6, panel A1) and was 4.75 (SD 0) at the conclusion of the PSP (Figure 6, panel A3) indicating strong agreement with their perceived optimal preparedness to enter residency training and provide direct pharmaceutical care to patients. Taken together, these data indicate that subjective learner satisfaction and the degree of perceived preparedness by the PSP were quite high. However, it does seem clear that significant work is needed on the HSP rotation to improve both learner satisfaction and degree of perceived preparedness of this rotation. Figure 6. Learner Satisfaction Evaluation Subsets

A. Evaluation subset focused on satisfaction with the PSP. A1. Comparison of PSP satisfaction by rotation. A2. Comparison of PSP satisfaction on HSP vs. all others. A3. Response to questions regarding preparedness for residency and practice, respectively, by rotation. B. Evaluation subset focused on satisfaction with preceptors. B1. Comparison of satisfaction with preceptors by rotation. B2. Comparison of satisfaction with preceptors on HSP vs. all others. C. Evaluation subset focused on satisfaction with rotation experiences. C1. Comparison of satisfaction with rotations by rotation. C2. Comparison of satisfaction with HSP vs. all others. a. p-value calculated by one-way ANOVA. b. p-value calculated by paired t-test. Scale: 1-5 Likert, 1 disagree strongly, 5 agree strongly.

A. Comparison of satisfaction on each rotation. B. Comparison of satisfaction with HSP vs. all others. a. p-value calculated by one-way ANOVA. b. p-value calculated by paired t-test. Scale: 1-5 Likert, 1 disagree strongly, 5 agree strongly.

Figure 5. Learner Satisfaction Evaluations

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Research Abstracts

Two teams of two scholars each undertook one research project per team. The following two abstracts reflect these projects and were presented at the 2013 American Society of Health-System Pharmacists Midyear Clinical Meeting in Orlando, FL. Oral ribavirin in lung transplant recipients with paramyxoviral infections: A retrospective safety and effectiveness analysis Williams EA1, Lyons PJ1, McDyer JF2, Smith RB1, Ensor CR1 University of Pittsburgh Schools of Pharmacy1 and Medicine2, Pittsburgh, PA USA. Purpose: Paramyxoviral infections (PMVI) result in clinically relevant morbidity and mortality in lung transplant recipients. Oral ribavirin (ORV) is active against RNA-based viruses and may be used for this indication, but supporting data are limited to reports of 11 total patients. The purpose of this retrospective analysis is to evaluate safety and effectiveness of ORV for PMVI in a larger cohort of lung transplant patients. Methods: This retrospective medical record review evaluated lung transplant recipients who received ORV for PMVI at UPMC Presbyterian Hospital and was approved by the local IRB. Safety endpoints included change in serum creatinine, hemoglobin, leukocytes, platelets, and incidence of hemolysis within 30 days after ORV. Effectiveness endpoints included pulmonary function tests at baseline, 30, 60, 90, and 120 days post ORV. Descriptive statistics were used to define baseline characteristics. Continuous variables were analyzed using students t-test, Wilcoxon rank sum test, or one-way ANOVA, where appropriate. Results: 21 patients with 22 unique PMVI episodes who received ORV were included. PMVI resulted in significant decline in allograft function from baseline (2.83±1.17 vs. 2.16±1, p<0.001), which remained significantly below baseline 120 days after ribavirin therapy (2.16±1 vs. 1.82±0.93, p=0.002), despite viral clearance. Three patients had multiple positive cultures on repeat sampling; though, all eventually cleared the virus. Toxicities included significant anemia (10.9±1.5 vs. 9±1.7, p<0.001), leukopenia (6.3±4.5 vs. 3.6±1.5, p=0.006), thrombocytopenia (197.8±75.8 vs. 161.2±81.4, p<0.001), and worsening renal function (SCr 1.86±1.1 vs. 2.09±1.2, p=0.002) within 30 days of therapy. However, anemia did not appear to be hemolytic in nature (peak LDH 312.4±243). Drug toxicities prevented 14% of patients from completing a minimum seven-day ORV course. Conclusions: Treatment with ORV is not associated with improvement of allograft function or return of allograft function to baseline after PMVI infection, despite viral clearance. Although ORV duration was short, significant toxicities were experienced in treated patients. (see Figure 7 on page 10)

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Bleeding risk assessment among patients receiving antithrombotics for hip and knee replacement surgery

Byerly RA1, Martin LT1, Saul M2, Seybert A1, Coons JC1 University of Pittsburgh Schools of Pharmacy1 and Biomedical Informatics2, Pittsburgh, PA USA.

Purpose: Over one million total hip replacement (THR) and total knee replacement (TKR) surgeries were performed in 2010. National guidelines recommend use of anticoagulation as orthopedic surgery patients are at increased risk for developing venous thromboembolism. Evidence supports various therapeutic options, causing significant variability between surgical centers. This can lead to undesirable adverse effects in patients. The objective of this study was to systematically develop an algorithm that can be used clinically to appropriately select anticoagulation therapy based on patient characteristics and risk factors in those undergoing THR and TKR.

Methods: Our institutional review board approved this retrospective chart review of the 11,000 patients aged >18 and <90 who underwent either THR or TKR between July 1, 2012 and August 31, 2013 at any of our hospital systems. By using the electronic medical archival retrieval system, trigger words, ICD-9 codes, and lab values will be collected and used to construct indicators for orthopedic bleeding events. Indicators with the highest specificity and sensitivity will be selected to apply to the entire cohort in order to assess bleeding related to anticoagulation use. Anticoagulation will be stratified according to incidence and severity of bleeding to formulate a proposed algorithm for future anticoagulation order sets in THR and TKR surgeries.

Results: There were a total of 9,249 surgeries (3,890 THA and 5,359 TKA) among 8,645 patients between July 1, 2012 and June 30, 2013 with follow-up through August 30, 2013. ICD-9 codes for bleeding complications on or after surgery and up to 90 days post-op was evaluated within the total cohort, resulting in 173 patients (100 THA and 73 TKA). 60 patients were randomly selected for evaluation-30 THA and 30 TKA. De-identified histories and physicals, discharge summaries, and ER notes were annotated using the GIANT® software tool and evaluated according to the following criteria: is the patient receiving an antithrombotic drug, is there evidence that a bleeding event occurred, is it suggested that the event is drug-related, what is the primary location of the bleed, and is there a history of a bleeding event. Validation was performed separately by three evaluators (RB, LM, and JC) for the first 10 consecutive patients to ensure accuracy and reliability of data collection. Out of the 8,645 patients that underwent surgery, 7,687 received an antithrombotic drug following THA and TKA. There were 3,148 hip patients and 4,539 knee patients. Of the hip patients 286 (9.1%) received aspirin, 819 (26.0%) enoxaparin, 430 (13.7%) fondaparinux, 468 (14.9%) heparin, 512 (16.3%) rivaroxaban, and 633 (20.1%) warfarin. Of the knee patients 455 (10.0%) received aspirin, 1212 (26.7%) enoxaparin, 724 (15.9%) fondaparinux, 229 (5.0%) heparin, 831 (18.3%) rivaroxaban, and 1088 (23.9%) warfarin. Bleeding evaluation results for the 60 patients evaluated based on ICD-9 codes are as follows. There were 58 (96.7%) patients who received antithrombotic therapy, 2 (3.3%) that did not, and 0 (0%) unknown. There were 43 (71.7%) bleeding events, 8 (13.3%) determined to not be a bleeding event, and 9 (15.0%) were unknown. Of these, 5 (8.3%) were determined to be drug-related, 20 (33.3%) were not, and 35 (58.4%) were unknown.

Conclusion: Current progress demonstrated the feasibility of evaluating drug-related bleeding based on identified clinical indicators for an orthopedic surgery population. The next steps will be to assess the other clinical indicators for bleeding within the randomly selected cohorts and then apply each to the overall population. Finally, the results from the evaluation of each indicator will be used to construct a bleeding risk assessment to optimize medication use for these patients. (see Figure 8 on page 10)

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Figure 7.

Figure 8.

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Inaugural Program Scholars and Reflections Pamela J. Lyonsa, pursuing PGY-1 pharmacy practice residency training Evan A. Williamsa, pursuing PGY-1+2 health-system pharmacy administration residency training Lukas T. Martin, pursuing PGY-1 pharmacy practice and PGY-2 critical care pharmacy residency training Rachel A. Byerly, pursuing PGY-1 pharmacy practice and PGY-2 pediatrics residency training a. Winners of the regional ASHP clinical skills competition and finished fifth of 124 programs in the national ASHP clinical skills competition. Pamela Lyons: Completing the Pharmacotherapy Scholars Program was one of the most challenging yet rewarding experiences I had while in Pharmacy School. The long hours, high expectations from preceptors, cases conferences, special projects, and my own lofty goals for the program pushed me farther than I had ever been pushed in school or on previous rotations. However, this program taught me more than just drug information. I learned how to be part of the health care team, build trust with doctors and nurses, make recommendations with confidence but without offending practitioners, and educate the team on evidence-based drug therapy. I also learned important life lessons: how to balance work and fun, how to say ‘no’ when I have way too much on my plate, and how to say that I didn’t know the answer. I have had the opportunity to make connections with so many hard-working and intelligent pharmacists who put so much time and effort into my education for which I am extremely grateful. Spending time with different practitioners gave me the opportunity to take pieces of their style and develop my own. Their advice on residency, interviewing, and life have prepared me for my next steps. After completing this program, I feel prepared to take on whatever comes my way. I know that I have been handed the skills that I need to be a successful resident and a caring pharmacist. I’m ready. Evan Williams: The Pharmacotherapy Scholars Program was a unique experience, and I was glad to be a part of it during the inaugural year. I believe the program provided exposure to more topics and areas of practice than we would have seen during a regular rotation experience. I think what makes this program stand out from just doing four rotations at Presbyterian were the research component, the professional development series, and the structured journal clubs, journal reviews, and case conferences. Although there were bumps along the road, this was to be expected of a program in its first year. I think this program will be an asset to the University of Pittsburgh School of Pharmacy, but be cautious not to make the rest of the students feel second-rate. I have enjoyed working with all the preceptors and feel my knowledge has increased dramatically. I am grateful for the opportunity to complete this program with my fellow scholars. Lukas Martin: I believe the Scholars program provided me with an excellent opportunity that not only developed my skills and knowledge of a pharmacist, but also allowed me to improve my communication and “non-pharmacy” skills required in a good resident. Through daily challenges of increased patient loads, longitudinal projects, and somewhat stricter evaluation criteria than most rotations, I felt inspired to push myself out of my comfort zone and to master self-management techniques that extend beyond a career. I think this is especially evident as I begin my next rotation at another hospital. My ability to adapt and quickly learn that was developed through interacting with different faculty and services allowed me to begin working up patients and making recommendations to the medical team within the first few days. My refined technique to review medical records, charts, and progress notes to understand each

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patient’s complete health has enabled me to manage a larger volume patients than both myself and my preceptor anticipated I would have done in the first week. Lastly, skills reinforced during journal clubs and case conferences have easily translated to topic discussions and journal clubs that I have participated in thus far. I am extremely grateful for being selected into the Scholars program, and I hope that my outcome in matching with a residency and my career path reflects the degree that I feel I have developed over the past 4 months. Although this program does have some areas that do require improvement, they have been discussed in detail, and I believe that this program will only move forward and continue to garner reputation. I thank all the faculty, staff, and preceptors involved in creating and executing this program, and I am positive that it will continue affect the lives and careers of dedicated students. Rachel Byerly: The Pharmacotherapy Scholars Program was a unique and challenging rotation that tied together institutional, acute, and ambulatory care experiences with an additional longitudinal research component. The 20 week rotation block was designed to mimic residencies in that it placed significant emphasis on the student to be an independent and proactive thinker, to find a role as part of a primary care and consult team, as well as to learn how to adapt to various settings, both clinically and academically. The ability to complete four blocks at a single institution allowed for familiarity with the computer system, hospital schematics, and staff. In reflecting across my experiences upon completion of the Pharmacotherapy Scholars Program, I am able to note significant progress in my ability to efficiently work-up patients, present complex journal articles, and prepare patient cases. Most importantly, I am able to approach how I think about patients and patient care at a higher complexity than before I started the program. Once I learned how to efficiently use the EMR to pull information for each patient, I was able to tie together more clinically relevant items that helped me to see the entire picture and progress as a clinician. I also noted my ability to adapt to difficult situations significantly improved throughout the rotation. I learned how to approach various dynamic environments and what learning points to take away from each. I am extremely lucky to have been part of such an incredible experience. The Pharmacotherapy Scholars Program ultimately allowed me to prove to myself that you do not need fantastic grades and excellent test taking abilities to excel as a clinician-you need the willingness to be able to fail as you learn and grow and to be able to remain calm in an environment drenched in stress and intensity.

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Leadership Team and Reflections

Christopher R. Ensor, PharmD, BCPS-CV, Assistant Professor, Program Co-Director James C. Coons, PharmD, BCPS-CV, Associate Professor, Program Co-Director Randall B. Smith, PhD, Senior Associate Dean, School of Pharmacy Amy L. Seybert, PharmD, FASHP, FCCP, Chair, Department of Pharmacy and Therapeutics James J. Pschirer, PharmD, Director, Experiential Education Susan M. Parnell, Education Support Specialist Christopher Ensor: This program started as a notion. This notion was that our students were being disadvantaged in the residency candidate selection process relative to other strong schools of pharmacy who were offering similar programs. While we acknowledged that these other programs were analogous simply to block-rotation scheduling at one site, it seemed critical to establish a competitive program that produced a product that was greater than the sum of its parts. In rapid fashion, the program was designed, enrolled, and completed its inaugural class of graduates this past November. In my assessment, it is clear in evaluating the above data and statements that this program, its longitudinal nature, and innovative format provided for significant learning and professional growth amongst the scholars. Moreover, it seems clear when considering the reflections of the inaugural scholars that learners respond positively and rise to the challenge if preceptors inspire the characteristics of intrinsic self-motivation and demand higher-level performance. This program is scalable and enhances the number of learners and exposure of each of those learners to the various aspects of care in the UPMC system. I am quite satisfied with the results of the inaugural program and will continue to vociferously advocate for and work with the leadership team to refine and improve this program for the next incoming class and beyond. James Coons: The Pharmacotherapy Scholars Program is the culmination of joint efforts by many individuals committed to enriching the student learner’s experience. The concept for the Program evolved out of the need to adapt to significant changes in the health care delivery model, the role of the pharmacist, and the highly competitive nature of post-graduate residency training programs. The inaugural Program was successful and informative in many capacities. The first graduates did attain significant improvements in their proficiency toward embracing roles as pharmacist providers and we will soon learn of their placement and transition into competitive residency training programs. The learners’ and the Program itself informed us of a model template for training future residents, care providers, and leaders which leverage our capacity for training while remaining scalable for future growth. The initial experiences and results of our Program also provided insights on opportunities for further growth and improvement in how we educate and train our students at earlier points in the curriculum. The Program itself will continue to evolve as we look forward to significantly increasing the number of scholars for the next academic year. Randall Smith: The Pharmacotherapy Scholars Program was a remarkable success in its first year. It went from an idea to a fully functioning program in less than three months due to the exceptional efforts of the program directors, Dr. Chris Ensor and Dr. Jim Coons, the administrative support and commitment of Ms. Susan Parnell, and the full support of Dr. Amy Seybert, Department Chair. The contributions of other faculty and hospital staff were invaluable and well recognized by the development team. I was privileged to be able to interact with the four students on numerous occasions during the 20 weeks of the program. I watched them grow in confidence and skills as a direct benefit of the challenges offered them. I am certain that each of them is fully prepared to be an

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outstanding PGY1 resident in the best programs in the country. We will learn from this year and continue to raise the bar in a program that has already demonstrated high performance. Amy Seybert: As we strive to enhance our students’ learning opportunities and enhance their patient care skills in today’s contemporary healthcare environment, our faculty wholeheartedly developed an idea into an advanced training program. The sincere passion and dedication to this program is evident by the stellar program outcomes seen after only the first year. As department chair, I am extremely delighted to see the drive, innovation, focus, and leadership of this team to produce a superb training program. This program provides tremendous opportunities for our students to engage in all aspects of pharmacy practice. This is truly an amazing product of faculty leadership and expertise, staff dedication, and student diligence that will continue to advance our mission of improving health through excellence, innovation, and leadership in education of pharmacists and pharmaceutical scientists, in research and scholarship, in care of patients, and in service to our communities. James Pschirer: The Pharmacotherapy Scholars Program, in its inaugural pilot year, allowed four motivated P4 students to complete an intensive series of APPE rotations in a single health system setting. The advantage of this arrangement was that it allowed a more complete immersion into the workings of the hospital, avoiding lost time due to the need to learn new computer systems and “re-acclimate” for each rotation. Our Scholars were expected to attain an in-depth understanding of the medication use process and accept responsibility for patient outcomes in their rotation areas. Each student was also required to complete a project worthy of consideration for presentation at a national meeting. The benefit to the students upon completion of the twenty-week program was that they would have an increased proficiency as a patient care provider and would also have a competitive advantage in attaining admission into a post-graduate residency program. Susan Parnell: I am very thankful to have been part of a dedicated team devoted to bringing the Pharmacotherapy Scholars program from idea to fruition in a single calendar year. It has been personally rewarding to see the hard work of the team result in a truly professional program that will be an asset to the University and students for years to come. I am grateful for the close personal relationships that were developed with the participating P4 scholars that were forged over the course of this intensive 20 week program. It was exciting to see their personal and professional growth as they began the difficult transition from student to pharmacotherapy care provider. We are absolutely committed to continue to develop and improve this program so that it can become the “standard” in preparing students for post graduate residency programs.