Seminar 2016

Schools/Colleges of Pharmacy - Preceptor Track Sponsors

Implementation of NEW ASHP PGY1 Standards:

Tools for a Successful Survey

Harminder Sikand Pharm D., FCSHP, FASHP, FCCP

Director of Clinical and Residency Services

Clinical Professor UCSF School of Pharmacy

ASHP Committee on Credentialing

Scripps Mercy Hospital

San Diego, CA

Disclosure

No Conflict of Interest

Learning Objectives

1. Identify four recent changes to the new standards (2014) compared to past standards (2005)

2. Develop a RPD checklist for a successful survey

3. Describe a quantitative approach to preceptor development

4. Define criteria to include for a resident checklist for graduation

5. Site top 5 findings noted with the new standards

Background (Residents, Residencies, PharmAcademic® & Match)

Survey Readiness/ RPD Checklist

New standards and updates

Tools for Preceptor Development

Resident checklist for graduation

Top findings noted with new standards

Outline

COC Meeting 8-16-16

What is the Most Common Length of Accreditation?

6yr 5yr

4yr 3yr

2yr 1yr

Conditional = 11Denied = 2

Length of Accreditation by Percentage of Programs( March 2015, August 2015, March 2016 COC)

N= 810 Programs

6yr 5yr 4yr

3yr 2yr 1yr

Conditional = 11Denied = 2

39%

47%

8%

Length of Accreditation by Percentage of Programs( March 2015, August 2015, March 2016 COC)

N= 810 Programs

7 Programs Saudi Arabia Qatar Abu Dhabi 3 more expected from Saudi Arabia

New ventures in progress Singapore India

Development of international standards Need to be sensitive to international practice Graduates of “new” international standard will not be eligible applying

for PGY2Development of new international standards in progress outside US

International Footprint

Number of Practicing PGY1 & PGY2 Pharmacists in USA ?

PGY1 14,050 (24%)

PGY2 3,650 (5.9%)

Estimate of number of hospital pharmacist FTEs reported to complete residencies with added 10% for non hospital settings.

1Personal communication, ASHP Director of Accreditation Services

Practicing PGY1 and PGY2 in USA1 ?

PGY1 PGY2

Programs 1324 753

Positions 3323 987

Number of Positions and Programs 2016

* Incudes Hospital, Community and Managed Care

Applicants & Positions in 2016

POSITIONS OFFERED

PGY1◦ 7.9% increase

PGY2* ◦ 8.9% increase

APPLICANTS IN MATCH

PGY1 11.6% increase

PGY222.7 % increase

* Includes early commitment process

0

500

1000

1500

2000

2500

ASHP Accredited Pharmacy Residency Program Growth in Last 30 Years

Hospital Pharmacy Practice PGY1 Clinical Specialized PGY2

2,071

1,861

Predominant PGY2 Residency Programs in US

0

20

40

60

80

100

120

1402015 2016

Nu

mb

er

of

Pro

gram

s

Highest growth

2nd highest growth

Less Common PGY2 Residency Programs

0

5

10

15

20

25

2015 2016

Did the Two Phase Match in 2016 Work?End of Match or Phase II End of Match or Phase II

2015 Unfilled Positions Unmatched Applicants

PGY1 270 1547

PGY2 112 208

Total 382 1755

2016

PGY1 13 893

PGY2 24 76

Total 37 969

Reduced Unfilled Positions by 90%Reduced Unmatched Applicants by 45%Overall position fill rate for PGY1 and PGY2 was 99.1%

Match 2017 Timeline

Nov. 2, 2016: List of ASHP match programs available

March 3, 2017: Phase I Match deadline for rank order list

March 17, 2017: Results Phase I Match

Phase II Program list on the Match website @ 12:00 p.m EST

March 21, 2017: Applicants ( new or from Phase 1 Phase) submit applications to programs participating in Phase II Match (0900 EST)

April 5, 2017: Phase II Match deadline for rank order list

April 12, 2017: Results of Phase II Match

288 323

635

964

1104

12931239

14911373

1297

0

200

400

600

800

1000

1200

1400

1600

1800

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

PGY1 Gap - Applicants to Available Positions

PharmAcademic® Updates

Copying Learning Experiences◦ A learning experience can be copied to the same program or a different

program at the same site. The document

◦ “Copying a Learning Experience” document added to PharmAcademic Help page.

New/Updated Evaluation Reports ◦ “Overall Evaluations Report” in red when an evaluation is overdue

◦ “Overall Evaluation Status - All Residents.”◦ Available to RPD/Designee onReport tab

◦ Displays evaluation status for all residents in program (the other report is resident-specific).

PharmAcademic® Updates

Minor Improvements/Resolved Issues◦ More header information in new Send Back for Edit History report

◦ Clarified process for adding preceptors to learning experience. Added newinstructions and a validator to warn users when they clicked “Add withoutselecting a preceptor name”

◦ User preferences are now saved for certain settings, such as search dates toview schedule and the “Include Cosign” box on the Global Task List◦ Ie. if you set dates for your schedule to display, those dates will remain until you change

them (even if you leave the page or exit PharmAcademic)

◦ Updated Learning Experience report to include new information that wasadded in the last release: site, status and whether or not it is required.

PharmAcademic® UpdatesAdded Residency Advisory Committee (RAC)

◦ Added RAC role to PharmAcademic.

◦ Users can add formative feedback for the residents, view all resident and program information

◦ User does not have editing rights for either the program or resident, unless granted.

Added Global Announcement Capability on Home Page◦ Capability to send global announcements from McCreadie Group to all users

◦ Announcement can be used to alert users to updates/enhancements and can either be in text format or provide a link to direct users to a page within PharmAcademic

Added PharmAcademic Access to Graduate Tracking for Residents in ResiTrak

◦ Graduate Tracking available in PharmAcademic for residents closed out of ResiTrak

PharmAcademic® UpdatesImproved “Scheduled Learning Experiences for Assigned Goals & Objectives”

◦ Report to include a tally next to each objective pertaining to the number of times that a specific objective was assigned to be evaluated in a learning experience

Audit Trail for Evaluations◦ When a user changes or deletes an answer in a PharmAcademic evaluation, the

original answer is saved in our data base. The user does not have access to this data, but support can access it if needed

New PGY2 standard approved – August 2015◦Optional implementation – July 2016◦Required implementation – July 2017

PGY2 Standards Update

Background (Residents, Residencies, PharmAcademic & Match)

Survey Readiness/ RPD Checklist New standards and updates

Tools for Preceptor Development

Resident checklist for graduation

Top findings noted with new standards

Outline

Preparation phase:1. Be Ready at ALL times

2. Realistically Plan for your survey 2 years in advance

Attend RLS again

Teach RLS to your preceptors

Review ASHP self assessment document with preceptors

3. Do a gap analysis with standards at least 2.5 years in advance

4. Know critical factors in the standard

5. Begin survey readiness meetings with preceptors

6. Have preceptors complete ASHP academic record annually

Survey Readiness

1. Documentation Review On site documents PharmAcademic® reports (before survey visit) Documents submitted with pre survey questionaire (mailed in advance of survey) Resident binder/shared drive / PharmAcademic® files Results of your past survey reviewed

2. On Site Interviews RPD Preceptors Technicians Nurses, Physicians, Residents

3. Facility tour Main Pharmacy Outpatient Pharmacy Areas of pharmacist practice

How Does the Surveyor Learn About YOU?

Remember : Surveyors Survey to Best Practice Standards

RPD Basic Checklist for a Successful Survey

Adopt ASHP PGY1 purpose statement

Acceptance letter w/ pre-employment req.

Define consequences if not licensed in 90 day

2/3 time direct patient care activities

2/3 (12 month) program as licensed pharmacist

≤ 1/3 time in specialty area of focus

Learning activities for all TE and T

One activity per objective

Evaluation due ≤ 7 days end of rotation

Quarterly evaluation > 12 week rotation

Pre-survey checklist annual review

Preceptor actionable feedback

Preceptor formative feedback process discuss with RAC

Preceptor development plan

self evaluation

areas identified for training

ASHP academic record annual update

Resident evaluation ASHP Goals & Objectives

Preceptor meetings share:

Resident development plans if not in PharmAcademic

Checklist for documentation of completion requirements

Interview share requirements for successful

completion

leave polices

dismissal policy

failure to progress policy and consequences

Quarterly review of resident progress in achieving competencies, goals and objectives

document in development plan

Preceptors verbalize 4 preceptor roles

RPD Basic Checklist for a Successful Survey

Background (Residents, Residencies, PharmAcademic & Match)

Survey Readiness/ RPD Checklist

New standards and updates Tools for Preceptor Development

Resident checklist for graduation

Top findings noted with new standards

Outline

Developed 2005, then 2014

Guidance documents updated ashp.org

Last update April 2016

New Standards

Comparison of Goals & ObjectivesCategory Past New

Principles →Standards 7 6

Outcomes →Competency Areas 6 4

Goals 23 6

Objectives 66 33

34

Major Changes

Terminology “Standards” replace “Principles “Competency areas” replaces

“Outcomes” One purpose statement for all

PGY1 programs Principles 1 and 3 combined

in standard 1 Objectives streamlined Reduce in number and length

No instructional objectives –only criteria

“Resident Development plan” replaces “Customized plan”

Preceptor qualifications expanded

Addition of Preceptor-in-training

Informatics interspersed within learning experiences

35

New Changes to the Guidance Document for 2014 Standard

Standard 1.5:

Consequences of residents’ failure to obtain appropriate licensure either prior to or within 90 days of the start date of the residency must be addressed in written policy of the residency program

◦ Added as a critical factor

◦ Guidance added: Programs ensure a minimum of 2/3 of residency is completed as a pharmacist licensed to practice in the program’s jurisdiction.

Standard 3.1:

Purpose statement (see standard for required purpose statement)◦ Guidance changed to: The program documents the required purpose statement in

program materials. (changes in red)

April 2016 update

New Changes to the Guidance Document for 2014 Standard

Standard 6.3:

The pharmacist executive must provide effective leadership and management for the achievement of short- and long-term goals of the pharmacy and the organization for medication-use and medication-use policies.

◦ Removed definitions of short-term goals as one year and long-term goals as greater than 2 years

◦ Changed how it will be surveyed to:

◦ Review of department of pharmacy strategic plan and specific departmental goals and initiatives

◦ Discussion with organization and pharmacy leaders, physicians, nurses and pharmacy staff about the role of pharmacy in strategic planning for the organization and medication-use process

April 2016 update

Critical Factors Critical factors (CF)

Heavier weighted elements of the Accreditation standards Defined by ASHP commission to be integral to training

Used to determine length of accreditation (1, 3, 6 year) Progress must be shown on CFs Identified on guidance documents at ASHP.org

38

Know your CFStandards # Elements Number CF CF defined

1 Selection of Resident

6 1 1.5

2Responsibilities of Program to Resident

13 4 2.5,2.7,2.7a,2.9a

3Design and Conduct

49 13 3.2b (1-4) Competency Standards3.3a(2-4), 3.3c(1)c,d, 3.4a(2), 3.4b(1), 3.4c(1), 3.4d(2)

4Requirements of Preceptors and RPD

42 4 4.2,4.3,4.6,4.8

5Requirements of Site

9 1 5.1

6Pharmacy Services

60 23 6.2d,6.3,6.4f,6.4g,6.5,6.6b,6.6c,6.6g,6.6i,6.6k, 6.7a-f,6.7i, 6.7m,6.7m(3)6.8a(1-2), 6.9a,6.9b

Total 179 46

Developing a standardized residency purpose statement

PGY1 pharmacy residency programs build on Doctor of Pharmacyeducation and outcomes to contribute to the development of clinicalpharmacists responsible for medication-related care of patients witha wide range of conditions, eligible for board certification, andeligible for post graduate year two (PGY2) pharmacy residencytraining.

ASHP Purpose Statement PGY1

New Changes to the Guidance Documents for the 2014 Competency Areas, Goals, and Objectives Objective R3.1.2 (Applying): Apply a process of ongoing self evaluation and personal performance improvementAdded guidance on minimum number of times objective must be assigned to be

taught and evaluated.

Objective must be taught and formally evaluated at least 3 times

Assigned to 3 different learning experiences

Assigned to be evaluated in 1 learning experience and twice in a longitudinal learning experience

Assigned to be evaluated 3 times in a longitudinal learning experience

Strategy written/verbal and articulated by preceptors

Evidence preceptors track resident progress to achieve this objective

1. Patient Care 3.2b(1) Communication, team integration, medication therapy, team integration,

intervention, design intervention, documentation, prepare and dispense

2. Advancing practice and improving patient care 3.2b(2) Formulary, MUE, ADE, outcomes

3. Leadership and management 3.2b(3) Self-evaluation, conflict resolution, administration ( finance, labor HR)

4. Teaching, education and dissemination of knowledge 3.2b(4) Presentation, writing, preceptor roles, write objectives

Located as separate document at ashp.org

Used as self-assessment for residents on PharmAcademic

Used in evaluation of all rotations on PharmAcademic

April 2016 update

Competency Areas- Required (Under Standard 3 Design and Conduct of Residency Program)

Background (Residents, Residencies, PharmAcademic & Match)

Changes to the new standards

Survey Readiness/ RPD Checklist

Tools for Preceptor Development

Resident checklist for graduation

Top findings noted with new standards

Outline

RAC meeting brain storming Decide areas to work on and vote Choose one topic to address

Student and resident evaluation feedback to preceptor Document discussion

Consider policy that has “meat” (Annual 3hrs CE on preceptor development )

ASHP Preceptor Handbook Assign sections for discussion at RAC Role playing

Attendance at ASHP National Pharmacy Preceptor Conference Attendees provide a Grand Rounds to preceptors

Partner with Pharmacy Schools

Annual completion of Academic record and gap analysis

Assign responsibility to different preceptors each year

Preceptor Development

Plans are documented and include: assessment of needs

schedule of activities to address identified needs

review of effectiveness of development plan

Preceptor Development Plan

Background (Residents, Residencies, PharmAcademic & Match)

Changes to the new standards

Survey Readiness/ RPD Checklist

Tools for Preceptor Development

Resident checklist for graduation

Top findings noted with new standards

Outline

Resident Checklist for Graduation Ideas(completion of program requirements must be documented( 2.7a).Match them with competency areas )

Skills and competency ( quantify)

Formulary review

MUE

Presentations of research

Adverse drug events ( choose a number)

Nursing inservices

Operations

unit inspections

regulatory topic discussions and ideas to improve

Medication safety project

Student precepting

Staffing commitment

Timely completion of evaluations

Self-evaluation process

Attending local chapter meeting

Background (Residents, Residencies, PharmAcademic & Match)

Changes to the new standards

Survey Readiness/ RPD Checklist

Tools for Preceptor Development

Resident checklist for graduation

Top findings noted with new standards

Outline

Top Citings: 2014 PGY1 Standard

47 programs surveyed on new standard as of March 2016

Average citations: 21 elements/survey (range 7-40)

2014 PGY1 Standard: Top 5 Frequent CitingsStandard Standard Cited Percent of

Time Cited

3.4c(1)

At the end of each learning experience, residents receive, and discuss with preceptors, verbal and written assessment on the extent of their progress toward achievement of assigned educational goals and objectives, with reference to specific criteria

79%

3.3c(1)(d)For each objective, the learning experience contains a list of learning activities that will facilitate its achievement

68%

1.6

Requirements for successful completion and expectations of the residency program are documented and provided to applicants invited to interview, including policies for professional, family, and sick leaves and the consequences of any such leave on residents’ ability to complete the residency program and for dismissal from the residency program

64%

6.6kThe medication system includes a system ensuring accountability and optimization for the use of safe medication-use system technologies. 62%

6.8a(2)Professional, technical, and clerical staff complement is sufficient and diverse enough to ensure that the department can provide the level of service required by all patients served.

51%

2014 PGY1 Standard: Top Items Cited Related to Program Policies

Standard Standard Cited Percent of Time Cited

1.6

Requirements for successful completion and expectations of the residency program are documented and provided to applicants invited to interview, including policies for professional, family, and sick leaves and the consequences of any such leave on residents’ ability to complete the residency program and for dismissal from the residency program

64%

1.5

Consequences of residents’ failure to obtain appropriate licensure either prior to or within 90 days of the start date of the residency are addressed in written policy of the residency program.

36%

2.4b

Residents’ acceptance of these terms and conditions, requirements for successful completion, and expectations of the residency program is documented prior to the beginning of the residency.

36%

2.2The program complies with the ASHP Duty-Hour Requirements for Pharmacy Residencies.

32%

2014 PGY1 Standard: Top Cited Items Program Structure & Preceptors

Standard Standard Cited Percent Time Cited

3.4c(1)

At the end of each learning experience, residents receive, and discuss with preceptors, verbal and written assessment on the extent of their progress toward achievement of assigned educational goals and objectives, with reference to specific criteria.

79%

3.3c(1)(d)For each objective, the learning experience contains a list of learning activities that will facilitate its achievement

68%

3.3c(1)(a)Learning experiences include a general description, including the practice area and the roles of pharmacists in the practice area

49%

3.4d(2)On a quarterly basis, the RPD or designee assesses residents’ progress and determines if the development plan needs to be adjusted.

47%

4.4e

The RPD serves as the organizationally authorized leader of the residency program and has responsibility for creating and implementing a preceptor development plan for the residency program.

45%

Top Items Frequently Cited Related to Pharmacy Services

Standard Number

Standard Verbiage Percent Time Cited

6.6k

The medication distribution system includes the following components: a system ensuring accountability and optimization for the use of safe medication-use system technologies.

62%

6.8a(2)

Professional, technical, and clerical staff complement is sufficient and diverse enough to ensure that the department can provide the level of service required by all patients served.

51%

6.2d

Pharmacy services extend to all areas of the practice site in which medications for patients are prescribed, dispensed, administered, and monitored.

47%

6.7b

The following patient care services and activities are provided by pharmacists in collaboration with other health-care professionals to optimize medication therapy for patients: prospective participation in the development of individualized medication regimens and treatment plans.

43%

Standard Finding Percent

5.9 Preceptors do not meet 4/7 criteria for commitment and

contribution to pharmacy

77%

4.1d Learning experience descriptions not adequately

developed

76%

4.13(3) Preceptor and learning experience evaluations not

scheduled at end of the learning experience

or at least quarterly for longitudinal learning experiences

64%

4.2d(1)-4.2d(3)

Preceptors do not complete all aspects of the assessment

61%

Areas of Partial Compliance Frequently Cited

1. It is not required to have a resident graduation checklist. T or F

2. Which of the following statements are true?a. Three-fourths of the residency will focus on patient care

b. No more than 1/3 of the residency can focus in one area of practice

c. Purpose statements can be individualized to meet the needs of your facility

d. Critical factors can affect the length of your residency accreditation

3. The most frequently cited element of the current standard is ?a. 4.8c – related to preceptor qualifications

b. 1.5 – related to licensure requirements

c. 3.3c(1)(d) – related to learning experience descriptions

d. 3.4c(1) – related to preceptor evaluation of residents

Test Questions

CSHP thanks our Schools/Colleges of Pharmacyfor their support of Seminar 2016

1. Write down the course code. Space has been provided in the daily program-at-a-glance sections of your program book.

2. To claim credit: Go to www.cshp.org/cpe before December 1, 2016.

Session Code: