REQUIRED COMPETENCY AREAS, GOALS, AND OBJECTIVES FOR POSTGRADUATE YEAR TWO (PGY2) AMBULATORY CARE PHARMACY RESIDENCIES

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1 REQUIRED COMPETENCY AREAS, GOALS, AND OBJECTIVES FOR POSTGRADUATE YEAR TWO (PGY2) AMBULATORY CARE PHARMACY RESIDENCIES Intrductin The cmpetency areas, gals, and bjectives are t be used in cnjunctin with the ASHP Accreditatin Standard fr Pstgraduate Year Tw (PGY2) Pharmacy Residency Prgrams. The first fur cmpetency areas described herein are required, and the thers are elective. The required cmpetency areas and all f the gals and bjectives they encmpass must be included in all prgrams. Prgrams may add ne r mre required additinal cmpetency areas frm the elective cmpetency area chices t meet prgram-specific needs. Prgrams selecting an additinal cmpetency area are nt required t include all f the gals and bjectives in that cmpetency area. In additin t the ptential additinal cmpetency areas described in this dcument, prgrams are free t create their wn unique cmpetency areas with assciated gals and bjectives based n the specific needs f their prgram. Each f the bjectives assciated with the gals encmpassed by the prgram s selected prgram cmpetency areas (required and additinal) must be taught and evaluated at least nce during the residency year. Elective cmpetency area(s) may als be selected fr specific residents when creating their residency develpment plan. Each f the bjectives listed in this dcument has been classified accrding t educatinal taxnmy (cgnitive, affective, r psychmtr) and level f learning. An explanatin f the taxnmies is available elsewhere. 1 Cmpetency areas fr PGY1 residencies are available n the ASHP website. PGY2 cmpetency areas, gals, and bjectives in ambulatry care pharmacy are differentiated frm thse frm PGY1 by specializatin and the expectatin f PGY2 residents fr greater wrk cmpetence and prficiency. Definitins Cmpetency Areas: Categries f the residency graduates capabilities. Cmpetency areas are classified int ne f three categries: Required: Fur cmpetency areas are required (all prgrams must include them and all their assciated gals and bjectives). 1 Andersn, L. W. and Krathwhl, D. R., et al (Eds.) (2001) A Taxnmy fr Learning, Teaching, and Assessing: A Revisin f Blm s Taxnmy f Educatinal Objectives. Allyn & Bacn. Bstn, MA (Pearsn Educatin Grup).

2 Additinal (fr prgram): Cmpetency area(s) that residency prgrams may chse t use (in additin t the fur required areas) t meet prgram-specific prgram needs. Additinal cmpetency areas als include thse develped by individual prgrams. Elective (fr specific residents): Cmpetency area(s) r specific gals and bjectives within the cmpetency area(s) selected ptinally fr specific resident(s). Educatinal Gals (Gal): Brad statement f abilities. Educatinal Objectives: Observable, measurable statements describing what residents will be able t d as a result f participating in the residency prgram. Examples that describe cmpetent perfrmance f educatinal bjectives. Since the criteria are examples, they are nt all required but are intended t be used t give feedback t residents n hw well they are ding and hw they can imprve n the skill described in educatinal bjectives while they engage in an activity. Activities: The Standard requires that learning activities be specified fr each educatinal bjective in learning experience descriptins. Activities are what residents will d t learn and practice the skills described in bjectives. Activities are the answer t the questin, What can residents d in the cntext f this learning experience that will prvide the kind f experiences necessary t achieve the educatinal bjective? (Cmpare and cntrast activities with criteria by referring t the definitin f criteria immediately abve.) Specified activities shuld match the Blm s Taxnmy learning level stated in parentheses befre each bjective. Example: Objective R1.1.2: (Applying) Interact effectively with patients, family members, and caregivers. Learning activity: Prvide educatin t patients regarding prper medicatin use and administratin, adherence, and pssible adverse drug effects fr all new medicatins initiated during clinic appintments. Interactins are respectful and cllabrative. Uses effective cmmunicatin skills. Shws empathy. Empwers patients t take respnsibility fr their health. Demnstrates cultural cmpetence. Page 2

3 Cmpetency Area R1: Patient Care (See the appendix fr additinal specific requirements.) Gal R1.1: Prvide cmprehensive medicatin management t ambulatry care patients fllwing a cnsistent patient care prcess. Objective R1.1.1: (Applying) Interact effectively with health care teams t cllabratively manage ambulatry care patients medicatin therapy. Interactins are cperative, cllabrative, cmmunicative, and respectful. Demnstrates skills in cnsensus building, negtiatin, and cnflict management. Demnstrates advcacy fr the patient. Effectively cntributes pharmactherapy knwledge and patient care skills as an essential member f the healthcare team. Objective R1.1.2: (Applying) Interact effectively with ambulatry care patients, family members, and caregivers. Interactins are respectful and cllabrative. Maintains accuracy and cnfidentiality f patients prtected health infrmatin Uses effective (e.g., clear, cncise, accurate) cmmunicatin skills. Shws empathy. Empwers patients, family members, and caregivers regarding the patient s well-being and health utcmes. Demnstrates cultural cmpetence. Cmmunicates with family members t btain patient infrmatin when patients are unable t prvide the infrmatin. Cmmunicates with patient and family abut initiatin and changes f patient therapies. Demnstrates advcacy fr patients, family members, and caregivers. Objective R1.1.3: (Analyzing) Cllect infrmatin t ensure safe and effective medicatin therapy fr ambulatry care patients. Cllectin/rganizatin methds are efficient and effective. Cllects relevant infrmatin abut medicatin therapy, including: Histry f present illness. Relevant health data that may include past medical histry, health and wellness infrmatin, bimetric test results, and physical assessment findings. Scial histry. Medicatin histry, including prescriptin, nn-prescriptin, illicit, recreatinal, and nntraditinal therapies; ther dietary supplements; immunizatins; and allergies. Patient assessment (examples include, but are nt limited t, physical assessment, physilgic mnitring, labratry values, micrbilgy results, diagnstic imaging, prcedural results, and risk assessments). Pharmacgenmics and pharmacgenetic infrmatin, if available. Adverse drug reactins. Page 3

4 Medicatin adherence and persistence. Patient lifestyle habits, preferences and beliefs, health and functinal gals, and sciecnmic factrs that affect access t medicatins and ther aspects f care. Surces f infrmatin are the mst reliable surces available, including electrnic, face-t-face, and thers. Recrding system is functinal fr subsequent prblem slving and decisin making. Clarifies infrmatin as needed. Displays understanding f limitatins f infrmatin in health recrds. Pses apprpriate questins as needed. Objective R1.1.4: (Analyzing) Analyze and assess infrmatin t ensure safe and effective medicatin therapy fr ambulatry care patients. Includes accurate assessment f patient s: Health, functinal and nutritinal status. Risk factrs. Labratry and ther bjective data. Cultural factrs. Health literacy. Access t medicatins. Immunizatin status. Need fr preventive care and ther services, when apprpriate. Other aspects f care, as applicable. Identifies medicatin therapy prblems, including: Lack f indicatin fr medicatin. Medical cnditins fr which there is n medicatin prescribed. Medicatin prescribed r cntinued inapprpriately fr a particular medical cnditin. Subptimal medicatin regimen (e.g., dse, dsage frm, duratin, schedule, rute f administratin, methd f administratin). Medicatin txicity requiring medicatin therapy mdificatins. Abnrmal lab values requiring medicatin therapy mdificatins. Therapeutic duplicatin. Adverse drug r device-related events r the ptential fr such events. Clinically significant drug drug, drug disease, drug nutrient, drug DNA test interactin, drug labratry test interactin, r the ptential fr such interactins. Use f scial, recreatinal, nnprescriptin, nntraditinal, r ther medicatin therapies. Patient nt receiving full benefit f prescribed medicatin therapy. Prblems arising frm the financial impact f medicatin therapy n the patient. Patient lacks understanding f medicatin therapy. Patient nt adhering t medicatin regimen and rt cause (e.g., knwledge, recall, mtivatin, financial, system). Patient assessment needed Discrepancy between prescribed medicatins and established care plan fr the patient identified thrugh medicatin recnciliatin. Priritize an ambulatry care patient s health care needs. Triage ambulatry care patients health care needs as necessary. Page 4

5 When presented with a patient with health care needs that cannt be met by the ambulatry care pharmacist, make a referral t the apprpriate health care prvider based n the patient s presenting prblem and acuity. Assures a plan fr fllw up fr a referred ambulatry patient. Objective R1.1.5: (Creating) Design, r redesign, safe and effective patient-centered therapeutic regimens and mnitring plans (care plans) fr ambulatry care patients. Specify evidence-based, measurable, achievable therapeutic gals that include cnsideratin f: Relevant patient-specific infrmatin, including cultural preferences and shared decisinmaking. The gals f ther interprfessinal team members. The patient s disease state(s) and cmrbidities. Medicatin-specific infrmatin. Best evidence, including clinical guidelines and the mst recent literature Effectively interprets new literature fr applicatin t patient care Ethical issues invlved in the patient's care. Quality-f-life issues specific t the patient. End f life issues, when needed. Integratin f all the abve factrs influencing the setting f gals. Designs/redesigns regimens that: Are apprpriate fr the disease states being treated. Reflect: Clinical experience The therapeutic gals established fr the patient. The patient s and caregiver s specific needs. Cnsideratin f: Any pertinent pharmacgenmic r pharmacgenetic factrs. Best evidence. Pertinent ethical issues. Pharmacecnmic cmpnents (patient, medical, and systems resurces). Patient preferences, culture, and/r language differences. Patient-specific factrs, including physical, mental, emtinal, and financial factrs that might impact adherence t the regimen. Drug shrtages. Adhere t the health system s medicatin-use plicies. Fllw applicable ethical standards. Address wellness prmtin and lifestyle mdificatin. Supprt the rganizatin s r patient s insurance frmulary. Address medicatin-related prblems and ptimize medicatin therapy. Engage the patient thrugh educatin, empwerment, and prmtin f self-management. Designs/redesigns mnitring plans that: Effectively evaluate achievement f therapeutic gals. Ensure adequate, apprpriate, and timely fllw-up. Establish parameters that are apprpriate measures f therapeutic gal achievement. Reflect cnsideratin f best evidence. Select the mst reliable surce fr each parameter measurement. Page 5

6 Have apprpriate value ranges selected fr the patient. Have parameters that measure efficacy. Have parameters that measure ptential adverse drug events. Have parameters that are cst-effective. Have btainable measurements f the parameters specified. Reflects cnsideratin f adherence. Anticipates future drug-related prblems. When applicable, reflects preferences and needs f the patient. Plan represents the highest level f patient care. Objective R1.1.6: (Applying) Ensure implementatin f therapeutic regimens and mnitring plans (care plans) fr ambulatry care patients by taking apprpriate fllw-up actins. Effectively recmmends r cmmunicates patients regimens and assciated mnitring plans t relevant members f the health care team. Determines whether prvider's alternative recmmendatin is justified and reasnable. Pses apprpriate questins as needed. Recmmendatin is persuasive. Presentatin f recmmendatin accrds patient s right t refuse treatment. If patient refuses treatment, pharmacist exhibits respnsible prfessinal behavir. Creates an atmsphere f cllabratin. Skillfully defuses negative reactins. Cmmunicatin cnveys expertise. Cmmunicatin is assertive but nt aggressive. Where the patient has been directly invlved in the design f the plans, cmmunicatin reflects previus cllabratin apprpriately. Ensures recmmended plan is implemented effectively fr the patient, including ensuring that the: Plan represents the highest level f patient care. Therapy crrespnds with the recmmended regimen. Regimen is initiated at the apprpriate time. Patient receives their medicatin and supplies as directed. Medicatin rders are clear and cncise. Activity cmplies with the health system s plicies and prcedures. Tests crrespnd with the recmmended mnitring plan. Tests are rdered and perfrmed at the apprpriate time. Takes apprpriate actin based n analysis f mnitring results (redesign regimen and/r mnitring plan if needed). Apprpriately initiates, mdifies, discntinues, r administers medicatin therapy as authrized by cllabrative practice agreements, scpe f practice r state law. Respnds apprpriately t ntificatins and alerts in electrnic medical recrds and ther infrmatin systems that supprt medicatin rdering prcesses (based n factrs such as patient weight, age, gender, cmrbid cnditins, drug interactins, renal functin, and hepatic functin). Prvides thrugh and accurate educatin t patients and caregivers, when apprpriate, including infrmatin n medicatin therapy, adverse effects, adherence, apprpriate use, handling, and medicatin administratin. Addresses medicatin- and health-related prblems and engages in preventive care strategies, including vaccine administratin. Page 6

7 Schedules fllw-up care as needed t achieve gals f therapy. Objective R1.1.7: (Applying)Dcument direct patient care activities apprpriately in the medical recrd, r where apprpriate. Accurately and cncisely cmmunicates drug therapy recmmendatins t apprpriate healthcare prfessinals. Apprpriately dcuments all relevant direct patient care activities in a timely manner. Dcumentatin fllws rganizatinal plicies and prcedures. Objective R1.1.8: (Applying) Demnstrate respnsibility t ambulatry care patients fr patient utcmes. Gives pririty t patient care activities. Rutinely ensures all steps f the medicatin management prcess. Assumes respnsibility fr medicatin therapy utcmes. Actively wrks t identify the ptential fr significant medicatin-related prblems. Actively pursues all significant existing and ptential medicatin-related prblems until satisfactry reslutin is btained. Ensures apprpriate transitins f care. Cmmunicates with patients and family members/caregivers abut their medicatin therapy. Determines barriers t patient adherence and makes apprpriate adjustments. Gal R1.2: Design and/r deliver prgrams that cntribute t public health effrts r ppulatin management. Objective R1.2.1: (Applying) Design and/r deliver prgrams fr patients that fcus n health imprvement, wellness, and disease preventin (e.g., immunizatins, health screenings). Cnsiders prevalent health imprvement, wellness, and disease preventin educatinal needs in public health effrts. Prmtes and prvides health imprvement and wellness resurces fr patients (e.g. tbacc cessatin). Cmpetency Area R2: Advancing Practice and Imprving Patient Care Gal R2.1: Manage the develpment r revisin, and implementatin, f prpsals related t the ambulatry care setting. Objective R2.1.1: (Creating) Prepare r revise a prtcl (e.g., wrk flw, scpe f practice, cllabrative practice agreement, r clinical practice prtcls) related t ambulatry care. Displays bjectivity. Effectively synthesizes infrmatin frm the available literature. Applies evidenced-based principles. Cnsults relevant surces. Page 7

8 Cnsiders medicatin-use safety and resurce utilizatin. Effectively cmmunicates any changes in medicatin frmulary, medicatin usage, r ther prcedures t apprpriate parties. Demnstrates apprpriate assertiveness and timeliness in presenting pharmacy cncerns, slutins, and interests t internal and external stakehlders. When apprpriate, may include prpsals fr medicatin-safety technlgy imprvements. Objective R2.1.2: (Applying) Cntribute t the develpment f a new ambulatry care pharmacy service r t the enhancement f an existing service. Accurately assesses current ambulatry care pharmacy service r prgram t determine if it meets the stated gals. Identifies need(s) that may exist. Makes cntributins t a prpsal fr a new service, r enhancement f existing services that clearly describes the service r enhancement, the rle f different health care prviders in the service/enhancement, predicts financial utcme(s) and system and human resurces needs. Plans effectively fr implementatin and utilizatin f the new r enhanced service. Demnstrates understanding f the relevance f the existence and use f evidence-based treatment guidelines/prtcls in the ambulatry envirnment. Effectively selects metrics fr evaluatin, such as humanistic and ecnmic utcmes, when applicable. Apprpriately interprets existing quality and/r safety metrics data, when applicable. Gal R2.2: Demnstrate ability t cnduct a research prject. Objective R2.2.1: (Analyzing) Identify a schlarly questin related t clinical practice,educatin, r healthcare that wuld be useful t study and can be cmpleted within the PGY2 residency year. Apprpriately identifies r understands prblems and pprtunities fr research prjects. Analyzes relevant backgrund data. Evaluates data generated by health infrmatin technlgy r autmated systems t identify pprtunities fr imprvement, if a quality imprvement prject. Cmpleted in a timely manner within the residency year. Area identified is relevant t imprving ambulatry patient care, the medicatin-use system and/r the schlarship f teaching. Effectively assimilates scientific evidence. Objective R2.2.2: (Creating) Develp a plan r research prtcl fr the prject. Develps specific aims, selects an apprpriate study design, and develps study methds t answer the research questin(s). Develps and fllws an apprpriate research r prject timeline. When applicable, applies safety design practices (e.g., standardizatin, simplificatin, human factrs training, lean principles, FOCUS-PDCA, ther prcess imprvement r research methdlgies) apprpriately and accurately. Applies evidence-based and/r pharmacecnmic principles, if needed. Page 8

9 Develps a feasible design fr a prspective r retrspective clinical r utcmes analysis prject that cnsiders wh r what will be affected by the prject. Identifies and btains necessary apprvals, (e.g., IRB, quality review bard, funding, departmental, and ther relevant stakehlders) and respnds prmptly t feedback r reviews fr a practicerelated prject. Acts in accrdance with the ethics f research n human subjects, if applicable. Crrectly identifies need fr additinal mdificatins r changes t the prject. Plan design is practical t implement and is expected t remedy r minimize the identified challenge r deficiency. Objective R2.2.3: (Evaluating) Cllect and evaluate data fr the prject. Cllects the apprpriate types f data as required by prject design. Uses apprpriate electrnic data and infrmatin frm internal infrmatin databases, external nline databases, apprpriate Internet resurces, and ther surces f decisin supprt, as applicable. Uses apprpriate methds fr analyzing data in a prspective and retrspective clinical, humanistic, and/r ecnmic utcmes analysis. Uses cntinuus quality imprvement (CQI) principles t assess the success f the implemented change, if applicable. Cnsiders the impact f the limitatins f the prject r research design n the interpretatin f results. Accurately and apprpriately develps plan t address pprtunities fr additinal changes. Fllws rganizatinal prcedures fr prtected health infrmatin. Objective R2.2.4: (Applying) When applicable, implement the prject. Plan is based n apprpriate data. Effectively presents plan (e.g., accurately recmmends r cntributes t recmmendatin fr peratinal change, frmulary additin r deletin, implementatin f medicatin guideline r restrictin, r treatment prtcl implementatin) t apprpriate audience. Demnstrates apprpriate assertiveness in presenting pharmacy cncerns, slutins, and interests t external stakehlders. Gains necessary cmmitment and apprval fr implementatin. Fllws established timeline and milestnes. Implements the prject as specified in its design. Effectively cmmunicates any changes in medicatin frmulary, medicatin usage, r ther prcedures t apprpriate parties. Outcme f change is evaluated accurately and fully. Objective R2.2.5: (Evaluating) Assess changes r need t make changes based n the prject. Evaluate data and/r utcme f prject accurately and fully. Includes peratinal, clinical, ecnmic, and humanistic utcmes f patient care, if applicable. Uses cntinuus quality imprvement (CQI) principles t assess the success f the implemented change, if applicable. Crrectly identifies need fr additinal mdificatins r changes based n utcme. Page 9

10 Accurately assesses the impact f the prject, including its sustainability, if applicable. Accurately and apprpriately develps plan t address pprtunities fr additinal changes. Objective R2.2.6: (Creating) Effectively develp and present, rally and in writing, a final prject reprt suitable fr publicatin. Outcme f change is reprted accurately t apprpriate stakehlders(s) and plicy-making bdies accrding t departmental r rganizatinal prcesses. Reprt includes implicatins fr changes t r imprvement in pharmacy practice. Reprt uses an accepted manuscript style suitable fr publicatin in the prfessinal literature. (Submissin f manuscript t a peer-reviewed jurnal is preferred, when pssible.) Oral presentatins t apprpriate audiences within the department and rganizatin r t external audiences use effective cmmunicatin and presentatin skills and tls (e.g., handuts, slides) t cnvey pints successfully. (Reprting t an external audience is preferred, when pssible.) Cmpetency Area R3: Leadership and Management Gal R3.1: Demnstrate leadership skills. Objective R3.1.1: (Applying) Demnstrate persnal, interpersnal, and teamwrk skills critical fr effective leadership. Demnstrates efficient time management. Manages cnflict effectively. Demnstrates effective negtiatin skills. Demnstrates ability t lead interprfessinal teams. Uses effective cmmunicatin skills and styles. Demnstrates understanding f perspectives f varius health care prfessinals. Effectively expresses benefits f persnal prfessin-wide leadership and advcacy. Objective R3.1.2: (Applying) Apply a prcess f nging self-evaluatin and persnal perfrmance imprvement. Accurately summarizes wn strengths and areas fr imprvement (in knwledge, values, qualities, skills, and behavirs). Effectively uses a self-evaluatin prcess fr develping prfessinal directin, gals, and plans. Effectively engages in self-evaluatin f prgress n specified gals and plans. Demnstrates ability t use and incrprate cnstructive feedback frm thers. Effectively uses principles f cntinuus prfessinal develpment (CPD) planning (reflect, plan, act, evaluate, recrd/review). Gal R3.2: Demnstrate management skills in the prvisin f care fr ambulatry care patients. Objective R3.2.1: (Applying) Manage ne s wn ambulatry care practice effectively. Page 10

11 Review and interpret the mst recent primary literature. Evaluate clinical practice activities fr ptential cntributins t schlarship. Accurately assesses successes and areas fr imprvement (e.g., a need fr staffing prjects r educatin) in managing ne s wn practice. Makes accurate, criteria-based assessments f ne s wn ability t perfrm practice tasks. Regularly integrates new learning int subsequent perfrmances f a task until expectatins are met. Rutinely seeks applicable learning pprtunities when perfrmance des nt meet expectatins. Demnstrates effective wrklad and time-management skills. Assumes respnsibility fr persnal wrk quality and imprvement. Is well prepared t fulfill respnsibilities (e.g., patient care, prjects, management, and meetings). Sets and meets realistic gals and timelines. Demnstrates awareness f wn values, mtivatins, and emtins. Demnstrates enthusiasm, self-mtivatin, and a can-d apprach. Wrks cllabratively within the rganizatin s plitical and decisin-making structure. Demnstrates pride in and cmmitment t the prfessin thrugh appearance, persnal cnduct, planning t pursue bard certificatin. Demnstrates pride in and cmmitment t ambulatry care thrugh membership in prfessinal rganizatins related t ambulatry care. Demnstrates effective advcacy fr ne s wn practice and fr pharmacy. Gal R3.3.: Manage the peratin f an ambulatry care pharmacy service. Objective R3.3.1: (Analysis) Effectively manage nging peratinal functins f the service. Effectively manages clinic appintment lengths and space needs. Effectively utilizes EMR technlgy t maintain efficient dcumentatin, alerts, and referral prcesses. Effectively maintains the established system fr securing service supplies (e.g., patient educatin materials, clinic supplies). Effectively implements plans fr the nging marketing f the service including the recruitment f patients. Effectively applies the principles f perfrmance imprvement t the nging functins f the service. Effectively slves prblems arising in the peratin f the service, such as when demand exceeds staffing, when clinic resurces are nt sufficient, managing verbks, managing n shws t clinic, managing patients discharged frm the clinic. Demnstrates understanding f the functins f a grup sessin clinic. Effectively cntributes t strategic planning fr the service and/r practice. Effectively participates in rienting new ambulatry care staff, and ther trainees. Effectively selects factrs fr evaluatin, such as humanistic and ecnmic utcmes Objective R3.3.2: (Creating) Assure that the service perates in accrd with legal and regulatry requirements. Page 11

12 Demnstrates understanding f relevant legal and regulatry requirements. Takes effective actin t ensure cmpliance with requirements. Effectively maintains legal cding and billing activities. Maintains applicable certificatins and training requirements. Cmpetency Area R4: Teaching, Educatin, and Disseminatin f Knwledge Gal R4.1: Demnstrate excellence in prviding effective medicatin and practice-related educatin. Objective R4.1.1: (Applying) Design effective educatinal activities related t ambulatry care. Accurately defines educatinal needs, including learning styles, with regard t target audience (e.g., individual versus grup) and learning level (e.g., health care prfessinal versus patient). Defines educatinal bjectives that are specific, measurable, at a relevant learning level (e.g., applying, creating, evaluating), and address the audiences defined learning needs. Plans use f teaching strategies that address specified bjectives and match learner needs, including active learning (e.g., patient cases, plling). Selects cntent that is relevant, thrugh, evidence based (using primary literature where apprpriate), and timely and reflects best practices. Includes accurate citatins and relevant references and adheres t applicable cpyright laws. Objective R4.1.2: (Applying) Use effective presentatin and teaching skills t deliver ambulatry care related educatin t pharmacy r interprfessinal attendees, including cmplex tpics t expert drug therapy audiences. Demnstrates rapprt with learners. Captures and maintains learner/audience interest thrughut the presentatin. Implements planned teaching strategies effectively. Effectively facilitates audience participatin, active learning, and engagement in varius settings (e.g., small r large grup, distance learning). Presents at apprpriate rate and vlume and withut exhibiting pr speaker habits (e.g., excessive use f um and ther interjectins). Bdy language, mvement, and expressins enhance presentatins. Summarizes imprtant pints at apprpriate times thrughut presentatins. Transitins smthly between cncepts. Effectively uses audi-visual aids and handuts t supprt learning activities. Includes critical evaluatin f primary literature regarding drug therapy. Effectively utilizes cmplex drug therapy bjectives (higher learning levels f Blm s Taxnmy (e.g., creating, evaluating). Objective R4.1.3: (Applying) Use effective written cmmunicatin t disseminate knwledge related t ambulatry care. Writes in a manner that is easily understandable and free f errrs. Demnstrates thrugh understanding f the tpic. Page 12

13 Ntes apprpriate citatins and references. Includes critical evaluatin f the literature and knwledge advancements r a summary f what is currently knwn n the tpic. Develps and uses tables, graphs, and figures t enhance reader s understanding f the tpic when apprpriate. Writes at a level apprpriate fr the target readership (e.g., physicians, pharmacists, ther health care prfessinals, patients, and the public). Creates ne s wn wrk and des nt engage in plagiarism. Objective R4.1.4: (Applying) Assess effectiveness f educatin related t ambulatry care. Selects assessment methd (e.g., written r verbal assessment r self-assessment questins, case with case-based questins, and learner demnstratin f new skill) that matches activity. Prvides timely, cnstructive, and criteria-based feedback t learner. If used, assessment questins are written in a clear, cncise frmat that reflects best practices fr test item cnstructin. Determines hw well learning bjectives were met. Plans fr fllw-up educatinal activities t enhance r supprt learning and (if applicable) ensure that gals were met. Identifies ways t imprve educatin-related skills. Obtains and reviews feedback frm learners and thers t imprve effectiveness as an educatr. Gal R4.2: Effectively emply apprpriate preceptr rles when engaged in teaching students, pharmacy technicians, r fellw health care prfessinals in ambulatry care. Objective R4.2.1: (Analyzing) When engaged in teaching related t ambulatry care, select a preceptr rle that meets learners educatinal needs. Identifies which preceptr rle is applicable fr the situatin (direct instructin, mdeling, caching, facilitating). Selects direct instructin when learners need backgrund cntent. Selects mdeling when learners have sufficient backgrund knwledge t understand the skill being mdeled. Selects caching when learners are prepared t perfrm a skill under supervisin. Selects facilitating when learners have perfrmed a skill satisfactrily under supervisin. Objective R4.2.2: (Applying) Effectively emply preceptr rles, as apprpriate, when instructing, mdeling, caching, r facilitating skills related t ambulatry care. Instructs students, technicians, r thers as apprpriate. Mdels skills, including thinking ut lud, s learners can bserve critical-thinking skills. Caches, including effective use f verbal guidance, feedback, and questining, as needed. Facilitates, when apprpriate, by allwing learner independence and using indirect mnitring f perfrmance. Page 13

14 ELECTIVE COMPETENCY AREAS, GOALS, AND OBJECTIVES FOR AMBULATORY CARE POSTGRADUATE YEAR TWO (PGY2) PHARMACY RESIDENCIES Cmpetency Area E1: Academia Gal E1.1: Demnstrate understanding f key elements f the academic envirnment and faculty rles within it. Objective E1.1.1: (Understanding) Demnstrates understanding f key elements f the academic envirnment and faculty rles within it. Accurately describes expectatins f public and private schls f pharmacy fr teaching, practice, research, and service. Demnstrates understanding f relatinships between schlarly activity and teaching, practice, research and service. Accurately describes the academic envirnment (e.g., hw administratin decisins and utside frces impact faculty). Accurately describes faculty rles and respnsibilities. Accurately describes the types and ranks f faculty appintments. Demnstrates understanding f the rle and implicatins f part-time and adjunct faculty. Accurately describes the cmplexity f the prmtin and/r tenure prcess. Accurately explains the rle and influence f faculty in the academic envirnment. Accurately identifies resurces available t help develp academic skills. Accurately identifies and describes ways that faculty maintain balance in their rles. Accurately describes typical affiliatin agreements between a cllege f pharmacy and a practice site (e.g., health system, hspital, clinic, retail pharmacy). Gal E1.2: Exercise case-based and ther teaching skills essential t pharmacy faculty. Objective E1.2.1: (Applying) Develp and deliver cases fr wrkshps and exercises fr labratry experiences. Identifies the apprpriate level f case-based teachings fr small grup instructin. Identifies apprpriate exercises fr labratry experiences. Prvides apprpriate and timely feedback t imprve perfrmance. Objective E1.2.2: (Evaluating) Cmpare and cntrast methds t prevent and respnd t academic and prfessin dishnesty and adhere t cpyright laws. Accurately evaluates physical and attitudinal methds t prevent academic dishnesty. Accurately describes methds f respnding t incidents f academic dishnesty. Accurately explains the rle f academic hnr cmmittees in cases f academic dishnesty. Identifies examples and methds t address unprfessinal behavir in learners. Page 14

15 Accurately describes cpyright regulatins as related t reprducing materials fr teaching purpses. Accurately describes cpyright regulatins as related t linking and citing n-line materials. Gal E1.3: Develps and practices a philsphy f teaching. Objective E1.3.1: (Creating) Develp r update a teaching philsphy statement. Teaching philsphy includes: Self-reflectin n persnal beliefs abut teaching and learning; Identificatin f attitudes, values, and beliefs abut teaching and learning; and, Illustrates persnal beliefs n practice and hw these beliefs and experiences are incrprated in a classrm r experiential setting with trainees. If updating, reflect n hw ne s philsphy has changed. Objective E1.3.2: (Creating) Prepare a practice-based teaching activity. Develps learning bjectives using active verbs and measureable utcmes. Plans teaching strategies apprpriate fr the learning bjectives. Uses materials that are apprpriate fr the target audience. Organizes teaching materials lgically. Plans relevant assessment techniques. When used, develps examinatin questins that are lgical, well-written, and test the learners knwledge rather than their test-taking abilities. Participates in a systematic evaluatin f assessment strategies (e.g., pst-exam statistical analysis) when apprpriate. Ensures activity is cnsistent with learning bjectives in curse syllabus. Objective E1.3.3: (Applying) Deliver a practice-based educatinal activity, including didactic r experiential teaching, r facilitatin. Incrprates at least ne active learning strategy in didactic experiences apprpriate fr the tpic. Uses effective skills in facilitating small and large grups. Fr experiential activities: Organizes student activities (e.g., student calendar); Effectively facilitates tpic discussins and learning activities within the alltted time; Effectively develps and evaluates learner assignments (e.g., jurnal clubs, presentatins, SOAP ntes; Effectively assesses student perfrmance; and, Prvides cnstructive feedback. Objective E1.3.4: (Creating) Effectively dcument ne s teaching philsphy, skills, and experiences in a teaching prtfli. Prtfli includes: A statement describing ne s teaching philsphy; Curriculum vitae; Page 15

16 Teaching materials including slides and ther handuts fr each teaching experience; Dcumented self-reflectins n ne s teaching experiences and skills, including strengths, areas fr imprvement, and plans fr wrking n the areas fr imprvement; Peer/faculty evaluatins; and, Student/learner evaluatins. Cmpetency Area E2: Credentialing Gals E2.1: Where the ambulatry care pharmacy practice is within a setting that allws pharmacist credentialing, successfully apply fr credentialing. Objective E2.1.1: (Applying) Fllw established prcedures t successfully apply (may be a hypthetical applicatin if nt permitted at the site) fr credentialing as an ambulatry care pharmacy practitiner. Fllws the practice setting s plicy fr applying t be credentialed as an ambulatry care pharmacy practitiner. Cmpetency Area E3: Management f Medical Emergencies Gal E3.1: Participate in the management f medical emergencies. Objective E3.1.1: (Evaluating) Exercise skill as a team member in the management f medical emergencies accrding t the rganizatin s plicies and prcedures. Acts in accrdance with the rganizatin s plicies and prcedures fr medical emergencies. Applies apprpriate medicatin therapy in medical emergency situatins. Accurately prepares medicatins and calculates dses during a medical emergency. Effectively anticipates needs during a medical emergency. Obtains certificatin in the American Heart Assciatin Advanced Cardiac Life Supprt (ACLS). Cmpetency Area E4: Treatment f Hspitalized Patients Gal E4.1: In cllabratin with the health care team, prvide safe and effective patient care t a diverse range f patients, including thse with multiple c-mrbidities, high-risk medicatin regimens, and multiple medicatins fllwing a cnsistent patient care prcess. Objective E4.1.1: (Applying) Interact effectively with health care teams t manage patients medicatin therapy. Interactins are cperative, cllabrative, cmmunicative, and respectful. Demnstrates skills in negtiatin, cnflict management, and cnsensus building. Demnstrates advcacy fr the patient. Page 16

17 Objective E4.1.2: (Creating) Design r redesign safe, effective and evidence-based patient-centered therapeutic regimens and mnitring plans. Specifies evidence-based, measurable, achievable therapeutic gals that include cnsideratin f: Relevant patient-specific infrmatin, including culture and preferences. The gals f ther interprfessinal team members. The patient s disease state(s). Medicatin-specific infrmatin. Best evidence. Ethical issues invlved in the patient's care. Quality-f-life issues specific t the patient. Integratin f all the abve factrs influencing the setting f gals. Designs/redesigns regimens that: Are apprpriate fr the disease states being treated. Reflect: The therapeutic gals established fr the patient. The patient s and caregiver s specific needs. Cnsideratin f: Any pertinent pharmacgenmic r pharmacgenetic factrs. Quantitative labratry values. Best evidence. Pertinent ethical issues. Pharmacecnmic cmpnents (patient, medical, and systems resurces). Patient preferences, culture, and/r language differences. Patient-specific factrs, including physical, mental, emtinal, and financial factrs that might impact adherence t the regimen. Adhere t the health system s medicatin-use plicies. Fllw applicable ethical standards. Address wellness prmtin and lifestyle mdificatin. Supprt the rganizatin s r patient s frmulary. Address medicatin-related prblems and ptimize medicatin therapy. Engage the patient thrugh educatin, empwerment, and prmtin f self-management. Designs/redesigns mnitring plans that: Effectively evaluate achievement f therapeutic gals. Ensure adequate, apprpriate, and timely fllw-up. Establish parameters that are apprpriate measures f therapeutic gal achievement. Reflect cnsideratin f best evidence. Select the mst reliable surce fr each parameter measurement. Have apprpriate value ranges selected fr the patient. Have parameters that measure efficacy. Have parameters that measure ptential adverse drug events. Have parameters that are cst-effective. Have btainable measurements f the parameters specified. Reflects cnsideratin f adherence. If fr an ambulatry patient, includes strategy fr ensuring patient returns fr needed fllw-up visit(s). When applicable, reflects preferences and needs f the patient. Page 17

18 Objective E4.1.3: (Applying) Ensure implementatin f therapeutic regimens and mnitring plans (care plans) by taking apprpriate fllw-up actins. Effectively recmmends r cmmunicates patients regimens and assciated mnitring plans t relevant members f the health care team. Recmmendatin is persuasive. Presentatin f recmmendatin accrds patient s right t refuse treatment. If patient refuses treatment, pharmacist exhibits respnsible prfessinal behavir. Creates an atmsphere f cllabratin. Skillfully defuses negative reactins. Cmmunicatin cnveys expertise. Cmmunicatin is assertive but nt aggressive. Where the patient has been directly invlved in the design f the plans, cmmunicatin reflects previus cllabratin apprpriately. Ensures recmmended plan is implemented effectively fr the patient, including ensuring that the: Therapy crrespnds with the recmmended regimen. Regimen is initiated at the apprpriate time. Medicatin rders are clear and cncise. Activity cmplies with the health system s plicies and prcedures. Tests crrespnd with the recmmended mnitring plan. Tests are rdered and perfrmed at the apprpriate time. Takes apprpriate actin based n analysis f mnitring results (redesign regimen and/r mnitring plan if needed). Apprpriately initiates, mdifies, discntinues, r administers medicatin therapy as authrized. Respnds apprpriately t ntificatins and alerts in electrnic medical recrds and ther infrmatin systems that supprt medicatin rdering prcesses (based n factrs such as patient weight, age, gender, cmrbid cnditins, drug interactins, renal functin, and hepatic functin). Prvides thrugh and accurate educatin t patients and caregivers, when apprpriate, including infrmatin n medicatin therapy, adverse effects, adherence, apprpriate use, handling, and medicatin administratin. Addresses medicatin- and health-related prblems and engages in preventive care strategies, including vaccine administratin. Schedules fllw-up care as needed t achieve gals f therapy. Cmpetency Area E5: Specialty Pharmacy Thanks t the Natinal Assciatin f Specialty Pharmacy (NASP) fr prviding the jb analysis n which these gals, bjectives, and criteria are based. Gal E5.1: Effectively fulfill the majr functins f a specialty pharmacist, including intake, clinical management, fulfillment, and facilitating ptimal utcmes. Objective E5.1.1: (Applying) Effectively cnduct the patient intake prcess fr specialty pharmacy patients. Screens patient demgraphic and clinical infrmatin t determine suitability fr specialty pharmacy services. Page 18

19 Cnducts benefits investigatin and validatin f insurance cverage fr requested medicatin (submit test claims) and crdinate benefits with multiple payers. Determines payer cverage and which benefit channel is required by medicatin r ptimal fr patient when either channel is acceptable. Initiates and cnducts prir authrizatin prcess. Determines eligibility fr specific clinical management prgrams. Determines patient eligibility and need fr financial assistance based n insurance, available prgrams, and patient financial burden. Wrks with patient care crdinatr t enrll qualified patients in financial assistance prgrams. Bills payer under pharmacy benefit structure r medical benefit structure. Objective E5.1.2: (Applying) Effectively engage in clinical management activities fr specialty pharmacy patients. Addresses Risk Evaluatin and Mitigatin Strategies (REMS). Develps individualized educatin plan fr specialty pharmacy patients t achieve treatment gals. Enrlls specialty pharmacy patients in specific clinical management prgrams. Manages patient treatment hlidays and ther extenuating circumstances. Manages specialty pharmacy patient discntinuatin f medicatin. Objective E5.1.3: (Applying) Effectively cnduct fulfillment activities fr specialty pharmacy patients. Verifies that medicatin is available. Refers medicatin referral t anther prvider if unable t distribute medicatin. Accurately determines delivery lcatin and makes arrangements fr the delivery and receiving f medicatin package. Ships the medicatin package using apprpriate shipping methd. Crrectly bills patient fr services rendered. Cntacts patients prir t delivery f medicatin refill. Reslves situatins in which the integrity f medicatin shipment has been cmprmised r the shipment was nt received. Cnducts investigatin in the case f discrepancy between patient and facility. Cntacts manufacturer fr replacement f prduct in the case f patient misuse r prduct failure. Objective E5.1.4: (Evaluating) Effectively facilitate ptimal treatment utcmes fr specialty pharmacy patients. Determines clinical, patient-reprted, peratinal, and financial data t be cllected based n the parameters f disease state and medicatin, and hw data will be btained frm internal and external surces. Determines patient, internal stakehlder, and external stakehlder requirements fr data reprting and structuring the frmat f reprts t meet requirements. Obtain, cllect, and extract clinical, patient-reprted, peratinal, and financial data. Integrate and recncile clinical, patient-reprted, peratinal, and financial data frm disparate surces and use standard data elements. Analyzes and interprets clinical and patient-reprted data t determine clinical and patient-reprted utcmes t imprve patient treatment and quality f life. Page 19

20 Analyzes and interprets peratinal and financial data t determine peratinal and financial utcmes t evaluate the pharmacecnmic impact f service fferings. Reprts clinical, patient-reprted, peratinal, and financial data and make recmmendatins t patients, internal stakehlder, and external stakehlder. Cmpetency Area E6: Cntinuity f Care Gal R6.1: Ensure cntinuity f care during ambulatry care patient transitins between care settings. Objective R6.1.1: (Applying) Manage transitins f care effectively fr ambulatry care patients. Participates in thrugh medicatin recnciliatin when necessary. When apprpriate, fllws up n identified drug-related prblems, additinal mnitring, and educatin in a timely and caring manner. Prvides accurate, pertinent, and timely fllw-up infrmatin when patients transfer t anther facility, level f care, pharmacist, r prvider, as apprpriate. Takes apprpriate and effective steps t help avid unnecessary hspital admissins and/r readmissins. Prvides apprpriate infrmatin t ther pharmacists in transitins t mitigate medicatin therapy prblems. Cmpetency Area E7: Medicatin Event Reprting and Mnitring Gal R7.1 Ensure apprpriate medicatin event reprting and mnitring. Objective R7.1.1: (Applying) Participate in the review f medicatin event reprting and mnitring related t care fr ambulatry care patients. Effectively uses currently available technlgy and autmatin that supprts a safe medicatin-use prcess. Apprpriately and accurately determines, investigates, reprts, tracks, and trends adverse drug events, medicatin errrs, and efficacy cncerns using accepted institutinal resurces and prgrams. Cmpetency Area E8: Delivery f Medicatins Gal E8.1: Manage and facilitate delivery f medicatins t supprt safe and effective drug therapy fr ambulatry care patients. Objective E8.1.1: (Applying) Manage aspects f the medicatin-use prcess related t frmulary management fr patients. Page 20

21 Fllws apprpriate prcedures regarding exceptins t the frmulary, if applicable, in cmpliance with plicy. Ensures nn-frmulary medicatins are evaluated, dispensed, administered, and mnitred in a manner that ensures patient safety. Objective E8.1.2: (Applying) Facilitate aspects f the medicatin-use prcess fr patients. Makes effective use f technlgy t aid in decisin-making and increase safety. Demnstrates cmmitment t medicatin safety. Effectively priritizes wrklad and rganizes wrkflw. Checks accuracy f medicatins dispensed, including crrect patient identificatin, medicatin, dsage frm, label, dse, number f dses, and expiratin dates; and prper repackaging and relabeling medicatins, including cmpunded medicatins (sterile and nnsterile). Prmtes safe and effective drug use n a day-t-day basis. Cmpetency Area E9: Medicatin-Use Evaluatins Gal E9.1: (Evaluating) Lead a medicatin-use evaluatin related t care f ambulatry care patients. Objective E9.1.1: (Evaluating) Lead a medicatin-use evaluatin related t care fr ambulatry care patients. Uses evidence-based principles t develp criteria fr use. Demnstrates a systematic apprach t gathering data. Accurately analyzes data gathered. Demnstrates apprpriate cnfidence and assertiveness in presenting pharmacy cncerns, slutins, and interests t internal and external stakehlders. Implements apprved changes, as applicable. Apprved by the Cmmissin n Credentialing f the American Sciety f Health-System Pharmacists n March 5, Endrsed by the ASHP Bard f Directrs n April 6, Develped by an ASHP wrking grup f the fllwing specialized pharmacy practitiners and ASHP staff: Jennie Brders Jarrett, Pharm.D., BCPS, Directr, PGY1 Pharmacy Residency Prgram UPMC St. Margaret. Directr, Inpatient Pharmactherapy Educatin UPMC St. Margaret Family Medicine Residency Prgram; Rachana Patel, PharmD, BCPS, BCACP, Clinical Pharmacy Residency Supervisr, Kaiser Permanente Clrad; Beth Phillips, Pharm.D., FCCP, BCPS, Clinical Assciate Prfessr, University f Gergia Cllege f Pharmacy; Jhn Refar, Pharm.D., PGY1 Pharmacy Residency Prgram Directr, VA Bstn Healthcare System; Jseph Saseen, Pharm.D., FCCP, BCPS, Prfessr and Vice Chair, University f Clrad Schl f Pharmacy; Nancy L. Shapir, PharmD, FCCP, BCPS, Operatins Crdinatr, Antithrmbsis Clinic, University f Illinis Hspital and Health Sciences System, Clinical Assciate Prfessr, Pharmacy Page 21

22 Practice, Directr, PGY2 Ambulatry Care Residency, University f Illinis at Chicag Cllege f Pharmacy; and Nami Schultheis, M.Ed., Directr, Standards Develpment and Training, Accreditatin Services Office, ASHP. This dcument replaces a set f gals and bjectives apprved by the ASHP Bard f Directrs September 22, The cntributin f reviewers is gratefully acknwledged. Cpyright 2017, American Sciety f Health-System Pharmacists, Inc. All rights reserved. The effective date fr implementatin f these educatinal utcmes, gals and bjectives is cmmencing with the entering resident class f Page 22

23 Appendix The resident will explain signs and symptms, epidemilgy, risk factrs, pathgenesis, natural histry f disease, pathphysilgy, clinical curse, etilgy, and treatment f diseases and cnditins in areas listed belw. The resident will als have experience managing patients in these areas. The resident will explain the mechanism f actin, pharmackinetics, pharmacdynamics, pharmacgenmics, pharmacecnmics, usual regimen (dse, schedule, frm, rute, and methd f administratin), indicatins, cntraindicatins, interactins, adverse reactins, and therapeutics f medicatins and nn-traditinal therapies, where relevant, that are applicable t diseases and cnditins in the areas listed belw. The resident will explain varius frms f nn-medicatin therapy, including life-style mdificatin and the use f devices fr disease preventin and treatment, fr diseases and cnditins in the areas listed belw. Frm the list f 15 areas belw, residents are required t have direct patient care experience in at least eight areas. When direct patient care is nt pssible, up t tw f these eight areas may be cvered by case-based applicatin thrugh didactic discussin, reading assignments, case presentatins, and/r written assignments. Cardilgy Dermatlgy Endcrinlgy Gastrenterlgy Geriatrics Hematlgy Onclgy Infectius diseases Men s health Nephrlgy Neurlgy Pediatrics Psychiatry Pulmnlgy Rheumatlgy Wmen s health Page 23