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

Outline 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

COC Meeting 8-16-16

What is the Most Common Length of Accreditation?

Length of Accreditation by Percentage of Programs ( March 2015, August 2015, March 2016 COC) N= 810 Programs 6yr 4yr 2yr 5yr 3yr 1yr Conditional = 11 Denied = 2

Length of Accreditation by Percentage of Programs ( March 2015, August 2015, March 2016 COC) 8% N= 810 Programs 39% 6yr 5yr 4yr 3yr 2yr 1yr 47% Conditional = 11 Denied = 2

International Footprint 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 PGY2 Development of new international standards in progress outside US

Number of Practicing PGY1 & PGY2 Pharmacists in USA?

Practicing PGY1 and PGY2 in USA 1? 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. 1 Personal communication, ASHP Director of Accreditation Services

Number of Positions and Programs 2016 PGY1 PGY2 Programs 1324 753 Positions 3323 987 * 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 PGY2 22.7 % increase * Includes early commitment process

ASHP Accredited Pharmacy Residency Program Growth in Last 30 Years Hospital Pharmacy Practice PGY1 Clinical Specialized PGY2 2500 2000 1,861 2,071 1500 1000 500 0

Number of Programs Predominant PGY2 Residency Programs in US 140 120 2015 2016 100 80 60 Highest growth 2 nd highest growth 40 20 0

Less Common PGY2 Residency Programs 25 20 2015 2016 15 10 5 0

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

PGY1 Gap - Applicants to Available Positions 1800 1600 1400 1293 1239 1491 1373 1297 1200 1104 1000 964 800 600 635 400 288 323 200 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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 new instructions and a validator to warn users when they clicked Add without selecting a preceptor name User preferences are now saved for certain settings, such as search dates to view 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 was added in the last release: site, status and whether or not it is required.

PharmAcademic Updates Added 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 Updates Improved 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

PGY2 Standards Update New PGY2 standard approved August 2015 Optional implementation July 2016 Required implementation July 2017

Survey Readiness 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

How Does the Surveyor Learn About YOU? 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 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

RPD Basic Checklist for a Successful Survey 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

New Standards Developed 2005, then 2014 Guidance documents updated ashp.org Last update April 2016

Comparison of Goals & Objectives Category 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-intraining 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 CF Standards # Elements Number CF CF defined 1 Selection of Resident 2 Responsibilities of Program to Resident 3 Design and Conduct 4 Requirements of Preceptors and RPD 5 Requirements of Site 6 Pharmacy Services 6 1 1.5 13 4 2.5,2.7,2.7a,2.9a 49 13 3.2b (1-4) Competency Standards 3.3a(2-4), 3.3c(1)c,d, 3.4a(2), 3.4b(1), 3.4c(1), 3.4d(2) 42 4 4.2,4.3,4.6,4.8 9 1 5.1 Total 179 46 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

Developing a standardized residency purpose statement

ASHP Purpose Statement PGY1 PGY1 pharmacy residency programs build on Doctor of Pharmacy education and outcomes to contribute to the development of clinical pharmacists responsible for medication-related care of patients with a wide range of conditions, eligible for board certification, and eligible for post graduate year two (PGY2) pharmacy residency training.

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 improvement Added 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

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

Outline 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

Preceptor Development 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 Plan Plans are documented and include: assessment of needs schedule of activities to address identified needs review of effectiveness of development plan

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

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 Citings Standard Standard 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 Percent of Time Cited 79% 3.3c(1)(d) 1.6 For each objective, the learning experience contains a list of learning activities that will facilitate its achievement 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 68% 64% 6.6k The 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 1.5 2.4b 2.2 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 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. 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. The program complies with the ASHP Duty-Hour Requirements for Pharmacy Residencies. 64% 36% 36% 32%

2014 PGY1 Standard: Top Cited Items Program Structure & Preceptors Standard Standard Cited Percent Time Cited 3.4c(1) 3.3c(1)(d) 3.3c(1)(a) 3.4d(2) 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. For each objective, the learning experience contains a list of learning activities that will facilitate its achievement Learning experiences include a general description, including the practice area and the roles of pharmacists in the practice area On a quarterly basis, the RPD or designee assesses residents progress and determines if the development plan needs to be adjusted. 79% 68% 49% 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 6.6k 6.8a(2) 6.2d 6.7b Standard Verbiage The medication distribution system includes the following components: a system ensuring accountability and optimization for the use of safe medication-use system technologies. 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. Pharmacy services extend to all areas of the practice site in which medications for patients are prescribed, dispensed, administered, and monitored. 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. Percent Time Cited 62% 51% 47% 43%

Areas of Partial Compliance Frequently Cited Standard Finding Percent 5.9 Preceptors do not meet 4/7 criteria for commitment and contribution to pharmacy 4.1d Learning experience descriptions not adequately developed 4.13(3) Preceptor and learning experience evaluations not scheduled at end of the learning experience or at least quarterly for longitudinal learning experiences 4.2d(1)- 4.2d(3) Preceptors do not complete all aspects of the assessment 77% 76% 64% 61%

Test Questions 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

CSHP thanks our Schools/Colleges of Pharmacy for their support of Seminar 2016

Session Code: 1. Write down the course code. Space has been provided in the daily program-at-aglance sections of your program book. 2. To claim credit: Go to www.cshp.org/cpe before December 1, 2016.