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Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
Events related to residency training
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Events related to residency training

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  • 1. A Postgraduate Training Update from the ASHP Commission on Credentialing (COC) Mary Hess, Chair Commission on Credentialing
  • 2.
    • “ Great Leaders are never satisfied with current levels of performance. They are relentlessly driven by possibilities and potential achievements.”
    • D. Harrison
  • 3. Objectives
    • Explain the differences between the postgraduate year one (PGY1) and postgraduate year two (PGY2) pharmacy residency programs.
    • Explain changes that can be implemented to a pharmacy practice residency program to meet the intent of the new ASHP accreditation standards.
    • Apply strategies to maximize your program’s effectiveness when participating in the resident matching program.
  • 4. Factors related to release of new Residency Accreditation Standards
    • IOM reports
    • JCAHO Roundtable/conference
    • Future of Residency Training Conference
    • ACCP/ASHP Partnership
    • Open Hearings & comment periods
    • ACPE standards
  • 5.
      • Patient-centered
      • Interdisciplinary teams
      • Evidence-based practice
      • Utilize informatics
      • Apply quality improvement
    IOM - Core competencies for all health professionals JCAHO - improving education of health professionals
  • 6. Pharmacy Residency Training in the Future: A Stakeholders’ Roundtable Discussion January 23-24, 2005
    • Stakeholders:
    • ASHP
    • AACP
    • ACCP
    • AMCP
    • APhA
    • Other invitees: ACPE, BPS, ASCP, NCPA, NACDS, VA
  • 7. Strong Areas of Agreement
    • Accreditation by one national body that includes key stakeholders
    • All residencies should be accredited
    • Residencies help develop innovative practices
    • Colleges provide knowledge; residencies are becoming necessary to integrate knowledge into practice
  • 8. Conclusions
    • ↑ n eed for residency trained individuals by 2015
    • ↑ n eed for community residencies
    • Specialization in the profession needs clarity
    • PGY1 & PGY2 is appropriate model
    • Terms and vision need to be consistent, defined, endorsed and embraced by the profession
  • 9. What happened in 2005?
    • CCP endorsed
    • PGY1, PGY2 concept
    • Published Conference proceedings
    • AJHP September 1, 2005
    • New Standards Approved & Released: PGY1, PGY2
  • 10. What’s happening in 2006?
    • Implementing new standards
    • Sunset PGY2 goals and objectives, as they are rewritten
    • Revision of RLS training to match new standards
    • Rewrite of Community & Managed Care standard
  • 11. New Pharmacy Residency Accreditation Standards
    • PGY1 Pharmacy Residency
    • Replaces Pharmacy Practice (2001)
    • PGY2 Pharmacy Residency
    • Replaces Specialized Pharmacy Practice (1994)
    • and all supplemental standards
    • (Goals & objectives remain)
    • Standards not altered at this time:
    • Managed Care Pharmacy Practice
    • Managed Care Systems Residency
    • Pharmacy Practice (with emphasis in Community Care)
  • 12. New Standards – overall changes
    • Different terminology/concept
    • PGY1/PGY2
      • General training vs. advanced depth of training
    • Incorporates IOM core competencies
    • Duty hours
    • Participation in the match
  • 13. PharmD Graduate Patient/Practice FOCUS Broad DEPTH of knowledge, skills, abilities, experience Narrow Basic Advanced PGY2 D Advanced Practitioner More experience, skill, and ability developed in a focused area of practice (e.g., oncology, critical care) C PGY2 Advanced Practitioner More experience, skill and ability developed in a broad set of patients (e.g., pharma-cotherapy) PGY1 B Generalist Focused Practitioner Wide variety of diseases may be in a unique setting or population (e.g., pediatrics, geriatrics, ambulatory, managed care) A PGY1 Generalist Wide variety of patients & diseases
  • 14. Standards similar PGY1 & PGY2
    • I Qualifications of Residents
    • II Obligations of the Program to Residents
    • III Obligations of Resident to Program
    • IV Design & Conduct of the Residency
    • V RPD & Preceptors
    • VI Site Requirements
    • VII Pharmacy Requirements
  • 15. So what is different PGY1 vs PGY2?
    • PGY1
      • First year of post graduate residency training
      • Wide variety of disease states/patients
      • Advances individual beyond PharmD
      • Training a generalist
    • PGY 2
      • Second year of post graduate residency training
      • Advances training beyond PGY1
      • Usually focused on a specialized area of practice
  • 16. So what is different PGY1 vs PGY2?
    • Applicant requirements
    • RPD requirements
    • Outcomes, goals and objectives
    • Expectations of Residents
  • 17. Review of each section of new stds
    • Highlight changes
    • Highlight differences PGY1 vs PGY2
    • Highlight frequently cited areas of partial compliance
  • 18. I. Qualifications of the Residents
    • PGY1 “should” graduate from ACPE Pharm D (Foreign graduates – must be able to be licensed)
    • PGY2 : complete PGY1
    • Must have a policy on what to do if the resident does not become licensed
    • Must have a process for evaluating candidates
  • 19. II. Obligations of Program
    • Policy on the impact of leave on the residency
    • Letter of acceptance & conditions
    • Rules of the match
    • Duty Hours
      • 80 hrs/wk
      • 1/7 days off
      • 10 hrs between shifts
  • 20. III. Obligations of Resident
    • Residency = primary commitment
    • Rules of the Match
    • FYI: Hours paid to resident to staff are included in count towards 80 hr/week duty hours requirement
  • 21.
    • Design & Conduct of Program PGY1 & PGY2
    • Design
    • Delivery
    • Evaluation & Improvement
    • Tracking of Residents
  • 22.
    • IV. Design of Program PGY1 - 6 Core Outcomes Required
      • Medication use process
          • Quality Improvement IOM
      • Patient-centered care IOM
          • Interdisciplinary Teams IOM
          • Evidence Based Practice IOM
      • Leadership and management
      • Project management
      • Education/training
      • Medical informatics IOM
  • 23. IV. Design of Program – PGY1
    • Clarity
      • Must include associated goals & objectives
      • Must evaluate each required goal at least once
      • Can add elective goals & objectives
    • Must encompass a variety of disease states
      • Not greater than 1/3 of year in any one area
  • 24.
    • Design of Program PGY2
    • All goals & objectives are being rewritten for
    • each specialized area of practice
    • Until your area is rewritten use current G&O
    • 2006:
    • Primary Care, Management, Critical Care
    • NEW: Informatics
  • 25. IV. Design of Program PGY1 & PGY2
    • Competency based evaluations
      • Focus on verbal feedback and alternatives
        • Formative evaluation
        • Top snap shots still available
      • Summative evaluations
      • Resident learns self-evaluation
      • Resident evaluates preceptors
  • 26.
    • Delivery of Program PGY1 & PGY2
    • Orientation to system of training
    • Assessment & customize program
    • Focus on effective feedback
    • Track residents progress across time
  • 27.
    • Program Evaluation & Improvement (PGY1 & PGY2)
    • Enhance preceptors training
    • Overall program enhancement at least yearly
  • 28. IV. Tracking of Residents
    • What type of jobs do they go to
    • Evaluate if program is producing what they say they are
  • 29.
    • Residency Program Director PGY1 & PGY2
    • Contribution & Commitment to Profession
    • (at least 4)
    • Documented improvements
    • Appointments to committees
    • Publications
    • Presentations
    • Reviewer for papers
    • Leadership at local, state, national assoc.
    • Effectiveness in teaching
  • 30. V. Residency Program Director
    • RPD: residency & 3 yrs
    • or 5 years
    • ALSO: BPS in appropriate area (nuclear, psychiatry, oncology, nutrition, pharmacotherapy, added qualifications infectious disease & cardiology
    RPD: residency & 3 yrs or 5 yrs PGY2 PGY1
  • 31. V. Preceptors PGY2 Residency & 1 year or 3 years in the area of practice Residency & 1 year or 3 years Contribution & commitment to profession (4) Contribution & commitment to profession (4) PGY2 PGY1
  • 32. VI. Site
    • Seek outside accreditation
      • (JCAHO, NCQA, AOA, DPH, etc)
    • Seek excellence
    • Sufficient # of patients
  • 33. VII. Pharmacy
    • Leadership
    • Safe & effective drug distribution
    • Meet patient’s needs
    • Safe & effective patient care outcomes
    • Personnel, facilities, resources
    • Meet national standards, state laws
  • 34. Strategies to implement new standards
    • Clear the decks!
      • Look at new standards
      • Try to understand big picture
      • Instead of matching old goals and objectives to new begin with new ones
  • 35. Strategies to implement new standards continued
    • Design from a clean slate
      • Review program purpose
      • Consider required outcomes
      • Create structure to ensure required outcomes are met
    • Resist temptation
      • Adding too many electives
      • Consider time needed to meet required outcomes
  • 36. Strategies to implement new standards continued
    • Design the program (read the standard!)
      • Develop learning experiences
      • Assign goals and objectives for evaluation to experiences
      • Ensure all understand evaluations required
    • Reflect on previous program
      • Note many learning experiences will require very little change
  • 37. Frequently Asked Questions
  • 38. Are all Specialized programs automatically a PGY2 residency?
    • Specialized ≠ PGY2
      • Either PGY1 or PGY2 training, depending on depth of training
      • If PGY1, must meet core competencies for PGY1 & provide a wide range of disease states
      • Summer of 2006 all programs must decide if they are PGY1 or PGY2 and communicate to ASHP their intent
  • 39. PGY1 or PGY2?
  • 40. Does the new PGY1 standard define “PGY1 with emphasis in” ?
    • No – Standards define PGY1 and PGY2
    • PGY1 can occur in a wide variety of settings & with focused populations as long as PGY1 outcomes are achieved
    • PGY1 can customize programs to individual residents
    • PGY1 programs can market their strengths to residents (e.g., ambulatory, pediatrics)
  • 41. Does the new PGY2 standard define equivalent experience for PGY2?
    • No
    • PGY1 must be done prior to PGY2
    • Extremely rare situation where equivalent experience would apply to the new PGY1-PGY2 standards
    • All “specialized” are not automatically PGY2; some may actually be PGY1 (e.g. ambulatory, pediatrics); must meet PGY1 outcomes
  • 42. Why a matching program for all ?
    • Prevent undue pressure on residents
    • Prevent premature decisions
      • Resulting in less than “optimal” placements
    • Equity for all programs
    • Equal time for all programs/applicants to decide the best fit
  • 43. Matching Rules
    • Deadlines
      • Late Summer – contract
      • November – Early Commitment for PGY2
      • March – Match
    • All positions in match
    • Rank is confidential
    • Cannot pressure candidates
    • Cannot accept candidates outside of the match
    • Binding Contract (applicant & program)
  • 44. Match Process
    • Resident Rank Order Submissions
    • Mary Bob Jennifer Molly
    • Hosp B Hosp B Univ A Hosp B
    • Best Rx Univ A Best Rx
    • Univ A Best Rx
  • 45. Match Process
    • Site Rank Order Submissions
    • Univ A (2) Hosp B (1) Best Rx (1)
    • Mary Mary Bob
    • Bob Jennifer
    • Jennifer Molly
    • Molly
  • 46. Match Process Match: Mary w/ Hosp B Mary Resident Rank Order Submissions Hosp B Best Rx Univ A Site Rank Order Submissions Univ A (2) Hosp B (1) Best Rx (1) Mary Mary Bob Bob Jennifer Jennifer Molly Molly
  • 47. Match Process Resident Rank Order Submissions Mary Bob Hosp B Hosp B Univ A Best Rx Site Rank Order Submissions Univ A (2) Hosp B (1) Best Rx (1) Mary Mary Bob Bob Jennifer Molly Bob matches with Univ A
  • 48. Match Process Resident Rank Order Submissions Mary Bob Jennifer Hosp B Univ A Univ A Best Rx Site Rank Order Submissions Univ A (2) Hosp B (1) Best Rx (1) Mary Mary Bob Bob Jennifer Jennifer Molly Molly Jennifer matches with Univ A
  • 49. Match Process Resident Rank Order Submissions Mary Bob Jennifer Molly Hosp B Univ A Univ A Hosp B Site Rank Order Submissions Univ A (2) Hosp B (1) Best Rx (1) Mary Mary Bob Bob Jennifer Jennifer Molly Molly Molly & Best Rx go unmatched
  • 50. Strategies to maximize your effectiveness when participating in the resident matching programs.
    • Only rank your true preferences
    • Rank in the order you would normally make a verbal offer
    • Don’t second guess how an applicant will rank you and try to adjust to that
    • Interview a variety of applicants if not using the early commitment process
    • Get your rank in on time!
  • 51. What if I have PGY1 and want to keep them for my PGY2 program, do they have to go through the match for the PGY2 program at my site?
    • Early Commitment process available –
    • part of the matching process
    • To occur in November prior to the March match, otherwise in the match
  • 52. Other match accommodations?
    • Couples – contact NMS
      • Both in Pharmacy Match
      • One in Pharmacy, one in Medical Match
    • Simultaneous matches
    • Multi-site Program – separate #’s
    • # positions
    • Reversion of positions
  • 53. Misunderstanding
    • ASHP makes money off of the matching program.
    • Fact:
    • It actually costs ASHP to run the matching program.
    • ASHP pays per program and position to the matching service.
    • All fees are paid directly to NMS, not ASHP.
  • 54. When do the new accreditation standards go into effect?
    • 2007
    • Sites scheduled for on site survey in the fall of 2006 – Jan 2007, have the option of which standard for review
    • All surveys after January 2007 use the new standard
    • All new applications must use new standards
    • All 2007-2008 programs must meet new standards
    • First all match - 2007
  • 55. Where can I learn more about the new standards?
    • ASHP Residency web page:
    • http://www.ashp.org/rtp/index.cfm
  • 56. Summary
    • Explain the differences between the PGY1 and PGY2 pharmacy residency programs.
    • First vs second year or training
    • Generalist vs specialized focus
    • RPD qualifications (PGY2=BPS if appropriate)
    • Depth of knowledge, skill, abilities gained
  • 57. Summary
    • Explain changes that can be implemented to a pharmacy practice residency program to meet the intent of the new ASHP accredited standards.
    • Review & redesign your program
    • Include all require outcomes, goals & objectives
    • Review your evaluation system
    • Review for duty hour violations
  • 58. Summary
    • Apply strategies to maximize your effectiveness when participating in the resident matching program.
    • Interview a number of candidates
    • Only rank true preferences
    • Rank in the order you would make an offer
    • Don’t second guess how an applicant will rank
    • Submit on time!
  • 59.  

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