A Postgraduate Training Update A Postgraduate Training Update from the ASHP Commission on from the ASHP Commission on

Credentialing (COC)Credentialing (COC)

Mary Hess, Chair

Commission on Credentialing

““Great Leaders are never satisfied with Great Leaders are never satisfied with current levels of performance. They are current levels of performance. They are relentlessly driven by possibilities and relentlessly driven by possibilities and

potential achievements.”potential achievements.”

D. HarrisonD. Harrison

ObjectivesObjectives

Explain the differences between the Explain the differences between the postgraduate year one (PGY1) and postgraduate year one (PGY1) and postgraduate year two (PGY2) pharmacy postgraduate year two (PGY2) pharmacy residency programs. residency programs. Explain changes that can be implemented to a Explain changes that can be implemented to a pharmacy practice residency program to meet pharmacy practice residency program to meet the intent of the new ASHP accreditation the intent of the new ASHP accreditation standards.standards.Apply strategies to maximize your program’s Apply strategies to maximize your program’s effectiveness when participating in the resident effectiveness when participating in the resident matching program. matching program.

Factors related to release of new Factors related to release of new Residency Accreditation Standards Residency Accreditation Standards

IOM reportsIOM reports

JCAHO Roundtable/conferenceJCAHO Roundtable/conference

Future of Residency Training ConferenceFuture of Residency Training Conference

ACCP/ASHP PartnershipACCP/ASHP Partnership

Open Hearings & comment periodsOpen Hearings & comment periods

ACPE standards ACPE standards

•Patient-centered

•Interdisciplinary teams

•Evidence-based practice

•Utilize informatics

•Apply quality improvement

IOM - Core competencies for all health professionalsJCAHO - improving education of health professionals

Pharmacy Residency Training in the Future: A Stakeholders’ Roundtable DiscussionJanuary 23-24, 2005

Stakeholders:Stakeholders:ASHPASHPAACPAACPACCPACCPAMCPAMCPAPhAAPhA

Other invitees:Other invitees: ACPE, BPS, ASCP, NCPA, ACPE, BPS, ASCP, NCPA, NACDS, VANACDS, VA

Strong Areas of AgreementStrong Areas of Agreement

Accreditation by one national body that Accreditation by one national body that includes key stakeholdersincludes key stakeholders

All residencies should be accreditedAll residencies should be accredited

Residencies help develop innovative Residencies help develop innovative practicespractices

Colleges provide knowledge; residencies Colleges provide knowledge; residencies are becoming necessary to integrate are becoming necessary to integrate knowledge into practice knowledge into practice

ConclusionsConclusions

↑ ↑ nneed for residency trained eed for residency trained individuals by 2015individuals by 2015↑ ↑ nneed for community residencies eed for community residencies Specialization in the profession needs Specialization in the profession needs clarity clarity PGY1 & PGY2 is appropriate model PGY1 & PGY2 is appropriate model Terms and vision need to be consistent, Terms and vision need to be consistent, defined, endorsed and embraced by the defined, endorsed and embraced by the profession profession

What happened in 2005?What happened in 2005?

CCP endorsedCCP endorsed

PGY1, PGY2 conceptPGY1, PGY2 concept

Published Conference proceedings Published Conference proceedings

AJHP September 1, 2005AJHP September 1, 2005

New Standards Approved & Released: New Standards Approved & Released: PGY1, PGY2PGY1, PGY2

What’s happening in 2006?What’s happening in 2006?

Implementing new standardsImplementing new standards

Sunset PGY2 goals and objectives, as Sunset PGY2 goals and objectives, as they are rewrittenthey are rewritten

Revision of RLS training to match new Revision of RLS training to match new standardsstandards

Rewrite of Community & Managed Care Rewrite of Community & Managed Care standardstandard

New Pharmacy Residency New Pharmacy Residency Accreditation StandardsAccreditation Standards

PGY1 Pharmacy ResidencyPGY1 Pharmacy ResidencyReplaces Pharmacy Practice (2001)Replaces Pharmacy Practice (2001)

PGY2 Pharmacy ResidencyPGY2 Pharmacy ResidencyReplaces Specialized Pharmacy Practice (1994)Replaces Specialized Pharmacy Practice (1994)and all supplemental standards and all supplemental standards (Goals & objectives remain)(Goals & objectives remain)

Standards not altered at this time:Standards not altered at this time: Managed Care Pharmacy PracticeManaged Care Pharmacy Practice Managed Care Systems Residency Managed Care Systems Residency Pharmacy Practice (with emphasis in Community Care)Pharmacy Practice (with emphasis in Community Care)

New Standards – overall changesNew Standards – overall changes

Different terminology/concept Different terminology/concept

PGY1/PGY2PGY1/PGY2– General training vs. advanced depth of General training vs. advanced depth of

trainingtraining

Incorporates IOM core competenciesIncorporates IOM core competencies

Duty hoursDuty hours

Participation in the matchParticipation in the match

PharmDGraduate

Patient/Practice FOCUS

Broad

DEPTH ofknowledge, skills, abilities, experience

A A PGY1PGY1

GeneralistGeneralist

Wide variety of patients & Wide variety of patients & diseasesdiseases

PGY1 PGY1 B B

Generalist Focused PractitionerGeneralist Focused Practitioner

Wide variety of diseases may be Wide variety of diseases may be in a unique setting or population in a unique setting or population (e.g., pediatrics, geriatrics, (e.g., pediatrics, geriatrics, ambulatory, managed care)ambulatory, managed care)

C C PGY2PGY2

Advanced PractitionerAdvanced Practitioner

More experience, skill and More experience, skill and ability developed in a broad ability developed in a broad set of patients (e.g., pharma-set of patients (e.g., pharma-cotherapy)cotherapy)

PGY2 PGY2 D D

Advanced PractitionerAdvanced Practitioner

More experience, skill, and ability More experience, skill, and ability developed in a focused area of developed in a focused area of practice (e.g., oncology, critical practice (e.g., oncology, critical care)care)

Narrow

Basic

Advanced

Standards similar PGY1 & PGY2Standards similar PGY1 & PGY2

II Qualifications of ResidentsQualifications of Residents

IIII Obligations of the Program to ResidentsObligations of the Program to Residents

IIIIII Obligations of Resident to ProgramObligations of Resident to Program

IVIV Design & Conduct of the Residency Design & Conduct of the Residency

VV RPD & PreceptorsRPD & Preceptors

VIVI Site RequirementsSite Requirements

VIIVII Pharmacy RequirementsPharmacy Requirements

So what is different PGY1 vs PGY2?So what is different PGY1 vs PGY2?

PGY1PGY1– First year of post graduate residency trainingFirst year of post graduate residency training– Wide variety of disease states/patientsWide variety of disease states/patients– Advances individual beyond PharmDAdvances individual beyond PharmD– Training a generalistTraining a generalist

PGY 2PGY 2– Second year of post graduate residency trainingSecond year of post graduate residency training– Advances training beyond PGY1Advances training beyond PGY1– Usually focused on a specialized area of practiceUsually focused on a specialized area of practice

So what is different PGY1 vs PGY2?So what is different PGY1 vs PGY2?

Applicant requirementsApplicant requirements

RPD requirements RPD requirements

Outcomes, goals and objectivesOutcomes, goals and objectives

Expectations of ResidentsExpectations of Residents

Review of eachReview of each section of new stdssection of new stds

Highlight changesHighlight changes

Highlight differences PGY1 vs PGY2 Highlight differences PGY1 vs PGY2

Highlight frequently cited areas of partial Highlight frequently cited areas of partial compliancecompliance

I.I. Qualifications of the ResidentsQualifications of the Residents

PGY1 “should” graduate from ACPE PGY1 “should” graduate from ACPE Pharm D (Foreign graduates – must be Pharm D (Foreign graduates – must be able to be licensed)able to be licensed)

PGY2 : complete PGY1PGY2 : complete PGY1

Must have a policy on what to do if the Must have a policy on what to do if the resident does not become licensed resident does not become licensed

Must have a process for evaluating Must have a process for evaluating candidatescandidates

II.II. Obligations of ProgramObligations of Program

Policy on the impact of leave on the Policy on the impact of leave on the residency residency

Letter of acceptance & conditionsLetter of acceptance & conditions

Rules of the matchRules of the match

Duty Hours Duty Hours – 80 hrs/wk80 hrs/wk– 1/7 days off 1/7 days off – 10 hrs between shifts10 hrs between shifts

III.III. Obligations of ResidentObligations of Resident

Residency = primary commitmentResidency = primary commitment

Rules of the MatchRules of the Match

FYI:FYI: Hours paid to resident to staff are Hours paid to resident to staff are included in count towards 80 hr/week duty included in count towards 80 hr/week duty hours requirementhours requirement

IV.IV. Design & Conduct of ProgramDesign & Conduct of ProgramPGY1 & PGY2PGY1 & PGY2

DesignDesign

DeliveryDelivery

Evaluation & ImprovementEvaluation & Improvement

Tracking of ResidentsTracking of Residents

IV.IV. Design of ProgramDesign of ProgramPGY1 - 6 Core Outcomes RequiredPGY1 - 6 Core Outcomes Required

Medication use processMedication use processQuality ImprovementQuality Improvement IOMIOM

Patient-centered care Patient-centered care IOMIOM

Interdisciplinary TeamsInterdisciplinary Teams IOMIOMEvidence Based PracticeEvidence Based Practice IOMIOM

Leadership and managementLeadership and managementProject managementProject managementEducation/trainingEducation/trainingMedical informaticsMedical informatics IOMIOM

IV.IV. Design of Program – PGY1Design of Program – PGY1

Clarity Clarity – Must include associated goals & objectivesMust include associated goals & objectives– Must evaluate each required goal at least once Must evaluate each required goal at least once – Can add elective goals & objectives Can add elective goals & objectives

Must encompass a variety of disease statesMust encompass a variety of disease states– Not greater than 1/3 of year in any one areaNot greater than 1/3 of year in any one area

IV.IV. Design of ProgramDesign of ProgramPGY2PGY2

All goals & objectives are being rewritten forAll goals & objectives are being rewritten foreach specialized area of practiceeach specialized area of practice

Until your area is rewritten use current G&OUntil your area is rewritten use current G&O

2006:2006:Primary Care, Management, Critical CarePrimary Care, Management, Critical CareNEW: Informatics NEW: Informatics

IV. Design of ProgramIV. Design of ProgramPGY1 & PGY2PGY1 & PGY2

Competency based evaluationsCompetency based evaluationsFocus on verbal feedback and alternativesFocus on verbal feedback and alternativesFormative evaluationFormative evaluation

Top snap shots still availableTop snap shots still available

– Summative evaluationsSummative evaluations– Resident learns self-evaluationResident learns self-evaluation– Resident evaluates preceptorsResident evaluates preceptors

IV.IV. Delivery of ProgramDelivery of ProgramPGY1 & PGY2PGY1 & PGY2

Orientation to system of trainingOrientation to system of training

Assessment & customize programAssessment & customize program

Focus on effective feedback Focus on effective feedback

Track residents progress across timeTrack residents progress across time

IV.IV. Program Evaluation & ImprovementProgram Evaluation & Improvement(PGY1 & PGY2)(PGY1 & PGY2)

Enhance preceptors trainingEnhance preceptors training

Overall program enhancement at least Overall program enhancement at least yearlyyearly

IV.IV. Tracking of ResidentsTracking of Residents

What type of jobs do they go toWhat type of jobs do they go to

Evaluate if program is producing what they Evaluate if program is producing what they say they aresay they are

V.V. Residency Program DirectorResidency Program DirectorPGY1 & PGY2PGY1 & PGY2

Contribution & Commitment to Profession Contribution & Commitment to Profession (at least 4)(at least 4)

- Documented improvementsDocumented improvements- Appointments to committeesAppointments to committees- PublicationsPublications- PresentationsPresentations- Reviewer for papersReviewer for papers- Leadership at local, state, national assoc.Leadership at local, state, national assoc.- Effectiveness in teachingEffectiveness in teaching

V.V. Residency Program DirectorResidency Program Director

PGY1PGY1 PGY2PGY2

RPD: residency & 3 yrsRPD: residency & 3 yrs

or 5 yrsor 5 yrs

RPD: residency & 3 yrsRPD: residency & 3 yrs

or 5 yearsor 5 years

ALSO: BPS in ALSO: BPS in appropriate area appropriate area (nuclear, psychiatry, (nuclear, psychiatry, oncology, nutrition, oncology, nutrition, pharmacotherapy, pharmacotherapy, added qualifications added qualifications infectious disease & infectious disease & cardiologycardiology

V. PreceptorsV. Preceptors

PGY1PGY1 PGY2PGY2

Residency & 1 yearResidency & 1 year

or 3 years or 3 years

PGY2 Residency & 1 year PGY2 Residency & 1 year or 3 years in the area of or 3 years in the area of practicepractice

Contribution & Contribution & commitment to commitment to profession (4)profession (4)

Contribution & commitment Contribution & commitment to profession (4)to profession (4)

VI.VI. Site Site

Seek outside accreditationSeek outside accreditation(JCAHO, NCQA, AOA, DPH, etc)(JCAHO, NCQA, AOA, DPH, etc)

Seek excellenceSeek excellence

Sufficient # of patientsSufficient # of patients

VII.VII. PharmacyPharmacy

LeadershipLeadership

Safe & effective drug distributionSafe & effective drug distribution

Meet patient’s needsMeet patient’s needs

Safe & effective patient care outcomesSafe & effective patient care outcomes

Personnel, facilities, resourcesPersonnel, facilities, resources

Meet national standards, state lawsMeet national standards, state laws

Strategies to implement new standardsStrategies to implement new standards

Clear the decks!Clear the decks!– Look at new standardsLook at new standards– Try to understand big pictureTry to understand big picture– Instead of matching old goals and objectives Instead of matching old goals and objectives

to new begin with new ones to new begin with new ones

Strategies to implement new standards Strategies to implement new standards continued continued

Design from a clean slateDesign from a clean slate– Review program purposeReview program purpose– Consider required outcomesConsider required outcomes– Create structure to ensure required outcomes Create structure to ensure required outcomes

are metare met

Resist temptationResist temptation– Adding too many electivesAdding too many electives– Consider time needed to meet required Consider time needed to meet required

outcomesoutcomes

Strategies to implement new standards Strategies to implement new standards continuedcontinued

Design the program (read the standard!)Design the program (read the standard!)- Develop learning experiencesDevelop learning experiences- Assign goals and objectives for evaluation to Assign goals and objectives for evaluation to

experiencesexperiences- Ensure all understand evaluations requiredEnsure all understand evaluations required

Reflect on previous program Reflect on previous program – Note many learning experiences will require Note many learning experiences will require

very little changevery little change

Frequently Asked QuestionsFrequently Asked Questions

Are all Specialized programs Are all Specialized programs automatically a PGY2 residency?automatically a PGY2 residency?

Specialized Specialized ≠ PGY2≠ PGY2– Either PGY1 or PGY2 training, depending on Either PGY1 or PGY2 training, depending on

depth of training depth of training – If PGY1, must meet core competencies for If PGY1, must meet core competencies for

PGY1 & provide a wide range of disease statesPGY1 & provide a wide range of disease states– Summer of 2006 all programs must decide if Summer of 2006 all programs must decide if

they are PGY1 or PGY2 and communicate to they are PGY1 or PGY2 and communicate to ASHP their intentASHP their intent

Specialized ResidenciesPrimary Care 66Critical Care 43Drug Information 28Oncology 25Infectious Diseases 20Pediatrics 19Geriatrics 16Management 14Psychiatric 10Internal Medicine 9Pharmacotherapy 9Managed Care Systems 8Nutrition Support 4Nuclear 3

PGY1 or PGY2?

Does the new PGY1 standard define Does the new PGY1 standard define “PGY1 with emphasis in” ?“PGY1 with emphasis in” ?

No – Standards define PGY1 and PGY2No – Standards define PGY1 and PGY2PGY1 can occur in a wide variety of PGY1 can occur in a wide variety of settings & with focused populations as settings & with focused populations as long as PGY1 outcomes are achievedlong as PGY1 outcomes are achievedPGY1 can customize programs to PGY1 can customize programs to individual residentsindividual residentsPGY1 programs can market their PGY1 programs can market their strengths to residents (e.g., ambulatory, strengths to residents (e.g., ambulatory, pediatrics)pediatrics)

Does the new PGY2 standard define Does the new PGY2 standard define equivalent experience for PGY2?equivalent experience for PGY2?

NoNoPGY1 must be done prior to PGY2PGY1 must be done prior to PGY2Extremely rare situation where equivalent Extremely rare situation where equivalent experience would apply to the new PGY1-experience would apply to the new PGY1-PGY2 standards PGY2 standards All “specialized” are not automatically All “specialized” are not automatically PGY2; some may actually be PGY1 (e.g. PGY2; some may actually be PGY1 (e.g. ambulatory, pediatrics); must meet PGY1 ambulatory, pediatrics); must meet PGY1 outcomesoutcomes

Why a matching program for all ?Why a matching program for all ?

Prevent undue pressure on residentsPrevent undue pressure on residents

Prevent premature decisionsPrevent premature decisions– Resulting in less than “optimal” placementsResulting in less than “optimal” placements

Equity for all programsEquity for all programs

Equal time for all programs/applicants to Equal time for all programs/applicants to decide the best fit decide the best fit

Matching RulesMatching Rules

DeadlinesDeadlines– Late Summer – contractLate Summer – contract– November – Early Commitment for PGY2November – Early Commitment for PGY2– March – Match March – Match

All positions in matchAll positions in match

Rank is confidential Rank is confidential

Cannot pressure candidatesCannot pressure candidates

Cannot accept candidates outside of the match Cannot accept candidates outside of the match

Binding Contract (applicant & program)Binding Contract (applicant & program)

Match ProcessMatch Process

Resident Rank Order SubmissionsResident Rank Order Submissions

MaryMary BobBob JenniferJennifer MollyMolly

Hosp BHosp B Hosp BHosp B Univ AUniv A Hosp BHosp B

Best RxBest RxUniv AUniv A Best RxBest Rx

Univ AUniv A Best RxBest Rx

Match ProcessMatch Process

Site Rank Order SubmissionsSite Rank Order Submissions

Univ A (2)Univ A (2) Hosp B (1)Hosp B (1) Best Rx (1)Best Rx (1)MaryMary MaryMary BobBobBobBob JenniferJenniferJenniferJennifer MollyMollyMollyMolly

Match ProcessMatch Process

Match: Mary w/ Hosp B

Mary Resident Rank Order SubmissionsHosp BBest RxUniv A

Site Rank Order Submissions

Univ A (2) Hosp B (1) Best Rx (1)Mary Mary BobBob JenniferJennifer MollyMolly

Match ProcessMatch Process Resident Rank Order Submissions

Mary BobHosp B Hosp B

Univ ABest Rx

Site Rank Order Submissions

Univ A (2) Hosp B (1) Best Rx (1)Mary Mary BobBobJenniferMolly

Bob matches with Univ A

Match ProcessMatch Process Resident Rank Order Submissions

Mary Bob JenniferHosp B Univ A Univ A

Best Rx

Site Rank Order Submissions

Univ A (2) Hosp B (1) Best Rx (1)Mary Mary BobBob JenniferJennifer MollyMolly

Jennifer matcheswith Univ A

Match ProcessMatch Process Resident Rank Order Submissions

Mary Bob Jennifer MollyHosp B Univ A Univ A Hosp B

Site Rank Order Submissions

Univ A (2) Hosp B (1) Best Rx (1)Mary Mary BobBob JenniferJennifer MollyMolly

Molly & Best Rx go unmatched

Strategies to maximize your effectiveness Strategies to maximize your effectiveness when participating in the resident matching when participating in the resident matching programs.programs.

Only rank your true preferencesOnly rank your true preferences

Rank in the order you would normally Rank in the order you would normally make a verbal offermake a verbal offer

Don’t second guess how an applicant will Don’t second guess how an applicant will rank you and try to adjust to that rank you and try to adjust to that

Interview a variety of applicants if not Interview a variety of applicants if not using the early commitment processusing the early commitment process

Get your rank in on time!Get your rank in on time!

What if I have PGY1 and want to keep them What if I have PGY1 and want to keep them for my PGY2 program, do they have to go for my PGY2 program, do they have to go through the match for the PGY2 program at through the match for the PGY2 program at my site?my site?

Early Commitment process available – Early Commitment process available –

part of the matching processpart of the matching process

To occur in November prior to the March To occur in November prior to the March match, otherwise in the match match, otherwise in the match

Other match accommodations?Other match accommodations?

Couples – contact NMSCouples – contact NMS– Both in Pharmacy MatchBoth in Pharmacy Match– One in Pharmacy, one in Medical MatchOne in Pharmacy, one in Medical Match

Simultaneous matchesSimultaneous matches

Multi-site Program – separate #’sMulti-site Program – separate #’s

# positions # positions

Reversion of positionsReversion of positions

MisunderstandingMisunderstandingASHP makes money off of the matching program.ASHP makes money off of the matching program.

Fact: Fact:

It actually costs ASHP to run the matching It actually costs ASHP to run the matching program. program.

ASHP pays per program and position to ASHP pays per program and position to the matching service. the matching service.

All fees are paid directly to NMS, not All fees are paid directly to NMS, not ASHP.ASHP.

When do the new accreditation When do the new accreditation standards go into effect?standards go into effect?

20072007

Sites scheduled for on site survey in the fall of Sites scheduled for on site survey in the fall of 2006 – Jan 2007, have the option of which 2006 – Jan 2007, have the option of which standard for reviewstandard for reviewAll surveys after January 2007 use the new All surveys after January 2007 use the new standardstandardAll new applications must use new standardsAll new applications must use new standardsAll 2007-2008 programs must meet new All 2007-2008 programs must meet new standardsstandardsFirst all match - 2007First all match - 2007

Where can I learn more about the new Where can I learn more about the new standards?standards?

ASHP Residency web page: ASHP Residency web page:

http://www.ashp.org/rtp/index.cfmhttp://www.ashp.org/rtp/index.cfm

SummarySummary

Explain the differences between the PGY1 and Explain the differences between the PGY1 and PGY2 pharmacy residency programs. PGY2 pharmacy residency programs.

First vs second year or trainingFirst vs second year or training

Generalist vs specialized focusGeneralist vs specialized focus

RPD qualifications (PGY2=BPS if appropriate)RPD qualifications (PGY2=BPS if appropriate)

Depth of knowledge, skill, abilities gainedDepth of knowledge, skill, abilities gained

SummarySummary

Explain changes that can be implemented Explain changes that can be implemented to a pharmacy practice residency program to a pharmacy practice residency program to meet the intent of the new ASHP to meet the intent of the new ASHP accredited standards.accredited standards.

Review & redesign your programReview & redesign your programInclude all require outcomes, goals & Include all require outcomes, goals & objectivesobjectivesReview your evaluation systemReview your evaluation systemReview for duty hour violationsReview for duty hour violations

SummarySummary

Apply strategies to maximize your effectiveness Apply strategies to maximize your effectiveness when participating in the resident matching when participating in the resident matching program. program.

Interview a number of candidatesInterview a number of candidatesOnly rank true preferencesOnly rank true preferencesRank in the order you would make an offerRank in the order you would make an offerDon’t second guess how an applicant will rankDon’t second guess how an applicant will rankSubmit on time!Submit on time!