Principle 4 of the ASHP Accreditation Standard for Postgraduate Year One (PGY1) Pharmacy Residency Programs, the Requirements for the Design and Conduct of the Residency Program, specifies that the resident's training will be designed, conducted, and evaluated using a systems-based approach, sometimes also referred to as a "systematic" approach. This approach begins with the development by the residency program of a purpose statement. The relevant part of the standard, in Requirement 4.1a, is quoted below with points about purpose statement highlighted in red:
"4.1 Program Design.
The RPD and, when applicable, program preceptors will collaborate to design the residency program. The resulting design will include the following elements:
a. The program will document its purpose (the type of practice for which the residents are to be prepared); its outcomes (the residency graduates' capabilities); its educational goals (broad, sweeping statements of abilities); and educational objectives (observable, measurable statements of resident performance, the sum of which ensure achievement of the educational goal) for each educational goal. The program's purpose will be reflected in the program's choice of outcomes. For each outcome there must be goals that further explain the capabilities specified by the outcome. For each goal there must be a set of educational objectives that specifies the resident performance to be measured."
When developing a purpose statement, it is helpful to think about why you are offering your unique residency program. What is/are the types of practice for which you are preparing residents in your program? The purpose statement should specify the type of practice for which residents are being prepared to assume upon graduation.
In addition to its contribution to helping you have a successful accreditation survey, having a clear purpose statement that meets standards provides the basis for building an effective residency program. Strong residency programs have been shown to improve the quality of patient care in organizations that develop and implement them, as well as training highly skilled pharmacy practitioners.
In this program, you'll review two residency programs and their purpose statements as examples. You'll learn about the criteria by which surveyors evaluate your purpose statements during accreditation site visits. This will enable you to evaluate your own purpose statement as a surveyor would to help ensure a successful survey in this area, as well as to develop a clear purpose statement that will provide a sound foundation for your residency program
Objectives
By the end of this program you will be able to:
1. Describe the parts of the ASHP Pharmacy Residency Accreditation Standard relevant to residency program purpose statements.
2. Describe the relationship between having an effective residency program purpose statement and enabling residents to provide positive patient care outcomes and ensure patient safety.
3. List accreditation standard criteria for residency program purpose statements.
4. Using accreditation standard criteria, determine if a specified purpose statement meets the standard.
Review the description of Patients-Come-First Hospital:
Background
Overview
Patients Come First Hospital (PCFH) is a 380 bed, community teaching hospital. Its centers of excellence include:
§ Region's largest obstetrics/gynecology (OB/GYN) service
§ Cardiology and cardiovascular surgery
§ Family Medicine
The hospital has Cardiology and Family Medicine medical residency programs. There are two hospitalist groups that provide care for the majority of medical patients other than Cardiology and Family Medicine.
Pharmacy Services at PCFH
§ Management team
- Director
- Assistant Director for Clinical Services
- Assistant Director for Operations
§ Sterile products preparation
- Centralized
- Operating Room (OR) satellite
§ Medication distribution system
- Cartless
- Automated dispensing cabinets (ADCs) profiled to hospital information system (including pharmacy)
§ Medication safety pharmacist oversees medication safety efforts of the department.
§ Information technology (IT) oversees information systems including automation, bar code medication administration (BCMA), and computerized physician order entry (CPOE)
§ Clinical Pharmacy Specialists (4):
§ Critical care
§ Oncology
§ Cardiology
§ Pediatrics
§ One critical care satellite pharmacy, open 16 hours/day, 5 days/week, and 10 hours on weekends.
§ Pharmacists on floors in patient care area pharmacist (PCAP) decentralized integrated practice model 8 hours/day, 5 days/week
- Identification of medication-related problems
- Monitoring drug therapies
- Order entry
- Drug information
- Coordinate distribution system
- Collect data for medication-use evaluations (MUE), adverse drug reactions (ADR)
PCFH has an affiliation agreement with a college of pharmacy, providing about 30 clerkship months each year. The college of pharmacy provides one full time faculty member who practices in inpatient/outpatient Family Medicine.
PCFH Residency Program
§ Two residency slots approved
§ Start-up July 1
§ Assistant Director of Clinical Services will be the Residency Program Director (RPD)
At a meeting of their Residency Advisory Committee (RAC), PCFH developed this purpose statement for their program:
PCFH Residency Program Purpose Statement: Prepare pharmacist clinicians for any of the following: patient care positions, adjunct faculty positions, PGY2 training in area of choice.
Does this purpose statement meet accreditation standards? To answer this question, review the criteria for a purpose statement:
Criteria:
Determine if you think this purpose statement meets the criteria by answering these questions:
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Go to the next screen for a discussion of the questions.
Patients-Come-First Hospital's purpose statement meets the first three criteria. It describes type of position the resident is qualified to accept following the residency program, is clearly stated and concise.
The last two criteria cannot be evaluated just by reading the purpose statement. During accreditation surveys, included in the surveyors' evaluation of these criteria are a review of the structure of the program, the preceptor qualifications and practices, and learning experience descriptions. Each of these should reflect how they support the achievement of the purpose statement by the resident(s).
Defining your program purpose can help you develop your program description for written materials about the program. This what PCFH wrote:
Program description for the PCFH residency manual:
"Patients Come First Hospital (PCFH) PGY1 pharmacy residency prepares its graduates to assume positions as patient care clinicians, to serve as adjunct faculty for a college of pharmacy, or to pursue second year post-graduate training in a focused area of practice. PCFH is a community teaching hospital providing the unique capability to engage each of our residents in patient care, project management, and practice management."
Review the description of University Medical Center.
Background:
Overview
University Medical Center (UMC) is an 1140 bed tertiary-quaternary care academic medical center. Its centers of excellence include:
§ Level I trauma center
§ Level III Neonatal Intensive Care Unit (NICU)
§ Region's largest OB/GYN service
§ Comprehensive cancer referral center including bone marrow transplant (BMT)
§ Cardiology and cardiovascular surgery
§ Neurology and neurosurgery
§ Solid organ transplantation
§ Clinics (where pharmacists provide patient care services)
- Pediatric specialties
- Internal medicine
- Family medicine
- Anticoagulation
- Oncology
- Geriatrics assessment
- Transplant
UMC is the teaching site for a college of pharmacy, offering some 200 clerkship months each year. Clinical pharmacy specialists in the department have appointments in the college.
Pharmacy Services at UMC
§ Management team
- Director
- Associate director
- Assistant director
- Clinical coordinator
- Evening shift supervisor
- Sterile products/purchasing supervisor
§ Sterile products preparation
- Centralized
- OR satellite
§ Medication distribution system
- Cartless
- Automated dispensing cabinets (ADCs) profiled to hospital information system (including pharmacy)
§ Associate director oversees clinical services program, and the assistant director oversees medication safety efforts of the department.
§ Information technology (IT) oversees information systems including automation, BCMA, and CPOE
§ Clinical Pharmacy Specialists (21):
§ Critical care: Medical Intensive Care Unit (MICU), Surgical Intensive Care Unit (SICU) (2)
§ Neonatal Intensive Care Unit (NICU)
§ Pediatrics
§ Geriatrics
§ Oncology, Bone Marrow Transplant (BMT) (2)
§ Infectious diseases (2)
§ Internal medicine (4)
§ Trauma/neurosurgery
§ Cardiology/Cardiovascular Intensive Care Unit (CVICU)
§ Transplant: renal/pancreas; liver/small bowel; cardiac/lung (3)
§ Drug information/drug policy
§ Internal medicine ambulatory care
§ Family medicine/anticoagulation
§ Clinical specialists are responsible for quality improvement programs in the department and are mentors for the (PCAP) decentralized pharmacists.
§ Pharmacists on floors in patient care area pharmacists (PCAP) decentralized integrated practice model 16 hours/day 7 days/week
- Medication histories and reconciliation
- Identification of medication-related problems
- Monitoring drug therapies
- Order entry
- Drug information
- Coordinate distribution system
- Collect data for MUE, ADR
§ Clinical pharmacy specialists rotate call on a weekly basis.
§ 24 hour pharmacist response to all pediatric and adult medical emergencies
UMC Residency Program
§ Four residency slots approved
§ Start-up July 1
§ Clinical coordinator is the RPD
Now review how UMC defined their residency program's purpose:
"The purpose of the University Medical Center's PGY1 pharmacy residency is to prepare pharmacist clinicians for patient care positions, adjunct faculty positions or to pursue PGY2 training in a focused area of practice."
Does this purpose statement meet accreditation standards? Again, review the criteria for a purpose statement:
Determine if you think this purpose statement meets the criteria by answering the following questions:
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Go to the next screen for a discussion of the questions.
University Medical Center's purpose statement meet the first three criteria. It describes type of position the resident is qualified to accept following the residency program, is clearly stated and concise.
As with the first example, the last two criteria cannot be evaluated just by reading the purpose statement. During accreditation surveys, included in the surveyors' evaluation of these criteria are a review of the structure of the program, the preceptor qualifications and practices, and learning experience descriptions. Each of these should reflect how they support the achievement of the purpose statement by the resident(s).
Here is an example of a purpose statement for a community pharmacy residency program:
Purpose: The Jamestown University Community Pharmacy Residency Program prepares residents to fill positions as clinical providers of advanced patient care services in the community pharmacy setting. The program will equip the resident to: 1. Provide direct patient care to diverse populations, 2. Engage in collaborations with physicians and other healthcare providers, 3. Educate pharmacy students and providers, 4. Manage an advanced patient care practices, 5. Provide leadership for advancing community practice and the profession.
Here is an example of a purpose statement in a managed care pharmacy residency program:
Purpose: The Middle America Health managed care residency program will train residents to be competent in practice areas within managed care pharmacy, including operations and management of the organization, clinical strategy, network relations, drug utilization, sales, and industry relations/contracting. The residency program will prepare the resident to successfully apply for mid-level positions, such as a clinical program manager and formulary pharmacist manager at a managed health care organization, such as a health plan or pharmacy benefit management (PBM) company.
Here is one more purpose statement for critique.
"The purpose of the PGY1 Residency is to provide the learning environment, instruction, mentoring and evaluation necessary for the resident to develop high level pharmaceutical care skills. This 12-month residency program strives to develop a pharmacy practitioner who is able to apply the unique skills that pharmacists possess in innovative settings in order to meet health care needs that are not adequately met by other professions and add to the body of knowledge of the clinical, financial and humanistic value of pharmaceutical care."
Answer these questions about whether or not this purpose statement meets accreditation standards.
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Go to the next screen for a discussion of the questions.
This purpose statement does not meet the accreditation standard criteria. Terms used in the purpose statement, such as "unique skills," "high level," and "innovative settings" are vague rather than specific. The statement is lengthy, as opposed to concise. It does not specify the positions for which it is preparing the resident(s). It uses terminology that describe the site and program, as opposed to the type of practitioner the program is designed to produce. It is more appropriate to include this type of statement in a description, rather than the purpose statement.
Now critique the purpose statement of your residency program(s). Click here for a criteria checklist.
Now you know all about purpose statements. You can use the criteria to ensure that your residency program purpose statement meets ASHP residency accreditation standards. Good luck with your program!