Posted on March 15, 2017 in: Member News
By Deborah Isopi, B.S. Pharm, M.B.A., PGY1 residency program director, Detroit Medical Center
The American Society of Health-System Pharmacists (ASHP) Commission on Credentialing (COC) is currently updating the goals and objectives for all ASHP accredited residency programs. ASHP recognized that the previous documents were out-of-date and burdensome, so experts from across the country have been consulted to comment on the draft program goals, objectives and evaluation process. Eventually all residency program objectives will be revised. The following programs have already been approved by the COC: PGY1 in hospital pharmacy and community pharmacy practices and PGY2 programs in critical care, oncology, pediatric and psychiatric pharmacy.
Many of the residency programs in the state of Michigan will be undergoing reaccreditation in the next few years. It will be important to review several areas within your residency program for a successful survey. These areas include the program structure, learning experience descriptions and resident development plans. However, in order to interpret the new standards, a review of the terminology used in the standards is necessary. “Principles” has been replaced by “standards” to similarly match The Joint Commission jargon. Standards are defined as the required elements to be completed by each resident enrolled in the program.1 Standards are subdivided into competency areas, which are categories of the residency graduates’ capabilities and can be considered 1) required, 2) additional for the program and 3) elective for specific residents.1 Essentially competency areas are broad areas of practice which a resident should be proficient before graduating from the program. A program only has to select the required competency areas; however, it can choose to encompass other areas from the elective categories. The term "competency areas" replaces "outcomes" in the old standards. Expertise in a particular competency area can be achieved by successful completion of the goals and objectives assigned in the competency area, similar in structure to the old standards. Additionally, what was previously termed as the customized plan is now called the "development plan."
ASHP New Standards Terminology
Residency Program Design and Conduct (RPDC)
Residency Learning System (RLS)
In the past, site residency programs had to develop their own purpose statement. On accreditation visits, the ASHP surveyors would critique these statements to be sure that they supported the intent of the standards. In the new standards, the COC has defined the purpose statement for all programs. The creativity of each program now lies in the program structure. The program structure document should be a formal written document that facilitates the residents' achievement of the goals and objectives. It should list the required rotations and length of each rotation and should be standardized to allow residents sufficient practice with diverse patient populations, a variety of disease states and a range of patient problems.2 This is the first document that is requested by the survey team. The program structure document is considered a critical factor, which is an element the COC determined to carry more weight than others when they are assessing compliance and is used to determine length of accreditation.2
Another area of review will be the learning experience documents. Each rotation or learning experience should have a written document which includes a general description and expectations and evaluation schedule of the resident. Also, included are the educational goals and objectives that will be achieved by the resident during the rotation. Each objective must have learning activities assigned that will facilitate the achievement of the objective. The learning activities will be examined to be sure they are at a level to achieve the objective and are specific in nature using action verbs. Each objective is written using verbs taken from Bloom's taxonomy3 and the learning activity verbs should match the same level or higher than the verbs in the objective. For example, a learning activity of participating in daily rounds can be better described as "the resident should arrive to the nursing unit five minutes before patient care rounds, with all medication levels collected and a plan documented on the monitoring form." The learning descriptions are a critical factor, and the ASHP website has additional education in this area. It is recommended to review the ASHP online programs before the accreditation survey.
The initial and quarterly development plans are other areas that will be reviewed by the survey team. The initial assessment of the resident must be completed and documented by the end of orientation and must be shared with preceptors. Documentation of the assessment in PharmAcademic™ is not adequate to meet the standards and a mechanism of active review with preceptors should be implemented. For example, each residents' initial plan could be reviewed with preceptors at the Residency Advisory Committee meeting. Also, the quarterly residents' development plans should document the modifications of the rotation schedule based on the evaluations and comments of the preceptors.
ASHP develops a guidance document to assist sites in navigating through the standards. The guidance document will be updated by ASHP every six months and will specify how the COC will interpret the standards when conducting the reaccreditation visit. The Detroit Medical Center will have all of their residency programs reaccredited in October 2017, so feel free to contact me at firstname.lastname@example.org if you have any questions. Good luck in your survey visit.