RESIDENT REPORT AND REVISED PHARMACY GRAND ROUNDS PROPOSAL Summary: Restructuring of the current Pharmacy Grand Rounds, Journal Club and Practice Management Experience is required. Pharmacy Grand Rounds will be limited by the increased interest by our clinical pharmacists to present as a result of the Pharmacist Advancement and Recognition Program. Great Lakes practice sessions have expanded for all PGY-1’s to include a focus on presentation skills. For both Grand Rounds and Journal Club, currently attendance by preceptors is not consistent. Practice Management is limited to PGY-1 Pharmacy residents only and no assessment strategy is included. Historically, no ASHP goals or objectives for the PGY-1 program have been tied to Grand Rounds or the Journal Club. The hours of resident and presentation advisor time can then be reclaimed for other educational needs. The need exists in ensuring a forum for case-based teaching, more frequent evidence evaluation, practice management discussion and structured resident clinical skill evaluation. This is a component of each of our residency program goals (Case Based Teaching: Pharmacy [includes JAR, SARs, MSO, Specialty] Goal 5.1, Community Goal 5.1, Critical Care Goal 3.1, ID Goal 4.1, Oncology Goal 4.1, Transplant Goal 5.1; Evidence-based Drug Information: Pharmacy [includes JAR, SARs, MSO, Specialty] Goal 1.5, Community Goal 5.2; Practice Management: Pharmacy [includes JAR, SARs, MSO, Specialty] Outcome R3, Community Outcome R3, Pharmacy Administration Outcome R2-R3). One longstanding method for accomplishing this in the medical school system is through a resident report and Morbidity and Mortality Conference. These have been adjusted to meet the needs of pharmacy residents. Procedure – Pharmacy Grand Rounds This is no longer a requirement for PGY-1 residents. Residents in their PGY-2 year (SARs, Specialty, MSO, Transplant, Oncology, ID and Critical Care) will be required to complete a Grand Rounds or In-service. A list of required competency programs will be maintained by the Compliance Officer. If a program director or resident would like to present at Pharmacy Grand Rounds the normal request process should be followed. Proposed Procedure – Resident Report and Core Clinical Skills Evaluations A. Scheduling 1. A senior administrative resident on the Admin RPD experience will set up logistics (resident schedule, calendar invites, and rooms) related to Resident Report for all residents with oversight by the PGY-1 Pharmacy RPD (see example - Appendix A). 2. Resident Report will be held September through May, excluding December and Great Lakes. 3. All Junior Administrative Residents, PGY-1 Pharmacy Residents, first year MSO or Specialty Pharmacy Residents and APPE-RT students are required to attend and this should be prioritized above rotation activities. PGY-2 residents when presenting are required to attend. a. The acceptable reasons for missing Resident Report include: 1. P&T presentation or minutes responsibilities 2. Offsite rotation commitment 4. All pharmacists, Senior Administrative Residents, PGY-2 Residents and PGY-1 Community residents are encouraged to attend. 5. Clinical PGY-2 Residents are divided throughout the year to facilitate journal club or case based discussions. 6. There will be two components of Resident Report and Core Clinical Skills Evaluations (CCSE). a. Resident Report will take place every Monday, Wednesday, and Thursday. (Tuesday excluded due to clinics/staff meetings/in-services and Friday due to staffing). Mondays from 12:00 to 12:30, Wednesdays from 15:30 to 16:00 and Thursdays from 12:00 to 12:30.

b. PGY-1 Pharmacy Residents should expect to stay until 13:00 for weekly meeting on Thursdays c. Core Clinical Skills Evaluations will be completed following the PGY-1 Pharmacy second clinical rotation, fourth clinical and sixth clinical rotation. B. Process – Resident Report 1. The assigned PGY-1 resident selects one of three education session formats and completes the preparatory work. a. A patient case that meets the Resident Case Report Guidelines (see Appendix B) and completes the Resident Report Worksheet (see Appendix C). b. A journal article that meets the Resident Journal Club Guidelines (see Appendix D) and completes the 30 point Manuscript Assessment Tool (see Appendix E). c. A practice management case that meets Resident Practice Management Case Guidelines (see Appendix F) and completes the Resident Report Worksheet (see Appendix C). Each presenting resident must do at least one Practice Management Case per year. 2. For clinical cases or journal clubs: the Resident Report Worksheet or Manuscript Assessment Tool is reviewed with the PGY-2 facilitator at least 1 week ahead of time for residents, 2 weeks ahead of time for APPE-RT students; if the PGY-2 is unavailable, the PGY-1 Pharmacy RPD will review. At this meeting the worksheet must be reviewed, a finalized plan for the session made, and content experts identified. If this is not completed or the worksheet is not to the level of publication in the weekly department newsletter, the PGY-2 will cancel the session and inform the presenting residents RPD. 3. For practice management cases: the Resident Report Worksheet is reviewed with the SAR facilitator at least 1 week ahead of time for residents, 2 weeks ahead of time for APPE-RT students; if the SAR is unavailable, the PGY-1 Pharmacy RPD will review. At this meeting the worksheet must be reviewed, a finalized plan for the session made, and content experts identified. If this is not completed or the worksheet is not to the level of publication in the weekly department newsletter, the PGY-2 will cancel the session and inform the presenting residents RPD. 4. For practice management cases the PGY-1 must confirm a SAR or manager will attend to supplement the PGY-2’s practice management knowledge. 5. Two business days prior to the session the PGY-1 will email All Inpatient Pharmacists the finalized Resident Report Worksheet or Manuscript Assessment Tool and invite all pharmacists to attend. All sessions will be listed on the Pharmacy Teaching Calendar. 6. The facilitator is responsible for introducing the speaker, quieting the room and assisting in guiding the discussion as needed. 7. The session should utilize the Socratic Method with group participation and problem solving. While preparation, as above, is required, there is no need to prepare slides or handouts. 8. Immediately following the session the facilitator should provide verbal feedback to the PGY-1 presenter, this should be additionally documented on Feedback Sheet (See Appendix G). 9. The presenter will send the final Resident Report Worksheet with any notable takeaways from the discussion to Mike Kaiser for the department newsletter. Notable cases or article topics should be referred for publication as case reports or review articles. 10. Feedback to the presenter will be gathered using the Resident Report Feedback Sheet (Appendix G) and provided to the resident’s program director. 11. The facilitator should keep records of attendance records saved to the Excel file located at J:\Rx\RXShare\Resident\Resident Report. C. Process – Core Clinical Skills Evaluations 1. CCSE’s will take place in October, March and June. 2013 start date is March. 2. Only PGY-1 Pharmacy residents participate in CCSE’s in March. 3. The Resident Report coordinator (SAR) will set up a 30 minute session with the previous rotation preceptors and the PGY-1 Residency Program Director or Coordinator – Patient

4.

5. 6.

7.

Care Services and Practice Advancement during these weeks. The resident’s advisor will be invited, but is not required to attend. The rotation preceptors will prepare questions covering the core learning objectives for their respective rotation and reviewed prior to the session by the PGY-1 Pharmacy RPD or Coordinator – Patient Care Services and Practice Advancement. The preceptors will evenly divide the 30 minutes for their questions. Preceptor questions should be aimed to assess learning objectives in the higher domains of Bloom’s taxonomy and should have objective answers. It is the expectation that all questions will be drawn from observed clinical cases or rotation articles / presentations / journal clubs. Feedback will be summarized and forwarded to the resident’s advisor and RPD for incorporation into customized plans.

Appendix A: Scheduling Grid Week

9/1/14 9/8/14

9/15/14 9/22/14 9/29/14 10/6/14 10/13/14

10/20/14 10/27/14 11/3/14 11/10/14

11/17/14

Monday (see below) 12:00-12:30 OFF Labor Day Emily Zimmerman F6/133b Bryan Wang G5/114 Jerame Hill G5/114 Brian Buss G5/114 Yang He G5/114 Emily Zimmerman G5/170 Bryan Wang G5/114 Jerame Hill G5/114 Jen Garber G5/114 Christian Holm G5/170 Brian Buss G5/114

11/24/14

Thursday G5/170 15:30-16:00 Sara Koth

Friday G5/114 12:00-12:30 Chris Viesselmann Kathryn Hensley

Jen Garber Russell Findlay Jen Garber Russell Findlay

Rachel Fleagel Sara Emanuele Eileen Shannon Chris Viesselmann Kathryn Hensley

Kate Croegaert Jordan Rush Kate Croegaert Jordan Rush Jen Garber Maria Ajami Jen Garber Maria Ajami Ron Kendall Scott Canfield

Katy Berres

Rachel Fleagel Sara Emanuele Kara Buck

Erin McAllister

Karrie Radovich

Ron Kendall Scott Canfield Jason Jared Russell Findlay Jason Jared Russell Findlay Daniel Felix Jordan Rush

Angela Green Heather Helsel Tim Hinkley Amy Aumann Sara Koth Angela Green Heather Helsel Tim Hinkley

Yang He

Eilleen Shanon OFF – Training, Midyear, Holidays

Facilitators

Daniel Felix Jordan Rush

12/1/14 12/8/14 12/15/14 12/22/14 12/29/14 1/5/2015 1/12/2015

Chris Viesselmann Angela Green

Emily Zimmerman Kathryn Hensley

Bryan Wang

Heather Helsel Jerame Hill

Rachel Fleagel Tim Hinkley

3/2/2015

Ron Kendall

Sara Koth

3/9/2015

Chris Viesselmann Kathryn Hensley

Kate Croegaert Emily Zimmerman Bryan Wang

1/19/2015

1/26/2015 2/2/2015 2/9/2015 2/16/2015 2/23/2015

3/16/2015

Sara Koth

Kate Croegaert Maria Ajami Kate Croegaert Maria Ajami

OFF Martin Luther King, Jr Day OFF – Great Lakes Abstract Submissions - Interviewing

Jason Jared Scott Canfield Megan Kroll Jason Jared Scott Canfield Sara Daniel Felix Jason Jared Daniel Felix Emanuele Russell Findlay OFF – Great Lakes Presentations Deadline

Angela Green Heather Helsel

Daniel Felix Russell Findlay Jen Garber Jordan Rush Jen Garber Jordan Rush

3/23/2015 3/30/2015 4/6/2015 4/13/2015 4/20/2015

Rachel Fleagel Sara Emanuele Brian Buss Eileen Shannon Emily Zimmerman

4/27/2015 5/4/2015

Bryan Wang

5/11/2015

Jerame Hill

5/18/2015

Sara Koth

5/25/2015

OFF Memorial Day Bryan Wang

6/2/2015 6/9/15 6/15/15 6/22/15

Jerame Hill

Tim Hinkley

Amy Aumann Luiza Kerstenetzky Sara Koth

Katy Berres

Heather Helsel Tim Hinkley

Rachel Fleagel Sara Emanuele Emily Zimmerman Kathryn Hensley

Karrie Radovich Chris Viesselmann Angela Kathryn Green Hensley OFF – Great Lakes

Chris Viesselmann Angela Green Heather Helsel Tim Hinkley

Ron Kendall Maria Ajami Ron Kendall Maria Ajami Kate Croegaert Scott Canfield Kate Croegaert Scott Canfield Jason Jared Russell Findlay Jason Jared Russell Findlay Daniel Felix Jordan Rush Daniel Felix Jordan Rush Ron Kendall Maria Ajami

Rachel Ron Kendall Fleagel Maria Ajami Jerame Hill Sara Scott Canfield Emanuele OFF – Exit Interviews and Manuscript Reviews

Appendix B: Resident Case Report Guidelines The following guideline outlines the structure of a case-based resident report session. Residents are asked to follow this guideline exactly when presenting their first case. Upon successful presentation of the first case, residents are encouraged to modify the guidelines to highlight other areas of clinical interest. Time Topic Owner Expectation Details 5-7 min Case Resident Presenter guides group through HPI: Include chief complaint and Presentation Presenter the case and initial work-up. pertinent +/- ROS. Past medical, Presentation illustrates presenter’s family, social, medication and understanding of the patient, other history. medication therapy, and the Exam: Vitals and pertinent disease process. findings. Laboratory, procedure or imaging data as necessary. Present your patient as you would to your preceptor. Your goal is to have participants come up with your care plan. You are providing the Subjective and Objective data. 1 min Patient Resident Summarize key elements of case summary Participants statement 3-5 min Assessment Team Ask for additional subjective and Reasoning for each problem is objective data needed. expected when the list is made. Assess patient and medication risk Consider: 1. Correlation between drug factors and key elements of therapy and medical situation. problems Determine list of drug related 2. Appropriate drug selection problems. 3. Drug regimen (dose, route, schedule, duration) 4. Therapeutic duplication 5. Drug allergy or intolerance 6. Adverse drug events 7. Interactions 8. Social or recreational drug use 9. Failure to receive therapy 10. Financial impact 11. Patient knowledge of drug therapy

3-5 min

Prioritize problem list

Team

Develop a prioritized list of therapy problems that need to be addressed.

3-5 min

Plan

Team

Develop goals for each therapy and a recommendation for each problem, identifying alternatives.

3-5 min

Monitoring

Team

3-5 min

Learning Summary

Resident Presenter

Develop monitoring plan including frequency and measurable endpoints. Summarize key learning points.

Define most urgent problem, other problems that must be addressed immediately and those that can be handled in follow up. Consider all patient specific factors (physical, psychological, social, economic, cultural, and environmental). Endpoints should include clinical, laboratory, quality of life or other defined parameters. Emphasize 2-3 take home messages. Cite references to include in each participants personal library.

Appendix C: Resident Report Worksheet Case Topic (e.g. ESBL UTI or “Fitness for Duty”): List 2 specific learning objectives/goals (1. The group will be able to assess a culture sensitivity report and determine if ESBL activity should be suspected. 2. Given patient specific factors, the group will be able to determine if treatment is necessary and if so, recommend optimal therapy for an ESBL UTI or 1. The group will be able to summarize Hospital Administrative Policy 9.34. 2. The group will be able to, given a vignette, determine an appropriate action plan acting as a clinical manager.). Learning Objectives: 1. 2. Write a one-sentence summary of the case that will guide the group’s thinking. (e.g., a 32 yo female who presented to the ED following BMT with fever, dysuria, and incontinence or a PM technician is found sleeping and with slurred speech in a patient family waiting room)

Write the 1-2 main practical applications / takeaways of your case to share with the department in the newsletter

Provide the citation(s) of the reference(s) that you used to help you learn about or teach your case.

Appendix D – Resident Journal Club Guidelines The following guideline outlines the structure of a resident journal club session. Residents are asked to follow this guideline exactly when presenting their first journal club. Upon successful presentation of the journal club, residents are encouraged to modify the guidelines to highlight other areas of clinical interest. Time 2-3 min

Topic Background

Owner Resident Presenter Or Subject matter expert Resident Presenter

Expectation Presenter or subject matter expert puts the publication in context. They describe the reason the research project was published and what value the results would provide to the general state of knowledge.

Details A brief handout may be necessary. Focus on placing the research and article in the context of knowledge prior to the publication. The impact of the manuscript will be discussed at the end of the journal club.

Discuss the hypothesis. Is it appropriate? Did the authors accurately describe the context of the research? Critically analyze the methods section.

Based on the manuscript background, what other hypotheses could be formed?

Are the statistics appropriate for testing the hypothesis? May need to seek assistance from ICTR on this step. Resident should have an understanding deep enough to defend the authors choice of statistical tests Do the authors overstate/understate their results? What do the results mean? Are the results appropriate for the hypothesis?

2 min

Introduction

5 min

Methods

Resident Presenter

2-3 min

Statistics

Resident Presenter

Critically analyze the statistics used. Assist the audience in understanding the choice of statistical test

5 min

Results

Resident Presenter

Critically section

8-10 min

Discussion

Team

Lead discussion with the audience about author’s interpretation of the results. How will this affect practice?

analyze

the

results

Appropriate research design to address the hypothesis? Alternatives? Proper inclusion, exclusion criteria?

Does the group’s review of the manuscript differ than the authors? Summarize the group discussion and how this will change practice at our institution.

2 min

Learning Summary

Resident Presenter

Summarize key learning points.

Emphasize 2-3 take home messages.

Appendix E - Manuscript Assessment Tool Article Title/Citation Study objectives/purpose Brief background Study design and methodology Patient selection & enrollment Interventions (if applicable) Outcome measures/ endpoints Statistical analyses Enrollment & baseline characteristics Summary of primary and secondary outcomes Summary of authors’ main discussion points Study strengths Study limitations, weakness, potentials for bias, etc.

Overview 1. What is the journal's reputation? Are the articles refereed? 2. Is the title or abstract misleading? Does the author's bias show? 3. Are the researchers qualified to undertake this study? 4. Is the location of the study adequate or appropriate? 5. Is the article referenced with key up-to-date articles? Introduction 6. Is there a brief review of previous work and background on why the study was done? 7. Is the hypothesis or objectives of the trial clearly stated? Overall study design 8. Was the study design appropriate to the hypothesis? Ethical? Methodology 9. Was subject selection and exclusion criteria clearly detailed? Was subject selection adequate for extrapolation to the appropriate population? 10. Was the number of subjects enrolled adequate? (Was the subject sample described sufficiently) 11. Were appropriate controls used? 12. Was allocation to treatment groups truly random? 13. Were doses, schedules and duration of drug treatment adequate and comparable? 14. Were washouts used? Were they of sufficient duration? 15. Was concurrent therapy allowed? Controlled? 16. Was the study blinded? Was it truly blinded? 17. Were observers identified? Were they qualified? Were they blinded? 18. Were the test measures used indicative of therapeutic efficacy? Could a more reliable test measurement have been used? 19. Did the test measurements use subjective or objective assessment? 20. How long were subjects followed? Was it long enough? Results 21. Were the results clearly, accurately and adequately presented? 22. Were all the results presented? 23. Were dropouts adequately accounted for? 24. Was the impact of patient compliance considered? 25. Was an appropriate statistical method used? 26. Does statistically significant difference necessarily imply clinical significance? Discussion/Conclusion

27. Were valid conclusions based upon the results presented? 28. Were valid conclusions based upon the hypothesis of the study? 29. Does the discussion place the results of this study into the perspective of previous clinical trial comparing and contrasting results? Does the discussion honestly outline the clinical trials shortcomings?

Appendix F: Resident Practice Management Case Guidelines The following guideline outlines the structure of a practice management case-based resident report session. Residents are asked to follow this guideline exactly when presenting their first case. Upon successful presentation of the first case, residents are encouraged to modify the guidelines to highlight other areas of interest. Time Topic Owner Expectation Details 5-8 min Case Resident Presenter guides group through a Include and summarize relevant Presentation Presenter vignette, either from experience or UW or pharmacy department a contrived case from a leadership policies. team member’s experience. Summarize literature needed for Presentation illustrates presenter’s case. understanding of the management principles. 1 min Practice Resident Summarize key elements of vignette management Participants summary statement 3-5 min Situation Team Ask for additional subjective and Encourage the group to apply assessment objective data needed. policy or other reference Determine a list of unanswered information directly to the questions and resources needed. vignette. 3-5 min Plan Team Develop a plan of next steps. Steps should include rationale and identification of alternative approaches. Each step should be weighed against alternatives. Alternatively, group could be asked to prepare a personal response to the topic (SMART goals for a CPD plan or a brief outline of a business plan). 3-5 min Questions Resident Presenter either alters case to look Encourage participation from and answers Presenter at other aspects of the policy or entire group and do not provide and Team asks group to consider plan in light answers without participation. of changes in the vignette. Alternatively, group could be asked to prepare a personal response to the topic (SMART goals for a CPD plan or a brief outline of a business plan).

3-5 min

Learning Summary

Resident Presenter

Summarize key learning points.

Emphasize 2-3 take home messages. Cite references to include in each participants personal library.

Suggested Case Management Topics: Continuing professional development (CPD) plans, rationale and development Professional dress Publication process Harassment-free workplace Recruitment and hiring Interviewing Duty hours Fitness for duty Diversion HIPPA violation Absenteeism, tardiness Change management Customer satisfaction Employee engagement Progressive discipline Providing performance feedback Performance evaluation Social media conduct Conduct at professional meetings

Conflicts of interest Plagiarism Strategic planning Mission, vision and values Medication error Drug recall Internal or external compounding error Budget development (request for additional FTE or monetary support for new services) Residency accreditation CMS or JC auditing Work delegation Time management Strategies for effective leadership of a meeting Leadership philosophies Negotiation

Appendix G: Resident Report Feedback Sheet Resident Presenter:_____________________ Topic:________________________________________ Please provide specific and actionable feedback to the resident presenter. Consider speaking style, preparation, confidence, level of group discussion, how well questions were developed; was the content usable and subject appropriate for the audience; was it well organized and meet your educational goals. What went well with this presentation (provide at least 2 items):

What could have been better (provide at least 1 item):

Evaluator Name (print):__________________ Evaluator Role (circle one): Preceptor

PGY-2 Facilitator

PGY-2

PGY-1

Consider for publication (case study or review article): Yes____ No____ N/A____ ** RETURN TO PRESENTER’S PROGRAM DIRECTOR **

APPE-RT