An Elective Course on Postgraduate Residency Training

INTRODUCTION

The need for pharmacists in direct patient care roles is growing. Postgraduate residency training prepares pharmacy graduates for these roles. Professional organizations recognize this need and have called for all pharmacy graduates who enter careers with direct patient care responsibilities to complete residency training by the year 2020.^1,2 The American Association of Colleges of Pharmacy also encourages completion of residency training, and in 2002, called for colleges and schools of pharmacy to actively develop and enhance residency programs.³

To meet these goals, it is critical to foster knowledge and interest in residency training among pharmacy students. Since 2005, the number of residency applicants submitting rank order lists for the residency match has tripled.^4,5 Although the number of residency positions has increased over 30% in the last 5 years, it has not kept pace with demand.⁴ In 2011, there were 1250 unmatched postgraduate year 1 (PGY1) residency applicants, more than double the number of unmatched applicants in 2007.⁴ This unprecedented interest in residency training has created intense competition among applicants for the available positions. Student training and education related to preparing and competing for these coveted positions is, therefore, timely.

At the University of Georgia College of Pharmacy, interest in residency training is increasing among students. The college admits PharmD students into a 4-year “2+2” program, where approximately 25% of students complete their last 2 years of the curriculum on the regional campuses in Augusta, and Albany, Georgia. The number of students entering residency programs upon graduation has increased dramatically in the last 5 years by approximately 20%. The need for residency-trained pharmacists is recognized by the faculty as an important issue affecting our profession. The capacity to train pharmacy residents in the college has increased twofold over the past 5 years by developing additional positions and programs. The college’s strategic plan now includes a goal to increase the percent of graduating students pursuing postgraduate training from approximately 25% to 40%.

For many students, deciding to pursue a residency and making the commitment to follow through with applying to residency programs is a complicated process. Additionally, students often have difficulty navigating the residency application and match process. A majority of students entering pharmacy school are unaware of residency opportunities and find out about them at various points throughout the curriculum, sometimes after it is too late to pursue them. In addition to using professional organizations to heighten awareness of residency programs, colleges and schools of pharmacy educate students about residency training opportunities through a variety of methods. These often include informational handouts or brochures and 1-hour lectures, discussions, or seminars, and most often occur in the last year of the curriculum.^6-11 More recently, a preparatory seminar for fourth-year students on interviewing for residency positions has been described.¹² Studies that have evaluated the factors affecting completion of residency programs have recommended that instruction concerning residency training should occur early in the curriculum.^6,7,13,14 A 2010 survey of US colleges and schools of pharmacy reported that 16 colleges and schools provided a structured program to promote and prepare students for residency training.⁸ These programs were diverse in nature and included components such as promotion by student professional organizations, financial support to attend the American Society of Health-System Pharmacists Midyear meeting, career pathways program, one-on-one mentoring during advanced pharmacy practice experiences (APPEs), pre-specified required or elective APPEs, required residency program visits, and participation in student clinical competitions.⁸

In response to interest among students, the increase in unmatched residency candidates nationally, and the college’s strategic plan, an elective course in postgraduate residency training was developed and offered to third-year pharmacy students. This course supported the institution’s competency statements and terminal and enabling objectives for the doctor of pharmacy (PharmD) degree relating to options for postgraduate education, leadership, and lifelong learning. Educating and preparing students for postgraduate residency training aligns most closely with Accreditation Council for Pharmacy Education Guideline 16.1, which states that colleges and schools of pharmacy should provide education on postgraduate residency training opportunities.¹⁵ The specific goals of the course were to increase knowledge, interest, and confidence among students about residency training; identify and develop the skills needed for application to these programs; and increase the number of students obtaining residency positions upon graduation.

DESIGN

The Introduction to Postgraduate Residency Training course was a 2-credit hour elective, offered to third-year students on all campuses who are in good academic standing. All class sessions were taught simultaneously using distance learning, with 1 or more faculty members at each campus leading or participating in small group discussions during class time. Each instructor in the course was a practicing faculty member with current or previous experience with residency training as a preceptor or residency program director. An online course management system was used for faculty members to deliver course announcements, post course content, assignments, and grades, and for students to submit assignments. Class size was initially limited to 25 students because of the intensive commitment required by the faculty members to provide feedback to students on their curriculum vitae (CV) and letter writing and interviewing skills, and to optimize faculty-student interaction.

Because the students were learning and then applying new information, the course objectives were designed around and integrated several levels and approaches of Bloom’s and Fink’s taxonomy.^16,17 Lower levels of Bloom’s taxonomy were used when students were learning new information. Higher levels of analyzing and evaluating were used when students were expected to use information learned and apply it to real-life situations. Several approaches of Fink’s taxonomy of significant learning were used, including foundational knowledge, application, and integration. A variety of teaching methods were used.

A textbook on curricula vitae and interviewing specific to pharmacy professionals was required for the course.¹⁸ For each topic taught in the course, students were expected to read the corresponding chapter in the textbook if applicable. The instructors presented short, interactive lectures during class, followed by discussion and small-group activities. Detailed information on course content and activities is provided in Table 1.

To demonstrate the matching process, students engaged in a mock residency match. Students were randomly assigned a realistic applicant profile containing information about residency interests, grade point average, performance on APPEs, publication and presentation experience, and comments from reference letters and interviewer perceptions. Students were then asked to review 4 program profiles, illustrating various program types, and develop a residency rank list. A mock residency match was performed manually based upon the candidate and predetermined program rank lists. Students were provided with a simulated e-mail message with their match results prior to class. A lecture was presented on the matching process, including the post-match process, often called the “scramble,” and then a discussion was held on the match and results.

To practice interviewing skills, students were scheduled for 1 individual, 30-minute mock interview session. The interview session was intended to simulate a panel interview and students were expected to wear appropriate interview attire. Each panel consisted of 1 resident and 2 clinical faculty/resident preceptor interviewers. The interviewers asked the same 4 interview questions and were allowed to ask additional questions as time allowed. Students were given an opportunity to ask questions during the interview. After the interview, immediate verbal feedback was provided. The interviewers used a sample interview evaluation form for written feedback. The interview sessions were video recorded and uploaded onto a secure Web site. Students watched their own password-protected interview and completed a self-evaluation with the same candidate evaluation form used by the interviewers. Students were graded on the quality of their self-evaluation.

Additional educational activities regarding the residency application process included practicing clinical competencies 4 times throughout the semester. The first 2 competency assessments were treated as practice exercises. Immediately after administration of each competency, the key components were discussed in detail. Competency activities included identification and prioritization of drug-related problems, making recommendations to optimize drug therapy, completion of a SOAP (subjective, objective, assessment, and plan) note based on a given scenario, and completion of short-answer questions. The competency content included information students learned in therapeutics-type courses in the second and third years of the curriculum.

EVALUATION AND ASSESSMENT

Twenty-four students (12 from the Athens and Augusta campuses) enrolled in the first offering of the course in fall 2010. Because of the limitation in class size and scheduling conflicts, not all interested students were allowed to enroll. The course was offered again in spring 2011, with 12 students enrolling, all on the Athens campus.

Students were graded on content learned and class participation. The CV, letter of intent, and thank you letter were graded based on rubrics developed by the course coordinator and reviewed by the course instructors. Clinical competencies were graded using faculty-developed rubrics. The mock interview was graded on the quality of the self-evaluation. Other assignments such as the residency rank list and panel interview questions were assigned points based upon participation. Grades were recorded and posted. The course was graded as pass/fail, with a course average of 80% needed to pass. All students enrolled during the first year of the course completed the assignments and participation requirements to a satisfactory level and passed the course.

DISCUSSION

This manuscript provides a detailed description of an elective course, Introduction to Postgraduate Residency Training, offered to third-year pharmacy students at the University of Georgia College of Pharmacy. This course was designed to educate students about residency programs and how to pursue residency training upon graduation. The textbook was chosen due to its applicability to the pharmacy profession and served the course well, with general comments from students indicating they planned to keep the book for use during the following year when they applied to residency programs.

Greater knowledge and confidence in completing the skills needed to pursue residency training were demonstrated by significant improvements in self-rated student abilities from the beginning to the end of the course based on the course objectives. A limitation associated with this method is that students may not accurately assess their abilities and may unknowingly overestimate their skills in a particular area. However, the self-assessed improvement in skills for every objective suggests their abilities did improve compared to skills at course initiation.

Because this evaluation was conducted during the first year the elective course was offered, the number of students assessed was relatively small. Additionally, the pre- and post-course self-assessments were conducted as part of the course and therefore were not anonymous. No grades were assigned for the assessments but completing course activities did count for class participation. Although the course objectives did not change between the fall and spring semesters, there were small changes in course content. These changes may have had limited impact on the pre- and post-assessment responses. Significantly more students planned to pursue residency training upon graduation after completion of the course. Factors leading to the greater interest in pursuing residency training may include learning more about residency training itself, increased confidence regarding completion of training after further development of patient care skills during the third year of the curriculum, and advancements in the PharmD curriculum that allowed the students to learn and practice more patient-centered drug therapy. Some changes were found in the PGY1 program type and institution from the beginning of the course to the end. Students may have changed their minds after receiving education about the various types of programs, or it may reflect that the students do not have enough clinical experience in their third year to determine the best fit. No significant changes were seen in the number of students interested in pursuing PGY2 residency training. This is likely because this was not stressed during the course and it may have been too early in the curriculum for students to evaluate these options.

At the end of the first semester, the instructors sought specific feedback from the students regarding each topic and assignment in the class. Student comments included that more detailed information on resident activities should be provided, a demonstration of the matching process should be given, the order of the topics taught should be rearranged, and the resident panel discussion should be conducted in the absence of faculty members. Students also reported that they did not understand information presented on the Residency Learning System, the systematic process used in the design, conduct, and evaluation of the residency program.²² Because of the complexity of the information and limited time, the course coordinators felt this information could be minimized in future course content in favor of more detailed information on resident responsibilities.

Other revisions to the course included having a PGY2 resident lead the class describing daily and longitudinal resident activities, illustrating the match process using slide graphics, and assigning a PGY1 or PGY2 resident to organize and lead the resident panel interview. For the resident panel interview, potential topics of interest to the students were discussed with the residents prior to the discussion, such as weekend staffing, resident satisfaction, compensation, and moonlighting. The CV workshop was scheduled earlier in the semester to separate student assignment deadlines and give faculty members more time for grading. The students also requested moving one of the panel interviews later in the semester to give them a chance to ask questions after learning more about the process. As a result, the resident panel interview was also moved to week 9 of the semester. Based on student feedback regarding the letter of intent assignment and benefits of attending a regional residency showcase, attending a showcase became a requirement. Table 1 reflects the course schedule with these changes.

There are several issues to consider in future course offerings. As designed, the course does require a significant amount of faculty time and effort. Factors leading to greater faculty resources include having a faculty member present for each class on all campuses to facilitate small group discussion and active learning, the number of faculty members involved in the course and facilitating their participation, and the number of faculty members needed to evaluate and mentor students for the CV and letter of intent assignments, and mock interviews. As the college grows to include additional regional campuses, the course will need to be adapted to accommodate student interest in the course. This will include identifying faculty members on each regional campus to work with the students directly. At the time the course was developed, limited materials existed regarding pharmacy residency training. As materials become available, consideration will be given to determine the value for incorporating these into the course.^23-25 Examples include the Resident Survival Guide²³ and key journal articles discussing residency-related topics.

Other descriptions of formal programs to educate and prepare students for postgraduate residency training report a variety of structures, ranging from a specific curricular pathway to one-on-one mentoring and extracurricular programs. To our knowledge, this elective is the first course of its kind to educate and develop skills related to residency training for third-year students. Given the positive student evaluations and improvement in self-rated confidence in knowledge and skills needed to pursue residency training, we believe the course added value to the curriculum and will continue to offer it. This course could easily be implemented at other institutions. Some colleges of pharmacy with limited resources could adopt certain components of the course as initial steps in developing a formal course to educate and train students for residencies.

CONCLUSION

An elective course on residency training, Introduction to Postgraduate Residency Training, provided third-year PharmD students the opportunity to learn about residency training and enhance their skills. Pharmacy students rated the course positively and would recommend it to their fellow classmates. Students felt more confident in their understanding of and skills to pursue residency training after completing the course. As residency training continues to gain momentum, preparing students for postgraduate training will become increasingly important.