James Kalus, Chair, ASHP Commission on CredentialingJanet ...

James Kalus, Chair, ASHP Commission on CredentialingJanet ...

Update from the ASHP Commission on Credentialing James Kalus, Chair, ASHP Commission on Credentialing Janet Silvester, Vice President, Accreditation Services ASHP Commission on Credentialing Update Introductions New COC members Residency Growth Residency Match Accomplishments Standards Update COC actions CMS audits Annual report and Preceptor survey findings

2019 ASHP Commission on Credentialing Jamie Kalus, Chair Suzanne Turner, Vice Chair Melissa Heigham, Past Chair Sheryl Cosme (Public Member) Marcia Buck (ACCP) Amy Seybert (AACP) Diane Erdman (AMCP) Michael Melroy Donna Beehrle-Hobbs (VA) Katie Mieure Julie Dagam Marjorie Phillips Harminder Sikand Janelle Ruisinger (APhA) Luke Mortensen (Public Member) Stephen Davis Elizabeth Canterbury- resident Michael Hoying Kelly Smith (Board Liaison) non-voting Leaving after 2019 Serves August 2019 and March 2020

New COC Members 2020 Suzanne Turner Chair Julie Dagam Vice Chair Joanna Huang- resident Noelle Trinder, Public Member Jeff Huntress Lonnie Smith Kerry Pickworth Marnie Wickizer (AMCP) Jean-Venable (Kelly) Goode (APHA) Kathy Pawlicki (Board Liaison) non-voting (thru March 2020 )

Residency Growth and Capacity ASHP Accredited Pharmacy Residency Program Growth 3000 Hospital Pharmacy Practice PGY1 Clinical Specialized PGY2 2,543 2500 48% 2000

1,720 1500 As of October 2019 1000 500 0 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 2019 Residency Program Distribution 1600 1400 1200 1000 800 600 400 200 0 1369

1084 Includes Accredited, Candidate Status, and Pre-Candidate Status Programs as of 10/2/2019 90 3 2019 PGY1 Residency Programs 1400 1200 1148 1000 800 600 400 200 169 0

Includes Accredited, Candidate Status, and Pre-Candidate Status Programs as of10/2/2019 52 3 Distribution of PGY2 Programs 200 180 160 140 120 100 80 60 40 20 0 2015 2016

2017 Includes Accredited, Candidate Status, and Pre-Candidate Status Programs as of 10/2/2019 2018 2019 2019 Two-Phase Match 2019 Match: Increases in both the number of applicants and positions offered PGY1 5% increase in positions offered (5% in 2018) 7% increase in applicants (8% in 2018) PGY2* 9% increase in positions offered (7% in 2018) 11% increase in applicants (11% in 2018) There were 473 early commits in 2019 compared to 401 in 2018

* Includes early commitment process 6000 Applicants vs Positions PGY1 5560 5585 5160 4864 5000 Since 2010 Applicants up 92% Positions up 96% 4142 3933 4000 3832 3706

3323 3277 2694 2508 2092 1900 1873 1951 1769 1612 2000 3491 3652 3081 2915 3000

1000 1,753 4358 2862 2413 2173 1356 1203 1222 1091 2004; 1079 2004; 1041 2003; 974 2003; 953 2002;

887 2001; 804 2002; 802 2001; 2000; 703 2000; 697 729 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 # applicants # positions Going Into the Scramble End of Match or Phase II End of Match or Phase II Unfilled Positions

Unmatched Applicants* PGY1 17 1925 PGY2 42 232 59 2157 PGY1 11 2115

PGY2 26 258 37 2373 2018 Total 2019 Total Overall position fill rate for PGY1 and PGY2 was 99.2% *Includes applicants who only participated in Phase II Residency Program Growth Summary 48% increase in programs in past 5 yrs

PGY2 and combined programs outpacing PGY1 programs in percent growth from 2015-2019 Ambulatory Care, Critical Care, Emergency Medicine, Peds, and Palliative Care seeing significant growth Percentage of Graduates Seeking PGY1 Residency of Grads Participants in PGY1 Match Percentage in Match Year Graduates 2006 2007 2008 2009 2010 2011 2012 2013 10,199

10,282 11,127 11,516 11,487 12,346 13,163 13,207 1,356 1,898 2,092 2,501 2,898 3,257 3,706 3,933 13% 19% 19% 22% 25% 26% 28%

30% 2014 13,838 4,142 30% 2015 2016 2017 2018 13,994 14,556 14,502 14,905 4,358 4,864 5,160 5,560

31% 33% 36% 37% Match 2020 Schedule Nov. 1, 2019: List of ASHP match programs available and PhORCAS opens. Feb 28, 2020: Rank order lists submission deadline for Phase I Match March 13, 2020: Results of Phase I Match are released to applicants, program directors. The list of programs with available positions for Phase II of the Match will be provided on the Match web site beginning at 12:00 p.m. Eastern Time. March 17, 2020: Applicants who either did not obtain a position in the Phase I Match or did not participate can submit applications to programs participating in Phase II Match (0900 ET).

April 1, 2020: Rank order lists submission deadline for Phase II Match April 8, 2020: Results of Phase II Match are released to applicants and program directors. Accomplishments 2019 PGY1 Guidance document updates preceptor qualifications Revised PGY2 Medication Use, Safety, and Policy Pharmacy Residency Competency Areas, Goals, and Objectives (merger of Drug Information and Medication-Use Safety) Revised PGY2 Oncology Pharmacy Residency Competency Areas, Goals, and Objectives Appendix Transition to 8 year accreditation cycle 2nd Annual RPD report and new preceptor and resident survey Planning for revision of the PGY1 and PGY2 residency standards PharmAcademic - many updates Guidance update on Preceptor Qualifications Preceptors must have one of the following: Examples: BPS certification Fellow at a state or national level organization Certificate of Completion from a state or nationally available program that relates to the area of practice in which they precept (e.g., Epic Willow certification, Six Sigma/LEAN Six Sigma certification, ISMP sponsored Medication Safety certificate, ASHP sponsored certificates). Health-system/local residency site based programs are excluded.

Validated certification that results from an exam by the organization providing certification Guidance update on Preceptor Qualifications Pharmacy related certification recognized by Council on Credentialing in Pharmacy (CCP) http://www.pharmacycredentialing.org/Files/CertificationPrograms.pdf Other examples include: Certified Professional in Patient Safety (CPPS), Certified Diabetes Educator(CDE) Exceptions to the list that do not meet this domain are ACLS, PALS and BLS Post-Graduate Fellowship in the advanced practice area or an advanced degree beyond entry level pharmacy degree (e.g., MBA, MHA) Formal recognition by peers as a model practitioner Pharmacist of the year - recognized at state, city or institutional level where only one individual is recognized Guidance update on Preceptor Qualifications Patient care, quality, or teaching excellence recognition at organization level (not internal to pharmacy department only) for an initiative that resulted in positive outcomes for all patients that either was operational, clinical or educational in nature) Credentialing and privileging granted by the organization/practice/health system with ongoing process of evaluation and peer review

Subject matter expertise as demonstrated by ten or more years of practice experience in the area of practice in which they precept Added to demonstrated professionalism Active community service related to professional practice (e.g., Free Clinic, medical mission trips) Active involvement on committees within an enterprise (e.g., work impacts more than one site across a health-system) Also Available: Sterile Product Preparation Certificate for Institutions Coming Spring 2020: Medication Reconciliation Pharmacy Revenue Cycle Management Residency Accreditation Standards Revision Objectives for Standards Revision Optimal standards - should reflect contemporary practice and push the profession forward

Harmonize PGY1, PGY1 Community-based and PGY1 Managed Care standards Revise the PGY2 standard concurrently to allow for consistency Assure that the PGY2 standard is distinctly different from the PGY1 standard and supports a higher level of learning. Reduce redundancy Objectives for Standards Revision Consider whether existing guidance should be reflected in the standard. Find right balance between generality and detail.

Simplify where possible. Keep what adds value and improves quality Evaluate best placement in the standards for preceptor qualifications Consider well-being and resilience and diversity as new additions Include more nutrition and operations in the next standard Objectives for Standards Revision Incorporate requirements for diversity in recruitment Incorporate requirements for well-being and resilience

The PAI 2030 document as well as the revised Long Range Vision for the Pharmacy Workforce document will inform the development of the new standards. Will conduct a survey of residency programs to obtain feedback on the current standards and to inform the next standard revision input is critical Will create a draft that will also go out for public comment Other COC Actions Multihospital subcommittee of the COC This group is discussing the growing complexity of the pharmacy and residency enterprises in large health systems. The goal of these discussions is to identify those areas of residency training that require standardization across the enterprise to improve efficiency, incentivize adoption of best practices across the health system, and strengthen the resident learning experience. Other COC Actions

Well-being and resilience subcommittee This group is evaluating whether well-being and resilience should be addressed through a standards revision (requiring programs to have a structured curriculum devoted to resident well-being and resilience) as medicine has done. We recognize well-being and resilience in residency training as a key component to developing competent, caring, and resilient pharmacy practitioners. What goes in the Standard will be informed by the results of the NAM study results and the ASHP survey that was recently completed. Other COC Actions New annual surveys for preceptors and residents beginning this residency year preceptor late October or early November and resident in spring Together with the RPD Annual Residency Report, these surveys will support the accreditation process as we move to the 8 year cycle The resident survey will reflect time spent w/preceptors, evaluation, training

content, resources, patient safety and teamworkan overall evaluation of the program not intended to point fingers These additions represent perspectives of the residency program and how well things are going and support the longer accreditation cycle replacing midterm reports Examples of Program Documentation to Standards 1 & 2 that meet the intent of the Standard will be available in the first quarter of 2020. ASHP Advocacy on CMS Audits of residency ASHP Asks CMS to Stop Cost Disallowances, Improve Audit Procedures, and Technical Assistance for Pharmacy Residency Programs On June 13, ASHP sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting they cease cost disallowances for pharmacy residencies until CMS provides technical assistance and improves audit processes and auditor training. We encourage all of our members to send an email to their congressional reps

asking that Congress protect residency funding. Its easy to do through our Call-to-Action alert. If you have information to share about a current or previous CMS audit, email Jillanne Schulte Wall, ASHP Director of Federal Regulatory Affairs. ASHP supporting orgs suing CMS over funding disallowances w/ AMICUS brief. Meeting with CMS on December 5th. Preliminary Data from the 2019 Annual Residency Accreditation Report 3866 3634 Residency positions by program year 8.1% increase for all (399 positions) P GY1 1333 142

135 1173 Residency Year Beginning in 2018 Residency Year Beginning in 2019 P GY1 /2 P GY2 6.4% increase overall (232 positions) 3507 79 73 280 Residency Year Beginning

in 2018 Residency Year Beginning in 2019 261 3300 PGY1 Residency Positions 2018 vs 2019 Was Resident Hired by Organization Providing Training? 2500 2000 61% 1500 Yes No 1000 500

0 3 9 % PGY1 68% 41% 59% PGY1/2 32 % PGY2 Number of Residents who Completed Each Type of Training After Completing their Program (2012-2018 Reside By Progam Year 32%*

36%* 41%* 46%* 50%* 54%* 58%* *% completing additional training # of Graduated Residents Linear (# of Graduated Residents) No Additional Training PGY2 Residency (if

PGY1) # of Graduated Residents vs # of Board Certificated Residents per Year Residents graduating between 2013 and 2019 67% 44% 37% P GY1 # of Graduated Residents # of Board Certified Residents P GY1 /2 P GY2 Did Resident Take Post-Grad Position Requiring Residency Training? 3000 2500 2000

71% 1500 Yes 83% 1000 500 0 83% PGY1 PGY1/2 PGY2 No In your recruitment process, with regard to promoting diversity in your residency class, do you:

700 600 575 495 500 400 Developed a written diversity policy 389 385 Have procedures in place to enable you to implement a diversity policy and achieve diversity goals 300 200 Developed specific diversity goals relating to the recruitment of new residents

172 128 100 29 0 PGY1 39 8 PGY1/2 PGY2 Follow Organization's Non-discrimination Policies in Resident Recruitment No 4 programs Yes Do you consider diversity in your recruiTment process? PGY1 Programs

26.78% Ye s No Do you consider diversity in your recruiTment process? PGY1/2 Programs 73.22% 16.42% Yes No Do you consider diversity in your recruiTment process? PGY2 Programs 83.58% 25.14% Yes No

74.86% In the last 12 months, have any pharmacy services been discontinued as a result of budgetary issues? Overall: 4% w/ services DCD No Yes 4% P GY1 5% 3% P GY1/2 P GY2 Preliminary Data from the 2019 Preceptors Survey (70% complete) # Hours Spent with Residents/Week

# of Hours Spent Directly with Residents in a Typical Week 14000 20 12272 18 18 12000 16 14 10000 16 14 12 8000 5725

6000 10 8 6 4000 4 2000 0 772 PGY1 PGY1/2 2 PGY2 0

Average Hours # of responses Is Your Participation as a Preceptor Required? 8000 60% 7000 6000 5000 40% 4000 66% 3000 34% 59% PGY1

1000 41% PGY1/2 2000 PGY2 0 Yes No If Yes, Would You Prefer Not to Precept Residents? 8000 7000 6000 94% 5000

Yes No 97% 4000 97% 3000 2000 97% 1000 0 PGY1 PGY1/2 PGY2

Did you work on a Residency Longitudinal Project with a Resident in the Past Year? 7000 6115 6157 6000 5000 4000 3131 3000 2594 2000 1000 268 0

PGY1 504 PGY1/2 PGY2 Yes No If Yes, Did you feel well-prepared to mentor the resident in this area? 6000 5000 91% 4000 Yes No 3000

2000 95% 1000 0 94% PGY1 PGY1/2 PGY2 Do you routinely participate in clinical research studies that require Institutional Review Board (IRB) approval in your own practice? 9000 66% 8000 7000 6000

Yes No 5000 34% 4000 45% 3000 2000 28% 1000 0 PGY1 72% PGY1/2

PGY2 55% Do you feel your program's residency requirements and expectations exceed the capacity of the resident to complete required work? 12000 10000 86% 8000 Yes No 6000 89% 4000 14% 2000 0

PGY1 11% 86% 14% PGY1/2 PGY2 Is there an established and EFFECTIVE process in your program for addressing problems related to your resident(s) progress? 12000 10000 88% 8000 Yes No 6000

4000 91% 200012% 0 90% PGY1 9% 10% PGY1/2 PGY2 Does your organization, department, or residency program provide you education and resources to manage preceptor well-being and resilience? 9000 8000 7000

68% 6000 Yes No 5000 4000 32% 3000 68% 2000 69% 1000 0

PGY1 PGY1/2 PGY2 31% 32% Summary of annual report and surveys Resident survey Under construction Will be sent to residents around mid-May Evaluating the creation of an annual report to include data from all three data collection efforts RPD, Preceptors and Residents Purpose of this data collection is to support 8 year cycle and allows us to keep up with what is happening in between surveys. Also allows for aggregation of data from all programs

ASHP Commission on Credentialing Update Introductions New COC members Residency Growth Residency Match Accomplishments Standards Update COC actions CMS audits Annual report and Preceptor survey findings QUESTIONS?

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