by Samuel O. Adeosun, PhD, PGY1 Pharmacy Practice Resident, St. Dominics Hospital
One of the requirements for successful completion of pharmacy residency is the completion of a data-driven project. This is a requirement under the American Society for Health-System Pharmacists (ASHP) accreditation standards for both PGY1 and PGY2 residencies. While most programs do not require that the project be submitted for publication in a peer-reviewed journal, they usually require that the project be written up in a standard manuscript format and submitted to the program director or committee.1 However, publishing residency research projects has several advantages. Publishing promotes visibility, for both the resident and the residency program, in the field and may attract collaborators who have similar interests. A published project also promotes a sense of accomplishment. Furthermore, the experience makes the publishing process less intimidating. Moreover, publishing residency research broadens career opportunities (even beyond academia) and early career publication success has been associated with faster career advancement.2,3 Very importantly, the dissemination of research findings is crucial as findings that are never published are of no value to the research community. Even negative findings have value and should be disseminated. Unfortunately, despite the requirement and the many potential benefits, the publication rate for resident research projects since 1981 has been low and appears to be trending downward.4
There are many reasons why the publication rate is low including time limitations, knowledge gaps among residents and preceptors about conducting research, and lack of mentor support during or after the residency.5,6 Time is often considered a major problem because a 12-month residency is perceived to be too short to conduct a meaningful research study.6,7 However, perhaps the most important issue is that no time is specifically allocated for research or instruction about research in most programs. In one survey 80% of residency program directors (RPDs) agreed that research is important to make good patient care decisions but only 44% agreed there should be an equal emphasis on research as on clinical skills.5 Although some programs have a designated research month, research must be done longitudinally. Another important limitation is the lack of mentorship and support. Many preceptors are not well trained in research methods or are not motivated (or incentivized) to publish, especially in non-academic settings.8,9 Thus, for a new pharmacy graduate, conducting a research project is a daunting task because they lack the experience and the support and there is limited time allocated to conducting it.
A well-designed strategy to address the training needs of residents to conduct research, while also providing sufficient guidance and time, was developed and implemented at the University of Utah in partnership with Intermountain Health.10 This involved the formation of a resident research committee (RRC) that included two clinical pharmacy specialists, two pharmacy administrators, and one drug information pharmacist. The committee provided oversight and assistance to residents so that they could achieve research goals and complete their projects by the end of the residency year. Before the arrival of the residents in June, the group distributed research overview, guidelines, and deadlines to the incoming residents. Residents were also encouraged to start thinking about their research topic and were scheduled to complete their institutional review board (IRB) training before the residency program started. During the first week of orientation, the RRC gave presentations on formulating research ideas and helped residents refine their ideas based on several factors including data availability, novelty, and alignment with institution initiatives. By the end of August, residents presented their research proposals to the department and data collection commenced after IRB approval. Residents were required to present preliminary results from their projects at a national professional meeting in December. The findings and analyzed results were presented to mentors in April. Preceptors’ feedback were incorporated before residents presented their final project to the department and at the residency conference in May. Finally, a manuscript was submitted to the RRC and residents were encouraged to submit their projects for publication.
It is worth noting that the core elements of this instructional design is learner support and distributed effort. This is not just a deadline-driven program as support and learner feedback provided at every step. The support included helping residents to navigate the health system in order to get the resources and data they need. Also, the RRC enlisted the help of a statistician during the project development and data analysis stages. This is quite important as most residents (and preceptors) feel statistical analysis is daunting and a major barrier.7 Surprisingly, although only 1.5% of RPDs believe their residents have sufficient knowledge regarding statistical analysis, little to no training is provided during pharmacy residency programs and statisticians are not usually enlisted.11
The approach developed and implemented by the University of Utah and Intermountain Health proved to be very effective. Within the four years since the program started, all the residents completed their research projects within the allotted 12 months, far more resident research papers were submitted to peer-review journals, and the anticipated publication rate increased to 31%.
A similar approach adopted by Kaiser Permanente Colorado in partnership with the University of Colorado School of Pharmacy significantly improved residency research publication rates. The residency research committee included personnel with specialized clinical research training (including PhDs). The committee provided the residents with refined and ready-made research ideas and residents participated in an educational program with 18-hours of didactic instruction on research design. This approach increased the publication rate to 86.1% (previously 47%) and shortened the time to publication to 23 months (previously 30 months).15
Another important issue is the quality of the study design. A majority of RPDs and residents perceive this to be major barrier to publication.7 To address this problem, alternative approaches to research and scholarly activities have been suggested. These include conducting high-quality retrospective studies or writing comprehensive reviews that have much higher acceptance rates rather than performing time-consuming prospective studies that are unlikely to have generalizable results.12 Such an approach led to much higher publication rates (72-82%) in some residency programs.13,14
Research is critically important to inform evidence-based practice and all pharmacy residents should receive training about how to conduct research. However, most residency training programs ignore best practices in instructional design and fail to teach residents how to conduct research. Few programs provide instruction and ongoing support. Consequently, most residents never develop the interest and skills needed to conduct scholarly work and successfully publish their project results.8 Following an instructional design process based on clearly stated program goals and objectives, learner needs assessments, well-developed instructional materials, and ongoing learner feedback and support can significantly increase project completion and publication rates.
1. Accreditation Standards for PGY1 Pharmacy Residencies - ASHP. https://www.ashp.org/Professional-Development/Residency-Information/Residency-Program-Directors/Residency-Accreditation/Accreditation-Standards-for-PGY1-Pharmacy-Residencies. Accessed February 8, 2020.
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15. Olson KL, Irwin AN, Billups SJ, Delate T, Johnson SG, Kurz D, Witt DM. Impact of a clinical pharmacy research team on pharmacy resident research. Am J Heal Pharm. 2015;72(4):309-316. doi:10.2146/ajhp140214.