Author's Accepted Manuscript

Surveying Residents of Postgraduate Year 2 Critical

Care Pharmacy Residencies About Their Level of
Preparedness to Practice
Mitchell S. Buckley PharmD, FCCM, BCPS, Robert
MacLaren PharmD, FCCM, FCCP, Erin N. Frazee
PharmD, BCPS, Pamela L. Smithburger PharmD,
BCPS, Heather A. Personett PharmD, BCPS, Sandra
L. Kane-Gill PharmD, FCCM, FCCP
http://www.pharmacyteaching.com

PII:
DOI:
Reference:

S1877-1297(13)00162-7
http://dx.doi.org/10.1016/j.cptl.2013.09.013
CPTL251

To appear in:

Currents in Pharmacy Teaching and Learning

Cite this article as: Mitchell S. Buckley PharmD, FCCM, BCPS, Robert MacLaren
PharmD, FCCM, FCCP, Erin N. Frazee PharmD, BCPS, Pamela L. Smithburger
PharmD, BCPS, Heather A. Personett PharmD, BCPS, Sandra L. Kane-Gill PharmD,
FCCM, FCCP, Surveying Residents of Postgraduate Year 2 Critical Care Pharmacy
Residencies About Their Level of Preparedness to Practice, Currents in Pharmacy
Teaching and Learning, http://dx.doi.org/10.1016/j.cptl.2013.09.013
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1

Surveying Residents of Postgraduate Year 2 Critical Care Pharmacy Residencies About

Their Level of Preparedness to Practice

Mitchell S. Buckley, PharmD, FCCM, BCPS [corresponding author]

Clinical Pharmacist, Banner Good Samaritan Medical Center
Department of Pharmacy
1111 E. McDowell Rd Phoenix, AZ 85006
Office: 602-839-3095
Fax: 602-839-6734
Mitchell.buckley@bannerhealth.com

Robert MacLaren, PharmD, FCCM, FCCP

Associate Professor
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Department of Clinical Pharmacy
12850 E. Montview Blvd. V20-1227
Aurora, CO 80045
Office: 303-724-2622
Fax: 303-724-0979
Rob.maclaren@ucdenver.edu

Erin N. Frazee, PharmD, BCPS

Critical Care Pharmacist
Mayo Clinic Rochester Methodist Hospital
200 1st St SW
Rochester, MN 55905
Office: 507-255-5165
Fax: 507-255-7556
Frazee.erin@mayo.edu

2

Pamela L Smithburger, PharmD, BCPS

Assistant Professor
University of Pittsburgh School of Pharmacy
200 Lothrop St.
Pittsburgh, PA 15213
Office: 412-647-0899
Fax: 412-647-0899
smithburgerpl@upmc.edu

Heather A. Personett, PharmD, BCPS

Critical Care Pharmacist
Mayo Clinic Rochester Methodist Hospital
200 1st St SW
Rochester, MN 55905
Office:507-255-5165
Fax: 507-255-7556
Heather.personett@mayo.edu

Sandra L. Kane-Gill, PharmD, FCCM, FCCP

Associate Professor
University of Pittsburgh
Department of Pharmacy and Therapeutics School of Pharmacy
Department of Critical Care Medicine, School of Medicine
918 Salk Hall
Pittsburgh, PA 15213
Office: 412-624-5150
Fax: 412-624-1850
Slk54@pitt.edu

Abstract: Objective: As the scope of pharmacy services in the critical care setting advances
there has been a parallel evolution in critical care pharmacy residency training programs. The

3

purpose of this study was to assess the ability of critical care pharmacy residency learning
experiences to prepare trainees for provision of critical care pharmacy services. Methods: This
prospective, cross-sectional study of critical care pharmacy residents used a 53 item web-based
questionnaire to evaluate resident satisfaction and the exposure frequency, self-perceived
competency and satisfaction rates for the provision of clinical, administrative, educational, and
scholarly pharmacy services. Satisfaction and competency were rated on scale of -10 to +10. The
survey was distributed via email and reminder email to 98 critical care residency programs in
May 2012. Descriptive statistics were used to categorize responses. Results: 45 (54.1%)
respondents, representative of all 98 programs, completed the questionnaire. The majority of
residents reported feeling somewhat or very satisfied with both the program and their mentorship
(91% and 76%, respectively). With the exception of managing nutrition support, respondents felt
competently trained to provide most clinical services and educational activities. In contrast,
trainees were infrequently exposed as well as uncomfortable providing many administrative and
scholarly services. Conclusion: Most critical care pharmacy residents were satisfied with their
overall experience and mentorship and felt competent providing routine clinical and educational
functions. Programs should enhance administrative responsibilities of their residents to
adequately prepare them for real-world practice. Additional scholarship may be outside the
current resident requirements.

Keywords: pharmacy residency; critical care; practice; education; competency

Financial support: No financial and material support was available for this article.

Conflict of interest: No conflicts of interest are reported by the authors pertaining to this article.

Data have not been presented. The manuscript is not under consideration at another journal. A
300-word abstract was accepted for a poster presentation at the Society of Critical Care Medicine
at their annual congress meeting January 19-23, 2013.

4

Introduction
The role of critical care clinical pharmacists has evolved over the past several decades to
assume greater responsibilities of direct patient care, resulting in beneficial clinical and
economic outcomes.1-21 Several organizations, including the Society of Critical Care Medicine
(SCCM), American College of Clinical Pharmacy (ACCP), and American Society of HealthSystem Pharmacists (ASHP) acknowledge the value of the services provided by clinical
pharmacists in the intensive care unit (ICU).1-6 As a result, critical care clinical pharmacists are
recognized as an essential member of the multidisciplinary ICU team.1-6
A joint publication of ACCP/SCCM and another separate ASHP white paper have published
position papers on critical care pharmacy services.1,22 The scope of clinical pharmacy functions
are characterized as relating to patient care, administration, education, and scholarship.
Components of these services are further delineated as fundamental, desirable, or optimal
activities.1,22 The definitions of each level of activity (fundamental, desirable, optimal) has been
previously reported.1 A nationwide, hospital survey of critical care pharmacy services found that
ICU pharmacists frequently provided patient care and administrative services, but activities that
involved education and scholarship were much more variable.7 Moreover, fundamental functions
were much more likely to occur than desirable or optimal services. Ultimately, this survey
demonstrated the heterogeneity of clinical pharmacy services rendered in the ICU, highlighting
the disparity between current practice and ideal patient care.
Residency training appears to be an effective pathway in developing competent and skilled
pharmacy practitioners.23-27 Postgraduate year 2 (PGY2) residency programs in critical care
should prepare independent clinicians with advanced knowledge and skills to provide the full
scope of clinical pharmacy services and enhance patient care.2,22,24,28 Established training
standards and recommendations have been approved for PGY2 critical care residencies.29,30
Experiences offered by programs may influence the ability of trainees to feel comfortable
providing services in an independent manner. Several national surveys of postgraduate year 1
(PGY1) pharmacy residency training sites have shown significant variability in learning
experiences and requirements despite established ASHP accreditation standards.31-33 A national
assessment of current PGY2 critical care residency training characteristics has not been

5

conducted. The purpose of this survey was to compare the learning experiences and expectations
of PGY2 critical care residency training programs in preparing graduates to independently
provide critical care pharmacy services pertaining to patient care, scholarly, and administrative
activities.
Methods
Survey Development and Measures
The research design consisted of a cross sectional evaluation using a web-based 53-item
questionnaire primarily assessing the residents perception of their ability to practice
independently. The survey questions were categorized according to 1) program and practice site
characteristics, 2) perceptions of comfort level to independently render pharmacy services, 3)
satisfaction with the overall program and the extent of mentoring, and 4) employment after
training. Respondent identifiers and institution-specific details were not collected. The pharmacy
functions evaluated represented all domains of practice including patient care (eleven functions),
administration (ten functions), education (five functions), and scholarship (six functions) across
fundamental, desirable, and optimal levels of service.1,7 For statistical analysis on categorical
responses pertaining to level of exposure for various activities, exposure frequency was
converted into a 1-7 scale (1 = never; 2 = once a year; 3 = few times a year; 4 = once a month; 5
= once a week; 6 = several times a week; 7 = daily). Their perceived level of preparedness to
perform each activity as an independent practitioner was assessed on a scale of -10 to +10 with
descriptive anchors of -10 representing that they felt completely unprepared, +10 that they felt
completely prepared, and 0 as neutral. Survey validation occurred by questionnaire review and
feedback from five PGY2 residents of programs with a critical care emphasis but not the primary
focus (e.g. transplant, infectious diseases), three critical care pharmacists that had completed a
PGY2 residency within the past year, and two critical care pharmacists with >10 years of
experience.
Recruitment Methods
The study protocol was approved by the investigational review board at the primary study
institution. The weblink to the questionnaire was distributed via email in May 2012 to the
program directors of the 98 PGY2 critical care residency programs identified on the ASHP
residency directory webpage.34 Program directors were requested to forward the email and
weblink to their respective PGY2 critical care resident. A reminder email was sent to the

6

program directors eight weeks later. Instructions specified confidentiality and implied consent
with the completion of the questionnaire. All responses were blinded to the program director and
investigators. Incomplete survey responses were excluded from data analysis.
Data Analyses
It was anticipated that 33% of the questionnaires would be completed by eligible
respondents. Responses were not weighted and missing data were not imputed. Data were
collated into an excel spreadsheet (Excel 2007, Microsoft Corp., Redmond, WA) for
determination of frequencies, mean, median, standard deviation, and interquartile ranges.
Results
Institution and Residency Program Characteristics
A total of 98 PGY2 critical care programs involving a total of 115 potential PGY2 critical
care residents were surveyed with 53 independent responses. Eight responses were excluded
because of incomplete survey answers (n=7) or the residency program did not have a resident
during the 2011-2012 academic year (n=1). Therefore, the survey response rate was 54.1%
representing PGY2 critical care residency programs and 46.1% among all potential PGY2
residents. The majority of included programs were ASHP-accredited PGY2 residencies at large
academic institutions (Table 1). Residents report exposure to a diverse group of ICU patients
with a wide range of required and elective residency rotation experiences (Table 1). Twentythree (51.1%) programs offered off-site clinical rotations. Other residency requirements
included advanced cardiopulmonary life support certification (88.9%; n=40), pharmacy response
to resuscitation events (71.1%; n=32), and participation in an on-call program (35.6%; n=16).
Teaching certificate programs were available to 68.9% (n=31) of respondents. Most respondents
reported the staffing component during their PGY2 critical care residency training to be 4-11
hours per week, representing distributive, order entry and clinical pharmacy functions (Table 1).
Patient Care Services
The majority of patient care activities were reported as occurring daily or several times each
week and respondents generally perceived themselves as feeling comfortable to provide these
services after residency training (Table 2). The only fundamental (evaluates parenteral nutrition
support regimens as a part of a multidisciplinary, collaborative team) and desired
(independently manages parenteral nutrition support) clinical activities reported with a
moderate rating of preparedness involved the management of parenteral nutrition, which

7

respondents were less frequently exposed. Assisting physicians with patient or family
discussions was the only optimal patient care activity assessed and was reported to occur on a
monthly basis with most respondents feeling somewhat prepared to perform this following
residency training.
Administrative Services
Residents were generally exposed to fundamental and desirable administrative activities a
few times in the year and felt at least somewhat comfortable providing these services (Table 3).
Respondents were rarely exposed to optimal activities and seemed uncomfortable performing
these functions.
Educational and Scholarly Services
Variable responses were observed for educational and scholarly activities during residency
training (Table 4). In general, respondents were exposed to fundamental and desirable
educational activities on a weekly or monthly basis and felt comfortable providing these services.
The comfort level providing optimal educational functions was related to the frequency of
exposure. With the exception of designing research methods and performing data assessment,
residents were rarely exposed to scholarly functions and did not feel comfortable delivering these
services.
Resident Satisfaction and Position Attainment
Respondents rated their overall rates of satisfaction with the PGY2 program as 57.8% very
satisfied, 33.3% somewhat satisfied, 4.4% neutral, and 4.4% somewhat dissatisfied.
Respondents described their level of satisfaction with the degree of mentoring and timecommitment from clinical preceptors as 48.9% very satisfied, 26.7% somewhat satisfied,
15.6% neutral, and 8.8% either somewhat or very dissatisfied. All 45 (100%) responding
PGY2 residents anticipate completing certification as Board of Pharmacy Specialties after
completing their training. As of June 2012, respondents indicated their employment status
immediately after training would be 53.3% Clinical Pharmacy Specialist in critical care, 22.2%
unknown, 11.1% Clinical Staff Pharmacist in a critical care setting, 11.1% academic positions,
and 2.2% Clinical Staff Pharmacist in a non-ICU setting. Nearly 90% of residents stated the
PGY2 program significantly influenced the type of position they had obtained.
Discussion

8

These findings suggest PGY2 critical care residents 1) are exposed to a variety of ICU
populations; 2) frequently provide patient care functions and are comfortable delivering services
with the exceptions of nutrition support services and patient or family discussions; 3) deliver
most fundamental and desirable administrative, educational, or scholarly functions frequently
enough to feel comfortable providing most of these services; 4)perceived lack of confidence in
rendering services to which they were rarely exposed during their training; 5) are generally
satisfied with their residency experiences and mentoring. With few exceptions, these results are
consistent with the ASHP goals and objectives for PGY2 critical care programs and the job
functions most commonly reported by clinical critical care pharmacists.7,34
The ASHP goals of PGY2 critical care programs are intended to ensure graduates are
equipped to be fully integrated members of the interdisciplinary critical care team, able to make
complex medication and nutrition support recommendations in a fast-paced environment.30
Training focuses on developing resident capability to deal with a range of diseases and disorders
that occur in the critically ill. Graduates of the critical care residency are experienced in shortterm research in the critical care environment and excel in their ability to teach other health
professionals and those in training to be health professionals.34 These goals guide programs to
train residents to become independent practitioners and appear to emphasize the knowledge and
skills to perform direct patient care activities.1-6 Therefore, it is not surprising that respondents
were frequently exposed to these functions and felt competent to deliver these services.
Respondents indicated they were somewhat uncomfortable delivering nutrition support services
and interacting with patients or families. This lack of self-perceived competency likely relates to
the fact that trainees were infrequently exposed to these functions. It may also partly explain why
these two services are the patient care activities delivered the least by ICU pharmacists with rates
less than 33% of patient ICU days.7 Since ASHP goals R1.3 and R2.3 as well as objective R2.4.3
specifically address these services, programs should strive to enhance training opportunities to
ensure residents possess the skills to feel competent providing these services.34 In addition,
patient and family interaction continues to increase in importance with the emphasis on patient
reported outcomes in the Hospital Consumer Assessment of Healthcare Provides and Systems
(HCAHPS) and influence on reimbursement, thus supporting the need for residents to feel
comfortable with these interactions.35 This may advance the delivery of these important
functions by practicing pharmacists.

9

With respect to other domains of clinical pharmacy, respondents generally felt at least
somewhat comfortable providing most fundamental and desirable administrative, educational, or
scholarly functions. Regarding patient care activities, their perceived level of preparedness
seemed related to how frequently they were exposed to the particular activity. The level of
preparedness for most administrative and scholarly activities also corresponded with the
frequency of each activity. However, some activities were less frequently performed with the
resident reporting a higher level of preparedness. For example, an exposure frequency of several
times per year to various administrative activities provided residents enough skill development to
feel somewhat comfortable providing these services. However, for the two administrative
functions, evaluates new or existing clinical pharmacy programs by analyzing institutional
pharmacoeconomic data and involvement with developing and implementing a new clinical
pharmacy program, the median exposure frequency was never so its not surprising
respondents felt unprepared to independently render these functions. Residency programs should
attempt to expose trainees to these activities at least several times so residents feel as
comfortable with these services as they do with other administrative functions. Although most
practicing critical care pharmacists are involved with administrative functions, the specific
activities vary considerably.7 Therefore, its important for trainees to be exposed to all
administrative functions. Similar to the administrative functions, residents were rarely exposed to
educational and scholarly functions. Residents reported a lack of comfort with the independent
delivery of research and educational initiatives (i.e. teach advanced cardiac life support, educate
lay people about the ICU pharmacist, assist in patient enrollment for research, and
grantsmanship). Practicing pharmacists frequently provide educational services, but teaching
advanced cardiac life support and educating lay people about the ICU pharmacist are delivered at
rates less than 20%.7 Less than half of all practicing ICU pharmacists are involved with
scholarship and the activities of enrolling subjects and grantsmanship are rarely provided.7
Therefore, it may be impractical to expect programs to provide training related to these
educational and scholarship goals and PGY2 graduates wishing to perform these activities may
need to pursue additional training or seek mentorship.22
While each residency program and institution is unique, programs generally provide skill
development to the extent that almost all ASHP goals are consistently attained and residents feel
competent providing these activities. Moreover, the large majority of respondents were satisfied

10

with their training program and the mentoring they received. However, it is equally important to
note 11 responses stated the level of satisfaction of their training was either indifferent or
dissatisfied. We believe satisfaction levels may be influenced by multiple factors including
staffing levels, job outlook at time of survey, and quality of preceptors. Other elements possibly
influencing their satisfaction levels may involve the quality of professional relationships among
the PGY2 resident possibly with the residency program director, preceptors, and other pharmacy
residents Unfortunately, we did not survey reasons or provide responders to comment on factors
supporting their satisfaction or dissatisfaction responses. While certain deficiencies identified by
this survey exist and offer opportunities for program improvement, its important for PGY2
residencies to remain diversified so trainees are offered learning experiences tailored to their
needs.
Many potential limitations may exist as a result of the survey development process and
distribution approach. While question items were pretested, issues with content validity may
have arisen from a systematic error in the structure, representation, or interpretation of the
questions, response categories, or rating scales. Additionally, inter- and intra-rater reliability
cannot be assessed as respondents were anonymous. A related issue is that the questionnaire was
designed to assess perceptions. Therefore, the reported results are beliefs or attitudes, and must
not be misinterpreted to indicate that these respondents can or cannot independently provide
certain services in a demonstrable manner. For example, the residency training program may be
very effective with highly competent preceptors in a challenging academic environment.
However, the residents level of confidence in his or her abilities may result in a lower rank in
their perceived rather than actual ability to perform these services. The web-based mode of
surveying and the distribution of the questionnaire to program directors have inherent problems
that may infer biases. While most items were consistently answered, the order of questions may
have influenced the responses to the items concerning satisfaction as respondents may have
answered these in the context they addressed their perceptions about various clinical pharmacy
services. Primacy effect did not appear to occur as response categories were evenly and
appropriately selected. The response rate is satisfactory, but multiple PGY2 residents from the
same program may have completed the questionnaire. This may limit the generalizability of the
results as a lack of reflection from all residency programs, but from the limited sample size.
Also, it is important the residents satisfaction rate with the residency program may have been

11

influenced by their employment status.. Lastly, our findings reflect perceptions of PGY2 critical
care residency training. However, perceptions are important because they bridge attitudes, which
are our interpretation of data or facts as well as beliefs that are based on personal thought.
Residents will make decisions and convey their thoughts about a program based on their
perceptions, possibly not due to reality. We did not track each resident over an extended period
of time to assess this since our potential response rate would be expected to be decrease more so
from our initial survey. Therefore, perceptions are the next best option to assess.
Conclusion
Critical care pharmacy residents are exposed to a variety of activities during their training
and feel competent providing most patient care and common educational functions. Similarly,
they are exposed to fundamental and desirable administrative or scholarly functions frequently
enough to feel comfortable providing the majority of these services. However, infrequent
exposure of some scholarly and administrative functions was perceived as uncertain to
independently render these services. Programs should enhance administrative responsibilities of
their residents to adequately prepare them for real-world practice, while customizing the
residency learning experience to the specific interests of the PGY2 critical care pharmacy
resident. It may be overambitious to expect programs to provide additional training related to
educational and scholarship goals based on current standards and practices.

12

References
1.

Rudis MI, Brandi KM. Position paper on critical care pharmacy services. Society of Critical

Care Medicine and American College of Clinical Pharmacy Task Force on Critical Care
Pharmacy Services. Crit Care Med. 2000;28:3746-3750.

2.

Horn E, Jacobi J. The critical care clinical pharmacist: evolution of an essential team

member. Crit Care Med. 2006;34[Suppl.]:S46-S51.

3.

Erstad BL, Haas CE, OKeeffe T, Hokula CA, Parrinello K, Theodorou AA.

Interdisciplinary patient care in the intensive care unit: focus on the pharmacist.
Pharmacotherapy 2011;31:128-37.

4.

Kane SL, Weber RJ, Dasta JF. The impact of critical care pharmacists on enhancing

outcomes. Intensive Care Med. 2003;29:691-8.

5.

Brilli RJ, Spevetz A, Branson RD, et al. Critical care delivery in the intensive care unit:

defining clinical roles and best practice model. Crit Care Med. 2001;29:2007-19.

6.

Haas CE, Eckel S, Arif S, et al. Acute care pharmacy practice: unit- versus service-based

models. Pharmacotherapy 2012;32:e35-e44.

7.

MacLaren R, Devlin JW, Martin SJ, Dasta JF, Rudis MI, Bond CA. Critical care pharmacy

services in United States hospitals. Ann Pharmacother. 2006;40:612-8.

8.

Miyagawa CI, Rivera JO. Effect of pharmacist interventions on drug therapy costs in a

surgical intensive-care unit. Am J Health-Syst Pharm. 1986;43:3008-13.

9.

Katona BG, Avd PR, Walters JK, Caspi M, Finkelstein BW. Effect of a pharmacists and a

nurses interventions on cost of drug therapy in a medical intensive-care unit. Am J Health-Syst

Pharm. 1989;46:1179-82.

13

10. Montazeri M, Cook DJ. Impact of a clinical pharmacist in a multidisciplinary intensive care
unit. Crit Care Med. 1994;22:1044-8.

11. Devlin JW, Holbrook AM, Fuller HD. The effect of ICU sedation guidelines and pharmacist
interventions on clinical outcomes and drug cost. Ann Pharmacother. 1997;31:689-95.

12. Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and
adverse drug events in the intensive care unit. JAMA. 1999;282:267-70.

13. Kaye J, Ashline V, Erickson D, et al. Critical care bug team: a multidisciplinary approach to
reducing ventilator-associated pneumonia. Am J Infect Control. 2000;28:197-201.

14. Gandhi PJ, Smith BS, Tataronis GR, Maas B. Impact of a pharmacist on drug costs in a
coronary care unit. Am J Health-Syst Pharm. 2001;58:497-503.

15. Krupicka MI, Bratton SL, Sonnenthal K, Goldstein B. Impact of a pediatric clinical
pharmacist in the pediatric intensive care unit. Crit Care Med. 2002;30:919-21.

16. Jain M, Miller L, Belt D, King D, Berwick DM. Decline in ICU adverse events, nosocomial
infections and cost through a quality improvement initiative focusing on teamwork and culture
change. Qual Saf Health Care. 2006;15:2359.

17. Ng TMH, Bell AM, Hong C, et al. Pharmacist monitoring of QTc interval-prolonging
medications in critically ill medical patients: a pilot study. Ann Pharmacother. 2008;42:47582.

18. MacLaren R, Bond CA, Martin SJ, Fike D. Clinical and economic outcomes of involving
pharmacists in the direct care of critically ill patients with infections. Crit Care Med.
2008;36:3184-9.

14

19. Kalina M, Tinkoff G, Gleason W, Veneri P, Fulda G. A multidisciplinary approach to

adverse drug events in pediatric trauma patients in a adult trauma center. Pediatr Emer Care.
2009;25:444-6.

20. Weant KA, Armitstead JA, Ladha AM, et al. Cost effectiveness of a clinical pharmacist on a
neurosurgical team. Neurosurgery. 2009;65:946-51.

21. Kim MM, Barnato AE, Angus DC, Fleisher LF, Kahn JM. The effect of multidisciplinary
care teams on intensive care unit mortality. Arch Intern Med. 2010;170:36976.

22. Dager W, Bolesta S, Brophy G, et al. An opinion paper outlining recommendations for
training, credentialing, and documenting and justifying critical care pharmacy services.
Pharmacotherapy. 2011;31:135e-175e.

23. Miller WA. Changing the structure of pharmaceutical education to require doctor of
pharmacy and postgraduate residency education and training. Pharmacotherapy. 2006;587-93.

24. Murphy JE, Nappi JM, Bosso JA, et al. American College of Clinical Pharmacys vision of
the future: postgraduate pharmacy residency training as a prerequisite for direct patient care
practice. Pharmacotherapy. 2006;26:722-33.

25. Nahata MC. Residency requirement for pharmacists providing direct patient care. Ann
Pharmacother. 2010;44:1822-5.

26. Bright DR, Adams AJ, Black CD, Powers MF. The mandatory residency dilemma: parallels
to historical transitions in pharmacy education. Ann Pharmacother. 2010;44:1793-9.

27. Keresztes JM. Education a must in all levels of pharmacy practice. Ann Pharmacother.
2010;44:1826-8.

15

28. Erstad BL. A primer on critical care pharmacy services. Ann Pharmacother. 2008;42:187181.

29. ASHP supplementary standard and learning objectives for residency training in critical-care
pharmacy practice. Am J Hosp Pharm. 1990;47:609-12.

30. American Society of Health-System Pharmacists: Residency Accreditation PGY2

Outcomes,

Goals,

and

Objectives.

http://www.ashp.org/menu/Accreditation/ResidencyAccreditation.aspx. Accessed September 27,

2013.

31. Jennings HR, Empey PE, Smith KM. Survey of ASHP-accredited pharmacy residency
programs. Am J Health-Syst Pharm. 2000;57:2080-6.

32. Hoffman JM, Thomley S, Vermeulen L, Smith KM. Pharmacy residency training in
academic medical centers. Am J Health-Syst Pharm. 2004;61:2528-33.

33. Phillips H, Jasiak KD, Lindberg LS, Ryzner KL. Characteristics of postgraduate year 1
pharmacy residency programs at academic medical centers. Am J Health-Syst Pharm.
2011;68:1437-42.

34. American

Society

of

Health-System

Pharmacists:

Residency

Directory.

http://accred.ashp.org/aps/pages/directory/residencyProgramSearch.aspx. Accessed September

27, 2013.

35. Hospital

Care

Quality

Information

from

the

Consumer

http://www.hcahpsonline.org/home.aspx. Accessed September 27, 2013.

Perspective.

Table

Geographic location

residency program

ASHP accreditation status of the

Characteristic

3
5

Candidate
Pre-candidate

10
5

Southeast: Kentucky, Tennessee, Mississippi, Alabama

West Virginia, North Carolina, South Carolina, Georgia, Florida

South Atlantic: Delaware, Maryland, District of Columbia, Virginia,

Dakota, Nebraska, Kansas, Minnesota, Iowa

Midwest (West North Central): Missouri, North Dakota, South

Ohio

14

Mid-Atlantic: New York, Pennsylvania, New Jersey

Midwest (East North Central): Wisconsin, Michigan, Illinois, Indiana,

Rhode Island, Connecticut

New England: Maine, New Hampshire, Vermont, Massachusetts,

37

Accredited

Category

Table 1. Hospital and Residency Program Characteristics

11.1%

22.2%

2.2%

31.1%

11.1%

8.9%

11.1%

6.7%

82.2%

the hospital system

Number of total licensed beds in

Type of hospital setting

7
17
9
0

500-750
250-499
<250

Government

750-1000

Community (non-teaching/non-academic)

12

13

Community (teaching/academic)

>1000

28

University

Islands

Samoa, Guam, Northern Mariana Islands, Trust Territory of the Pacific

Pacific: Alaska, Washington, Oregon, California, Hawaii, American

Arizona, New Mexico

Mountain West: Idaho, Montana, Wyoming, Nevada, Utah, Colorado,

South Central: Oklahoma, Texas, Arkansas, Louisiana

0.0%

20.0%

37.8%

15.6%

26.7%

4.4%

4.4%

28.9%

62.2%

6.7%

4.4%

2.2%

the residency training program

Type of ICU patients applicable in

in the hospital

Number of total licensed ICU beds

45
31
43
24
45
23
34

Medical
Neonatal
Neurosurgical
Pediatric
Surgical
Transplant (solid organ and/or bone marrow transplant)
Trauma

<20

42

21-40

Cardiac

41-60

21

61-80

Burn

28

>80

75.6%

51.1%

100.0%

53.3%

95.6%

68.9%

100.0%

93.3%

46.7%

2.2%

8.9%

11.1%

13.3%

62.2%

weekends or after hour coverage

Type of staffing responsibilities for

hour coverage

program for weekends or after

component of the residency

professional service/staffing

Time requirements for the

19
3

Not applicable

Not applicable

Both

<4 hours / week

12

14

4-7 hours / week

Clinical (e.g. therapeutic drug monitoring)

15

8-11 hours / week

11

12-16 hours / week

Distribution (centralized or decentralized staffing, etc.)

>16 hours / week

Other

6.7%

42.2%

26.7%

24.4%

6.7%

4.4%

31.1%

33.3%

8.9%

15.6%

8.9%

REQUIRED core clinical rotations

0
10
30
19
11
45
2
25
10
7
22
2
40
6
2
27

Bone marrow transplant

Burn unit
Cardiac-related ICU
Emergency medicine
Infectious diseases
Medical ICU
Neonatal ICU
Neurosurgical ICU
Nutrition support
Pediatric ICU
Research (i.e. rotation devoted to research)
Solid organ transplant
Surgical ICU
Teaching
Toxicology
Trauma ICU

60.0%

4.4%

13.3%

88.9%

4.4%

48.9%

15.6%

22.2%

55.6%

4.4%

100.0%

24.4%

42.2%

66.7%

22.2%

0.0%

offered

ELECTIVE clinical rotations

17
20
21
25
32
13
25
20
21
25
6
29
14
10

Burn unit
Cardiac-related ICU
Emergency medicine
Infectious diseases
Medical ICU
Neonatal ICU
Neurosurgical ICU
Nutrition support
Pediatric ICU
Research (i.e. rotation devoted to research)
Solid organ transplant
Surgical ICU
Teaching

Bone marrow transplant

Other

22.2%

31.1%

64.4%

13.3%

55.6%

46.7%

44.4%

55.6%

28.9%

71.1%

55.6%

46.7%

44.4%

37.8%

2.2%

14
7

Trauma ICU
Other

ASHP = American Society of Health-System Pharmacists; ICU = intensive care unit

15

Toxicology

15.6%

31.1%

33.3%

Table

Provides pharmacokinetic monitoring

Fundamental

causality

Assesses suspected drug-related ICU admissions for

pharmacotherapy monitoring/recommendations, etc.

record including disease state management,

Documents clinical activities in the patients medical

effectiveness and adverse drug events

monitors the patients pharmacotherapeutic regimen for

indication, dose, drug interactions, drug allergies, and

Prospectively evaluates drug therapy for appropriate

Resident Activity

Level of Activity

Table 2. Patient Care Pharmacy Services

Level of

Activity

6.0 (5.0-7.0)

6.0 (5.0-7.0)

7.0 (7.0-7.0)

7.0 (6.0-7.0)

7.2 (2.9)

9.0 (1.4)

9.1 (1.1)

9.2 (0.9)

Preparedness

Reported

Exposure for

Performed

Mean (SD)

Frequency of

Median (IQR)

regarding treatment options

family members to help make informed decisions

4.0 (2.0-5.0)

3.0 (1.0-4.0)

Independently manages parenteral nutrition support

Assists physicians in discussions with patients and/or

5.0 (4.0-6.0)

6.0 (4.0-7.0)

7.0 (7.0-6.0)

7.0 (7.0-7.0)

4.0 (3.0-5.0)

for cardiac or respiratory arrests (code blue)

Active patient care participation during resuscitation

to a clinical intervention

Utilizes a documentation tool designating an outcome

acute illness

continuation of maintenance pharmacotherapy during

Assesses the patients medication history to determine

provide drug therapy management recommendations

ICU = intensive care unit; IQR = interquartile range; SD = standard deviation

Optimal

Desired

Attends multidisciplinary critical care rounds to

part of a multidisciplinary, collaborative team

Evaluates parenteral nutrition support regimens as a

4.9 (4.5)

3.4 (5.6)

7.7 (2.7)

7.8 (3.0)

8.7 (2.4)

9.2 (1.2)

4.9 (4.6)

Table

Fundamental

Level of Activity

medication errors and preventable ADEs

Develops a process improvement strategy to reduce

related to ICU medications

3.0 (2.0-3.0)

3.3 (1.0-4.0)

3.0 (1.0-4.0)

Participates in ADE reporting to institutional committees

Identifies and implements cost-containment strategies

3.0 (3.0-3.0)

3.0 (2.0-3.0)

4.0 (3.0-4.0)

4.2 (3.5)

4.5 (4.2)

4.8 (4.0)

5.5 (3.2)

5.3 (4.0)

6.1 (3.3)

Preparedness

Reported Level of

Exposure for
Activity Performed

Mean (SD)

Frequency of

Median (IQR)

procedures related to optimizing ICU medications

Develops and implements institutional policy and

monographs relating to ICU medications

Contributes to the hospital newsletter or drug

Therapeutics, critical care committee, etc.)

Involvement with hospital committees (e.g. Pharmacy &

Resident Activity

Table 3. Administrative Pharmacy Services

clinical pharmacy program

Involvement with developing and implementing a new

analyzing institutional pharmacoeconomic data

Evaluates new or existing clinical pharmacy programs by

protocols in the ICU

Evaluates the impact of institutional guidelines and/or

critical care pathways

1.0 (1.0-2.0)

1.0 (1.0-3.0)

3.0 (1.0-3.0)

3.0 (1.0-3.0)

ADE = adverse drug event; ICU = intensive care unit; IQR = interquartile range; SD = standard deviation

Optimal

Desired

Develops and implements drug therapy protocols and/or

0.9 (3.7)

1.8 (0.9)

3.9 (4.4)

4.2 (3.6)

Table

Desired

Fundamental

Level of Activity

3.0 (2.0-4.0)
2.0 (2.0-3.0)

Publication (or will be submitting for publication in

5.0 (3.0-6.0)

4.0 (3.0-4.0)

5.0 (4.0-6.0)

4.5 (3.5)

6.0 (2.7)

7.3 (3.3)

7.4 (3.0)

7.8 (2.9)

Preparedness

Reported Level of

Exposure for Activity

Performed

Mean (SD)

Frequency of

Median (IQR)

assessment (analysis and/or result interpretation)

Designs research methods and performs data

residents through experiential critical care rotations

Participates in the training of pharmacy students or

students)

and/or healthcare professionals in training (residents,

professionals (physicians, pharmacists, nurses, etc.)

Provides formal didactic lectures to healthcare

team members

Provides informal drug therapy education to the ICU

Resident Activity

Table 4. Educational and Scholarly Pharmacy Services

research

writing, budget management, etc.) for conducting

Participates in the grant funding process (proposal

of a multidisciplinary team

community about the role of ICU pharmacists as part

1.0 (1.0-1.0)

1.0 (1.0-2.0)

1.0 (1.0-2.0)

Involved in teaching advanced cardiac life support

Educates lay people and medical groups in the

2.0 (2.0-3.0)

3.0 (2.0-3.0)

1.0 (0.0-4.0)

(platform and/or poster presentation)

regional or national organizational meetings

clinical research or pharmacoeconomic analyses at

Presents (or will be presenting in the next 12 months)

Provides accredited continuing education sessions

ICU = intensive care unit; IQR = interquartile range; SD = standard deviation

Optimal

screening and/or enrollment process

Involved in research by assisting in the patient

report, original research, review article, etc.)

the next 12 months) in peer-reviewed journal (case

-1.8 (4.5)

0.0 (6.0)

2.3 (3.8)

5.5 (4.3)

7.1 (3.2)

3.2 (5.0)