- Email: [email protected]
Pharmacy residents’ barriers to scholarly pursuits
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Currents in Pharmacy Teaching and Learning 7 (2015) 40–46
Research
http://www.pharmacyteaching.com
Pharmacy residents’ barriers to scholarly pursuits Paul Brandon Bookstaver, PharmD, FCCP, BCPS (AQ-ID), AAHIVPa,*, Tisha M. Felder, PhD, MSWa,b, April Miller Quidley, PharmD, BCPSc, Kelly Ragucci, PharmD, FCCP, BCPS, CDEd, Jean Nappi, PharmD, FCCP, BCPS (AQ-Cardiology)d, Heather M. Draper, PharmD, BCPSe a
Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC b Cancer Prevention & Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC c Critical Care Pharmacist and PGY2 Critical Care Residency Program Director, Vidant Medical Center, Greenville, NC d Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC e Clinical Pharmacist Emergency Medicine, Mercy Health Saint Mary’s, Grand Rapids, MI
Abstract Objectives: This study examined barriers to pursuing scholarly activities among pharmacy residents. Methods: Pharmacy residents of American Society of Health-System Pharmacists (ASHP)-accredited programs in the Southeastern region of the United States during the 2009–2010 residency cycle were invited to participate in a web-based survey to assess interests in and barriers to pursuing scholarly activities (e.g., peer-reviewed manuscript development). A 22question, web-based survey instrument was developed and pilot tested to assess demographics, confidence, interest and intent in pursuing scholarly activities, and barriers to scholarly activity. The survey instrument was administered in April 2010, and respondents were given four weeks to complete. Descriptive statistics (e.g., frequency and median ⫾ IQR) were used to report respondent characteristics and identifiable barriers. Results: A total of 209 out of 405 (52%) residents completed the survey. Respondents were primarily female (80%), under the age of 30 years (86%), and in a first-year residency program (75%). The majority of respondents (79%) intended on pursuing scholarly activities beyond their residency project. Lack of time was the most frequently reported and was ranked the most important barrier to pursuing scholarly activities. Lack of knowledge of the processes associated with scholarly activity and limited mentorship from residency preceptors were identified as barriers by 37% and 25% of residents, respectively. Conclusions: Noteworthy barriers to pharmacy residents’ pursuit of scholarly activity were identified including lack of time, mentorship, and knowledge of the process. Pharmacists involved in mentoring residents should facilitate opportunities for scholarly activities, including peer-reviewed publications. r 2014 Elsevier Inc. All rights reserved.
Keywords: Pharmacy resident; Post-graduate training; Scholarship; Peer-reviewed publications
* Corresponding author: Paul Brandon Bookstaver, PharmD, FCCP, BCPS (AQ-ID), AAHIVP, Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina Campus, 715 Sumter Street, Columbia, SC 29208. E-mail: [email protected] http://dx.doi.org/10.1016/j.cptl.2014.09.003 1877-1297/r 2014 Elsevier Inc. All rights reserved.
Background As the accrediting body for post-graduate training in pharmacy, the American Society of Health-System Pharmacists (ASHP) requires documented completion of a resident-
P.B. Bookstaver et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 40–46
led project.1 The project is designed to provide residents the opportunity to develop a basic skill set related to the development, conduct, and completion of a project. Deliverables from a resident project may improve overall written and oral communication skills, and completion of a resident project can be valuable to both the resident and institution.2 Many of these projects include original research, and the impact of the project can extend beyond those directly involved if results are disseminated through publication in a peer-reviewed journal.3,4 Additionally, scholarly publication of a resident’s project will add to that resident’s skill set. The role of the pharmacist in research and scholarly activity has long been recognized.3 As such, professional pharmacy organizations have issued statements encouraging trainees seeking research-focused careers to begin early development and pursue advanced degrees.4 There is also support for residency programs to establish proposed standards and training modules for clinical research and pharmacy models.5 A mentored manuscript submission and publication experience during the pharmacy residency year is a tangible learning opportunity that can encourage future scholarly activities. Without that initial scholarly activity experience, it can be very difficult for former residents to decide to publish later without the guidance and mentorship offered by a residency program. Even if not all residents pursue publication in their future career, a residency experience with scholarly publication and dissemination is foundational. This is not unlike the movement to publish Doctor of Philosophy (PhD) dissertations and make them widely available for others to use. Despite organization support and the benefits of resident scholarship, the publication rate of projects completed by pharmacy residents remains relatively low, especially compared to medical resident counterparts.6–13 Several barriers to scholarship from residency projects have been suggested, including the limited one-year or two-year time frame and the lack of resident training in study design, data collection, and data analysis.2,3 This lack of formalized training may also stem from some project preceptor’s limited scholarship experience or a program’s lower priority placed on scholarship.2 Additionally, some project preceptors may not be expected to participate in scholarly activity as a part of their job responsibilities, as is required in many academic settings where scholarship is directly tied to promotion and/or tenure. However, data on barriers to project publication that residents perceive are lacking. These data can be helpful in identifying key objectives to include in the training on scholarship for residents. In order to develop an improved model for training residents to successfully complete a pharmacy residency project from concept development to peer-reviewed publication, perceived barriers should be identified from a resident’s perspective. This study aimed to identify perceived barriers to the pursuit of scholarly activity by pharmacy residents in the southeastern United States.
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Methods Design and overview Current residents of ASHP-accredited pharmacy residency programs in the southeast United States (including Florida, Georgia, South Carolina, North Carolina, Alabama, Mississippi, and Tennessee) were invited to participate in an anonymous web-based survey distributed through SurveyMonkeys (Appendix I). This study was approved by the Institutional Review Board (IRB) at the University of South Carolina. All ASHP-accredited PGY-1 and PGY-2 pharmacy residents in the 2009–2010 residency cycle from the aforementioned states were eligible for participation. Since ASHP does not maintain a roster of current residents, a list of residents was created utilizing the Southeastern Pharmacy Residency Conference (SERC) database, which maintains a current resident e-mail list. Missing contact information was obtained through direct contact with the residency program director or representative as needed. Based on these rosters, a total of 405 pharmacy residents were eligible for study participation. The survey instrument was administered in April 2010 and a four-week deadline was given for completion. A reminder e-mail was sent three weeks after the initial mailing to encourage study participation. Survey instrument The survey instrument was collaboratively developed by all study investigators with the combined experience as a residency director, resident mentor, and/or research scholar. Study investigators also have published experience with survey methodology using a resident audience. Published literature was examined for validated survey instruments related to the current study, but provided no useful tools. The survey instrument was pilot tested among students, current residents, and faculty who were ineligible for study inclusion. Pilot testing resulted in only minor grammatical changes and established an estimated completion time for prospective study participants. The survey instrument consisted of four sections totaling 22 questions: Section (1)—eight personal characteristics and academic-related questions including gender, age, current residency position (PGY-1 or PGY-2), type of residency program, location, affiliation with a college of pharmacy, institution type, and career plans after current residency completion; Section (2)—five questions related to anticipated scholarly activities during residency and level of interest; Section (3)—five questions related to confidence and motivation in seeking publication of scholarly activities; and Section (4)—four questions on identifying barriers and existing resources (Appendix I). Scholarly activities were defined as dissemination of residency project results in the form of a presentation at a conference (local, state, regional, or national), submission an abstract for peer-review to a professional meeting and creation of an oral or poster
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presentation if accepted to present or a manuscript published in a peer-reviewed journal. Each confidence question was scored on a 5-point Likert scale ranging from “strongly disagree” (1) to “strongly agree” (5). Questions about barriers asked the respondent to identify which barriers were relevant to them and then rank their perceived barriers as “most important” (1) to “not at all important” (6). Similarly, questions about existing resources asked the respondent to identify which resources were currently available to them and then to rank them by level of importance. (1 ¼ not important at all to 5 ¼ definitely important). Additional questions were multiple choice and allowed the respondent the option of selecting all applicable answers or providing free-text comments. Additional comments were encouraged at the conclusion of the survey.
reported as medians ⫾ IQR values. Analyses were conducted in STATA Version 13 (Statacorp, 2013).
Results A total of 209 out of 405 potential pharmacy residents completed the survey, indicating a 52% response rate. The characteristics of the respondents are presented in the Table 1. Respondents were primarily female (80%), under the age of 30 years (86%), and in PGY-1 residency (75%). The majority Table 1 Summary of overall respondent characteristics Respondent characteristics
Primary outcome of interest The purpose of the survey was to assess perceived barriers to and pharmacy residents’ interest or intent in pursuing scholarly activities. Barriers were assessed with responses to two questions (Questions 19 and 20, Appendix I). Resources that may help to overcome these barriers were assessed in two questions (Questions 21 and 22, Appendix I). A respondent intention to pursue scholarly activities was determined by their responses to two separate questions asking if the respondent: (1) had or would complete any additional scholarly activities (verbal presentations, presentation of an abstract, publish a manuscript, or other) other than their residency project (Appendix I, Question 9) and (2) intended to pursue any additional scholarly activities with their residency project (verbally present project, submit an abstract, submit a manuscript, or other activity) (Appendix I, Question 13). A respondent’s interest level in pursuing scholarly activities was assessed by responses to two questions asking (1) if there was interest in pursuing further scholarly pursuits of their residency project (yes/no) (Question 12, Appendix I) and (2) to qualify their generalized interest in pursuing scholarly activities on a 5-point Likert scale (Question 16, Appendix I).
Analysis Descriptive statistics [e.g., frequencies, medians ⫾ interquartile ranges (IQR)] were calculated to summarize pharmacy residents’ characteristics including gender, age, year of residency, type of residency, residency practice setting, college of pharmacy affiliation, level of confidence, and plans following residency. For the analysis, the following characteristics were re-categorized: age (r25, 26–29, and Z30 years), type of residency (PGY-1 vs. PGY2), residency practice setting (academic medical center vs. non-academic), and plans after residency (academic vs. professional practice). Responses to barriers were ranked by importance (1 ¼ most important, 6 ¼ least important) and
Total, n ¼ 209 (%)
Gender Male 42 (20.1) Female 167 (79.9) Age (in years) 25 and under 78 (37.3) 26–29 102 (48.8) 30 and older 29 (13.9) Year of residency Year 1 157 (75.1) Year 2 52 (24.9) Type of residency General pharmacy practice 112 (53.6) Specialty 97 (46.4) Residency practice setting Academic medical center 94 (45.0) Non-academic setting (e.g., community hospital) 114 (55.0) College of Pharmacy affiliation No 95 (45.5) Yes 114 (54.5) Practice site location Alabama 13 (6.2) Florida 45 (21.5) Georgia 32 (15.3) North Carolina 63 (30.1) South Carolina 34 (16.3) Tennessee 22 (10.5) Plans after completion of residency Academic (e.g., obtain position in academia or 28 (13.4) graduate degree) Professional practice (e.g., practice as clinical 180 (86.1) pharmacist) Interest in pursuing further scholarly activity of residency project Yes 153 (73.6) No 55 (26.4) Interest in scholarly activity related to residency 4 (4–5) project, median rating (IQR: 25–75) (5 ¼ strongly agree, 1 ¼ strongly disagree) Confidence in pursuing scholarly activities, median 4 (3–4) rating (IQR: 25–75) (5 ¼ strongly agree, 1 ¼ strongly disagree) Expect scholarship as part of professional career Yes 194 (93.3) No 14 (6.7)
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of respondents’ residency programs were general pharmacy practice (54%). Overall, 45% of respondents were affiliated with an academic medical center, and approximately half were affiliated or sponsored by a college of pharmacy. Study respondent characteristics are comparable to national statistics of ASHP-accredited residency programs.14 Respondents (87%) indicated a high level of interest in pursuing scholarly activities (median ¼ 4; IQR: 4–5). Only 3.4% of respondents indicated they had not received formal training on pursuing scholarly activities, with 92% reporting training in this area during PGY-1 residency. Confidence level in pursuing scholarly activities was high in 59% of respondents, although only 19 (9.1%) reported the highest level of confidence. Professional advancement was ranked as the primary motivation for pursuing scholarly activities (85% of respondents), with personal satisfaction being the second most common response (69%). The majority of respondents agreed that completing scholarly activities would improve their curriculum vitae, offer professional advancement, increase positioning in their career, and add to the medical literature.
Identified barriers and resources among respondents intending to pursue scholarly activities Of the six potential barriers to pursuing and completing scholarly activities, respondents identified lack of time available to complete activities (n ¼ 192, 92%), lack of knowledge of the processes associated with scholarly activity (n ¼ 76, 37%), and limited mentorship from residency preceptors (n ¼ 52, 25%) as the most common barriers. When asked to rank potential barriers by level of importance (with 1 ¼ most important and 6 ¼ not at all important), lack of time (most important by 76% of respondents), limited knowledge of the process, limited mentorship, and not being sure of how to get started were identified as the most important (Fig. 1). There were no differences in identified
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barriers among those who reported high level of interest or intent in pursuing scholarly activity compared to those who did not. Respondents identified library resources (e.g., access to full-text articles, assistance with literature search/retrieval, n ¼ 185, 89%), mentorship from preceptors with extensive pharmacy practice experience (n ¼ 163, 79%), and access to literature or textbooks explaining manuscript development and publication process (n ¼ 139, 67%) as the most common resources currently available to assist them with the pursuit of scholarly activity. When asked to rank current resources by level of importance, mentorship from preceptors with extensive scholarly experience (ranked as definitely important by 55% or respondents), having dedicated time, and mentorship from preceptors with extensive pharmacy practice experience were the most important (Fig. 2). Discussion The majority of respondents in our study reported that they were interested in pursuing scholarly activities, including peer-reviewed publication of their residency projects. There are limited studies examining publication rates of pharmacy residency projects in the literature.6–11 Several studies have examined publication rates of either residency projects or abstracts from meetings and found a small percentage of projects were eventually published in peerreviewed journals (4.2–33%).6–11 Abstracts that contained actual results as well as those that involved a physician coauthor were more likely to be published. Even among nontrainees, Ensom and Walker9 found that only 25% of abstracts presented at a Canadian national meeting were eventually published in peer-reviewed journals. Current study investigators found publication rates of residency projects were approximately 9% and highest among abstracts presented at the American College of Clinical Pharmacy national meeting (15.5%).10 Nearly one-third of
Fig. 1. Personal barriers identified by pharmacy residents ranked by level of importance (average rating score).
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Fig. 2. Resources currently available to assist pharmacy residents in completing scholarly activities ranked by level of importance (average rating score).
these published manuscripts included residents who pursued academic positions, suggesting a primary motivation similar to the findings in this current study.10 Although a full review of the medical literature is beyond the scope of this article, it should be noted that there are similar barriers noted related to medical resident publications, including lack of time, training, and resource constraints.15–17 Time constraints, both during residency and after completion, are often a major reason for low rates of publication of pharmacy residency projects.6 Similar to these previous studies, we found that lack of time was ranked the most important barrier among residents who were interested in pursuing scholarly activities and only 12% of them had dedicated time to pursue these activities. An American Association of Colleges of Pharmacy task force conducted a survey of pharmacy practice-based faculty to determine barriers to the pursuit of publication, identifying insufficient time as the number one barrier.18 In addition to time, our study also found lack of knowledge and limited mentorship from preceptors with extensive experience with scholarly activities among the top barriers identified by our respondents. This may be due to the fact that there are limited expectations or rewards for scholarship for non-faculty preceptors and therefore, residency projects at these institutions have a lower priority for publishing. There appears to be a lack of interest in expanding the overall knowledge base upon which the profession of pharmacy is based. Both preceptors and residents should embrace the responsibility to contribute to the literature. Another factor related to low resident publication rates is the fact that many residency projects are retrospective, single-center studies and of limited interest to peer-reviewed journals. A recent article by Hasegawa19 stated that the American Journal of Health-System Pharmacy places high priority on originality and scientific quality, and often resident project submissions are lacking in one or both of
these areas. This is also true of several other pharmacy journals. Scholarship opportunities for post-graduate trainees are not limited solely to the primary resident project, which was the primary focus of this study. Other potential avenues of publication include case reports, review articles, and less often Medication Use Evaluation or Quality Initiative projects. Generating interest and involvement in scholarship activities by trainees, both student and resident, has been shown to lead to a high rate of residents pursuing faculty positions (38%).3 The link of mentorship and scholarship involvement by trainees to the pursuit of careers in academia has been suggested in previous studies.20–23 Because of this perceived linkage, several college of pharmacy-affiliated residency programs have established teaching certificate or academia preparation programs.24–26 These programs are primarily designed to mentor trainees in variable didactic and experiential teaching experiences, offer faculty seminar series on academia-related topics, and generate a heightened interest in scholarship. The influence of these types of programs on resident publication rates or scholarship interest levels has not been reported. Results of our study suggest that there are several areas for resident mentors to focus on for promoting an environment that fosters scholarly activity. Published information on systematic approaches to resident research and reports of strategies to improve resident research place varying emphasis on publications by residents. For example, one suggested approach to conducting a successful researchoriented residency project provides recommendations for “sharing the data” by presenting the results of the project within the institution.27 Residents and program directors perceived benefit from this type of model, although data on the pursuit of peer-reviewed publications were not discussed. A second model suggests the benefits of a practicebased research network consisting of the residency director, preceptor, residents, and research faculty. Peer-
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reviewed publications of resident projects nearly doubled after the introduction of this research-focused program.3 Individuals who are not directly associated with the residency but have publishing and/or scholarship experience may address several of the barriers identified by resident participants in this study (e.g., knowledge, training, and mentorship) in addition to increasing the rate of scholarly activities. There are a few important limitations to this study. It is unknown if response rates varied by state or program. Additionally, many residency programs may not be represented in this study. However, the overall response rate is appropriate given the size of this study. Acquiescence bias, a type of response bias that occurs when respondents have a tendency to agree with statements or indicate positivity when in doubt, may have been present when evaluating interest and intent to publish with the survey. Additionally, we did not provide a standardized definition of college of pharmacy affiliation. Residents in programs with strong affiliations to a college of pharmacy cannot be distinguished from respondents whose institution may have a single faculty member. Again, some full-time faculty members have more incentive and pressure to publish and could likely be more engaged in scholarship as mentors compared to those faculty members without the expectation or incentive to publish. In order to find potential solutions, the interests, needs, and barriers of institutions, programs, and residency preceptors would also be valuable. Our analysis did not include inferential statistics due to the lack of an expansive exploration of resident interest and motivation in scholarly pursuits in the present survey. Finally, the method for study selection was not examined. For instance, some residents are able to choose a research project in which they are highly interested, whereas others may be asked to complete a project that is assigned to them by their program director. This may influence an individual’s interest in actually pursuing scholarly activity related to the project. Future research is needed to identify potential solutions or strategies to overcome barriers to scholarly pursuits among residents, including the role of preceptor development for resident project advisors and other research mentors. Conclusion In order to develop an improved model for successfully completing a pharmacy residency project from concept development to peer-reviewed publication, residents’ perceived barriers must be identified. In our study, noteworthy barriers such as time and access to mentors with knowledge of the process were identified. Residents appeared to have a strong desire and intent to pursue peer-reviewed publication of their project and other experiences. Residency program directors and preceptors can uniquely position pharmacy residents to excel in scholarly pursuits by linking them to experienced scholars, providing necessary resources, and
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educating on effective time management for manuscript development. Preceptor development should focus on enhancing the effectiveness of resident project advisors and research mentors in promoting scholarly deliverables from resident-led projects. Acknowledgments We thank the pharmacy residents and faculty who participated in the pilot testing of our survey.
Appendix A. Supplementary Information Supplementary material cited in this article is available online at doi: 10.1016/j.cptl.2014.09.003.
References 1. American Society of Health-System Pharmacists. Residency Accreditation Standards and Regulations. 〈http://www.ashp. org/Import/ACCREDITATION/ResidencyAccreditation/Regula tionsStandards.aspx〉; Accessed October 23, 2014. 2. Ellis JJ, McMcredie SR, McGregory M, Streetman DS. Effect of pharmacy practice residency training on residents’ knowledge of and interest in clinical research. Am J Health Syst Pharm. 2007;64(19):2055–2063. 3. Pruchnicki MC, Rodis JL, Beatty SJ, et al. Practice-based research network as a research training model for community/ ambulatory pharmacy residents. J Am Pharm Assoc (2003). 2008;48(2):191–202. 4. Fagan SC, Touchette D, Smith JA, et al. The state of science and research in clinical pharmacy. Pharmacotherapy. 2006;26 (7):1027–1040. 5. Smith JA, Olson KL, Sowinski KM, 2005 ACCP Research Affairs Committee. Pharmacy practice research careers. Pharmacotherapy. 2009;29(8):1007–1011. 6. Olson KL, Holmes M, Dang C, Patel RJ, Witt DM. Publication rates of abstracts presented by pharmacy residents at the Western States Conference. Am J Health Syst Pharm. 2012;69(1):59–62. 7. McKelvey RP, Hatton RC, Kimberlin CA. Pharmacy resident project publication rates and study designs from 1981, 1991 and 2001. Am J Health Syst Pharm. 2010;67(10):830–836. 8. Byerly WG, Rheney CC, Connelly JF, Verzino KC. Publication rates of abstracts from two pharmacy meetings. Ann Pharmacother. 2000;34(10):1123–1127. 9. Ensom MH, Walker SE. From abstract to publication: what makes the grade? Can J Hosp Pharm. 1998;51(6):280–284. 10. Evans RA, Miller AD, Bookstaver PB, et al. Pharmacy resident research publication rates: a national and regional comparison. Pharmacotherapy. 2012;32(10):e178–e320 [Abstract presented at 2012 American College of Clinical Pharmacy Annual Meeting, Hollywood, FL]. 11. Hung M, Duffett M. Canadian pharmacy practice residents’ projects: publication rates and study characteristics. Can J Hosp Pharm. 2013;66(2):e86–e95.
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12. Holmes J, Sokolove PE, Panacek EA. Ten-year experience with an emergency medicine resident research project requirement. Acad Emerg Med. 2006;13(5):575–579. 13. Tintara H, Lumbiganon P, Preutthipan S, Tannirandorn Y. Research Subcommittee of the Royal Thai College of Obstetricians and Gynecologists. Research publication by the Royal Thai College of Obstetricians and Gynecologists residency training program, 1994–2003. J Med Assoc Thai. 2007;90(5):870–875. 14. Teeters J. American Society Health-System Pharmacy New. The current landscape of pharmacy residency training. Presented at the Residency Stakeholder’s Conference. 〈http:// www.ashp.org/DocLibrary/Accreditation/PRC2011/Current-Land scape.aspx〉; 2011 Accessed October 23, 2014. 15. Kurahara DK, Kogachi K, Yamane M, et al. A pediatric residency research requirement to improve collaborative resident and faculty publication productivity. Hawaii J Med Public Health. 2012;71(8):224–228. 16. Namdari S, Baldwin KD, Weinraub B, Mehta S. Changes in the number of resident publications after inception of the 80-hour work week. Clin Orthop Relat Res. 2010;468(8): 2278–2283. 17. Millis SR, Campagnolo DI, Kirshblum S, Elovic E, Jain SS, DeLisa JA. Improving resident research in physical medicine and rehabilitation: impact of a structured training program. J Spinal Cord Med. 2004;27(5):428–433. 18. Robles JR, Youmans SL, Byrd DC, Polk RE. Perceived barriers to scholarship and research among pharmacy practice faculty: survey report from the ACCP scholarship/research
19. 20.
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23. 24.
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26. 27.
faculty development task force. Am J Pharm Educ. 2009;73(1): Article 17. Hasegawa GR. Publication of residency projects: another perspective. Am J Health Syst Pharm. 2012;69(1):77–78. Siracuse MV, Schondelmeyer SW, Hadsall RS, Schommer JC. Third-year pharmacy students’ work experience and attitudes and perceptions of the pharmacy profession. Am J Pharm Educ. 2008;72(3): Article 50. Sheaffer EA, Brown BK, Byrd DC, et al. Variables impacting an academic pharmacy career choice. Am J Pharm Educ. 2008;72(3): Article 49. Clark CA, Mehta BH, Rodis JL, Pruchnicki MC, Pedersen CA. Assessment of factors influencing community pharmacy residents’ pursuit of academic positions. Am J Pharm Educ. 2008;72(1): Article 3. Carter RA. More than a summer job. Am J Pharm Educ. 2006;70(5): Article 110. Castellani V, Haber SL, Ellis SC. Evaluation of a teaching certificate program for pharmacy residents. Am J Health Syst Pharm. 2003;60(10):1037–1041. Romanelli FR, Smith KM, Brandt BF. Teaching residents how to teach: a Scholarship of Teaching and Learning Certificate Program (STLC) for pharmacy residents. Am J Pharm Educ. 2005;69(2): Article 20. Nappi JM. Assessment and evolution of an academician preparation program. Am J Pharm Educ. 2013;77(5): Article 101. Barletta JF. Conducting a successful residency research project. Am J Pharm Educ. 2008;72(4): Article 92.
Currents in Pharmacy Teaching and Learning 7 (2015) 40–46
Research
http://www.pharmacyteaching.com
Pharmacy residents’ barriers to scholarly pursuits Paul Brandon Bookstaver, PharmD, FCCP, BCPS (AQ-ID), AAHIVPa,*, Tisha M. Felder, PhD, MSWa,b, April Miller Quidley, PharmD, BCPSc, Kelly Ragucci, PharmD, FCCP, BCPS, CDEd, Jean Nappi, PharmD, FCCP, BCPS (AQ-Cardiology)d, Heather M. Draper, PharmD, BCPSe a
Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC b Cancer Prevention & Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC c Critical Care Pharmacist and PGY2 Critical Care Residency Program Director, Vidant Medical Center, Greenville, NC d Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC e Clinical Pharmacist Emergency Medicine, Mercy Health Saint Mary’s, Grand Rapids, MI
Abstract Objectives: This study examined barriers to pursuing scholarly activities among pharmacy residents. Methods: Pharmacy residents of American Society of Health-System Pharmacists (ASHP)-accredited programs in the Southeastern region of the United States during the 2009–2010 residency cycle were invited to participate in a web-based survey to assess interests in and barriers to pursuing scholarly activities (e.g., peer-reviewed manuscript development). A 22question, web-based survey instrument was developed and pilot tested to assess demographics, confidence, interest and intent in pursuing scholarly activities, and barriers to scholarly activity. The survey instrument was administered in April 2010, and respondents were given four weeks to complete. Descriptive statistics (e.g., frequency and median ⫾ IQR) were used to report respondent characteristics and identifiable barriers. Results: A total of 209 out of 405 (52%) residents completed the survey. Respondents were primarily female (80%), under the age of 30 years (86%), and in a first-year residency program (75%). The majority of respondents (79%) intended on pursuing scholarly activities beyond their residency project. Lack of time was the most frequently reported and was ranked the most important barrier to pursuing scholarly activities. Lack of knowledge of the processes associated with scholarly activity and limited mentorship from residency preceptors were identified as barriers by 37% and 25% of residents, respectively. Conclusions: Noteworthy barriers to pharmacy residents’ pursuit of scholarly activity were identified including lack of time, mentorship, and knowledge of the process. Pharmacists involved in mentoring residents should facilitate opportunities for scholarly activities, including peer-reviewed publications. r 2014 Elsevier Inc. All rights reserved.
Keywords: Pharmacy resident; Post-graduate training; Scholarship; Peer-reviewed publications
* Corresponding author: Paul Brandon Bookstaver, PharmD, FCCP, BCPS (AQ-ID), AAHIVP, Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina Campus, 715 Sumter Street, Columbia, SC 29208. E-mail: [email protected] http://dx.doi.org/10.1016/j.cptl.2014.09.003 1877-1297/r 2014 Elsevier Inc. All rights reserved.
Background As the accrediting body for post-graduate training in pharmacy, the American Society of Health-System Pharmacists (ASHP) requires documented completion of a resident-
P.B. Bookstaver et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 40–46
led project.1 The project is designed to provide residents the opportunity to develop a basic skill set related to the development, conduct, and completion of a project. Deliverables from a resident project may improve overall written and oral communication skills, and completion of a resident project can be valuable to both the resident and institution.2 Many of these projects include original research, and the impact of the project can extend beyond those directly involved if results are disseminated through publication in a peer-reviewed journal.3,4 Additionally, scholarly publication of a resident’s project will add to that resident’s skill set. The role of the pharmacist in research and scholarly activity has long been recognized.3 As such, professional pharmacy organizations have issued statements encouraging trainees seeking research-focused careers to begin early development and pursue advanced degrees.4 There is also support for residency programs to establish proposed standards and training modules for clinical research and pharmacy models.5 A mentored manuscript submission and publication experience during the pharmacy residency year is a tangible learning opportunity that can encourage future scholarly activities. Without that initial scholarly activity experience, it can be very difficult for former residents to decide to publish later without the guidance and mentorship offered by a residency program. Even if not all residents pursue publication in their future career, a residency experience with scholarly publication and dissemination is foundational. This is not unlike the movement to publish Doctor of Philosophy (PhD) dissertations and make them widely available for others to use. Despite organization support and the benefits of resident scholarship, the publication rate of projects completed by pharmacy residents remains relatively low, especially compared to medical resident counterparts.6–13 Several barriers to scholarship from residency projects have been suggested, including the limited one-year or two-year time frame and the lack of resident training in study design, data collection, and data analysis.2,3 This lack of formalized training may also stem from some project preceptor’s limited scholarship experience or a program’s lower priority placed on scholarship.2 Additionally, some project preceptors may not be expected to participate in scholarly activity as a part of their job responsibilities, as is required in many academic settings where scholarship is directly tied to promotion and/or tenure. However, data on barriers to project publication that residents perceive are lacking. These data can be helpful in identifying key objectives to include in the training on scholarship for residents. In order to develop an improved model for training residents to successfully complete a pharmacy residency project from concept development to peer-reviewed publication, perceived barriers should be identified from a resident’s perspective. This study aimed to identify perceived barriers to the pursuit of scholarly activity by pharmacy residents in the southeastern United States.
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Methods Design and overview Current residents of ASHP-accredited pharmacy residency programs in the southeast United States (including Florida, Georgia, South Carolina, North Carolina, Alabama, Mississippi, and Tennessee) were invited to participate in an anonymous web-based survey distributed through SurveyMonkeys (Appendix I). This study was approved by the Institutional Review Board (IRB) at the University of South Carolina. All ASHP-accredited PGY-1 and PGY-2 pharmacy residents in the 2009–2010 residency cycle from the aforementioned states were eligible for participation. Since ASHP does not maintain a roster of current residents, a list of residents was created utilizing the Southeastern Pharmacy Residency Conference (SERC) database, which maintains a current resident e-mail list. Missing contact information was obtained through direct contact with the residency program director or representative as needed. Based on these rosters, a total of 405 pharmacy residents were eligible for study participation. The survey instrument was administered in April 2010 and a four-week deadline was given for completion. A reminder e-mail was sent three weeks after the initial mailing to encourage study participation. Survey instrument The survey instrument was collaboratively developed by all study investigators with the combined experience as a residency director, resident mentor, and/or research scholar. Study investigators also have published experience with survey methodology using a resident audience. Published literature was examined for validated survey instruments related to the current study, but provided no useful tools. The survey instrument was pilot tested among students, current residents, and faculty who were ineligible for study inclusion. Pilot testing resulted in only minor grammatical changes and established an estimated completion time for prospective study participants. The survey instrument consisted of four sections totaling 22 questions: Section (1)—eight personal characteristics and academic-related questions including gender, age, current residency position (PGY-1 or PGY-2), type of residency program, location, affiliation with a college of pharmacy, institution type, and career plans after current residency completion; Section (2)—five questions related to anticipated scholarly activities during residency and level of interest; Section (3)—five questions related to confidence and motivation in seeking publication of scholarly activities; and Section (4)—four questions on identifying barriers and existing resources (Appendix I). Scholarly activities were defined as dissemination of residency project results in the form of a presentation at a conference (local, state, regional, or national), submission an abstract for peer-review to a professional meeting and creation of an oral or poster
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presentation if accepted to present or a manuscript published in a peer-reviewed journal. Each confidence question was scored on a 5-point Likert scale ranging from “strongly disagree” (1) to “strongly agree” (5). Questions about barriers asked the respondent to identify which barriers were relevant to them and then rank their perceived barriers as “most important” (1) to “not at all important” (6). Similarly, questions about existing resources asked the respondent to identify which resources were currently available to them and then to rank them by level of importance. (1 ¼ not important at all to 5 ¼ definitely important). Additional questions were multiple choice and allowed the respondent the option of selecting all applicable answers or providing free-text comments. Additional comments were encouraged at the conclusion of the survey.
reported as medians ⫾ IQR values. Analyses were conducted in STATA Version 13 (Statacorp, 2013).
Results A total of 209 out of 405 potential pharmacy residents completed the survey, indicating a 52% response rate. The characteristics of the respondents are presented in the Table 1. Respondents were primarily female (80%), under the age of 30 years (86%), and in PGY-1 residency (75%). The majority Table 1 Summary of overall respondent characteristics Respondent characteristics
Primary outcome of interest The purpose of the survey was to assess perceived barriers to and pharmacy residents’ interest or intent in pursuing scholarly activities. Barriers were assessed with responses to two questions (Questions 19 and 20, Appendix I). Resources that may help to overcome these barriers were assessed in two questions (Questions 21 and 22, Appendix I). A respondent intention to pursue scholarly activities was determined by their responses to two separate questions asking if the respondent: (1) had or would complete any additional scholarly activities (verbal presentations, presentation of an abstract, publish a manuscript, or other) other than their residency project (Appendix I, Question 9) and (2) intended to pursue any additional scholarly activities with their residency project (verbally present project, submit an abstract, submit a manuscript, or other activity) (Appendix I, Question 13). A respondent’s interest level in pursuing scholarly activities was assessed by responses to two questions asking (1) if there was interest in pursuing further scholarly pursuits of their residency project (yes/no) (Question 12, Appendix I) and (2) to qualify their generalized interest in pursuing scholarly activities on a 5-point Likert scale (Question 16, Appendix I).
Analysis Descriptive statistics [e.g., frequencies, medians ⫾ interquartile ranges (IQR)] were calculated to summarize pharmacy residents’ characteristics including gender, age, year of residency, type of residency, residency practice setting, college of pharmacy affiliation, level of confidence, and plans following residency. For the analysis, the following characteristics were re-categorized: age (r25, 26–29, and Z30 years), type of residency (PGY-1 vs. PGY2), residency practice setting (academic medical center vs. non-academic), and plans after residency (academic vs. professional practice). Responses to barriers were ranked by importance (1 ¼ most important, 6 ¼ least important) and
Total, n ¼ 209 (%)
Gender Male 42 (20.1) Female 167 (79.9) Age (in years) 25 and under 78 (37.3) 26–29 102 (48.8) 30 and older 29 (13.9) Year of residency Year 1 157 (75.1) Year 2 52 (24.9) Type of residency General pharmacy practice 112 (53.6) Specialty 97 (46.4) Residency practice setting Academic medical center 94 (45.0) Non-academic setting (e.g., community hospital) 114 (55.0) College of Pharmacy affiliation No 95 (45.5) Yes 114 (54.5) Practice site location Alabama 13 (6.2) Florida 45 (21.5) Georgia 32 (15.3) North Carolina 63 (30.1) South Carolina 34 (16.3) Tennessee 22 (10.5) Plans after completion of residency Academic (e.g., obtain position in academia or 28 (13.4) graduate degree) Professional practice (e.g., practice as clinical 180 (86.1) pharmacist) Interest in pursuing further scholarly activity of residency project Yes 153 (73.6) No 55 (26.4) Interest in scholarly activity related to residency 4 (4–5) project, median rating (IQR: 25–75) (5 ¼ strongly agree, 1 ¼ strongly disagree) Confidence in pursuing scholarly activities, median 4 (3–4) rating (IQR: 25–75) (5 ¼ strongly agree, 1 ¼ strongly disagree) Expect scholarship as part of professional career Yes 194 (93.3) No 14 (6.7)
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of respondents’ residency programs were general pharmacy practice (54%). Overall, 45% of respondents were affiliated with an academic medical center, and approximately half were affiliated or sponsored by a college of pharmacy. Study respondent characteristics are comparable to national statistics of ASHP-accredited residency programs.14 Respondents (87%) indicated a high level of interest in pursuing scholarly activities (median ¼ 4; IQR: 4–5). Only 3.4% of respondents indicated they had not received formal training on pursuing scholarly activities, with 92% reporting training in this area during PGY-1 residency. Confidence level in pursuing scholarly activities was high in 59% of respondents, although only 19 (9.1%) reported the highest level of confidence. Professional advancement was ranked as the primary motivation for pursuing scholarly activities (85% of respondents), with personal satisfaction being the second most common response (69%). The majority of respondents agreed that completing scholarly activities would improve their curriculum vitae, offer professional advancement, increase positioning in their career, and add to the medical literature.
Identified barriers and resources among respondents intending to pursue scholarly activities Of the six potential barriers to pursuing and completing scholarly activities, respondents identified lack of time available to complete activities (n ¼ 192, 92%), lack of knowledge of the processes associated with scholarly activity (n ¼ 76, 37%), and limited mentorship from residency preceptors (n ¼ 52, 25%) as the most common barriers. When asked to rank potential barriers by level of importance (with 1 ¼ most important and 6 ¼ not at all important), lack of time (most important by 76% of respondents), limited knowledge of the process, limited mentorship, and not being sure of how to get started were identified as the most important (Fig. 1). There were no differences in identified
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barriers among those who reported high level of interest or intent in pursuing scholarly activity compared to those who did not. Respondents identified library resources (e.g., access to full-text articles, assistance with literature search/retrieval, n ¼ 185, 89%), mentorship from preceptors with extensive pharmacy practice experience (n ¼ 163, 79%), and access to literature or textbooks explaining manuscript development and publication process (n ¼ 139, 67%) as the most common resources currently available to assist them with the pursuit of scholarly activity. When asked to rank current resources by level of importance, mentorship from preceptors with extensive scholarly experience (ranked as definitely important by 55% or respondents), having dedicated time, and mentorship from preceptors with extensive pharmacy practice experience were the most important (Fig. 2). Discussion The majority of respondents in our study reported that they were interested in pursuing scholarly activities, including peer-reviewed publication of their residency projects. There are limited studies examining publication rates of pharmacy residency projects in the literature.6–11 Several studies have examined publication rates of either residency projects or abstracts from meetings and found a small percentage of projects were eventually published in peerreviewed journals (4.2–33%).6–11 Abstracts that contained actual results as well as those that involved a physician coauthor were more likely to be published. Even among nontrainees, Ensom and Walker9 found that only 25% of abstracts presented at a Canadian national meeting were eventually published in peer-reviewed journals. Current study investigators found publication rates of residency projects were approximately 9% and highest among abstracts presented at the American College of Clinical Pharmacy national meeting (15.5%).10 Nearly one-third of
Fig. 1. Personal barriers identified by pharmacy residents ranked by level of importance (average rating score).
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Fig. 2. Resources currently available to assist pharmacy residents in completing scholarly activities ranked by level of importance (average rating score).
these published manuscripts included residents who pursued academic positions, suggesting a primary motivation similar to the findings in this current study.10 Although a full review of the medical literature is beyond the scope of this article, it should be noted that there are similar barriers noted related to medical resident publications, including lack of time, training, and resource constraints.15–17 Time constraints, both during residency and after completion, are often a major reason for low rates of publication of pharmacy residency projects.6 Similar to these previous studies, we found that lack of time was ranked the most important barrier among residents who were interested in pursuing scholarly activities and only 12% of them had dedicated time to pursue these activities. An American Association of Colleges of Pharmacy task force conducted a survey of pharmacy practice-based faculty to determine barriers to the pursuit of publication, identifying insufficient time as the number one barrier.18 In addition to time, our study also found lack of knowledge and limited mentorship from preceptors with extensive experience with scholarly activities among the top barriers identified by our respondents. This may be due to the fact that there are limited expectations or rewards for scholarship for non-faculty preceptors and therefore, residency projects at these institutions have a lower priority for publishing. There appears to be a lack of interest in expanding the overall knowledge base upon which the profession of pharmacy is based. Both preceptors and residents should embrace the responsibility to contribute to the literature. Another factor related to low resident publication rates is the fact that many residency projects are retrospective, single-center studies and of limited interest to peer-reviewed journals. A recent article by Hasegawa19 stated that the American Journal of Health-System Pharmacy places high priority on originality and scientific quality, and often resident project submissions are lacking in one or both of
these areas. This is also true of several other pharmacy journals. Scholarship opportunities for post-graduate trainees are not limited solely to the primary resident project, which was the primary focus of this study. Other potential avenues of publication include case reports, review articles, and less often Medication Use Evaluation or Quality Initiative projects. Generating interest and involvement in scholarship activities by trainees, both student and resident, has been shown to lead to a high rate of residents pursuing faculty positions (38%).3 The link of mentorship and scholarship involvement by trainees to the pursuit of careers in academia has been suggested in previous studies.20–23 Because of this perceived linkage, several college of pharmacy-affiliated residency programs have established teaching certificate or academia preparation programs.24–26 These programs are primarily designed to mentor trainees in variable didactic and experiential teaching experiences, offer faculty seminar series on academia-related topics, and generate a heightened interest in scholarship. The influence of these types of programs on resident publication rates or scholarship interest levels has not been reported. Results of our study suggest that there are several areas for resident mentors to focus on for promoting an environment that fosters scholarly activity. Published information on systematic approaches to resident research and reports of strategies to improve resident research place varying emphasis on publications by residents. For example, one suggested approach to conducting a successful researchoriented residency project provides recommendations for “sharing the data” by presenting the results of the project within the institution.27 Residents and program directors perceived benefit from this type of model, although data on the pursuit of peer-reviewed publications were not discussed. A second model suggests the benefits of a practicebased research network consisting of the residency director, preceptor, residents, and research faculty. Peer-
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reviewed publications of resident projects nearly doubled after the introduction of this research-focused program.3 Individuals who are not directly associated with the residency but have publishing and/or scholarship experience may address several of the barriers identified by resident participants in this study (e.g., knowledge, training, and mentorship) in addition to increasing the rate of scholarly activities. There are a few important limitations to this study. It is unknown if response rates varied by state or program. Additionally, many residency programs may not be represented in this study. However, the overall response rate is appropriate given the size of this study. Acquiescence bias, a type of response bias that occurs when respondents have a tendency to agree with statements or indicate positivity when in doubt, may have been present when evaluating interest and intent to publish with the survey. Additionally, we did not provide a standardized definition of college of pharmacy affiliation. Residents in programs with strong affiliations to a college of pharmacy cannot be distinguished from respondents whose institution may have a single faculty member. Again, some full-time faculty members have more incentive and pressure to publish and could likely be more engaged in scholarship as mentors compared to those faculty members without the expectation or incentive to publish. In order to find potential solutions, the interests, needs, and barriers of institutions, programs, and residency preceptors would also be valuable. Our analysis did not include inferential statistics due to the lack of an expansive exploration of resident interest and motivation in scholarly pursuits in the present survey. Finally, the method for study selection was not examined. For instance, some residents are able to choose a research project in which they are highly interested, whereas others may be asked to complete a project that is assigned to them by their program director. This may influence an individual’s interest in actually pursuing scholarly activity related to the project. Future research is needed to identify potential solutions or strategies to overcome barriers to scholarly pursuits among residents, including the role of preceptor development for resident project advisors and other research mentors. Conclusion In order to develop an improved model for successfully completing a pharmacy residency project from concept development to peer-reviewed publication, residents’ perceived barriers must be identified. In our study, noteworthy barriers such as time and access to mentors with knowledge of the process were identified. Residents appeared to have a strong desire and intent to pursue peer-reviewed publication of their project and other experiences. Residency program directors and preceptors can uniquely position pharmacy residents to excel in scholarly pursuits by linking them to experienced scholars, providing necessary resources, and
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educating on effective time management for manuscript development. Preceptor development should focus on enhancing the effectiveness of resident project advisors and research mentors in promoting scholarly deliverables from resident-led projects. Acknowledgments We thank the pharmacy residents and faculty who participated in the pilot testing of our survey.
Appendix A. Supplementary Information Supplementary material cited in this article is available online at doi: 10.1016/j.cptl.2014.09.003.
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