Evaluating Programs Offered for Pharmacy Residents

Background

While recruitment and retention of qualified faculty members are critical for the success of an academic program, the faculty shortage remains a recurring challenge in the schools /colleges of pharmacy across the nation. The AACP Institutional Research Brief indicated that 454 vacant faculty positions in 129 US colleges and schools of pharmacy in 2015-2016.1 Of those vacant positions, the clinical science/pharmacy practice account for the most (46.9%).  A number of studies have described efforts to promote academic careers that include promoting postgraduate training including pharmacy residency and fellowships.2, 3

Shin and colleagues4 recently have shown that pharmacy residents are interested in academia, and some obtain faculty positions immediately after residency. The teaching certificate programs for pharmacy residents have gained widespread acceptance after Romanelli and colleagues described the first teaching certificate program in the University of Kentucky College of Pharmacy in 1999.5 Since that time, teaching programs have been developed throughout the country to provide organized instruction for pharmacy residents seeking competence in classroom teaching or clinical precepting.6, 7 In addition, the American Society of Health-System Pharmacists (ASHP) accreditation standards for residency programs emphasized on developing the teaching skills of pharmacy residents.8 Residents in teaching certificate programs affiliated with a college of pharmacy are provided with instructional opportunities to design and deliver lectures or serve as teaching assistants or small-group facilitators for students.9

There are isolated reports on the teaching certificate programs offered by several schools/colleges of pharmacy. Manasco et al. surveyed 154 residency programs and identified 99 programs offering academic rotations with varying teaching opportunities.6 Gonzalvo et al. described the successful evolution of Indiana Pharmacy Resident Teaching Certificate program over 10 years and redesign of the program to accommodate growing number of residents and programmatic changes for the current generation of pharmacy educators.10 Studies have shown that graduates from teaching certificate programs are more likely to obtain faculty positions in academia. In addition, they have more confidence in their teaching abilities than those who did not complete the programs.11, 12

Recently, Strang and Baja identified twenty teaching certificate programs for residents by investigating published peer-reviewed literature.13 While there are isolated reports on teaching certificate programs, the trend in offering these programs across the nation remains unclear. The objective of this study is to evaluate teaching certificate programs offered by US colleges/schools of pharmacy which focus to prepare pharmacy residents and fellows for academic positions.

Methods

A survey instrument was developed to collect quantitative and qualitative information on teaching certificate programs in US schools and colleges of Pharmacy. The survey items solicited information on the design and implementation of teaching certificate programs. The survey items were formulated based on our current understanding of literature on teaching certificate programs. As a pre-testing process, the survey was reviewed by four independent pharmacy faculty members and an Associate Dean of Academic Affairs who did not participate in the study.  The survey instrument was revised based on their feedback on the clarity of question composition and whether the survey items adequately addressed the study objectives. An electronic hyperlink to the survey instrument was emailed to pharmacy practice department chairs/vice chairs at 132 ACPE-accredited and candidate-status PharmD programs in the United States and its territories by using American Association of Colleges of Pharmacy (AACP) email distribution list. SurveyMonkey (SurveyMonkey, Inc., Portland, OR) was utilized to collect responses.  The survey was configured to track each response from individual college/school of pharmacy based on respondents’ email address. A cover letter accompanying the survey explained the purpose of the survey along with the assurance that participation would be voluntary and identity would remain confidential. To ensure confidentiality, all files were password protected and stored in a password protected stationary computer in a locked office. Only the principal investigator of this study had access to raw data. Survey responses were downloaded into Microsoft Excel.

Due to a low response rate in the survey, a second approach of data collection was utilized by visiting websites of 132 colleges and schools of pharmacy.  The search was conducted by three third year PharmD students who were enrolled in a Research Elective course with the principal investigator. Key terms such as “residency”, “teaching certificate”, and “certificate program” were utilized in the search process.  An excel data collection sheet was created based on the original survey instrument. Data were collected by three individual investigators and recorded in Microsoft Excel worksheets. The data collected from websites were cross-checked with the data gathered by survey by the principal investigator and then merged for analysis. Descriptive statistics were used for data analysis. This research was granted exempt status by the Institutional Review Board of West Coast University.

Results

Out of 132 pharmacy schools surveyed, 40 schools responded indicating offering of teaching certificate programs. The websites search of ACPE accredited schools further identified 29 more schools/colleges that offered teaching certificate programs. Website search yielded limited data on the status of offering teaching certificate programs and structured activities required for completion of the certificate programs. These data were merged with survey data and presented in the Tables and Figures.

The demographic characteristics of the schools/colleges of pharmacy that offer teaching certificate are shown in Table 1. Responding schools/colleges were asked about the goals of their teaching certificate programs and to provide feedback as open-ended comments. As summarized in Table 2, there were a total of 34 comments on the overarching goals of these programs. Respondents identified two major goals: preparing residents for academic profession and teaching them diverse teaching and assessment strategies. Only two comments indicated that research was optional and not an emphasis in the teaching certificate programs.

Table 3 presents the characteristics of teaching certificate programs. Out of 69 programs, 32 enroll both Post-Graduate Year 1 and Post-Graduate Year 2 residents, 29 programs enroll only Post-Graduate Year 1 residents and 7 programs enroll only Post-Graduate Year 2 residents. Twenty six programs were found to enroll fellows in addition to pharmacy residents. These programs utilize longitudinal (n=26), concentrated (n=3), or combination of both experiences (n=8) to expose residents to the various academic experiences. With longitudinal format of teaching certificate, the activities are spread out throughout the year. The schedule varied depending on when the residents sign up, rotation sites, and residency program participant preferences. Two programs reported the self-directed format throughout the year with once a semester on-campus meeting. One program reported to have two meetings in the Fall and three in the Spring. Similarly, other programs reported that Fall semester was front-loaded with teaching, but the programs required and other assignments throughout the year. Ten programs reported to have assigned academic mentors for residents/fellows. Nine programs reported that they charged registration fee to participants.

The teaching certificate programs offered diverse teaching activities are shown in Figure 1. The most commonly offered teaching related activities include teaching didactic courses (n=27), facilitating group/case discussion (n=28), precepting students at rotations (n=22), assisting/teaching in laboratory courses (n=23), and developing and submission of a teaching portfolio (n=28). In thirty teaching certificate programs, residents/fellow received formal feedback on teaching performance by faculty/ mentors.

While various teaching activities are required by nearly all programs, the requirements for attending teaching seminar, research design, project and grant proposal writing were reported by 51%, 12%, and 0.07% of the responding programs, respectively. Thirty five programs required residents/fellows to attend teaching seminars on various topics such as teaching or pedagogical methodologies, assessment of student learning, and development of teaching portfolios (Table 4). Sixty three percent of the respondents reported that they invited guest speakers for teaching seminars. Only a few teaching certificate programs required residents/fellows to engage in some other academic activities that include attending committee/faculty meeting (n=6), shadowing a faculty members for daily academic works (n=3), shadowing an administrator (dean, chair, experiential director) (n=2), participating in community health education session (n=4), and working on accreditation process (n=4).

Thirty one programs had a designated director/team leader and 14 programs had joint leadership between the college of pharmacy and other residency programs. These programs are fully supported by faculty members within the schools/colleges. Faculty coordinated the courses, while residence/fellow develop course contents and participate in teaching. Faculty conduct and lead sessions related to teaching certificate, review portfolio, and provide seminars.

A total of 173 residency programs were reported to be affiliated with 29 teaching certificate programs in colleges and schools of pharmacy. With a total enrollment of 2,596 residents in 34 teaching certificate programs, since their inception, the overall completion rate was 91%. Data provided by 14 teaching certificate programs reported that 33% of the graduates have accepted full-time faculty positions.  Figure 3 demonstrates the challenges associated with the development and sustenance of teaching certificate programs as reported by 28 respondents. The prevailing challenges included scheduling conflict, budget constraints, technology limitations, and availability of funds/grants.  Availability of interested faculty to teach and mentor residents was identified as a challenge by two programs. Two schools/colleges of pharmacy indicated no barriers with sustained operations of their well-established teaching certificate programs.

The achievements of the goals of teaching certificate programs were assessed by multiple mechanisms as reported by respondents (Table 5). The most common assessment strategies included teaching portfolios and survey feedback from residents, residency directors, and faculty mentors.

Discussion

The numbers of teaching certificate programs offered by colleges and schools of pharmacy have been increasing to provide an organized training for pharmacy residents who are interested in pursuing a career in academia. Many pharmacy residency programs have adopted an academic rotation or teaching certificate programs in affiliation with colleges and schools of pharmacy. In the current study, we have identified that 69 schools/colleges of pharmacy were offering teaching certificate programs to pharmacy residents and/or fellows. The study presents qualitative and quantitative data on the goals, structure, implementation, and assessment of such programs across US colleges and schools of pharmacy.

In schools/colleges of pharmacy, the teaching certificate programs were structured to provide residents with an academic teaching experience that increase knowledge about careers in academia, faculty roles/responsibilities, and pharmacy education trends.  The survey solicited comments from responding colleges/schools of pharmacy on the open-ended question about goals of their respective teaching certificate program. Major goals were identified from respondents’ comments include: 1) preparing residents for academic profession and 2) providing them opportunities to gain experiences in diverse teaching and assessment strategies in classroom or experiential settings. Only two comments indicated that research was optional and not an emphasis in the teaching certificate programs. The American Society for Health System Pharmacists (ASHP) pharmacy practice residency accreditation standards requires that residents participate in teaching at various levels including medication counseling to patients and their caregiver, formal academic lectures, writing grant proposals, conducting clinical research, precepting students/residents, and presenting in in-service seminars to healthcare professionals.8 Teaching certificate programs should aim to increase the depth of knowledge, skills, attitudes, and abilities needed to raise the level of academic expertise14.  Medina et al. described an eight-module program in which PGY2 residents can expand their teaching abilities by exploring more advanced topics such as course coordination, grading, active learning, teaching with technology.15

The structures of teaching certificate programs vary from school to school, which necessitates a more uniform teaching certificate requirement across schools and colleges of pharmacy to ensure all residents have similar training. The current survey has shown that the components of teaching certificate programs in US colleges and schools of pharmacy have expanded to include diverse teaching related activities to enhance residents’ academic skills. In addition to teaching didactic courses, other teaching related activities included facilitating group/case discussion/problem-based learning, developing syllabi and course materials, assessment activities such as writing test questions, serving as a teaching assistant, teaching in a clinical setting, assisting/teaching in laboratory courses, precepting pharmacy students in experiential rotations, and submission of a  teaching portfolio. In addition, a number of teaching certificate programs required participant residents to involve with research design, grant writing, and attending teaching seminar as the requirement for completion of the certificate programs.

The American College of Clinical Pharmacy (ACCP) 2013 guideline for residency programs offering a teaching certificate highlights the importance of interactive seminars that offer education on core pedagogy topics.16 In the current study, thirty-five teaching certificate programs were identified which incorporated seminars on various aspects of academic activities including teaching or pedagogical methodologies, development of teaching portfolios, curriculum development, assessment of student learning, academic careers, promotion and tenure system, grant writing, research and scholarship, and publishing. Though not all programs may have the resources or qualified individuals to host these seminars, this type of instruction is highly recommended to provide a foundation before the program participants engage in teaching responsibilities.

Research and scholarship is a fundamental tenet of an academician in higher education setting. In pharmacy education, faculty members must meet an institutional expectation of research, in addition to teaching and service.17 Therefore, the American Association of Colleges of Pharmacy 2002 task force recommended that pharmacy post-graduate training programs should focus on research and scholarship including grant writing.14 The current teaching certificate programs, nonetheless, place most emphasis on teaching and less so on scholarship and clinical services.  In the current study, we have identified less than ten teaching certificate programs with a requirement of having a research project or grant writing as the requirement for completion of the certificate programs. There should be a balance between teaching, scholarship, and service in teaching certificate programs that prepare pharmacy residents to have a successful career in academia. Consideration should be given to the development of research design and grant proposal.

Most programs utilized longitudinal or combination of both longitudinal and concentrated experiences to expose residents to various academic experiences. Across the programs with longitudinal format, the schedule varied depending on residents’ rotation sites and residency program participant preferences. There is no published literature regarding the advantages and disadvantages of formats of teaching certificate programs; however, the prevalence of the longitudinal format was most likely due to the current program design in postgraduate residencies. Residency programs that adopted a concentrated teaching style usually involved the creation of a teaching rotation. Kirdahy et al. described a four-week elective academic rotation for PGY1 residents that comprised a variety of experiences, including daily participation in several large- and small-group teaching activities, opportunities for participation in admission interviews of prospective pharmacy students and other service activities, and independent scholarship, such as the preparation of article manuscript suitable for publication in the professional journal18. A combination of both longitudinal and concentrated approaches has been reported.10 In addition to required teaching related activities, the Indiana Teaching Certificate program adopted a 2-day conference format to provide classroom seminars on diverse topics which was a change from its previous format that included seminars throughout the residency year.10

The American College of Clinical Pharmacy (ACCP) 2013 guideline for residency programs offering a teaching certificate emphasized on assigning a teaching mentor for residency participants to offer guidance for and evaluation of all teaching experiences.19 Per ACCP guideline, a teaching mentor should have both academic and experiential experiences. Qualifications of an academic mentor include a faculty member with at least 3 years of teaching experience in an ACPE-accredited institution or a minimum of 1 year of teaching experience with completion of a teaching certificate program. Qualifications of an experiential mentor should be a preceptor with at least 3 years of experiential teaching experience. This study identified that ten teaching certificate programs required the residents/fellows to have assigned academic mentors. A mentoring relationship provides an avenue for offering guidance, resources, and networking to pharmacy residents pursuing careers in academic pharmacy. In a survey conducted by Purdue University College of Pharmacy, almost all teaching certificate program participants indicated that having a professional mentor was either important or very important to their professional development.20

Teaching certificate programs are considered important and highly valued by program participants, little data substantiates that these programs improve teaching of residents. The assessment of such programs has traditionally been based on perception-based study.10, 11 The quality assessment of teaching certificate programs were performed by multiple mechanisms including residents’ teaching portfolios and survey feedback from residents, residency directors, and faculty mentors. Castellani et al. have shown that participation in a teaching certificate program increases the residents’ confidence in their teaching abilities pharmacy.21 In a recent article, Wahl and colleagues12 reported the impact of a teaching certificate program on the career experiences of alumni. The alumni agreed/strongly agreed that the teaching certificate program stimulated their interests in pursuing careers in academia and increased the likelihood in obtaining academic positions. In addition, the skills and knowledge learned in the teaching certificate program were applicable in their workplace, with a significant higher level of agreement among those in academia.11, 12

There are some inherent challenges associated with the development and sustenance of teaching certificate programs. As our data suggest, the major barrier is the scheduling of sessions for resident training in the colleges/schools of pharmacy.   The number of participants in teaching certificate programs has increased over time.6, 11With this increase, coordinating multiple teaching sessions throughout the year for a participant is a daunting task.22 Availability of faculty mentor, budget constraint, technological limitations have been identified as barriers to teaching certificate programs. After 10 years of successful program implementation, the Indiana Pharmacy Resident Teaching Certificate program reported to face similar challenges.10

The study has a number of limitations. The survey was sent to colleges and schools of pharmacy across the United States, but the response rate was low.  Although we gathered additional data from websites of colleges and schools of pharmacy, we were not able to receive detailed information, such as number of years the program has been in place, number of graduates who have enrolled/completed the program, trend of enrollment, number of graduates accepted a pharmacy faculty position, etc. Furthermore, we acknowledge that the information on the websites may not be updated.

Summary

The results suggest an increasing trend in development of teaching certificate programs in recent years by colleges and schools of pharmacy. Our study has identified that teaching certificate programs provide participants with opportunities for formal instruction and development of skills that can help prepare them for a faculty position. We have, however, noticed that there is less emphasis on research and scholarship in many teaching certificate programs. Additionally, there is lack of uniformity in structures and requirements among the programs. To reap maximum benefits out of a teaching certificate program, the challenges identified in this study and the above mentioned concerns need be addressed. Finally, this study may  assist colleges and schools of pharmacy that are planning to develop such programs for pharmacy residents and fellows.

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