50 YEARS OF PHARMACY RESIDENCY ACCREDITATION  Advancement in pharmacy

ar Layar

Celebrating 50 years of advancement in pharmacy residency training Toby Clark Am J Health-Syst Pharm. 2014; 71:1190-5

T

his overview of the history of the first 50 years of accredited pharmacy residency training covers only a few facets of the complete story. These are facets that especially interested me as I reviewed the historical record of the ASHP accreditation program. When reflecting on the pioneers in hospital pharmacy residency training—individuals such as Harvey A. K. Whitney, Donald E. Francke, Clifton Latiolais, and Paul Parker— we are reminded that many people made it possible for us to celebrate the golden anniversary of residency accreditation. We stand on the shoulders of those who had the vision and unwavering resolve to pursue high standards for the specialized knowledge, skills, and abilities needed in hospital pharmacy and in clinical pharmacy practice. The first accredited programs As of August 2, 1964, there were 31 accredited pharmacy residency programs in 32 different hospitals. Among those was a multisite program that included 2 hospitals in Boston (Peter Bent Brigham and

Massachusetts General) that offered one accredited program. All of the former “internship” program directors were encouraged to apply for residency program accreditation after January 1, 1963. Some of the applicants were surveyed before the end of July 1964. Each of those programs had graduated at least one resident. The original 32 ASHP accredited residency program hospitals comprised an Army medical center in Texas, 4 U.S. Public Health Service (PHS) hospitals, 9 Veterans Affairs (VA) hospitals, 12 university medical centers, and 6 community teaching hospitals (appendix). The 4 PHS hospitals and 2 of the community hospitals are now closed, with no identifiable successor institutions. The first applicant for accreditation to receive an onsite survey was Jefferson Medical College Hospital in Philadelphia. The official date of ASHP accreditation was the date that the application for accreditation was accepted (as is still the policy today) (Figure 1). To determine which program was the first to be accredited, I contacted each original site to see if

Toby Clark, M.Sc., FASHP, FFIP, is (ret) Director of Hospital Pharmacy and Professor, University of Illinois at Chicago, Chicago, and Lead Surveyor Accreditation Services Division, American Society of Health-System Pharmacists, Bethesda, MD ([email protected]). Based on a presentation at the ASHP National Pharmacy Preceptors Conference, Washington, DC, August 23, 2013. Sincere appreciation is expressed to the many persons on the staff of ASHP who assisted in information compilation, especially Anne Callas, Janet Teeters, and Douglas Scheckelhoff. The assistance of the

1190

Am J Health-Syst Pharm—Vol 71 Jul 15, 2014

it had a copy of its application or an original certificate of accreditation. I also researched ASHP’s accreditation database and archives. I found that the application for accreditation from the VA Hospital in Los Angeles, California, was the first to be accepted (January 21, 1963). It should be noted that the ASHP Board of Directors released simultaneously the names of the first group of accredited residency programs without singling out any program as being “first.” Determining which residency program was the first to be accredited is not as important as the collective vision and pioneering leadership of those who stepped forward to become accredited. More than 50 residency program applications were initially rejected and did not qualify for a site visit (Oddis JA, personal communication, 2013 Jul 7). Further, 4 programs were denied accreditation as a result of a site review. The quality bar was set high from the beginning. Initially, ASHP had one accreditation standard for the residency training program1 and a separate minimum standard for the pharmacy service,2

library staff at the South Carolina College of Pharmacy/Medical University of South Carolina Campus, including Robert Poyer, M.S.L.S., is gratefully recognized. The author has declared no potential conflicts of interest. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0702-1190$06.00. DOI 10.2146/ajhp140112

50 YEARS OF PHARMACY RESIDENCY ACCREDITATION  Advancement in pharmacy

and both standards were used to assess if a hospital pharmacy residency would be accredited for a three-year period. At the end of three years, the site was completely resurveyed. Developments in the 1960s Hospital pharmacy in the 1960s focused largely on manufacturing and dispensing. Very few hospital pharmacies prepared unit doses; most dispensed medications to nursing units in floor-stock bottles or in patient-specific bottles with a multiple-day supply. Nurses prepared injections and intravenous admixtures on an open counter. All records and patient charts were handwritten. A few hospital pharmacy directors were beginning to deploy qualified pharmacists as drug information consultants to physicians. For example, the pharmaceutical service project at the University of California, San Francisco, began in September 1966.3 Pharmacist salaries were in the vicinity of $6500 per year. I can add from personal experience that some hospital pharmacy residents were paid $3993.60 per year. The role of Catholic Sisters. Few groups in the United States have been more consistently engaged in the development of hospitals, hospital pharmacy practice, and accredited pharmacy residency training than Catholic Sisters.4 A wonderful example of this is Sister Mary Louise Degenhart, who has served as a pharmacy director, assistant director of ASHP Accreditation Services, and a very influential lead surveyor of residency and technician training programs. Many Catholic Sisters, including Sister Mary Gonzales Duffy (a past president of ASHP) (Figure 2), provided direction and focus to accredited residency programs over the past 50 years. Effects of federal and state laws. The creation of Medicare in 1965 brought about profound changes in health care. This federal legislation put pressure on hospital administra-

tors to have competent pharmacy service operations. North Carolina was among the states that changed state board of pharmacy rules to ensure that qualified pharmacists practiced in hospitals.5 Partly in response to this law, pharmacy residencies were established at North Carolina Memorial Hospital, Duke University Hospital, Watts Hospital, and Moses H. Cone Memorial Hospital. In 1968, Congress extended the Health Manpower Act to include grants to colleges of pharmacy. Known as capitation grants, this funding was linked to an increase in education in clinical pharmacy, druguse and abuse concepts, and clinical pharmacology.5 This stimulated a change in the focus of pharmacy education, which had a direct effect on the future focus of postgraduate residency training.

Second special conference. In 1966, the Society conducted the Second Special Conference on Hospital Residency Training in Columbus, Ohio.6 The registration fee was $20, with $14 per night for a hotel room. By this time, the number of residency programs had dipped to 28, and no surveys were being scheduled. Paul Parker reported that many wanted to offer a hospital pharmacy residency but not all were qualified to do so.6 Developments in the 1970s The late 1960s and early 1970s saw a resurgence of pharmacy residency accreditation activity with more definition and specificity. The ASHP Statement on Accreditation of Pharmacy Residencies in Hospitals and the ASHP Accreditation Standard for Pharmacy Residency were revised and officially approved in April 1970.7

Figure 1. The certificate of accreditation for a pharmacy residency issued to Bronson Methodist Hospital, Kalamazoo, Michigan (March 7, 1963), was among the first issued by ASHP. Bronson has been accredited continuously since the start of the accreditation program in 1963. Courtesy of the author.

Am J Health-Syst Pharm—Vol 71 Jul 15, 2014

1191

50 YEARS OF PHARMACY RESIDENCY ACCREDITATION  Advancement in pharmacy

The changes, which were similar to those proposed by Parker in 1966, included a requirement for “clinical services in patient care areas.”7 At the third ASHP conference on residency training and accreditation, Vincent E. Bouchard, director of pharmacy at the University of Michigan Medical Center, opened the program by commenting on the spirit of the preceding conferences: excitement in 1962 and frustration about an outdated accreditation standard in 1966. He expressed the hope that the 1973 conference would be infused with a sense of accomplishment.8 In 1973, ASHP extended the cycle of accreditation from three years to six years. Also that year, because of undue preceptor tactics in selecting residents, a match system came under consideration. By 1976, 84 programs were accredited. In 1977, ASHP started charging fees for accreditation.9 Previously,

the cost of the accreditation program was borne by ASHP. The ASHP Commission on Credentialing was created as a body reporting directly to the ASHP Board of Directors. This new relationship caused actions to occur much more rapidly. Paul Parker, in a 1957 article, described the need for pharmacists to assume roles far different from traditional dispensing.10 His vision was pharmacist participation with physicians in therapeutic decisionmaking. Further, he suggested a level of knowledge and practice skills that required special education and experiential preparation. The special experiential preparation he referred to is that of residency training involving preceptors. In 1973, the American Pharmaceutical Association—now the American Pharmacists Association (APhA)—appointed a task force

Photo courtesy of ASHP Archives.

Figure 2. Sister Mary Gonzales Duffy, RSM (1909–85), a past president of ASHP (1979– 80), served as director of pharmacy at Mercy Hospital in Pittsburgh and led one of the first accredited pharmacy residency programs.

1192

Am J Health-Syst Pharm—Vol 71 Jul 15, 2014

on specialties in pharmacy to study these emerging changes, such as the nondispensing roles of pharmacists.11 The report of the Study Commission on Pharmacy (also known as the Millis Commission) in 1975 prognosticated the need for credentialing specialties in pharmacy. 12 APhA created the Board of Pharmaceutical Specialties (now the Board of Pharmacy Specialties) in January 1976. This helped set the stage for postgraduate residency training in specialized areas of practice (Ellis WE, Board of Pharmaceutical Specialties, personal communication, 2013 Jul 9). Developments in the 1980s An important and controversial development occurred in 1980 when the accreditation standard for hospital pharmacy residencies was divided into separate standards for hospital pharmacy residencies13 and clinical pharmacy residencies.14 This was controversial because it defined a primary nondispensing role for pharmacists that included clinical services. The clinical standard was revised in 1988 to include educational goals related to “advancing knowledge and skills in application of drugs and drug therapy plus professional clinical practice patterns and habits and a level of accountability far exceeding clinical clerkships.”15 In the early 1980s, the first accreditation standard for a specialty residency was established in psychiatry. So now three types of accredited residency training were in place—hospital pharmacy, clinical pharmacy, and specialty pharmacy. Community pharmacy residencies were proposed in the 1980s,16 and regional resident and preceptor conferences became well established in this decade.17 In August 1988, the 200th residency program was accredited. Of the 200 programs, 124 were in hospital pharmacy practice, 39 in clinical

50 YEARS OF PHARMACY RESIDENCY ACCREDITATION  Advancement in pharmacy

pharmacy, and 37 in specialties like psychiatry and hospital pharmacy administration.18 The 25th anniversary of ASHP residency accreditation was celebrated in Washington, DC, at the Willard Hotel in 1987, and a “town hall” open hearing meeting was held at the Dallas ASHP Midyear Clinical Meeting in 1988. The purpose of the town hall was to encourage feedback from preceptors to Commission members. The March 1989 National Residency Preceptors Conference was structured to focus on the future of residency training.9 It is worth noting that at the conference, Paul Parker19 discussed the concept of all hospital pharmacists having postgraduate residency training. He called for colleges of pharmacy to encourage students to obtain residencies and for teaching hospitals to train a larger number of pharmacy residents consistent with their commitment to training medical residents. ASHP partnerships with other pharmacy organizations to expand support for residency training grew in the late 1980s and early 1990s. Among those efforts was a meeting of the ASHP Commission on Credentialing with representatives of the American Association of Colleges of Pharmacy to discuss residency training as a requirement for pharmacy practice faculty members.20 In an editorial about the 1989 preceptors conference, Zellmer21 wrote that “accreditation of postgraduate training for pharmacy practice has been a powerful lever in elevating the profession. With proper planning, the effectiveness of this tool can be enhanced even further.” He went on to advocate that goals should be established for residency training, such as doubling or tripling the proportion of pharmacy graduates who enter accredited residencies. Developments in the 1990s and 2000s In the 1990s, the numbers of

matched residents continued to escalate as did the number of unmatched applicants. Highlights of the biennial National Residency Preceptors Conferences included 2002 Commission on Credentialing Chair Harold Kornfuher’s discussion of concerns related to the number of residency positions exceeding the number of residency applicants. 22 Daniel Ashby of Johns Hopkins University told the audience to minimize handholding and give residents major responsibilities and opportunities to work on their own and develop thoughtfulness, creativity, and accountability. 22 Noting that health-system pharmacists and their residents were working more at the bedside, Sherri Ramsey from the University of Tennessee and Lisa Lifshin from the ASHP staff hammered home the need for more preceptor development.22 As the number of residents increased, so did the need for more and better preceptors. A postgraduate year 2 resident was added to the Commission on Credentialing to give a resident’s point of view.23 In 2008, then ASHP staff member David Warner and past Commission on Credentialing chair Alison Apple lectured on the value of effective learning experience descriptions.24 There was growing concern in the 2000s about a widening gap between the growing number of pharmacists seeking residency positions and the more limited number of positions available. All the national pharmacy associations that had an interest in residency training made plans to expand the number of positions for residents.25 Notable leaders in the residency movement The first 50 years of pharmacy residency accreditation were blessed with many outstanding leaders of the movement. A few of them are profiled briefly here.

Paul F. Parker. Dr. Parker (1919– 98) was a remarkable leader of hospital pharmacy on multiple fronts, including residency training. (Some of his visionary and progressive comments about residency training have been highlighted in previous sections of this article.) After serving as a naval corpsman in World War II, he completed pharmacy school and a pharmacy residency (then called an “internship”) coupled with a master of science (M.S.) degree in hospital pharmacy at the University of Michigan at the age of 31. By age 37, he was elected president of ASHP. Parker was an early proponent of clinical pharmacy education and practice, including the doctor of pharmacy (Pharm.D.) degree program combined with residency training, pharmacists on rounds, the provision of drug information services, and community pharmacy clinical services, to name a few of his passions. Pharmacy historian Dennis Worthen10 called Parker a “visionary innovator.” In 1962, at age 43, Parker became the chair of the ASHP Committee on Accreditation (later renamed the Commission on Credentialing) and remained a member of that body until 1984. He retired in 1984 from his position as director of pharmacy at the University of Kentucky Hospital. Parker then joined the ASHP Accreditation Services Division as a nonresident staff member to perform accreditation surveys until 1994. His last survey was conducted at the University of Michigan where it all began, both for him and for pharmacy residency training. For more than 30 years, Parker was an influential force for high quality and continuous advancement in residency training and accreditation. Max D. Ray. Through his remarkable and varied career in the profession, Dr. Ray continues to epitomize inspiring philosophical leadership of the residency movement. He earned his bachelor of science, Pharm.D.,

Am J Health-Syst Pharm—Vol 71 Jul 15, 2014

1193

50 YEARS OF PHARMACY RESIDENCY ACCREDITATION  Advancement in pharmacy

and M.S. degrees in the early 1960s and completed the residency program at Methodist Hospital in Memphis, Tennessee, in 1964.26 In the early 1970s, he returned to his native state to serve as chair of pharmacy practice and director of pharmacy at the Medical University of South Carolina (MUSC). At MUSC, he greatly expanded the depth and breadth of a clinical pharmacy services program that became a nationwide model of excellence. Between 1976 and 1985, he served ASHP as director of the clinical services department, director of the Professional Practice Division, and director of the Accreditation Services Division. While at ASHP, he led planning for the 1985 Hilton Head Conference on Directions for Clinical Practice in Pharmacy.27 Later, among other positions, he became dean at Western University College of Pharmacy. A deep thinker and prolific writer and lecturer, Ray continues to help focus change in health-system pharmacy toward clinical practice. Other notable leaders. Many others have been important change agents in pharmacy residency training. They include Warren E. McConnell, William A. Miller, Larry Strom, Harold N. Godwin, Donald E. Letendre, Sara White, Daniel Ashby, Gary Smith, Eric T. Herfindal, Richard A. Hutchinson, and Wayne Conrad. For example, at the University of Illinois Hospital, Hutchinson had more than 20 first- and secondyear residents per year in training during the 1980s. Another example is the combined effort by Wayne Conrad of the University of Cincinnati and Christine Nimmo of the ASHP staff in creating the Residency Learning System.28 ASHP executive leadership. A firm commitment to leadership accountability by ASHP Chief Executive Officers Joseph A. Oddis, Henri R. Manasse Jr., and Paul W. Abramowitz has caused the philosophy behind pharmacy residency ac1194

creditation to be placed into forceful action. Shortly after assuming the Society’s executive leadership post in 1960, Oddis appointed John A. Oliver to be the first paid leader of residency accreditation (1962), shortly followed by the appointment of Warren E. McConnell to this position (Oddis JA, personal communication, 2013 Jul 7). Oddis provided leadership for 38 years in nurturing the growth of postgraduate residency accreditation. In 1997, Henri R. Manasse Jr. became ASHP’s chief executive officer and expanded the Accreditation Services Division staff. In addition, he fostered the expansion of preceptor conferences, launched the Pharmacy Practice Model Initiative, and built consensus in the profession about the need to expand the capacity for residency training.25 Chief Executive Officer Paul W. Abramowitz added to the executive leadership focus in 2013 by establishing the position of ASHP Vice President for Accreditation. Volunteerism. Fifty years of residency accreditation has required 50 years of volunteer commitment. Being selected to serve on the Commission on Credentialing or as a program surveyor is an outstanding professional accomplishment. Volunteerism by countless individuals has been a major contributor to the success of the residency accreditation program. Conclusion AJHP listed 57 residency graduates for the 1963–65 program years.29 By 1988, there had been 5,800 graduates of ASHP accredited residency programs of all types.19 As of June 2013, 34,824 individuals have graduated from ASHP accredited residency programs.30 Over the past 50 years, the number of accredited pharmacy residency programs has grown from 31 to 1,692 (Teeters J, ASHP, personal communication, 2013 Jul 10). These spectacular accomplishments were made possible by the vision and

Am J Health-Syst Pharm—Vol 71 Jul 15, 2014

action of practice leaders. We have much to be proud of during this 50th year of the ASHP residency accreditation program. References 1. News. Am J Hosp Pharm. 1964; 21:510. 2. Jeffrey LP. Report of the Council on Education and Training. Am J Hosp Pharm. 1966; 23:435-6. 3. Day RL, Goyan JE, Herfindal ET, Sorby DL. The origins of the clinical pharmacy program at the University of California, San Francisco. DICP. 1991; 25:308-14. 4. Henderson ML, Wright M. Sister pharmacists and pharmacy practice from the 1700s to the 1970s. Am J Health-Syst Pharm. 2009; 66:e32-42. 5. Cocolas GH. A history of the UNC School of Pharmacy. www.pharmacy.unc.edu/ about-us/history (accessed 2013 Jun 20). 6. Rosenberg AA, Pfau LR. Resume of the Second Special Conference on Hospital Residency Training, October 12–14, 1966. Columbus, OH. 7. McConnell WE. Current status of residency accreditation. Am J Hosp Pharm. 1971; 28:184-6. 8. Proceeding of the ASHP Conference on Pharmacy Residency Training and Accreditation August 26–29, 1973. Am J Hosp Pharm. 1973; 30:1118-27. 9. Letendre DE. Directions for postgraduate pharmacy residency training. Am J Hosp Pharm. 1990; 47:85-91. 10. Worthen DB. Paul Frederick Parker 1919–1998: a visionary innovator. J Am Pharm Assoc. 2009; 49:117-21. 11. Board of Pharmacy Specialties. About BPS. www.bpsweb.org/about/history.cfm (accessed 2013 Jun 26). 12. Study Commission on Pharmacy. Pharmacists for the future. Ann Arbor, MI: Health Administration; 1975. 13. American Society of Hospital Pharmacists. ASHP accreditation standard for residency training in clinical pharmacy. Am J Hosp Pharm. 1980; 37:1223-8. 14. American Society of Hospital Pharmacists. ASHP accreditation standard for specialized residency program. Am J Hosp Pharm. 1980; 37:1229-32. 15. American Society of Hospital Pharmacists. ASHP accreditation standard for residency training in clinical pharmacy practice. Am J Hosp Pharm. 1988; 45:1912-23. 16. APhA taskforce on pharmacy education. Am J Hosp Pharm. 1985; 42:355. 17. Regional Residency Conferences. Am J Hosp Pharm. 1987; 44:1517. 18. News. Am J Hosp Pharm. 1989; 46:1616. 19. Parker PF. Improving postgraduate pharmacy residency training. Am J Hosp Pharm. 1990; 47:88-91. 20. Commission on Credentialing address pharmacy dean on residency programs. ASHP Newsl. 1990; Apr:5. 21. Zellmer WA. Postgraduate training in pharmacy practice. Am J Hosp Pharm. 1990; 47:81-2. Editorial.

50 YEARS OF PHARMACY RESIDENCY ACCREDITATION  Advancement in pharmacy

22. 2002 ASHP National Residency Preceptors Conference celebrates 40 years of programs, emphasizes caring. Am J Health-Syst Pharm. 2003; 60:386-90. 23. Proceedings of the 2006 ASHP National Residency Preceptors Conference. Am J Health-Syst Pharm. 2007; 64:e11-7. 24. Proceedings of the 2008 ASHP National Residency Preceptors Conference. Am J Health-Syst Pharm. 2009; 66:e51-5. 25. American Society of Health-System Pharmacists. Expanding the number of positions for pharmacy residents: highlights from the Pharmacy Residency Capacity Stakeholders’ Conference. Am J Health-Syst Pharm. 2011; 68:1843-9. 26. American Society of Health-System Pharmacists. ASHP awards Max Ray honorary membership. www.ashp.org/menu/ AboutUs/ForPressReleases (accessed 2013 Aug 4). 27. Ray ML. Proceedings of the 1992 Residency Preceptors Conference. Am J Hosp Pharm. 1992; 49:2161-6. 28. ASHP project helps residents learn. ASHP Newsl. 1995; Feb:4. 29. Roster of residents in training in accredited hospital pharmacy residency programs. Am J Hosp Pharm. 1965; 22:198200. 30. National Matching Services. ASHP Resident Matching Program 2013. www.natmatch. com/ashprmp/stats/2013progstats.html (accessed 2013 Jul 13).

Appendix—Original 32 hospitals accredited for pharmacy residency training

U.S. Public Health Service Hospital San Francisco, CA

U.S. Public Health Service Hospital Staten Island, NY

Colorado Veterans Administration Hospital Denver, CO

North Dakota Veterans Administration Hospital Fargo, ND

Illinois University of Chicago Hospitals Chicago, IL

Ohio St. Luke’s Hospital Cleveland, OH

Indiana Veterans Administration Hospital Indianapolis, IN Iowa University Hospital State University of Iowa Iowa City, IA

Grant Hospital Columbus, OH Mount Carmel Hospital Columbus, OH Ohio State University Hospital Columbus, OH

Veterans Administration Hospital Iowa City, IA Maryland U.S. Public Health Service Hospital Baltimore, MD Massachusetts Massachusetts General Hospital—Peter Bent Brigham Hospital (joint program) Boston, MA Michigan University Hospital Ann Arbor, MI

Springfield City Hospital Springfield, OH Pennsylvania Jefferson Medical College Hospital Philadelphia, PA Mercy Hospital Pittsburgh, PA Veterans Administration Hospital Pittsburgh, PA South Carolina Medical College of South Carolina Charleston, SC Texas Brooke Army Medical Center Fort Sam Houston, TX

Bronson Methodist Hospital Kalamazoo, MI

Arkansas University of Arkansas Medical Center Little Rock, AR

Minnesota Veterans Administration Hospital Minneapolis, MN

California Veterans Administration Hospital Los Angeles, CA

New York Albany Medical Center Albany, NY

University of California Hospital San Francisco, CA

Veterans Administration Hospital (joint program) New York, NY

Veterans Administration Hospital Houston, TX Washington U.S. Public Health Service Hospital Seattle, WA Wisconsin University Hospital Madison, WI

Am J Health-Syst Pharm—Vol 71 Jul 15, 2014

1195

Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Celebrating 50 years of advancement in pharmacy residency training.

Celebrating 50 years of advancement in pharmacy residency training. - PDF Download Free
594KB Sizes 5 Downloads 5 Views