Letters Continued from page 994
Remeasuring job satisfaction among pharmacy residents
J
ob satisfaction among pharmacy residents in programs accredited by ASHP was studied in a 1996 survey administered by VanDenBerg and Murphy.1 Overall satisfaction with the programs was reported, with higher satisfaction scores among women compared with men and in participants in specialized residencies compared with nonspecialized residencies. The degree of job satisfaction among current residents is unclear and might be influenced by recent developments affecting postgraduate pharmacy training, including the evolution of training experiences,2-4 new factors motivating pharmacy students to pursue residencies,5 and duty-hour revisions put forth by the Accreditation Council for Graduate Medical Education.6,7 We conducted a survey to identify the current level of satisfaction among pharmacy residents in ASHP-accredited programs relative to results reported by VanDenBerg and Murphy. A 17-item electronic questionnaire was developed using SurveyMonkey (SurveyMonkey, Portland, OR). Survey questions regarding satisfaction were duplicated from those used by VanDenBerg and Murphy. In order to classify satisfaction with their residency experience, the survey asked residents to rate the degree to which they agreed or disagreed with 16 statements on a 5-point Likert scale. Additional survey data collected encompassed the interest of postgraduate year 1 (PGY1) residents in postgraduate year 2 (PGY2) programs, time devoted to the residency program and to additional employment, and on-call requirements. Our electronic survey was sent in March 2013 via e-mail to the program directors of 1585 pharmacy residency programs whose ASHP-accreditation status was classified as precandidate, candidate, or accredited. Program directors were requested to forward this survey to all of their current residents.
We received 726 responses, 704 of which were complete (502 from PGY1 residents, 152 from PGY2 residents, and 50 from residents in combined PGY1– PGY2 programs). The results are summarized in the table. Our respondents’ mean age was 27 years for both PGY1 and PGY2 residents; 69% and 74% of our PGY1 and PGY2 respondents, respectively, were women. Scores for all statements in our survey were nearly identical to those of VanDenBerg and Murphy; scores for selected statements are compared in the table. Satisfaction among respondents has not changed since 1996; residents remain largely content.
We performed a multivariate logistic regression analysis for residents in institutional settings to determine significant predictors of satisfaction. Covariates were included for analysis on the basis of substantive knowledge of the authors and retained if the p value was less than 0.2. A final parsimonious model was selected on the basis of model fit by the likelihood ratio test or the Akaike information criterion if the nested assumption did not hold. All analyses were performed in Stata SE, version 12 (StataCorp LP, College Station, TX). When other variables were held constant, each additional year of residents’ age decreased the odds of satisfaction by 8% (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87–0.97). For example, the odds of a 30-year-old respondent reporting satisfaction was 39%
Comparison of Selected Satisfaction Scores Between Survey of VanDenBerg and Murphy1 and Current Survey Mean ± S.D. Scorea
Survey Statement 1. My residency affords me the opportunity to use my skills and abilities. 2. For the amount of hours I work, I don’t receive the benefits I expect. 7. I often see the results of my work. 8. I get along well with my mentor(s)/ preceptor(s). 9. I feel my mentor(s)/preceptor(s) have a lot to teach me. 10. My mentor(s)/preceptor(s) give me the recognition I deserve. 12. This residency will help me obtain my future goals as a pharmacist. 14. Knowing what I know now, if I had the opportunity to decide again, I would definitely decide to accept the residency. 15. My residency has met my expectations. 16. All things considered, I am satisfied with my pharmacy residency.
VanDenBerg and Murphy Survey Current Survey (n = 704) (n = 413)
4.5 ± 0.8
4.4 ± 0.7
2.7 ± 1.2 3.9 ± 0.7
2.7 ± 1.2 3.8 ± 0.8
4.3 ± 0.7
4.4 ± 0.8
4.2 ± 0.9
4.3 ± 0.8
3.8 ± 0.9
3.8 ± 0.9
4.4 ± 0.7
4.4 ± 0.7
4.1 ± 1.0 3.8 ± 1.0
4.2 ± 0.9 3.9 ± 1.0
4.0 ± 0.9
4.1 ± 0.9
Extent of agreement with statement was indicated with a 5-point Likert scale, with 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree. a
Continued on page 999
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Letters Continued from page 997
lower than for a 24-year-old respondent (OR, 0.61; 95% CI, 0.45–0.84). An oncall component of the residency program (OR, 0.5; 95% CI, 0.3–0.7) and number of hours worked per week (OR, 0.98; 95% CI, 0.96–0.99) were also significant predictors for decreased odds of satisfaction with a residency program. For example, a respondent who worked 80 hours per week had a lower odds of residency satisfaction than a respondent working 60 hours per week (OR, 0.7; 95% CI, 0.5–0.9). Specifying whether the on-call program required remaining on the premises during duty hours did not change the negative effect of on-call duty on satisfaction (OR, 0.6; 95% CI, 0.3–1.2). A residency class of six or more residents and a stated interest in pursuing a PGY2 position were predictors for increased odds of satisfaction. Limitations of our study also pertained to the previous satisfaction survey by VanDenBerg and Murphy.1 The one-year nature of pharmacy residency programs may render typical job satisfaction questions and tools suboptimal for evaluating resident perceptions. The ability to directly compare the two surveys was enhanced by their being administered during the same month of the year, but potential bias remains in generalizing a snapshot of residency satisfaction to the entire program year. We relied on residency program directors to forward our survey to current residents, so we could not accurately calculate a response rate; external validity is consequently limited. No significant changes in overall satisfaction were noted among residents in the two surveys. Among residents in institutional settings, decreased satisfaction in our survey was associated with increasing age, being in a program with an on-call component, and working longer hours. 1. VanDenBerg C, Murphy JE. Satisfaction among residents in ASHP-accredited pharmacy residency programs. Am J Health-Syst Pharm. 1997; 54:1521-7.
2. Ellis JJ, McCreadie 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; 64:2055-63. 3. Fuller P. Program for developing leadership in pharmacy residents. Am J HealthSyst Pharm. 2012; 69:1231-3. 4. Kirdahy K, Turner S, Williams J. Description of an academic teaching rotation for postgraduate year 1 pharmacy residents. Am J Health-Syst Pharm. 2012; 69:228-31. 5. McCarthy BC Jr, Weber L. Update on factors motivating pharmacy students to pursue residency and fellowship training. Am J Health-Syst Pharm. 2013; 70:1397-403. 6. American Society of Health-System Pharmacists. Duty-hour requirements for pharmacy residencies. www.ashp.org/ DocLibrary/Accreditation/RegulationsStandards/Duty-Hours.aspx (accessed 2014 Feb 4). 7. Accreditation Council for Graduate Medical Education. Resident duty hours in the learning and working environment: comparison of 2003 and 2011 standards. www. acgme.org/acgmeweb/Portals/0/PDFs/ dh-ComparisonTable2003v2011.pdf (accessed 2013 Sep 26).
Bryan C. McCarthy Jr., Pharm.D., M.S., BCPS, Interim Director, Ambulatory Care Pharmacy Services and Clinical Coordinator, Quality, Outcomes, and Utilization Department of Pharmacy Services University of Chicago Medicine Chicago, IL [email protected] Kevin McConeghy, Pharm.D., M.S., BCPS, Infectious Diseases Fellow Department of Pharmacy Practice College of Pharmacy University of Illinois at Chicago Chicago, IL Jennifer H. Austin, Pharm.D., BCPS, Postgraduate Year 1 Residency Program Director and Clinical Pharmacist Specialist, Internal Medicine Department of Pharmacy Services University of Chicago Medicine
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140080
Activities of palliative care and pain management clinical pharmacists
A
literature search was performed to describe details of clinical pharmacists’ roles in providing palliative care and pain management to gather information for a newly proposed position at our institution. Due to a lack of published information to adequately define the roles and responsibilities of these pharmacists, a 28-question survey of palliative care and pain management pharmacists was conducted to determine practice sites, roles on interdisciplinary teams, training, academic duties, patient care responsibilities, research activities, and structure of financial compensation. A pharmacist with experience in pain management and palliative care who was not otherwise involved in the project reviewed the survey items for face and content validity. The survey was administered through an online survey platform (SurveyMonkey). Members of U.S. pharmacy organiza-
tions (American Society of Health-System Pharmacists, American Society of Consultant Pharmacists, American College of Clinical Pharmacy, and National Hospice and Palliative Care Organization) were sent an invitation and asked to complete the survey if they were pharmacists who had practiced in pain management or palliative care within the past year; a link to the survey was included in the e-mail message. All survey questions were optional; all responses were included in the survey results, including those from incomplete surveys. Of the 316 invited participants, 109 responded to the survey. The states from which the highest numbers of responses were received were Maryland (n = 9), Ohio (n = 9), Florida (n = 8), and New York (n = 5). Most respondents (96 of 105) provided either pain management or palliative care services, and 37 of 55 stated that they provided both, suggesting that
Am J Health-Syst Pharm—Vol 72 Jun 15, 2015
999
Remeasuring job satisfaction among pharmacy residents
J
ob satisfaction among pharmacy residents in programs accredited by ASHP was studied in a 1996 survey administered by VanDenBerg and Murphy.1 Overall satisfaction with the programs was reported, with higher satisfaction scores among women compared with men and in participants in specialized residencies compared with nonspecialized residencies. The degree of job satisfaction among current residents is unclear and might be influenced by recent developments affecting postgraduate pharmacy training, including the evolution of training experiences,2-4 new factors motivating pharmacy students to pursue residencies,5 and duty-hour revisions put forth by the Accreditation Council for Graduate Medical Education.6,7 We conducted a survey to identify the current level of satisfaction among pharmacy residents in ASHP-accredited programs relative to results reported by VanDenBerg and Murphy. A 17-item electronic questionnaire was developed using SurveyMonkey (SurveyMonkey, Portland, OR). Survey questions regarding satisfaction were duplicated from those used by VanDenBerg and Murphy. In order to classify satisfaction with their residency experience, the survey asked residents to rate the degree to which they agreed or disagreed with 16 statements on a 5-point Likert scale. Additional survey data collected encompassed the interest of postgraduate year 1 (PGY1) residents in postgraduate year 2 (PGY2) programs, time devoted to the residency program and to additional employment, and on-call requirements. Our electronic survey was sent in March 2013 via e-mail to the program directors of 1585 pharmacy residency programs whose ASHP-accreditation status was classified as precandidate, candidate, or accredited. Program directors were requested to forward this survey to all of their current residents.
We received 726 responses, 704 of which were complete (502 from PGY1 residents, 152 from PGY2 residents, and 50 from residents in combined PGY1– PGY2 programs). The results are summarized in the table. Our respondents’ mean age was 27 years for both PGY1 and PGY2 residents; 69% and 74% of our PGY1 and PGY2 respondents, respectively, were women. Scores for all statements in our survey were nearly identical to those of VanDenBerg and Murphy; scores for selected statements are compared in the table. Satisfaction among respondents has not changed since 1996; residents remain largely content.
We performed a multivariate logistic regression analysis for residents in institutional settings to determine significant predictors of satisfaction. Covariates were included for analysis on the basis of substantive knowledge of the authors and retained if the p value was less than 0.2. A final parsimonious model was selected on the basis of model fit by the likelihood ratio test or the Akaike information criterion if the nested assumption did not hold. All analyses were performed in Stata SE, version 12 (StataCorp LP, College Station, TX). When other variables were held constant, each additional year of residents’ age decreased the odds of satisfaction by 8% (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87–0.97). For example, the odds of a 30-year-old respondent reporting satisfaction was 39%
Comparison of Selected Satisfaction Scores Between Survey of VanDenBerg and Murphy1 and Current Survey Mean ± S.D. Scorea
Survey Statement 1. My residency affords me the opportunity to use my skills and abilities. 2. For the amount of hours I work, I don’t receive the benefits I expect. 7. I often see the results of my work. 8. I get along well with my mentor(s)/ preceptor(s). 9. I feel my mentor(s)/preceptor(s) have a lot to teach me. 10. My mentor(s)/preceptor(s) give me the recognition I deserve. 12. This residency will help me obtain my future goals as a pharmacist. 14. Knowing what I know now, if I had the opportunity to decide again, I would definitely decide to accept the residency. 15. My residency has met my expectations. 16. All things considered, I am satisfied with my pharmacy residency.
VanDenBerg and Murphy Survey Current Survey (n = 704) (n = 413)
4.5 ± 0.8
4.4 ± 0.7
2.7 ± 1.2 3.9 ± 0.7
2.7 ± 1.2 3.8 ± 0.8
4.3 ± 0.7
4.4 ± 0.8
4.2 ± 0.9
4.3 ± 0.8
3.8 ± 0.9
3.8 ± 0.9
4.4 ± 0.7
4.4 ± 0.7
4.1 ± 1.0 3.8 ± 1.0
4.2 ± 0.9 3.9 ± 1.0
4.0 ± 0.9
4.1 ± 0.9
Extent of agreement with statement was indicated with a 5-point Likert scale, with 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree. a
Continued on page 999
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Letters Continued from page 997
lower than for a 24-year-old respondent (OR, 0.61; 95% CI, 0.45–0.84). An oncall component of the residency program (OR, 0.5; 95% CI, 0.3–0.7) and number of hours worked per week (OR, 0.98; 95% CI, 0.96–0.99) were also significant predictors for decreased odds of satisfaction with a residency program. For example, a respondent who worked 80 hours per week had a lower odds of residency satisfaction than a respondent working 60 hours per week (OR, 0.7; 95% CI, 0.5–0.9). Specifying whether the on-call program required remaining on the premises during duty hours did not change the negative effect of on-call duty on satisfaction (OR, 0.6; 95% CI, 0.3–1.2). A residency class of six or more residents and a stated interest in pursuing a PGY2 position were predictors for increased odds of satisfaction. Limitations of our study also pertained to the previous satisfaction survey by VanDenBerg and Murphy.1 The one-year nature of pharmacy residency programs may render typical job satisfaction questions and tools suboptimal for evaluating resident perceptions. The ability to directly compare the two surveys was enhanced by their being administered during the same month of the year, but potential bias remains in generalizing a snapshot of residency satisfaction to the entire program year. We relied on residency program directors to forward our survey to current residents, so we could not accurately calculate a response rate; external validity is consequently limited. No significant changes in overall satisfaction were noted among residents in the two surveys. Among residents in institutional settings, decreased satisfaction in our survey was associated with increasing age, being in a program with an on-call component, and working longer hours. 1. VanDenBerg C, Murphy JE. Satisfaction among residents in ASHP-accredited pharmacy residency programs. Am J Health-Syst Pharm. 1997; 54:1521-7.
2. Ellis JJ, McCreadie 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; 64:2055-63. 3. Fuller P. Program for developing leadership in pharmacy residents. Am J HealthSyst Pharm. 2012; 69:1231-3. 4. Kirdahy K, Turner S, Williams J. Description of an academic teaching rotation for postgraduate year 1 pharmacy residents. Am J Health-Syst Pharm. 2012; 69:228-31. 5. McCarthy BC Jr, Weber L. Update on factors motivating pharmacy students to pursue residency and fellowship training. Am J Health-Syst Pharm. 2013; 70:1397-403. 6. American Society of Health-System Pharmacists. Duty-hour requirements for pharmacy residencies. www.ashp.org/ DocLibrary/Accreditation/RegulationsStandards/Duty-Hours.aspx (accessed 2014 Feb 4). 7. Accreditation Council for Graduate Medical Education. Resident duty hours in the learning and working environment: comparison of 2003 and 2011 standards. www. acgme.org/acgmeweb/Portals/0/PDFs/ dh-ComparisonTable2003v2011.pdf (accessed 2013 Sep 26).
Bryan C. McCarthy Jr., Pharm.D., M.S., BCPS, Interim Director, Ambulatory Care Pharmacy Services and Clinical Coordinator, Quality, Outcomes, and Utilization Department of Pharmacy Services University of Chicago Medicine Chicago, IL [email protected] Kevin McConeghy, Pharm.D., M.S., BCPS, Infectious Diseases Fellow Department of Pharmacy Practice College of Pharmacy University of Illinois at Chicago Chicago, IL Jennifer H. Austin, Pharm.D., BCPS, Postgraduate Year 1 Residency Program Director and Clinical Pharmacist Specialist, Internal Medicine Department of Pharmacy Services University of Chicago Medicine
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140080
Activities of palliative care and pain management clinical pharmacists
A
literature search was performed to describe details of clinical pharmacists’ roles in providing palliative care and pain management to gather information for a newly proposed position at our institution. Due to a lack of published information to adequately define the roles and responsibilities of these pharmacists, a 28-question survey of palliative care and pain management pharmacists was conducted to determine practice sites, roles on interdisciplinary teams, training, academic duties, patient care responsibilities, research activities, and structure of financial compensation. A pharmacist with experience in pain management and palliative care who was not otherwise involved in the project reviewed the survey items for face and content validity. The survey was administered through an online survey platform (SurveyMonkey). Members of U.S. pharmacy organiza-
tions (American Society of Health-System Pharmacists, American Society of Consultant Pharmacists, American College of Clinical Pharmacy, and National Hospice and Palliative Care Organization) were sent an invitation and asked to complete the survey if they were pharmacists who had practiced in pain management or palliative care within the past year; a link to the survey was included in the e-mail message. All survey questions were optional; all responses were included in the survey results, including those from incomplete surveys. Of the 316 invited participants, 109 responded to the survey. The states from which the highest numbers of responses were received were Maryland (n = 9), Ohio (n = 9), Florida (n = 8), and New York (n = 5). Most respondents (96 of 105) provided either pain management or palliative care services, and 37 of 55 stated that they provided both, suggesting that
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