Teaching and learning curriculum programs: recommendations for postgraduate pharmacy experiences in education.

SPECIAL FEATURE Postgraduate pharmacy

SPECIAL FEATURE

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Teaching and learning curriculum programs: Recommendations for postgraduate pharmacy experiences in education Eric A. Wright, Bonnie Brown, Jacob Gettig, Jay L. Martello, Katie S. McClendon, Kelly M. Smith, Janet Teeters, Timothy R. Ulbrich, Nicole Wegrzyn, and Lynette R. Bradley-Baker Supplementary material is available with the full text of this article at www.ajhp.org.

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ostgraduate pharmacy education opportunities include pharmacy residency and fellowship programs facilitated by health care institutions, pharmacies, health plans, industry, and academic centers. Standards for residency programs are provided by the American Society of Health-System Pharmacists (ASHP) along with partner organizations. These standards provide a framework for program design, including required and elective learning goals, outcomes, and objectives pertaining to specified areas of postgraduate training, which include those related to teaching and learning.1 Although not explicitly stated within the guide-

Purpose. Recommendations for the development and support of teaching and learning curriculum (TLC) experiences within postgraduate pharmacy training programs are discussed. Summary. Recent attention has turned toward meeting teaching- and learningrelated educational outcomes through a programmatic process during the first or second year of postgraduate education. These programs are usually coordinated by schools and colleges of pharmacy and often referred to as “teaching certificate programs,” though no national standards or regulation of these programs currently exists. In an effort to describe the landscape of these programs and to develop a framework for their basic design and content, the American Association of Colleges of Pharmacy Pharmacy Practice Section’s Task Force on Student Engagement and Involvement, with input from the American Society of Health-System Pharmacists, reviewed evidence from the literature and

Eric A. Wright, Pharm.D., BCPS, is Associate Professor, Nesbitt College of Pharmacy and Nursing, Wilkes University, Wilkes-Barre, PA. Bonnie Brown, Pharm.D., is Assistant Dean of Student Affairs, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN. Jacob Gettig, Pharm.D., M.P.H., BCPS, is Assistant Dean for Postgraduate Education and Associate Professor, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL. Jay L. Martello, Pharm.D., BCPS, is Clinical Assistant Professor, School of Pharmacy, West Virginia University Morgantown. Katie S. McClendon, Pharm.D., BCPS, is Clinical Assistant Professor, School of Pharmacy, University of Mississippi, Jackson. Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP, is Associate Dean, Academic and Student Affairs, and Associate Professor, Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington. Janet Teeters, M.S., is Director, Accreditation Services, American

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conference proceedings and considered author experience and expertise over a two-year period. The members of the task force created and reached consensus on a policy statement and 12 recommendations to guide the development of best practices of TLC programs. The recommendations address topics such as the value of TLC programs, program content, teaching and learning experiences, feedback for participants, the development of a teaching portfolio, the provision of adequate resources for TLC programs, programmatic assessment and improvement, program transparency, and accreditation. Conclusion. TLC programs provide postgraduate participants with valuable knowledge and skills in teaching applicable to the practitioner and academician. Postgraduate programs should be transparent to candidates and seek to ensure the best experiences for participants through systematic program implementation and assessments. Am J Health-Syst Pharm. 2014; 71:1292-302

Society of Health-System Pharmacists, Bethesda, MD. Timothy R. Ulbrich, Pharm.D., is Director, Pharmacy Resident Education, and Assistant Professor of Pharmacy Practice, College of Pharmacy, Northeast Ohio Medical University, Rootstown. Nicole Wegrzyn, Pharm.D., is Assistant Professor, School of Pharmacy, Pacific University Hillsboro, OR. Lynette R. Bradley-Baker, B.S.Pharm., Ph.D., is Director, Professional Alliance Development, American Association of Colleges of Pharmacy, Alexandria, VA. Address correspondence to Dr. Wright ([email protected]). Dr. Smith is a member of the ASHP Board of Directors. The authors have declared no other potential conflicts of interest. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0801-1292$06.00. DOI 10.2146/ajhp130657


lines for fellowships produced by the American College of Clinical Pharmacy (ACCP),2 postgraduate fellowships often contain objectives related to teaching and learning. Recent attention has turned toward meeting teaching- and learningrelated educational outcomes through a programmatic process during the first or second year of postgraduate education. These programs are usually coordinated by schools and colleges of pharmacy and are often referred to as “teaching certificate programs,” though no national standards or regulation of these programs currently exists. In an effort to describe the landscape of these programs and to develop a framework for their basic design and content, the American Association of Colleges of Pharmacy (AACP) Pharmacy Practice Section’s Task Force on Student Engagement and Involvement, with input from ASHP, reviewed evidence from the literature and conference proceedings and considered author experience and expertise over a two-year period. This report describes the results of these efforts, which contributed to the development of the following policy statement presented to the AACP Pharmacy Practice Section and adopted by the AACP House of Delegates at the 2013 AACP Annual Meeting in Chicago: AACP encourages the inclusion of Teaching and Learning Curriculum (TLC) Programs, which meet national guidelines, in post-graduate pharmacy training programs including residencies and fellowships and encourages schools and colleges of pharmacy to provide such programs.

Along with conceiving this position statement for the academy, the members of the task force created and reached consensus on an additional 12 recommendations to guide the development of best practices of TLC programs (Box). In addition to this

work, ACCP has published guidelines for resident teaching experiences.3 Our efforts, along with those of ACCP, provide complementary guidance and references for individuals and institutions interested in the conduct and composition of TLC programs. Program terminology Recommendation 1: Systematic experiences in teaching and learning should collectively be termed Teaching and Learning Curriculum (TLC) programs. A teaching certificate program is often described as a one-year longitudinal or concentrated experience in education that is typically conducted within the first or second year of postgraduate training. The use of the term certificate infers recognition by a body (namely the issuing institution) of completion and the acquisition of a minimum-acceptable level of knowledge and skills. The Council on Credentialing in Pharmacy (CCP) defines a certificate program as A structured, systematic, postgraduate education and continuingeducation experience for pharmacists that is generally smaller in magnitude and shorter in duration than a degree program or residency training program. Certificate programs are designed to instill, expand, or enhance practice competencies through the systematic acquisition of specific knowledge, skills, attitudes, and performance behaviors.4

Certification is described by CCP as a voluntary process by which a nongovernmental agency or an association grants recognition to an individual who has met certain predetermined qualifications specified by that organization.4 Thus, certification is a formal recognition granted to designate to the public that an individual has attained the requisite level of knowledge, skill, and experience in a well-defined, often specialized, area

of the total discipline. Certification generally requires initial assessment and periodic reassessments of the individual’s knowledge, skills, or experience.

Recommendations to guide best practices for teaching and learning curriculum programs 1. Systematic experiences in teaching and learning should collectively be termed Teaching and Learning Curriculum (TLC) programs. 2. TLC programs should be facilitated through a school/college of pharmacy or other postsecondary institution. 3. TLC program content should include a discussion of specified core topics at a minimum. 4. TLC program content should be delivered using different teaching styles. 5. TLC program content should be delivered commensurate with the learning level of the participants. 6. Participants in a TLC program should be expected to gain experience in a variety of educational modalities. 7. Participants in a TLC program should be evaluated at regular intervals. 8. Participants should develop and maintain a teaching portfolio. 9. TLC programs should have adequate personnel and institutional resources. 10. TLC programs should incorporate a system of assessment to enhance ongoing programmatic improvement. 11. TLC program offerings, features, and participant obligations should be clearly described in all recruitment materials. 12. A formal external validation process for TLC programs should be established.


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Teaching certificate programs should meet CCP criteria to be designated a certificate program. However, the development of a teaching curriculum need not be dependent on a certificate designation, as many teaching certificate programs forgo some of the components of a certificate designation yet offer valuable and credible teaching and learning experiences for participants. To avoid confusion with terminology regarding certificate programs and certification as defined by CCP, program sponsors should refer to their teaching skill development programs for postgraduate trainees as TLC programs. History of TLC programs TLC prog r ams are offered throughout the country and are mainly directed by schools of pharmacy, with documentation of the first formal pharmacy program in 1998.5 That first TLC program at the University of Kentucky has since expanded its enrollment to trainees across the country through the use of asynchronous technology.6 Other published examples of TLC programs include the University of Arizona College of Pharmacy’s Clinical Pharmacy Scholars Teaching Certificate Program, the University of Florida College of Pharmacy, and the Indiana Pharmacy Teaching Certificate, which includes instructors from Purdue University, Butler University, and the University of Illinois at Chicago.7-9 Each program includes a seminar series, classroom teaching, and preceptorship opportunities, though requirements differ among programs. The University of Oklahoma College of Pharmacy offers a separate TLC program for postgraduate year 2 (PGY2) residents, which is an expansion of their postgraduate year 1 (PGY1) TLC program, and requires residents to further develop skills learned in the previous year.10 Additional methods to introduce teaching and learning to residents have been created. These 1294

formats include a seminar series, a practice-based learning experience, and academic teaching rotations.11-13 A 2006 survey of recent pharmacy residents found that 30% of residents had some form of formal training in teaching and learning during their residency. Among the residents who later accepted a faculty position, 46% had completed formal training during the residency.14 In 2008, residency program directors reported that formal TLC programs were available through 180 residency programs (49% of those responding).15 Among the 99 institutions affiliated with a school of pharmacy who responded to a 2010 survey, 26 programs with academic rotations and 39 programs with longitudinal learning experiences in academia also offered a TLC program.16 Another 2010 survey of PGY1 program directors found that 27% of respondents (312 programs) offered a TLC program.17 The actual prevalence of TLC programs is unknown, since response rates to these surveys ranged from 11% to 64%. TLC programs and higher education Recommendation 2: TLC programs should be facilitated through a school/ college of pharmacy or other postsecondary institution. Academics and academic institutions currently facilitate the majority of TLC programs in the United States. Although programs outside of academia may exist, it is the recommendation of this task force that all pharmacy residency programs and other training programs offer teaching programs in conjunction with an Accreditation Council for Pharmacy Education accredited school of pharmacy or other postsecondary institution. Furthermore, we recommend that schools of pharmacy take an active role in developing and providing TLC programs and reach out to residency and fellowship programs for these types of partnerships as part of their operating mission.


Schools of pharmacy and other postsecondary institutions are well equipped to offer TLC programs. These institutions employ faculty with teaching and academic insight and experience, provide facilities and curriculum to afford structured classroom teaching opportunities, allow for the use of meeting space and other technologies such as videoconferencing that may not be available at program sites, and house unique faculty development resources and opportunities. These human and physical resources are not commonly available in most patient care institutions that host pharmacy residency programs, yet such resources are important for the conduct of a well-designed TLC program. In addition, postsecondary institutions may provide valuable expertise for TLC programs. One TLC program is offered jointly with a school of pharmacy and a school of education and human development.18 The school of education and human development is able to provide expertise during pedagogy seminars. Postgraduate programs interested in collaborating with TLC programs should be encouraged to reach out to local or distant schools of pharmacy or postsecondary institutions. In approaching a school of pharmacy, the postgraduate program may want to introduce a mutually beneficial exchange, such as introducing or expanding introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs) at practice sites, for resident participation within a TLC program. Value of TLC programs Postgraduate programs. In the current competitive environment for pharmacy residencies and fellowships, the development and availability of a TLC program as part of a training program afford a marketing advantage over programs without such a program. In addition, TLC


programs make for a directed, packaged method to satisfy applicable residency accreditation goals and objectives.1 Schools of pharmacy. For academic institutions, TLC programs contribute to the teaching mission of the institution, provide a source of potential scholarship, and serve as a method to collaborate with external residency and fellowship programs. In addition, by sponsoring a TLC program, a school of pharmacy becomes a central hub for area programs, which exposes residents to the school, allows program participants to assist with instruction, and helps to develop meaningful mentoring relationships for trainees with faculty and staff. TLC program development and support are investments in potential future faculty and preceptors as the school trains residents to be educators. Residents and participants. Many candidates seeking residencies or other postgraduate education inquire about the presence of a TLC program; some candidates may focus their search on residencies with TLC programs, citing the lack of one as a reason not to apply to a program. Participants in TLC programs learn how and are provided opportunities to teach using a structured, formalized process. In addition, a TLC program offers a locale where participants from various programs can meet and develop collegial relationships. Participants are also likely to develop relationships with faculty members and staff who deliver the TLC program and with students they ultimately teach. The listing of the completion of a TLC program on a participant’s curriculum vitae may offer a competitive advantage for applicants seeking faculty positions. One of the most important professional uses of a TLC program is to serve as training for future preceptors of pharmacy and other health professional students. While some TLC program participants will pursue a

career in academia, virtually all will serve as a preceptor to pharmacy students at some point in their careers. Finally, and perhaps most importantly, TLC program participants will develop essential educational skills transferrable to various aspects of their professional lives. This includes interactions with patients, health care providers, and students as well as presentations given at their place of employment or professional organization meetings. TLC program faculty. Faculty who teach in or coordinate the TLC program have the opportunity to mentor participants and thereby add a dimension to their teaching beyond pharmacy students. Faculty may use their work in a TLC program as additional teaching or service experiences to include in their annual reviews and eventually in their promotion or tenure dossier. Participation in TLC programs may also expose faculty to scholarly projects with other faculty who teach in the TLC program or with the residents or fellows they instruct. Students. Pharmacy students benefit from their interaction with residents and fellows by having the opportunity to be exposed to postgraduate training. If students have a positive interaction with residents and fellows as teachers, they may be more inclined to pursue postgraduate training after graduation. Also, resident and fellow educators provide unique insights into the profession and often add a youthful exuberance to educational offerings. With proper guidance and oversight, these contributions to the student learning experience are invaluable. TLC program content Recommendation 3: TLC program content should include a discussion of specified core topics at a minimum. As education is constantly evolving, TLC program participants should be exposed to a wide variety

of topics. For topics that may not be encountered in all teaching environments or those that are unique to a specific TLC program, it is recommended that the TLC program provide background information on the subject, particularly if it is unique or the focus of the particular program. An example of this would be simulation. We recognize that not all programs will be able to provide simulation experiences; however, participants in a TLC program should be exposed to what simulation entails so that they have the baseline knowledge to practice it if they are at an institution that uses simulation-based learning. After extensive compilation of content categories, this task force recognizes the need for all TLC programs to include core content areas. Collectively, these yield a breadth of important concepts about which graduates of TLC programs should have a foundational understanding. Additional content, based on the institution’s preference, may also be provided. A complete listing of these core areas and the corresponding level of learning expected for each are provided in Figure 1. Core topics listed within this document were discussed and developed by consensus from a list of larger topics compiled from the literature and task force members’ selection. Recommendation 4: TLC program content should be delivered using different teaching styles. Providing content in different manners (such as lecturing versus problem-based learning) allows participants with different visual, aural, reading and writing, and kinesthetic learning styles to learn the way that is best for them. Several sources suggest that this amplifies the educational experience to provide education via a familiar or comfortable learning environment, while others have argued the opposite—that academic challenge from an unfamiliar or uncomfortable learning environ-


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ment enhances learners’ abilities and retention. 19-22 Thus, it makes sense that, when training potential teachers, different methods and styles of teaching are utilized. In addition, by using multiple styles to deliver content, the faculty member is modeling the various techniques the participant may use in his or her own teaching. For example, for the topic of composing multiple-choice questions, the participants may be charged to create their own questions and analyze them as a group. This allows participants to “do” (kinesthetic and reading and writing) as well as “listen” (aural) and “see” (visual), tailoring the activity to each learner’s unique style. Another example is to have two different faculty members give a 10-minute presentation to a group, one designed to be a “good”

lecture and the other to be a “bad” lecture. Following each, the participants should discuss the components of the lectures that made them good or bad to emphasize the key components of how to deliver an effective lecture. Recommendation 5: TLC program content should be delivered commensurate with the learning level of the participants. In TLC programs that are available to participants of differing knowledge levels, the program should assess the participants’ level of experience in teaching and provide tailored instruction to them based on their previous exposure to teaching concepts. In general, those with more experience in teaching (such as PGY2 residents who completed a TLC program during

their PGY1 residency) should be provided with level-appropriate training. We recognize that this can be logistically difficult; however, to create effective and well-trained teachers, TLC programs should provide the most relevant, challenging experiences possible, tailored to participants’ teaching needs. Proficiency in a number of general teaching methods is fundamental for succeeding in any type of teaching position, including both classroom and experiential teaching. Aspiring teachers must learn a multitude of skills to succeed in education, including developing learning objectives, facilitating small and large groups, and evaluating student achievement, writing examination questions, and using other core teaching concepts.

Figure 1. Core content recommended for teaching and learning curricula. The pyramid contains all core content areas to be provided throughout the curricula via focused instruction. Higher-level activities should incorporate instruction classified at lower levels of the pyramid. For example, large-group facilitation (practice based) should include ample instruction in knowledge (knowledge based) and in application of that knowledge (application based). Experiences acquired throughout the TLC program should be compiled within the teaching portfolio and incorporated into the teaching philosophy statement (left side of pyramid). IPPEs = introductory pharmacy practice experiences, APPEs = advanced pharmacy practice experiences, ACPE = American Council for Pharmacy Education, AACP = American Association of Colleges of Pharmacy, CAPE = Center for the Advancement of Pharmacy Education.

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TLC program experiences Recommendation 6: Participants in a TLC program should be expected to gain experience in a variety of educational modalities. In addition to developing knowledge from content sessions, participants in a TLC program should have various experiences that allow for practicing learned skills, receiving feedback, and partaking in selfreflection (Figure 1). The majority of TLC programs described in the literature5-9 include the following core experiences: • Participation in educational seminars (as noted in the previous section), • Participation in teaching assignments, including large-group, small-group, and experiential teaching, and • Development of a teaching portfolio that provides evidence of the participant’s philosophy of teaching, teaching experiences, self-reflection, and other components listed below.

Other TLC program experiences may include, but are not limited to, the following: attendance at faculty meetings, participation in oncampus committees, teaching observation, and on-campus student assessments (e.g., journal club, patient counseling). As participants navigate through teaching and learning seminars, they should have a chance to apply the skills learned throughout the year. It is not enough for a participant in a TLC program to read or be instructed on teaching without practice. All TLC programs should offer practical experiences for participants to teach in a variety of settings, including didactic, small group, and experiential. The types of instruction (e.g., online versus live, traditional lecture versus team-based learning) the participant is able to experience will vary from institution to institution depending on the specific institution’s resources and faculty areas of expertise.

While many TLC programs focus on classroom learning (both large and small groups), participants will likely enter positions that require more experiential teaching. Therefore, programs should include instructional technique as it relates to experiential learning as well as require participants to partake in instructing a certain amount of experiential learning. Ideally, experiences serving as a preceptor for IPPE or APPE students should be offered. In addition, practice locales often provide ample opportunities to educate other health care providers in formal and informal settings. Participants in TLC programs should also be encouraged to contribute to the education of other health care professionals through interactive rounds, team meetings, or other venues. TLC performance feedback for participants Recommendation 7: Participants in a TLC program should be evaluated at regular intervals. It is important that TLC program participants receive feedback throughout their continuum of learning and have regular opportunities for practice. While there may be several methods to accomplish this, one approach is to assign each participant at least one faculty mentor. The mentor could be responsible for guiding the participant and providing regular feedback on teaching experiences and portfolio development. The participant should receive detailed feedback (peer and student) for both classroom and experiential teaching. When partnering with a school of pharmacy, there likely is an opportunity to use established evaluation forms and processes. Teaching for the first time can be intimidating; therefore, providing the participant a chance to practice and observe other teaching is important. Both formative and summative feedback should be provided for experiences and should be documented for partici-

pants in program-specific locations (e.g., ResiTrak). It is expected that TLC program participants contributing to the education of students also receive student feedback in the formalized method used for other course instructors. Student feedback is an important component of reflective educational development. Hence, participants should be given the opportunity to receive and reflect on the feedback received from students. After receiving feedback, the TLC program participant should identify and work with a mentor to assist in the interpretation of and response to student evaluations. Mentors can provide valuable insight into the evaluation, including suggesting changes to the teaching delivery and using feedback to improve teaching performance. For example, evaluations that suggest poor grading should prompt a discussion and root-cause analysis by both the TLC program participant and the mentor. When applicable, participants should be encouraged to incorporate common themes and personal thoughts about student feedback into their reflections. Mentors should assist in fostering connections among the evaluation, reflection, and teaching philosophy. TLC program participants should have periodic classroom and experiential peer evaluations of teaching performance. These could be either formal or informal in nature. In addition, though many of the teaching experiences are directed toward student learning, participants also typically deliver other formal presentations (e.g., seminars, inservice education) during the course of their postgraduate training, allowing other audiences to evaluate their performance. When applicable, feedback from learners should be sought and also incorporated into reflections. Specific findings and recommendations from peers are useful before and after a given teaching experience. It is therefore recommended that


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TLC programs provide a structured evaluation of teaching performance. Examples of large-classroom and experiential evaluation forms are provided in eAppendixes A and B (available at www.ajhp.org). TLC portfolio Recommendation 8: Participants should develop and maintain a teaching portfolio. A teaching portfolio is a compilation of documents and exhibits related to teaching. 23 A teaching portfolio is compiled by instructors pursuing promotion at an academic institution to provide documentation of their teaching effectiveness. In the context of a TLC program, a teaching portfolio contains material related to the completion of the program, serves as evidence to be evaluated (e.g., by program, preceptor, or potential employer), and can be an effective tool for self-growth and reflection. Typical components include but are not limited to a teaching philosophy statement, topic discussion handouts and materials, curriculum vitae, peer evaluations, student evaluations, course syllabuses, course handouts and materials, and a collection of scholarly works.24 The completed portfolio should be reviewed by the faculty mentor or coordinator of the TLC program. There should be clearly established criteria for what the portfolio should include so the participant can plan accordingly throughout the year. Portfolios may be paper or electronic in format, and copies should be retained by the teaching program leadership and the program participant. It is recommended that the portfolio be evaluated regularly throughout the experience (e.g., quarterly for yearly programs) by a faculty mentor, advisory group, or coordinator of the TLC program to ensure adequate progress and to avoid any incomplete sections at the end of the year. One of the most structured and important components of the teach1298

ing portfolio is the teaching philosophy statement. A teaching philosophy “is a reflective writing assignment whereby teachers describe, analyze, and justify their teaching methods and consider areas for improvement.”25 It is used within the academic promotional process and increasingly expected of candidates seeking academic appointments. In many TLC programs, a teaching philosophy statement is a required component, and participants are often asked to begin the teaching program and end it with a philosophy statement. The frequency with which a teaching philosophy statement is updated is dependent on the program, but routine reference to and revision of the philosophy should be encouraged. The updating of a teaching philosophy demonstrates to participants the evolution of a statement over time secondary to increased knowledge, experiences, and reflections. The development of a teaching philosophy is useful to gauge a participant’s underlying approach to teaching and can assist in assessing the achievement of learning outcomes. Hence, TLC programs should incorporate this experience into the program itself and provide feedback on the document as participants progress through the program. TLC challenges A number of challenges may hinder training programs and institutions from designing and executing new or improving established TLC programs. A common challenge is how to strike an appropriate balance between available resources and TLC program expectations and desired outcomes. In addition, delineating which institution or individual is responsible for components of the TLC program can prove challenging. The best remedy for minimizing these challenges is to effectively plan TLC programs. Key stakeholders should engage in candid discussions about the vision for the TLC program


and its benefits for the residency or other postgraduate program and the school of pharmacy. Resources that are available from each participating institution and the reporting lines and organizational structure of the TLC program should also be clearly delineated. The development and execution of a TLC program require unwavering support of the administration of all sites involved. Obtaining a signed agreement and transparent expectations from sites before program implementation may help prevent problems later. There are several logistic considerations for new and established programs. Curriculum. A TLC program that is designed to yield the desired outcomes is more likely to be successful than one that is not designed thoughtfully. Linkage to accreditation standards’ outcomes, goals, and objectives should be conducted whenever possible. Members involved in curricular planning should set broad goals for the TLC program before initiation. This will drive the selection and development of content, activities, and learning objectives. Delivery modalities. Methods to ensure participation in topic discussions, classroom presentations, and experiential teaching need to be designed early on. Consideration of the classroom schedules and participant responsibilities makes arranging experiences a complex process that requires much planning. Sessions may be conducted weekly or monthly; other programs have chosen an intensive approach (one- or twoday retreats) to the seminars at the beginning of postgraduate training. Some programs offer both live and recorded seminars; Web offerings may also be appropriate. Teaching opportunities for participants. The types of teaching activities participants will be required to complete should be identified. A sufficient number of experiences


should be available, and programs should be forthright about their availability. Most schools of pharmacy are in need of preceptors for doctor of pharmacy students. TLC program participants can also teach learners beyond the area of pharmacy (e.g., nursing students). To the extent possible, TLC programs should match teaching experiences to participants’ interests and expertise. Time commitment of participants. A TLC program can be a significant addition to a participant’s expected workload during postgraduate training. Program leaders should identify the estimated time commitment and demands of the TLC program and be candid with participants to allow them to make an informed decision regarding their involvement. If the TLC program is required by the residency program, it is recommended that dedicated time be scheduled for TLC program activities and communicated to rotation preceptors, if applicable. When counted with all other activities, the time commitment associated with participating in a TLC program should not exceed the maximum duty hours defined by the accrediting body. ASHP defines duty hours as “all scheduled clinical and academic activities related to the pharmacy residency program.”26 As such, programs should count scheduled TLC program activities as duty hours. Faculty support. Program leaders should identify individuals with the expertise and interest to teach within the TLC program. Faculty support is vital to the success of the TLC program. It must be made clear to faculty if they will be rewarded for their engagement in the program (e.g., stipend, additional teaching opportunities with a new audience, an activity that may be applicable for promotion). Physical facilities. A central location with adequate meeting space is preferred. Additional costs for seminar venues should be considered.

Web technologies or video conferencing may be valuable to the success of a large TLC program in which it would be unrealistic to expect participants to travel far distances to participate. However, valuable networking experiences take place when participants can meet face-toface. Direct interaction with other program participants also enhances networking, a feature that should not be discounted when determining the program’s delivery method. Finances. Recommendation 9: TLC programs should have adequate personnel and institutional resources. The organization responsible for providing the TLC program with financial assistance should be clearly defined in the signed agreement. Faculty, space, materials, and other TLC program elements are resources that are expended throughout the course of a TLC program and should be properly accounted for. Schools of pharmacy should be expected to support TLC programs (as noted in the 2013 AACP policy statement), but the full coverage of administering a TLC program may extend beyond the academic institution itself to the affiliated participant programs. TLC programs should develop a process to ensure adequate financial support for program administration and sustainability. Program oversight. The expectations for all parties involved in the program should be clearly delineated. Who will be the primary contact for the TLC program and for the participant? Who will schedule the seminars and teaching assignments? If there is an affiliation between clinical sites and schools of pharmacy, how will conflicts or competing interests be resolved? Potential conflicts and challenges should be anticipated to the extent possible before moving forward with the program. A coalition or advisory committee that manages and oversees the TLC program should exist. Record of completion. If a certificate will be awarded on program

completion, TLC programs should make explicitly clear which components participants will have to complete to earn a certificate (e.g., attendance at all topic sessions, completion of a minimum amount of teaching, successful documentation within a portfolio). A certificate is not a necessary endpoint of a TLC program and should only be awarded if the intent of the CCP position on certification is met.4 TLC programmatic assessment and improvement Recommendation 10: TLC programs should incorporate a system of assessment to enhance ongoing programmatic improvement. Ideally, programs should create a systematic mechanism for evaluation and feedback to ensure that some form of continuous quality improvement (CQI) exists for the TLC program. Programs should consider annual surveys or debriefings with participants or other constituents to hear how the TLC program can be improved. There is a need to connect TLC program feedback and oversight to a more intentional assessment approach. A coalition or advisory committee could help with the CQI process. Table 1 provides some guidance on developing a CQI process for a TLC program. TLC transparency Recommendation 11: TLC program offerings, features, and participant obligations should be clearly described in all recruitment materials. As the number of schools that offer TLC programs grows and as the variety among TLC programs expands, prospective participants would benefit from having a mechanism that they can use to identify and compare the offerings of various TLC programs. By having a deeper insight into the elements offered within a TLC program, the candidates are able to make a more informed decision regarding the programs to which they are applying.


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Am J Health-Syst Pharm—Vol 71 Aug 1, 2014 Quarterly to annually

Quarterly to annually for TLC program participants Annually for TLC program instructors and planning and review committee Every 2–3 yr for key contacts at clinical site partners

Baseline, at completion of TLC program

Surveys or scoring rubrics, focus groups, one-on-one meetings

Surveys, focus groups, oneon-one meetings

Surveys, one-on-one meetings

TLC program participants (self-assessment), faculty reviewer

TLC program participants, TLC program instructors (e.g., for didactic portion), TLC program planning and review committee, key contacts at clinical site where TLC program participants practice (e.g., program directors of residents who are participating in the TLC program) TLC program participants

Reflective portion (e.g., teaching portfolio)

Administration (e.g., logistics, communication to TLC program participants and instructors)

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• Breadth and depth of seminar topics (e.g., to increase foundational knowledge) • Quantity and breadth of teaching experiences for TLC program participants (e.g., increasing number of required lectures TLC program participants must present) • Structure or depth of mentoring component of TLC program, if applicable

Formative: immediately after each teaching session Summative: quarterly to annually


TLC program participants (self-assessment), learners, faculty, preceptors

Practical portion (e.g., largegroup teaching)

Perceptions of confidence of program participants (e.g., to teach in smallgroup vs. large-group settings, to precept)

• Breadth, depth, variety, and order of topics • Teaching mechanism (e.g., lecture, discussion) • Topic instructors • Quantity and types of teaching experiences TLC program participant should be involved in • Specific aspects of teaching (e.g., content expertise, delivery) that TLC program participant should further develop • Quantity and focus of reflections included in teaching portfolio • Timing of deadlines for reflections • Didactic or mentoring portion of TLC program (e.g., if TLC program participants consistently mention a topic or teaching experience with which they struggled) • Communication strategies of requirements, deadlines, etc., to participants and instructors • Sequence and timing of TLC program required components (e.g., seminar schedules, teaching experience workload) • Choice of seminar topics

Formative: immediately after each seminar or discussion Summative: quarterly to annually


Focus of Feedback

Suggested Frequency of Feedback Collection

Feedback Collection Mechanism

TLC program participants

Feedback Source

Didactic portion (e.g., seminars)

Component Evaluated

Assessment and Improvement for Teaching and Learning Curriculum (TLC) Programs

Table 1. SPECIAL FEATURE Postgraduate pharmacy

As needed but at least annually

Before TLC program completion and follow-up with TLC program graduates every 1–3 yr thereafter

Quarterly for educational objectives Annually for educational goals

Accounts

Surveys, one-on-one meetings

Surveys, focus groups, goal tracking mechanisms (e.g., ResiTrak for residents)

Budget managers, administrators

TLC program participants

TLC program participants (self-assessment), TLC program mentors (if applicable), administrators

a

IPPE = introductory pharmacy practice experience, APPE = advanced pharmacy practice experience.

Career metrics (which TLC program participants pursue or obtain faculty roles or engage in teaching activities during their careers) Achievement of educational goals and objectives

Annually

Course directors, department chairs, course syllabuses, administrative records, surveys

Administrators, TLC program instructors

Workload metrics (e.g., hours of teaching that TLC participants “take” from faculty, hours of teaching TLC program instructors spend teaching in TLC program) Budget metrics

Suggested Frequency of Feedback Collection

Feedback Collection Mechanism

Feedback Source

Component Evaluated

Table 1 (continued)

• Breadth and depth of content and components of TLC program • Revisions to linkages between learning activities in TLC program and educational objectives and goals

• Quantity and length of teaching experiences for TLC program participants • Quantity and length of TLC program instructors’ teaching commitments in TLC program • Number of IPPE and APPE students precepted by TLC participantsa • Resource allocation with respect to faculty and staff support, office supplies, teaching technologies or tools, etc. • Term of contracts (if applicable) between TLC program administrator and clinical partners • TLC program marketing strategies and materials • TLC program career mentoring component, if applicable

Focus of Feedback



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Increasing transparency will produce more-informed candidates and perhaps a better match for the program. Increasing transparency may provide a potential employer with additional tools to assess the candidate’s background in teaching during postgraduate training. A simple listing of a TLC program offering within a residency program’s entry in online residency directories will assist candidates looking for postgraduate experiences offering TLC programs. In addition, a listing of components within the TLC program should be made available for review by candidates on request. TLC accreditation Recommendation 12: A formal external validation process for TLC programs should be established. As of 2014, there is no recognized external accrediting body for TLC programs. Although not currently present, TLC programs should develop their curriculum and offerings according to best available practices and guidelines, including guidance from this document and from credible groups.3 Consistent evaluation and documentation of program offerings will enable TLC programs to ensure the quality of program offerings and, when and if accreditations become available (voluntary or mandatory), that programs will be prepared. It is therefore the recommendation of this task force that AACP establish a mechanism to evaluate and validate TLC programs. This recommendation is made to serve TLC programs interested in external validation of their programs rather than as a mandatory accreditation process. Conclusion TLC programs provide postgraduate participants with valuable

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knowledge and skills in teaching applicable to the practitioner and academician. Postgraduate programs should be transparent to candidates and seek to ensure the best experiences for participants through systematic program implementation and assessments. References 1. American Society of Health-System Pharmacists. Required and elective educational outcomes, goals, objectives, and instructional objectives for postgraduate year one (PGY1) pharmacy residency programs, 2nd ed., effective July 2008. www. ashp.org/DocLibrary/Accreditation/ PGY1-Goals-Objectives.aspx (accessed 2013 Sep 5). 2. American College of Clinical Pharmacy. Guidelines for clinical research fellowship training programs; approved by the Board of Regents October 22, 2004. www.accp.com/resandfel/guidelines.asp (accessed 2013 Sep 5). 3. Havrda DE, Engle JP, Anderson KC et al. Guidelines for resident teaching experiences. Pharmacotherapy. 2013; 33:e14761. 4. Council on Credentialing in Pharmacy. Scope of contemporary pharmacy practice: roles, responsibilities, and functions of pharmacists and pharmacy technicians. www.pharmacycredentialing.org/ Contemporary_Pharmacy_Practice.pdf (accessed 2013 Jan 31). 5. Romanelli F, Smith KM, Brandt BF. Certificate program in teaching for pharmacy residents. Am J Health-Syst Pharm. 2001; 58:896-8. 6. Romanelli F, 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:article 20. 7. Castellani V, Haber SL, Ellis SC. Evaluation of a teaching certificate program for pharmacy residents. Am J Health-Syst Pharm. 2003; 60:1037-41. 8. Taylor JR, Scolaro KL, Williams JS. Development of a teaching certificate program utilizing distance education. Ann Pharmacother. 2006; 40:1215. 9. Gettig JS. Perceived value of a pharmacy resident teaching certificate program. Am J Pharm Educ. 2008; 72:article 104. 10. Medina MS, Herring HR. An advanced teaching certificate program for postgraduate year 2 residents. Am J HealthSyst Pharm. 2011; 68:2284-6. 11. Sylvia L. Mentoring prospective pharmacy faculty seminar series. Am J Pharm Educ. 2004; 68:article 38.


12. Slazak EM, Zurick GM. Practice-based learning experience to develop residents as clinical faculty members. Am J HealthSyst Pharm. 2009; 66:1224-7. 13. 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. 14. McNatty D, Cox C, Seifert C. Assessment of teaching experiences completed during accredited pharmacy residency programs. Am J Pharm Educ. 2007; 71:article 88. 15. Smith K, Patton L, Cannon B, Romanelli F. Status of teaching skill development programs (TSDPs) in pharmacy residencies. Am J Pharm Educ. 2008; 72:article 72. 16. Manasco KB, Bradley AM, Gomez TA. Survey of learning opportunities in academia for pharmacy residents. Am J Health-Syst Pharm. 2012; 69:1410-4. 17. Aistrope DS, Attridge RT, Bickley AR et al. Strategies for developing pharmacy residents as educators. Pharmacotherapy. 2011; 31:526. 18. Johnson M, Clements J. Four years of experiences of a joint school of pharmacy and school of education pharmacy residency teaching certificate program for affiliated residency programs. Curr Pharm Teach Learn. 2013; 5:276-82. 19. Grasha A. Teaching with style: the integration of teaching and learning styles in the classroom. Teach Excell. 1996; 7:31-4. 20. Kolb A, Kolb D. Learning styles and learning spaces: enhancing experiential learning in higher education. Acad Manag Learn Educ. 2005; 4:193-212. 21. Romanelli F, Bird E, Ryan M. Learning styles: a review of theory, application, and best practices. Am J Pharm Educ. 2009; 73:article 9. 22. Hawk T, Shah A. Using learning style instruments to enhance student learning. Decisn Sci J Innov Educ. 2007; 5:1-19. 23. Seldin P, Miller J, Seldin C. The teaching portfolio: a practical guide to improved performance and promotion/tenure decisions. 4th ed. San Francisco: Jossey-Bass; 2010. 24. Johnson PN, Smith KM. The teaching portfolio: a useful guide for pharmacists’ teaching goals. Am J Health-Syst Pharm. 2007; 64:352-6. 25. Medina MS, Draugalis JR. Writing a teaching philosophy: an evidence-based approach. Am J Health-Syst Pharm. 2013; 70:191-3. 26. American Society of Health-System Pharmacists. ASHP accreditation standard for postgraduate year one (PGY1) pharmacy residency programs—effective April 2012. www.ashp.org/DocLibrary/ Accreditation/ASD-PGY1-Standard.aspx (accessed 2013 Dec 3).

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