CoxHealth Pharmacy Residencies Manual

Introduction

PGY1

PGY1 (postgraduate year 1) residency programs build upon Doctor of Pharmacy (PharmD) education and outcomes to develop pharmacist practitioners with knowledge, skills, and abilities as defined in the educational competency areas, goals, and objectives. Residents who successfully complete PGY1 residency programs will be skilled in diverse patient care, practice management, leadership, and education, and be prepared to provide patient care, seek board certification in pharmacotherapy (i.e., BCPS), and pursue advanced education and training opportunities including postgraduate year two (PGY2) residencies.

PGY2

PGY2 residency programs build upon Doctor of Pharmacy (PharmD) education and PGY1 pharmacy residency training to develop pharmacist practitioners with knowledge, skills, and abilities as defined in the educational competency areas, goals, and objectives for advanced practice areas. Residents who successfully complete PGY2 residency programs are prepared for advanced patient care or other specialized positions, and board certification in the advanced practice area, if available.

Table of Contents

• Overview of ASHP Standards
• Application and Appointment
• Benefits and Leave
• Duty Hours
• Design and Conduct of the Residency
• Evaluation Procedures
• Disciplinary Actions and Dismissal from the Program
• Requirements for Completion of the Program and Certification
• Additional Resident Information
• Residency Program Leadership
• Preceptor Assessment, Appointment and Reappointment
• Preceptor Development
• Continuous Residency Program Improvement

Overview of ASHP (American Society of Health System Pharmacists) Standards

View ASHP website

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Standard 1: Recruitment and Selection of Residents

Provides guidance to residency programs for the recruitment and selection of residents by defining candidate eligibility requirements along with the policies and procedures necessary to the recruitment process. The goal of the selection process is to ensure selected candidates will be successful in the training environment, attain professional competence, contribute to the advancement of profession of pharmacy, and support the organizations’ mission and values.

Standard 2: Program Requirements and Policies

Details the specific requirements for residency program policies; materials to be provided to candidates invited to interview; resident financial support and resources; and requirements of ASHP Regulations on Accreditation of Pharmacy Residencies and ASHP Duty Hour Requirements for Pharmacy Residencies.

Standard 3: Structure, Design, and Conduct of the Residency Program

Defines required components of program structure, design, and conduct. It is important that the program’s structure and design enable residents to achieve the purpose of the residency program through skill development in the program’s required competency areas. Requirements for oversight of residents’ development, formative and summative evaluations, and self-assessment are defined along with guidelines for continuous program improvement.

Standard 4: Requirements of the Residency Program Director and Preceptors

Defines eligibility and qualification requirements for residency program directors (RPDs) and preceptors as well as requirements for the residency advisory committee (RAC) and continuous preceptor development. RPDs and preceptors are critical to the success of both residents and the residency program and are the foundation of residency training. They serve as role models for residents through their professionalism and commitment to advancing the profession of pharmacy.

Standard 5: Pharmacy Services

Serves as a guide to best practices across the continuum of pharmacy practice environments and focuses on the key elements of a well-managed department that are applicable to all practice environments. Each standard applies to all practice environments, unless otherwise indicated.

Application and Appointment

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Licensing Requirements

In addition to Application Procedure expectations listed on our website, applicants to CoxHealth pharmacy residencies must be:

• All programs:
  • Medication Therapy Services Certified through the Missouri Board of Pharmacy at time of pharmacist licensure, or as soon as possible thereafter.
  • Certified in the delivery of immunizations (preferred but not required).
  • Licensed as a Missouri Intern Pharmacist or Missouri Pharmacy Technician prior to day 1 of residency to be on the premises, if Missouri pharmacist license is pending.
• PGY1: Failure to pass Missouri State Board of Pharmacy Licensure requirements within first 90 days of start date or two failed attempts of the same examination (i.e., NAPLEX or MPJE) occurring within in first 90 days of start date of the residency will result in termination from the residency program.
  • Exceptions (e.g., medical leave) will be considered on an individual basis and required program extension will be determined by the System Director of Pharmacy (or designee).
• PGY2: Licensed or eligible for licensure as a pharmacist in the state of Missouri within 90 days of residency commencement (this can include a temporary training license)
  • Failure to attain licensure within 90 days of residency commencement will result in termination from the residency program.
    • Exceptions (e.g., medical leave) will be considered on an individual basis and required program extension will be determined by the System Director of Pharmacy (or designee).
  • Must have successful completion of an ASHP-accredited PGY1 Pharmacy Residency or candidate-status PGY1 residency or must qualify for and be granted PGY1 residency exemption by ASHP.

Selection

Diversity, Equity and Inclusion are priorities here at CoxHealth. All persons involved in recruiting are assigned training. Out of a commitment to the importance of equality and visibility for all, CoxHealth has added its first Diversity, Inclusion and Equity officer: Heather Hardinger. Through her work, Hardinger will help further the health system’s efforts to address health disparities, reach underserved populations, and identify gaps in equality and awareness for patients and employees.

“The best way to serve our patients, employees, and communities is to ensure we can provide and maintain safe, welcoming environments for all as we serve, heal, educate, and innovate. I look forward to bringing the best of who I am to this new role to advance diversity, inclusion, and health equity as essential components to providing exceptional care to the communities we serve.” – Heather Hardinger

Programs select from among eligible applicants based on their preparedness and ability to benefit and benefit from the program in which they are seeking appointment. Academic performance, cultural alignment in relation to our mission, vision, and values, letters of recommendation, letter of intent, scholarship, leadership, community service, professional experience, and ability to communicate are considered in the selection. In selecting from among qualified candidates, all CoxHealth programs participate in the PhORCAS electronic application process, participate in an organized file review and interview process, participate in the ASHP Resident Matching Program, and adhere to the Rules for the ASHP Pharmacy Resident Matching Program.

Program Screening and Ranking of Residency Applicants With Early Commitment

Resident Qualifications

• Graduate from Accreditation Council for Pharmacy Education (ACPE) accredited degree program or one in process of pursuing accreditation.
• Ability to be fully licensed as a pharmacist in Missouri within 90 days of beginning residency.
• For PGY2 ONLY: Complete an ASHP accredited or ASHP candidate status PGY1 pharmacy residency with submission of PGY1 certificate at the start of the PGY2 program.
  • Will consider candidate status PGY1 program completion with review of program.

Residency Application Procedure

Early Commitment

• PGY1 residents may apply to early commit to the PGY2 program
  • Early Commitment process and timeline:
    • By November 1st: Early commitment candidate(s) must apply via email to the PGY2 RPD for early commitment
    • The following application materials must be submitted
• Curriculum vitae
• One-page letter of intent
• A minimum of one letter of recommendation (to be emailed to RPD by reference writer)
  • • Summative evaluations may also be requested from the PGY1 RPD
    • Early November (before 11/15): Interview of resident(s) following the same format and scoring as utilized for non-early commit candidates, except the presentation and tour/lunch will be excluded.
    • If more than one PGY1 resident has applied for the position, the interview team will go through the same selection process as used to rank outside candidates for the match. If only one candidate, the team will decide based on resident’s merit and program alignment.
    • Prior to Thanksgiving, the RPD will offer a position to the selected candidate.
    • If no candidates are offered the position, candidates can elect to apply for the program again when the position becomes open to all applicants.
  • If the PGY2 RPD extends an early commitment offer, the selected PGY1 candidate must notify the RPD in two business days of their decision via email.
  • If the position is accepted, the RPD will provide the candidate with a letter of agreement that outlines all preemployment requirements, terms, and conditions that constitute acceptance of the position. This document must be signed by the accepting resident prior to the ASHP Midyear Clinical. Also, the PGY2 RPD and candidate will sign the National Matching Service (NMS) Early Commitment Letter of Agreement and send to NMS.
  • If the position is not accepted, this procedure will be duplicated with the next highest-rated candidate.
  • Candidates who do not accept the offered position can also re-apply following the same procedures as outside candidates (see below). The candidate understands that this option does not guarantee an interview.

No Early Commitment

Candidate Process and Timeline

• November:
  • PhORCAS™ opens
• December:
  • Recruiting and interviews at PPS at ASHP Midyear Clinical Meeting
  • Interviews at PPS – if candidate moves to application, interview score included in application evaluation
  • Showcase is an opportunity to ask questions but is not considered an interview
• January:
  • Application window closes January 5th
  • RPD plus at least one other preceptor/resident independently review resident applications using the provided rubric.
  • The application review committee will review the compiled rank lists after each has scored the applicants. Any discrepancies in scoring between reviewers will be reviewed and resolved by the residency executive committee.
  • The resident candidate applications, based on final score, will be invited to interview.
    • If a candidate withdraws from the selection process, the RPD reserves the right to invite the next candidate on the list or to not continue to invite resident candidates.
    • At the time of the invitation to interview, the RPD will provide the requirements of completion of the residency program and all policies and procedures relating to the program by email.
• January-February:
  • Residents interview onsite:
    • Leadership interview (director of pharmacy, operations director, clinical director)
    • RPD interview
    • Preceptor interview 1 (three clinical preceptors)
    • Preceptor interview 2 (longitudinal and clinical preceptor, or clinical preceptor and technician)
    • Residency Executive Committee
    • Tour / lunch with current resident
    • Presentation: 5 minutes on yourself
    • PGY2s only – 15 minutes patient case presentation with Q/A with REC
• Late February:
  • After all interviews are complete, the individual scores from each interviewer will be entered into a spreadsheet and an initial rank list will be generated.
  • All members of the interview committee and the current resident meet to discuss and develop the final rank of applicants to the program.
  • Adjustments to the initial rank list may be made based on discussion of applicant’s program alignment.
  • The preceptors and RPD may rank all candidates or may choose to only rank a partial list of applicants. If a consensus is not able to be reached, the RPD has final authority to finalize the rank list.
  • After the final rank list has been developed, the RPD will input the Rank Order List into the National Match Service system by the due date.
• Early March:
  • The Match results
    • If the match provides a matched candidate, the RPD will reach out to the candidate to confirm the match result and provide the match agreement letter within the week.
• March-April:
  • Phase II and Scramble, if applicable
    • If all positions are not matched, the residency program will enter the Phase II match.
    • All of the application documents for Phase I will be required for Phase II and submitted via PhORCAS™.
    • The screening process will be the same as Phase II.
    • The interview will consist of the same components.
      • This interview will be completed via Teams.
      • The presentation(s) will still be required.
    • After all interviews are complete, the individual scores from each interviewer will be entered into a spreadsheet and an initial rank list will be generated.
    • All members of the interview committee and the current resident(s) meet to discuss and develop the final rank of applicants to the program.
    • Adjustments to the initial rank list may be made based on discussion of applicant’s program alignment.
    • The preceptors and RPD may rank all candidates or may choose to only rank a partial list of applicants.
    • If a consensus is not able to be reached, the RPD has final authority to finalize the rank list. After the final rank list has been developed, the RPD will input the Rank Order List into the National Match Service system by the due date.
  • If a candidate is matched via Phase II, the RPD will reach out to the candidate to confirm the match result and provide the match agreement letter within the week.

Scramble

• If no match in phase II, the residency program may participate in the Scramble
  • RPD will ask for letter of intent, CV, and 3 letters of recommendation from scramble candidates.
  • 1-3 candidates will be invited to interview
    • Interview will consist of the same components as Phase I and Phase II
    • This interview will be completed via Teams.
    • The presentation will still be required.
• After all interviews are complete, all preceptors available and current resident(s) meet to discuss and rank applicants to the program.
  • Scores from the interviews and the presentation will be included in the discussion.
  • The preceptors and RPD may rank all candidates or may choose to only rank a partial list of applicants.
  • The top candidate will be offered the residency program spot. If this is declined, the RPD will work through the list of candidates.
• Once a candidate verbally accepts the position, RPD will provide the match agreement letter within the week.

Post-Match Pre-Employment Requirements

• All residents accepted into a CoxHealth residency program will receive a letter from the Residency Program Director (RPD) outlining their acceptance to the program, along with pre-employment requirements; and requirements and expectations for successful residency completion, which must be accepted/signed by the resident and returned to the RPD prior to the beginning of residency
• The matched applicant will formally apply for the Pharmacy Resident I/II position through CoxHealth and will receive an official offer from the Human Resources (HR) Pharmacy Recruiter
• Healthcare Source reference check email is sent for the resident to complete and send to their references
• Background check is initiated based on electronic form in Position Manager
• Onboarding appointment is scheduled by HR
  • In house – Visit with a Coordinator or Recruiter in person
    • Complete New Hire/Onboarding Paperwork – All paperwork sent and signed via DocuSign
      • New Hire Note
      • New Hire Information
      • Voluntary Disclosure/Equal Employment Opportunity (EEO) Voluntary Disclosure
      • Signs release for Fair Credit Reporting Act (FCRA) Background Check
      • Signs Conditional Offer of Employment
      • Badge Form
      • Parking Form
      • I-9 (provide employment verification documents)
      • New Hire Compliance Checklist
      • Provides copy of Education (diploma) – can be uploaded to DocuSign 
      • Provides copy of Licensure (or application for licensure) – can be uploaded to DocuSign
      • Receives Job Description – sent via performance manager 
      • Direct Deposit form (provide voided check or letter from bank)
      • W-4 (state & federal)
      • NH Information Form
      • Maps for Orientation
      • Attestation/Sign on Bonus/Relocation Bonus (if granted)
      • Badge picture taken
      • Drug & Nicotine Testing as well as blood draw is performed by employee health within 96 hours from Conditional Offer of Employment.
      • Follow up appointment set with Employee Health to review blood draw results
  • Out of area – New hire lives too far from a CoxHealth location to physically complete process on property
    • Complete New Hire/Onboarding Paperwork – All paperwork sent and signed via DocuSign
      • I-9 (provide employment verification documents at orientation)
      • W-4 (state & federal) 
      • NH Information Form
      • Direct Deposit form (provide voided check or letter from bank)
      • EEO Voluntary Disclosure
      • Parking Form
      • Signs Conditional Offer of Employment
      • Signs release for Background Check (FCRA) 
      • Receives Job Description – sent via performance manager 
      • Provides copy of Education (diploma) – can be uploaded to DocuSign
      • Provides copy of Licensure (or application for licensure) – can be uploaded to DocuSign
      • Drug & Nicotine Testing scheduled at a facility near new hires home or current employer – to be completed within 96 hours of scheduled date and time
      • Blood draw done by Employee Health at Orientation – must be done ON-SITE no later than the Wednesday prior to start date
      • All HR processes must be successfully completed by our processing deadline in order to be able to work.
      • A follow-up appointment with Employee Health and HR will be scheduled for Monday after the scheduled start date. This appointment must be completed before the employee can report to their department training
• Department and residency orientation and training will commence afterwards

Duration of Appointment

Each resident must complete a minimum of 12 months and a full-time practice commitment or equivalent, with a minimum of 2/3 of the residency year completed as a pharmacist licensed to practice in the state of Missouri in order to receive a certificate of completion.

• PGY1 Programs: 55-week appointment (second Monday in June to last Friday the following June)
• PGY2 Programs: 54-week appointment

Salary Approximations

PGY1 Residents (55-week appointment) - $53,040

PGY2 Residents (54-week appointment) - $57,900

Orientation

• Residents will participate in CoxHealth System Wide Orientation and are responsible for completing all assigned CoxHealth onboarding competencies.
• Residents will be oriented to their respective residency program, including, but not limited to:
  • Residency purpose, description, and practice environment
  • American Society of Health-System (ASHP) Accreditation Standards; ASHP Competency Areas, Goals, and Objectives
  • Residency program design, including all program requirements for successful completion
  • Description of required and, if applicable, elective learning experiences
  • Evaluation strategies
  • Residency policies, terms, and conditions
• Each program will develop an orientation calendar based upon the individual resident's needs and will distribute the calendar to the resident.

Benefits and Leave

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Refer to the CoxHealth Benefits page for details of all provided employee benefits.

Leave Allowed for Completion of Residency Program

This section does not define the amount of paid leave that may be provided as part of an organization’s benefits for employees; it defines eligibility to receive a certificate of completion related to the maximum time away from the program within a 52-week period which is 37 days, without requiring extension of the program.

• Examples of time away from the program include vacation time, sick time, holiday time, religious time, interview time, personal time, jury duty time, bereavement leave, military leave, parental leave, leave of absence, and extended leave. Conference or education days, though they are considered to be a required part of the program, will also be included in the number of days away from the program.
• 37 days is defined as 37 scheduled training days. Service commitment/staffing shifts are considered independent of training days and are included in the total service commitment/staffing shifts required to complete the residency program requirements. Compensatory days for staffing shifts, if given, are considered to be part of the service commitment and therefore are not counted as time away from the program.
• The program may be extended at the discretion of the System Director of Pharmacy or designee for up to 90 days after the original end date to ensure residency completion.
  • The resident will be paid at the stipend (resident) rate for the remainder of days worked.
  • Benefits will continue while in full time employment with CoxHealth.

Professional Leave

• With the approval of the RPD, residents may be granted up to 10 workdays of leave per year, with pay, to assist in recruitment efforts as assigned by the RPD or to pursue scholarly activities pursuant to their educational curriculum.  
• Professional leave days may not be used for interviews.
• Compensation for required meetings of the residency will be offered, however maximum amount of compensation will not be determined until the start of the fiscal year in October and is based on the approved annual Pharmacy Residency Budget.  Once the Pharmacy Residency Budget and meeting time is approved, amounts will be communicated to the residents.  Residents may be granted up to $1000 for meeting compensation annually.  
• Time not taken may not be carried over from one academic year to the next and will be forfeited at the end of the residency year.

Earned Time Off (ETO)

• Residents accrue ETO at a rate of 0.0654 hours per hour of paid time, which equates to 17 days of ETO annually.  All ETO requests must be approved by the Residency Program Director and preceptor prior to the period requested.
• ETO is used for vacation days, absences, sick days, non-worked holidays and extended leaves of absence.
• For sick days/unplanned absences, the resident must call the department manager/supervisor and notify the RPD each day of absence. Each sick day/day of unplanned absence will be removed from the resident’s ETO total.
• All other ETO requests must be approved by the RPD and preceptor prior to the period requested.
• Residents taking leave greater than 17 days (i.e., vacation, sick, holiday, extended leaves of absence) cannot be awarded a certificate of completion unless additional leave is made up. Depending on the amount of leave, the program may be prolonged, but pay will not extend beyond the contracted annual residency stipend.  Method for extension or make-up time will be determined by the RPD, along with Pharmacy Leadership, and documented in the Resident Development Plan. 
• ETO not taken by the end of the residency year will not be paid out and will be forfeited, unless eligible for roll-over per CoxHealth Human Resources policy.

Extended Leave of Absence

• Pharmacy Residency Programs follow the CoxHealth System Policy in regard to Employee Leaves of Absence (including Family and Medical Leaves of Absence, Adoption Assistance, Personal Leave of Absence, and Military Leave of Absence)
  • Employees in a temporary status are not eligible for leave under the Medical Leave of Absence policy. Employees other than those in a temporary status, may qualify for an unpaid Medical Leave of Absence after six (6) months of employment with the appropriate medical documentation.
  • If the employee is not eligible for a Family Medical Leave of Absence and the employee has been off of work for more than seven (7) calendar days, the employee may apply for a Medical Leave of Absence with the start date of the leave being the eighth day off. The employee must request a Medical Leave of Absence through the Leave of Absence Administrator (Leave Administrator) to seek approval for a Medical Leave of Absence.
• Approved leaves of absence will be documented in the Resident Development Plan (including duration of leave and extension date of residency).

Duty Hours

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All CoxHealth pharmacy residency programs comply with the ASHP Duty-Hour Requirements for Pharmacy Residencies.

• Duty hours are defined as all scheduled clinical and academic activities related to the pharmacy residency program. This includes inpatient and outpatient care; in-house call; administrative duties; and scheduled and assigned activities, such as conferences, committee meetings, and health fairs that are required to meet the goals and objectives of the residency program. Duty hours do not include reading, studying, and academic preparation time for presentations and journal clubs; travel time to and from conferences; and hours that are not scheduled by the RPD or a preceptor.  
• Moonlighting is voluntary, compensated, pharmacy-related work performed outside the organization (external), or within the organization where the resident is in training (internal), or at any of its related participating sites. These are compensated hours beyond the resident’s salary and are not part of the scheduled duty periods of the residency program.
  • Residents moonlighting internally shall be compensated at a pharmacist’s base hourly pay rate.
  • CoxHealth allows both internal and external moonlighting as long as hours remain within the acceptable duty hours limits, do not exceed 20 hours per two week pay period, and do not affect residents’ judgment while on scheduled duty periods or impact their ability to achieve the educational goals and objectives of their residency program and provide safe patient care.
    • All moonlighting hours must be approved at least one week in advance by RPD to ensure that Duty Hours remain within policy.
    • All moonlighting hours will be logged in the development plan quarterly.
    • If moonlighting hours place the resident above duty hours a verbal warning will be given.
    • If moonlighting hours place resident above duty hours a second time or if moonlighting affects clinical decision making and judgement, the availability of moonlighting will be removed and assess quarterly on the development plan for re-instatement.
• Voluntary, non-compensated hours include any pharmacy-related work performed outside the organization (external), or within the organization where the resident is in training (internal), or at any of its related participating sites; and are not required hours to meet the competency areas, goals, and objectives of the residency program (i.e. community service hours, hours attending optional meetings or conferences, or time devoted to teaching certificate programs).
• The following specific duty hours shall be maintained for all residents:
  • Duty hours must be limited to 80 hours per week, averaging over a four-week period, inclusive of all in-house call activities and moonlighting. 
  • Moonlighting (internal or external) must not interfere with the ability of the resident to achieve the educational goals and objectives of the residency program.
  • All moonlighting hours must be counted towards the 80-hour maximum weekly hour limit.
  • Mandatory time free of duty: residents must have a minimum of one day in seven days free of duty (when averaged over four weeks). At-home calls cannot be assigned on these free days. 
  • Residents should have 10 hours free of duty between scheduled duty and must have at a minimum 8 hours between scheduled duty periods.
  • Continuous duty periods of residents should not exceed 16 hours. The maximum allowable duty assignment must not exceed 24 hours even with built in strategic napping or other strategies to reduce fatigue and sleep deprivation, with an additional period of up to two hours permitted for transitions of care or educational activities.
• Reporting of duty hours
  • Residents shall report all voluntary and moonlighting hours to the RPD at least 1 week prior to the scheduled date, for approval. In addition, each resident shall attest to their adherence to the duty hours requirement monthly in PharmAcademic.
  • Moonlighting and voluntary, non-compensated hours that negatively impact resident judgment or ability to achieve the required competency areas, goals, and objectives of the residency program will be addressed and documented in the Resident Development Plan.  Issues not resolved will result in disciplinary action up to and including dismissal from the program.

Staffing

• Weekend and Holiday Staffing
  • See program-specific appendices for details
• Staffing Outside of Program Requirements / Pulling Residents Off Scheduled Learning Experiences
  • The CoxHealth Pharmacy Leadership Team is committed to honoring the ASHP Standard 3: Design and Conduct of the Residency Program, noting the importance that residents’ training enables them to achieve the purpose, goals, and objectives of their residency programs.  However, during the course of the residency year, there may be times in which the CoxHealth Pharmacy Leadership Team asks to remove a resident from a learning experience for an enhanced educational opportunity (i.e., participation in a DNV survey, pharmacy inventory, ASHP Visiting Leader, etc.), or to assist in times of crisis/disaster.
  • To honor this commitment to ASHP Standard 3, the CoxHealth Pharmacy Leadership Team will not remove a resident from a learning experience without prior discussion with and approval from the RPD.   

Design and Conduct of the Residency

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Program Descriptions

• PGY1 Springfield: In addition to the ASHP PGY1 Program Purpose, further emphasis is placed on preceptor development; interdepartmental collaboration; enhancement of leadership and project management skills; and the provision of medication education.
• PGY1 Branson: In addition to the ASHP PGY1 Program Purpose, this program provides residents the opportunity to advance the practice of rural pharmacy.
• PGY2 Ambulatory Care: In addition to the ASHP PGY2 Program Purpose, this program provides residents with the necessary skills to become confident and competent ambulatory care pharmacy specialists qualified to provide exceptional pharmacy services in a variety of dynamic ambulatory care settings.
• PGY2 Critical Care: In addition to the ASHP PGY2 Program Purpose, this program provides the resident with advanced clinical training in critical care pharmacotherapy, as well as opportunities for research, teaching, and scholarship. Upon completion of this residency, the pharmacist will be a competent clinical pharmacy practitioner in critical care that engages in multidisciplinary collaboration, demonstrates advanced critical thinking skills, and is able to design and implement complex medication recommendations in a variety of critical care environments.

Competency Areas, Educational Goals, and Objectives

View ASHP website

CoxHealth residency program educational goals and objectives support achievement of the residency purpose and are designed to meet the competency areas, goals, and objectives (CAGO) required by the ASHP Accreditation Standards for Pharmacy Residency Programs.  

• Competency Areas: Categories of the residency graduates’ capabilities; Competency areas fall into one of three categories:
  • Required:  Four competency areas are required (all programs must include them and all their associated goals and objectives)
    • R1: Patient Care
    • R2: Advancing Practice and Improving Patient Care
    • R3: Leadership and Management
    • R4: Teaching, Education, and Dissemination of Knowledge
  • Additional: Competency area(s) other than the four areas required above that are required for all residents
  • Elective: Competency area(s) selected optionally for specific resident(s)
• Educational Goals: Broad statement of abilities
• Educational Objectives: Observable, measurable statements describing what residents will be able to do as a result of participating in the residency program
• Criteria: Examples intended to help preceptors and residents identify specific areas of successful skill development or needed improvement in resident performance.
• Individual Program Competency Areas, Goals and Objectives
  • PGY1 CAGO: PGY1 Required Competency Areas
  • PGY2 Ambulatory Care CAGO: PGY2-Ambulatory-Care-CAGO-BOD-Approved-2017
  • PGY2 Critical Care CAGO: PGY2 Critical Care Pharmacy Residency Goals and Objectives

Disciplinary Actions and Dismissal from the Program

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CoxHealth Pharmacy Residency Programs abide by the CoxHealth Corporate Policy for Counseling and Disciplinary Practices

Employee Expectations

It is the responsibility of all employees to conform to CoxHealth’s policies and standards of conduct, performance, and attendance and to meet all duties as defined below:

• Duty to Produce an Outcome: The duty of the employee to timely and satisfactorily comply with ASHP Standards; to satisfactorily progress in scholarship and professional growth as outlined by the ASHP guidelines for achievement of competency areas, goal, and objectives of the residency program; to comply with CoxHealth Pharmacy Residency requirements for successful completion of the residency; and to comply with CoxHealth standards, such as, but not limited to, the Code of Conduct, Dress Code, Time and Attendance.
• Duty to Follow a Procedural Rule: The duty of the employee to perform their assigned job in a responsible manner avoiding at-risk behavior. At-risk behavior is a behavioral choice that increases risk where risk is not recognized or is mistakenly believed to be justified.
• Duty to Avoid Causing Unjustifiable Risk or Harm: The duty of the employee to avoid causing risk or harm to himself, to fellow employees, customers, visitors and to the organization by demonstrating reckless behavior. Reckless behavior is a conscious disregard or substantial and unjustifiable risk.

Conditions for Disciplinary Action

• If an employee fails to meet any of the duties defined above, the coaching process or more formal discipline process, as outlined in the CoxHealth Corporate Policy for Counseling and Disciplinary Practices shall occur. Documentation of the issue, action items, timeline, and expectation for improved performance will be documented in both Performance Manager and in the Resident Development Plan. The appropriate response will consider the seriousness of the behavior and the employee’s prior actions. Although every attempt will be made to operate within the parameters of these guidelines, CoxHealth retains the legal right to take discipline at any step of the disciplinary process it deems appropriate and/or to separate employees at will.
• If an employee's misconduct or reckless behavior may be a violation of criminal law, the Human Resources Department will seek an opinion from in-house legal counsel about reporting the violation to law enforcement officials and act accordingly.

Conditions for Dismissal

• Failure to attain licensure as outlined in the Eligibility Requirements
• Failure to uphold the expectations as outlined in the Pharmacy Resident I and/or Pharmacy Resident II Job Descriptions
• Failure to show successful improvement or achievement of required program performance after engaging in the formal coaching and/or discipline process as outlined in the CoxHealth Corporate Policy for Counseling and Disciplinary Practices.
• An employee has incurred at least eight periods of absence and has been counseled through all steps of the progressive disciplinary process within the preceding twelve months, according to the Absence/Tardiness Policy (F4) (Discipline during the preceding 24 months may also be considered where the employee has a chronic absence pattern resulting in repetitive discipline short of discharge)
• An employee has incurred at least seven periods of tardiness and has been counseled through all steps of the progressive disciplinary process within the preceding three months, according to the Absence/Tardiness Policy (F4)
• An employee commits an offense that is so serious that progression through the formal levels of progressive discipline is not warranted. Failure to self-report any arrests and/or convictions of any of the crimes listed in Addendum A of Human Resources policy Recruitment, Employment, and Job Postings in a reasonable time frame (usually the next business day) 
• Theft including diversion of drugs from the hospital or patients 
• Fighting or threatening physical assault on hospital property 
• Willful destruction of hospital property or property of others
• Careless job performance
• Insubordination (refusal to carry out reasonable instructions)
• Clocking-in or out another employee
• Falsification of reason for absence
• Falsification of business records (e.g., Human Resources records, patient records). Falsification of time records, which includes the excessive use of internet and or email privileges for personal use (such use will be considered falsification of a timecard and theft of company time).
• Conviction of a felony or receiving a court sentence in lieu of trial as a result of a nolo contendere (no contest) or Alford plea
• Harassment of other individuals.
• Violation of the Drug and Alcohol in the Workplace Policy (F2). Violation of moral conduct or ethics
• Reckless behavior or disregard for the safety of self, others, or property in the course of employment
• Carrying concealed weapons
• Leaving prescribed work area without permission
• Sleeping on the job
• A shift of unreported absence (No Call – No Show)
• Conduct detrimental to hospital image, including but not limited to conduct in violation of CoxHealth values while serving as a volunteer or representing CoxHealth at health system or community events
• Discourtesy to patients or others
• Disruptive behavior (anything in the course of their employment that significantly disturbs a patient, visitor, physician, co-worker, or others conducting business or performing services for CoxHealth)
• Submits or causes to be submitted a false worker’s compensation claim or otherwise fails to abide by CoxHealth’s Worker’s Compensation standard
• Submits or causes to be submitted a false harassment claim
• Submits or causes to be submitted a false claim under any other CoxHealth policy
• Previous steps in the disciplinary process have not corrected the inappropriate behaviors or conduct
• Violation of CoxHealth Information Management policies
• Unauthorized release of documents, whether electronic or written, restricted by CoxHealth for internal use only to unaffiliated outside organizations or individuals.
• Becoming excluded from participation in government programs
• Use of social or electronic media, regardless of where messages are sent or received, that results in false, malicious, or disparaging comments regarding persons associated with CoxHealth
• Misuse of CoxHealth property, including hardware, software, photos/images or representing CoxHealth in any manner if not authorized to do so
• Use of health system equipment, supplies, facilities, or paid time to provide or receive care outside the normal care delivery system and business operations of CoxHealth (This prohibition is intended to address care delivered without the benefit of patient registration, documentation in medical records and billing for services provided. It is not intended to prohibit minor care provided for a superficial injury or common ailment using inexpensive supply items such as aspirin or band aid)

Appeal Process

• A resident suspended or discharged may request a review of the decision by an impartial appeal committee. The employee must request this review in writing within five business days of the suspension or date of discharge.  Please refer to the CoxHealth System Policy (Employee Concerns, Grievance, and Appeal Process).

Requirements for Completion of the Program and Certification

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Residents must successfully complete all program specific requirements listed below to be awarded a certificate of completion.

Additional Resident Information

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Documentation of Resident Activities

• The resident will be responsible for maintaining a compilation of activities including but not limited to the following:
  • Educational in-services
  • Grand rounds presentation
  • Formal drug policy projects
  • Written requests/responses for drug information
  • Drafts and final reports
  • Evaluations not included in PharmAcademic
• Copies of all handouts, feedback forms, proposals, and formal projects should be dated and placed in the residents’ personal electronic binder.  This information will be used to process evaluations and provide feedback for areas of excellence and/or improvement throughout the residency.

Professionalism Expectations

• Code of Conduct: Residents are expected to uphold the CoxHealth Compliance Code of Business Conduct and Ethics (i.e.  “Code of Conduct”).
• Dress Code: All residents are expected to dress in appropriate professional attire as outlined in the CoxHealth Dress Code policy, or as mandated by learning experience preceptor.
• Name Badges: All personnel must wear his or her badge while on campus. If misplaced, a temporary badge may be obtained at the Security Office. Badges may be replaced at a fee.
• Cell Phones: While it is recognized that smart phones may be used for clinical information purposes (i.e., Lexicomp, UpToDate, email), residents should refrain from using cell phones in patient care areas per department policy. Excessive use of cell phones, especially for non-work-related activities, will result in disciplinary action. Extenuating circumstances should be discussed with the learning experience preceptor. 

Professional/Educational Meeting Attendance

• The expectation is for any meeting attended in which compensation is granted that the resident is representing CoxHealth and the Pharmacy Residency Program(s) in some manner (i.e., poster presentation, formal recruitment efforts, panel discussion, presentation, submitted poster/abstract).  Not fulfilling the ‘Expectations of the Resident’ outlined below or failure to represent CoxHealth and the Pharmacy Residency Program will result in compensation being denied or a request for repayment from the resident to CoxHealth.
• Expectations of the Resident
  • Meeting attendance, averaging a minimum of 6 hours of contact hours or program attendance per day for scheduled meeting days/non-travel days is expected (i.e., keynote address, residency showcase, Personal Placement Service, poster presentation, pharmacy school or ASHP socials, breakfast, or dinner programs, etc.). 
    • Proof of completed hours shall be submitted to the Chief Resident or RPD within 30 days from the return of the meeting.
  • Residents will be expected to attend all required meetings, showcases, and presentations as assigned prior to departure.
  • Residents will be expected to provide and/or present informational items to the pharmacy staff within 30 days from the return of the meeting.
  • Residents are expected to uphold the CoxHealth Compliance Code of Business Conduct and Ethics (i.e., “Code of Conduct”) at all professional/educational meetings.
    • Failure to adhere to these guidelines may result in immediate expulsion from the residency program.

Chief Pharmacy Resident

The Chief Pharmacy Resident is a PGY2 resident who manages and coordinates activities of all concurrent pharmacy residents, and delegates tasks to other residents as appropriate.  The Chief Pharmacy Resident acts as intermediary between the Residency Advisory Committees (RAC), the Residency Executive Committee, and residents; and provides leadership in all areas pertaining to pharmacy residency programs, monitoring the professional and personal well-being of each resident.

• Knowledge, Skills, and Abilities Required
  • Ability to communicate effectively, both orally and in writing
  • Skill in organizing participation in meetings and visits with other programs
  • Skill in examining and implementing new strategies and procedures
  • Ability to exercise leadership skills within the pharmacy department and among peers
• Application Process
  • A written letter of application (1 page or less) should be addressed and provided to the members of the Residency Executive Committee via the Springfield PGY1 RPD by July 30th of the residency year. This letter should highlight the applicant’s qualifications and cite specific examples of previous leadership. After the Residency Executive Committee reviews all applications, qualified candidates will interview with the Residency Executive Committee. The Residency Executive Committee will select and appoint one Chief Pharmacy Resident after the interview process is complete.
• Responsibilities
  • Serving as a liaison for residents during RAC meetings (both Springfield and Branson PGY1 RAC, and the Residency Executive Committee)
    • Chief to attend all RAC and Residency Executive Committee meetings, and communicate applicable information to appropriate RPD/committee as necessary
    • Chief to schedule monthly touchpoint with Springfield PGY1 RPD
  • Disseminating information of interest to all residents and coordinating resident activities
  • Representing residents at departmental and System functions; as well as at local, regional and/or national functions
  • Providing leadership and motivation to all residents as a colleague in clinical practice
  • Chief to schedule monthly touchpoints with residents (can be a group meeting after the monthly System Leadership Journal Club meetings)
  • Advising/coaching residents on feedback received as appropriate
  • Overseeing PGY1-PGY2 mentor/liaison relationships
  • Organizing and managing all resident travel throughout the year (ensuring hotels, flights and meeting registrations are completed in a timely fashion)
    • Process for registration, flights, and hotel reservations will typically start 2-3 months prior to meeting date(s)
    • Chief to coordinate with RPDs, residents, and Administrative Assistant (see Travel Policy)
    • Ensure all meeting attendees have shared contact information and a list of expectations (i.e., agenda, required meetings) prior to arrival
  • Coordinating resident participation in events
    • Convert all candidate information collected at recruitment events to an Excel that can be shared with all RPDs
    • Coordinate with RPDs/preceptors/residents a schedule for who needs to be present in the booth at what time (i.e., resident booth rotation)
    • Ensure all posters and recruitment materials make it to scheduled events and back
  • Assisting RPDs with interview date planning/set-up
  • Chairing the Preceptor of the Year Award Committee
  • Coordinating end-of-year events with Springfield PGY1 RPD in April
  • Assisting with any other residency related tasks as delegated by the RPD(s)
• Succession
  • If fthe Chief Pharmacy Resident is deemed unable to complete their responsibilities, the Residency Executive Committee will appoint an alternative Chief Pharmacy Resident.
• Relationships
  • Directly Reports to: PGY1 Pharmacy RPDs (Springfield and Branson)
  • Indirectly Reports to: PGY2 Pharmacy RPDs, Program Preceptors
  • Supervises:  PGY1 and PGY2 Pharmacy Residents

Residency Program Leadership

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Program Leadership Requirements

• Each residency program must have a single residency program director (RPD) who must be a pharmacist from a practice site involved in the program or from the sponsoring organization.
• The RPD must establish and chair a residency advisory committee (RAC) specific to that program as well as represent their program on the Residency Executive Committee (REC).
  • oversight of the residency program is accomplished by a combination of committees including a REC and RAC
  • RAC
    • committee membership includes RPD(s), preceptors, and pharmacy leaders.
    • ongoing program assessment will include
      • discussion of program improvement opportunities
      • discussion of applicant selection process outcomes
      • review of learning experiences
      • review of residents’ evaluations of preceptors and learning experiences
  • REC
    • committee membership includes residency program directors for all CoxHealth residency programs, chief resident, and a member of the steering committee
    • ongoing assessment includes
      • recruitment and selection of residents
      • program requirements and policies
      • structure, design and conduct of the residency program
      • annual program assessment

Residency Program Director Eligibility

PGY1 RPDs are licensed pharmacists from the practice site who:

• completed an ASHP-accredited PGY1 residency and a minimum of three years of relevant pharmacy practice experience;

or

• completed ASHP-accredited PGY1 and PGY2 residencies and a minimum of one year of relevant pharmacy practice experience;

or

• has a minimum of five years of relevant pharmacy practice experience if they have not completed an ASHP-accredited residency.

PGY2 RPDs are licensed pharmacists from the practice site who:

• completed an ASHP-accredited PGY2 residency in the advanced practice area, and a minimum of three years of additional practice experience in the PGY2 advanced practice area;

or

• has a minimum of five years of experience in the advanced practice area if they have not completed an ASHP-accredited PGY2 residency is the advanced practice area.

Residency Program Director Qualifications

RPDs serve as role models for pharmacy practice and professionalism as evidenced by:

• models and creates an environment that promotes outstanding professionalism (e.g., an environment free from harassment and bullying).
• maintaining BPS certification in the specialty area when certification is offered in that specific advanced area of practice (PGY2 RPDs only).
• contribution to pharmacy practice. For PGY2 RPD’s, this must be demonstrated relative to the RPD’s PGY2 practice area.
• ongoing participation in drug policy or other committees/workgroups of the organization or enterprise.
• ongoing professional engagement.
• modeling and creating an environment that promotes outstanding professionalism.
• maintaining regular and ongoing responsibilities in the advanced practice area in which they serve as RPDs (PGY2 RPDs only).

Residency Program Leadership Responsibilities

RPDs serve as organizationally authorized leaders of residency programs and have responsibility for:

• organization and leadership of a residency advisory committee that provides guidance for residency program conduct and related issues;
• oversight of the progression of residents within the program and documentation of completed requirements;
• implementing use of criteria for appointment and reappointment of preceptors;
• evaluation, skills assessment, and development of preceptors in the program;
• creating and implementing a preceptor development plan for the residency program;
• continuous residency program improvement in conjunction with the residency advisory committee; and,
• working with pharmacy administration.
• Annual program evaluation
  • assessment of methods for recruitment that promote diversity and inclusion.
  • end-of-the year input from residents who complete the program.
  • input from resident evaluations of preceptors and learning experiences.
  • input from preceptors related to continuous improvement.
  • documentation of program improvement opportunities and plans for changes to the program.

Preceptor Assessment, Appointment and Reappointment

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Appointment and Reappointment

The Residency Executive Committee will review all submitted ASHP Academic and Professional Records (APR) annually in June, and grant preceptor or preceptor-in-training (PIT) status based on ASHP eligibility criteria and expectations, as outlined below. Preceptors and/or PITs appointed or reappointed will be documented in the REC meeting minutes. For all preceptors not meeting ASHP eligibility criteria and expectations, a Preceptor Development Plan (PDP) will be created and submitted.

Initial Preceptor Assessment

• Initial assessment for potential preceptors shall include an interview with the Residency Program Director (RPD) to discuss preceptor eligibility criteria and expectations as outlined by the American Society of Health-System Pharmacists (ASHP) Standards. 
  • Preceptor candidates must review the following:
    • ASHP Standards for the residency program in which the preceptor will be precepting
    • ASHP competency areas, goals, and objectives of the residency program in which the preceptor will be precepting
  • Preceptor candidates must submit the following to the RPD for review and to the Residency Executive Committee (REC) for a vote:
    • ASHP preceptor Academic and Professional Record (APR)
    • One-time formal letter of intent or teaching philosophy, expressing desire to precept pharmacy residents
• Preceptor Eligibility
  • Preceptor must be a licensed pharmacist who:
    • has completed an ASHP-accredited PGY1 residency followed by a minimum of one year of pharmacy practice experience; or
    • has completed an ASHP-accredited PGY1 residency followed by and ASHP-accredited PGY2 residency and a minimum of six months of pharmacy practice experience; or 
    • without completion of an ASHP-accredited residency, have three or more years of pharmacy practice experience
• Preceptors’ Responsibilities
  • Preceptors serve as role models for learning experiences. They must:
    • contribute to the success of residents and the program;
    • provide learning experiences in accordance with Standard 3;
    • participate actively in the residency program’s continuous quality improvement processes;
    • demonstrate practice expertise, preceptor skills, and strive to continuously improve;
    • adhere to residency program and department policies pertaining to residents and services; and,
    • demonstrate commitment to advancing the residency program and pharmacy services.
• Preceptor Qualifications
  • Preceptors must demonstrate the ability to precept residents’ learning experiences by meeting one or more qualifying characteristics in all of the following six areas:
    • demonstrating the ability to precept residents’ learning experiences by use of clinical teaching roles (i.e., instructing, modeling, coaching, facilitating) at the level required by residents;
    • the ability to assess residents’ performance;
    • recognition in the area of pharmacy practice for which they serve as preceptors;
    • an established, active practice in the area for which they serve as preceptor;
    • maintenance of continuity of practice during the time of residents’ learning experiences; and,
    • ongoing professionalism, including a personal commitment to advancing the profession.

Ongoing Preceptor Assessment

• Preceptors will complete and submit an updated APR annually (December 31) to the program RPD and/or designee
• The RPD and/or designee will review submitted preceptor APR, resident-submitted ASHP Preceptor Evaluations, ASHP Learning Experience Evaluations, verbal feedback, and a resident-submitted CoxHealth Program Evaluation annually in the spring, which will be used to provide preceptors with ongoing assessment of performance
• Preceptor self-assessment
  • At the end of each learning experience, the preceptor is encouraged to self-assess precepting and the learning experience, using questions similar to the ASHP Preceptor Evaluation, to prompt self-reflection.
  • Preceptors will complete a self-evaluation of preceptor performance and their learning experience, as part of the annual CoxHealth Preceptor Needs Assessment.

Preceptor Development

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Preceptor Development Plans

• If a preceptor has deficiency in qualifications a specific development plan to meet all preceptor eligibility goals will develop in conjunction with RPD for the specific program, if precepting in more than one program all involved RPD will have input in the development plan
• Preceptor must meet eligibility within 2 years based on actionable plan.

Ongoing Preceptor Development 

• Direct feedback (verbally or in writing) from the RPD and/or designee will be provided to preceptors annually in June/July, at a minimum
• RAC attendance/review of RAC meeting minutes
• Completion of all assigned preceptor development educations via HealthStream
• Minimum attendance, live or virtual, at each of the following per calendar year (end December 31):
  • Two resident formal presentations (i.e., journal club or patient case)
  • One resident Grand Rounds
  • One resident final research practice presentation

Preceptor Development Plans

• It is an expectation that all preceptors are actively engaged in meeting and maintaining ASHP Preceptor Qualifications
• A preceptor development plan (PDP) will be created among the preceptor, RPD and/or designee/Pharmacy Administration, for the following:  
  • Preceptors who do not meet the minimum ASHP preceptor qualifications and/or completion of ongoing preceptor development criteria
    • Preceptors can refer to Preceptor Development Resources documents for contribution/experience ideas to meet minimum criteria.
  • Preceptors who receive a score of NEVER or FALSE from a resident on an ASHP Preceptor and/or Learning Experience Evaluation Form
• PDPs must include met vs. unmet preceptor qualifications, preceptor barriers, action items and follow-up timeline; and will be reviewed/updated annually by the preceptor, RPD, and/or designee.
  • If it is felt the preceptor has not made sufficient effort toward meeting ASHP Preceptor Qualifications by the RPD and/or designee, the issue will be brought before the REC. Preceptor status may be suspended with majority vote by the REC.
    • Suspended preceptors may resubmit for preceptor status after one year and evidence of improvement/meeting ASHP Preceptor Qualifications.
    • The decision to reinstate a suspended preceptor must be passed by both the RPD and majority vote by the REC.

Continuous Residency Program Improvement

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The CoxHealth Residency Executive Committee (REC), comprised of all CoxHealth Residency Program Directors (RPDs), as well as any Residency Coordinator(s) and/or designees, will meet quarterly (February, May, August, November) to:

• Update and maintain all residency-related documents across the system
• Identify program improvement opportunities for all programs across the system
• Review, appoint, and reappoint preceptors across all programs
• Provide preceptor development opportunities and resources
• Ensure all ASHP Standards are met

Revised 11/8/2023