Crafting a Recipe for Research Success in Pharmacy Residency Programs

The American Society of Health-System Pharmacists (ASHP) and the American College of Clinical Pharmacy (ACCP) advocate for the inclusion of research or other project opportunities within postgraduate year 1 (PGY1) pharmacy residency programs as a means of utilizing scientific evidence to improve patient care and promote critical thinking, collaboration, and project management skills.^1,2 An estimated 36% to 40% of residency-trained pharmacists will publish in their career, emphasizing the increasing integration of scholarly activities within the pharmacy field, including both academic and non-academic practice settings.^3-5 However, despite approximately 80% of pharmacy residency programs including research as a program requirement,^6,7 residents often report poor confidence in their research skills, and their efforts result in publication rates as low as 1.8%.⁸ While these residents often have excellent “ingredients” to work from—motivation, supportive preceptors, unique practice settings and pharmacy initiatives—these alone are not enough. They need a recipe in place in order to know how to put the ingredients together and craft a publication. In this article, we share our best practices for establishing a successful and sustainable resident research program.

Tip 1. Get the Right Cooks in the Kitchen

Preparing to open a new restaurant often starts with identifying a head chef to lead the team and shape the menu’s concept. Leadership oversight is also necessary for an effective resident research program. Although residency preceptors affiliated with a college or school of pharmacy who are seeking to boost their scholarly productivity may have the greatest interest and investment in the research program’s success, we would suggest that the clinical coordinator affiliated with the residency program is often most suited to the role of chef de cuisine, as they can best liaise with upper leadership to secure administrative buy-in, advocate for increased program resources, outline the vision and goals for the program, and secure the commitment of their team. Other dedicated preceptors thus can adopt the role of the “sous chef” and work to execute the vision, handle program logistics, and identify clinical and operational needs. However, few restaurants could survive, let alone thrive and grow, if staffed by only one chef, no matter how passionate or highly skilled.

Similarly, laying the groundwork for a successful residency research program begins with recruiting a team of motivated pharmacists and expanding pharmacy services throughout the institution. Ensuring adequate staffing for clinical coverage allows more “breathing room” in the day to free up time for research endeavors and other professional growth opportunities associated with pharmacists’ career satisfaction.9 Since 2016, the clinical team at our institution, St. Joseph’s Hospital and Medical Center (SJHMC), has added 3 investigational drug services pharmacists who help the residents navigate the institutional review board (IRB) process, 8 clinical pharmacists who are involved in the daily clinical work flow, and 1 additional faculty pharmacist who is involved in experiential education and residency training.

Tip 2. Keep Your Pantry Well-Stocked Through Leadership Buy-in

Lack of administrative support has frequently been cited as a notable barrier to residency research efforts.^10,11 Just as even a top chef would struggle to prepare a quality meal in a cramped kitchen lacking pantry staples, the growth of a residency research program is likely to be similarly stymied without institutional support. The pharmacy leadership team, which includes clinical managers in addition to residency program directors, can contribute substantially to the success of residency research programs by fostering a departmental culture that promotes scholarship. For residency program directors and coordinators, this may include delineating the research project and select dissemination opportunities as program requirements, and explicitly naming publication as a goal. While it should be acknowledged and communicated to residents that publication may not always be achievable for every residency project and is secondary to skills development,² having publication in mind as the quality standard can help build a culture of excellence around research and lead to more successful research endeavors.¹²

For pharmacy managers seeking to boost their department’s research productivity, it is also important to demonstrate to their team that research is incentivized and valued. This includes recognizing research efforts in annual performance evaluations and raises, supporting pharmacists’ professional development in research (such as through full or partial reimbursement for the ASHP Research Skills Certificate or travel associated with the ACCP Focused Investigator Training Program), and allocating funding for statistical support and publication charges when feasible.

Pharmacy departments, like restaurants, operate under thin margins and “affording the pantry” represents a common barrier to providing residents with optimal research support.¹⁰ Potential solutions for programs include partnerships with colleges of pharmacy or more “resource-rich” institutions in order to take advantage of existing resources.^13,14 Integration of pharmacists within patient care teams can also help spark research questions and promote interdisciplinary research collaborations.15 This can allow the program to tap into the resources of other departments within the institution, which often have more expansive budgets for supporting research endeavors.

Image Credit: © Maksim Kostenko - stock.adobe.com

Tip 3. Design a Cohesive Menu

If you enter a New Orleans restaurant anticipating some authentic local cuisine, you would probably be surprised to see a hamburger on the menu. However, with locally sourced meat, Cajun spices, and sides of hush puppies and Maque Choux, the inclusion of the dish would start to make sense. Similarly, if you choose to incorporate presentations and topic discussions within your resident development program, it is encouraged to keep the content cohesive with the rest of your residency “menu.” In other words, research should not be presented as an ancillary, optional skill; rather, the tools needed for research success should be anchored to those used in residents’ clinical practice.

Structured research training and development programs have been shown to increase the likelihood of publication success while increasing resident satisfaction.16 Aligning research program outcomes with the overall goals of the residency program can help pharmacy faculty and preceptors interested in establishing a formal residency research training program best make the business case to pharmacy leadership that research education brings value to the residents and department beyond publication and is something that should be emphasized and supported. Cultivating a research mindset involves sparking residents’ curiosity while developing ownership, humility, resiliency, and a healthy skepticism—all traits that can be used to positively benefit patient care and interprofessional relationships.

Research programs additionally provide an excellent platform for residents to hone their communication skills by learning how to distill the results of a year-long project into its most salient components and convey a focused and clear message for their audience. At SJHMC, quarterly research update meetings are designed to increase resident comfort with communicating research methodology and outcomes in a low-stakes setting to strengthen their presentation skills. Study design and biostatistics reviews in particular represent often underutilized opportunities to tie research fundamentals to clinical practice. For example, at SJHMC a review of diagnostic test performance and sensitivity, specificity, and predictive value calculations is presented alongside an article on the predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction assay for diagnosis of MRSA pneumonia, fostering a discussion of the clinical implications of a positive or negative result as it relates to antibiotic therapy for pneumonia and whether the results can be used to support vancomycin or linezolid (Zyvox; Pfizer) discontinuation.

Tip 4. Watch the Clock!

For chefs executing a complex recipe, little time is spent standing still. The time needed for each of the dish’s components is planned down to the minute and fit together to minimize downtime and maximize efficiency. However, most new pharmacists do not enter residency with a honed understanding of the time involved in each of the steps needed to bring a research project to completion. Inherent to any PGY1 program, residents juggle multiple competing demands on their time and despite, in theory, having a full year to work on these demands, suboptimal time management is often a major reason why resident research is not published.⁸ We thus encourage programs to take a “work smarter not harder” approach to the structuring of any research program, aligning research education with the pacing of the residency project.

The research development series and update meetings within SJHMC’s program are designed to promote “micro-planning” and break down the components of the research project and its deliverables into a set of recommended progress points to promote effective pacing and time-management (Table 1).

For example, residents receive training on writing a manuscript’s introduction and methods in September, following the time the residents will have completed a literature search and protocol development for IRB submission. This allows the material to be directly applied at the time it is fresh and most relevant, rather than being forgotten later or presented as an overwhelming amount of information. We have found additionally that a quarterly presentation frequency for the residents represents the optimal balance between spurring research progress and promoting accountability while maintaining realistic workload expectations.

Tip 5. Taste as You Go

Even when they are preparing dishes for a well-established menu, chefs continue to taste, assess, and modify the amount of each ingredient throughout the cooking process as needed to reach the most harmonious balance of flavors. Similarly, resident research programs should build in mechanisms for assessment and reassessment of research feasibility. Early refinement of potential ideas into answerable research questions (for example, using the PICO [Patient-Intervention-Comparison-Outcome] framework) is particularly important as not all worthy ideas for investigation are suitable as resident research projects, but may be appropriate subjects of medication use evaluations or quality improvement projects.¹⁷ Continual reassessment and troubleshooting of arising issues allows for project modification as needed, for example cutting or simplifying a data point that requires an outsized amount of time to collect, and helps to avoid the “scope creep” that can result in projects ballooning out beyond their initial objectives.

Tip 6. Savor Your Success…and Build a Bigger “Dinner Table”

In line with the prior comments about establishing a research culture, it is important to celebrate and promote successful research efforts, particularly those describing outcomes of institutional initiatives and collaborations. This can include internal recognition through newsletters, committee meetings, and health system groups. We also suggest promoting resident research and any formal development programs on the residency website and other social media. Resident research training programs are rarely highlighted despite research requirements being common among PGY1 programs,¹⁸ which may serve as a differentiator and support resident recruitment efforts. Anecdotally, at SJHMC we commonly receive inquiries related to our research program from prospective residents, which has helped to widen our application pool and attract motivated candidates, which further increases the likelihood of publication.

In addition to opening up more avenues within the pharmacy community, as the success of our research program has gained attention within our institution, physician collaborators that initially the pharmacy department was recruiting to work on projects together are now coming to the pharmacy department with research ideas and resources. These resources have included funding for statistical expertise and meeting attendance to present data, institutional support for IT services and reports generation, and open access publication funding. Close collaboration within research has also benefited the relationship and trust within the clinical space as well.

Conclusion: Digesting it All

Developing a successful residency research program is challenging but enjoyable, with potential benefits to residents, preceptors and faculty, departments of pharmacy, and patient care as a whole. Just like the first time preparing a gourmet meal, the first iteration may not always come out the way the chef planned, but with continued enhancement and innovation it can become the talk of the town.

About the Authors

Kellie J. Goodlet, PharmD, BCIDP, BCPS, BCTXP, is an associate professor, Midwestern University College of Pharmacy, in Glendale, Arizona.

Michael D. Nailor, PharmD, BCPS, is a clinical specialist – infectious diseases, St. Joseph’s Hospital and Medical Center, in Phoenix, Arizona.

Christian Eslinger, PharmD, MBA, Meng, is a clinical pharmacy manager / PGY1 residency program director, St. Joseph’s Hospital and Medical Center, in Phoenix, Arizona.

Disclosures: Michael D. Nailor, PharmD, BCPS, has served as a consultant for Shionogi. All other authors have no relevant conflicts of interests to disclose.

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