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Nebraska Medicine

 Pharmacist Role, Education, & Training

Sub-Domain: Profession-Focused

Integrating Well-Being and Resiliency into a Pharmacy Residency Program

Submitted by Sonya Anderson, Pharm.D., Seth Stahl, Pharm.D., Alice Callahan, Pharm.D., Patrick Fuller, Pharm.D., BCPS, FASHP

Nebraska MedicineCase Overview

Nebraska Medicine has implemented initiatives designed to improve resident well-being and resiliency. Several years ago, Nebraska Medicine recognized the growing need for well-being resources for medical and nursing staff. A “Peers in Need of Support” (PiNS) program was initiated by Nebraska Medicine to serve as a resource for staff.

Dr. Patrick Fuller, residency program director for Nebraska Medicine’s PGY1 Pharmacy Practice residency program, also recognized the need for these well-being resources to support pharmacy residents and staff who may be struggling with the challenges of a rigorous program.

Dr. Fuller and other pharmacy staff completed training as a PiNS volunteer and educates residents about this resource during orientation. Additionally, through collaboration with Nebraska Medicine’s vice chancellor for campus wellness and the vice-president for educational strategy, Dr. Fuller implemented ideas from Nebraska Medicine’s medical residency wellness program into their pharmacy residency program.

This included measures to help identify different types of stress, use of coping mechanisms, and integration of pharmacy residents under the House Officer Assistance Program, which is dedicated to the health and well-being of its constituents. Through various initiatives, Nebraska Medicine has interwoven pharmacy resident well-being and resiliency with foundations of pharmacy practice to help ensure each resident’s success.

Key Elements

Previously, Nebraska Medicine had several informal initiatives to support resident well-being. A few years ago, Dr. Fuller helped formalize these initiatives into a resident wellness program. Key elements of the program involve wellness plans with scheduled meetings to discuss thoughtful questions, bonding days outside of the hospital setting, understanding baseline personality characteristics, monthly wellness challenges with rewards, and an emphasis on sleep.

Pre-pandemic, bonding days would consist of gatherings for game nights, sporting events, and cultural events. During the pandemic, residents have utilized these nights to virtually connect with their families and for personal time. Residents also meet with the vice chancellor of wellness at the beginning of the residency year to learn about stress management coping strategies and how to find balance throughout the residency year.

Outside of resident involvement, Nebraska Medicine also incorporates its pharmacy staff into residency wellness. Pharmacy staff and preceptors receive monthly wellness emails and well-being challenges. Nebraska Medicine’s Preceptor Development Committee also schedules periodic seminars to educate pharmacy staff and integrates well-being and stress management into the orientation month of each new residency class. These tools help to strengthen preceptor and staff resiliency which better equip them to support the residents. Each year presents unique challenges, and Nebraska Medicine continues to enhance its wellness program based on feedback from its residents.

Impact on Patient Outcomes

The wellness program has had a powerful impact on pharmacy staff and residents. While this may potentially lead to better self-care and well-being, it is not feasible to quantify this impact. However, these resource offerings have helped residents to grow personally and professionally.

One early component of understanding each resident’s baseline personality characteristics was the identification of a Grit score. Scores can range from 1 to 5 (with a score of 5 indicating strong grit) and represent an individual’s tendency to sustain interest in and effort towards long-term goals. Grit can be measured on an 8-item or 12-item scale developed by Angela Duckworth.

Through observation only, Dr. Fuller found that some residents whose baseline grit scores of 3.5 or lower tended to require increased wellness support, prompting more of a hands-on approach than other residents, though there is no direct correlation. The Grit score is just one of many tools that can be used to tailor support to residents. Continuous communication between the program director and residents is of vital importance and being present to support each resident has demonstrated excellent results since the program’s implementation.

Pharmacy and Pharmacist Roles

Both the residency program director and preceptors help ensure the successful incorporation of measures to improve resident well-being and resiliency. The residency program director is involved with assessing and strengthening resiliency initially and at each quarterly development meeting. By understanding each resident’s baseline characteristics and support systems, Dr. Fuller can tailor each resident’s customized development to maximize emotional and well-being support.

Preceptors and staff play an integral role at Nebraska Medicine in identifying and supporting resident well-being. With frequent resident-preceptor communication and checkpoints, preceptors can help identify early warning signs that a resident might be struggling and/or experiencing emotional exhaustion.

Lastly, pharmacy residents support each other. Through resident bonding days and various events, postgraduate year one and two residents are strongly encouraged to support each other inside and outside of Nebraska Medicine.

Lessons Learned

We learned that the “be here now” mindset should be considered—be present and listen to residents’ struggles and concerns. This can help foster empathy and understanding. Each resident has their own degree of personal, professional, and/or financial burdens to bear. Having just one person who is willing to listen could make a world of a difference for that resident.

Additionally, certain times of the residency year (e.g., October/November, February/March) may be more stressful. This may mean residents are experiencing additional external stressors in their lives during these timepoints. Re-emphasizing the use of wellness resources during these times was found to alleviate pressure and strengthen resilience.

Well-being and resilience have not historically been at the forefront of the pharmacy profession. It is important to find the right balance of providing employee support while holding employees accountable, and promotion of well-being and resilience from an organizational perspective presents new opportunities. Staff members who have a working understanding of well-being and resilience can help to start conversations about how best to support each other, including residents.

Like many other organizations throughout the COVID-19 pandemic, Nebraska Medicine has had a portion of its employees working from home. Employees who are working from home have maintained and continue to maintain strong productivity. This past year, residents were offered to take allotted project days and work from home instead of coming into their office. Feedback from residents was positive, and productivity did not diminish.

Budget & Resource Allocation

The program does not rely on external funding to support its key measures. While these residency well-being strategies were initially conducted as a part of a pilot program, they have become an integral part of the residency program.

Future Goals

Nebraska Medicine and other programs can learn from adaptations during the COVID-19 pandemic and apply these new experiences post-pandemic. Interviews across the board, whether it be for residencies, jobs, or otherwise, have primarily shifted to virtual platforms during the pandemic. This has allowed interviewees to cast a much larger net than was previously possible.

Components of this virtual interview format can continue to be applied post-pandemic. With the timing of swift COVID-19 restrictions and precautions, residency interviews were conducted virtually. Many aspects of the residency onboarding process were also changed to a virtual environment in 2020. Going forward, Dr. Fuller and his program are considering which onboarding aspects can be conducted virtually as opposed to in-person.

Implementation of the work-from-home model has sparked conversations in multiple industries about whether it was really necessary to have an employee on-site for the completion of work. Naturally, productivity at home has been a point of concern with this model.

Although Nebraska Medicine’s residents remained at the patient’s bedside throughout the pandemic, the program allowed its residents to work from home on allotted project days. Program directors noted no decline in resident productivity, and residents reported feeling more refreshed and productive when taking project days at home. As with any other industry reassessing the utility of remote workers, programs should reconsider what types of situations (e.g., project days, research) are appropriate for pharmacy residents to work from home if they choose to do so.