Rocking Residency Research - ASHP
Transcript of Rocking Residency Research - ASHP
Patricia Poole, PharmD, BCPS‐ AQ ID, AAHIVP
Jeremiah J. Duby, PharmD, BCPS, BCCCP
Rocking Residency Research: Effective Design, Process, & Practice
Patricia Poole, PharmD, BCPS‐ AQ ID, AAHIVPClinical Pharmacy Specialist, Ambulatory Practice
HIV Ambulatory Care Residency Program Director
UC Davis Medical Center
Associate Clinical Professor
UCSF, School of Pharmacy
UC Davis, College of Medicine
Rocking Residency Research
DisclosureIn accordance with the ACPE’s and ACCME’s Standards for Commercial Support, anyone in a position to control the content of an educational activity is required to disclose their relevant financial relationships. In accordance with these Standards, ASHP is required to resolve potential conflicts of interest and disclose relevant financial relationships of presenters.
• In this session:
All planners, presenters, reviewers, and ASHP staff report no financial relationships relevant to this activity.
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Disclaimer(s)➢ industry ties:
▪ N/A
➢ off‐label medication use or product promotion:
▪ N/A
➢ other financial interest(s):
▪ N/A
➢ perspective:
▪ Academic medical center
▪ Ambulatory care pharmacist, Residency Administrator
▪ P‐ROC co‐chair4
Affiliations➢ University of California, Davis
▪ Ambulatory Care Pharmacist
• (UCDMC and One Community Health)
▪ Residency Program Administrator
➢ U.C. Davis, College of Medicine
▪ Associate Professor, Clinical Practice
➢ U.C. San Francisco, College of Pharmacy
▪ Associate Professor, Pharmacy Practice5
Rocking Residency Research
Jeremiah J. Duby, PharmD, BCPS, BCCCPClinical Pharmacy Specialist, Critical CareCritical Care Residency Program Director
UC Davis Medical CenterAssociate Clinical Professor
Touro University, College of PharmacyUCSF, School of Pharmacy
UC Davis, College of Medicine
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Disclaimer(s)➢ industry ties:
▪ N/A
➢ off‐label medication use or product promotion:
▪ N/A
➢ other financial interest(s):
▪ N/A
➢ perspective:
▪ academic medical center
▪ critical care pharmacist, residency program director
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Affiliations
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➢ University of California, Davis
▪ Critical Care Pharmacist (UCDMC)
▪ Critical Care Residency Program Director
▪ Assistant Clinical Professor of Medicine
➢ Touro University, College of Pharmacy
▪ Associate Professor, Clinical Practice
➢ U.C. San Francisco, College of Pharmacy
▪ Assistant Professor, Pharmacy Practice
Learning Objectives➢ Describe effective methods to design, process and practice of clinical
research projects.
➢ Develop essential skills needed as a preceptor to develop clinical research
projects.
➢ Demonstrate timelines, deadlines and deliverables in project
development.
➢ Illustrate how to use leverage and collaboration with the research
oversight community to support faculty development and project
management.
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Resident Research: Why➢ product
▪ process, resident, staff, culture
➢ training▪ comprehensive skill set
▪ future project preceptors and managers
➢ CQI ▪ data‐driven, methodologically robust
▪ $$$
➢ recruitment & retention strategy▪ goal & expectation of high‐level talent
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Resident Research: Opportunity
420,000+ person hours
~100 hours
4,217 residents
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Even the Odds➢ publication rate
▪ PGY‐1: ~4.2%;▪ PGY‐2: ~31%
➢ barriers ▪ insufficient time▪ poor design ▪ lack of novelty▪ attitude resident and/or preceptor
➢ factors that improve publication▪ academic affiliation ▪ results within abstract▪ physician co‐author
Curr Pharm Teach Learn. 2015; 7(6): 892‐898. 12
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Objectives➢Explore research topic selection
➢Create timeline of deadlines and deliverables
➢Prepare a proper data collection sheet
➢Collaborate with biostatistician
➢Review research design and basic biostatistics
➢ Leverage PROC for faculty development & project management
➢Assemble the final product(s)
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Objectives➢Explore research topic selection
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Objective➢Explore research topic selection
▪ failure: bad matches, bad ideas
• speed dating concept and tools (ACTIVITY)
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Selection of theresearch topic
Research topic selection: Common Failures➢ Mentor interview missing
▪ consider mentor availability and shared responsibility…
▪ intellectual property ownership and publication planning
➢ Forgetting inter‐professional collaboration
▪ starts in pharmacy → stays in pharmacy?
➢ Does anybody care?
▪ this was already done/question answered
▪ this wasn’t a priority to LEADERSHIP after all
▪ will this information translate to clinical practice
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Project = Idea + Mentor➢ Quick Pitch
➢ Project vetting
▪ begin with end in mind, who are the stakeholders and what brings
value
▪ Scorecard session with pharmacy leadership
▪ (Director, P&T Chair, Clinicians)
➢ Total Points and Making the cut
▪ Pick the top 10, top 10%, those scoring at least 70 points
➢ Speed Dating18
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Project → Quick Pitch
Insert the quick pitch outline
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Project Ve. ng → Scoring Points
Speed Dating (ACTIVITY)➢ SCORE the Sample Project Provided
➢ Pitch the Project if your Birthday is an ODD month.
• You are the Mentor
➢ Interview the Project Mentor if your Birthday is in an EVEN month.
▪ You are the resident.
➢ Assess the research mentor’s availability, commitment, track record
▪ Ask about the cohort, preliminary number of subjects
▪ Inquire about co‐collaborators, other stakeholders
▪ Self‐reflection: does this inspire me?21
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No Love Connection?: Time to assign➢P‐ROC and Leadership to identify priority projects
▪ include proven mentors or create mentor collaborative
▪ present to resident more than one option
➢Start smart
▪ make the commitment by August 1st
➢Accountability
▪ monthly P‐ROC meeting attendance and deliverables
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Self‐assessment:
Which of the following is not a focus of speed
dating for research?
• Feasibility, access to cohort, timeline
• Results translatable to clinical practice
• Inter‐professional collaboration
• Research mentor enthusiasm about project
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Objectives➢Create timeline of deadlines and deliverables
Failure: neglect missed deadlines, over‐budgeting on data
misadventures
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Objectives➢Create timeline of deadlines and deliverables
▪ failure: missed deadlines, bad budgeting
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Create timeline of deadlines and deliverables
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Project Timeline: Common Failures➢ Neglect
▪ share brilliant concept, set high expectations, (drop mic), walk away…
• poor accountability = poor leadership
➢ Missed deadlines
▪ lost momentum → lost project
➢ Poor planning
▪ skipping literature search
▪ under‐estimating time necessary for data collection
▪ exhausting research budget without data analysis or write up27
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Timeline = Deadlines + Deliverables➢ Deadlines
▪ begin with end in mind (i.e. envision June 30th or July 31st)
▪ maintain momentum: weekly meetings, monthly presentations
➢ Deliverables
▪ def ne goals: end product(s) → target audience(s)
▪ divide project into manageable objectives
▪ design to finish (e.g. submit manuscript, present results)
➢ Accountability
▪ present progress, defend work, troubleshoot obstacles
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Project Timeline → Checklist
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Background & Methods
(Jun – Aug)
Data CollectionSep - Dec
Analysis(Jan – Mar)
Dissemination (Apr – Jun)
100 – 120 hours
Project Timeline: Budgeting
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LiteratureReview
Develop Hypothesis
Draft Study ProtocolBackground &
Methods(Jun – Aug)
Data CollectionSep - Dec
Analysis(Jan – Mar)
Dissemination (Apr – Jun)
100 – 120 hours
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Draft data collection sheet
Collect Data(20 – 30 hours)
Collect 1st ptwith preceptor
Background & Methods
(Jun – Aug)
Data CollectionSep - Dec
Analysis(Jan – Mar)
Dissemination (Apr – Jun)
100 – 120 hours
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Power Analysis
Interpret Results
Mock Up Tables & Figures
Preliminary Statistical Analysis
Background & Methods
(Jun – Aug)
Data CollectionSep - Dec
Analysis(Jan – Mar)
Dissemination (Apr – Jun)
100 – 120 hours
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SketchAbstract
WriteManuscript
Build Poster
CreatePresentation
100 – 120 hours
Background & Methods
(Jun – Aug)
Data CollectionSep - Dec
Analysis(Jan – Mar)
Dissemination (Apr – Jun)
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Draft data collection sheet
Collect Data(20 – 30 hours)
Collect 1st ptwith preceptor
Power Analysis
Mock Up Tables & Figures
Preliminary Statistical Analysis
SketchAbstract
WriteManuscript
Build Poster
CreatePresentation
LiteratureReview
Develop Hypothesis
Draft Study Protocol
Interpret Results
100 – 120 hours
Background & Methods
(Jun – Aug)
Data CollectionSep - Dec
Analysis(Jan – Mar)
Dissemination (Apr – Jun)
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Project Timeline → Calendar
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Preventing Delays (Before They Happen)➢ Start early, start fast
▪ orientation: introduce curriculum, preceptors, projects (early July)
▪ August 1st: deadline for preceptor & project selection
➢ Study protocol & IRB application
▪ create template for study protocol
▪ resource page: links to human subjects training & IRB
▪ share access to previous study protocols and IRBs
▪ invite IRB liaison to present to residents
▪ Oct 1st: deadline for submission of IRB application
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Preventing Delays: Show, Don’t Tell➢ Identify patient cohort
▪ include in project proposal
▪ perform screening for subjects as 1st step of data collection
➢ Start smart
▪ collect 1st few patients with resident to pilot data collection
▪ show resident where and how to efficiently find data points
▪ simplify & organize data collection sheet
➢ Accountability
▪ meet weekly: review progress; identify & troubleshoot obstacles
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Interactive Scenario – Timeline➢Create or amend a basic timeline for your residency research.
▪ checklist → � meline → calendar
Jun – Aug‐‐‐
Sep – Nov‐‐‐
Dec – Feb‐‐‐
Mar – May‐‐‐
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Objective➢Prepare a proper data collection sheet
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Objective➢Prepare a proper data collection sheet
▪ failure: mission creep
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Prepare a proper data collection sheet
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Data Collection: Common Failures➢ running out of time
▪ mission creep (columns AA, AB, AC…)
▪ collecting too much detail (on too few subjects)
➢ forgetting why you collected _______, _______, and _______
➢measuring or collecting wrong data
▪ incorrect
▪ imprecise: 8/18/2017 vs 8/18/2017 09:15 – 08/18/2017 10:30
▪ wrong type categorical (WNL) vs continuous (12 g/dL)44
Data Collection: Security➢Keys
▪ de‐identified
• code sheet: subject # → MRN (only)
▪ encrypted and password protected
▪ backed up on share drive or thumb drive
▪ use standard system for saving and sharing files
➢Accountability
▪ ensure data is properly stored & secured
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Data Collection: Strategy➢ Budget
▪ cost: 25 – 30 hours
• 60 subjects: 1 min = 1 hour
• more data points = ↓ subjects, ↓ analysis, ↓ probability of success
▪ options: a) do it now, b) schedule it, c) forget about it, d) stress
▪ set deadlines for 25%, 50%, 100% of target subject #
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Data Collection: Strategy➢ Economy: sprint
▪ collect as little as possible (for retrospective studies)
▪ focus on baseline, primary endpoint, 1 – 2 secondary endpoints
▪ perform prelim. analysis on 30 – 50% target sample & re‐assess
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Data Collection: Reproducibility➢ Data dictionary
▪ explain purpose for every data point
• work backwards from tables, figures, etc.
▪ describe what, where, how
▪ translate code (SOFA_A = admit SOFA score; 0 = male, 1 = female)
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Data Collection: Reproducibility➢ Preparation
▪ train resident in data collection
▪ provide example data sheets to avoid starting from zero
➢ Accountability
▪ data audit by preceptor (5 – 10% subjects)
▪ focus on 1 – 2 critical elements (e.g. primary endpoint, severity of illness)
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Objectives➢Collaborate with biostatistician
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Objectives➢Collaborate with biostatistician or DIY
▪ failure: inadequate statistical power, un‐interpretable results,
(and other unpleasant misadventures)
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collaborate with a biostatistician*
*disclaimer: no statistician or statistical test(s) can correct or compensate for poorly conceived study questions or bad study designs
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Biostats 101: Common Failures➢data dump(s)
▪ self‐explanatory [ ]
➢no statistical power calculation
▪ symptom of poor overall design → poor execu� on
➢un‐interpretable results
▪ tests: if you cannot spell and/or say it, then you cannot use it
▪ complex analysis to compensate for poor design and/or
insufficient data
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Biostatistics: Healthy Habits➢ involve biostatistician early & often
▪ brainstorm design phase
▪ review data collection sheet
▪ perform early preliminary analysis (25% target sample)
➢ resident performs descriptive and basic inferential statistics▪ means (SD), medians (IQR)…
▪ t test, chi‐squared & Fischer’s exact test, sensitivity & specificity
➢ accountability: project management▪ identify areas for biostatistician to help and double check
▪ show resident how to perform tests (and double check results)54
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Better Graphics → Be� er Results
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Better Graphics → Be� er Results
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Better Graphics → Be� er Results
5757
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Better Graphics → Be� er Results
5858
Better Graphics → Be� er Results
5959
Better Graphics → Be� er Results
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Better Graphics → Be� er Results
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Biostatistician: Opportunities➢ $$$ opens/closes doors
▪ leverage existing staff with stats skills• provide protected time (admin)
• offset time (preceptor or resident)
➢ lab or workshop▪ perform stats as group with support of “super users”
➢ collaborate ▪ work in teams (oncology, ID, critical care)
▪ local university faculty
▪ multi‐disciplinary teams
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Interactive Scenario – Power Calculation 1. Determine the sample size necessary to identify a 25% size
effect with a beta of 0.8 and alpha of 0.05.
▪ https://www.stat.ubc.ca/~rollin/stats/ssize/
2. Determine how many additional subjects are needed to detect
a difference between groups below (β = 0.95, α = 0.05).
▪ cohort 1 (n = 90) : cost of care = $8,540 + 4,230
▪ cohort 2 (n = 80): cost of care = $7,202 + 3,805
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Practice Reflection – Measuring Success1. How do you currently measure the success of your residency
research?
2. What internal marketing methods do you use to disseminate
your work within your institution?
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Measuring Success➢publication
▪ number (%), quality
➢poster presentations
➢media (news, social)
➢preceptor & resident survey
➢ cost savings
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Objectives➢P‐ROC community: meeting schedule‐‐ topics, speakers
▪ failure: neglect
➢Putting together the final power point & delivery of the
research project
▪ failure: bad delivery
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Objectives➢P‐ROC community: meeting schedule‐‐ topics, speakers
▪ failure: neglect
➢Putting together the final power point & delivery of the
research project
▪ failure: bad delivery
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P‐ROC community: meeting schedule‐‐ topics, speakers
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P‐ROC Community➢Staff and Preceptors
▪ Annual call for volunteers
▪ Committee appointment letters
▪ Lunchtime meeting
▪ Occasional personal reminders
➢All PGY‐1 and PGY‐2 Residents
▪ Take attendance and give time away from rotations
▪ Expect deliverables
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P‐ROC Monthly Topics➢ July, August, September
▪ Speed dating, Cohort discovery, Literature search, Elevator pitch
➢October, November
▪ Power analysis, Data collection sheet, Statistical design
➢ January, February: Data collection and Abstract submitted
➢March, April: Data analysis, graphs and charts
➢May: Cancel in lieu of podium practice presentations
➢ June: Manuscript drafted, close‐out IRB
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P‐ROC Guest Speakers➢P‐ROC co‐chairs
▪ Default for working meetings with less didactic
➢Biostatistician
▪ Scope of service and self‐service with Excel
➢ IRB Representative
▪ Forms, contact information, definitions, timeline
➢Regional Conference Podium presentation panel
➢Research publication panel
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Putting together final power point & delivery of the research project
poised and professional
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Podium Presentation Panel➢ What not to do:
▪ don’t light up pointer for longer than 1 second
▪ monotone lullaby
▪ the dreaded, uhs and ums
➢ ALSO:▪ tell a story,
▪ know your data,
▪ pre‐plan your Q&A discussion with extra slides,
▪ know your stats and use proper verbiage
▪ relate to audience, relax, PRACTICE!!!
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Podium Practice Sessions➢Scheduled 3 weeks prior to final presentation date:
▪ Presentation includes research mentor and stakeholder input
▪ Timed
▪ Detailed slide‐by‐slide feedback, verbally and in writing
▪ Resident opportunity to view other presentations/critiques
▪ Requires committed preceptors/staff
▪ Leadership input ideal
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Podium Practice Sessions
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Pimp up your PowerPoint➢ What not to do:
▪ tiny font, non‐readable, verbatim script, include data that is irrelevant,
text excess, embed video or animation that won’t work
➢ ALSO:
▪ Follow directions (scale, template, disclosures, objectives)
▪ Consider corporate identity
▪ Use graphics and flow diagrams to clarify data
▪ Pre‐plan next presentation, manuscript, poster
▪ Have resident save serial versions in their portfolio (feedback)76
PowerPoint Critique (ACTIVITY)➢Review the following slides and identify:
▪ The one that is most readable
▪ The one that best tells the story
▪ The one that looks the most polished
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Patient Selection656 Patients were available for review during time period
105 Charts were reviewed in chronological order based on discharge date
28 Patients excluded 25 age < 18 3 deceased
77 Charts included in analysis
36 CAP Patients
19 HAP Patients
2 VAP Patients
20 HCAP Patients
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Research Methodology
Pre Group(n=106)
Did not meet inclusion criteria
(n=3)
Met inclusion criteria (n=103)
Post Group (n=108)
Did not meet inclusion criteria
(n=3)
Met inclusion criteria (n=105)
Did not meet with a pharmacist
(n=57)
Met with a pharmacist (n=48)
2 prisoners, 1 did not complete intake
3 pregnant women
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Results
Patients Screened
n = 265
Included Patients
n = 152
AMLn = 92
APLn = 18
ALLn = 42
Excluded Patients
n = 113
AML = acute myeloid leukemia; APL= acute promyelocytic leukemia; ALL= acute lymphocytic leukemia
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Interactive Scenario – Resources1. What external resources do you use for faculty/staff
development?
1. What is your research curriculum for the residents?
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Resources➢ASHP Foundation
➢ACCP Research Institute
➢Mentored Research Investigator Training (MeRIT) Program
➢Research and Scholarly Academy
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Resources➢ASHP Foundation
▪ Essentials of Practice‐Based Research for Pharmacists
▪ Research Fundamentals
▪ Tips for New Investigators
• literature review
• study design
• cohort and case‐controlled studies
• measurement
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Resources➢Grant writing
▪ tutorials (NIAID)
➢Biostatistics
▪ Introduction to Biostatistics (Yale)
▪ Statistical Reasoning I (Johns Hopkins)
➢ Journals
▪ Scimago Journal Ranking
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Key Takeaways➢ Start early!!
▪ All projects confirmed Aug 1st
➢ Start smart▪ project pitch form & speed dating concept
➢ Research calendar▪ deadlines & deliverables
➢ Engage staff and leadership ▪ preceptors, teams, working meetings, panels, project vetting
➢ Sample data collection sheets and coding▪ show, rather than tell
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Self‐Assessment Questions1. Identify barriers to successful residency research from the
following options.
A. insufficient time
B. biostatistician
C. physician collaboration
D. academic affiliation
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Self‐Assessment Questions1. Identify barriers to successful residency research from the
following options.
A. insufficient time
B. biostatistician
C. physician collaboration
D. academic affiliation
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©2018 American Society of Health-System Pharmacists Page 29 of 31
Self‐Assessment Questions2. List one resource for creating a research curriculum.
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Self‐Assessment Questions2. List one resource for creating a research curriculum.
▪ ASHP Foundation
▪ ACCP Research Institute
▪ Mentored Research Investigator Training (MeRIT) Program
▪ Research and Scholarly Academy
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Patricia Poole, PharmD, BCPS‐ AQ ID, AAHIVP
Jeremiah J. Duby, PharmD, BCPS, BCCCP
Rocking Residency Research
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice
©2018 American Society of Health-System Pharmacists Page 30 of 31
UC Davis Health Pharmacy Residency Class of 2016‐2017
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