Rocking Residency Research

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Patricia Poole, PharmD, BCPSAQ ID, AAHIVP Jeremiah J. Duby, PharmD, BCPS, BCCCP Rocking Residency Research: Effective Design, Process, & Practice Patricia Poole, PharmD, BCPSAQ ID, AAHIVP Clinical 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 Disclosure In 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. 2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice ©2018 American Society of Health-System Pharmacists Page 1 of 31

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(874-L04) Rocking Residency Research: Effective Design, Process, & PracticeJeremiah J. Duby, PharmD, BCPS, BCCCP
Rocking Residency Research: Effective Design, Process, & Practice
Patricia Poole, PharmD, BCPS AQ ID, AAHIVP Clinical Pharmacy Specialist, Ambulatory Practice
HIV Ambulatory Care Residency Program Director
UC Davis Medical Center
Rocking Residency Research
Disclosure In 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.
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice
©2018 American Society of Health-System Pharmacists Page 1 of 31
Disclaimer(s) industry ties: 
N/A
Ambulatory Care Pharmacist 
Residency Program Administrator
Associate Professor, Clinical Practice
Associate Professor, Pharmacy Practice 5
Rocking Residency Research 
Jeremiah J. Duby, PharmD, BCPS, BCCCP Clinical Pharmacy Specialist, Critical Care Critical Care Residency Program Director
UC Davis Medical Center Associate Clinical Professor
Touro University, College of Pharmacy UCSF, School of Pharmacy
UC Davis, College of Medicine 
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice
©2018 American Society of Health-System Pharmacists Page 2 of 31
Disclaimer(s) industry ties: 
N/A
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Affiliations
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Associate Professor, Clinical Practice
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.
development.
Illustrate how to use leverage and collaboration with the research 
oversight community to support faculty development and project 
management.
©2018 American Society of Health-System Pharmacists Page 3 of 31
Resident Research: Why product
process, resident, staff, culture 
training comprehensive skill set 
$$$
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PGY1: ~4.2%; PGY2: ~31%
barriers  insufficient time poor design  lack of novelty attitude resident and/or preceptor
factors that improve publication academic affiliation  results within abstract physician coauthor
Curr Pharm Teach Learn. 2015; 7(6): 892898. 12
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice
©2018 American Society of Health-System Pharmacists Page 4 of 31
Objectives Explore research topic selection
Create timeline of deadlines and deliverables
Prepare a proper data collection sheet 
Collaborate with biostatistician
Leverage PROC for faculty development & project management
Assemble the final product(s)
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• speed dating concept and tools (ACTIVITY)
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©2018 American Society of Health-System Pharmacists Page 5 of 31
Selection of the research topic
Research topic selection: Common Failures Mentor interview missing 
consider mentor availability and shared responsibility…
intellectual property ownership and publication planning
Forgetting interprofessional collaboration
Does anybody care?
this wasn’t a priority to LEADERSHIP after all
will this information translate to clinical practice
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Project vetting
begin with end in mind, who are the stakeholders and what brings 
value
Total Points and Making the cut
Pick the top 10, top 10%, those scoring at least 70 points
Speed Dating 18
©2018 American Society of Health-System Pharmacists Page 6 of 31
Project  → Quick Pitch
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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.
Ask about the cohort, preliminary number of subjects
Inquire about cocollaborators, other stakeholders
Selfreflection: does this inspire me? 21
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice
©2018 American Society of Health-System Pharmacists Page 7 of 31
No Love Connection?: Time to assign PROC and Leadership to identify priority projects
include proven mentors or create mentor collaborative
present to resident more than one option
Start smart 
Accountability
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Which of the following is not a focus of speed 
dating for research?
• Interprofessional collaboration 
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Failure: neglect missed deadlines, overbudgeting on data 
misadventures
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Objectives Create timeline of deadlines and deliverables
failure: missed deadlines, bad budgeting
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share brilliant concept, set high expectations, (drop mic), walk away…
• poor accountability = poor leadership
exhausting research budget without data analysis or write up 27
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice
©2018 American Society of Health-System Pharmacists Page 9 of 31
Timeline = Deadlines + Deliverables Deadlines
begin with end in mind (i.e. envision June 30th or July 31st)
maintain momentum: weekly meetings, monthly presentations
Deliverables
divide project into manageable objectives
design to finish (e.g. submit manuscript, present results)
Accountability 
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©2018 American Society of Health-System Pharmacists Page 10 of 31
Literature Review
Develop Hypothesis
Background & Methods
(Jun – Aug)
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Sketch Abstract
Write Manuscript
Build Poster
Create Presentation
Power Analysis
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Project Timeline → Calendar
orientation: introduce curriculum, preceptors, projects (early July)
August 1st: deadline for preceptor & project selection
Study protocol & IRB application
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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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
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©2018 American Society of Health-System Pharmacists Page 13 of 31
Interactive Scenario – Timeline Create or amend a basic timeline for your residency research.
checklist →  meline → calendar
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failure: mission creep
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Prepare a proper  data collection sheet 
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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
wrong type categorical (WNL) vs continuous (12 g/dL) 44
Data Collection: Security Keys
encrypted and password protected
Accountability
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©2018 American Society of Health-System Pharmacists Page 15 of 31
Data Collection: Strategy Budget
cost: 25 – 30 hours 
• 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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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 & reassess
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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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©2018 American Society of Health-System Pharmacists Page 16 of 31
Data Collection: Reproducibility Preparation
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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failure: inadequate statistical power, uninterpretable 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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selfexplanatory  [ ]
uninterpretable 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
brainstorm design phase
resident performs descriptive and basic inferential statistics means (SD), medians (IQR)…
t test, chisquared & 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
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice
©2018 American Society of Health-System Pharmacists Page 18 of 31
Better Graphics → Be er Results
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5757
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Better Graphics → Be er Results
5858
5959
6060
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Better Graphics → Be er Results
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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
multidisciplinary 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 Success 1. 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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failure: neglect
research project
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Objectives PROC community: meeting schedule topics, speakers
failure: neglect
research project
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Annual call for volunteers
Take attendance and give time away from rotations
Expect deliverables
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PROC Monthly Topics July, August, September
Speed dating, Cohort discovery, Literature search, Elevator pitch
October, November
May: Cancel in lieu of podium practice presentations
June: Manuscript drafted, closeout IRB
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Default for working meetings with less didactic
Biostatistician
IRB Representative
Research publication panel
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
ALSO: tell a story, 
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
Resident opportunity to view other presentations/critiques
Requires committed preceptors/staff
Leadership input ideal
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Pimp up your PowerPoint What not to do: 
tiny font, nonreadable, verbatim script, include data that is irrelevant, 
text excess, embed video or animation that won’t work
ALSO:
Consider corporate identity
Preplan 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 Selection 656 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
(n=3)
Post Group  (n=108)
(n=3)
Did not meet with  a pharmacist 
(n=57)
2 prisoners, 1 did not complete intake
3 pregnant women
AML = acute myeloid leukemia; APL= acute promyelocytic leukemia; ALL= acute lymphocytic leukemia 
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Interactive Scenario – Resources 1. What external resources do you use for faculty/staff 
development?
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Resources ASHP Foundation
ACCP Research Institute
Research and Scholarly Academy 
Research Fundamentals
• measurement 
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Journals
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Key Takeaways Start early!!  
Start smart project pitch form & speed dating concept
Research calendar deadlines & deliverables
Sample data collection sheets and coding show, rather than tell
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SelfAssessment Questions 1. Identify barriers to successful residency research from the 
following options.
SelfAssessment Questions 1. Identify barriers to successful residency research from the 
following options.
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SelfAssessment Questions 2. List one resource for creating a research curriculum.
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SelfAssessment Questions 2. List one resource for creating a research curriculum.
ASHP Foundation
Research and Scholarly Academy 
Jeremiah J. Duby, PharmD, BCPS, BCCCP
Rocking Residency Research
©2018 American Society of Health-System Pharmacists Page 30 of 31
UC Davis Health Pharmacy Residency  Class of 20162017
2018 National Pharmacy Preceptors Conference Rocking Residency Research: Effective Design, Process, & Practice