Development of an Educational Sabbatical Program for Pharmacists

INTRODUCTION The University Health Network (UHN) is an acute care teaching hospital providing clinical services at 3 sites in Toronto, Ontario. It serves a large and diverse community that includes local, regional, and provincial populations, as well as out-of-province and out-of-country clients. The patient care continuum covers the full spectrum from primary care to highly specialized tertiary care services. Pharmacists work within 1 of 5 clinical teams aligned with priority programs under the direction of clinical leaders. The pharmacists (mean number per team = 13) are responsible for decentralized distribution and clinical services in the team’s assigned area: cardiology, cardiovascular surgery, and cardiovascular intensive care; transplant, medical/surgical intensive care, general surgery, and psychiatry; general medicine, nephrology, hemodialysis, urology, respirology, and surgery; general medicine, neurology, rheumatology, othopedics, medical/surgical intensive care; and oncology. When a pharmacist is hired, he or she is assigned to one of these teams according to where a position is available; if possible, pharmacists are assigned to positions that correspond with their practice interests. Details about the team and the therapeutic area are specified in job postings, which facilitates recruitment of pharmacists with appropriate interests. Pharmacists work only within their own team area; thus, over time, they develop highly specialized practices and clinical skills. Although this arrangement means that pharmacists are able to consistently offer comprehensive, high-level clinical services, it also limits their exposure to areas of practice outside their team’s activities. The Pharmacy Department employs approximately 100 pharmacists, ranging from new graduates to long-term employees with more than 25 years of experience, many of whom have completed or are in the midst of postgraduate education, including studies toward doctorate of pharmacy (PharmD), master of business administration, and master’s degrees in bioethics, clinical epidemiology, and health administration. This large and varied group offers the department strength through diversity and challenges the department to develop retention strategies that will stimulate and support all staff members. A significant change to human resource management strategies in recent years is the increasing emphasis on long-term staff retention.1,2 Staff satisfaction and retention have been positively linked to supportive work environments that foster professional development, mentorship, and succession planning.2,3 This shift has been further supported by the Canadian Council on Health Services Accreditation, which has identified the need for hospitals to “provide ongoing training to cope with changing roles, competency demands and working relationships”.4 At UHN, although staff have enjoyed the stability of working within specific clinical areas, it was recognized that many individuals with specialized practices also had an interest in expanding their horizons. In the past, a clinical pharmacist with an interest in another therapeutic program had to either wait until a position became available within the new area or leave the organization to pursue a job within the chosen field of interest. UHN human resource data showed that the period of greatest vulnerability for loss of pharmacists occurred after staff had been at the institution for 3 to 5 years. Exit interviews also indicated that the reason for moving to another organization was often to pursue new areas of clinical practice or leadership positions. In an employee satisfaction survey conducted in the Pharmacy Department in 2002 (n = 125), 50% of respondents rated recognition and compensation as “good” to “excellent”, and 41% of respondents rated organizational commitment as “good” to “excellent”. Therefore, departmental leadership was interested in supporting staff growth and career development while minimizing staff loss. As an academic health science centre, UHN has developed experiential learning programs for new pharmacists (e.g., undergraduate exposures, postgraduate residencies, doctorate of pharmacy rotations). It was felt that this expertise could be used to develop an innovative experiential program to address the continuing education needs of staff pharmacists and to potentially act as a retention incentive. Therefore, the Educational Sabbatical Program (ESP) was launched in 2004. Several clinical training programs for staff pharmacists, primarily in the United States, have previously been described.5-9 In general, these programs are 3 to 18 months in duration and incorporate a mix of lectures, didactic course work (often done on the pharmacist’s own time), and some experiential learning, with or without formalized testing or certification of the pharmacist upon completion of the program. One program was formulated as an additional position that was filled on a 6-week rotating basis by staff pharmacists, who received clinical training under supervising clinical pharmacists.8 The authors found that, on average, completion of at least 2 or 3 rotations was necessary for distribution pharmacists to develop and maintain desired drug information and clinical skills. In the late 1970s, a 2-week mini-residency in drug information for pharmacists was developed by the University of Washington Drug Information Service and the University of Washington School of Pharmacy’s Division of Continuing Education.10 Overall, these programs were successful in training distribution pharmacists with little to no previous clinical experience to practise as clinical pharmacists. To the authors’ knowledge, no such exposure or training program has been described for staff pharmacists with high-level clinical skills who wish to gain experience in a different practice area.

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