Abstract
Purpose:
To provide a description of a pharmacy residency rotation dedicated to medical writing developed at a tertiary care academic medical center.
Summary:
Contribution to the medical literature is an important component of professional pharmacy practice, and there are many benefits seen by practitioners actively involved in scholarly activities. Residency programs have an opportunity to expand beyond the standard roles of postgraduate pharmacist training but rarely is there formal instruction on medical writing skills or are scholarship opportunities provided to residents. In order to address this deficiency, a residency program may consider the implementation of a formal Medical Writing rotation. This rotation is designed to introduce the resident to medical writing through active discussion on medical writing foundational topics, engage the resident in a collaborative review of a manuscript submitted to a peer-reviewed professional journal, and support the resident in the design and composition of manuscript of publishable quality.
Conclusion:
A structured Medical Writing rotation during a pharmacy resident’s training can help develop the skills necessary to promote scholarly activities and foster resident interest in future pursuit of professional medical writing.
Introduction
Contribution to the medical literature is an important component of pharmacy practice and there are many benefits seen by the practitioners actively involved in scholarly activities. 1 These benefits may include the enhancement of clinical practice, professional advancement, and personal satisfaction. However, there are often barriers to scholarship for clinicians including limited administrative time, teaching requirements, lack of awareness of opportunities, and other patient care responsibilities. 1,2 One identified method to overcome these barriers includes creating a stronger foundation in scholarship through the incorporation of dedicated learning opportunities into a postgraduate pharmacy residency program, which is often lacking during traditional pharmacist training programs.
Although residency training plays a pivotal role in developing clinicians, rotation experiences vary depending on the practice site. Many residency programs are expanding beyond the standard clinical, administrative, and distributional duties of the resident pharmacist. Implementation of experiences such as teaching certificates, advanced research projects, and completion of certificate or degree programs are examples of some recent additions to program curriculums. Scholarship development would be another option for residents to gain broad exposure to pharmacy practice.
Many postgraduate pharmacy residency programs require their residents to complete a manuscript of publishable quality as the final product of the longitudinal residency research project. 3 Although this practice has the potential to give the resident direct experience in medical writing, there is rarely formal instruction on medical writing skills, and often the publishing process of these manuscripts is not pursued. In addition, there are often limited opportunities to introduce residents to other scholarship experiences such as writing and publishing case reports or review articles and peer reviewing for professional journals. In order to fill this gap in knowledge, a residency program may consider the design and implementation of a Medical Writing rotation.
Although other residency rotations have previously been described in the literature, the available resources on developing a rotation dedicated specifically to medical writing have been limited. One particular article describes an academic teaching rotation for postgraduate year 1 (PGY1) pharmacy residents. During the month-long academic teaching rotation, the resident was assigned a writing project to simulate the activities required of faculty members. Many topics were discussed including brainstorming, literature review, and manuscript submission during the rotation. This article helped expose pharmacy residents to scholarly activities in preparation for future career expectations. 4 Another descriptive report assesses an innovative education method in order to increase medical residents’ research involvement. This program provided basic research tools and a structured research program that included house staff mentoring, participation in journal clubs, medical writing instruction, and research engagement. Seminars were delivered monthly throughout the residency year and included information on basic statistics, introduction to the institutional review board, searching electronic databases, and other topics of interest focused on research. Particular emphasis of the research program was placed on projects that could be completed in 1 month. After 1 year of this program, there were significant increases in the number of research submissions to physician conferences and a 110% increase in scholarly activity from 2010 to 2011 to 2011 to 2012. 5
Therefore, the function of a Medical Writing rotation is to provide an in-depth introduction to medical writing for each pharmacy resident completing the rotation. This experience may be particularly appealing to pharmacy residents with academia aspirations, but the Medical Writing rotation also creates a foundation for all residents that can be carried forward in any professional track. The purpose of this article is to describe the design and implementation of a pharmacy residency rotation dedicated to medical writing developed at a tertiary care academic medical center.
Practice Setting
The Durham VA Medical Center is a 271-bed tertiary care referral, teaching, and research facility affiliated with Campbell University College of Pharmacy and Health Sciences, the University of North Carolina Eshelman School of Pharmacy, and the Duke University School of Medicine. The current residency program includes 3 PGY1 pharmacy practice residents and 2 PGY2 pharmacy residents specializing in geriatrics. Completion of the Medical Writing rotation is mandatory for all PGY2 residents and an elective option for PGY1 residents.
To date, 5 PGY2 residents have completed the Medical Writing rotation since its implementation into the residency curriculum. The residents’ work on this rotation directly led to the publication, or acceptance for publication, of 5 articles in peer-reviewed journals. In addition, feedback obtained from previous residents after the completion of the rotation has helped to further develop the curriculum of this experience over a 3-year period to reflect the current Medical Writing rotation structure.
Medical Writing Rotation
The curriculum for the Medical Writing rotation is designed to introduce the resident to medical writing, peer reviewing, and support the design and completion of a manuscript suitable for publication in a peer-reviewed journal. A framework calendar for the organization of the rotation is included in Table 1. The rotation is divided into 3 learning components: medical writing topic discussions, composition of a manuscript, and peer reviewing. Although conceptually similar to the previously described rotation designed for medical residents, this experience is scheduled as a month-long block rotation and focuses exclusively on medical writing and scholarship activities. 5
Framework Calendar for Medical Writing Elective Rotation.
Rotation Considerations
Faculty for this rotation are expected to have medical writing experience and a sustained contribution to scholarship to be qualified to precept this learning experience. The typical qualifications include publication in peer-reviewed journals as well as a consistent record of contribution to peer reviewing for biomedical journals. More advanced qualifications include serving as an editorial board member on a peer-reviewed journal or as an author of a reference book or book chapter. Other clinical pharmacists can support the Medical Writing rotation by serving as content experts for the resident.
When scheduling the Medical Writing rotation, it is recommended to use the inherent scheduling flexibility of this rotation to the advantage of the Residency Program Director. Advantageous months for scheduling include December, February, and June due to the difficulty in scheduling clinical rotations during those months and due to the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting and end of the calendar year, the resident’s participation in interviews, and the end of the residency year. Another option would be to combine the medical writing experience with another existing rotation month such as Drug Information or Administration or to implement as a longitudinal rotation. Longitudinal scheduling of the Medical Writing rotation has the opportunity to better represent the medical writing experiences of pharmacists in clinical practice but likely would not allow for dedicated time during the residency year for the resident to focus on medical writing. Thus, this learning experience was scheduled as block rotation to enhance teaching and learning opportunities.
As part of the core rotation responsibilities, each resident is required to complete 2 formal projects: the composition of a manuscript of publishable quality and the completion of a collaborative review of a manuscript submitted to a professional journal. In order to maximize the opportunity to complete a high-quality manuscript prior to the end of the rotation, it is encouraged that the preceptor contacts the resident before the beginning of the rotation. With this correspondence, the preceptor can challenge the resident to begin identifying gaps in the tertiary literature as a potential review article or identify interesting patient cases that could be prospective case reports. Introducing the resident to these expectations early will allow them opportunity to reflect on potential topics and be better positioned to begin the rotation with a high-quality topic or idea.
For the Medical Writing rotation, the preceptor will work directly with the resident to create publishable products that can be mutually beneficial. The preceptor can use this as an opportunity for preceptor development by mentoring the resident as they work to collaboratively publish by the conclusion of the rotation month.
Introduction to Medical Writing
The purpose of this series of topic discussions is to introduce the resident to medical writing and the publication process at an advanced depth. These discussions are scheduled to begin very early in the rotation month to create a foundation of knowledge prior to the resident initiating the composition of a manuscript. The first topic discussion focuses on how to prepare oneself for medical writing. In order to reinforce these topics, the preceptor may request the resident to complete a medical writing self-assessment to further gauge the resident’s interest in medical writing and publication (Table 2). The next topic discussion focuses on general principles when designing a first draft, including detailed information on the individual sections of a manuscript. Manuscripts of original research, reviews of the literature, and case reports are discussed. The final topic discussion in this series focuses on the submission process including discussions of the publication pathway from submission to final acceptance by the journal.
Medical Writing Initial Self-Evaluation.
Manuscript Composition
By the end of the Medical Writing rotation, each resident is required to compose a manuscript of publishable quality. It is the responsibility of the preceptor to assist the resident in the development and composition of the manuscript. Therefore, early in the rotation, the resident will be responsible for the submission of a manuscript outline to the preceptor. For the purposes of a review article, the resident is tasked with creating an outline that includes pertinent background information, the clinical question, basic literature review strategies, and initial review of primary literature. If the resident will be pursuing the composition of a case report manuscript, the outline should include the clinically interesting patient case, pertinent therapeutic considerations such as laboratory test results, diagnosis, and treatment history, an initial background literature evaluation including similar descriptive reports in the biomedical literature, and a statement of impact for publication of the proposed case report. It is the responsibility of the preceptor to evaluate the proposed outline for quality and content and to determine the potential for the development of a successful manuscript of publishable quality. If the resident does not meet the minimum competencies for continuation, the preceptor can use this as a teaching opportunity to help redirect the resident and require the resubmission of another outline for approval.
Once the outline is approved, the resident will then work to compose a draft manuscript using the techniques and strategies taught during the rotation, with the goal to have a draft submission to the preceptor by the midpoint of the rotation. Based on the feedback from the preceptor, the resident will revise the draft manuscript and submit a final version to the preceptor with enough time to review the manuscript and incorporate any feedback into the final evaluation for the rotation. Although submission to a biomedical journal may not be a requirement of the rotation, the residents are strongly encouraged to take this step and will likely require continued communication and collaboration after the completion of the rotation.
Collaborative Peer Reviewing
In addition to the composition of a manuscript, successful completion of the rotation also requires the collaborative peer review of a manuscript submitted to a peer-reviewed journal. In order to prepare the resident for this learning opportunity, the preceptor leads the resident in a discussion and formal introduction to peer reviewing. Once the concept of peer reviewing is introduced to the resident, the preceptor identifies and submits a manuscript for the resident to independently review. Ideally, this manuscript would have been received from the solicitation of a biomedical journal requesting peer reviewing, but this does not always occur based on the timing of solicitations. If the preceptor is not able to acquire a manuscript from this process, a manuscript that the preceptor has previously peer reviewed may also be used. It is the preceptor’s responsibility to review the manuscript in conjunction with the resident and meet with the resident to discuss the review. If the preceptor uses the contributions of the resident in the final draft of the peer-reviewed comments submitted to the journal, the preceptor should acknowledge the resident as a coreviewer when corresponding with the journal’s editor.
Potential Challenges
Implementation of a Medical Writing rotation may pose several challenges to preceptors and program directors. One of these concerns may be the limited number of preceptors with writing experience in peer-reviewed journals. If this is the case, residency programs are encouraged to contact more experienced individuals outside the pharmacy department for guidance and support, such as in medicine or research departments. In the experience of this team, many experts are willing to contribute to the pharmacy resident’s pursuit of a publishable manuscript. In addition, although preceptors may not be experienced directly with the submission process, they may be able to assist with editing, peer reviewing, and content support. By participating in this process, it may result in the preceptor developing an interest in this area of scholarship. Such involvement may also be beneficial to the preceptor when yearly evaluations for preceptor advancement and performance review are completed.
Another potential challenge to the implementation of a formal Medical Writing rotation is the ability of the Residency Program Director to adequately justify the existence of the rotation in an environment of competing clinical and administrative program requirements. Fortunately, the merits of this rotation are easily identifiable and include expanding learning opportunities beyond traditional rotations, enhancing the professional development of the participants, improved opportunity to meet the ASHP requirements for precepting in a postgraduate residency program, and promotion of the residency program when manuscripts are published in professional journals. 6 Thus, there are appropriate learning opportunities to substantiate a formal rotation in medical writing and this rotation has the potential to enhance the residency experience.
Conclusion
A structured Medical Writing rotation during a pharmacy resident’s training can help develop the skills necessary to promote scholarly activities and foster resident interest in future pursuit of professional medical writing. Through participation in this rotation, the resident will be able to make a positive contribution to the profession early in his or her career while networking with professionals throughout the process. Contribution to the medical literature is often an expectation in many areas of pharmacy practice and it is beneficial for residents to gain experience and create a strong foundation in medical writing during a postgraduate pharmacy residency program.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.