Surveying Support Opportunities in Pharmacy Residency Training (SUPPORT): A Cross-Sectional Analysis and Focus Group of Year 1 Canadian Pharmacy Residents

Abstract

Background

Pharmacy residents are at risk of burnout, which can affect their well-being and performance and reduce their sense of satisfaction. Support interventions, specifically peer support, mentorship, and connectedness, may help to alleviate stress and improve well-being.

Objectives

To describe the current opportunities for and perceptions of support available to Canadian year 1 (Y1) pharmacy residents and to identify their interest in and desire for additional support opportunities.

Methods

A cross-sectional national online survey of Canadian Y1 residents from the 2021/22, 2022/23, and 2023/24 residency years was conducted. A subset of survey respondents participated in an online focus group designed to further explore themes identified in the survey.

Results

A total of 109 residents participated in the survey, and 7 participated in the focus group. Participants reported that support was available to them in the forms of mentorship (n = 99, 90.8%), wellness or self-care opportunities (n = 45, 41.3%), and peer connection (n = 94, 86.2%). Mentorship and peer connection were highly valued, yet just over half of participants reported being satisfied with the level of mentorship and peer connection they experienced. Identified opportunities for improvement included formalizing mentorship programs, with clear roles, protected time, intentional matching, and paid training for mentors; enhancing access to health and wellness resources; and designating site-based support for residents.

Conclusions

Mentorship and peer connection were the most commonly provided and highly valued supports for the Canadian Y1 pharmacy residents who participated in this study. Opportunities exist to enhance all forms of support offered to Y1 pharmacy residents, which ultimately may help to reduce resident burnout and improve resident well-being.

INTRODUCTION

Canadian pharmacy residency programs are 1-year structured postgraduate curriculums designed to equip pharmacists with the skills to become proficient in the provision of patient care.^1,2 The residency year is challenging, requiring residents to manage a multitude of responsibilities, including a research project, case presentations, and journal clubs, on top of direct and non-direct patient care rotations. Residents’ knowledge and skills are assessed in many diverse rotation settings; they continuously receive feedback and are required to regularly self-reflect and self-assess their development to foster a continuous growth mindset.³

Burnout is a state of exhaustion related to prolonged stress that can lead to reduced energy and productivity, as well as feelings of hopelessness.^4,5 Burnout among health care providers is associated with increases in medical errors, patient mortality, and patient morbidities, such as infections.⁶ As health care providers, pharmacy residents experience the impacts of burnout on well-being, level of career satisfaction, and performance.⁶ In a survey of Canadian pharmacy residents, 93% of year 1 (Y1) and year 2 (Y2) pharmacy residents thought burnout was an issue affecting pharmacy residents, and 62% of pharmacy residents were found to be at high risk of burnout.⁷

Support from the residency program is an integral factor in maintaining and improving resident well-being.⁶ Support can be offered to residents in a variety of ways, both formally and informally by residency program leadership and through peer connections. Many residency programs have endeavoured to support residents through mentorship programs, group or one-on-one discussions, and delivery of wellness or resiliency curricula.^7,8 Peer support, whereby fellow residents provide social support and connectedness with individuals who share their professional identity, can be advantageous in building a network and promoting collaboration between and among residents that will follow them into their future professional careers and encourage deeper reflection on their own experiences and learnings.⁹

Little is known about the specific design, characteristics, and perceptions of supports available in Canadian pharmacy residency programs. We aimed to identify and characterize the current opportunities and unmet needs for support among Canadian Y1 pharmacy residents. The primary objective was to determine the support opportunities that exist for Canadian Y1 pharmacy residents. The secondary objectives were to determine current and past residents’ perceptions of the support opportunities that were available to them within their residency program and to determine residents’ interest in and desire for additional opportunities.

METHODS

Ethics approval was granted by the harmonized research ethics boards of the University of British Columbia and Interior Health Authority (H23-02964).

This study involved a cross-sectional electronic survey and subsequent focus group. The survey and focus group interview guide were developed by the study team, who have experience in pharmacy residency training, and were informed by a literature review. The interview guide was further adapted before the focus groups took place to explore additional themes identified in the survey. The Qualtrics platform (version XM) was used to deliver the survey. The survey was anonymous and consisted of 17 questions in English regarding demographic characteristics, available supports, characteristics and perspectives of available supports, and desire for additional support opportunities (Supplement 1, part 1, available from https://doi.org/10.4212/cjhp.3792). It included multiple choice, Likert scale, and open-ended questions. No questions were mandatory. The survey was pretested by a current pharmacy resident of an accredited Canadian pharmacy residency program (who was subsequently eligible to participate in the study) for content validity and skip logic.

Survey respondents were invited to sign up for a semistructured focus group that would explore themes identified from the survey (Supplement 1, part 2). Two focus groups were convened, both led by one investigator (J.K.D.) and held on the Zoom teleconferencing platform (version 5.15.7). No questions in the focus group were mandatory, and participants had the opportunity to withdraw at any point. The focus group was pretested once with a team member (B.G.) who had completed a Y1 program.

Individuals eligible to participate in the study were pharmacists who were currently enrolled in an accredited or accreditation-pending Canadian Y1 residency program for the 2023/24 year or had been enrolled in such a program in the 2022/23 or 2021/22 residency year, including pharmacists who withdrew from the program at any point and those enrolled in a Master of Advanced Pharmacotherapy program at Université Laval or Université de Montréal in the province of Quebec. Individuals were excluded if they were current pharmacy residents in an accredited or accreditation-pending Canadian Y2 residency program and were not a past resident of a Y1 program. Individuals who were past residents of both Y1 and Y2 Canadian pharmacy residency programs were asked to specifically respond only about the Y1 program with which they had been involved.

A convenience sampling strategy was used. The survey was open from December 1, 2023, to January 26, 2024. The survey invitation (including link to the online survey) was distributed by email to Canadian pharmacy residency program coordinators, with 2 reminder emails. It was also advertised through emails sent by the Canadian Society of Hospital Pharmacists (now the Canadian Society of Healthcare-Systems Pharmacy; CSHP), the CSHP Pharmacy Specialty Networks on the QID platform, and social media. Advertisements provided a synopsis of the study, included a link to the survey, and indicated that the survey was available for individuals who had successfully completed a Y1 residency, had un-enrolled from a Y1 residency, or were currently enrolled in a Y1 residency program.

The survey was used to determine the percentage of Canadian pharmacy residents whose programs provided them with support through any means, including mentorship, wellness, resilience curricula, or opportunities for peer connections to other residents within and outside of their programs. Survey and focus group participants were also asked to characterize the available opportunities and describe their perceptions of available opportunities and the need for additional supports, as well as potential barriers, facilitators, and optimal design of a future intervention for additional supports.

Mentorship was defined as the provision by an experienced individual (such as a working pharmacist) of help and advice to a less experienced individual (such as a resident). Peer-to-peer mentorship was defined as the provision of help and advice by an individual who is in the same social position or has the same abilities as other people in the group (e.g., current residents), and near-peer mentorship was defined as the provision of help and advice by an individual (e.g., a past resident) who has recently gone through an experience that someone is now or soon will be facing. Residency program sizes were categorized as very large (> 20 residents), large (10–20 residents), medium (5–9 residents), small (2–4 residents), or single (1 resident). Residency program types were categorized as general hospital, ambulatory or primary care, pediatrics, oncology, or mental health. Formal support was defined as support administered by a residency program, and informal support was defined as support not administered by a residency program. A wellness curriculum was defined as workshops or half-day events about well-being. A complete list of definitions can be found in Supplement 1, part 3.

At the time of study design, there were 35 accredited or accreditation-pending residency programs in Canada, with a total of 234 residency positions. Based on Canadian Pharmacy Residency Board statistics, there were an estimated 681 residents during the eligible residency years (2021–2024).¹⁰

To ensure generalizability of the findings across Canada, the target response rate for the survey was about 30% (214 respondents), with the goal of having equal representation from past and current residents in each province and across program sizes.¹¹

Survey responses that consisted only of answers to the demographic questions were considered incomplete and were removed from the dataset. Free-text responses from the survey and focus group transcripts were coded separately by inductive thematic analysis using NVivo 12 software (Lumivero). Each set of data was initially coded, and codes were collated into themes. Continuous quantitative data were described using means and standard deviations, ordinal data were described using medians and interquartile ranges, and categorical data were described using percentages.

RESULTS

A total of 170 survey responses were received. Of these, 61 were incomplete and were removed from the dataset, resulting in 109 participant responses included in the analysis. This represented 16% of all eligible pharmacy residents and 28.3% of the 385 eligible residents in English-language residency programs. Eleven participants who completed the survey expressed interest in the focus group, of whom 7 participated.

The 109 survey respondents consisted of 44 (40.4%) current residents and 65 (59.6%) past residents, with representation from all provinces (except Prince Edward Island, which does not have a pharmacy residency program) and all sizes and types of programs, including pharmacists who did and did not complete their residency year (Table 1). Of the 7 focus group participants, 3 were current residents and 4 were past residents, with 6 from British Columbia and 1 from Ontario.

TABLE 1.

Characteristics of Survey and Focus Group Participants

Characteristic	Participant Group; No. (%) of Participantsa
	Survey Respondents (n = 109)	Focus Group (n = 7)
Year in residency program
2023/24	44 (40.4)	3 (43)
2022/23	35 (32.1)	3 (43)
2021/22	30 (27.5)	1 (14)
Residency program province
Alberta	5 (4.6)	0
British Columbia	41 (37.6)	6 (86)
Manitoba	1 (0.9)	0
New Brunswick	1 (0.9)	0
Newfoundland and Labrador	1 (0.9)	0
Nova Scotia	9 (8.3)	0
Ontario	37 (33.9)	1 (14)
Quebec	1 (0.9)	0
Saskatchewan	13 (11.9)	0
Gender
Cisgender female	85 (78.0)	4 (57)
Cisgender male	21 (19.3)	3 (43)
Prefer not to say	3 (2.7)	0
Residency program sizeb
Single (1 resident)	5 (4.6)	0
Small (2–4 residents)	52 (48.1)	2 (29)
Medium (5–9 residents)	32 (29.6)	4 (57)
Large (10–20 residents)	1 (0.9)	0
Very large (> 20 residents)	18 (16.7)	1 (14)
Residency program type
General hospital	98 (89.9)	7 (100)
Ambulatory/primary care	4 (3.7)	0
Pediatrics	6 (5.5)	0
Mental health	1 (0.9)	0
Age at start of residency year (years)		Not collected
20–24	32 (29.4)
25–29	67 (61.5)
30–34	8 (7.3)
35–40	2 (1.8)
Experience in practice before entering residency (years)c		Not collected
0	79 (79.8)
0.5–5	17 (17.2)
> 5 – 10	3 (3.0)
Time spent on residency-related work in average week (hours) (mean ± SD)	63 ± 12.8	Not collected

^aExcept where indicated otherwise.

^bIncomplete survey responses for residency program size (n = 108)

^cIncomplete survey responses for years of experience before entering residency (n = 99).

All 109 survey respondents reported that they experienced some form of support. The majority (90.8% [99/109]) of respondents had been offered mentorship opportunities, which were predominantly formalized through the residency programs (Table 2). Wellness or self-care support opportunities were less available to respondents (41.3% [45/109]) and consisted of formal curriculums (46.7% [21/45]), discussion groups (40.0% [18/45]), and other opportunities (e.g., wellness or self-care webinars, presentations, additional flex days). Peer connection opportunities were offered to 94 (86.2%) of the 109 respondents, the majority of which involved interactions with residents outside their own program but within their own province (77.7% [73/94]).

TABLE 2.

Type and Origin of Year 1 Pharmacy Resident Supports Available, as Reported by Survey Respondents

Type of Support	Source of Support; No. of Responses			Overall No. (%) of Responsesa (n = 109)
	Residency Program	Institution	Sought Out by Self
Mentorship (n = 99/109 [90.8%])
Mentorship program	64	8	7	70 (64.2)
Near peer	62	6	9	69 (63.3)
Peer to peer	18	1	24	38 (34.9)
From residency coordinator	61	5	7	70 (64.2)
Wellness or self-care (n = 45/109 [41.3%])
Curriculum (e.g., workshops, half-day session)	20	2	0	21 (19.3)
Discussion group	17	0	1	18 (16.5)
Peer connection (n = 94/109 [86.2%])
Local (within province) pharmacy conference	46	9	6	59 (54.1)
National (outside province) pharmacy conference	46	7	1	51 (46.8)
Residency showcase or networking events	40	9	3	52 (47.7)
Interactions with residents from other programs, within province	52	9	11	73 (67)
Interactions with residents from other programs, outside province	13	2	1	16 (14.7)
Social events within residency program	21	2	15	44 (40.4)
Virtual connection or networking opportunities	17	5	4	27 (24.8)

^aFor each type of support listed, a respondent could select more than one option.

As such, the overall number of responses in each row (final column) may be less than the sum in that row by source of support, and the overall number of responses for each of the 3 types of support may be less than the sum of responses in the respective sections of the table, whereas the sum of percentages in the first column is greater than 100%. Conversely, participants had the option to select “other” as a source of support, not reported in this table. As such, the overall number of responses in each row (final column) may be greater than the sum in that row by source of support.

More than half of the survey respondents somewhat or strongly agreed that they were satisfied with the opportunities for mentorship (59.6% [59/99]), wellness/self-care supports (57.6% [57/99]), and peer connection (51.1% [48/94]) available to them during their residency year (Figure 1A). The majority of survey respondents somewhat or strongly agreed that all categories of mentorship and wellness/self-care supports were beneficial for them (Figure 1B). The majority somewhat or strongly agreed that peer connection is important for professional growth (94.0% [79/84]) and believed that additional connection opportunities outside of their residency program would be valuable (65.1% [54/83]). Most survey respondents stated that they would prefer peer connection opportunities to be offered locally (within province) (93.8% [75/80]) and in person (88.8% [71/80]), with fewer preferring national (71.3% [57/80]), international (47.5% [38/80]), or virtual (47.5% [38/80)] opportunities.

FIGURE 1.

Perceptions of supports and peer connection opportunities available, as reported by survey respondents. For each bar, the percentages may not sum to 100 because of rounding. A: Respondents’ satisfaction with forms of support available. B: Perceptions of personal benefit derived from mentorship and wellness/self-care supports.

Of the 109 survey participants, 99 (90.8%) provided free-text comments that could be analyzed. Of these, the majority (74.7% [74/99]) identified at least one potential barrier to and/or facilitator of the various types of supports. Potential barriers to peer connection opportunities outside of participants’ own programs were a lack of time, unsuitable location, scheduling conflicts, lack of funding, lack of relatability, and lack of interest in others’ work. Facilitators of peer connection opportunities included networking events, social gatherings, attendance at conferences, in-person connections, and rotations with residents from other programs. Barriers to mentorship were lack of time, unsuitable location, scheduling conflicts, lack of a structured mentorship program, discomfort in sharing concerns with future colleagues, lack of relatability, and a feeling of burdening the mentor. Facilitators of mentorship were the existence of structured mentorship programs, protected time for meetings, relatability, comfortableness, and absence of conflicts of interest.

Focus group participants described support as being provided through a network and by means of a program culture exemplified by peers, mentors, program leaders, and preceptors to ensure the residents’ success throughout the residency year. Support from the residency coordinator, near peers, and past preceptors was of greatest value, while mandatory wellness curricula and supports from residents outside one’s own program were valued least (Table 3). Some focus group participants expressed the concept that support itself should be a national accreditation standard. The culture of a program and a safe, judgment-free learning environment were important. Participants expressed that they felt valued as residents when the residency program site was invested in their learning and growth. Outside of the program itself, family and nonpharmacy peer support was important. Participants felt that there were several factors affecting supports, including program size and a resident’s prior experiences.

TABLE 3.

Type and Origin of Year 1 Pharmacy Resident Supports Available, as Reported by Focus Group Participants

Themes	Correlating Quotes
Most valuable supports
Mentorship from residency coordinator	“… I think having a well-connected, well-experienced residency coordinator makes a really big difference” “… monthly check ins with the residency coordinator because it was a way to make sure you’re on track…”
Peer support from residents within own program	“… we leaned on each other from day 1. It happened organically, and we were in close proximity right away and able to build relationships” “… peer group really becomes a safe space …” “… sharing my experiences with them and them echoing the same thing—it validates what I’m going through”
Informal mentorship from past preceptors	“… switched after being a preceptor to becoming like a mentor …” “… because they precepted you and knew your strengths and weaknesses … I found some of the advice I got … was the most beneficial”
Less valuable supports
Peer connection outside of own resident program	“… I feel like I get what I need out of my near peers in the hospital and from my friends” “I think it would be a cool idea, but feasibility wise, I don’t think it would happen and I don’t know that it would be on the top of my list to reach out to peers …”
Formal wellness presentations or workshops	“… mandatory sessions weren’t necessarily helpful”
Opportunities for improvement
Mentorship program should be structured and formalized with clear roles, protected time, and intentional matching	“Some of the ownership of reaching out should be shifted on to the mentors because … you don’t always have the self-awareness to realize that you need checking in on …” “… built-in time within the residency schedule to encourage mentorship meetings, discussions, and reflection”
Paid training for mentors	“… dedicated hours during the day where you are paid to work on being a mentor …”
Designated site support	“… have designated peer person that’s not a preceptor that can be connected with resident at [each] site …”
Enhanced access to health and wellness resources	“… making sure we are all well aware of the formal supports in the counselling or therapy realm …”

DISCUSSION

We sought to identify and characterize the current opportunities and unmet needs for supports among Canadian Y1 pharmacy residents. Support was available in the forms of mentorship (reported by 90.8% of survey respondents), wellness or self-care (by 41.3%), and peer connection (by 86.2%), with just over half of residents reporting satisfaction with the level of supports received.

In a previous study, residents reported that they found mentorship programs to be useful,⁷ a finding corroborated by our results. Mentorship from the residency coordinator, which provided reassurance and allowed the residency experience to be individualized, was greatly valued, particularly if the coordinators were well connected, experienced, and admired personally and professionally by the residents. Mentorship from past preceptors was also highly valued, as these individuals were uniquely positioned to provide feedback on the resident’s systematic thought process and to share career advice. Conversely, less value was placed on formalized mentorship programs due to lack of time, poor relatability, unclear roles and responsibilities, and the resident’s inability to recognize when they would benefit from mentorship guidance, which is consistent with literature concerning Canadian medical residents.^12,13 Our findings suggest that if a formalized mentorship program is employed, it should be structured, should define clear roles and responsibilities, and should have a mechanism for intentional matching of mentors with mentees based on prior experiences. These findings align with recommendations for mentorship among Canadian medical residents, which advocate for formal scheduled sessions for mentorship and similar personalities for good mentorship pairing.^13,14

Peer support from co-residents within an individual’s own program created a safe, holistically supportive space, providing emotional support for both their personal and professional lives. This experience is similar to that of medical residents, for whom peers are a critical source of support and who cite benefits of reduction in perceived work demands, development of communication skills, promotion of academic and scholarly success, development of a sense of community and connectedness within and outside the residency program, and reduction in the harmful effects of stress.^15–18 Peer supports also exist outside of pharmacy residents’ own programs. For example, the Ontario Pharmacy Residents Association holds events for residents to develop peer connections outside their own residency programs. However, this form of external peer connection was found to be less valuable, for reasons of distance, location, and timing, as well as a lack of relatability, interest, and motivation to develop relationships. Given the high value that residents place on peer support, coupled with a relatively low (51.1%) level of overall satisfaction with current peer support, opportunities exist to enhance peer support for pharmacy residents.

Participants in our study placed less value on formal wellness presentations and workshops. This finding differs from the results of a study at the University of Minnesota, which found that most pharmacy residents highly valued the residency program’s resiliency curriculum, citing its benefits in promoting self-care, balance, and validation.¹⁹ The effectiveness of a formal wellness presentation or workshop depends on the topic, the speaker, and the speaker’s understanding of the residency year and the resident’s role, which may explain the inconsistency between our findings and the literature. Wellness strategies that respondents felt would be beneficial were workshops on incorporating wellness strategies and tips on transitioning from residency to career, wellness days, wellness rooms, opportunities to debrief, psychotherapy, counselling, and enhanced access to health and wellness resources. The University of Ottawa implemented a peer support wellness forum for medical students and residents, and participants felt that this forum was beneficial, decreasing stress, reducing feelings of burnout and anxiety, and encouraging collegiality.^20,21

Although this study had several strengths, there are also some limitations to consider. First, the survey was presented in English only, and just one of the respondents was from a Quebec-based program. Thus, the results are likely not representative of residents from French-language residency programs in Canada. Additionally, the overall response rate was low, which could also affect generalizability. Second, there was a risk of incomplete sampling, which was mitigated by sending personalized emails to coordinators and posting the survey on various platforms. However, it is likely that some individuals were missed, such as those who un-enrolled from their residency programs, were struggling during the residency year, or did not have time to participate in the survey or focus group. This limitation, in addition to responder bias (whereby individuals more invested in the topic may have been more likely to respond), could have resulted in over-representation of those who had positive experiences. Third, the definitions of well-being and support can vary, and individual understandings of these terms are subjective. This limitation was mitigated by including definitions of key terms within the survey, as well as by asking respondents to provide their own definitions of what support meant to them. However, some formalized supports, such as institutional employee assistance programs, may not have been adequately captured through our survey. Finally, the survey was anonymous; therefore, it was not possible to correlate the survey responses with focus group input.

CONCLUSION

Supports are provided to pharmacy residents in various forms, including mentorship, peer connection, and wellness and self-care curriculums and discussion groups. Mentorship and peer connection opportunities were highly valued by the pharmacy residents who responded to this survey study, yet just over half of respondents were satisfied with the levels of mentorship and peer connection. Opportunities identified for optimization of mentorship programs included paid training for mentors, protected time, clear roles, and intentional matching based on relatability. Additionally, programs could provide meaningful access to health and wellness resources. Interest exists in additional peer connection opportunities provided locally and in person. Peer connection across Canada may be beneficial in providing information and networking opportunities for residents, but it may not provide adequate day-to-day support. Future research could include obtaining perspectives from residency program representatives, including residency program coordinators and directors, preceptors, and those acting as mentors, to compare and determine valuable interventions for implementation.