Scholastic synergy: A team prototype for pharmacy faculty engagement in education, research, and service

Abstract

Introduction:

Many clinical faculty members are challenged by competing factors of scholarly productivity, education, service obligations, and patient care. A team-based approach has the potential to synergistically increase productivity and mitigate factors associated with burnout.

Methods:

The purpose of this report is to discuss a prototype for a small, team-based, practice-oriented collaborative approach to advancing critical care pharmacy practice through research and education. Productivity was evaluated in the areas of scholarship and teaching.

Results:

This team was formed in 2017 and includes five critical care faculty across four campuses from a single academic institution. This collaborative has published peer-reviewed articles, secured grant funding, and developed novel teaching modalities.

Conclusions:

Challenges encountered include timeline adherence, development of uniform data collection processes, clarifying roles and expectations for different projects, and authorship. This team may act as a prototype for clinical faculty teams to enhance engagement and scholarship productivity in a practice-based setting.

Introduction

Pharmacy faculty faced high rates of burnout in demanding environments even prior to the era of SARS coronavirus 2, aka COVID-19.¹ Further, the discipline of critical care for all healthcare professionals, including pharmacists, has high rates of burnout.² Given the strain of developing remote rotations, courses, research projects, etc. in this new environment, strategies to enhance productivity while mitigating the myriad of adverse effects of burnout have never been more paramount. Teams improve productivity, quality, and satisfaction. This concept holds true in patient care through interprofessional and interdisciplinary teams, in research through team science, and in education through team taught courses, but, a team-based approach in academic and clinical pharmacy has not been previously described.^2–5

While varying among schools of pharmacy, clinical faculty are required to not only provide teaching and service but also have a minimum expectation for scholarly productivity. Additionally, clinical pharmacist specialists, especially those active in pharmacy postgraduate training, are expected to participate in and mentor teaching (including precepting) and scholarly activities, often within a layered-learning environment.⁶ Faced with competing demands and high reported rates of involvement in teaching and scholarship roles, reported rates of burnout, especially among critical care specialties, are strikingly high, and despite residency training, reported scholarly productivity is relatively low.^7–10

To fulfill the mission within the college of pharmacy for clinical faculty to be engaged in scholarship, teaching, and service, The University of Georgia Critical Care Collaborative (UGAC3) was created “to foster critical care research and education across the state of Georgia and beyond.” This model has not been described in the literature and holds high potential and applicability for the profession of pharmacy given the ability to enhance productivity while fostering relationships that prevent burnout syndrome. The purpose of this report is to describe the structure and initial productivity of UGAC3 as a possible model for other types of collaborations for practice-based pharmacists.

Methods

The University of Georgia (UGA) College of Pharmacy is a multi-campus four-year pharmacy school with a central campus in Athens and three extended campuses in Albany, Augusta, and Savannah. This multi-campus model has allowed the college to enhance the learning experiences for its students through maximizing rotation sites throughout the state of Georgia and create more favorable faculty to student ratios in the final two years of the curriculum. In 2017, recent hires at UGA College of Pharmacy brought the total number of faculty with a specialty in critical care to five individuals across four campuses. The department encouraged these five faculty members to meet with the idea of helping onboard the two newest faculty and evaluate the potential for collaboration. The concept of creating a team to achieve joint goals was developed.

When forming UGAC3, each member was at varying points in their career, but all shared a commonality of critical care pharmacy and a passion for teaching and mentoring. Three members were assistant level faculty members with zero, two, and four years of professional experience at the time of formation, and two members were associate level with > 10 years of experience in practice. During this period, all faculty had the following time allocation: 70% teaching (which includes six months on clinical service), 20% research, and 10% service, except for one member in the last year transitioned to 75% research and 25% teaching/service due to external funding.

The purpose of UGAC3 became clear as developing a synergistic team-based environment centered on a common mission to foster critical care research and education across the state of Georgia and beyond. The mutual goal was then to develop a usable and sustainable framework for multi-campus collaboration. The collaborative kicked off in the form of an in-person retreat, which took place in Athens during fall 2017 (See Fig. 1). Table 1 describes the framework and key structural elements to UGAC3 that were developed. This retreat has been followed by annual formal retreats on the Augusta and Savannah campuses in spring 2018 and 2019, respectively. In 2020, an eight-hour virtual retreat was conducted. These retreats were supported by the college of pharmacy and served to evaluate progress, create new goals, and discuss challenges. The evolution of this process and the specific activities performed at each retreat are described in the Figure. Monthly web-based meetings are facilitated by the chair, and two major document types are reviewed in addition to an open forum for conversation. First, the UGAC3 Goals & Objectives document is reviewed, which includes global one-year and five-year goals and a table breakdown of each individual project that includes title, team lead, timeline, and status. Second, project specific research plans are reviewed.

Fig. 1.

Evolution of the UGAC3.

ACCP = American Association of Colleges of Pharmacy; DISC = Dominant, Influencing, Steadiness, Conscientious model; MBTI = Myers-Briggs Type Inventory; UGAC3 = The University of Georgia Critical Care Collaborative.

Table 1.

Framework and key structural elements of UGAC3.

Element	Description
Mission	To foster critical care research and education across the state of Georgia and beyond
Membership	Active members of UGAC3 will be listed
Chair	An elected chair will preside over meetings and retreats and is responsible for developing the agenda and recording minutes
Activities, duties, responsibilities	UGAC3 will maintain active efforts in three broad categories: scholarship, teaching, and service in the realm of critical care
Annual retreat	UGAC3 will have an annual in-person retreat in the spring/summer at one of the four UGA College of Pharmacy campuses.
	Agenda will be agreed upon prior to the retreat. Minutes will be recorded and distributed
Monthly meetings	Monthly meetings will be held to discuss progress. Agenda will be agreed upon prior to each meeting. Minutes will be recorded and distributed
Goals	One- and five-year goals will be reviewed and discussed annually
Research template	A research protocol will be completed and used to guide all scholarly projects. The protocol will be agreed upon by all participating UGAC3 members prior to initiating research
Productivity report	Submitted annually to department head
Central repository	A cloud-based sharing drive will be used as a central repository for all group efforts

UGA = The University of Georgia; UGAC3 = The University of Georgia Critical Care Collaborative.

Productivity has been measured based on the scholarship and education domains. Metrics that have been tracked and are subsequently reported include the following for scholarship: publications, abstracts, poster presentations, grant awards, research awards, joint speaking engagements, and submitted grant applications. Education specific metrics include supervision of student and resident scholarly works, research awards for collaborative work, innovative teaching methods (e.g., development of new elective courses for the second and third professional year of the curriculum, interactive formats), and teaching awards.

Results

From 2017 to 2020, UGAC3 had broad initial success. The scholarship domain results include 11 publications, 67 abstract presentations, five grant awards, 10 research awards, three joint speaking engagements, and 8 grant applications submitted. In the education domain, over 30 learners, including three postgraduate year two critical care pharmacy specialty residents in addition to doctor of pharmacy (PharmD) students have been supervised in scholarly works and multiple innovative classroom techniques have been developed, all serving the mission of fostering critical care research and education. Notably, five learners have published with UGAC3. The contribution to education for students and residents has culminated in three members being awarded teacher of the year by the UGA College of Pharmacy and two members awarded preceptor of the year by a state pharmacy organization. Productivity is outlined further in Table 2 and excludes individual productivity of UGAC3 members outside of the collaborative.

Table 2.

UGAC3 productivity.

Metric	Number	Number of involved UGAC3 members (N = 5)	Number of learners mentored
Original research manuscript	5	5	4
Review manuscript	1	5	1
Published correspondence	5	3	2
Intramural grants	2	5	0
Extramural grants	3	2	0
International abstracts	10	5	8
National abstracts	39	5	31
State/local abstracts	8	3	7
Poster awards	10	5	9
Regional presentations	1	3	0
Research electives	4	5	25
Critical care electives (semester)	6	5	167
ACLS certification (semester)	1	2	18
UGAC3 journal clubs	24	5	70

ACLS = Advanced Cardiovascular Life Support; UGAC3 = The University of Georgia Critical Care Collaborative.

Combined efforts have resulted in enhanced training environments for students and residents. Teaching initiatives in the PharmD curriculum have included development of a second annual offering of the critical care elective, creation of a critical care pharmacotherapy research elective,¹¹ provision of an Advanced Cardiovascular Life Support certification through two-day workshops and an elective course,¹² and development of the multi-campus UGAC3 journal club as an advanced pharmacy practice experience (APPE) activity for fourth year students. While the critical care elective had already been developed and offered in the fall semester, the addition of two more course coordinators made it feasible to add a second course offering during the spring semester and to expand the number of interactive web-based modules from four to six to meet the high demand of student enrollment. Because of the close collaboration with research projects and the development of the infrastructure for a multi-campus research elective, students are offered the opportunity to engage in multicenter research and to interact with multiple co-investigators through the critical care research elective. Results of the elective have been previously published.¹¹ During APPEs, students and residents are offered a forum to present a web-based journal club in a multi-campus setting and then to engage in high quality discussion with five critical care practitioners on that topic. The structure is influenced by debate-style pedagogy for teaching critical care.¹³ The UGAC3 journal club also acts as an introduction for learners to Twitter, as learners are required to develop original content based on their journal club to tweet.

Discussion

UGAC3 is a successful prototype, as measured by scholarship and teaching initiatives over a sustained three-year period. To our knowledge, this report is the first to describe the infrastructure of a multi-campus pharmacy faculty team focused on all three primary academic pillars. The team itself is comprised of a diverse set of individuals with regard to strengths, personality traits, interests, training, and career levels. This diversity, with the potential for both innovation and divisiveness, is channeled effectively through agreed-upon infrastructure including a tight research focus, development of common themes, narrow year-to-year objectives, and regularly scheduled communication.

The success of this team is owed to multiple factors, including administrative support, thoughtful architecture, and deliberate creation of collaborative relationships. College level leadership has supported in-person annual retreats in addition to providing potential for intramural funding. This team has seen sustained support due to its productivity and annual reporting of metrics valued by leadership. With approximately one-quarter of schools and colleges of pharmacy having multi-campus models, organizational and team building efforts are instrumental to success.¹⁴ In particular, scheduling regular monthly touch points has allowed for management of two common issues: accountability and responsibility. Regular communication has allowed for flexibility of timelines as needed in addition to re-ordering of responsibilities for team members based on workload and other factors. Thus, while aspects such as author order are discussed at the outset when the initial project proposal is developed, fluidity in order has been observed based on new interests, new career needs, or new responsibilities (e.g., the decision to transfer first author because the original team lead was awarded a new grant). It cannot be underscored that these meetings also have a social element that includes casual conversation, which fosters a sense of comradery. High quality connections are created through this shared time together. In The Happiness Advantage, Shawn Achor¹⁵ discusses how these connections “fuel openness, energy, and authenticity among coworkers, and in turn lead to a whole host of measurable, tangible gains in performance” and are fueled by this shared time together.

In The Infinite Game by Simon Sinek,¹⁶ Sinek discusses forming vulnerable teams that are willing to admit mistakes and genuinely believe that each individual is cared for by the collective. This environment has been fostered by both annual retreats and regular team meetings. Annual retreats have served as a key team-building opportunity that include open discussion of personality traits but also have the more informal conversation and relationship building that occurs over shared meals. While a tendency to avoid such informal interaction due to time or financial constraints may exist, this time together is necessary for the formation of trusting relationships and individual buy-in. This buy-in that has been core to success was fostered through these retreats but also through focus on individual growth and development of mentor-mentee relationships. Indeed, two relatively unintended findings of this team’s formation included the development of meaningful mentor-mentee relationships and connections that appear to mitigate burnout. The value of shared trust and belief that each member is invested in each individual’s growth and success is vital to the success of such a collaboration and cannot be undersold.

Formal mentoring programs among pharmacy faculty have been extensively discussed and provide unique value to junior faculty members through the provision of institution specific insights and perspective, sponsorship of new opportunities, and sharing personal experience.^17–19 While the expressed intent of these formal programs is junior faculty development, the primary mission of this collaborative was advancement of critical care pharmacy through scholarship and education. However, the informal mentoring relationships that were established proved invaluable and became a core tenet of this team.²⁰ The possibility exists that junior faculty would be most benefited by both formal mentor relationships established and sponsored by their institution in addition to the collaborative and informal mentor-mentee relationships described here. Conversely, more seasoned faculty members can gain a new spark of enthusiasm and drive fueled by their interactions with junior faculty mentees. Further, peer mentorship has been an invaluable aspect to this group with same rank members providing review and comments to various work products.

Indeed, a team-based atmosphere creates a supportive environment for growth as a clinician scientist. Clinical faculty and pharmacists alike are limited by lack of formalized research training. The American Society of Health-System Pharmacists pharmacy residency accreditation objectives require a medication use evaluation or research project but do not emphasize objectives specific to research such as biostatistics. UGAC3 has placed a high priority on the training of its members including objectives of participating in training programs such as the American College of Clinical Pharmacy’s Mentored Research Investigator Training, Focused Investigator Training, and completing a two-day workshop on utilizing statistical software to conduct independent statistical analyses. Additionally, expertise is sought including statistical support and outside mentorship. Also, through combining multiple individuals’ professional networks and the use of social media platforms like Twitter, promotion of individuals, as well as the group, has allowed for broadened professional and research connections as well as reporting of trainee accomplishments. Previously reported publication rates for pharmacy practice faculty are less than one publication per year at both public/private and health science and non-health science campuses.^21,22 However, with 11 publications over three years that are direct products of UGAC3 activities in addition to other independent activities during that timeframe, UGAC3 faculty have a notably higher publication rate with over 45 peer-reviewed publications by five faculty members over three years. Although expectations for publication vary based on institution and position type, applicability of team-based work still likely holds credence.²³

Productivity and wellness are interrelated.¹⁵ Risk factors for burnout include lack of community, job-personality mismatch, perceived lack of fairness, pressure regarding work performance, lack of control of workplace scenarios, individual-organization value mismatch, demanding workload, high stakes decision-making, and minimal rewards.^24,25 While some of these are non-modifiable, the mutual support of each individual in their personal growth, the mentoring provided by the more senior members of the group, and the strong sense of comradery likely mitigates the stress and potential burnout possible in a pharmacy career.²⁶ The rates of pharmacist burnout are notably high especially among clinical practice faculty, and mentorship and social connectedness have been shown to be protective factors, increasing resiliency in other healthcare professions.^1,27 Creating a team culture that values productivity in the setting of connectedness has been a great benefit. Indeed, this team-based concept has recently been shown to mitigate burnout among critical care pharmacy practice faculty through an off-service model, wherein faculty fill in for each other to allow for off-service time to enhance productivity. Though not feasible due to the multi-campus nature of UGAC3, this concept may have special utility for single-center based teams.^28,29

This prototype may succeed where other networks did not in part due to its more localized nature and daily interactions. Further, this model likely augments existing collaborative research networks such as Discovery, the Critical Care Research Network. While Discovery provides resources such as a clinical informatics team and database administrators, the ability to recruit large numbers of sites, and an internationally known dissemination platform, such an organization likely lacks the more close-knit feel of individuals that see and work together on a daily basis. Indeed, these smaller groups may be able to develop high quality ideas that can be subsequently supported and carried out with a broader set of resources. Further, establishing an identified name under which scholarship is done may have high value in the grant submission process. Other collaborative team-based groups of pharmacy practice faculty have shown success. Notably, the Applied Therapeutics, Research and Instruction at the University of Maryland (ATRIUM) Cardiology Collaborative has a team of five members and has also shown high productivity in scholarship through peer-reviewed publications, a blog, and other works in addition to education through the management of a cardiology specialty residency and teaching.²⁹ Though UGAC3 is the first to focus within critical care and across four campuses, the presence of other team-based success lends support to this general structure. Further, synergistic potential of different collaboratives working supports the concepts of team science.^29,30

Although multi-campus collaboration and the involvement of multiple individuals in multiple simultaneous projects has great potential yield, these characteristics also pose unique logistical challenges. Table 3 lists some of the solutions to these challenges. Without an ability to evaluate the effectiveness of the collaborative in a pre/post design, the possibility exists that each individual would have had a similar rate of productivity independently versus the overall totals reported in the team environment. Application of this prototype in a non-academic setting (e.g., clinical pharmacists in a hospital setting) has yet to be evaluated; however, pharmacy service lines (e.g., internal medicine, oncology, critical care) may offer natural infrastructure for team-based activities including journal clubs/monthly topics and scholarship efforts, especially with the ability to incorporate quality improvement initiatives and existing residency framework. Additionally, partnerships between clinical pharmacists who often serve as adjunct faculty and full-time faculty may allow for enhanced educational and scholarly effectiveness within this type of framework. Future plans incorporate “stretch goals” that increase the impact of scholarly and educational pursuits (e.g., prospective trials) and development of a framework for how multiple teams similar to UGAC3 could potentially work together.

Table 3.

Challenges and solutions to collaborative team structure.

Challenge	Solution
Timeline adherence	Establishing monthly meetings allows for both increased accountability and flexibility
Project communication	Development of research protocols that delineate pertinent details of projects
Uniformity in data collection	Development of both research protocols and data definition bank
Which scholarly works to “count” as UGAC3	Formal definition of UGAC3 work (must have two or more authors from UGAC3 and discussed during UGAC3 meeting)
Authorship	Formalized research protocols that delineate author order from beginning of project; Monthly meetings that allow for project lead flexibility based on individual needs
Involvement of learners in manuscripts	Formalized research protocols that delineate responsibilities and authorship roles; Thoughtful selection of learners based on interests, demonstrated productivity, and use of application process
Balancing non-UGAC3 scholarly work	Senior UGAC3 member mentorship; Discussion of timelines for UGAC3 projects during annual retreat and monthly meetings
Institutional review board approval for multiple campuses	Memorandums of understanding that serve as umbrella for all non-external UGA sites
Marketing	Identification of resources to develop marketing materials;
	Communication at the institution level regarding names
Timing of annual retreat	Balancing semester workload; opportune time to leverage learners

UGA = The University of Georgia; UGAC3 = The University of Georgia Critical Care Collaborative.

Conclusions

The UGAC3 model may be adapted to group specific goals (e.g., a purely research focus vs. a triple focus on research, service, and education) and to institution specific needs (e.g., a single-campus institution may still benefit). Although only in the first three years, UGAC3 could serve as a prototype for pharmacists both inside and outside of academia who are interested in high productivity balanced by the protective factors of comradery and mentorship.