Academic and healthcare institutions have become increasingly focused on incorporating and committing to equity diversity, inclusion, and accessibility (EDIA) as it is understood that the programs and organizations should be reflecting the diverse communities that they serve. Similarly, learners, graduates, and health care professionals should be prepared to meet the needs of our diverse
communities. 

At Nova Scotia Health, we felt compelled to examine our pharmacy residency program to ensure we were adhering to EDIA principles and in addition to seeking out areas where we could improve. To start, I reviewed relevant institutional and academic policies and guidance documents and engaged with relevant stakeholders within our organization. A literature review was completed to see what EDIA initiatives within residency programs and guidance around best practices was available. Several articles were found describing EDIA initiatives within faculties of pharmacy and undergraduate pharmacy education and training (even more so for medical education and training). Most initiatives focused on strategies such as reducing barriers to entry, promoting retention, the importance of increasing as well as fostering diversity and inclusion among those entering the profession. However, less literature is available specifically to pharmacy residency programs beyond improving the diversity among residents through recruitment measures. Of note, the American Society of Health-System Pharmacists (ASHP) produced a diversity resource guide that includes strategies to increase diversity and reduce bias during the pharmacy residency recruitment and selection process (ASHP Diversity Guide, 2022). At present, no similar guidance documents or resources were found specific to pharmacy residency programs in Canada. 

Given the limited information available, we developed and distributed an on-line survey to all the pharmacy residency programs in Canada to determine if and how programs have implemented EDIA initiatives on top of identifying any potential challenges and opportunities. The survey included questions regarding demographics of the residency program, general questions about EDIA in residency programs and perceived importance, implementation of EDIA initiatives, and challenges. For the implementation piece, we were interested in if and how EDIA has been incorporated into aspects of the program. We looked specifically at recruitment, applicant screening, interviews, ranking, and education and training for residents and preceptors. 

Of the 44 Canadian pharmacy residency programs (year 1 and year 2 programs) surveyed, 28 responded with many surveys having been completed by the residency program coordinator. Overall, there was overwhelming agreement that incorporating EDIA into pharmacy residency programs is important. Only a handful of programs stated that they had formal policies around EDIA, but many programs are planning to incorporate EDIA principles into applicant recruitment and screening. Around half of all the programs responded that they had a diverse team of residency interviewers, with 80 per cent of programs responding that they had a diverse team of residency preceptors. Incorporating EDIA into education and training for residents and preceptors was currently done or in development for 64 per cent (residents) and 44 per cent (preceptors) of programs, respectively. There were several other interesting findings (e.g., what EDIA education and training is provided to residents), but the main takeaway was that residency programs agree that incorporating EDIA is important, though there is variation in if and how this is achieved. Most programs stated they were in the development phase of implementing EDIA with few having established initiatives or policies. Our program, like others that responded, recognizes the importance of incorporating EDIA but are less confident about where and how to begin. 

The results of the survey showed 64 per cent of respondents reported they face challenges implementing EDIA initiatives. Most of this related to a feeling of lack of knowledge, experience, and skills related to addressing EDIA. They also faced staffing and preceptor limitations, time and resources required to implement, and competing interests (particularly during the height of the pandemic). When respondents were asked what could be done to address these challenges, some suggestions offered included educational and training workshops on EDIA for residency programs, development and dissemination of compiled resources, collaboration and sharing strategies amongst residency programs, and leadership around EDIA from affiliated institutions and the pharmacy residency board. These suggestions are reasonable and serve as a call to action. The results of the survey show residency programs are supportive of EDIA but may be struggling with the ‘how to’ start EDIA initiatives. For those residency programs looking to incorporate EDIA, start by looking to your affiliated academic and institutional resources for support as all opportunities may not be fully appreciated. It may also be fruitful to reach out to other non-pharmacy residency programs (e.g., medicine, psychology, etc.) to see what initiatives they currently have in place.  Residency programs should share resources and publish their initiatives and strategies to help inform those programs that are looking for ideas and inspiration through a central hub, like the Canadian pharmacy residency website. Programs should also consider if and how EDIA is incorporated into the various vision statements and strategic plans of the pharmacy residency program, pharmacy department, and institution, at large. This can be helpful when trying to prioritize your goals and to find a starting point. Finally, I am hopeful that additional guidance, similar to that released by the American Society of Hospital Pharmacists (ASHP 2022), will come from organizations such as the Canadian Society of Hospital Pharmacists and the Canadian Pharmacy Residency Board to help inform EDIA in pharmacy residency programs, with the goal of improving the quality of pharmacy residency programs in Canada from an EDIA perspective.

By Sarah Burgess

Dr. Sarah Burgess bscpharm, acpr, pharmd, is a clinical pharmacist in critical care and currently coordinates the pharmacy residency program at Nova Scotia Health.