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Residency Training

Accreditation Standards

Canadian Hospital Pharmacy Residency Board
Conseil canadien de résidence en pharmacie d'hopital

Table of Contents

1. INTRODUCTION

1.1 Preamble

The Canadian Hospital Pharmacy Residency Board (CHPRB) Accreditation Standards for residencies in pharmacy practice (subsequently referred to as “pharmacy practice residency”) outline the basic criteria to be used in evaluating such programs in health care organizations applying for accreditation by the CHPRB.

The CHPRB Accreditation Standards will be uniformly applied to all pharmacy practice residency programs in Canada who apply for accreditation.

The Accreditation Standards are based in part upon the current Standards of Practice developed by the Canadian Society of Hospital Pharmacists (CSHP). The accreditation process uses these Standards of Practice to evaluate the pharmacy services within the institution. The accreditation process considers the evaluation of both the residency program and the pharmacy services.

The Accreditation Standards and process apply to pharmacy practice residencies that are completed over a one year period. Alternative models may be considered if such programs meet the standards and provide a continuous learning experience. Each standard is followed by a description of the requirements, where applicable, to meet the standard. The appendix includes suggested learning objectives for standards related to the Pharmacy Practice Rotations.

Throughout the Accreditation Standards, where the auxiliary verb “shall” is used, an absolute requirement is implied. The use of “should” denotes a recommended guideline for compliance. The term “department” refers to the health care organizational structure for the provision of pharmacy services.

It is the institution’s responsibility to award the certificate of residency. In accrediting a residency program, the CHPRB does not presume to certify the individual resident. Reference may be made in the residency certificate to its accredited status in accordance with the provisions of the CHPRB Accreditation Standards

1.2 Purpose of Residencies in Pharmacy Practice

The purpose of a pharmacy practice residency is:

• to provide an experiential learning environment using pharmacist practitioner role models so the necessary skills, knowledge, and values can be acquired and applied by the resident in the provision of exemplary patient care; and, 
• to develop competent and progressive pharmacist practitioners in health care organizations and encourage future leaders for the profession.

2.   QUALIFICATIONS

2.1 Health Care Organization

2.1.1  Standard 

Pharmacy practice residencies shall be conducted in health care organizations whose governing bodies, senior management, professional staff and employees have collaborated to seek excellence and have demonstrated substantial conformance with professionally developed and nationally applied criteria.

Requirement(s)

1. The health care organization shall be accredited by the Canadian Council on Health Services Accreditation (CCHSA).  

2. The health care organization’s accreditation status and most recent survey report shall be available for review by the survey team. 

3. Two or more sponsoring organizations, working in cooperation, may jointly provide a residency in pharmacy practice.

2.1.2  Standard 

Pharmacy practice residencies shall be conducted only in those pharmacy departments that have demonstrated a commitment to education.

Requirement(s)

1. The department shall conduct the residency program in a manner that will ensure that the educational benefits to the resident take precedence over other services the health care organization may obtain from the resident.  

2. A pharmacy practice residency program is expected to provide experience in all aspects of institutional pharmacy practice including pharmaceutical care. Participation by the resident in all activities of the pharmacy department is essential in pursuing this goal and on-the-job experience and training will need to be scheduled for this purpose. The department shall avoid assigning the resident to perform repetitive tasks solely to meet its service needs. This requirement does not preclude the limited scheduling of residents on the staff pharmacist duty roster, provided that it is in keeping with the objectives of the standards.

2.2 Program Direction

2.2.1  Standard 

Pharmacy practice residents shall be directed by pharmacists who hold to high professional ideals, have the desire and aptitude to teach, and administer the program.

Requirement(s)

1. The director of pharmacy for the health care organization (or pharmacist designate if the director is not a pharmacist) shall be the residency program director and, as such, shall be administratively responsible and totally accountable for the program. Coordination of the program may be delegated to a residency coordinator and preceptor responsibilities may be delegated to other qualified pharmacists. In the absence of a director of pharmacy, the residency coordinator shall be considered the residency program director.  

2. The residency program director and coordinator shall have completed a pharmacy practice residency or hospital pharmacy residency or have equivalent experience. Equivalent experience to a pharmacy practice residency is interpreted as three years experience in a broad range of distributive, clinical and administrative pharmacy practice.

3. The residency program director and/or coordinator shall also have had two years administrative experience in pharmacy practice. Administrative experience is interpreted to mean experience as a director, manager, coordinator or supervisor. 

4. The residency program director and coordinator shall be members of CSHP. 
5. The roles of the director and coordinator shall be defined for administration of the program.
6. A Residency Advisory Committee with representation external to the Pharmacy Department shall be in place to provide general oversight and guidance to the structure and function of the program. Terms of reference for this committee shall be established.

2.2.2 Evaluation and Monitoring of the Program

2.2.2.1  Standard 

The pharmacy department shall conduct the program in a manner which reflects the principles of continuous quality improvement in the evaluation of the program.

Requirement(s)

1. An ongoing review process shall be established to assess the performance of the residents and preceptors and to evaluate the training environment.

2. A process shall be established for formative and summative evaluation of the residency program.

3. A review process shall be in place to assess early withdrawals from the residency program.

2.2.3 Evaluation of the Residency Coordinator

2.2.3.1 Standard

The pharmacy department shall conduct the program in a manner which reflects the principles of continuous quality improvement in the evaluation of the residency coordinator.

Requirement(s)

1. A process shall be in place to evaluate and provide feedback to the residency coordinator with respect to his or her role in coordinating and supporting the residency program.

2.3 Preceptors

2.3.1  Standard 

The resident(s) shall be precepted by pharmacists who have the experience, desire and aptitude to teach.

Requirement(s)

1. Preceptors shall have the knowledge, skills and practice experience to act as role models and to assist in the development of the resident’s problem-solving skills and self-directed learning. A defined process for orientation of new preceptors and continuing preceptorship development shall be established. 
2. A primary pharmacist preceptor shall be designated for each rotation and shall be responsible for ensuring that all assessments are completed. Co-preceptors or preceptors from other disciplines may be appointed but must be fully apprised of rotation objectives, resident’s progress to date, and assessment expectations.  
3. The residency rotation preceptors shall develop specific goals and objectives for the resident in consultation with the program coordinator or director. Rotation goals and objectives shall be reviewed annually. 
4. Goals and objectives shall be reviewed and confirmed with the resident at the beginning of the rotation. 
5. Preceptors shall provide timely and regular feedback to, and assessment of, the resident.

2.3.2 Evaluation of the Preceptor

2.3.2.1  Standard 

The pharmacy department shall conduct the program in a manner that reflects the principles of continuous quality improvement in the evaluation of the preceptor.

Requirement(s)

1. The resident shall complete a written evaluation of the preceptor. Feedback shall be provided to the preceptor.  

2. The resident shall evaluate the preceptor on the basis of his/her knowledge, skills and attitudes as a role model and teacher. 

3. The resident shall complete a written evaluation of the rotation based on the structure, content and the degree to which the learning objectives were met. The written evaluation shall be discussed with the preceptor.  

4. The residency director and/or coordinator shall review and sign all the evaluations of the preceptor and the rotation.

5. The preceptor and rotation evaluations shall be used as part of the continual review and improvement process of the program.

2.4 The Resident

2.4.1  Standard 

Pharmacy practice residents shall be individuals who hold to high professional ideals and continued learning.

Requirement(s)

1. The resident shall be eligible for registration as a pharmacist by a Canadian pharmacy regulatory authority.
    
2. The residency program director or coordinator shall establish a formal procedure for evaluating each applicant's qualifications.
    
3. Selection of the applicant(s) shall be the responsibility of the residency director or coordinator.
    
4. The resident shall be a member of CSHP.

3.   RESIDENCY PROGRAM REQUIREMENTS

3.1 General Educational Approach

3.1.1  Standard 

The residency program shall be organized in accordance with sound educational and administrative principles.

Requirement(s)

1. A full-time residency shall be defined as a minimum 52 week training period (including approved leave/vacation).
   
2. Residency training may occur on a part-time basis, however such a program shall be composed of a minimum of 52 weeks training (including approved leave/vacation not exceeding that which would be offered in a full-time program) offered over not more than 24 months, and breaks in residency training shall not exceed 45 working days.
    
3. Residency days must be clearly defined at the beginning of the program, and educational benefits of the resident shall take priority over services.
    
4. Programs may grant credit for prior learning outside of an accredited residency program, or transfer credit from rotations completed at another accredited residency program up to a maximum of 25% of the total residency training period, provided that:

   • The process(es) for granting prior learning credit and transfer credit shall be well defined and documented.

   • Documentation shall provide evidence to support the decision to grant credit.

   • Prior credit/transfer credit documentation shall be maintained in the resident’s training record.

   • Transfer credit shall be awarded only for rotations completed at another accredited residency program within 24 months prior to entering the Program which is granting transfer credit.

5. A resident manual shall provide a comprehensive description of the full-time and/or part-time residency program.
    
6. Objectives for the residency program shall be developed and provided to the resident at the beginning of the program. The objectives shall relate to pharmacy practice, education and research, and shall describe the learning objectives to be achieved in the residency program. Learning objectives shall be clearly written, outcome-oriented and measurable.
    
7. A formal process shall be in place to assess prior learning for each resident prior to the beginning of the residency program.
    
8. An individualized plan shall be developed for each resident at the commencement of his/her program. Based on the assessment of prior learning, a broad written plan for the residency program shall be developed, setting forth goals, as well as a schedule of activities for achieving those goals. This plan should build on the resident’s strengths and address the areas for improvement.
    
9. A formal process shall be in place to orient the resident to the program.
    
10. Each resident’s activities shall be under the preceptorship of a pharmacist. Residency activities shall include a broad scope of contemporary services and need not be limited to the systems and services of the parent health care organization responsible to operate the residency program. Up to twenty-five percent of the resident’s activities may take place outside the parent health care organization. Time shall be allocated for instruction, observation and assessment of the resident in each rotation. The resident’s schedule should be written in sufficient detail to give the resident a clear understanding of each activity in a specific rotation. The schedule shall reflect the predetermined goals and learning objectives.
     
11. The resident shall be presented with opportunities to develop interpersonal skills to communicate effectively with patients, staff and other health professionals.
12. The resident shall be presented with opportunities to work collaboratively with other health professionals.
13. The rotations shall be structured to provide a systematic approach to enhance problem-solving skills with progression to more complex problems within each rotation and throughout the residency year.
14. The program shall provide opportunities to develop critical thinking and teaching skills in the resident.
15. The level of responsibilities and the degree of supervision assigned should be consistent with the skill levels of the resident.
16. The program shall use a variety of instructional methods (i.e., observational, case study, seminars, etc.) and experiences to present learning opportunities to the resident.
17. By the end of the program, the resident shall be able to function as an independent practitioner.
18. Residents shall maintain a learning portfolio, which may include preceptor assessments, self-assessments, career objectives, clinical activities during the rotations, awards, projects, and other documentation relating to their progress throughout the duration of their residency program. Residents shall use the learning portfolio to provide evidence and self-assessment of their learning experiences, and to share the tool with preceptors, residency coordinator and / or director in order to individualize each rotation based on previous experiences.
19. The residency program shall maintain the following documentation for a period of one full accreditation cycle (until the next on-site survey):
     
    • Resident's activities/schedule;
    • Evaluation of the resident(s);
      - all rotations, e.g. administration;
    • Evaluation of presentations & projects;
      - administration rotations, “mini-projects” & drug information papers;
      - formative & summative feedback;
      - any other evaluations e.g. quarterly work reports;
    • Experience records of each resident (i.e. list of presentations made by recent residents);
    • Resident(s)' self-evaluations;
    • Evidence of resident(s) writing learning objectives for presentations; and
    • Confirmation of completion of program (e.g., copies of transcripts, letters and certificates).

3.2 Assessment of Resident’s Learning

3.2.1  Standard 

The resident shall receive both formative assessment at midpoint and summative assessments at completion of each component of residency training using methods that offer opportunity for the resident to demonstrate learning or the achievement of educational outcomes.

Requirement(s)

1. Assessment of the resident’s progress shall be continuous and ongoing throughout the program. A process shall be in place to ensure communication between preceptors of the resident’s progress throughout the program.
    
2. The resident’s achievements shall be regularly assessed in terms of previously established goals and objectives. A midpoint and final evaluation shall be completed for each rotation. The final evaluation should be conducted within 1 week of completion of the rotation. The evaluation meeting shall be conducted by the preceptor for each rotation or by the program director/coordinator with input from the preceptors. The assessment shall relate to the resident’s progress in achieving goals and learning objectives. Subjective criteria such as personality traits should be considered only in relation to their impact on achieving goals and objectives. A written record of the final evaluation of each rotation shall be maintained and reviewed with the resident and signed by the residency coordinator and/or director.
    
3. A process shall be in place to take remedial action if deficiencies in the progress of the resident are noted.
    
4. A process shall be established to address any discrepancies in assessments.
    
5. Each resident shall perform written self-assessments based on the learning objectives established for each rotation. The purpose of these reports shall be to assist the resident in identifying any objectives that were not met during the rotation. These reports shall be reviewed with the resident by the preceptor with or without the program director/coordinator at the time of regularly scheduled evaluations.

3.3 Pharmacy Practice Rotations

Requirement(s)

1. The resident shall receive training in the following:

   3.3.1   Direct Patient Care

   3.3.2   Drug Distribution & Intravenous Admixtures

   3.3.3   Drug Information & Literature Evaluation

   3.3.4   Practice Management & Drug Use Control

3.3.1 Direct Patient Care

3.3.1.1  Standard 

The resident shall develop the skills necessary to provide direct patient care using pharmaceutical care principles.

Requirement(s)

1. Rotations shall provide for a broad experience in the application and management of medications in the treatment of patients.
    
2. The resident shall establish a relationship with the patient and work cooperatively with other health care providers in the provision of pharmaceutical care.
    
3. The rotation shall increase the resident’s knowledge and skills in the following key areas of pharmaceutical care: interview patients; develop a patient database; identify patients most likely to experience drug-related problems; prioritize drug related problems; develop and implement a pharmacy care plan; follow-up evaluation of patient outcomes; document pharmaceutical care activities in the health record; use knowledge of drugs and disease states to enhance pharmaceutical care; apply basic principles of pharmacokinetics and laboratory test interpretation in the care of patients.

3.3.2 Drug Distribution & Intravenous Admixtures

3.3.2.1  Standard 

The resident shall develop an understanding of the drug distribution system, from the receipt of drugs by the health care organization up to and including their administration to the patient.

Requirement(s)

1. The resident shall develop the necessary skills to function in the following key areas of drug distribution:
   i) medication order/profile review;
   ii) medication order clarification; and
   iii) medication incident reporting.
2. The rotation shall increase the resident’s knowledge of drug distribution systems and the roles of pharmacy, nursing and medical staff within these systems.
3. The rotation should develop the resident’s problem solving skills related to drug distribution.

3.3.2.2  Standard 

The resident shall develop an understanding of an intravenous admixture service including total parenteral nutrition and chemotherapy.

Requirement(s)

1. The rotation shall increase the resident’s knowledge related to the following key areas:
   i) pharmacy-based intravenous admixture services;
   ii) aseptic technique;
   iii) applications of technology in sterile product preparation; and,
   iv) total parenteral nutrition and chemotherapy admixture services.
2. The rotation should develop the resident’s problem solving skills related to intravenous admixture services.

3.3.3 Drug Information and Literature Evaluation

3.3.3.1 Standard 

The resident shall develop the skills necessary to document drug information requests, perform literature searches, critically evaluate published research, formulate and communicate the response effectively to the client.

Requirement(s)

1. The resident shall develop the necessary skills to function in the following key areas of drug information:

   i) receipt of drug information requests;

   ii) conducting a literature search;

   iii) critical appraisal of the literature;

   iv) formulation and communication of responses to requests; and,

   v) reporting of adverse drug reactions.
    

2. The rotation should increase the resident’s knowledge of drug information resources.
    
3. The rotation should increase the resident’s knowledge of drug information services and the roles of pharmacy staff within the service.

3.3.4 Practice Management & Drug Use Control

3.3.4.1  Standard 

The resident shall develop an understanding of the principles of management that may be applied to the provision of pharmacy services as well as the role of the pharmacy management team and the role of the department within the health care organization.

Requirement(s)

1. The director of pharmacy or a designated manager shall serve as the principal preceptor in this area of training.
    
2. The rotation shall increase the resident’s knowledge and should develop problem-solving skills related to the following areas of management: organization, human resources, resource utilization, communications, and continuous quality improvement and patient safety.

3.4 Communication & Research Skills

3.4.1  Standard 

The resident shall develop the skills necessary to present effective educational seminars to pharmacists and other health professionals.

Requirement(s)

1. The resident shall be knowledgeable in the general principles of organizing and presenting an effective seminar.
2. Seminar presentations shall increase the resident’s knowledge and skills in organizing instructional content, writing learning goals and objectives, communicating effectively with a variety of audiences, using instructional media, and evaluating presentations.

3.4.2  Standard 

The resident shall undertake and successfully complete a project related to health care organization pharmacy practice.

Requirement(s)

1. There shall be a process for solicitation, evaluation, and approval of project topics.
2. The time allotted for the residency project shall not exceed ten (10) weeks. The scope of the project shall be such that it does not significantly interfere with other rotations.
3. A pharmacist affiliated with the department shall be designated the primary preceptor of the project.
4. A process shall be in place to provide ongoing review, support, and feedback to the resident.
5. The resident shall be involved in protocol development, data collection, analysis, and interpretation.
6. The resident shall present and defend the project and prepare a written report.

3.4.3  Standard 

The resident shall develop the skills necessary to write and publish articles.

Requirement(s)

1. The resident shall prepare an article suitable for internal or external communications.

3.5 Program Completion

3.5.1  Standard

The requirements for the successful completion of the residency program shall be attested to by the health care organization.

Requirement(s)

1. The health care organization and/or university shall recognize those who have successfully completed the residency program by awarding an appropriate certificate of residency. Criteria shall be in place to define successful completion of the program.
2. A certificate shall not be issued to any individual who has failed to complete the prescribed program or to meet the intent of this Standard.
3. The program shall maintain a list of all successful and unsuccessful candidates of the program.
4. Accredited programs should grant the ACPR (Accredited Canadian Pharmacy Resident) designation to residents who successfully complete the residency program.

4. Bibliography

1. Standards of Practice, Canadian Society of Hospital Pharmacists, Ottawa, Ontario.

5. Appendix - Learning Objectives

These are suggested learning objectives for selected standards related to the rotations.

Pharmacy Practice Rotations
3.3.1 Direct Patient Care
3.3.1.1
Standard

The resident shall develop the skills necessary to provide direct patient care using pharmaceutical care principles.

Learning Objective(s)

At the end of the rotation the resident shall be able to:

1. Develop a patient database from the health records, the patient or family members, and other caregivers.
2. Identify patients most likely to experience drug-related problems.
3. Identify and prioritize a patient’s drug-related problems using input from other health care providers and the patient.
4. Develop and implement a pharmacy care plan by evaluating therapeutic options, defining outcomes and developing a monitoring plan.
5. Document direct patient activities in the patient’s health record in accordance with health care organization and departmental policies and procedures.
6. Demonstrate an understanding of the diseases and treatment(s) of patients for the purpose of identifying, preventing and resolving drug-related problems.
7. Integrate pharmacokinetic principles with patient-specific parameters (e.g., demographics, disease states, serum drug concentrations, laboratory results, therapeutic endpoints) to perform appropriate calculations/estimations to optimize drug therapy.
8. Interview patients to assess compliance and attainment of pharmacotherapeutic endpoints, need for medication counselling and counselling aids.

3.3.2 Drug Distribution & Intravenous Admixtures
3.3.2.1
Standard

The resident shall develop an understanding of the drug distribution system, from the receipt of drugs by the health care organization up to and including their administration to the patient.  

Learning Objective(s)

At the end of the rotation the resident shall be able to:

1. Describe all legal requirements and professional standards that pertain to the distribution and control of drugs in health care organizations.
2. Demonstrate evidence of understanding of policies and procedures relating to drug distribution and administration.
3. Explain the principles, advantages and disadvantages of the drug distribution systems used in health care organizations.
4. Describe the role of drug distribution as a component of the provision of pharmaceutical care.
5. Identify potential drug-related problems that could occur as a result of the health care organization’s distribution system and identify ways to prevent their occurrence.
6. Describe the role of pharmacy technicians and other support personnel in the functioning of the drug distribution system.
7. Identify real or potential drug-related problems through the use of medication profiles and initiate appropriate action.
8. State the benefits and limitations of using a profile for pharmacotherapy monitoring and drug distribution.
9. Explain the process of medication incident reporting and analysis.

3.3.2 Drug Distribution & Intravenous Admixtures
3.3.2.2
Standard

The resident shall develop an understanding of an intravenous admixture service including total parenteral nutrition and chemotherapy.

Learning Objective(s)

By the end of the rotation the resident shall be able to:

1. Describe the basic principles of aseptic technique.
2. Describe the advantages and limitations of a pharmacy-based intravenous admixture service.
3. Describe the specialized equipment used in an intravenous admixture service, including TPN, and describe the techniques and technology that may be used to increase efficiency and productivity of the service.
4. Describe the unique requirements of a chemotherapy admixture service.
5. Describe other types of parenteral drug delivery systems and programs (e.g., PCA, home IV therapy, etc.).

3.3.3 Drug Information and Literature Evaluation
3.3.3.1
Standard

The resident shall develop the skills necessary to document drug information requests, perform literature searches, critically evaluate published research, formulate and communicate the response effectively to the client.  

Learning Objective(s)

At the end of the rotation the resident shall be able to:

1. Describe the methods of organizing drug information resources.
2. Develop a process for obtaining relevant background information from the client about the patient, disease and/or drug.
3. Determine the urgency and depth of response for any given question.
4. Prioritize requests to ensure that responses are provided in a timely fashion.
5. Develop a logical step-wise approach to searching the information resources in an attempt to answer request.
6. Critically review primary, secondary, and tertiary literature on a specific drug/therapeutic topic.
7. Formulate and communicate clear and comprehensive verbal and written responses to requests.
8. Identify the strengths and weaknesses of the resources utilized by the drug information service.
9. State the benefits of documentation of drug information requests and responses.
10. Explain the role of the drug information service in disseminating drug information to health professionals.
11. Describe federal and/or provincial adverse drug reaction reporting programs.

3.3.4 Practice Management & Drug Use Control
3.3.4.1
Standard

The resident shall develop an understanding of the principles of management which may be applied to the provision of pharmacy services as well as the role of the pharmacy management team and the role of the department within the health care organization.

Learning Objective(s)

By the end of the rotation the resident shall be able to:

1. Outline the organizational structure of the health care organization and the pharmacy department.
2. Explain the roles of:

   i) health care organization “board”;

   ii) health care organization administration;

   iii) pharmacy management team; and,

   iv) other relevant management positions.

3. Identify the impact of the following on departmental policies:

   i) legislation;

   ii) practice standards; and,

   iii) accreditation standards.

4. Describe the financial planning cycle and routine financial monitoring, including monitoring of drug expenses.
5. Outline the purpose of the departmental policy and procedure manual and its maintenance.
6. Outline the function, terms of reference and purpose of all health care organization committees with pharmacy representation.
7. Explain the principles of continuous quality improvement and outline the steps that would be taken to conduct an audit of a given pharmacy activity.
8. Explain the principles of drug procurement and inventory control and outline their applications in the department.
9. Identify and assess the applications of technology.
10. Outline the basic principles of human resource management including recruitment, hiring, evaluation of staff, and the essential features of labour relations.
11. Describe the principles of strategic and operational planning.
12. Describe the economic evaluation of new drugs and technologies.
13. Explain the role of the formulary system and drug-use review in promoting rational drug therapy.
14. Explain the underlying principles of medication safety including the process for assessing, managing, preventing, and reporting medication errors.

3.4 Communication & Research Skills
3.4.1
Standard

The resident shall develop the skills necessary to present effective educational seminars to pharmacists and other health professionals.

Learning Objective(s)

At the end of the residency, the resident, when presenting a seminar or in a formal teaching activity, shall be able to:

1. Develop learning objectives.
2. Incorporate appropriate principles of critical appraisal.
3. Communicate effectively at the appropriate level for the audience.
4. Use visual aids effectively to enhance the presentation.

3.4 Communication & Research Skills
3.4.2
Standard

The resident shall undertake and successfully complete a project related to health care organization pharmacy practice.  

Learning Objective(s)

At the completion of the project, the resident shall be able to:

1. Identify and define a pharmacy practice problem to be studied.
2. Develop clear objectives for the project.
3. Demonstrate knowledge of protocol development, data collection, analysis, and interpretation.
4. Prepare a written report of a project in a format that is suitable for publication.

3.4 Communication & Research Skills
3.4.3
Standard

The resident shall develop the skills necessary to write and publish articles.

Learning Objective(s)

At the end of the residency the resident shall:

1. Demonstrate proficiency in scholarly writing.