Research, leadership, and teaching skills-a realist review and synthesis of how and why these develop in pharmacy residency programs.

OBJECTIVES: Pharmacy residency programs accelerate the skill development of early career pharmacists. To establish a program theory of how and why pharmacy residents develop skills most effectively and consistently a realist review was performed. METHODS: A realist review of articles reporting on skill development by pharmacy residents through completion of a pharmacy residency program was conducted. Reports describing the development of clinical skills were scarce and the review was focused on the investigation of contexts and mechanisms which favor the development of non-clinical skills, such as research, leadership, and teaching skills. The review findings were synthesized with interviews of recent pharmacy residents to further elucidate contexts and mechanisms which have to be activated to achieve these outcomes. KEY FINDINGS: Thirteen Context-Outcome-Mechanism Configurations were synthesized from data presented in 57 articles and former resident interviews to develop a program theory of how and why pharmacy residency programs advance non-clinical skills. The program theory was validated by theories of workplace and experiential learning. Contexts, which influence the development of leadership, research, and teaching skills, were affordances provided by workplaces through the structure of residency programs, workplace capabilities, and culture. In favorable contexts, mechanisms of resident engagement, accountability, understanding of strengths and development needs, support by experts, mentors and peers, and learning through observation, reflection and practice were activated. CONCLUSION: The program theory established via a realist synthesis provides guidance on how workplaces and pharmacy residency programs can support the accelerated development of leadership, research, and teaching skills by early career pharmacists.