Episode 5:An Interview about Cedars-Sanai Medical Center's Pharmacy Technician Residency Program

Margarita Fedorova, CPhT, joins host Jeremy Sasser and co-host Jessica Langley on the latest episode of OnScript with NHA to discuss the innovative pharmacy technician residency program at Cedars-Sinai Medical Center in Los Angeles, the first program of its kind nationally.

Recently named Pharmacy Employer of the Year at the Western Pharmacy Exchange (WPE), Margarita serves as manager of pharmacy services for Cedars-Sinai Medical Center in Los Angeles, where she has led numerous initiatives that push the boundaries of pharmacy technician practice and improve operational efficiency. She is responsible for coordinating the hospital’s tech-check-tech program, and has led the redesign of the technician practice models, supported a “meds to beds” program, and co-led the development and implementation of the pharmacy technician residency program.

Read the full transcript

Jeremy:
Pharmacy Podcast Nation. Welcome to OnScript, the only podcast on the Pharmacy Podcast Nation dedicated to the technician workforce advancement and overall well-being. Super excited to have a guest today from Cedar Sinai hospital out in California, Margarita Fedorova. She and the Cedar Sinai organization have been the masterminds behind a wonderful program for technicians to bolster their careers, advance their careers and participate quite frankly in a lot of different tasks that are really outside of the typical pharmacy box, if you will. So, we are very excited to have her. Jessica Langley is going to be joining the conversation today, and going to be driving the interview with Ms. Fedorova, and we always like to do a word or phrase of the day. Today's is very fitting. The word of the day, or phrase of day is technician residency. Briefly, Margarita, before we get into intros, could you define technician residency?

Margarita F.:
Well, technician residency would be the program that provides a technician resident with accelerated knowledge of medication use process, knowledge of how to build presentations, data analytics and leadership skills.

Jessica Langley:
There we go. So Jeremy and I had the opportunity at the beginning of this year to connect with Cedar Sinai and Margarita and some of her extended leadership team to kind of partner. And we started this first by allowing the technician residency program to share their knowledge at the Western Pharmacy Exchange Conference in April that is through the California Pharmacists Association. So that was our first interaction, and I also want to put in there as your Pharmacy Manager Services at Cedar Sinai, that Margarita was also the recipient of the California Pharmacist Association Pharmacy Technician Employer of the year. And I'll let her kind of boast about herself as well.

Jessica Langley:
But I do know that she is engaged, on a national level with multiple initiatives, committees, work, in which, obviously as a technician herself that has had a highly successful career. She is truly an advocate for technicians everywhere. And I am so excited and happy to have made this connection with her and be able to not only share her personal story, but also share the successes that Cedar Sinai is doing to empower technicians there as well. So Margarita, I'll kind of let you introduce yourself and your role. And maybe just tell our listeners a little bit about your career journey and where you got where you are today.

Margarita F.:
Well, I've immigrated from the Republic of Belarus, former Soviet Union in 1991 to the United States. And I found my first job elsewhere, not Cedar Sinai, in 1993 and I was there for three years. So what was happening there that after those three years, I've experienced what other technicians tell me in the interviews these days when I interview them in my current role, is that you kind of grow to the max. You already learned everything you could in your job. And then what?

Margarita F.:
And I found, at the time that Cedar Sinai was one of the rare organizations that's already actually had a career level that was already advanced in technicians back then. And it was very great for me that I was hired there in 1993. I'm sorry, in 1996 actually, after my first job. And since then I was growing kind of with the organization of being from level one that our career level still stands as you get hired as level one. And then I progressed to level two and three, and in 2006, I was promoted to a supervisor, and now I hold the manager's position. So, and that's been my career. Again, at Cedar Sinai, originally, I worked in various technician roles. Anywhere as unit-based and prior again, in my first job I was a IV Room Technician, and then I was doing different functions, as far as also working in Pediatrics and working in Oncology, and Controlled Substance Management. So and again, after that, went into management.

Jessica Langley:
That's amazing. So we also talked about how you presented earlier on this philosophy of technician residency, with that also being the word of the day. So Cedar Sinai is the only organization in the country that offers a technician residency program for Pharmacy Techs. So tell us a little bit about the program and why Cedar Sinai came up with this idea to implement this within your organization.

Margarita F.:
Again, since we really like innovations and we are never satisfied with the status quo. In my organization, our leadership has always been looking to, what programs we need to develop, what kind of skills technicians need to have to really provide the best patient care outcomes. And Dr. Shane, our Pharmacy Executive Officer, had this idea of technician residency that she outlined in one of her articles in 2011, we had put together a task force containing a few members of the management team and we came up with the technician residency program as kind of, it exists right now. Even though we made some changes down the line, because the needs always change, and we adjusted the lens of the rotations and some of the rotations are now different than originally, to basically satisfy the needs of the current state.

Jessica Langley:
Mm-hmm (affirmative). Can you describe a little bit about what an individual will experience as they go through the residency program, and how long it is, and details around it.

Margarita F.:
Well the individual pretty much will experience pretty much everything that the technician and health system will [crosstalk 00:07:28].

Jessica Langley:
Need to know.

Margarita F.:
Basically, or needs to know. Because what we do is, this is a 50 week program where we have 35 weeks in core and supplemental roles, and I will explain a little more. And then 15 weeks of advanced training. And also we do have, this are your 50 weeks. Then we also have one week of the orientation, which is a standard three days of hospital orientation into this of the department orientation. And in our core, we have 24 weeks right now, and that is seven weeks in central pharmacy, 10 weeks in compounding, which is a sterile and non-sterile compounding.

Margarita F.:
We have four weeks as a unit based. We have three weeks in transitions of care, two weeks in pediatrics, and two weeks in outpatient pharmacy. One week in prioritization, one week in automation. And we also have compliance and med safety for of one week, procurement and reimbursement another week, and patient assistant program is another week. And finally we have investigational drug studies and that's basically what is in our program.

Jessica Langley:
Yeah.

Margarita F.:
Now this is [crosstalk 00:08:46] also core and supplemental. So to explain further, towards the four weeks of core is where technician is going to staff. That they staff once they're trained. And that's longitudinal staffing. And again, in supplemental program we have all those different rotations and at the end, based on the needs of the department again and the technician, residents and clinicians, we pick the kind of the specialized role for them and that's where their advanced training of 15 weeks is happening.

Jessica Langley:
So you're following a little bit of their strengths, their passion-

Margarita F.:
Correct.

Jessica Langley:
For what they want to do, so you ensure that it's aligned with their goals and their drive and everything like that.

Margarita F.:
Yes.

Jessica Langley:
Amazing. Can you tell a little bit about how you pick an individual to go into this residency program? And then maybe after that, some of the outcomes that you all have seen from these individuals that have successfully completed the residency program?

Margarita F.:
Yeah, absolutely. So again, we do have certain requirements. The candidate needs to be having one year of experience, at least one year of experience, or they could graduate from their accredited program, ASCP accredited program, or they need to be board certified. Or the combination of any. And what we're looking for is, it was funny that one of my candidates ask me in the interview, are you looking for a super tech? And I said, we're not looking for a super tech, we're looking to make you a super tech. But at this point we really are looking for the right protoplasm. Someone who we can see who has great communication skills, someone personable, someone who can work with many other disciplines and many different people.

Margarita F.:
Because, keep in mind, that this are so many rotations we're going through, and we are going through different trainers. We're going through different preceptors. Again, they're working with me, they're working with the residency director, I'm the coordinator. So it's like, you really need to kind of fit in. And have this in you to be able to graduate, as well as we're looking to have someone who can learn how to deliver presentations, where again, developing leadership skills. And that's the person who, kind of, we are looking again for, this kind of a protoplasm that we can develop in someone, who may not be a super tech in the beginning, but definitely kind of needs to become a super tech.

Jessica Langley:
Morph them into one.

Margarita F.:
Yeah.

Jeremy:
I have to interject right now, and say I'm adopting your technician protoplasm phrase. That is absolutely phenomenal. I love that. Technician protoplasm.

Jessica Langley:
We've created a new word.

Jeremy:
So, coming at you as a word of the day to a future episode.

Jessica Langley:
There you go. So how many years have you guys been doing the residency program?

Margarita F.:
From 2015.

Jessica Langley:
Awesome. And then how many of those individuals have stayed on with the organization and what are you seeing as some of the benefits or the rewards of having this program?

Margarita F.:
Well, we had one technician, the first technician resident who got into being a 340b Technician. And now I am with a current technician resident just started the program in April, 2019, this year, and we'll see what will happen in the future. So far she's been through a few rotations from, yeah. And we are working on, and she's already done presentations and working on projects. Again, that's something that we've developed too, working with data. There are many different aspects of what technician resident does in their program.

Jessica Langley:
Do they say that their satisfaction with their work has increased, that they feel more connected to the organization, into the profession, they feel valued? Does that impact your kind of operational effectiveness and efficiency? And are you having to not train some... You obviously just helping with turnover and training costs and those sorts of aspects?

Margarita F.:
Absolutely. My current technician resident came from the independent pharmacy and she's had seven years of experience in different independent pharmacies. However, she's never had the chance to learn medication use process in the health system. And when I'm asking her, "Where do you stand right now from where we started to this day?" She's very excited, and she says that, "I've learned so much. I've never thought, I would be..." She is someone who is actually very grateful for the opportunity and experience. And that's what I personally appreciate is the coordinator, someone who is really driving and really wants to learn. And so yeah, she's already had, she says, "I've never expected to have so many, I guess, chances to learn so many different things so far."

Margarita F.:
And we are really now, only been through four rotations and there's so many to come. So, and so many presentations, and so many projects that she is already kind of lined up to do and that is quite amazing. I just really, I can say that we have amazing outcomes here. And it helps us in a way that with, I'm hoping that with some minimal training, she will be able just to step into any of these roles that will take probably someone else to learn. It takes so many years to learn, because, as a measure of success of this program, for example, we have three measures of success of the program is the knowledge and medication use process. And what we've done originally is that we have an exam where 24 technicians ranging from the two years of experience to 31 years of experience. And my technician resident took the test, and my technician resident actually scored 75%, and on average, we had 73% from everybody else which is, again, my technician residents was slightly higher in the score.

Margarita F.:
And in presentation and communication, we are assigning projects such as clinical pearls, met safety, regulatory readiness, innocent [inaudible 00:15:53] nature and more. And we actually did an anonymous survey where we surveyed 27 technicians who listened to my technician resident presentation, and 100% of them agreed that the topics were relevant and technician resident was knowledgeable, and 93% agreed that they understood the information. And when it comes to data analytics and leadership skills, we are assigning projects in medication cost intervention and [inaudible 00:16:25], for example, and my first technician resident was able to implement the near miss intervention tracking program. And at the end of the program, eight out of eight preceptors, again, 100% percent of them, agreed the technician resident has developed satisfactory leadership skills and analytic skills. So-

Jessica Langley:
That's amazing. That's great. So needless to say, this will continue, right?

Margarita F.:
Yes.

Jessica Langley:
This program will continue in Cedar Sinai. Are there other things, or other ways, because as you mentioned, it is a very innovative organization and I've met some of your leaders and peers in the space. What's next on the horizon for Cedar Sinai? What are you guys talking about doing? What's the next thing that you feel like you're going to maybe implement or advantage that you'll give to technicians within your organization?

Margarita F.:
Well, what we're looking for in this particular program is to expand. To hopefully recruit more, have more technician residents in the future. And again, we are always working on advancing our technicians, whether it's through the career leader, or advanced roles. And our programs are always expanding. So in the even near future, I foresee the need for more advanced technicians. And we're working on it.

Jessica Langley:
Great. If you had a point of advice to give to fellow technicians, after obviously a very successful tenure and career as a technician working your way up from just a staff technician into a manager role, what would you tell them? What type of advice would you share with them right now if you could? If they were all sitting in a room, or they're all listening on the podcast network.

Margarita F.:
I would just say never be satisfied with your own status quo. Just never think that, "Oh, I'm just a tech." What is it I have in my future? You do because as there is, in the current healthcare is rapidly changing in terms of like it requires more and more skills as of for the technician to have. It requires more and more knowledge for the technician to have. I'm sure that if you've worked hard enough, you will find your niche.

Jessica Langley:
There you go. Also, we obviously encourage them to get involved, just like you sitting on...

Margarita F.:
with organizations. Again, thank you for, that's the good point, Jessica. Again, changes don't happen overnight. Changes don't happen just because we want them to happen. We have to make them happen and that's where we can get involved with different organizations and that's where we need to have voice and tell the world what we need and what we want. Otherwise no one will know.

Jessica Langley:
That's right. Step up, advocate for yourself. Find those ways to connect both locally, nationally, never give up. Empower yourself. Find a mentor and support within your organization, individuals that will come alongside of you to build you up. Such a great message today. Jeremy...

Jeremy:
Man. I've just been sitting here with a grin on my face the entire time.

Jessica Langley:
I think you've experienced some of the same things that she did in your career path.

Jeremy:
I'll tell you, and I'm about ready to go make a foam finger. You know the number one with like the Cedar Sinai Hospital logo on there. I just think this is fantastic. And if we can provide a platform to get your message out to get other health systems interested in implementing something like this, seeing the value of really building up their technicians within their organization. And again, you know, central message that we have often have as all of these things technicians can do, they can do well, they can do safely, freeing up pharmacists to provide more clinical consultative services, direct patient care. The more of that we can do, fantastic.

Margarita F.:
Yeah, the better outcomes our organizations will have.

Jeremy:
Absolutely.

Jessica Langley:
That's right. Because ultimately it comes down to patient safety and health outcomes.

Margarita F.:
Patient satisfaction.

Jessica Langley:
There you go. So I challenge our listeners today to ask themselves, if you're a technician, you know, what do I want? What's my passion? What's my end goal in my career? And make a map or a list of how you could get there. If you're a pharmacy employer or a pharmacist, ask yourself, Hey, does this technician residency program have a potential life in my organization? And I don't think it has to be health system focused. I think I challenge retailers to think about that as well as to how you can, you know, develop these kind of internal residency programs alongside thinking about career laddering in a different way and what different roles technicians can do and how you can kind of spearhead away for individuals to work up that ladder and advance themselves. And again, it's never in a negative light for organizations when you do that for your people.

Jeremy:
Absolutely.

Jessica Langley:
They obviously feel good, they feel empowered, they feel valued and they truly can see themselves as a part of the healthcare team

Jeremy:
There are a growing number of community pharmacy residency programs for pharmacists that could look at something like what you're doing and inject into that program, a technician to go along with those pharmacists that are in that residency program. Go along, shoulder-shoulder hand-in-hand, whatever kumbaya you want to describe and go on that journey with them. And really learn how they can add value to that organization by thinking critically and coming up with innovative ways that they can practice.

Jessica Langley:
Yes, so Jeremy, I'm going to pose a question out there to our listeners. If you want to learn more, both from a personal or professional level about a rep technician residency program or just personal development, give us a call, send us a question, we can connect you with some people that can potentially help in that. As always, email us any comments or questions that you have.

Jeremy:
Email us that OnScript@nhanow.com. Or visit our blog at nhanow.com/learning-leading. You'll find all of our episodes there and we'll certainly try to provide some links or information to Margarite at your institutions website, webpage, what have you, where listeners can get some more information. And of course if there's anybody out there listening and in the Southern California area, I encourage you, if you're a technician, you feel like you've kind of climaxed in terms of not your ability to learn and take on new responsibilities, but possibly you're at the point where there's not much room for growth where you're currently at. I encourage you to look into this program, it is fantastic. Thank you so much, margarita. We really appreciate having you.

Jessica Langley:
Keep up the good work and continue advocating for technicians everywhere. They thank you.

Margarita F.:
Thank you. I was very excited to be on this podcast because this is the only podcast that is targeting pharmacy technicians and I'm very impressed.

Jeremy:
Absolutely. Well, thank you so much. We appreciate it.