Within the field of pharmacy, one witnesses the profession evolving dramatically, not only through the elevation in standards of training requirements but also in the broadening of scope of pharmacy practice as a whole. As front-line gatekeepers to health care, we are increasingly finding ourselves serving not only independently but also as integral players within a progressive, multidisciplinary environment. Our expertise and intimate knowledge of disease state management is affirming us a place within the health care continuum. As the profession increasingly demands the clinical knowledge, experience and confidence to engage within these settings, postgraduate residency programs appear advantageous. Pharmacy residencies involve training in a defined area of pharmacy practice, providing knowledge and experience that pharmacy practitioners need in order to face challenges in today’s complex health-care environment, while also providing essential skills to meet the practical demands of the future. Also, residents have a competitive edge within the job market as many employment opportunities indicate a strong preference for individuals who have completed a residency program. Clearly, our profession is thrusting forward for further credentialing and for a permanent position within the collaborative health care framework. What are postgraduate trainings today may be the core components and values of our practice tomorrow. Furthermore, due to consider dialogue about making pharmacy practice residencies for direct patient care mandatory, an expectation by the year 2020, residency programs are an importance option to strongly consider.

Attending the American Society of Health-Systems Pharmacists (ASHP) Midyear Clinical Meeting last year as a 3rd year pharmacy student I was intrigued, excited, curious, and very overwhelmed. Reflecting on my conversations with countless pharmacists, rekindled my enthusiasm and inspired me all over again. The same words of wisdom and passionate opinions resounded in my mind. Despite the grueling hours and the low salaries, residents from a wide array of care settings, described a program that involved training beyond the classroom setting, describing new-found abilities to think more critically, sharpening diagnostic skills within an interdisciplinary approach. A few residents explained how they were now able to truly connect the dots between classroom, theoretical knowledge and application of knowledge learned into rigorous, unpredictable, real-life practice. Second year residents spoke of acquiring greater self-confidence, communication skills, and self-knowledge. One resident eloquently spoke of a deeper, more tangible appreciation for patient care complexities, truly treating and seeing the whole patient. She described not only focusing on drug classifications, mechanisms of actions, and drug interactions, but thoroughly evaluating the impact of drug interventions and their involvement in various, increasingly complex disease states.

Speaking to residency directors as well, these skilled clinicians assured me that residency programs helped them develop the confidence, proficiency, and practicality necessary to become capable, autonomous practitioners and key figures within collaborative teams. They echoed the revelations of their residents. They spoke of greater recognition and preparation acquired by residents for increasingly clinical and complex direct-care roles in both inpatient and outpatient settings. Directors illustrated the need for greater vigilance as more clinical conditions with multiple drug regimens, with associated increased risk of drug interactions and chemical incompatibilities, lead to heightened risk of adverse events. They described an increased demand for greater individual tailoring of drug therapy, our core expertise, to be integrated into the health care mosaic.

All these positive experiences and compelling arguments are encouraging and convincing. Yet, it is important to get an overall picture of what a residency truly entails, to consider various factors involved in the decision making process, and to really choose a residency that is tailored towards your interests, capabilities, and goals.

Why a residency?

• Gets you the job or promotion
  
  • Qualify for positions that require training, a growing trend in hospitals, health care systems, direct patient care
    
  • Flexibility and adaptability to change during developing career path
    
  • Distinguishes you from other PharmD graduates.
    
• Networking
  
• Mentors, expanding resources, future job opportunities.
  
• Career building, professional vision
  
• Plan career, develop leadership skills, practice in variety of settings

What will you do?

• Practice as a pharmacist, precept students, complete research, projects, and educational talks
  

What is the difference between a residency and a fellowship?

• A fellowship is more geared towards industry, and is designed to make you an independent researcher
  
• Residencies primarily emphasize development of patient care and practice skills.
  

How many pharmacists do residencies?

• 1500 pharmacists/year and increasing
  
• 800 programs in hospitals, community practice, managed care, clinics
  
• PGY1 programs have steadily grown over the last 10 years; there were 200 programs in the 1990s, now there are 545. In the 1990s, there were 100 PGY2 programs, now there are 285.
  
• Demand exceeds supply; In 2005, there were 1200 pharmacists competing for 1100 spots.
  

What is the difference between a PGY1 and a PGY2?

• PGY1 provides pharmacy practice training for generalists in health systems, managed care, community settings
  
• It is mandatory for continuation on to PGY2 residencies.
  PGY2 provides advanced training in focused areas of patient care.
  
• PGY1 rotations in:
  
• Ambulatory care, cardiology, critical care, drug information, emergency medicine, geriatrics, immunology, infectious disease, internal medicine, managed care, nuclear pharmacy, nutritional support, oncology, pediatrics, pharmacotherapy, administration, psychiatry, transplantation.
  

How does one prepare for residencies?

• Talk to faculty members, mentors, pharmacists in multiple practice areas, current residents, fellow classmates, new practitioners
  
• Before 4th year
  
  • Develop ideas and prospective sites to talk to, visit residency showcase at ASHP residency midyear conference in December. Visit Showcases to talk to program directors, preceptors, current residents, interview with select number of programs through personnel placement service.
    
• Things to keep in mind when choosing a residency
  
  • Program design, core requirements, flexibility, setting, specialty areas, types of patient populations (acute care, ambulatory care, indigent populations)
    
  • teaching involvement, investigational drug studies, public health initiatives, if PGY2 training is also offered
    
  • Personal preferences
    
  • Location, benefits, salary, number of residents.
    
  • Keep in mind:
    

Why is accreditation of a residency program important?

• Programs undergo rigorous national training standards, reviewed by expert site survey teams, and have received ASHP (American Society of Health-System Pharmacists) seal of approval thus ensuring that quality training programs meet the core standards required for accreditation.
  

What is the Match? .

• The match pairs residents and appropriate residency programs
  
• It levels the playing field for all potential residents, requires applicants and programs to concurrently rank preferred sites and applications, respectively.
  
• Giving all programs and candidates equal amount of time to complete interviews and make selections.
  
• Line up best placements between candidates and programs based on list of preferences. .
  

What is the timeline for the residency decision making/application process?

• September
  
  • Submit resident matching program application agreement form with the appropriate fee.
    
  • Begin working on curriculum vitae (CV) and cover letters.
    
• October
  
  • Review the ASHP Online Residency Directory which provides information on ASHP-accredited residencies. www.ashp.org/directories/residency/
    
  • Request additional information and applications from programs of interest.
    
  • Register to attend the ASHP Midyear Clinical Meeting (MCM) and select programs to visit in the MCM Residency Showcase.
    
  • To interview one-on-one with employers at the meeting, consider registering for the Personnel Placement Service (PPS). www.careerpharm.com/
    
• November
  
  • Finalize CV
    
• December
  
  • Attend ASHP MCM.
    
  • Request letters of recommendation.
    
  • Complete all paperwork for applications, including ordering transcripts.
    
  • Schedule on-site interviews.
    
• January
  
  • On-site interviews begin.
    
  • Submit application agreement form to National Matching Services Inc. by published date.
    
• February
  
  • Complete interviews. Narrow residency choices to programs that best meet personal goals, needs and professional interests.
    
• March
  
  • Submit Rank Order Form to be received by National Matching Services Inc by their published date.
    
  • Receive “Match” outcome at 12 P.M. Eastern Daylight Savings Time on published date.
    
  • Unmatched residency candidates resubmit application to programs with positions remaining.
    
• July
  
  • Most residencies begin

Due to the ever-evolving pharmacy profession, more and more graduates are recognizing that in their lifetime and in the near future, much like the PharmD became the gold standard of practice, so may the pharmacy practice residency. Thus when contemplating future career paths, postgraduate pharmacy residency training is an increasingly important option to thoroughly consider.

Contributed By Alison Healey
URI PharmD Candidate
Class of 2008