After reviewing the position statement from ACCP please consider the following:
Do you agree that residency training should be required for all pharmacists participating in direct patient care?
How do you define direct patient care? More specifically, should this apply to all community pharmacists?
Should all pharmacy schools be able to prepare their graduates to function as independent clinical pharmacists by the time they graduate (thus preventing the need for mandatory residencies)?
If residencies were currently required to practice as a community pharmacist, would you still have chosen to enter pharmacy school?
10 comments:
Why residency? Is it an advantage for a community pharmacist? should it be made mandatory for all graduating pharmacy students?
Aadi Parikh
aadi85.parikh@gmail.com
What benefit do you feel that residencies provide and do you feel that it would be beneficial in ALL pharmacy settings?
Ashley Cortright
P1 Student
How do you see the field of pharmacy changing if residency programs are required? If they are required, do you think that community pharmacists should be exempt?
How does a community pharmacy residency augment your capabilities as a community pharmacist?
Lauren Hawkins
l.m.hawkins@wingate.edu
Do you see any benefits from a manditory community pharmacy residency?
"Manditory Residency Training" are three difficult words to hear for many pharmacists with B.S. degrees or who have practiced in clinical setting w/o a residency for years or who have recently or will soon complete 4 to 8 years of school and have a PharmD degree.
The position paper shows some validity in why residency should be the standard for direct patient care. I have a B.S. with little advanced training. I have learned on the job and have many questions on a day to day basis. It would be better to have had advanced training before performing clinical care, but perhaps not manditory. If better trained pharmacists are available for clinical positions, that will motivate non-residency trained pharmacists who want to provide clinical patient care to seek skills they may be lacking.
It will be interesting to see what happens as the "deadline" approaches.
With a residency, you experience what I equate to a fifth year of pharmacy school where your committed year is split into various modules, some required by the program and other elected by you. Each module lasts approximately one month and you have a preceptor that shows you the ropes, grants advice when sought, holds topic discussions with you, and seeks out experiences for you to learn from. The residency also allows you refine your presentation skills as you are required to hold in-services, present journal clubs , and give various other presentations your preceptor/program sees fit. You also develop your research skills as at the end of the program, you much present a research project as well as create a manuscript worthy of publication. Many programs also allow you to try your hand at academia via education of pharmacy students. Many programs also offer longitudinal experience where thoughout the year you are completing projects for management, leadership, P&T committees, community service, or whatever the program wishes. As a resident, you are thrown a lot of various projects.
As a recent graduate, I feel that there is still so much for me to learn. I had hopes of matching with a residency program in my home town but things did not work out as planned. I instead was able to land a clinical position with one of the local hospitals which does offer a residency program. I went through a rigorous training process and shadowed many established clinical pharmacists before being set out on my own. I have a network of highly qualified pharmacists at my disposal for advice and recommendations. I am involved in committees and in a community health outreach project through the hospital. I will be training to attend codes soon. I hear that my luck is just that and not many that I graduated with can obtain a clinical position without having completed a residency or have at least one years experience in a clinical setting.
Should residencies be mandatory? That is a difficult question as the programs currently still do not have enough slots available to fill that demand. Could more be done to prepare students while in pharmacy school? Another difficult question. Perhaps by eliminating/combining some redundant classes, an "advanced fourth year" could be established where by the current curriculum for fourth year be completed as a P3 and a program similar to a residency could be established for P4 year.
All in all, I feel that a residency helps to prepares you for your career and offers many experiences. Could you seek out these same experiences out on your own? Perhaps. What about board certification, could that take the place of a residency? With so much up in the air, I would consider planning on going through the matching process upon graduation. A residency only gives you one more key to place on your belt for a future locked door you never considered.
Lisa DePetris, PharmD
Clinical Pharmacist
St. Vincent's Medical Center
lgdepetris@gmail.com
Q from Aadi: Why residency? Is it an advantage for a community pharmacist? Should it be made mandatory for all graduating pharmacy students?
I definitely think a residency puts you at an advantage in the shortest amount of time possible. You gain a condensed amount of experience in 1 or 2 years vs. gaining on the job training where it may take several years to gain the same experiences from residency. I say this because I have worked with some very talented pharmacists without a PharmD or residency as Joe spoke of. In my opinion, a 1 year residency puts you at an advantage compared to a new graduate with 1 year on the job experience. In addition, on the job experience varies greatly. A new graduate could choose to seek out opportunities to gain experience, obtain certifications, get involved in organizations, write and publish, present CEs, precept students, teach, conduct research etc. but it may be more difficult to get the opportunity to do some of these things. In contrast, a new graduate could punch in and out for 40 hrs a week and skate through their career without putting forth effort to learn and develop skills. A residency allows you these opportunities in a structured environment where you have mentors, feedback and self-reflection. These experiences and feedback may never occur on the job.
I am not fully convinced that we should require residencies for ALL graduates of pharmacy school. Residency may not be the best route for all paths unless more specialties are developed. A fellowship, masters degree, PhD etc may be alternatives depending on the chosen path.
Qs from Ashley: What benefit do you feel that residencies provide and do you feel that it would be beneficial in ALL pharmacy settings?
Residencies help develop communication skills, writing/publishing/literature evaluation, presentation skills, precepting and teaching skills, experience with IRBs/research and give you confidence to practice autonomously. These are just a few broad benefits as I could go on about personal growth and things I have learned in my residency training to this point. Residencies open doors in your career and allow greater flexibility if you are interested in academia, clinical coordinator, residency program director or clinical specialist positions.
Yes, I feel residency training would benefit ALL pharmacy setting. The question really is should they be required?
How do you see the field of pharmacy changing if residency programs are required? If they are required, do you think that community pharmacists should be exempt?
If we truly want to expand clinical roles, I do not think community pharmacists should be exempt. If we are satisfied with where things are now residencies may not be needed for every career path. I feel that schools should be giving students basic skills in presenting, evaluating literature, assessing and triaging a patient, communicating and conducting oneself professionally.
Requiring residencies cannot happen overnight. Unfortunately our profession doesn’t have the resources right now but it is possible to work toward this goal. In looking at the physician model we may need to change requirements based on specialty chosen the number of years for residency training/fellowship may differ.
Q from Lauren: How does a community pharmacy residency augment your capabilities as a community pharmacist?
I cannot speak to community residencies from personal experience but the benefits above would apply here. Changes in training requirements could lead to changes in the role of a community pharmacy. Would this allow technicians and technology to play a larger or expanded role?
Q from Callie: Do you see any benefits from a mandatory community pharmacy residency?
I have described benefits above and certainly envision benefits of residency trained pharmacists in community settings.
Zack Deyo
PGY2 Am Care Resident
U of MD SOP
Aadi: Residencies offer students experience in a shorter time window. In your fourth year, you will be on rotation and see many things; however, you will not be "practicing" at most of your sites without first consulting your preceptor. As a resident, you have the benefit of "practicing" with an experienced pharmacist behind you to help guide you if you deviate from correct practice. I think most people would agree that you can learn a lot from books but what you remember comes from experiences. These experiences also help you furhter link all of the book information together and help you stop looking at individual pieces of your patients. Job training is very broad with little specifics and no time to learn in between. I have experienced this. A residency gives you time to expand your knowledge and prepare you for bigger things, like research, teaching, and publications.
Ashley, Callie, and Lauren: Residencies would be beneficial for all settings, even community pharmacy. I have worked in community, and I realize there is little time for extra activities. Now, the minute clinics, etc are becoming popular, which is going to put community pharmacists in a more clinical environment. By doing a residency in a commmunity pharmacy that goes above and beyond our standard definition today, you see what can be accomplished for your patients with a little extra effort. Yes, it is worth the time, especially when it makes a difference to even 1 patient. Pharmacy school does prepare you for community pharmacy practice, but it does not prepare you for making the practice patient-centered.
If residencies are mandatory in the future, I know it would be a great thing for the pharmacy profession because then the medical profession would really begin to see our potential in patient care. I do think if this happens they should create a "grandfather clause" for current pharmacists in community and even hospital pharmacy who practice on a general level with a certain number of years of service. I do think residencies should be required for those who want to practice in a specialty because I have seen the difference in those with additional experience and those without, and excellent patient care comes with experience. This being said, availability will be a problem, and I do not think this action would be acceptable without a huge increase in number of residencies and funding.
I currently practice as a clinical staff pharmacist. While my clinical skills and knowledge are improving as I find my way, a residency would offer me the opportunity to expand my knowledge base and experiences.
Community pharmacists utilize clinical knowledge on a daily basis – if anyone needs specialty training to handle the demands of patient care in their setting, it’s a community pharmacist. We are often a patient’s sounding board, and the ability to talk with patients (not at them) is an acquired skill. The challenge in community pharmacy is that we quite frequently do not have a diagnosis on which to base a recommendation. In a traditional clinic setting, you are either seeing a patient BECAUSE of their condition (i.e. Coumadin clinic) or because they HAVE a condition (i.e. heart failure, MI, stroke, trauma, etc.), both determined by a physician. Patients have open access to community pharmacists - I see patients who THINK they have something and I have to act accordingly. Walking the fine line between recommending and diagnosing is one that is nowhere more apparent than in the community pharmacy setting – developing into a patient-centered practitioner is perhaps the greatest benefit that could be drawn from a community pharmacy residency.
It seems as though we, as pharmacists, are putting ourselves into hierarchies. The profession as a whole is in such a rush to demand respect and be recognized as a higher entity of healthcare provision that we’re dividing ourselves into higher and lower ranking professionals. Maybe the real problem is that we’re competing with each other instead of working together to advance our profession. While the PharmD has been around since the 60’s, AACP made the degree mandatory in 1990... then practice residencies came along... at first, you could do a one-year postgraduate residency, opt into specialty training in a specific field during that residency, and come out a specialist. Now, you have to do a PGY2 residency to specialize. Why not diversify the possibilities to allow a pharmacist to tailor a residency to their needs? For example, as Dr. DePetris mentions, why not incorporate a specialized P4 rotation year – where you could do advanced activities as part of your coursework to (A) determine if a residency is right for you, and (B) make you more marketable to postgraduate residency programs? Make this an option that pharmacy schools must provide their P4 students and then allow those students access to a specialized PGY1 residency instead of the current two years to specialize. What about part-time residencies? The profession should open up a more expansive set of possibilities for students instead of limiting the process to either one or two years.
Mandatory residencies would also eliminate competition – my residency-trained colleagues on these boards can attest to the competition that goes into attaining a residency position. Many slots are highly coveted. Would these residencies carry as much value if residencies were required and every single student had to be matched with a site? Pharmacy is an interesting profession in that most people will not work for the same employer for their entire career. Therefore, if residencies were mandatory, they would have to be mandatory for all facets of pharmacy – community, consulting, hospital, nuclear, managed care, academia, and so on. And, they would all have to be the same the first year to ensure that a residency graduate could work in any area of pharmacy. Will this ever happen? Probably not... at least any time soon. Just look at the numbers – there are a total of 720 PGY1 residencies in the nation (ASHP-accredited). According to AACP, there were 52,685 total first professional degree students enrolled in 2008. Divide by 6 to cover the fast-track programs – nearly 9,000 pharmacy graduates per year. Divide by 50 states… need about 175 residencies per state. There are 30 PGY1 residencies in North Carolina. There is obviously work to be done.
Erica Harms, Pharm.D., R.Ph.
Staff Pharmacist - Target
Charlotte, NC
eharms@carolina.rr.com
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