Many people know about pharmacy residencies in general, but not many people know about 24-month pharmacotherapy resident opportunities. In this article a pharmacist in the tail-end of her 24-month pharmacotherapy residency discusses the reality that she has experienced as compared to her expectations prior to starting.
Authored by: Alexandra E. Foster, PharmD, BCPS
Article Mentor: Sarah T. Eudaley, PharmD, BCPS
[Last updated: 31 May 2018]
When considering career opportunities as a pharmacy student, I was sure of two things: (1) I wanted to pursue post-graduate residency training and specialize in one of my interest areas, and (2) I was interested in everything. It seemed that every disease state discussed in my Therapeutics courses and every rotation I took as a fourth-year pharmacy student sparked my interest. After countless hours of researching pharmacy residency programs, I finally found what would fit my interests and career goals perfectly – a 24-month combined post-graduate year one (PGY1) and post-graduate year two (PGY2) pharmacotherapy residency.
The American Society of Heath-System Pharmacists (ASHP) and American College of Clinical Pharmacy (ACCP) describe 24-month PGY1/PGY2 pharmacotherapy residencies as programs “…designed to produce a specialized practitioner with an advanced degree of proficiency and expertise in working with interdisciplinary teams to deliver pharmaceutical care to diverse populations…with varied and complex health problems” [1]. The first 24-month pharmacotherapy residency was established in 1996 [2], and there are now thirteen 24-month pharmacotherapy residencies available in 9 different states [3-4].
As a pharmacy student, I was fortunate to interact with residents of a 24-month pharmacotherapy residency that was affiliated with my college of pharmacy. This provided me the opportunity to learn about 24-month pharmacotherapy residencies and the unique experiences available to residents completing these programs. After beginning the first year of my pharmacotherapy residency and recruiting for my program at state and national residency showcases, I quickly realized that most pharmacy students are not familiar with this type of residency program and the opportunities it provides.
Here I share some misconceptions I had as a pharmacy student researching these opportunities, as well as my experiences as a 24-month pharmacotherapy resident..
Expectation #1: 24-month pharmacotherapy residencies provide the same general rotation experiences in the PGY1 and PGY2 years
This is false! One of the greatest benefits of completing a pharmacotherapy residency is the diverse patient care experiences that are available to take each residency year, from ambulatory care to critical care and everything in between. While my personal interests are primarily with inpatient internal medicine, I really enjoyed and found great benefit caring for these additional patient populations and learning how to manage several different disease states. This also allowed me to develop clinical decision-making skills that are applicable in many patient care settings and for many patient populations.
Required competency topic areas for pharmacotherapy residents encompass a wide range of disease states and patient populations, including: cardiovascular, critical care, endocrine, fluid and electrolyte, gastrointestinal, genitourinary, hematologic, infectious disease, bone and joint, neurological, oncology, psychiatric, renal, and respiratory diseases [1]. Completing various required and elective rotation experiences in these topic areas has allowed me to feel very comfortable and confident in managing these disease states and making clinical decisions around pharmacotherapy. These experiences have also helped me gain a better understanding of how to optimize pharmacotherapy for my patients as they transition from one setting to the next.
Expectation #2: There is really no difference between completing a 24-month pharmacotherapy residency and a PGY1 and PGY2 internal medicine pharmacy residency
While similarities do exist between pharmacotherapy and internal medicine specialty residency programs, there are a few notable differences that distinguish these programs and the experiences they provide from one another.
One difference between the two programs is the patient populations around which rotation experiences are centered. As mentioned, 24-month pharmacotherapy residencies provide rotation experiences with diverse patient populations, including patients of all ages and in both inpatient and outpatient settings [1]. While specific rotations are required in these different settings to meet necessary standards for ASHP accreditation, all 24-month pharmacotherapy residencies offer elective rotations to allow residents to gain more experience in their particular interest areas [2]. In contrast, PGY2 internal medicine residency programs focus on rotation experiences with adult patient populations with a variety of disease states, primarily in the inpatient setting [5]. Required and elective rotation experiences are available in these programs, as well.
Additionally, residencies designed as 24-month programs provide the benefit of structuring PGY1 and PGY2 rotations in a complementary and logical manner [6]. They also allow for longitudinal rotation and project experiences, such as a longitudinal ambulatory care component and development of a larger scale research project over the two years [6].
Expectation #3: All 24-month pharmacotherapy residencies have a strong emphasis in academia
While all 24-month pharmacotherapy residencies offer academic experiences, the type and extent of experiences varies based on the institution. A 2014 survey of 24-month pharmacotherapy residencies noted that programs with academic funding provided a larger extent of academic experiences compared to programs without academic funding [2].
Academia is one of my interest areas, so as I was researching 24-month pharmacotherapy residencies, I was interested in programs with a large academic focus. With my residency program director and residency program coordinator as full-time faculty at the college of pharmacy, I have had a variety of teaching opportunities throughout my two years of residency, including course coordination, didactic teaching, active learning, and small group facilitation. I have also served as a primary preceptor and co-preceptor for third- and fourth-year pharmacy students and PGY1 pharmacy residents. However, for pharmacy students who may not have an interest in academia like I did, other 24-month pharmacotherapy residencies exist with varying academic opportunities and requirements.
Expectation #4: Graduates of 24-month pharmacotherapy residencies are most-qualified for inpatient internal medicine or academic positions
While graduates of 24-month pharmacotherapy residencies are definitely qualified for positions in internal medicine or academia (based on the program), these are not the only positions they accept following completion of residency training. The diverse patient care experiences provided in 24-month pharmacotherapy residencies allow these pharmacists to develop the knowledge and skills to be proficient in a variety of patient care settings and specialties. Pharmacotherapy residency graduates are in the unique position to fill a variety of positions, providing flexibility throughout their careers [2,6].
In my pharmacotherapy residency program alone, the past four graduates have taken infectious disease, clinical faculty, ambulatory care, and neurology specialists positions! I recently accepted a position as an adult medicine pharmacist at an academic medical center, allowing me to practice as a specialist in my area of clinical interest, while also being involved in education. This is similar to an editorial on 24-month pharmacotherapy residencies published in 2008 that demonstrated the unique array of positions 24-month pharmacotherapy residency graduates accepted upon completion of training [6].
Expectation #5: Completing a 24-month pharmacotherapy residency limits your interactions with other PGY1 and PGY2 residents at the institution.
Knowing that I would be the only PGY1 pharmacotherapy resident at my institution, I was a little apprehensive about how much interaction I would have with the other PGY1 and PGY2 residents. After starting the program, I quickly realized I had nothing to worry about, and I found I had the benefit of being in both a small and large residency class. Being one of two pharmacotherapy residents at my institution (my program recruits for one resident every year), I automatically had the mentorship and support of my residency program director, program coordinator, and PGY2 pharmacotherapy resident. I also had the advantage of being in a large residency class, as the PGY1 and PGY2 pharmacotherapy residents are well integrated with the other residency programs at my institution.
All 24-month pharmacotherapy residencies recruit for one to two positions every one to two years, meaning that there are one to four pharmacotherapy residents in each program per residency year [2]. Additionally, all institutions with 24-month pharmacotherapy residencies offer other residency programs [2].
Closing Comments
I highly recommend pharmacy students, especially those who are interested in PGY1 and PGY2 residency training and have a wide variety of clinical interests, explore the opportunities available in 24-month pharmacotherapy residencies.
Since the PGY1 and PGY2 residency years are combined, pharmacy students should be certain they are ready to make a 24-month commitment when interviewing for and ranking these programs. Because of this, 24-month pharmacotherapy residencies may not be for everyone.
However, since I knew I wanted to complete two years of residency training and gain a wide variety of experiences working with different patient populations, I have found it to be a perfect fit.
References/Recommended Readings
4. Search directory. American College of Clinical Pharmacy web site. Accessed May 29, 2018.
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