The road to residency can be a bumpy one, so being prepared before you go through the process can make a world of difference. In this article a pharmacist who recently ran the “residency process gauntlet” provides guidance for those who seek to follow a similar path.
Authored By: Meagan Adamsick, Pharm.D.
Mentored By: Erin McCreary, Pharm.D., BCPS
[Last updated: 27 August 2017]
Early advanced pharmacy practice experiences (APPEs aka rotations)
Congratulations on completing the didactic coursework of pharmacy school. You are now armed with the foundation to excel on rotations. Note that I did not say you are armed with the knowledge to excel on rotations. You are still going to have to work for it as you transition to experiential learning.
The first thing you should do is start a peripheral brain. I have found GREAT success with a small, inexpensive photo album (that I bought at a thrift store). I carry it in my white coat pocket at all times. Helpful slides, charts, equations, or other references that I find myself constantly looking up get printed in a 4×6 version and find a home in my little photo album. Seriously, start this early in your APPEs. I used mine every day on APPE rotations and it continues to evolve with me throughout my residency training.
As you are working hard to learn and diligently filing knowledge into your photo album, remember that every day on rotations is not a dream come true. You may be faced with “busy work” or assignments that do not interest you and you will definitely have some of your first encounters with difficult providers or other colleagues. Do not despair, my friend. Embrace it. Learn something from each task you complete and each person you interact with while on rotation. Write your challenging experiences down so you have an excellent answer to behavioral interviewing questions such as, “Tell me about a time when you had an interaction with a difficult co-worker.” I promise you, no matter how daunting the rotation syllabus, you want to approach every rotation with an open mind. That includes those elective rotations you drew last because you had a low lottery number for rotation selection. You will be surprised by the rotations you love the most at the end of the year – I most certainly was.
My last piece of advice is to start a journal. Your APPEs are the only the beginning of working as a pharmacist and gaining exposure to consistent, direct patient care. Your journal can be strictly professional or you can mix a little personal stuff in, too. In roughly six months, interviewers are going to ask you about the patient interactions you are having today. You will not remember most of them in enough detail to really shine in an interview. Write these experiences down. Also, this year is going to be a big one for you, so dumping your thoughts and feelings onto paper can be very cathartic. Trust me.
A few rotations down, several to go
Is it already time to start thinking about residency applications? This time comes so fast and you want to make sure you are prepared. Decide if you are going to travel to ASHP Midyear and start budgeting! Midyear, and the subsequent residency interview process, can be very expensive without proper financial planning.
Brainstorm your priorities for residency programs sooner rather than later to evaluate what is most important to you. Writing a personal mission statement may help here. This step is different for every applicant. Location? Program type? Available PGY-2 programs? Intangible feelings? There is NOT a “top programs” list for pharmacy residency training, because every applicant has different must-haves, interests, and non-negotiables. My top program may be your worst nightmare.
Once you have your priorities and values down, it is time to start perusing the ASHP Residency Directory for programs that interest you. Do not stop there! Be sure to check out the program-specific websites for more in-depth information. Make sure you decide on a way to organize residency program information as you research. Some people live and die by Microsoft Excel. I cannot figure out that program for the life of me, so I opted for a template form in Word that I filled out for each program as I found information. I then brought these forms to Midyear and used them while talking to programs and residents. This helped me ask meaningful questions and to keep track of the programs I had already talked to during the Residency Showcase. Whatever method you chose you cannot go wrong it if works for you… just stick to it and make sure you stay organized.
Maybe I should have warned you about this earlier, but it is NEVER too early to be thinking about who is going to write you a letter of reference for residency applications. If your rotation went well, ask your preceptor if he or she is willing to write you a POSITIVE letter of reference as your rotation is coming to a close. It may feel awkward to ask that specific question, but it is necessary to guarantee your recommendation letters shine and that you are your preceptor are on the same page with your rotation. By the way… do not wait until the end of your rotation to get on the same page with other things. Ask for feedback early and often. This makes you a better student and ultimately, a better pharmacist. It also does not hurt that letter, either.
The scariest thing about this holiday during your APPEs is that it is go-time. Time to get serious. Your CV should be constantly open on your computer and reviewed by your mentors and preceptors. Then have it meticulously reviewed by anyone and everyone with impeccable grammar. Finally, take advantage of free review services offered through ACCP and ASHP. I also recommend converting your CV into a table on your preferred word processing program. By utilizing a table, all of the formatting for the entire document can be kept consistent and when you are ready to print or save as a PDF, highlight the entire table and click the “No Borders” button. BOOM – perfectly formatted and beautiful CV. Proofread it, proofread it and proofread it again!
Next, get your business gear ready. Order business cards, but keep them simple and don’t order 500 of them. Remember you will not be an APPE for much longer! Purchase a business suit that makes you feel incredible. Find shoes that are professional, tasteful and comfortable. I also recommend purchasing a portfolio to bring to Midyear and job interviews. Taking notes is crucial throughout the application and interview process.
Start to ask your mentors and preceptors how to write a cover letter/letter of intent. Dig out some old presentations from student organizations about how to successfully accomplish this, google to your heart’s content, and ask current residents for advice. After Midyear, you have a very short amount of time to write cover letters for every program you decided to apply to, not to mention you still have to attend rotation and, if you choose to attempt the impossible, have a social life over the holiday season. This can be a lot to juggle, but taking the time to prepare ahead of Midyear and organize your thoughts/general approach can truly help.
One piece of advice when writing a letter of intent is to tell a story. Where have you been, where are you now, and where do you want to go in your career? If you can show you are equipped to succeed in their program and what they offer can help get you where you want to go, you are probably a good fit.
Midyear Clinical Meeting
It is not required to attend Midyear. Plenty of students match with residency programs without attending, but I personally felt that I gained insight into programs and learned helpful information that was not readily available on program websites by attending the meeting. It is also a fabulous time to see classmates you have not seen in a while during rotation year and pharmacy friends throughout the world. If you are applying to a small geographical area, it may not be necessary to go to Midyear, but if your net is cast much wider in terms of location, Midyear can be very beneficial for you.
Real talk about the Residency Showcase: it’s a zoo. As soon as you step foot into the Residency Showcase for the first time, you will understand. It is honestly like Best Buy on Black Friday if the first 100 shoppers got a free iPhone X.. or the Hunger Games, but the arena is a giant room in a convention center, and the shoppers/players are rocking their business suits. IT’S INSANE. I literally had to buy myself a milkshake after the first session because, comfort food. My tips for survival:
- Remember that residents and preceptors are talking to hundreds of candidates. This time is not necessarily for you to get the program to remember you; it is for you to decide whether or not you want to apply to the program. Say it with me. “This is your time.”
- Have a plan of attack. Before Midyear, make a list of programs you want to visit and find them on the showcase map. Then, create a route and be prepared to deviate from that route if a booth is especially busy when you approach it. Be aware that each program is only at one of three sessions. This could mean that all of the programs you want to meet are all during the same session (#truth). This also means you have a lot of talking to do in a short period of time. Have your questions ready and be efficient, for your sake and out of respect for the program representative’s time.
- Write everything down. After each showcase session, my head was a crazy, confused mess. I could barely remember who I had talked to and definitely not what we talked about. Do not be like me. After each conversation you have with a program, take a moment to write down whom you spoke with and what you learned before moving on to the next program.
Post-Midyear Stress Disorder
First and foremost, keep your reference writers in the loop. They volunteer a lot of their time for your benefit, so tell them as early as possible after Midyear which programs you are applying to, why you are applying to each program, and the program deadline. They are very busy this time of year as well, so give them a realistic timeframe to write your letters in PhorCAS.
Now to continue on the rollercoaster of emotions. Proofread that CV one last time. Finish your cover letters and have preceptors provide feedback. Double check requirements for supplemental materials. Then, submit your applications. Just do it. Yes, make them amazing. But then PLEASE click the submit button eventually. You will feel so much better once you do.
Prepare yourself for incredible joy and the pang of rejection. Nothing, I mean nothing, is a guarantee. Even if you are on a first-name basis with the residency program director or are absolutely in love with a program, prepare yourself to potentially not get an interview offer. The average application to interview ratio is about 2:1. This means chances are that 50% of the programs you apply to will not offer you an interview. If you do not get an interview, please remember that you are not a horrible candidate. You are not a horrible person. You just might not be what the program is looking for, and that is okay. Remember from the beginning, there are countless amazing programs out there.
Once the interview invitations start rolling in – breathe! It is a hectic time and the logistics of scheduling interviews and travel can be tricky, but it is a time to cherish. If you are offered an interview, you are qualified for that position. They want to meet you. They want to get to know you. You have as good of a shot as anyone else they are interviewing.
That being said, make sure you prepare for your interviews like you would any major exam. Study the subject (AKA the program). Prepare numerous questions to ask each potential person you could meet throughout the interview day. Get sleep the night before. Eat breakfast the morning of. Get to know your co-candidates. They could be your co-residents.
The anxiety associated with submitting your rank list is REAL. Make sure you submit your rankings based on what YOU want. You have no idea what a program thinks of you. If you want to rank a program #1, you should rank it #1. On the flip side, if you cannot see yourself at a particular program, DO NOT RANK THEM “because any residency is better than no residency”. Residency is stressful enough and you will not be successful if you do not fit with the institution.
Communicate with your current preceptor. Let him or her know you are going through the residency match and remind them when Match Day is. Some APPE’s ask for the day off from rotation, but this is an entirely personal decision. I went to rotation on Match Day and was just fine, but had many friends who did not go to rotation on Match Day.
No matter the result, you are a great candidate! If you match, congratulations! If you don’t match, be sad. Take the hit. And then wake up on Saturday morning and get your A-game back in gear. There are GREAT programs in Phase 2 of the Match process, and there are opportunities outside of residency training. How can you improve your application or ensure you are contacting programs that align with your priorities and values? Reach out to mentors and ask for help! Do not underestimate the power of networking.
Congratulations! You graduated from pharmacy school and life is awesome! Celebrate and then…. Back to the books. Sign up to take your NAPLEX and Law Exam sooner rather than later. Resident life is so much better once you are a licensed pharmacist. The earlier you can verify orders, the more of a jump start you get on your training. Congrats on surviving an emotionally challenging professional year! Good luck in your next chapter!!
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