Remember back to Grey’s Anatomy or Scrubs where the medical residents look drained, are pulled in every direction, and are constantly being evaluated? That is basically equivalent to a pharmacy residency. Also, you earn about 40% of a full pharmacist's salary. Sounds appealing, does it not? In all reality, a pharmacy residency – like a medical residency – does have a purpose. A purpose that is worth the uncomfortable year(s) of life and money. A pharmacy residency, as defined by the American Society of Health-System Pharmacists (ASHP), “is an organized, directed, postgraduate training program in a defined area of pharmacy practice. It provides the knowledge and experience that pharmacy practitioners need to face challenges in today's complex healthcare environment, while also providing essential skills to meet the practice demands of the future.”
Although ASHP sets the standard guidelines for all accredited pharmacy residencies, every pharmacy residency program is not structured the same way. Some programs require night shifts, on-call status, five case presentations instead of three, and the list continues. I will outline my experience as a PGY1 resident at a large academic medical institution that is also a Level 1 trauma center. Whether you are a morning person or not, you will become one as a resident. My focus is impeccable in the wee hours of the morning, so with that, I typically arrive at the hospital by 5 AM. Sometimes I stumble in at 4:30 AM depending on the tasks to be done. For the first two hours of my day, I work on research projects, medication use evaluation data collection, topic discussions, case presentations, or clinical pearls to bring to the medical team on rounds. At 7 AM I begin to look at patients for the day. My internal medicine team follows anywhere from 11-15 patients on service. I work through all my patients in an hour and head upstairs to meet my student who I have the privilege to co-precept.
Most residency programs offer an optional teaching certificate which, in my opinion, is definitely worth pursuing. Most of the criteria for the certificate are already met by the requirements of the residency program. Some specifics of my teaching requirements include helping in a handful of lectures/labs at an associated school of pharmacy, providing topic discussions, journal clubs, and case presentations to the pharmacy department, writing a teaching philosophy, and co-precepting one APPE student. Getting back to my day, around 8 AM I head upstairs and talk about the patients that I've assigned to my student for work up. We then head to rounds for the next 4-5 hours with a team of medical students, residents, and the attending provider. We discuss each patient’s treatment regimen and then we go to each room to assess the patient. This is what I love most about my internal medicine rotation: seeing the patient helps me understand disease states and clinical presentations much better than I ever could from reading a guideline or clinical trial. Also, my internal medicine team is incredibly receptive to pharmacy and thoroughly enjoys having us as a member of the team. I try to anticipate what questions they might ask and have answers prepared prior to rounds to keep patient discussion streamlined and efficient. When necessary, I do quick literature searches on the spot to help provide evidence-based recommendations to the team.
After rounds, my student and I return to the office to debrief about the recommendations and plans for the day. We then have topic discussions, medication histories to reconcile, and discharge educations to complete. A big focus of our internal medicine rotation is improving transitions of care from a pharmacy standpoint, which means ensuring appropriate and adequate medications on admission and discharge. After the “business day” ends, I typically debrief with my preceptor and then head back to my personal office to work on my own projects and presentations for longitudinal rotations and general residency requirements.
Ultimately, residency is exhausting but rewarding all the same. I leave the hospital every day with a feeling of pride knowing that I have worked hard, pushed myself, and assisted my team with patient care. I may average 12 hours per day at the hospital and work 12 days on with 2 days off, but I know it's only temporary. I have yet to decide if I want to pursue a second year of residency. I am a curious individual who enjoys diving into all types of disease states and literature; specialization in a second year may be a disservice to me. However, if you know you have a niche, a second year may be the path for you. At the end of the day, a residency will help provide you with a wide array of experiences to further develop you as a clinical pharmacist for optimal patient care. You have to get uncomfortable to get comfortable, and a pharmacy residency will do just that.