postgraduate year (PGY)1 residency training: Postgraduate year one of pharmacy residency training is an organized, directed, accredited program that.
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Why do we need residencies? randy p. mcdonough
D
uring dinner at the APhA Annual Meeting in Baltimore last month, a colleague asked me an intriguing question: “Why do we have residencies, anyway?” The context of this discussion centered on developing a high-performing network of community pharmacies and the core clinical services they agree to provide.
I asked him for further clarification. His concerns had to do with the clinical competencies of all pharmacists to receive and act on clinical information obtained from patients, other providers, health systems, or laboratories. If pharmacists are prepared to do this following their graduation from colleges/schools of pharmacies, he asked, why even have residency programs? It was an interesting question and one that required thought before answering, especially since I have a biased opinion: I am the residency site coordinator and a preceptor for our practice site, and I have trained more than 20 residents in my career. Before I give the answer I gave to my colleague, I’d like to share how it aligns with the American College of Clinical Pharmacy’s definition of postgraduate year (PGY)1 residency training: Postgraduate year one of pharmacy residency training is an organized, directed, accredited program that builds upon knowledge, skills, attitudes, and abilities gained from an accredited professional pharmacy degree program. The first-year residency program enhances general competencies in managing medication-use systems and supports optimal medication therapy outcomes for patients with a broad range of disease states.1 MTM pearls
The answer I gave my colleague was that colleges/schools of pharmacy provide practitioners with the base knowledge required for a pharmacist. Student pharmacists develop a rich knowledge of pharmaceutics, medicinal chemistry, pharmacology, 38
PharmacyToday • APRIL 2016
therapeutics, pharmacokinetics, and drug literature evaluation. In introductory and advanced practice experiences, they apply their new and up-to-date knowledge in a limited, controlled environment while being closely monitored by their preceptors. They have up-to-date clinical knowledge and a limited time to apply their knowledge and skills, but this doesn’t
setting, will have responsibilities to ensure that their patients are achieving their therapeutic outcomes with safe and effective therapy. The knowledge and skills they need will be similar across the practice type continuum. Pharmacists will be interventionists—identifying and resolving drug therapy problems, working collaboratively with other health care providers, counseling and educating patients, and documenting their patient care activities. They will be integrated into the health care team as medication managers to improve patient care and outcomes. They will be involved in drug therapy selection, dosing, and monitoring. This vision requires that pharmacists have a mastery level of a com-
Residencies … give residents the opportunity to further apply their clinical knowledge with consistent and regular oversight and feedback from their preceptor(s). mean they feel comfortable or confident applying their knowledge on their own, in diverse clinical situations, with unfamiliar providers or health care environments. This confidence and competence come with experience, time, and repetition. In fact, it is often quoted that one does not become an expert at something until one has repeated an activity 10,000 times. This is why residencies exist—to give residents the opportunity to further apply their clinical knowledge with consistent and regular oversight and feedback from their preceptor(s). Over the course of the residency, the resident becomes more and more independent, with the goal of becoming an independently functioning clinical provider who is confident and competent to manage patients’ drug therapies regardless of the clinical complexity or situation. Future of pharmacy practice
My answer is consistent with my vision for pharmacy practice 10 years from now. By that time, all pharmacists, regardless of their practice
plex set of knowledge and skills. It will be challenging, if not impossible, for students to achieve this mastery level at the time they graduate from pharmacy school. Residencies will need to become the norm or standard for all graduating pharmacists to ensure they develop the clinical competence and mastery knowledge to be successful in evolving and complex health care systems that are focused on patient outcomes and quality measures. Although it is not possible today due to resource constraints, at some point residencies will need to be a required educational and training experience for all graduating students! Reference 1. www.accp.com/resandfel/resandfel.aspx
Randy P. McDonough, PharmD, MS, CGP, BCPS, FAPhA, column coordinator (mcdonough9@mchsi. com), and Co-owner and Director of Clinical Services, Towncrest and Solon Towncrest Pharmacies, Iowa City; www. thethrivingpharmacist.com www.pharmacytoday.org
