postgraduate training - ipha training tablet.pdf · in p.b. bookstaver roadmap to postgraduate...

Postgraduate TrainingRebecca Young, PharmD, BCACP

Assistant Professor of Clinical Sciences Roosevelt University College of Pharmacy

Disclosure and Conflict of Interest

Rebecca Young declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

Objectives

At the conclusion of this program, the pharmacist and technician will be able to:

1. Identify the different types of Post-Graduate Training opportunities

2. Describe the application process and the role of Pharmacy Online Residency Centralized Application Service (PhORCAS)

3. Distinguish a typical interview schedule

4. Explain the match process

Pre-Test Questions

The first residency, known as “internships” began in _____.

A. 1920’s

B. 1930’s

C. 1940’s

D. 1950’s

Pre-Test Question

Which of the following is a resident responsibility?

A. Research

B. Patient care services

C. PharmAcademic

D. All of the above

Pre-Test Question

Which of the following is a mission of a community hospital?

A. Emphasis on patient care

B. Emphasis on patient care, education and research

C. Provision of patient care and interest in improving patient outcomes, wellness and health

D. Provide patient care to veterans

Opportunities After Graduation

• Fellowships

• Advance Degree Programs

• Residencies

– Post-graduate year 1 (PGY1)

– Post-graduate year 2 (PGY2)

Fellowships

• Opportunities:

– Traditional (2 yrs.)

– Industry (1-2 yrs.)

– Specialized

• Pharmacoeconomics and outcomes research (2 yrs.)

• Regulatory affairs

• Others– Medical affairs, market access/managed markets and clinical

research and development

• Affiliations

Johnson MD. Pursuing pharmacy fellowships. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill,2013:327 – 336. Wooley M, Alsaraf M, Barone JA, Miller ML. Pharmaceutical industry fellowships. In Getting Started in a Pharmacy Residency. Washington, DC: American Pharmacists Association; 2013:141-164.

Advance Degree Programs

Interests in management and leadership in pharmacy or health care• Masters of science in pharmacy administration

(MS)– Degree varies based on institution

• Masters of business administration (MBA)• Masters of healthcare administration (MHA)

– Focused in health systems and health compared to MBA

• Masters in public health (MPH) or health policy– Focuses on conditions and services to protect the

community

Goldman MP. Advanced degree programs. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:337 – 344.

Residencies

• Postgraduate Year One (PGY1)

– General pharmacy experience

– Meets ASHP standards and outcomes

• Postgraduate Year Two (PGY2)

– Builds upon competencies in PGY1

– Focused in specific area of practice

– Preparation for board certification

Kania D, Miller ML. Deciding on Postgraduate Training. In In Getting Started in a Pharmacy Residency. Washington, DC: American Pharmacists Association; 2013:1-20.

Residency History

1930’s

1948

1962

1970’s

1993

2005

“Internships”

Development of

standards, ASHP

involvement

Accreditation

process,

“Residency”

Clinical practice

grows

Pharmacy Practice

Residency

PGY-1/PGY-2

Apple, AL. The maturation of postgraduate pharmacy training. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:3 – 8. ASHP General Info. ASHP. http://www.ashp.org/menu/Residents/General Info/FAQs.aspx#3. Accessed August 19, 2016.

TYPES OF RESIDENCIES

PGY1 Pharmacy Practice Residency

• Experience in ICU, internal medicine, and ambulatory care

• Exposure to many disease states and pharmacotherapy issues

• Rotate through different experiences • Opportunities to work with preceptors in many

specialties• Develop skills in drug information, drug-policy

development, pharmacy administration , and/or practice management (staffing) absences

Terriff CM. Postgraduate year one pharmacy residency. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:209 – 223.

Community Pharmacy Residency Programs (CPRP)

• Chain, supermarket, independent, health-system pharmacies

• Many programs have longitudinal experiences

• Clinical Services

• Common disease states targeted

• Possible teaching commitment

• Projects (some longitudinal)

• Business opportunities

Ferreri SP. Postgraduate year one community pharmacy residency. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:225 – 237.

PGY2 Residencies

• Managed care

• Ambulatory Care

• Cardiology

• Psychiatry

• Nephrology

• Infectious Disease

• Internal Medicine

• Acute Care (ER,

critical care)

• Oncology

• Pediatrics

• Veterinary

• Solid Organ Transplant

• Drug Information

Bookstaver PB. Roadmap to Postgraduate Training in Pharmacy. New York: McGraw-Hill; 2013.

Reasons to Complete a Residency

• Competitive advantage in job market

• Networking opportunities

• Improvement in clinical skills, confidence, and critical thinking

• Develop teaching skills, tools and teaching portfolio

• Build leadership skills

• Career planning

• Professional visionKania D, Miller ML. Deciding on postgraduate training. In Getting Started in a Pharmacy Residency. Washington, DC: American Pharmacists Association; 2013:1 – 19. Clark JS, Pleva M. What’s in it for me? Benefits of postgraduate training. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:9 – 29. ASHP. http://www.ashp.org/menu/Residents/PGY1/WhyaResidency.aspx. Accessed August 19, 2016.

Resident Responsibilities

Patient care

services

Population-based care

Education

Service Responsibilities

Research

PharmAcademic

Pruchnicki MC, Bennett MS. A day in the life: what to expect as a pharmacy resident. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:31 – 51.

Program Characteristics

• Variety of Institutions

• Residency size

• Hospital size

Academic Medical Centers

• Three-part mission:

– Patient care, education, research

• Affiliated with schools of pharmacy

• Variety of discipline practicing and learning in the medical center

• Focus on teaching and education

• Many healthcare professionals have dual roles

Philips BB. Selecting the ideal residency program. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:55 – 75.

Community Hospitals

• Serve their surrounding communities

• Mission:

– Emphasizes patient care, although education or research can be included (especially in community teaching hospitals)

• Could hold formal rounds

• Offer community service programs to patients


Hospitals Apart of Managed Care Organization

• Share aspects of community hospitals

• Focus on serving members rather than community

• Mission:– Provision of patient care, interest in improving

patient outcomes, wellness and health prevention

• Teaching healthcare professionals, patient education classes, and experiential teaching of pharmacy students


VA Medical Centers

• Mission:

– Provide patient care to men and women veterans

– May include education and research

• Largest provision of residency training

• Often located near academic medical centers

• Share patient care, teaching and research opportunities with academic medical centers

• Large amount of pharmacist autonomy


Community Pharmacy

• Chain, grocery store, or independent pharmacies

• Chain and grocery store incorporate more managerial and corporate aspects

• Independent pharmacies and local chains have less complex business model and structure


Institution Size

• Hospital size: measured by number of beds– Typically licensed for a larger number of beds than

they actually utilize at one time

– Average census is more reflective of hospital size

– Not limited by type or affiliation• Academic centers can be medium sized (300-500 beds) or

very large (>1000 beds)

– Very small hospitals and small hospitals usually in rural areas

– Larger hospitals have > diversity of disease states and specialties


Program Size

• Large: 10+ residents

– More colleagues

– More rotation experiences

– Less flexibility in scheduling rotations

• Medium: 5-9 residents

• Small: 1-4 residents

– More one-on-one interactions

– Greater flexibility in scheduling rotations or events


Accreditation

• Act of granting approval through an official process

• Allows program to partake in recruiting benefits

– ASHP’s Online Residency Directory

– Participates in National Residency Matching Program

• Rigorous process

• Granted for 6 years typically, may have 1-3 years based on compliance

• ASHP crediting bodyHess MM, Smith KM. Who’s in charge? The role of accreditation in postgraduate pharmacy training. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:3 – 8.ASHP General Info. ASHP. http://www.ashp.org/menu/Residents/General Info/FAQs.aspx#3. Accessed August 19, 2016.

Pre-Candidate

Request Pre-Candidate Status

Recruit Resident(s)

Candidate

Commence Residency; submit

residency application

Conduct residency self-assessment; participate in site

survey

Make improvements in

response to survey team findings

Provide formal response to survey

team findings

Graduate first resident(s)

Accredited

Receive notice of accreditation

action

Hess MM, Smith KM. Who’s in charge? The role of accreditation in postgraduate pharmacy training. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:3 – 8.

How Programs Evaluate Residency Applicant

• Number of different ways• Core:

– Experiential training– Professional organization involvement– Leadership activities– Community services– Academic performance– Scholarly activities– Professional work experiences– Other employment experience– Overall communication skills

Kania D, Miller ML. Setting the foundation for a residency position. In Getting Started in a Pharmacy Residency. Washington, DC: American Pharmacists Association; 2013:21 – 34. Armitstead JA, Turner S. The ‘ideal;” residency candidate. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:77 – 90.

APPLICATION PROCESS

Timeline

August

November

December

January/

February

March

April

• Registration for

ASHP match

opens

• List of programs

in Match available

• PhORCAS opens

• Begin

applications

• Attend ASHP MCM

• Final date for PGY2

early commitment

• Apply to residency

• Residency

interviews

• Rank order

opens

• RANK ORDER

DEADLINE

• Match I results

revealed

• Match II Begins

ASHP Resident Matching Program. ASHP Match. https://www.natmatch.com/ashprmp. Accessed August 19, 2016.

• Match II Rank

order Due

• Match II results

• Post

Match/Scramble

PhORCAS

• Pharmacy Online Residency Centralized Application Service

• Tool to manage applications

• Developed by ASHP accreditation services and Liaison International

• Opens in November

Pharmacy Online Residency Centralized Application Service. Pharmacy Online Residency Centralized Application Service. http://www.ashp.org/phorcas. Accessed August 19, 2016.

Application Process

Create account & register for

match

Official transcript requests

Application information

entry

Upload documents*

Select 3 references

Submit application

*CV, Letter of Intent for each program, supplemental material

Pharmacy Online Residency Centralized Application Service. Pharmacy Online Residency Centralized Application Service. http://www.ashp.org/phorcas. Accessed August 19, 2016.

On-Site Interviews

• All day (2-8 hrs)

• Aspects of the program

• Formal presentation

• Patient cases, clinical assessments or exams

• 1:1 interviews and/or group interviews

• Lunch sometimes dinner

• Facility tour

Johnson MD. Interview Process. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:163– 176. Kania D, Miller ML. The Residency Interview. In Getting Started in a Pharmacy Residency. Washington, DC: American Pharmacists Association; 2013:109 – 130.

Interview

• Travel and hotel arrangements

• Attire

• Prepare list of questions

• Research program and preceptors

• Practice presentation, review CV, and disease states

Johnson MD. Interview Process. In P.B. Bookstaver Roadmap to postgraduate training in pharmacy: McGraw-Hill;2013:163– 176. Kania D, Miller ML. The Residency Interview. In Getting Started in a Pharmacy Residency. Washington, DC: American Pharmacists Association; 2013:109 – 130.

Match Process

• Links applicant’s highest preference with program’s highest preference

• Attempts to place applicant into program most preferred on applicant’s list

• Preference given to applicant not program

ASHP Resident Matching Program. ASHP Match. https://www.natmatch.com/ashprmp/. Accessed August 19, 2016.

Example Match

Voice (2 positions) Show (1 position) Winner (1 position)

1. Pharell Williams 1. Blake Shelton 1. Blake Shelton

2. Blake Shelton 2. Pharell Williams 2. Gwen Stefani

3. Gwen Stefani 3. Gwen Stefani

4. Adam Levine

Adam Levine Blake Shelton Pharell Williams Gwen Stefani

1. Winner 1. Voice 1. Show 1. Show

2. Show 2. Show 2. Voice 2. Voice

3. Voice 3. Winner

Programs’ Rank Order Lists

Applicants’ Rank Order Lists

UNMATCHED VOICE SHOW VOICEASHP Resident Matching Program. ASHP Match. https://www.natmatch.com/ashprmp/. Accessed August 19, 2016.

Match Phases

• Phase I:– Programs and residents find out who was matched with particular

programs– National Match Service send email around noon EST possibly sooner– Rank Order for Phase I due March 4, 2016– Results on March 18, 2016

• Phase II:– Unfilled programs offer positions to unfilled applicants– Programs with new funding/positions are added– Opens March 23, 2016– Rank Order for Phase II due April 1, 2016– Results on April 8th, 2016

• Scramble

ASHP Resident Matching Program. ASHP Match. https://www.natmatch.com/ashprmp/. Accessed August 19, 2016.

Post Test: Question #1

Which of the following is an example of a postgraduate year 2 residency?

A. Industry fellowship

B. Ambulatory care

C. Masters of business administration

D. None of the above


Which month does PhORCAS open?

A. April

B. August

C. January

D. November


Which of the following is FALSE regarding on-site interviews?

A. Candidate may give a formal presentation

B. Candidate may have group interviews

C. Candidate may go on a facility tour

D. Candidates travel arrangements will be paid for by program


Which of the following is FALSE regarding the match?

A. Program and applicant must submit rank order in March

B. Attempts to place applicant into program most preferred by program

C. Attempts to place applicant into program most preferred on applicant's list

D. Consists of two phases; Phase I and Phase II

Take Home Points

• Start applications early

• Budget for the application and travel costs

• Determine your career goals

• Use professors, preceptors, pharmacists, books, and websites to help you

Resources & References

References:ASHP Resident Matching Program. ASHP Match. https://www.natmatch.com/ashprmp/. Accessed August 19, 2016. Bookstaver PB. Roadmap to Postgraduate Training in Pharmacy. New York: McGraw-Hill; 2013. Miller ML. Getting Started in a Pharmacy Residency. Washington, D.C.: American Pharmacists Association; 2013. Pharmacy Online Residency Centralized Application Service. Pharmacy Online Residency Centralized Application Service. http://www.ashp.org/phorcas. Accessed August 19, 2016.

Resources:Caballero J, Clauson KA, Benavides S. Get the Residency: ASHP's Guide to Residency Interviews and Preparation. Bethesda, MD: American Society of Health-System Pharmacists; 2012. Crouch MA. Securing and Excelling in a Pharmacy Residency. Burlington, MA: Jones & Bartlett Learning; 2013.

Additional Resources

• American College of Clinical Pharmacy (ACCP) (includes Fellowships and non-accredited residencies)– http://www.accp.com/resandfel/index.aspx

• Academy of Managed Care Pharmacy (AMCP) (includes fellowships and non-accredited residencies)– http://amcp.org/Residencies/

• American Pharmacist Association (APhA)– http://www.pharmacist.com/residency

• Indian Health Service (IHS sites only)– http://www.ihs.gov/pharmacy/resident/

• American Society of Health-System Pharmacy (ASHP) residency directories (accredited residencies only)– http://www.ashp.org/

http://www.accp.com/resandfel/index.aspx

http://amcp.org/Residencies/

http://www.pharmacist.com/residency

http://www.ihs.gov/pharmacy/resident/

http://www.ashp.org/

Rebecca Young, PharmD, BCACP

Assistant Professor of Clinical Sciences

Roosevelt University College of Pharmacy

[email protected]

mailto:[email protected]

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