March 5, 2013

Why is a Pharmacy Residency Needed?

by Melonie Blake, PharmD, PGY1 Pharmacy Practice Resident, Sibley Memorial Hospital
The profession of pharmacy has evolved considerably over the past few years toward the provision of patient-centered care. It has been imperative to ensure that pharmacists can function in a capacity that will provide safe and effective medication use. In order for this to occur, there has been a lot of advocacy to support the premise that all pharmacists should complete a residency before assuming direct patient care roles. I have heard the arguments in favor of this notion, as well as rebuttals that residencies are not necessary.

Before starting pharmacy school, I knew that I wanted to become a clinical pharmacist and completion of a residency was a path toward that goal. It was apparent that some clinical pharmacists did not complete a residency, particularly those who graduated before the entry-level Doctor of Pharmacy degree became the norm. Unfortunately, in recent years, the job market has taken a turn and it has become more difficult and competitive.  But the professional is also more accountable and pharmacists are more involved with patients by using the expertise that has been gained from pharmacy school, experiential learning, residency, and other post-graduate experiences.

This evoluation has led to greater participation by pharmacists on interprofessional teams, performing as the “drug experts”, and optimizing medication use by ensuring safety and efficacy, tailored to each patient’s need.1 In order to fulfill this demand and to live up to these new expectations and standards, we have to be well prepared and confident in the decisions that we make. After going through the Introductory and Advanced Pharmacy Practice Experiences (IPPE/ APPE) at my school, I did not feel fully prepared to take on the challenges of being a clinical pharmacist, even though I valued and gained a great deal from those experiences. They provided me the foundation, along with didactic instruction, to continue to develop my clinical skills after graduation and introduced me to the integral role that clinical pharmacists play in healthcare today.

In Securing and Excelling in a Pharmacy Residency, the value of residency training is discussed.  In one of the chapters, the author explains that pharmacy residencies build upon pharmacy school by expanding the new pharmacist’s knowledge base and learning to effectively apply our knowledge and skills to each patient.  Through these experiences it increases the new practitioner’s confidence. The residency program provides a structured process to develop clinical skills with an “effective preceptor.”2 By taking an active role to give efficient, individualized care to each patient, pharmacy residents become increasingly capable of delivering patient-centered care.  Like experiential learning, pharmacy residencies are necessary and cannot be replaced.

Organizations such as American College of Clinical Pharmacy (ACCP) and American Society of Health-systems Pharmacists (ASHP) have advocated for requiring pharmacy residencies for pharmacist involved in direct patient care, especially as the role of the pharmacist continues to expand.3 ACCP noted that pharmacy residents contribute to the profession through research and innovation.  This demonstrates the positive impact residency training has on patients, the institution, and the future of the profession.

Pharmacy residencies present an opportunity for residents to perform analyses. Analysis can help to determine the priority of patient needs, leading to safe and effective care based on the patient, clinical guidelines, best practices and the policy of the institution. In addition, analysis allows for residents to self-assess. Being able to analyze their strengths and weaknesses seems to play an important role, as residents continue to develop clinically. It allows the resident a chance to deepen their knowledge and focus in areas that need improvement. A union between experience and analysis can help to bridge the performance gap of residents, as they acquire the tools for continuous professional development, and transition to becoming independent practitioners.

As a resident, I have had the opportunity to be involved in pharmacist-led protocols, provide services in drug information to patients and health care providers, and continue to help shape the profession of pharmacy through my experiences, research and involvement in the profession. As medication therapy management (MTM), ambulatory care and other specialty areas of pharmacy become commonplace, I look forward to being at the fore front of our profession. My experiences have not strayed me away from the view that residencies are needed in order to maximize our fullest potential to provide patient-centered care.

1.  Schommer, JC, Planas, LG, Johnson, KA, et al. Pharmacists contribution to the U.S. health care system. Innovations in pharmacy. 2010; 1:1-8. 
2.  Crouch, M. Securing and excelling in a pharmacy residency. Burlington: Jones & Barlett Learning; 2013. Chapter 2, the value of residency training andvision for the future; p. 9-14.

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