Pharmacy residents find a competitive edge

Want to implement an innovative plan for viable patient-care services, work one-on-one with patients, teach in the classroom, present the latest industry research, and advocate for the profession - all while working with some of the best mentors in community pharmacy?

This may sound like a career-long wish list, but pharmacists are able to accomplish this and more in the course of just one year, through community pharmacy residency programs that are springing up across the country.

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Competitive and unique

Kelly GoodeThese residency programs give participants a competitive edge over the experiences of their peers and pack years’ worth of experience and leadership opportunities into just 12 months, according to Jean-Venable “Kelly” R. Goode, PharmD, director of the Virginia Commonwealth University School of Pharmacy’s PGY1 community pharmacy residency program.

"It gets you to places faster than you would normally get just going through the normal channel paths of going directly to work," she said.

Begun in 1996, the program at VCU serves anywhere from two to six residents each year, working closely with community partners to customize an experience unique to each resident.

"I really think that when we look at community residencies, they are truly developing the leaders for the profession," Goode said.

The school's community partners also see the value of these programs; some believe community pharmacy residents have helped them identify the next great thing in community pharmacy.

Michele Fountain"That's what I feel our residents are really good at, helping us with the next great thing, trying it out in the stores and finding out what works and what doesn't work, and changing it, so that when we are ready to do it as a whole division, we are ready to roll," said Michele Fountain, PharmD, division clinical coordinator for Kroger Mid-Atlantic in Virginia.

Across the country, community residency programs are growing in number, and program administrators say that competition for community residency slots is heating up. According to James Owen, vice president of practice and science affairs, American Pharmacists Association (APhA), there were 42 accredited community pharmacy residencies in 2007; that number has now grown to more than 125 programs. It’s estimated that more than 200 pharmacists each year participate in the residencies.

Although the numbers are still below the figures for hospital residency programs, Owen said, it's clear that more pharmacists, pharmacies, and ambulatory care centers see the value these programs can provide.  

The basic framework

PGY1 community pharmacy residency programs are found in a variety of practice settings from national chain or independent pharmacies to outpatient health-system pharmacies. Many of these residency programs are affiliated with a college or school of pharmacy, providing help with a variety of administrative responsibilities, but this isn't required. Some exist without this partnership and are instead independent programs run by community pharmacies, chain corporations, or health systems.

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To ensure consistency and quality among these programs, the American Society of Health-System Pharmacists (ASHP) and APhA have created an accreditation program that provides specific standards intended to guide the creation of PGY1 community pharmacy residency programs.

Each accredited program includes certain universal elements, such as the use of committed preceptors who have an aptitude for teaching patient-care services and the development of leadership and practice-management skills. Residents also must complete a yearlong research project that they develop based on their interests and the needs of the practice site.

Stevie Veach"Sometimes it's more implementation-based rather than strict research methods, but they are learning how to take something from an idea and conceptualize it, such as starting a new pharmacy service or sending out a survey for market research," said Stevie Veach, PharmD, BCACP, director of the PGY1 community pharmacy residency program at the University of Iowa's College of Pharmacy.

Customization is another common theme in many of the residency programs, with residents and preceptors working closely together to tailor the yearlong experience to the resident's ultimate goals in the field.

While the accreditation standards provide the basic framework for these programs, community pharmacy residencies put their own stamp on their programs as well. Below is a sample of the opportunities available for pharmacists.

MCPHS University

By design, the community pharmacy residency program partnership between MCPHS University School of Pharmacy, Boston, and Walgreens serves just one resident a year. This concentration allows the program to maintain a high level of quality, personalization, and focus.

"We pride ourselves on tailoring each resident's year beyond the core standards and activities, to where they would want to challenge themselves," said Matthew Machado, PharmD, residency program director and associate professor at MCPHS.

Begun in 2000, the longitudinal learning program is structured to enable the resident to develop long-term relationships with preceptors. The average week for the resident focuses primarily on developing patient-care skills in the community pharmacy setting at two Walgreens locations in greater Boston. To this base is added a mix of teaching, management, and ambulatory care experience. Residents are able to hone their skills through hands-on experience and repetition.

"Your ability to say that you've done it once is great, but your ability to replicate it consistently over time or find your style is what each resident needs to do. They need to find what works for them," Machado said.

With just one position available annually, Machado said, competition for the residency program is steadily increasing, with more applications arriving each year. The program has attracted residents from as far as Louisiana, Iowa, and Kentucky.

The Ohio State University

At The Ohio State University College of Pharmacy PGY1 Community Care Program, administrators know they are preparing the innovators of tomorrow.

"We want them to be thinking about how they can develop their skills, how they can take advantage of all the opportunities and preceptors that they are going to be working with and really develop personally, so that they can be agents of change in community pharmacy," said Jennifer Seifert, MS, RPh, residency program director for the PGY1 Community Care Program.

Community pharmacy residents make up four of the school's 12 college-based residents. The community pharmacy residents are based in three different sites: a Kroger patient-care center, an independent pharmacy, and a pharmacy serving underserved patients of Franklin County, Ohio.

Through individualized development plans, the school guides students to develop leadership skills in their area of focus, whether it be legislative advocacy, direct patient care, or practice management.

The program also places emphasis on teaching and encourages residents to get their teaching certificates. For a semester, residents spend at least one full day a week at the university, where they teach in the classroom.

"They are put on a teaching team, and on that team they have someone who is leading the course, and they have a teaching mentor outside the course, who’s helping to build those skills for them," Seifert said.

University of Iowa

Established in 1997 through a collaboration between the college and practitioners in the community, the University of Iowa College of Pharmacy PGY1 Community Pharmacy Residency Program is known as the longest-running accredited multisite community residency program in the nation.

With six residency slots, the college works with seven community practice sites to find yearlong homes for its residency students. The practice sites are a mix of independent pharmacy, grocery chain, and regional chain, along with an outpatient pharmacy affiliated with a local hospital.

"The residents are looking for different final career paths," Veach said. "Some want to practice in a clinic-based ambulatory-care setting, so one of our sites that works closely with the medical clinics, like the one that's affiliated with a hospital, might be a better fit for them. Some sites are accredited for diabetes education, so if they have a strong interest in that and want to see if it's a future career path for them, then they might be more drawn to those sites."

Throughout the different practice settings, Veach said, many of the day-to-day activities are the same, such as medication therapy management (MTM), immunizations, patient education on different disease states, or teaching.

"In general, you want the residency graduates to have a good depth and breadth of all disease states, all patient populations, young and old," she said. "So we are really looking for them to feel proficient in not just one area."

University of Minnesota

Unlike some of the other programs, the residency program at the University of Minnesota College of Pharmacy is accredited not as a community pharmacy residency but as a pharmacy-practice residency.

Sarah WestbergAccording to Sarah M. Westberg, PharmD, FCCP, BCPS, the residency program director for the school's ambulatory-care residency program, the program has several areas of emphasis. For its one-year residency options, residents can choose a community clinic or rural health systems emphasis. The school also offers a two-year pharmaceutical care leadership emphasis.

Across the program, 24 residents are based at 16 different practice sites.

"Either many of our sites are in community pharmacy as their primary location, or there's a lot of cross-collaboration with the community pharmacies and their sites," Westberg said.

The residency offers interested pharmacists support, mentorship, and experience in an ambulatory-care environment.

"Just getting experience interacting with patients and building confidence, and providing comprehensive medication management to several hundred patients - that's a huge experience," Westberg said.

The administrative aspects of the program - such as leading the accreditation process, infrastructure management, and marketing - are housed at the college, freeing individual sites from some of the administrative burden associated with the residencies.

"For many sites in our program, if they had to do everything, they probably wouldn't have a resident, but they can bring the financial commitment to it and the teaching commitment to it," Westberg said.

Virginia Commonwealth University

Kelly Goode,PharmD (fourth from left) and community pharmacy practice residents from VCU School of Pharmacy at last year's annual meeting of APhA (Image courtesy of Kelly Goode)Patient care is the focus of the community pharmacy residency program at the Virginia Commonwealth University School of Pharmacy, where as many as six residents are placed at six practice sites.

"About 50% of the program is providing patient care to patients in the community, so the residents are looking at immunization services, disease management, and medication therapy management," Goode said.

In addition to their activities at their practice sites, all residents also spend some time in ambulatory care at a free clinic to gain patient-care experience and build relationships with other healthcare professionals.

When they aren't focusing on patient care, residents teach pharmacy students at their practice sites and in the classroom, advocate for the profession, or work on their research project.

Each resident completes an individual, practice-based research project, to be presented as a poster at an APhA meeting, delivered orally at a residency conference, and written up in manuscript style as a submission for publication.

" When we look at community practice and where we are going, we see so much great care happening by pharmacists in the community, but we don't do a great job of disseminating or documenting that," Goode said. "So we are trying to build our residents into scholars as they leave us, to share those best practices."

Community partners

For each program, one of the benefits of a community pharmacy residency is having the opportunity to work closely with established mentors in the community over time throughout the year.

"When you look at community residency sites, those are the innovators, the movers and the shakers, and the leaders. The residents are training under these people who are doing all these really cool things and are sharing what they've learned with the residents," Goode said.

But the residencies don’t benefit only the residents themselves. For the staff at the community practice sites, it's an opportunity to work with someone who can fully integrate into the pharmacy's workflow and process, while also providing new energy and enthusiasm.

"The residents are always so motivated. They are excited to talk about the things that they do, and then when we hire them it's so awesome to know that they already know how to do a lot. We don't have to train them, and they have the vision and the excitement and the interest," Fountain said of her experience working with residents at Kroger.

The Kroger Mid-Atlantic division works with six residents each year, two from the Virginia Commonwealth University. Fountain said the company as a whole has seen tremendous benefit from their residencies. Over the years, the residents have helped implement immunizations and mandatory MTM for pharmacists, and now they help with health screenings for Kroger employees and at off-site flu clinics.

Bumps in the road

While the benefits of community pharmacy residency programs are vast, the programs aren't without their challenges.

One of the biggest obstacles is finding the financial resources necessary to sustain the programs.

"The typical program for even just one resident costs about $100,000 per year when you count everything, between the cost of the stipend for the resident and the cost of personnel to supervise travel to meetings, and all of those things," Owen said.

The programs also carry a significant administrative burden, but partnering with a university and college of pharmacy can help alleviate some of that stress for preceptors.

Matt Osterhaus"Right off the bat our residents are employees of the university, so you don't have to start the year off figuring out an HR situation with a new employee who is only going to be with you for one year," said Matt Osterhaus, owner of Osterhaus Pharmacy in Maquoketa, Iowa and recent past president of APhA.

The universities often also lead the efforts to achieve and maintain accreditation.

Providing the mentorship necessary to help residents succeed can also be a time-consuming process that requires the commitment of the entire staff.

"It's not a pretty little walk in the park where you are adding a new pharmacist to your staff and paying half a salary. You have to be dedicated to the fact that this is an educational experience. You have to be willing to put the resources forward, and it takes both financial and human resources to do that," Osterhaus said.

Looking ahead

Interest in and awareness of community pharmacy residency programs is growing, and more pharmacists are seeing the benefits connected with the industry, but change is also on the horizon.

ASHP and APhA are developing new accreditation standards that are slated for approval in March 2016. Implementation would begin in July 2017.

The new standards place a greater emphasis on training individual pharmacists wherever they treat patients - whether in a community pharmacy, federally-qualified health center, or community health clinic - and stress the concept of a community care pharmacist-practitioner, rather than a community pharmacy practitioner.

"As a standard, what we are trying to focus on is the individual, rather than the four walls of the practice, because the emerging marketplace of community practice may not be within the four walls of a pharmacy," Owen said.

Under the proposed standards, greater emphasis will be placed on the need for residents to gain additional experiences and training outside the community pharmacy, in ambulatory care clinics and other settings.

Jill Sederstrom is a freelance writer based in Kansas City.