Residency Training in Wisconsin

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					Residency Training in Wisconsin
by Kristin Hanson, MS, RPh

                  s	the	role	of	the	pharmacist	          ASHP,	 working	 closely	 with	 its	 partners,	                          GROWTH – KEEPING UP WITH THE
                  in	health	care	today	contin-        continues	as	the	sole	organization	recognized	                             DEMAND
                  ues	to	expand,	the	need	for	        and	responsible	for	accreditation	of	pharmacy	                             The	number	of	pharmacy	graduates	continues	
                  individuals	 with	 advanced	        residency	training	programs.                                               to	climb.	The	American	Association	of	Colleges	
                  and	specialty	training	does	as	                                                                                of	Pharmacy	(AACP)	tracks	and	trends	graduate	
well.	The	numbers	of	residency	programs	and	          RESIDENCY TRAINING VISION                                                  data	on	an	annual	basis.	The	10,988	pharmacy	
positions	continue	to	grow	in	Wisconsin	and	          The	 value	 of	 post-graduate	 training	 is	 well	                         school	graduates	in	2009	is	over	50%	higher	
throughout	the	country	–	a	positive	sign	indeed.	     recognized.	 In	 2002	 The	 American	 College	                             than	ten	years	earlier.5	Table	1	reflects	the	annual	
The	challenge	lies	in	the	fact	that	the	need	in	      of	 Clinical	 Pharmacists	 (ACCP)	 included	 a	                            number	of	graduates	with	their	first	professional	
our	 profession	 and	 the	 demand	 for	 amongst	      lofty	vision	statement	as	a	part	of	its	strategic	                         degree	according	to	AACP.	With	new	schools	
graduating	 pharmacy	 students;	 outpace	 the	        plan	stating	“Formal,	postgraduate	residency	                              of	pharmacy	opening	and	others	expanding	the	
growth	of	programs	and	positions.	The	ques-           training	will	become	mandatory	before	one	can	                             class	size,	the	number	of	graduates	is	expected	
tion	we	must	all	ask	ourselves,	are	we	at	our	        enter	practice.”2	This	ACCP	vision	was	further	                            to	climb	in	the	coming	years.
residency	program	capacity?                           defined	in	2006	stating	“By	2020,	residency	                                   The	increasing	number	of	unique	residency	
                                                      training	 should	 become	 a	 prerequisite	 for	                            training	programs	throughout	the	country	is	
BACKGROUND                                            entry	into	pharmacy	practice.”3	The	following	                             impressive	as	well	as	depicted	in	table	2,	with	
A	 pharmacy	 residency	 is	 defined	 as	 “an	         year,	ASHP	endorsed	the	vision	in	a	position	                              the	number	of	programs	nearly	tripling	from	
organized,	 directed,	 postgraduate	 training	        statement	 “To	 support	 the	 position	 that	 by	                          1999	 to	 2009.6	 The	 number	 of	 pharmacists	
program	 in	 a	 defined	 area	 of	 pharmacy	          the	year	2020,	the	completion	of	an	ASHP-                                  in	both	PGY1	and	PGY2	residency	programs	
practice.”1	 Residencies	 and	 post-graduate	         accredited	residency	should	be	a	requirement	                              continues	to	climb	steadily	as	well	as	shown	in	
internships	 have	 been	 in	 existence	 since	 the	   for	all	new	college	of	pharmacy	graduates	who	                             table	3	reaching	the	1886	PGY1	residents	and	
1930s.	Standards	related	to	these	post-graduate	      will	be	providing	direct	patient	care.”4	While	it	                         436	PGY2	residents	in	2009.
training	 programs	 were	 originally	 drafted	 by	    may	not	be	clear	what	percentage	of	pharmacy	                                  Despite	significant	efforts	in	recent	years	to	
American	Society	of	Health-System	Pharmacists	        school	graduates	will	move	into	direct	patient	                            develop	new	residency	programs	and	expand	
(ASHP)	in	1948	followed	by	a	revision	in	1962	        care	roles,	one	could	argue	that	vast	majority	of	                         existing	ones,	the	demand	for	these	residency	
which	also	established	an	accreditation	process.	     graduates	would	fall	into	this	category.                                   positions,	 PGY1	 positions	 in	 particular,	
Since	that	time,	standards	for	residency	training	
have	continued	to	evolve	and	training	programs	                                                    PROFESSIONAL PHARMACY DEGREE5
                                                                                   TABLE 1: FIRST First Professional Pharmacy Degree
have	been	delineated	as	post	graduate	year	one	
(PGY1)	and	two	(PGY2).	The	focus	of	a	PGY1	                         12,000

training	program	is	broad	in	nature	and	serves	
as	a	prerequisite	for	entry	into	a	PGY2	program	
in	any	number	of	specialized	areas.	A	limited	                      10,000

number	of	24-month	combined	PGY1/PGY2	
programs,	 most	 commonly	 with	 a	 PGY2	 in	
health	 system	 pharmacy	 administration,	 are	
also	in	existence;	including	two	in	Wisconsin.
                                                      # graduates

    While	residency	programs	have	traditionally	                     6,000
been	 hospital	 based,	 the	 expansion	 of	
pharmacists	 practicing	 in	 different	 settings	
has	 necessitated	 creation	 of	 additional	 types	                  4,000

of	 training	 programs.	 In	 recent	 years,	 new	
standards	for	PGY1-community	and	PGY1-
managed	 care	 pharmacy	 residency	 programs	                        2,000

have	 been	 developed	 by	 ASHP	 through	
partnerships	 with	 American	 Pharmacists	
Association	(APhA)	and	Academy	of	Managed	                                   1996-97 1997-98   1998-99 1999-00 2000-01 2001-02   2002-03 2003-04 2004-05 2005-06 2006-07   2007-08 2008-09

Care	Pharmacy	(AMCP),	respectively.

22 JPSW July/August 2010
continues	to	grow	at	a	much	faster	pace.	Table	
                                                                                       TABLE 2: #PGY1 PROGRAMS IN ASHP ACCREDITATION PROCESS6
                                                                                                      # PGY1 Programs in ASHP Accreditation Process
4	is	an	illustration	of	this	situation	with	the	
gap	 between	 the	 number	 of	 applicants	 and	                           800

the	number	of	programs	widening.	Accredited	
residency	programs	and	those	in	the	process	                              700
of	 seeking	 accreditation,	 are	 required	 to	
participate	in	the	pharmacy	resident	matching	                            600
program	 managed	 by	 National	 Matching	
Services,	 Inc.	 The	 2010	 resident	 match	 saw	                         500
its	 biggest	 numbers	 to	 date,	 matching	 1651	

                                                         # of Programs
PGY1	 applicants	 and	 positions.	 The	 1114	                             400
unmatched	 candidates,	 however,	 were	 left	
scrambling	 for	 the	 remaining	 150	 unfilled	                           300
positions.7	As	noted	earlier,	with	an	increasing	
numbers	of	pharmacy	school	graduates	in	the	
coming	 years,	 it	 is	 fully	 anticipated	 that	 the	
demand	for	residency	training	positions	will	
continue	to	grow.	Unfortunately,	the	gap	will	
likely	continue	to	grow	as	well.
                                                                                       1996     1997     1998     1999    2000    2001    2002      2003     2004     2005      2006     2007   2008    2009
POSITIONS – DUAL STRATEGIES                              program	 at	 your	 site	 and	 performs	 well	 is	                                        upon	the	type	of	service,	outcomes	can	have	
As	we	work	to	increase	opportunities	for	post	           often	 one	 of	 the	 most	 qualified	 candidates	                                        positive	 financial,	 quality,	 and/or	 customer	
graduate	training,	two	strategies	are	necessary.	        for	a	position	following	program	completion.	                                            service	impacts.
 •	 Increase	the	number	of	sites	or	programs	            In	 addition,	 students	 who	 may	 have	 looked	                                            Project Completion –	 Residents	 are	
    conducting	residency	training                        at	your	program	but	ended	up	elsewhere	for	                                              required	as	a	part	of	an	accredited	program	to	
 •	 Increase	the	number	of	residents	training	           residency	may	be	inclined	to	return	to	apply	for	a	                                      complete	a	major	project.	Selecting	projects	
    at	each	site                                         permanent	position	at	some	point	in	the	future.                                          that	are	of	mutual	interest	to	both	the	resident	
                                                             Expansion of Services	–	The	presence	of	                                             and	site	can	be	beneficial	in	accomplishing	high	
JUSTIFICATION AND BENEFITS OF                            a	pharmacy	resident	may	enable	you	or	your	                                              priority	and	important	initiatives.	Examples	
RESIDENCY TRAINING                                       department	to	explore	new	services.	Examples	                                            may	include	development	of	a	new	treatment	
Budgets	are	tighter	than	ever	for	most	us,	so	           may	include	developing	pharmacy	services	in	                                             guideline	 or	 collaborative	 practice	 program.	
how	can	we	justify	adding	a	pharmacy	resident?	          the	ED,	expanding	the	presence	of	pharmacy	in	                                           Projects	aimed	at	improving	safety,	decreasing	
While	there	are	financial	obligations	involved	          an	ambulatory	clinic	or	offering	a	new	patient	                                          costs,	and	/or	increasing	revenue	can	clearly	
in	residency	training	including	the	resident’s	          service	in	a	community	pharmacy.	Depending	                                              benefit	 the	 site	 while	 fulfilling	 residency	
stipend,	 travel	 allowance,	 accreditation	 fees	
and	 perhaps	 some	 additional	 resources	 such	
                                                                                                                 TABLE 3: #RESIDENTS IN PROGRAM6
                                                                                                                          # of Residents in Programs
as	a	computer,	references,	etc;	be	sure	to	look	
at	 the	 benefits.	 Cost	 avoidance,	 improved	                               2000
quality	and	/or	increased	revenues	can	be	tied	                                                                                                                                        1886

to	many	of	the	items	below	to	support	position	                               1800

justification.	 Pass-through	 funding	 through	
CMS	may	be	available	to	many	sites	as	well	                                                                                                                                   1472

that	can	substantially	off-set	residency	program	                             1400

related	expenditures.	
     Staffing		–	The	resident’s	staffing	commitment	                          1200
                                                             # of Residents

is	an	easy	place	to	start	–	not	only	can	it	be	a	                             1000
                                                                                                                                                                                                PGY1 Residents
                                                                                                                                          931                                                   PGY2 Residents
good	learning	experience	for	the	resident,	but	                                                                           844     860

it	can	also	help	off-set	some	of	the	expenses	by	                             800
filling	a	shift	that	would	have	otherwise	required	                                     544
a	staff	pharmacists	to	cover.
     Recruitment	 –	 Training	 of	 pharmacy	                                  400                                                                                                332
residents	 can	 serve	 as	 an	 excellent	 source	 of	                                     199
                                                                                                   250     258
                                                                                                                    226     237
                                                                                                                                    268     269
recruitment.	In	many	cases,	students	are	looking	                             200

to	complete	a	residency	in	the	geographical	area	
in	which	they	wish	to	practice	in	the	future.	A	                                        1998     1999     2000    2001    2002    2003    2004      2005     2006     2007     2008     2009

resident	 that	 completes	 an	 in-depth	 training	

                                                                                                                                                                              JPSW July/August 2010 23
Feature Training

                                                                                                                  proposal	 in	 the	 same	 manner	 as	 if	 you	 were	
                                 Unmatched POSITIONS & APPLICANTS6, 7
                TABLE 4: UNMATCHED PGY1 PGY1 Positions & Applicants
                                                                                                                  developing	 the	 initial	 program.	 The	 most	
             1200                                                                                                 effective	and	efficient	programs	are	often	those	
                       unmatched applicants                                                                       that	are	incorporated	into	the	structure	of	the	
                       unmatched positions
                       gap                                                                                        site	or	department	–	residents	and	the	program	
                                                                                       964                        itself	become	a	vital	part	of	the	site’s	success.	
                                                             857                                                  One	of	the	most	important	points,	however,	
                                                                                                                  is	not	to	sacrifice	quality	for	quantity.	Discuss	
                                                                                                                  modifications	 carefully	 with	 your	 preceptor	
                                                                                                                  group	 –	 slow	 and	 steady	 growth	 more	 easily	
                                              605                  635
             600      557                                                                                         allows	for	adjustments.

                                                                                                                  FINAL THOUGHTS
                                                                                                                  So	 back	 to	 the	 original	 question	 –	 are	 we	
                            288                     323
                                                                                                                  at	 our	 residency	 training	 capacity?	 The	
                            269                     282                                                           demands	 on	 us	 continue	 to	 increase.	 We	
                                                                                                                  work	in	a	fast-paced,	complex	environment	
                                                                                                                  and	 the	 consequences	 of	 mistakes	 are	 high.	
               0                                                                                                  Hiring	well-trained	pharmacists	with	strong	
                        2007                    2008            2009               2010
                                                                                                                  knowledge	base	and	excellent	problem-solving	
                                                                                                                  and	 communication	 skills	 is	 imperative.	
requirements.                                      program.	 Taking	 time	 to	 read	 through	 the	                Residency	training	is	a	way	to	jump-start	the	
    Precepting of Students	–	Residents	often	      standards	and	reviewing	the	outcomes,	goals	                   development	 of	 a	 new	 pharmacy	 graduate’s	
welcome	involvement	with	students	as	a	way	        and	objectives;	is	an	important	starting	point.	               skills;	 however,	 the	 competition	 to	 secure	 a	
to	 develop	 teaching	 and	 precepting	 skills	 or	    Beyond	 the	 resources	 available	 online,	                residency	training	program	is	high.	Wisconsin	
help	solidify	a	complex	clinical	topic	by	hav-     networking	 with	 preceptors	 from	 existing	                  has	a	long	traditional	of	high	quality	pharmacy	
ing	to	explain	it	to	someone	else.	Likewise,	a	    programs	 can	 be	 extremely	 valuable	 as	 is	                education	–	both	during	pharmacy	school	and	
resident	is	often	quick	to	connect	and	relate	to	  attendance	at	conferences	or	sessions	devoted	                 beyond,	with	many	of	our	graduates	pursing	
a	student	in	a	manner	that	provides	guidance	      to	residency	training	and	/	or	precepting	skills.	             post-graduate	 training.	 Of	 this	 year’s	 UW	
and	career	planning.                               Residency	Learning	System	(RLS)	training	is	                   School	of	Pharmacy	graduates,	53	participated	
    Staff Development –	While	the	focus	of	a	      offered	by	ASHP	in	conjunction	with	several	                   in	the	resident	matching	program.	Thirty-seven	
residency	training	program	is	to	develop	the	      national	meetings	such	as	the	Midyear	Clinical	                of	 those	 graduates	 matched	 with	 a	 PGY1	
                                                   Meeting	and	the	National	Residency	Preceptor	
skills	of	the	resident,	the	process	in	doing	so	can	                                                              program	somewhere	in	the	country,	yet	16	of	
                                                   Conference	and	often	upon	request	for	more	
be	of	benefit	to	existing	staff	as	well.	Activities	                                                              our	2010	UW	graduates	were	among	the	1114	
such	as	clinical	discussions,	journal	clubs	and	   local	groups.	The	program	is	highly	valuable	for	              scrambling	 for	 one	 of	 those	 150	 remaining	
case	presentations	necessitate	involvement	and	    all	preceptors	but	especially	critical	for	program	            positions.	With	such	a	high	demand,	we	need	
can	stimulate	discussion	and	learning	for	all.     directors	–	a	valuable	tool	as	you	design	your	                to	look	for	opportunities	within	our	own	sites	
                                                   program.	Make	sure	you	also	learn	from	your	                   to	initiate	or	expand	residency	training.	●
GETTING STARTED                                    peers	–	exchange	ideas,	strategies	and	tools	for	
The	ASHP	website	has	a	number	of	valuable	 success.	If	possible,	arrange	a	site	visit	to	their	 Kristin	Hanson	is	the	PGY1	Residency	Program	
resources	related	to	residency	training	including	 program	to	meet	those	involved.                     Director	at	Froedtert	Hospital	in	Milwaukee,	WI.
documents	specifically	aimed	at	starting	a	new	        Having	sufficient	scope	and	depth	of	clinical	
                                                   pharmacy	services	is	a	key	factor	as	is	having	 REFERENCES
                                                   qualified	preceptors	for	the	resident.	Partnering	 1.	 American	Society	of	Hospital	Pharmacists.	Definitions	of	
                                                                                                       pharmacy	residencies	and	fellowships.	Am	J	Hosp	Pharm	1987;	
                                                   with	another	site	may	be	worth	considering,	 44:1142-1144.
                                                   especially	if	your	clinical	services	or	resources	 2.	 American	College	of	Clinical	Pharmacy.	The	strategic	plan	
                                                                                                       of	the	American	College	of	Clinical	Pharmacy.	ACCP	Report	
                                                   are	more	limited.	A	multisite	residency	can	be	 2002;	21:S1–7.
                                                   easier	to	justify	and	create	as	you	are	sharing	 3.	 Murphy	JE,	Nappi	JM,	Bosso	JA,	et	al.		American	College	
                                                                                                       of	Clinical	Pharmacy’s	Vision	of	the	Future:	Postgraduate	
                                                   the	resources	and	responsibilities.                 Pharmacy	Residency	Training	as	a	Prerequisite	for	Direct	
                                                                                                                  Patient	Care	Practice.		Pharmacotherapy	2006;	26:722–733.
                                                                                                                  4.	 American	Society	of	Health-System	Pharmacists.	Policy	
                                                          EXPANDING YOUR PROGRAM                                  Positions:	Education	and	Training.
                                                          For	 those	 sites	 with	 existing	 programs,	 I’d	      PRACTICEANDPOLICY	(accessed	17	May	2010).
                                                                                                                  5.	 American	Association	of	Colleges	of	Pharmacy.	Trend	
                                                          challenge	 you	 to	 consider	 expanding	 the	           Data.		
                                                          number	of	residency	training	positions.	While	          (accessed	17	May	2010).
                                                          additional	residents	require	more	time,	there	          6.	 Teeters	J.		Residency	Update	2009.		Presented	at	ASHP	
                                                                                                                  Midyear	Clinical	Meeting;	Las	Vegas,	NV;	2009	Dec	7.
                                                          are	efficiencies	that	are	realized.	Strategies	noted	   7.	 ASHP	Resident	Matching	Program.	Match	Results.	www.
                                                          above	can	be	incorporated	into	an	expansion	  		(accessed	21	May	2010).

24 JPSW July/August 2010

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