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Community Pharmacy Residencies Refine Career Goals
Community Pharmacy Residencies Refine Career Goals Residents in community pharmacy develop a variety of marketable skills in a short time. by Melissa M. Murer
f Greta Sweney had not participated in a comn1unity pharn1acy reside ncy , her career might have taken a w rong turn into adn1inistration instead of keeping her involved w ith patients, where she has found she likes to be. "1 w orked in an outpatient hospital phannacy after graduating in 1988, but 1 knew 1 didn't want to be a staff phannacist forever," Sweney says. "1 was interested in management, but 1 didn't really know what 1 wanted to do. " In 1990 she started a year-long community pharn1acy residency at Virginia Mason Medical Center in Seattle, and it he lpe d h e r see that the master's degree in health care administration she'd considered earning was not the right choice for her. "After my rotation in Inanagement 1 realized that 1 shouldn't become an adn1inistrator, " she says . "I found I really missed the public. " She also found that she wanted to steer her career toward an area she'd known little about before her residency: long-tern1 care.
I
Why Do a Residency? Refining career goals for young pharmacists who are unsure where their niche lies is one important function of residencies , which started taking hold in the con1munity pharn1acy setting a few years ago . Like their long-established counterpart in hospitals, comn1unity residencies give pharn1acists an overview of a particular type of practice and help then1 develop Inarketable skills in a short tiine. Residencies also help pharmacists develop confidence , according to Curtis Coffn1an, a 1989-90 resident at Capitol Drug Center in White Bear Lake, Minnesota. "I just didn't feel cOlnfortable cOIning out of school and going right into practice ," he says. "Now I've got a varied background, including management experience. It gives n1e a jun1p start over Inost other new graduates." AMERICAN PHARMACY
According to residency director Howard Juni, PharmD, pharmacist-owner of Capitol Drug Center, the residency experience is "like five years of con1111unity practice." Because residents are exposed to several 11l0del practice experiences and leadership styles, a residency also prepares then1 to deal with the dyna111ics of today's health care environn1ent, Juni suggests. Ideally, c0111n1unity pharmacy residents possess the raw n1aterials-ability , motivation , creativity-fron1 which innovative leaders in C011111lUnity pharn1acy practice are n1ade.
Program Overvievv A comn1unity pharn1acy residency is a stnlctured postgraduate education and training experience that helps pharmacists develop advanced knowledge and skills for delivering pharn1aceutical services fron1 a C0111111unity pharInacy or other a111bulatory setting. Cominunity pharmacy residencies coordinated on a national level are available through the At11erican Pharn1aceutical Association (APhA). Launched in 1986, APhA's Community Pharmacy Residency Progran1 (CPRP) offers residencies at 10 sites, ranging fron1 a U.S. Public Health Service Clinic in Alaska, to an independent phannacy in rural W ashington, to a small chain in Massachusetts. (A few con1Inunity residencies are also offered independently, son1e the result of an Atnerican College of Apothecaries pilot progran1.) A con1munity residency typically is 12 Inonths or longer and involves a minin1un1 of 2,000 clock hours of education and training. Pharn1acists n1ay pursue a residency anytime after con1pleting an entty-Ievel (BS or Pharn1D) degree in pharn1acy and acquiring a license to practice pharn1acy in the state where they plan to do the residency. During the prograln, residents typically rotate through November 1991/806 Vol. NS31, No. 11
experience in (1) administration and management, (2) drug distribution and drug use control, (3) clinical services, (4) drug information services, (5) home health care, (6) longterm care, and (7) areas of special interest. Juni provides written learning objectives at the beginning of the program and holds weekly meetings to discuss future directions for the year, evaluate the resident's performance, and receive the resident's feedback. How to conduct a blood glucose screening program, proper monitoring of the hypertensive patient, the intricacies of supplying durable medical equipment, and how to manage third party reimbursements are among specific skills a resident will develop at Capitol Drug. Residents spend 100/0-20% of their time consulting for the long-termcare facilities, and about 75% of their practice experience involves geriatric patients. Another residency director, Amber Andrews, helped develop two CPRP sites in conjunction with the University of Washington in 1986. She has practiced community pharmacy and currently teaches in the school's Department of Pharmacy Practice. One site she works with is Virginia Mason Medical Center-a large health care organization with an outpatient pharmacy, main clinic, home intravenous service, and 11 satellite clinics. The other is Valley View Clinical Pharmacists. Andrews oversees the program, but preceptors at the residency sites work directly with the residents to target competencies, assign projects, and provide feedback. The resident, preceptor, and Andrews meet monthly to evaluate
several areas such as administration, drug distribution, home health care, long-term care, and marketing. They may do special projects such as conducting a health promotion can1paign or lecturing to a community group, as well as a long-term project that they work on throughout the year. However, residency directors are given flexibility in tailoring the program to their site as well as to the resident's experience and goals, so components vary. The residency director serves as the principal teacher and motivator; additional preceptors may also be assigned to guide the resident through each rotation. Community pharmacy residents receive a stipend established and paid by the residency program site. Sometimes community pharmacy residencies may be done in conjunction with an advanced degree program, such as a master's in business or health care administration.
Applying for the Program Acceptance into the CPRP is done on a competitive basis using a forn1al application process. The application includes: (1) basic demographic information, (2) history of academic activity (e.g., colleges and/ or universities attended), (3) pharmacy employment history, (4) at least three recomn1endations from fonner faculty and preceptors or employers, and (5) a statement of career objectives. Residency directors are strongly encouraged to interview each residency applicant personally. The director at each training site holds final approval of qualifications and acceptance of a candidate into the residency program.
Residencies continued on p. 33
1991-92 Residency Sites Community phannacy residencies will be offered at the following sites in 1991-92. Residencies typically start in the summer. Deadlines for applications vary with each site.
Residency Sites: A Closer Look Howard Juni, one of CPRP's first four residency directors, recognized the need for additional training in ambulatory and community settings and established his own residency before becoming affiliated with CPRP . His community pharmacy, Capitol Drug Center, provides prescription services to walk-in patients, to three facilities for the mentally retarded, and to 13 long-term-care facilities. One division of Capitol Drug, Cetac Associates, handles consulting services in 17 long-term-care facilities. Another, Capitol Medical Supply, handles the sales, rental and service of durable medical equipment, colostomy and ostomy supplies, urologicals, and oxygen. Juni and his staff, including the CPRP resident, interact with nurses, physicians, and other medical personnel daily. Pharmacists on staff spend a large percentage of their time consulting at the various long-term-care facilities, spending the balance of activity at the pharmacy. Juni carefully plans the resident's curriculum and activities to match his or her experience, strengths, and weaknesses, he says. The general curriculum at Juni 's site includes Vol. NS31, No. 11 November 1991/807
Capitol Drug Center, White Bear Lake, Minn. Freedom Drug Center, Amesbury, Mass. Jones Pharmacy, Spokane, Wash. Davenport Pharmacy, DavenpOlt, Wash. Valley View Clinical Pharmacists, Monroe, Wash. Virginia Mason Medical Center, Seattle, Wash. u.S. Public Health Service, Alaska Area Native Health Service, Ketchikan u.S. Public Health Service, Winslow Health Center, Winslow, Ariz. Arbor Drugs, Inc. , Detroit, Mich. Perry Drug Stores, Inc. , Detroit, Mich. The program is supported in part by grants from Bristol-Myers Squibb u.S. Pharmaceutical Group, McKesson Drug Company, Bergen Brunswig Corporation, and McNeil Consumer Products Company. For more information contact the Community Pharmacy Residency Program, American Pharmaceutical Association, 2215 Constitution Ave., NW, Washington, DC 20037. (202) 429-7522.
ED
AMERICAN PHARMACY
Residencies continuedfrom p. 3 1
master's degree in business administration. I will begin teaching in the Professional Practice Laboratory at the Massachusetts College of Pharmacy for the spring quarter. Teaching and taking classes is a challenging change of pace for me.
April and May 1990 Being with fourth-year students during Professional Practice Lab is a wonderful experience. I have never taught before, so I am learning as much as they are. They are discovering fast that pharmacists have a unique, responsible position in the community. My own classes are going very well. I am learning the textbook theory behind the actual work going on at Freedom Drug. It is a great advantage to have a real company to apply my classroom expe riences to. Between classes and teaching, I have n1anaged to squeeze in rotations in store Inanagement, warehousing, and purchasing. I became a store manager's shadow in order to learn how to run a store on a daily basis. Employee supervision, training and scheduling, inventory , control, store security, and cash accounting are a few of the responsibilities I have been involved with. I feel there is a need to revise and update the employee handbook. The current handbook does not adequately explain company policies and procedures, and I have found confusio n on many basic issues. Stuart and Denis have asked that I put together a new handbook. My warehousing and purchaSing rotation taught me what a "good deal" on products is. I have learned the importance of purchasing items in bulk and warehousing them. I have met salesmen from many companies and sat in o n buying meetings. I now better understand how merchandise moves from manufacturer to store shelves, and appreciate the effort it takes to get it there. Summer 1990 It is hard for me to believe that my residency is winding down. It has been the fastest year of my life so far. I finished a new employee hanqbook, which now awaits final approval from the company president. I spent much of the summer as a staff pharmacist at Freedom Drug. This gave me an excellent understanding of the responsibilities of a community pharmacist and the rigors of the job. I have enjoyed the daily contact with patients and physicians. I now see how pharmacists in1pact patient care in a positive way. I coauthored a poster, "A Community Pharmacy Residency Experience," presented at the American Association of Colleges of Pharmacy Annual Meeting in Salt Lake City, Utah, last July. Recently, I have been working on my resume and have noticed that my experiences as a resident make up the bulk of it. I have presentations, community activities, professional associations, and publications that are directly the result of my unique position as a community pharmacy resident.
Vol. NS31, No. 11 November 1991/809
progress and keep the program running smoothly. At Virginia Mason, residents gain experience in home intravenous programs for total parenteral nutrition, oncology care, and antibiotics; computerized prescription services; medication counseling; third party-payer billing; pharmacy operations; and durable medical equipment. Residents may work in Virginia Mason's drug information center, diabetes teaching center, and diabetes clinic, as well as in the health education center. Residents also can assist with precepting responsibilities for pharmacy students from the University of Washington. Valley View Clinical Pharmacists is an independent pharmacy located in a family medicine clinic that has 10 physicians and two nurse practitioners. The pharmacists and resident provide extensive tnedication information to patients and physicians. They use private patient counseling rooms to discuss medications and health concerns with patients and to show patient education videos. The pharmacists also provide comprehensive pharmacy services for a local hospital and consult with physicians whose patients are in long-term-care facilities. As a result, residents at Valley View gain experience in following a patient's medication therapy in and out of the clinic, hospital, and long-term-care facility. They also learn how to develop and implement drug use evaluation of specific dnlgs.
A Better Pharmacist Roxanne Schuler, Capitol Dnlg's first resident in 1985 and now on staff as a clinical consultant pharmacist, recommends that anyone considering a community pharmacy residency write down the pros and cons. "Ask yourself, is this going to be helpful to me? Are all the elements added up going to make me a better pharmacist?" Schuler, who now helps precept residents, also stresses that a successful resident must be self-motivated. "We don't necessarily spell out every day what a resident will be doing. They need to say, This is what I want to learn today; show me more. ' They need to be willing to put forth extra effort and to learn. " As for the long-term benefits, Am1ger Andrews feels that today's residents are likely to be tomorrow's progressive practitioners. "Pharmacists who complete the APhA Community Pharmacy Residency Program should possess the knowledge and training to stimulate innovative programs in community and ambulatory practice," she says. Melissa M. Murer was the American Pharmaceutical Association/National Council of State Pharmaceutical Association Executives' 1990-91 executive resident in association management, and is now staff associate in APhA 's Executive Office.
AMERICAN PHARMACY
f Greta Sweney had not participated in a comn1unity pharn1acy reside ncy , her career might have taken a w rong turn into adn1inistration instead of keeping her involved w ith patients, where she has found she likes to be. "1 w orked in an outpatient hospital phannacy after graduating in 1988, but 1 knew 1 didn't want to be a staff phannacist forever," Sweney says. "1 was interested in management, but 1 didn't really know what 1 wanted to do. " In 1990 she started a year-long community pharn1acy residency at Virginia Mason Medical Center in Seattle, and it he lpe d h e r see that the master's degree in health care administration she'd considered earning was not the right choice for her. "After my rotation in Inanagement 1 realized that 1 shouldn't become an adn1inistrator, " she says . "I found I really missed the public. " She also found that she wanted to steer her career toward an area she'd known little about before her residency: long-tern1 care.
I
Why Do a Residency? Refining career goals for young pharmacists who are unsure where their niche lies is one important function of residencies , which started taking hold in the con1munity pharn1acy setting a few years ago . Like their long-established counterpart in hospitals, comn1unity residencies give pharn1acists an overview of a particular type of practice and help then1 develop Inarketable skills in a short tiine. Residencies also help pharmacists develop confidence , according to Curtis Coffn1an, a 1989-90 resident at Capitol Drug Center in White Bear Lake, Minnesota. "I just didn't feel cOlnfortable cOIning out of school and going right into practice ," he says. "Now I've got a varied background, including management experience. It gives n1e a jun1p start over Inost other new graduates." AMERICAN PHARMACY
According to residency director Howard Juni, PharmD, pharmacist-owner of Capitol Drug Center, the residency experience is "like five years of con1111unity practice." Because residents are exposed to several 11l0del practice experiences and leadership styles, a residency also prepares then1 to deal with the dyna111ics of today's health care environn1ent, Juni suggests. Ideally, c0111n1unity pharmacy residents possess the raw n1aterials-ability , motivation , creativity-fron1 which innovative leaders in C011111lUnity pharn1acy practice are n1ade.
Program Overvievv A comn1unity pharn1acy residency is a stnlctured postgraduate education and training experience that helps pharmacists develop advanced knowledge and skills for delivering pharn1aceutical services fron1 a C0111111unity pharInacy or other a111bulatory setting. Cominunity pharmacy residencies coordinated on a national level are available through the At11erican Pharn1aceutical Association (APhA). Launched in 1986, APhA's Community Pharmacy Residency Progran1 (CPRP) offers residencies at 10 sites, ranging fron1 a U.S. Public Health Service Clinic in Alaska, to an independent phannacy in rural W ashington, to a small chain in Massachusetts. (A few con1Inunity residencies are also offered independently, son1e the result of an Atnerican College of Apothecaries pilot progran1.) A con1munity residency typically is 12 Inonths or longer and involves a minin1un1 of 2,000 clock hours of education and training. Pharn1acists n1ay pursue a residency anytime after con1pleting an entty-Ievel (BS or Pharn1D) degree in pharn1acy and acquiring a license to practice pharn1acy in the state where they plan to do the residency. During the prograln, residents typically rotate through November 1991/806 Vol. NS31, No. 11
experience in (1) administration and management, (2) drug distribution and drug use control, (3) clinical services, (4) drug information services, (5) home health care, (6) longterm care, and (7) areas of special interest. Juni provides written learning objectives at the beginning of the program and holds weekly meetings to discuss future directions for the year, evaluate the resident's performance, and receive the resident's feedback. How to conduct a blood glucose screening program, proper monitoring of the hypertensive patient, the intricacies of supplying durable medical equipment, and how to manage third party reimbursements are among specific skills a resident will develop at Capitol Drug. Residents spend 100/0-20% of their time consulting for the long-termcare facilities, and about 75% of their practice experience involves geriatric patients. Another residency director, Amber Andrews, helped develop two CPRP sites in conjunction with the University of Washington in 1986. She has practiced community pharmacy and currently teaches in the school's Department of Pharmacy Practice. One site she works with is Virginia Mason Medical Center-a large health care organization with an outpatient pharmacy, main clinic, home intravenous service, and 11 satellite clinics. The other is Valley View Clinical Pharmacists. Andrews oversees the program, but preceptors at the residency sites work directly with the residents to target competencies, assign projects, and provide feedback. The resident, preceptor, and Andrews meet monthly to evaluate
several areas such as administration, drug distribution, home health care, long-term care, and marketing. They may do special projects such as conducting a health promotion can1paign or lecturing to a community group, as well as a long-term project that they work on throughout the year. However, residency directors are given flexibility in tailoring the program to their site as well as to the resident's experience and goals, so components vary. The residency director serves as the principal teacher and motivator; additional preceptors may also be assigned to guide the resident through each rotation. Community pharmacy residents receive a stipend established and paid by the residency program site. Sometimes community pharmacy residencies may be done in conjunction with an advanced degree program, such as a master's in business or health care administration.
Applying for the Program Acceptance into the CPRP is done on a competitive basis using a forn1al application process. The application includes: (1) basic demographic information, (2) history of academic activity (e.g., colleges and/ or universities attended), (3) pharmacy employment history, (4) at least three recomn1endations from fonner faculty and preceptors or employers, and (5) a statement of career objectives. Residency directors are strongly encouraged to interview each residency applicant personally. The director at each training site holds final approval of qualifications and acceptance of a candidate into the residency program.
Residencies continued on p. 33
1991-92 Residency Sites Community phannacy residencies will be offered at the following sites in 1991-92. Residencies typically start in the summer. Deadlines for applications vary with each site.
Residency Sites: A Closer Look Howard Juni, one of CPRP's first four residency directors, recognized the need for additional training in ambulatory and community settings and established his own residency before becoming affiliated with CPRP . His community pharmacy, Capitol Drug Center, provides prescription services to walk-in patients, to three facilities for the mentally retarded, and to 13 long-term-care facilities. One division of Capitol Drug, Cetac Associates, handles consulting services in 17 long-term-care facilities. Another, Capitol Medical Supply, handles the sales, rental and service of durable medical equipment, colostomy and ostomy supplies, urologicals, and oxygen. Juni and his staff, including the CPRP resident, interact with nurses, physicians, and other medical personnel daily. Pharmacists on staff spend a large percentage of their time consulting at the various long-term-care facilities, spending the balance of activity at the pharmacy. Juni carefully plans the resident's curriculum and activities to match his or her experience, strengths, and weaknesses, he says. The general curriculum at Juni 's site includes Vol. NS31, No. 11 November 1991/807
Capitol Drug Center, White Bear Lake, Minn. Freedom Drug Center, Amesbury, Mass. Jones Pharmacy, Spokane, Wash. Davenport Pharmacy, DavenpOlt, Wash. Valley View Clinical Pharmacists, Monroe, Wash. Virginia Mason Medical Center, Seattle, Wash. u.S. Public Health Service, Alaska Area Native Health Service, Ketchikan u.S. Public Health Service, Winslow Health Center, Winslow, Ariz. Arbor Drugs, Inc. , Detroit, Mich. Perry Drug Stores, Inc. , Detroit, Mich. The program is supported in part by grants from Bristol-Myers Squibb u.S. Pharmaceutical Group, McKesson Drug Company, Bergen Brunswig Corporation, and McNeil Consumer Products Company. For more information contact the Community Pharmacy Residency Program, American Pharmaceutical Association, 2215 Constitution Ave., NW, Washington, DC 20037. (202) 429-7522.
ED
AMERICAN PHARMACY
Residencies continuedfrom p. 3 1
master's degree in business administration. I will begin teaching in the Professional Practice Laboratory at the Massachusetts College of Pharmacy for the spring quarter. Teaching and taking classes is a challenging change of pace for me.
April and May 1990 Being with fourth-year students during Professional Practice Lab is a wonderful experience. I have never taught before, so I am learning as much as they are. They are discovering fast that pharmacists have a unique, responsible position in the community. My own classes are going very well. I am learning the textbook theory behind the actual work going on at Freedom Drug. It is a great advantage to have a real company to apply my classroom expe riences to. Between classes and teaching, I have n1anaged to squeeze in rotations in store Inanagement, warehousing, and purchasing. I became a store manager's shadow in order to learn how to run a store on a daily basis. Employee supervision, training and scheduling, inventory , control, store security, and cash accounting are a few of the responsibilities I have been involved with. I feel there is a need to revise and update the employee handbook. The current handbook does not adequately explain company policies and procedures, and I have found confusio n on many basic issues. Stuart and Denis have asked that I put together a new handbook. My warehousing and purchaSing rotation taught me what a "good deal" on products is. I have learned the importance of purchasing items in bulk and warehousing them. I have met salesmen from many companies and sat in o n buying meetings. I now better understand how merchandise moves from manufacturer to store shelves, and appreciate the effort it takes to get it there. Summer 1990 It is hard for me to believe that my residency is winding down. It has been the fastest year of my life so far. I finished a new employee hanqbook, which now awaits final approval from the company president. I spent much of the summer as a staff pharmacist at Freedom Drug. This gave me an excellent understanding of the responsibilities of a community pharmacist and the rigors of the job. I have enjoyed the daily contact with patients and physicians. I now see how pharmacists in1pact patient care in a positive way. I coauthored a poster, "A Community Pharmacy Residency Experience," presented at the American Association of Colleges of Pharmacy Annual Meeting in Salt Lake City, Utah, last July. Recently, I have been working on my resume and have noticed that my experiences as a resident make up the bulk of it. I have presentations, community activities, professional associations, and publications that are directly the result of my unique position as a community pharmacy resident.
Vol. NS31, No. 11 November 1991/809
progress and keep the program running smoothly. At Virginia Mason, residents gain experience in home intravenous programs for total parenteral nutrition, oncology care, and antibiotics; computerized prescription services; medication counseling; third party-payer billing; pharmacy operations; and durable medical equipment. Residents may work in Virginia Mason's drug information center, diabetes teaching center, and diabetes clinic, as well as in the health education center. Residents also can assist with precepting responsibilities for pharmacy students from the University of Washington. Valley View Clinical Pharmacists is an independent pharmacy located in a family medicine clinic that has 10 physicians and two nurse practitioners. The pharmacists and resident provide extensive tnedication information to patients and physicians. They use private patient counseling rooms to discuss medications and health concerns with patients and to show patient education videos. The pharmacists also provide comprehensive pharmacy services for a local hospital and consult with physicians whose patients are in long-term-care facilities. As a result, residents at Valley View gain experience in following a patient's medication therapy in and out of the clinic, hospital, and long-term-care facility. They also learn how to develop and implement drug use evaluation of specific dnlgs.
A Better Pharmacist Roxanne Schuler, Capitol Dnlg's first resident in 1985 and now on staff as a clinical consultant pharmacist, recommends that anyone considering a community pharmacy residency write down the pros and cons. "Ask yourself, is this going to be helpful to me? Are all the elements added up going to make me a better pharmacist?" Schuler, who now helps precept residents, also stresses that a successful resident must be self-motivated. "We don't necessarily spell out every day what a resident will be doing. They need to say, This is what I want to learn today; show me more. ' They need to be willing to put forth extra effort and to learn. " As for the long-term benefits, Am1ger Andrews feels that today's residents are likely to be tomorrow's progressive practitioners. "Pharmacists who complete the APhA Community Pharmacy Residency Program should possess the knowledge and training to stimulate innovative programs in community and ambulatory practice," she says. Melissa M. Murer was the American Pharmaceutical Association/National Council of State Pharmaceutical Association Executives' 1990-91 executive resident in association management, and is now staff associate in APhA 's Executive Office.
AMERICAN PHARMACY