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Residencies aren’t just for hospitals anymore
EN'T JUST FOR
ORE By Suzanne Scott and Lynne M. Constantine
Postgraduates are leamingand practicing-pharmaceutical care in innovative community pharmacies across the country. growing number of recent graduates are taking advantage of community-based residencies, where pharmaceutical care is making a visible difference in the lives of ambulatory patients. APhA's expanding Community Pharmacy Residency Program is based on the premise that postgraduates need opportunities to participate in patient care programs in real-world community pharmacy settings-where the majority of the nation's pharmacists work and where opportunities to improve the health of patients are boundless. "Serving as a resident in a community pharmacy has given me a great opportunity to develop skills and to gain experience in many different areas of pharmaceutical care," says Renee Ahrens, PharmD, a pharmacy resident at Travis Pharmacy in Shenandoah, Iowa. During her residency, Ahrens has participated in many disease state management and patient education programs such as blood pressure, lipid, and anticoagulation management. She also is about to begin a weight-loss research project with an OTC manufacturer and is involved in several wellness programs and a Smoking cessation initiative. In addition to participating in innovative patient care programs, Ahrens is getting fIrst-hand experience with the realities of the business side of pharmacy practice. She earned an MBA at the same time she earned her PharmD from Drake University, and is looking forward to wearing both hats-as pharmacist and as entrepreneur. According to Roger Davis, PharmD, director of the commu-
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JanuarylFebruary 1999
nity pharmacy residency program at the University of Tennessee, meaningful entrepreneurial experience and a good introduction to the business side of pharmaceutical care is an important component of the residency program. In addition to understanding the principles of pharmaceutical care and innovative practice that improve patient outcomes, Davis says, students need to learn how to obtain appropriate reimbursement for their services and how to create business that gives them a reasonable economic return on their investment. The residencies give participants a frrst-hand view of the pharmacist's impact not only in managing patient's health, but also in lowering health care costs through appropriate medication managment, says Davis. "There is a tremendous need in the community marketplace for the skills these pharmacists bring to the table." Although the face of community pharmacy practice will continue to change as health care delivery evolves, Davis says that the need for community pharmacies will not go away. ''The community pharmacy may not look exactly the same in the future, but I am confIdent it will be important for pharmaceutical care services to be readily accessible in the communities where people live and work," he says. Warren Narducci, associate professor and director of the Bracken Pharmaceutical Care Learning Center at the University of Washington School of Pharmacy, agrees that communitybased pharmacies are here to stay and that pharmacy graduates can gain valuable postgraduate education through the community pharmacy residency programs. "Although every community residency site has its own set of services and programs, residents all get additional experience in providing patient education and follow-up care for patients with such diseases as diabetes, asthma, and rheumatoid arthritis," he says. ''They also will gain valuable experience in documenting their services and collaborating with other health care professionals." The residency program is a win-win situation for the community
Community residency programs provide opportunities to: • Become involved in health promotion and applied research in a community practice setting. • Develop critical skills in presenting drug infonnation, creating patient care plans, and compounding. • Provide clinical pharmacy services and direct patient care in a community-based pharmacy. • Work with a knowledgeable preceptor and experienced practitioner. • Learn the practice management, marketing and entrepreneurial skills, and the reimbursement strategies vital to keeping a community pharmacy economically viable. • Gain hands-on experience with technology used for pharmaceutical care and practice management.
phannacyas well as for the resident. ''The synergies created by the preceptor-resident teams inevitably help these phannacies develop into more valuable community health resource centers," says Michael Pollack, manager of practice development at the American Phannaceutical Association (APhA). The primary purpose of the program, however, is to provide a framework for competency-based postgraduate pharmacy education and training that focuses on six core areas: professionalism, practice management, communication, data collection and management, clinical problem solving, and practice-based research. APhA has established an instrument for preceptors to use in evaluating residents' mastery of the core competencies. "APhA suggests that residents be evaluated quarterly," says Pollack. "With that kind of constructive and frequent feedback, residents are more motivated, and they are more likely to consider the residency a top-quality educational experience." For Chad Shedron, PharmD, a resident at Family PharmaCare in West Lafayette, Indiana, the residency program has been professionally rewarding and educational. "Working with the people at PharmaCare has been a tremendous learning experience for me," he says. "It also has given me an opportunity to implement new programs." In addition to the routine disease management programs in place at Family PharmaCare, Shedron has started an immunization program and a wellness program that focuses on nutrition and weight management. "In that program, we will be measuring body fat and working with patients to get them on a good nutrition and exercise regimen," he says. In the past, hospital residency programs may have been considered more prestigious than those in the community pharmacy setting. The tide is changing, however, because dramatic changes in health care mean that fewer people are being hospitalized. With acute-care hospitals closing and sicker patients being sent home
earlier, the demand on community pharmacists is growing. "I don't really like to make comparisons," says University of Tennessee's Davis. "Even though the focus is strictly on ambulatory services in the community pharmacy, the clinical emphasis is just as intense." He points out also that in the community pharmacy setting there are valuable opportunities for collaboration with physicians and other health care providers in patients' ongoing care. The experiences of Ahrens and Shedron are typical of what is available in the 43 community residency program sites across the country, according to Pollack. Each residency consists of at least 2,000 hours of education and training over a 12-month period, usually running from July 1 to June 30. Each site has a residency preceptor who oversees the training. "The APhA Community Pharmacy Residency Program is designed to foster the development of formal postgraduate education and training experiences in innovative community pharmacy practice settings," Pollack says. Because of the rapidly changing health care system and the explosion of drug and therapeutics information, the need for creative, innovative pharmacy practice leaders is essential. "The key components of the residency experience are the advancement of the pharmacy profession and the discovery of new knowledge that will lead to improved patient care," he adds. Most of the residency programs are open to new PharmD graduates, but a few are awarded to B.S. pharmacy graduates. "PharmD graduates are preferred," says Davis, "but some exceptional B.S. students have served community pharmacy residencies." The program is open to any graduates of accredited schools or colleges of pharmacy who want to apply their clinical skills in a community pharmacy setting. The preceptor selects the resident and establishes the stipend that will be paid to the resident. "Individual sites may have specific application criteria for the residents," says Pollack, "so it's a good idea for people looking for a residency to check out the various sites that are open by contacting the director of the residency program that is of interest." Suzanne Scott and Lynne M. Constantine are medical writers in Arlington, Va., andfrequent contributors to Pharmacy Student.
January/FebruaI"Y 1999
ORE By Suzanne Scott and Lynne M. Constantine
Postgraduates are leamingand practicing-pharmaceutical care in innovative community pharmacies across the country. growing number of recent graduates are taking advantage of community-based residencies, where pharmaceutical care is making a visible difference in the lives of ambulatory patients. APhA's expanding Community Pharmacy Residency Program is based on the premise that postgraduates need opportunities to participate in patient care programs in real-world community pharmacy settings-where the majority of the nation's pharmacists work and where opportunities to improve the health of patients are boundless. "Serving as a resident in a community pharmacy has given me a great opportunity to develop skills and to gain experience in many different areas of pharmaceutical care," says Renee Ahrens, PharmD, a pharmacy resident at Travis Pharmacy in Shenandoah, Iowa. During her residency, Ahrens has participated in many disease state management and patient education programs such as blood pressure, lipid, and anticoagulation management. She also is about to begin a weight-loss research project with an OTC manufacturer and is involved in several wellness programs and a Smoking cessation initiative. In addition to participating in innovative patient care programs, Ahrens is getting fIrst-hand experience with the realities of the business side of pharmacy practice. She earned an MBA at the same time she earned her PharmD from Drake University, and is looking forward to wearing both hats-as pharmacist and as entrepreneur. According to Roger Davis, PharmD, director of the commu-
A
JanuarylFebruary 1999
nity pharmacy residency program at the University of Tennessee, meaningful entrepreneurial experience and a good introduction to the business side of pharmaceutical care is an important component of the residency program. In addition to understanding the principles of pharmaceutical care and innovative practice that improve patient outcomes, Davis says, students need to learn how to obtain appropriate reimbursement for their services and how to create business that gives them a reasonable economic return on their investment. The residencies give participants a frrst-hand view of the pharmacist's impact not only in managing patient's health, but also in lowering health care costs through appropriate medication managment, says Davis. "There is a tremendous need in the community marketplace for the skills these pharmacists bring to the table." Although the face of community pharmacy practice will continue to change as health care delivery evolves, Davis says that the need for community pharmacies will not go away. ''The community pharmacy may not look exactly the same in the future, but I am confIdent it will be important for pharmaceutical care services to be readily accessible in the communities where people live and work," he says. Warren Narducci, associate professor and director of the Bracken Pharmaceutical Care Learning Center at the University of Washington School of Pharmacy, agrees that communitybased pharmacies are here to stay and that pharmacy graduates can gain valuable postgraduate education through the community pharmacy residency programs. "Although every community residency site has its own set of services and programs, residents all get additional experience in providing patient education and follow-up care for patients with such diseases as diabetes, asthma, and rheumatoid arthritis," he says. ''They also will gain valuable experience in documenting their services and collaborating with other health care professionals." The residency program is a win-win situation for the community
Community residency programs provide opportunities to: • Become involved in health promotion and applied research in a community practice setting. • Develop critical skills in presenting drug infonnation, creating patient care plans, and compounding. • Provide clinical pharmacy services and direct patient care in a community-based pharmacy. • Work with a knowledgeable preceptor and experienced practitioner. • Learn the practice management, marketing and entrepreneurial skills, and the reimbursement strategies vital to keeping a community pharmacy economically viable. • Gain hands-on experience with technology used for pharmaceutical care and practice management.
phannacyas well as for the resident. ''The synergies created by the preceptor-resident teams inevitably help these phannacies develop into more valuable community health resource centers," says Michael Pollack, manager of practice development at the American Phannaceutical Association (APhA). The primary purpose of the program, however, is to provide a framework for competency-based postgraduate pharmacy education and training that focuses on six core areas: professionalism, practice management, communication, data collection and management, clinical problem solving, and practice-based research. APhA has established an instrument for preceptors to use in evaluating residents' mastery of the core competencies. "APhA suggests that residents be evaluated quarterly," says Pollack. "With that kind of constructive and frequent feedback, residents are more motivated, and they are more likely to consider the residency a top-quality educational experience." For Chad Shedron, PharmD, a resident at Family PharmaCare in West Lafayette, Indiana, the residency program has been professionally rewarding and educational. "Working with the people at PharmaCare has been a tremendous learning experience for me," he says. "It also has given me an opportunity to implement new programs." In addition to the routine disease management programs in place at Family PharmaCare, Shedron has started an immunization program and a wellness program that focuses on nutrition and weight management. "In that program, we will be measuring body fat and working with patients to get them on a good nutrition and exercise regimen," he says. In the past, hospital residency programs may have been considered more prestigious than those in the community pharmacy setting. The tide is changing, however, because dramatic changes in health care mean that fewer people are being hospitalized. With acute-care hospitals closing and sicker patients being sent home
earlier, the demand on community pharmacists is growing. "I don't really like to make comparisons," says University of Tennessee's Davis. "Even though the focus is strictly on ambulatory services in the community pharmacy, the clinical emphasis is just as intense." He points out also that in the community pharmacy setting there are valuable opportunities for collaboration with physicians and other health care providers in patients' ongoing care. The experiences of Ahrens and Shedron are typical of what is available in the 43 community residency program sites across the country, according to Pollack. Each residency consists of at least 2,000 hours of education and training over a 12-month period, usually running from July 1 to June 30. Each site has a residency preceptor who oversees the training. "The APhA Community Pharmacy Residency Program is designed to foster the development of formal postgraduate education and training experiences in innovative community pharmacy practice settings," Pollack says. Because of the rapidly changing health care system and the explosion of drug and therapeutics information, the need for creative, innovative pharmacy practice leaders is essential. "The key components of the residency experience are the advancement of the pharmacy profession and the discovery of new knowledge that will lead to improved patient care," he adds. Most of the residency programs are open to new PharmD graduates, but a few are awarded to B.S. pharmacy graduates. "PharmD graduates are preferred," says Davis, "but some exceptional B.S. students have served community pharmacy residencies." The program is open to any graduates of accredited schools or colleges of pharmacy who want to apply their clinical skills in a community pharmacy setting. The preceptor selects the resident and establishes the stipend that will be paid to the resident. "Individual sites may have specific application criteria for the residents," says Pollack, "so it's a good idea for people looking for a residency to check out the various sites that are open by contacting the director of the residency program that is of interest." Suzanne Scott and Lynne M. Constantine are medical writers in Arlington, Va., andfrequent contributors to Pharmacy Student.
January/FebruaI"Y 1999