PGY1 Community-Based Pharmacy Residency: A Door to Endless Possibilities

By: Dr. Taylor Mitchell and Dr. Geena Eglin

Pharmacy resident candidates are often overwhelmed with various postgraduate year 1 (PGY1) residency opportunities nationwide. Yet, candidates may not be fully informed about their options during the application process. The PGY1 Community-Based Pharmacy Residency Programs (CPRP) are one of three PGY1 residency types formally recognized by the American Society of Health-System Pharmacists (ASHP); however, each PGY1 CPRP is unique when comparing their learning experiences. This article highlights the benefits of a candidate pursuing a PGY1 CPRP in North Carolina.

Introduction

Pharmacy residency programs have become integral to a pharmacist’s training to aid in the fasttrack development of advanced clinical skills and knowledge needed to practice at the top of one’s license. Formal pharmacy residency training programs and accreditation standards were developed in the early 1960s. (1) Since its establishment, residency training programs have dramatically changed to incorporate to- day’s dynamic clinical field. The American Society of Health-System Pharmacists (ASHP) formally recognizes three types of PGY1 residency programs: PGY1 Pharmacy, PGY1 Community-Based Pharmacy (CPRP), and PGY1 Managed Care Pharmacy. (2) Pharmacy residency candidates interested in ambulatory care, chronic disease state management, or other outpatient pharmacy practices often find themselves at a crossroads when deliberating on which type of first-year residency program to pursue. Although PGY1 CPRP and PGY1 pharmacy residency programs expose pharmacists to various clinical experiences, some students may misunderstand the depth a PGY1 CPRP offers candidates based on its nomenclature. In this article, the different types of North Carolina PGY1 CB pharmacy residency programs CPRP are further discussed while evaluating the unique opportunities that may arise from each.

Pgy1 Cprp Types

The American Pharmacists Association (APhA) defines a PGY1 CPRP as “an advanced training opportunity where cutting-edge pharmacists mentor postgraduate pharmacists in a community-based pharmacy setting.” (3) A community-based program allows pharmacists to care for patients in various outpatient settings through longitudinal experiences by incorporating disease state management, medication therapy management (MTM), immunizations, wellness services, and collaborative and integrative team-based care models. (3) All PGY1 CPRPs have the resident concentrate the majority of their time in patient care, including a focus on at least three chronic disease states (e.g., diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, etc.), and many programs offer experiences with a specific disease state or patient population such as oncology, HIV, or hepatitis C virus. (4) This allows the PGY1 CPRP resident to see a variety of common and specialty chronic diseases over their training year. A PGY1 CPRP allows pharmacists to gain skills in four competency areas defined by ASHP in partnership with APhA, including patient care, advancing community-based practice, leadership and management, and teaching, education, and dissemination of knowledge.

(4) These are similar to competencies described for PGY1 Pharmacy but will be completed in different settings offering other unique characteristics and projects. Where these competencies and skills will be developed may vary as community-based settings provide direct patient care in locations outside of the inpatient or acute care health-system setting. (3) This may include specialty pharmacies, patient-centered medical homes, free clinics, and federally qualified health centers, to highlight a few.

The PGY1 CPRP settings in North Carolina are based in chain and independent pharmacies, ambulatory care centers, and hospital/ health-system outpatient pharmacies. Each program’s definitions are outlined in Table 1

(5,6) The 2022 ASHP Directory advertises that 30 PGY1 CPRP positions were available from nine different ASHP-accredited programs across North Carolina (Figure 1). While accredited programs are surveyed against a set of best practice standards, how they train residents and the patient care opportunities provided may differ significantly between residency programs. This allows programs to capitalize on the unique aspects of their organization and patient population as a part of the residency design, including their physical locations and service areas.

Retail pharmacies, including large national or regional chains and independent and grocery-based pharmacies, are a common location for PGY1 CPRPs and may have unique advantages to the type of practice and opportunities offered. Chain pharmacies or other organizations with multiple pharmacy locations often provide residents with the opportunity to obtain regional or national management experience. As a result, such involvement could lead the resident to be hired into a management position upon graduation from the program. Although the opportunities to obtain chronic disease management experiences may vary across such pharmacies, residents may still provide patient education regarding medications and perform blood sugar, blood pressure, and lipid screenings during volunteer community events. Independent pharmacy programs uphold similar opportunities and may allow for further creativity in developing and marketing business programs due to their differences in management and policy-making procedures. Independent pharmacies may enable residents to see all aspects of a pharmacy’s operational and ownership requirements from a business perspective and learn about various payment models. A resident commonly has longitudinal MTM service responsibilities in chain and independent pharmacy environments. These locations continuously provide pharmacy residents with patient education opportunities, given the high demand for such pharmacies to fill prescriptions for their community. Chain and independent pharmacy PGY1 CPRPs are dispersed throughout the central, western, and eastern regions of North Carolina. As a result, each of the pharmacies in these locations will have access to various resources they can direct patients to for additional assistance, including those supporting mental health, preventative medical care, laboratory tests, and more.

Ambulatory care centers are another setting for PGY1 CPRPs. Ambulatory care pharmacy provides integrated, accessible healthcare services by pharmacists to assist patients in their medication needs and practice in the context of family and community. (7) More interdisciplinary opportunities can be available for ambulatory care residents. Experience may be available in various services, such as pharmacist-run anticoagulation clinics, transitions of care practices, and population health management. Patient appointments focusing on congestive heart failure, oncology, hepatitis C, HIV, and cystic fibrosis would also likely be available. Depending on the center’s physical location, funding source, and structure, residents may have a greater focus of care centered around underserved, uninsured, and rural populations. Within ambulatory care centers, a resident may obtain less retail experience than one might get from an independent and chain-based pharmacy residency program. Yet, residents still fulfill patient-centered medication dispensing via evening and weekend clinical shifts in their respective program’s associated hospitals. One institution currently offers a PGY1 CPRP opportunity focused in the ambulatory care center setting in the North Carolina Piedmont region.

The final area for a PGY1 CPRP is within a hospital/health-system outpatient pharmacy. These organizations offer residents a combination of retail and ambulatory care pharmacy settings. An additional advantage is access to patients leaving the inpatient setting, thus allowing for a robust transition of care experience. Such programs encourage their residents to simultaneously uphold longitudinal responsibilities over the year with the possibility of transitioning between shortterm rotational requirements. Longitudinal responsibilities may focus on patient care activities in transitions of care, discharge, specialty pharmacy, and chronic disease management. In contrast, others focus on projects in population health, business planning, pharmacy management, and research.

Often, residents can expect preceptor(s) of such programs to be credentialed as Clinical Pharmacist Practitioners (CPP). North Carolina CPPs, defined as “licensed pharmacists authorized to initiate, modify, and discontinue drug therapy and order specific laboratory tests under the supervision of one or more physicians,” may practice in various outpatient settings. (8) However, fewer CPPs are seen in community pharmacies (both retail and independent) due to many physicians and providers prescribing for the larger patient population served.

(8) While many states have some form of collaborative practice laws, prescribing authority for pharmacists is limited, thus making programs that allow residents to work under CPPs highly valued.

(9) Residency programs in health systems may include the PGY1 CPRP resident in a larger residency class and provide more phar- macy students to precept. Opportunities such as patient care with CPPs, population health, specialty pharmacy, and discharge services are not secluded to just a health-system PGY1 CPRP; however, these examples highlight how they might be incorporated into such a program.

Outpatient health-system residency programs comprise the most significant portion of PGY1 CPRP positions across North Carolina. As a result, careful consideration is warranted when selecting a PGY1 CPRP in a hospital/ health-system outpatient pharmacy program to match one’s personal and professional goals best.

The Benefits Of A Pgy1 Cprp

Upon completing a PGY1 CPRP, pharmacists are exceptionally equipped with various clinical and operational skill sets. Job opportunities may include management, specialty pharmacy, transitions of care, value-based care models, continuing community pharmacy services, or a faculty position at a pharmacy school. The extraordinary clinical skillset also fully prepares the pharmacist to practice at the top of their license through CPP credentialing.

Graduates of a PGY1 CPRP may also consider pursuing a specialized PGY2 residency position. Candidates completing a PGY1 CPRP hold skill sets developed within the aforementioned four main competency areas of patient care: advancing community-based practice, leadership and management, and teaching, education, and dissemination of knowledge. These skill sets give the candi- date a solid foundation for further PGY2 training. While most often this is within the ambulatory care setting, graduates from a PGY1 CPRP are also well equipped for other specialties such as cardiology, geriatrics, informatics, or medication-use safety and policy, to name a few. Depending on affiliations with schools of pharmacy or health systems, candidates may also have the opportunity to early commit to such a PGY2 program within the same hospital/health system via early commitment or a different program.

Conclusion

The decision of which PGY1 CPRP to pursue can be difficult to navigate and is often not a “one size fits all” approach. PGY1 CPRP candidates must review programs within North Carolina carefully to ensure the learning experiences offered align with their personal and professional goals. All PGY1 CPRPs offer experiences in patient care, leadership, management, advancement of community practice, and education. Nevertheless, there may be unique advantages in one or more of these areas based on the program’s setting. Retail chain and independent pharmacy programs allow residents to gain skills in managing a pharmacy while sharpening medication knowledge, performing patient education sessions, and completing MTM interventions. Ambulatory care centers enable residents to clinically manage patients through scheduled appointments and population health interventions while still obtaining medication dispensing skills. This setting continues to support longitudinal patient relationships in various geographical locations.

Hospital/health-system outpatient pharmacy programs combine both experiences by encouraging residents to obtain a broad range of experiences in providing patient care from managerial, ambulatory care, retail, and outpatient pharmacy perspectives. For those who desire to pursue any pharmacy career in the outpatient setting or obtain a PGY2 in ambulatory care, a PGY1 CPRP is the best way to develop an array of clinical skills and knowledge to prepare one for such longitudinal patient care opportunities. With the diversity of outpatient-focused learning experiences available for PGY1 CPRP residents, they are set up for success when pursuing additional residency training or their dream career in pharmacy.

Authors: Taylor Mitchell, PharmD, is a PGY1 Community-Based Resident at Novant Health New Hanover Regional Medical Center, Taylor.Mitchell@novanthealth. org. Geena Eglin, PharmD, BCACP, CSP, CPP, is the PGY1 Community-Based Residency Director at Novant Health New Hanover Regional Medical Center in Wilmington, NC.

Acknowledgement

The authors thank Michelle Rager, PharmD, BCPS, BCACP, for the helpful discussion and comments on this manuscript.

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Personal Perspectives

Geena Eglin, PharmD, BCACP, CSP, CPP, secured her PGY2 ambulatory care residency position at Novant Health NHRMC in 2019-2020 after completing a PGY1 CPRP in Springfield, Massachusetts. After completion of her postgraduate training, Dr. Eglin was well prepared for her job in a specialty CPP position and is now transitioning into her newly appointed role as the Novant Health NHRMC PGY1 CPRP residency director. Dr. Eglin states, “Candidates completing a PGY1 CPRP are exposed to the best range of experiences, setting up graduates to be successful in many different practice areas, including traditional operations, specialty pharmacy, ambulatory care, and population health.”

This was the case for Samantha Seivert, PharmD, BCPS, a graduate of the University of Illinois at Chicago. “I looked heavily at programs in North Carolina because of the opportunity for a CPP license, which is a unique opportunity this state provides for pharmacists to practice at the top of their license,” states Dr. Seivert, a Novant Health NHRMC PGY1 CPRP graduate. Due to her advanced and unique learning experiences obtained during her PGY1 CPRP residency, Dr. Seivert received her Board-Certified Pharmacotherapy Specialist certificate and transitioned into a CPP role focusing on cardiology.