Residency

[Rockinacoustic]

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Straight from ASHP. Very insulting to be honest. No wonder pharmacy is so fractured

Personal feelings aside, I don't see what's untrue about that statement.

 

[samven582]

Personal feelings aside, I don't see what's untrue about that statement.

lets here your thoughts

 

[Rockinacoustic]

lets here your thoughts

I'm more curious about the details of your conversation leading up to that response you posted

 

[lord999]

Straight from ASHP. Very insulting to be honest. No wonder pharmacy is so fractured View attachment 347779

ASHP's statement is hilarious without context. Particularly given if you account for experience in actual inpatient settings, the BCPS pass rate has always been higher among the challengers than the residency trained (a Simpson's Paradox effect from numbers). It's the same observation that the highest passers of the CA Boards have almost always been the Canadians (unless one of the UC's happened to have a 100% that year) mainly because anyone challenging the BCPS and not had the requisite training is already unusual and probably has insider information that they know a thing or two.

The only one where I think you do need basic training is the original one, the BCNP. That one, you do need basic Radiation Safety Officer knowledge and some physics to have some idea when exceptions happen. Though the laboratories though are designed to be Homer Simpson proof even in extraordinary stupidity, it's nice to have people who aren't idiots in the lab.

On the other hand, Steve Ford is highly respected and exceptionally competent among the Civil Service for being extensively prepared. I would consider him in the Top 10-15 practitioners when he was in practice with the DoD. So, his experience isn't anything like yours, but he's had to manage a bunch of poor, dumb basement pharmacists enough to have contempt for the usual lack of competence and care. I didn't realize he switched over to ASHP as a retirement gig.

 

[KidPharmD]

I can't disagree more with this statement. Again - I teach residents as a PGY-0 (not bashing a residency at all) but there is something that years of experience cannot teach. I am amazed how often I bring up something that is common place to myself, but a recent PGY-2 graduate has never heard of. Just a few examples from the past month.
1. you don't give midodrine right before bedtime due to risk of postural hypotension.
2. The difference in absorption between cyclosprine (sandimune) and cyclosporine, modified (neoral)
3. If you paralyze someone with roc (and use etomidate as a sedative) you need to give additional sedation - a opioid push alone is not sufficient.

I don't think these are great examples of things that residency doesn't teach you. We don't even give that much midodrine and I would bet real money that both of my PGY2's would know all of these things off the cuff. No offense, but this sounds like a problem with your program (or the PGY1 they completed).

No amount of experience prepares you for every situation, but that isn't how we train pharmacists. Eventually we start sacrificing breadth of knowledge for depth of knowledge. It is what drives us to specialize (even those who specialize in IM or Operations). Not knowing about the the absorption differences between cyclosporine forms doesn't make that PGY2 an ineffective pharmacist if they don't regularly need that information when it can't be looked up (as long as they can identify that they need to look it up). I can't imagine the scenario where I would need that information in my brain so I couldn't have come up with it to save my life. Be careful or someday the brand new PGY2 grads will talk about that old pharmacist who doesn't even know monitoring parameters for the newest immunologic agents.

Again, having worked at several institutions, absolutely none of them had staffing positions that would have offered experience that would have ever replaced even a single year of residency for specific situations regardless of how long people had been doing it.

Straight from ASHP. Very insulting to be honest. No wonder pharmacy is so fractured View attachment 347779

What was the context of this statement?

 

[Dred Pirate]

I don't think these are great examples of things that residency doesn't teach you. We don't even give that much midodrine and I would bet real money that both of my PGY2's would know all of these things off the cuff. No offense, but this sounds like a problem with your program (or the PGY1 they completed).

No amount of experience prepares you for every situation, but that isn't how we train pharmacists. Eventually we start sacrificing breadth of knowledge for depth of knowledge. It is what drives us to specialize (even those who specialize in IM or Operations). Not knowing about the the absorption differences between cyclosporine forms doesn't make that PGY2 an ineffective pharmacist if they don't regularly need that information when it can't be looked up (as long as they can identify that they need to look it up). I can't imagine the scenario where I would need that information in my brain so I couldn't have come up with it to save my life. Be careful or someday the brand new PGY2 grads will talk about that old pharmacist who doesn't even know monitoring parameters for the newest immunologic agents.

Again, having worked at several institutions, absolutely none of them had staffing positions that would have offered experience that would have ever replaced even a single year of residency for specific situations regardless of how long people had been doing it.



What was the context of this statement?

I think you might have misunderstood the context of my statement. I get frustrated when people discount years of experience when they compare a seasoned Rph to a new grad from a PGY-2. Obviously a lot also depends on your practice model. I am the lone clinical RPh on nights - so I literally cover everything from NICU/peds to cards to onc to ED. I am the classic - jack of all trades, master of none (except ED because that is where I have spent the majority of my career).

If you are a the classic "in the basement ops rph" I completely agree with you- and I would say the same about many of our ops rphs.

1. We use a lot of midodrine - ironically one of our hires (a ICU pgy-2 from a big academic university) had no idea about the topic.
2. Cyclosporine - it comes down to knowing what you don't know. In this situations they continued the sandimune order - I caught it a couple of days into therapy - and guess what - their levels were sub therapeutic - gotta love an acute liver rejection ontop of the sepsis they were being treated for.

My point is not to bash residencies - but not to say their grads are automatically better than the guys or gals that have spent years in the trenches.

 

[samven582]

I'm more curious about the details of your conversation leading up to that response you posted

ASHP’s PGY1 residency exemption program. Its been removed

 

[samven582]

What was the context of this statement?

ASHP’s PGY1 residency exemption program. Its been removed

 

[Dred Pirate]

ASHP’s PGY1 residency exemption program. Its been removed

I am curious how many pharmacists have qualified for the exemption. I am not familiar with it. The stats would be interesting. Not that I have any desire to do it, I would be tempted to apply for ****s and giggles

 

[samven582]

I am curious how many pharmacists have qualified for the exemption. I am not familiar with it. The stats would be interesting. Not that I have any desire to do it, I would be tempted to apply for ****s and giggles

I asked ASHP for this information. No response

 

[owlegrad]

I cannot imagine going back for a residency after three years of being a pharmacist. I would also be super curious how common of a pathway this was.

 

[Dred Pirate]

I cannot imagine going back for a residency after three years of being a pharmacist. I would also be super curious how common of a pathway this was.

I work with two rph's who went back for a PGY-2 after they had been practicing for 3ish years (they both did a PGY-1) - of note - this was 15-20 years ago.

 

[Rockinacoustic]

ASHP’s PGY1 residency exemption program. Its been removed

You were trying to apply for pgy2 programs?

 

[samven582]

You were trying to apply for pgy2 programs?

yes a non-clinical one within the VA Health-system

 

[lane one]

I get where ASHP is coming from, but I also don't think their point matters. There ARE things that you'll experience in residency that you likely never would through experience alone. However, it's mostly research, presentations, posters....things that you won't really use in 95% of clinical jobs. It's true that you'll get wider breadth of knowledge, I just don't think that wider breadth alone makes you a super pharmD. Most clinical pharmacists don't really participate in clinical trials and give grand rounds presentations.

So in conclusion, everyone is right.

 

[KidPharmD]

I get where ASHP is coming from, but I also don't think their point matters. There ARE things that you'll experience in residency that you likely never would through experience alone. However, it's mostly research, presentations, posters....things that you won't really use in 95% of clinical jobs. It's true that you'll get wider breadth of knowledge, I just don't think that wider breadth alone makes you a super pharmD. Most clinical pharmacists don't really participate in clinical trials and give grand rounds presentations.

So in conclusion, everyone is right.

I think where ASHP is coming from is not if that breadth of knowledge makes you a better PharmD. Its if you are adequately prepared for a PGY2 without that knowledge.

 

[Rockinacoustic]

I get where ASHP is coming from, but I also don't think their point matters. There ARE things that you'll experience in residency that you likely never would through experience alone. However, it's mostly research, presentations, posters....things that you won't really use in 95% of clinical jobs. It's true that you'll get wider breadth of knowledge, I just don't think that wider breadth alone makes you a super pharmD. Most clinical pharmacists don't really participate in clinical trials and give grand rounds presentations.

So in conclusion, everyone is right.

I don't know of any pharmacist jobs where you have structured months rotating in 8-10 various practices areas gaining experience to competently cover a shift in that area. The presentations and research are fluff if you want to go into academics or real research.

And if by chance this is your job, you likely aren't applying for a residency.

 

[TheBlaah]

I don't know of any pharmacist jobs where you have structured months rotating in 8-10 various practices areas gaining experience to competently cover a shift in that area. The presentations and research are fluff if you want to go into academics or real research.

And if by chance this is your job, you likely aren't applying for a residency.

I think part of the problem is much of what they learn is specific to the hospital they're doing residency at. Besides much of what they learn not being tangibly useful in a clinical setting, nearly the rest of what they learn (Policy, protocols, p&t meetings, research, and even kinetics) are all subject to how that hospital decides to do things.

Sure, it makes them an excellent candidate for the hospital that did the residency in, but I don't believe it's worth more "experience" elsewhere. Even then it's not a sure thing; one of the worst pharmacists at my hospital was residency trained in-house.

All we know is that they're residency trained and maybe the reputation of the residency.
What we don't know is how well they were trained or performed.

Maybe if there was a grading system in place or test scores from the bcps? Granted, normal employees aren't expected to show their previous evaluations to future employers. But if employers are mandating residency and/or equating it to multiple years of experience, it seems fair.

 

[gwarm01]

I work with two rph's who went back for a PGY-2 after they had been practicing for 3ish years (they both did a PGY-1) - of note - this was 15-20 years ago.

I can only imagine these people had high earning spouses. I could never just quit my job, cut my salary by 100k for a year, and hope that I find a new position that uses my new skill set a year from now. I'm sure my wife would be thrilled if after all of that I was still making the same salary as before.

 

[Rockinacoustic]

I think part of the problem is much of what they learn is specific to the hospital they're doing residency at. Besides much of what they learn not being tangibly useful in a clinical setting, nearly the rest of what they learn (Policy, protocols, p&t meetings, research, and even kinetics) are all subject to how that hospital decides to do things.

Sure, it makes them an excellent candidate for the hospital that did the residency in, but I don't believe it's worth more "experience" elsewhere. Even then it's not a sure thing; one of the worst pharmacists at my hospital was residency trained in-house.

All we know is that they're residency trained and maybe the reputation of the residency.
What we don't know is how well they were trained or performed.

Maybe if there was a grading system in place or test scores from the bcps? Granted, normal employees aren't expected to show their previous evaluations to future employers. But if employers are mandating residency and/or equating it to multiple years of experience, it seems fair.

I'm not following how a minimum competency exam like BCPS differentiates pharmacists better than residency training.

Not saying there aren't bad programs out there, but if your hires are duds, then it reflects your hiring process more than residency training as a whole. For every person on these forums who state their worst employee was residency trained, I can name two who were my best colleagues or direct reports.

 

[rxkrafted]

I don't think the answer is clear-cut. The type of training and experience that both pharmacists (residency-trained and seasoned) play the differentiating factor. That one year of residency training in a big-academic hospital with great preceptors will be way more knowledgeable than a seasoned pharmacist working at the same small hospital that sees the same thing over and over for the past 10 years.

The 1-year residency equivalent to 3-years experience rule-of-thumb obviously has to be taken with a grain of salt but mainly applicable to clinical knowledge.