Friday, March 20, 2015

I GOT A PHARMACY RESIDENCY!!

Sorry, I am writing this from my phone, on my lunch break...because I cannot wait to share the news with you!

This morning at 7:02 I got the glorious email that said
I matched to a pharmacy residency program! 

Thank the LORD 
and Hallelujah (even though it's not Easter yet)

More details to follow soon.

Agnes

Friday, March 6, 2015

PGY-1 Pharmacy Residency Interview, Rank, and Match Process


Last week, I introduced you to the pharmacy residency application process and presented you with my PGY-1 Residency Letter of Intent, which answered questions such as: Why I want to do residency, Why I would be the best candidate, What my future goals are, and Why I am a good fit for the particular program I am applying to. The applications were due early in January and interviews happened all throughout February. Like I already mentioned, I was invited to interviews at 6 different hospitals, which I presented in the picture above. 


 A Pharmacy Residency Interview is not your ordinary employment interview. The shortest of my interviews were a half day, but most of them took the whole entire day (9-4pm). At most employment interviews, you might interview with 1-3 different individuals in the chain of command (your direct supervisor, a Human Resources person, and perhaps a company or department manager). For a pharmacy residency, I was interviewed by anywhere from 4 to 10 different pharmacists, the pharmacy residency director and/or residency/clinical coordinator, and the current residents. At most interviews, I had to give a formal presentation to the pharmacists and residents, on a topic of my choice. I chose to present my 20 minute mini-lecture on Restarting Anticoagulation after Major Gastrointestinal Bleeding in Patients at a High Risk of Thromboembolic Events ( I talked about that briefly in my APPE#2 Post). At 4 of my interviews, I was put on the spot and was given a clinical case, given 10 minutes to identify and solve all the medical problems, and present an assessment and plan for each problem. This included identifying a primary diagnosis, most of which happened to be infectious disease related (pneumonia, sepsis, etc), in addition to the patients having multiple other complications such as dehydration, acidosis, hyperkalemia, and acute kidney injury. There were also plenty of medication reconciliation and drug-drug or drug-disease interactions to intervene on. It was a bit stressful and 10 minutes was not nearly enough to hit all of the major points in these complicated patients. Well, I did my best and I'm sure all of the other candidates also did the best they could in the time allowed. It's a good thing I have been warned about clinical cases being a possibility on residency interviews and I started studying the major and most important disease states / pharmacotherapeutics topics back in January. I figured I am killing two birds in one stone since this is a good time to start studying for the Naplex - the lovely "185-question computerized examination designed to determine whether candidates have the knowledge, judgment and skill necessary to practice pharmacy at entry-level competence" aka the BOARD EXAM necessary to become a licensed pharmacist. The day also included taking a hospital tour and eating lunch with the current residents...so that we can ask them all of the questions we possibly have to make sure that both that program/hospital is a good fit for us and that we are a good fit for the program.






 And now that the nightmare of interviews is over, I can breathe...

Well, not quite.


Now I have to THINK, THINK, THINK and RANK each program in the centralized application system. And in the same way, each program will RANK the candidates they interviewed and liked.


Ranks are due TOMORROW, Friday, March 6th at midnight. And the official, long-awaited, bittersweet MATCH DAY is March 20th. And March 19th is the night that all the stressed out, nail-biting, potential residency candidates do not sleep but sit in front of their computers, hitting "refresh," and awaiting the match results to be posted.


(Update: The MATCH DAY nightmares starting happening. I just had my first nightmare last night, about not getting into any of the six residency program where I interviewed, only because I forgot to submit my ranks before the deadline....thinking that I did submit them. When I realized this, I began despairing in my dream...only to be woken up by my alarm clock and being oh so relieved that this was only a dream - a dream that seemed so real that I think it gave me palpitations during my sleep). I think this is a sign of how badly I want to get into residency.



I do have a general idea about what I like and don't like about each program I interviewed at, and I remember the general impression and feeling that each program left me with after interview day, but to better prepare to submit my official ranks, I decided to go through the pros and cons of each program and think about all the different factors that I must plug into my brain so I that I may make a good, informed decision. Of course, the general feeling I currently have in my heart, especially my choice of my #1 program, I believe, was put in my heart by THE BOSS, my God. He is responsible for all of this - for me going to pharmacy school, and going through all of these different pharmacy experiences, and for deciding to apply to residency. He has been with me through my discernment process and I, in turn, have placed everything in His Hands. 

But here is some insight into what kinds of impressions the different program left on me upon interviewing, and why I will be ranking these programs the way that I'll be ranking them:

(I made a table in Microsoft Word before the interviews with the information I was able to gather about each program to help me better prepare for the interview questions...now I just have to add the information I gathered during the interviews to this table to have a complete picture)


There is a lot to consider when ranking residency programs. Many different factors go into one's decision, including things like:


  • The size of the program (ex: 1-2 residents vs. 8-12 residents)
  • The size of the hospital/institution (ex: small, 200-bed community hospital vs. large, 700-bed academic medical center)
  • Types of rotations offered (do they match your interests?)
  • Types of certificates / training offered / required (Basic Life Support, Advanced Cardiac Life Support, Teaching certificate)
  • The required projects (Ex: Research Project, Medication Utilization Evaluation, etc)
  • The resident's level of autonomy (Ex: Micromanaged by preceptors vs. allowed to make recommendations/decisions individually)
  • Residents' office/ work space (Ex: Cubicle/desk right in the center of a busy, noisy pharmacy or office vs. a small, private room intended ONLY for residents)
  • How often "staffing" is required (Ex: do you have to come in every weekend to be a staff pharmacist and verify orders, or is it every other weekend, or is it a week long experience after each rotation? [Most institutions have the residents staff 2 days every OTHER weekend, meaning you work 12 days on, 2 days off])
  • What some of the past residents of the program are doing now.
  • And then there are secondary things like location, driving distance, pay, etc....
If those are not addressed on the program's website or in the brochures you have received at the Midyear Conference, those are good questions to ask during the interviews.

So here is what's going through my head and helping me to decide how to spend an entire year post-graduation:

Interview #1 --> February 2


Pros
Cons
·       Smaller program (2 positions)
o   Fits my personality
o   Allows for flexibility, customization and tailoring of rotations to resident’s interests
o   No competition for choosing rotations
·       Offers rotations in my potential areas of interest: internal medicine, critical care, cardiology, and TEACHING
o   They’re adding an oncology rotation for next year
·       Offers a longitudinal experience in ambulatory care (1/2 day clinic every Thursday)
·       Offers a teaching certificate + a teaching rotation (fits my passion for academia)
·       Has substantial project time built-in (entire month of December is dedicated to research project)
·       The current residents are very happy
·       Nice, private office space for residents to get work done
·       Physician led multidisciplinary rounds and decentralized pharmacist model
·       All 6 Holidays are off
·       Residency Director is awesome!
·       Only one critical care unit (cannot get various critical care experiences such as surgical ICU, trauma ICU, etc)
·       No pediatric/neonatal rotations
·       Staffing is 2 days (Sat & Sun) every other weekend (12 days on, 2 days off)

- General impression from the interview: "I LOVE IT. I can definitely picture myself here for a year."


- Major drawback: No pediatric population to care for; no pediatric or NICU rotations offered 


Interview #2 --> February 10


Pros
Cons
·       Rotations available at 2 different campuses
·       Smaller community hospital but it has one of the most progressive pharmacy departments in the state of Indiana
·       Pharmacy recognized by ASHP as one of the most robust clinical programs in the nation
·       Rotations in my areas of interest: internal medicine, critical care, cardiology
·       Offers Indiana Pharmacy Teaching certificate
·       A lot of their current pharmacists are past residents (they offered them positions, they stayed on, and they love their jobs)
·       Amazing, Catholic Residency Director
·       Smaller, community hospital
·       No physician led rounds
·       Not the greatest impression from the current resident(s) (maybe because they’re lazy?!)
·       Staffing 2 days every other week (12 days on, 2 off) + clinical staffing after rotations


- General impression from the interview: "I really, really like it."

- Major drawback: smaller, community hospital so there is a lack of physician-led multidisciplinary rounds. Pharmacist interventions are made by paging / calling the doctor, who may or may not be in the hospital at the time, since all of the doctors are private practitioners and not hospitalists.


Interview #3 --> February 17


No pro/con table here. I wasn't even planning on attending this interview and only applied here kind of as a back-up. But the director kept bugging me after my lack of response and I had the day off work anyways, so I went. 


General impression from the interview: eh. it's a nice, freshly remodeled, cozy community hospital but the residency program is fairly new and not really well-developed yet. 


Major drawbacks: Very limited rotation experiences available; not a lot of structure to the program. No medical/academic rounds, but instead only nursing reports called "dailys" which don't really address medical issues but rather discharge disposition, etc...which provides almost no learning experience for the pharmacy resident.


Interview #4 --> February 18


Pros
Cons
·       408-bed teaching hospital
·       Level I Trauma Center
·       Level III Neonatal Intensive Care Unit
·       Certified Primary Stroke Center
·       Small program (2 positions)
·       Physician-led, multidisciplinary team rounds
·       Had rotation here, know all the pharmacists / preceptors and current residents
·       Happy & enthusiastic current residents
·       Staff only 1 day every other week
·       Rotations that match my interests: internal medicine, critical care, cardiology, Peds/NICU
·       Also unique experiences like trauma, oncology
·      Great, private, secluded office space for residents
·      Pharmacy dept is very advanced and pharmacist presence on floors is well-received and appreciated (aka docs take our recommendations seriously)
·       Very long drive


- General impression from the interview: Love it. Love the hospital, love the pharmacy department, love the residency program. 


- THE ONLY MAJOR DRAWBACK: ~40 miles away from my house and requires commute through entire length of the city of Chicago...which, when traffic backs up, can be even up to 2-3 hours.


Interview #5 --> February 20


Pros
Cons
·       445 bed community hospital: part of a 3 hospital health-system
·       Rotations in my areas of interest: internal medicine, critical care, NICU/Peds
·       CSU teaching certificate
·       Office space
·       Project days will be scheduled throughout course of the year
·       Residents have access to employment opportunities before the search is taken to the public and can apply for an open position in the final month of their residency
·       Ability to Lecture or teach pharmacy students at an affiliated college of pharmacy
·       Lots of PTO
·       Looking to hire more clinical pharmacists and expand the clinical pharmacy dept à employment opportunity
·       Staffing 2 days every other week (12 days on, 2 off) + clinical staffing after rotations
·       no physician-led team rounds (official rounds only in ICU) since this is a community hospital


Highlight from the interview upon questioning why I want to do residency: 
- I told the Residency Program Director: "because every time I go to work at a retail pharmacy, a little part of me dies inside"
I almost immediately bit my tongue upon saying that to DA RESIDENCY DIRECTOR but luckily, he said he felt the same way back when he was a retail pharmacy intern, like me :-)

General impression from the interview: I like it. I could potentially see myself here.


Major drawbacks: Lack of physician-led multidisciplinary rounds. Pharmacist interventions are made by paging / calling the doctor, who may or may not be in the hospital at the time. Also, it is their first year of running a residency program - I would be a guinea pig for a program that may or may not turn out good. Currently, there is no residents to talk to in order to get their honest feedback about the program, since the program is just starting. I would have to risk it and be prepared to either really love those 12 months of my life, or really hate and be miserable for 12 months of my life. Not sure I'm quite ready to take a risk like that. But let God's Will be done if that's His place for me. 


Interview #6 --> February 27


Pros
Cons
·       Also smaller program (2 positions)
·       Large (695 bed) teaching hospital
·       Level I trauma center
·       Level I NICU & Level III Perinatal center
·       Has an excellent Children’s Hospital
·       Offers rotations in my potential areas of interest: internal medicine, critical care, pediatrics (PICU, NICU, Peds)
·       Offers unique rotations: oncology, neurology, nephrology, transplant
·       PGY2 in Emergency Medicine and Infectious Disease offered
·       Program will potentially start a NICU/Peds PGY-2 in 2016 (opportunity for an early-commitment PGY-2 in my area of interest)
·       The current residents are happy
·       Physician led rounds and decentralized pharmacist model
·       Staffing 2 days every other weekend and 3/6 holidays
·       A little too intense for me; this hospital is huuuuge and they get some of the sickest and most seriously injured trauma patients (gunshot wounds, stabbings, very serious car accidents)


General impression from the interview: Excellent hospital and program, but probably not for me (too intense). 


If I was single and had no responsibilities, I would probably rank this #1. But since I'm a married, cooking, cleaning, gardening, and soon-to-be pursuing pregnancy Catholic wife....I cannot take this residency thing as seriously as some other super-determined people with no other responsibilities and no regrets, hehe. I GOT MY PRIORITIES ALL FIGURED OUT :-) GOD 1ST, MARRIAGE 2ND, FAMILY 3RD, then CAREER.


----------------------------------

And I will not be sharing my official, final ranking list on here, since that information is confidential. You can probably guess the way that I'll rank them from my "general impressions" and other descriptions above. 


My very supportive and very silly husband!
He's the best and I hope that residency
does not TAKE anything AWAY form our marriage,
but rather adds to it and strengthens it.
And despite what my final ranking is...
I believe God is the real matchmaker behind "the Match"

 As I have been praying for the past several months, so I repeat now: Lord, please place me into a residency program that is best not only for me but also for my marriage and my future family. You know me better than I know myself and You know what is best for me and for my future, so have at it! Let Thy Will Be Done!









If you have any questions about any part of the residency application or interview or match process, feel free to comment or shoot me an e-mail!

Love, Agnes