The Transition from PGY-1 to PGY-2

Ying Long, PharmD
PGY-2 Oncology Pharmacy Resident
Massachusetts General Hospital
Boston, MA

Traveling on a red-eye flight during my move from Los Angeles to Boston was exhilarating. Seventy-two hours after I waved goodbye to my PGY-1 residency, I was sitting in the new-employee orientation at Massachusetts General Hospital (MGH) as a PGY-2 oncology resident. Even before I entered pharmacy school, I knew I wanted to pursue a PGY-2 residency in a specialty. When this moment arrived, I was filled with enthusiasm. I knew that the program at MGH would be rigorous and demanding, but I was thrilled to be able to devote a full year to oncology.

A structured orientation in both the pharmacy department and oncology pharmacy helps transition new residents to the new work environment. Along with all the other incoming PGY-1 and PGY-2 residents, I started out my PGY-2 residency with a month of orientation in the MGH Graduate Pharmacy Education Program. In addition to the general hospital and pharmacy orientation, I had an orientation specifically for PGY-2 oncology residents, which included clinical training and assessments. A series of oncology pharmacology review sessions were also planned to help us build a solid foundation in chemotherapy and targeted therapies. I began shadowing pharmacists in both inpatient and outpatient oncology pharmacies early in the orientation, which helped me learn the oncology pharmacy workflow and provided me the opportunity to work with a number of pharmacists. I felt that this orientation setup helped transition me to the oncology pharmacy work environment.

One of the most important items on the PGY-2 oncology resident’s checklist is to communicate with the residency program director (RPD) about short-term and long-term goals. During the orientation month, I met with my RPD several times to develop a customized learning plan that would incorporate both the program’s goals and my personal goals. These goals and objectives were translated into specific activities, including clinical rotations, research, operation, leadership, education, and community services. I have found it very useful to have a goal-oriented plan that systematically guides me through the process. 

Initially, I felt overwhelmed by the extensive list of activities under each of the objectives and goals set by the American Society of Health-System Pharmacists for completion during this year. Depending on the resident’s prior experiences, preceptors or the RPD may need to allocate more time to areas requiring improvement. For example, because I did not have the opportunity to verify chemotherapy orders during my PGY-1 residency, my preceptors provided me one-on-one guidance through professional practice experiences to help me become accustomed to the workflow. I would also like to improve my oral chemotherapy counseling skills and would find mock patient education sessions very helpful.

Though I have a structured schedule for the year, I have been given the flexibility to develop my own research project and select clinical trial pharmacy rotations in my areas of interest. The learning experiences are arranged by disease states, and each preceptor has a subspecialty in that disease state. Unlike the situation in other specialties, most oncology disease states are new to the resident, and didactic lectures can therefore be extremely helpful in building one’s knowledge base. For example, my first two rotations were in lymphoma and breast cancer. My preceptors held a number of one-on-one teaching sessions with me, which we spent analyzing patient cases and doing literature reviews, especially during the first week of each rotation. Preparing weekly lectures under the guidance of my preceptors helped me learn in depth about the disease states, treatment options, National Comprehensive Cancer Network guideline recommendations, landmark trials, and agents in the pipeline. In the beginning of the residency I needed more teaching from my preceptors, but I expect that as my oncology knowledge base grows, I will acquire more autonomy.

My learning experiences about clinical trials are incorporated into my core rotations. While providing guideline-based patient care, I will also be learning innovative therapy protocols and witnessing their implementation; MGH has an extensive clinical trials program that is moving oncology practice forward. As the PGY-2 oncology resident at MGH, I feel fortunate to be constantly exposed to the very forefront of oncology practice. In oncology, unlike other specialty practices, numerous clinical trials are conducted; learning how to read a study protocol and search for information in it is a critical skill that every resident must possess. Nevertheless, learning the standard-of-care regimen is the first step before one delves into clinical trials. Preceptors play a pivotal role in helping the resident who is new to the disease state to understand and differentiate among treatment regimens.

Feedback provided by the RPD and preceptors is essential to every resident’s growth. Ever since August 1, when my clinical rotations began, I have been receiving constructive feedback and have been asked to provide feedback. I meet with my preceptor weekly to reflect on the positives and negatives of my training so that we can optimize my learning experience and I can continue to achieve the goals set for each rotation. It is important for the resident to document his or her daily and weekly progress and actively seek feedback from the preceptors so that potential problems are addressed immediately. Also helpful is a 10-minute daily recap with the preceptor to discuss what the resident learned that day and identify areas for improvement. Providing and receiving timely feedback allows the resident to reflect on progress and stay on track with the learning objectives.

The field of oncology is changing rapidly. Although what was learned in pharmacy school may become outdated shortly after graduation, pharmacists still need to apply the methodology of providing pharmaceutical care plans to oncology patients. Residency teaches us a framework for approaching patient cases and further refines the skills we already possess. Oncology pharmacy residency builds a solid foundation for our oncology knowledge and equips us to tackle future challenges in our oncology career.