A Tale of Two Residents: Exploring a PGY2 Residency

Stephanie Folan,PharmD PGY1 Resident
UMass Memorial Medical Center
Worcester, MA

Nicole Gunderson, PharmD PGY1 Resident
UMass Memorial Medical Center
Worcester, MA

Oncology pharmacy is a highly specialized field, necessitating the pursuit of PGY2 oncology pharmacy residency positions for new practitioners. The American Society of Health-System Pharmacists’ website currently lists more than 80 sites offering a PGY2 in oncology pharmacy, up 76% from 2010. Sites offering PGY2s include academic centers, community hospitals, outpatient clinics, Veterans Affairs medical centers, and others. When pursuing an oncology pharmacy residency program, residents have to consider factors such as program size, rotation structure, specialties of the practice site, and residency requirements, and make sure they coincide with their career goals.

The increase in specialized PGY2 pharmacy residency opportunities is not unique to the oncology field. In 2014, 795 PGY2 positions were available for pharmacists pursuing residency training in one of 26 specialties. With so many options, why are increasing numbers of PGY1 residents focusing on PGY2 residencies in oncology?

Stephanie’s Journey

My exposure to oncology began in elementary school. My mom was diagnosed with stage III breast cancer at the age of 39, and I remember her being worn out and taking plenty of naps. However, I was not truly aware of the severity of her illness at the time. Looking back to- day as a healthcare professional, my perception surrounding her treatment has changed. My mom underwent a lumpectomy, mastectomy, and reconstructive surgery. She endured weeks of radiation and sever- al cycles of chemotherapy. Her healthcare team, consisting of oncologists, surgeons, nurses, and pharmacists, worked together to provide her with a treatment plan that allowed her to function in her everyday life and that has kept her cancer free for 14 years. This treatment plan not only accounted for the care my mom received, but it also included care for our family. She never seemed as sick as she truly was. When I reflect on the care my mom received, I realize the practitioners who specialize in oncology care for the whole patient as well as their family and friends.

My personal experience sparked an interest in a career in oncology that has grown with my professional experiences. As a student, I learned about oncology medications and their place in therapy during pharmacotherapeutics and pharmacology. I was surprised that much of the curriculum was focused on supportive care, and I realized pharmacists can play a large part in improving a patient’s quality of life as they receive chemotherapy. I completed an intern rotation in bone marrow transplant with a team guiding patients through high-dose chemotherapy and life-saving transplants. I was fascinated with the complexity of treatment regimens. There are many opportunities for

pharmacists to make interventions related to chemotherapy, antibiotics, and supportive care. While following the palliative care team as a resident, I interviewed many patients and their families regarding pain and symptom management. I enjoyed developing relationships with patients while helping improve their quality of life as they persevered through difficult situations. Even though oncology pharmacy is considered a specialty, I have learned that there are many different opportunities for pharmacists in the oncology field, and that is one reason why I am excited to pursue a PGY2 oncology pharmacy residency.

These experiences only scratch the surface of potential opportunities for pharmacists in oncology pharmacy. There are endless chances for pharmacists who specialize in oncology to affect the lives of patients. PGY2 programs offer rotations in inpatient oncology, outpatient oncology, infectious disease in the immunocompromised population, pediatric oncology, bone marrow transplantation, and palliative care. Because of the specialized nature of an oncology pharmacist, a PGY2 residency offers an opportunity for young pharmacists to explore the specialty and better understand the expanding roles pharmacists can play in oncology. I look forward to building on my experiences in oncology, as well as the foundation built during PGY1 pharmacy practice residency, through a PGY2 oncology pharmacy residency.

Nicole’s Journey

I became interested in pursuing a PGY2 in oncology pharmacy for several reasons. I first became involved in oncology while working as an oncology pharmacy technician at a Veterans Affairs medical center. My science-minded side enjoyed learning about complex chemo- therapy regimens and compounding, while my outgoing side enjoyed meeting with patients and their families. As a technician, each morning I would evaluate the infusion center schedule, review the regimens and organize my supplies, and then prepare the chemotherapy as patients arrived. I wanted to know everything and was constantly asking the pharmacists “Why?” Why this regimen? Why were there different doses? Why do we have premedications? When I delivered chemotherapy, if time permitted, I would stop and chat with patients. I loved being able to sit with patients and hear about their adventures. Throughout my experiences as an intern, and now as a pharmacy practice resident,

I continue to see oncology-related issues from different perspectives, not just from the perspective of an oncology pharmacist.

I find there are dynamic opportunities within the oncology pharmacy field. Oncology pharmacists have the possibility to work in the outpatient setting as a clinician, the inpatient setting as part of the healthcare team, or in a combination of the two. In either setting, the pharmacist has an opportunity to develop a relationship with patients and encourage them to take an active role in their health care. Some patients may feel that it is them versus the insurance company or the healthcare system as a whole. Numerous new oral chemotherapy agents have emerged on the market, creating a daunting experience for the patient when high costs and difficult dosing regimens are involved. Pharmacists can advocate for the patient, motivate patients when they are discouraged, provide alternatives and education, and act as a conduit between the doctor and insurance provider.

I’ve always loved a difficult puzzle, and I view patients with complex medical issues as a great challenge. On paper, two patients may seem very similar in their diagnosis, past medical history, and medication profile. However, their response to treatment and medication tolerance can vary greatly. Each patient’s case is like a puzzle with pieces made from their medications, response to treatment, comorbidities, insurance coverage, and personal beliefs. A clinical oncology pharmacist must be able to collaborate with the patient’s healthcare team to fit the pieces together to help provide optimal patient care.

As new agents enter the market at incredible speeds, the field of oncology pharmacy is continuously evolving. Treatments that were once considered the gold standard are being used in combination with new therapies, or in some cases, are being replaced altogether. I am excited to stay up to date on new medications, guidelines, and clinical trials published at an ever-increasing pace. I will be able to evaluate the data to determine whether study results support a change in clinical practice that would apply to my clinical setting and can take what I learn to help educate the team and patients. I continue to ask “why” to my preceptors and feel a PGY2 specializing in oncology will help me develop the skills needed to find the answers.

Each candidate has his or her own reasons for pursuing a PGY2 pharmacy residency. For me, I enjoy that oncology pharmacy is a great combination of oncology, critical care, infectious disease, internal medicine, cardiology, and more. Opportunities within the field will allow me to be an advocate for patients, a problem solver, a collaborative member of the healthcare team, and a life-long learner.