Ask a PGY-2 Pharmacy Resident

Laura M. Lourenço, PharmD, BCPS, is a PGY-2 Solid Organ Transplant Pharmacy Resident at Barnes-Jewish Hospital in St. Louis, Missouri. Dr. Lourenço completed her PGY-1 training at the University of Illinois at Chicago College of Pharmacy and Hospital & Health Sciences System in Chicago, Illinois, and she holds a PharmD degree from MCPHS University in Boston, Massachusetts. Her clinical interests include cardiothoracic transplantation, infectious diseases in the immunocompromised host, and clinical research opportunities. Her PGY-1 residency research project on prophylaxis against CMV in kidney transplant recipients was distinguished as a poster of distinction at the World Transplant Congress this past July. Dr. Lourenço hopes to obtain a job in cardiothoracic transplant at a large, academic medical center after the completion of her residency experience.

Q: Why did you decide to pursue a PGY-1 and PGY-2 pharmacy residency?

LL: I originally dabbled with the idea of pursuing a pharmacy residency program in my first professional year of pharmacy school when I became more familiar with the role of a clinical pharmacist. Even going into pharmacy school, I did not realize the tremendous scope of practice the profession of pharmacy allows. My ultimate decision to pursue a PGY-1 residency and ultimately a PGY-2 pharmacy residency was the realization of my love of solid organ transplantation as a specialty.

I am passionate about all aspects of patient care and found that specializing in transplantation was a great way to incorporate my love of the inpatient and ambulatory settings, critical care, and infectious disease with a fascinating and ever-changing field booming with research questions and opportunities for patient care initiatives to improve outcomes. In order to practice as a clinical pharmacist in solid organ transplantation, training in both PGY-1 and PGY-2 pharmacy residencies is required.

Q: What is the structure of your residency program?

LL: The structure of my current residency program is primarily based on my clinical rotation schedule. I have chosen to specialize in solid organ transplant, and as such, my rotations are focused in that specialty. My first 6 months of residency were spent mastering each of the different organ types: kidney, pancreas, liver, heart, and lungs. My second half of the residency year will be spent bringing my transplant skillset to other areas including Transplant Infectious Diseases, Cardiothoracic Surgery and Intensive Care Unit, Surgical Intensive Care Unit, and the ambulatory care clinic for abdominal transplant patients.

Interspersed throughout my clinical rotations in these areas, I also am responsible for holding hour-long appointments with the newly discharged post-lung transplant patients. At these appointments, I thoroughly review their medications, quizzing them for their adherence and understanding, and review their pill box to make sure that it was constructed correctly. Other requirements of my residency include 2 research projects, a variety of teaching experiences including precepting and a formal lecture on solid organ transplantation, several hour-long formal CE presentations to pharmacists and nurses, staffing requirements, an optional (but helpful!) statistics course, and of course, topic discussions and in-services for my clinical rotations.

We also have a transplant journal club series bimonthly where I am able to hone my literature evaluation skills all while cementing the landmark literature that is available in solid organ transplant across all organ types. It is certainly a sizeable workload, but no pain, no gain!

Q: What are your day-to-day tasks?

LL: As you can imagine, my day-to-day tasks vary with each clinical rotation. Generally speaking, though, I come to my office early in the morning to start my day pre-rounding on the patients on my service. Pre-rounding refers to time spent looking at the patients on my service, looking through their current orders and evaluating for medication-related issues or omissions. I also look at their laboratory values and therapeutic drug monitoring parameters, as appropriate. Also, I speak with patients at this time (if it isn’t too early!) to investigate the story behind certain home medications if there are discrepancies in our electronic medical record.

I then go on rounds with my team, which typically consists of the attending physician, fellow, medical residents, and mid-level practitioners, including physician assistants and nurse practitioners. I also work closely with the nurse coordinators to provide education to patients who will be discharged, particularly those who just received a transplant.

Providing education is a large portion of my day, as well. I typically spend about 45 minutes with each patient before discharge to ensure that he or she understands the medications and does not have any lingering issues. Once my patient care activities are completed and I have gone to any appointments with post-lung transplant patients that have been scheduled and followed up on all of my recommendations, I typically return to my desk to work on the multiple other projects, presentations, and readings.

On Tuesday nights, I also staff the central pharmacy and perform order verification and other dispensing responsibilities. I always try to make sure that I can make the most of my daylight hours and always make time for my mental health and well-being, including exercising and sleeping! Being a resident is tough, but you need to take care of yourself to better care for others! Work-life balance is key.

Q: What are the benefits of completing a PGY-2 residency? What about the disadvantages?

LL: The chief benefit of completing a PGY-2 residency is being able to practice in your specialty area of choice! PGY-2 programs are really directed towards taking the general (and important!) skills you have taken from your PGY-1 experience, honing them, and directing them towards your specialty. For example, I have really been working on my ability to critically evaluate the literature and have done so using articles that have been published in the field of transplantation. I can certainly apply these skills in other disciplines, but the PGY-2 experience is really built towards growing as a specialist and expert in your area of choice.

The downside of this is that you are focused on your specialty and thus could potentially “fall out of practice” in some other areas that you do not see as often. I am lucky in that transplant encompasses almost every specialty that there is, including critical care, internal medicine, infectious disease, and even oncology at times!

Q: How did you decide your residency program was the right fit for you?

LL: I decided that my residency program was the right fit for me chiefly at the interview. I think meshing well with those interviewing you is incredibly important, as these are the people you will be working with for the remainder of the year. That was how I realized each program I matched at was the one for me. At my PGY-1 interview, I vividly remember my interactions with my future PGY-1 director and I was really impressed with and intrigued by his philosophy on pharmacy practice, professionalism, and life. I remember meeting him and thinking, “Wow! This guy gets it!” He put a tremendous emphasis on playing different people’s strengths and putting together a team of people with different assets and weaknesses so that we could practice being collaborative and learn from each other.

He also did not put too much emphasis on being “cookie cutter” or believing that there was only one way of doing things; he allowed us to grow into more knowledgeable and perhaps more refined versions of who we already were and I truly appreciated that, and grow to appreciate it even more as I have transitioned to a new institution. Interestingly, for a PGY-2 experience, I felt it would be constructive to seek out an opportunity at an institution that did a higher volume of organ transplants and also performed cardiothoracic transplants.

I also sought out a program that I thought would foster my growth and refine my skills with a plethora of opportunities, and my PGY-2 has done just that. I am required to do several formal presentations, journal clubs, and other assignments that make me really delve into the literature and form my own bag of tricks, so to speak, that I believe in and will utilize as I transition to the work force. Also, I am a very firm believer that “clicking” with your future program director is essential. I am so lucky in that both of my program directors to date have really become life mentors to me, beyond professional growth. This is more than I could have hoped for in my residency experiences.

Q: What opportunities does a PGY-2 resident have after completion of the residency?

LL: The primary opportunity that a PGY-2 resident has after the completion of the residency is a highly specialized job, particularly if the resident is seeking a high-level, clinical job at a large academic medical center. If anything, a PGY-2 resident is trained for a wider opportunity of jobs than a pharmacist without such training. A variety of staffing jobs, academic jobs, and even jobs in similar specialties are also possibilities with this level of training.

Q: What advice do you have for students looking to pursue a PGY-1 and PGY-2 residency?

LL: My advice for students looking to pursue a PGY-1 and PGY-2 residency is to dedicate yourself to your residency and make the most out of the amount of opportunities that are available to you in such a short period of time. It certainly is a tremendous work load at times, but you will be amazed at what you can learn and accomplish if you commit yourself to it. Two years truly is not that long at all, and it can open up so many doors and even provide a great opportunity to network and meet alumni of your program.

Also, I advise any students looking to pursue residency to be mindful of maintaining strategies to have a healthy work-life balance because the experience will force you to develop these. It is an incredible thing to love what you do, but you must always remember to take care of yourself for your well-being and the well-being of your patients and colleagues! I think that has been the hardest lesson for me thus far, and I think it is the most important!