Q&A with a Cardiology PGY-2 Pharmacy Resident

Dr. Jaclynne Metayer grew up in Rochester, New Hampshire before graduating with her Doctor of Pharmacy degree in May 2016 from the Massachusetts College of Pharmacy & Health Sciences in Boston, Massachusetts. After graduation, she completed her PGY-1 Residency at the Massachusetts General Hospital in Boston, Massachusetts and is currently a PGY-2 Cardiology Resident at the University of Illinois at Chicago (UIC) in Chicago, Illinois. Her main interests include antithrombotic therapy, heart failure, research and academia.

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

A: I chose to pursue post-graduate residency training for several reasons. First, I wanted to further apply the concepts I had learned throughout pharmacy school and advanced pharmacy practice experience rotations at an advanced level and continue to be challenged. I knew that I ultimately wanted to be a clinical pharmacist, while working in a hospital pharmacy as an intern throughout pharmacy school, and knew that residency would prepare me for future success.

Throughout pharmacy school, cardiology was a focus that piqued my interest. Early on in my PGY-1 year, I was exposed to various cardiovascular disease states and was able to learn from truly dedicated and top-notch residency preceptors, further solidifying my interest. This is when I realized that cardiology was the specialty I was meant to pursue. As a PGY-1 resident and brand new pharmacist, I was provided with the tools I needed to further develop my understanding of various disease states, assess primary literature and how to serve as a preceptor and mentor to my successors.

Though I gained these great skills, I knew that further post-graduate training would be necessary to master this specialty and practice the utilization of the skills I had learned. An entire year of post-graduate residency training may seem like a long time to dedicate to learning, but it truly is not! I still wanted to learn more and therefore pursued a second year of residency. During my PGY-2 year, I have been able to solidify these principles and am even better prepared for my post-residency career.

Q: What is the structure of your residency program?

A: The PGY-2 Cardiology Residency Program at UIC offers a variety of longitudinal and monthly rotations. I have had the opportunity to rotate through the medical ICU, cardiac care unit, cardiology consults, and various outpatient clinics; including antithrombosis, heart failure, electrophysiology, heart disease in pregnancy and women, general cardiology, pulmonary hypertension, and a pharmacist-managed medication titration clinic. I have also been able to rotate at off-site hospitals to learn about advanced heart failure/heart transplantation and cardiothoracic surgery.

This program has a fairly equal split between inpatient and outpatient learning experiences, which was a feature I was looking for when searching for PGY-2 programs. In addition to clinical learning experiences, I have been involved in creating clinical practice guidelines for the hospital and participating in multidisciplinary research projects. Since the hospital is affiliated with the college of pharmacy, my program has a large focus on academia as well. I have delivered didactic lectures in the cardiovascular sector of the therapeutics, and critical care elective courses for the UIC college of pharmacy, and have assisted with facilitating small group discussion classes. I have also gained teaching experience by co-leading our weekly critical care conference with the PGY-1 residents, where I and the critical care PGY-2 review various critical care topics.

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

A: My day-to-day tasks vary significantly with each monthly rotation. For inpatient services, I arrive early in the morning to begin pre-rounding on the patients on my service, prior to rounds. This is when I prepare the majority of my interventions for the day. I then attend rounds with the medical students, medical residents, and interns; and fellow, and attending physicians. After rounds, I typically follow up on other patient care-related issues that come up during rounds, and assist with discharge counseling. I try my best to attend the daily noon report, which is a round table discussion of patient cases from overnight on-call with the PGY-1 residents. In the afternoons, I tend to other daily tasks, such as topic discussions with preceptors, work on research or other projects, and prepare lectures for the college of pharmacy.

For outpatient clinical rotations, my days are somewhat different. I attend clinic to see patients; perform medication reconciliations, and symptom assessments; and resolve any medication compliance or access issues. After I see each patient, I present my findings to the fellow or attending physician within the clinic. We then go see the patient as a team and formulate a final plan. I assist in executing that plan if needed (e.g., prior authorization, medication access, ordering of medication(s) or labs etc.) and document all of this information in a patient note for the medical record.

In addition to rotational learning experiences, on the weekends I am responsible for covering the intensive care units, and emergency department on a rotating basis as part as the clinical staffing component of my program. I am also the primary pharmacy representative that responds to medical emergencies and stroke codes during this time.

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

A: The foremost advantage is the ability to care for patients in an area that you are devoted to and passionate about. You learn the ‘how’ during your PGY-1 year, but really learn the ‘why’ during PGY-2. With that, you really delve into the supporting literature behind your recommendations, and gain a thorough understanding of why we manage patients with certain cardiovascular disease states the way that we do. You become proficient in critically evaluating the available literature, finding gaps that may lead to potential research ideas, and applying those concepts to your patients. Completing a PGY-2 specialty residency opens the door for many other opportunities, including working with highly respected individuals within the specialty, encountering leadership opportunities, and assuming the role as the expert at your clinical site.

The potential disadvantage to specializing is that as you fill your memory space with all-things-cardiology; other focused areas you once learned may begin to fade and may be difficult to remain conversant with. Cardiology differs from other specialties in that no matter the patient population (e.g., internal medicine, transplantation, infectious diseases), cardiovascular disease states occur in a large number of patients, and thus no matter where you end up in your career, you must manage the patient as a whole with consideration of their heart, and you will have the tools you need to manage those disease states from your training in cardiology. In the end, is it ever really a disadvantage to learn more about something you are particularly passionate about? In my opinion, the answer is 'no.'

Q: How did you decide your PGY-2 program was the right fit for you?

A: I knew coming to UIC to learn more about cardiology within an academic medical center would be well-suited for me from the moment I met my residency program director, Robert DiDomenico, PharmD, BCPS-AQ Cardiology, FCCP, FHFSA, FACC, at our PPS interview at the ASHP Midyear. Not only did the program itself encompass all aspects I was searching for (academia opportunities to strengthen my leadership and preceptor skills, outpatient clinic involvement, and a program in the Midwest), but I remember thinking during my interview, “I can absolutely envision myself learning here!” I was looking for a director that would foster the type of learning that would suit my style, as well as challenge me. Dr. DiDomenico is an impressive, accomplished individual within cardiology and I knew I would be able to learn how to accomplish some of the same goals he has with the help of his mentorship.

Because almost all of my training up until PGY-1 was in the Northeast, I wanted to expand my clinical experiences in another part of the country. I knew that pharmacy practice was not the same across the country, and the role of the pharmacist in the Midwest was known to be more prominent within the patient care team. Thus far, it has been a great experience and has differed in many ways from the experiences I had as a PGY-1 resident.

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

A: The sky is the limit, in my opinion, even more so within the cardiology specialty compared to others. Post-residency, the resident will have the opportunity to become a highly specialized clinical pharmacist within cardiology, or even a subspecialty of cardiology (e.g., heart failure, antithrombotic therapy, cardiothoracic surgery). I frequently tell students, and residents that cardiology is great because there is so much versatility within the specialty.

If you love critical care, a cardiac care unit or cardiothoracic surgery is a great fit for you. If you love ambulatory care, there are countless cardiology clinics that could benefit from the presence of a pharmacist. If you are passionate about academia or research, then your PGY-2 program will have laid the foundation you need to become successful in those goals. If you find yourself in the inpatient setting immediately post-residency and 10 years later you find that you would like a change, then outpatient opportunities and many others are available to you with cardiology PGY-2 training.

Q: What advice do you have for students looking to pursue a residency in cardiology?

A: My advice is to work hard in all that you are involved in as a student, and seek opportunities to work with faculty on research projects or presentations. If you have the opportunity, gain experience in cardiology during your advanced pharmacy practice experience rotations—and choose those that are known to be challenging and will place you outside of your comfort zone. The hard rotations are those where I learned the most.

If cardiology is a specialty that gets you excited, pursue it wholeheartedly. Search for programs that have the qualities that parallel your future goals. As I mentioned previously, the residency year goes by quickly, so be prepared to learn an incredible amount of information in a short period of time, but you will have a lot of fun doing so. Work diligently to understand the basics and the rest is easy. If you can appreciate the cardiovascular pathophysiology under normal circumstances, followed by the pathophysiology in particular disease states (or what I call the ‘road block’), then the medications used to correct those disease states make perfect sense. Lastly, expose yourself to programs across the country. Healthcare is not indistinguishable for pharmacists at every institution.