Q&A with a Critical Care PGY-2 Pharmacy Resident

Jackie Johnston, PharmD, is a post-graduate year 2 (PGY-2) critical care pharmacy resident at Yale-New Haven Hospital located in New Haven, Connecticut. Dr. Johnston completed both her bachelors in pharmaceutical sciences and pharmacy degree at the University of Connecticut, and her post-graduate year 1 (PGY-1) pharmacy residency at Yale-New Haven Hospital. Her interest in critical care began during her special population pharmacy school course, and her passion continues to grow as her clinical experiences expand. Upon completion of her PGY-2 Critical Care pharmacy residency, she hopes to work clinically as a critical care pharmacist in a dedicated intensive care unit and academically training the next generation of student pharmacists.

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

A: Following the start of my pharmacy school career, I was quickly exposed to the numerous opportunities in the field of pharmacy. While I had worked in retail pharmacy throughout my academic career, my advanced pharmacy practice experience rotations opened my eyes to the clinical opportunities for pharmacists. Seeing firsthand the impact pharmacists had as part of an interdisciplinary team to improve the overall quality of care provided to the patient, I knew clinical practice was the path I would pursue.

After just a few clinical rotations, I felt strongly that residency would provide me the opportunity to continue to expand my clinical knowledge. While critical care had always been a passion of mine, the intensive care unit experiences early in my PGY-1 residency year further solidified my desire to pursue a PGY-2 in critical care.

I also greatly enjoy teaching, with academia being a future career goal of mine. As my PGY-1 experience had provided me with numerous teaching and precepting opportunities, I was confident a PGY-2 residency would further enhance these skills.

Q: What is the structure of your residency program?

A: While my residency program overall is quite large, including 21 PGY-1 and 10 PGY-2 residents, the majority of my critical care residency experience is focused in an intensive care unit setting. Yale-New Haven Hospital truly provides a great variety of critical care experiences including burn, cardiac, cardiothoracic, medical, neurologic, and surgical intensive care units. I also have the opportunity to expand my knowledge in transplant, toxicology, emergency medicine and infectious diseases.

The remaining portions of my residency experience are focused on research, teaching, and involvement in health-system wide interdisciplinary committees.

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

A: As a critical care pharmacy resident, the most essential role I have is providing optimal pharmaceutical care to my patients. As all of my learning experiences are focused in the inpatient setting, I am responsible for rounding with the interdisciplinary teams throughout the units I rotate through.

I typically arrive early in the morning to provide myself with enough time to work up my patients prior to morning rounds. During this time, I will assess the medications ordered for the patient to ensure the appropriate doses, routes, and dosing intervals have been ordered. Additionally, I am responsible for monitoring levels for medications with narrow therapeutic indexes such as aminoglycosides, vancomycin, voriconazole, tacrolimus, and digoxin.

I am fortunate to practice at an institution that allows pharmacists to work autonomously. We have several pharmacy- driven protocols including IV to enteral agents, vancomycin dosing, aminoglycoside dosing, and renal dose adjustments that allow pharmacists to adjust pharmacologic therapy as appropriate.

Other responsibilities of our clinical pharmacists include counseling patients on new medications, ensuring appropriate prophylactic therapy has been ordered (e.g. stress ulcer prophylaxis, DVT prophylaxis) and completing medication reconciliations to better facilitate transitions of care.

Antibiotic stewardship is another essential role pharmacists have, especially in the intensive care unit setting. When assessing patients prior to morning rounds, I also review the microbiology data for each patient to ensure the antibiotic therapy selected is appropriate regarding the organisms growing and the susceptibility patterns.

Following morning rounds, the remainder of my day consists of a variety of things. Throughout the week I attend pharmacy noon conferences, which include non-formulary request reviews, pharmacy grand rounds, clinical case conferences, or continuing education sessions. As a PGY-2 resident, I also serve as a non-formulary preceptor to a PGY-1 resident, therefore I often meet with my resident to review the cases she recently had while holding our non-formulary pagers. I am actively involved in several health-system wide interdisciplinary committees which meet on a regular basis.

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

A: The benefits of completing a PGY-2 residency are endless! For me, a PGY-2 critical care residency experience has provided me the opportunity to further develop my clinical skills and knowledge in my area of interest. While a PGY-1 experience provided me a broad variety of pharmacy experiences, my PGY-2 residency has allowed me to focus specifically in critical care. Not only does a PGY-2 residency experience provide further training, but it also provides the opportunity to further strengthen relations with others in your field of expertise, both which provide an advantage when entering the job market.

While I have not found a PGY-2 experience to be disadvantageous, some may feel that specializing can remove you from general practice. I personally have not found this to be true as I often care for patients with complex transplant, oncologic, neurologic or infectious histories/complications in the intensive care unit.

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

A: When deciding where to pursue a PGY-2 residency, there were several factors I considered such as resources for research, teaching and precepting opportunities, and whether a wide variety of intensive care unit experiences were available.

During my PGY-1 pharmacy residency experience at Yale-New Haven Hospital, I was quickly exposed to the numerous opportunities available at my institution. I made the decision early to commit to the PGY-2 critical care residency program at Yale-New Haven Hospital in the fall of my PGY-1 experience for several reasons.

First, I felt my institution provided the widest variety of intensive care unit experiences (cardiac, cardiothoracic, neurological, surgical, medical and burn), in addition to rotations such as toxicology, infectious disease, transplant and emergency medicine. Second, I was excited for the numerous teaching and precepting opportunities that were available. Lastly, I was confident the mentorship and support I received throughout my PGY-1 experience, would be ongoing throughout my PGY-2 year.

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

A: Critical care pharmacy is a pharmacy specialty that is not only well established, but also constantly growing. The training from a PGY-2 critical care residency allows individuals to enter into careers in an intensive care unit, emergency medicine, or in some cases, transplant. It also qualifies individuals who complete the specialty year to be eligible to take the Board Certified Critical Care Pharmacy Specialist (BCCCP) exam. The teaching experiences during a PGY-2 experience can also prepare individuals for careers in academia.

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

A: To any individual considering pursuit of a critical care residency experience I offer 3 pieces of advice. First, choose the program that is right for you. While I have enjoyed my experience training at a 1,500 bed academic medical center with over 30 PGY-1/PGY-2 pharmacy residents that does not mean it is the right place for everyone. Find a program that offers the components of a residency that are essential for you in terms of further developing your clinical skills and knowledge.

Second, find ways to get involved. During my PGY-1 residency experience, a mentor encouraged me to join organizations such as the Society of Critical Care Medicine (SCCM). This provided me the opportunity to serve as an activate member and network with other critical care specialists prior to the start of my PGY-2 critical care residency.

Third, ensure you maintain a healthy work-life balance. Enhancing your time management skills early on in your pharmacy career will better prepare you for the busy life of a resident. While it is important to focus on the tasks at hand during residency, it is also important to find time to maintain your health and partake in activities you enjoy.