Q&A with an Oncology PGY-2 Pharmacy Resident

Paul Avenoso, PharmD, is a post-graduate year 2 (PGY-2) oncology pharmacy resident at The Hospital of the University of Pennsylvania in Philadelphia, Pennsylvania. Dr. Avenoso completed his PGY-1 residency at Robert Wood Johnson University Hospital in New Brunswick, New Jersey, and holds a PharmD from MCPHS University, in Boston, Massachusetts.

His clinical interests include liquid oncology, academia, and clinical research opportunities. Upon completion of his second year of residency, he hopes to work as an oncology clinical specialist at an academic medical center or as a faculty member working in conjunction with a school of pharmacy.

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

PA: I was first undecided about whether to pursue a residency or a fellowship program. I decided in my final year of pharmacy school that pharmacy residency was the path for me because I valued patient care and patient interaction. My passion has always been oncology, and I used my last few years of pharmacy school to achieve my ultimate goal of becoming an oncology clinical pharmacy specialist.

Q: What is the structure of your residency program?

PA: It includes a variety of rotations, both inpatient and outpatient. The first month orients the residents to the hospital, the health system, and preceptors. Once orientation is complete, oncology rotations include 2 months of inpatient liquid oncology, inpatient solid oncology, pain and palliative care; 2 months of outpatient experience, allogeneic and autologous bone marrow transplant, oncology infectious disease; and an elective of my choice.

Also within the residency program are 4 “therapeutics conferences” that each resident must complete. These are a way for residents to present either a patient case or journal club in front of their peers and preceptors. A more formal continuing education presentation to the whole pharmacy staff, known as “Pharmacy Grand Rounds,” is also required. I recently completed my Grand Rounds presentation; my topic was the management of steroid refractory acute graft versus host disease.

Within each rotation, there are topic discussions, mini journal clubs, and other small projects assigned by the preceptor. These are meant to enhance our understanding of material that we’d see on our daily rounds. Finally, our residency program is unique in that PGY-2 residents work with PGY-1 residents in completing a research project for the year. The research project is conducted this way for various reasons. For example, the PGY-2 resident can provide mentorship to the PGY-1 resident, and work in collaboration with other preceptors if a question arises.

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

PA: Every rotation has a slightly different schedule. Usually, my mornings begin by pre-rounding on my patients on the floor. I usually keep a sign-out to myself with pertinent information about each patient so that I’m organized in the morning. I update my sign-out with overnight events or questions I have that I can ask the team during rounds. Typically, I’m on the floor with the medical residents, so if the team has any questions before rounds begin, I can be there to answer them. Then, shortly after rounds, I round with my preceptor and offer additional suggestions for my patients.

Rounds usually begin at 8:30 am for most services, and last until 12-1 pm depending on the patient load and attending physician. Every team varies, but an example of a team on the liquid oncology services consists of an attending, a fellow, a medical resident, 2 medical interns, and myself. Once rounds are completed, I follow up with the team and offer more interventions if they were missed during rounds.

Tasks in the afternoon vary from meeting with my preceptor, to working on projects, to having formal topic discussions with my other oncology co-resident and both of our preceptors.

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

PA: The benefit of completing a PGY-2 residency is being able to practice in a specialty area. I also enjoy working with a patient population that’s vastly different than most other specialty areas. Although it can be challenging at times, my experience thus far has been extremely rewarding.

A disadvantage of a PGY-2 residency is that if you wanted to branch out to other specialties, or if you aren’t fully interested in one area of practice, it can be challenging. I wouldn’t recommend a PGY-2 residency to someone who isn’t 100% passionate about a specific area of practice.

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

PA: I have always valued large academic medical centers as a potential residency choice because of the various opportunities they can provide. I also looked at programs that had both inpatient and outpatient experiences in oncology because I quickly learned that some programs had stronger outpatient experiences than others. I also wanted to have a co-resident in oncology with me, so I looked at programs that had more than one oncology resident.

The search for a PGY-2 residency began at Midyear, where I narrowed down programs during Personnel Placement Service (PPS) interviews. After Midyear and applications, the onsite interview was extremely important in seeing how I’d fit in with the personalities of the preceptors that I’d be potentially working with. It became very clear during my interviews that certain programs were a better fit than others. I knew during my interview with my current program that they were the perfect fit for me.

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

PA: Depending on your interests, you can become an oncology specialist in the inpatient setting or an oncology specialist in the outpatient world.

You can also become involved in academia, working in conjunction with a practice site to teach oncology at a pharmacy school. Also, there’s even interest in industry—pharmaceutical companies are often seeking pharmacists who have completed residencies to work for their company.

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

PA: For one, make sure you’re extremely passionate about the specialty that you’re applying for. This doesn’t just apply to oncology, but to all specialty areas. This will create a better residency experience for you.

Go somewhere that isn’t your home town, your college town, or where you are currently in your PGY-1 residency. Easier said than done, I know. But, the practice of pharmacy is different from state to state, and I’ve had the opportunity to see pharmacy practice in 3 different states.

Finally, find strategies to maintain proper time management. Use the skills you’ve learned during pharmacy school and in your PGY-1 residency because time management can become more of a challenge during your PGY-2 year.

Also, take care of yourself! Don’t spend too much time at the hospital. Go out and explore the new city you just moved to and go out with your co-residents. Most importantly, have fun!