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Going Above and Beyond in Your Career Following Residency Training

Megan May, PharmD BCOP
Clinical Oncology Pharmacy Specialist
Baptist Health Lexington
Lexington, KY

During the time of year when residency candidate interviews are occurring and residency match day is on the horizon, it is only fitting that residents would begin to reflect on their own personal residency experience and the role that postgraduate training has played in shaping who they are today. After being asked to reflect on my own experience as a resident, I knew I needed to start from the beginning of my career journey. By the ripe age of 7, I had established the goal to become a pharmacist when I grew up. My mom had a few female friends who were community pharmacists and who truly enjoyed their career and the quality of life they were able to have while being full-time pharmacists. I started working at a community pharmacy the day I turned 16 in an effort to gain experience in the field. I always knew I wanted to do something that would help others and have a positive impact on their lives. During my first year of pharmacy school, I transitioned my focus to hospital pharmacy and the opportunity to specialize. Throughout my oncology rotation during my postgraduate year-1 residency at UF Health Jacksonville, I fell in love with the positive and encouraging atmosphere of the UF Health Cancer Center. I then went on to complete a postgraduate year-2 (PGY-2) residency in oncology at the Medical University of South Carolina, where I was challenged daily to learn as much as possible and was engulfed in all the oncology opportunities I could find.

The experience and knowledge I gained as a resident was invaluable. Following my residency, I am still using and continuing to build on the education I obtained. I’ve had to learn how to create and implement policies and facilitate practice changes in the clinic, both of which are important skills I use in my practice every day. My year as a resident was one of the more challenging of my career thus far, but it also contained some of the most rewarding experiences. According to the American Society of Health-System Pharmacists, the purpose of a pharmacy residency is “to accelerate the resident’s growth beyond entry-level professional competence in direct patient care and in practice management, and to further develop leadership skills that can be applied in any position and in any practice setting.”1 I can honestly say that this is exactly what my residencies did for me: they put me years ahead of where I would have been professionally without residency training. In pharmacy school you hone critical thinking skills and learn about direct patient care and pharmacotherapy. A residency propelled me above and beyond, allowing me to develop my time management, research design, and professional communication skills, as well as providing opportunities in leadership and public speaking.

After securing a PGY-2 residency, the next phase is to find a job postresidency, and my mentors and preceptors assisted me a great deal during the decision-making process. One of the best pieces of advice I received was to interview at more than one place and keep an open mind. I thought I knew what type of position I wanted and where I wanted to practice; however, that opinion changed during my on-site interviews. I accepted my first postresidency position at Baptist Health Lexington in Lexington, KY, where I remain today. I was one of two oncology specialists hired throughout Baptist Health System in Kentucky, which consists of eight hospitals. I was the first oncology pharmacy specialist at Baptist Health Lexington and was given the opportunity to develop my own position in the Cancer Center’s medical oncology clinic, gynecologic oncology clinic, and outpatient infusion center. The majority of my time is spent in the outpatient clinic and infusion center; however, I am the liaison between the pharmacy department and the inpatient oncology unit. In our medical oncology clinic and gynecological cancer clinic, we average approximately 100 outpatient visits per day, and in the infusion center we average about 63 patient infusion visits per day. We treat both benign and malignant hematology, oncology, and gynecological cancers. Because we care for patients with a variety of disease states on any given day, each day brings something new.

The most satisfying part of my job is my interaction with patients. I get to know my patients personally during their journey fighting cancer, which allows me to better serve them on an individual basis. Our patients are grateful for everything we do, and they express that gratitude to the entire staff. I have also had the opportunity to initiate the expansion of pharmacy services in the clinics by becoming a readily available resource for the entire staff. Over time, I have become even more involved with the education of our patients and now have separate appointments with patients to discuss their cancer treatment and what to expect throughout their treatment process.

Over the last 6 years, my role has changed numerous times in order to fulfill the needs of our clinic and the patients we serve. My residency training provided me the necessary tools and skills to establish innovative programs and incorporate pharmacy services throughout the Cancer Center. I developed oncology competencies for the staff pharmacists to ensure that they were proficient in the oncology area; I presented monthly education sessions with formal lectures, gave updates on recent publications, and created annual competency assessments. At one time I was also responsible for developing annual competencies in compounding hazardous medications and tracking completion of this competency by staff pharmacists and technicians. After practicing for 4 years, I was able to show the value of having a PGY-2-trained oncology pharmacist on staff and completed a research project that demonstrated the need for a second pharmacy position in the Cancer Center to focus on patients receiving oral chemotherapy agents. On the basis of the project data, positions were created for a full-time PGY-2 trained oncology pharmacist and an oral chemotherapy financial navigator. After successfully hiring a financial navigator for patients receiving oral chemotherapy, the team and I were able to facilitate the creation of another new position for a financial navigator focusing on patients receiving intravenous medications.

In April 2019, I had the honor and privilege of accepting the HOPA New Practitioner Award at HOPA Ahead. The HOPA New Practitioner Award is given to an early-career practitioner who has made a significant contribution to developing or supporting clinical hematology/oncology pharmacy services. It is wonderful to know that I was nominated for this award by my current partner at work, a mentor of mine, and one of my past students, and I am humbled to have been chosen by the committee. Residency training set me up to be able to better serve my patients and community, even as a new practitioner. Residency also provided a framework that continues to be valuable as I seek to be an educator to other pharmacists and learners.

Oncology pharmacists are expanding their roles in both the clinic and inpatient settings. As more providers realize the benefits of having a pharmacist working directly with them, they are requesting that a pharmacist join their team. I am still a newer practitioner, but in the 6 years I have been in practice, I have noticed that both nurses and providers rely on me to provide education to staff and patients and provide consultation on difficult patient cases. In some states, pharmacists can provide collaborative services to help reduce the medical practitioner’s time and add value to the care of the cancer patient. Pharmacists are starting their own provider clinics to deliver supportive care management, patient instruction on oral chemotherapy (especially adherence), and education on many other aspects of cancer care. Our responsibilities and privileges will only increase as we promote our abilities and as our potential is realized by the providers we work with.

I believe that pharmacist-run clinics will continue to increase in number and expand in scope. Pharmacists provide a unique perspective for the patient and often incorporate specialized education, specialized knowledge about medicine, and information about cost into their treatment decisions. Looking back, I see that one of the biggest strengths of completing a PGY-2 oncology residency was the initial establishment of a professional network that continues to grow. It allows me to learn about the different roles oncology pharmacists are playing in clinics and infusion centers and bring suggestions back to my hospital for improvements in practice integration. Residency training advanced my skills and continues to give me opportunities for future advancement by teaching me how to navigate this complex healthcare system. As the American historian Daniel J. Boorstin said, “Education is learning what you didn’t even know you didn’t know.”

Reference

  1. American Society of Health-System Pharmacists. Accreditation standards for PGY1 pharmacy residencies. Available at https://www.ashp.org/Professional-Development/Residency-Information/Residency-Program-Directors/Residency-Accreditation/Accreditation-Standards-for-PGY1-Pharmacy-Residencies. Accessed December 26, 2019.
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