Q&A with a Neurology PGY-2 Pharmacy Resident

MARCH 31, 2016
Grace Minassian, PharmD, BCPS, is a post-graduate year 2 (PGY-2) neurology pharmacy resident at the Veterans Affairs (VA) Greater Los Angeles Healthcare System in Los Angeles, California.

Dr. Minassian completed her undergraduate degree in neuroscience at University of California, Los Angeles, obtained her pharmacy degree from the University of Southern California, and her PGY-1 training at Glendale Adventist Medical Center.

Her keen interest in neurology stems from her undergraduate years, and her interest was strengthened during her time in pharmacy school and now while in clinical practice.

Upon completion of her second year of residency, she hopes to work as a neurology pharmacist in both a clinical and academic setting to provide care to patients who suffer from a wide variety of neurological ailments, and to guide the next generation of pharmacists into her chosen profession.

Q: Why did you decide to pursue a PGY-1 and PGY-2 pharmacy residency? 
GM: Upon entry into pharmacy school I had already created a road map with the awareness that pharmacy school equipped the fuel, but a clinical residency would be the vehicle to get to my vocation. Throughout my academic career, my calling for neurology was tested as I cultivated many passions in numerous areas of pharmacy and patient care.

I also greatly enjoyed providing patient care in both the community and hospital-based settings, but throughout these experiences the one thing that remained true was my calling for neurology, which did not waver. The PGY-2 neurology program I was looking into required the completion of a PGY-1 residency, and to be honest, for me, making that commitment was an easy one. 

Q: What is the structure of your residency program? 
GM: The structure of the residency program is an even split between providing neurology services in an inpatient and outpatient basis.

The inpatient services include serving as the clinical pharmacist for the inpatient neurology team and Epilepsy Monitoring Unit service for the entire residency year, as well as serving as the neurology pharmacist for our neurosurgery service for the second half of the residency year.
In addition, I am an active member for stroke codes to deliver tissue plasminogen activator when necessary. (I get to have a code stroke pager, which is awesome.)

As a clinical pharmacy resident in neurology, I ensure optimal pharmaceutical management by providing drug information and education; giving pharmacokinetic dosing recommendations for any medication that requires extensive pharmacokinetic monitoring, including but not limited to, antibiotics, anticoagulants, and antiepileptic drugs (AEDs); and providing patient education during admission and on discharge.

The outpatient services include providing patients with stroke medication therapy management by initiating and/or adjusting medications for secondary stroke prevention (eg, blood pressure, cholesterol, diabetes, anti-thrombotics), obtaining a detailed AED history and assisting with management of AED therapy, assisting with management of Parkinson disease medications, evaluating medication regimens of patients with dementia, obtaining a detailed headache history, and evaluating medication regimens of patients with headache disorders. 

Other requirements of the residency include at least 1 research project and a quality assurance project, poster presentations at state and/or national neurology-based conferences, a variety of teaching opportunities including student/resident precepting, weekly case conferences, a formal lecture on a neurological process geared to pharmacy students at the University of Southern California, and in-service presentations to neurologists, pharmacists, pharmacy students, medical students, and nurses.

Q: What are your day-to-day tasks?
GM: As mentioned, the residency is structured to allow for both inpatient and outpatient involvement. The inpatient services are carried out during the first half of the day. The outpatient services, namely ambulatory-based clinics, take place during the second half of the day. There are 5 ambulatory-based clinics—most of which have a designated day of the week.

I typically arrive at work early in the morning so I can work-up my patients prior to rounds. I start rounding with the neurosurgery team first, followed by rounds with the neurology inpatient team, and finally end my morning by rounding with the Epilepsy Monitoring Unit team. To give an example of the team structure, namely the neurology inpatient team: it consists of an attending neurologist, a senior neurology medical resident, 2 junior neurology residents, a psychiatry intern, 3 to 4 medical students, 1 pharmacy student or PGY-1 resident, and myself .

After rounds, I provide bedside education to stroke patients who are awaiting discharge, by reviewing any new and/or continuing medications, discussing the rationale for the use, and providing comprehensive stroke prevention education. Later, I prepare for the afternoon clinics, which take place at the second part of the day.

I encounter every patient seen in clinic, and I work closely with the neurologists in optimizing their medication regimens. I end my work day by making patient phone calls to the patients assigned to clinic the following day and working on projects and presentations.
The residency as it appears is service heavy, but it has a lot of opportunity for pharmacy involvement, is a great working environment, and caters to providing patients with optimal patient care. In short, you never go home unfulfilled from your work day.

Q: What are the benefits of completing a PGY-2 residency? What about the disadvantages?
GM: The benefits are endless for those who have a specific area of interest. Completing a PGY-2 in any specialty allows you to practice at the top of your profession, as it allows you to receive extensive field knowledge, work with expert specialists, become well-versed in the chosen area, and provides you with a competitive advantage in the job market.

I can’t say that there is a disadvantage to pursuing a PGY-2, except that it isn’t for everyone. You really should evaluate what your passions are and what setting you envision yourself working in. If you find that you are an individual with a thirst for knowledge in all areas of pharmacy, then you may not want to limit yourself to specialize in 1 area.

Q: How did you decide your PGY-2 residency program was the right fit for you?
GM: This is by far the easiest question to answer. There is only 1 center that offers a neurology residency program nationwide. Luckily that center was not far from home. To add, I should shine necessary light on the fact that my preceptor, the pharmacy department, the neurology department, and really the entire VA agency is a delightful setting to receive my training in.

I had the honor of learning from the best during the course of my PGY-1 and PGY-2 residency years as both programs cultivated my skills professionally and personally. I treasure my experiences these past 2 years tremendously, as they have not only allowed me to reach greater heights in my career, but they have also given me the opportunity to learn from esteemed mentors. I am lucky.

Q: What opportunities does a PGY-2 neurology resident have after completion of the residency?
GM: Neurology is a growing area of specialty for pharmacists, and it’s an area that hasn’t gained much pharmacy footprint. The specialty training in neurology provides background for careers in Neurological Intensive Care Unit, acute care settings, academic medical centers that cater to stroke and epilepsy population, neurorehabilitation centers, facilities with a geriatric population suffering from dementia, and of course academia.

The reality is that a neurology practice site can be implemented in any ambulatory care or acute care settings where pharmacists can contribute to public health efforts for health improvement, wellness, neurological disease management, and progression.

Q: What advice do you have for students looking to pursue a residency in neurology?
GM: Similar to pharmacy school, pursuing a residency is not easy work. At times, it is even harder. So, my advice to students is 2-fold. 

First, be true to yourself and specialize in an area that really makes you “tick.” Be proactive during your pharmacy school career to find it, and be able to recognize your interest when you do.

Second, don’t be afraid to take the road less traveled. You may come across some specialty residencies, like neurology, that are not accredited and/or in the process of accreditation. Don’t let that be your sole determining factor for pursuit.

Many opportunities in life don’t come in perfectly wrapped boxes; you have to create them, and those that you create are the most gratifying.

If you choose to pursue neurology, delve into it whole-heartedly. Learn the anatomy, the pathophysiology of neurological disease, and become an active member of well-known neurology-based organizations, such as the American Epilepsy Society, American Stroke Association, and American Academy of Neurology. 

For more information visit  VA Greater Los Angeles Healthcare System’s pharmacy residency program page.

Timothy O'Shea, PharmD
Timothy O'Shea, PharmD
Timothy O'Shea, PharmD, is a Clinical Pharmacist working at a large health insurance plan on the east coast. Additionally he works per diem at a retail pharmacy chain. He graduated from MCPHS University - Boston in 2015 and subsequently completed a PGY-1 Managed Care Pharmacy Residency. His professional interests include pharmacy legislation and managed care pharmacy. He can be followed on Twitter at @toshea125.
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