A great deal of learning experience obtained during residency has to do with patient care.
Now that most of this year’s PharmD candidates have made it through their commencement ceremonies, those who’ve committed to continuing their education in the form of postgraduate training like residencies or fellowships likely have some downtime before the typical July 1 start date.
Unfortunately, the next month and a half will probably be spent cramming for board exams. After that last intellectual hurdle is cleared, however, a different kind of learning begins.
My PGY1 community pharmacy residency and executive fellowship comprised 2 of the most challenging years in my career.
A great deal of learning experience obtained during residency has to do with patient care. The requirements for residency accreditation have increased from a requisite 50% of your time being spent on patient care to 67%.
This makes a lot of sense for those pursuing careers that depend on excellent clinical skills, but it may be a bit annoying for those who have more administrative or managerial aspirations. Although the volume of a resident’s time will be heavily slanted toward clinical skills development, I’d argue that the most important lessons I learned were far more generally applicable than topics like aminoglycoside dosing.
Here are the top 3 lessons I learned during residency:
Lesson #1: You still have a lot to learn.
If you’ve matched (or scrambled) to a residency, there’s a good chance you’ve performed pretty well academically in pharmacy school. Although good grades aren’t the sole determining factor for obtaining a residency, poor grades can definitely be a roadblock when you’re trying to stand out in an increasingly competitive pool of candidates.
Since the typical resident likely has above-average academic performance attached to a doctoral degree, it’s understandable that these exemplary students may show up to their first practice site thinking they have it all together. However, most of them will quickly learn that this couldn’t be further from the truth.
In my experience, I happened to schedule my board exam a little later than some of my colleagues. In some aspects, this was definitely a good thing.
In my first couple weeks on the job, my residency preceptor quizzed me with some rapid-fire questions that I wasn’t able to readily answer. At the time, I was thinking, “Why is she picking on me like this? There’s no way this is the kind of stuff that’s on the boards.”
I was sorely mistaken. In fact, a few of the questions that appeared on my board exam were the exact same questions my preceptor had quizzed me on during sessions I had viewed as “professional hazing.”
Obviously, most pharmacists don’t walk into residencies thinking they won’t learn anything. If you had already arrived, you wouldn’t be spending a year making a third of what many pharmacists make and commanding about half of the respect.
When you’re a resident, you expect to learn something, but sometimes, residents don’t act like they still have much to learn. I speak not only from personal experience, but also having watched cream-of-the-crop graduates arrive at their new practice site acting like they own the place.
The lesson for me here was humility. When you have “Dr.” in front of your name, you’re generally going to command a certain level of respect, but I urge you to remember that all the talk about “lifelong learning” isn’t just lip service. The brightest among us embrace the idea that there will always be more to learn, and they conduct themselves in a manner that bears this in mind.
Lesson #2: Working as a team can be tough.
Of all the knowledge I garnered through residency, the things I found most valuable weren’t clinical pearls or policy topics. The lessons that paid the most dividends had an interpersonal nature, because no matter what your future position will be, you’ll more than likely have to deal with others in some fashion.
Having interned through pharmacy school, working behind the pharmacy counter was something I was fairly comfortable with. My residency was in an independent community pharmacy, so I was back in a workflow where I’d logged plenty of hours practicing at other locations.
The major difference was instead of being under the supervision of a pharmacist, much like my pharmacy technician colleagues, I was the pharmacist who was responsible for quality assurance and leading the team in the dispensing process.
I had no idea how different the dynamic would be when working with pharmacy technicians as a pharmacist versus as an intern. As I flew through pharmacy school as fast as I could, I was still fairly young when I was first licensed as a pharmacist. As a matter of fact, I was the youngest member on staff, which created a very strange dynamic in the store.
To keep things from getting awkward, I did my best to establish a peer-to-peer relationship with the staff. This worked great, until I had to asked them to do something for me. Since I hadn’t established a sense of authority, I was just as likely to be argued with or told to do something myself as I was to receive the assistance I needed to do my job.
Working with technicians wasn’t the only challenge. When I first started out, I had a few uncomfortable moments with my preceptor. I can vividly remember the conversation I had with her after putting out a patient pamphlet I neglected to have her review. I had run it by the owner, but I wasn’t aware of the dynamics and expectations that came with having more than one boss.
This and other mistakes were eventually repaired, but it was a long, challenging process. Starting that first year after graduation, I had no idea that the difficulty of interpersonal challenges would far exceed any administrative or clinical project I’d deal with that entire year.
Lesson #3: You’re going to make mistakes, and that’s okay.
Odds are that most pharmacists will make some type of mistake within the course of their career, but I had hoped my first one wouldn’t be less than a year after graduation.
I’d made a relatively minor dispensing error that was caught prior to being issued to the patient. To make matters worse, I made the exact same mistake twice in the same day. After hearing about the second error, I pulled up the dispensing logs and rejected every script I’d verified during that shift.
This is only one example of the kinds of failures I had throughout that year, which ranged from papers covered in red ink to failing to submit my research abstract on time. The lesson I learned from these experiences is somewhat cliché: everybody fails, but what matters is how you learn from those failures.
Even though most of us have heard this before, it still seems like many of us don’t actually believe it. In one of my more recent classes in pursuit of my MBA, the professor commented that, in his experience, “all graduate students are overachievers.”
Adversity to failure comes as part of the territory for pharmacists, which is a good thing. After all, we certainly don’t want clinicians having a lackadaisical attitude toward dispensing errors that could potentially harm our patients.
What I’m saying is we need to take the emphasis off of failure and put it on the next challenge. Not surprisingly, I didn’t stop making mistakes after residency. In fact, my failures are not only just as frequent, but also tend to have broader consequences as my responsibility has increased.
It’s important to note that every failure is different. When we make a mistake, it’s an opportunity for learning and growth, and we capitalize on it by not making the same mistake when we’re put in that situation again.
Residency is hard. In fact, I fondly remember lamenting to a former professor with a fellow resident about how miserable we were about 4 months into our programs, to which he responded, “Of course; you’re doing residencies. What were you expecting?”
My message isn’t intended to discourage anyone about to start a residency. To the contrary, I hope you enjoy this experience and make the most of the opportunity you’ve been given. Walk in on your first days with an open mind, realizing that you won’t be perfect, but you can choose to make the most of a year filled with incredible potential for learning, growth, and professional development.