Ambulatory Care Pharmacy Resident Q&A

Learn what it's like to be an ambulatory care resident.

Rebecca Wenzel, PharmD, is a PGY-1 ambulatory care pharmacy resident at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. She graduated from MCPHS University in Boston with her PharmD degree in 2015.

Dr. Wenzel’s professional interests include diabetes, anticoagulation, and geriatrics. She aspires to continue to work in an ambulatory care setting in the future as a preceptor, or as an adjunct or assistant faculty member at a pharmacy school.

Q: What motivated you to apply to residency programs over other postgraduate training pathways?

RW: As a student, I worked as an intern in a variety of pharmacy settings, including retail, managed care, and hospital. Although I enjoyed each of these settings, I enjoyed my inpatient experience the most, and I wanted to spend an additional year in training so that I would be able to work in a hospital setting.

After completing an ambulatory care rotation at the VA Boston Healthcare System, I realized how much I enjoyed working with veterans in the clinic setting, so I decided to pursue residencies in this setting.

Q: What experiences in pharmacy school helped you during your residency?

RW: My Advanced Pharmacy Practice Experience (APPE) rotations most prepared me to be successful as a resident. I developed foundational skills in ambulatory care through my VA Boston rotation. Additionally, I rotated through 2 critical care rotations, which provided a lot of exposure to different disease states.

I also held leadership positions as a student. By being active in pharmacy organizations, I developed the confidence that I now have as a resident.

Through my leadership roles, I’ve worked in many team-based settings and improved my public speaking skills. These experiences have positively influenced me as a resident.

Q: Have you faced challenges while transitioning from a student to a practicing pharmacist?

RW: Honestly, not as much as I believed I would. Through my APPE rotations, I had enough experiences to give me a strong foundation as a resident.

I will admit that when I am in an unfamiliar clinic setting, I still have to review the medications and information prior to that clinic day. However, the reason I chose this residency was to learn, so I believe that the extra work I put in now will only help me in the future.

If I ever have any questions or concerns, the preceptors at my site are incredibly helpful. They are always available to assist residents with the questions we have. I feel lucky to work with such an established residency site that has many past residents working in the clinic setting.

Q: Can you elaborate on some of the unique qualities of your residency program?

RW: My site is strictly ambulatory care. I do not have any inpatient rotations, which is something I was looking for when I was applying to residency programs. Of the required rotations at my site, I also have the opportunity to work in a variety of clinics.

The clinic settings I am required to rotate through include allergy and asthma clinic, anticoagulation, diabetes, epilepsy, hypertension, integrated care, medication management, mental health, osteoporosis, pain management, rheumatology, and tobacco cessation.

Almost every day I rotate through a different clinic. To me, this is very exciting because no 2 days are the same.

This site also has clinics every morning and afternoon, so it is not uncommon to have one clinic in the morning and a different clinic in the afternoon, which makes the time pass by very quickly!

There is also a home-based primary care team that visits patients in their homes if they are no longer able to ambulate to the clinics, which I feel is a very unique experience.

Q: What responsibilities as a resident do you enjoy the most?

RW: I enjoy working with the veteran population every day. It is very unique and deserving of quality care, and I enjoy the responsibility of serving as veterans’ care provider.

I also have a lot of teaching experiences, which includes faculty appointments and working with P2 and P3 students in pharmacy school labs. I precept students and have them rotate through the different clinics with me. I enjoy serving as a mentor to my students and help them prepare for postgraduate training.

Q: What projects have you had during your residency training?

RW: My formulary rotation offered the most project experiences. During this 6-week rotation, I assisted in working with the formulary team to improve our current product usage. I also completed formulary conversion projects to control our cost-savings.

My current research project is a quality improvement project in which an inpatient tobacco cessation consult is completed for every patient entering the hospital. I will be following up with the results of the beginning stages of the project and have the opportunity to present the material at the Great Lakes Convention in the spring.

Each resident also completes 2 journal clubs, a case presentation, and an in-service every 6 months. I feel that I have been able to improve and strengthen my presentation and public speaking skills through these experiences.

Q: How do you stay current in your field of practice?

RW: The VA sends out resident updates periodically, which helps me stay current in my workplace. By participating in projects like journal clubs and presentations, I am also able to stay up to date.

Q: What advice do you have for ranking a residency program?

RW: Rank the program you feel is the best fit for you. I remember walking out of my interview at this site and loving the program and people, but I kept thinking I had messed up on an interview and I worried that it did not go well as I thought it had.

As pharmacy students, we are often hard on ourselves. However, we usually complete tasks better than we think, so rank the program you loved the most.

I would also advise students to only rank programs that you could truly see yourself at. If you cannot imagine yourself being at a program for a full year, then it may be better to not rank the program than end up there and be unhappy.

Q: What advice do you have for students choosing APPE rotations who are interested in applying to residency programs?

RW: Sometimes, I feel as though students are caught in a trap of picking rotations that may not challenge them. I know as a final-year student, I was ready to take the easy way out and pick rotations that did not have as much work associated with them.

Ultimately, I am happy that I chose faculty-driven settings and difficult electives that were a lot of work but helped me discover my true interest areas. These settings also allowed me grow as a student and gave me the experiences I needed to be successful this year. They also helped me transition easier to a resident.