Letters
Letters Motivations in seeking advanced pharmacy training
T
he recent article by McCarthy and Weber1 analyzed changes in the factors motivating pharmacy students to pursue residency training over the past 18 years. While the authors did touch on many reasons why these factors have changed in recent years, I was disappointed that they did not relate their findings to the numerous changes occurring in health care and the evolving use of pharmacists on health care teams. The job opportunities that pharmacists have today are vastly different than those pharmacists could ever imagine 18 years ago, and this factor should have been given more weight throughout the article. In both the 1993 and 2011 surveys, respondents were provided with a list of factors affecting their decisions to pursue residency training. As a new resident who recently had to weigh these same factors, I felt that there were many additional elements that should have been included. With the competitiveness in the job market for pharmacists today, many students choose to pursue residency training to gain a competitive edge over their peers. Residency training also offers students the ability to gain qualifications in addition to their doctor of pharmacy degree, such as teaching certificates and postgraduate degrees. Furthermore, many students find residency training attrac-
tive because it provides vast experience in a short period of time, and students have the flexibility to adapt their program to their changing interests and career paths. Since the survey was designed to have respondents select options from a predetermined list, the authors may have missed these important factors that influence students’ decision to pursue residency training. I would have been curious to see how the results of the survey differed among a few select groups. Coming from a pharmacy school affiliated with an academic medical center, my peers and I were continually surrounded by residency-trained faculty, clinicians, and residents from academic hospitals. Thus, it would have been interesting to see how the motivating factors for the 37% of respondents who were affiliated with a university or academic hospital differed from those of respondents in community or industry programs. Also, as many more women than men choose to pursue residency training, the motivating factors of men and women would have been interesting to compare. While many pharmacy students pursue postgraduate training because it is a prerequisite for desirable jobs, I believe that this is attributable to the evolving role of pharmacists in a changing health
The Letters column is a forum for rapid exchange of ideas among readers of AJHP. Liberal criteria are applied in the review of submissions to encourage contributions to this column. The Letters column includes the following types of contributions: (1) comments, addenda, and minor updates on previously published work, (2) alerts on potential problems in practice, (3) observations or comments on trends in drug use, (4) opinions on apparent trends or controversies in drug therapy or clinical research, (5) opinions on public health issues of interest to pharmacists in health systems, (6) comments on ASHP activities, and (7) human interest items about life as a pharmacist. Reports of adverse drug reactions must present a reasonably clear description of causality.
care environment. As health care continues to evolve throughout the country and as pharmacists continue to fight for provider status, these motivating factors will continue to change and grow far beyond those included in this survey. 1. McCarthy BC Jr, Weber LM. Update on factors motivating pharmacy students to pursue residency and fellowship training. Am J Health-Syst Pharm. 2013; 70:1397402.
Sarah L. Rindfuss, Pharm.D., Postgraduate Year 1 Pharmacy Practice Resident University of Pittsburgh Medical Center St. Margaret Hospital Pittsburgh, PA [email protected]
The author has declared no potential conflicts of interest. DOI 10.2146/ajhp130574
W
e appreciate the feedback and additional information provided by Dr. Rindfuss. We agree that pharmacists are being used differently today than almost 20 years ago but also recognize that the standardization and utilization of clinical pharmacy services vary nationally. As mentioned in our background discussion, there have been shifts in the supply and demand for pharmacists, increased formal recognition of the value of residency training, and an evolving utilization of pharmacists in health care teams. Since both studies reported on survey responses at particular points
Short papers on practice innovations and other original work are included in the Notes section rather than in Letters. Letters commenting on an AJHP article must be received within three months of the article’s publication. Letters should be submitted electronically through http://ajhp.msubmit.net. The following conditions must be adhered to: (1) the body of the letter must be no longer than two typewritten pages, (2) the use of references and tables should be minimized, and (3) the entire letter (including references, tables, and authors’ names) must be typed double-spaced. After acceptance of a letter, the authors are required to sign an exclusive publication statement and a copyright transferal form. All letters are subject to revision by the editors.
Am J Health-Syst Pharm—Vol 71 Mar 1, 2014
357
Letters
in time, we felt it prudent to hypothesize about rather than investigate how the changing landscape of pharmacy could have been a factor or a barrier in the pursuit of residency or fellowship training. In retrospect, it may have been effective to provide a historical perspective on progress of the profession between our survey and the earlier one, by Bucci et al.,1 specifically noting the proceedings of the March 1993 conference “Implementing Pharmaceutical Care” (conducted by ASHP and the ASHP Research and Education Foundation),2 held just six months before Bucci et al. conducted their survey. In 1993, the concept of pharmaceutical care was surfacing, and pharmacists were just beginning to assume responsibility for drug therapy outcomes. Interestingly, then-ASHP President Jannet M. Carmichael3 also shared her vision of the health care world as it would be in 2010, including how “the product focus of pharmacy has become a patient focus” and “nearly all drug information is available to all pharmacists at the touch of a few buttons.” Reflecting on our practice today, we agree that the recognized and respected value of pharmacists in the provision of patient-centered care may certainly play a role in the pursuit of residency and fellowship training. Given the many advances made in residency training, we also agree that there may have been additional factors not explicitly stated in the survey; this issue was discussed in the limitations section of our report. Competitiveness in the job market and the ability to gain additional qualifications are sound reasons for pharmacy students to pursue residency training and were not available, as stated, in the predetermined list provided. That said, some pharmacy positions do require specialized training or additional qualifications as a prerequisite for employment, so some students choose residency training to gain a competitive edge. After completion of our survey, one resident respondent sent us an e-mail stating that “the biggest barrier of all is simply burnout from pharmacy school.” Although this obstacle was not included in this study, we sought to identify what
358
changes, if any, have occurred in the factors motivating pharmacy students to pursue residency and fellowship training through direct comparison of our survey results with those of Bucci et al.1 While the stated limitations were anticipated, our intention to perform statistical analysis required our survey to remain in the format of the earlier one. Ultimately, descriptive statistics were used, since the results of the previous survey were reported as percentages, without n values. The influence that different pharmacy schools would have on the pursuit of residency training is intriguing. In fact, this concept was a foundation for the Bucci et al.1 survey, as 80% of residency candidates were from only 20–30% of pharmacy schools at that time. Such a subanalysis would require a comparison of respondents based on the pharmacy school from which they graduated and not a comparison of the resident respondents from various residency program funding sources. Unfortunately, we did not collect this demographic information, which precluded our ability to compare results based on respondents’ pharmacy school affiliation. Although more women than men pursue residency training, an unpublished subanalysis of our data revealed that the top three most important factors to pursue residency or fellowship training were identical in ranking order for both sexes: the desire to (1) gain knowledge and experience, (2) attain specialized training, and (3) attain a prerequisite for certain jobs. The leading reasons selected
for why classmates chose not to pursue a residency or fellowship were also identical: financial obligations, job availability at graduation, and family obligations. As the landscapes of health care, pharmacy practice, and residency training continue to evolve, consideration of additional factors and barriers may warrant an updated, noncomparative study of these factors. 1. Bucci KK, Knapp KK, Ohri LK et al. Factors motivating pharmacy students to pursue residency and fellowship training. Am J Health-Syst Pharm. 1995; 52:2696-701. 2. Implementing pharmaceutical care. Proceedings of an invitational conference conducted by the American Society of Hospital Pharmacists and the ASHP Research and Education Foundation. Am J Hosp Pharm. 1993; 50:1585-656. 3. Carmichael JM. Comments on our vision of the future. Am J Hosp Pharm. 1993; 50:1642-5.
Bryan C. McCarthy Jr., Pharm.D., M.S., BCPS, Clinical Coordinator, Quality, Outcomes and Utilization University of Chicago Medicine Chicago, IL [email protected] Lynn Weber, Pharm.D., BCOP, Clinical Pharmacy Specialist, Hematology/Oncology, and Postgraduate Year 1 Residency Program Director Hennepin County Medical Center Minneapolis, MN
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp130687
Fatal dabigatran-associated bleeding
W
e read with great interest the case presented by Schaeffer and Conway1 describing a fatal outcome with the use of dabigatran and would like to address several points about the patient’s medical management. We find it peculiar that the patient received the medications she did in the first
Am J Health-Syst Pharm—Vol 71 Mar 1, 2014
place, given her advanced age, comorbidities, and high risk of major bleeding. We are surprised that there did not seem to be a pharmacist intervention at any point in the care of the patient. After the patient developed paroxysmal atrial fibrillation, she was prescribed warfarin sodium 10 mg daily for three
Letters Motivations in seeking advanced pharmacy training
T
he recent article by McCarthy and Weber1 analyzed changes in the factors motivating pharmacy students to pursue residency training over the past 18 years. While the authors did touch on many reasons why these factors have changed in recent years, I was disappointed that they did not relate their findings to the numerous changes occurring in health care and the evolving use of pharmacists on health care teams. The job opportunities that pharmacists have today are vastly different than those pharmacists could ever imagine 18 years ago, and this factor should have been given more weight throughout the article. In both the 1993 and 2011 surveys, respondents were provided with a list of factors affecting their decisions to pursue residency training. As a new resident who recently had to weigh these same factors, I felt that there were many additional elements that should have been included. With the competitiveness in the job market for pharmacists today, many students choose to pursue residency training to gain a competitive edge over their peers. Residency training also offers students the ability to gain qualifications in addition to their doctor of pharmacy degree, such as teaching certificates and postgraduate degrees. Furthermore, many students find residency training attrac-
tive because it provides vast experience in a short period of time, and students have the flexibility to adapt their program to their changing interests and career paths. Since the survey was designed to have respondents select options from a predetermined list, the authors may have missed these important factors that influence students’ decision to pursue residency training. I would have been curious to see how the results of the survey differed among a few select groups. Coming from a pharmacy school affiliated with an academic medical center, my peers and I were continually surrounded by residency-trained faculty, clinicians, and residents from academic hospitals. Thus, it would have been interesting to see how the motivating factors for the 37% of respondents who were affiliated with a university or academic hospital differed from those of respondents in community or industry programs. Also, as many more women than men choose to pursue residency training, the motivating factors of men and women would have been interesting to compare. While many pharmacy students pursue postgraduate training because it is a prerequisite for desirable jobs, I believe that this is attributable to the evolving role of pharmacists in a changing health
The Letters column is a forum for rapid exchange of ideas among readers of AJHP. Liberal criteria are applied in the review of submissions to encourage contributions to this column. The Letters column includes the following types of contributions: (1) comments, addenda, and minor updates on previously published work, (2) alerts on potential problems in practice, (3) observations or comments on trends in drug use, (4) opinions on apparent trends or controversies in drug therapy or clinical research, (5) opinions on public health issues of interest to pharmacists in health systems, (6) comments on ASHP activities, and (7) human interest items about life as a pharmacist. Reports of adverse drug reactions must present a reasonably clear description of causality.
care environment. As health care continues to evolve throughout the country and as pharmacists continue to fight for provider status, these motivating factors will continue to change and grow far beyond those included in this survey. 1. McCarthy BC Jr, Weber LM. Update on factors motivating pharmacy students to pursue residency and fellowship training. Am J Health-Syst Pharm. 2013; 70:1397402.
Sarah L. Rindfuss, Pharm.D., Postgraduate Year 1 Pharmacy Practice Resident University of Pittsburgh Medical Center St. Margaret Hospital Pittsburgh, PA [email protected]
The author has declared no potential conflicts of interest. DOI 10.2146/ajhp130574
W
e appreciate the feedback and additional information provided by Dr. Rindfuss. We agree that pharmacists are being used differently today than almost 20 years ago but also recognize that the standardization and utilization of clinical pharmacy services vary nationally. As mentioned in our background discussion, there have been shifts in the supply and demand for pharmacists, increased formal recognition of the value of residency training, and an evolving utilization of pharmacists in health care teams. Since both studies reported on survey responses at particular points
Short papers on practice innovations and other original work are included in the Notes section rather than in Letters. Letters commenting on an AJHP article must be received within three months of the article’s publication. Letters should be submitted electronically through http://ajhp.msubmit.net. The following conditions must be adhered to: (1) the body of the letter must be no longer than two typewritten pages, (2) the use of references and tables should be minimized, and (3) the entire letter (including references, tables, and authors’ names) must be typed double-spaced. After acceptance of a letter, the authors are required to sign an exclusive publication statement and a copyright transferal form. All letters are subject to revision by the editors.
Am J Health-Syst Pharm—Vol 71 Mar 1, 2014
357
Letters
in time, we felt it prudent to hypothesize about rather than investigate how the changing landscape of pharmacy could have been a factor or a barrier in the pursuit of residency or fellowship training. In retrospect, it may have been effective to provide a historical perspective on progress of the profession between our survey and the earlier one, by Bucci et al.,1 specifically noting the proceedings of the March 1993 conference “Implementing Pharmaceutical Care” (conducted by ASHP and the ASHP Research and Education Foundation),2 held just six months before Bucci et al. conducted their survey. In 1993, the concept of pharmaceutical care was surfacing, and pharmacists were just beginning to assume responsibility for drug therapy outcomes. Interestingly, then-ASHP President Jannet M. Carmichael3 also shared her vision of the health care world as it would be in 2010, including how “the product focus of pharmacy has become a patient focus” and “nearly all drug information is available to all pharmacists at the touch of a few buttons.” Reflecting on our practice today, we agree that the recognized and respected value of pharmacists in the provision of patient-centered care may certainly play a role in the pursuit of residency and fellowship training. Given the many advances made in residency training, we also agree that there may have been additional factors not explicitly stated in the survey; this issue was discussed in the limitations section of our report. Competitiveness in the job market and the ability to gain additional qualifications are sound reasons for pharmacy students to pursue residency training and were not available, as stated, in the predetermined list provided. That said, some pharmacy positions do require specialized training or additional qualifications as a prerequisite for employment, so some students choose residency training to gain a competitive edge. After completion of our survey, one resident respondent sent us an e-mail stating that “the biggest barrier of all is simply burnout from pharmacy school.” Although this obstacle was not included in this study, we sought to identify what
358
changes, if any, have occurred in the factors motivating pharmacy students to pursue residency and fellowship training through direct comparison of our survey results with those of Bucci et al.1 While the stated limitations were anticipated, our intention to perform statistical analysis required our survey to remain in the format of the earlier one. Ultimately, descriptive statistics were used, since the results of the previous survey were reported as percentages, without n values. The influence that different pharmacy schools would have on the pursuit of residency training is intriguing. In fact, this concept was a foundation for the Bucci et al.1 survey, as 80% of residency candidates were from only 20–30% of pharmacy schools at that time. Such a subanalysis would require a comparison of respondents based on the pharmacy school from which they graduated and not a comparison of the resident respondents from various residency program funding sources. Unfortunately, we did not collect this demographic information, which precluded our ability to compare results based on respondents’ pharmacy school affiliation. Although more women than men pursue residency training, an unpublished subanalysis of our data revealed that the top three most important factors to pursue residency or fellowship training were identical in ranking order for both sexes: the desire to (1) gain knowledge and experience, (2) attain specialized training, and (3) attain a prerequisite for certain jobs. The leading reasons selected
for why classmates chose not to pursue a residency or fellowship were also identical: financial obligations, job availability at graduation, and family obligations. As the landscapes of health care, pharmacy practice, and residency training continue to evolve, consideration of additional factors and barriers may warrant an updated, noncomparative study of these factors. 1. Bucci KK, Knapp KK, Ohri LK et al. Factors motivating pharmacy students to pursue residency and fellowship training. Am J Health-Syst Pharm. 1995; 52:2696-701. 2. Implementing pharmaceutical care. Proceedings of an invitational conference conducted by the American Society of Hospital Pharmacists and the ASHP Research and Education Foundation. Am J Hosp Pharm. 1993; 50:1585-656. 3. Carmichael JM. Comments on our vision of the future. Am J Hosp Pharm. 1993; 50:1642-5.
Bryan C. McCarthy Jr., Pharm.D., M.S., BCPS, Clinical Coordinator, Quality, Outcomes and Utilization University of Chicago Medicine Chicago, IL [email protected] Lynn Weber, Pharm.D., BCOP, Clinical Pharmacy Specialist, Hematology/Oncology, and Postgraduate Year 1 Residency Program Director Hennepin County Medical Center Minneapolis, MN
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp130687
Fatal dabigatran-associated bleeding
W
e read with great interest the case presented by Schaeffer and Conway1 describing a fatal outcome with the use of dabigatran and would like to address several points about the patient’s medical management. We find it peculiar that the patient received the medications she did in the first
Am J Health-Syst Pharm—Vol 71 Mar 1, 2014
place, given her advanced age, comorbidities, and high risk of major bleeding. We are surprised that there did not seem to be a pharmacist intervention at any point in the care of the patient. After the patient developed paroxysmal atrial fibrillation, she was prescribed warfarin sodium 10 mg daily for three
