In December 2008, Ashley Branham had a doctor of pharmacy degree in hand and was in the midst of a PGY1 community pharmacy residency at UNC. Yet, when she interviewed for jobs at the American Society of Health-System Pharmacists Midyear Clinical Meeting, she couldn’t find a position that met her community-practice interests, and she felt under-qualified for the faculty positions she was looking for.

"I enjoy working with students and student groups, and I like to share with students why I’m passionate about community pharmacy," Branham says. "I was trying to figure out a way to get into the academic world and learn more about it, but I just couldn’t find an appropriate entry-level position.."

Branham raised the concern during one of her quarterly residency evaluations and mentioned that she would like to see a community pharmacy residency focusing on academia.

Coincidentally, the person she was talking to — Macary Weck Marciniak, PharmD — was thinking the same thing.

"It was something that was in the back of my head," says Marciniak, assistant director of the community pharmacy residency program at the UNC Eshelman School of Pharmacy. "Her bringing it forward and it being an interest of mine made us say, ‘Maybe we should really think about this.’ "

That convergence of minds, some well-timed funding, and a willing preceptor created the right set of circumstances to make Branham’s wish come true. In July 2009, she became the first resident in the School’s new PGY2 community pharmacy residency program.

There have been PGY1 residencies in community pharmacy for about a decade — with UNC’s program being one of the oldest — and there are PGY2 residencies in many specialty areas of pharmacy. However, Marciniak says she is not aware of any other PGY2 residencies in community pharmacy.

"We are the first that we know of to create a PGY2 in community pharmacy," she says. "There are some other people who are doing fellowships in community pharmacy, but they are doing more research-type activities."

The School’s PGY2 program, on the other hand, focuses on preparing residents to be community-pharmacy faculty members, the kind of position occupied by Marciniak, a clinical associate professor at the School. The residency emphasizes four major areas: practice, teaching, research, and leadership.

Branham spent about half of her time at the School and half at her practice site, Moose Pharmacy in Concord, which was near where she lived. To make the residency work, she made the two-and-a-half-hour drive to Chapel Hill twice a week, but she didn’t mind the commute and says the program directors and preceptors were very flexible in order to make the residency work for her. For instance, on her days in Chapel Hill, she stayed at the house of Stefanie Ferreri, PharmD, the director of the community pharmacy residency program.

"When we were discussing the possibility of starting this residency, we knew we were going to have to be flexible," Branham says. "There have been some tweaking that have gone on along the way, but I do not think this has negatively impacted my development. I have been involved with experiences that I have helped me achieve the outcomes I wanted. I am very satisfied with the residency.

"I think I’m definitely more qualified to step into the role of a community-pharmacy faculty member."

The current PGY2 resident, Shanna O’Connor, has a much shorter commute. Starting in July 2010, the PGY2 practice site moved to the new Kerr Drug facility in Chapel Hill, a five-minute drive from the School.

"If you are a practice site partnering with an academic institution, it’s best to be fairly close location-wise, because we are going to be bringing the resident back here to be a teaching assistant and work with different people at the School," Marciniak says. "Kerr Drug in Chapel Hill offers us that flexibility. Plus, it’s a very established practice site. It was our first practice site and has been with us since the beginning. "

Meeting a Need

Marciniak says that while there have always been pharmacists who are interested in becoming community-pharmacy faculty members, the demand for such individuals is growing.

"The number of schools of pharmacy has increased a lot over the last few years," she says. "New schools are coming up, and existing schools are increasing the number of faculty that they need. So there’s more of a need, so we need to have more residents who are going the faculty route so we can meet the current faculty demand."

Marciniak, a 2000 graduate of the School who returned in 2008 to join the faculty, knows first-hand the learning curve for new community-pharmacy faculty members. She and most of her colleagues in similar positions learned on the job. That’s why she was already toying with the idea of creating a PGY2 community pharmacy residency focusing on academia when Branham came to her with the same thought.

Around that same time, Marciniak had the opportunity to apply for a faculty-development fellowship from the National Association of Chain Drug Stores Foundation and the American Foundation for Pharmaceutical Education. She pitched the idea of creating the PGY2 residency and was awarded the grant in early 2009. There was already an interested candidate in Branham, and Moose Pharmacy, where she did her PGY1 residency, was willing to take on another resident, so the School decided to start the PGY2 sooner rather than later.

Even before the funding came through, the idea of starting such a program was sparking a lot of interest, as Marciniak found out at the 2009 APhA Annual Meeting & Exposition when word about the PGY2 started to get out.

"I had quite a number of colleagues who are faculty members in community practice at other schools tell me, ‘I would have loved to have this when I was in school.’ " she says. "For many of us, we learned on the job. Once we got into our roles, we learned what we should do. But it’s nice to have that extra year of training under the guidance and mentorship of other faculty before you take the job yourself."

Marciniak is preparing to apply for accreditation in June 2010. The accreditation process usually takes one to two years, but once approved, the accreditation will retroactively cover residents who were in the program at the time the application was submitted.

Narrowing the Focus

While a PGY1 residency exposes residents to the myriad aspects of being a community pharmacist, the School’s PGY2 program is designed to help the resident get more in-depth training in a few areas, Marciniak says. For instance, the PGY2 features a heavy dose of teaching experiences. During her PGY2 year, Branham served as a clinical instructor in several courses and as a teaching assistant in the Pharmaceutical Care Lab. She also shadowed faculty members and worked with some of them on projects related to assessment and experiential education. In addition, she mentored PGY1 residents and PharmD students completing their introductory and advanced practice experiences at her practice site.

"Sometimes when you are doing a first-year residency, you might see pieces of the whole teaching process," Marciniak says. "You may get the chance to give a lecture in front of students, but you probably only do it once or twice. It may be a small or a large group. You might write the objectives, or they might be given to you. Maybe you write test questions, maybe you don’t.

"In the PGY2, you do it all. You are going to see how you design a class from start to finish: writing really strong objectives, delivering learning materials that are very active and new, incorporating novel teaching methodologies, seeing how the students do, and thinking about what you would tweak the next time."

The same idea applies to the practice and research components as well. At Moose Pharmacy, Branham focused on providing immunization services, giving consultations for biomedical hormonal replacement, and working to establish collaborative relationships with physicians in the area to start new programs. One of those programs entailed pharmacists providing home-based medication-therapy management.

"If a physician is seeing a patient whose outcomes aren’t being met no matter what types of interventions they are trying, they will refer the patient to us, and our pharmacists will go out and meet with the patient in their home," Branham says.

On the research side, Marciniak says the PGY2 projects are designed to be larger in scope than their PGY1 counterparts. One of Branham’s projects, for instance, analyzed data related to medication-therapy management from all of the School’s residency sites to see which pharmacist interventions make the most difference with particular types of patients.

"Sometimes when you do your research project in your first-year residency, it’s just at your site with a small number of patients," Marciniak says. "Ashley is getting a chance to do broader research and see how that works when you’re involving multiple people."

The PGY2 also carries a strong emphasis on developing leadership skills. Branham honed hers through active service with the North Carolina Association of Pharmacists. She chaired the NCAP’s Immunization Task Force, which is working to expand immunization opportunities for pharmacists in the state.

Branham says the task force is working through legislative means to get authorization for pharmacists to provide all the vaccinations that are approved by the Centers for Disease Control and Prevention, as well as lower the minimum age of patients whom pharmacists can vaccinate. Currently that minimum age is 18. Branham says the task force is advocating lowering it to 7.

"Ashley really helped us make the PGY2 an awesome program in its first year, and we’re hoping we can keep up that good tradition," Marciniak says. "We’re hoping this could help change the future of community practice. We are hoping this could get more people interested in being faculty members, and in turn that will help us build more practice sites and do more in community and more research."