PhORCAS and References

Hopefully you have already contacted your reference writers by this point.  If this was a topic discussed with them many months ago, this would also be a good time to confirm that they are still willing to serve as a reference.  If you have not contacted anyone yet, it would be a good idea to reach out to 3 - 4 people who meet the following criteria:

• They are knowledgeable about what pharmacy residencies are looking for in a candidate.
• They know details about your assertiveness, time management, dependability, emotional maturity, ability to work with peers, professional demeanor, leadership, resourcefulness, willingness to accept constructive criticism, independence, and clinical problem-solving skills.  They have worked side-by-side with you and have seen you work in challenging conditions, in other words.
• They have had the opportunity to evaluate your writing and verbal communication skills directly (watched you give a presentation, read one of your assignments, etc.).
• They believe that you exceed what is expected in the majority of all of these areas.

Consider the possibility that you are also being judged on the relative importance of WHO you ask to serve as a reference for you.  This does not mean that you should immediately go and ask the Dean.  If they can only speak about you in very vague and non-specific terms, do not ask that person (ex. "he came to class," "she turned assignments in on time," "she wasn't unprofessional," "it seems like his peers like him").  If a nationally-recognized clinical pharmacist has recently served as a preceptor for you, you might get some mileage out of the recognition of that person; only ask this person if they know you well and truly think you are a rock star.  Do not ask administrative assistants, friends or family members (even if healthcare professionals), or pharmacy technicians.  Think carefully before asking undergraduate professors and some types of prior supervisors.  Their endorsement of you may not carry as much weight.

There is a big change this year for references and you need to let people know this information up front.  PhORCAS will no longer be accepting uploaded letters of recommendation.  Instead, reference writers will only answer the questions provided online.  This will ultimately save the reference writer some time and effort, which will hopefully mean that it will be easier for deadlines to be met.  There will also be no size limits for fields where reference writers can include open comments.  Take some time to review the questions that reference writers will be asked to answer online (PhORCAS Standardized Reference questions).  It may not be a bad idea to discuss some of these questions with them so that they know your self-identified areas of weakness and measures you are taking to improve on those areas. Keep in mind that you are not going to be able to review any of their responses in PhORCAS.

Finally, it is suggested that you provide reference writers with a list of programs to which you will be applying, with their published deadlines, even if you have not yet selected all of your designations in PhORCAS.  Consider also letting them know information about why you are interested in specific programs so they can speak specifically about your perceived fit with those programs.

Pharmacy Residency Applications and Pre-Interview Rankings

The larger residency programs often receive hundreds of applications each year for a handful of residency positions.  Before PhORCAS, large amounts of data would need to be transferred from paper applications to spreadsheets allowing for a fair and consistent comparison of candidates.  As the number of applicants has grown and because the applicant numbers are expected to continue growing, more programs are turning to internal rankings using data pulled from PhORCAS.  A recent study published in the American Journal of Health-System Pharmacists describes one program's system for determining which applicants to invite for an on-site interview.  Prior to the analysis, they used 13 different characteristics.  After evaluating which factors were most likely to predict whether an applicant received an on-site interview, they removed duplicate factors and came up with 7 applicant characteristics which are starred below:

• Work experience pertaining to pharmacy*
• Professional association involvement*
• Types of rotation experiences*
• Publications*
• Presentations*
• Certifications and skills attained*
• Experience with research
• Grades*
• Recommendation letters
• Service to the community
• Awards and scholarships
• Letter of interest
• Leadership experience

Although letters of recommendation had the highest odds ratio of all of the characteristics (2.04), the 95% confidence interval suggests high variability with the predictability of this characteristic (0.79 - 5.27). The authors noted that most candidates score highly in this area making it a less valuable predictor of whether a student will be extended an offer to interview.

Grade point average was evaluated as a continuous variable in this model.  The applicability of the model to evaluating candidates without a GPA (ex. students from Roseman University) were not evaluated.  They noted that in the future, GPA could instead be used as a dichotomous variable (ex. yes or no to GPA above a certain cutoff) since students with a GPA below 3.0 were not extended an offer to interview.  

The authors felt that this process would be generalizable to other institutions but note that specific factors may vary by institution and that characteristics were not evaluated against PGY1 pharmacy practice residency performance.

Ensor CR, Walker CL, Rider SK, Clemente EU, Ashby DM, Shermock KM. Streamlining the process for initial review of pharmacy residency applications:  An analytic approach. Am J Health Syst Pharm. 2013 Oct 1; 70(19):1670-5.

Personal Placement Service - decision time!

Personal Placement Service (PPS) is a service offered by the American Society of Health-System Pharmacists which takes place at their Midyear Clinical Meeting (MCM).  It allows employers and potential employees to meet face-to-face for a mini-interview at Midyear.  In addition to traditional job opportunities, PPS is also a venue for those interested in pharmacy residencies.  Participation in PPS is not universal so it is important to understand the factors which will predict whether a PGY-1 residency program will participate in PPS.  The programs most likely to participate are:

• Large programs which offer both PGY-1 and PGY-2 positions
• Large employers which may also have multiple job openings as well
• Pharmaceutical industry fellowships
• Programs geographically located close to where the MCM will be held ( this will be Florida in 2013)

Decision time is here because early-bird prices for PPS applicants expire on October 21st (prices go from $70 to $130 for students).  Although the ASHP meeting is not until December, if you are interested in participating in PPS, you should consider getting started now so that you can secure an interview slot at the meeting.  Once you register for PPS, employers and residency directors will be able to find you in searches for PPS participants.  You will also be able to express your interest in participating programs.  Because PPS involves scheduled interview times, not everyone who wants an interview will receive one.  Programs will be looking for your qualifications as well as whether what they are offering matches what you are looking for.  

Although what happens at PPS is an "interview," different programs have different practices.  Some may treat PPS as a pre-screening activity where they will ask tough questions and try to get to know each applicant so that they can decide who moves to the next round.  Others will treat PPS as an opportunity to showcase their program and attract interested applicants.  It will be tough to determine which is which but if you are extended an offer to interview at PPS, it is always a good idea to ask whether there is anything specific you need to do to prepare for the interview.

To best take advantage of the PPS experience, avoid looking at programs which are located in your city.  Programs will want to use that time to look at applicants more geographically distant and you can always work on scheduling a visit with programs in your town when things are less hectic.  Make sure you make that face-to-face connection, however.  It is strange for a program to receive first contact with a local applicant when the application arrives.  You don't want the program to think they are your last choice or back-up program if they are not.

More about PPS will be posted on this web site in November.

Academic/Research Fellowships vs. Industry Fellowships. What's the difference?

I know this is the "Residency Preparation Blog" but why not include fellowships?  There are a lot of similarities between residencies and fellowships but a few important differences in terms of what these opportunities have to offer as well as how to go about applying for a position.  There is just one potentially confusing thing to clear up first since there are two types of post-graduate fellowships in pharmacy.  According to ASHP, an academic pharmacy fellowship (usually 2 years, possibly 3) is a "directed, highly individualized, postgraduate program designed to prepare the participant to become an independent researcher."  These types of programs are almost always affiliated with an academic institution and are peer-reviewed by the American College of Clinical Pharmacy, which has rigorous standards for quality and types of activities.  Some may offer graduate degrees as well.  Pharmacists completing an academic pharmacy fellowship often go on to work in academia but some may also work in a research area for a pharmaceutical company as well.

A postgraduate industry fellowship, on the other hand, is a one- or two-year position with the pharmaceutical or biopharmaceutical industry designed to prepare a pharmacist for a pharmaceutical industry career.  While many are affiliated with academic institutions, the primary experiential learning occurs with a sponsor company in a specific focus area.  The academic affiliation allows for didactic teaching and precepting opportunities as well as faculty collaboration to help with scientific publications and presentations.  Fellows also become integral parts of the day-to-day functions of their pharmaceutical industry department while learning how to problem-solve and become an active member of a project team.  As many as 17% may not be affiliated with a college of pharmacy, so it is important to make that distinction when researching programs if the goal is to work with pharmacy faculty and students.

In a recent survey of industry fellowships affiliated with colleges of pharmacy published in AJHP in 2012, the following trends were identified:

• 64% were headquartered in New Jersey, 14% in Massachusetts, and 11% in North Carolina.
• Medical affairs (medical information, medical communications, medical science liaisons) fellowships made up 39% of fellowship positions available followed by clinical research (32%), regulatory affairs (9%), commercial (8%), health economics/outcomes (8%) and pharmacovigilance (4%).
• The most common first position following completion of an industry fellowship was in the pharmaceutical industry (93%); 56% were with the same company where the graduate completed a fellowship.
• In the first 1 - 5 years after fellowship completion, 81% of the 271 graduates (from 2005 - 2009) remained with pharmaceutical or biopharmaceutical companies.

There are currently only proposed guidelines for industry fellowship uniformity, so the types of experiences and oversight is likely to be highly variable.  To learn more about these proposed guidelines, review the article published by Larochelle PA and colleagues published in the American Journal of Pharmceutical Education in 2009.  

The process for peer-review of academic/research fellowships is detailed and rigorous.  To learn more about these types of fellowships and the standards for peer review, visit ACCP's Peer Review of Fellowships web page.

Roseman residency history file

On Friday, June 15th, all Roseman University P3s received an email containing a document describing where students from Roseman University have done residency in previous years.  The document also described where our faculty trained and where they are currently affiliated with residency programs.  While it is not possible to provide names of alumni, some faculty have kept in touch with these former students and can contact them on your behalf.

Residency candidates and social media

If you are a residency-bound student graduating in 2014, you are probably thinking about the contents of your curriculum vitae (CV) with some frequency.  There are numerous places where you can get feedback on your CV including the USHP CV Review Night (Sept. 23, 2013) and the ACCP CV Review Service.  While you have probably heard all of the stories about typos and irrelevant information which have appeared on "bad" residency candidate CVs, in the grand scheme of things, this is nothing compared to what could potentially be discovered about you via social media.  Consider the possibility that what you might consider typical off-work behavior might be poorly perceived by the workplace environment when an attempt is being made to judge your character or values.  As evidenced through timeline posts, comments, photographs, "likes" of companies/organizations/events, residency program directors might discover explicit language, racist/sexist/ageist remarks, evidence of substance abuse, behavior which is in poor taste, etc.  Consider the following.  In a survey conducted in 2009, 75 - 90% of residency program directors agreed or strongly agreed to the following statements:

• "Information published voluntarily online in social media should be "fair game" for judgments on character, attitudes, and professionalism."
• "Residency candidates should be accountable for unprofessional behavior discovered through social media postings."
• "Professional students should be held to higher standards than other students regarding the image they portray on social media."
• "The attitudes and behaviors displayed (e.g., comments, photos) on social media reflect upon an individual as a health care provider."
• "It is acceptable for a pharmacy residency program director to review a prospective residency candidate's social media profile."
• "If a pharmacy residency program director chooses to review a residency candidate's social media profile, it is acceptable for that information to be used when considering the candidate's suitability."

While social media might seem like a great place to showcase yourself, consider that in the same survey, of the small number residency program directors who viewed pharmacy residency candidates social media information, 52% discovered issues revealing an unprofessional attitude.  This does not mean that pharmacy residency candidates are unprofessional.  It just means that social media allowed a view into people's private or personal lives which reflected on their professional lives.  If you would not like to openly discuss your leisure time activities with an employer, make sure that "conversation" is not happening without your consent via social media.

Cain J, Scott DR, Smith K. Am J Health-Syst Pharm. 2010;67:1635-9.

Meetings Meetings Everywhere!

Today's blog post is about the wealth of pharmacy meetings which are scheduled between now and residency application deadlines (early January).  Each one offers slightly different professional development and/or residency applicant resources.  Lower student registration prices reflect the costs for members of the organization. Organized by date...

September 14th, 2013 Utah Society of Health-System Pharmacists ($40 for students)
University of Utah Campus (HSEB), Salt Lake City, Utah

• Opportunities to network with local residency preceptors and directors
• Residency "speed dating." Students rotate between stations to learn about PhORCAS, the Match, letters of reference, ASHP Midyear residency showcase, PPS, letters of intent

October 4th - 5th, 2013 Nevada Society of Health-System Pharmacists ($25 - $35)
John Ascuaga's Nugget, Reno, Nevada

• Opportunities to network with local residency preceptors and directors
• Professional development roundtables (details TBA)

October 12th - 16th, 2013 American College of Clinical Pharmacy ($165 - $230)
Albuquerque, New Mexico

• Opportunities to network with residency and fellowship preceptors and directors
• Residency-related programming:  Emerge from the crowd: how to become a standout residency candidate
• Clinical Pharmacy Career Path Roundtables where you can speak with practitioners about 15 different specialties in clinical pharmacy
• Opportunities to meet residency and fellowship preceptors and directors via the Residency and Fellowship Forum
• CV and portfolio development workshop
• Mock residency interviews

October 15th - 18th, 2013 Academy of Managed Care Pharmacists ($120 - $140)
San Antonio, Texas

• Opportunities to meet preceptors and directors via the showcase of managed care residencies and fellowships
• CV review clinic
• Programming on understanding the residency match

October 31st - November 3rd, 2013 California Society of Health-System Pharmacists Annual Seminar ($225 - $305)
Anaheim, California

• Opportunities to meet preceptors and directors via the residency showcase
• Student programming

December 8 - 12th, 2013 American Society of Health-System Pharmacists Midyear Meeting ($270 - $375)
Orlando, Florida

• Opportunities to network with residency preceptors and directors
• Residency-related programming (the Match, applications, PhORCAS, interviews, PPS, CVs)
• Opportunities to meet preceptors and directors via the residency showcase
• Opportunities for a mini-interview with some residency programs

Pharmacy Specialties? There may or may not be student or residency-specific programming, but why not go to network? 

• Society of Infectious Disease Pharmacists (September 9th, Denver, Colorado)
• Hematology/Oncology Pharmacy Association (September 27th, Chicago, Illinois)
• Pediatric Pharmacy Advocacy Group (April 2014)
• College of Psychiatric and Neurologic Pharmacists (April 2014)

Taking the risk on residency

More than any other generation of pharmacy students, you have taken a sizeable gamble in deciding to become a pharmacist.  Most likely you are taking a large financial risk in going to school to study pharmacy and the chances that there won't be a paycheck to help you with those loans is higher than it has been for previous students.  Pursuing a residency position is yet another huge gamble.  What will happen if your time and effort spent networking, working on applications, and completing projects don't pay off? 

Around this time of year, Dr. Sebranek and I talk to a lot of students who are hesitant to take the gamble on a residency position.  They perhaps enjoyed and did well in their first two rotations.  Maybe a recent preceptor told them they would make a good resident.  Maybe they have heard that a residency will best prepare them to compete for the type of pharmacy position they want.  The problem is that they are unsure if the gamble is worth the effort.  Here are some questions you should ask yourself if you are finding yourself in this position.

1. What am I losing by putting time and effort into applying for a residency if I don't get one? How does that time and effort compare to what I've already invested in the profession?
2. What advice have I been given about my "chances?"  Do people (classmates, preceptors, mentors, faculty) seem surprised when I say I want to pursue residency training? Do people seem enthusiastic and encouraging?  What is in my power to change if my chances don't seem favorable in other's eyes?
3. How well informed do I feel about what I will get out of residency training?
4. What do I risk by spending my first (or second) year after graduation in residency training? What are the expectations of my friends and family? What do and don't they understand about the risks vs. benefits of completing a residency?

A recent study published in the American Journal of Health-System Pharmacists reveals the results of a survey of current residents and pharmacy faculty on the factors motivating students to decide to pursue or not pursue residency training.  The most common barriers were as follows: financial obligations (79%), a job was available upon graduation (45%), family obligations (37%), geographical limitations (28%), the belief that grades were not good enough (17%), competition for highly sought after programs (28%), disappointment of not matching (20%). 

I don't know about you, but I think it is a shame that 3 out of the 6 most common reasons have to do with fear and lack of confidence.  As you are thinking about your next steps, evaluate your fears carefully and take a hard look at the "worst case scenarios." 

Scramble blues?

We've learned in the last few weeks that nothing has gone completely according to plans in the scramble.  It made sense to us that programs would want to see information from scramblers populate in their PhORCAS "inbox" starting on March 25th.  What happened instead is that perhaps programs were waiting to hear from those still interested in an effort to save students the time and expense of loading a bunch of stuff into PhORCAS without prior contact with the program.  We feel this is unfortunate and it may have put some students who were trying not to be a nuisance at a disadvantage over the "squeaky wheels."  We did hear of a few cases of programs responding with "don't email us" or "don't call us" so this was definitely not always the case.  We also wondered why students didn't seem to be given the opportunity to make changes to their pre-match application without forking over another $25 per program.  Dr. Sebranek spoke with Janet Teeters at ASHP last week and made her aware of this issue.  This is something they were definitely interested in hearing about.  Ms. Teeters couldn't confirm whether the cause of programs disappearing from PhORCAS before April 1 was the filling of positions or programs already receiving plenty of inquiries/applications.  She mentioned that the moratorium on offers before April 1 may become mandatory in the future.

What to do now?

Option 1: Keep your eyes peeled for new positions coming open in PhORCAS.  Since there is no cost to the programs, it would seem they would want to put their openings in there.  In case inertia is the issue, keep your eyes peeled in other places as well such as the pharmacy association email distribution lists and web sites which display openings (especially ACCP).  Continue to let people in your area and in your speciality (ex. managed care) know you are still looking.

Option 2: Start planning for next year.  Look for job openings in areas which are related to your practice site of interest.  Think about casting a wide geographic net and don't forget about rural areas where demand might be higher.  One Roseman student started working per diem for a hospital shortly after graduation.  This position eventually turned into a full-time night-shift position. That position eventually turned into a 9 - 5 M-F shift in a hospital in another city.

Hang in there and continue to feel free to reach out to Dr. Sebranek or myself for assistance.

How to select programs in the scramble

I know it's been a long and arduous process, but if you are scrambling, get ready for the final sprint.  By now you have probably at least browsed through the unmatched position list, but where to start?  Here are some steps which might help you break this down a little. 

1. Look for places for which you have already applied.  They might not be THE hospital you sent your original application to, but consider the possibility that they might be willing to consider you more seriously since you have already been vetted by their "sister" hospital.  Another reason I put this first is that you might be able to swing a rotation at the other hospital which first attracted you to the system.  This couldn't hurt if they have a PGY-2 you are interested in for next year as well.
2. Ask a few mentors for ideas.  They might know someone at one of the sites.  Make sure they know what you are looking for so they don't try to send you to a critical care place when you really want more of an ambulatory care place.  This means you need to give people copies of the unmatched list so that they can browse and do a little research.  As I was poking around, I found a former student from Henderson who is now in a completely different part of the country at a site with an unmatched slot.
3. Since you have a much smaller list than when you did this the first time around, consider a process of elimination vs. a process of adding sites to your list.  If you don't want home infusion, for example, you can cross off all of the "Critical Care Systems" slots.  If you are considering this program, give me a call, I know the director pretty well.
4. If you are thinking about a PGY-2 in an inpatient specialty, consider the benefits of a good solid well-rounded PGY-1 experience at a community hospital.  If they offer the basics like cardiology, critical care, pediatrics, internal medicine, administration, and infectious disease, you will have a good foundation for future specialization.  Some of these places might be in more rural areas, which might mean less competition from students at other schools.
5. Don't be afraid of programs in candidate status.  Like the regular application process, you want to apply broadly to more well-known and lesser-known to improve your chances.  EVERY program started in candidate status at some point.  There could be something in there with great potential as long as you will get the experiences you are looking for.

More updates to come!  Hang in there scramblers.  I have a long list of former Roseman students who started out in the scramble and now are gainfully employed in top-notch positions.

Preparing for The Scramble

I have had a few individual questions about how best to prepare for "The Scramble."  Each year navigating the Scramble becomes more difficult as there are increasing numbers of unmatched PGY1 applicants (in 2012 this number was 1438 unmatched candidates) and decreasing number of unmatched positions for all types of PGY1 residencies (in 2012 this number was 145 unmatched residencies).  Please do not be discouraged as there are many well-qualified student pharmacists who do not Match.  Each year Roseman *has* had at least one student secure a position in the Scramble.  See a few tips below about how to streamline your efforts:

Prior to Match Day (Friday, March 22nd):
1.  Update your CV and upload again into PhORCAS.  Even if you have favorable results with the Match, spending the time to update your CV is worth it because you will need to continue updating your CV throughout your career.

2.  Contact your reference writers.  If you haven't already done so, please send them thank you notes.  Depending on the number of programs where you applied, each reference writer spent between 5-10 hours of their own time to write a letter.

On Match Day:
1. Access information about unmatched programs in PhORCAS starting at 10 a.m. Mountain time.  Research these programs just as you did when you originally selected programs prior to submitting your applications starting on Monday, March 25th.  Though it may be tempting, do not apply to programs outside your area of interest simply for the sake of obtaining a residency.  Remember a residency is a commitment for a year and being in an undesired practice setting is unlikely to meet your professional goals.  Both you and the program may be similarly frustrated in the coming year.

2.  Let your reference writers know your status right away.  They will want to share your success if you matched.  If you did not match, you will need your references to write new letters of recommendations.  Letter writers can upload new evaluations as early as 10 a.m. Mountain time on March 22nd.  Since programs can make offers as early as April 1st, your reference writers will need to submit a new letter within a few days so you will need to verify they have this availability to do so.

3. Use your networking strategies.  Programs receive hundreds to thousands of inquiries about unmatched positions so they are much more likely to pursue a known candidate.  This may translate to if you had any contact with them at ASHP Midyear or other professional meetings, if you had previously applied to their program, or if they know anyone who knows you.  I highly encourage you to contact college faculty (especially Dr. Smith) about your status in the Scramble.  We can determine if there is a connection between any Roseman faculty member or past alumni with the program. 

Do not underestimate the power of networking!  Last year a South Jordan candidate shared how he matched in the Scramble due to networking on behalf of a program.  The residency director knew one of the pharmacists at an APPE site where the Roseman candidate had completed a rotation.  The director contacted this site pharmacist without the knowledge of the candidate at the time. The site pharmacist had never served as the candidate's preceptor but was able to relay positive information about the candidate's professional demeanor and clinical performance based on word-of-mouth.  Remember, pharmacy is a small world and you want to use this to your advantage!

Beyond Match Day:
1. Await contact from programs.  If a program is interested in you, you will most likely be asked to participate in a brief in-person interview (if local) or a telephone interview.  These interviews are likely to be much shorter so you have to make a strong impression very quickly.  You may be asked to submit examples of projects (journal club, case presentations, educational handouts, etc.) you completed on APPE rotations for them to gauge your clinical skills.  Programs will evaluate all candidates they decided to pursue and then extend acceptance or rejection offers at their discretion.

2. Recheck PhORCAS often about available positions.  Keep in mind some programs will find out in April or May if they have been granted funding for additional positions.  These positions will become available in PhORCAS and you can apply to them just as you did in December/January.

Good luck and keep us posted!

Upcoming Dates -- Residency Match 2013

March 22, 2013 at 12:00 PM Eastern Time

• Match results are released to applicants and program directors.
• The PhORCAS application portal will be reopened so that unmatched applicants may begin updating their information (CVs, letters of intent, letters of recommendation, etc.).  Previous information will be accessible in the system for students who used PhORCAS pre-match.
• The list of programs with openings will be preloaded into PhORCAS.
• New applicants may participate in the scramble however they must register for the match and PhORCAS and pay associated fees. 
• New programs and new positions for existing programs can be added.

March 25, 2013 (update: 12:00 PM Eastern Time)

• Designation portal is again open to applicants in PhORCAS. No distinction will be made between "in progress" and "complete" applications. The fees of $25 per application will again apply.
• Programs may designate a new application deadline or they may keep the default deadline of May 31, 2013.   April 1, 2013
• Available applicant list is posted for programs.

April 1, 2013

• The Commission on Credentialing has asked for a moratorium on position offers to applicants until this date in an effort to give programs and applicants sufficient time to make good decisions without the fear of competition with the best applicants/programs. This is non-binding but Dr. Sebranek and I believe this recommendation will be followed by the residency programs.
• Programs will begin to remove remaining unmatched positions as they are filled

April 22, 2013

• Matched applicants must sign and return their letter of confirmation to their residency program.

May 31, 2013

• PhORCAS closes for the post-match process.

Rank Order Decisions

As a reminder, rank order lists are due to the National Matching Service (NMS) or "The Match" are due on Friday, March 8th and Match results will be released on Friday, March 22nd!

Deciding which program to rank can be even more agonizing than deciding where to apply.  Programs that looked good "on paper" may not be as impressive in person.  Alternatively, a program which wasn't initially the highest on your list of considerations may now have some big selling points after you have visited the site and met with staff .  You may be creating lists of "pros" and "cons" for each interview site and also weighing just how important each "pro" and "con" is to you.

Here are a few basic things to consider:
1. Let your rank order reflect your short-term and long-term goals but don't forget to consider what your training will be like in the interim.  After you finish your PGY1 residency, what do you want to do next?  If you perform well as a resident, you may have a PGY2 position or job offer at the site if positions are available.  You may be weighing objective factors such as opportunities at a site (training stucture and opportunities) against the intangible factors (organizational philosophy or how much you felt you "fit"at a site).  My recommendation is to ultimately go with the "gut instinct" because if you are self-motivated, you may be able to create some learning opportunities in your residency.  Just remember:

2. DO NOT base your ranking decisions on how much you think the site liked you. Remember, it is against ASHP residency matching rules for either the site or the candidate to overtly share rank order before the match.  Some places are better about playing "poker face" than others.  A few sites may more aggressively court candidates but the larger majority stay silent until Match Day.  Dr. Smith and I have many, many stories of candidates who didn't rank a site or prioritize them higher and then were very surprised / disappointed to learn later on how much the site wanted them.

3. Conversely, if you encountered some red flags during an interview, think about the context.  Were there extenuating circumstances on your interview day?  For instance, a local hospital had a Joint Commission survey during their major interview week so staff there were understandably pulled in many directions during that week.  Was the negative interaction with a specific person at the site or did you sense it was the overwhelming culture?  When I was interviewing for residencies, I was put off by the attitude of a current resident at the time.  I finally decided I liked the site as a whole and am so glad I matched at a site where the overwhelming majority of pharmacists were very positive and welcoming.  You do have to spent at least 40 hours a week at site so were these red flags a deal-breaker?  How much are you willing to risk not matching at any site if you decide not to rank an institution? 

Best of luck with a difficult decision!  Please keep Dr. Smith and I informed about your results so we can congratulate your success or strategize during the scramble.

What will you be asking during interviews?

Most candidates will go through the process leaving a favorable or neutral impression, but occasionally candidates come up with questions which are perceived very negatively by the residency program.  They are negative because they are judgemental or delve into privacy issues.  Other questions which leave a negative impression are those which leave the residency preceptors with an impression that the candidate doesn't want to work hard or that the candidate is "high maintenance."  Here are some examples of questions which are best left out of your interview.

1. What problem areas were identified during the last ASHP accreditation visit?  It's fine to ask about what the program is hoping to improve upon; it is not okay to try to identify "dings" from accrediting bodies.
2. Why was so-and-so ex-resident let go from this residency program? Personnel issues are private as all pharmacy residents are considered employees.  There is really not a good way to ask about this topic. 
3. Why did so-and-so ex-resident quit this residency program? See #2 above.
4. Why did this program have an unmatched position last year (or the year before, etc.)? Because the matching process starts with the candidate and not the program, there are many reasons the program may have an unmatched position which may have nothing to do with the program's quality.  Sometimes the highly competitive programs are all going after a common pool of candidates, for example. Use other questions to try to assess the quality of the program but keep in mind that you should also be thinking about "fit."
5. What time would I be allowed to leave for the day as a pharmacy resident? This question implies that there is something in this resident's life which is a greater priority than the residency.  Candidates indeed have practicality concerns when it comes to childcare and similar responsibilities, but consider instead asking the current residents about the hours of their "typical day."
6. How did I do on the interview? Even if you have done well, this will leave a negative impression because it makes it seem like you are needy for constant feedback.  Asking this question is not worth the risk because you can't change how you did and even if they think you are a good fit, another candidate may outrank you.
7. Where will you rank me or how many candidates will you be ranking? This relates to the question above.  The "how many candidates" question is a problem because there may be candidates who will not be ranked and answering the question may reveal which candidates fall into that category.
8. How many candidates were interviewed? The temptation to try to calculate where you will end up in the match is very high in this process. It is far more valuable to focus your efforts on asking detailed questions about the residency as that will help sell your committment to finding the best residency for you vs. revealing your anxiety about "getting something" in the end.

Residency Interview Structure

The following list describes some of the features of pharmacy residency interviews of which pharmacy residency candidates should be aware.

• Half of all programs ask clinical questions.  They might ask about practice guidelines or drugs of choice, for example.  Five to fifteen percent of programs might ask for a case presentation or preparation of a SOAP note.
• A little less than a third of programs ask the candidate to prepare a short (15 - 30 min.) presentation necessitating the use of slides.
• Most programs involve their current residents in the interview process, including the selection of candidates.
• About half of programs have an interview that is a half-day (5 hours or less) in length.
• Three quarters of programs provide breakfast, lunch, or both.
• Few programs (< 20%) provide any travel accommodations for out-of-state applicants.
• Candidates do not interview with more than one candidate in the room.  Each candidate will usually have multiple one-on-one or small group interviews with each lasting a half-hour to an hour.
• Each candiate might interact with as many as 10 preceptors or staff members throughout the day.

Adapted from Mancuso CE, Paloucek FP. Understanding and preparing for pharmacy practice residency interviews. Am J Health-Syst Pharm. 2004;61:1686-9 and Mersfelder TL, Bickel RJ. Structure of postgraduate year 1 pharmacy residency interviews. 2009 Jun 15;66:1075-6.

Are you ready to interview?

Pharmacy residency interviews usually begin in late January and continue through the month of February.  If you've made the first cut based on your goals, achievements and the support of your mentors, congratulations!  Now the fun begins.  Here is a list of questions to help you determine if you are ready for the interview process.

1. Do you have your "elevator speech" prepared in response to the request to "tell me a little about yourself"?
2. Do you have your list of good scenarios prepared for a behavioral interviewing approach?  Can you come up with a story to describe a time when you: were shot down, made a successful intervention, were challenged by a patient, disagreed with a supervisor, had a conflict with a teammate...?
3. Do you feel confident that you won't appear stupid if you don't know the answer to a clinical question when you aren't sure of the correct answer?
4. Can you describe your weaknesses without using personality flaws?  For example, telling the interview team that you are always late is a problem.
5. Has anyone checked your mannerisms lately in high-pressure scenarios to make sure you don't do anything which is distracting or confusing (ex. use of "um," playing with hair, picking at clothing, grimmacing, laughing/smiling at the wrong time, etc.)?
6. Have you practiced your handshake with someone who will be completely honest with you about whether you've given a good handshake?
7. Have you prepared your list of questions for the programs and do you feel confident that the types of questions you will ask will reflect upon you favorably (ex. avoid "why did the program let a resident go last year?")?
8. Can you clearly describe your own preferences for a program in terms of the amount of flexibility, degree of autonomy, quantity/frequency of feedback, and exposure to certain activities like teaching and management projects?

The good news is that there is still plenty of time to make improvements to all of these items!  The bad news is that some work will be required on your part.  Don't forget about the opportunity to participate in the Mock Interview Workshop at the University of Utah on January 16th.  The preceptors/faculty know to look for the items on this list and can give you honest feedback without holding anything against you.  You only have until Friday the 11th to indicate that you want to participate.  Check your email inbox for the Surveymonkey invitation which was sent last Friday; you must fill it out to attend.

Top 20 Residency Interview Questions!

This is based on the results of a study where researchers attempted to collect a list of the most common interview questions with median rankings for importance (5 = most important, 1 = least important). Questions without rankings were provided as open questions by survey participants.

1. Why do you want to do a residency? (100% asking, importance 5/5)
2. Where do you see yourself after a PGY-1 residency?* (97% asking, importance 4/5)
3. What areas of practice most interest you? (93% asking, importance 4/5)
4. What qualities do you possess would make you a good resident? (88% asking, 4/5 importance)
5. What are your worst qualities? (73% asking, 4/5 importance)
6. What was your favorite rotation? (73% asking, 4/5 importance)
7. Describe the most significant contribution you made to a patient's care this past year. (60% asking, 4/5 importance)
8. Are you considering a PGY-2 residency or fellowship?* (59% asking, 3/5 importance)
9. What was your least favorite rotation? (56% asking, 3/5 importance)
10. Describe your most memorable experiences from rotations. (47% asking, 4/5 importance)
11. If I were to ask preceptor X to describe you, what words would he or she use? (37% asking, 4/5 importance)
12. Describe your favorite or most memorable patient. (32% asking, 4/5 importance)
13. What is your definition of pharmaceutical care?* (24% asking, 3/5 importance)
14. Who was your favorite preceptor? (19% asking, 4/5 importance)
15. Why are you interested in our program? (13% asking)
16. Describe or discuss the most interesting medical journal article you have recently read. (13% asking, 3/5 importance)
17. How do you handle conflict? (10% asking)
18. What do you like to do for fun? (8% asking)
19. Describe a conflict with a preceptor or attending physician. (7% asking)
20. Describe your time-management skills. (7% asking)

* Because this study was conducted in 2003, certain terms have been updated or might be phrased differently to reflect current standards and practices.

Be prepared for these questions to include follow-up, especially if the question is closed-ended (ex. Are you considering a PGY-2? vs. Why are you considering a PGY-2?).

Mancuso CE, Paloucek FP. Understanding and preparing for pharmacy practice residency interviews. Am J Health-Syst Pharm. 2004;61:1686-9.