The overreaching goals of a Postgraduate Year Two (PGY-2) Internal Medicine or Ambulatory Care resident are to become an autonomous expert in delivering pharmacy care to a large cohort of patients, develop the interpersonal skills needed to become an effective leader and educator, and develop practical research skills that can be translated into clinical research. Residency outcomes are outlined below for PGY-2 Ambulatory Care and General Internal Medicine.
The ambulatory care specialty in pharmacy has evolved since the adoption of the PGY-1/2 residency model. Previously, ambulatory care could be separated into “Primary Care” and “Family Medicine” specialties. These programs could be completed as either a first or second year residency, dependent on the program application criteria.
Family medicine pharmacy residency programs were structured as a hybrid between internal medicine and ambulatory care. Typically, a resident would be expected to perform 50% to 70% outpatient duties and 30% to 50% inpatient duties. This model allowed for flexibility in interest and diversity of disease state management from birth to death. Unfortunately, the family medicine hybrid model programs were a poor fit in the structure of primary care accreditation from the American Society of Health-System Pharmacists (ASHP).1 Switching to the PGY-1/2 residency model has increased the emphasis on accreditation, despite little change in ASHP's residency structure. As such, family medicine programs have decreased in number and only a few remain as PGY-2 Ambulatory Care residency programs with an emphasis on family medicine. Certainly, there still remains an opportunity to participate in a family medicine practice as a dedicated or longitudinal experience in most PGY-2 Ambulatory Care residency programs.
Primary care programs were also impacted significantly with the shift to the PGY-1/2 residency model. Many primary care programs adjusted their criteria to match the 2007 PGY-1 standards. Some of these programs maintained their ambulatory care interest by listing as a PGY-1 Pharmacy Practice residency with emphasis on ambulatory care. Initially, this type of training was sufficient for post-residency employment. Unfortunately, an increase in PGY-1 Pharmacy Practice residents and more uniform PGY-1 program structure have decreased the competitiveness for external employment of a PGY-1 residency trained candidate in the absence of PGY-2 experience. Thus, PGY-2 Ambulatory Care programs are becoming more prominent and sought-after by both candidates and employers.
ASHP has outlined six required outcomes for PGY-2 Ambulatory Care residents2:
1. Establish a collaborative interdisciplinary practice.
2. In a collaborative interdisciplinary ambulatory practice provide efficient, effective evidence-based, patient-centered treatment for chronic, and/or acute illnesses in all degrees of complexity.
3. Demonstrate leadership and practice management skills.
4. Promote health improvement, wellness, and disease prevention.
5. Demonstrate excellence in the provision of training or educational activities for healthcare professionals in training.
6. Serve as an authoritative resource on the optimal use of medications.
The specialty of internal medicine focuses on the health care of the adult patient. Patients may be seen by ...