*Please note this article was originally published in 2020 when Sara was the Infectious Diseases Outcomes, Fellow Anti-infective Research Laboratory at Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.

Q: Should I pursue residency training, a clinical research fellowship, or both?

Two roads diverged in a wood, and I –

I took the one less traveled by,

And that has made all the difference.

–Robert Frost

Undoubtedly, this is the question that I have received most often during my post-graduate training journey. I have achieved a B.S. degree in science, earned a Pharm.D. degree, completed PGY1 and PGY2 (infectious diseases [ID]) residencies, and finally, committed to a 2-year ID outcomes fellowship.

A PGY1 clinical residency training program offers a generalized clinical experience, usually exposing residents to a broad range of clinical rotations to gain general competency in medication use for patients with an extensive range of diseases.^{(1, 2)} A PGY2 builds on the competencies achieved in the PGY1 program to endorse a resident’s specific area of interest and ultimately trains residents to become pharmacy specialists in their area of focus. PGY2 specialties offered include ambulatory care, cardiology, critical care, ID, and transplantation. Both PGY1 and PGY2 programs require the resident to participate in clinical rounds/services, provide medication information to the clinical team, and conduct clinical residency research. However, a clinical research fellowship is a directed, highly individualized post-graduate training experience designed to prepare the trainee to become an independent and successful research investigator.³ The research fellow gains expertise under the close direction of a qualified primary investigator–preceptor in various research processes, which consume most of the fellow’s typical day. These processes include hypothesis generation, study design, protocol development, grantsmanship, conducting experiments, laboratory technical skills, data collection, statistical analysis and interpretation, manuscript preparation, and, ultimately, publication. Common clinical research fellowship programs in pharmacy are in the fields of cardiology, critical care, ID, and translational/outcomes research, as well as many more.

On one hand, a clinical residency, whether PGY1 or PGY2, is set according to accreditation standards observed continuously by the American Society of Health-System Pharmacists (ASHP). Although the regulations are broad-spectrum to allow for variability in the experiences provided by each residency site, they have a consistent minimum set of clinical and professional competencies. A clinical fellowship, on the other hand, is peer reviewed by the American College of Clinical Pharmacy (ACCP).⁽³⁾ The process assesses whether a program and a program’s principal investigator meet the ACCP Guidelines for Clinical Research Fellowship Training Programs, which primarily ensure high quality in all research fellowship programs.

All residency programs require the candidate to be at least a pharmacy school graduate because the trainee must be a licensed pharmacist. A fellowship program’s criteria are more flexible, given that candidates can be fresh pharmacy graduates or holders of a PGY1, and a PGY1 and a PGY2, or even a Ph.D. degree. Different fellowship programs have diverse preferences for a candidate’s qualifications in order to find the best match for the research and principal investigator’s goals and objectives. Residency program candidates apply through the ASHP Match at a standard time annually, typically ending in February, whereas fellowship program candidates reach out to programs individually and typically secure positions before the Match application deadline. This accommodates applicants who are considering either a residency or a fellowship program.

Candidates must carefully consider their ultimate career goals when selecting their training pathway. A PGY1 residency adequately trains the candidate for clinical and direct patient care roles, including precepting and teaching pharmacy students. A PGY2 residency provides specific clinical experience, resulting in trainees who are well suited to become expert leaders in their corresponding clinical specialties. A fellowship prepares the candidate to become an independent researcher and investigator. Fellowship graduates are prepared for academic positions, including tenure-track roles. Understandably, the criteria for jobs are dynamic, and certainly, there is no one path to achieving one’s career goals. Nevertheless, a careful consideration when evaluating type and amount of training will facilitate candidates’ readiness for their definitive career goals.

Personally, I pursued the “road less taken” when completing the PGY1, PGY2, and fellowship programs. In fact, I am also pursuing an Master of Public Health (MPH) degree (but that is for another discussion!). Both PGY1 and PGY2 residencies significantly contributed to my success as an ID research fellow. The PGY1 experience gave me confidence in my pharmacotherapy knowledge base and a robust set of skills as a patient care provider. The PGY2 experience allowed me to practice my authority as an ID specialist. Residency and fellowship training combined has allowed me to effectively evaluate the literature, independently develop research ideas, and effectively construct projects with confidence in my clinical background. This process would not have been as seamless had I started the fellowship right after pharmacy school without more in-depth clinical training. In addition, exposure to various stages of clinical and research training has given me unique insights into pharmacy experts in the hospital, academic, and industry settings. These opportunities provided the foundation  that I needed to make the best career choice after completing my training.

Of most importance throughout your training, trust the process and remember to enjoy what you do. Otherwise, the process will be exhausting, dreadful, and unfruitful. Extended years of training (in my case, four years) are inevitably long, but worthwhile. Early in my career, I was trained to achieve a work-life balance. I challenge you to do the same. Remember that, as a well-rounded pharmacist, you will always be a lifelong learner, regardless of your decision to pursue a training program.

Sara Alosaimy, Pharm.D., BCPS
Infectious Diseases Outcomes Fellow
Anti-infective Research Laboratory
Eugene Applebaum College of Pharmacy and Health Sciences
Wayne State University
Detroit, MI

1. “Residency Information.” ASHP ASoH-SP, 2020, www.ashp.org/Professional-Development/Residency-Information.

2. “What Is a Residency and How Do I Get One?” ACCP, American College of Clinical Pharmacy, www.accp.com/stunet/compass/residency.aspx.

3. “Peer Review of Fellowships.” ACCP ACoCP, 2020, www.accp.com/resandfel/peerReview.aspx.