The story of how pharmacy residency practice grew from the vision of one man into a teaching model admired around the world is a complex tale that mirrors the remarkable transformation of pharmacy practice itself.

While the complete story is told in the lives and careers of the more than 250 individuals who have completed pharmacy residency training at Michigan over the past 80 years, the plot line starts with Michigan Pharmacy alumnus Harvey A. K. Whitney Sr., PhC’23 (1894—1957).

It was in 1927, the first year of his 14-year tenure as director of pharmacy at University of Michigan Hospital, that Whitney established the nation’s first hospital pharmacy “internship” — what is now called a residency. From the beginning, Whitney’s master plan was to redefine both the profession of hospital pharmacy, and the role of the hospital pharmacist. Pharmacy resident training was a crucial step in that plan.

Through resident training, Whitney saw the opportunity to create a new kind of pharmacist. Residency-trained pharmacists would be technically and scientifically astute, but they would also be trained to be innovators and thought-leaders; future directors of hospital pharmacy operations; avatars of change, fanning out to hospitals across America to champion transformation from within.

Many did just that, including two Whitney proteges — Donald Francke, BSPharm’36, MSPharm’48, HonDSc’67, and George Phillips, BSPharm’39, MSPharm’50 — who succeeded their mentor as pharmacy director at Michigan Hospital. Francke was director from 1944 to 1962; Phillips from 1962 to 1972. Both went on to become American Society of Health-system Pharmacists (ASHP) presidents; were recipients of the Harvey A. K. Whitney Lecture Award, hospital pharmacy’s highest honor; and achieved international fame as pharmacy innovators of the first rank.

“In his early writings, Harvey Whitney Sr. saw the implicit value of linking a theoretical education to an experiential component that was structured, mentored, and evaluated on a regular basis,” explains Henri R. Manasse Jr., MSPharm, PhD, executive vice president, ASHP in Bethesda, Md. “Whitney’s training model placed certain burdens and requirements on the student going through the internship program so that by the time a student completed it, his sponsoring agency could attest to his competence.”

Hospital pharmacy practice in 1927 (and for decades after) was largely manufacturing and dispensing based. Even within this context, Whitney saw that pharmacists could have a direct, even dramatic, impact on health outcomes through system refinements, medical staff education, rigorous adherence to quality standards, standardization to formularies, dosage control, and many other major innovations.

His visionary thinking not only laid the foundation for all sub- sequent residency programs, it shifted the practice paradigm for what a hospital pharmacist could be and could do. In effect, his hospital practice model was an early version of pharmacist as patient care advocate; that, at a time when pharmacists were forbidden even to tell patients what they were taking, and why.

It did not take long for Whitney’s U-M residency training guidelines to become the unofficial blueprint for other residency training programs springing up around the U.S. In the 1940s, ASHP was enlisted to formalize and standardize the training, urged on by Whitney, a founding father of ASHP and the organization’s first chairman (1943). Under Whitney’s leadership, the association founded the Bulletin of the American Society of Hospital Pharmacists, forerunner of theAmerican Journal of Health-system Pharmacists, with Whitney as the Bulletin’s first editor. In the 1950s, the ASHP Bulletinbecame the authoritative source for residency training standards.

Michigan was one of 33 hospital pharmacy residency training programs in existence by the time ASHP established a residency accreditation process in the early 1960s. In addition to helping developthe first set of accreditation standards, Michigan was one of the first programs to go through the accreditation process.

Today, there are more than 900 ASHP- accredited pharmacy residency training programs, enrolling over 1,750 residents. Michigan’s own program consistently attracts top scholars from around the nation and the world, accommodating up to seven combined Postgraduate Year One (PGY1) and Postgraduate Year Two (PGY2) Pharmacy residents annually.

With so strong a residency tradition permeating the College and Medical Center, it is not surprising that, historically, more than 30 percent of the College’s new PharmD graduates pursue residencies, compared to a national average of 18 percent.

“Our residency program has never stopped evolving, never stopped seeking ways to improve our training, teaching, and research capabilities,” states Nabil Khalidi, PharmD’74, director of international programs, and long-time director of the pharmacy residency program at University of Michigan Hospitals and Health System (UMHHS). “In addition to providing experiences that all other large teaching institutions provide, we stress teaching, research, writing-skill development, and peer-to-peer presenting — all in the context of clinical-skill development. Preceptorship and mentorship continue to be our main model for training residents.”

Past and present Michigan Pharmacy residents gathered Friday, June 1 to celebrate the unveiling of the Michigan Pharmacy Residency display case. Located on the first floor of C.C. Little Building, the display case will house a changing exhibition of photos, artifacts, historical sketches, educational vignettes, first-person narratives, and other content related to the residency experience at U-M from the 1930s to the present day. Participating in the June 1 dedication were, left to right: Shawna Van de Koppel, PharmD’06, PharmRes’07; Dorothy Surowiec, PharmRes’07; Valerie Luis, PharmD, PharmRes’07; P.Neil Edillo, PharmD’05, PharmRes’07; Gloria Francke, PharmRes’46, PharmD; Harvey A.K.Whitney Jr., BSPharm’59, PharmRes’61, MSPharm’61; Jennifer Ludwig, PharmD, PharmRes’07; and James Miller, PharmD’06, PharmRes’07.

Khalidi recalls that in the late 1960s and 1970s, when the PharmD program was an add-on to the five-year BSPharm degree, U-M offered the combined PharmD-Residency program. When the College standardized to the six-year PharmD degree in 1979, the residency program was spun out as a separate option. In the early 1980s, U-M expanded its residency options by offering specialty residency (PGY2) programs; this, at a time when very few institutions in the nation offered such options.

U-M recently helped ASHP revise PGY2 standards criteria to make them more rigorous, reflecting the higher-level clinical and administrative skills specialty pharmacists need to succeed in contemporary health systems. Last year, five UMHHS PGY2 residencies — pediatrics, hematology/oncology, information technology/informatics, critical care, and infectious diseases — were accredited by ASHP. (U-M is one of the first programs to be ASHP accredited in the area of PGY2 in informatics training.) This year, Michigan will add a sixth accredited PGY2 residency, in cardiology.

Succession of Thought-Leaders

“Hospital pharmacy practice excellence and pharmacy resident training excellence go hand-in-hand,” observes Manasse. “Michigan has achieved both, thanks to a long line of talented, visionary pharmacy directors, from Harvey A.K. Whitney Sr. right up to the present day with Jim Stevenson, PharmD. Each director has been a respected leader in his own right, and has maintained a strong commitment to residency education. This commitment shows not only in the quality of the residency training program, but in the achievements of the individuals who have completed a Michigan residency training program.”

Manasse cites another important factor in Michigan’s tradition as a top-echelon pharmacy resident training ground: the tight integration of the pharmacy department at UMHHS and the College.

“Only 25 U.S. colleges of pharmacy are located in such centers,” Manasse says. “There are many, built-in advantages whenever you have a close relationship between a medical center pharmacy operation and a college of pharmacy. One, of course, is a shared commitment to keep the educational mission a top priority.”

Despite the fact that there are 900 ASHP-accredited pharmacy resident training programs, placement demand now out-strips the supply. This trend is certain to continue, says Janet Teeter, RPh, MSPharm, director of the Accreditation Services Division at ASHP.

Part of the growing demand for residency training is the evolution of the pharmacy curriculum itself, Teeter notes. In 2004, the pharmacy profession completed a change begun four decades earlier: standardizing to the PharmD as the sole professional pharmacy degree. (Michigan, as mentioned earlier, made the switch in 1979.)

“Now that every pharmacy school offers a PharmD, residencies have become the means for students to differentiate themselves,” Teeter says. “If they want to go into practice at many clinical sites, they must complete a residency, first; at least that’s true for a hospital setting. It’s less an issue in community practice at this point; however, we are starting to accredit residencies on the community side, too.”

In June, the ASHP House of Delegates adopted a resolution stating that any health system pharmacist with responsibilities for direct patient care should complete an ASHP-accredited PGY1 residency as a pre-condition of employment. The resolution calls for this requirement to be in place by 2020.

“You will see our profession talking more about this as job responsibilities and demands for advanced clinical skills mount,” Teeter observes. “The driving force behind this resolution is that while pharmacy school is great for imparting basic practice knowledge, and experiential training provides a sampling of career options, it’s the residency that integrates the knowledge and teaches you how you function as an interdisciplinary team member in a complex healthcare environment.”

Harvey A. K. Whitney Sr. must be smiling as he watches the unfolding wonder that was his brain child 80 years ago.