At the 2014 American College of Emergency Physicians Scientific Assembly, ACEP passed Resolution 44, officially recognizing Emergency Medicine Pharmacists as valuable members of the EM team. Nadia Awad (@Nadia_EMPharmD) summarized the importance of the resolution’s passage on the EMPharmD blog. The role of an EM Pharmacist has been outlined by the American Society of Health-System Pharmacists (ASHP). In addition, Zlatan Coralic (@ZEDPharm), one of ALiEM’s regular contributors, framed the EM Pharmacist as the ‘ultimate consult service.’ The intent behind this post is not to discuss the role of the EM Pharmacist, but to highlight the rigorous training process through which most EM Pharmacists have traversed to work in this amazing specialty.

The inspiration for the post came from my good friend Brent Reed (@brentnreed), a cardiology pharmacist who leads The Unit blog. He wrote of the intense training to become a cardiology pharmacy specialist in a recent post Clinical Pharmacy Specialist in Cardiology: What’s in a Name? I highly recommend reading his post to understand the intimate details behind pharmacy training programs in the U.S. The purpose here is to focus on the training needed to specialize in emergency medicine pharmacy practice.

Pre-Pharmacy

All pharmacists in the U.S. must first complete at least 2 years of undergraduate education before entering the Doctor of Pharmacy program. Specific pre-pharmacy coursework is required. Most pharmacists have a 4-year undergraduate degree before entering pharmacy school, similar to their physician colleagues.

Testing

Analogous to the MCAT, most pharmacy schools require the Pharmacy College Admission Test (PCAT).

Pharmacy School

The only degree now available for pharmacists is the Doctor of Pharmacy (PharmD). This is a four-year program similar to medical school. The first 2-3 years cover the essentials of pharmacy including pharmacology, therapeutics, and medicinal chemistry. The final year is dedicated to clinical rotations, though some schools have more than a year’s worth of patient-focused clinical activity.

Licensing

After graduation and before any pharmacist can practice pharmacy, two licensing examinations must be passed. The first is the NAPLEX which tests clinical knowledge and pharmacy calculations. The second is the MPJE, which is both a federal and state-specific law exam. A pharmacist must pass the law exam for each state in which he/she practices.

PGY-1 Residency Training

Similar to the intern year of physician residency training, pharmacists can pursue a PGY-1 pharmacy residency. The pharmacist rotates for 4-5 weeks in various units throughout the hospital under the supervision of a pharmacist expert in that area. ASHP accredits most of the PGY-1 training programs in the U.S. to meet strict standards for clinical, educational, research, and teaching content, and the proper support staff for optimal learning.

PGY-2 Training and Beyond

Many EM Pharmacists have completed a second year of residency focused specifically on emergency medicine. ASHP accredits most of the EM PGY-2 programs. Unfortunately, the number of EM PGY-2 training spots available does not meet the demand. There are only about 30 EM pharmacy training programs in the U.S. So, some EM Pharmacists have completed other related training programs before becoming an EM Pharmacy Specialist. Some have a PGY-2 in critical care. Others have completed clinical toxicology residencies or fellowships. I wrote about the clinical toxicology residency and fellowship programs a few years back in the American Journal of Health System Pharmacy.

Board Certification

After completing one or two years of residency training, most pharmacists practicing in clinical pharmacy obtain board certification. While there is not a specific board certification for EM pharmacy just yet, there is one for general pharmacotherapy (BCPS). Similarly, those with specific training in toxicology can obtain board certification in that area through the American Board of Applied Toxicology (ABAT). Both paths are rigorous in their credentialing, examination, and continuing certification processes.

My Journey in Emergency Medicine

2000: B.S. Chemistry, Worcester Polytechnic Institute, Worcester, MA

2005: Doctor of Pharmacy (PharmD), Massachusetts College of Pharmacy & Health Sciences, Worcester, MA

2006: PGY-1 Pharmacy Residency, UMass Memorial Medical Center, Worcester, MA

2008: Clinical Toxicology Fellowship, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD

2011: Board certification in clinical toxicology, American Board of Applied Toxicology (DABAT)

2014: Fellow of American Academy of Clinical Toxicology (FAACT)

2017: Fellow of the American Society of Health-System Pharmacists (FASHP)

From 2008-2016, I was privileged to work with some of the best EM faculty, residents, and nurses in the world at the University of Maryland Medical Center in Baltimore. Now I am doing the same at Massachusetts General Hospital/Harvard Medical School.

Final Thought

If you’re working with an EM Pharmacist, be assured that most have completed at least one year of post-graduate residency training (if not two or three) focused on direct patient care and are probably board-certified in their area of expertise.