PGY2 Ambulatory Care Pharmacy Residency

At LHMC, the Pharmacotherapy Clinic exemplifies collaborative, patient-centered care. Through Collaborative Drug Therapy Management (CDTM) agreements, Ambulatory Clinical Pharmacy Specialists (CPS) at LHMC Pharmacotherapy Clinic provide comprehensive disease state management and optimize therapeutic outcomes in areas such as:

• Diabetes
• Hypertension
• Dyslipidemia
• Heart failure
• Specialty areas such as gastroenterology

In partnership with physicians and other healthcare professionals, CPSs individualize and initiate medication therapy, monitor progress, adjust medications, and educate patients to promote self-management and adherence. This collaborative model positions pharmacists as integral members of the care team—improving outcomes, enhancing satisfaction, and supporting high-value care across the system.

Pharmacotherapy Clinic services are provided both in-person and via telehealth, using Epic video, Doximity, or telephone visits.

Patient Population

The patient population within pharmacotherapy clinic is primarily adult outpatients with a span of insurance types—including commercial, Medicare, and Medicaid—providing opportunities to navigate real-world medication access and coverage challenges amidst evidence-based care. Patients also present with a spectrum of health literacy levels, allowing residents to develop tailored education strategies, enhance communication skills, and optimize adherence and outcomes.

Required Learning Experiences

Learning experiences are structured in a longitudinal format that emulates an established clinical pharmacy specialist (CPS) schedule, with varying clinical experiences throughout the work week.

Following orientation, rotations are organized by quarters, 10-12 weeks in length, with 1-2 days spent in a clinical area. For example, in the first rotation block, a resident may spend Mondays and Wednesdays in Anticoagulation, Tuesdays in outpatient pharmacy, and Thursdays and Fridays in primary care.

• Orientation (daily for 2-4 weeks, based on resident prior experience)
• Year-long required longitudinal rotations:
  • Primary Care (at least 1-2 days per week)
    • Includes serving as primary preceptor for an APPE student later in the year
  • Research Project
    • Includes dedicated project weeks or clinic time for project intervention
  • Practice Management
• Required longitudinal rotations (1-2 days per week each)
  • Heart Failure, 1 quarter
  • Anticoagulation , 2 quarters
  • Outpatient pharmacy, 1 quarter
  • Specialty pharmacy, 1 quarter
  • Gastroenterology, 1 quarter

There are no on call or weekend duties.

Sample Schedule

Please note the timelines below are approximations of what a schedule could look like.

All required learning experiences are intentionally designed in alignment with the ASHP Accreditation Standard for PGY2 Ambulatory Care Pharmacy Residencies and are driven by the Competency Areas, Goals, and Objectives (CAGOs). Residents will develop advanced skills across the required competency areas, including Patient Care; Advancing Practice and Improving Patient Care; Leadership and Management; and Teaching, Education, and Dissemination of Knowledge—ensuring well-rounded preparation for independent clinical practice in ambulatory care.

All ASHP-required goals and objectives will be assigned to one or more learning experiences, assessed by preceptors, and evaluated longitudinally. Residents must demonstrate progression toward mastery of each objective over the course of the year.

Elective Learning Experiences

• Quarter-long longitudinal elective rotations (2-3 per year, 1 day per week)
  • Pulmonary
  • Population health
  • Informatics 
  • Palliative Care
  • Hematology/Oncology*
  • Solid Organ Transplant*
  • Advanced experience in any core rotation

*For 2026-2027, elective rotations in Solid Organ Transplant and Hematology/Oncology may not available due to pharmacist preceptor availability

Practice Management

Personal Professional Development: encompasses the resident's day-to-day practice; it occurs on a daily basis, not necessarily during discreet blocks of time. In addition, the resident will have a dedicated ½ day session during the week to work on related practice management projects and meet with preceptors on longitudinal development.

Pharmacy Leadership & Administration: exposure and practice of the necessary skills in pharmacy leadership, including, topic discussions with pharmacy leaders, preparing or updating policies/procedures/documents necessary for the current pharmacy administration needs, and maintaining a comprehensive portfolio with evidence of their completed activities, including documentation of patient cases, presentations, research, etc.

Research Project Requirements

PGY2 residents design and lead an ambulatory care project that develops a new service or enhances an existing one, directly or indirectly benefiting LHMC patients. Projects must be suitable for national presentation and publication, though publication is not required for program completion.

Residents manage all aspects of the project, including planning, implementation, communication, and meeting deadlines, fostering professional growth and hands-on experience in practice improvement. The resident will be expected to develop their own research idea, though may be assigned a project depending on institution/departmental needs.

The resident is responsible to set and meet project activity deadlines throughout the year, and adhere to professional conduct, including effective communication with research team members and creation of project content as outlined in the learning experience description.

Examples of past projects include:

• Impact of a Pharmacist-Led Glucagon-Like Peptide-1 Receptor Agonist Weight Loss Pharmacotherapy Clinic in the Primary Care Setting (2023-2024)
• Perioperative Management of Direct Oral Anticoagulants and Antiplatelet Therapy for Gastrointestinal Procedures (2022-2023)
• Implementation and evaluation of a pharmacist-led antidepressant follow-up telehealth service (2021-2022)
• Pharmacist-Led Deprescribing of Proton Pump Inhibitors in the Elderly (2020-2021)
• Impact of a quality improvement initiative for patients with type 2 diabetes and atherosclerotic cardiovascular disease eligible for a GLP-1 agonist or SGLT2 inhibitor (2019-2020)
• Effectiveness of a pharmacist-led intervention on clinical and economic outcomes in patients with asthma who overuse asthma rescue medication compared to controller medication (2018-2019)

Required Deliverables & Additional Expectations

Residents must maintain a comprehensive portfolio with evidence of their completed activities, including documentation of patient cases, presentations, research, etc. Residents are required to track appendix progression (ASHP Required Areas of Patient Management) in Pharmacademic on a weekly basis. Resident portfolios and appendix entries will be reviewed quarterly, at minimum.

Teaching

• Annual update to pharmacist employee flu vaccination competency and facilitate training for PGY1 residents and other pharmacists 
• Two clinical presentations to the ambulatory care pharmacy team
• Two formal education sessions to internal medicine providers
  • Such as during weekly division meeting CME, monthly provider meetings, advanced practice provider meetings, or medical resident education series. Education to general internal medicine providers (minimum of 2 topics)
• One education session to multidisciplinary CDCES group, comprised of pharmacists, nurse educators, dieticians and a nurse practitioner.  
• Facilitate the “Medications and You” group class for the Diabetes Self-Management Education (DSME) patient program (observe 1 and provide at least 1)
• Continuing Education activity for pharmacists (1 hour). This may serve as a competency
• A didactic lecture and/or facilitating therapeutic seminar at a local college of pharmacy
• Co-precepting pharmacy students & PGY1 residents

Rotation Locations

While the majority of learning experiences occur on the Burlington, MA, campus, residents will also participate in activities at additional BILH sites. For example, the specialty rotation includes required travel to BILH Pharmacy Direct in Westwood, MA (approximately 1 day per week for 10 to 12 weeks).

Elements of other rotations may also be delivered at affiliated locations such as Lahey Medical Center in Peabody, MA, and Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA.

Access to a car is recommended for ease of travel between training sites.

Please note that curriculum changes may occur throughout the year, depending on resident and program needs.

Precepting within the program combines in-person and virtual supervision, allowing for flexibility in learning, continuity of patient care, and real-world experience managing diverse patient encounters. We provide a supportive precepting approach that gradually transitions from close, direct guidance to growing independence as residents demonstrate readiness.

The approach is progressively tailored to each resident’s development toward greater autonomy as clinical independence and confidence grow. Our preceptors are actively engaged in continuous professional development, ensuring the teaching and mentorship residents receive reflects current best practices and evolving standards in ambulatory care.

Mentorship & Program Leadership Support

Residents receive strong, personalized mentorship throughout the year. The resident will maintain regular, scheduled touchpoints with the residency program director and/or the residency program coordinator to guide professional growth, competency development, and successful advancement through the program.

Meetings with program leadership occur more frequently at the start of the residency year to provide focused support, then taper to a minimum of quarterly follow-ups as residents progress toward independence.

Residents also work closely with Clinical Pharmacy Specialists in ambulatory care who provide ongoing clinical guidance, performance feedback, and role modeling. This multi-layered support structure fosters continuous development, confidence, and independence as an advanced practitioner in ambulatory care pharmacy.

Internal PGY1 residents may be considered for early commitment. Please contact RPD for more information regarding the early commitment process. All other applicants must participate in the National Matching Services Program. Requirements include:

• Doctor of Pharmacy degree from an ACPE-accredited school of pharmacy
• Successful completion of an ASHP-accredited PGY1 pharmacy residency program
• Active Massachusetts pharmacy license by September 1
• Complete application in PhORCAS by deadline (letter of intent, curriculum vitae, three letters of recommendation using the Standard Reference Template Form, official college of pharmacy transcript)
• Interview by invitation

The PGY2 Ambulatory Care Pharmacy Residency offers the following benefits to residents:

• Annual stipend of $63,000
• Medical and dental insurance
• Basic and supplemental term life insurance 
• Ten days paid time off (sick or vacation time) and six paid holidays 
  
  • Residents accrue earned-time. Unused or accrued earned-time is paid out at the end of the year, or rolled over if employment is continued beyond PGY2.
• Free on-site parking  
  
  • Up to 25% of the program may occur at other practice site locations, such as our dispensing pharmacy in Westwood, MA, or other affiliated facilities and care centers. Reimbursement for mileage, tolls and parking is not available, but we expect such travel to be minimal and parking is free at most sites.
• Attendance at regional meeting to present research project
• Registration and travel reimbursement for a national meeting to present research project
  
   

Sarah L. Howard, PharmD, BCACP
PGY2 Ambulatory Care Residency Program Director
Ambulatory Care Clinical Pharmacy Specialist, Pharmacy Department
Email Sarah