Definitions of pharmacy residencies and fellowships.

Pharmacy residencies (originally termed “internships”) began in the early 1930s, primarily for the purpose of training pharmacists for the management of pharmacy services in hospitals. The first nonacademic residency program is believed to have been conducted by Harvey A. K. Whitney at the University of Michigan Hospital. Approximately 10 years later, the first residency program combined with formal graduate studies was created. Developments in these programs eventually led the American Society of Hospital Pharmacists to establish, in 1948, standards for pharmacy internships in hospitals. Those standards defined an internship as “a period of organized training in an accredited hospital pharmacy under the direction and supervision of personnel qualified to offer such training.” Two types of internships were recognized, nonacademic and academic. The nonacademic internship consisted of a period of training in a hospital pharmacy. The academic internship consisted of training in a hospital pharmacy and study in an accredited graduate school associated with a college of pharmacy and leading to a Master of Science degree. In 1962, following several revisions in the standards, ASHP established an accreditation process and accreditation standards for residencies in hospital pharmacy. In this action, the term “internship” was replaced by “residency.” A residency was defined as “a postgraduate program of organized training . . .” (and further detailed within the various standards). In 1985, the concept that a resident’s training should be directed was incorporated into the definition. It was also acknowledged that a residency is practice oriented and that it is possible for a residency to focus on a defined (specialized) area. During the early 1970s, numerous residencies developed in clinical practice, leading to the establishment, in 1980, of accreditation standards for clinical pharmacy and specialized residency training. In 1986, the American Pharmaceutical Association published a compilation of programmatic essentials for community pharmacy residencies. In that same year, the American College of Apothecaries published specific guidelines for the accreditation of community pharmacy residencies. Paralleling these developments and fostered by a growing sophistication and clinical thrust in institutional pharmacy practice, postgraduate research-oriented programs (generally termed “fellowships”) developed in the 1970s. These programs were conducted primarily in colleges of pharmacy and in academically based health centers to educate and train individuals to conduct pharmacy research. A 1981 survey of fellowship programs reported the existence of 58 fellowships in 19 topic areas. Two-thirds of these fellowships had existed for 3 years or less. The oldest program had existed for less than 9 years. The ASHP Research and Education Foundation initiated clinical fellowships in 1978 and defined a pharmacy fellowship as “a directed, but highly individualized program [that] emphasizes research. The focus of a pharmacy fellowship is to develop the participant’s (the fellow’s) ability to conduct research in his or her area of specialization.” ASHP publishes an annual directory of ASHPaccredited residency programs. In 1985, there were 184 accredited programs. The American College of Clinical Pharmacy publishes an annual listing of residencies and fellowships conducted by its members. In 1985, ACCP reported the availability of 51 such residencies and 83 such fellowships. Another source reported 115 known fellowships in 1986. In that year, there were 12 clinical fellowships sponsored by the ASHP Research and Education Foundation in nine areas of specialization. By 1986, a lack of conformity had arisen in the use of the terms “residency” and “fellowship,” and considerable potential existed for program applicants to be misinformed or misled regarding program purposes and content. In 1986, at the recommendation of the ASHP Commission on Credentialing, ASHP invited six other national pharmacy organizations to discuss the issue and develop consensus definitions for the terms. The definitions and interpretations that follow resulted from that conference. These definitions and interpretations are viewed as accurate for current residencies and fellowships yet sufficiently broad and flexible to allow the development of new types of programs. Education, practice, and research developments may generate changes in residencies and fellowships and ultimately stimulate revisions in the definitions and interpretations.