Graduate Pharmacy Education

Application for Pharmacy Residency Programs

November 16, 2011

Dear Residency Applicant,

Thank you for your interest in the Pharmacy Residency Programs at the University of Chicago Medical Center. As I am sure you have found out by now, all PGY1 and PGY2 pharmacy residency programs at UCMC are unified as a group collectively referred to as Graduate Pharmacy Education (GPE). This conscientious integration of senior residents (PGY2) with junior residents (PGY1) provides all programs a dynamic and collaborative training environment based on the principles of graduate medical education. Collaboratively these programs develop residents into independent practitioners and pharmacy leaders who possess in-depth therapeutic knowledge, confident precepting skills, and integrated professional attributes.

Attached you will find a copy of the GPE Application which is used by all pharmacy residency programs at UCMC (PGY1 Pharmacy, PGY2 Cardiology, PGY2 Critical Care, PGY2 Infectious Diseases, PGY2 Internal Medicine, PGY2 Oncology, and PGY2 Pediatrics residencies). Program requirements and submission instructions are listed in detail on the last page of the application. In summary, all candidates must submit a completed application, formal letter of intent, curriculum vitae, official transcripts for all pharmacy education, and three formal recommendations from health care professionals and/or supervisors who can attest to practice abilities and aptitudes. UCMC utilizes a standardized recommendation form which serves as the official documentation tool for residency recommendations. The “Pharmacy Residency Recommendation Request Form” is separate from the application and available electronically. Supplemental letters may accompany this form at the discretion of the recommender. All application materials except the official transcripts should be emailed to our residency application review committee at .

Applicants should submit a single email which contains their application, letter of intent, and curriculum vitae as attachments. Application emails should include the applicant’s last name, first name, and the name of the program to which you are applying in the subject line (e.g. “Last Name, First Name PGY1 Pharmacy”, “Last Name, First Name PGY2 Critical Care Application”, etc.). Letters of recommendation may be emailed as attachments from an official professional email account (letters of recommendations sent from public accounts such as Gmail will not be accepted) directly to the above email address. Recommendation emails should include the applicant’s last name, first name, and the following phase in the email title “Last Name, First Name Letter of Recommendation”. Printed and signed letters of recommendation may alternatively be mailed to the address below.

Please note all application materials must be received by January 3, 2012. Incomplete applications will not be considered. On-site interviews will be extended to selected applicants. Thank you in advance for your consideration of the programs at UCMC. We look forward to receiving your application packet. Please feel free to contact us if you have any questions.

Sincerely,

Heath R. Jennings, PharmD, BCPS (AQ Cardiology)

Executive Director of Pharmacy and Acute Care Services

Director of Graduate Pharmacy Education

University of Chicago Medical Center

5841 S. Maryland Ave, MC 0010 TE026

Chicago, IL 60637


Graduate Pharmacy Education / Pharmacy Residency Program
Application
Choose programPGY1 Pharmacy ResidencyPGY2 Critical Care ResidencyPGY2 Internal Medicine ResidencyPGY2 Oncology ResidencyPGY2 Pediatrics ResidencyPGY2 Cardiology ResidencyPGY2 Infectious Diseases Residency

Please type your answers. Candidates will be invited for on-site interviews based on their score in the following four areas: education and GPA, pharmacy practice experience, professional development activities, and community service / extra-curricular activities.

APPLICANT INFORMATION

Name (First, Middle, Last)
Date of Birth / U.S. Citizen? / No / Yes
Preferred Mailing Address
Alternate Mailing Address
Preferred Telephone Number / Alternate Telephone Number
Preferred E-Mail Address
ASHP Match Number

EDUCATION & GPA

List colleges/ universities attended, dates of attendance and degrees earned beginning with most recent.

College/University / Dates Attended / Degree/Major / GPA / Degree Obtained
(Yes/No)
Current Pharmacy GPA / GPA Scale (e.g., 4.0)

PHARMACY PRACTICE EXPERIENCE

Practice Pharmacy Experiences

PGY1 applicants should describe their student rotations and clerkship experiences. PGY2 applicants should describe their PGY1 rotation experiences.

What was the length of each rotation? / weeks
How many of your rotations included direct patient care (rounds, counseling, monitoring, etc.)?
How many of your rotations included operational experiences (dispensing, compounding, etc.)?
Rotation Name / Practice Site of Rotation / Dates
From To / Direct Patient Care
Yes / Ave # Pat.


Hospital Experience

Have you practiced in a hospital pharmacy? / No / Yes, for / years

In reverse chronological order, please list your pharmacy practice experience.

Place of Employment / Location / Dates / Position Held
Are you a licensed pharmacist? / No / Yes, for / years
State of License / License Number / Renewal Date

PROFESSIONAL DEVELOPMENT ACTIVITIES

Professional Organizations, Committees, & College Groups

Professional Organization / Committee / College Group / Leadership Positions Held / Dates

Research, Presentations, & Publications

Do you have research experience? / No / Yes, please list below
Research Project Title / Your Role / Dates
Do you have any local, state, or national presentations? / No / Yes, please list below
Presentation Title / Venue Presented / Date
Do you have any peer-reviewed publications? / No / Yes, please list below
Publication Title / Journal Published / Date

COMMUNITY SERVICE & EXTRACURRICULAR ACTIVITIES

List the community service and extracurricular activities which you have been involved in the last 4 yrs.

Community Service / Extracurricular Activity / Your Role / Dates


REFLECTIVE RESPONSES

Please provide a narrative commentary for each of the following questions in the space provided below. Please limit responses to 1250 characters or less.

1.) Why are you pursuing a residency (PGY1 or PGY2 as appropriate), and what characteristics make up your ideal program?
2.) Why you are interested in the Pharmacy Residency Programs at the University of Chicago?
3.) Please describe your current pharmacy practice interests and your professional goals.
4.) Please describe the personal professional weaknesses you wish to improve during your residency.
5.) Please describe your professional and personal strengths and any other special attributes.
6.) Please describe a situation that involved a conflict among peers and describe how you worked to
resolve the issue.


SUBMISSION INFORMATION

All application materials except the official transcripts should be emailed to our residency application review committee at .

Application Packets – Please submit a single email which contains the completed application, letter of intent, and curriculum vitae as attachments. Application emails should include the applicant’s last name, first name, and the name of the program to which the applicant is applying in the subject line (e.g. “Last Name, First Name PGY1 Pharmacy”, “Last Name, First Name PGY2 Critical Care Application”, etc.). Official transcripts should be in a Registrar sealed envelope and send directly to the address below. Official transcripts may be sent directly from the Registrar.

Recommendations – “Pharmacy Residency Recommendation Request Forms” and any supplemental letters should be emailed directly as attachments from an official professional email account. Recommendations sent from public accounts (such as Gmail) will not be accepted. Recommendation emails should include the following phase in the email title “Last Name, First Name Letter of Recommendation”. Printed and signed letters of recommendation may alternatively be mailed to:

Heath R. Jennings, PharmD, BCPS

Graduate Pharmacy Education

Department of Pharmaceutical Services

University of Chicago Medical Center

5841 S. Maryland Ave

MC 0010 TE026

Chicago, IL 60637

Check List:

Application

Letter of Intent

Curriculum Vitae

Official transcripts for all pharmacy education

Three “Pharmacy Residency Recommendation Request Form” – UCMC utilizes a standardized recommendation form which is to be completed by health care professionals who can attest to your practice abilities and aptitudes. All applications must include three formal recommendations which are completed separately using this tool. Supplemental letters may accompany this form at the discretion of the recommender.

The complete application packet should be RECEIVED no later than January 3, 2012. Incomplete application packets will not be accepted.

APPLICANT ATTESTATION OF ACCURACY

By denoting my signature below (or typewritten signature for electronic applications), I certify the information submitted in this application is complete and correct to the best of my knowledge and belief. I grant the University of Chicago Medical Center permission, if necessary, to request additional information from previous schools, employers, and any organization listed in this application to verify my academic record and professional activities.

Signature ______Date ______

Last updated 11/16/11

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