Residency training is designed to provide recent pharmacy school graduates who have the profession's terminal Doctor of Pharmacy (PharmD) degree with accelerated growth beyond entry-level professional competence. Placement into residency programs is highly competitive through an application and match process. These programs provide additional training in patient-centered care with advancement of skills in clinical judgment, pharmacy operations, clinical research, project management, and leadership. Approximately 20% of a pharmacy graduating class will apply for a residency. With increasing numbers of pharmacy schools across the country, the availability of residency programs is falling behind applicants. The establishment of the Daniel K. Inouye College of Pharmacy (DKICP) has addressed the shortage of pharmacists within the state. In recent years, resident positions in Hawai'i have doubled to a total of ten first year residency (PGY1) and two second year (PGY2) specialty residencies. Given the limited availability of positions in Hawai'i, graduates continue to return to the continental US to seek positions, thus increasing the likelihood of them not returning to practice in Hawai'i. Establishing residency programs is essential to elevate the level of pharmacy practice toward innovation and adherence to best practices, academia/teaching and scholarly research. This descriptive paper will detail the general components and types of pharmacy practice residency, the unique components of the Hawai'i programs, the career placement of Hawai'i's programs graduates and future challenges.