PGY1 Pharmacy Residency Curriculum

Preceptor/s:
Ryan Chapin, PharmD, BCIDP
Nicholas Mercuro, PharmD, BCIDP
BIDMC Clinical Specialists, Infectious Diseases/Antibiotic Stewardship

Rotation description: The Infectious Diseases (ID) rotation is a required, five week learning experience. There are two ID teaching teams: one focusing on the immunocompromised patient and the other on the immunocompetent patient. Each team includes an attending physician and 2 ID fellows. Additional team members may include medical interns, medical residents, medical students, pharmacists and/or pharmacy students. The ID consult service sees a wide variety of patients from many different backgrounds (medical service, critical care, oncology, HIV, etc.).

The resident works with the ID consult team at daily rounds, maintaining a responsibility to optimize anti-infective therapy for the consult patients. This includes dosing recommendations based on organ function, avoidance or mitigation of adverse reactions, and daily monitoring of anti-infective therapies, including performing kinetics consultations. While on rotation, the resident will also participate in the P&T Antimicrobial Subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and ID Departments.

Preceptors:
Alexa Carlson, PharmD, BCPS
Assistant Clinical Professor, Department of Pharmacy Practice
Northeastern University, Bouvé College of Pharmacy and Allied Health Sciences

Nicholas Edmonds, PharmD
Clinical Pharmacy Manager, Med/Surg

Kristen Knoph, PharmD, BCPS
BIDMC Clinical Pharmacist

Rotation description: Internal Medicine (IM) is a required, five week learning experience. The goal of the IM rotation is for residents to develop skills and competencies in the provision of pharmaceutical care for a diverse population of IM patients, enabling them to effectively participate in therapeutic decision making, drug therapy selection, monitoring of acutely ill patients and discharge counseling. Typically pharmacy residents will round on one of 4 internal medicine teaching teams: Robinson A, Robinson B, Kurland A, or Kurland B. Each of the teaching teams includes an attending physician, a PGY2 or PGY3 medical resident, 2 PGY1 medical interns, and medical students (MSIII or MSIV). Other disciplines on the team include the clinical pharmacy specialist or clinical pharmacist, and pharmacy students.

The clinical pharmacy specialist, and in turn the pharmacy resident on the team is responsible for ensuring safe and effective medication use for all patients. This involves active participation in daily rounds and collaboration with other pharmacy, nursing, and physician personnel as appropriate. The pharmacy resident is responsible for identifying and resolving medication therapy issues for all patients on their team. These problems include drug dosing, drug allergy issues, drug-drug and drug-disease state interactions, adverse drug reactions, drug monitoring, route of administration, and cost-effectiveness issues. The pharmacy resident should assume an active role in assisting the team with medication reconciliation issues, including obtaining accurate home medication lists, and providing patient counseling at the time of discharge. Strong communication and interpersonal skills, as well as time management skills are necessary to succeed during this rotation experience. Residents will have opportunities to further refine these abilities and further develop their clinical knowledge, ability to provide patient care, develop a working relationship with an interprofessional health care team, identify and interpret health literature, and educate patient and providers while on this rotation.

Preceptors:
Gabrielle Cozzi, PharmD, BCCCP
BIDMC Clinical Pharmacist

Mehrnaz Sadrolashrafi, PharmD, BCCCP
BIDMC Clinical Pharmacist, and others

Rotation description: The Medical Intensive Care Unit (MICU) rotation is a required, 5 week learning experience at Beth Israel Deaconess Medical Center. The MICU typically has a service of up to 8 patients, but this may increase based on the specific location (East Campus versus West Campus) and service (MICU orange versus green). Each MICU team consists of an attending pulmonary/critical care physician, pulmonary/critical care fellow, 2-3 senior medical residents, and 2-3 medical interns. Additionally, rounds are attended by the critical care nurses and respiratory therapy/physical therapy as needed.

The medical intensive care unit (MICU) rotation allows the pharmacy resident to gain experience in caring for the critically ill patient with a focus on pulmonary or GI/liver disease. The resident will attend daily rounds and be involved with medication management with the MICU team. Responsibilities will include proactively assessing and monitoring all aspects of care of the critically ill patient with various end-organ failures (e.g. lung, kidney, liver etc.). The resident will participate in drug monitoring, renal dosing, individualized pharmacokinetics assessment, and patient interaction/education as needed. Along with these clinical requirements, the resident will be responsible for various topic discussions relating to critical care or respiratory or systemic end-organ disease, such as acute respiratory distress, acute/chronic/end-stage organ failure, fluid/nutrition/electrolyte imbalance, acid-base disorders, mechanical ventilation, sepsis and hemodynamic imbalance, sedation/analgesia, use of neuromuscular blocking agents, liver failure, GI bleeding and toxic ingestion or drug overdose.

The decentralized clinical pharmacist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation in work and attending rounds daily, education of physicians and nurses, and education of pharmacy trainees, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees. When a pharmacy resident is on service, they will assume the roles of the decentralized clinical pharmacist, under the supervision of the critical care rotation preceptor/s. By week 3 of the rotation experience, the resident will also be asked to process all medication orders for the MICU team on which they are rounding as well as complete all departmental drug monitoring requirements (Vancomycin and anticoagulation).

Preceptor:
May Adra
Director, Pharmacy Safety, Quality & Regulatory Affairs

Rotation description: Medication Safety is a required, 4 week learning experience. The goal of the medication safety rotation is to offer the resident experience in identifying methods to enhance the medication use system to minimize the risk of adverse drug events. During this rotation, the resident will gain knowledge and experience in identifying and analyzing medication errors, adverse drug reactions and adverse drug events. The resident will identify opportunities for improvement in the organization's medication-use system by comparing the medication-use system to relevant best practices using the Institute for Safe Medication Practices newsletters or other recent literature on patient safety as a comparator. The resident will have the opportunity to develop and implement safe medication practices. Activities will include participating in medication error reporting, performing a root cause analysis, and when feasible completing a failure mode and effects analysis. The resident will work collaboratively with members of the medication safety subcommittee and other quality improvement committees in the hospital. The resident's responsibilities will include preparing meeting agendas, taking minutes, analyzing medication events, publishing a medication safety newsletter, performing quality improvement initiatives, and providing educational sessions on safe medication practices.

Preceptor:
Nick Edmonds, PharmD
Clinical Pharmacy Manager, Med/Surg

Co-Preceptor/s:
TBD as assigned per practice site

Rotation description: The Pharmacy Practice Concentrated Learning Experience provides the resident the opportunity to develop essential practice skills in the role and responsibilities of a Clinical Pharmacist in one of the medical center’s decentralized practice sites. This rotation builds upon the fundamental knowledge gained through their initial training and work in the central pharmacy and facilitates the resident to advance their training and practice to be able to independently practice as a decentralized Clinical Pharmacist. The role of a decentralized Clinical Pharmacist in an assigned practice area includes the medication management and oversight of 60-100 patients on one or more floors. The focus of training will be geared towards the routine operational and clinical responsibilities of the decentral pharmacist.

Preceptor:
TBD as assigned per practice site

Rotation description: BIDMC is one of the Advanced Pharmacy Practice Experience (APPE) sites for 6th year PharmD students from MCPHS University. The resident will be involved in providing experiential education to the clerkship students, including teaching and student assessment as it relates to providing pharmaceutical care. One of the main goals of the rotation is for each resident to effectively develop essential precepting/teaching skills utilizing his/her own experience and guidance from the teaching rotation preceptor. The rotation will allow the resident to use a variety of learning activities that meet MCPHS University objectives for the in-patient APPE rotation. The resident will design a syllabus incorporating those learning activities and formulate site-specific goals and objectives for student-centered activities. During the rotation the resident will guide students in developing professional skills required for in-patient pharmacy activities and assess student performance in accordance with the MCPHS University PharmD experiential program guidelines.

Each resident will participate in several venues to provide drug information, which include but are not limited to Drug Information Questions, Development/update of PPGD, P & T Committee Formulary Reviews and other drug information activities, etc. The goal of these activities is to provide the resident with experience in the provision of pertinent drug information in a number of venues.

Each resident will serve as a MCPHS University instructor in PPB 551, Pharmacotherapeutics Seminar, during the fall and spring semester. The course requires the resident to be at the University for approximately three hours per week. The goal of this experience is for the resident to gain experience in problem based learning techniques and small classroom facilitation. The resident will facilitate a weekly case based discussion with fifth year PharmD students to assist in the students' development of professional problem solving skills. During each class, the resident will be expected to encourage an open forum for discussion to help enhance the students' ability to communicate and to help them develop life-long learning skills.

Each resident will work with Safety coordinator on related activities throughout the residency year.

Each resident is responsible for the completion of residency project. The project may be in the form of original research, a problem-solving exercise, or development, enhancement or evaluation of some aspect of pharmacy operations or patient care services. As a component of the project, the resident will submit the project as a work in progress for poster presentation at the ASHP Midyear Meeting. Each resident will complete a project report using an accepted manuscript style suitable for publication in the professional literature.

A number of activities and opportunities for leadership development will be scheduled throughout the residency year to foster an understanding of leadership within the department of pharmacy, within the profession of pharmacy and within the field of healthcare.

During the residency year, each resident will participate in a minimum of two P&T Committee meetings where he/she will: Take minutes at meetings and summarize ; Develop and present a drug monograph/ guideline for formulary consideration; Develop and complete a MUE; Contribute to hospital drug information communications.

Each resident will participate in the weekly Resident Report where the focus will be to develop oral and written skills through a variety of clinical skills activities such as: case presentations, journal clubs, problem based learning activities and others.

Each resident is required to complete a pharmacy service component of the residency program. Often referred to as "staffing," the service component of the residency is crucial to the development of professional practice and distribution skills so as to provide safe and effective pharmaceutical care. Residents will gain insight into the operations, policies and procedures of an acute-care facility.

Each resident will participate in the Residency Teaching Certificate Program (RTCP) at MCPHS University. The RTCP will provide residents with a foundation of core educational principles presented in live and online didactic modules. Mentored by an academic faculty preceptor, the resident will also gain practical teaching experience in a variety of educational settings (large/small classroom, clerkship, laboratory, or seminar). Residents will also develop, with the assistance of their faculty mentor, a formative teaching portfolio that will document their progress and enhance the learning experience.