Pharmacy residency learning experiences

Pharmacy residency learning experiences

The Wilkes-Barre VAMC Clinical Pharmacy Program operates 4 outpatient clinics. Clinical pharmacists are responsible for managing the care of patients in these clinics including medication ordering, monitoring/ordering labs, and making appropriate changes in therapy.

Required learning experience

• Pharmacy Patient Aligned Care Team  (PACT) clinic (8 weeks)
• Anticoagulation (5 weeks)
• Internal medicine (6 weeks)
• Mental health (6 weeks)
• Geriatrics (Longitudinal)
• Pharmacy staffing (Longitudinal)
• Drug information (4 weeks)
• Practice management (3 weeks)

Electives

• Antimicrobial stewardship (5 weeks)
• Academic detailing (5 weeks)
• Diabetes clinic (5 weeks)
• Pain management (5 weeks)
• Home-Based Primary Care (HBPC) (5 weeks)
• Oncology (5 weeks)
• Pharmacy informatics/pharmacoeconomics (5 weeks)
• Teaching certificate in affiliation with Wilkes University (longitudinal)

Patient- Aligned Care Team (PACT):

The Pharmacy PACT clinic is a required 8 week learning experience for the pharmacy practice resident.  It is a clinical pharmacist-operated clinic which provides care for patients who require expertise in the management of chronic medical conditions such as hyperlipidemia, hypertension, diabetes, COPD, congestive heart failure, tobacco cessation, and polypharmacy.  The patients are referred by primary care providers and/or other specialists or can be identified through population health.  The resident can adjust medications after a thorough review of the patient’s medical records and a detailed patient interview.  Other responsibilities include changing regimens as clinically indicated, ordering appropriate labs, monitoring patients throughout therapy, and providing comprehensive patient education.  The resident will document all patient interactions in a progress note which shall be written the same day as the visit.  Medication reconciliation will also be a responsibility of the resident.  The resident will be able to manage patients with chronic conditions with a high degree of independence, confidence, and efficiency. 

 

Anticoagulation management rotation:

The Anticoagulation Management Service (AMS) is a required 5-week learning experience for pharmacy practice residents.  The Anticoagulation Service is a clinical pharmacist operated service, which provides anticoagulation services for all patients on chronic warfarin and direct oral anticoagulants (DOACs) at the medical center and community-based outpatient clinics (CBOCs).  The resident will be required to interview and manage patients receiving chronic anticoagulation therapy after an initial training period.

The resident will become proficient in starting patients’ oral anticoagulants; including warfarin, dabigatran, rivaroxaban, apixaban and edoxaban.  This will also include providing patient education concerning chronic anticoagulation.  The resident will become proficient in management of the DOAC Dashboard. The resident will be responsible for determining the need for bridge therapy when patients on warfarin undergo procedures.

After successfully completing this learning experience, the resident will become proficient in all areas of outpatient anticoagulation.  The resident will also become proficient in providing patient education.  In addition, the resident will gain communication skills as he/she will need to communicate with physicians on a regular basis.  The resident, after successfully completing this learning experience, will be able to manage patients receiving chronic anticoagulation.

 

Internal medicine:

Internal medicine is a required 6-week learning experience.  The Pharmacy Practice resident (PGY-1) will have the opportunity to be involved with all aspects of patient care in the internal medicine/acute care environment.  Residents will be introduced to the treatment modalities, pharmacotherapy, and patient monitoring parameters that are unique to the inpatient hospital setting.  Residents will develop and practice the skills of patient assessment, pharmacotherapy planning, patient monitoring, and evaluation of outcomes of acute medical conditions.  The resident is expected to provide individualized evaluation of drug therapy and participate in the patient’s care through interaction with physicians and other health care professionals.  Interaction and communication with other health care professionals for the promotion of optimal drug therapy are stressed to help the resident develop a sound professional approach to the practice of pharmacy.  In addition, residents are encouraged to broaden their existing competencies and incorporate their professional and personal goals into this clerkship.

Development and utilization of the following skills will be emphasized throughout this clerkship: communication, patient interaction, patient monitoring, provision of drug information to healthcare professionals/patients/families, and appropriate pharmacotherapy interventions.

 

Mental health:

The Mental Health rotation is a 6 week learning experience for the pharmacy practice resident.  The rotation will consist of experience in both an acute inpatient psychiatry unit and outpatient mental health clinic. The resident will be exposed to various psychiatric disorders ranging from more severe illness or acute exacerbations on the inpatient unit versus more stable or chronic symptoms in the outpatient setting. The following disorders will likely be encountered: major depressive disorder, bipolar disorder, schizophrenia, post traumatic stress disorder, personality disorders, substance use disorder, and anxiety disorders including obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder. 

The inpatient psychiatry unit is a 10 bed acute care unit located on the 9th floor of the hospital. The inpatient psychiatry experience will require the resident to start their day by reviewing each patient admitted to the acute psychiatric unit. They will prepare assessments and recommendations for daily treatment team and patient rounds. After rounds, the resident will participate in, and eventually conduct, patient encounters and a note will be entered for the encounter. The resident will also use this time to conduct and document discharge counseling. Medication group will take place twice a week. The resident will be responsible for participating in, and eventually conducting and documenting, the group encounters.

The outpatient experience will occur in the mental health clinic which is located on the 1st floor of the hospital. The resident will be expected to  participate in and eventually lead patient encounters  and provide psychiatric medication therapy management, side effect management,  medication renewal, and counseling. The resident will also field questions or concerns from colleagues in the clinic and work with their preceptor to determine the provider’s or patient’s request and address appropriately. Finally, the encounter will be documented in the patient chart.

The resident will also be expected to attend and participate in various meetings and committees for which their preceptors are involved including the Prevention and Management of Disruptive Behavior Committee, Psychopharmacology Drug Safety Initiative and Behavioral Health Interdisciplinary Program. Dates and times of these meetings will be included in your rotation calendar.
 

Geriatrics:

The geriatric rotation is a longitudinal learning experience designed to provide PGY-1 pharmacy practice residents with a knowledge base of geriatric medicine principles which can be utilized during the practice of pharmaceutical care.

The Wilkes-Barre VA Medical Center, located in Wilkes-Barre, Pennsylvania, is a complexity level 2 teaching hospital which provides a full range of patient care services. The medical center is equipped with state-of-the-art technology such as the computerized medical record and tele-radiology. Comprehensive health care is provided through primary and tertiary care in areas of medicine, surgery, psychiatry, physical therapy, occupational therapy, neurology, oncology, dentistry, cardiology, hematology, and nephrology. Geriatrics and extended care services are offered including long term care, telemedicine, respite, dementia, rehabilitation, hospice, transitional care and a variety of home care services. The medical center currently has 105 operating Community Living Center beds with specialized units devoted to dementia, hospice, and transitional care.  The Community Living Center primarily serves geriatric patients; however, services are provided to patients of all ages. 

The resident is expected to become an integral member of the interdisciplinary healthcare team, which consists of specialists including geriatric physicians, clinical pharmacists, nurses, dieticians, physical/occupational therapists, and patients/family representatives.  Clinical pharmacy services are well established in this setting.  The resident will be responsible for monthly medication profile reviews and monitoring of drug therapy for veteran residents residing in the WBVA Community Living Center.  The resident will collaborate with geriatric physicians, nurse practitioners, and other healthcare providers and will act as a consultant for medication management, geriatric/renal dosing of medications, gradual dose reduction of psychotropic medications, and pain management.  Additionally, the resident will be responsible for the evaluation of falls risk/precautionary measures for all veterans.

 

Pharmacy staffing:

Hospital Pharmacy Practice is a longitudinal, required learning experience for the pharmacy practice resident.  This experience will allow residents to develop expertise in the process of preparing and dispensing drugs while focusing on patient care.   The resident will be responsible for reviewing new medication orders for accuracy and will also be responsible for recognizing drug-drug, drug-food, and drug-disease state interactions.  The resident will function as an outpatient and inpatient pharmacist.  The resident will also learn to prepare IV medications according to our facility’s policies and procedures, including proper aseptic technique.   The resident will also learn to supervise pharmacy technicians and precept pharmacy students.  The overall goal of this learning experience is to produce a pharmacist who is capable of performing all of the job responsibilities of a VA pharmacist.   After successfully completing staffing requirements, the resident will become a competent pharmacist in both the outpatient and inpatient settings.

 

Drug information

Drug information (DI) is a required 4-week rotation for the pharmacy practice resident.  This experience will allow the resident to develop competency in a broad range of drug information topics.  The resident will be responsible for providing responses to drug information requests from the medical staff.  When a request is received, the resident will research the question and complete a drug information request form.  Resident responsibilities also include completing non-formulary drug requests and evaluating and reporting ADR’s.

 

Practice management

The Practice Management Learning Experience is a 3-week block.  The resident will become familiar with all aspects of pharmacy management.  The resident will become familiar with policy development and review; organization and department structure, management techniques, human resources, economic rationale and problem solving, strategic planning, departmental performance improvement efforts, quality and safety practices, information systems and budgeting. The resident becomes integral in the main department initiatives multitasking on different projects over the three- week block.

 

Antimicrobial stewardship rotation:

The Antimicrobial Stewardship Rotation is a 5-week learning experience for the pharmacy practice resident.  The daily experience is divided between internal medicine Inter D rounds and Infectious Disease Consultation when applicable.  The resident will be exposed to various infectious diseases ranging from mild infections to severe complicated infections, depending on patient load.  The following diseases will likely be encountered: community acquired pneumonia, skin and soft tissue infections, urinary tract infections and bacteremia.

The resident will start their day by reviewing each patient admitted on 4e, 4icu and the nursing home on antibiotics.  They will prepare assessments and recommendations for inter D and infectious disease rounds.  After inter D rounds, the resident will enter patient notes documenting interventions and patient progress.  The resident will also be responsible for making recommendations based on facility specific protocols and identifying need for new protocols.

The entire experience will involve encounters with internal medicine and infectious disease providers regarding infectious disease medication related management, side effect management, drug disease and drug-drug interactions as well as lab monitoring.

All encounters and medication/monitoring recommendations will occur under the direct supervision of the preceptor.
 

Academic detailing:

The Academic Detailing rotation is an elective 5-week learning experience for PGY-1  residents.  The Academic Detailer is responsible for providing academic detailing to the medical staff based on national and VISN initiatives. Academic detailing involves reviewing and learning evidence-based medicine, developing and/or promoting educational pieces that include key messages, providing academic detailing outreach visits to VA staff, identifying and resolving barriers, and socializing new academic detailing campaigns. The academic detailing rotational experience will introduce the pharmacy resident to the skills and techniques of academic detailing and to allow them to practice these skills.
 

Diabetes management clinic

The Diabetes Clinic is a 5-week elective learning experience for pharmacy practice residents. The clinic is pharmacist-run and is part of the Endocrinology department, consisting of an on-board endocrinologist, a telehealth endocrinologist, Allentown community-based outpatient clinic (CBOC) endocrinologist, Allentown certified diabetes educator (CDE) nurse, a diabetes pharmacist, nurses, and dieticians. The clinic manages both Type 1 and Type 2 Diabetes Mellitus patients on insulin or insulin pump therapy referred to by the endocrinologists. The clinical pharmacy specialist is responsible for ensuring safe and effective medication use via face-to-face and phone clinics. Routine responsibilities include: adjusting and starting medications, adjusting insulin pump settings, reviewing insulin pump candidacy, therapeutic drug and lab monitoring, and addressing formal consults for non-formulary drug requests specific to diabetes management. 

The pharmacy resident will participate in the above responsibilities after an initial training period. The pharmacy resident will be required to be prepared for topic discussions and complete any assignments designated by the preceptor. After successfully completing this learning experience, the resident will become proficient and confident in diabetes management and become familiarized with continuous glucose monitors (CGMs) and insulin pump therapy. The resident will also become proficient in providing patient education and communication skills.

 

Pain management/Substance use disorder (SUD):

The Pain Management/Substance Use Disorder (SUD) rotation is an elective 5-week learning experience for pharmacy practice residents to further gain clinical knowledge and experience in pharmacotherapy management of patients with chronic pain and SUD through direct patient care.  The resident is expected to provide patient care to patients in the face-to-face pharmacy clinic, multispecialty pain team, Substance Abuse Residential Rehabilitation Treatment Program (SARRTP) groups and through telephone appointments.  The resident will also be in-charge of Stratification Tool for Opioid Risk Mitigation (STORM) Data-Based Opioid Risk Reviews and chart review requests.  The resident will be responsible for conducting patient interviews, addressing medication therapy issues and questions, interpreting lab results/urine drug screen (UDS) and documenting direct patient care activities appropriately in the electronic medical record.  The resident will be expected to develop appropriate therapeutic treatment plans (to include pharmacological and non-pharmacological), goals, monitoring plans and provide education to the patient and caregivers.  This rotation gives the resident the opportunity to expand their clinical knowledge in specific patient populations that will require special consideration, such as individuals with mental health and substance use disorders. The resident will also gain experience in developing interviewing and communication skills specific to assessing chronic pain/SUD issues and needs.  The resident will have the opportunity to become involved in Academic Detailing and VA national initiatives. 

 

Home based primary care (HBPC):

Home Based Primary Care (HBPC) is a 5 week elective learning experience for the pharmacy resident.   The pharmacy practice resident will be part of a multi-disciplinary team which provides primary care to home-bound veterans who are unable to physically travel to the medical center.  The resident will collaborate with physicians, nurse practitioners, nurses, and other healthcare providers.  The resident is expected to become an important contributing member of this interdisciplinary healthcare team.  The resident will provide functions such as, but not limited to, drug information, medication profile reviews and the initiation, selection, and monitoring of drug therapy. 
 

Oncology:

The Oncology rotation is an elective 5-week learning experience for the pharmacy practice resident to further gain clinical knowledge and experience in pharmacotherapy management of patients with cancer. The resident will focus primarily on cancer treatment protocols and patient-related supportive care (anti-emetic therapy, chemotherapy induced neutropenia and anemia, pain management). While the resident is expected to concentrate on cancer treatment protocols, they will also be expected to assess the entire patient’s drug therapy and make recommendations as necessary. The clinical pharmacy specialist (CPS) is responsible for ensuring safe and effective medication to this patient population. The pharmacist also provides drug information and education to patients and healthcare professionals as requested.

Pharmacy informatics/pharmacoeconomic:

The Pharmacy Informatics/Pharmacoeconomic Learning Experience is a 5-week elective rotation. The resident will become familiar with all aspects of pharmacy informatics and pharmacoeconomics. The resident will gain knowledge and experience in managing the various pharmacy packages and automation, including VISTA, CPRS, Bar Code Medication Administration (BCMA), Omnicell and ScriptPro. The resident will become familiar with CPRS ordering menus, the National Drug File (NDF) and the National Formulary. The resident will become familiar with how to actively manage the local drug file to ensure safe, effective, and cost-conscious ordering of pharmaceutical products and supplies. The resident will gain experience in reviewing Care in the Community non-formulary requests. The residents will be expected to create ordersets, prepare pharmacoeconomic proposals, and complete a drug utilization evaluation (DUE). The resident will gain an understanding of running reports and analyzing data.

Teaching certificate:

The purpose of the Precepting & Learning Program (rotation) is to assist pharmacy residents approach the role of clinical preceptor. This is a longitudinal experience, hosted in conjunction with Wilkes University's Nesbitt School of Pharmacy. Residents in the program will develop plans and tools for precepting students and have the opportunity to participate in didactic and experiential learning.  Attendees will earn continuing education (CE) credit and meet ASHP requirements for residency preceptor development.

Residency project

The residency project is a longitudinal requirement to successfully complete the residency program.  It is either a research project or quality improvement project. Each resident will either develop their own project or choose between projects the pharmacy service has developed.  Each resident will work with their research mentor or team on the project. 

The project should be presented as a platform presentation at the Eastern States residency conference. 

A publishable manuscript for the project is a requirement to successfully complete the residency and obtain the certificate of completion.

Good communication, time management, and decision-making skills are necessary for this learning experience.  The resident should set up meetings with their research preceptor(s) at least monthly to ensure the project is on track.