Pharmacy Residency

Please note:

• 5 weeks in length (except where noted)
• *Occurs longitudinally throughout the year
• **Also will include a concentrated 2-week rotation for each

Orientation (4 weeks)

The Orientation Rotation is a 4-week rotation designed to provide a strong foundation in local pharmacy practice. Residents will be oriented to several aspects of the residency including resident projects, rotations, committee involvement, and graduation requirements. Residents will receive scheduled didactic education regarding operation and clinical aspects of practice at our institution. Residents will shadow pharmacists in centralized and decentralized areas to become familiar with information technology, institutional policy, and a standard approach to how a pharmacist manages their practice. Rotation focus is in supporting the residents as they transition from student to pharmacist.

Internal Medicine

The Internal Medicine Pharmacy Residency Rotation is a 5-week rotation designed to provide a foundational clinical pharmacy experience and introduction to decentralized pharmacy practice. During this rotation, residents will work closely with the internal medicine team, which includes pharmacy, nursing, medical residents, medical interns, and an attending physician. Residents will learn to approach patient cases systematically, with an emphasis on efficient data gathering, organization, and interpretation. Additionally, they will receive practice in utilizing the electronic medical records, navigating hospital policy and resources. A focus will be placed on utilization of evidence-based medicine and literature assessment, as well as soft skills including documentation, professional communication, and management of personal responsibilities

Internal Medicine II (6 weeks)

Teaching Pharmacy Residency Rotation is a 6-week rotation designed to provide an advanced clinical pharmacy experience building from Internal Medicine I and introduce residents to preceptorship. During this rotation, residents will work closely with the internal medicine team, which includes a pharmacist, pharmacy students, nurses, medical residents, medical interns, and an attending physician. Residents will continue to approach patient cases systematically, building on skills obtained in Internal Medicine I, including efficient data gathering, organization, and interpretation. Residents will continue utilizing the electronic medical records, navigating hospital policy and resources to provide evidence-based therapeutic recommendations based on current literature. They will also continue to utilize skills including documentation, professional communication, and management of personal responsibilities. During this rotation, residents will be directly responsible for precepting pharmacy student(s) which included overseeing them on rounds with the internal medicine team, evaluation of their work, as well as developing educational activities for students.

Critical Care

The Medical Intensive Care Unit (MICU) rotation is a required 5 weeks learning experience at Mount Auburn Hospital. The MICU typically has a service of 1-20 patients averaging about 8 patients/day. Each MICU team is composed of an attending critical care/pulmonary physician, 3 residents, 4 medical interns, 1-2 medical students, 1 pharmacist plus 2 pharmacy students. Additionally, rounds are attended by the critical care nurses, and respiratory therapists as needed.  The resident will gain competency to care for various critically ill patients. The resident will participate in daily rounds to provide and implement in collaboration with other health care professionals an evidence based patient centered pharmacy care plan.

Ambulatory Care (6 weeks)

Ambulatory Care is a required learning experience that is six weeks in length.  The learning experience takes place in Mount Auburn Hospital’s Primary Care Center (PCC). The PCC team consists of: primary care providers (PCP), medical residents and interns, a nurse practitioner, a physician’s assistant, a nurse, and medical assistants. The resident will be responsible for identifying drug-related problems and working with physicians and other members of the PCC team to resolve or prevent adverse medication related issues. While in the PCC, residents will provide Medication Therapy Management services (MTM) either face-to-face and/or via telehealth to patients at high risk of adverse drug events due to excessive pill burden. MTM services will include comprehensive medication review, medication reconciliation, and making and implementing plans for deprescribing potentially inappropriate medications as needed. The resident will also provide chronic disease states management to patients who suffer from disease states such as uncontrolled diabetes, hypertension and/or chronic pain. In addition, the residents will support the PCC staff by answering drug information questions and offer provider and staff education on new medications and guidelines updates while learning from other health care providers. Residents will also participate in transitions of care activities.

Antimicrobial Stewardship

The Infectious Diseases Pharmacy Residency Rotation is a 5-week rotation designed to provide a foundational clinical pharmacy experience and introduction to decentralized pharmacy practice and antimicrobial stewardship. During this rotation, residents will work closely with the antimicrobial stewardship team by attending stewardship rounds, assisting with restricted pager duties, and taking part in daily prospective audit and feedback reviews. Residents will learn to approach patient cases systematically, with an emphasis on efficient data gathering, organization, and interpretation. Additionally, they will receive practice in utilizing the electronic medical records, navigating hospital policy and resources. A focus will be placed on utilization of evidence-based medicine and literature assessment, as well as soft skills including documentation, professional communication, and management of personal responsibilities. The resident will gain necessary skills and knowledge in infectious diseases through direct patient care, topic discussions, self-directed learning, and presentations.

Decentralized Pharmacy Practice

The Step-down Unit (SDU) rotation is a 4-6 week rotation designed to provide a foundational clinical pharmacy experience and introduction to decentralized pharmacy practice. During this rotation, residents will work closely with medical team, which includes pharmacy, nursing, respiratory therapy, physical therapy, medical residents/students, and an attending physician. Pharmacy residents will learn to approach patient cases systematically, with an emphasis on efficient data gathering, organization, and interpretation. Additionally, they will receive practice in utilizing the electronic medical records, navigating hospital policy and resources. A focus will be placed on utilization of evidence-based medicine and literature assessment, as well as soft skills including documentation, professional communication, and management of personal responsibilities.

**Medication Safety

Medication Safety is a required, longitudinal rotation that starts in the beginning of the residency year with an introduction to safety event reporting system, the basic tenets of reporting and reviewing medication errors or medication related events, and attendance of a Medication Reliability meeting (within the first 3 months of residency).  Medication Reliability is a monthly meeting where interdisciplinary members review medication errors, process improvements and ISMP best practice alerts.  The longitudinal requirements for the residents will be to review medication related events filed through safety event reporting system when assigned to do so by the Clinical Pharmacy Coordinator – Informatics and Medication Safety.  This longitudinal component will be equally shared with the co-residents.

The medication safety rotation is also comprised of a concentrated 2 week experience that focuses on the aspects of medication safety that are intermingled with medication use processes.  Performing an MUE or utilizing an MUE to develop policies and or procedures to promote patient safety will comprise the concentrated portion of this learning experience.  The resident will work with the pharmacy’s Operation Manager and will have the opportunity to develop their understanding of medication safety monitoring and response that continues in the hospital setting beyond medication safety reports.  This may include (but is not limited to): monitoring and reporting of medication adverse events, reacting to recall notices, responding to patient related complaints, maintaining compliance with accrediting body standards (throughout the hospital and within the pharmacy), diversion monitoring and investigations

**Pharmacy Administration

Pharmacy Administration has both a leadership and a managerial role at Mount Auburn Hospital. Pharmacy administrators are responsible for operational and clinical oversight of the pharmacy as well as pharmacy strategic planning. The goal of this rotation is to give the resident an understanding of the leadership and managerial skills that are necessary to provide a hospital with exceptional pharmacy services. The resident will attend a variety of meetings for the hospital and health system. The resident will attend Pharmacy & Therapeutics Committee monthly throughout the year and develop agendas and minutes for the meetings. The resident will also attend the pharmacy Medication Management meeting weekly.

*The Teaching Certificate Program at MCPHS

The resident will be assigned a MAH faculty preceptor for the longitudinal teaching rotation. The resident will hold an adjunct teaching appointment in the department of pharmacy practice at MCPHS University. MCPHS University–Boston is the second oldest pharmacy school in the United States, with a strong commitment to preparing future leaders of the profession of pharmacy.

Requirements to obtain teaching certificate:

• Starting in September, the residents co-facilitate Pharmacotherapeutics Seminar 1 day/week for a 3-hour session. This class is for 5th year PharmD students. The co-facilitator is an experienced faculty or adjunct faculty member. In the spring semester, the resident will facilitate the class independently. This is an application-based course in which students will work up a variety of patient cases and journal clubs. The facilitators leads the class as they discuss the day’s assignment together. Students will apply the concepts they learn in didactic lectures in this seminar.
• The resident will attend didactic lectures once a month to gain exposure to a variety of teaching topics, such as how to facilitate journal club and write exam questions.
• Residents will also co-precept students during their APPE Internal Medicine rotation at MAH.
• Residents deliver a formal lecture an 5th year elective PharmD course, typically during the spring.
• The resident must choose an elective teaching experience (options include but not limited to: additional lecturing, additional precepting, developing cases/exam questions for different courses, etc).

*Research

The resident will be introduced to research through readings and ASHP’s Residency Research modules. The resident will also complete the CITI Certificate training. The resident will choose a pharmacy focused research projects based on their interests; preceptors develop a list of project ideas for the resident to choose from. This project will be submitted to IRB for approval. An abstract will be submitted to ASHP and an interim analysis of the project will be presented at Midyear as a poster. The project will be presented at Eastern States, the MCPHS Presentation meeting, and to the Pharmacy and Therapeutics Committee at MAH.

5 weeks in length; resident to choose 2

Ambulatory Care II

Ambulatory Care II is an elective learning experience that is four weeks in length. The learning experience takes place in Mount Auburn Hospital’s Primary Care Center (PCC). The PCC team consists of: primary care providers (PCP), medical residents and interns, a nurse practitioner, a physician’s assistant, a nurse, and medical assistants. The resident will be responsible for identifying drug-related problems and working with physicians and other members of the PCC team to resolve or prevent adverse medication related issues. While in the PCC, residents will provide Medication Therapy Management services (MTM) either face-to-face and/or via telehealth to patients at high risk of adverse drug events due to excessive pill burden. MTM services will include comprehensive medication review, medication reconciliation, and making and implementing plans for deprescribing potentially inappropriate medications as needed. The resident will also provide chronic disease states management to patients who suffer from disease states the focus on but not limited to uncontrolled diabetes,  obesity, and hypertension. In addition, the residents will support the PCC staff by answering drug information questions and offer provider and staff education on new medications and guidelines updates while learning from other health care providers. Residents will also participate in transitions of care activities.

The Ambulatory Care II experience will take place after completing the Ambulatory Care I experience. The resident will assume a more autonomous role. Residents will be provided with opportunities to conduct patient visits under the indirect supervision of the preceptor.

Cardiology/Anticoagulation

The Cardiology rotation is a 5-week elective that provides an opportunity for the pharmacy resident to round with both the Cardiology consult service and the Cardiothoracic Surgery service and collaborate with the team to optimize care for the cardiac patients through an interdisciplinary approach. Residents will be challenged to utilize evidence-based medicine, national guidelines, and pharmacology principles to develop high-impact treatment plans for patients admitted with cardiac disease.

Additionally, residents will engage in the pharmacist-operated Anticoagulation Clinic for patients on warfarin. Recommendations will be implemented independently by pharmacy.

Emergency Medicine

The Emergency Medicine Pharmacy Residency Rotation is a 5-week rotation designed to be an introduction to emergency medicine. This rotation will provide the resident the opportunity to develop skills related to decentralized clinical pharmacy practice. During this rotation, residents will work with the emergency department (ED) team through various tasks consisting of: the delivery and preparation of medications, order verification, answering drug information questions, and attending emergency responses. Residents will learn the structure and workflow of the ED while also working with the medical team to optimize pharmacotherapy. Within the rotation, the resident will also build skills pertaining to gathering information through chart review and verbal hand-off from emergency services.

Informatics

The Informatics I Pharmacy Residency Rotation is a 5-week rotation designed to introduce the technological aspects of pharmacy and how it connects to medication safety, Pharmacy and Therapeutics committee (P&T), and maintaining hospital standards. During this rotation, residents will learn how healthcare technology interplays with one another and how to implement new medications from the start, from P&T approval to EHR ordering. A focus will be placed on validating medication build and data collection using Epic reports. Soft skills include interdisciplinary communication, management of projects, and documenting changes in systems.

Informatics II

The Informatics II Pharmacy Residency Rotation is an additional 5-week rotation designed to expand on the topics covered in informatics I. During this rotation, residents will have more independence to validate medication build in systems and work with IT to troubleshoot fixes. Residents will be expected to develop learning materials for staff and lead in-services as needed during the rotation.

Oncology

The Hematology/Oncology Pharmacy Residency Rotation immerses residents in the specialized field of cancer care, focusing on both hematologic and oncologic disorders. This rotation offers exposure to variety of disease states, treatment modalities, and interdisciplinary collaboration within a dynamic care team.

Residents are required to staff in the main pharmacy, for 45 shifts/year (every third weekend on average, one evening shift/month [on average], and two holidays). Initially, residents train for 4 weeks as a part of orientation. Responsibilities include optimizing drug therapy through identification, resolution, and prevention of drug related problems. The resident communicates with physicians and nurses on medication order discrepancies, possible drug interactions, incompatibilities, allergies, drug administration, and answers drug information questions. The resident will learn the operational components of the pharmacy as well.