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

During the orientation rotation, the resident will attend hospital orientation. The RPD and resident will plan the resident’s schedule for the year, as well as start the resident’s development plan. The resident will complete Pharmacy Department onboarding and staff pharmacist training.

Didactic education on core clinical and operational competencies will be provided throughout the experience.

Internal Medicine (4 weeks)

The Internal Medicine team includes an attending physician, medical resident(s) and intern(s), and/or medical student(s). The team cares for a maximum of 20 patients. The PGY-1 resident will be assigned to one IM team for the duration of the rotation. The residents will have the opportunity to improve their knowledge base and pharmacotherapeutic skills while enhancing care for patients. The resident will become familiar with and monitor pharmacotherapy for the most commonly encountered disease states, review major guidelines and landmark trials for relevant disease states, and participate in the education of team members and patients. The resident will also attend noon conferences and Medical Grand Rounds.

Internal Medicine II/Teaching (6 weeks)

The resident will co-precept 1-2 MCPHS Univ. pharmacy students during their 6 week APPE Internal Medicine Rotation. The resident will mentor students during pre-rounds; provide verbal and written feedback; and grade required rotation assignments. Through the Primary Site Internal Medicine Preceptor for the resident determines specific resident teaching responsibilities, the resident is expected to heavily contribute to precepting and educating APPE students. Student evaluations are conducted by both the Faculty preceptor and resident for each assignment (written and verbal feedback).

Critical Care

This rotation occurs in the Medical Intensive Care Unit (MICU). 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 residents, 1-2 medical students, and 1 pharmacist. 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)

The learning experience takes place in Mount Auburn Hospital’s Primary Care Clinic (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 these issues. While in the PCC, residents will provide face-to-face care for patients at high risk of adverse drug events due to excessive pill burden, patients who suffer from disease states such as uncontrolled diabetes, hypertension and/or chronic pain, support the PCC staff by answering drug information questions, and learn from other health care providers. Residents will also participate in transitions of care activities.

Antimicrobial Stewardship

This learning experience prepares residents to perform stewardship activities during patient care activities throughout the residency year. Residents will conduct prospective audit and feedback and attend antimicrobial stewardship and infectious diseases consult rounds. By the end of the learning experience, the resident will have gained exposure to the tenants of safe antibiotic use; including: key principles to de-escalation, IV to PO conversions, how to evaluate culture and sensitivity information, selection of appropriate antibiotic regimen taking into account patient specific considerations, safety monitoring and renal/weight based dosing of antibiotics.

Decentralized Pharmacy Practice

The resident will round on the step-down unit (SDU) with a team includes an attending physician, medical resident(s) and intern(s), and/or medical student(s). The team cares for a maximum of 15 patients. In addition to rounding, the resident will be required to perform order verification, triage nursing questions, and provide clinical pharmacy services for the patients on the SDU. This rotation grows on the foundations of internal medicine, with a focus on evidence-based medicine in a higher acuity patient population. The goal is this rotation is to prepare residents to succeed as a decentralized pharmacist.

**Medication Safety

This rotation starts with an introduction to the medication safety reporting system, the basic tenets of reporting and reviewing medication errors or medication related events, and attendance of a Medication Reliability meeting. The longitudinal requirements include reviewing medication related events as they are reported in medication safety reporting system and subsequently assigned to the resident by the Pharmacy Operations Manager. This longitudinal component will be equally shared with the co-resident.

**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

A layered-learning model is utilized during this rotation. As with Ambulatory Care, the learning experience takes place in Mount Auburn Hospital’s Primary Care Clinic (PCC). The resident will build on the knowledge and skills they have gained in Ambulatory Care I. Responsibilities are similar to Ambulatory Care, with an expected greater level of autonomy. In addition, the resident will be a co-preceptor for an average of 3 APPE students. The resident will learn to employ all 4 roles of the preceptor.

Cardiology/Anticoagulation

The cardiology/anticoagulation is a blended inpatient/outpatient experience that allows the resident to round with the Cardiology service (attending cardiologist and medical residents and interns) and collaborate with the team to optimize care for the cardiac patients on service through an interdisciplinary approach during the mornings and attend the pharmacist manage anticoagulation clinic in the afternoons.

The clinic provides point-of-care INR testing for patients who take warfarin. Pharmacists in clinic manage warfarin regimens and design individualized monitoring plans for patients. Patient encounters are either in person or by phone with the pharmacist. In addition to point-of-care INR testing, the clinic also has manages patients that test their INR at outside sources. The resident will learn how to counsel patients who receive warfarin, adjust dosing regimens, provide point-of-care INR testing, and document in the medical record. The resident will learn more about indications for warfarin therapy, such as atrial fibrillation, deep vein thrombosis, pulmonary embolism, and prosthetic heart valves.

Informatics

The resident will gain detailed exposure to the role of Informatics in clinical pharmacy practice and operations. The resident will work with IS Pharmacists and interdisciplinary staff to develop, optimize and support automation and technology for safe and effective medication use within the hospital. The resident may be expected to attend related meetings, develop/implement projects/presentations and participate in topic discussions.

Informatics II

For residents who are interested in Informatics, this rotation will help resident’s build on the skills they developed in Informatics I, with an expected greater level of autonomy.

Oncology

The ambulatory infusion center provides the resident the opportunity to work as part of a multidisciplinary health team to provide patient-centered pharmacotherapy and implement new chemo- and immunotherapy evidence-based treatment protocols. There is an opportunity to practice sterile compounding and to learn more about USP 797 and USP 800 compliance requirements. Residents will be able to educate patients and caregivers on treatment plans, perform medication reconciliation, and help manage adverse effects. Operational component of the rotation will include order processing, verification of sterile preparations, inventory procurement and assistance with prior authorization requests. A countless number of research projects could stem out from this rotation.

Residents are required to staff in the main pharmacy, for 42 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.