PGY1 Rotations - Tennessee Valley Healthcare System
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PGY1 Rotations

Pharmacy Residency Links

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Residents gather to review a patients chart with a staff member.

Structure

The specific program for each resident is developed initially based upon the resident’s goals, interests, and previous experience. The program is continually developed throughout the training year at regular intervals based on evolving resident goals and interests, resident training needs determined by review of summative preceptor evaluations, resident self-evaluations, quarterly evaluations by the residency leadership board, and the pharmacy service infrastructure.

All residents are required to complete rotations in core subject areas considered to be essential to the general pharmacy practitioner. These include drug distribution and operations, practice management & pharmacoeconomics, geriatrics, critical care, acute psychiatry, primary care, and acute medicine. Extended 6-month block longitudinal learning experiences aimed at producing a well-rounded pharmacy practitioner include: drug information (DI) with newsletter (The Valley Times) and medication safety. Yearlong longitudinal learning experiences aimed at producing a well-rounded pharmacy practitioner include: (1) resident-initiated research project related to pharmacy practice, (2) Community Living Center (CLC) chart review (3) prior authorization drug review, and (4) drug distribution and operations. A broad range of elective rotations are available to permit the resident flexibility in attaining individual goals. Upon satisfactory completion of the program, trainees are awarded a residency certificate.

The program is a twelve-month, post-graduate training experience composed of month-long discrete core components (see attachment A for brief descriptions of required rotations):

  • Drug Distribution and Operations (with longitudinal weekend assignments)
  • Critical Care
  • Primary Care (with anticoagulation service days on the core month)
  • Geriatrics (outpatient and inpatient)
  • Acute Medicine
  • Acute Psychiatry
  • Practice Management & Pharmacoeconomics

Yearlong extended longitudinal experiences are comprised of:

  • Research Project
  • Community Living Center Chart Review
  • Prior Authorization Drug Review
  • Drug Distribution and Operations (weekend assignments – see below on details)

Extended 6-month block longitudinal experiences are comprised of:

  • Drug Information with newsletter (shared months of service)
  • Medication Safety (shared months of service)


Required Core Rotations

Acute Medicine

Residents will gain experience managing all aspects of pharmacotherapy for acutely ill patients through active participation on a medicine team, ensuring medications are properly reconciled on admission to and discharge from the ward, and attending morning reports/grand rounds. The resident will document in computerized progress notes pertinent clinical activities.

Primary Care

Residents will see scheduled patients in a clinic setting and have the opportunity to develop, implement, and redesign pharmacotherapeutic plans. The resident will document in computerized progress notes all clinical activities. Residents will also develop the physical examination skills that are necessary to be an effective clinician in the primary care setting.

Critical Care

Residents will monitor patients in the Medical Intensive Care Unit (MICU), which includes cardiology and pulmonary critical care patients, on a daily basis for pharmacotherapeutic needs through rounding and medication reconciliation/discharge planning. Residents will have active participation on a critical care team. The resident will document in computerized progress notes pertinent clinical activities.

Practice Management and Pharmacoeconomics

Residents will participate in pharmacy leadership, work on relevant assignments/projects, attend committee meetings with pharmacy representatives, lead pharmacy events (pharmacy week, medication reconciliation week, and residency recruitment), and have discussions with the pharmacoeconomic clinical pharmacy specialist two to three times a week. Additionally, the resident will complete P&T minutes.

Geriatrics

Residents will have the opportunity to participate in a combined outpatient Geri-PACT/Community Living Centers (CLC) experience. In Murfreesboro, residents gain experience in the marketable services of reviewing CLC charts each month (Medication Therapy Management) and entering Minimum Data Set information. Additionally, residents will attend interdisciplinary treatment team meetings and submit reports as required by accreditation bodies. In Nashville (geri-PACT), residents gain experience in managing all aspects of pharmacotherapy for geriatric patients through active participation as a core member of a geriatrics primary care team.

Drug Distribution and Operations

Residents will gain experience reviewing and processing patient-specific orders, correctly preparing medications and successfully communicating medication-related issues with providers.

Acute Psychiatry

Residents will review patient specific data, prepare and update pharmaceutical care plans, meet with the inpatient psychiatric treatment care team along with the patient, and serve as a drug information resource. The resident will document in computerized progress notes pertinent clinical activities.


Extended Block Core Experiences

Drug Information Service

Residents will each have experience carrying the Drug Information pager, replying to inquiries in a timely fashion, and documenting each response.

Medication Safety

Residents will each have experience preparing an adverse drug reaction (ADR) monthly report, documenting and submitting relevant ADRs to the Food and Drug Administration’s MedWatch program and communicating findings.


Longitudinal Rotations

Research Project

Residents will gain experience in completing a practice-related project of publishable quality. Residents will be involved in literature review, project design, data gathering, statistical evaluation, writing, and reporting of their project. Residents will work closely with the Residency Research Advisory Board and a team of co-investigators that will assist them at every step of the process.

Prior Authorization Drug Review

Residents will gain hands-on experience reviewing and then either approving or denying requests for non-formulary/restricted medications entered by healthcare providers.

Community Living Center (previously known as Long Term Care)

Residents will gain experience completing monthly CLC chart reviews for 5 patients throughout the year and communicate their recommendations to the patient’s primary provider.

Drug Distribution and Operations

Residents will gain experience reviewing and processing inpatient and outpatient prescriptions for patients or working on the acute medicine floor participating in pharmacokinetic dosing, anticoagulation management, and discharge medication reconciliation/counseling. Weekend Staffing: Weekend coverage will be provided by 2 residents every Saturday from 7 AM – 5:30 PM at the Nashville campus. Resident 1 will be assigned to work on the floor with a decentralized clinical pharmacist where responsibilities will include, but are not limited to: assistance with pharmacokinetics (vancomycin, aminoglycosides, warfarin, etc.), providing discharge medication reconciliation and discharge counseling to patients being discharged by the medical teams, and being an available clinical resource to the medical teams. Resident 2 will be assigned to work in the central pharmacy where responsibilities will include, but are not limited to: processing of orders, dispensing of discharge medications, compounding of IVs, and preparation of inpatient medication orders.  Please note that these responsibilities and duties may vary based on the needs of the service.

Cased-Based Presentation

Each PGY1 pharmacy resident will present a one-hour case-based CE presentation to pharmacists and pharmacy technicians at TVHS.

Journal Club

Each PGY1 pharmacy resident will present a one-hour journal club to pharmacists at TVHS.


Elective Rotations

Residents may repeat core rotations for one of their elective months, or they may choose one of the rotations listed below:

Inpatient Cardiology

Residents will gain experience serving as the drug therapy specialist actively participating in team meetings and bedside rounds with the cardiology attending and fellow on service. Interventions and patient education will be recorded in the medical record. Residents can expect to have exposure to a variety of acute cardiovascular conditions including acute coronary syndromes, heart failure exacerbation, and arrhythmias during this elective rotation.

Outpatient Cardiology Pharmacotherapy Clinic

This ambulatory clinic service within the cardiology specialty clinics at Nashville and Murfreesboro campuses gives PGY1 residents exposure to evaluating and optimizing pharmacotherapy for ambulatory patients with cardiovascular diseases including heart failure, coronary artery disease with and without angina, hypertension, hyperlipidemia, and arrhythmias.

Home-Based Primary Care

Residents will gain experience performing initial and quarterly chart reviews, participating in interdisciplinary treatment team meetings, visiting veterans in veterans’ homes if desired, completing telephone follow-up calls, acting as the drug expert for HBPC team, and assisting with performance improvement projects as requested.

Hospice/Palliative Care

Residents will serve as a functioning member of an interdisciplinary treatment team. Throughout the rotation, residents will come to understand and apply palliative care principles including pain management, nausea, constipation, depression, and insomnia. Residents will also receive Minimum Data Set training.

Pain Management Residents will see scheduled patients in a clinic setting and have the opportunity to develop, implement, and redesign pharmacotherapeutic (pain) plans.  The resident will document in computerized progress notes all clinical activities.

Outpatient Mental Health

This elective will allow the resident to participate in a team-based outpatient mental health clinic, referred to as BHIP (Behavioral Health Interprofessional Program). With the Clinical Pharmacy Specialist, residents will participate in individual clinic appointments, attend interprofessional treatment team meetings, and assist in mental health medication-related consultant services.

Anticoagulation

Residents will have the opportunity to develop, implement, and redesign a pharmacotherapeutic plan in patients requiring anticoagulation through a telephone-based warfarin clinic and population-based management of direct oral anticoagulants. Residents will also gain experience with difficult and unique anticoagulation cases as the centralized clinics manage all anticoagulation patients and questions for TVHS. The resident will document computerized progress notes of all clinical activities.

Emergency Medicine

Residents will gain experience providing drug information to the interprofessional team at the point of care, medication order processing, medication refill services, and chronic disease management following triage by a physician.

Nutrition

Residents will gain experience participating in daily parenteral nutrition support rounds and documenting treatment plans in CPRS.  Residents will develop a personal mechanism to expediently and accurately monitor the initial and on-going nutritional management of parenteral nutrition patients based on a variety of factors including medical history, active problems, pertinent laboratory analysis, vital signs and I/O’s.

Surgical Intensive Care

Residents will gain experience managing pharmacotherapy for critically ill surgical patients. Relevant topics to the SICU will be mastered by the resident including but not limited to gastrointestinal stress ulcer prophylaxis, appropriate nutrition therapy (enteral and parenteral), adrenal insufficiency, acid-base management, and fluid/electrolyte management.

Infectious Disease

Residents will gain experience following patients on the infectious disease team. Residents will review patients on intravenous antibiotics, assess for appropriateness, and communicate recommendations to the treatment team. There will be an emphasis on developing a solid knowledge base of infectious disease guidelines.

Mental Health Residential Rehabilitation Treatment Program (RRTP)

Residents will gain experience working in the Resident Rehabilitation Treatment Program (RRTP), a voluntary inpatient admission for patients to receive intensive treatment for substance abuse, PTSD, depression, etc.

Bone Marrow Transplant

Residents will work with the interdisciplinary team on the Bone Marrow Transplant Unit where duties will include both inpatient and outpatient patient care. They will gain experience with medication dosing in special patient populations and supportive care management.

Telemedicine

Residents will gain Ambulatory Care experience seeing patients scheduled into the Clinical Video Telehealth (CVT) clinic which provides Clinical Pharmacy services to patients in surrounding Community-Based Outpatient Clinics (CBOCs). Residents will also participate in completion of E-consults involving one-time comprehensive chart review to answer patient-specific pharmacotherapy questions from the CBOC staff. The resident will document in computerized progress notes all clinical activities.

Academic Detailing

Academic Detailing will allow residents a unique opportunity to learn how to utilize motiviational interviewing skills to work one on one with providers in regard to evidence-based education. This rotation will also allow the residents to develop evidence-based resources for providers. They will also glean an understanding of utilization of metrics including dashboards and other forms of clinical data

Outpatient Pain and Mental Health Telemedicine

Residents will learn how to properly use televideo equipment for the management of psychiatry and pain management in the Veteran population. Residents will be responsible for reviewing patients, executing appropriate assessment measures, analyzing current therapies, making changes to treatment plans, and monitoring pertinent lab information.

Advanced Medicine

PGY1 residents will have the opportunity to utilize and extend their knowledge/skills from the core acute medicine rotation to an elective rotation month in which they are afforded a greater level of autonomy and the ability to go into greater depth on discussion of acute medicine topics of interest. They will also have the opportunity for an academia focus with co-precepting P4 APPE students and additional didactic and/or small group facilitator teaching experiences at Lipscomb University College of Pharmacy.

Heart Failure Transitions of Care

This service incorporates volume management, medication management, patient education, and care coordination for patients admitted with decompensated heart failure. Residents will be exposed to the process of identifying qualifying inpatients, determining eligibility and appropriateness for enrollment in the CPS run service post-discharge, as well as intensive sub-acute ambulatory heart failure management. The resident can expect ambulatory clinic experience as well as telephone follow-up.

Integrated Pharmacy Operations

The primary purpose of this clinical rotation is the provide the resident with experience in an integrated pharmacy setting. This rotation is designed to mimic the schedule of a clinical pharmacist in a de-centralized pharmacy model. Residents will become proficient in managing pharmacotherapy regimens for acutely ill Veteran patients with a variety of disease states and complex medication regimens. Residents will also gain hands-on experience in central pharmacy responsibilities to develop the resident’s ability to practice in both settings.

Outpatient Mental Health/ Mental Health Residential Rehabilitation Treatment Program (RRTP)

This rotation affords the resident the opportunity for the resident to experience the outpatient mental health and RRTP settings within a one-month rotation timeframe.

Geri-PACT (Outpatient Geriatrics)

The geriatric patient-aligned care team (GeriPACT) at TVHS is an outpatient interdisciplinary team of providers, including physicians/geriatricians, nurse practitioners, nurses, social workers, dieticians and administrative assistants. Routine clinic visits are shared appointments between the primary provider and clinical pharmacy specialist (CPS). Medication management is provided by the GeriPACT CPS in several different ways: medication reconciliation, assessment and management of fall risk and neurocognitive impairment, deprescribing, chronic disease state management, preventative care, and caregiver support.