The resident will learn both the distributive and clinical functions of
a pharmacist. The resident will gain knowledge in profiling prescriber
orders, filling orders, checking orders, making/checking intravenous medication,
WMCs clinical pharmacy protocols and policies, writing SOAP notes, documentation,
and communication with prescribers, nursing, and other health care professionals.
The resident will also gain knowledge of the organizations policies and
procedures. Throughout orientation, the resident will complete clinical
competencies and meet with various pharmacy personnel.
Mini-rotation (2 weeks)
This is an experience that takes place before regularly scheduled rotations
begin. The mini-rotation learning experience is designed to help the resident
become more comfortable with some of the clinical services provided at
the hospital, provide a glimpse of a practice area that they may not have
been able to get a full rotation in, and transition from orientation to
more formal rotations.
Internal Medicine (5 weeks)
Internal medicine in intended to provide the resident with an understanding
of the pharmaceutical management of adult internal medicine patients.
Residents will learn to develop and monitor a pharmaceutical care plan
for a patient, provide consultation to other health care professionals,
and assume the responsibility of drug therapy for the patient. The ultimate
goal is to become valued as a drug expert on the health care team. Residents
will also gain experience in providing consultative services such as pharmacokinetic
dosing, as well as patient education and discharge counseling.
Antimicrobial Stewardship (5 weeks)
Antimicrobial Stewardship is a required, learning experience at WMC. The
antimicrobial stewardship service addresses all patients on antimicrobial
therapy within the institution. The Antimicrobial Stewardship learning
experience will involve the resident prospectively reviewing patients
on antimicrobial therapy within the institution, meeting with an ID physician
to determine appropriate therapy, and communicating these recommendations
to other prescribers. This rotation is intended to provide the resident
with an understanding of antimicrobial therapy and antimicrobial stewardship
practices. Residents will learn how to assess for appropriate antimicrobial
therapy, ways to streamline therapy, and develop effective communication
techniques. Residents will also gain an understanding of appropriate antibiotic
formulary management and an understanding of the role and functioning
of the Antibiotic Subcommittee and Infection Control Committee.
Leadership and Practice Management (5 weeks)
Leadership and Practice Management is a required, learning experience at
WMC. The resident will meet with the pharmacy manager in the inpatient
pharmacy office on a daily basis. Each morning, the pharmacy manager will
delegate to the resident what their responsibilities will be for that
day, whether it be to continue on a project or begin a new assignment
or project. During the Leadership and Practice Management rotation, the
resident will develop an understanding of core operational, financial
and leadership techniques used as a pharmacy manager. The resident will
participate and complete management projects, including medication safety
initiatives. The resident will have the opportunity to participate in
both the facility budgetary process and the system process.
Teaching Rotation (5 weeks)
For this rotation, the resident will act as the preceptor to a 4th year
APPE student in a rotation of interest. The resident will complete the
rotation prior to teaching it. The resident will be responsible for assigning
the student a patient load, projects, leading topic discussions, and giving
feedback to the student. While being a preceptor for a student, the resident
will also have their own patient load to give them experience of being
a clinical pharmacist while teaching. The resident’s preceptor will
be more of a mentor than a preceptor during this rotation.
Adult Critical Care of your choice (5 weeks)
One of three choices: medical ICU, cardiac ICU, or neuro ICU
Transitions of Care (Longitudinal)
Transitions of Care is a required, longitudinal learning experience designed
to expose the resident to the different roles that pharmacists can play
in transitioning patients home, or to different levels of care. This rotation
will focus on caring for and counseling patients hospitalized with heart
failure and/or coronary artery disease. This service takes place on the
third floor telemetry units of WMC. The primary responsibilities of the
resident will be evaluating patients' heart failure therapy, and counseling
the patient on their medications, the disease process, and lifestyle interventions.
The resident may also communicate with outpatient providers when appropriate.
Patients are identified by examining the census and running a report of
patients admitted with elevated B-type natriuretic peptide levels. With
the help of the preceptor, the resident will select patients from this
list that may benefit from focused education. Other responsibilities will
include performing educational presentations and participating in topic
discussions throughout the year.
Formulary Management (Longitudinal)
Formulary Management is a required longitudinal learning experience designed
to provide the resident with training and skills of formulary management
including drug monographs, drug class reviews and MUE. Residents will
learn to understand the philosophy of formulary management in a health
system and prepare and disseminate written drug information related to
formulary and MUE results. Also, they will participate in the health system's
formulary process to include drug monograph development, drug class reviews
and medication use evaluations. This rotation is designed to instill in
the resident an appreciation for how pharmacists may be involved in managing
both pharmacoeconomic and quality of patient care in the acute care setting,
relating to formulary.
Staffing (Longitudinal)
Staffing is a required longitudinal learning experience at WMC. The resident
will staff once every 3rd weekend as well as one major holiday. The staffing
requirement covers multiple locations. The resident could be assigned
to the main pharmacy where they will be responsible for checking medications,
answering questions, verifying orders, as well as some of our clinical
consults. The resident may also be assigned to one of the decentralized
pharmacies where they would be more heavily involved in our clinical services.
Community Outreach (Longitudinal)
Community outreach is a required, longitudinal learning experience at WMC.
The resident will gain experience with public health initiatives by participating
in local events in the community. The purpose of this rotation is to facilitate
organization and leadership skills and to prepare the resident to be a
well-rounded, community and patient focused professional. The resident
will gain knowledge counseling patients and organizing public health events.
Each resident will act as the outreach coordinator for at least one service
event and is responsible for organizing participation, educating participants,
and updating education materials for each local event assigned to the
resident. The other component of this rotation is career development.
Residents will meet with the preceptor monthly to discuss a variety of
career development topics including, interview preparation, CV/ cover
letter reviews in order to prepare the resident for his or her career
after residency.
Elective Learning Experiences
Cardiology Critical Care (5 weeks)
Cardiology Critical Care is an elective, learning experience taking place
in the Cardiovascular Intensive Care Unit (CVICU) at WMC. The service
will include CVICU patients being followed by the intensivist service.
Typically, the critical care rounding team will be responsible for anywhere
from 10-12 patients. ). Residents are responsible for rounding daily with
their assigned multidisciplinary team as well as provision of clinical
pharmacy services to the patients and health care practitioners (nurses,
physicians, etc.) in the critical care units.
Medical Critical Care (5 weeks)
Medical Critical Care is an elective, five week learning experience at
WMC. The primary area for rounding will include adult critical care units
made up of the CCU (Cardiac/Coronary Care Unit) and MSCU (Medical/Surgical
Intensive Care Unit). Residents are responsible for rounding daily with
their assigned multidisciplinary team as well as provision of clinical
pharmacy services to the patients and health care practitioners (nurses,
physicians, etc.) in the critical care units. This Critical Care rotation
allows residents to follow patients admitted from a variety of services
including cardiology, neurology, pulmonary, surgery, and medicine. Common
disease states encountered include: sepsis, pneumonia, acute respiratory
distress syndrome (ARDS), myocardial infarction/cardiac arrest, heart
failure, cirrhosis/acute liver injury, and substance withdrawal. Residents
will also get the opportunity to work closely with the clinical dietician
on writing parenteral nutrition orders, and understanding of enteral nutrition
requirements.
Neuro Critical Care (5 weeks)
Neuro Critical Care is an elective, five week learning experience at WMC.
Residents are responsible for rounding daily with their assigned intensivist
team as well as provision of clinical pharmacy services to the patients
and health care practitioners (nurses, physicians, etc.) in the adult
critical care units. This Critical Care rotation allows residents to follow
patients admitted with various neurological and neurosurgical conditions.
Common disease states encountered include: head injury and poly trauma,
hemorrhagic and embolic strokes, seizure disorders, and substance withdrawal.
NICU/Pediatrics (5 weeks)
NICU/Pediatrics is an elective learning experience at WMC. The goal of
this rotation is to learn about care of a neonate and pediatric patient
in a hospital setting. The resident will round daily with the neonatologist,
nurse practitioner, and dietician in the NICU. There will also be opportunities
to round with the pediatricians and medical residents on the pediatric
floor. The resident will also spend time with various members of the pediatric/NICU
teams such as the NICU dietitian, the ketogenic diet dietician, respiratory
therapist, lactation consultant, and nurses. The resident will also be
able to watch circumcisions, eye exam, and deliveries if desired. Throughout
the rotation, the resident will be required to participate in daily rounds,
maintain clinical documentation in EPIC, and document adverse drug reactions/medication
errors appropriately in the risk reporting system. The resident will attend
pediatric, Ob/Gyn, and neontatolgy meetings as able.
Anticoagulation (5 weeks)
Anticoagulation is an elective, five week learning experience at WMC. The
anticoagulation service will follow adult patients on full anticoagulation
or any consults requested by physicians. Patients can be located on any
area within the hospital except for pediatric units. The anticoagulation
rotation will expose the resident to the complexity of caring for a patient
treated for thromboemoblic diseases. Through active involvement in education,
therapy monitoring and adverse event monitoring, the resident will gain
understanding of a system approach to improve current practice and patient
safety. The completion of this rotation will allow the resident to apply
principles learned, as well as contribute to patient care. The resident
will have an opportunity to attend anticoagulation committee meeting and
work on policy related work to improve safety of anticoagulation use around
the system.
Emergency Department (5 weeks)
The Emergency Department (ED) learning experience is an elective rotation
at WMC. WMC ED is a Level II Trauma Center and serves as the initial point
of contact for patients being admitted to a 495-bed community hospital.
During service hours, the Med Rec Team collects the best possible medication
history (BPMH) for patients being admitted to WMC. A pharmacist reviews
the BPMH to ensure appropriateness and addresses any medication-related
problems. The ED pharmacy service also includes code stroke response,
where the ED pharmacists help determine eligibility and dosing for alteplase.
PGY1 residents selecting this learning experience can expect immersion
in all aspects of the ED. In addition to transitions of care, residents
will be involved in acute care experiences, such as code strokes, and
response to traumas, and cardiac/respiratory arrests. Residents will be
expected to engage in direct interaction with patients and other healthcare
providers to ensure the best possible patient outcomes. Residents will
also gain significant experience in staff management by working alongside
pharmacy technicians and ED staff on a daily basis. Good communication
skills, self-initiative, and effective time management will enable residents
to get the most out of this experience.
Neurology (5 weeks)
This rotation is an elective experience for residents interested in learning
about neurology, with an emphasis on acute management of stroke and epilepsy.
The rotation will be primarily focusing on patients on the neurology consult
list and patients located on the neurology floor. Patient care will also
include neuro-intensive care patients. A typical day will consist of rounding
with the advanced practice providers on any new consults or required follow-up
consults followed by time to provide patient education or complete medication
reconciliations and attend discharge rounds. Residents are responsible
for identifying new patients who would benefit from a medication reconciliation
or patients who would benefit from medication education. Residents will
be responsible for chart reviewing all patients on the service daily and
then making necessary recommendations to the neurologists (or their advanced
practice providers) or other attendings. Other required learning experiences
will include preparing provider specific in-services and working on longitudinal
neurology-related projects. Elective experiences may include watching
procedures such as mechanical thrombectomy, electroencephalogram (EEG),
or electromyography (nerve conduction studies) as available and participating
in academia-related activities. During this rotation, residents will have
direct patient care interactions and the opportunity to interact with
a multidisciplinary treatment team on a daily basis. The rotation experience
can be tailored to the resident's individual interests as able while maintaining
consistent patient care.
Inpatient Psychiatry (5 weeks)
The Inpatient Psychiatry rotation is an elective, experience for pharmacy
residents interested in learning about the psychiatric patient population,
the unique problems that they face, and how to manage the use of psychiatric
medications. The rotation is located on the Behavioral Health Services
(BHS) unit within WMC. Common diagnoses include schizophrenia, major depressive
disorder, generalized anxiety disorder, bipolar disorder, posttraumatic
stress disorder, borderline personality disorder, and various substance
use disorders. During this rotation, residents will provide direct patient
care while serving as a member of a multidisciplinary treatment team.
On a typical day, the resident will follow a panel of patients and be
responsible for providing evidence-based pharmaceutical care, including
identifying and resolving errors on medication reconciliation, managing
drug-drug interactions, interpreting therapeutic drug monitoring results,
and exploring other opportunities to optimize therapy. Prior to the interdisciplinary
"lightning rounds" each morning, the resident will work up their
panel of patients and interview patients as needed to obtain necessary
medication-related information and perform medication reconciliation.
The resident will participate in rounds and make medication-related recommendations.
The resident will serve as a liaison between BHS and the pharmacy department
and address any medication-related concerns that may arise. Other required
learning experiences will include providing discharge medication counseling,
educating BHS staff, reporting medication errors, and leading topic discussions
on key psychopharmacology subjects. Other experiences may include leading
patient medication education groups, shadowing with the electroconvulsive
therapy team, opportunities in academia, co-precepting IPPE/APPE students
(as available), and demoing long-acting injectable antipsychotic preparation
and administration. The rotation experience will be tailored to the resident's
individual interests and educational needs.
Practice Experiences
Rounding with interdisciplinary healthcare professional teams
Medication therapy management
Education of pharmacy students and healthcare professionals
Participation in departmental and committee meetings
Involved in medication safety practices
Providing community service
Additional Learning Experiences
Research project
Medication Utilization Evaluations
Manuscript writing
Formal presentations including continuing education seminars
Staffing every third weekend and 1 major holiday
ACLS/BLS certification
Journal Club
Career Development
Teaching Opportunities
Precept a 4th year pharmacy student on rotation
Provide didactic lectures to pharmacy students
Shenandoah University Pharmacy Residency Teaching and Learning Curriculum Program
