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,
clinical protocols, 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 npt have
been able to get a full rotation in, and transition from orientation to
more formal rotations.
Internal Medicine (5 weeks)
Internal medicine is 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)
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)
The resident will meet with the pharmacy manager or the medication safety
program manager in the inpatient pharmacy office on a daily basis. Each
morning, the pharmacy manager or med safety program 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 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 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 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)
The resident will staff once every 3rd weekend as well as one major holiday.
The staffing requirement covers multiple locations within the hospital.
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 clinical consults. The resident may also be assigned to
one of the decentralized pharmacies where they would be more heavily involved
in clinical services.
Community Outreach/Career Development (Longitudinal)
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. 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, and 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)
The service will include Cardiovascular Intensive Care Unit (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)
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)
Residents are responsible for rounding daily with their assigned intensivist
team as well as provision of clinical services to the patients and health
care practitioners. This rotation allows residents to follow patients
admitted with various neurological and neurosurgical conditions. Common
disease states include head injury and poly trauma, hemorrhagic and embolic
strokes, seizure disorders, and substance withdrawal.
NICU/Pediatrics (5 weeks)
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 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 neonatology meetings as able.
Anticoagulation (5 weeks)
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)
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 will be primarily focusing on patients on the neurology consult
list and patients located on the neurology floor. 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)
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
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
