The orientation learning experience (LE) purpose is to help orient the resident to all aspects of pharmacy service and introduce them to the various personnel and services provided. It covers the residency's purpose and practice environment, the appropriate accreditation standards, competencies, goals and objectives. The design of the residency program including all program requirements will be discussed. A description of all possible learning experiences will be provided along with the evaluation strategy. The residency manual will be presented along with policies and terminology.

This LE includes extensive computer training, intensive hands-on training, and ample training for inpatient pharmacist staffing on weekends and evenings. There is a general orientation to outpatient processing  and inpatient processing, including filling of prescriptions, processing of narcotics for both inpatient and outpatient areas, sterile compounding and USP requirements, unit dose repackaging, compounding and barcoding, as well as technician oversight. Orientation includes discussions and training for both inpatient and outpatient areas. The orientation also includes ACLS and BLS certification, introduction to Formulary Management and Quality Management areas and an introduction to the automation used throughout the medical center.

Internal Medicine (IM I) is a required, four-week (minimum) learning experience at the Dayton VA Medical Center. There are approximately 63 acute care beds within the facility.  There are four IM teaching teams which are responsible for a maximum of 32 patients per day.  Each of the teaching teams includes an attending physician, a senior medical resident, a medical intern, frequently medical students (MSIII or MSIV), and occasional podiatry intern. 

The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team. Routine responsibilities include: reconciling medications for all patients admitted to the team, addressing formal consults for non-formulary drug requests, and therapeutic drug monitoring. The pharmacist will also provide drug information and education to healthcare professionals, as well as to patients and caregivers.

PACT is a required, 4-6 week learning experience at the Dayton VA Medical Center. Primary Care Clinical Pharmacists work under the PACT (Patient Aligned Care Team) model. PACT is a partnership of the Veteran, family, and health care teams, established through continuous relationships and provide an optimal healing environment, in order to improve health outcomes and the Veteran's experience of care.

The primary responsibility of the Clinical Pharmacy Specialist is the provision of evidence-based pharmaceutical care services through both direct and indirect interaction with patients and providers. Clinical pharmacist in PACT promote and manage drug therapy based on current clinical knowledge that is consistent with policies and protocols established at the local, VISN and national  levels as well as practice guidelines. The Clinical Pharmacy Specialist functions as part of the PACT Team and manages an assigned panel of patients, to support continuity of care. Along with these services, PACT pharmacists provide drug information and education to healthcare professionals as well and patients and caregivers.

Psychiatry is a required, four week long learning experience.  The purpose of this clinical experience is to  the pharmacy resident with the knowledge and skills necessary to care for patients with psychiatric and neuropsychiatric disorders.  For the inpatient experience the pharmacy resident will work as part of an interdisciplinary team focusing on improving patient care, optimizing medication therapy, and providing medication expertise to patients and healthcare professionals. Residents will participate in daily treatment team meetings, rounds, contribute to the development of treatment plans, and provide evidence-based, patient-centered treatment for chronic mental illness in all degrees of complexity.

Residents will be given responsibility for direct patient care, progressively increasing toward independence at a pace determined by both the resident and preceptors.  Residents will work in the mental health outpatient clinics, serious mental illness clinic and depression clinic providing medication therapy management, monitoring plans, psychoeducation and supportive counseling.  The resident assumes responsibility for providing evidence-based pharmacotherapy management and focuses on recovery-based interventions to improve patient outcomes.

This is a required, longitudinal learning. The resident will work with several administrative preceptors throughout the residency year – the time required with each preceptor will vary based on needs of the institution and workload. In having this model, it is designed to mimic real world administrative workload. This rotation is a combination of the broad areas of administration and medication safety & regulatory compliance. This rotation has several sections of overlap across the respective areas listed above and as a result is now a combined rotation to increase efficiency with time and evaluations.

This rotation will expose residents to patient safety issues and regulatory compliance within the Department of Veterans Affairs.  Some of the areas the resident will focus on include but are not limited to internal and external quality standards, quality improvement, legal, regulatory, safety, and accreditation requirements, adverse drug event and medication error reporting, and technology in medication safety. 

This is a required, four week learning experience. The resident will work with the Anticoagulation Clinic clinical staff throughout the residency year in completing this rotation.  There are approximately 1,400 patients in the anticoagulation clinic. The clinic team includes: several clinical pharmacy specialists and 2 clinical pharmacy technicians.  The clinic staff is all within the pharmacy department. The clinic is a consult service and any medical issues outside of the scope of the clinical pharmacist are directed to patient’s primary care physician. Emergent issues are directed to the emergency room.

Pharmacists identify and resolve medication-related problems for all outpatients who have anticoagulants provided by the Dayton VA. Anticoagulation include warfarin, low molecular weight heparins and direct oral anticoagulants (DOAC). The clinical pharmacy specialists on the team are responsible for ensuring safe and effective anticoagulation for all patients consulted to the clinic, including review of all patient charts, collaboration with pharmacy to assure timely medication availability; education of patients and their family members, education of physicians and nurses, and education of pharmacy trainees; and participation in organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees.

Heart Failure (HF) is an ambulatory care, longitudinal learning experience. The outpatient cardiology clinics consist of cardiologists, nurse practitioners, cardiology fellows, medicine residents, dietary, clinical pharmacists, behavioral health psychology fellows, registered nurses. This elective is designed for a resident with high maturity level and has the ability to work independently amongst a high functioning interdisciplinary team. Commonly referred disease states include HF, anti-arrhythmic monitoring, angina, and Atrial Fibrillation. Due to the observed common link with increased hospitalizations of HF and lung disease, COPD education will be required to compliment HF clinic. During this learning experience, residents will collaborate with the interdisciplinary team in the management of all patients within the clinic. 

A Medication Use Evaluation (MUE) and a major project are required learning experiences. MUE encompasses the goals and objectives of drug use evaluation in its broadest application, with an emphasis on improving patient outcomes. MUE will be applied to a medication or therapeutic class, disease state or condition, a medication-use process (prescribing, preparing and dispensing, administering, and monitoring), or specific outcomes.

Major project teaches the resident project management skills. It requires the development of an idea into a feasible project, writing a proposal, obtaining the necessary approvals, implementing a project, analyzing the results, writing a manuscript suitable for publication and completing the documents required for manuscript submission to the selected journal. The project manuscript is the culmination of the year-long project which is evaluated throughout the year in the longitudinal experience.

The resident will work with the Inpatient & Outpatient pharmacy staff throughout the year in completing this rotation. Each resident will staff every other Saturday & Sunday, and additional staffing based on resident’s need for inpatient/outpatient staffing to meet the LE goals/objectives. Residents will switch their designated weekends in December to gain exposure to different pharmacy personnel. The resident will be responsible for notifying the Inpatient Pharmacy Supervisor as early as possible to discuss any weekend switches to this schedule.  The longitudinal Staffing rotation will provide exposure for the resident to the daily functioning operations of the inpatient and outpatient pharmacy. The resident will gain an understanding of the roles the pharmacist and the technician play, as well as the systems and technology used in the pharmacy.

Integrative Medicine is a four-week long learning experience.  The purpose of this clinical experience is to equip the pharmacy resident with the knowledge and skills necessary to care for patients with pain by using a comprehensive, multicultural and integrated approach to pain management that reduces pain and suffering for patients experiencing acute and chronic pain. This includes a comprehensive pain assessment as appropriate to the patient's condition and ongoing pain re-assessment and follow-up.  The pharmacy resident will work as part of an interdisciplinary team focusing on improving patient care, optimizing medication therapy, and providing medication expertise to patients and healthcare professionals. Residents will participate in treatment team meetings, contribute to the development of treatment plans, and provide evidence-based, patient-centered treatment to manage pain (acute and chronic) in all degrees of complexity.

This is a longitudinal learning experience in Academia completed at Cedarville University or University of Cincinnati. It’s designed to prepare pharmacy residents for successful didactic and clinical teaching. This program will provide the resident a broad understanding of issues in pharmacy education and opportunities to enhance their teaching skills. It has been constructed for residents to gain knowledge in educational theory, develop experience in teaching in various instructional settings, and document and reflect upon their teaching activities. It is the expectation that when a resident begins the Teaching Certificate Program, they will commit to the entire program which culminates in receiving a certificate of accomplishment. Residents will have several didactic sessions throughout the residency year.

In addition to the Teaching Certificate, residents will be involved in a variety of teaching experiences throughout their residency year including precepting students and facilitating student learning experiences in critical literature evaluations through journal clubs, topic discussions and patient presentations. The resident will also be doing formal presentations and ACPE Continuing Education Programs for the pharmacy.

Some elective learning experiences include infectious disease, Endocrinology, Home-Based Primary Care, Long-Term Care, Women’s Health/Academic Detailing, and Teaching rotation. Residents have 3-4 months of elective experiences in the second six months of the residency year. Some electives do not include pharmacists and will be offered in the last quarter of the residency year.

If scheduling allows, residents are allowed to repeat required/elective learning experiences for additional training.