Learning Experience Descriptions
Academic Detailing
Academic detailing (AD) is an innovative method of educational outreach for healthcare professionals. It supports improved clinical decision-making by fostering one-on-one interaction between healthcare professionals and trained academic detailers to communicate the latest evidence-based clinical data. The resident will actively participate on the AD service, in collaboration with the AD pharmacist. A target prescribing practice will be identified based on departmental and/or national/regional goals. The resident will help develop initiatives and formulate an academic detailing plan to address gaps in knowledge that may facilitate prescribing change. The resident will perform a baseline prescribing assessment, develop educational efforts to address findings, implement education efforts, and measure prescribing patterns following implementation.
Ambulatory Care – PACT
The Patient Aligned Care Team (PACT) is a team of healthcare professionals that provides comprehensive and personalized primary care in partnership with the patient. The PACT pharmacist is consulted to provide management for chronic conditions. The resident will perform medical chart review, patient interview and assessment, order and review lab tests, and provide physician consultation. The resident will evaluate patients, monitor response to treatment, and make changes in therapy as needed in collaboration with the PACT pharmacist. The resident will gain proficiency in common chronic disease states and consensus guidelines that include, but are not limited to diabetes, hypertension, hyperlipidemia, smoking cessation, thyroid disorders, COPD/asthma, and osteoporosis.
Anticoagulation Clinic
During this learning experience, the resident will gain a better understanding of disease states and pharmacotherapy as it relates to adult anticoagulation. The resident will develop skills in assessment and monitoring of disease states, gain experience in pharmacist managed clinics, and collaborate with providers regarding drug therapy. The resident will also provide patient education regarding pharmacotherapy and make interventions to improve medication adherence. For patients taking warfarin, the resident will order and assess labs, interview the patient, and adjust the regimen as needed in collaboration with the anticoagulation pharmacist. For patients taking direct oral anticoagulants (DOAC), the resident will review DOAC consults, provide patient education, and conduct follow-up as appropriate.
Geriatric Ambulatory Care – PACT
The Geriatric Patient Aligned Care Team (PACT) provides comprehensive primary care services to elderly patients with a focus on reducing polypharmacy, falls risk, and managing other geriatric syndromes. This learning experience will give the resident an understanding of common disease states and associated treatments encountered in the geriatric patient. The resident will interview patients in clinic and collaborate with other disciplines to optimize medication regimens. During patient appointments, the resident will perform medication reconciliation, assess for efficacy of medications, and provide education to patient/caregiver(s). The resident will present the findings and recommendations to the provider.
Home Based Primary Care (HBPC)This rotation will emphasize the application of therapeutics in the geriatric patient and require the resident to develop skills in proper drug therapy selection, assessment and monitoring, and patient/staff education. The resident will collaborate with the HBPC pharmacist as part of the interdisciplinary team (includes PT/OT, social worker, dietician, nursing, provider, psychologist, etc.) which provides comprehensive primary care to patients in a home-based setting. The resident will respond to clinical questions and perform initial and quarterly medication reviews for assigned patients enrolled in HBPC. The resident may also have the option to perform home visits for HBPC patients during which the resident will conduct patient interview, provide education, and reconcile medications.
Hospice and Palliative Care/Acute Care for the Elderly
This rotation is designed to give the resident an understanding of disease states and the associated treatment encountered in the acute care geriatric and hospice/palliative care patient. The resident will participate in daily multidisciplinary rounds on patients admitted to the inpatient hospice unit as well as patients on other inpatient units that have an Acute Care for the Elderly (ACE) consult or a palliative care consult. ACE team rounds are attended by the ACE team attending physician, physician assistants, and Coordinated Transitional Care (C-TraC) care managers. Hospice/palliative team rounds are attended by the hospice/palliative attending physician, physician assistants, social worker, psychologist, and chaplain. This rotation will stress the application of therapeutics in the care of patients 65 years of age or older and patients with life-limiting illness and require the resident to develop skills in proper drug therapy selection, patient monitoring, and patient/staff education.
Infectious Disease
This experience involves the provision of patient care for hospitalized patients receiving antimicrobial therapy. The resident will round daily with the infectious disease (ID) team (i.e., attending physician, ID fellow, medical students) on ID consult patients. The resident will make recommendations on selection and dosing of antimicrobial agents, evaluate for potential drug interactions or contraindications, and monitor labs/vitals to evaluate for efficacy and toxicity of antimicrobial therapies. In addition, the resident will participate in antimicrobial stewardship for the facility by performing pre-authorization and prospective audit with feedback to ensure that antimicrobials are used appropriately in the institution.
Inpatient Mental Health
This rotation will develop the resident's knowledge and skills in the treatment of psychiatric diagnoses and comorbid medical disorders. The resident will make recommendations during daily interdisciplinary treatment team meeting (includes attending psychiatrists, psychiatric residents, nurses, social workers, psychologists, and others). The team provides care for patients suffering from an acute psychiatric episode. The resident will also conduct patient education classes on various mental health diagnoses and associated treatments for patients admitted to the psychiatric unit. The resident will complete discharge medication reconciliation for team patients. In addition, the resident will be involved in patient care in the outpatient setting through completion of mental health pharmacist e-consults and participation in the VA national Psychotropic Drug Safety Initiative, among other activities.
Internal Medicine
The internal medicine (IM) rotation will provide the resident experience in managing pharmacotherapy of acutely ill patients. On this rotation, the resident will be responsible for rounding daily with the assigned internal medicine team (i.e., attending physician, medical residents/interns/students). The resident will work toward assuming care of all patients on the team throughout the learning experience. Assuming full ownership on the team entails following pharmacotherapy and making appropriate recommendations as well as managing pharmacokinetic and anticoagulation dosing for patients assigned to the team in collaboration with the IM pharmacist. The resident will also be responsible for completing discharge medication reconciliation for team patients.
Medical Intensive Care Unit
The medical intensive care unit (MICU) rotation will provide the resident experience in managing pharmacotherapy of critically ill patients. The resident will be exposed to a variety of both acute and chronic general medicine disease states requiring a higher, intensive level of care. The resident will participate in the comprehensive care of MICU patients from admission to discharge which includes attending daily interdisciplinary rounds with the MICU team (i.e., attending physician, critical care fellow, medical residents/interns/students). The resident will recommend appropriate evidence based therapeutic interventions during rounds as well as manage pharmacokinetic and anticoagulation dosing for critical care patients in collaboration with the MICU pharmacist.
Oncology
In this learning experience, the resident will develop clinical skills in providing pharmaceutical care to hematology and oncology patients. The resident will take responsibility and function as the oncology pharmacotherapy consultant for nursing staff, attending physicians, nurse practitioners, medical fellows, and pharmacy staff. The resident will participate in patient education and assessment, management of medication adverse effects, management of oral anticancer treatment, patient care consultation, staff education, and medication therapy review. The resident will gain knowledge of oncology disease states, treatment guidelines and resources, chemotherapy regimen assessment, supportive care of the oncology patient, policy development, laboratory value interpretation, medication order review, and hazardous medication preparation and dispensing.
Outpatient Mental Health
This rotation will develop the resident's knowledge and skills in the treatment of psychiatric diagnoses in the outpatient setting. The resident, working under the scope of practice of the preceptor, will see Veterans independently and address their psychiatric medication management needs. The resident will also participate and make recommendations for assigned patients to the behavioral health interdisciplinary program (BHIP) treatment team huddles (including psychiatrists, nurse practitioners, psychiatric residents, nurses, social workers, psychologists). The resident will be responsible for drug information questions that arise during team meetings and through e-consult service. In addition, the resident will be responsible for mental health (MH) prior authorization drug requests as assigned. The resident is expected to shadow and/or participate in committee meetings, including but not limited to the VA national Psychotropic Drug Safety Initiative, BHIP facility meetings, and the CPPO MH Subject Matter Expert (SME) Workgroup.
Pharmacoeconomics/Formulary Management
This experience introduces the resident to managed care principles involved with managing a health system pharmacy formulary by utilizing formulary management and pharmacoeconomic principles. An understanding of the VA Formulary System and the role of National, VISN, and Local P&T committees will be developed. Skills developed will include medical literature searches to provide drug information, develop drug protocols, and for special project presentations. Additional skills obtained will include principles involved in the electronic formulary management process using medication use evaluation, case management, treatment guidelines/criteria for use, cost containment initiatives, non-formulary process, and understanding the importance of utilizing formulary management and pharmacoeconomics principles in formulary decision making.
Practice Management
This rotation will expose the resident to general administrative and clinical skills necessary to lead a complex tertiary care center with extensive inpatient, outpatient, and clinical pharmacy services. The rotation will provide the resident with insight into key issues confronting pharmacy practice, specifically from pharmacy leadership's perspective. The resident will attend meetings and work on assigned projects in order to develop knowledge and skills related to communication, decision making, productivity management, problem identification, problem solving, strategic planning, and policy development. The resident will also gain a general understanding of human resource management, financial management, labor relations and pharmacy regulations and law.
Substance Use Disorders
This learning experience will provide the resident with experience managing all aspects of pharmacotherapy for substance use disorders and associated mental health conditions. The resident will provide care for patients engaged in all levels of recovery – inpatient, residential, and ambulatory – on an interprofessional team including psychiatrists, psychologists, family medicine physicians, social workers, nurses, and peer counselors. The resident will evaluate patients, initiate therapy, monitor response to treatment, and make changes in therapy as needed, in collaboration with the SUD pharmacist. The resident will gain proficiency in treatments and guidelines for opioid and alcohol use disorders, harm reduction principles, and motivational interviewing/patient-led treatment plans.