This is a longitudinal rotation intended to provide continued clinical practice in combination with population management throughout the residency year.  The resident will be working in collaboration with the pharmacy service of our VISN 21 stations Pharmacy Service and available VISN 21 dashboard tools to improve patient safety, quality and other outcomes. The resident will be assigned to this experience ½ day/week throughout the year. The purpose of this rotation is to continue to expose the resident to direct patient care through the use of analysis tools to identify/target patients based on local needs at the assigned VISN 21 station (to assist in meeting metrics, measures, or fulfilling another patient care need).  This will maintain and improve the resident’s clinical abilities while allowing them the opportunity to utilize tools they are creating in order to provide the perspective of an end-user.  The resident will not only collect and analyze patient information from the analysis tools, but work in collaboration with other healthcare providers at the medical center to create patient plans and directly involve themselves in patient care as necessary. 

Overall the resident will learn and apply a variety of data skills from database extraction to final product development, with the goal of independent creation and maintenance of electronic dashboards and reports.  Knowledge and applied use of structured query language (SQL) will be taught for leveraging relational databases. This includes formulating, executing, and revising plans and coding procedures for data extractions using SQL. Upon graduation from the program, the resident will have an overall understanding of the VA health data repository, the Corporate Data Warehouse (CDW), and the VISN 21-specific database within the CDW. In addition to SQL, the resident will be taught data analysis and report design with programs such as Power BI. 

This learning experience is designed to develop, execute, and report results of investigations of pharmacy practice-related issues.  The resident will be responsible for obtaining experience in all areas of a research or quality improvement project including development of a hypothesis, submission of a project proposal, application to IRB (for research approval or classification as a QI), data collection, data analysis, drawing conclusions, and manuscript presentation.  The resident will work with the RPD and one or more preceptors throughout the project life cycle as well as the Research personnel from the VASNHCS who will assist in coordinating project deadlines and IRB approval.  Residents will be encouraged to conduct outcomes-based research or quality improvement projects, preferably incorporating the skills learned from other rotations and building a new analysis tool that will assist in the data mining component of the project.  In addition to the manuscript, residents are required to present a project poster at the ASHP Midyear Clinical Meeting and a PowerPoint presentation at the annual NVSHP resident CE forum in the spring, in addition to a poster or platform presentation at another professional meeting of their choosing in the spring.

This rotation is an extended learning experience that will help residents become familiar with the key principles utilized in health systems for leadership and overall practice improvement.  The VISN 21 Pharmacy Executive and Deputy VPEs will serve as the primary preceptor and evaluators for this experience; though the resident will be precepted by other management/leaders within the organization as well.  This experience is designed to expose the resident to leadership nomenclature, key principles, tools, and available resources that will assist them in growing as clinicians, practitioners, and leaders.  During the residency, practice foundation skills and values will be taught and observed by preceptors and the experience will be individualized based on the resident’s baseline knowledge and growth throughout the year.  The resident will participate in a number of activities designed to improve their working knowledge and experience with leadership concepts.  The overarching goal of this longitudinal experience is to enable the resident to apply the knowledge gained to any pharmacy practice setting to improve their individual practice and confidently utilize leadership skills.  Topics may include mission/vision statements, strategic plans, effective communication, networking, mentoring, clinical leadership, leadership strategies, available resources/opportunities, regulatory bodies, finances, medication safety, organizations, the importance of publishing, and various programs/activities designed to develop the resident’s pharmacy practice/leadership foundation. 

This rotation will provide the resident exposure and experience in Academic Detailing. They will receive training and learn techniques and skills for performing academic detailing visits, and be able to apply what they learn in detailing sessions. Residents will be working with the VISN academic detailing program manager all VISN 21 facilities.   

Role of the Academic Detailer

The Academic Detailer is responsible for providing Academic Detailing to staff based on national and VISN initiatives. Academic Detailing involves reviewing and learning evidence-based medicine, developing and/or promoting educational pieces that include key messages, providing Academic Detailing outreach visits to VA staff, identifying and resolving barriers, and socializing new Academic Detailing campaigns. 

This is a required longitudinal learning experience that begins after orientation and continues throughout the year.  The VISN 21 Pharmacy Executive and the VISN 21 Pharmacy Program Manager will serve as the primary preceptors for this learning experience.  The resident will develop the knowledge, skills, values and abilities necessary to assist in creating and maintaining Drug Use Criteria/Criteria for Use, improving procurement, contract compliance, and inventory control activities to achieve maximum savings and data accuracy.  Several standing committees and many practitioners are involved with the work of developing, modifying, and maintaining the VA National Formulary.  In addition, the VISNs are responsible for adherence to Drug Use Criteria and Criteria for Use developed nationally and locally.  The VISN PBM supports many aspects of the programs designed to support this system.  The resident will be exposed to the concepts of managed care systems through their involvement in all aspects of VISN formulary management.  Overall, the resident will better understand the complete cycle of drug procurement from the formulary addition, to negotiating contracts with the manufacturer, to ordering, and to receiving the pharmaceuticals.  In addition, the resident will gain the necessary knowledge and experience in revenue generation to better understand the legislation, regulation and policies concerning the prescription benefit within the Veterans Health Care Administration.  From this fundamental knowledge the resident will also be able to gain expertise in minimizing drug expenditures through cost-containment projects such as pharmacoeconomic conversion proposals.  These are therapeutic interchanges which assess the feasibility of changing a VISN 19 and 21 population from one drug or item to another which incorporate safety, efficacy, cost projections and logistics of changing market share.  These projects will be developed and assigned by the preceptor at the direction of committees, task forces, informal groups and will be independent and group learning experiences.  The resident will be assigned tasks and will work with a variety of VISN employees in diverse areas to accomplish PBM goals/business for this learning experience. 

The resident will develop skills, values and abilities in the practical application of pharmacoeconomic principles to the VA healthcare environment and in research design and methodologies to assess pharmaceutical-related economic, clinical, and humanistic health outcomes.  The VISN Pharmacoeconomics lead, PADR team, VASNHCS Pharmacoeconomics Pharmacist, and VISN data analysts serve as the preceptors for this learning experience that begins after orientation and continues through March with the option of an Advanced elective.  The resident will be assigned tasks and will work with a variety of VISN employees in diverse areas to accomplish tasks for this learning experience.  Outcome projects will be developed and assigned by the preceptor at the direction of committees, task forces, informal groups and will be independent and group learning experiences. 

Each resident will have opportunities for elective experiences during the second-half of the residency year.  These are specifically intended to tailor the residency experience to the resident’s needs, goals, and interests.  Offered elective experiences include academia, advanced skills with technology or automation systems, advanced leadership and management, and advanced pharmacy benefit design and formulary management.