Internal Medicine I
Internal Medicine involves the provision of pharmaceutical care on internal medicine/telemetry units within the hospital. The resident will review medication profiles daily to ensure appropriate indications for use, appropriate dosing, monitor for adverse effects, prevent drug interactions, and ensure proper laboratory monitoring.
Daily responsibilities will also include providing pharmacokinetic dosing and management, anticoagulation monitoring, parenteral nutrition management, antimicrobial stewardship, ensuring medication safety, properly documenting patient care activities, and effectively communicating with healthcare providers and patients. The resident will provide drug information and education for healthcare providers and patients. In addition, the resident will observe medical procedures as available to gain a better understanding and knowledge base.
The Infectious Diseases rotation involves the evaluation of empiric as well as definitive antibiotic therapy. The resident will gain experience and proficiency in a diverse patient population and will develop problem solving skills through a variety of patient care experiences including antibiotic dose optimization and antibiotic surveillance. The resident will also participate in a variety of interdisciplinary activities in the inpatient setting such as lab rounds and the Antibiotic Stewardship Program. The ultimate goal is to facilitate and increase the therapeutic knowledge and development of practice skills in the infectious disease setting.
The Critical Care learning experience is intended to provide an opportunity for the resident to apply didactic learning with clinical experience, to further knowledge of critical care medicine and to develop skills in providing pharmaceutical care to the critically ill. The resident will participate in pharmacokinetic dosing, parenteral nutrition consults and respond to medical emergencies. The resident is expected to monitor patient labs and culture and sensitivity reports, review patient medical records and participate in daily interdisciplinary morning rounds. The resident will participate in the education of medical and hospital personnel and attend multidisciplinary team conferences.
Pharmacy Management is a one month rotation involving the management of the pharmacy department services in the hospital environment. The longitudinal experience is comprised of five, two month rotations focusing on pharmacy administration, pharmacy education, quality management, antimicrobial stewardship and drug-information/ clinical services. The resident participates with the pharmacy managers in all aspects of the department management. The resident will be introduced to basic principles of pharmacy financial management, human resource management, clinical performance measures, regulatory requirements and professional strategic planning.
Therapeutic Drug Policy
Therapeutic Drug Policy is a two-month longitudinal rotation with a concentrated one month rotation that involves gathering and organizing information in order to assist or directly identify ongoing drug-related problems, root cause analyses and formulary issues. This rotation entails evaluating and analyzing the medication-use system against current best practices to ensure optimal outcomes. The learning experience is devised to establish a working foundation for providing pharmaceutical care to patients and pharmaceutical information to healthcare professionals and the general public. The resident will participate in a medication use evaluation and journal clubs and will formulate a drug monograph or a drug class review. The resident will also be required to participate and interact with select medical professionals and hospital committees including the Pharmacy and Therapeutic Committee.
The Pharmacy Education rotation involves the educational development of pharmacy staff, healthcare associates, students, and patients. The resident will participate with the Pharmacy Professional Educational Coordinator in all aspects of staff professional development and residency program planning activities. The resident will serve as the Chief Resident and will relay communications between the Residency Director and other residents. The resident will work closely with the Residency Director to coordinate the education calendar including the Resident Interactive Teaching Experiences (RITEs) schedule for the pharmacy department. In addition, the resident will assist with patient education by providing Cardiac and Pulmonary Rehabilitation Medication Class teachings as available.
Throughout the residency year, the resident will also apply the principles of professional education with required presentations. The resident is required to present one Pharmacy Grand Rounds which is Florida approved continuing education for pharmacists, physicians, and nurses and a continuing education program for pharmacy technicians. The resident will also participate in RITEs and present one (1) clinical cases and one (1) Journal Club presentation. Presentations should be approximately 30 minutes in length allowing for 15 minutes of questions and discussions. As part of RITEs programing, the resident will also participate in a learning curriculum involving discussions and development of precepting skills. In addition, the residents work together as a residency class to plan, coordinate, and carry out Pharmacy Week activities for the department. The resident is also required to complete one service project of the resident’s choice per quarter. The intent of the activity is for the resident to contribute to the mission and core values of St. Vincent’s HealthCare.
Antimicrobial Stewardship is a two-month longitudinal rotation focused on developing the residents understanding of the core elements of antimicrobial stewardship in the hospital setting. Throughout this longitudinal experience residents develop educational opportunities aimed towards improving antimicrobial stewardship for Ascension St. Vincent's and improving patient care. Residents are responsible for the implementation of at least two stewardship initiatives during this experience. One initiative will focus on the pharmacy department implementing one of the "5 Ways Hospital Pharmacists can be Antibiotics Aware". The second initiative aims to improve antimicrobial stewardship for the hospital directed towards the medical staff. The resident will also have the opportunity to take part in the antimicrobial stewardship council and attend meetings to gather a better understanding of the operational aspects of antimicrobial stewardship.
Pharmacy Practice is a longitudinal rotation intended to provide the resident the opportunity to develop necessary skills to function as an independent, confident practitioner while providing pharmaceutical care to patients. The resident will complete pharmacy practice shift assignments one evening a week and every third weekend. In addition, the resident will staff one major holiday (Thanksgiving, Christmas, or New Year’s Day) and two minor holidays (the day after Thanksgiving, Christmas Eve or New Year’s Eve and Labor Day, Good Friday or Memorial Day). Staffing assignments will be sufficient to provide the practice experience necessary to function as a competent practitioner. Responsibilities will include both distributive functions utilizing established systems and procedures and clinical pharmacy services for the physicians, nursing staff and patients. The depth of the resident’s level of responsibility will increase during the residency year as the resident develops further knowledge and competency with distributive and clinical services. Shifts requiring increasing professional independence will be assigned progressively to the resident during the course of the residency year.
One of the outcomes of the residency program is the completion of a research project. It requires the resident to identify a pharmacy practice-related issue that needs to be investigated and design, execute, and report the results of the investigation. The resident will present the research results at the Florida Residency Conference. The completed project must include a written manuscript suitable for publication. The objective of this activity is for the resident to gain skills in study design, the IRB approval process, data collection, presentation of research data and publication. The resident may choose the research project from a list of ideas from the pharmacy department or from an idea of their own. The Research Council will give final approval of the research project idea, oversee the progress of the research project and will serve as a resource for the resident. The resident will work closely with a research team that will be assigned based on the research project.
Elective Rotations (24 weeks total)
Cardiology involves the provision of pharmaceutical care on interventional cardiology and telemetry units within the hospital. The resident will review medication profiles daily to ensure appropriate indications for use, appropriate dosing, monitor for adverse effects, prevent drug interactions and ensure proper laboratory monitoring. The resident will provide daily anticoagulation monitoring and dosing. In addition, the resident will provide warfarin counseling to patients. The resident will also observe cardiac procedures to gain a better understanding and knowledge base.
The resident will review admission and non-admission patient medication orders to ensure appropriate indications for use, appropriate dosing and the avoidance of potential drug interactions in order to provide pharmaceutical care for patients in the Emergency Medicine Department. The resident will be responsible for identifying patients presenting with adverse drug events, including overdoses, sub- or supra-therapeutic laboratory parameters and allergic or other drug-related events. Daily responsibilities will include initiation of pharmacokinetic dosing consultations, response to medical emergencies, ensuring medication safety, properly documenting patient care activities and effectively communicating with healthcare providers and patients. The resident will also provide drug information and education for healthcare providers, patients and students.
The Family Medicine rotation involves the provision of pharmaceutical care for patients in the Family Medicine outpatient clinic. The pharmacy resident will be responsible for identifying and resolving pharmacotherapy issues for patients including reviewing outpatient medications for appropriate indication, interactions, dose, duration and appropriate monitoring according to evidence based medicine. The resident will obtain medication histories, assess patient compliance and provide counseling for inhalers, insulin administration and all new medications. The resident will participate in the Transitions of Care Clinic for recently discharged patients. One patient home visit with an attending physician and medical resident is required. The resident will also provide patient education classes for cardiac medications, pulmonary medications and warfarin. Finally, the resident will serve as a drug information resource for Family Medicine and will provide one formal presentation.
Infectious Diseases II
The Infectious Diseases II rotation is designed to empower the resident to develop antimicrobial stewardship initiatives for the healthcare system. The resident will gain experience and develop proficiency in analyzing antimicrobial utilization reports and medication use evaluations to improve antibiotic utilization. The resident will also be responsible for preparing for and presenting at the system-wide antimicrobial stewardship committee. Additional learning opportunities may include: development and review of order sets, synthesis of local antibiogram, refinement of empiric therapy guide, creation of a national monograph for antimicrobial agents, and formulation of criteria for use of antimicrobial agents.
Internal Medicine II
On Internal Medicine II, the resident will participate in rounds with the Medicine Team for the Family Medicine Residency Program. The resident will be responsible for identifying and resolving pharmacotherapy issues for the patients admitted to the hospital under the care of Family Medicine. This includes an appropriate review of outpatient and admission medications for indication, interactions, dose, and duration and providing therapeutic drug monitoring. The resident will serve as the drug information specialist to the team and will provide at least one in-service presentation. The resident will also assist the medical residents with the medication reconciliation process upon discharge of a patient from the service and will provide discharge counseling to the patients.
On the Oncology rotation, the resident will become part of the Oncology team which includes the Oncologist, patient care coordinator (PCC), oncology pharmacist and oncology nurse in order to provide direct patient care to patients on St. Vincent’s inpatient and outpatient oncology units. The resident will assume the responsibility for all aspects of patient drug therapy including advising physicians, nurses and patients on appropriate drug use, participating in formal morning oncology rounds, monitoring patient labs, monitoring culture and sensitivity reports, pharmacokinetic and parenteral nutrition consults and medication-use assessments. Other responsibilities include patient education, drug information consults, contributing to the pharmacy oncology monthly newsletter, reviewing chemotherapy medications and cancer disease states, attending oncology educational meetings and providing lectures on drug therapy to medical and nursing staff.
The purpose of the Parenteral Nutrition rotation is to allow the resident the opportunity to enhance his/her knowledge base and develop the clinical skills in providing nutrition support therapy. The resident will gain direct patient care experience and become familiar with providing best evidence nutrition care for adult medical and surgical patients in need of parenteral nutrition support therapy. With the multidisciplinary coordination of the physician, clinical dietician, nephrologist and endocrinologist, the resident is responsible for designing, implementing, and monitoring all parenteral nutrition throughout the hospital.
Pharmacy Informatics involves the management and development of pharmacy technology and informatics in the hospital environment. The resident will work on technology projects at each of the three hospital campuses and contribute to meetings with the health system’s Information Technology Department. In addition, the resident will participate in topic discussions including principles of process analysis and automation, clinical decision support, clinical documentation in the electronic medical record, evidence based protocols for CPOE, automated dispensing, workload statistics and clinical reporting and medication integration in the electronic medical record.
Quality Management entails quality and patient safety issues that involve the pharmacy department services in the hospital environment. The resident will participate with the department manager in all aspects of quality management and patient safety issues such as adverse drug reaction investigation, medication error reporting, Joint Commission readiness and root cause analyses. The resident will be given an opportunity to participate in projects that address quality improvement and patient safety.
The Sterile Products learning experience focuses on the compounding of intravenous admixtures in a hospital setting. The rotation will cover aseptic technique, USP 797 guidelines and compliance, stability and compatibility of compounded products, and specialty products such as chemotherapy. The pharmacy resident is responsible for developing proficiency in aseptic technique. Once this is achieved, the resident will progress to IV room pharmacist responsibilities: managing workflow, performing the final check of sterile products, chemotherapy review and verification, and TPN review and verification.
Transitions of Care
Transitional Care involves the provision of pharmaceutical care for patients in the ambulatory care setting. The rotation will be based on activities in the outpatient clinics located in the Transitional Care Clinic and the Family Medicine Center. The resident is responsible for all medication management activities for their service, including transitions between different locations. The resident resolves medication system issues, resolving insurance coverage when appropriate to assure safe transition to community pharmacies and providers. The resident becomes skilled in providing education to multiple audiences: patients, caregivers, providers, and other members of the health care team.
Potential Offsite Electives
Pediatrics, psychiatry and toxicology are potential electives at other local healthcare facilities based on availability.
St. Vincent’s Medical Center Riverside’s Department of Pharmacy Services is committed to developing and maintaining high quality learning experiences and opportunities. Changes may be made to the curriculum and other learning activities in order to ensure excellence in the training program.