Learning Experiences
Internal Medicine I
The Acute Medicine I learning experience is a required 1 month patient care learning experience that occurs on a general medicine floor and encompasses 33-36 beds. During this rotation, the resident will attain skills and knowledge regarding the treatment and monitoring of various disease states including, but not limited to COPD, pneumonia, diabetes, hypertension, UTI, and skin and soft tissue infection. The resident will also participate in roles of the decentralized pharmacist assigned to the floor, namely managing and responding to pharmacy consults, Sentri7® intervention and documentation, and order verification. By the end of the rotation, the resident should be able to effectively monitor patients, recommend treatment plans, collaborate with other healthcare professionals, and manage a decentralized pharmacy practice.
Internal Medicine II
The Acute Medicine II learning experience is a required 1 month rotation that occurs on a general medicine floor. Successful completion of Acute Medicine I is a prerequisite to this learning experience. This rotation allows for residents to provide evidence-based patient-centered care to patients admitted to a medical/surgical unit. The resident will practice as the decentralized pharmacist for the floor and become fully integrated into the interdisciplinary team which includes nursing, respiratory therapy, physical therapy, hospitalist, and case management. The resident will be expected to review floor patient profiles daily.
Antimicrobial Stewardship
The Antimicrobial Stewardship learning experience is a required 4 month longitudinal experience. During this experience the resident will gain a general understanding of appropriate empiric and definitive utilization of antimicrobial agents in the adult inpatient population. The resident will support antimicrobial stewardship initiatives through the development of education, protocols, and prospective audit and feedback. Antimicrobial utilization data will be collected, analyzed, and presented to appropriate stakeholders/committees.
Code Response
Code Blue: Code Blue situations on the medical floors are low volume, high stress situations. The Code Blue learning experience is designed to ensure that residents have adequate exposure to the code environment and to allow for management of various cardiac rhythms and patient intubation. The resident will learn to manage the medication cart during codes, anticipating needs based on the identified rhythm and ACLS algorithms.
Code Stroke: This learning experience is designed to give our residents the opportunity to gain familiarity and excellence in providing care to patients who present with ischemic strokes. The resident will attend stroke responses with the assigned preceptor and learn from direct instruction and progress to facilitating code stroke care before the end of the residency year. This includes knowing inclusion and exclusion criteria for thrombolytic therapy, blood pressure goals and agents to lower blood pressure, medication dosing, and patient monitoring.
Code Stroke: This learning experience is designed to give our residents the opportunity to gain familiarity and excellence in providing care to patients who present with ischemic strokes. The resident will attend stroke responses with the assigned preceptor and learn from direct instruction and progress to facilitating code stroke care before the end of the residency year. This includes knowing inclusion and exclusion criteria for thrombolytic therapy, blood pressure goals and agents to lower blood pressure, medication dosing, and patient monitoring.
Continuing Education Presentations
Each resident will prepare and present two 1-hour presentations that are certified for continuing education credit per the Accreditation Council for Pharmacy Education (ACPE). Compliance with ACPE requirements such as developing measurable learning objectives, incorporating active learning, and providing post-presentation assessment questions is required. One presentation may be related to the resident's chosen research project topic, and the other presentation should address a new or controversial topic in clinical pharmacy. Both presentations should be presented in an interactive manner with the audience.
Critical Care
The Critical Care learning experience is a required 1 month experience designed to provide the resident with the opportunity to develop the knowledge and skills about the clinical course, manifestations and therapy of common critical care disease states through direct instruction, observation and modeling by the preceptor. The resident will have the opportunity to apply this knowledge through active participation in the multi-disciplinary team and focused projects relating to critical care with coaching and facilitation occurring by the preceptor.
Drug Information
The Drug Information learning experience is a required 12 month longitudinal experience. The resident will have opportunities to learn drug information principles and critical appraisal skills from institution preceptors. The resident will respond to drug information questions, complete a drug information project, present journal clubs, and have the opportunity to participate in a medication use evaluation (MUE).
Emergency Medicine
The Emergency Medicine learning experience is an elective 1 month experience in a ~90 bed emergency room. The rotation involves the care of patients in the hospital's emergency department (ED). The ED is a fast-paced environment that can allow for experience in hands-on patient care. In addition to issues relating to critically ill patients, principles of internal medicine and other areas will be covered. The clinical pharmacist collaborates with physicians, residents, nurses and other disciplines to ensure appropriate, evidence-based medicine is used to treat and monitor the patient. The resident will participate in discussions of pharmacotherapy related to patients observed in the ED and are responsible for their monitoring. There may also be opportunities to participate in the education of student pharmacists, nurses, and Emergency Medicine residents.
Family Medicine
The Family Medicine elective is a 1 month learning experience on a medical/surgical unit in conjunction with a non-geographic internal medicine rounding service. This unique interdisciplinary learning experience takes place with the inpatient rounding service staffed by a rotating attending physician, and resident physicians within the Family Medicine Residency Program. The resident will collaborate with the medicine team to deliver evidence-based care to general medical and surgical patients within the underserved community, present once-weekly pharmacotherapy-based presentations to educate the team, and complete chart review and pharmacist-driven consults for all patients on service.
Heart Failure
The Heart Failure learning experience is an elective, 1 month rotation. This rotation will focus on the inpatient management and transitions of care of patients with heart failure. The resident will round with the heart failure team and collaborate with providers and nursing staff to ensure appropriate, evidence-based medicine is used to treat and monitor the patients. There may also be opportunities to participate in the education of student pharmacists and in discharge counseling for patients.
Infectious Disease
The Infectious Disease learning experience is an elective 1 month experience designed to provide experience in the management of patients with a variety of complicated infectious processes. The resident will gain a general understanding of the etiology, pathophysiology, prognosis, and antimicrobial therapy for certain infectious diseases. Throughout the rotation, the resident will routinely collaborate with infectious disease physicians to ensure appropriate implementation of evidence-based pharmacotherapeutic care plans. The resident will also be required to complete one infectious disease or antimicrobial stewardship related project or presentation based on the needs of the organization.
Leadership Development
The Leadership Development series is a required 4 month experience where the resident will gain insight into pharmacy’s role within the facility and at the system level, leadership techniques to develop and maintain the right culture, and strategies for operational improvements. The resident will have opportunities to discuss and put into practice leading others, time management, and feedback. Insight and understanding will also be offered in the areas of regulatory compliance.
Medication Safety
The Medication Safety rotation is a required 4 month longitudinal experience that gives the resident an insight into and experience with medication event reporting and monitoring. The resident will investigate medication safety events, conduct a root cause analysis (RCA), and develop a recommendation to prevent a similar error in the future. The resident will also gain an appreciation for ISMP's purpose, publications, and quarterly gap analysis.
NICU, Nursery, and OB
The NICU, Nursery, and OB learning experience is an elective 1 month experience designed to provide the resident with the opportunity to develop the knowledge and skills about the clinical course, manifestations and therapy of common mother/baby disease states through direct instruction, observation, and modeling by the preceptor. Residents will have the opportunity to apply this knowledge through active participation in order verification and focused projects relating to mother/baby with coaching and facilitation occurring by the preceptor.
Pain and Palliative Care
The Pain and Palliative Care learning experience is an elective 1 month experience designed to provide the resident with the opportunity to develop the knowledge and skills necessary to provide appropriate treatment strategies for patients with acute and chronic pain. The resident will develop pain management strategies through direct instruction, observation, and modeling by the preceptor. Residents will have the opportunity to apply this knowledge through active participation in the Palliative Care team focusing on pain management in palliative care, post-surgical patients with pain care needs, and chronic pain patients admitted for acute care management.
Parenteral Nutrition Service
The Parenteral Nutrition Support Service is a required 12 month longitudinal learning experience where residents will assess parenteral nutrition indication, create safe and effective parenteral nutrition plans, and complete ongoing monitoring in conjunction with our registered dietitian team. Residents will have the opportunity to create individualized parenteral nutrition plans based on patient specific information and established guidelines to include goal kilocalories, macronutrients, fluids, electrolytes, micronutrients, and glucose management.
Pharmacotherapy Clinic
The Pharmacotherapy Clinic learning experience is a required 1 month experience that provides a focused experience in primary care. The clinic is located within St. Louise Clinic Family Medicine Center and is in collaboration with the Family Medicine Residency program. The clinic is a family practice setting composed of attending physicians, medical residents, nurse practitioners, nurses, medical assistants, and a social worker. The pharmacist's role in the clinic is to provide comprehensive medication management (CMM) via a collaborative practice agreement, patient/caregiver counseling and education, as well as drug information to other members of the healthcare team.
Pharmacy Operations
Pharmacy Operations is an 1 month required learning experience. The learning experience will provide an opportunity for the resident to develop foundational pharmacy operational practice skills. The scope will include automated medication distribution, sterile and non-sterile compounding, narcotic medication distribution and management, preparing, packaging and labeling oral and intravenous medications, and monitoring medication therapy. The resident will work in the central pharmacy and participate in the medication procurement, preparation and distribution process. The resident will supervise pharmacy technicians and maintain Central Pharmacy operations.
Pharmacy Orientation
Orientation is a 1 month required learning experience. The learning experience will provide a focused introduction to hospital pharmacy practice. It will include Ascension Saint Thomas Health/Saint Thomas Rutherford Pharmacist onboarding activities, as well as activities specific to the Residency program. Orientation topics include: completion of Pharmacist Onboarding Checklist, review of PGY1 Resident Manual and Resident Policies and Procedures, training in Cerner, PowerChart and PharmNet, introduction to consult services, including pharmacokinetics, parenteral nutrition, and code response. Baseline competency will be assessed via ASHP modules, and patient presentations in SOAP note format. Orientation topics will be scheduled and communicated via a calendar.
Precepting Applied Therapeutics
The Precepting Applied Therapeutics learning experience is a required, longitudinal experience that is designed to give the resident an opportunity to precept 1st, 2nd and 3rd year pharmacy students. The goal of the Applied Therapeutics course is to prepare students to provide direct patient contact and to apply therapeutic knowledge to solve drug-therapy problems. The resident's responsibility is to help mentor and guide students as they prepare for and present assigned patients.
Progressive Care Unit
The Progressive Care Unit is an elective, 1 month learning experience designed to provide experience in the management of higher acuity disease states. Residents will gain experience in managing select drips for the treatment of hypertensive crisis, diabetic ketoacidosis, end stage heart failure, atrial fibrillation, and severe sodium disorders. The resident will practice as the decentralized pharmacist for the floor and become fully integrated into the interdisciplinary team which includes nursing, respiratory therapy, physical therapy, hospitalist, and case management.
Research Project
Each resident will conduct a residency research project. The residents will be provided with a list of topics early in the residency year. Each of the topics will identify an area specific to our institution that could positively impact patient care or the medication-use system. Residents will work with a preceptor and/or project advisor to complete the project by all assigned deadlines. Project results are required to be presented as a poster at the Tennessee Society of Health System Pharmacists (TSHP) and in a platform format at a regional residency conference or in another forum considered appropriate. The project will be written in manuscript format suitable for submission to a peer-reviewed journal.
Staffing
Staffing is a required 12 month, longitudinal learning experience. Residents are required to staff in the Central Pharmacy every third Saturday and Sunday. Every third Tuesday evening from 1530-1930 (weekday subject to change depending on department needs), the resident will be expected to staff in a decentralized role with a focus on order verification and operations. Residents will also be assigned additional staffing shifts throughout the year as needed, especially during the month of December.
The rotation will provide an opportunity for the resident to develop and continue to refine foundational hospital pharmacy practice skills. The resident will participate in the medication procurement, preparation and distribution process. The resident will focus on the safe, effective and cost-conscious delivery of medications to inpatients. Other staffing duties will include answering drug information questions as they arise, and clinical duties including pharmacy consults, Sentri7, and emergency code response. Residents will be assigned code response and Parenteral Nutrition consults until competency is attained, at which time the frequency will be concentrated to the resident's other rotation opportunities.
The rotation will provide an opportunity for the resident to develop and continue to refine foundational hospital pharmacy practice skills. The resident will participate in the medication procurement, preparation and distribution process. The resident will focus on the safe, effective and cost-conscious delivery of medications to inpatients. Other staffing duties will include answering drug information questions as they arise, and clinical duties including pharmacy consults, Sentri7, and emergency code response. Residents will be assigned code response and Parenteral Nutrition consults until competency is attained, at which time the frequency will be concentrated to the resident's other rotation opportunities.