Learning Experiences

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.

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.

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 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.

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.

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.

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.

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.

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.

Orientation is a one 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.

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.

The Progressive Care Unit is an elective, one 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.

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 is a required 12-month, longitudinal learning experience. Residents are required to staff in the Central Pharmacy every third Saturday and Sunday. Every third Monday 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.