PGY1 Pharmacy Residency Curriculum

Orientation and Training is a required learning experience that will provide an overview and orientation to the residency program. Additionally, the resident will receive training in the central pharmacy with a focus on distributive operations and regulatory workflow. A minimum of three full days within the first week of orientation will be dedicated to orientation to the residency program and related requirements, policies, and procedures.

Following introduction to the residency program policies and procedures, residents will begin orientation and training in the central pharmacy. This training is designed to be consistent with the schedule, standards, and expectations of any new clinical pharmacist at BIDMC who would be scheduled for a shift in the distributive (central) pharmacist role.

The curriculum includes, but is not limited to, achieving competence in operations of the BIDMC Department of Pharmacy, departmental workflow, use of departmental and hospital information systems and technology, knowledge and application of departmental and hospital policies and procedures, and the skills needed to serve as a clinical pharmacist during the service requirements of the residency.

The PGY1 pharmacy resident will train for a minimum of fourteen (14) shifts in the centralized pharmacy to learn the core functions and responsibilities of pharmacists in this practice area. A training checklist and other documents are provided to provide more detail relative to the content and competency requirements in this role.

The Pharmacy Practice learning experience provides the resident the opportunity to develop essential practice skills in the role and responsibilities of a Clinical Pharmacist in one or more of the medical center’s decentralized, clinical practice sites. This learning experience builds upon the fundamental knowledge gained through their initial training and work in the central pharmacy and facilitates the resident to advance their training and practice to be able to independently practice as a decentralized Clinical Pharmacist.

The role of a decentralized Clinical Pharmacist in an assigned practice area includes the medication management and oversight of 60-100 patients on one or more floors including providing prospective order verification, therapeutic drug monitoring, patient education, and drug information to the multidisciplinary team. The focus of training will be geared towards the routine operational and clinical responsibilities of the decentral pharmacist and increasing confidence with institutional policy, procedures, and clinical practice.

The Infectious Diseases (ID) learning experience is a required, five-week learning experience. Residents may spend time with two different ID teaching teams: one focusing on the immunocompromised patient and the other on the immunocompetent patient. Each team includes an attending physician and two ID fellows. Additional team members may include medical interns, medical residents, medical students, pharmacists and/or pharmacy students. The ID consult service sees a wide variety of patients from many different backgrounds (medical service, critical care, oncology, HIV, etc.).

The resident works with the ID consult team at daily rounds, maintaining a responsibility to optimize anti-infective therapy for the consult patients. This includes dosing recommendations based on organ function, avoidance or mitigation of adverse reactions, and daily monitoring of anti-infective therapies, including performing kinetics consultations. While on the learning experience, the resident will also participate in the P&T Antimicrobial Subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and ID Departments.

Internal Medicine (IM) is a required, five-week learning experience. The goal of the IM learning experience is for residents to develop skills and competencies in the provision of pharmaceutical care for a diverse population of IM patients, enabling them to effectively participate in therapeutic decision making, drug therapy selection, monitoring of acutely ill patients, and providing patient education.

Typically pharmacy residents will round on one of 4 internal medicine teaching teams. Each of the teaching teams includes an attending physician, a PGY2 or PGY3 medical resident, 2 PGY1 medical interns, and medical students (MSIII or MSIV). Other disciplines on the team include the clinical pharmacist and pharmacy students. Teaching teams typically are responsible for 15-18 medicine patients.

The clinical pharmacist on the team, and in turn the pharmacy resident, is responsible for ensuring safe and effective medication use for all patients. This involves active participation in daily rounds and collaboration with other pharmacy, nursing, and physician personnel as appropriate. The pharmacy resident assumes an active role in assisting the team with medication reconciliation issues, including obtaining accurate home medication lists, and providing patient counseling at the time of discharge.

Strong communication and interpersonal skills, as well as time management skills are necessary to succeed during this learning experience. Residents will have opportunities to further refine these abilities and further develop their clinical knowledge, ability to provide patient care, develop a working relationship with an interprofessional health care team, identify and interpret health literature, and educate patient and providers while on this learning experience.

The Critical Care learning experience is a required five (5) week learning experiences intended to introduce the pharmacy resident to foundational topics of caring for critically ill patients. Residents will gain experience and knowledge in the pharmaceutical care and disease states specific to the critical care setting. The Critical Care learning experience may be completed in any of the following specialty settings:

• Medical Intensive Care (MICU/FICU)
• Cardiovascular Intensive Care (CCU)
• Neuroscience Intensive Care (NSICU)
• Surgical Intensive Care (SICU)
• Trauma/Surgical Intensive Care (TSICU)

Regardless of practice setting, the resident will have the opportunity to round with an interdisciplinary team composed of the following team members: attending physician and fellow, medical residents, medical interns, medical students, clinical pharmacist, nursing staff, and additional allied healthcare professionals (ex. dietitian, respiratory therapist, etc.) as needed. While on the learning experience the resident will assume the role of clinical pharmacist for their assigned patients including evaluation and management of patient's medications and will be responsible for identifying and resolving medication-related issues, providing responses to drug information questions from the team, performing therapeutic drug monitoring, providing informal education to the team on pharmacy-related topics, and monitoring all aspects of medication therapy in relation to end organ damage (ex. lung, kidney, liver, etc.).

BIDMC is one of the Advanced Pharmacy Practice Experience (APPE) sites for 6th year PharmD students from MCPHS University. The resident will be involved in providing experiential education to the clerkship students, including teaching and student assessment as it relates to providing pharmaceutical care. One of the main goals of the learning experience is for each resident to effectively develop essential precepting/teaching skills utilizing his/her own experience and guidance from the teaching learning experience preceptor.

The learning experience will allow the resident to use a variety of learning activities that meet MCPHS University objectives for the in-patient APPE learning experience. The resident will design a syllabus incorporating those learning activities and formulate site-specific goals and objectives for student-centered activities. During the learning experience the resident will guide students in developing professional skills required for in-patient pharmacy activities and assess student performance in accordance with the MCPHS University PharmD experiential program guidelines.

Pharmacy Management and Leadership is a required, five-week learning experience at BIDMC that provides the resident the opportunity to gain an understanding of the institutional and departmental structure of the Department of Pharmacy at BIDMC and its role and impact within the BILH system. The purpose of the learning experience will be to give the resident the firsthand experience in pharmacy leadership, quality and process improvement, strategic planning and policy development, and personnel management.

Through discussions with preceptors and members of the department leadership, completion of projects, and attending and leading various meetings the resident will have the opportunity to learn about pharmacy leadership’s role in:

• Pharmacist professional development, engagement, and satisfaction
• Identifying and executing on opportunities for departmental quality and process improvement
• Interdisciplinary project management and leadership
• Effectively communicating a message as a leader (both written and verbal)
• Drug shortage and formulary management
• Ensuring regulatory and quality best practices
• Fiscal responsibility of the department (i.e. pharmacy budget process, purchasing, clinical on call, etc.)

Residents will work primarily with the learning experience preceptors and will also attend meetings with and collaborate with other members of the department leadership team and external stakeholders throughout the medical center.

• Cardiovascular Medicine
• Ambulatory Care Clinics:
  
  • General Cardiology/Heart Failure
  • Infectious Diseases/OPAT
  • Hematology/Oncology
  • Pain/Palliative Care
  • Primary Care
  • Solid Organ Transplant
• Emergency Medicine
• Hematology/Stem Cell Transplant (BMT)
• Hepatology
• Infectious Diseases II: Antibiotic Consult Service or Stewardship
• Medication Safety
• Oncology
• Oncology Infusion
• Solid Organ Transplant
• Specialized ICUs:
  • Cardiac Intensive Care
  • Medical Intensive Care
  • Surgical Intensive Care
  • Trauma Intensive Care
  • Neonatal Intensive Care

Each resident is responsible for the completion of both a medication use evaluation (MUE) and longitudinal residency research/quality improvement (QI) project. Projects may be in the form of original research, problem-solving exercises, or development, enhancement or evaluation of some aspect of pharmacy operations or patient care services. 

Residents will be asked to select from high quality projects developed by clinical preceptors that align with departmental and institutional goals. Each project will have associated timelines with major milestones to guide the resident and ensure progress toward successful completion of the project(s). Residents will utilize their time and project management skills and be asked to work with their project team to add additional detail to their project plan and timeline. 

Both the MUE and research/QI project will be presented externally with the most common presentation including a poster presenting their MUE at ASHP Midyear Clinical Meeting and their research/QI at a regional residency conference.

Resident report is a weekly pharmacy conference meant to enhance the resident’s clinical knowledge and give the resident an opportunity to present and/or facilitate discussion in a large group setting. All members of the pharmacy department will be invited to each resident report session and residents will be expected to provide presentations that promote audience engagement and discussion on the respective topic.

Each resident will be required to complete at least five (5) presentations throughout the year. It is expected that all residents attend all scheduled resident report presentations being delivered by any PGY1 or PGY2 resident.

Upon successful completion of central and decentralized training residents will be expected to serve as an independent clinical pharmacist, covering shifts in both central operations and decentral clinical sites throughout the residency year. Residents will split their time in both central pharmacy operations and decentralized, clinical practice sites to ensure they achieve proficiency in both settings, understanding both the complexities of medication dispensing and provision of direct patient care on a decentralized practice site. The practice experience schedule is individualized based on training needs, clinical interests, and successful completion of direct patient care rotations.

Each resident will participate in the Residency Teaching Certificate Program (RTCP) at MCPHS University. The RTCP will provide residents with a foundation of core educational principles presented in live and online didactic modules. Mentored by an academic faculty preceptor, the resident will also gain practical teaching experience in a variety of educational settings (large/small classroom, clerkship, laboratory, or seminar). Residents will also develop, with the assistance of their faculty mentor, a formative teaching portfolio that will document their progress and enhance the learning experience.

Each resident will serve as a MCPHS University instructor in PPB 551, Pharmacotherapeutics Seminar, during the fall and spring semester. The course requires the resident to be at the University for approximately three hours per week. The goal of this experience is for the resident to gain experience in problem based learning techniques and small classroom facilitation. The resident will facilitate a weekly case based discussion with fifth year PharmD students to assist in the students' development of professional problem solving skills. During each class, the resident will be expected to encourage an open forum for discussion to help enhance the students' ability to communicate and to help them develop life-long learning skills.

Additional teaching activities will include monthly didactic sessions provided by MCPHS faculty on different teaching and precepting topics, didactic lecture delivered by the resident in a therapeutic course, precepting a pharmacy student on an acute care rotation, and additional learning opportunities based on resident goals and interests.

Each resident will present at least one (1) formal CE presentation during the residency year. Several residency goals will be addressed within this residency requirement. Upon successful completion of this residency requirement, the resident will demonstrate:

• Critical evaluation of the literature pertaining to the presentation topic
• The provision of CE programs for pharmacists and other health care professionals
• Presentation, teaching, and communication skills
• Skill in responding to audience questions and comments

Residents will apply their growing clinical knowledge, understanding of institutional and regulatory policies, and critical thinking skills gained throughout concentrated and longitudinal learning experiences to serve as a 24-hour clinical resource to the pharmacy and medical staff.

Primary coverage of the clinical on call pager assignment will rotate through all acute care PGY1 and PGY2 pharmacy residents and residents will have a Clinical Pharmacy Manager who serves as back up at all times throughout the year.

NOTE: pharmacy residents will not provide primary pager coverage during other assigned residency learning experiences (ex. service shifts, teaching certificate activities, etc.).