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Pharmacy PGY2 Rotations

BVAHCS Pharmacy Residency

Past_Residents

Required Core Experiences

Pain Stewardship (Longitudinal)

  • The Resident will be responsible for Pain Management E-consult, Urine Drug Screen E-consults, pain prior authorization/non-formulary consults, and Opiate Advisory consults offered at BVAHCS for both inpatient and outpatient veterans. The primary target of these consults is the primary care providers seeking assistance with opioid and non-opioid treatment alternatives, UDS interpretation, opioid rotations, PDMO reviews, opioid tapering schedule recommendations, etc. Resident will also attend Pain Management Committee and Opiate Advisory Team (Pain management subcommittee) to provide opioid metrics. Resident will also serve as the manager for Stratification Tool for Opioid Risk Mitigation (STORM) to provide recommendations to primary care and specialty providers on risk mitigation strategies for very high-risk patients of a suicide- or opioid-related event.

Research (Longitudinal)

  • This learning experience is a longitudinal, 12 month required rotation for the PGY2 resident.  A completed medication use evaluation (MUE) and research project are required for completion of the residency program.  The purpose of these projects is to provide the resident with the opportunity to develop the skills and processes necessary to perform different types of clinical pharmacy research. The data obtained should contribute to the development of the pharmacy department or the profession as a whole. It is the intent of the residency program to provide an experience that will extend the knowledge of pharmacotherapy by publishing the results of research studies in pharmacy or medical journals.

Orientation (4 weeks)

  • Resident will be exposed to pharmacy services at Birmingham VA Healthcare System (BVAHCS) and Tuscaloosa VA Medical Center including distribution, processing, clinical pharmacy services, administration, and others depending on the needs of the individual resident.

Addiction Medicine and Medication Assisted Treatment (MAT) (4 weeks)

  • As part of the Mental Health service, the resident will collaborate with the psychiatrist specializing in addiction medicine for the treatment of diverse substance abuse disorders including Opioid Use Disorder (OUD). The resident will provide medication management recommendations for buprenorphine/naloxone (Suboxone or Subutex) for the treatment of OUD, as well as alternative treatment approaches in the mental health setting.

Interdisciplinary Pain Rehabilitation Program I (12 weeks)

  • The Interdisciplinary Pain Rehabilitation Program (PRP) Clinic rotation is a learning experience over 8-12 weeks . This clinic is a tertiary referral center for our most complex cases where veterans may be seen jointly by a pain physician, pain pharmacist, physical therapist, occupational therapist, health coach, and pain psychologist. This clinic is a part of the Physical Medicine and Rehabilitation (PM&R) Clinic and patient referrals must come from primary or specialty care. This clinic often functions as a second opinion for complex care where practitioners can collaboratively review the patient case, discuss potential solutions, and present a plan of care. The purpose of this rotation is to develop direct patient care experience for high risk and complex patients and integrate into an interdisciplinary team of pain specialists at the highest level. The pharmacy resident will be relied upon to coordinate clinic activities including triaging which patients are appropriate for referral to the PRP.  

Mental Health and Substance Abuse RRTP (6 weeks)

  • This four-week experience is based out of the Central Alabama Veterans Health Care System (CAVHCS) in Montgomery, Alabama.  The resident will provide evidence-based, patient-centered psychiatric medication therapy management for both patients in a residential care unit and from the community. The resident will attend daily interdisciplinary care team meetings, meet with veterans to perform medication reconciliation interviews, work closely with prescribers to manage medication therapy during residential stay, lead educational group sessions, and provide discharge counseling. The resident will be exposed to psychiatric conditions with emphasis on Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD).  Journal club, disease state and patient-centered discussions will occur longitudinally throughout the experience.

Palliative Care and Acute Pain Management (8 weeks) 

  • The acute pain management/palliative care rotation is designed to provide the resident with an advanced experience in the inpatient pain management setting. The resident will provide pain pharmacotherapy recommendations for several inpatient attending providers and their medical or surgical teams when they have pain management concerns. The resident will gain experience on transitions of care both during the admission and discharge process to assure pain concerns are addressed and patients can be transitioned smoothly.

Primary Care Pain Management, Opioid Safety and Whole Health (4 weeks) 

  • This rotation involves two different approaches to pain management at the primary level of care. The resident will be exposed to shared medical appointments (SMA) which focus on pain management through a Whole Health approach. The whole health model is a holistic consideration of the many areas of life that can affect health — work environment, relationships, diet, sleep patterns, and more. The pharmacy goal is to provide medication safety counseling including opioid safety and naloxone education (to prevent accidental opioid overdose) and general pain treatment alternatives to empower Veterans to seek safer treatment alternatives. Opioid Safety is a primary care clinic created to provide close monitoring of high risk patients within the primary level of care.

Behavioral Pain Management and Outpatient Mental Health Clinic (6 weeks)

  • The Behavioral Pain Management School at TVAMC provides concentrated education to patients about a wide variety of available pain management services. The class has been developed to highlight changes to pain management practice particularly regarding the increased awareness of risks with opioid therapy and decreased emphasis on their use in clinical practice. We provide education on the importance of multimodal treatment and incorporating active and passive strategies for long-term success managing their pain as a chronic disease. This rotation will also individualize pain management alternatives in the Mental Health Setting.

Interdisciplinary Pain Rehabilitation Program II (whole clinic) (4 weeks)

  • The Interdisciplinary Pain Rehabilitation II at BVAHCS is a one-month rotation that will expose the resident to the role of the pharmacist serving as the primary provider of pain management for Veterans. The resident will participate in the provision of pharmaceutical care to outpatients followed in the Pharmacy Pain Management Clinic. This rotation is designed to give the resident the opportunity to provide clinical pharmacy services as a part as the primary provider of pain management, both providing recommendations for treatment as well as patient counseling, and providing follow-up care in treating chronic non-malignant pain. Patients are enrolled in the clinic through the Pharmacy Pain Evaluation Consult, where a plan is developed regarding pain management. Resident will have the opportunity to apply knowledge and perform as the interdisciplinary pain team member independently.

Elective Learning Experiences: (4 weeks total, 1 rotation)

Physical Medicine & Rehabilitation (PM&R) (BVAHCS)

  • The General Physical Medicine and Rehabilitation rotation is an elective 4 week learning experience at the Birmingham VA medical clinic for the resident. The resident will work closely with attending faculty on the outpatient rehabilitation service. Educational impact will be significant, as residents will have intensive exposure to complex, traumatic brain injury, amputations and orthopedic trauma/polytrauma, neuropathy, myopathy and debility. Resident will be key contributor to the management of a diverse group of patients. Trainees will learn during the PGY2 year how to function effectively as part of a coordinated team, how to take medical histories, order appropriate diagnostic tests and labs, and how to interpret the results. They will be educated on utilizing history and physical data to appropriately establish goals and outcomes for each patient.

Academic Detailing (elective, 4 weeks at BVAHCS)

  • The purpose of Academic Detailing is to provide educational outreach to healthcare providers based on National and VISN initiatives. This rotation includes reviewing and learning evidence-based medicine, developing and/or promoting educational material that include key messages, providing Academic Detailing outreach to VA providers, identifying and resolving barriers, socializing new campaigns, and conducting patient chart reviews for opioid safety measures. This rotation will also include one clinic day a week in the interdisciplinary pain clinic.
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