Pharmacy PGY2 Rotations

Required Core Experiences

Pain Stewardship (Longitudinal)

• The Resident will be responsible for Pain Management E-consults, 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, PDMP 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.  

Acute Psychiatry and Substance Abuse RRTP (4 weeks)

• The Residential Rehabilitation Treatment Program (RRTP) and Acute Psychiatry is a 4 week rotation at the Tuscaloosa VAMC. The role of the RRTP Clinical Pharmacy Specialist (CPS) is to provide comprehensive medication management for all RRTP veterans.  The CPS completes an admission medication regimen review note for each new patient admitted to the unit(s), as well as a 30-day medication review note (if applicable).  These reviews are to include thorough medication reconciliation. The CPS is also responsible for clinical pharmacy consults on this unit(s), which may include drug information, targeted drug level monitoring, anticoagulation monitoring, etc.  The CPS will also provide drug information and education to healthcare professionals, patients, and caregivers, as required. The role of the Acute Psychiatric CPS is to perform a medication review on each patient admission to determine what labs are needed for appropriate drug therapy monitoring. The CPS is responsible for entering the appropriate lab orders (chem 8, drug levels, hepatic function test, lipid panel, hgba1c, vit d levels, etc.) and adjust doses of various medications while collaborating with the psychiatrists. The acute psych CPS will also attend psychiatric emergencies to assist with ensuring the  appropriate medications and dosing of medications for administration.

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 (4 weeks)

• The outpatient mental health clinic learning experience rotation is a 4 week required rotation offered at the Tuscaloosa VA Medical Center. The resident will be working with several psychiatrists and nurse practitioners in interviewing the mental health patients in the mental health clinic. The resident will review veterans for drug interactions and appropriate use of medications for various mental health disorder and neurologic disorders. The Resident will be able to perform PHQ 2 or 9 depression psychological testing and report to the psychiatrist the results. The Resident will monitor clozapine veterans on a weekly basis, checking for stability, ANC values, and metabolic parameters as required per policy. The resident will also work with the veterans in the suboxone program and COSAT (Comprehensive Outpatient Substance Abuse Treatment) program and will interview patients and monitor UDS (urine drug Screen) and therapy of veterans in this program. The Resident will also be able to conduct AIMS test and EKG as required. The purpose of this learning experience will be to expose the resident to all the possibilities of working as an outpatient Mental Health Pharmacist Specialist. The resident will provide efficient, effective, evidence-based, patient centered treatment for patients requiring chronic pain and mental health symptom co-management and for treatment of specified disease states.

Outpatient Pain Management Clinic (4 weeks)

• The outpatient pain management learning experience rotation is a 4 week required rotation offered at the Tuscaloosa VA Medical Center. The purpose of this rotation is for the resident to become familiarized with the interdisciplinary pain management team, which includes a Physician, Nurse Practitioner, Pharmacist, Social Workers, Psychologists, Psychiatrist, and administrative assistants. The resident will provide efficient, effective, evidence-based, patient centered treatment for patients requiring chronic pain and mental health symptom management and for treatment of specified disease states. The resident will review veterans for drug interactions and appropriate use of medications for various mental health, pain, and neurologic disorders. The resident will provide appropriate follow-up as clinically indicated for each practice area in the outpatient setting. The resident will be given the opportunity to be independent in this setting, making independent clinical decisions and documentation into the facilities medical chart utilizing CPRS. The rotation will give the resident the opportunity to further enhance their time management skills in managing a clinic work load as a clinical pharmacy specialist while also completing consults and longitudinal projects.

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.

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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.