PGY-1 Pharmacy Residency Program

The resident will work with the RPD and/or designee(s) in the month of July to review orientation materials for the residency program. Activities include orientation to the staff and work site, residency year schedule, electronic health record, VA Pharmacy Benefits Management (PBM) introduction, Lean Six-Sigma training, Institutional Review Board and Research and Development if appropriate, PharmAcademic, Initial Skills Assessments/Reviews, Learning Experience Descriptions for core rotations, and VA policy and procedures. The resident will complete entering interest forms and provide self-assessments of their learning needs. The Resident Development Plan will be finalized by the end of July. The Resident Development Plan will be adjusted quarterly to fit the resident’s learning needs and to choose electives. The Residency Advisory Committee will review quarterly summative evaluations for overall resident progress and improvement to the program. The rotation will continue through quarter 2 to ensure the resident has transitioned into residency expectations successfully.

The resident will work daily for 4-6 weeks in the CMM clinic for a block rotation providing patient care in clinic or through virtual care appointments. The rotation will focus on the chronic disease state management of common chronic disease states including hypertension, hyperlipidemia, diabetes, tobacco cessation, hypothyroidism, COPD, and vitamin D deficiency. CMM occurs in Patient Aligned Care Teams (PACT) where clinical pharmacist providers (CPP) have a global scope of practice, meaning that they are constantly learning and growing to find ways to help their primary care teams manage new disease states and meet Veteran care needs. CPPs function as licensed independent practitioners with their scopes of practice with prescriptive authority giving them the ability to initiate, adjust, discontinue and monitor medications as appropriate. The resident may have exposure to other services offered by the Pharmacy CMM Clinic including medication reconciliation, polypharmacy review, and epoetin monitoring. After the block rotation, the longitudinal rotation begins and continues for 1-2 days per week through the remainder of the year. During the second half of the year, the goal is for the resident to function more independently taking on more patients, and precept APPE student(s).

The resident will work daily for 4-6 weeks in the Anticoagulation Clinic for the initial block rotation. VA providers refer anticoagulated patients to the Anticoagulation Clinic where CPPs perform anticoagulation initiation and monitoring. Point of care machines are used for warfarin therapy and pharmacists make dose changes with patients during appointments. The rotation will focus on the management of warfarin, direct oral anticoagulants (DOACs) and proper use of outpatient Low Molecular Weight Heparin. The block rotation will focus on warfarin clinic and consult management.  The longitudinal rotation will begin during quarter two for 1-2 days/week and continue to develop the resident’s clinical knowledge with anticoagulant dosing and monitoring, perioperative management, and DOAC dashboard management. 

HBPC serves patients with complex chronic disabling medical conditions. The resident will spend 2 days per week for 2 months working with the HBPC pharmacist performing chart reviews, participating in weekly interdisciplinary team meetings (if schedule permits), completing CMM, and going on home visits as allowed and appropriate. The resident will make recommendations to optimize patient’s medication regimen based on disease state specific therapeutic goals and minimize polypharmacy. The resident will participate in bi-weekly case discussions and article reviews during this rotation. Additionally, the resident will serve as a resource to the HBPC team for drug information and patient/provider education.

The resident will spend 4 weeks in the first quarter training in the areas of prescription processing and dispensing medications. During this time, the resident will increase their efficiency in prescription processing and providing counseling to patients. The goal is for the resident to be independent early on and thus able to function independently as a clinical pharmacist in this setting. The rotation preceptors will provide feedback and regularly assess progress towards the rotation goals so that the resident is prepared for the staffing requirements.

The resident will spend 0.5 days/week for 8-10 weeks on this required rotation. The VACOHCS is participating in the Pharmacogenomics Testing for Veterans (PHASER) Program. This test can help to individualize prescriptions for medicines used to treat several common health concerns, including pain, depression, anxiety and blood clotting. Pharmacists are key members of this team and complete e-consults to interpret and help providers understand results once completed. Pharmacists also can be consulted to review results with patients.

The resident will spend time working with the Associate Chief of Clinical Services longitudinal throughout the residency year. This rotation will take no more than ½ day per week and may have time separately assigned or may be combined with assigned project time. Pharmacists at the VA Ambulatory Care Center participate in activities to improve the quality of pharmaceutical care including adverse drug event reporting, medication error prevention, medication error reporting, and medication use evaluations. The Pharmacy and Therapeutics Committee is responsible for local management of the VA national formulary, medication performance measures, and medication use evaluations.

The residency program is designed to provide one on one experience with the Chief of Pharmacy monthly throughout the residency year to learn about management-related activities vital to the smooth operation of a pharmacy department. The resident will spend 1 day per month with the chief and may have additional discussion sessions assigned.

The education learning experience is a required, longitudinal rotation. This rotation provides the PGY1 resident with opportunities to develop skills for the provision of effective medication-related training. Examples of projects include drug information questions, journal clubs, continuing education (CE) presentations, and education/precepting of pharmacy students. The experience will be longitudinal and incorporated into the weekly schedule during project time along with the resident preparing projects after hours as appropriate to facilitate completion. 

The research project will give the resident experience to design, execute, and report results of investigations of pharmacy-related issues. Pharmacy projects may go through a formalized IRB and Research and Development Committee approval process. An alternative to this is to have the resident participate in a LEAN yellow belt training course and work on systems redesign yellow belt project to identify issues, and work towards creating, implementing, and sustaining a solution during the residency year. This is a yearlong, required, longitudinal rotation. Residency projects may be worked on during assigned project time but do not always have time assigned and may require residents to work outside of business hours to ensure progress and completion.

The required yearlong longitudinal leadership rotation is in collaboration with other VISN 10 VA PGY1 pharmacy residency programs. There are TED talks or articles assigned based on monthly topics which the residents are required to review. After review and self-reflection, the residents post discussion as well as comment on other residents’ posts. Monthly discussions build on the self-reflections and posts through discussion with PGY2 residents as available. While there is no formal time assigned for this rotation, residents find it beneficial to discuss some important topics such as giving and receiving feedback, work life balance, time management, and storytelling/speaking skills amongst others.

Residents are required to complete a monthly assessment where they reflect on important topics like emotional, mental, and physical health as well as sleep. They are also require to confirm they are in compliance with the ASHP Moonlighting hours policy and report any Moonlighting hours within this document. This assessment is discussed with the RPD monthly to identify any issues which have come up although the resident is always encouraged to discuss any concerns with the RPD at the soon as possible. There is no time assigned for the completion of this monthly self-assessment and residents are required to find time to compete the same. The resident and RPD will find time monthly to discuss the resident’s response on the survey and identify if there are any areas of concern.