PGY1 Pharmacy Residency

VA Pharmacy Systems (3-week block rotation )

The VA Pharmacy Systems (Inpatient and Outpatient Rotation) is a required three-week learning experience at the Salt Lake City VA Medical Center. It is an in-depth orientation to current VA technology.

The role of the preceptor is to provide the resident with a global understanding of our community hospital medication distribution system. The resident will gain experience in the VA distribution process by utilizing multiple software and hardware packages including; Computerized Patient Record System (CPRS), Veterans Health Information System and Technology Architecture (VISTA), ScriptPro, VISTA Chemotherapy Manager (VCM), Talyst and Pyxis.

All learning activities will be geared towards proficiency with these systems as they will be the foundation for future rotations, patient care activities, and resident projects. Learning activities may be facilitated by different pharmacy staff with expertise in certain hardware or software applications. Learning activities will be accomplished in parallel with the varied roles of the preceptor including clinical, staff, and administrative workload.

Internal Medicine (6-week block rotation)

Preceptors: Preceptors: Hilary Parkin PharmD; Thomas Kerr, PharmD; Kathleen (Athern) Tinker, PharmD

It is a six-week experience where the resident will participate in the provision of pharmaceutical care to acute care patients admitted to one of the three internal medicine teams on the Acute Medicine Floor.

Most medicine teams consist of an attending, resident, two intern physicians and medical students. Each internal medicine team cares for up to 20 patients. This rotation allows the resident the opportunity to apply pharmacy-related concepts to patient care as a member of a multi-disciplinary health care team.

The resident is responsible for identifying, preventing and resolving medication therapy issues for patients and serving as a drug information resource for the team. This will include, but is not limited to, performing admission and discharge medication reconciliations, developing pharmaceutical care plans for patients with complicated medical histories as well as for those on high-risk medications, performing pharmacokinetic and pharmacodynamic assessments, screening medications for appropriate indications and dosing, and proactively identifying drug interactions.

The resident will create therapeutic regimens for individual patients utilizing the VA formulary when possible. These activities are expected to be completed for every patient that is assigned to the resident. The resident’s patient load will vary based on the preceptor’s discretion. The resident is proactively involved in the medication use process, including assisting nursing service with medication-related issues and working to promptly solve problems that impede the appropriate delivery of medications.

Good communication and interpersonal skills are necessary to promote efficient function of the team. The resident will be expected to communicate their findings and recommendations to the appropriate clinician(s).

Primary Care (6-week block rotation)

Preceptors: Kelly Starman, PharmD; Katherine Liu, PharmD; John Gardner, PharmD

This is a required six-week learning experience designed to teach residents how to apply pharmaceutical care as an integrated member of a patient aligned care team (PACT) within the primary care clinics at VA Salt Lake City’s main campus, or if available, at the West Valley or Ogden Community Based Outpatient Clinics (CBOC)

During the experience, residents are directly involved in the development and monitoring of medication treatment regimens for patients, with emphasis placed on the independent assessment and development of pharmaceutical care plans for Veterans with chronic diseases. Focused areas for clinical experience include: diabetes care, hypertension, hyperlipidemia, hypothyroidism, chronic kidney disease, gout, mental health and tobacco abuse.

Critical Care (4-week block rotation) 

Preceptors: Nathan Kamerath, PharmD; Bonnie Portley , PharmD

The VA Critical Care Rotation is with one of two preceptors in SICU or MICU. Each location has unique learning experiences that will be slightly different. The critical care rotation is a required four-week learning experience for the pharmacy practice resident.

The resident will participate in the provision of pharmaceutical care to acute care patients admitted to the MICU or SICU. The MICU and SICU share the same space but have distinct rounding services. The MICU service consists of an attending, fellow, three residents, three intern physicians and a clinical pharmacist. The SICU is a team that consists of an attending, midlevel provider, and clinical pharmacist.

The resident is responsible for performing admission and discharge medication reconciliations, developing pharmaceutical care plans for patients with complicated medical histories as well as for those on high-risk medications, performing pharmacokinetic and pharmacodynamic assessments, screening medications for appropriate indications and dosing, and proactively identifying drug interactions. The resident will create therapeutic regimens for individual patients utilizing the VA formulary when possible.

These activities are expected to be completed for every patient that is assigned to the resident. The resident’s patient load will vary based on the preceptor’s discretion.

Management (4-week block rotation)

Preceptor: Chad Nelson, PharmD

During this four-week rotation, the resident will have the opportunity to meet with each member of the administration team to understand their roles and responsibilities.

The resident will gain insight into the administration functions by participating in Veterans Affairs National Telecommunications System (VANTS) calls, interdepartmental meetings, or work with VA staff to complete pharmacy administrative projects. Independent time will be given for longitudinal assignments, background reading, and other assignments as directed by the preceptor.

The focus of the rotation will be to understand essential elements of the VA organizational chart, pharmacy operations, human resources, budget, procurement, staff supervision, and other administrative components as they present during the PGYI rotation. The resident will be expected to participate or lead administrative assignments on a longitudinal basis until project conclusion.

The resident will also be given independent time to learn, evaluate, and make recommendations about current policy and procedures. In addition, the resident will have the opportunity to evaluate differences between federal, state or VA regulations regarding pharmacy services.

Rotation elements are dynamic given that national VA mandates change over time and the resident experience may vary depending on current inspections, national policy directives, or other procedural changes occurring in the pharmacy. Independent work and time management skills are essential for success in this rotation.

Inpatient Psychiatry (4-week block rotation)

Preceptors: Rachel Bauer, PharmD; Joel Grussendorf, PharmD; Cathy Yao, PharmD

The psychiatric pharmacy rotation is a four- to five-week rotational experience designed to develop resident’s knowledge and skills in the area of provider/patient interaction, psychiatric disorders and psychotropic drug therapy on the inpatient psychiatry unit.

Patients are most commonly admitted for mood disorders, PTSD, schizophrenia, and/or substance use disorders. This is an interdisciplinary unit with 4 teams. Each team includes a psychiatrist, nurse practitioner, team nurse, and social worker. Each team also has a mental health clinical pharmacist.

Residents are exposed to trainees from other disciplines on the inpatient psychiatry unit and may be involved in assisting in pharmacy student precepting. Residents are expected to provide patient and provider education, conduct medication histories and reconciliation on admission and discharge, and participate in team rounds.

Residents generally begin by shadowing the clinical pharmacist and by the end of the rotation are independently rounding on the team with coaching from their preceptor. In order to solidify psychotropic drug therapy knowledge, residents conduct and participate in regular topic discussions.

This rotation allows residents who are interested in the Salt Lake City VA PGY2 Psychiatric Pharmacy Residency to explore psychiatry.

Project Weeks (4 weeks total)

Resident will have 4 project weeks built into their schedule allowing for dedicated time to complete longitudinal projects.

Inpatient Central Pharmacy (5 month longitudinal rotation)

This five-month longitudinal rotation (from August to December) will provide the PGY1 pharmacy resident with an understanding of how to practice and function as an inpatient pharmacist.

The resident will spend 2.5 hours per week in the inpatient pharmacy and will be responsible for verifying medication orders for completeness and processing orders accurately. The resident will be responsible for identifying the presence of medication therapy problems in a patient's current medication regimen.

The resident will learn to process IV medications correctly, by selecting the appropriate diluent, the right concentration, and the correct infusion rate. The resident will work closely with pharmacy technicians to ensure timely delivery of medications; will respond to drug information inquiries from MDs, clinical pharmacists and nurses.

Ambulatory Care Clinic (6 month longitudinal rotation) 

Each resident selects one longitudinal clinic to participate in over six months, generally spending four hours in the selected clinic each week from January to July.  While in the selected clinics, residents will play an active role in patient care, developing care plans, initiating and monitoring medication therapy, and identifying, preventing, and resolving medication therapy issues.

Residents may choose to spend time in in any of the following clinics: anticoagulation, general primary care, clozapine, geriatric assessment, geriatric primary care, infectious disease, neurology, renal, physical medicine and rehabilitation, or pain and palliative care. 

Service Commitment/Staffing (12 month longitudinal)

The service commitment learning activity is a required longitudinal experience. This activity consists of acting as the clinical pharmacist during one weekend every three weeks. The clinical pharmacist is responsible for completing and documenting the medication reconciliations for all patients within 24 hours of admission.

The clinical pharmacist is also responsible for providing pharmaceutical support to the medicine and surgery teams when requested. This includes answering drug information questions, responding to medical or surgical pager calls and educating patients on anticoagulation or insulin regimens prior to discharge.

Staffing responsibilities will not begin until the resident has completed 3 weeks of their internal medicine rotation. The resident will also be responsible for proper communication of continued patient needs to the appropriate person, either the provider or team pharmacist, for continuity of care after the weekend.

Efficient data collection and documentation skills will be essential for completing this learning activity.

Quality and Medication Safety (12 month longitudinal)

During the rotation, residents will learn the fundamentals of Joint Commission medication management standards and how they apply to the health care system and patient care. They will also learn to identify system gaps and potential solutions through retrospective review of patient incident reports, proactive review of national safety reports, and root cause analyses. Through the activities in the rotation, the residents will be exposed to change management, gap analysis, and system redesign concepts. Residents will present ISMP report findings once every three months to the patient safety committee.

• Acute Care Cardiology
• Acute Care Surgery
• Anticoagulation Clinic
• Emergency Department
• General Outpatient Mental Health 
• Geriatrics Specialty Clinic
• Hematology/Oncology
• Infectious Disease- Antimicrobial Stewardship
• Infectious Diseases- Inpatient Consult Team/Ambulatory Care Clinic
• Pain and Palliative Care   
• Poison Control Center (University of Utah)
• Physical Medicine & Rehabilitation Inpatient/Ambulatory Care Clinic
• Substance Abuse Ambulatory Care Clinic
• Repeat of any core block rotation

• Year-long research or process improvement project
• Medication use evaluation
• 60-minute continuing education presentation
• Poster presentation and attendance of ASHP Midyear Clinical Meeting
• Oral platform presentation at Mountain States Conference
• Monthly leadership conference with PGY2 residents
• Optional teaching certificate

Teaching opportunities include precepting students on rotation, presenting to pharmacy staff, leading small group discussions with pharmacy students and lecturing at the University of Utah College of Pharmacy or Roseman University College of Pharmacy.