Pharmacy Residency Program - PGY2 Ambulatory Care Curriculum - Central Arkansas Veterans Healthcare System
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Central Arkansas Veterans Healthcare System

 

Pharmacy Residency Program - PGY2 Ambulatory Care Curriculum


David Dillinger
David Dillinger, PharmD, BCACP
PGY2 Ambulatory Care Program Director

Pharmacy Residency

This program is accredited by the American Society of Health System Pharmacists

This residency site agrees that no person at this site will solicit, accept, or use any ranking-related information from any residency applicant.

Program Purpose

PGY2 pharmacy residency programs build on Doctor of Pharmacy (Pharm.D.) education and PGY1 pharmacy residency programs to contribute to the development of clinical pharmacists in specialized areas of practice. PGY2 residencies provide residents with opportunities to function independently as practitioners by conceptualizing and integrating accumulated experience and knowledge and incorporating both into the provision of patient care or other advanced practice settings. Residents who successfully complete an accredited PGY2 pharmacy residency are prepared for advanced patient care, academic, or other specialized positions, along with board certification, if available.

Requirements to Receive Residency Certificate

  • Satisfactory completion of all rotations and required activities. If a rotation is not satisfactorily completed, appropriate remedial work must be completed as determined by the preceptors and program director
  • Completion of 12 months of residency related activities
  • Compliance with all institutional and departmental policies
  • Minimum of Achieved (Ach) on at least 85% on all goals and objectives by the end of the residency with no Needs Improvement (NI)
  • Completion of all assignments and projects as defined by the preceptors and Residency Program Director
  • Completion of a practice-related project with a draft manuscript submitted in AJHP format to the Residency Program Director no later than the day of the Residency Research Conference
  • Two major disease or treatment-related presentations (i.e. Grand Rounds) as well as presentation of the research project results at the CAVHS Residency Research Conference
  • Attend at least one professional state or regional meeting and one national meeting (must be pharmacy-related) as approved by the RPD and Chief of Pharmacy
  • Design and deliver a program that contributes to public health efforts
  • Participate in recruiting activities for the residency
  • Contribute to optimal patient care and achieve the mission and goals of CAVHS and the Pharmacy Service
  • Successfully apply for a Scope of Practice in Anticoagulation
  • Demonstrate appropriate storage of all research-related data and documents at the end of the year.
  • Closure of your residency project with the IRB and VA R&D committee and completion of your resarch audit (if applicable).

Required Rotations

Community Based Outpatient Clinic

Rotation Type: Required/Concentrated

The rotation at the Conway CBOC focuses on providing primary care in the community outpatient setting. This rotation is a concentrated experience where the Ambulatory Care PGY2 Resident will provide hands on specialized pharmaceutical care in the primary care setting for 3-5 days per week during a 1-2 month period. The role of the resident is to provide clinical pharmacy services as a part of an interdisciplinary team that includes physicians, nurses, dietitians, optometrists and psychiatrists. The resident will be evaluating and adjusting treatment regimens as well as educating patients and their caregivers. The Conway CBOC has approximately 3500 patients enrolled in 3 PACT teams. In addition, the clinic also provides Mental Health, Eye Clinic and Audiology Services. During the course of the rotation, the resident will have extensive experience managing diabetes as well as other typical diseases seen in the ambulatory setting. The resident will at first function with close supervision by the preceptor but will be expected to work independently throughout the remainder of the rotation.

Faculty Preparedness

Rotation Type: Longitudinal

The Ambulatory Care resident will complete the requirements for a teaching certificate at the University of Arkansas for Medical Sciences. The Adult Family Medicine Clinic rotation is an elective, longitudinal learning experience for the Ambulatory Care Specialty resident. In this rotation, the resident will place himself/herself in the role of a clinical faculty member with responsibilities that include being a part of a multidisciplinary team as well as a full time faculty member. The resident will also participate in and facilitate a College of Pharmacy Course under the supervision of a clinical pharmacist/faculty member. Good communication and interpersonal skills are necessary to promote efficient function of the team. The resident must devise strategies for accomplishing the rotation activities in a timely fashion while still completing other residency assignments. Additionally, if applicable, residents will have the opportunity to serve as co-preceptors for pharmacy students and/or PGY1 pharmacy practice residents.

Geriatric Clinic

Rotation Type: Required/Concentrated

The Geriatric Clinic rotation is a required, concentrated learning experience for the Ambulatory Care Specialty resident. The experience involves the provision of direct patient care for patients in the GC program. During this experience, the resident will participate in the provision of pharmaceutical care to ambulatory patients followed in the Geriatric Clinic at the North Little Rock campus. The specialty resident will work in the outpatient clinic setting and interact with all team members including physicians, APNs, nurses, social workers, dieticians, patients and caregivers. This rotation allows the resident to gain independence as a pharmacist as a member of a multidisciplinary healthcare team, improve literary retrieval skills, and improve communication with other healthcare professionals. The resident is responsible for identifying, preventing, and resolving medication therapy issues for patients (including adjusting doses when necessary, counseling patients on medications when appropriate, and making sure the patient is on the optimal drug regimen for each condition or disease state), while also serving as a drug information resource for the team. Good communication and interpersonal skills are necessary to promote efficient function of the team. The resident must devise strategies for accomplishing the rotation activities in a timely fashion while still completing other residency assignments. Additionally, if applicable, residents will have the opportunity to serve as co-preceptors for pharmacy students and/or PGY1 pharmacy practice residents.

Home Based Primary Care (HBPC)

Rotation Type: Required/Concentrated

The Home Based Primary Care concentrated experience involves the provision of direct patient care for homebound patients. The rotation site is located at the West Little Rock HBPC office. The resident will serve as the clinical pharmacist for multiple HBPC teams as assigned.

The Ambulatory Care PGY2 Resident will serve as the clinical pharmacist for multiple HBPC teams and will interact with all team members including physicians, APRNs, psychologists, nurses, social workers, dieticians, occupational therapists, patients and caregivers (both private and Medical Foster Home). This rotation is designed to provide the resident advanced experience serving as the clinical pharmacist on the multidisciplinary healthcare team. The preceptor will remain available for consult and feedback throughout the rotation. After a few days of preceptor observation, the resident will be encouraged to perform independently as a valuable member of the team. In this role the resident must be able to retrieve and interpret appropriate clinical literature then synthesize appropriate patient recommendations which will be communicated with other healthcare professionals during team meetings, note in the electronic chart, or via one to one interactions. The resident is responsible for identifying, preventing and resolving medication therapy issues for patients and serving as a drug information resource for the team. Residents will actively participate in discovering drug-induced problems, adjusting dosages when necessary, counseling patients on medications when appropriate, and making sure the patient is on the optimal drug regimen for each condition or disease state. Additionally, if applicable, residents will have the opportunity to serve as co-preceptors for 4th year pharmacy students and first year pharmacy practice residents. The resident may have the opportunity to participate in Performance Improvement projects and to provide presentations or educational handouts to the home care staff or caregiver groups.

This HBPC service has eight APRN managed, physician supervised Patient Aligned Care Teams (PaCTs) who provide comprehensive primary care to the patient in the home environment. The coverage area includes about a one hour radius from the Little Rock area. Our patient population consists predominantly of complex elderly male Veterans; however, there are some female patients as well as younger patients with extensive medical problems. The resident's primary workstation will be in the Benton Building at the Westlake Office Park. If time and resources allow, and at the request of the resident, home visits with preceptor or other members of the PACT team may be allowed.

Medication Management Clinic- Anticoagulation Clinic

Rotation Type: Required/Concentrated

The Medication Management Clinic rotation is an ambulatory care concentrated learning experience that provides the PGY2 Am Care resident with patient care experience in the Medication Management (Anticoagulation) Clinic. This is a one month learning experience with a longitudinal component for the remainder of the residency year.

The Medication Management Clinic is an experience in the Anticoagulation Clinic. The resident's role in this clinic is to evaluate INR levels and appropriately adjust the patient's warfarin dosing, taking into account any pertinent factors. In addition, the resident will provide intensive patient counseling to patients that are new to anticoagulants (both warfarin and direct oral anticoagulants - DOACs), design low-molecular weight heparin bridging plans for patients having upcoming procedures, and review patient consults for the new oral anticoagulants to ensure appropriate inclusion and exclusion criteria are met.

Residents will successfully complete the on-site specialty anticoagulation training program at the beginning of the residency. This didactic training is designed to prepare the resident to function effectively in the clinic setting by providing background knowledge in anticoagulation as well as the skills needed to function in VISTA and CPRS. This course consists of two days then a final exam. The resident must successfully pass the Anticoagulation Exam with a score of 70% in order complete the rotation. The resident will work towards applying and/or possibly obtaining a limited Scope of Practice in anticoagulation by the end of the concentrated learning experience.

Primary Care/PACT

Rotation Type: Required/Concentrated

The Primary Care/PACT rotation is an ambulatory care concentrated learning experience that provides the PGY2 Am Care resident with direct patient care experience in the Patient Aligned Care Teams Clinic. This is a one month learning experience. The PACT clinic rotation is designed to allow the resident to gain independence as a pharmacist as a member of a multidisciplinary healthcare team, improve literary retrieval skills, and improve communication with other healthcare professionals. The resident will interact with all team members including physicians, APNs, nurses, social workers, dieticians, patients, and caregivers on a daily basis. The resident is responsible for identifying, preventing, and resolving medication therapy issues for patients and serving as a drug information resource for the team. The resident will provide chronic disease state management and patient/caregiver education including initiation of therapy, drug therapy monitoring, and medication adjustment. The resident will be exposed to multiple disease states during this learning experience as noted below. The resident will be required to give one formal presentation on a topic decided by the preceptor and resident. The presentation will be given to the PACT pharmacy staff. The resident may have the opportunity to participate in Performance Improvement projects.

Elective Rotations

Electives may be arranged from well-established pharmaceutical care areas or developed for unconventional areas. The selection of elective rotations should be based on the resident's interest area and previous experiences and is also subject to approval by the Residency Program Director. Because of the depth of this tertiary care facility and her sister facilities, University of Arkansas for Medical Sciences (UAMS) and Arkansas Children’s Hospital (ACH), the resident has a wide variety of electives available spanning practice sites from pediatrics to geriatrics and numerous specialty areas. In keeping with ASHP Accreditation Principle 5.11, non-pharmacist faculty from CAVHS, UAMS as well as ACH may serve as rotation preceptors once the resident has demonstrated the readiness to practice independently. The resident may also select any of the core areas as an advanced elective rotation.

The resident is responsible for arranging all electives with the preceptor and the RPD.
It is recommended that this be accomplished as early as possible in the residency year to facilitate planning of all involved.