PGY1 Pharmacy Residency Program

Program Purpose Statement

The purpose of the Hospital of the University of Pennsylvania (HUP) postgraduate year one (PGY1) pharmacy residency program is to build on Doctor of Pharmacy (PharmD) education and outcomes to contribute to the development of clinical pharmacists responsible for medication-related care of patients with a wide range of conditions, eligible for board certification, and eligible for postgraduate year two (PGY2) pharmacy residency training.

The resident will structure their year by choosing a schedule consisting of calendar month-long rotations with eight required rotations and four elective rotations. In addition, there are several required longitudinal experiences described below:

Required Rotations 

Orientation (required, five weeks)

Orientation takes place during the month of July (and sometimes may extend through the first week of August). During the month, the resident is oriented to the residency program purpose, structure, competencies, goals, and objectives. Residents will be oriented to all required and elective rotations; PharmAcademic and the evaluation process; and the Residency Manual which contains all residency policies. During orientation, the resident will have the opportunity to meet the staff, preceptors, and leadership team through several welcome/ introductory activities.

The residents will also be oriented to the Department of Pharmacy operations. This training emphasizes the distributive functions of the hospital’s pharmacy, medication and departmental policies and procedures, and the skills required to serve as a clinical pharmacist during residency rotations and clinical service requirements.

The resident will participate in an orientation to the Central Inpatient Pharmacy (CIP), the hospital's clinical information systems, departmental procedures, and the robotic unit dose systems. The resident will be introduced to the sterile and non-sterile compounding areas, which will provide an overview of aseptic technique, chemotherapeutic handling, dosage calculations, USP795, 797 and 800 guidelines, and specialty product preparation.

During the orientation rotation, the resident will also be trained to cover all longitudinal responsibilities as detailed below.

Medication Use Policy and Safety (required, five weeks)

The Medication Use Policy and Safety learning experience takes place in the Center for Medication Use Policy (CMUP) at the Hospital of the University of Pennsylvania. CMUP is staffed by several pharmacists who specialize in Drug Information and Medication Safety and who are responsible for:

• Supporting organizational interdisciplinary committees tasked with improving medication safety/ medication-use systems/policies
• Improving medication-use systems/policies through appropriate formulary management
• Contributing to the organization's evaluation of, and response to, medication errors and medication-related adverse events
• Leading/ participating in medication use evaluations and reviewing order sets for clinical appropriateness
• Identifying improvements to electronic medication-use systems that improve patient care and/or safety
• Conducting quality improvement and research projects
• Managing drug shortages and supply interruptions
• Maintaining the drug libraries on all smart infusion pumps for the Health System and monitoring medical and nursing compliance
• Precepting pharmacy learners

During this required, month-long rotation, the resident will serve as a member of the Center for Medication Use Policy team and be a resource to the hospital and health system patients and staff. The resident will be responsible for responding to inquiries in the Drug Information Center, participating in the review of medication errors and adverse events, and assisting in the drafting and review of medication use policies, guidelines, and order sets. The resident will be assigned formal written drug information responses, a formulary monograph, a formulary/category review a formulary guideline to review, a drug information clinical pearl/adverse drug evaluation bulletin, a medication safety related project, as well and other projects as needed. During the month the resident will attend the Pharmacy and Therapeutics Committee (P&T,) and Medication Safety Committee meetings. The resident will be working on projects or reports for each of these committees. The resident will also be actively involved in planning and communication around current Drug Shortages through participation in the Drug Shortage Task Force.

Pharmacy Leadership (required, five weeks)

The Pharmacy Administration Leadership experience will introduce each resident to the activities required to operate and maintain a comprehensive pharmacy department comprised of over 300 employees, an overall pharmacy budget of over $250 million, and a broad scope of clinical, academic, research, and distributive services. The goals of this rotation are to expose the resident to health-system pharmacy leadership including organizational leadership and decision making, department planning, performance improvement, best practices, regulatory requirements, and department policies through reading and topic discussions, shadowing with department leaders, and active participation in a variety of projects and meetings. The resident will work with the Chief Pharmacy Officer as well as other members of the leadership team.

Internal Medicine (required, five weeks)

This rotation is a direct patient-care experience in Internal Medicine, providing exposure to acute and chronic disease states, focusing on acute care management and transitioning patients to successful outpatient treatment. The role of the pharmacist is to perform the daily clinical responsibilities necessary to enhance the care of patients and education of the general medical team while balancing unit-based pharmacy responsibilities. This service will include, but not be limited to: patient data collection, organization and assessment; development of therapeutic plans and corresponding monitoring for both efficacy and toxicity; communication with patients and caregivers to acquire necessary medication information, assess outcomes and provide education; verification of medication orders; communication with other health care providers to seek clarification and provide recommendations consistent with the therapeutic plan; assuring medication reaches the patient; and provision of drug information to health care professionals in the hospital. Teaching responsibilities may include engaging with IPPE and APPE students during topic discussions, patient presentations and other activities.

Critical Care (required, five weeks)

The Critical Care rotation is designed to offer the PGY1 resident experience in providing pharmaceutical care for critically ill patients. The focus of the rotation will be on core intensive care unit (ICU) topics such as stress ulcer prophylaxis; venous thromboembolism (VTE) prophylaxis; glycemic control; pain, agitation, and delirium; hemodynamics; mechanical ventilation; rapid sequence intubation; Advanced Cardiac Life Support (ACLS) and clinical emergencies; pharmacokinetic and pharmacodynamic alterations in critically ill patients; acute kidney injury and continuous renal replacement therapies; and management of sepsis.

There are six adult ICU Intensive Care Unit types at HUP: medical, medical/oncology cardiac, neurological, surgical, and cardiothoracic/vascular surgery. The resident has an opportunity to rotate in any of these ICU settings listed above. A team of pharmacists, including clinical pharmacy specialists in critical care medicine, provide care for the patients in each of these units. HUP is a tertiary care referral site supported by PENNSTAR 1 and 2 life flight helicopters, which respond as a primary resource for critical care transport. The ICU patient acuity is extremely high, and there are many opportunities for the pharmacy team to interact with the medical, nursing, respiratory, clinical nutrition, physical therapy, and occupational therapy team members. The pharmaceutical care provided to patients includes drug distribution, prospective evaluation of drug therapy, provision of drug information, prevention of medical errors, pharmacokinetic monitoring, education, development of critical pathways and drug utilization guidelines, patient-specific case management, and quality assurance initiatives. Management of critical illness, awareness of the unique considerations of the critically ill patient/family, and the ability to work with a closely aligned interdisciplinary professional staff are unique aspects of this practice site.

Infectious Diseases (required, five weeks)

There are four different inpatient infectious diseases (ID) services at HUP: a general consult service, a solid organ transplant consult service, an HIV primary service, and an oncology consult service. Residents are required to complete a rotation on the general ID consult service. This general ID consult service team consists of an ID attending, an ID fellow, medical residents, a pharmacy resident, and medical students. The other three services primarily consist of an ID attending with or without an ID fellow. The pharmacy resident participates in daily rounds to monitor patients’ therapies for efficacy and toxicity, to provide pharmacokinetic support, and to research any questions that arise. In addition, the pharmacy resident attends ID Management Conference, ID Grand Rounds, and the ID Fellows’ Journal Club.

Research (required, two weeks and longitudinal)

The Research experience is a systematic evaluation of an important and novel clinical question that seeks to improve knowledge directly or indirectly impacting patient care. This activity occurs through a structured program that is coordinated by the Pharmacy Research Committee at HUP. The majority of activities occur in a longitudinal fashion with the exception of a dedicated research block in December. The purpose of the Research program is to examine a clinically important research question and to provide the resident with a mentored research experience. This includes active participation in the Pharmacoepidemiology Lecture Series, which presents both a basic overview of the research experience and hands-on learning experiences such as statistical interpretation and database creation.

Basic research ideas will be generated by the clinical pharmacy staff prior to the new residency year in July. Proposals will be reviewed for appropriateness, feasibility, and impact by the Pharmacy Research Committee. Once approved, the research committees’ ideas will be presented to the residents. As a group, the residents will then choose their project based on their personal preferences. Following this, each resident will then be assigned a research team, which will consist of the resident, a primary preceptor, and secondary preceptors. The purpose of the research team is to allow for collaboration and to assist the resident in developing details as the pertain to the research project and their research question. Throughout the year, the resident will be required to present aspects of the research to the Pharmacy Research Committee and eventually give a final presentation at The Eastern States Residency Conference in May of the residency year.

Ambulatory Care (required, five weeks)

The learning activities in this rotation are designed to give the resident a foundation in ambulatory care skills that can be used throughout the residency and in the resident's post-residency career. Pending preceptor availability, residents will be assigned to one of the following experiences: pulmonary/cystic fibrosis, infectious disease, neurology, oncology, or cardiology/anticoagulation.

Pulmonary/cystic fibrosis:

The pharmacist is responsible for the annual review of each adult cystic fibrosis patient (>350 patients) seen at the lung center, in accordance with guidelines outlined by the Cystic Fibrosis Foundation. Routine responsibilities include the following: medication reconciliation, drug interaction assessment and management/monitoring, drug selection/medication management, drug efficacy and safety monitoring, medication adherence assessment, monitoring and optimization, medication education, therapeutic drug monitoring of home intravenous antibiotics, and answering drug information questions. These actions are documented in the Pharmacy Annual Visit for cystic fibrosis patients.

Infectious disease (HIV/HCV):

The role of the pharmacist is to anticipate, review, or resolve medication-related problems for all patients in addition to ensuring safe and effective medication use for patients seen by the Infectious Disease Practice. Routine responsibilities include: medication reconciliation, drug interaction assessment and management/monitoring, drug selection/medication management, drug efficacy and safety monitoring. The pharmacist will also provide drug information and education to healthcare professionals as well as patients and caregivers.

Residents primarily assist in the care of HIV infected patients who have polypharmacy and comorbidities, HCV treatment education and follow up, and PrEP initiation education and monitoring.

Neurology:

The role of the pharmacist is to anticipate, review, and resolve medication-related problems for all patients in addition to ensuring safe and effective medication use for patients with Multiple Sclerosis. Routine responsibilities include counseling all new start patients or those switching their Disease Modifying Therapies (DMT), reconciling medication lists, and performing drug interaction checks. The pharmacist will also provide drug information and education to healthcare professionals as well as patients and caregivers.

Oncology:

Pharmacists regularly work with the medical team to identify and resolve medication-related problems for all patients in the clinic and infusion suite. The focus of this rotation is placed on managing patients actively receiving chemotherapy/biotherapy (both oral and IV) and supportive care, with an increased focus on general management of the oncology patient and best supportive care measures.

Cardiology/anticoagulation:

Pharmacists initiate, monitor, and modify medication therapy to ensure patients are within their target INR goal. They also assist in developing anticoagulation plans for upcoming procedures by evaluating the risk of bleeding and thrombosis for each patient. In addition, they serve as a consult service to outpatient practices to address questions related to anticoagulation therapy and provide recommendations to optimize patient outcomes, minimize safety issues, and ensure cost effectiveness. Lastly, they provide education to pharmacy students and residents through both didactic and hands-on experiences.

Elective rotations (*all electives are five weeks long):

• Hematology/Oncology
  • Liquid Oncology
  • Solid Tumor Oncology
  • Allogeneic Hematopoietic Stem Cell Transplant and Cellular Therapy
• Solid Organ Transplant
  • Kidney Transplant
  • Liver Transplant
  • Lung Transplant
  • Heart Transplant
• Pain and Palliative Care
• Opioid Use Disorders
• Cardiology
  • Cardiology Medicine
  • Cardiac Intensive Care Unit
  • Cardiac Surgery
• Anticoagulation
• Emergency Department
• Pharmacy Informatics
• Antimicrobial Stewardship
• Investigational Drug Service
• Neonatal Intensive Care
• Unit Based Clinical Pharmacy

Required Longitudinal Experiences

Service Commitment

• Weekend: An average of two shifts a weekend every 3 weeks will be completed by the resident over the course of the residency year. Staffing shifts include IV room, medicine (general and pulmonary), cardiac/thoracic surgery, GI surgery, vascular surgery, and central operations.
• Weekday Evening: Each PGY1 resident will serve as Evening Lead Central Pharmacist in one of our central pharmacy locations for an average of 1 evening every 2 weeks over the course of the residency year.

Clinical On-Call

• Each PGY1 resident will participate in covering the clinical on-call service throughout the year. The on-call shift is an average of one night every two weeks from 4 PM to 11 PM (alternating with weekday evening lead central pharmacist shift), as well as weekends from 11AM to 11PM, an average of one weekend shift every 10 weeks replacing their weekend staffing.. During the call shift, the residents will be available to answer any clinical questions posed by pharmacy staff members, responsible for non-formulary medication approvals, and for covering the anticoagulation on call service. Additionally, they will respond to and participate in all medical emergencies. Clinical pharmacy specialists serve as clinical back-up for the residents throughout the shift. Residents will fill out a report after on-call and present brief cases on their experiences throughout the year. The performance of the resident will be monitored by the preceptor, and feedback will be delivered verbally and documented in PharmAcademic.

Professional Development

• Medication Use Evaluation (MUE)
  • The MUE experience is a quality improvement project focused primarily on the use of medications at the Hospital of the University of Pennsylvania. This activity occurs through a structured program that is coordinated by the Center for Medication Use Policy. Residents will collaborate with a group of preceptors to a complete a MUE. Residents select a project of interest from a list of topics approved by Pharmacy Leadership and the HUP P&T committee. Each topic promotes performance improvement involving medication or medication use processes designed to improve patient or institutional outcomes. Findings are presented to the Pharmacy Department and the HUP P&T Committee (and or one of its subcommittees).
• Formulary Monographs
  • Each resident will be expected to complete a formulary monograph to be presented to the UPHS and HUP P&T committees. The residents will receive an orientation to this process at the beginning of the year. The process is overseen by the Center for Medication Use policy which will assign the monograph, a preceptor, and presentation dates for each resident.
• Therapeutics Conference/Grand Rounds
  • Each PGY1 resident is required to present one journal club and at least one patient case presentation as part of the Residency Program’s Therapeutics Conference.
  • Each PGY1 resident is required to provide one Pharmacy Grand Rounds presentation, which is an hour long CE program attended by pharmacists throughout the health system.
• Committee Assignment
  • Each PGY1 resident is assigned a hospital or health system committee to serve as a member throughout the year. The purpose of this experience is to provide the resident with an understanding of how committees function and their role in the hospital or health system. The resident is expected to attend all committee meetings and will be asked to participate by preparing minutes and agendas, as well as work on relevant projects throughout the year.
  • Residents may also elect to serve on a resident specific committee such as Recruitment & Orientation Committee, Wellness Committee, Preceptor Development Committee, Research Committee, Didactic Learning Committee, and On-call Committee.
• IPPE Student Precepting
• Each resident will be assigned 1-2 residents who will rotate through the hospital one-half day every week. Residents will serve as their student’s primary preceptor and expose students to a variety of experiences throughout the hospital.

Other longitudinal experiences

• Assist in mentoring and serving as a pharmacy role model and preceptor to pharmacy students, other residents, and pharmacy staff
• Act as an integral part of the team taking care of patients in both the inpatient and outpatient clinic settings by providing education to nurses, physicians, and patients
• Actively participate in medication reconciliation at admission and discharge
• Maintain certification in Basic Life Support (BLS) and ACLS
• Submit an abstract for poster presentation at Vizient Midyear Conference and the American Society of Health System Pharmacists (ASHP) Midyear Clinical Meeting
• Formally present a completed research project at the Eastern States Residency Conference
• Complete Medication Adherence consults for the Kidney Transplant service
• Participate in the Teaching Certificate Program at the Philadelphia College of Pharmacy at Saint Joseph's University (optional)

Each resident will choose a mentor for the year. This mentor will assist the resident in strategically laying out the year and will provide guidance, based on the resident’s career goals and interests. The mentor may also meet with the resident and RPD regularly to discuss the resident’s progress and to review all rotation evaluations.

Application Requirements

Candidates interested in the program should submit the following through PhORCAS:

• Academic transcripts from your School of Pharmacy (including pre-pharmacy college transcripts)
• Letter of intent
• Curriculum vitae
• Three letters of recommendation; if possible from:
  • A clinical rotation preceptor
  • A representative from University or College
  • A previous employer or another clinical rotation preceptor

All required application materials should be submitted via PhORCAS by Jan 3rd 

PGY1 Residency Program Director

Nikitha Patel, PharmD, BCPS
Clinical Pharmacy Specialist, Internal Medicine
Hospital of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
Nikitha.Patel@Pennmedicine.upenn.edu