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 five week rotations with eight required rotations and four elective rotations. In addition, there are several required longitudinal experiences described below:

Required Rotations

(required, five weeks unless otherwise noted)

Orientation

Orientation takes place during the first five weeks of residency. During this block, 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. 

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

Medication Use Policy and Safety

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 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 rotation 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

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

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 education and other activities.

Critical Care

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

Infectious Diseases (ID) is a required, 5-week learning experience at the Hospital of the University of Pennsylvania. The ID rotation can focus on one of two areas: ID consult services or antimicrobial stewardship.

There are a total of six ID consult services at HUP, consisting of three general ID consult services, two solid organ transplant ID consult services, and one oncology ID consult service, as well as an ID primary service medicine team that cares for persons living with HIV/AIDs and other complex infections. The general ID consult service is composed of an ID attending physician and an ID fellow or Advanced Practice Provider (APP) such as a nurse practitioner or physician assistant. Other members of the team may include up to two medical residents, up to two medical students, and up to two pharmacy representatives split amongst a clinical pharmacy specialist, a PGY2 ID resident, a PGY1 resident, and a pharmacy student. Patients span nearly all services, inpatient locations, and levels of acuity. Common disease states encountered include: bloodstream infections, infective endocarditis, osteoarticular infections, intra-abdominal infections, complicated urinary tract infections/acute pyelonephritis, community-acquired/hospital-acquired/ventilator-associated pneumonia, skin and skin structure infections, and both community-acquired and nosocomial meningitis.

Antimicrobial stewardship includes optimizing antimicrobial selection, dose, route, and duration of therapy while limiting unintended consequences such as emergence of resistance, adverse drug events, and pharmacy/institution costs. The Antimicrobial Stewardship Program (ASP) at the Hospital of the University of Pennsylvania was first established in the early 1990's and is currently operated by five infectious diseases (ID) trained pharmacists and three ID physicians. The ASP leverages many of the nationally endorsed stewardship modalities including (but not limited to) prior approval of restricted antimicrobials, prospective audit and feedback, dose optimization, IV to oral conversion, rapid diagnostic technology, and indication-specific treatment guidelines.

The purpose of this core rotation is to gain experience in the management of infectious diseases, develop a basic knowledge base in microbiology, understand the pharmacokinetics and pharmacodynamics of antimicrobial therapy, and to strengthen communication skills by presenting in-services and interacting with other healthcare professionals in a variety of settings.

Ambulatory Care

Ambulatory care is a five week, required learning experience for the PGY1 Pharmacy Resident. The learning activities 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: pulmonology, infectious diseases, gastroenterology, neurology, oncology, cardiology, rheumatology, solid organ transplant or dermatology. All experiences will be conducted at the Perelman Center for Advanced Medicine (PCAM). 

Research (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. 

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
• Substance Use Disorders
• Cardiology     
• Anticoagulation
• Emergency Department
• Pharmacy Informatics
• Investigational Drug Service
• Pulmonary Medicine

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 specialty), cardiac/thoracic surgery, GI surgery, vascular surgery, and central operations.

Weekday Evening: Each PGY1 resident will serve as Evening Lead Central Pharmacist in the ICU pharmacy for an average of one evening every two 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 staffing service commitment for that weekend. 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.

Kidney Transplant Medication Adherence Assessments

As part of the kidney/pancreas transplant evaluation process, all patient candidates undergo chart review by the transplant pharmacist as part of their evaluation. Each candidate is also presented and discussed by the transplant team in a weekly selection meeting. Since pre-transplant medication adherence practices may predict post-transplant medication adherence, in some cases where non-adherence concerns are identified, it is recommended for candidates to undergo further assessment and or/education with a pharmacist prior to transplant. Residents will be assigned patients on a rotating basis, based on the kidney/pancreas team's requests for patients to undergo medication adherence assessments as part of their adherence agreements. Residents will be assigned up to 5 candidates who require medication adherence assessment and based on findings, pharmacy team will evaluate if patients need ongoing follow-up assessments with the team.

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 Drug Class Reviews
  • Each resident will be expected to complete a formulary drug class review 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 drug class review, a preceptor, and presentation dates for each resident.
• Therapeutics Conference/Grand Rounds
  • Each PGY1 resident is required to present one journal club and two 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 committees 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, Research Committee, and On-call Committee.
• IPPE Student Precepting
  • Each resident will be assigned 1-2 IPPE students 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

• Maintain certification in ACLS
• Submit an abstract for poster presentation at Vizient Midyear Conference
• Formally present a completed project at the Eastern States Residency Conference
• 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 2nd

We do accept applications for students who have an F1 student visa with OPT for 12 months after graduation, who do not require sponsorship from Penn Medicine.

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