PGY2 Critical Care Residency

Program Purpose Statement

The PGY2 Critical Care pharmacy residency program builds on Doctor of Pharmacy (PharmD.) education and PGY pharmacy residency programs to contribute to the development of clinical pharmacists in critical care practice. The PGY2 critical care residency provides 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 critical care pharmacy residency are prepared for advanced patient care, academic, or other specialized positions, along with board certification.

Residency Goals

• Develop into an independent, competent, critical care practitioner with the ability to work with a multidisciplinary team to provide pharmaceutical care to patients in a range of critical care settings.
• Develop the knowledge and clinical skills to provide evidence-based pharmacotherapy recommendations for critically ill patients.
• Formulate a research question, develop methods and complete a short-term research project.
• Develop teaching and communication skills necessary to provide education to multidisciplinary critical care providers and trainees.
• Develop the essential skills necessary of a practice leader.

Critical Care Training Site

The Hospital of the University of Pennsylvania (HUP) Intensive Care Units (ICUs) are fully staffed by registered nurses, respiratory therapists, clinical nutritionists, pharmacists, medical students, residents, advanced practice providers, and fellows under the supervision of the attending medical physicians. There are currently 144 adult critical care beds divided between our HVICU, NCCU, SICU, MICU and CICU. The HUP Emergency Department is a bi-level ED with 61 patient treatment areas, and a total annual volume of over 69,000 visits. HUP's reputation as a world leader in medical research and clinical care attracts the highest quality medical specialists from around the world. The supportive and collaborative environment encourages physicians and staff to continuously seek new ways to improve the quality and length of life for all patients.

Learning Experiences

Required Rotations (36 weeks)

• Orientation – (four weeks)
  • Consists of hospital and departmental training including pharmacokinetic and code training. BLS and ACLS will be scheduled during this time if not already certified. The resident will also be trained on the pharmacy teams covering the intensive care units as this is where their primary weekend staffing responsibility will fall.
• Medical Intensive Care Unit – (eight weeks)
  • The medical intensive care units (MICU) include a 24-bed unit on Founders 9, a 12-bed unit on Founders 8 and a 12-bed unit in the Pavilion on City 14. All three units are under the direction of the Pulmonary, Allergy, and Critical Care medicine division. The resident will participate in daily patient care rounds on one of the teams with the goal to develop proficiency in proactively solving problems and communicating effectively with all members of the healthcare team.
• Surgical Intensive Care Unit – (four to eight) weeks
  • The surgical ICU consists of 24 beds staffed by two multidisciplinary teams. The resident will be assigned to one team with the primary focus of optimizing pharmaceutical care for those patients. One rotation (4 weeks) in the HUP SICU is required. If the elective Trauma SICU experience (4 weeks) at PPMC is not selected, an additional 4-week HUP SICU rotation is required. Common disease states encountered in the SICU include: necrotizing fasciitis, skin and soft tissue infections, wound infection, pancreatitis, intra-abdominal infection, sepsis, alcohol withdrawal, CRRT, and pain, agitation, and delirium.
• Cardiac Intensive Care Unit – (four weeks)
  • The cardiac intensive care unit (CICU) is a 12-bed unit located in Pavilion 8 Campus.  The attending physicians are trained in either interventional cardiology, heart failure, electrophysiology, or imaging. The CICU is responsible for providing direct patient care to the following patient populations and/or disease states: acute coronary syndromes, heart failure, electrophysiology procedures, cardiogenic shock, valvular disease, ventricular assist devices (VAD), heart transplant, pulmonary embolism, mechanical circulatory support, and congenital heart disease. The CICU team is comprised of an attending physician, second-year cardiology fellow, medicine residents, and pharmacist.
• Emergency Medicine – (four weeks)
  • The Department of Emergency Medicine provides clinical care in many exciting and diverse venues, offering a remarkable breadth and depth of care for our patients. Its clinical services include disaster preparedness, emergency medical services, emergency ultrasound, hyperbaric medicine, observation medicine, resuscitation and critical care, toxicology, quality improvement and safety, trauma, and travel medicine. There is a high level of acuity in the HUP ED with a high admission rate to the hospital. The department has developed prioritized care for patients with cardiologic, neurologic, oncologic and traumatic emergencies. The resident will work parallel with a preceptor with an expectation to take over the responsibility of the primary pharmacist towards the end of the rotation.
• Heart and Vascular Surgical Intensive Care Unit – (four weeks)
  • The heart and vascular surgical intensive care unit (HVICU) is a 36-bed unit located on the 7 Campus and Center Floor of the Pavilion. The unit is under the direction of the cardiothoracic surgery service with primary ICU care provided by a critical care or cardiothoracic anesthesia attending. The ICU team is responsible for providing direct patient care to patients undergoing complex procedures including: valve repair/replacement, TAVR, adult congenital heart disease, arrhythmia ablation, complex thoracic aortic repair, coronary artery bypass grafting, mechanical circulatory assist device placement which includes ventricular assist devices (VAD), heart transplantation, lung transplantation, extracorporeal membrane oxygenation (ECMO), minimally invasive cardiac surgery, and vascular surgery cases including minimally invasive endovascular repair (EVAR).
• Neurocritical Care Unit – (four weeks)
  • The Neurocritical Care Unit (NCCU) is located on Pavilion 10 City (PAV 10 City) is a 24-bed critical care unit including neurocritical care and neurosurgery patients. The NCCU does not cap and may overflow to Surgical ICU on Pavilion 11 Center. Common disease states encountered in the NICU include: subarachnoid hemorrhage, ischemic stroke, intracranial hemorrhage, status epilepticus, intracranial hypertension, CNS infections, and neurosurgical post-operative care.
• Leadership, Medication Use Policy, and Safety – (longitudinal – 12 months)
  • This rotation is based in the Center for Medication Use Policy (CMUP) which is staffed by three Drug Information Specialists and a Medication Safety Pharmacist. The resident will be responsible for participating in the submission of medication errors and adverse events, and assisting in the drafting and review of medication use policies, guidelines, and order sets relating to critical care where applicable. The resident will also review assigned safety nets and/or participate in a RCA if possible, with the potential to assist with a critical care related medication safety project.

Electives (12 weeks)

Depending on the elective, there are opportunities to have a brief two-week elective experience to gain exposure to a topic. The resident may also repeat any of the required rotations as an elective experience.

• Research
• Nutrition Support (*Highly encouraged unless PGY1 rotation exposure)
• Solid Organ Transplant
• Infectious Diseases
• Oncology
• Trauma Surgical ICU @ PPMC (**If chosen, not required to complete 8 weeks in the SICU)
• Palliative Care and Pain Management

Additional Experiences

The resident will have the opportunity participate in the following supplementary activities throughout the year and will work with their RPD and/or advisor to set up these activities:

• Conduct a Medication Use Evaluation and subsequent quality improvement plan
• Conduct a longitudinal research project including all steps of the research method and completion of a research manuscript
• Assist in the guideline review process of a critical care related institutional guideline
• Prepare and present presentations to the pharmacy department including: Therapeutics Conferences, Grand Rounds continuing education presentation, Critical Care conferences, and others as assigned
• Provide weekend staffing coverage to an ICU practice area
• Assist in the mentoring of pharmacy residents, students and staff
  • Serve as primary preceptor for a PGY1 resident Therapeutics Conference Presentation
  • Serve as primary preceptor to a PGY1 resident for the clinical on call program
• Provide in-service education to nursing, pharmacy and physician staff as needed
• Participate in department, hospital and clinical unit committees as assigned and interest dictates
• Attend critical care conferences including pulmonary/surgical critical care, cardiothoracic/cardiology and specialty conferences as assigned by the preceptor
• Attend the PGY2 CC RAC meeting to provide monthly resident progress update and serve as secretary
• Attend the Mid-year clinical meeting, and SCCM Congress (optional) as funding allows
• Submit abstract for poster presentation (research or case report) to SCCM or other national meeting (optional)
• Present SCCM journal club or other national journal club (ie. Neuro Critical Care Society, etc.) during residency year (optional)
• Participate in writing a review article (optional)
• Instruct pharmacy students in didactic coursework at St. Joseph’s University in Philadelphia (optional)
• Participate in the Teaching Certificate Program at St. Joseph’s University (optional)
• Serve as primary preceptor for an IPPE or APPE student rotation (optional)

Program Director

Michael DiCesare, PharmD, BCCCP
Clinical Pharmacy Specialist, Medical ICU
Hospital of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
michael.dicesare@pennmedicine.upenn.edu

Program Coordinator

Rick Carlson, PharmD, BCEMP
Clinical Pharmacy Specialist, Emergency Medicine
Hospital of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
rick.carlson@pennmedicine.upenn.edu

Application Requirements

Candidates interested in the program should submit the following to Phorcas:

• Academic transcripts from your School of Pharmacy
• Letter of intent which addresses the following:
  • Why you have chosen the Hospital of the University of Pennsylvania,
  • Why you have chosen to pursue specialized training in critical care, and
  • Your PGY2 CC residency as well as short & long-term career goals.
• Curriculum vitae
• Three letters of recommendation should be submitted through the Phorcas system from the following:
  • Clinical rotation preceptor, preferably from an ICU rotation
  • PGY1 Residency Program Director
  • Other clinical preceptor

All required application materials should be submitted to Phorcas by the deadline of January 3rd.