PGY2 Pain Management and Palliative Care Pharmacy Residency

Program Purpose Statement

The PGY2 Pain Management and Palliative Care Pharmacy Residency Program at the Hospital of the University of Pennsylvania (HUP) is designed to develop PGY1 Pharmacy Residency graduates into clinical specialists who can successfully manage all aspects of pharmaceutical care for patients with pain management and palliative care needs. Graduates of this rigorous program will be well equipped to care for patients with complex comorbidities needing acute and chronic pain management, palliative and hospice care, and patients with comorbid opioid use disorder in both inpatient and ambulatory settings.

Program Description

This residency is a full-time practice commitment and is 12 months in duration. The program offers comprehensive learning experiences in all types of pain. Residents will serve as an integral part of the interdisciplinary care teams, ensuring the safe and effective use of all medications, educating patients and caregivers, and facilitating smooth transitions between patient care settings. Residents will be able to make complex therapeutic recommendations in a broad variety of practice settings and for patients with a wide variety of pain syndromes, including chronic malignant and non-malignant pain, neuropathic pain, and pain related to neurologic and hematologic conditions. Residents will also get significant exposure to a well-established Opioid Stewardship Program and related efforts and opportunities.

Palliative care emphasis will be placed on symptom management throughout patients’ illnesses and at the end of life. All required learning experiences are 1 month (4 weeks) in duration except where noted in table below. Longitudinal experiences are designed to focus on pharmacy operations, opioid stewardship, palliative care clinic, clinical research, and professional development which includes opportunities to deliver formal and informal presentations, teach and mentor residents and students, and develop professional writing skills. The program will be tailored specifically for each resident based upon the resident’s goals, interests, and previous experience. Elective learning experiences are available to enhance the resident’s experience and knowledge in pain management, palliative care, and related areas. Electives may be structured as 2-week, or 1-month learning experiences as noted below. Elective rotation requests will be considered on an individual basis, with regards to resident interests and preceptor availability.

Residency Goals

Required Goals:

• In collaboration with the health care team, provide comprehensive medication management to patients requiring pain management and palliative care following a consistent patient care process.
• Ensure continuity of care during patient transitions between care settings for patients requiring pain management and palliative care.
• Demonstrate ability to manage formulary and medication-use processes for patients requiring pain and palliative care, as applicable to the organization.
• Demonstrate ability to conduct a quality improvement or research project.
• Lead a medication-use evaluation.
• Demonstrate leadership and management skills for successful self-development in the provision of care for pain management and palliative care patients.
• Demonstrate management skills in the provision of care for pain management and palliative care patients.
• Provide effective medication and practice-related education to patients requiring pain management and palliative care, caregivers, health care professionals, students, and the public (individuals and groups).
• Effectively employ appropriate preceptor roles when engaged in teaching students, pharmacy technicians, or fellow health care professionals in pain management and palliative care.

Elective Goals:

• Effectively fulfill the major functions of a specialty pharmacist, including intake, clinical management, fulfillment, and facilitating optimal outcomes.
• Lead a medication-use evaluation.
• Exhibits additional skills of a practice leader

Training Site

The primary site for rotations will be at the Hospital of the University of Pennsylvania (HUP), which is world-renowned for its clinical and research excellence, forging the way for newer and better ways to diagnose and treat illnesses and disorders. HUP is a 988-bed-academic teaching hospital and tertiary referral center located in the heart of Philadelphia.

Ambulatory rotations will primarily be conducted as The Perelman Center for Advanced Medicine (PCAM), which is designed to create an ideal environment for patient-focused care and collaboration among health professionals. The Perelman Center is a state-of-the-art, 500,000 square foot outpatient facility located on the corner of 34th Street and Civic Center Boulevard, adjacent to the Hospital of the University of Pennsylvania. Our pharmacy services extend into a multitude of areas including oncology, cardiology, anticoagulation, internal medicine, infectious diseases, gastroenterology, hepatology, neurology, dermatology, transplantation, and rheumatology.

We offer our home hospice rotation through Penn Care at Home, with the opportunity to do home visits and spend time at the inpatient hospice unit at Penn Hospice at Rittenhouse. Penn Medicine Rittenhouse includes two buildings — the main building and the Tuttleman Center, where the Anesthesia Pain Service provides clinic-based care. The campus also features the post-acute care facility managed by Good Shepherd Penn Partners.

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 keep reaching ahead to find new ways to improve the quality and length of life for everyone.

Learning Experiences

*Residents may elect to repeat any of the required rotations as an elective as well, new learning descriptions and objectives will be created in this case.

* 1-month experience; activities may vary based on in-coming early commitment status

‡ Available as 2-week, or 1-month experience, only 2 rotations that are two weeks in duration can be elected, all others must be 4 weeks in duration

Longitudinal Experiences

Professional Development:

• Attend Vital Talk Training
• Contribute to a Quality Improvement Project with Palliative Care physician fellows (Topic-TBD)
• Participate in Society of Pain and Palliative Care (SPPCP) Weekly Conferencev
• Assist in the mentoring of pharmacy residents, students and staff.
• Develop presentations for Therapeutics Conference (two required – one as a mentor of a PGY-1 resident and one that can be either Journal Club, Case, or Conference)
• Present one journal club at Palliative Care Seminar Journal Club Series
• Attend ambulatory care, APS (Acute Pain Service) and Palliative Care conferences based on topic schedule and in discussion with the preceptor and/or RPD
• Present one topic Ambulatory Care Topic Discussion, one SPPCP virtual education session (as available), and one topic within the Oncology Topic Discussion series.
• Provide an ACPE-accredited presentation at Pharmacy Grand Rounds.
• Serve as primary preceptor for an IPPE or APPE student rotation (optional).
• Attend the ASHP Mid-year clinical meeting
• Optional meetings for attendance/presentation: Eastern States Residency Conference or a local or national pharmacy or pain/palliative care specialty meeting, as funding allows.
  • ASHP Midyear Clinical Meeting; SPPCP Virtual Meeting; AAHPM Annual Meeting ; PainWeek Conference; APhA Pain Institute; APhA Substance Use Summit; AMERSA Meeting; AAPP Meeting
• Peer review on one Journal article as able based on Journal requests

Oncology Teach Program, Toxicity Support:

• This longitudinal rotation intends to introduce and familiarize the resident to the most common cancers and the acute and chronic toxicity issues patients have related to the therapies they are on and general progression of their disease.
• The goal of this experience is for the resident to become familiar with toxicity management among the most common cancers while also helping to manage symptoms related to their disease and overall well-being.
• The resident will be able to hone their palliative care skills in the context of enhancing clinical and critical thinking skills with increasing the confidence and competence within oncology pharmacy.
• This will occur in the first 6 months, follow by the longitudinal clinic experience

Research/Scholarly Activities:

• Identify or choose a pain management or palliative care specific research question and complete a research project including study design, statistical analysis, data collection and results analysis
• Submit a pain management/palliative care-related abstract to a national meeting
• Participate in pain management or palliative care-related research project
• Develop a pain management or palliative care-related poster and/or platform presentation for a national meeting
• Prepare a manuscript suitable for publication in a professional journal

Opioid Stewardship

• Complete one medication use evaluation
• Review therapeutic guidelines and policies as assigned.
• Participate in HUP Inpatient Pain Committee meetings.
  • Prepare and present HUP Opioid Prescribing Data
  • Participate in quarterly review and follow up of pain-related safety event reports.
• Attend monthly Opioid Stewardship Task Force meetings.
• Cover HUP Pain Pharmacy Secure Chat On-Call in weekly rotation starting in October and for duration of the year.

Pharmacy Operations:

• Function as a unit based clinical pharmacist during weekend staffing coverage in a general practice area, responsibilities include:
  • Order verification
  • Medication distribution
  • Pharmacokinetic consult recommendations
  • Drug information resource for health care providers
  • Emergency response participation at all codes, anesthesia stats, and rapid response calls for assigned units
  • Complete at least 208 hours of weekend clinical operations as a unit based clinical pharmacist

Program Director

Tanya Uritsky, PharmD
Opioid Stewardship Coordinator
Hospital of the University of Pennsylvania
Tanya.Uritsky@pennmedicine.upenn.edu

Application Requirements

Candidates interested in the program should submit the following to the RPD (not currently via PhORCAS until accredited) by the deadline of January 3rd:

• Academic transcripts from your pharmacy school (including pre-pharmacy college training)
• Letter of intent addressing why you have chosen the Hospital of the University of Pennsylvania, why you have chosen to pursue specialized training in pain management and palliative care and your residency and career goals.
• Curriculum vitae
• Three letters of recommendation (at least one from a clinical rotation preceptor)
• Completion of an accredited PGY1 Residency program