PGY1 Pharmacy Residency Curriculum

Orientation and Training is a required learning experience that will provide an overview and orientation to the residency program. Additionally, the resident will receive training in the central pharmacy with a focus on distributive operations and regulatory workflow. A minimum of three full days within the first week of orientation will be dedicated to orientation to the residency program and related requirements, policies, and procedures.

Following this introduction to the residency program, residents will begin pharmacy service orientation and training in the central pharmacy. This training will be designed to be consistent with the training schedule, standards, and expectations of any new clinical pharmacist at BIDMC who would be scheduled for a shift in the distributive (central) pharmacist role.

The curriculum includes, but is not limited to, achieving competence in operations of the BIDMC Department of Pharmacy, departmental workflow, use of departmental and hospital information systems and technology, knowledge and application of departmental and hospital policies and procedures, and the skills needed to serve as a clinical pharmacist during the service requirements of the residency.

The PGY1 pharmacy resident will train for a minimum of fourteen (14) shifts in the centralized pharmacy to learn the core functions and responsibilities of pharmacists in this practice area. A training checklist and other documents are provided to provide more detail relative to the content and competency requirements in this role.

The Pharmacy Practice Concentrated Learning Experience provides the resident the opportunity to develop essential practice skills in the role and responsibilities of a Clinical Pharmacist in one of the medical center’s decentralized practice sites. This learning experience builds upon the fundamental knowledge gained through their initial training and work in the central pharmacy and facilitates the resident to advance their training and practice to be able to independently practice as a decentralized Clinical Pharmacist.

The role of a decentralized Clinical Pharmacist in an assigned practice area includes the medication management and oversight of 60-100 patients on one or more floors. The focus of training will be geared towards the routine operational and clinical responsibilities of the decentral pharmacist and increasing confidence with institutional policy, procedures, and clinical practice.

The Infectious Diseases (ID) learning experience is a required, five-week learning experience. There are two ID teaching teams: one focusing on the immunocompromised patient and the other on the immunocompetent patient. Each team includes an attending physician and 2 ID fellows. Additional team members may include medical interns, medical residents, medical students, pharmacists and/or pharmacy students. The ID consult service sees a wide variety of patients from many different backgrounds (medical service, critical care, oncology, HIV, etc.).

The resident works with the ID consult team at daily rounds, maintaining a responsibility to optimize anti-infective therapy for the consult patients. This includes dosing recommendations based on organ function, avoidance or mitigation of adverse reactions, and daily monitoring of anti-infective therapies, including performing kinetics consultations. While on learning experience, the resident will also participate in the P&T Antimicrobial Subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and ID Departments.

Internal Medicine (IM) is a required, five-week learning experience. The goal of the IM learning experience is for residents to develop skills and competencies in the provision of pharmaceutical care for a diverse population of IM patients, enabling them to effectively participate in therapeutic decision making, drug therapy selection, monitoring of acutely ill patients and discharge counseling.

Typically pharmacy residents will round on one of 4 internal medicine teaching teams. Each of the teaching teams includes an attending physician, a PGY2 or PGY3 medical resident, 2 PGY1 medical interns, and medical students (MSIII or MSIV). Other disciplines on the team include the clinical pharmacy specialist or clinical pharmacist, and pharmacy students. Teaching teams typically are responsible for 15-18 medicine patients.

The clinical pharmacist (and in turn the pharmacy resident) on the team is responsible for ensuring safe and effective medication use for all patients. This involves active participation in daily rounds and collaboration with other pharmacy, nursing, and physician personnel as appropriate. The pharmacy resident assumes an active role in assisting the team with medication reconciliation issues, including obtaining accurate home medication lists, and providing patient counseling at the time of discharge.

Strong communication and interpersonal skills, as well as time management skills are necessary to succeed during this learning experience. Residents will have opportunities to further refine these abilities and further develop their clinical knowledge, ability to provide patient care, develop a working relationship with an interprofessional health care team, identify and interpret health literature, and educate patient and providers while on this learning experience.

The Medical Intensive Care Unit (MICU) learning experience is a required, 5-week learning experience at Beth Israel Deaconess Medical Center. The MICU typically has a service of up to 8 patients, but this may increase based on the specific location (East Campus versus West Campus) and service (MICU orange versus green). Each MICU team consists of an attending pulmonary/critical care physician, pulmonary/critical care fellow, 2-3 senior medical residents, and 2-3 medical interns. Additionally, rounds are attended by the critical care nurses and respiratory therapy/physical therapy as needed.

The medical intensive care unit (MICU) learning experience allows the pharmacy resident to gain experience in caring for the critically ill patient with a focus on pulmonary or GI/liver disease. The resident will attend daily rounds and be involved with medication management with the MICU team. Responsibilities will include proactively assessing and monitoring all aspects of care of the critically ill patient with various end-organ failures (e.g. lung, kidney, liver, etc.). The resident will participate in drug monitoring, renal dosing, individualized pharmacokinetics assessment, and patient interaction/education as needed.

Along with these clinical requirements, the resident will be responsible for various topic discussions relating to critical care or respiratory or systemic end-organ disease, such as acute respiratory distress, acute/chronic/end-stage organ failure, fluid/nutrition/electrolyte imbalance, acid-base disorders, mechanical ventilation, sepsis and hemodynamic imbalance, sedation/analgesia, use of neuromuscular blocking agents, liver failure, GI bleeding and toxic ingestion or drug overdose.

The decentralized clinical pharmacist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation in work and attending rounds daily, education of physicians and nurses, and education of pharmacy trainees, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees.

When a pharmacy resident is on service, they will assume the roles of the decentralized clinical pharmacist, under the supervision of the critical care learning experience preceptor/s. By week 3 of the learning experience, the resident will also be asked to process all medication orders for the MICU team on which they are rounding as well as complete all departmental drug monitoring requirements (Vancomycin and anticoagulation).

BIDMC is one of the Advanced Pharmacy Practice Experience (APPE) sites for 6th year PharmD students from MCPHS University. The resident will be involved in providing experiential education to the clerkship students, including teaching and student assessment as it relates to providing pharmaceutical care. One of the main goals of the learning experience is for each resident to effectively develop essential precepting/teaching skills utilizing his/her own experience and guidance from the teaching learning experience preceptor.

The learning experience will allow the resident to use a variety of learning activities that meet MCPHS University objectives for the in-patient APPE learning experience. The resident will design a syllabus incorporating those learning activities and formulate site-specific goals and objectives for student-centered activities. During the learning experience the resident will guide students in developing professional skills required for in-patient pharmacy activities and assess student performance in accordance with the MCPHS University PharmD experiential program guidelines.

Pharmacy Management and Leadership is a required, five-week learning experience at BIDMC that provides the resident the opportunity to gain an understanding of the institutional and departmental structure of the Department of Pharmacy at BIDMC and its role and impact within the BILH system. The purpose of the learning experience will be to give the resident the firsthand experience in pharmacy leadership, quality and process improvement, strategic planning and policy development, and personnel management.

Through discussions with preceptors and members of the department leadership, completion of projects, and attending and leading various meetings the resident will have the opportunity to learn about pharmacy leadership’s role in:

• Pharmacist professional development, engagement, and satisfaction
• Identifying and executing on opportunities for departmental quality and process improvement
• Interdisciplinary project management and leadership
• Effectively communicating a message as a leader (both written and verbal)
• Drug shortage and formulary management
• Ensuring regulatory and quality best practices
• Fiscal responsibility of the department (i.e. pharmacy budget process, purchasing, clinical on call, etc.)

Residents will work primarily with the learning experience preceptors and will also attend meetings with and collaborate with other members of the department leadership team and external stakeholders throughout the medical center.

• Cardiovascular Medicine
• Ambulatory Care Clinics:
  • Anticoagulation
  • Cardiology/Heart Failure
  • Infectious Diseases
  • Oncology
  • Pain/Palliative Care
  • Primary Care
  • Solid Organ Transplant
• Emergency Management/Toxicology
• Hematology/Stem Cell Transplant (BMT)
• Hepatology
• Infectious Diseases II: Antibiotic Consult Service or Stewardship
• Oncology-Solid Tumor (Inpatient)
• Solid Organ Transplant
• Specialized ICUs:
  • Cardiac Intensive Care
  • Medical Intensive Care II
  • Surgical Intensive Care
  • Trauma Intensive Care
  • Neonatal Intensive Care

Each resident will serve as a MCPHS University instructor in PPB 551, Pharmacotherapeutics Seminar, during the fall and spring semester. The course requires the resident to be at the University for approximately three hours per week. The goal of this experience is for the resident to gain experience in problem based learning techniques and small classroom facilitation. The resident will facilitate a weekly case based discussion with fifth year PharmD students to assist in the students’ development of professional problem solving skills. During each class, the resident will be expected to encourage an open forum for discussion to help enhance the students' ability to communicate and to help them develop life-long learning skills.

Each resident is responsible for the completion of residency project. The project may be in the form of original research, a problem-solving exercise, or development, enhancement or evaluation of some aspect of pharmacy operations or patient care services. As a component of the project, the resident will submit the project as a work in progress for poster presentation at the ASHP Midyear Meeting. Each resident will complete a project report using an accepted manuscript style suitable for publication in the professional literature.

Resident report is a weekly pharmacy conference meant to enhance the resident’s clinical knowledge and give the resident an opportunity to present and/or facilitate discussion in a large group setting. All members of the pharmacy department will be invited to each resident report session and residents will be expected to provide presentations that promotes audience engagement and discussion on the respective topic.

Each resident will be required to complete at least five (5) presentations throughout the year. It is expected that all residents attend all scheduled resident report presentations being delivered by any PGY1 or PGY2 resident.

Upon successful completion of central and decentralized training residents will be expected to serve as an independent clinical pharmacist, covering shifts in both central operations and decentral clinical sites throughout the residency year. Residents will split their time in both central pharmacy operations and decentralized, clinical practice sites to ensure they achieve proficiency in both settings, understanding both the complexities of medication dispensing and provision of direct patient care on a decentralized practice site. The practice experience schedule is individualized based on training needs, clinical interests, and successful completion of direct patient care rotations.

Each resident will participate in the Residency Teaching Certificate Program (RTCP) at MCPHS University. The RTCP will provide residents with a foundation of core educational principles presented in live and online didactic modules. Mentored by an academic faculty preceptor, the resident will also gain practical teaching experience in a variety of educational settings (large/small classroom, clerkship, laboratory, or seminar). Residents will also develop, with the assistance of their faculty mentor, a formative teaching portfolio that will document their progress and enhance the learning experience.

The goal of the medication safety learning experience is to offer the resident experience in identifying methods to enhance the medication use system to minimize the risk of adverse drug events. During this five-month longitudinal learning experience, the resident will gain knowledge and experience in identifying and analyzing medication errors, adverse drug reactions, and adverse drug events. The resident will identify opportunities for improvement in the organization’s medication-use system by comparing the medication-use system to relevant best practices using the Institute for Safe Medication Practices newsletters or other recent literature on patient safety as a comparator. The resident will have the opportunity to develop and implement safe medication practices.

Activities will include participating in medication error reporting, performing a root cause analysis, and when feasible completing a failure mode and effects analysis. The resident will work collaboratively with members of the medication safety subcommittee and other quality improvement committees in the hospital. The resident’s responsibilities will include analyzing medication events, publishing a medication safety newsletter, performing quality improvement initiatives, and providing educational sessions on safe medication practices.

Each resident will present at least one (1) formal CE presentation during the residency year. Several residency goals will be addressed within this residency requirement. Upon successful completion of this residency requirement, the resident will demonstrate:

• Critical evaluation of the literature pertaining to the presentation topic
• The provision of CE programs for pharmacists and other health care professionals
• Presentation, teaching, and communication skills
• Skill in responding to audience questions and comments

Residents will apply their growing clinical knowledge, understanding of institutional and regulatory policies, and critical thinking skills gained throughout concentrated and longitudinal learning experiences to serve as a 24-hour clinical resource to the pharmacy and medical staff.

Primary coverage of the clinical on call pager assignment will rotate through all acute care PGY1 and PGY2 pharmacy residents and residents will have a Clinical Pharmacy Manager who serves as back up at all times throughout the year.

NOTE: pharmacy residents will not provide primary pager coverage during other assigned residency learning experiences (ex. service shifts, teaching certificate activities, etc.).