PGY1 Core Rotations

Preceptor: Monica Mahoney, PharmD, BIDMC Clinical Coordinator, Infectious Diseases

Rotation description: The Infectious Diseases (ID) rotation is a required, five week learning experience. BIDMC has 673 licensed beds, located on two campuses. 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 rotation, 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.

Preceptor: Alexa Carlson, PharmD, BCPS, Assistant Clinical Professor, Department of Pharmacy Practice, Northeastern University, Bouvé College of Pharmacy and Allied Health Sciences

Preceptor: Kristen Knoph, PharmD, BCPS, BIDMC Clinical Pharmacist

Rotation description: Internal Medicine (IM) is a required, five week learning experience. The goal of the IM rotation 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: Robinson A, Robinson B, Kurland A, or Kurland B. 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.

The clinical pharmacy specialist, 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 is responsible for identifying and resolving medication therapy issues for all patients on their team. These problems include drug dosing, drug allergy issues, drug-drug and drug-disease state interactions, adverse drug reactions, drug monitoring, route of administration, and cost-effectiveness issues. The pharmacy resident should assume 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 rotation 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 rotation.

Preceptor: Mary Eche, PharmD, BIDMC Clinical Coordinator, Critical Care, PGY2 Critical Care Residency RPD

Preceptor: Pansy Elsamadidsi, PharmD, BIDMC Clinical Pharmacist

Preceptor: Adrian Wong, PharmD, MPH, BCPS, BCCCP, Assistant Professor, Pharmacy Practice, MCPHS University

Rotation description: The Medical Intensive Care Unit (MICU) rotation 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) rotation 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 clinical coordinator. Both the decentralized pharmacist and clinical coordinator are available to the resident for any questions or assistance as needed. By week 3 of the rotation 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).

Preceptor: Morgan Smith, PharmD, BCOP, BIDMC Clinical Coordinator, Oncology

Rotation Description: The Oncology rotation is a core rotation for PGY1 pharmacy residents intended to provide exposure to patients admitted to the oncology service due to complications from anti-cancer treatment, disease progression, to receive chemotherapy, and for end of life care/transition to hospice. The medical oncology service includes patients with solid tumors; primarily lung, breast, gynecologic, esophageal, head & neck, bladder, sarcomas, and pancreatic malignancies. Clinical pharmacy services are comprehensive with a focus on pharmacokinetics, pain/nausea/other symptom management, nutrition services, discharge counseling, and chemotherapy counseling. The resident is responsible for pre-rounding on his or her assigned patients as well as rounding with his or her inpatient team. The resident should work towards independent medication management of the inpatient team and is responsible for:

• identifying and resolving medication therapy issues
• providing drug information to the rounding team members
• participating in discharge
• planning and patient education
• assisting the team with chemotherapy planning

Preceptor: Katelyn Richards, PharmD, BIDMC Clinical Specialist, Solid Organ Transplant

Rotation Description: The solid organ transplant rotation will allow the resident to gain experience in management of kidney, liver and pancreas transplant recipients. The resident will make daily rounds with both the liver and kidney transplant teams and will assist in the management of immunosuppressive medications as well as infectious disease and other medical issues in the transplant patient. The resident will also have an opportunity to be involved with the outpatient transplant clinic if desired. As part of the transplant team the resident will participate in intake meetings where the resident will be exposed to the evaluation process that takes place prior to listing a patient for transplant. In addition to clinical roles the resident will also be responsible for providing discharge counseling to all new transplant recipients.

Preceptor: Snehal Bhatt, PharmD, BCPS, Associate Professor, Pharmacy Practice, MCPHS University

Rotation description: BIDMC is one of the Advanced Pharmacy Practice Experience (APEP) sites for 6th year PharmD students from MCPHS. 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 rotation is for each resident to effectively develop essential teaching skills utilizing his/her own experience and guidance from the teaching rotation preceptor. The rotation will allow the resident to use a variety of learning activities that meet MCPHS objectives for the in-patient APEP rotation. The resident will design a syllabus incorporating those learning activities and formulate site-specific goals and objectives for student-centered activities. During the rotation the resident will guide students in developing professional skills required for in-patient pharmacy activities and assess student performance in accordance with the MCPHS PharmD experiential program guidelines.