The resident rotates assignments throughout the year and, to the extent possible, areas of assignment are designed around the resident's interests. In all areas to which the resident is assigned, they assume the role and responsibility of team members in the clinical service, as well as teaching and administrative aspects of the unit.

Required Rotations : Clinical Component
Antimicrobial Stewardship (8 weeks)
Preceptor: Christopher McCoy, PharmD, BCPS - Clinical Coordinator, Antimicrobial Stewardship

Rotation description:
The Antimicrobial Stewardship (AST) rotation provides the resident with the opportunity to gain insight in the management of Infectious Diseases from the perspective of antibiotic resistance, evidence based practice, cost effectiveness, decreasing collateral damage and improving the selection of antibiotics throughout the institution. The resident will develop problem-solving skills relative to guidance of house staff in the selection of antibiotics, an evaluation of risk factors for drug resistance as well as antimicrobial pharmacokinetics and pharmacodynamics. The resident works with the Antimicrobial Stewardship team at daily rounds and independently, maintaining a responsibility to survey key drugs and infections in order to promote effective and evidence based use of antimicrobials with the ultimate goals of improving patient care and maintaining cost effectiveness. This includes setting durations of antibiotic therapy, ensuring compliance with hospital pathways and national guidelines. Additionally, surveillance of resistance throughout the institution will be important. The AST sees a wide variety of patients across the entire institution. The resident will also participate in the P&T antibiotic subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and ID Departments.

Infectious Diseases General Medicine/Surgery (8 weeks)
Preceptor: Monica Golik-Mahoney, PharmD, BCPS (AQ-ID) - BIDMC Clinical Coordinator, Infectious Diseases

Rotation description:
The goal of this rotation is for the resident to gain insight in the management of a broad range of Infectious Diseases, develop problem-solving skills in Infectious Disease therapy, and establishment of a firm knowledge base in antimicrobial pharmacokinetics and pharmacodynamics. The resident will work with the Infectious Disease consult team and will be expected to attend daily rounds. The resident is responsible for optimizing anti-infective therapy for all consult patients, including pharmacokinetic dosing and daily monitoring of anti-infective therapies. The ID consult service sees a wide variety of patients from many different backgrounds (medical, surgical, critical care, HIV, etc). The resident will also participate in the P&T antibiotic subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and Infectious Disease Departments.

Immunocompromised Infectious Diseases (ID) (8 weeks)
Preceptor: Christopher McCoy, PharmD, BCPS - Clinical Coordinator, Antimicrobial Stewardship

Rotation description:
The Immunocompromise Infectious Diseases (ID) rotation provides the resident with the opportunity to gain insight in the management of Infectious Diseases that affect the immunocompromised host, to develop problem-solving skills in the pharmacotherapy of these diseases, and to establish a firm knowledge base in antimicrobial pharmacokinetics and pharmacodynamics. 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 and daily monitoring of anti-infective therapies. The ID immunocompromised consult service sees patients on the East campus and those admitted to the Hepatobiliary Service as well as Solid Organ Transplant, Hematology-oncology, HSCT, etc. The resident will also participate in the P&T antibiotic subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and ID Departments.

Core Abbreviated Rotations
Infectious Diseases Clinic: HIV/HCV (4 weeks)
Preceptors: Christopher McCoy, PharmD, BCPS - Clinical Coordinator, Antimicrobial Stewardship
Mary LaSalvia, MD - Infectious Diseases Physician, Clinic Director

Rotation Description:
The HIV/HCV Clinic rotation provides the resident with the opportunity to gain insight in the management of outpatients with chronic infections, to develop problem-solving skills in the pharmacotherapy of these, and to broaden their knowledge base in antimicrobial, antiviral and antiretroviral pharmacokinetics and pharmacodynamics. The resident works with the clinic team and independently, maintaining a responsibility to provide patient education, assess medication adherence, assess medication profiles, and document quality initiatives. The clinic sees a wide variety of patients with unique comorbidities.

Infection Control/Health Care Quality (4 weeks)
Preceptors: Graham Snyder, MD - Infectious Diseases Physician, Infection Control Epidemiologist
Christopher McCoy, PharmD, BCPS -
Clinical Coordinator, Antimicrobial Stewardship

Rotation Description:
The rotation incorporates collaborative work on quality measures related to infection prevention, tracking hospital acquired events and potentially responding to outbreaks or local public health issues. The resident may engage in surveillance, prevention and control projects. The resident should work towards independent data collection and analysis and is responsible for: Identifying the essential elements of the Infection Control dashboard for QA, including surgical prophylaxis, immunization, and hospital acquired infections as they relate to CMS and or state regulations.
Additionally, the resident will participate in a short report of activities that are relevant to pharmacy collaboration with the IC division including influenza tracking, institutional concordance with CDC recommendations for antivirals and immunizations.

Medical Microbiology Rotation (4 weeks)
Preceptors: James Kirby, MD, D(ABMM) - Microbiology Director

Rotation Description:
This rotation provides training in clinical bacteriology, mycobacteriology, mycology, parasitology, virology, and infectious diseases serology. Residents can observe bench work in techniques and methods in diagnostic medical microbiology. Diagnostic techniques will also be included. Residents can also participate in weekly joint infectious disease-microbiology conferences. The resident will choose a topic of particular interest on which to give a presentation to medical and technical staff.

Elective Rotations:
Core Electives: (2-4 weeks) select at least two (2) of the following :
Medical Intensive Care (MICU) (4 weeks)
Preceptor: John Marshall, PharmD, BCPS, FCCM - BIDMC Clinical Coordinator, Critical Care

Rotation description:
The Medical Intensive Care rotation offers residents an opportunity to develop the skills necessary to provide pharmaceutical care to the critically ill patient. During the MICU rotation, the resident will develop competencies in the areas of critical care pharmacology, primarily related to anti-infective management, through direct patient care involvement. As an integral member of the multidisciplinary critical care team, the resident will actively participate in therapeutic decision making, drug therapy selection and appropriate dosing and monitoring of the critical care patient.

Solid Organ Transplant (2-4 weeks)
Preceptor: Christin Rogers, PharmD, BCPS, FCCP - BIDMC Clinical Coordinator, 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 and particularly related to Infectious Diseases problems. 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 diseases in the transplant patient. 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. The resident may be given the opportunity to participate in pre transplant ID evaluations within clinic.

Hematology/Oncology- Inpatient (4 weeks)
Preceptor: Zaven Norigian, PharmD, BCOP

Rotation Description:
The Hematology/Stem Cell Transplant block is an elective experience for PGY2 pharmacy residents. The two to four week rotation will include the clinical management of patients with hematologic diseases in the inpatient setting.
The inpatient Hematology/stem cell transplant service has an average of 25 patients. There are a wide variety of patients on the team, including acute leukemia, lymphomas and patients undergoing a stem cell transplant. The team consists of a hematology attending, a medical oncology fellow, three interns and the pharmacist. Patient rounds by the inpatient teams occur in the mornings between 8:00-8:30. 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 will round with one of the interns and will be responsible for all patients. The resident should work towards independent medication management of the patient with additional focus towards infectious diseases treatment or prophylaxis in this high risk population:

  1. Identify and resolve medication therapy issues
  2. Provide drug information to the rounding team members
  3. Participate in discharge planning and patient education

Outpatient Antimicrobial Therapy (OPAT)
Preceptors: Christopher McCoy, PharmD, BCPS
Mary Lasalvia, MD, OPAT Director

Rotation Description:

The OPAT rotation provides the resident with the opportunity to gain insight in the management of outpatients with chronic infections, to develop problem-solving skills in the pharmacotherapy of these, and to broaden their knowledge base in antimicrobial pharmacokinetics and pharmacodynamics. The resident works with the OPAT team and independently, maintaining a responsibility to provide patient education, assesses medication profiles, documents quality initiatives, and reviews dosing protocols for patients enrolled in OPAT. The goal is to promote enhanced pharmacotherapy of these patients based on practice guidelines, individual patient characteristics and needs. This includes optimizing drug dosing, quality initiatives and medication adverse event monitoring. The OPAT programs see a wide variety of patients with unique chronic illnesses (osteomyelitis, tuberculosis, fungal infections, etc).