PGY1 Pharmacy Residency in Olathe

Orientation

Orientation is a required, 1-month experience to introduce the resident to foundational hospital and pharmacy systems and processes. Orientation to clinical and operational workflows includes computer-based order entry and verification, documentation in the medical record, primary dispensing, sterile compounding, automated dispensing systems, ordering, packaging, storage, distribution and controlled substance processes. Residents will be oriented to pharmacy managed drug therapy protocols and other clinical activities. The duration of this learning experience is from the date of hospital orientation through July.

Antimicrobial stewardship/Introduction to infectious diseases

Antimicrobial stewardship and introduction to infectious diseases is a required, 1-month learning experience.

This rotation focuses on the fundamental skills and strategies of antimicrobial stewardship. The resident will participate in daily audit and feedback as well as administrative responsibilities. The resident will attend any meetings relevant to the antimicrobial stewardship program.

When performing audit and feedback, the pharmacy resident is responsible for evaluating and recommending optimal antimicrobial treatment plans for inpatients. In addition, the resident will be responsible for monitoring patients for drug therapy outcomes, providing drug information to medical staff, patients and families and participating in infectious diseases consult rounds.

Topics the resident is expected to gain knowledge, skills and abilities through literature review, discussion and/or direct patient care experience include: 

• Antimicrobial stewardship strategies, best practices and regulations
• Antimicrobials – spectrum of activity, indications, pharmacodynamics, pharmacokinetics, side effect profiles, drug interactions and resistance
• Pneumonia
• Urinary tract infections including asymptomatic bacteriuria
• Intra-abdominal infections
• Skin and soft tissue infections
• Clostridioides difficile-associated diarrhea

Cardiology

Cardiology is a required, 1-month learning experience.

The pharmacy resident will gain fundamental knowledge and exposure to common cardiology-related conditions including heart failure, arrhythmias, ischemic heart disease and thrombosis. The pharmacy resident is responsible for evaluating medication appropriateness, monitoring patients for drug therapy outcomes, managing drug therapy protocols, participating in multidisciplinary discharge rounds and providing drug information to the physicians, nurses, patients and caregivers. In addition, the resident will conduct journal club and prepare topic presentations for the pharmacy and/or nursing staff.

Critical care

Critical care is a required, 1-month learning experience to guide and prepare the resident to care for patients presenting with a variety of critical illnesses.

Preceptors will provide clear expectations and objectives for the pharmacy resident, resources for critical care issues and timely and constructive feedback. Preceptors will provide readings for core critical care topics and facilitate discussions. Additional topics may be discussed based on the interest of the resident or patient population presenting to the critical care unit. Preceptors will model and facilitate self-reflection and goal setting with the resident.

Internal medicine

Internal medicine is a required, 1-month learning experience designed to prepare the resident to care for patients presenting with a variety of conditions such as diabetes, gastrointestinal-related disorders, respiratory-related disorders, renal insufficiency and neurological disorders.

The pharmacy resident will be responsible for evaluating medication appropriateness, monitoring patients for drug therapy outcomes, managing drug therapy protocols, participating in multidisciplinary discharge rounds and providing drug information to the physicians, nurses, patients and caregivers. In addition, the resident will prepare educational in-services or other presentations for the pharmacy and/or nursing staff.

Topics the resident is expected to gain knowledge, skills and abilities through literature review, discussion and/or direct patient care experience include:

• Anticoagulation
• Diabetes mellitus
• Gastrointestinal disorders
• Pancreatitis
• Hepatitis
• Neurological disorders
• Stroke
• Pain management
• Renal disorders
• Acute and chronic renal failure
• Respiratory disorders
• Asthma
• Chronic obstructive pulmonary disorder

The resident will be responsible for actively contributing to multidisciplinary critical care rounds. In addition, the resident will be responsible for evaluating medications for appropriateness, monitoring patients for drug therapy outcomes, providing drug information to medical staff, patients and families, participating in critical care topic discussions and performing pharmacist-managed protocols including direct thrombin inhibitor dosing, parenteral nutrition formulation, IV acetylcysteine therapy, vancomycin and aminoglycoside pharmacokinetic dosing and IV to PO conversions. The pharmacy resident will also be responsible for actively participating in code stroke and code blue response teams. The resident will be assigned a minimum of 1 critical care related project during the learning experience.

Medical oncology

Medical oncology is a required, 1-month learning experience involving the provision of pharmaceutical care for patients at The University of Kansas Cancer Center in Olathe.

The experience includes a wide range of operational and patient care activities in the 18-chair cancer center. At the completion of the rotation, the resident will have gained experience processing, compounding and monitoring various chemotherapy regimens. A working knowledge of safety standards, best practices and supportive care issues are emphasized throughout the rotation. 

Practice leadership

This required, 10-month learning experience, from August 1-May 31, will focus on the administrative and leadership functions of the pharmacy enterprise, professional leadership and medication use policy. The experience includes 3 parts:

1) Interactive didactic sessions/discussions on finance, leadership and medication use policy

• Attendance at >80% of the didactic sessions is required.

2) Attendance at various department and organization meetings, including:

• Weekly department huddle
• Pharmacy, therapeutics and dietary committee
• Medication and pump safety team
• Organizational quality improvement committee

3) Completion of several projects and assignments, including:

• Administrative project – a list of potential projects will be developed by the preceptor and the residents will be allowed to select their specific project.

• Medication use policy assignments – formulary monograph/drug class review, medication use evaluation, medication safety executive summary, adverse drug reaction report, presentations to the PT&D committee and a formal education presentation

Topics the resident is expected to gain knowledge, skills and abilities through literature review and discussions include:

• Formulary management
• Medication safety
• Medication use evaluation
• Quality improvement/management
• Regulatory compliance
• Healthcare economics
• Financial management
• Operational practices
• Strategic planning
• Information technology
• Emotional intelligence
• Professional leadership skills
• Leadership styles/Myers Briggs tests
• Crucial conversations and navigating conflict
• Conducting meetings
• Elevator speech basics
• Presentation skills
• Interviewing skills
• Written and verbal communication
• Professional organizational involvement
• Career planning

Project/research

Project/research is a required, 11-month learning experience from August-June with a dedicated month in December or February. Each resident must develop and complete at least 1 major research project on an element of pharmacy practice with potential outcomes that benefit patients and/or the organization. The purpose of the assignment is to provide each resident with experience in development, research, analysis, implementation and presentation of a major research project.

The preceptor is responsible for aiding the resident in choosing a project that can be completed in the allotted timeframe of 1 year, assisting in the design and write-up of the research protocol, coordinating the contact of a statistician and aiding the resident in obtaining IRB approval. Additionally, the preceptor will ensure that each resident is following his/her prescribed project timeline, provide help with data collection (if appropriate), advise the resident regarding preparation and development of their posters and/or presentations, guide data analysis and assist in the preparation of the final manuscript.

The resident will identify and design a project, collect and analyze data and develop a timeline for project completion. The project will be formally presented at the Midwest Pharmacy Residents Conference. Residents may also be asked to present results of their projects to the pharmacy staff and/or other interested organizational or community groups. Each resident shall submit a project manuscript of publishable form to the project preceptor and RPD.

Staffing

Staffing is a required, 12-month learning experience from the first day of residency to the end of residency. Residents will provide inpatient pharmacy staffing as part of their service commitment. Staffing shifts will occur primarily on weekend days and weekday evenings. Shifts will be operational in nature for residents to gain experience with medication use activities targeted at ordering, transcribing, preparation, dispensing and storage. The weekend rotation is generally every third weekend (~15 weekends per residency year) plus 1 weekday evening per week (~50 per residency year).

Transitions of care

This rotation is a required, 10-month learning experience from August 1-May 31. The goal of the rotation is to provide fundamental knowledge for residents about the challenges associated with transitions between care facilities. Residents will spend 2 days per month focusing on patients in transition. The resident will spend approximately 4 hours of each scheduled day in each practice environment. Half of 1 day will be spent completing face-to-face encounters in cardiac rehab (determined by patient care demands). The remaining time will focus on recently discharged patients, following up in our ambulatory internal medicine clinic and completing gold standard medication reconciliation for the LEAPFROG accreditation. 

Ambulatory care

This 1-month rotation allows the resident to experience ambulatory care pharmacy practice in both internal medicine and family medicine clinics. Practice responsibilities include warfarin therapy management, drug interaction assessments, chronic medication management, patient counseling, pharmacotherapy recommendations for acute and chronic conditions and medication cost assessment. In addition, there will be opportunities for multidisciplinary outpatient rounding and independent practice with remote supervision from the preceptor.

This experience allows the resident to see a diverse patient population with a variety of chronic health conditions on multiple medications. Another primary component of the rotation will be discussing drug information questions with providers and nurses. The ambulatory care elective allows the resident to support preventive care and decrease hospital readmission rates.

Common disease states the resident will see in clinic include:

• Anticoagulation
• Cardiovascular conditions (atrial fibrillation, heart failure, hypertension)
• Diabetes mellitus
• Hyperlipidemia
• Infectious diseases (skin and soft tissue, urinary tract)
• Mental health conditions (anxiety, depression, schizophrenia)
• Pulmonary disorders (asthma, chronic obstructive pulmonary disorder)
• Sleep disorders

Advanced antimicrobial stewardship

Advanced antimicrobial stewardship is an elective, 1-month learning experience. The pharmacy resident will be responsible for evaluating and recommending optimal antimicrobial treatment plans for patients. In addition, he/she will be responsible for monitoring patients for drug therapy outcomes, participating in infectious diseases consult rounds and providing drug information to medical staff, patients and families

In this advanced rotation, the resident's primary responsibility will be managing patients on the infectious diseases consultation service. Residents will collaborate with the physicians to provide optimal antimicrobial regimens. A component of audit and feedback from antimicrobial stewardship may be added based on the resident's ability and interests.

Residents will be expected to be familiar with basic infectious diseases concepts, including:

• Antimicrobials ̶   spectrum, indications, pharmacodynamics, pharmacokinetics, side effect profiles, drug interactions
• Pneumonia, hospital and community onset
• Urinary tract infections, including asymptomatic bacteriuria
• Skin and soft tissue infections

The resident will gain exposure to advanced infectious disease topics, including:

• Intra-abdominal infections
• Clostridioides difficile-associated diarrhea
• Antimicrobial resistance
• Endocarditis
• Osteomyelitis
• Central nervous system infections
• Febrile neutropenia

Advanced critical care

Advanced critical care is an elective, 1-month learning experience to prepare the resident to care for patients presenting with critical illnesses. This learning experience builds on the required critical care rotation by providing additional independent practice, the opportunity to precept an APPE student (if available) and a more in-depth critical care administrative project.

The resident will be responsible for scheduling and selecting readings for discussions relating to clinical or administrative topics. The resident will come prepared with appropriate sources, present the information to the preceptor and discuss any remaining questions. The preceptor will not schedule formal topic discussions or lectures but will assist with topic selection.

Emergency medicine

The emergency medicine rotation is an elective, 1-month learning experience in the Emergency Department. The rotation helps guide and prepare the resident to care for patients presenting with a variety of illnesses in collaboration with physicians, physician assistants, nurses, respiratory therapists and care managers.

The preceptor is responsible for providing clear expectations and objectives for the pharmacy resident, facilitating case-based discussions and providing timely and constructive feedback to the resident. Precepting pharmacist(s) are responsible for instructing the resident on the physiologic concepts and therapeutic management of common and/or critical disease states encountered in the emergency setting.

In addition to monitoring and consulting on pharmaceutical issues, the resident will provide education to nursing, pharmacy and medical staff as well as patients and their families. The preceptor's goal is to incorporate the resident into the emergency care team and prepare the learner for independent practice in the emergency care setting, with facilitative guidance from the preceptor.

The resident is expected to proactively interact directly with patients and all members of the interdisciplinary team to facilitate evidence-based care. He/she will also be expected to triage patients based on acuity of illness and expedite the delivery of medications and drug information. In addition, the resident is responsible for recommending, verifying and assisting with medication treatment plans in agreement with evidence-based medicine and best practice. When necessary, the resident will assist with titration of medications and monitoring of patient response at the bedside. The pharmacy resident is responsible for actively participating in code stroke, code blue and toxic ingestion response. The resident will provide an in-service education for nursing staff as assigned by preceptor.

Advanced emergency medicine

Advanced emergency medicine is an elective, 1-month learning experience to guide and prepare the resident to care for patients presenting to the Emergency Department. This learning experience builds on the emergency medicine learning experience by providing additional independent practice, the opportunity to precept an APPE student (if available), the experience of leading complex topic discussions and an in-depth emergency policy or care plan/protocol project.

Expectations of residents include:

• Topic discussions
  • The resident will select and schedule topic discussions based on gaps in previous learning, patient cases and pages 25-27 of the ASHP Required Competency Areas, Goals, and Objectives for Emergency Medicine Postgraduate Year Two (PGY2) Pharmacy Residencies.
  • The resident should lead 2 topic discussions per week.
• Precepting

The resident should assist with precepting students, including creating schedules, completing evaluations, providing feedback, leading topic discussions, educating on best documentation practices, facilitating conversations with prescribers and acting as a mentor.

• Project

The resident will complete an administrative project relevant to emergency medicine practices. Potential options for this project include care plan/protocol updates, MUE/DUE, CE, order set updates or a PT&D proposal.

• Communication

The resident will carry the Emergency Department mobile phone and pager.

• Prerequisites
  • The resident must complete the critical care and emergency medicine learning experiences prior to starting the advanced emergency medicine elective learning experience.
  • Completing advanced critical care and infectious disease prior to advanced emergency medicine is preferred.

• Staffing

The resident will staff the Emergency Department independently through independent days, extended hours or weekend swaps. Advanced critical care is required for weekend swaps.

Advanced medical oncology

This rotation is an elective, 1-month learning experience involving the provision of pharmaceutical care for patients at The University of Kansas Cancer Center in Olathe.

The rotation includes a wide range of operational, patient care and educational activities in the 18-chair cancer center. At the completion of the rotation, the resident will have gained experience caring for patients with a variety of oncology conditions while navigating practice management issues. A working knowledge of disease management standards is emphasized throughout the rotation.

Obstetrics and neonatology

Obstetrics and neonatology is an elective, 1-month learning experience involving the provision of pharmaceutical care for patients in The Birth Place.

A comprehensive evaluation of patient therapies is expected, including identification of relevant data, recommendations for the therapeutic plan, monitoring for patient outcomes and follow up recommendations as necessary. The resident will determine the extent of topic discussions needed to supplement the literature provided by the preceptor. The resident will develop and apply skills in the following areas:

• Review and accurately assess appropriateness of weight-based dosing of all neonatal medication orders.
• Accurately enter TPN orders in CAPS and appropriately recommend any needed modifications to neonatal TPNs after evaluating patient's nutritional needs and TPN safety parameters.
• Attend and prepare medications during neonatal code events.
• Attend NICU rounds.
• Coordinate distribution problems related to drug delivery and automated dispensing cabinets.
• Work collaboratively with a neonatal nurse practitioner through a complete patient assessment and plan.
• Provide educational programs to healthcare professionals when needed.
• Educate patients and/or patient caregivers on discharge medications and appropriate administration techniques for neonatal patients.
• Share staffing responsibilities with the assigned floor pharmacists.
• Report adverse drug reactions and medication errors.
• Teach and mentor pharmacy students.
• Demonstrate effective drug information skills.
• Appropriately document relevant clinical notes and interventions in patient charts. 

Pharmacy management

Pharmacy management is an elective, 1-month learning experience. The roles of pharmacists in leadership and management are varied, with responsibilities such as strategic planning, budgeting, recruitment, personnel, communication, accountability and delegation. The rotation will provide an organized and directed learning experience in the administrative and managerial responsibilities of pharmacy directors, pharmacy managers and residency program directors.

In addition, the resident will spend time with IT analysts to learn about the relationship between the electronic medical record and the medication use process. The length of time spent in various activities and with each preceptor will be customized to the resident's preferences, interests and goals. 

Advanced pharmacy management

Advanced pharmacy management is an elective, 1-month learning experience that builds on the pharmacy management elective. The experience is meant to prepare the pharmacy resident for a variety of management responsibilities, including continuous department strategic planning and development, human resources and personnel management, performance improvement, rural health management, controlled substance surveillance and more. Priorities and activities are subject to change as the demands of the management roles change.

Precepting 

Precepting is an elective, 1-month learning experience designed to facilitate the growth and development of the resident’s teaching skills, with an emphasis on practice-based educational activities. This learning experience can help residents achieve goals and objectives related to precepting (Goal 4.2). It may also be chosen by residents who have already achieved the objectives under Goal 4.2 and want to improve their teaching skills.

This learning experience is best suited for later in the residency year. The resident is required to have co-precepted at least 2 advanced pharmacy practice experience (APPE) students prior to this elective. The RPD, the APPE student preceptor(s) and the learning experience preceptor will determine which APPE students will be precepted by the resident.

The preceptor is responsible for providing the resident with clear expectations and resources for precepting and mentorship in practice settings. Additionally, the preceptor will provide timely and constructive feedback to the resident.