Pharmacy Postgraduate Residencies - Learning Experiences

A state-of-the-art 30-bed intensive care unit at Cooper University Hospital is the practice site for this learning experience. The resident will round with one of two multidisciplinary teams caring for medical, surgical, neurologic and cardiothoracic patients. The resident is responsible for working collaboratively with critical care nurses, physician residents, critical care fellows and ICU attending physicians to identify, prevent, and resolve medication therapy issues for patients with a wide variety of disease states. Common disease states and topics covered on this learning experience include hemodynamics and shock, critical care infectious diseases, sepsis, respiratory failure, gastrointestinal bleeding, nutrition, stroke, among many others.

The Trauma Intensive Care Unit (TICU) is a 28-bed unit at Cooper University Hospital, a Level I Southern New Jersey Regional Trauma Center. The multidisciplinary team consists of an attending trauma surgeon, a fellow (critical care or surgery), residents (emergency medicine or surgery), medical students, a clinical pharmacy specialist, pharmacy students, a respiratory therapist, nursing staff, and nursing students. The resident will attend ICU rounds on a daily basis and function as an active member of the multidisciplinary team. The resident will design, monitor, and evaluate evidence-based patient-specific therapies for patients with conditions such as traumatic brain injury, aortic aneurysms, spinal cord injuries, pulmonary contusions, and closed and open fractures.

The resident will provide pharmaceutical care to cardiac ICU patients with acute coronary syndrome, acute heart failure, hypertensive emergency/urgency, ventricular arrhythmias, atrial fibrillation, and infections. Therapy with antiplatelets, anticoagulants, antihypertensives, antiarrhythmics, and anti-infectives is emphasized. The resident actively participates in multidisciplinary rounds and transitions of care planning.

The Nutrition Support experience will allow the resident to collaborate with multidisciplinary practitioners to optimize nutrition support therapy for critically ill patients. In collaboration with other health professionals, residents will manage enteral nutrition and parenteral nutrition. Residents will perform initial nutrition support consultations, recommend therapeutic goals, develop patient-specific nutritional regimens including type of support, route, formulation, and provide follow-up to optimize the patients’ nutritional care. Additionally, the resident will participate in management of fluids and electrolytes, acid/base disturbances, hyperglycemia, and complications associated with nutrition support therapy.

This residency is designed to prepare trainees to be critical care clinical specialists/academicians. Beyond the research project that is completed longitudinally, the resident will be involved with another scholarly endeavor such as writing a review article or case report during this experience. The resident will contribute to critical care education through teaching in a Critical Care Therapeutics elective course and serving as a facilitator for interprofessional education/simulation activities. The resident will demonstrate skills required to function in an academic setting during this experience.

The inpatient ID consult service at Cooper University Hospital serves approximately 25 inpatients every day. The team consists of an ID-trained physician, an ID-trained pharmacist, and 1-2 ID medical fellows. The team provides advice and recommendations on patients with any type of infection but most commonly encounters patients with bacterial, fungal, or viral infections. The purpose of this rotation is to provide the resident with in depth exposure to a wide range of infectious diseases topics. In addition to learning about common types of infections and infectious pathogens, the resident will explore various mechanisms of antimicrobial resistance, the relationship between antimicrobial pharmacokinetics and pharmacodynamics (PK/PD), and how to optimize the use of antimicrobial regimens.

The pharmacy resident will be responsible for following all active patients on the ID consult service. This will include evaluating patients for signs and symptoms of infections and their resolution or progression; recommending appropriate empiric antimicrobial therapy based on type of infection, suspected pathogens, expected resistance patterns, and patient-specific factors related to renal function, liver function, drug allergies, and drug interactions; optimizing antimicrobial regimens based on considerations of microbiology, PK/PD, and toxicities; and monitoring of antimicrobial regimens including therapeutic drug monitoring for vancomycin and aminoglycosides.

The antimicrobial stewardship rotation will primarily focus on chart review of targeted infections or anti-infective agents for inpatients at Cooper University Hospital. Patients will be primarily identified using various alerts and reports in TheraDoc® and EPIC®. The resident will also identify patients during “stewardship rounds” which will occur on specific high-risk units and be conducted in conjunction with the ID pharmacist and/or ID physician. The resident will work with the stewardship team to make interventions that are warranted. These interventions may include but are not limited to de-escalation, escalation/broadening, dosage modification, duration, ID consultation, and laboratory orders. Although a majority of patient reviews and interventions will focus on antibiotics, some will target antiretrovirals, antivirals, and antifungals. Interventions and recommendations will be documented in the electronic medical record.

The resident will also work on smaller projects throughout the rotation that target process improvement such as order sets, protocols and policies, if applicable at the time of the rotation. Topic discussions will occur at least weekly and will focus on infectious diseases that are most pertinent to stewardship versus inpatient ID consultation although some overlap may occur.

The resident will also learn about the importance of scope of practice of a stewardship pharmacist and when backup support is necessary so that upon graduation, would be prepared to independently run a stewardship program.

The Early Intervention Program (EIP) Clinic at Cooper University Hospital serves approximately 900 HIV patients with a multidisciplinary approach to provide a complete care package. In addition to clinical pharmacy services, the clinic provides primary care, addiction medicine, psychiatry, behavioral medicine, nutrition support, research, and a variety of financial and social support services through the case management team.

The purpose of this rotation is to provide the resident the experience to learn the basic fundamental principles, theories, and treatment strategies of HIV and common associated disease states such as Hepatitis C, opportunistic infections, sexually transmitted infections, neuro/psych disorders, and substance use disorders. The pharmacy resident will be responsible for identifying and resolving medication therapy issues for patients, reconciling patient medication lists, providing recommendations and drug information to the various clinic providers, as well as, providing medication information and education to patients and their caregivers. The resident will document all patient counseling activities, recommendations, and therapeutic interventions.

Didactic and small group teaching experiences for 2nd or 3rd professional pharmacy students is required. The resident will lead small group discussions in the lab portion of one of the modules, and will give at least one pharmacotherapy lecture in one of the ID modules. They will be expected to develop interactive activities and handouts for the class to aid in student learning. Co-precepting of 4th-year pharmacy students during inpatient infectious diseases consult service rotation is required.

Additional opportunities to conduct interprofessional didactic teaching sessions or journal club discussions are available in conjunction with the ID Division at Cooper University Hospital.

Participation in the teaching certificate program offered by The Philadelphia College of Pharmacy is optional for residents who have not previously completed one.

To fulfill service to the University, the resident may also precept students in a medical student clinic at Cooper University Hospital, or help facilitate OSCE exams for pharmacy students.

The resident will complete an ID-related research project including preparation of a manuscript for submission to a scientific journal. They will have the option (depending on the needs of the institution and interest of the resident) of performing an ID-related medication use evaluation that would be presented at Antimicrobial Subcommittee.

They will also complete an ID-related review article of a class of antimicrobials, stewardship topic, or disease state (e.g. durations of antimicrobial therapy, stewardship in nursing homes)

Based on the needs of the institution, and the interest of the resident, they may also complete a medication utilization review on an antimicrobial agent, which would be presented to the Antimicrobial Stewardship Subcommittee.

A state-of-the-art 30-bed intensive care unit at Cooper University Hospital is the practice site for this learning experience. The resident will round with one of two multidisciplinary teams caring for medical, surgical, neurologic and cardiothoracic patients. The resident is responsible for working collaboratively with critical care nurses, physician residents, critical care fellows and ICU attending physicians to identify, prevent, and resolve medication therapy issues for patients with a wide variety of disease states. Common disease states and topics covered on this learning experience include hemodynamics and shock, critical care infectious diseases, sepsis, respiratory failure, gastrointestinal bleeding, nutrition, stroke, among many others.

The resident will report to the microbiology laboratory manager and director early in the residency year to gain an understanding of the procedures and technology and a greater understanding of microbiology.

The pediatric ID service is comprised of attending physicians, pediatric medical residents and medical students. The resident will round with a pediatric clinical pharmacists in either the PICU or general pediatric floor to gain insight into pediatric patients, pharmacokinetic considerations and general infectious diseases.

Based on availability of the preceptor and interest of the resident, a transplant infectious diseases rotation will be offered at Einstein Hospital in Philadelphia. This will require the resident to be licensed in Pennsylvania in addition to New Jersey. The resident will be precepted by a pharmacist who specializes in transplant medicine, and will focus on infectious diseases in transplant recipients. The resident will also participate in topic discussions and other relevant activities at the rotation site.

Cooper University Hospital has five adult internal medicine teaching teams and each team services about 10 to 15 patients. The pharmacy resident will provide patient care during multidisciplinary rounds with an adult internal medicine teaching team. The team mostly consists of an attending physician, medical resident(s), medical intern, pharmacist and periodically pharmacy resident(s), medical student(s), pharmacy student(s), and physician assistant student(s). Under the guidance of the preceptor, the resident will provide pharmaceutical care, including medication reconciliation, medication counseling, answers to drug information questions, team in-services, therapeutic drug monitoring, and ensure safe transitions of care. The goal of this rotation is for the resident to develop the skills needed to identify and resolve medication therapy problems, using evidence-based medicine, and then effectively provide patient education and recommendations to the interdisciplinary team. The resident will also have the opportunity to be the primary preceptor for one or two APPE students completing their acute patient care rotation.

Interprofessional Education (IPE) Student Run Clinic - Cooper University Health Care

The setting for this rotation will be at the Cooper Rowan Clinic (CRC), an interprofessional student-run clinic, which serves uninsured/underserved adult patients. The pharmacy resident will work collaboratively with medical and pharmacy students, medical residents, faculty practitioners, and peers to provide care to uninsured residents of Camden, New Jersey. In the 2013-2014 academic year, the clinic provided care to 285 patients in over 900 visits. This rotation experience focuses on introducing and reinforcing concepts related to leadership, patient care, teaching, and practice management. This experience will further develop the resident’s knowledge and the skills needed to provide coordinated and collaborative patient-centered care for a unique patient population. A strong emphasis is placed on the development of interprofessional communication skills and the ability to work collaboratively with attending physicians and medical residents, pharmacists, nurses, medical assistants, medical interpreters, and social workers, and other members of the healthcare team. The pharmacy resident plays a vital role in educating and training students, patients, and other health care practitioners. The resident will participate in practice-based teaching and model the following responsibilities for students: medication history-taking for medication reconciliation and all steps of a comprehensive medication management service including the assessment, documentation of care plan, and follow up evaluation decision-making. Additionally, the resident will provide feedback to learners at various stages of professional development, and verify patient understanding.

The pharmacy resident will participate in the care of HIV infected patients at the Early Intervention Program (EIP) Clinic at Cooper University Hospital. The EIP clinic provides medical care and support services for approximately 800 HIV infected adult patients annually. Under the guidance of the preceptor, the resident will provide pharmaceutical care and medication counseling to clinic patients and drug information to providers, and other clinic support staff as needed. The resident will participate in general HIV clinic, HIV/Hepatitis C virus co-infected clinic, primary care clinic, and the infectious diseases fellows clinics, as well as attend weekly EIP management meetings. Knowledge of antiretroviral agents and antimicrobial therapy is emphasized, as well as, hepatitis C virus therapies, psychiatric medications, and general chronic ambulatory medicine pharmacotherapy.

The University of Pennsylvania Health System (UPHS) has clinical pharmacists providing services at Penn Internal Medicine Associates and Edward S. Cooper Practice of General Internal Medicine. Clinical pharmacists assist with chronic diseases state management, provide medication counseling and education, and participate in a multidisciplinary initiative to improve transitions of care. The pharmacy resident will participate in two types of office visits throughout this rotation. The first type of visit is focused around transitions of care, in which the pharmacy team and medical team collaborate to care for up to 20 patients per week. The primary focus of the pharmacist during this type of visit is medication reconciliation. The second type of visit is focused on chronic disease state and medication management in which the pharmacy team cares for up to 42 patients per week. Patients are referred to the pharmacy team by physicians or nurse practitioners for a variety of reasons, including hypertension management, diabetes management, medication reconciliation, and medication adherence. The pharmacy resident will work with the clinical pharmacist to provide care to these patients on an ongoing basis until goals of care are achieved. The pharmacy resident will work collaboratively with primary care providers to ensure continuity of care. In addition to direct patient care, the pharmacy resident will participate in drug information services, quality improvement initiatives, and topic discussions with clinical pharmacists and pharmacy students.

Pharmacy residents will have the opportunity to help with the development of new ambulatory care pharmacy services within the Cooper Health System’s Advanced Care Center, A Patient-Centered Medical Home (PCMH) and Internal Medicine residency training site that provides a variety of innovative services to the Medicaid and Medicare beneficiaries of Camden, New Jersey. Clinical pharmacists provide a wide variety of patient care, drug information, and educational services while co-precepting with medical attendings during Internal Medicine Resident office hours. Pharmacy residents will also participate in a high-risk hospital follow-up clinic as part of an interprofessional team that works to customize transitions of care services for individual patient’s needs. There are ample opportunities for providing educational in-services, conducting quality improvement projects and designing new services on this rotation.

The pharmacy resident will use population health reports that detail the patients seen by primary care providers in Cooper Health system to identify opportunities for improving patient outcomes. These efforts are currently focused on improving diabetes and post-hospitalization outcomes through addressing a collection of quality measures selected by Cooper's accountable care organization (ACO), the AllCare Health Alliance. The pharmacy resident will work to address prioritized lists of patients via telephone, face-to-face, and asynchronous electronic encounters while working closely with the primary care providers in the clinic to develop collaborative disease state management plans. Pharmacy residents will be required to document and track all patient care activities using a systematic process. Pharmacy residents may be involved in reporting outcomes at regularly scheduled ACO meetings.

The academia rotation provides a learning opportunity for the resident to gain experience in the three main roles of a faculty member: teaching, service, and scholarship. Teaching includes didactic small and/or large classroom teaching. Service includes participation on committees at the Department, College, and University levels at the Philadelphia College of Pharmacy, University of the Sciences. The resident may also be involved in a research and/or scholarship experience outside of their longitudinal residency research project.

A state-of-the-art 30-bed intensive care unit is the practice site for this learning experience. The resident will round with one of two multidisciplinary teams caring for medical, surgical, neurologic and cardiothoracic patients. The resident is responsible for working collaboratively with critical care nurses, physician residents, critical care fellows and ICU attending physicians to identify, prevent, and resolve medication therapy issues for patients with a wide variety of disease states. Common disease states and topics covered on this learning experience include hemodynamics and shock, critical care infectious diseases, sepsis, respiratory failure, gastrointestinal bleeding, nutrition, stroke, among many others.

The general pediatric team at Children’s Regional Hospital at Cooper University Health Care includes the attending physician, residents, interns, medical students, pharmacist, pharmacy students, and social workers. The pediatric intensive care unit (PICU) team includes the attending physician, residents, pharmacist, pharmacy students, respiratory therapists, and social workers. Nurses caring for the patients may also participate in daily patient care rounds. The clinical pharmacist attends patient rounds directly with the physicians, pharmacy students, nurses and other healthcare providers. Under the supervision of the preceptor, the pharmacy resident ensures all medications have indications, dosed appropriately, verify no drug-drug interactions, review monitoring parameters, assess adverse drug events and reduce medication errors. The resident also consults with the medical team regarding optimization of medication therapy. Furthermore, medication reconciliation is completed for all high-risk patients. All patients are screened for missing vaccinations. Discharge counseling is provided on a case-by-case basis. The resident may assist in rapid response/code situations when available.

The general pediatrics unit is located in the Keleman building on North 6 (PIMU) and South 7 in Children’s Regional Hospital at Cooper University HealthCare. The patients in PIMU and South 7 are primarily covered by the general pediatrics team. The surgery service will have patients on these units which will be primarily covered by surgery. The trauma service will also have patients on these units which will be co-managed by trauma and general pediatrics. The resident will bedside round with the general pediatrics team. The team includes the attending physician, medical residents, pharmacist, and social worker. Pharmacy students may be present on rounds. Nurses caring for the patients may also participate in daily patient care rounds.

The Neonatal Intensive Care Unit (NICU) learning experience provides the opportunity for PGY2 resident(s) to improve their knowledge base and pharmacotherapeutic skills while enhancing care for acute ill neonates and infants. The resident will become familiar with the pharmacotherapy for the most commonly encountered disease states, as well as participate in the education of team members and patients. PGY2 residents will work with members of the medical team.

The Pediatric Intensive Care Unit (PICU) learning experience provides the opportunity for PGY2 resident(s) to improve their knowledge base and pharmacotherapeutic skills while enhancing care for acute ill pediatric patients. The resident will become familiar with the pharmacotherapy for the most commonly encountered disease states, as well as participate in the education of team members and patients. PGY2 residents will work with members of the medical team.

The Pediatric and Adult Infectious Diseases learning experience provides the opportunity for PGY2 resident(s) to improve their knowledge base and pharmacotherapeutic skills while enhancing care for pediatric and adult patients with infectious diseases. The resident will become familiar with the pharmacotherapy for the most commonly encountered disease states, as well as participate in the education of team members and patients. PGY2 residents will work with members of the medical team.

This residency is designed to prepare trainees to be pediatric clinical specialists/academicians. Beyond the research project that is completed longitudinally, the resident will be involved with another scholarly endeavor such as writing a review article or case report during this experience. The resident will contribute to pediatric education through teaching in a Introduction to Pediatrics elective course and serving as a facilitator for interprofessional education/simulation activities. The resident will demonstrate skills required to function in an academic setting during this experience.

The setting for these rotations will be at General Pediatric Clinic, Medically Complex Pediatric Clinic, Pediatric/Adult HIV Clinic, Pediatric Infectious Diseases Clinic, and Pediatric Hematology Clinic.The pharmacy resident will work collaboratively with medical and pharmacy students, medical residents, faculty practitioners, and peers to provide care. These rotation experiences focus on introducing and reinforcing concepts related to leadership, patient care, teaching, and practice management. This experience will further develop the resident’s knowledge and the skills needed to provide coordinated and collaborative patient-centered care for a unique patient population. A strong emphasis is placed on the development of interprofessional communication skills and the ability to work collaboratively with attending physicians and medical residents, pharmacists, nurses, medical assistants, medical interpreters, and social workers, and other members of the healthcare team. The pharmacy resident plays a vital role in educating and training students, patients, and other health care practitioners. The resident will participate in practice-based teaching and model the following responsibilities for students: medication history-taking for medication reconciliation and all steps of a comprehensive medication management service including the assessment, documentation of care plan, and follow up evaluation decision-making. Additionally, the resident will provide feedback to learners at various stages of professional development, and verify patient understanding.

The pharmacy resident will be able to provide pediatric pharmacy/medical services to the children in Panajachel, Guatemala and San Juan, Guatemala. The pharmacy resident will provide care for 8-10 days in Guatemala. This experience will allow the pharmacy resident to precept APPE students and work interprofessionally with Occupational Therapy (OT) faculty and students. The pharmacy resident will complete a research project benefiting the patients in Guatemala along with the pharmacy students.

The Pediatric Emergency learning experience provides the opportunity for PGY2 resident(s) to improve their knowledge base and pharmacotherapeutic skills while enhancing care for pediatric patients within the emergency department. The resident will become familiar with pediatric trauma, pediatric codes, and pharmacotherapy care as well as participate in the education of team members and patients. The resident will help contribute to medication reconciliation and discharge counseling. PGY2 residents will work with members of the medical team.