Central Texas Veterans Health Care System
PGY-1 Residency Rotations
Required PGY-1 Training:
Elective PGY-1 Training: Elective training time is resident-specific, but generally a minimum of 4 weeks, average is 4-6 weeks, but can be up to 16 weeks if desired.
Outpatient Pharmacy
Learning Experience Type: Concentrated
Learning Experience Length: 4 weeks
Residents will function as a competent pharmacist in safely and accurately dispensing medications to Veterans in an outpatient pharmacy setting. Objectives will be to accurately process physician orders, check pharmacy technician work for accuracy, safely dispense all medications, provide appropriate counseling, effectively supervise support staff in the outpatient pharmacy, communicate medical information to Veterans and understand the work flow of an outpatient pharmacy.
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Inpatient Pharmacy
Learning Experience Type: Rotation
Learning Experience Length: 4 weeks (6 weeks if choosing to participate in Dual Appointment)
This rotation is designed to develop the resident’s skills in the inpatient pharmacy setting. The resident is expected to gain knowledge in a variety of areas such as medication order processing, pharmacokinetics, and IV compounding. The resident will be assigned a preceptor for the initial weeks of the rotation with increasing responsibilities assumed as directed by the preceptor. The resident will analyze relevant patient, drug, and disease information as needed to appropriately evaluate drug-related problems. Communication skills will be developed by discussing recommendations with physicians over the phone and by written progress notes in the medical chart.
At the completion of the rotation, the resident will be able to do the following: accurately process physician orders; accurately compound and dispense sterile products; effectively supervise support staff in the inpatient pharmacy; participate in the pharmacokinetic monitoring service; understand the work flow of an inpatient pharmacy; prepare chemotherapeutic agents observing rules for safe handling of cytotoxic and hazardous medications.
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Anticoagulation Clinic
Learning Experience Type: Concentrated
Learning Experience Length: 4 weeks
This experience is in a pharmacist-run clinic, and is designed to develop the resident's clinical skills to provide outstanding pharmaceutical care in an anticoagulation clinic setting. The resident will participate in the anticoagulation telephone and face-to-face clinics daily which allows the resident to develop and demonstrate: knowledge of the appropriate use and monitoring of anticoagulation medication therapies, both verbal and written communication skills via patient/health care professional interactions and progress notes, and pharmaceutical care plans to safely and effectively manage anticoagulation therapy.
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Acute Care Internal Medicine (8 weeks)
Learning Experience Type: Rotation
Learning Experience Length: 8 weeks
This rotation is designed to develop the resident’s direct patient care skills in order to provide outstanding pharmaceutical care in an acute care internal medicine setting. The resident is expected to increase his/her knowledge of the pharmacotherapy of a broad array of acute care disease states including: CHF, MI, acute coronary syndromes, CAD, community acquired pneumonia, healthcare facility acquired pneumonia, deep venous thrombosis and pulmonary embolism, COPD, diabetes, HTN, cirrhosis of the liver and other disease states.
The resident will attend patient care rounds with the internal medicine teaching team accompanied by preceptor for initial weeks of the rotation with increasing responsibilities assumed as directed by the preceptor. The resident will be responsible for accessing and analyzing the relevant patient, drug, and disease information required to select the appropriate alternative for each drug-related problem. Communication skills will be developed through written and verbal communications.
Resident will have teaching responsibility of pharmacy students also on their acute care internal medicine rotation. Teaching at resident level will be expected and will among other things include 1 topic discussion with student every week.
At the completion of this rotation, the resident will be able to identify all potential drug-related problems in an acute care internal medicine patient, and to determine the appropriate clinical and pharmacotherapeutic outcomes for each drug-related problem identified. In addition, the resident will demonstrate how to develop a therapeutic plan aimed at resolving or preventing each drug-related problem, as well as implement and effectively follow-up the therapeutic and monitoring plans for each drug-related problem. Finally, the resident will also be able to demonstrate continuous progress in the management of an acute care internal medicine clinical pharmacy practice.
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Primary Care (minimum 8 weeks)
Learning Experience Type: Rotation
Learning Experience Length: 8 weeks
This experience is in a pharmacist-run medication therapy management clinic, and is designed to develop the resident’s direct patient care skills in order to provide outstanding pharmaceutical care in a primary care setting. The resident is expected to increase his/her knowledge of the pharmacotherapy of a broad array of primary care disease states including: diabetes, hyperlipidemia, hypertension, heart failure, DJD/gout, depression, COPD/Asthma, and GERD.
The resident will attend primary care clinic with the assigned preceptor for initial weeks of the rotation with increasing responsibilities assumed as directed by the preceptor. The resident will be responsible for accessing and analyzing the relevant patient, drug, and disease information required to select the appropriate alternative for each drug-related problem. Communication skills will be developed through written and verbal communications.
At the completion of this rotation, the resident will be able to identify all potential drug-related problems in a primary care patient, and to determine the appropriate clinical and pharmacotherapeutic outcomes for each drug-related problem identified. In addition, the resident will demonstrate how to develop a therapeutic plan aimed at resolving or preventing each drug-related problem, as well as implement and effectively follow-up the therapeutic and monitoring plans for each drug-related problem. Finally, the resident will also be able to demonstrate continuous progress in the administration management of an ambulatory clinic.
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Drug Information Service
Learning Experience Type: Longitudinal
Learning Experience Length: Duration of Residency
Residents will manage the Central Texas Veterans Health System Drug Information Service with oversite provided by an assigned clinical staff reviewer. Questions will be answered utilizing pertinent literature and relevant references, and responses will be published with evidence-based recommendations based on literature summaries.
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Pharmacy Benefits Management (PBM)
Learning Experience Type: Concentrated
Learning Experience Length: 2 weeks concentrated block
Residents will become familiar with structure and benefits of a Managed Care Organization by working with our VISN 17 PBM. Residents will learn how the concepts of disease state management, formulary management, outcomes research, pharmacist cognitive services, drug use evaluations and pharmacy data and information systems are implemented in the managed care setting. With guidance from the PBM, a project will be identified by the resident, completed and presented at a VISN 17 P&T meeting.
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Pharmacy Management Practice
Learning Experience Type: Longitudinal
Learning Experience Length: 2 months
Residents will learn to manage and improve the medication-use process within the Central Texas Veterans Health Care System Pharmacy Department, aspects of pharmacy human resource management, project management, leadership and general department administration. Residents will learn to contribute working successfully in the health care environment.
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Research Project or Quality Improvement Project
Learning Experience Type: Longitudinal
Learning Experience Length: Duration of Residency
Residents will establish a timeline, demonstrate continuous progress on key milestones (submission to research committees, data collection, analysis, etc.), appropriately evaluate references and summarize them succinctly. The resident will organize research team meetings, negotiate team assignments, delegate assignments, and manage the overall completion of the project. A poster will be presented at the ASHP midyear meeting and platform presentation at the ALCALDE Southwest Leadership Conference. A completed manuscript is required by the end of the residency.
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VA Adverse Drug Reactions Service (VA ADRs)
Learning Experience Type: Longitudinal
Learning Experience Length: Duration of Residency
Residents will manage the Adverse Drug Reactions Service (VA ADERs), an external web-based portal containing aggregated data used to report, analyze and trend ADRs reported by providers and pharmacists at the Central Texas Veterans Health Care System. Management of this service includes electronic reporting of certain ADRs to the federal MedWatch program. This database is used to monitor, track, and report ADRs across the national network of VA health care facilities to enhance medication safety practices and aid in pharmacovigilance.
Cardiology
Learning Experience Type: Rotation
Learning Experience Length: 4 weeks
This rotation is designed to develop the resident’s clinical inpatient cardiology skills on in individual patient basis in order to provide outstanding pharmaceutical care in a multidisciplinary environment. The resident is expected to increase his/her knowledge of the pharmacotherapy of a broad array of disease states including congestive heart failure, acute coronary syndrome, atrial fibrillation and other arrhythmias, hypertension including emergency/urgency, dyslipidemia, stroke, cardiogenic shock, and CAD.
This rotation is combined with the outpatient heart failure clinic. Typically the resident will be with the inpatient cardiology team in the morning and designated afternoons will be assigned for heart failure clinic. At the completion of this rotation, the resident will be able to identify all potential drug-related problems in an inpatient cardiology patient, and apply evidenced based medicine when making recommendations/interventions. The resident will also be able to conduct patient interviews utilizing available quantitative and qualitative measures for the assessment of heart failure symptom severity, and to provide education related to heart failure, symptom severity, evidence-based treatment options and medications.
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Outpatient Mental Health
Learning Experience Type: Rotation
Learning Experience Length: 4 - 6 weeks
This experience is in a pharmacist-run clinic. Residents will interview patients, utilize available rating scales for the assessment of psychiatric symptom severity and provide education to the veterans related to psychiatric disease states, symptoms , treatment options, and psychotropic medications. Throughout the rotation, residents will evaluate and discuss current standard of care and treatment guidelines for schizophrenia, depression, and bipolar disorder.
Inpatient Psychiatry
Learning Experience Type: Rotation
Learning Experience Length: 6 weeks
Residents will provide pharmaceutical care by interviewing patients, assessing drug regimens for pharmacotherapy problems, making pharmacotherapy recommendations, writing SOAP notes, and assisting treatment teams with disease state management, patient follow-up, and patient education. Residents will also participate in interdisciplinary treatment team rounds with assigned inpatient treatment team as the pharmacy representative and perform pharmacy related patient care activites (initial pharmacy assessments, medication history review and reconciliation, psychotropic medication recommendations, discharge counseling, etc.) independent of structured treatment team rounds.
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Infectious Disease
Learning Experience Type: Rotation
Learning Experience Length: 4 - 6 weeks
Residents will have an active role in the Infectious Disease inpatient service, including rounds at least twice weekly with the ID physician and Microbiology lab. Residents will also have the opportunity to attend Antibiotic Stewardship rounds and complete Hepatitis C clinical pharmacy consults. Residents will review antibiotic and bacterial classes, HIV, opportunistic infections and common sources of infection.
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Oncology
Learning Experience Type: Rotation
Learning Experience Length: 4 weeks
Residents will evaluate the current standard of care and treatment guidelines for lung cancer, colon cancer, prostate cancer, hematologic malignancies and supportive care. Residents will have the opportunity to round with an oncologist in outpatient clinic or in the hospital setting as appropriate. Objectives will be to accurately process chemotherapy and non-chemotherapy orders, check pharmacy technician work for accuracy, safely dispense chemotherapeutic products, effectively supervise support staff and work with physicians for any medication related clarification or safety concerns.
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Critical Care
Learning Experience Type: Rotation
Learning Experience Length: 4 weeks
This rotation is designed to develop the resident’s critical care skills on in individual patient basis in order to provide outstanding pharmaceutical care in a multidisciplinary environment. The resident is expected to increase his/her knowledge of the pharmacotherapy of a broad array of primary care disease states including congestive heart failure, acute coronary syndrome, community acquired pneumonia, hospital acquired pneumonia, deep venous thrombosis and pulmonary embolism, COPD, diabetes mellitus types I & II – especially DKA & HONKS, and HTN.
At the completion of this rotation, the resident will be able to identify all potential drug-related problems in a critical care patient, and apply evidenced based medicine when making recommendations/interventions.
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Geriatrics
Learning Experience Type: Rotation
Learning Experience Length: 6 weeks
This rotation is designed to prepare the resident's clinical skills to provide pharmaceutical care in Geriatric-Long Term Care setting. Resident will be involved identifying the Quality Indicators related to drug use in the nursing home setting and the preparation of a monthly QI report. Residents will write monthly Pharmacist Assessment Notes for patients, prepare for and attend each of the rounds and IDT meetings assigned on the various LTC nursing home units and communicate with IDT members regarding drug therapy recommendations. The resident will also attend the Falls Intervention Team weekly meetings, monthly LTC QI subcommittee, monthly Falls Prevention meetings, and other meetings as designated.
At the completion of this rotation, the resident will be able to apply the guidelines in the LTC Psychotropic Drug Policy and Procedure and Beers Criteria in the treatment of Geriatric-Long Term Care settings. Residents will be able to coordinate with Interdisciplinary Team members to optimize medication therapy and patient care.
Home Based Primary Care
Learning Experience Type: Rotation
Learning Experience Length: 4-6 weeks
This rotation is designed to develop the resident’s patient care skills in order to provide outstanding pharmaceutical care as part of an interdisciplinary team in a home-based primary care setting. The resident is expected to increase his/her knowledge of the pharmacotherapy related to the care of geriatric and/or home-bound veterans.
The resident will attend interdisciplinary team meetings with the assigned preceptor for the initial weeks of the rotation with increasing responsibilities assumed as directed by the preceptor. The resident will be responsible for accessing and analyzing the relevant patient, drug, and disease information required to evaluate the appropriateness of medication therapy for patients in the home-based primary care program.
At the completion of this rotation, the resident will be able to identify all potential drug-related problems in a home-based primary care patient, and to make recommendations to the interdisciplinary team to optimize medication therapy. The resident will determine the appropriate clinical and pharmacotherapeutic outcomes for each drug-related problem identified and develop and effectively follow-up with a therapeutic plan aimed at resolving or preventing each drug-related problem. Finally, the resident will also be able to demonstrate continuous quality improvement in the Home-based Primary Care program.
Education and Academia
Learning Experience Type: Longitudinal
Learning Experience Length: 12 months
This learning experience is designed to offer an introduction to didactic, one-on-one and experiential teaching styles. Emphasis is placed on multi-modal communication strategies to customize learning to meet the needs of a variety of different target audiences. Activities include patient-centered Veteran education, precepting student pharmacists, presentation of residency project findings (poster presentation, platform presentation, manuscript preparation), facilitation of P3 pharmacotherapy lab, lecturing as part of interdisciplinary continuing education, presentation of journal clubs, patient cases, topic discussions, BPS recertification modules, pharmacotherapy rounds presentation, and completion of an optional Academic Training Program affiliated with the University of Texas at Austin.
