Description of Available Rotations
Core Rotations
Orientation
Duration: 6 weeks
A 6-week rotation at the beginning of the residency year where residents
will be introduced to the hospital and pharmacy department. Residents
will gain familiarity with the hospital’s policies and procedures,
pharmacy operations, and transition into the residency program. Pharmacy
operations include computerized physician order entry (CPOE), oversight
of dispensing, medication automation, etc. Throughout the rotation, residents
will complete all requirements mandated by the hospital and pharmacy department.
Clinical Pharmacy Services (CPS)
Duration: 14 weeks
Comprised of 4 rotations: Infectious Diseases, Nutrition Support, Inpatient
Anticoagulation, and Drug Monitoring. The goal of this rotation is for
residents to develop their own clinical practice and manage patients in
a safe, effective manner.
CPS: Infectious Diseases (ID)
Duration: 5 weeks
This rotation focuses on the management of all patients on antimicrobial
agents. Residents will learn diverse and complex infectious disease states,
while strengthening their understanding of the medications used to treat
such conditions. This learning experience will focus on two main elements:
dosing antibiotics such as vancomycin and aminoglycosides, and Antimicrobial
Stewardship Program (ASP). Residents will work closely with all physicians
but especially ID teams by staying in constant communication and attending
ID rounds.
CPS: Nutrition Support
Duration: 5 weeks
Nutrition support encompasses our Basal Bolus Insulin Program (BBIP) and
Total Parenteral Nutrition (TPN) management. Under pharmacy-driven protocol,
BBIP provides a unique platform for residents to independently manage
insulin regimens for patients enrolled in this service. Residents will
gain a thorough understanding of glycemic management and work closely
with nursing staff to ensure safe and effective therapy for patients.
Residents will be taught to manage all adult TPN patients from initiation
to discontinuation. Residents will work with registered dietitians, nurses,
and physicians to provide collaborative care in the nutritional support
of their patients.
CPS: Inpatient Anticoagulation
Duration: 1 week
This rotation provides training on a variety of anticoagulants that pharmacy
has been tasked to monitor. These agents include warfarin, heparin, enoxaparin,
and direct-oral anticoagulants. Using Vigilanz, residents will learn to
optimize anticoagulants for hospitalized patients. Services include dosing
and adjusting anticoagulant regimens, as well as recognizing when to initiate
and discontinue anticoagulants.
CPS: Drug Monitoring
Duration: 1 week
Drug Monitoring week provides intense training on a variety of AHGL protocols.
These protocols include renal dose adjustment, weight-based dosing, IV
to PO conversion, drug level monitoring, high risk medication review,
and pharmacotherapy consults. Residents will use Vigilanz to address and
manage all these various alerts to ensure patient safety.
Critical Care
Duration: 6 weeks
Critical care, designated as ICU, focuses on the management of critically
ill patients. AHGL has 3 critical care units: Intensive Care Unit (ICU),
Cardiac ICU, and Surgical ICU. Each unit holds 10-12 patients with a typical
census of 50-70%. Residents will be exposed to a diverse range of complex
acute disease states commonly seen in critical care medicine.
Residents will learn to efficiently assess patients to provide comprehensive
pharmacy support to the multidisciplinary team comprised of intensivists,
nurses, dietitians, social workers, respiratory therapists, and other
healthcare providers. Residents will engage in multidisciplinary rounds
(MDR) daily. Using Vigilanz, residents are responsible for the complete
care for all ICU patients through antimicrobial stewardship, anticoagulation
monitoring, nutrition support, and drug monitoring.
Due to the comprehensive nature of this rotation, residents will need to
complete the Clinical Pharmacy Services rotation prior to the Critical
Care rotation.
General Medicine
Duration: 4 weeks
Also known as Family Medicine Service (FMS), allows residents to work independently
with our Family Medicine team which is comprised of a physician attending
and medical residents. Residents will represent the pharmacy department
and provide pharmacy support to the FMS team to optimize care for patients
enrolled into their service. Residents will attend daily morning rounds
with the team to review each patient before rounding on the patient floors.
This rotation will be scheduled in the latter half of the residency to
ensure residents have gained enough experience and confidence to work
self-sufficiently. Residents will report to the clinical coordinator after
rounds to discuss patients and interventions made.
Transition of Care (TOC)
Duration: 3 weeks
Comprised of 3 learning experiences: Emergency Medicine, Discharge Pharmacy,
and Outpatient Pharmacy. Designed to expose and train residents in all
facets of Transition of Care.
TOC: Emergency Medicine (1st component)
Duration: 3 weeks
Residents will interview patients/caregivers or contact that patient’s
outpatient pharmacy/long-term care facility in the Emergency Department
(ED) to perform home medication reconciliation. If the patient/caregiver
is not available, residents will learn to utilize other resources to gather
the information. Residents will also learn to triage all direct and overnight
admissions to ensure these patients’ home medication lists are accurate.
Residents will also provide support to the ED staff which includes physicians,
nurses, social workers, etc.
TOC: Discharge Pharmacy (2nd component)
Duration: 3 weeks
Residents will work closely with our physicians and nurses to ensure patients
being discharged on optimized drug regimens by conducting discharge medication
reconciliations. Residents will learn to assess progress notes, review
inpatient and discharge medications, and resolve any discrepancies. Residents
will also play an active role in heart failure management by optimizing
medication management for congestive heart failure (CHF), completing bedside
consultations for CHF patients, and triaging CHF alerts on Vigilanz for
patients with high risk for readmission. Residents will also evaluate
for pharmacological intervention strategies in preventing falls in high-risk
patients. Lastly residents will further reinforce medication reconciliation
skills by conducting timely completion of long-term acute care (LTAC)
admission medication histories for patients admitted to our Transitional
Care and Rehabilitation Units.
TOC: Outpatient Pharmacy (3rd component)
Duration: 2 weeks
Residents will gain various outpatient pharmacy experiences which includes
filling and dispensing medications, order verification, bedside delivery
and consultations, prescribing/refill authorizations under collaborative
practice agreement, specialty pharmacy, and prior authorizations and appeals.
Residents will also play a role in discharge care which includes phone
calls to the patients as well as to their pharmacies to ensure continuity of care.
Intravenous and Sterile Compounding
Duration: 4 weeks
This rotation is designed to provide ample training in both the sterile
and non-sterile compounding IV room. Residents will learn to manage the
sterile IV compounding room and gain experience in parenteral medications
utilized in the hospital, including chemotherapy, outpatient infusion
center (OPIC), and neonatal intensive care unit (NICU) orders. Residents
will gain experience in both compounding medications as well as conducting
final checks of others’ work using BD IV preparations. Residents
must demonstrate the ability to successfully compound 10 items during
the rotation. Residents will also learn to manage tasks outside the IV
room which includes working with pre-mix medications and oral syringes.
Anticoagulation Clinic
Duration: 4 weeks
Anticoagulation clinic (ACC) focuses on the management of anticoagulation
in the ambulatory care setting. Residents will work closely with our ambulatory
care pharmacists to manage warfarin and direct oral anticoagulants (DOACs).
Residents will conduct patient interviews to gather information and optimize
medication regimens. When managing warfarin, residents will interpret
patients’ INR, extrapolate patient information, and coalesce this
information to provide recommendations for a weekly warfarin regimen under
pharmacy-driven protocol. Residents will also play an active role in the
management of DOAC regimens by assessing patient information and evaluating
appropriateness of medication (doses, lab values, etc.).
Elective Rotations
2 rotations (each 2 weeks in duration)
Residents will select 2 elective rotations by the midway point of residency.
Because electives are paired with physician preceptor(s), these rotations
are scheduled in the 2nd half of the residency year after residents are licensed and have demonstrated
competency in most of their Core Rotations. Residents will work directly
with the physician or specialist but will be evaluated by the Residency
Program Coordinator who facilitates all electives. The goal of the elective
is to allow residents to pursue their area of interest.
Available Elective Rotations:
