VA Salt Lake City PGY1 Residency - VA Salt Lake City Health Care System
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VA Salt Lake City Health Care System

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VA Salt Lake City PGY1 Residency

PGY1 Program Purpose: PGY1 pharmacy residency programs build on Doctor of Pharmacy (Pharm.D.) education and outcomes to contribute to the development of clinical pharmacists responsible for medication-related care of patients with a wide range of conditions, eligible for board certification, and eligible for postgraduate year two (PGY2) pharmacy residency training.

VASLCHCS PGY1 Residency Rotation Descriptions: The residency program has required core and elective learning experiences or rotations. The following required core learning experience descriptions illustrate the foundation of the PGY1 experience. The resident then selects electives to pursue clinical interests and customize their PGY1 experience. As needed, the PGY1 residency program can network with other sites (University of Utah and Intermountain Health Care) to provide additional specialty care rotations not available at the VA. These affiliated site rotations are subject to preceptor and site availability and are to be coordinated with the Residency Director.

PGY1 Core Learning Experiences (Rotations):

  1. VA Pharmacy Systems/Inpatient Rotation Description: The VA Pharmacy Systems/Inpatient Rotation is a required 3-week learning experience at the Salt Lake City VA Medical Center. It is an in-depth orientation to current VA technology. The role of the preceptor is to provide the resident with a global understanding of our community hospital medication distribution system. The resident will gain experience in the VA distribution process by utilizing multiple software and hardware packages including; Computerized Patient Record System (CPRS), Veterans Health Information System and Technology Architecture (VISTA), ScriptPro, VISTA Chemotherapy Manager (VCM), Talyst and Pyxis. All learning activities will be geared towards proficiency with these systems as they will be the foundation for future rotations, patient care activities, and resident projects. Learning activities may be facilitated by different pharmacy staff with expertise in certain hardware or software applications. Learning activities will be accomplished in parallel with the varied roles of the preceptor including clinical, staff, and administrative workload.
  2. Internal Medicine: The Internal Medicine rotation is a required learning experience for the pharmacy practice resident. It is a 6-week experience where the resident will participate in the provision of pharmaceutical care to acute care patients admitted to one of the three internal medicine teams on the Acute Medicine Floor. Most medicine teams consist of an attending, resident, two intern physicians and medical students. Each internal medicine team cares for up to 20 patients. This rotation allows the resident the opportunity to apply pharmacy-related concepts to patient care as a member of a multi-disciplinary health care team. The resident is responsible for identifying, preventing and resolving medication therapy issues for patients and serving as a drug information resource for the team. This will include, but is not limited to, performing admission and discharge medication reconciliations, developing pharmaceutical care plans for patients with complicated medical histories as well as for those on high-risk medications, performing pharmacokinetic and pharmacodynamic assessments, screening medications for appropriate indications and dosing, and proactively identifying drug interactions. The resident will create therapeutic regimens for individual patients utilizing the VA formulary when possible. These activities are expected to be completed for every patient that is assigned to the resident. The resident’s patient load will vary based on the preceptor’s discretion. The resident is proactively involved in the medication use process, including assisting nursing service with medication-related issues and working to promptly solve problems that impede the appropriate delivery of medications. Good communication and interpersonal skills are necessary to promote efficient function of the team. The resident will be expected to communicate their findings and recommendations to the appropriate clinician(s).
  3. Primary Care: This is a required 6-week learning experience designed to teach residents how to apply pharmaceutical care as an integrated member of a patient aligned care team (PACT) within the primary care clinics at VA Salt Lake City’s main campus, or if available, at the West Valley or Ogden Community Based Outpatient Clinics (CBOC).  During the experience, residents are directly involved in the development and monitoring of medication treatment regimens for patients, with emphasis placed on the independent assessment and development of pharmaceutical care plans for Veterans with chronic diseases. Focused areas for clinical experience include: diabetes care, hypertension, hyperlipidemia, hypothyroidism, chronic kidney disease, gout, mental health and tobacco abuse.
  4. Critical Care: The VA Critical Care Rotation is with one of two preceptors in SICU or MICU. Each location has unique learning experiences that will be slightly different. The critical care rotation is a required 4-week learning experience for the pharmacy practice resident. The resident will participate in the provision of pharmaceutical care to acute care patients admitted to the MICU or SICU. The MICU and SICU share the same space but have distinct rounding services. The MICU service consists of an attending, fellow, three residents, three intern physicians and a clinical pharmacist. The SICU is a team that consists of an attending, midlevel provider, and clinical pharmacist. The resident is responsible for performing admission and discharge medication reconciliations, developing pharmaceutical care plans for patients with complicated medical histories as well as for those on high-risk medications, performing pharmacokinetic and pharmacodynamic assessments, screening medications for appropriate indications and dosing, and proactively identifying drug interactions. The resident will create therapeutic regimens for individual patients utilizing the VA formulary when possible. These activities are expected to be completed for every patient that is assigned to the resident. The resident’s patient load will vary based on the preceptor’s discretion.
  5. Management: During this 4-week rotation, the resident will have the opportunity to meet with each member of the administration team to understand their roles and responsibilities. The resident will gain insight into the administration functions by participating in Veterans Affairs National Telecommunications System (VANTS) calls, interdepartmental meetings, or work with VA staff to complete pharmacy administrative projects. Independent time will be given for longitudinal assignments, background reading, and other assignments as directed by the preceptor. The focus of the rotation will be to understand essential elements of the VA organizational chart, pharmacy operations, human resources, budget, procurement, staff supervision, and other administrative components as they present during the PGYI rotation. The resident will be expected to participate or lead administrative assignments on a longitudinal basis until project conclusion. The resident will also be given independent time to learn, evaluate, and make recommendations about current policy and procedures. In addition, the resident will have the opportunity to evaluate differences between federal, state or VA regulations regarding pharmacy services. Rotation elements are dynamic given that National VA mandates change over time and the resident experience may vary depending on current inspections, national policy directives, or other procedural changes occurring in the pharmacy. Independent work and time management skills are essential for success in this rotation.
  6. Psychiatry: The psychiatric pharmacy rotation is a 4 to 5-week rotational experience designed to develop resident’s knowledge and skills in the area of provider/patient interaction, psychiatric disorders and psychotropic drug therapy on the inpatient psychiatry unit. Patients are most commonly admitted for mood disorders, PTSD, schizophrenia, and/or substance use disorders. This is an interdisciplinary unit with 4 teams. Each team includes a psychiatrist, nurse practitioner, team nurse, and social worker. Each team also has a mental health clinical pharmacist. Residents are exposed to trainees from other disciplines on the inpatient psychiatry unit and may be involved in assisting in pharmacy student precepting. Residents are expected to provide patient and provider education, conduct medication histories and reconciliation on admission and discharge, and participate in team rounds. Residents generally begin by shadowing the clinical pharmacist and by the end of the rotation are independently rounding on the team with coaching from their preceptor. In order to solidify psychotropic drug therapy knowledge, residents conduct and participate in regular topic discussions. This rotation allows residents who are interested in the Salt Lake City VA PGY2 Psychiatric Pharmacy Residency to explore psychiatry.
  7. Inpatient Central Pharmacy Longitudinal: This 6-month longitudinal rotation will provide the PGY1 pharmacy resident with an understanding of how to practice and function as an inpatient pharmacist. The resident will spend 4 hours per week in the inpatient pharmacy and will be responsible for verifying medication orders for completeness and processing orders accurately. The resident will be responsible for identifying the presence of medication therapy problems in a patient's current medication regimen. The resident will learn to process IV medications correctly, by selecting the appropriate diluent, the right concentration, and the correct infusion rate. The resident will work closely with pharmacy technicians to ensure timely delivery of medications; will respond to drug information inquiries from MDs, clinical pharmacists and nurses.
  8. Ambulatory Care Longitudinal Clinics (1-2): Participation in longitudinal ambulatory care clinics is a required learning experience for residents during the second half of the residency year. Each resident selects 1 to 2 longitudinal clinics to participate in over 3 to 6 months, generally spending 4 hours in the selected clinic each week. While in the selected clinics, residents will play an active role in patient care, developing care plans, initiating and monitoring medication therapy, and identifying, preventing, and resolving medication therapy issues. Residents may choose to spend time in in any of the following clinics: anticoagulation, general primary care, clozapine, geriatric assessment, geriatric primary care, liver, infectious disease, neurology, renal, physical medicine and rehabilitation, or pain and palliative care.
  9. Drug Information: Residents will learn different ways to provide drug information during this longitudinal, year-long rotation. As pharmacist’s roles expand, drug information has become essential to our profession. One of the important competencies of a residency trained PharmD is the ability to retrieve, analyze, and interpret the professional, lay and scientific literature to provide drug information and counseling to patients, their families or caregivers, and other involved health care providers. As practicing clinicians in dynamic patient care environments, all pharmacists have a responsibility to be effective drug information providers. With the development of new drugs and the advancement of medication therapy, it is challenging for health care professionals to keep abreast of new health information. Although pharmacists will not have the answer to every question, it is important to know how to approach drug information questions and how to locate the requested information.  
  10. Service Commitment/Staffing: The service commitment learning activity is a required longitudinal experience. This activity consists of acting as the clinical pharmacist during one weekend per month. The clinical pharmacist is responsible for completing and documenting the medication reconciliations for all patients within 24 hours of admission. The clinical pharmacist is also responsible for providing pharmaceutical support to the medicine and surgery teams when requested. This includes answering drug information questions, responding to medical or surgical pager calls and educating patients on anticoagulation or insulin regimens prior to discharge. Staffing responsibilities will not begin until after the resident has completed an internal medicine rotation. The resident will also be responsible for proper communication of continued patient needs to the appropriate person, either the provider or team pharmacist, for continuity of care Save Form EntrySave after the weekend. Efficient data collection and documentation skills will be essential for completing this learning activity.
  11. Project: Residents are required to complete a practice-related project to demonstrate project management skills. Residents usually select from quality-improvement and research projects that are proposed by pharmacists, physicians, and other individuals throughout the facility and approved by the residency advisory committee (RAC). The resident selects a project mentor whose responsibility is to assist and support the resident through the project with assistance from RAC. Given the time typically involved in completing a residency project, the RAC has put together timelines and deadlines that need to be met by the resident in order to ensure the resident’s project will be completed during the residency year. Residents must complete a project manuscript that is suitable for publication.

 

Optional Teaching Certificate

The PGY1 program offers the opportunity to earn a Teaching Certificate. Teaching opportunities include precepting students on rotation, presenting to pharmacy staff, leading small group discussions with pharmacy students and lecturing at the University of Utah College of Pharmacy or Roseman University College of Pharmacy. For further questions regarding the Teaching Certificate, email PGY1 residency coordinator, Katie Athern.


Rotations:

VA Salt Lake City PGY1 Pharmacy Residency Program Curriculum

 Rotation

Weeks

Start Date

June 2020

Graduation

June 2021

 Orientation

2

Human Resources

1

Training

1

 Core Rotations

Weeks

VA Systems (Inpatient and Outpatient Pharmacy)

3

Internal Medicine

6

Primary Care

6

Critical Care (MICU or SICU)

4

Management

4

Inpatient Psychiatry Unit

4

Longitudinal Experience (Inpatient Pharmacy, Primary Care, Clozapine, Anticoagulation, Neurology, Liver Clinic, Renal Clinic, Infectious Diseases)

3-6 months each 

Drug Information (Longitudinal)

Year Long 

 Electives

Weeks

Acute Care Surgery

4

PM&R Inpatient/Ambulatory Care Clinic

4

MICU or SICU

4

Emergency Department

4

Acute Care Cardiology

4

Infectious Diseases Inpatient Consult Team /Ambulatory Care Clinic

4

Infectious Diseases – Antimicrobial Stewardship

4

Pain and Palliative Care - Acute Care and Clinic(s)

4

Internal Medicine (2nd time through)

4

Anticoagulation Clinic

4

Poison Control Center (University of Utah)

4

General Outpatient Mental Health

4

Substance Abuse Ambulatory Care (ETOH & Opioid)

4

Hematology/Oncology

4

Geriatrics Specialty Clinic Ambulatory Care

4

Primary Care/Ambulatory Care

4

Other

4

Project Weeks

4



Sample Schedule:

 

 

# of weeks

# of days

Date started

Date Ended

Orientation

2

14

6/13/2020

6/24/2020

VA Systems

3

21

6/27/2020

7/15/2020

Internal med

6

42

7/18/2020

8/26/2020

Primary care

6

42

8/29/2020

10/7/2020

Project week 1

1

7

10/10/2020

10/14/2020

Critical care

4

28

10/17/2020

11/11/2020

Management

2

14

11/14/2020

12/2/2020

Midyear

1

5

12/4/2020

12/8/2020

Management

1

7

12/9/2020

12/16/2020

Project week 2

1

7

12/19/2020

12/23/2020

Psychiatry

4

28

12/26/2020

1/20/2021

Elective 1

4

28

1/23/2021

2/17/2021

Project week 3

1

7

2/20/2021

2/24/2021

Elective 2

4

28

2/27/2021

3/24/2021

Elective 3

5

35

3/27/2021

4/28/2021

Project week 4

1

7

5/1/2021

5/5/2021

Elective 4

5

35

5/8/2021

6/9/2021

Wrap up Week

1

7

6/12/2021

6/16/2021

Holidays

 

11

 

 

Vacation

 

13

 

 

Sick leave

 

13

 

 

Total

52

     
         

Longitudinal

# of weeks

# of days

Date started

Date Ended

Residency

52

364

6/13/2020

6/16/2021

Drug Information

52

364

6/13/2020

6/16/2021

Inpatient pharmacy - longitudinal

26

182

7/15/2020

12/15/2020

Ambulatory Care Clinic - longitudinal

26

182

1/5/2021

6/16/2021

         

Mountain States Conference

1

2

5/11/2021

5/12/2021

ASHP Midyear

1

7

12/4/2020

12/8/2020


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