Ambulatory Medicine
Rotation/Location:
Ambulatory Medicine - Pharmacotherapy Clinic – University Hospital
Preceptor(s):
Alicia Pence......................................................................................................pager: 513-577-4073
Judy Caldwell...................................................................................................pager: 513-249-0777
Outcomes/Goals:
For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.
R2.1, R2.2, R2.3, R2.4, R2.5, R2.6, R2.7, R2.8, R2.10, R2.12, R5.1
Overview:
The Ambulatory Medicine Rotation will be conducted in the General Medicine Clinic at The University Hospital. The office is incorporated into the University Medical Practices located on the 2nd floor of the Hoxworth Building. The resident will provide direct patient care and will participate in ongoing projects in the clinic. The resident is expected to be on rotation Monday through Friday each week. Generally the clinic operates from 8:00 AM to 4:00 PM. A schedule of clinic days and activities will be provided.
The General Medicine Clinic is a physician-resident staffed, multidisciplinary clinic. The resident will work with a variety of members of the health care team. The Pharmacotherapy Clinic (PC) is a pharmacist-directed clinic conducted within the Medicine Clinic and Faculty Practice Clinic. The resident will work with several different pharmacists throughout the rotation in order to gain experience with a variety of patients and educational styles. Also there may be another student or resident with which the resident will coordinate their activities.
Activities/Assignments:
The resident is expected to work within and assist with the day-to-day operations of the clinic. In addition, the resident will work on ongoing projects within the clinic. These assignments will be made at the beginning of the rotation, but may change depending on the needs of the clinic.
There is a Reading Binder of articles pertaining to ambulatory care. The resident is encouraged to become familiar with these articles during the first week of rotation. The resident is also encouraged to provide additional articles they feel may be beneficial to the clinic staff and future students/residents.
There will be weekly topic discussions during the rotation in which the resident is expected to participate in a discussion with the preceptors concerning the treatment of a selected disease state. The resident will be expected to lead at least one of the topic discussions. Topics may include diabetes, hypertension, smoking cessation, asthma, hyperlipidemia, thyroid, osteoporosis, depression, and GERD.
During the last week of the rotation, the resident will present a formal case presentation of a patient with the disease state that was discussed. The case presentation will review the patient’s disease states and therapy for each disease state. It will attempt to offer future suggestions as to the management of the patient.
The resident will lead one Journal Club. It is the resident’s responsibility to select one recent article on a subject pertinent to the clinic setting and present this article to the pharmacy clinic staff. The resident should submit the article to his/her preceptor for approval a minimum of 3 days prior to the scheduled time.
The resident may have the opportunity to present to the medical staff at the end of each rotation. The AME series is scheduled with the medical director and will be determined on an as needed basis.
Projects:
Residents will be given one half day per week to work on specific projects assigned by preceptors. Progress should be reported to the assigned preceptor weekly.
Attendance:
Residents will be required to attend clinic Monday- Friday. The resident is asked to come to clinic approximately 10-15 minutes prior to the first scheduled appointment to review patient charts. The resident will be permitted to leave after the last patient is seen and the progress note is written. Absences/ tardiness will require a phone call to the preceptor of the day. Residents may be asked to make up work on missed days.
Evaluation:
The resident will be evaluated based mostly on clinical service. Preparedness and participation in topic discussions is also an important component of the evaluation. The resident will also be evaluated on motivation and initiative in dealing with assignments and unexpected problems. Self-initiative and the ability to work independently are very desirable and will influence the resident’s grade. Other areas of evaluation will include timeliness of completion of assignments, professional demeanor, and motivation. There will be a midterm evaluation to identify areas of resident’s strengths and weaknesses.
Residents will be evaluated according to the Resident Learning System evaluation for ambulatory rotations. Additionally, the resident is required to complete a preceptor and rotation evaluation.
Ambulatory Medicine Anticoagulation
Rotation/Location:
Ambulatory Medicine – Pharmacy Anticoagulation Clinic – University Hospital
Preceptor(s):
Alicia Pence, PharmD......................................................................................................pager: 513-577-4073
Sharon Wright, PharmD..................................................................................................pager: 513-366-8152
Outcomes/Goals:
For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.
R2.1, R2.2, R2.3, R2.4, R2.5, R2.6, R2.7, R2.8, R2.10, R2.12, R5.1
Overview:
The Ambulatory Medicine Rotation will be conducted in the General Medicine Clinic at The University Hospital. The office is incorporated into the University Medical Practices located on the 2nd floor of the Hoxworth Building. The resident will provide direct patient care and will participate in ongoing projects in the clinic. The resident is expected to be on rotation Monday through Friday each week. Generally the clinic operates from 8:00 AM to 4:00 PM. A schedule of clinic days and activities will be provided.
The General Medicine Clinic is a physician-resident staffed, multidisciplinary clinic. The resident will work with a variety of members of the health care team. The Pharmacy Anticoagulation Clinic (AC) is a pharmacist-directed clinic conducted within the Medicine Clinic and Faculty Practice Clinic. The resident will work with several different pharmacists throughout the rotation in order to gain experience with a variety of patients and educational styles. Also there may be another student or resident with which the resident will coordinate their activities.
Activities/Assignments:
The resident is expected to work within and assist with the day-to-day operations of the clinic. In addition, the resident will work on ongoing projects within the clinic. These assignments will be made at the beginning of the rotation, but may change depending on the needs of the clinic.
There is a Reading Binder of articles pertaining to anticoagulation. The resident is encouraged to become familiar with these articles during the first week of rotation. The resident is also encouraged to provide additional articles they feel may be beneficial to the clinic staff and future students/residents.
There will be scheduled topic discussions during the rotation in which the resident is expected to participate in a discussion with the preceptors concerning the stated anticoagulation topic. The resident will be expected to lead many of these discussions.
The resident will lead one Journal Club (please bold Journal Club). It is the resident’s responsibility to select one recent article on a subject pertinent to the clinic setting and present this article to the pharmacy clinic staff. The resident should submit the article to his/her preceptor for approval a minimum of 3 days prior to the scheduled time.
Projects:
Residents will be given one half day per week to work on specific projects assigned by preceptors. Progress should be reported to the assigned preceptor weekly.
Attendance:
Residents will be required to attend clinic Monday- Friday. The student/resident is asked to come to clinic approximately 10-15 minutes prior to the first scheduled appointment to review patient charts. The resident will be permitted to leave after the last patient is seen and the progress note is written. Absences/ tardiness will require a phone call to the preceptor of the day. Residents may be asked to make up work on missed days.
Evaluation:
The resident will be evaluated based mostly on clinical service. Preparedness and participation in topic discussions is also an important component of the evaluation. The resident will also be evaluated on motivation and initiative in dealing with assignments and unexpected problems. Self-initiative and the ability to work independently are very desirable and will influence the resident’s grade. Other areas of evaluation will include timeliness of completion of assignments, professional demeanor, and motivation. There will be a midterm evaluation to identify areas of resident’s strengths and weaknesses.
Residents will be evaluated according to the Resident Learning System evaluation for ambulatory rotations. Additionally, the resident is required to complete a preceptor and rotation evaluation.
Cardiology
Rotation/Location:
Cardiology – University Hospital
Preceptor(s):
Emily Young, PharmD, BCPS..............................................................................pager: 513-585-9924 ext. 1592
................................................................................................................................................513-584-3346
Eric Mueller, PharmD............................................................................................pager: 513-585-9924 ext. 1756
...............................................................................................................................................513-584-1756
Neil Ernst, PharmD...............................................................................................pager: 513-585-9924 ext. 1422
...............................................................................................................................................513-584-6116
Shaun Keegan, PharmD......................................................................................pager: 513-585-9924 ext. 0564
.............................................................................................................................................. 513-584-7675
Outcomes/Goals:
For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.
R2.1, R2.2, R2.4, R2.6, R2.7, R2.8, R2.10, R2.12, R3.1, R5.1
Overview:
Patients are admitted to a cardiology service through the emergency department, from the cardiac cath lab, by transfer from another service, or via direct admit from another hospital or cardiology clinic. The cardiology or CCU teams follow cardiology patients of all acuities from the coronary care unit (CCU) unit to the cardiac step down unit (CSD) and to the cardiac floor (6 South).
Activities/Assignments:
Residents will participate in cardiology rounds daily. Rounds will begin between 0730 and 0830 depending upon the attending. Rounds last anywhere from 2 to 4 hours depending upon the number and acuity of patients. The resident is expected to follow all of the patients on the cardiology service that they are rounding with that month (CCU, CSD, and floor patients). The resident will also present patients to the preceptor on a daily basis and participate in all topic discussions as scheduled.
For at least the first week or so, the student/resident will pre-round with the preceptor prior to the actual cardiology team rounds. Pre-rounding will occur a half-hour before the scheduled team rounds. The purpose of this exercise is to prevent you from becoming “wallflowers” during rounds and to take a more active role on rounds. During this exercise you will address the following: 1) problems in drug therapy with each patient, and 2) suggestions to these problems. The ability to perform these tasks will require that you evaluate the patients prior to the pre-rounding process.
A daily report will be given to the 7E pharmacist after cardiology rounds. This report will entail highlights of each patient that you rounded on noting such issues as: 1) patients being transferred from the unit, 2) new admissions to the unit, 3) drugs that will be stopped or started, 4) status of patients - getting better/worse, new problems, etc. This will also provide the 7E pharmacist an opportunity to ask questions. Daily report should be done as soon as cardiology rounds are over and should last no longer than 15-20 minutes.
Grand Rounds take place every Tuesday at 1200 in the cardiology lecture room in the Medical Sciences Building. Residents are encouraged to attend these lectures if cardiology rounds are completed.
The resident will participate in any applicable research projects while on the cardiology service.
Topics To Be Covered
- Hypertension
- Hyperlipidemia
- Acute Coronary Syndromes
- UA
- NSTEMI
- STEMI
- Heart Failure
- Cardiogenic Shock
- Cardiac Transplantation
- Arrhythmias /Dysrhythmias
- Hypertensive Emergencies
- Pulmonary Hypertension
- Endocarditis
- Pulmonary Artery Catheter
- Inotropes and Pressors
Additional Requirements
- Lead one formal topic discussion
- Actively participate in all topic discussions (read ahead)
- Present one journal club
- Provide one in-service to the cardiology team
Miscellaneous:
There are two cardiology teams that are each comprised of the attending, cardiology fellow, 4 medicine residents, and medical students. The residents are on-call every fourth night. All patients admitted during their shift belong to that resident. At 1300 hours daily the residents will sign out their patients to the resident on call. In addition to the two cardiology teams, there is a heart failure/transplant consult team comprised of the attending, cardiology fellow, and a nurse practitioner.
Evaluation:
PGY1 pharmacy residents will be evaluated according to the Residency Learning System evaluation for Cardiology based on the Educational Outcomes and Goals listed above. Also taken into consideration will be preparedness for topic discussions, motivation and initiative in learning, timeliness in meeting deadlines, communication skills, and professionalism.
Emergency
Rotation/Location:
Emergency Medicine – University Hospital
Preceptor(s):
Nicole Harger, PharmD, BCPS...................................................................................................pager: 513-577-1435
.......................................................................................................................................................................513-584-1338
Shaun Keegan, PharmD..............................................................................................................pager: 513-585-9924 ext. 0564
.......................................................................................................................................................................513-584-7675
Outcomes/Goals:
For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.
R1.1, R1.2, R1.3, R1.4, R1.5, R2.1, R2.2, R2.3, R2.4, R2.5, R2.6, R2.7, R2.8, R2.9, R2.10, R2.11, R2.12
Overview:
The Emergency Medicine Rotation is designed to develop the resident’s knowledge of and problem-solving skills in the drug therapy of a wide range of patients in the Emergency Department setting.
Activities/Assignments:
During this rotation, the resident will have the opportunity to:
- Participate in the multidisciplinary care of patients in the Emergency Department
- Develop an understanding of the management and care of a patient in the Emergency Department through readings and practical experience
- Develop and refine the clinical skills that will allow the resident to rapidly and accurately assess a Emergency Medicine patient’s health status and formulate a therapeutic plan
- Communicate effectively through oral and written communication to assure complete and accurate information to healthcare team members and patients concerning drug therapy and patient response.
In addition to Goals and Objectives listed in the attached Residency Learning System Summative Evaluation, upon completion of this rotation, the resident will be able to:
- Discuss and understand the pathophysiology and etiologies of those disease states listed in the Resident and Student Curriculum general topic list (See attached Resident and Student Curriculum document).
- Discuss the etiologies and pathophysiologies of disease states that are encountered most often in the Emergency Department.
- The resident is expected to present 1 to 2 advanced topics per week (see attached Resident and Student Curriculum document).
- The resident is expected to present at least one to two journal club articles per month.
- The resident is expected to participate in 1 to 2 multidisciplinary in-services per month.
The following activities are required of the resident:
- Be present in the Emergency Department Monday through Friday to participate in patient care.
- Monitor patient therapy which shall include monitoring laboratory values, chart reviews, interviewing health care professionals, and physical assessment
- Participate in daily topic discussions and case presentations.
- Pharmacokinetic consultations
- Provision of drug information to other health care providers
Specific assignments will include:
- Daily patient presentations
- Writing pharmacy notes in patient charts
- Tracking pharmacy interventions with HealthProLink
- One to two presentation to other healthcare providers
- Discussion of selected readings from current literature
- One to two journal article presentation to Clinical Pharmacy Staff
Evaluation:
Residents will be evaluated according to the Resident Learning System evaluation for Emergency Medicine. In addition, there will be four weekly “Snapshot” evaluations.
Critical Care
Rotation/Location:
Critical Care – University Hospital
Preceptor(s):
Eric Mueller, PharmD.........................................................................................................pager: 513-585-9924 ext. 1756
.............................................................................................................................................................513-584-1756
Emily Young, PharmD, BCPS...........................................................................................pager: 513-585-9924 ext. 1592
.............................................................................................................................................................513-584-3346
Neil Ernst, PharmD.............................................................................................................pager: 513-585-9924 ext. 1422
.............................................................................................................................................................513-584-6116
Shaun Keegan, PharmD....................................................................................................pager: 513-585-9924 ext. 0564
.............................................................................................................................................................513-584-7675
Outcomes/Goals:
For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.
R2.1, R2.2, R2.3, R2.4, R2.5, R2.6, R2.7, R2.8, R2.9, R2.10, R2.11, R2.12, R5.1, R.6.1
Overview:
The critical care rotation is designed to develop the resident’s knowledge of and problem-solving skills in the drug therapy of critically ill patients.
The resident will rotate through either the medical intensive care or surgical intensive care unit. This rotation will provide the resident with the opportunity to:
- participate in a multidisciplinary critical care team
- gain an understanding of the management of critically ill patients through practical experience and literature review
- develop clinical skills that will allow the resident to rapidly and accurately assess a critically ill patient’s health status and formulate a patient-specific pharmacotherapeutic plan
- utilize and refine appropriate and effective oral and written communication to assure complete and accurate correspondence with team members and patients concerning drug therapy and patient response
In addition to Goals and Objectives listed in the Residency Learning System Summative Evaluation, upon completion of this rotation, the resident will be able to:
- discuss and understand the pathophysiology and etiologies of those disease states listed in the Resident and Student Curriculum general topic list (see attached Resident and Student curriculum document)
- discuss the etiologies and pathophysiologies of disease states that apply to the specific ICU (MICU or SICU) the resident rotating
Activities/Assignments:
The following activities are required of the resident:
- participation in intensive care unit multidisciplinary rounds Monday – Friday,
- monitor individual patients’ pharmacologic and non-pharmacologic therapy including monitoring laboratory and microbiology data assessment, interviewing other health care professionals and physical assessment
- morning and evening walk rounds with preceptor
- participate in daily topic discussions and case presentations
- pharmacokinetic consultations
- provision of drug information to other health care providers
- documenting interventions as clinical pharmacy progress notes (minimum of four)
- tracking pharmacy interventions with HealthProLink
Specific assignments will include:
- monitoring patient therapy using standard forms
- daily patient presentations
- present 1 to 2 advanced topics per week to the critical care
pharmacy group (see attached Resident and Student Curriculum
document)
- present at least one or two journal club articles per month to the critical care pharmacy group
- participate in one or two multidisciplinary in-services per month given to respective ICU team
- discussion of selected readings from current literature
Evaluation:
PGY1 pharmacy residents will be evaluated according to the Residency Learning System evaluation for Critical Care based on the Educational Outcomes and Goals listed above. In addition, there will be four weekly “snapshot” evaluations.
Critical Care Resident and Student Curriculum April 2006
Core Topics (2-3 per week as open discussion; no specific order)
General |
Acute Coronary Syndromes (ACS) |
ARDS |
Endocrine (hyperglycemia; adrenal insufficiency) |
Shock States / Hemodynamic Cases (ongoing) |
Hemodynamic Review (including Oxygen Delivery Principles) |
Hypertensive Crisis |
ICU Infections (general) |
Pneumonia (CAP – HAP – VAP) |
Sedation, Analgesia, and Neuromuscular Blockade |
Sepsis |
Stress-related Mucosal Injury |
Thromboembolic Disease/Prevention |
|
|
Medical |
Surgical |
CHF |
Abdominal Compartment Syndrome |
COPD; Asthma; Restrictive Lung Disease |
Aortic Dissection |
DKA/HHS |
Spinal Cord Injury (SCI) |
Liver Insufficiency/Failure |
Surgical Anatomy |
|
Traumatic Brain Injury (TBI) |
|
Advanced Topics (1-2 per week as discussion or resident/student presentation) |
Acid/Base Balance |
Acute Renal Failure |
Arrhythmias (Atrial v. Ventricular) |
Autoimmune Diseases (e.g., IBD; RA; Sarcoidosis) |
Endocrine Abnormalities |
Hematologic Diseases |
Infectious Diarrhea |
Nutrition Support |
Opportunistic Infections |
Pleural Disorders |
Sodium and Water Homeostasis |
Toxicology |
Journal Club (1-2 articles per month as resident/student presentation)
Critical Care Team In-service (1-2 per month as resident/student presentation)
Internal Medicine
Rotation/Location:
Internal Medicine – University Hospital
Preceptor(s):
Jamie Chapman, PharmD............................................................................pager: 513-585-9924 ext. 0303
........................................................................................................................................513-584-1064
Outcomes/Goals:
For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.
R1.5, R2.1, R2.2, R2.4, R2.6, R2.7, R2.8, R2.9, R2.10, R2.11, R2.12, R3.1, R5.1, R6.1
Overview:
The Internal Medicine (IM) clinical pharmacist provides direct patient care through participation in interdisciplinary rounds and individual pharmacy rounds for 6 inpatient internal medicine services. The pharmacist also follows patients in/on associated medicine areas and services through census review, targeted drug lists, and nursing or physician communication. General evaluations include, medication profile review, renal dosing, pharmacokinetic dosing, intravenous to enteral conversions, appropriateness of antibiotic therapy and length of therapy, drug interactions, and clarification of home medications.
Activities/Assignments:
The pharmacy resident will be present Monday-Friday. The start time for attending rounds is 0800 per attending preference. Morning work rounds (with assigned medicine service) begin each morning at 0700 or earlier as required for the individual resident to fulfill patient care responsibilities. Medical grand rounds are held on Tuesdays at 1200, and the pharmacy resident is encouraged to attend. The resident is directly responsible for their medicine service patients as outlined in the above information and the rotation’s residency standards. This will be measured through scheduled afternoon sessions with the preceptor to present patients and complete necessary patient and service follow-up. Topic discussions between the preceptor and pharmacy resident will be held on a routine basis as the educational goals and needs of the individual resident are realized.
The pharmacy resident will also be assigned to: present one to two journal club articles to the clinical pharmacy group; present at least two 10-15 minute topics to specific medicine service; present at least two specific topic discussions to the pharmacy group; participation in any applicable research projects, MUEs, residency project; and complete other service and patient-related assignments as dictated by service or preceptor.
Miscellaneous:
The inpatient medicine service team is composed of: a teaching attending physician, one senior medical resident, two PGY1 medical residents, and several medical students.
Evaluation:
PGY1 pharmacy residents will be evaluated according to the Residency Learning System evaluation for Internal Medicine based on the Educational Outcomes and Goals listed above. Also taken into consideration will be preparedness for topic discussions, motivation and initiative in learning, timeliness in meeting deadlines, communication skills, and professionalism.
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