Transcript PGY2 Pharmacy Residency Program

A SUCCESSFUL RESIDENCY PROGRAM
AT NY- PRESBYTERIAN HOSPITAL:
7TH YEAR
Liz G. Ramos, BS, PharmD, BCPS
Clinical Manager
Critical Care/Infectious Diseases
NY-Presbyterian Hospital Weill Cornell Medical Center
NY-PRESBYTERIAN HOSPITAL
• 2,400 bed tertiary care teaching hospital
• Comprised of two of the nation's most
prestigious medical centers
– Columbia University Medical Center
– Weill Cornell Medical Center
How To Have A Successful
Residency Program?
• PHARMACY DEPARTMENT SUPPORT
• RESIDENCY PROGRAM DIRECTOR
• PRECEPTORS
– Rotations available
• FUNDING $$
– ASHP Accreditation
– Salary
– Recruitment
NewYork-Presbyterian Hospital
The University Hospitals of Columbia and Cornell
Intended Residency Outcomes
After completion of the New York-Presbyterian Hospital
Pharmacy Residency, the individual will fulfill the
following:
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Assume responsibility for providing optimal and
comprehensive patient care in multiple care
environments.
Demonstrate the aptitude needed for leadership and
management of pharmacy practice.
Provide appropriate and timely medical information to
health care professionals, patients and the community.
Demonstrate a commitment to building the skills
necessary for professional development.
PGY-1: Rotations
• Required Rotations •
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(32 weeks Total)
Orientation & Training
Drug Information*
Internal Medicine
Critical Care
Infectious Diseases
Pediatrics
Practice Management
Ambulatory Care
* 6 weeks
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Elective Rotations
(12 weeks Total)
Ambulatory Care
Burn Unit
Emergency Medicine
HIV/AIDS
Investigational Drugs
Neonatal Intensive Care
Nutrition Support
Oncology/BMT
Pediatric Critical Care
Pediatric Oncology/BMT
Solid Organ Transplantation
(heart, lung, liver, kidney, pancreas)
NewYork-Presbyterian Hospital
The University Hospitals of Columbia and Cornell
Residency Learning System
• “The residents training will be designed,
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conducted, and evaluated using a systemsbased approach”
Following the RLS Is a Means to Meeting 4
Principle Requirements (PGY1)
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4.1
4.2
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Program Design
Program Delivery
Program Evaluation and Improvement
Tracking of Graduates
“SHAPING” THROUGH
FEEDBACK
Perform task
Decision to
modify
performance
in specific
way
Feedback
received
Feedback related to previous performance
THE LEARNING PYRAMID
Preceptor’s Role
Culminating
Integration
Facilitating
Coaching
Practical Application
Modeling
Foundation Skills and Knowledge
Direct
Instruction
Preceptor Qualifications
• NYS licensed
• Routinely practice in that area
• Complete preceptor orientation
• PGY-1
AND
– One of the following:
• PGY1 + PGY2 + 6 mos experience
• PGY1 + 1 year experience
• 5 years experience
• PGY-2
– One of the following:
• PGY1 + PGY2 + 1 year experience
• PGY1 + 3 years experience
• 5 years experience
Clinical Managers
(NY Weill Cornell Center)
• Drug Information
• Internal Medicine
• Medical Critical Care/
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• Maria Dubs, PharmD
• Olga Hilas, PharmD, BCPS
Infectious Diseases
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Critical Care - CTICU
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Nutrition Support
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Oncology/BMT
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Pediatrics
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Residency Program
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Solid Organ Transplantation,•
Renal
Liz G. Ramos, PharmD, BCPS
Regina Lee, PharmD, BCPS
Marc Roth, MS, RPh
Cindy Ippoliti, PharmD
Elena Mendez-Rico, PharmD
Adrianne Hewryk, PharmD
Demetrio Tappets, PharmD
Clinical Managers
(Columbia University Medical Center)
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Drug Information
Infectious Diseases
Infectious Diseases
Infectious Diseases
Medical Critical Care
NeuroCritical Care
Oncology/BMT
Pediatric Critical Care
Pediatric Oncology
Pediatrics, General
SOT, Cardiac/Lung
SOT, Liver
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Martha Rumore, PharmD
Greg Eschenauer, PharmD, BCPS
Christine Kubin, PharmD, BCPS
Kelly O’Neill, PharmD, BCPS
Amy Dzierba, PharmD, BCPS
Christine Lesch, PharmD, BCPS
Lillian Chou, PharmD
Enrico Ligniti, PharmD
Ibis Lopez, PharmD
Jason Topolski, PharmD
Thresiamma Lukose, PharmD
Stacey Balducci, PharmD
NewYork-Presbyterian Hospital
The University Hospitals of Columbia and Cornell
Design and Conduct of the Residency Program
Structure of Learning Experiences - Longitudinal
• Service Commitment
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Distribution Functions
Drug Information
Pharmacokinetic Monitoring
Continuation of Clinical Services
AOC liaison
NewYork-Presbyterian Hospital
The University Hospitals of Columbia and Cornell
Program’s Assessment Strategy
Evaluation Process
Learning Experience
Preceptor
Resident
Criteria-based
Checklists (2)
Criteria-based
Checklists (2)
Self-Evaluation
Summative
Evaluation
Summative
Self-Evaluation
Preceptor &
Learning Experience
RESITRAK – Evaluations…
RESITRAK – Evaluations…
RESITRAK – Evaluations…
Learning Experience
Preceptor Evaluation
NewYork-Presbyterian Hospital
The University Hospitals of Columbia and Cornell
Evaluation Process
• Residency Activity Committee
 Membership
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Director, Drug Use Policy and Acquisition
Residency Program Directors
4 Preceptors from New York Weill Cornell Center
4 Preceptors from Columbia Presbyterian Center
 Role
 Set time for Current Resident’s input
 Review Quarterly Evaluations
 Review Effectiveness of Residency Program
 Resident Evaluation
 Preceptor Evaluation
 Recommend Modifications to the Program
NewYork-Presbyterian Hospital
The University Hospitals of Columbia and Cornell
Structure of Learning Experiences - Longitudinal
 Medication Use Evaluation
 Darbepoetin, Aminoglycosides, Levofloxacin, IVIG, Eplerenone, Caspofungin,
Warfarin, Enoxaparin, Rifaximin, Daptomycin, Polymyxin B, CMV-IGIV,
Compliance Surgical Px, Conivaptan, Fondaparinux and HIT, De-escalation from
Zosyn, Hypoglycemia and sulfonylureas
 Research Project
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A Retrospective Review: Combination Antifungals in the Treatment of Invasive Aspergillosis
Development & Implementation of a PK monitoring Service
Comparison of a Continuous Insulin Infusion Protocol versus Sliding Scale Insulin in the ICU
Defining the management of post-operative nausea & vomiting in the post-anesthesia care unit
Retrospective review of the clinical, microbiological, and mortality endpoints of nosocomial candidemia before and after the
availability of caspofungin and voriconazole
Erythropoetin in the intensive care unit
A randomized, open-label study to compare C2 v.s. C0 monitoring of cyclosporine microemulsion on the incidence and severity
of rejection in kidney, liver, and heart transplant recipients
Effect of steroid-sparing immunosuppressive regimens on the morbidity and mortality of renal transplant patients infected with
Hepatitis C
Evaluation of the Sepsis Guidelines
Review of the outcomes in invasive aspergillosis in patients treated with combination versus monotherapy at New York Weill
Cornell Center and Columbia University Medical Center
Efficacy of palifermin for mucositis in hematopoietic stem cell transplant recipients
Timing to initiation of appropriate antifungal therapy
Antiretroviral medication errors in hospitalized patients
Inhaled epoprostenol use in acute respiratory distress syndrome
Impact of BK viremia and viruria in stem cell transplantation recipients
Clinical and microbiological outcomes in patients receiving tigecycline for infections due to multi-drug resistant organisms
Use of low-dose valganciclovir in high-risk renal transplant recipients
Minimizing cardiovascular risk among renal transplant recipients
PGY-2 Residencies: 2007
• PGY-2 Critical Care
– Program Director: Amy Dzierba, PharmD, BCPS
• PGY-2 Infectious Diseases
– Program Director: Christine Kubin, PharmD, BCPS
• PGY-2 Transplant
– Program Director: Thresiamma Lukose, PharmD
PGY-2 Residencies: 2007 (Cont’d)
• PGY2 Pharmacy Residency Program
• Duration: 12-months
• Positions: 1
• Starting Date:
July 1, 2009
• Estimated Stipend:
$50,000
• Interview Required: Yes
PGY-2 Critical Care Rotations…
• Required Rotations:
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Medical Intensive Care - Columbia
Surgical Intensive Care
Neurosciences Intensive Care
Cardiothoracic Intensive Care
Medical Intensive Care - Cornell
• Elective Rotations:
– Burn Intensive Care
– Infectious Diseases
– Coronary Care
– Emergency Medicine
– Solid Organ Transplant
(heart, lung, liver, kidney, pancreas)
– Neonatal Intensive Care
– Pediatric Intensive Care
– Nutrition Support
4 weeks
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2-4 weeks
2-4 weeks
2-4 weeks
YEAR
Name
PGY2 Residency Employer
2003
2004
2005
Theresa Lukose
SOT
NYP - CM SOT (Lung)
Anne McDonnell
Jeong Kim
Heme/Onc - UNC
B&W Hospital – CS -H/O
NYP, Staff Pharmacist
Anastacia Balducci
Bernard Lee
Simon Lam
Joni Maeda
SOT – Univ Cinn
CC – Mayo Clinic
Heme/Onc - JH
NYP - CM SOT (Liver)
NYP - CM – Gen Peds
NYP - CM – SICU
Hawaii MC – CP- Onc
HIV/ID – Univ Buff
UCSF – CP – Renal Tx
GSH – CP - IM
SFGH – CP – Med/Surg
Univ of MD - Faculty
2006
2007
2008
2009
Christine Borromeo
Hema Kothari
Amy Logan
Neha Sheth
Yanina Dubrovskaya
Jerry Hu
Rachel Tavares de Melo
Demetrio Tappets
ID – NYP
NYU – CP – ID
HSS – Staff Pharmacist
SOT – NYP
SOT – NYP
NYP - CM SOT (Renal)
Jessica Campaign
Maabo Kludze-Forson
Christine H. Paeng
Shazia A. Raheem
CC - NYP
Univ NM – Faculty
St Joseph’s – CP
NYP – Lead Rph – ED
NYP – CM – NeuroICU
Monique Bryan
Soonali Maniar
Leandra Miko
May Nguyen
SOT – NYP
ID - NYP
Recruitment…
NYPH – Pharmacy Website…
http://nyp.org/pro/pharmacy/index.html
Pharmacy Residency: PGY-1
http://nyp.org/pro/pharmacy/pgy1.html
Pharmacy Residency: PGY-2
http://nyp.org/pro/pharmacy/pgy2.html
Funding- NYPH Residency
Programs
• In 2003, the Centers for Medicare & Medicaid (CMS)
reaffirmed their support for Pharmacy Practice
Residency programs by continuing to support
Medicare1
• It is the “industry norm” for hospitals to generally
hire only pharmacists who have completed a
pharmacy practice residency to work directly in
patient care1
• CMS views “hospital pharmacy” as a “specialty” of
the pharmacy profession1
Reg. Sec. 413.85(e)
Funding- NYPH Residency Program
(Cont’d)
• Pharmacy Practice Residency program is eligible to receive
payment for the following:1
– The clinical training costs incurred for the program
– Classroom costs, but only those costs incurred by the provider for the
courses that were included in the programs
• The net costs of approved educational activities
– Determined by deducting, from the total cost incurred by the hospital
for these activities, any revenues the hospital receives from grants or
tuition
• Hospital’s total cost includes trainee stipends, compensation for
preceptors and residency directors, and other direct and
indirect costs of the activities as determined under Medicare
cost-finding principles2,3
1. Reg. Sec. 413.85(iii)
2. Miller DE, Woller TW. Understanding reimbursement for pharmacy residents. Am J Health-Syst Pharm. 1998; 55:62-5.
3. Cortese Annecchini LM, Letendre DE. Funding of pharmacy residency programs-1996. Am J Health-Syst Pharm. 1998; 55:1618-9.
Conclusion
• PHARMACY DEPARTMENT SUPPORT
• DEDICATED PRECEPTORS
• FUNDING
– ASHP Accreditation
– Salary
– Recruitment
THANK YOU !!