Pharmacy Residency Curriculum

Curriculum

Required Focused Experience Rotations

Pharmacy Administration

The Pharmacy Administration rotation allows the resident to become an integrated member of the pharmacy leadership team. During this rotation, residents have an opportunity to work with pharmacy administration, hospital leadership, clinicians, and nurses. At a minimum, the pharmacy resident will be exposed to CMS accreditation standards, State and Federal pharmacy regulations, staff management, hospital formulary processes, medication shortage management, medication safety, pharmacy operations, budget and resource management, leadership principles, goal and objective setting, performance metrics, and process improvement principles.

Infectious Disease/Antimicrobial Stewardship

Infectious Disease / Antimicrobial Stewardship Antimicrobial Stewardship Services have become an essential part of preserving the efficacy of this pharmaceutical class. This rotation will monitor the daily use of antimicrobials by prospective audit of orders by using the Epic computer systems. Other responsibilities include review of bug/drug mismatches, empiric choices based on indication, narrowing of antimicrobials based on microbiological susceptibilities, and giving feedback to providers on proper choices. The resident will also spend time in the microbiology laboratory, perform drug usage evaluations on antimicrobial use, perform literature review for proper development of antimicrobial use guidelines/order sets, and dose antimicrobials using proper pharmacokinetic/pharmacodynamic parameters and Bayesian forecasting software. Development of the antibiogram may also be part of the resident experience.

Internal Medicine/Decentralized Pharmacy Practice

The Internal Medicine / Decentralized Pharmacy Practice rotation allows the resident to become a member of the decentralized pharmacy clinical team. Residents will have the opportunity to provide patient care to internal medicine patients while rounding with the Central Michigan University Internal Medicine team. Clinical pharmacy services encountered will include but are not limited to: antimicrobial and anticoagulant dosing/monitoring, medication renal adjustments, discharge medication review, medication order verification, and acting as a source of drug information for other healthcare professionals on the multidisciplinary team.

Medical ICU

Medical ICU During the Medical ICU rotation, the resident will gain experience caring for critically ill patients while working toward being responsible for the care of an entire medical ICU. The resident can expect to see a diverse patient population with a variety of disease states such as: infectious diseases, septic shock, respiratory failure, hepatic diseases, alcohol withdrawal syndrome, gastrointestinal hemorrhage, and renal failure. The resident will round daily with the multidisciplinary team, which includes the medical intensivist, advanced practice providers, nurses, respiratory therapists, and a dietician. Most of this rotation will be spent providing direct patient care but will also include topic discussions, provider education, and guideline/protocol development to align with the goals of the resident. If desired, all efforts will be made to provide an opportunity to assist in precepting a student from the Ferris State University College of Pharmacy while on rotation.

Emergency Medicine

Our practice in the Emergency Department (ED) at Covenant HealthCare is focused on optimizing patient care and outcomes through pharmacotherapeutic interventions for admitted and discharged patients. Our ED projects and goals include demonstrating benefits and improved patient care outcomes related to pharmacist intervention and implementation of institutional ED specific policies and protocols. The ED at Covenant HealthCare is a 65-bed unit that sees approximately 6,500 patients each month. Our ED includes three level II trauma bays and eight rooms that serve primarily as a fast-track area. Additionally, we are an accredited pediatric and geriatric emergency care center. We assist in the care of all critically ill patients, including those with acute cardiac arrest, stroke, myocardial infarction, sepsis, and toxicological emergencies. Furthermore, our practice is dedicated to improving antimicrobial stewardship in the ED setting and includes a pharmacist-led culture follow up program under a collaborative practice agreement. Our ED is affiliated with Central Michigan University’s College of Medicine and Emergency Medicine Physician Residency programs. Pharmacy residents will interact with a variety of ED healthcare providers, including physicians, residents, medical students, pharmacy students, and nurses while caring for ED patients with acuities ranging across the spectrum.

Ambulatory Care

This required ambulatory care rotation provides patient care experience in services such as cardiology, oncology, and other outpatient specialties. Residents will also focus on developing clinical services with an emphasis on creating sustainable pharmacy services.

Elective Rotations

Pharmacy Informatics

Pharmacy Informatics The Pharmacy Informatics rotation allows the resident to become an integrated member of the pharmacy IT (Epic Willow) team. During this rotation, residents have an opportunity to work with pharmacy administration, hospital leadership, clinicians, nurses and IT analysts. At a minimum, the pharmacy resident will have the opportunity to develop basic understanding of the role and responsibilities of a Willow Analyst, Computerized Prescriber Order Entry (CPOE), pharmacy order entry, Barcode Medication Administration (BCMA), Automated Dispensing Systems (ADS), Electronic Medical Records (EMR), IT governance, system interfaces, clinical decision support and the hospital’s formulary process.

Ambulatory Care

In addition to the required ambulatory care experience, residents can elect to complete a focused rotation to further develop their skills. This elective provides additional patient care experience in ambulatory care services based on the resident’s interest. Residents will also focus on developing clinical services with an emphasis on creating sustainable pharmacy services.

Cardiovaascular ICU (CVICU)

This rotation entails providing pharmaceutical care as well as daily rounding with the multidisciplinary cardiovascular intensive care unit (CVICU). The CVICU is a 14-bed unit with patients presenting with acute coronary, cardiogenic shock and heart failure, also including cardiothoracic surgery patients with CABG, LVAD, TAVR, and/or valve replacements. The resident will round in the CVICU starting at 9:30am with the team, including the critical care physician, advanced practice practitioner, nurse, and respiratory therapist. The resident will provide all clinical pharmacy services for the unit. Also, the resident will be providing anti-thrombotic clinical services and have significant exposure to anti-arrhythmic and vasoactive medications.

Nephrology

During the Nephrology rotation, the resident will care for all the hemodialysis patients within the hospital. The resident will be responsible for all kinetic dosing for the hemodialysis patients. Depending on patient volumes, scope of care may be extended to other stages of chronic kidney disease. Multiple topics will be covered during the rotation, including chronic kidney disease, hemodialysis, acute kidney disease, continuous renal replacement therapy, drug removal via hemodialysis, anemia and mineral and bone disorder. Much of the rotation will be spent providing direct patient care, but will also include topic discussions, provider education, and guideline/protocol development to align with the goals of the resident.

Nutrition

The Nutrition rotation allows the resident to collaborate with other healthcare providers to make optimal decisions on nutritional support for a diverse adult in-patient population. Residents will collect information to design a patient-centered nutritional regimen. Focus will be on parenteral nutrition and should allow residents to become proficient in prescribing and monitoring parenteral nutrition.

Neonatal ICU

The Neonatal rotation allows the resident to work closely with the neonatal team to provide care for premature infants born with a variety of disease states. The resident will round daily with providers to gain knowledge of common disorders and treatments. The resident will provide medication-related information and develop paths to optimize medication utilization in this practice environment.

Pain Management/Palliative Care

The Pain Management/Palliative Care rotation allows residents to collaborate with providers and the palliative care team to provide optimal pain management for patients. Residents will become familiar with various formulations of opioids and their morphine equivalencies. Residents will become familiar with multi-modal pain management and will be able to help design/tailor a patient-specific pain management plan.

Oncology

The Pharmacy Oncology rotation allows the resident to become an integrated member of the ambulatory cancer care team. During this rotation, residents will have opportunities to work with oncologists, nurses, and other clinicians/specialties. At a minimum, the pharmacy resident will be involved in focused patient care as it relates to oncology treatment planning, key regimens/disease states, supportive care, patient counseling and follow-up, and navigating outpatient payor criteria. Additionally, the resident will attend tumor board conferences, participate in QI projects as applicable, participate in and lead topic discussions, and administer a patient case presentation.

Anticoagulation

The Anticoagulation rotation allows the resident to gain experience in the role of anticoagulation stewardship pharmacist. During this rotation, the resident will undertake the dosing of antithrombotic regimens, reversal of anticoagulation, review of rare hematologic disease states, and optimization of hospital processes to avoid drug-related adverse events.

Pediatrics/PICU

The Pediatric rotation allows the resident to become a member of the pediatric team, which includes the general pediatric and pediatric ICU units. The resident will interact with team members, including dieticians, nurses, physical therapists, physicians and social workers to provide direct patient care and clinical services. Services include pharmacokinetics, TPN, asthma education, new diabetes patient regimen initiation and family-oriented education like smoking cessation. The resident will also attend pediatric trauma rounds, pediatric quality meetings and participate in a pediatric QA project.

Other

Other elective learning experiences may be developed based on resident interest, preceptor availability, and established pharmacy services. Residents may also elect to extend a rotation by two weeks and/or choose from a selection of truncated (2-week) rotations for one 4-week block of their residency year.