Pharmacy Residency Program: Primary Care

PGY-2 Ambulatory Care Pharmacy Residency

Summary:

This post-graduate second year residency in Ambulatory Pharmacy Practice is a flexible, directed postgraduate program of clinical experience in outpatient settings.  Through structured rotations, the second year resident will gain a broad range of experience within an academic health-system. This dynamic and expanding area of practice provides clinical services to a diverse group of ambulatory patients.  What sets this residency apart is its flexibility and continuity of care.  The pharmacist will treat ambulatory patients in a variety of setting and clinical complexity.  In addition, the curriculum is flexible and allows the pharmacist to pursue specific interests that best complement their career goals.  This is achieved by choosing from a variety of core and elective clinical rotations that are structured to build upon previous learning experiences.

The pharmacist will participate in the direct care of two groups of patients: those with new onset disease with comprehensive educational needs and those patients with chronic, long-standing uncontrolled disease.  In all settings, patients are scheduled to physically see the pharmacist.  The interventions made in collaboration with the primary care provider, may include: initiating and modifying therapy, ordering labs, providing patient education, and teaching the use of medical devices.  Physical assessment and triaging skills will be used routinely.  Preceptors and/or attending physicians are always available for consultation.

Clinical expertise in other subspecialty areas will be developed through elective rotations in additional specialized clinic settings. Other opportunities for the resident include the development and implementation of a clinical pharmacy service, precepting Doctor of Pharmacy students and first year residents and professional advocacy through state and national associations.

The application process is initiated in the fall, with an intended start date of the following July.  Participants in the program will receive a stipend from the Department of Pharmacy for work completed within the residency.

Objectives:

Pharmacists completing this residency will be competent, autonomous providers of direct patient care in multidisciplinary environments.  They will demonstrate effective listening and communication skills.  They will use their knowledge of Primary Care literature and triage to appropriately and safely care for patients.  They will demonstrate professionalism and leadership when interacting with colleagues and patients.  These pharmacists will combine the above skills to effectively educate their patients and other health care workers.

Training Areas:

The pharmacist will spend a majority of their time in a pharmacist-managed, physician directed, adult internal medicine clinic which serves patients with multiple, chronic medical problems (e.g. endocrine, cardiovascular and pulmonary).  Direct patient care activities in this setting will be emphasized. Elective practice settings will provide the pharmacist the opportunity to provide direct patient care to ambulatory patients in the following areas: asthma, anticoagulation, hyperlipidemia, smoking cessation, hypertension, osteoporosis and related women’s health issues, preventative health care, diabetes and others.

The pharmacist will also be an integral member of an independent outpatient pharmacy and be involved with the acute to ambulatory transition among these patients. At The Johns Hopkins Outpatient Pharmacies (JHOP), there are 5 pharmacies in and around The Johns Hopkins and Bayview Hospitals.  The pharmacist will actively participate with the medical house staff and Department of Pharmacy colleagues throughout the year. They will also gain skill in advocating for their patients in managed care and private insurance systems to maintain high quality care in a world of restrictive formularies and policies.

Oral and written communication skills are emphasized through active participation in staff development activities (pharmacy, nursing, medical), ambulatory lectures given in conjunction with the attending physician at the clinic on common chronic ambulatory care disease states, weekly pharmacy resident report and therapeutic discussions with an inpatient internal medicine service.

Teaching skills are refined through association with University of Maryland.  In addition to experiential contact with pharmacy students, the specialty resident with interact on a regular basis with the JHH PGY-1 residents.  There are also didactic and small group availabilities at the University of Maryland.  The resident will formulate and answer a research question, using the scientific method, with a strong emphasis on outcomes and pharmacoeconomics and present their research findings at the Eastern States Residency Conference. The research project should be completed in a publishable form.

Content of the Residency Program:

The PGY-2 Ambulatory Care Residency will be based on the knowledge, skills and abilities (KSA’s) required for an expert level of clinical practice in the primary care arena.  Goals are general, broad statements about the KSA’s expected of program graduates.  Sometimes referred to as outcome competencies, goal statements convey the philosophical base upon which the educational objectives are built.  Educational objectives (terminal and enabling) specify observable, measurable behaviors.  Terminal objectives are the basis for objectively assessing resident performance.  The terminal objectives listed under each goal specify behaviors that ensure goal mastery and therefore are formally evaluated by the residency.

The PGY-2 Ambulatory Care Residency Program at The Johns Hopkins Hospital utilizes the Residency Learning System (RLS) developed and supported by the American Society of Health-System Pharmacists.  Goals, educational objectives, terminal and enabling objectives for the program are available in a separate document.  ResiTrak, the new web-based residency tracking system will be used to assist in the administration of RLS.

Summary of Residency Rotations and Training:

Other Operational Issues:

** Due to the longitudinal nature of this residency these time blocks tend to be extremely variable and will be determined based on the resident’s interests and plan for development.

For additional information about the operation of this residency, please refer to the operations sections of the Pharmacy Practice Residency manual.  Pay particular attention to meetings, resident plan for development, evaluation methods, pharmacy practice (staffing), on call clinical service, education requirements, travel, communication skills, research program, DUE, newsletter, and lead resident.

Qualifications:

Candidates must:

• have completed the Doctor of Pharmacy (Pharm.D.) degree from an ACPE accredited college or university.
• have completed a PGY-1 Pharmacy Practice Residency.  Candidates without a pharmacy practice residency, but with significant professional experience, will be evaluated on a case-by-case basis.
• be licensed, or eligible for licensure in the State of Maryland.
• meet minimum academic, work experience, leadership, presentations, publications, community service, letters of reference and letter of intent requirements.

Program Completion:

Upon completion of the program requirements participants will be awarded an ASHP accredited PGY-2 Ambulatory Care Residency certificate from The Johns Hopkins Hospital Department of Pharmacy

Program Director:

Jeffrey Brewer, Pharm.D., BCPS
Clinical Specialist, Primary Care
Clinical Assistant Professor, University of Maryland School of Pharmacy

Education: Pharm.D., University of Maryland School of Pharmacy

Training: ASHP accredited general pharmacy practice residency, Lakeside VA Chicago
Primary care specialty residency, University of Pittsburgh Medical Center

Practice Area: Primary Care Adult Internal Medicine

Research interests: Medication therapy management, cardiac risk factors, and residency training programs

Faculty:

Susan Arnold, Pharm.D.
Faculty: Primary Care Pharmacy Practice
Clinical Specialist - Primary Care
Clinical Assistant Professor, University of Maryland School of Pharmacy
Clinical Assistant Professor, Howard University School of Pharmacy

Education: Pharm.D., Medical College of Virginia, BS Engineering, Virginia Tech

Training: Primary care specialty residency, University of Maryland

Practice Area: Primary Care Adult Internal Medicine

Research Interests: Disease state management, patient outcomes, diabetes, hyperlipidemia

Peggy Kraus, Pharm.D., CACP
Clinical Pharmacy Specialist, Anticoagulation Management Service
Clinical Assistant Professor, University of Maryland School of Pharmacy

Practice Area: Anticoagulation management Inpatient and Outpatient Service

Research Interests: Anticoagulation

Brian Pinto, Pharm.D.
Clinical Specialist, Drug Information
Clinical Assistant Professor, University of Maryland School of Pharmacy

Education: Pharm.D. Auburn University

Training: ASHP accredited primary care specialty residency, The Johns Hopkins Hospital

Practice Area: Primary Care Adult Internal Medicine

Research interests: Diabetes, Pharmacoeconomics and Drug Policy Management

Patricia A. Ross, Pharm.D., BCPS
Clinical Specialist, Primary Care
Clinical Assistant Professor, University of Maryland School of Pharmacy

Education: Doctor of Pharmacy; Shenandoah University, Bernard J. Dunn School of Pharmacy

Training:
Pharmacy Practice Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Primary Care Specialty Residency, The Johns Hopkins Hospital, Baltimore, Maryland

Practice Area: adult internal medicine

Research Interests: hypertension, diabetes, pharmacy education