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School of Medicine
Program Type: ASHP accredited PGY 1 Residency
ASHP Match Number: 176813
Purpose: The purpose of The Johns Hopkins Hospital Post-Graduate Year 1 (PGY1) Pharmacy Residency is to prepare pharmacists to practice as highly qualified independent practitioners able to provide patient care in a variety of environments, apply skill in medication related education, serve as leaders within the profession of pharmacy, and excel during further post-graduate training.
Program Overview: The PGY1 Pharmacy Residency is a 12-month postgraduate curriculum that offers training opportunities in acute care, ambulatory care, drug information and drug use policy development, clinical services and practice leadership. Our residents will have the opportunity to provide pharmaceutical care to patients in multiple settings, develop independent learning skills, maintain a professional ethic, provide effective drug education to others, understand research methods and opportunities, recognize the principles and application of drug use control, and assume personal responsibility for effecting change. A wide range of elective rotations are available, allowing residents to purse individual goals as well as complete core rotations. Upon completion of the ASHP accredited program, individuals are awarded a residency certificate.
- Internal Medicine (1 month)
This rotation is designed to provide residents with a broad training experience in managing acutely ill internal medicine patients admitted for diverse and complex medical management. The goal of this rotation is for residents to develop the skills and competencies in pharmaceutical care in the area of inpatient internal medicine, enabling them to effectively participate in therapeutic decision making, drug therapy selection, monitoring of acutely ill patients and discharge counseling. The active involvement of residents in screening patients' medication profiles for potential problems involving dosing, drug allergies, drug interactions, intravenous compatibilities and medication response, in addition to monitoring antibiotic therapy and any medication that requires additional laboratory monitoring, will help assure high quality patient care.
- Integrated Practice Rotation ( 3 months)
The Integrated Practice Rotation is a 3 month block experience within one of the pharmacy divisions - critical care, pediatric, oncology, or adult medicine pharmacy division. During this 3 month experience, residents are expected to provide patient-care services within the division’s established team-based/integrated model of care. The resident will be exposed to and expected to perform a variety of roles and responsibilities of a pharmacist practicing in this model. This may include, but is not limited to: attending and actively participating in patient care rounds with the multi-professional team, performing order review and verification for assigned patients, participating in program-oriented services (such as: anticoagulation, therapeutic drug monitoring, readmission reduction and transition of care programs, or others), providing drug information and education, participating in patient safety initiatives, or performing any other functions expected of a pharmacist within the assigned division.
Leadership Collaborative Rotation (1 month)
The Leadership Collaborative Rotation (LCR) is a monthly collaborative experience required during the PGY1 residency that incorporates three areas of practice. Through this rotation residents gain experience regarding the medication-use process, medication safety, drug information and an understanding of administrative, management, and leadership principles within a large teaching and research-oriented hospital and health-system. The focus of this rotation includes such areas as practice leadership, drug policy, medication safety, operations, pharmaceutical outcomes, clinical and investigational drug services.
- One of the following Critical Care rotations ( 1 month)
- Cardiovascular Critical Care
This rotation is designed to allow residents to develop proficiency in the provision of pharmaceutical care to patients encountered in the specialized area of cardiovascular critical care medicine. The resident will be expected to build on the basic knowledge gained during other patient care rotations, while focusing intensively on the patients' cardiac and critical care issues. The resident will accomplish this by interacting with the interdisciplinary medical team during patient rounds and educational conferences, providing direct patient care through drug regimen reviews and by developing an understanding of the current application of drug therapy to various cardiovascular disease states encountered during rotation.
- Medical Intensive Care
The medical intensive care (MICU) offers provides the residents with the opportunity to provide pharmaceutical care to the critically ill medical patient. The resident will join the interdisciplinary MICU team and will be directly involved with and responsible for drug selection, dosing, and monitoring. The patient population encountered frequently includes patients with multi-organ failure and complex medical problems. The resident will develop skills in the management of infectious diseases and the application of pharmacokinetics.
- Surgical Intensive Care
There are two general surgical intensive care units: the Surgical ICU (SICU) and the Weinberg ICU (WICU). A rotation in either of these units enables the resident to provide care to critically ill surgical patients. In the SICU, patient populations primarily include trauma, abdominal organ transplant (kidney, liver, and pancreas), gastrointestinal surgery, and vascular surgery. In the WICU, patient populations primarily include gastrointestinal surgery, gynecologic oncology surgery, surgical oncology and endocrinology, urology, and otolaryngology. The resident will be a part of the ICU team, participating in daily patient care rounds to provide pharmacotherapy recommendations and drug information. Daily patient case discussions and frequent topic discussions will occur. The resident will develop skills in the management of infectious diseases, the application of pharmacokinetic principles, and various concepts in surgical critical care.
Neurosciences Critical Care
- The neurosciences critical care unit (NCCU) is a 24 bed intensive care unit consisting of approximately 70% neurosurgical and 30% neurological critical care patients. The rotation is designed to expand on basic knowledge and clinical abilities gained on previous rotations, and to enhance the residents critical thinking skills. The resident will join the interdisciplinary team on daily rounds and be intimately involved with the optimization of drug therapy in this specialized patient population. In addition, residents are expected to provide educational services to the team through a variety of forums. Patient care discussions are held daily, and numerous critical care topic discussions are performed throughout the rotation. Disease states commonly encountered in the NCCU include: hemorrhagic stroke, ischemic stroke, hydrocephalus, brain tumor, traumatic brain injury, spinal cord injury/disorders, status epilepticus, epilepsy, guillain barre, and myasthenia gravis. In addition to a specialized focus on the neurosciences, the resident will gain experience in more general critical care concepts such as: sedation, paralysis, fluids/electrolytes, nutrition support, pharmacokinetics, hemodynamics, invasive monitoring, multi-system organ failure, infectious diseases, and mechanical ventilation.
- Cardiac Surgical Intensive Care
The cardiovascular surgical intensive care unit (CSICU) is an 18 bed unit that provides care for patients undergoing cardiovascular surgery. Typical surgical procedures include heart and lung transplant, ventricular assist device implantation, extracorporeal membrane oxygenation, coronary artery bypass grafting, and cardiac valve repair/replacement. Patient care responsibilities are divided between two medical teams. Daily patient care activities include pre-rounding on all patients and then daily rounds with the interdisciplinary team. The resident will thoroughly evaluate medication related issues and present recommendations to the team, with follow-up for unresolved issues. After rounds, the resident will evaluate new admissions to the unit, review transfer orders, and meet with the preceptor for patient and literature review
- Cardiovascular Critical Care
- Ambulatory Care (6 months)
A unique feature of the program is the longitudinal nature of this rotation. This feature gives the resident the opportunity to develop continuity within a given site and to establish relationships with patients and medical providers.The goal of the longitudinal ambulatory care rotation is for the resident to develop expertise in the medication therapy management of chronic disease states commonly encountered in the outpatient setting. The disease states include, but are not limited to; hypertension, hyperlipidemia, diabetes, asthma, heart failure, dementia, coagulopathy, obesity and nicotine addiction. Residents develop the necessary knowledge and skills to provide quality direct patient care in pharmacist lead drug therapy and disease management clinics facilitated through collaborative physician-pharmacist relationships. Clinical experiences include hematology, anticoagulation, general internal medicine and geriatric internal medicine. Residents also assess the need for patient education, lifestyle modification reinforcement, appropriate inhaler use and technique, insulin titration or instruction and adherence with drug therapy plans. They will gain experience as a resource to clinicians by providing drug information, monitoring drug therapy for efficacy, completing cost comparisons, and making recommendations for potential alternative regimens to achieve optimal patient outcomes.Residents will choose two 3 month ambulatory care clinic experiences. The resident will participate in the clinics for half a day, every other week for each 3 month timeframe that they have chosen. The resident will work with the same preceptor, in the same clinic, on the same weekday during each 3 month clinic experience. There will be a midpoint evaluation at one and a half months and a summative evaluation at the end of each 3 month experience.
- Adult Hematologic Malignancies
The hematologic malignancy service is responsible for providing care for those patients diagnosed with acute and chronic leukemia, myelodysplastic syndrome, Hodgkin's and Non Hodgkin's lymphoma, and myeloma. These services may include induction, consolidation, or salvage chemotherapy as well as supportive care. In addition to learning about hematologic malignancies, the resident will gain experience in immunocompromised infectious diseases and some critical care. The service is composed of an attending physician, one to two oncology fellows, one medical resident, one medical intern, a charge nurse, social worker, dietician, and a clinical pharmacy specialist. The resident will attend daily rounds and is responsible for assuring appropriateness of drug therapy for individual patients and making recommendations. Additionally the resident is expected to be a drug information resource for the team. The resident will review the patients with the preceptor daily. Additional rotation activities include topic discussions, participation in patient education of chemotherapy regimens, adverse drug effects, and discharge medications. Residents may have other activities including pharmacy and nursing in-services or small projects.
- Infectious Disease
The Infectious Diseases rotation provides an opportunity for residents to gain insight in the management of infectious diseases and antimicrobial utilization. The resident will be working with the general infectious disease consult team and antimicrobial management program. They will be expected to attend daily rounds. The objective of this rotation is to develop problem-solving skills in infectious disease therapy and establishment of a firm knowledge base in infectious disease pharmacology and pharmacokinetics.
- Infectious Disease /Antibiotic Management Program
This rotation provides an opportunity for residents to gain insight in the management of infectious diseases and antimicrobial utilization. The resident will be working with the general Infectious Diseases (ID) consult team and Antimicrobial Management Program (AMP). They will also be expected to assess appropriates of antimicrobial therapy for assigned patients on daily basis, attend daily rounds with ID team and ID conferences. The objective of this rotation is to develop problem-solving skills in infectious disease therapy and establishment of a firm knowledge base in infectious disease pharmacology and pharmacokinetics.
- Inpatient HIV Service
The inpatient HIV service, also referred to as the “Polk” service, is a primary medical team led by an infectious diseases (ID) attending. Patients admitted to the Polk service range from those with advanced HIV presenting with an opportunistic infection to well controlled HIV patients admitted for acute care issues. The service also admits non-HIV patients with complicated infectious diseases. This rotation will provide an opportunity for residents to gain insight into the management of patients with HIV/AIDS across the entire spectrum of the disease. The resident is responsible for assessing the appropriateness of all HIV and non-HIV related pharmacotherapy for all patients admitted to the Polk service. The resident will serve as an essential member of the interdisciplinary ID team and will attend daily ID conferences. During this rotation, the resident should be able to develop solid problem-solving skills and establish a firm knowledge base in antiretroviral therapy as well as treatment of opportunistic infections and other complications of HIV.
- Neonatal Intensive Care
The Neonatal Intensive Care Unit (NICU) is a level-4 nursery with at 45-bed capacity. The majority of patients are premature infants, who may acquire a variety of unique disease states during their lives. The resident will be assigned to work closely with the medical team and attend daily work rounds. The goals of the rotation are to have the resident gain experience and proficiency for the pharmaceutical care of NICU patients. This will involve building the resident's knowledge on common NICU disorders and related therapies as well as related drug information resources. In addition, the resident will develop problem-solving skill in this patient population through a variety of patient care experiences.
The purpose of this rotation is to have residents gain experience and proficiency for the pharmaceutical care of general pediatric patients. This will involve building the resident's knowledge on general pediatric disorders and related therapies and drug information resources. In addition, residents will develop problem-solving skills in this patient population through a variety of patient care experiences. Residents will be working with the pediatric house staff team on a daily basis and attend work rounds each morning.
- Pediatric Infectious Diseases
This rotation will provide an opportunity for the resident to develop a knowledgebase of infectious diseases unique to the pediatric/neonatal population. The resident will gain experience with antimicrobial dosing in this patient population, as well as experience with pharmacokinetics. The resident is responsible for assessing all aspects of antimicrobial therapy for patients followed by the pediatric ID consult service, rounding with the consult team on a daily basis, and attending standing ID meetings. The resident is also expected to serve as a resource for drug information questions. Residents will work on developing their critical thinking skills through daily patient care activities, and will also work on presentation skills through various inservices/presentations that will be provided to the medical/pharmacy staff.
- Pediatric Intensive Care
The Pediatric Intensive Care Unit (PICU) is a 26-bed tertiary care unit that serves as the regional trauma unit for children in the Baltimore area. The age range of patients includes newborns up to older adolescents. Common diagnoses include trauma, postoperative, medical, and critically ill oncologic patients. The major goals of this rotation are to have the resident gain experience and proficiency in the pharmaceutical care of PICU patients. This will involve building the resident's knowledge on common PICU disorders and related therapies, as well as related drug information resources. In addition, the resident will develop problem-solving skills in this patient population through a variety of direct care experiences.
- Pediatric Nutrition Support
The goal of this rotation is for the resident to experience the pharmacists role on the team and to develop an appreciation for the multidisciplinary approach to patient care with respect to metabolic support. In turn, the rotation provides the resident perspective in viewing the full scope of pharmacy services relating to a pediatric patient's nutritional support in addition to the compounding and dispensing functions. The rotation also allows the resident to experience a variety of clinical therapies from a multidisciplinary point of view. Emphasis will be placed on developing the resident's communication skills in the field of nutrition support while tailoring the experience to the resident.
By the end of the rotation, the resident should be able to assess and evaluate a pediatric patient's nutritional status, participate in therapeutic decision-making, and monitor the patient's nutritional support. This rotation is intended to provide the resident with the basic tools needed to understand, rationally discuss, and continue self-study in pediatric nutritional support.
- Pediatric Emergency Medicine
- The service is responsible for the care of acutely ill pediatric patients within the department. During the rotation, residents will gain knowledge and experience in the management of acutely ill pediatric patients. This involves developing a systematic approach to obtain pertinent patient information, building the resident’s knowledge of common pediatric disease states and Peds ED disorders, and drug information references. The resident will be responsible for obtaining relevant patient information and developing evidence-based therapeutic plans for patients. In collaboration with the care team, the resident will work to provide care and will serve as the drug information resource. Lastly, the residents will be actively involved in critical care and trauma situations by providing assistance with medication selection, preparation, and dosing.
- Adult Emergency Medicine
The Emergency Medicine service is responsible for providing care for those patients in the Adult Emergency Department, and Emergency Acute Care Unit. During this rotation, pharmacy residents are expected to gain knowledge regarding the management of common emergency medicine disease states, which include a blend of critical care, internal medicine, and ambulatory care. Residents are expected to collect relevant information from the electronic medical record and patient interviews in order to develop evidence-based therapeutic plans for emergency department patients. Pharmacy residents will also be actively involved in all critical care situations, including all medical and trauma resuscitation, by providing assistance with medication selection, preparation and dosing. In addition, pharmacy residents will serve as a drug information resource for the interdisciplinary healthcare team.
- Pharmacy Informatics
This rotation includes the care and feeding of Pharmacy information technology systems in an academic medical center. The resident gains experience with implementing healthcare computer projects, drug-use policy, investigational services, pharmacy operations, clinical and decentralized pharmacy services, human resources, finance, and budget activities through the use of appropriate technologies. Previous residents completing this rotation have implemented a hand held documentation system for clinical practice, worked on the Pharmacy web site, and served on the Project team for the successful implementation of the current Provider Order Entry system.
The psychiatry elective rotation offers the resident an opportunity to work closely with team members and patients focusing in the following specialty areas: Schizophrenia, Bipolar disorder, Depression, Anxiety disorders, Eating disorders, Alzheimer’s Disease/Dementia, Parkinson’s Disease, and Alcoholism/Dual Diagnosis and Substance Abuse. Residents also have the opportunity to attend cognitive behavioral therapy (CBT) groups, schizophrenia teaching rounds, and psychiatry grand rounds and observe electroconvulsive (ECT) therapy, psychiatric consult service and the psychiatry emergency department. The resident will join the interdisciplinary team on daily rounds and be intimately involved with the optimization of drug therapy in this specialized patient population. The resident will participate in a variety of activities, including patient medication education groups and education to other healthcare providers. In addition to psychiatric care, the resident will also be responsible for managing patients’ somatic care. Patient care and topic discussions are held daily with preceptors. A detailed calendar will be provided to the resident prior to the start of their rotation.
- Medication Quality and Outcomes
The rotation is designed to give the resident practical experience in data management, analysis, interpretation of results, and use of data to effect practice change. The resident will have direct exposure to and gain competency in Stata data management and analytic software. There will also be an emphasis of integrating strong design principles to design more meaningful and influential displays of data (i.e., graphs and tables). The resident will become directly involved in ongoing projects at the Center for Medication Quality and Outcomes. Depending on timing, this could include involve contributing to the design, conduct, analysis, interpretation of results, and/or presentation of results of ongoing projects. It is also likely the resident will gain exposure to the writing and publication process in the peer-reviewed medical literature. Additionally, the resident will gain exposure at the Johns Hopkins Bloomberg School of Public Health (SPH) in the form of lectures, symposia, projects, and/or Center for Drug Safety and Effectiveness events (Dr. Shermock is Associate Director of this Center at the SPH). Lastly, time will be allocated to make progress on the resident’s own project(s).
- Investigational Drug Service (IDS)
The goal of this rotation is to understand the role and contributions of the Investigational Drug Service (IDS) in the context of the Department of Pharmacy, The Johns Hopkins Hospital and the Johns Hopkins University School of Medicine and Bloomberg School of Public Health. IDS directly dispenses for many drug studies, sets up studies in pharmacy satellites, and audits drug storage, labeling, and record keeping for studies where the investigator holds the drug. The AIDS Clinical Trials Group (ACTG) pharmacist is part of IDS. The resident will gain an understanding of the new drug development process, learn about regulations concerning the dispensing of investigational drugs, the pharmacist's role on the IRB, and become familiar with the daily operations of a pharmacy-based investigational drug service.
- Abdominal Organ Transplant
The abdominal organ transplant rotation will expose the resident to the inpatient care of adult patients receiving an abdominal (kidney, pancreas, or liver) transplant. The learning experience will allow the resident to become familiar with immunosuppressant pharmacotherapy as well as medical and surgical issues that affect transplant patients. The resident will attend morning rounds and discharge planning rounds daily with the multidisciplinary transplant team. The resident will perform medication reconciliation upon patient admission and patient medication teaching prior to patient discharge. Daily patient care discussions will be held with the preceptor. Potential disease states and topic discussions covered during the learning experience may include, but are not limited to, induction and maintenance immunosuppression, management of the incompatible transplant recipient, prevention and treatment of infection in an immunocompromised host including hepatitis B and C, acute cellular rejection, antibody mediated rejection, and common recurrent diseases after kidney or liver transplant.
- Blood and Marrow Transplant
The Myeloma, Transplant, and Lymphoma (MTL) service is primarily responsible for providing care to patients that are in the process of receiving or who have received an autologous or allogeneic hematopoietic stem cell transplant. Patients with multiple myeloma or lymphoma are also admitted to this service. The resident will gain experience managing infectious diseases in immunocompromised patients, providing supportive care to patients undergoing chemotherapy, and providing patient education. The resident will be responsible for attending daily rounds, monitoring drug therapy, and providing drug information to the medical team. The resident will meet with the preceptor daily to discuss patients and will cover topic discussions routinely.
- PAIN AND PALLIATIVE CARE
The Pain and Palliative Care learning experience will provide the resident with the opportunity to focus on providing optimal pain and symptom management to patient populations on either the Neurosciences Pain Resource Team or Oncology Pain and Palliative Care Service. The experience will provide an opportunity for residents to gain insight in acute and chronic pain management, symptom management, opioid dosing and equianalgesic conversions. The resident is responsible for assessment of patients’ analgesic regimen with regard to efficacy and adverse effects. The resident will be interacting with patients and caregivers on a daily basis and communicating with the patients’ primary service.
- ADVANCED HEART FAILURE AND HEART TRANSPLANTATION
The Advanced Heart Failure and Heart Transplantation Rotation focuses on the optimization of drug therapy in this specialized population. The resident will join the interdisciplinary team on daily rounds. Patient care discussions are held daily, and numerous applicable topic discussions are performed throughout the rotation. Disease states and therapeutics commonly encountered on the HF/HT service are of both medical and surgical varieties, including, but not limited to the following: advanced heart failure, hemodynamics, inotropic support, mechanical circulatory support, heart transplantation, immunosuppression, and pathology related to heart transplantation. In addition, the resident will gain experience with concepts including: pharmacokinetics, infectious diseases of the immunocompromised host, thrombosis and hemostasis.
- MEDICATION SAFETY
During the Medication Safety rotation, the resident will work closely with the Medication Safety Team to gain experience with various methodologies used to measure medication-use safety, participate in the application of technologies that improve the medication-use process, learn and apply methods to promote a culture of safety, and analyze complex systems to identify and correct system flaws. The pharmacy’s medication safety team have hospital-wide responsibilities for identifying and helping to resolve medication use system flaws that endanger patients. System flaws are identified by reviewing reported medication errors, by proactively evaluating medication use processes, by reviewing the literature for reports of errors that have occurred elsewhere, and by searching for and implementing “best practices”.
- TRANSPLANT NEPHROLOGY
This rotation will expose residents to kidney and pancreas transplant recipients who are more than six months post-transplant and admitted for inpatient care. The resident will gain experience managing a variety of disease states in this population including complications related to long-term immunosuppressive pharmacotherapy. The resident will be expected to closely follow patient drug therapy, actively participate in daily multidisciplinary rounds, and serve as a drug information resource to the team.
- Link to the application information:
Cathy L. Walker, B.S. Pharm
Title: Assistant Director, Education and Training
Education: B.S. Pharmacy, Philadelphia
College of Pharmacy and Science, 1985
Training: Pharmacy Practice Residency,
Children’s Hospital National Medical Center,
Washington D.C., 1986.
Cathy Walker is the Assistant Director, Education and Training, for the Department of Pharmacy at the Johns Hopkins Hospital. She is the Residency Program Director for the PGY1 Pharmacy residency, and serves as the Residency Program Coordinator for all of the Hopkins residency programs. Ms. Walker received her pharmacy degree from the Philadelphia College of Pharmacy and completed her Pharmacy Practice residency at the Children’s National Medical Center, Washington, DC.
Ms. Walker is active in the Eastern States Conference for Pharmacy Residents and Preceptors, serving on the Advisory Board and as the Conference Chair in 2008. She is committed to pharmacy education and is a member of the Notre Dame University of Maryland Experiential Education Advisory Board. She is a past member of the Preceptor Development Section Advisory Group of the American Society of Health System Pharmacists and the UHC Research and Education Committee. The Department of Pharmacy is an accredited ACPE provider, for which Ms. Walker is the Continuing Education Administrator.
Ms. Walker has been the recipient of the Maryland Society of Health-System Pharmacists’ Pharmacist of the Year award. Prior to moving into pharmacy administration, Ms. Walker practiced as a pediatric pharmacist and nutrition support pharmacist, where she served as preceptor for numerous pharmacy students and residents.
Cathy L. Walker, B.S. Pharm
Assistant Director, Education and Training
Department of Pharmacy
The Johns Hopkins Hospital
600 North Wolfe Street / Carnegie 180
Baltimore, Maryland 21287-6180
Phone: (410) 614-4377