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Non-traditional Flex PGY1 Pharmacy Residency Program
Program Type: PGY-1 program over a two year period
ASHP Match Number:
Purpose: The Non-traditional/Flex PGY1 Pharmacy Residency is committed to providing participants with the skills and knowledge to be highly qualified independent practitioners able to provide pharmaceutical care in various environments. They shall be responsible for drug therapy outcomes as an integral member of the multi-disciplinary health care team. Such pharmacists will be able to develop their own personal plan for professional development. They will be able to teach other professionals and patients about drugs. Pharmacists completing this program will be capable of conducting their practice with a high level of maturity and leadership, and be able to perform practice-related projects.
Program Overview: In this two-year program, residents will fulfill the same requirements as traditional PGY1 residents, including completion of eleven required rotations, a drug use evaluation, a major research project, five months of clinic experience, participation in the on-call program, and presentations at Pharmacotherapy Rounds, Resident Report, and the Eastern States Resident and Preceptor Conference.
- Drug Information
The goal of the Drug Information rotation is to offer pharmacy practice residents the experience of providing drug information services in a health-system organization. These services include receiving and answering drug information requests, reviewing medications for formulary inclusion, participating in various medication use policy programs, and educating hospital staff about the safe and effective usage of medications. Additionally, the resident will be exposed to a variety of information technology applications within the health system and gain an understanding of how these systems impact the medication use process. Upon completion of this rotation, the participant should be able to describe and understand the systematic approach to answering drug information requests, formulate appropriate and efficient information retrieval strategies, interpret and apply the biomedical literature to patient-specific pharmacotherapy, and communicate drug information responses clearly, both orally and in writing. Additionally, the resident should be able to understand the concepts involved in formulary management, drug policy development, adverse drug reaction reporting, and medication use evaluations.
- Internal Medicine
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.
- Pharmaceutical Care
In this rotation, residents will be responsible for coordinating daily work activities aimed at drug distribution and drug therapy management in their practice area. Responsibilities include computer order entry, supervision of support personnel, reviewing medication profiles, providing drug information, implementing pharmacotherapy and monitoring patient regimens. These activities entail substantial involvement with patient education and frequent interaction with other health care providers.
- Practice Leadership
This rotation fosters understanding of administrative, management and leadership principles within a large teaching and research-oriented hospital and health-system. The focus of the rotation includes practice leadership, drug policy, operations, pharmaceutical outcomes, medication safety, clinical and investigational drug services.
Concepts include organizational structure and design, quality improvement, performance goals and objectives, performance evaluation and improvement. The resident will become familiar with leadership roles within a large academic medical center. This is accomplished through active participation in leadership committees and projects impacting various and divisions.
One of the following Critical Care rotations
- 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 rotation offers residents an opportunity to develop comprehensive knowledge and skills necessary to meet the specific needs of the critically ill patient with multi-organ failure. The resident will be an integral member of the multidisciplinary critical care teams covering the units. The resident will develop competencies in the areas of critical care pharmacology, fluid and electrolyte balance, cardiovascular hemodynamics and ventilator support through direct patient care involvement and active participation in therapeutic decision making, drug therapy selection and appropriate dosing and monitoring using a multidisciplinary team approach to patient care.
- Surgical Intensive Care
A rotation on this unit allows residents to work with the medical team to provide care for patients with multi-system organ failure. Patient populations include abdominal organ (renal, pancreas, liver) transplant, trauma, GI and vascular surgery. The resident will have the opportunity to round with the team and provide drug information and therapeutic drug monitoring education both in daily rounds and in-service formats. Residents are expected to be familiar with interpretation of common lab values, general pharmacokinetic principles and general information about specific disease states. Residents will be evaluated based on improvement and mutually agreed upon areas of concentration.
- Neurosciences Critical Care
The neurosciences critical care unit (NCCU) is a 22 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 resident’s 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 CSICU is an 18 bed unit that provides care for patients undergoing cardiac surgery. The unit census typically runs 10-15 patients. 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 and review of patient transfer orders prior to discharge from the unit. After rounds, the resident will follow up on unresolved issues from rounds, review patient records and evaluate new admissions to the unit, review transfer orders, and meet with the preceptor for patient and literature review.
- 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.
- Ambulatory Care
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 through pharmacist-managed, physician-directed drug therapy and disease management clinics. 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 compliance with drug therapy plans. They will gain experience as a resource to clinicians by providing drug information, monitoring parameters for efficacy, completing cost comparisons and making recommendations for potential alternative regimens to achieve optimal patient outcomes.
- Cancer Pain Service
The cancer pain service rotation experience will focus on providing pharmaceutical care and appropriate pain management to both inpatient and outpatient oncology patients. It is a multidisciplinary consult team that screens and assesses adult inpatients on a daily basis. The resident will have the opportunity to participate in the service's weekly multidisciplinary case conference. In addition to gaining skills in assessing pain, the resident will also develop expertise in designing individual pain regimens and performing opioid equianalgesic conversions.
The HIV/AIDS rotation provides an opportunity for the resident to gain insight into the general management of HIV/AIDS and related opportunistic infections and complications. Residents will be expected to attend daily patient rounds and ID conferences. They also will be expected to conduct literature searches for participation in topic discussions and formulate responses to drug information requests.
- 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.
- 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 Disease
This rotation provides an opportunity for developing proficient skills in providing pharmaceutical care in pediatric infectious diseases. Activities include evaluating the pharmacotherapy of common pediatric infections; serving as the drug information and therapeutic drug monitoring resource for the consult service; and integrating and applying the elements of pharmaceutical care by contributing to the Pediatric ID consult service.
- 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 Oncology
The pediatric oncology service is responsible for providing care to pediatric patients (newborn – 21 years old) with solid tumors, hematologic malignancies and those patients receiving a hematopoietic stem cell transplant. This rotation will allow the resident to gain experience and knowledge in pediatric malignancies, immunocompromised infectious diseases and supportive care. The resident will also gain a better understanding of the basic fundamentals of pharmacotherapy in the pediatric patient. The resident will work closely with the multidisciplinary team in patient care decision making and will serve as the drug information resource for the team.
- Adult Emergency Medicine
The Emergency Medicine service is responsible for providing care for those patients in the Adult Emergency Department, Urgent Care, and Emergency Acute Care Unit. During this rotation, pharmacy residents are expected to gain and apply knowledge of the empiric treatment of emergency medicine disease states and monitor therapeutic regimens for effectiveness and adverse effects. Residents are expected to perform chart reviews and patient interviews/assessment in order to effectively evaluate medication management. The pharmacy resident will also be exposed to and actively involved in all “code” situations, including all patients seen in critical care and trauma scenarios. Residents will have the opportunity to build knowledge base in both medication preparation and dosing recommendations in critical situations. This rotation provides a blend of critical care medicine responsibilities and review of internal medicine disease states and their pharmaceutical needs.
- 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.
- Pharmaceutical Outcomes and Policy
The rotation is designed to give the resident a basic understanding of pharmacoeconomics and health services research as they relate to medication use policy. The rotation will have a strong didactic component which will require the resident to complete several readings and discussions on research methods, statistics, cost-benefit analysis, health economic analysis and current health policy issues. Practice experience is gained through participation in projects designed to optimize policy decisions for the organization.
- 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.
The transplant rotation will expose residents to kidney, liver and pancreas transplantation. They are expected to become familiar with immunosuppressant pharmacotherapy as well as medical and surgical issues that surround a transplant patient. The resident will attend daily morning rounds with the multidisciplinary transplant team. There will be daily discussions with the preceptor regarding the patients.
- Blood and Marrow Transplant
The adult blood and marrow transplant (BMT) service is responsible for providing care to patients undergoing BMT for hematologic malignancies. In addition, the service also includes management of patients undergoing routine therapy or supportive care for acute and chronic leukemia, Hodgkin’s and Non-Hodgkin’s lymphoma, myelodysplastic syndromes, and multiple myeloma. The resident will gain experience managing infectious disease in immunocompromised patients, and some critical care. 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. Additional rotation activities will include patient education and discharge coordination, and a nursing in-service during the month.
All applications will be accepted through PHORCAS
Special Requirements for Application Process:
Must be a licensed pharmacist possessing a Pharm.D. degree from an ACPE accredited college of pharmacy or equivalent degree, performing overall job standards at a proficient level and employed by The Johns Hopkins Hospital Department of Pharmacy for at least six months. Applicants will apply and participate in the ASHP matching process. Applicant’s current Department of Pharmacy supervisor will be required to serve as one of the applicant’s references to attest to the applicant’s level of proficiency.
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