PGY1 Pharmacy Practice
Milwaukee Veterans Affairs Medical Center Post Graduate Year One (PGY-1) Pharmacy Residency
Milwaukee Veterans Affairs Medical Center Post Graduate Year One (PGY-1) Pharmacy Residency. The Clement J. Zablocki VA Medical Center offers a post graduate year one (PGY1) residency that is accredited by the American Society of Health Systems Pharmacists (ASHP). The program offers a well-balanced pharmacy experience in both ambulatory and acute care settings which prepares residents for all aspects of pharmacy practice. The program is flexible to meet the career goals of each resident. In addition to the PGY-1 program, the Milwaukee VA also offers PGY-2 residencies in infectious diseases, internal medicine, medication use safety, and psychiatry.
Unique to VA system, pharmacists gain prescriptive authority in certain areas of expertise. After completing a thorough anticoagulation training program, pharmacists have authority to prescribe warfarin and other anticoagulant medications for veterans. Service commitment activities include anticoagulation monitoring on extended care floors and nursing home chart reviews. In addition, residents are involved in our pharmacokinetic service.
During the residency year, residents will learn skills to effectively outline and perform medication use evaluations. Throughout the course of this one-year program, residents will further develop drug information, administrative, time management and organizational skills to aid in the practice of pharmacy. Verbal and written communication skills will be enhanced. In addition, residents will be required to design, conduct, and complete a research project throughout their residency year. This research project should be suitable for publishing. Project proposals are reviewed by the Medical Center’s Research department and deemed research (which requires Investigational Review Board (IRB) approval) or process improvement (which is exempt from IRB). Final results are then presented at the Pharmacy Society of Wisconsin (PSW) Educational Conference in April.
The ZVAMC PGY1 Program has a strong commitment to the ensuring that the PGY1 experience is customized to meet the future career goals of the resident. To demonstrate that commitment, PGY1 residents are allowed to tailor the length of their rotations, required and elective, to best match the interests of the resident and what needs the resident has to achieve those future career goals. Each rotation has a defined number of weeks in the experience from which the resident may choose. A minimum number of weeks reflects what the Program believes to be adequate to understand the practice setting and achieve related rotation goals and objectives. A maximum number of weeks provides the full breadth and scope of the experience without turning the residency into a PGY2 program. Some rotations also have a defined moderate experience number of weeks.
For example, a resident interested in pursuing a PGY2 or career in ambulatory care may choose to maximize the amount of weeks spent in Primary Care, choose to do electives in Endocrine and Women’s Health, while doing a minimal number of weeks in Critical Care. A co-resident may choose to spend more time in General Medicine, Critical Care, and an Elective in Nutrition, while spending fewer weeks in ambulatory rotations. Some residents will maximize the amount of time spent in required rotations, doing minimal electives, while others will choose to have more rotations that are shorter in length.
Consideration is also given to schedule the rotations in which residents have the most interest early in the residency year. It is important that residents have that exposure up front prior to considering future career goals and/or PGY2 residencies. Residents’ interests may be fluid throughout the residency year, and at times changes are made to the residency schedule during the year based on newfound interests. This is the main reason that ZVAMC has limited its PGY1 class size. Having a smaller class allows for more flexibility in rotation scheduling, ensuring that the resident gets the rotations he or she desires, when most imperative to have them.
As a result, no two residents will have the same rotation schedule; no two residents will have the same residency experience. The ZVAMC experience is about meeting the needs of the resident and their future path in Pharmacy.
The philosophy of the Milwaukee VA Residency Program is to meet the personal and professional goals of the residents while providing pharmaceutical care to the patients. Elective rotations may be completed in various specialty areas. Residents have the option to repeat a prior required rotation at an advanced level or choose from a variety of new experiences (see list below).
Opportunities include advanced experiences in any of the required rotations or:
Residents have several longitudinal responsibilities throughout the residency year. Some of these responsibilities shift among the residents on a monthly basis while others are continuous responsibilities for all residents throughout the residency year. Training for each activity takes place with a clinical pharmacist during the orientation period.
Extended Care/Spinal Cord Anticoagulation Service: Pharmacy residents play a key role in this service. Residents and staff clinical pharmacists monitor patients on the extended care and spinal cord services for complete anticoagulation care. This includes prescribing and adjusting anticoagulation medications, ordering labs, providing education to patients, and arranging follow-up appointments upon discharge.
Prior Authorization Drug Requests (i.e. non-formulary review): Pharmacy residents are involved in the process of reviewing prior authorization drug requests entered by providers. The resident will receive the request, determine if the request meets criteria for use of the medication, approve or deny the consult, and communicate the decision to the provider. Participation in this process enhances residents' decision making, communication and negotiation skills.
Geriatrics Evaluation and Management (GEM) rounds & chart reviews: Residents rotate the responsibility of attending GEM rounds. GEM rounds are interdisciplinary and take place once per week (2 hours). Residents also complete monthly chart reviews for GEM patients.
Drug information: Throughout the year residents are resources for drug information for providers, pharmacists and other staff.
Hospital Committee Involvement
Residents routinely participate in a variety of Medical Center Councils and Committees. A sampling of these groups provides a wide overview of activities while participating in other groups all year, such as the Pharmacy, Nutrition, and Therapeutics (PNT) Council, and allows residents to observe the process from start to finish. The resident will also participate in the Drug Safety Subcommittee and will participate in patient safety initiatives throughout the year.
University of Wisconsin School of Pharmacy Responsibilities: The Milwaukee VA is the coordination site for all University of Wisconsin (UW) pharmacy students assigned to clerkships in the Milwaukee area and pharmacy residents play a key role in their training. Resident responsibilities throughout the year include organizing a weekly seminar series, independently grading drug inquiries and project presentations and leading pharmacy student orientation sessions. Residents also evaluate and grade case presentations along with other clinical pharmacy staff. During the later part of the residency year, residents have opportunities to help precept students. Residents receive training by UW and VA staff on all aspects of these UW responsibilities. Residents are appointed to adjunct faculty positions at UW in addition to receiving an additional stipend for their extensive involvement with these students. In addition to working with UW pharmacy students, residents also have opportunities to interact with student from other colleges of pharmacy.
Medical College of Wisconsin School of Pharmacy Responsibilities: Residents are required to help coordinate four labs (six if they are completing the teaching certificate).
Teaching Certificate: Residents have the opportunity to participate in programs at the Medical College of Wisconsin and Concordia University where they can gain additional experience in teaching and earn a specialized teaching certificate.
Staffing (weeknight staffing experience)
PGY1 residents will be scheduled for one weeknight staffing shift per week. The hours for this experience will be 1630 to 2000. The day of the week assigned will rotate throughout the year as equitably as possible. This experience will start about one month into the residency program and residents must be licensed as a pharmacist prior to starting this responsibility. The responsibilities during the staffing experience will evolve over the course of the year. Residents will start with outpatient staffing experiences which will include filling, checking prescriptions, processing prescriptions, counseling patients and answering phones. Inpatient experiences will occur later in the year which will include preparation, processing and checking of unit dose and IV medications, troubleshooting phone calls to the IV room, and performing PK and anticoagulation monitoring. The goal is that the resident will progress over the course of the year in order to function as a central pharmacist in either outpatient or inpatient pharmacy in an independent manner by the end of the year. Quarterly feedback will be provided to residents and pharmacy staff for this experience. Residents must report to the lead pharmacist during each shift and if leave is needed this must be communicated with the lead pharmacists (if day-of leave is needed) and the inpatient pharmacy supervisor and the RPD.