A SUCCESSFUL RESIDENCY PROGRAM A SUCCESSFUL RESIDENCY PROGRAM AT NY- PRESBYTERIAN HOSPITAL: AT NY- PRESBYTERIAN HOSPITAL: 7 7 TH TH YEAR YEAR Liz G. Ramos, BS, PharmD, BCPS Liz G. Ramos, BS, PharmD, BCPS Clinical Manager Clinical Manager Critical Care/Infectious Diseases Critical Care/Infectious Diseases NY-Presbyterian Hospital Weill Cornell Medical NY-Presbyterian Hospital Weill Cornell Medical Center Center
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A SUCCESSFUL RESIDENCY PROGRAM AT NY- PRESBYTERIAN HOSPITAL: 7 TH YEAR
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A SUCCESSFUL RESIDENCY A SUCCESSFUL RESIDENCY PROGRAM AT NY- PRESBYTERIAN PROGRAM AT NY- PRESBYTERIAN
HOSPITAL: HOSPITAL: 77THTH YEAR YEAR
Liz G. Ramos, BS, PharmD, BCPSLiz G. Ramos, BS, PharmD, BCPSClinical Manager Clinical Manager
NY-Presbyterian Hospital Weill Cornell Medical CenterNY-Presbyterian Hospital Weill Cornell Medical Center
NY-PRESBYTERIAN HOSPITALNY-PRESBYTERIAN HOSPITAL
• 2,400 bed tertiary care teaching 2,400 bed tertiary care teaching hospitalhospital
• Comprised of two of the nation's Comprised of two of the nation's most prestigious medical centersmost prestigious medical centers– Columbia University Medical Center Columbia University Medical Center – Weill Cornell Medical CenterWeill Cornell Medical Center
How To Have A Successful How To Have A Successful Residency Program? Residency Program? • PHARMACY DEPARTMENT SUPPORTPHARMACY DEPARTMENT SUPPORT
• RESIDENCY PROGRAM DIRECTORRESIDENCY PROGRAM DIRECTOR
• PRECEPTORSPRECEPTORS– Rotations availableRotations available
NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell
Intended Residency OutcomesIntended Residency OutcomesAfter completion of the New York-Presbyterian After completion of the New York-Presbyterian
Hospital Pharmacy Residency, the individual will Hospital Pharmacy Residency, the individual will fulfill the following:fulfill the following:
• Assume responsibility for providing optimal and Assume responsibility for providing optimal and comprehensive patient care in multiple care comprehensive patient care in multiple care environments.environments.
• Demonstrate the aptitude needed for leadership Demonstrate the aptitude needed for leadership and management of pharmacy practice.and management of pharmacy practice.
• Provide appropriate and timely medical Provide appropriate and timely medical information to health care professionals, information to health care professionals, patients and the community.patients and the community.
• Demonstrate a commitment to building the Demonstrate a commitment to building the skills necessary for professional development. skills necessary for professional development.
NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell
Residency Learning SystemResidency Learning System• ““The residents training will be designed, The residents training will be designed,
conducted, and evaluated using a conducted, and evaluated using a systems-based approachsystems-based approach””
• Following the RLS Is a Means to Meeting 4 Following the RLS Is a Means to Meeting 4 Principle Requirements (PGY1)Principle Requirements (PGY1)– 4.1 Program Design4.1 Program Design– 4.2 Program Delivery4.2 Program Delivery– 4.3 Program Evaluation and Improvement4.3 Program Evaluation and Improvement– 4.4 Tracking of Graduates4.4 Tracking of Graduates
“SHAPING” THROUGH FEEDBACK
Perform task
Feedback received
Feedback related to previous performance
Decision to modify performance in specific way
THE LEARNING PYRAMID
Preceptor’s Role
Foundation Skills and Knowledge
Practical Application
Culminating Integration
DirectInstruction
Modeling
Coaching
Facilitating
Preceptor QualificationsPreceptor Qualifications• NYS licensedNYS licensed• Routinely practice in that areaRoutinely practice in that area• Complete preceptor orientation Complete preceptor orientation
ANDAND• PGY-1PGY-1
– One of the following:One of the following:• PGY1 + PGY2 + 6 mos experiencePGY1 + PGY2 + 6 mos experience• PGY1 + 1 year experiencePGY1 + 1 year experience• 5 years experience5 years experience
• PGY-2PGY-2– One of the following:One of the following:
• PGY1 + PGY2 + 1 year experiencePGY1 + PGY2 + 1 year experience• PGY1 + 3 years experiencePGY1 + 3 years experience• 5 years experience5 years experience
NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell
Design and Conduct of the Residency ProgramDesign and Conduct of the Residency Program
• Service Commitment Service Commitment – Distribution FunctionsDistribution Functions– Drug InformationDrug Information– Pharmacokinetic MonitoringPharmacokinetic Monitoring– Continuation of Clinical ServicesContinuation of Clinical Services– AOC liaisonAOC liaison
Structure of Learning Experiences - Longitudinal
NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell
NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell
Director, Drug Use Policy and AcquisitionDirector, Drug Use Policy and Acquisition Residency Program DirectorsResidency Program Directors 4 Preceptors from New York Weill Cornell Center4 Preceptors from New York Weill Cornell Center 4 Preceptors from Columbia Presbyterian Center4 Preceptors from Columbia Presbyterian Center
RoleRole Set time for Current Resident’s inputSet time for Current Resident’s input Review Quarterly EvaluationsReview Quarterly Evaluations Review Effectiveness of Residency ProgramReview Effectiveness of Residency Program
Recommend Modifications to the ProgramRecommend Modifications to the Program
NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and The University Hospitals of Columbia and CornellCornell
Medication Use EvaluationMedication Use Evaluation Darbepoetin, Aminoglycosides, Levofloxacin, IVIG, Eplerenone, Darbepoetin, Aminoglycosides, Levofloxacin, IVIG, Eplerenone,
Caspofungin, Warfarin, Enoxaparin, Rifaximin, Daptomycin, Polymyxin Caspofungin, Warfarin, Enoxaparin, Rifaximin, Daptomycin, Polymyxin B, CMV-IGIV, Compliance Surgical Px, Conivaptan, Fondaparinux and B, CMV-IGIV, Compliance Surgical Px, Conivaptan, Fondaparinux and HIT, De-escalation from Zosyn, Hypoglycemia and sulfonylureasHIT, De-escalation from Zosyn, Hypoglycemia and sulfonylureas
Research ProjectResearch Project A Retrospective Review: Combination Antifungals in the Treatment of Invasive AspergillosisA Retrospective Review: Combination Antifungals in the Treatment of Invasive Aspergillosis Development & Implementation of a PK monitoring ServiceDevelopment & Implementation of a PK monitoring Service Comparison of a Continuous Insulin Infusion Protocol versus Sliding Scale Insulin in the ICUComparison of a Continuous Insulin Infusion Protocol versus Sliding Scale Insulin in the ICU Defining the management of post-operative nausea & vomiting in the post-anesthesia care unit Defining the management of post-operative nausea & vomiting in the post-anesthesia care unit Retrospective review of the clinical, microbiological, and mortality endpoints of nosocomial candidemia before Retrospective review of the clinical, microbiological, and mortality endpoints of nosocomial candidemia before
and after the availability of caspofungin and voriconazoleand after the availability of caspofungin and voriconazole Erythropoetin in the intensive care unitErythropoetin in the intensive care unit A randomized, open-label study to compare C2 v.s. C0 monitoring of cyclosporine microemulsion on the A randomized, open-label study to compare C2 v.s. C0 monitoring of cyclosporine microemulsion on the
incidence and severity of rejection in kidney, liver, and heart transplant recipientsincidence and severity of rejection in kidney, liver, and heart transplant recipients Effect of steroid-sparing immunosuppressive regimens on the morbidity and mortality of renal transplant Effect of steroid-sparing immunosuppressive regimens on the morbidity and mortality of renal transplant
patients infected with Hepatitis Cpatients infected with Hepatitis C Evaluation of the Sepsis GuidelinesEvaluation of the Sepsis Guidelines Review of the outcomes in invasive aspergillosis in patients treated with combination versus monotherapy at Review of the outcomes in invasive aspergillosis in patients treated with combination versus monotherapy at
New York Weill Cornell Center and Columbia University Medical Center New York Weill Cornell Center and Columbia University Medical Center Efficacy of palifermin for mucositis in hematopoietic stem cell transplant recipientsEfficacy of palifermin for mucositis in hematopoietic stem cell transplant recipients Timing to initiation of appropriate antifungal therapyTiming to initiation of appropriate antifungal therapy Antiretroviral medication errors in hospitalized patientsAntiretroviral medication errors in hospitalized patients Inhaled epoprostenol use in acute respiratory distress syndromeInhaled epoprostenol use in acute respiratory distress syndrome Impact of BK viremia and viruria in stem cell transplantation recipientsImpact of BK viremia and viruria in stem cell transplantation recipients Clinical and microbiological outcomes in patients receiving tigecycline for infections due to multi-drug resistant Clinical and microbiological outcomes in patients receiving tigecycline for infections due to multi-drug resistant
organismsorganisms Use of low-dose valganciclovir in high-risk renal transplant recipientsUse of low-dose valganciclovir in high-risk renal transplant recipients Minimizing cardiovascular risk among renal transplant recipientsMinimizing cardiovascular risk among renal transplant recipients
PGY-2 Critical Care PGY-2 Critical Care Rotations…Rotations…• Required Rotations:Required Rotations:
– Medical Intensive Care - ColumbiaMedical Intensive Care - Columbia 6 weeks6 weeks– Surgical Intensive CareSurgical Intensive Care 6 weeks6 weeks– Neurosciences Intensive CareNeurosciences Intensive Care 6 weeks6 weeks– Cardiothoracic Intensive CareCardiothoracic Intensive Care 6 weeks6 weeks– Medical Intensive Care - Cornell Medical Intensive Care - Cornell 4 weeks4 weeks
• Elective Rotations:Elective Rotations:– Burn Intensive CareBurn Intensive Care 4 weeks4 weeks– Infectious DiseasesInfectious Diseases 4 weeks4 weeks– Coronary CareCoronary Care 4 weeks4 weeks– Emergency MedicineEmergency Medicine 4 weeks4 weeks– Solid Organ Transplant Solid Organ Transplant 4 weeks4 weeks(heart, lung, liver, kidney, pancreas)(heart, lung, liver, kidney, pancreas)– Neonatal Intensive CareNeonatal Intensive Care 2-4 weeks2-4 weeks– Pediatric Intensive Care Pediatric Intensive Care 2-4 weeks 2-4 weeks– Nutrition Support Nutrition Support 2-4 weeks2-4 weeks
YEARYEAR Name Name PGY2 PGY2 ResidencyResidency
EmployerEmployer
20032003 Theresa LukoseTheresa Lukose SOTSOT NYP NYP - CM SOT (Lung)- CM SOT (Lung)
• In 2003, the Centers for Medicare & Medicaid (CMS) reaffirmed their support for Pharmacy Practice Residency programs by continuing to support Medicare1
• It is the “industry norm” for hospitals to generally hire only pharmacists who have completed a pharmacy practice residency to work directly in patient care1
• CMS views “hospital pharmacy” as a “specialty” of the pharmacy profession1
Reg. Sec. 413.85(e)
Funding- NYPH Residency Funding- NYPH Residency Program (Cont’d)Program (Cont’d)
• Pharmacy Practice Residency program is eligible to receive payment for the following:1
– The clinical training costs incurred for the program– Classroom costs, but only those costs incurred by the provider for
the courses that were included in the programs
• The net costs of approved educational activities – Determined by deducting, from the total cost incurred by the
hospital for these activities, any revenues the hospital receives from grants or tuition
• Hospital’s total cost includes trainee stipends, compensation for preceptors and residency directors, and other direct and indirect costs of the activities as determined under Medicare cost-finding principles2,3
1. Reg. Sec. 413.85(iii)2. Miller DE, Woller TW. Understanding reimbursement for pharmacy residents. Am J Health-Syst Pharm. 1998; 55:62-5.3. Cortese Annecchini LM, Letendre DE. Funding of pharmacy residency programs-1996. Am J Health-Syst Pharm. 1998; 55:1618-9.
ConclusionConclusion
• PHARMACY DEPARTMENT SUPPORTPHARMACY DEPARTMENT SUPPORT