Objectives

The objectives of the PGY1 Residency in the Ambulatory Setting are to provide systematic training of the resident for the purpose of achieving professional competence in the delivery of patient-centered care in a wide variety of ambulatory and inpatient care settings and in pharmacy operational services. PGY1 residents acquire substantial knowledge required for skillful problem solving, refine their problem-solving strategies, strengthen their professional values and attitudes, and advance the growth of their clinical judgment. The instructional emphasis is on the progressive development of clinical judgment, a process begun in the advanced pharmacy practice experiences of the professional school years but requiring further extensive practice, self-reflection, and shaping of decision-making skills fostered by feedback on performance. The specific program for each resident may vary in structure based upon the resident’s entry-level knowledge base, skill, and interest. This residency is accredited by the American Society of Health-System Pharmacists.

Program Overview

The PGY1 Residency in the Ambulatory Setting is a 12-month (2,000 hour minimum) program composed of advanced ambulatory and inpatient practice experiences. Residents receive training and develop competence in managing and improving the medication-use process, providing evidence-based, patient-centered medication therapy management with interdisciplinary teams, exercise leadership and practice-management skills, demonstrate project-management skills, provide medication and practice-related education/training, and utilize informatics. Residents will spend seven months in a variety of ambulatory care clinics or diabetes education, and one month in each of the following: inpatient internal medicine service, drug information/drug policy development/practice management, specialized inpatient pharmacy services (anticoagulation and pharmacokinetics), inpatient drug distribution training, and an inpatient elective.

During each experience, the resident is expected to perform independently and demonstrate proficiency in pharmacy practice. Clinical staff members with practice responsibilities in these areas serve as preceptors for the training experiences. The resident is expected to participate and develop competency in pharmacy managed patient care clinics and a Diabetes Education Program accredited by the American Diabetes Association, under the direction of the preceptors and the attending physicians.

During the program, the resident must complete a self-directed research project. The scope, magnitude and type of project may vary widely according to individual interests but must be completed in a manner suitable for presentation and publication. The resident presents the research project at a regional residency conference in the spring.

The education component of the program enables the resident to develop teaching and training skills by participating in education programs for patients, pharmacy students, physicians, nurses, pharmacists, and other allied health practitioners.

Selected Pharmacy Services

  • Anticoagulation Clinic
    This clinic provides collaborative anticoagulation management by clinical pharmacists for all patients seen in the Internal Medicine Clinic that receive anticoagulation therapy. Residents are responsible for patient interviews, physical assessment, therapeutic assessment, and decision-making.
  • Outpatient Diabetes Education 
    Patients are referred from Internal Medicine and various area community clinics for diabetes self management training in a program accredited by the American Diabetes Association. Patients attend two classes that are five hours in length. A multidisciplinary team made up of pharmacists, a nurse and a dietitian teach the classes. Residents are responsible for educational assessments, patient education, and setting goals for behavior modification. Pregnant patients in the High Risk Obstetrics Clinic with gestational or pregestational diabetes are provided one-on-one diabetes education by clinical pharmacists and residents at every clinic visit. Medication and Insulin dosing recommendations are also provided to physicians.
  • Inpatient Diabetes Education 
    Individualized diabetes education is provided to inpatients by clinical pharmacists and residents on a consult basis. The education may include survival skills management, glucometer teaching, and insulin administration teaching. Patients are also referred to the outpatient classes upon discharge.
  • Diabetes, Hypertension, and Hyperlipidemia Clinic
    Patients are referred to this clinic from the Internal Medicine Clinic for aggressive treatment of diabetes, hypertension and hyperlipidemia. Residents are responsible for patient interviews, physical assessment, therapeutic assessment, and decision-making.
  • HIV-AIDS Service
    This service provides patient education, compliance counseling, and medication monitoring for outpatients in the state’s largest HIV-AIDS Clinic. The resident participates in multidisciplinary community outreach.
  • Internal Medicine Clinic Consults
    Clinical pharmacists are available during Medicine Clinics for consultation on pharmacotherapy management, formulary selection, compliance counseling, individual diabetes education or other disease state and medication education.
  • Outpatient Pharmacokinetic Service
    This service provides pharmacokinetic monitoring and management of outpatients receiving selected intravenous antibiotics. Patients are referred from Orthopedics, Surgery, and Internal Medicine.
  • Internal Medicine Inpatient Service
    The resident is an integral member of one of the medicine teaching services caring for a large number of adult medicine patients with a wide range of complex medical conditions.  Patients are the medically underserved with high incidences of diabetes, hypertension, heart failure, obstructive lung disease, HIV, mental illness and substance abuse.  Responsibilities include general pharmacotherapy, antibiotic optimization, discharge continuity coordination, pharmacokinetics, and drug information and education. Pharmacy services require active daily participation in multidisciplinary patient care rounds and targeted formal written consultation in the patient’s medical record.
  • Inpatient Anticoagulation Service
    This service provides evaluations for the management of anticoagulation therapy and warfarin education for all inpatients. Residents provide written consultations in the medical record on all patients receiving oral anticoagulation. Pharmacists coordinate the Low Molecular Weight Heparin Expedited discharge Anticoagulation Program. Pharmacists may be consulted to collaboratively manage anticoagulation therapy. The Anticoagulation Service is provided 365 days a year.
  • Inpatient Pharmacokinetics Service
    This service provides written evaluations of all aminoglycosides and vancomycin drug concentration levels. This service also provides pharmacotherapy management when consulted. This service is provided 365 days per year.

Practice Management and Drug Information Experience Activities

  • Pharmacy and Therapeutics Committee
    Residents actively participate in the Pharmacy and Therapeutics Committee and learn how to effectively conduct P & T activities and implement drug-policy decisions. Residents are assigned activities such as adverse drug reaction summaries, P & T minutes, drug monograph preparation and presentation, and health care provider notices.
  • Drug Policy Development
    Residents are responsible for maintenance of policy and procedures to ensure rational and safe medication use in the hospital.
  • Pharmacy Newsletter
    Residents are responsible for publishing a newsletter for the hospital and the pharmacy staff.
  • Medication Use Evaluations
    Residents conduct medication-use evaluations targeted at appropriate use or cost-effective therapies.

Application Requirements

Applicants for the PGY1 Residency in the ambulatory setting should hold a Doctor of Pharmacy or Master of Science in Hospital Pharmacy degree and must obtain licensure in the State of Tennessee by September 1. Application is via PhORCAS and requires three (3) individualized letters of reference in addition to standardized PhORCAS reference, transcript, CV, class ranking and letter of intent.  A limited number of on site interviews will be offered. Application deadline is January 1.

For more information or to connect with a current resident, contact the Residency Program Director, Marilyn Lee, Pharm.D., BCPS, at mlee@regionalonehealth.org.