Preparing Graduates for Infectious Diseases Pharmacy Clinical Specialist Positions
PGY2 residency programs build upon Doctor of Pharmacy (PharmD) education and PGY1 pharmacy residency training to develop pharmacist practitioners with knowledge, skills, and abilities as defined in the educational competency areas, goals, and objectives for advanced practice areas. Residents who successfully complete PGY2 residency programs are prepared for advanced patient care or other specialized positions, and board certification in the advanced practice area, if available.
Founded in 2013, Renown Regional Medical Center’s PGY2 Infectious Diseases Pharmacy Residency is an American Society of Health-System Pharmacists (ASHP) accredited residency designed to provide a comprehensive experience in infectious diseases (ID) pharmacotherapy. The resident will participate in antimicrobial stewardship (AMS) activities and ID consults at Renown Regional Medical Center, an Infectious Diseases Society of America designated Antimicrobial Stewardship Center of Excellence. There will also be opportunity to impact AMS activities throughout Renown Health including but not limited to ambulatory care, home care, and rehabilitation. The resident will be required to complete an ID related research project, assist with precepting pharmacy students and residents, and make substantial contributions to the Infection Prevention/Antimicrobial Stewardship Committee and Pharmacy and Therapeutics Committee throughout the year.This residency program prepares its graduates for Infectious Diseases Pharmacy Clinical Specialist positions that have an emphasis in inpatient and ambulatory antimicrobial stewardship and general adult infectious diseases consulting services.
Infectious Diseases Services at Renown
Renown Health cares for a wide variety of common and rare infections due to its large catchment area, extensive trauma and oncology services, and Reno-Tahoe being an international tourist destination. The infectious diseases pharmacy team consists of three infectious diseases pharmacists and a PGY2 pharmacy resident. Together they provide pharmacotherapy expertise for infectious diseases consulting physicians and Renown Health Infection Control and Prevention. They also work in partnership with the Antimicrobial Stewardship Medical Director to provide antimicrobial stewardship services for the health-system. The infectious diseases pharmacy team at Renown has developed extensive protocols and collaborative practice agreements that allow pharmacists to practice at the top of their licenses.
Four infectious diseases physician groups provide consulting services for Renown Health. They range from private practice to healthcare system-employed to university-based with medical residents and students. The consulting groups rely heavily on Renown’s infectious diseases pharmacists and residents to provide optimal care to patients.
The primary focus of the antimicrobial stewardship program at Renown Health is Renown Regional Medical Center; however, the program extends to Renown South Meadows Medical Center, Rehabilitation Hospital, Medical Group, and Home Care. An antimicrobial stewardship and infection prevention module in the electronic medical record helps prioritize daily stewardship activities such as bug-drug mismatch, duplicate therapy, drug-lab mismatch, etc. Handshake stewardship occurs three days a week with the Medical Director. These rounds are unique because they not only include chart review, but also physical examine and patient interview prior to making recommendations to providers in person. The team works to educate, empower, and provide pharmacists tools to incorporate antimicrobial stewardship into their daily activities. Additionally, they collaborate with Infection Control and Prevention and Laboratory to align goals and initiatives throughout the organization.
Required Learning Experiences:
- Orientation (4 weeks)
- Introduction to Infectious Diseases (6 weeks)
- ID Consults I & II (4 weeks each)
- Antimicrobial Stewardship I, II, III, IV (4 weeks each)
- Pharmacy Clinical Specialist
- Longitudinal experiences
- South Meadows & Rehab AMS (one day per week, every other month)
- Ambulatory Care (two hours per week)
- Outpatient Infusion Center (30 minutes daily)
- Emergency Medicine Culture Follow-up (30 minutes daily)
- Infectious Diseases On-Call (every other weekend)
- Infection Prevention (1 hour per week)
- Infectious Diseases Practice Management
Elective Learning Experiences (select 3, 4 weeks each):
- Critical Care
- Emergency Medicine Antimicrobial Stewardship
- Pediatric Infectious Diseases
- Internal Medicine
Learning Experiences and Preceptors
Required Concentrated Direct Patient Care Learning Experiences
- Orientation with Jessica Thompson, PharmD, BCPS, BCIDP
The goal of the rotation is to become familiar with the residency program and the organization's policies, procedures, work environment, and coworkers. During this time the resident will also be oriented to all longitudinal learning experiences. It is expected that the resident enters the residency with a solid foundation of general clinical pharmacy skills due to successful completion of a PGY1 pharmacy residency program.
- Introduction to Infectious Diseases with Kiya Mohadjer, PharmD, BCPS, BCIDP
As the first learning experience specific to infectious diseases, the resident is expected to develop a foundation of common pathogens, antimicrobials, and infectious diseases. The resident will also be introduced to antimicrobial stewardship activities and operations at Renown Regional and South Meadows Medical Centers. In addition, the resident will spend a week in microbiology.
- Consults I & II with Kiya Mohadjer, PharmD, BCPS, BCIDP
The resident will round with the Renown and UNR Infectious Diseases Consulting groups and gain experience and knowledge of more advanced infectious diseases topics and cases. The preceptor will model and coach the resident on this experience during ID Consults I and progress to independent rounding by ID Consults II. The goal is for the resident to build and develop relationships with the infectious diseases consulting physicians and gain experience providing care to more complicated infectious disease states.
- Antimicrobial Stewardship I, II, III, IV with Kiya Mohadjer, PharmD, BCPS, BCIDP
These learning experiences are designed to provide residents with a comprehensive inpatient antimicrobial stewardship direct patient care experience. The resident will participate and contribute to the antimicrobial stewardship throughout the year, ultimately progressing to complete independence and responsibility of the service. There are two major components to this learning experience: pharmacist-driven antimicrobial stewardship and physician-assisted antimicrobial stewardship. The resident will become proficient in both aspects.
- Pharmacy Clinical Specialist with Kiya Mohadjer, PharmD, BCPS, BCIDP
The Pharmacy Clinical Specialist learning experience is the capstone of the year. The resident will be responsible for all ID-pharmacist related activities at Renown Regional Medical Center, including but not limited to antimicrobial stewardship activities and rounds, drug information requests, and precepting.
Required Longitudinal Direct Patient Care Learning Experiences
- South Meadows and Rehab Antimicrobial Stewardship with Adrienne Desens, PharmD, BCPS
The resident will attend and participate in antimicrobial stewardship rounds at South Meadows Medical Center one-half day each week, every other month. During this time the resident will also perform antimicrobial stewardship activities remotely for Renown Rehabilitation Hospital. The goal of this learning experience is for the resident to gain experience managing an antimicrobial stewardship service at a smaller, community hospital that has more limited resources and in the post-acute setting.
- Emergency Department Culture Follow-Up with Heather Townsend, PharmD, BCPS, BCCCP
The resident, through a collaborative practice agreement with the ED Medical Director, will follow-up on patients discharged from the ED with positive cultures. The collaborative practice agreement allows the resident to continue, discontinue, or modify therapy as needed. The resident will also contact, counsel, and obtain additional information from the patient as needed.
- Infectious Diseases On Call with Kiya Mohadjer, PharmD, BCPS, BCIDP
The Infectious Diseases On-Call learning experience is a longitudinal learning experience that serves as the resident's "staffing" component of the residency. Instead of staffing a standard clinical pharmacist shift, the resident will serve as the at-home on-call Infectious Diseases Pharmacist every other weekend.
- Ambulatory Care with Adrienne Desens, PharmD, BCPS
During ambulatory care the resident will operate under a collaborative practice agreement with the Infectious Diseases providers to provide Hepatitis C treatment. Additionally, the resident will serve as a drug information resource for the primary and urgent care providers in the Renown Health network which includes compiling an antimicrobial stewardship dashboard quarterly.
- Outpatient Infusion Center with Ian Ferrari, PharmD, BCPS
Outpatient Infusion Center is a required longitudinal learning experience and is designed to provide the residents with a clinical and operational experience of an outpatient infusion center and transitions of care. The resident will be responsible for reviewing referrals to the infusion center for antimicrobial therapy and ensuring indication, treatment, and lab monitoring are appropriate.
Required Longitudinal Non-Direct Patient Care Learning Experiences
- Infection Prevention with Adrienne Desens, PharmD, BCPS
Infection Prevention is a longitudinal learning experience designed to focus on preventing and stopping the spread of infections in the healthcare setting. The resident will become proficient in risk factors, prevention, ongoing process improvement, and education of healthcare associated infections. The resident is expected to participate as an integral member of the multi-disciplinary Infection Prevention team by providing evidence-based information, drug information services, and clinical insight to healthcare associated infection cases.
- Infectious Diseases Practice Management with Jessica Thompson PharmD, BCPS, BCIDP
The primary goal of the learning experience is to become recognized as a leader in infectious diseases pharmacy at Renown Health and the community. The resident will gain experience with the administrative (non-patient care) responsibilities of an infectious diseases pharmacist and learn to contribute to healthcare team. Major components of the learning experience include formulary review; utilization evaluations; journal club and case presentations; protocol, policy, procedure, and order set development and maintenance; multidisciplinary meetings; and education and inservices.
- Project (preceptor is dependent upon project selection)
The resident is expected to conduct an infectious diseases related research project that is relevant to patient care at Renown Health. The preceptor must approve any documents prior to them being submitted for approval or publication (i.e. institutional review board, poster presentation, Western States Conference, etc.). The pharmacy resident is responsible for developing a hypothesis, designing, and implementing the project. Additionally, the resident will analyze any data collected, present the results, and submit a manuscript for publication.
Elective Learning Experiences* (Select 3, 4 weeks each)
- Critical Care with Mike Thuyns, PharmD, BCPS, BCCP, BCCCP or Zack Marcus, PharmD, BCCCP
Critical Care is designed to provide a well-rounded experience of intensive care medicine and medical emergencies. The resident is to focus on the care of adult patients in the intensive care units at Renown Regional. The resident is expected to bring their infectious diseases expertise to the multi-disciplinary critical care team. While on rotation the resident is expected be an integral member of a multidisciplinary team by providing evidence-based medication information and applying it to therapeutic approaches. In addition to rounding the resident also assumes responsibility for the patient's medication related care, which include pharmacokinetic antibiotic dosing, anticoagulation dosing and monitoring, and formulating parenteral nutrition solutions. The resident is also expected to precept and mentor pharmacy students and PGY1 residents.
- Oncology with Lauren Zion, PharmD, BCPS, BCOP
This learning experience is designed to focus on the care of oncology patients and their medical problems with an emphasis in infectious diseases. The resident is expected to participate as an integral member of a multi-disciplinary team on the cancer nursing unit by providing evidence-based medication information and therapeutic interventions. The resident will serve as a pharmacy and infectious diseases resource for the team by providing drug information services and serving as a liaison with any consulting infectious diseases service. The resident is responsible for all aminoglycoside and vancomycin dosing per pharmacy protocol. Lastly, the resident will attend at least one tumor board and Beacon meeting, and complete at least one quality improvement project pertaining to the interphase of infectious diseases and oncology pharmacy.
- Pediatric Infectious Diseases with Carol Vollmer-Johnson, PharmD, BCPPS
Pediatrics is designed to focus on the care of pediatric patients and their medical problems with an emphasis in infectious diseases. The resident is expected to participate as an integral member of a multi-disciplinary team in the PICU and general pediatric floor by providing evidence-based medication information and applying it to therapeutic approaches. The resident will serve as a pharmacy and ID resource for the team. The resident will also be responsible for all aminoglycoside and vancomycin dosing per pharmacy protocol in the maternal- child areas. Lastly, the resident will observe at least one cystic fibrosis clinic during the rotation.
- Emergency Department Antimicrobial Stewardship with Heather Townsend, PharmD, BCPS, BCCCP
Throughout this learning experience, the resident will be tasked with developing, implementing, and/or managing an antimicrobial stewardship program focused on the ED. The ED is uniquely positioned to affect antimicrobial prescribing in both the outpatient and inpatient settings. In the outpatient setting, it is important to recognize and address increasing rates of antimicrobial resistance throughout the community. For inpatients, it is well documented that initial antimicrobial use in the ED is imperative for positive patient outcomes and may affect hospitalist prescribing. The goal of this learning experience is for the resident to develop, implement, and/or manage an antimicrobial stewardship program focused on the ED and to develop effective precepting skills. This experience will run jointly with the Emergency Medicine PGY2 Resident's Antimicrobial Stewardship/Infectious Diseases experience. The Emergency Medicine Resident and Infectious Diseases Resident will co-precept each other for their assigned experiences, with 50% of the time being spent on ID/stewardship, and 50% spent on emergency medicine.
- Internal Medicine with Michelle Barcelon, PharmD, BCCP
This elective is designed for residents that may have general medicine responsibilities in their post-residency career. As such, it is generally assigned to residents in the second half of the year to refresh skills that were obtained during the resident's PGY1 residency. The experience will be tailored to the needs of the resident but will likely include multi-disciplinary team rounds with a hospitalist, precept pharmacy students and residents, and complete an antimicrobial stewardship related project (new service, medication utilization evaluation, etc). The resident is expected to bring their expertise in infectious diseases to all aspects of this learning experience.
- Leadership with Kate Ward, PharmD, BCPS
- *Other elective learning experiences may be developed based on resident interest and preceptor availability.