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A SUCCESSFUL RESIDENCY PROGRAM AT NY- PRESBYTERIAN HOSPITAL: 7TH YEAR
Liz G. Ramos, BS, PharmD, BCPS Clinical Manager Critical Care/Infectious Diseases NY-Presbyterian Hospital Weill Cornell Medical Center
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NY-PRESBYTERIAN HOSPITAL
2,400 bed tertiary care teaching hospital Comprised of two of the nation's most prestigious medical centers Columbia University Medical Center Weill Cornell Medical Center
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How To Have A Successful Residency Program?
PHARMACY DEPARTMENT SUPPORT RESIDENCY PROGRAM DIRECTOR PRECEPTORS Rotations available FUNDING $$ ASHP Accreditation Salary Recruitment
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NewYork-Presbyterian Hospital The University Hospitals of Columbia and Cornell Intended Residency Outcomes After completion of the New York-Presbyterian Hospital Pharmacy Residency, the individual will fulfill the following: Assume responsibility for providing optimal and comprehensive patient care in multiple care environments. Demonstrate the aptitude needed for leadership and management of pharmacy practice. Provide appropriate and timely medical information to health care professionals, patients and the community. Demonstrate a commitment to building the skills necessary for professional development.
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PGY-1: Rotations Required Rotations (32 weeks Total)
Elective Rotations (12 weeks Total) Ambulatory Care Burn Unit Emergency Medicine HIV/AIDS Investigational Drugs Neonatal Intensive Care Nutrition Support Oncology/BMT Pediatric Critical Care Pediatric Oncology/BMT Solid Organ Transplantation (heart, lung, liver, kidney, pancreas) Required Rotations (32 weeks Total) Orientation & Training Drug Information* Internal Medicine Critical Care Infectious Diseases Pediatrics Practice Management Ambulatory Care * 6 weeks
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NewYork-Presbyterian Hospital The University Hospitals of Columbia and Cornell Residency Learning System “The residents training will be designed, conducted, and evaluated using a systems-based approach” Following the RLS Is a Means to Meeting 4 Principle Requirements (PGY1) 4.1 Program Design 4.2 Program Delivery 4.3 Program Evaluation and Improvement 4.4 Tracking of Graduates
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“SHAPING” THROUGH FEEDBACK
Perform task Decision to modify performance in specific way Feedback received Feedback related to previous performance
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THE LEARNING PYRAMID Preceptor’s Role Culminating Facilitating
Integration Facilitating Coaching Practical Application Modeling Foundation Skills and Knowledge Direct Instruction
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Preceptor Qualifications
NYS licensed Routinely practice in that area Complete preceptor orientation AND PGY-1 One of the following: PGY1 + PGY2 + 6 mos experience PGY1 + 1 year experience 5 years experience PGY-2 PGY1 + PGY2 + 1 year experience PGY1 + 3 years experience
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Clinical Managers (NY Weill Cornell Center)
Drug Information Internal Medicine Medical Critical Care/ Infectious Diseases Critical Care - CTICU Nutrition Support Oncology/BMT Pediatrics Residency Program Solid Organ Transplantation, Renal Maria Dubs, PharmD Olga Hilas, PharmD, BCPS Liz G. Ramos, PharmD, BCPS Regina Lee, PharmD, BCPS Marc Roth, MS, RPh Cindy Ippoliti, PharmD Elena Mendez-Rico, PharmD Adrianne Hewryk, PharmD Demetrio Tappets, PharmD
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Clinical Managers (Columbia University Medical Center)
Drug Information Infectious Diseases Medical Critical Care NeuroCritical Care Oncology/BMT Pediatric Critical Care Pediatric Oncology Pediatrics, General SOT, Cardiac/Lung SOT, Liver Martha Rumore, PharmD Greg Eschenauer, PharmD, BCPS Christine Kubin, PharmD, BCPS Kelly O’Neill, PharmD, BCPS Amy Dzierba, PharmD, BCPS Christine Lesch, PharmD, BCPS Lillian Chou, PharmD Enrico Ligniti, PharmD Ibis Lopez, PharmD Jason Topolski, PharmD Thresiamma Lukose, PharmD Stacey Balducci, PharmD
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Structure of Learning Experiences - Longitudinal
NewYork-Presbyterian Hospital The University Hospitals of Columbia and Cornell Design and Conduct of the Residency Program Structure of Learning Experiences - Longitudinal Service Commitment Distribution Functions Drug Information Pharmacokinetic Monitoring Continuation of Clinical Services AOC liaison
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NewYork-Presbyterian Hospital The University Hospitals of Columbia and Cornell Program’s Assessment Strategy Evaluation Process
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RESITRAK – Evaluations…
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RESITRAK – Evaluations…
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RESITRAK – Evaluations…
Learning Experience Preceptor Evaluation
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NewYork-Presbyterian Hospital The University Hospitals of Columbia and Cornell Evaluation Process
Residency Activity Committee Membership Director, Drug Use Policy and Acquisition Residency Program Directors 4 Preceptors from New York Weill Cornell Center 4 Preceptors from Columbia Presbyterian Center Role Set time for Current Resident’s input Review Quarterly Evaluations Review Effectiveness of Residency Program Resident Evaluation Preceptor Evaluation Recommend Modifications to the Program
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NewYork-Presbyterian Hospital The University Hospitals of Columbia and Cornell
Structure of Learning Experiences - Longitudinal Medication Use Evaluation Darbepoetin, Aminoglycosides, Levofloxacin, IVIG, Eplerenone, Caspofungin, Warfarin, Enoxaparin, Rifaximin, Daptomycin, Polymyxin B, CMV-IGIV, Compliance Surgical Px, Conivaptan, Fondaparinux and HIT, De-escalation from Zosyn, Hypoglycemia and sulfonylureas Research Project A Retrospective Review: Combination Antifungals in the Treatment of Invasive Aspergillosis Development & Implementation of a PK monitoring Service Comparison 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 Retrospective review of the clinical, microbiological, and mortality endpoints of nosocomial candidemia before and after the availability of caspofungin and voriconazole Erythropoetin in the intensive care unit 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 recipients Effect of steroid-sparing immunosuppressive regimens on the morbidity and mortality of renal transplant patients infected with Hepatitis C Evaluation of the Sepsis Guidelines 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 Efficacy of palifermin for mucositis in hematopoietic stem cell transplant recipients Timing to initiation of appropriate antifungal therapy Antiretroviral medication errors in hospitalized patients Inhaled epoprostenol use in acute respiratory distress syndrome Impact 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 organisms Use of low-dose valganciclovir in high-risk renal transplant recipients Minimizing cardiovascular risk among renal transplant recipients
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PGY-2 Residencies: 2007 PGY-2 Critical Care PGY-2 Infectious Diseases
Program Director: Amy Dzierba, PharmD, BCPS PGY-2 Infectious Diseases Program Director: Christine Kubin, PharmD, BCPS PGY-2 Transplant Program Director: Thresiamma Lukose, PharmD
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PGY-2 Residencies: 2007 (Cont’d)
PGY2 Pharmacy Residency Program Duration: 12-months Positions: 1 Starting Date: July 1, 2009 Estimated Stipend: $50,000 Interview Required: Yes
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PGY-2 Critical Care Rotations…
Required Rotations: Medical Intensive Care - Columbia 6 weeks Surgical Intensive Care 6 weeks Neurosciences Intensive Care 6 weeks Cardiothoracic Intensive Care 6 weeks Medical Intensive Care - Cornell 4 weeks Elective Rotations: Burn Intensive Care 4 weeks Infectious Diseases 4 weeks Coronary Care 4 weeks Emergency Medicine 4 weeks Solid Organ Transplant 4 weeks (heart, lung, liver, kidney, pancreas) Neonatal Intensive Care weeks Pediatric Intensive Care weeks Nutrition Support weeks
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2003 2004 2005 2006 2007 2008 2009 YEAR Name PGY2 Residency Employer
Theresa Lukose SOT NYP - CM SOT (Lung) 2004 Anne McDonnell Jeong Kim Heme/Onc - UNC B&W Hospital – CS -H/O NYP, Staff Pharmacist 2005 Anastacia Balducci Bernard Lee Simon Lam Joni Maeda SOT – Univ Cinn CC – Mayo Clinic Heme/Onc - JH NYP - CM SOT (Liver) NYP - CM – Gen Peds NYP - CM – SICU Hawaii MC – CP- Onc 2006 Christine Borromeo Hema Kothari Amy Logan Neha Sheth HIV/ID – Univ Buff UCSF – CP – Renal Tx GSH – CP - IM SFGH – CP – Med/Surg Univ of MD - Faculty 2007 Yanina Dubrovskaya Jerry Hu Rachel Tavares de Melo Demetrio Tappets ID – NYP SOT – NYP NYU – CP – ID HSS – Staff Pharmacist NYP - CM SOT (Renal) 2008 Jessica Campaign Maabo Kludze-Forson Christine H. Paeng Shazia A. Raheem CC - NYP Univ NM – Faculty St Joseph’s – CP NYP – Lead Rph – ED NYP – CM – NeuroICU 2009 Monique Bryan Soonali Maniar Leandra Miko May Nguyen ID - NYP
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Recruitment…
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NYPH – Pharmacy Website…
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Pharmacy Residency: PGY-1
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Pharmacy Residency: PGY-2
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Funding- NYPH Residency Programs
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 (e)
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Funding- NYPH Residency 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 (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 Am J Health-Syst Pharm ; 55:
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Conclusion PHARMACY DEPARTMENT SUPPORT DEDICATED PRECEPTORS FUNDING
ASHP Accreditation Salary Recruitment
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THANK YOU !!
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