1. General Description and Expectations of Residents:
Cardiology is a required 1-month learning experience at Bronson Methodist Hospital. The resident will be assigned to the cardiology floor for the month. The team is composed of attending physicians, various medical residents, interns, physician assistants/nurse practitioners, pharmacists and/or students. Other disciplines may consult with or round with the team, including, but not limited to respiratory therapy, dietary, and nursing.
The resident is responsible for identifying and resolving medication therapy issues for patients admitted to the cardiology unit at Bronson Methodist Hospital. The resident will become proficient in identifying pharmacotherapeutic problems, implementing cost-effective medication regimens, identifying and counseling high risk patients, and providing patients with effective discharge counseling. The resident will also be responsible for providing therapeutic drug monitoring for cardiology patients on target medications including but not limited to warfarin, heparin and argatroban. Patient and topic discussions will be done throughout the month with the resident responsible for leading these discussions. By the end of the rotation, the resident will be expected to give a formal presentation the cardiology staff. The resident will also be expected to complete an edition of the cardiology newsletter and send out to the pharmacy staff.
During the rotation, a resident may be shown a heart cath and/or a cardioversion pending progress throughout the rotation or preceptors discretion. If a resident has an interest in heart failure and is unsure of future rotations, they may be given the opportunity to shadow in the Bronson Heart Failure Clinic. This is an elective rotation that can be pursued once the cardiology rotation is completed.
The role of the pharmacist on the cardiology floor is to review patient's charts, provide medication interventions that will be of benefit of the patient, dosing medications and providing a thorough review of the patient's medications prior to discharge. The expectation is to also counsel patient on high risk medications, heart failure and AMI medications. The pharmacist will attend rounds and answer questions from physicians, APPs, nurses and other staff.
2. Disease States:
Common disease states in which the resident will be expected to gain proficiency may include, but are not limited to:
- Atrial fibrillation
- Congestive heart failure
Topic discussions, referring to the guidelines and reading key articles will be used to help develop the resident's patient care skills for common disease states or acquiring knowledge about diseases seen infrequently on the service.
During the learning experience the resident will focus on the goals and objectives outlined below by performing the activities that are associated with each objective. The resident will gradually assume responsibility for all of the patients within the assigned unit. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame.
During the learning experience the resident will focus on the designated goals and objectives by performing the activities that are associated with each objective. The resident will gradually assume responsibility for all of the patients within the assigned unit. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame.
Preceptor Interaction/Expected Progression:
0805 Attend morning Huddles with preceptor
0815 Work-up patients
1100 Attend Rounds
1300 Meet with preceptor for topic discussions, patient reviews, journal club, etc.
Various times: Discharge counseling/counseling on high risk medications, dosing medications, verifying orders, consults and other required duties of the cardiology pharmacist
Day 1: An update about expectations and topic discussions will be sent to the resident prior to starting the rotation. Expectations will be discussed and goal is to orient to the floor.
Week 1: Resident to work up assigned patients and present to preceptor and students. Preceptor will participate in rounds and resident will observe modeling of the pharmacist's role in the healthcare team. Goal is to completely work-up 5-10 patients during the first week.
Week 2: Resident to work up assigned patients and present to preceptor and students. Preceptor may attend/participate in team rounds and will coach the resident to take on more responsibility as a pharmacist on the team. Goal is for the resident to be independent on counseling and start participating in rounds pending comfort leve. Resident expected to be working up 10-15 patients at this point. A mid-point evaluation will be completed by the end of this week to look into progress.
Week 3: Resident will continue to increase patient load. The expectation is that the resident will be working up 20-25 patients at this time. Resident is expected to be more independent which includes having the phone on the floor (pending comfort level), answering questions independently, running rounds under the preceptor supervision and starting to complete all activities that the cardiology pharmacist completes with guidance.
Week 4: Resident is expected to be independently running the cardiology floor during this week (preceptor will determine the comfort level of the resident). Goal is for the resident to work-up every patient on the cardiology floor. This would include verifying orders in PRU and cath lab. Preceptor will be available as needed. Resident to go to rounds independently (preceptor to determine readiness/comfort). At the end of this week, a formal evaluation will be done and documented in PharmAcademic.
[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident's progressions in the current rotation and where the rotation occurs in the residency program]
The resident will receive on-going, regular formative verbal feedback throughout the rotation. In addition, the preceptor and resident will have a midpoint discussion to assess the overall learning experience for the resident. The goal for this meeting will be to identify areas on which to focus, future activities, etc., based on resident feedback as well as preceptor identification of areas for improvement. This feedback will be documented as a formative assessment in PharmAcademic. At the completion of the rotation the resident and preceptor will independently complete the Summative Evaluation, then will meet and compare the evaluations prior to cosigning. The resident will also complete the Learning Experience Evaluation and a Preceptor Evaluation for each preceptor.
Expectation of Learners:
See General Description
Non-Patient Care Related Activities
Topic discussions: Each week a topic discussion will be assigned (subject to change per preceptor discretion)
Newsletter: Resident will write a 1-2 page article regarding new/hot topics in cardiology that will be sent out to the staff. Preceptor to review and give feedback before sending out to the pharmacy staff.
Nursing presentation: Resident will give a short presentation on topics that the nursing staff would like to learn more about. The presentation is around 20 minutes in length.
Journal club (as directed by preceptor): If a new study comes out or there is a hot topic in cardiology during the month, the resident will be directed to do a journal club to discuss with the preceptor.