Internal Medicine-Practical
PGY1 - Pharmacy (43400)
Faculty: Amanda Hult, Pharm.D., hultam@bronsonhg.org
Site: Bronson Methodist Hospital
Status: Active
Required
General Description:
Internal Medicine - Practical (IMP) is a four week learning experience at Bronson Methodist Hospital that fulfills the required internal medicine experience. IMP uses a floor based practice model to give the resident the opportunity to participate in direct patient care activities and gain experience practicing as a clinical pharmacist. They will also experience working with a multidisciplinary team that includes attending physicians, medical residents, nurses, case managers, social workers, dietitians, and respiratory therapists. The resident will work towards assuming responsibility for all patients admitted to the Adult Medical Unit (AMU, maximum number of beds assigned is 33)and Extended Medical Care Unit (EMCU, maximum number of beds assigned is 25). During the learning experience the resident will develop and monitor pharmaceutical care plans, participate in multidisciplinary rounds, provide antibiotic and anticoagulation dosing services, initiate and monitor TPNs, offer medication counseling to patients, and engage in topic discussions with the preceptor.
The pharmacist's role is to interact effectively with the healthcare team to provide excellent care to the patients. This role also includes daily chart reviews of patients, identifying issues with medication regimens and making appropriate recommendations to providers, answering phone calls from staff, documenting interventions within EPIC, order verification, completion of consults requested by providers, admission and discharge medication reconciliation, IV to PO medication conversion per policy, renal dosing of medications per policy, and patient counseling.
Disease States:
Common disease states in which the resident will gain experience during this rotation include, but are not limited to:
Cardiovascular disorders: Hypertension, heart failure, stroke, hyperlipidemia, atrial fibrillation
Alcohol withdrawal and substance abuse
Renal disorders: Acute renal failure, end-stage renal disease
Gastrointestinal disorders: GERD, PUD, pancreatitis, hepatitis, diverticulitis, GI bleed
Endocrinologic disorders: Diabetes, thyroid disorders, osteoporosis
Infectious diseases: UTI, pneumonia, endocarditis, sepsis, skin and soft tissue infections, bone and joint infections, bacteremia
Neurological disorders: Drug overdose, encephalopathy
Pulmonary disorders: Asthma, COPD
Psychiatric disorders: Depression, anxiety, bipolar disorder, schizophrenia, dementia, delirium
Thromboembolic disorders: DVT and PE
Schedule and Preceptor Interaction*:
Daily Schedule:
0800: Meet with preceptor for morning information and attend huddles
0815-0945: Patient chart reviews in preparation for multidisciplinary rounds
0945-1000: Present patient care plans to preceptor prior to rounds
1000-1100: Attend EMCU rounds 1100-1200: Attend AMU rounds
1200-1530: Complete daily responsibilities (ie. Antibiotic/anticoagulation/TPN dosing services, medication counseling, documenting interventions, review discharge medication reconciliations) and make further recommendations to providers as necessary.
1530: Sign out with second shift staff and provide information for evening follow-up if needed
Four Week Timeline:
Day 1: Preceptor to review learning experience description, associated activities, schedules, evaluation strategy, and general expectations with the resident. Preceptor to provide tour of the floors and introduce resident to staff.
Week 1: Resident to work up assigned patients and present to preceptor. Preceptor will participate in rounds and resident will observe modeling of the pharmacist's role.
Week 2: Resident to work up assigned patients and present to preceptor. Preceptor may attend/participate in rounds and will coach the resident to take on more responsibility as the pharmacist on the team.
Week 3-4: Resident to work up assigned patients and present to preceptor. Preceptor may attend and observe resident's participation in rounds and/or may expect a summary report from the resident regarding rounding activities and use of recommendations made by the resident. Preceptor will be available for questions, will follow patients independently to monitor resident skill development in all aspects of the learning experience, and will facilitate the resident as the pharmacist on the team.
*The length of time the preceptor spends in each of the phases of learning will depend both on the resident's progression in the current rotation and where the rotation occurs in the residency program.
Evaluation Strategy
The resident will receive on-going, regular informative 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. 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.
Expectation of Learners:
The expectation of the resident is that they become an effective member of the healthcare team. They will work towards assuming responsibility for all patients admitted to the Adult Medical Unit and Extended Medical Care Unit. During the learning experience the resident will develop and monitor pharmaceutical care plans, participate in multidisciplinary rounds, provide antibiotic and anticoagulation dosing services, initiate and monitor TPNs, offer medication counseling to patients, and engage in topic discussions with the preceptor as time allows.
The resident will also be responsible for creating and giving an inservice presentation to the AMU and EMCU nursing staff on a topic to be determined by the nurses or of the resident's own choosing. Inservice materials will be presented to the preceptor prior to the presentation for review and approval. The presentation itself should be no longer than 15 minutes with a short handout or pocket card created to provide to the staff.
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Taught and Evaluated Objectives
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Activities
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Goal R1.1
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In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple comorbidities, high-risk medication regimens, and multiple medications following a consistent patient care process
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OBJ R1.1.1
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(Cognitive - Applying) Interact effectively with health care teams to manage patients’ medication therapy
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Demonstrate ability to participate effectively in multidisciplinary rounds.
Demonstrate professionalism when interacting with the healthcare team.
Use appropriate communication methods with the healthcare team (ie. in person, telephone, paging, sticky notes to provider)
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