What does a year in the life of an Island Health Pharmacy Resident look like?
The bulk of the Residency Program takes place in Victoria, at the Royal Jubilee and Victoria General Hospitals, although some rotations are offered at the Nanaimo Regional General Hospital and the Cowichan District Hospital in Duncan. On occasion, Residents are required to travel to Vancouver to attend BC-wide Program events, or to other sites in BC if an external elective rotation is approved and available.
Below is a summary of how the typical residency year is divided (to view the learning goals and objectives for the rotations click here):
General Orientation (1 week)
Evidence Based Medicine & Pharmacokinetics and/or other didactic topics (3 days, off-site in Vancouver, together with the other BC pharmacy residency programs)
Clinical Orientation (3 weeks)
Direct Patient Care Rotations (28 weeks)
There are four Mandatory rotations – Emergency, Critical Care, Internal Medicine, Infectious Disease & Antimicrobial Stewardship
Elective rotations (pick 3) – Ambulatory Care, Cardiovascular Medicine, Geriatrics, Nephrology, Pediatrics, Perinatology, Psychiatry, Surgery
Drug Distribution & Sterile Products(3 weeks)
Medication Use Management (1 week)
Academic Detailing (1 week)
Precepting Skills (4 weeks)
Toxicology (1 week, off-site in Vancouver)
Residency Project (7 weeks dedicated project time)
Leadership/Management (52 weeks, longitudinal), includes leadership project that involves organization of Annual Pharmacy Conference
Vacation (2 weeks)
Other elective rotations may be available, including a maximum of one off-Island rotation. Rotation availability subject to change.
Academic Detailing (Mandatory)
Academic Detailing is an educational outreach program designed to meet the learning needs of family physicians. Clinical education sessions are provided in individual or small-group settings in primary care clinics. The primary ambition of the service is to translate evidence-informed medical information into clinically relevant knowledge that can be used to optimize prescribing patterns and, ultimately, patient outcomes. The service is currently based out of two communities on Vancouver Island (Comox Valley, Victoria) and provides service to family physicians throughout the entire Island Health region. This one-week experiential learning opportunity will involve independent travel to family physician clinics to observe education sessions and web-conferencing sessions regarding the critical appraisal of medical literature. It will also include the opportunity to participate in knowledge translation (searching for, critically appraising and synthesizing drug-therapy evidence) with the aim of producing an effective professional presentation for the team of academic detailing pharmacists. The clinical rotation in Academic Detailing will provide the Pharmacy Resident with training and experience in medication and practice-related clinical education. The rotation will have a specific focus on the topics being prepared and detailed at the time of the rotation.
Adult Critical Care (Adult ICU) - All Sites - (Mandatory)
The clinical rotation in adult intensive care provides the Pharmacy Resident with training and experience in the various aspects of critical care pharmacotherapy. The rotation is based in the intensive care units at the Royal Jubilee Hospital (RJH), Victoria General Hospital (VGH) and Nanaimo Regional General Hospital (NRGH). These tertiary care ICUs are similar in size, with approximately 10 beds per site. Patients present with various medical and surgical issues – RJH and NRGH provide greater representation of cardiac and chronic renal failure populations, whereas VGH provides greater representation of neurosurgery and trauma populations
The ICU team typically consists of critical care physicians (rotating weekly), registered nurses, respiratory therapists, physiotherapists, dieticians, social workers, chaplains, and the clinical pharmacy specialist. Multidisciplinary students and residents are regular participants in all of the units, and members of the ICU team are eager to provide teaching in their respective areas of expertise. The majority of rotation time is spent on direct patient care activities, including but not limited to active participation in daily patient care rounds. The remainder of the time is comprised of working on assigned projects and/or presentations and participating in scheduled therapeutic discussions. The resident is provided with informal feedback on a daily basis and is formally assessed at the rotation midpoint and at the end of rotation. A final oral exam, in short-answer format, may be a component of the final evaluation.
Ambulatory Care - Geriatrics (Elective)
The clinical rotation in ambulatory care – geriatrics is based at the Seniors Outpatient Clinic (SOPC) located at the Royal Jubilee Hospital – Memorial Pavilion. SOPC serves seniors who are living in the community who have cognitive or mobility issues or are medically complex. SOPC has an interdisciplinary approach. The team includes the following clinicians: geriatricians, geriatric psychiatrists, nurse practitioner, registered nurses, pharmacist, occupational therapists, physiotherapists, rehabilitation assistant and social workers. Each clinician is involved with clients in whom s/he has received a referral for. Clients are referred to the pharmacist for a comprehensive assessment and management of drug related issues. Interactions with clients are achieved through clinic visits, home visits and phone visits. Please note that access to a vehicle/transportation for home visits may be required during rotation.
This rotation provides the pharmacy resident with training and experience in the various aspects of geriatric pharmacotherapy and chronic disease management. This may include, but is not limited to, management of polypharmacy, Parkinson’s disease, pain, behavioural and psychological symptoms of dementia and other chronic diseases. The majority of the rotation time is spent on direct patient care activities, which includes comprehensively assessing a client and identifying his/her medication issues, implementing, monitoring, adjusting, and educating of a client’s medication plan, full SOAP note documentation of all client interactions, liaising with appropriate team members in regards to care plan and participating in interdisciplinary rounds as appropriate. The remainder of the time is comprised of working on assigned projects and/or presentations and participating in scheduled therapeutic discussions.
The resident is provided with informal feedback on a daily basis and is formally evaluated at the rotation midpoint and at the end of rotation.
Clinical Orientation (Mandatory)
Week One (Clinical Orientation Workshop)
The first week includes both didactic and hands-on sessions that expose the residents to various skills necessary to provide pharmaceutical care, and prepares the residents for their direct patient care rotations. During the first week they are introduced to finding information on Island Health’s intranet needed to provide direct patient care. The resident is introduced to resources which include drug and formulary information, policy and procedure information and intranet resources commonly utilized by ward based clinical pharmacists.
There is also an introduction to documentation, information gathering (powerchart and paperchart) and personal safety in the acute care environment (patient aggression, biohazard, isolation & contact precautions). Residents are also introduced to “working up and presenting a patient”. Residents spend two introductory days to ward-based clinical pharmacy practice during the first week. One full day is spent participating in a physical assessment workshop. During the final day of week one residents are oriented to the allied health professionals they will work along with during their direct patient care rotations.
Week Two and Three (Clinical Orientation Ward)
The skills learned in week one will then be applied in weeks two and three, when the resident will spend their time performing direct patient care activities. Pharmacy residents will complete full patient assessments and work as part of an interdisciplinary team. The pharmacy residents will follow patients from their admission on the ward to the time of discharge. They will perform full initial medication assessments, admission medication reconciliation, documentation of recommendations, discharge medication reconciliation and medication counseling, and will collaborate with the interdisciplinary team at rounds. The residents will be asked to present their patients using a systematic head to toe approach. At the end of week three, the residents will undergo a mock exam situation where time limits will be placed on their patient work up and presentation. The overall goal of this rotation is to develop the residents’ process for patient assessments, thereby preparing them for their clinical rotations.
Emergency Medicine (Mandatory)
The clinical rotation in emergency medicine provides the Pharmacy Resident with pharmacotherapy training and experience in a variety of patient populations (medical, ambulatory, critical care). The rotation is provided at the Royal Jubilee Hospital (RJH), a 500-bed tertiary care hospital which provides specialized care to cardiac, nephrology, critically-ill and surgical patients. The RJH Emergency Department (ED) has 2 trauma beds, 24 acute care beds, 8 minor treatment beds, a busy ambulatory patient care area and up to 14 hallway beds which all serve to accommodate over 57,000 patients per year (~155 / day).
The ED is a dynamic, unpredictable environment that will allow the Pharmacy Resident to be exposed to a variety of activities throughout this rotation including opportunities to observe various procedures that take place for patients admitted to the ED. During this 4-week rotation, the Pharmacy Resident will work with the multidisciplinary team to provide clinical pharmacy services to a wide variety of acute illness cases including resuscitations, acute cardiac and respiratory presentations, infectious diseases, pain-related presentations, and overdoses. Identification and management of medication-related adverse events which result in ED visits are emphasized throughout the rotation.
A majority of rotation time is spent on direct patient care activities. The remainder of the time is comprised of working on assigned projects and/or presentations and participating in scheduled therapeutic discussions. The resident is provided with informal feedback on a daily basis and is formally evaluated at the rotation midpoint and at the end of rotation.
Infectious Disease & Antimicrobial Stewardship All Sites - Victoria, Duncan and Nanaimo (Mandatory)
This rotation involves two distinct services – the The Infectious Disease and Antimicrobial Stewardship Program (AS) as well as Infectious Diseases (ID) consult service(AMS). Each day, the resident will take on the care of one at least one new patient , either from the ID consult service list, Outpatient Parenteral Therapy Service (OPAT) oras identified by: having a positive blood culture, positive c dificile infection, antibiotic resistant organism, an OPAT patient, a request for consult from a pharmacist or physician, or a selected patient requiring anthat would benefit from an AMS consult. It is therefore expected that the resident follows a minimum of 20 patients during their 4 weeks. Each day, a new therapeutic topic will be covered that is relevant to the patient case that day.
The AS portion of this This rotation will provide the resident with the opportunity to learn about the appropriate use of antimicrobials on various wards at NRGH. With the goal of stewardship in mind, the resident will provided clinical patient care to selected patients who have a drug therapy problem related to optimization of antimicrobial therapy. The resident will work to identify and resolve the patient’s DTPs, make suggestions to the teamcare providers, monitor therapy and provide education as appropriate regarding the optimal use of antimicrobials. The resident will attend the OPAT clinic daily to optimize drug therapy for outpatients which are managed by emergency room physicians. The resident will also spend time learning about the different modalities of providing AMS services (audit and feedback, protocol development, education etc.) and about the different moving parts of the program (medical microbiology, laboratory medicine, infection prevention and control, ID, research etc.).
What about work-life balance?
Our curriculum is designed to offer a rigorous experience that promises to propel our residents’ careers to the next level. Work-life balance is part of the fabric of Island Health, and we recognize it as an integral component of navigating the challenges of the program and ensuring an optimal experience for the resident. Fortunately, Vancouver Island offers a myriad of opportunities to integrate with the West Coast lifestyle. Without a doubt, learning in Island Health provides a rich and truly unique experience for our residents.