Island Health Pharmacy Residency
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.).
Internal Medicine - CTU RJH Victoria (Available as Mandatory or Elective for Second Internal Medicine Rotation)
The Clinical Teaching Unit (CTU) is an internal medicine-teaching program for medical students and residents that is based on 5N in the Patient Care Centre at the Royal Jubilee Hospital. There are three CTU teams which are led by various attending Internal Medicine physicians who oversee the medical teaching and rotate on a biweekly basis. Each team has a 2nd or 3rd year internal medicine (senior) resident who manages each CTU team. In addition, two to three junior medical residents and two to three medical students make up the rest of the team and carry a patient load. The program strives to have bedside clinical teaching rounds which the pharmacy resident is encouraged to take part in. The unit is structured around teaching and as a result there are many educational opportunities available, including daily morning report, Medicine Grand Rounds, and Interesting Cases Rounds, which the pharmacy resident is expected to attend. The pharmacist participates fully in direct patient care rounds with medical staff, medical residents, nurses and other support staff and provides teaching and education as required.
Internal Medicine - NRGH- Nanaimo (Mandatory)
The clinical rotation in internal medicine provides the Pharmacy Resident with training and experience in cardiovascular diseases (particularly ACS), respiratory issues, diabetes, renal complications, and infection. The rotation will occur on Floor 1 at NRGH, which is one of the only wards offering telemetry and has a capacity for approximately 32 patients presenting with various complex medical issues. The medicine team consists primarily of internal medicine physicians and hospitalists though there are regularly circulating respirologists, hematologists, endocrinologists, cardiologists, and nephrologists as well. The inter-professional team also includes registered nurses, registered care aides, physiotherapists, social workers, dieticians, occupational therapists, speech-language pathologists, and the clinical pharmacist. Multidisciplinary students (pharmacy and nursing) and family medicine residents are regular participants in the unit. Majority of rotation time is spent on direct patient care activities.
The remainder of the time is comprised of working on assigned projects such as journal club, a case presentation, teaching an antithrombotic class for nursing students, and participating in 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 by the preceptor.
Internal Medicine - Victoria General Hospital - Victoria (Mandatory)
The clinical rotation in internal medicine provides the Pharmacy Resident with training and experience in a variety of medical conditions, including but not limited to: pain managements, diabetes, anemia, common infections, cardiovascular diseases, geriatric medicine, gastroenterology, and respiratory pharmacotherapy. The rotation may occur on either of two medicine units: North 6 floor or South 4 floor at the Victoria General Hospital (VGH) . Both the A and B units of South 4, as well as, the C and D units of North 6, have a capacity for approximately 50 patients presenting with various medical and surgical issues.
The general medicine team consists of house physicians (rotating approx. weekly), specialist physicians, nurse practitioners, registered nurses, licensed practical nurses (LPN), registered care aides, physiotherapists, social workers, dietitians, occupational therapists, nurse liaisons, [PJM5] , and clinical pharmacists. Multidisciplinary students and residents are regular participants in both of the units. 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 presentations for the North 6 or South 4 team or pharmacy department and participating in therapeutic discussions on relevant medical conditions.. 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 by their preceptor(s).
Medication Use Management - RJH - Victoria (Mandatory)
The Medication Use Management (MUM) rotation is a one-week rotation that provides the Pharmacy Resident with training and experience in provincial hospital formulary management. The rotation is based at the Royal Jubilee Hospital (RJH). Rotation time will be divided between didactic teaching, observation and participation in formulary-related meetings, and work on individual or group assignments. Assignment work will involve an opportunity to practice scholarly writing, which will be formally evaluated. The resident will have an opportunity to meet with the preceptor daily. The resident will be provided with informal feedback during the rotation and a formal rotation evaluation will be completed at the end of the week.
Orthopedic Surgery - RJH - Victoria (Elective)
This rotation will involve the direct care of patients admitted to an Orthopedics unit for management of both surgical and non-surgical orthopedic diagnoses. This rotation is based in Victoria at the Royal Jubilee Hospital (RJH). This rotation will allow the resident to expand their knowledge in many areas of orthopedics, including, but not limited to, post-operative pain management, the management of chronic pain in non-surgical patients, VTE prophylaxis in a variety of surgical and non-surgical situations, treatment of related infections (osteomyelitis, septic arthritis, infective osteonecrosis, etc.), and the treatment and prevention of osteoporosis. If time and resources allow, the resident will also be given the opportunity to directly observe an orthopedic surgery.
The resident will be provided with the opportunity to learn about the role of the pharmacist within the patient care team, which serves a variety of orthopedic patients. They will also have the opportunity to make initial assessments and recommendations and then provide follow-up and monitoring for commonly encountered orthopedic conditions. The resident will work to identify and resolve each of their patient’s drug therapy problems (DTPs), make suggestions to the interdisciplinary team, monitor therapy, and provide education and feedback regarding evidence-based approaches to treatment. The level of involvement may differ for each patient depending on patient-specific factors; however, every effort will be made to identify and assign patients to the resident for whom complex disease processes, complex medication regimens, or the presence of multiple actual or potential DTPs provide an opportunity for the most beneficial pharmacist involvement as well as an optimal experience for learning and skills development.
Each day, the resident will take on the care of at least one patient admitted to the unit. It is therefore expected that the resident will comprehensively work up and follow a minimum of 20 patients during their four week rotation. The number of patients a resident will be responsible for at one time will vary depending on the acuity and intensity of the patients admitted to the unit. Generally, this will be limited to 10-15 patients at one time. It is the responsibility of the resident to discuss workload with the preceptor if it becomes overwhelming. The preceptor will make every effort to ensure that workload is appropriate and applicable to the goals of the residency.
As new therapeutic topics arise that are relevant to each patient case, they will be covered daily via a combination of self-directed and preceptor-assisted learning. Scheduled therapeutic discussions on select topics will be confirmed at the start of the rotation, and other items may be discussed informally according to the resident’s area(s) of interest/need for learning, as well as the types of patients encountered during the rotation. These topics will generally be preceded by assigned readings.
Pediatrics - VGH - Victoria (Elective)
The clinical rotation in pediatrics provides the Pharmacy Resident with training and experience in various aspects of pediatric pharmacotherapy. The rotation is based on three different wards at Victoria General Hospital – 4C, 4D and PICU. The focus is on the diagnosis and treatment of acutely sick children. Each ward patient has his or her own staff pediatrician, child psychiatrist or surgeon who serves as their most responsible physician. Pediatric Royal College residents (R1-R4), first year Family and Royal College medical residents (R1) and third year UBC medical students are also involved in patient care. A pediatric intensivist is responsible for PICU patients. There is also a full multidisciplinary team consisting of a pharmacist, dietician, respiratory therapist, physiotherapist, occupational therapist, social worker, child life specialist, social worker as well as registered nurses. A 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 evaluated at the rotation midpoint and at the end of rotation.
Perinatology - VGH - Victoria (Elective)
The clinical rotation in perinatal care provides the Pharmacy Resident with training and experience in the various aspects of neonatal and maternal pharmacotherapy. The rotation is based in the neonatal intensive care unit (NICU), the high-risk antepartum (AP) unit, the labour and delivery unit (LDR) and the post-partum unit (Mom and Babe). The NICU has 22 beds, the high-risk antepartum unit has 8 beds, LDR has 2 operational rooms, 8 delivery rooms and 2 post anaesthetic recovery rooms and Mom and Babe has 28 beds. The rotation time will be divided among these units in a flexible manner based on the resident’s interest.
The inter-professional perinatal team includes: neonatologists, paediatricians, obstetricians, anaesthetists, family doctors, midwives, registered nurses, clinical nurse educators, clinical nurse leaders, respiratory therapists, physiotherapists, occupational therapies, dieticians, diabetic educators, social workers, aboriginal liaison, public health nurses, the program manager and the clinical pharmacy specialist. Multidisciplinary students and residents are regular participants in the perinatal units, and members of the perinatal 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 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 evaluated at the rotation midpoint and at the end of rotation.
Precepting - VGH + RJH Victoria (Mandatory)
The precepting skills rotation is a mandatory four-week rotation in the Island Health Pharmacy Practice Residency Program. During the rotation, the resident will be responsible for precepting a University of British Columbia Entry-to-Practice (E2P) PharmD student, in addition to providing clinical pharmacy services within a designated patient care area under the supervision of the primary preceptor. The E2P student is a fourth year pharmacy student who will be completing their eight-week hospital rotation ( PHRM 472 or PHRM 473). The resident is required to precept the first four weeks of this rotation.
This rotation will follow the tiered model of precepting. This means that the resident will act as the primary preceptor for the E2P student during their rotation. The resident will, in turn, be precepted by a designated Clinical Pharmacist, who will act as a resource for the resident during this rotation. During this rotation, the resident will have the opportunity to develop skills in the four roles of practice-based teaching (direct instruction, modeling, coaching, and facilitation), while at the same time continuing to build on existing skills in the provision of direct patient care.
Psychiatry - RJH - Victoria (Elective)
The clinical rotation in adult inpatient psychiatry provides the Pharmacy Resident with training and experience in the various aspects of psychiatric pharmacotherapy. The rotation is based primarily in the psychiatric units at the Royal Jubilee Hospital (RJH) Patient Care Centre (PCC). Each ward is divided mostly by age, specialty and/or acuity (6 wards total). Most of these have capacity for 15-16 patients per ward. There is also Psychiatric Emergency Services (PES) located in the Archie Courtnall Centre within the Emergency Department at the Royal Jubilee Hospital. It is a specialized emergency area that provides intensive assessment and crisis intervention for patients arriving in emergency with psychiatric disorders. The inpatient units are primarily involved in achieving stabilization of patients’ psychiatric conditions. The majority of patients suffer from schizophrenia, mood disorders, and drug-induced psychosis. Stabilization is achieved through a multi-disciplinary team approach, which involves psychiatrists, nurses, psychologists, social workers, occupational/recreational therapists, dieticians and the clinical pharmacist. The clinical pharmacist for psychiatry also provides some ambulatory services out of Victoria Mental Health Centre and the Mental Wellness Day Program (both located in Eric Martin Pavilion (EMP) on the RJH campus). Additionally, psychiatric-related consultations from Island Health colleagues and other clinicians (independent of geographic location) are a regular component of the practice.
Therefore, while some rotation time will be spent on attending patient care rounds/huddles and doing initial overviews of new admissions, the nature of this pharmacy service is primarily consultative. Completing requested consults and drug information queries will comprise a bulk of the rotation. The remainder of the time is dedicated to completing assigned projects and/or presentations and participating in therapeutic discussions and/or groups. In order to provide a comprehensive experience, rotation time will also include exposure to non-pharmacological treatment modalities, primarily occurring at the Mental Wellness Day Program. 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.