A SUCCESSFUL RESIDENCY A SUCCESSFUL RESIDENCY PROGRAM AT NY- PRESBYTERIAN PROGRAM AT NY- PRESBYTERIAN

HOSPITAL: HOSPITAL: 77THTH YEAR YEAR

Liz G. Ramos, BS, PharmD, BCPSLiz G. Ramos, BS, PharmD, BCPSClinical Manager Clinical Manager

Critical Care/Infectious DiseasesCritical Care/Infectious Diseases

NY-Presbyterian Hospital Weill Cornell Medical CenterNY-Presbyterian Hospital Weill Cornell Medical Center

NY-PRESBYTERIAN HOSPITALNY-PRESBYTERIAN HOSPITAL

• 2,400 bed tertiary care teaching 2,400 bed tertiary care teaching hospitalhospital

• Comprised of two of the nation's Comprised of two of the nation's most prestigious medical centersmost prestigious medical centers– Columbia University Medical Center Columbia University Medical Center – Weill Cornell Medical CenterWeill Cornell Medical Center

How To Have A Successful How To Have A Successful Residency Program? Residency Program? • PHARMACY DEPARTMENT SUPPORTPHARMACY DEPARTMENT SUPPORT

• RESIDENCY PROGRAM DIRECTORRESIDENCY PROGRAM DIRECTOR

• PRECEPTORSPRECEPTORS– Rotations availableRotations available

• FUNDING $$FUNDING $$– ASHP AccreditationASHP Accreditation– SalarySalary– RecruitmentRecruitment

NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell

Intended Residency OutcomesIntended Residency OutcomesAfter completion of the New York-Presbyterian After completion of the New York-Presbyterian

Hospital Pharmacy Residency, the individual will Hospital Pharmacy Residency, the individual will fulfill the following:fulfill the following:

• Assume responsibility for providing optimal and Assume responsibility for providing optimal and comprehensive patient care in multiple care comprehensive patient care in multiple care environments.environments.

• Demonstrate the aptitude needed for leadership Demonstrate the aptitude needed for leadership and management of pharmacy practice.and management of pharmacy practice.

• Provide appropriate and timely medical Provide appropriate and timely medical information to health care professionals, information to health care professionals, patients and the community.patients and the community.

• Demonstrate a commitment to building the Demonstrate a commitment to building the skills necessary for professional development. skills necessary for professional development.

PGY-1: RotationsPGY-1: Rotations

• Required Required Rotations Rotations (32 weeks (32 weeks Total) Total)

• Orientation & TrainingOrientation & Training• Drug Information*Drug Information*• Internal MedicineInternal Medicine• Critical CareCritical Care• Infectious DiseasesInfectious Diseases• PediatricsPediatrics• Practice ManagementPractice Management• Ambulatory CareAmbulatory Care

• Elective Rotations Elective Rotations (12 (12 weeks Total)weeks Total)

• Ambulatory CareAmbulatory Care

• Burn UnitBurn Unit

• Emergency MedicineEmergency Medicine

• HIV/AIDSHIV/AIDS

• Investigational DrugsInvestigational Drugs

• Neonatal Intensive CareNeonatal Intensive Care

• Nutrition SupportNutrition Support

• Oncology/BMTOncology/BMT

• Pediatric Critical CarePediatric Critical Care

• Pediatric Oncology/BMTPediatric Oncology/BMT• Solid Organ Transplantation Solid Organ Transplantation

(heart, lung, liver, kidney, pancreas)(heart, lung, liver, kidney, pancreas)

* 6 weeks

NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell

Residency Learning SystemResidency Learning System• ““The residents training will be designed, The residents training will be designed,

conducted, and evaluated using a conducted, and evaluated using a systems-based approachsystems-based approach””

• Following the RLS Is a Means to Meeting 4 Following the RLS Is a Means to Meeting 4 Principle Requirements (PGY1)Principle Requirements (PGY1)– 4.1 Program Design4.1 Program Design– 4.2 Program Delivery4.2 Program Delivery– 4.3 Program Evaluation and Improvement4.3 Program Evaluation and Improvement– 4.4 Tracking of Graduates4.4 Tracking of Graduates

“SHAPING” THROUGH FEEDBACK

Perform task

Feedback received

Feedback related to previous performance

Decision to modify performance in specific way

THE LEARNING PYRAMID

Preceptor’s Role

Foundation Skills and Knowledge

Practical Application

Culminating Integration

DirectInstruction

Modeling

Coaching

Facilitating

Preceptor QualificationsPreceptor Qualifications• NYS licensedNYS licensed• Routinely practice in that areaRoutinely practice in that area• Complete preceptor orientation Complete preceptor orientation

ANDAND• PGY-1PGY-1

– One of the following:One of the following:• PGY1 + PGY2 + 6 mos experiencePGY1 + PGY2 + 6 mos experience• PGY1 + 1 year experiencePGY1 + 1 year experience• 5 years experience5 years experience

• PGY-2PGY-2– One of the following:One of the following:

• PGY1 + PGY2 + 1 year experiencePGY1 + PGY2 + 1 year experience• PGY1 + 3 years experiencePGY1 + 3 years experience• 5 years experience5 years experience

Clinical Managers Clinical Managers (NY Weill Cornell Center)(NY Weill Cornell Center)

• Drug InformationDrug Information

• Internal MedicineInternal Medicine

• Medical Critical Care/ Medical Critical Care/ Infectious DiseasesInfectious Diseases

• Critical Care - CTICUCritical Care - CTICU

• Nutrition SupportNutrition Support

• Oncology/BMTOncology/BMT

• PediatricsPediatrics

• Residency ProgramResidency Program• Solid Organ Solid Organ

Transplantation, Transplantation, RenalRenal

• Maria Dubs, PharmDMaria Dubs, PharmD

• Olga Hilas, PharmD, BCPSOlga Hilas, PharmD, BCPS

• Liz G. Ramos, PharmD, BCPSLiz G. Ramos, PharmD, BCPS

• Regina Lee, PharmD, BCPSRegina Lee, PharmD, BCPS

• Marc Roth, MS, RPhMarc Roth, MS, RPh

• Cindy Ippoliti, PharmDCindy Ippoliti, PharmD

• Elena Mendez-Rico, PharmDElena Mendez-Rico, PharmD

• Adrianne Hewryk, PharmDAdrianne Hewryk, PharmD

• Demetrio Tappets, PharmDDemetrio Tappets, PharmD

Clinical Managers Clinical Managers (Columbia University Medical (Columbia University Medical Center)Center)

• Drug InformationDrug Information• Infectious DiseasesInfectious Diseases• Infectious DiseasesInfectious Diseases• Infectious DiseasesInfectious Diseases• Medical Critical CareMedical Critical Care• NeuroCritical CareNeuroCritical Care• Oncology/BMTOncology/BMT• Pediatric Critical CarePediatric Critical Care• Pediatric OncologyPediatric Oncology• Pediatrics, GeneralPediatrics, General• SOT, Cardiac/LungSOT, Cardiac/Lung• SOT, LiverSOT, Liver

• Martha Rumore, PharmDMartha Rumore, PharmD• Greg Eschenauer, PharmD, BCPSGreg Eschenauer, PharmD, BCPS• Christine Kubin, PharmD, BCPSChristine Kubin, PharmD, BCPS• Kelly O’Neill, PharmD, BCPSKelly O’Neill, PharmD, BCPS• Amy Dzierba, PharmD, BCPSAmy Dzierba, PharmD, BCPS• Christine Lesch, PharmD, BCPSChristine Lesch, PharmD, BCPS• Lillian Chou, PharmDLillian Chou, PharmD• Enrico Ligniti, PharmDEnrico Ligniti, PharmD• Ibis Lopez, PharmDIbis Lopez, PharmD• Jason Topolski, PharmDJason Topolski, PharmD• Thresiamma Lukose, PharmDThresiamma Lukose, PharmD• Stacey Balducci, PharmDStacey Balducci, PharmD

NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell

Design and Conduct of the Residency ProgramDesign and Conduct of the Residency Program

• Service Commitment Service Commitment – Distribution FunctionsDistribution Functions– Drug InformationDrug Information– Pharmacokinetic MonitoringPharmacokinetic Monitoring– Continuation of Clinical ServicesContinuation of Clinical Services– AOC liaisonAOC liaison

Structure of Learning Experiences - Longitudinal

NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell

Program’s Assessment StrategyProgram’s Assessment Strategy

Evaluation ProcessEvaluation Process

Sum m ativeEvaluation

Criteria-basedChecklists (2)

Preceptor

Preceptor &Learning Experience

Sum m ativeSelf-Evaluation

Criteria-basedChecklists (2)

Self-Evaluation

Resident

L earn in g E xp erien ce

RESITRAK – Evaluations…RESITRAK – Evaluations…

RESITRAK – Evaluations…RESITRAK – Evaluations…

RESITRAK – Evaluations…RESITRAK – Evaluations…

Learning Experience Preceptor Evaluation

NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellThe University Hospitals of Columbia and Cornell

Evaluation ProcessEvaluation Process

• Residency Activity CommitteeResidency Activity Committee MembershipMembership

Director, Drug Use Policy and AcquisitionDirector, Drug Use Policy and Acquisition Residency Program DirectorsResidency Program Directors 4 Preceptors from New York Weill Cornell Center4 Preceptors from New York Weill Cornell Center 4 Preceptors from Columbia Presbyterian Center4 Preceptors from Columbia Presbyterian Center

RoleRole Set time for Current Resident’s inputSet time for Current Resident’s input Review Quarterly EvaluationsReview Quarterly Evaluations Review Effectiveness of Residency ProgramReview Effectiveness of Residency Program

Resident EvaluationResident Evaluation Preceptor EvaluationPreceptor Evaluation

Recommend Modifications to the ProgramRecommend Modifications to the Program

NewYork-Presbyterian HospitalNewYork-Presbyterian HospitalThe University Hospitals of Columbia and The University Hospitals of Columbia and CornellCornell

Medication Use EvaluationMedication Use Evaluation Darbepoetin, Aminoglycosides, Levofloxacin, IVIG, Eplerenone, Darbepoetin, Aminoglycosides, Levofloxacin, IVIG, Eplerenone,

Caspofungin, Warfarin, Enoxaparin, Rifaximin, Daptomycin, Polymyxin Caspofungin, Warfarin, Enoxaparin, Rifaximin, Daptomycin, Polymyxin B, CMV-IGIV, Compliance Surgical Px, Conivaptan, Fondaparinux and B, CMV-IGIV, Compliance Surgical Px, Conivaptan, Fondaparinux and HIT, De-escalation from Zosyn, Hypoglycemia and sulfonylureasHIT, De-escalation from Zosyn, Hypoglycemia and sulfonylureas

Research ProjectResearch Project A Retrospective Review: Combination Antifungals in the Treatment of Invasive AspergillosisA Retrospective Review: Combination Antifungals in the Treatment of Invasive Aspergillosis Development & Implementation of a PK monitoring ServiceDevelopment & Implementation of a PK monitoring Service Comparison of a Continuous Insulin Infusion Protocol versus Sliding Scale Insulin in the ICUComparison 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 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 Retrospective review of the clinical, microbiological, and mortality endpoints of nosocomial candidemia before

and after the availability of caspofungin and voriconazoleand after the availability of caspofungin and voriconazole Erythropoetin in the intensive care unitErythropoetin in the intensive care unit A randomized, open-label study to compare C2 v.s. C0 monitoring of cyclosporine microemulsion on the 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 recipientsincidence 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 Effect of steroid-sparing immunosuppressive regimens on the morbidity and mortality of renal transplant

patients infected with Hepatitis Cpatients infected with Hepatitis C Evaluation of the Sepsis GuidelinesEvaluation of the Sepsis Guidelines Review of the outcomes in invasive aspergillosis in patients treated with combination versus monotherapy at 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 New York Weill Cornell Center and Columbia University Medical Center Efficacy of palifermin for mucositis in hematopoietic stem cell transplant recipientsEfficacy of palifermin for mucositis in hematopoietic stem cell transplant recipients Timing to initiation of appropriate antifungal therapyTiming to initiation of appropriate antifungal therapy Antiretroviral medication errors in hospitalized patientsAntiretroviral medication errors in hospitalized patients Inhaled epoprostenol use in acute respiratory distress syndromeInhaled epoprostenol use in acute respiratory distress syndrome Impact of BK viremia and viruria in stem cell transplantation recipientsImpact 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 Clinical and microbiological outcomes in patients receiving tigecycline for infections due to multi-drug resistant

organismsorganisms Use of low-dose valganciclovir in high-risk renal transplant recipientsUse of low-dose valganciclovir in high-risk renal transplant recipients Minimizing cardiovascular risk among renal transplant recipientsMinimizing cardiovascular risk among renal transplant recipients

Structure of Learning Experiences - Longitudinal

PGY-2 Residencies: 2007PGY-2 Residencies: 2007

• PGY-2 Critical CarePGY-2 Critical Care– Program Director: Amy Dzierba, PharmD, BCPSProgram Director: Amy Dzierba, PharmD, BCPS

• PGY-2 Infectious DiseasesPGY-2 Infectious Diseases– Program Director: Christine Kubin, PharmD, Program Director: Christine Kubin, PharmD,

BCPSBCPS

• PGY-2 TransplantPGY-2 Transplant– Program Director: Thresiamma Lukose, Program Director: Thresiamma Lukose,

PharmDPharmD

PGY-2 Residencies: 2007 PGY-2 Residencies: 2007 (Cont’d)(Cont’d)

• PGY2 Pharmacy Residency PGY2 Pharmacy Residency Program Program

• Duration:Duration: 12-months12-months

• Positions:Positions: 11

• Starting Date:Starting Date: July 1, 2009July 1, 2009

• Estimated Stipend:Estimated Stipend: $50,000$50,000

• Interview Required:Interview Required: YesYes

PGY-2 Critical Care PGY-2 Critical Care Rotations…Rotations…• Required Rotations:Required Rotations:

– Medical Intensive Care - ColumbiaMedical Intensive Care - Columbia 6 weeks6 weeks– Surgical Intensive CareSurgical Intensive Care 6 weeks6 weeks– Neurosciences Intensive CareNeurosciences Intensive Care 6 weeks6 weeks– Cardiothoracic Intensive CareCardiothoracic Intensive Care 6 weeks6 weeks– Medical Intensive Care - Cornell Medical Intensive Care - Cornell 4 weeks4 weeks

• Elective Rotations:Elective Rotations:– Burn Intensive CareBurn Intensive Care 4 weeks4 weeks– Infectious DiseasesInfectious Diseases 4 weeks4 weeks– Coronary CareCoronary Care 4 weeks4 weeks– Emergency MedicineEmergency Medicine 4 weeks4 weeks– Solid Organ Transplant Solid Organ Transplant 4 weeks4 weeks(heart, lung, liver, kidney, pancreas)(heart, lung, liver, kidney, pancreas)– Neonatal Intensive CareNeonatal Intensive Care 2-4 weeks2-4 weeks– Pediatric Intensive Care Pediatric Intensive Care 2-4 weeks 2-4 weeks– Nutrition Support Nutrition Support 2-4 weeks2-4 weeks

YEARYEAR Name Name PGY2 PGY2 ResidencyResidency

EmployerEmployer

20032003 Theresa LukoseTheresa Lukose SOTSOT NYP NYP - CM SOT (Lung)- CM SOT (Lung)

20042004 Anne McDonnellAnne McDonnell

Jeong KimJeong KimHeme/Onc - UNCHeme/Onc - UNC B&W Hospital – CS -H/OB&W Hospital – CS -H/O

NYPNYP, Staff Pharmacist, Staff Pharmacist

20052005 Anastacia BalducciAnastacia Balducci

Bernard LeeBernard Lee

Simon LamSimon Lam

Joni MaedaJoni Maeda

SOT – Univ CinnSOT – Univ Cinn

CC – Mayo ClinicCC – Mayo Clinic

Heme/Onc - JHHeme/Onc - JH

NYP NYP - CM SOT (Liver)- CM SOT (Liver)

NYP NYP - CM – Gen Peds- CM – Gen Peds

NYP NYP - CM – SICU- CM – SICU

Hawaii MC – CP- OncHawaii MC – CP- Onc

20062006 Christine BorromeoChristine Borromeo

Hema KothariHema Kothari

Amy LoganAmy Logan

Neha ShethNeha Sheth HIV/ID – Univ BuffHIV/ID – Univ Buff

UCSF – CP – Renal TxUCSF – CP – Renal Tx

GSH – CP - IMGSH – CP - IM

SFGH – CP – Med/SurgSFGH – CP – Med/Surg

Univ of MD - FacultyUniv of MD - Faculty

20072007 Yanina DubrovskayaYanina Dubrovskaya

Jerry HuJerry Hu

Rachel Tavares de MeloRachel Tavares de Melo

Demetrio TappetsDemetrio Tappets

ID – ID – NYPNYP

SOT – SOT – NYPNYP

SOT – SOT – NYPNYP

NYU – CP – IDNYU – CP – ID

HSS – Staff PharmacistHSS – Staff Pharmacist

NYP NYP - CM SOT (Renal)- CM SOT (Renal)

20082008 Jessica CampaignJessica Campaign

Maabo Kludze-ForsonMaabo Kludze-Forson

Christine H. PaengChristine H. Paeng

Shazia A. RaheemShazia A. Raheem CC - CC - NYPNYP

Univ NM – FacultyUniv NM – Faculty

St Joseph’s – CPSt Joseph’s – CP

NYPNYP – Lead Rph – ED – Lead Rph – ED

NYPNYP – CM – NeuroICU – CM – NeuroICU

20092009 Monique BryanMonique Bryan

Soonali ManiarSoonali Maniar

Leandra MikoLeandra Miko

May NguyenMay NguyenSOT – SOT – NYPNYP

ID - ID - NYPNYP

Recruitment…

NYPH – Pharmacy Website…NYPH – Pharmacy Website…http://nyp.org/pro/pharmacy/index.html

Pharmacy Residency: PGY-1Pharmacy Residency: PGY-1

http://nyp.org/pro/pharmacy/pgy1.html

Pharmacy Residency: PGY-2Pharmacy Residency: PGY-2

http://nyp.org/pro/pharmacy/pgy2.html

Funding- NYPH Residency Funding- NYPH Residency ProgramsPrograms

• 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. 413.85(e)

Funding- NYPH Residency Funding- NYPH Residency Program (Cont’d)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. 413.85(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-1996. Am J Health-Syst Pharm. 1998; 55:1618-9.

ConclusionConclusion

• PHARMACY DEPARTMENT SUPPORTPHARMACY DEPARTMENT SUPPORT

• DEDICATED PRECEPTORSDEDICATED PRECEPTORS

• FUNDING FUNDING – ASHP AccreditationASHP Accreditation– SalarySalary– RecruitmentRecruitment

THANK YOU !!