Pharmacy Residency Program Expands, Offers Teaching Certificates
Writer: Sheila Roberson, 706-542-5303, roberson@rx.uga.edu
Contact: Brain Buck, 706/542-5321, bbuck@rx.uga.edu
Date: February 15, 2008
This spring three new pharmacy residents will be named to the two new residency programs that will begin in July at the University of Georgia College of Pharmacy. The pediatric pharmacy residency program will operate in conjunction with the Medical College of Georgia in Augusta as a second-year postgraduate (PGY2) program designed to follow a one-year (PGY1) pharmacy practice residency. The pediatric pharmacy residency program is the first program of its kind at MCG.
The second new program is a PGY1 pharmacy practice residency planned for two residents; it will be the first pharmacy practice residency program sponsored by the College of Pharmacy at Phoebe Putney Memorial Hospital in Albany.
The two new pharmacy residency programs reflect the growing trend in pharmacy education to provide postgraduate training in specialized disciplines to improve patient care, said Dr. Brian Buck, director of the College?s Residency Program.
"The complexity of caring for today's patients, particularly in the hospital setting, requires additional training," he stated. "Pharmacists are becoming more involved in direct patient care and in working with physicians to resolve complex drug-related problems and drug process issues."
Pediatric Pharmacy Residency
Case Study--An 8-year-old female with a complex medical history including cerebral palsy and a seizure disorder was admitted to the hospital for respiratory distress, fever, dehydration, and lethargy over the past three days. Her current home medications were metoclopramide, lansoprazole, baclofen, topiramate, oxcarbazepine, and glycopyrrolate. When the pediatric pharmacy resident was completing her review of home medications as a part of the medication reconciliation process, she noticed a high dose of topiramate written for the patient upon admission the previous evening. The resident intervened by asking the patient?s mother what the current home dose of topiramate was and identified a medication error because the dose written on admission was incorrect. The resident communicated this information to the other members of the healthcare team who immediately clarified the order, thanked her for the intervention, and asked about possible complications from an overdose of topiramate.
The new PGY2 pediatric pharmacy residency offers an advanced, comprehensive training experience at the MCG Children's Medical Center, the site of the area's only pediatric trauma center. Core requirements include general pediatrics, pediatric intensive care, neonatal intensive care, hematology and oncology. Elective experiences are offered in pulmonology, emergency medicine, cardiology, neurology, and medication safety, among others.
"The flexibility of the program allows the resident to individualize the residency to meet specific needs and interests," said Dr. Kalen Porter, pediatric pharmacy residency program director and clinical assistant professor at the College of Pharmacy.
As active members of the health care team, pharmacy residents will be accountable for achieving optimal drug therapy outcomes. They will also serve as role models to other health care professionals by contributing to improved pharmacy services and patient outcomes in their practice settings, she added.
"This is a new field with many challenges. Not a lot of drug formularies have been written for pediatric medications; dosing is different in every disease state," she said. "At the end of the residency, our residents will have become competent, confident and compassionate pediatric pharmaceutical care providers."
Pharmacy Practice Residency
Case Study--An 88-year-old African American male was hospitalized for an acute myocardial infarction (MI). Patient had a drug eluting stent placed in August 2007 and was discharged on plavix and aspirin, also receiving warfarin therapy for atrial fibrillation. Six months later patient had an acute MI (although receiving plavix and aspirin therapy). While hospitalized was prescribed aggrenox, plavix, aspirin, lovenox, and warfarin per Cardiology. Platelets began to slightly decrease each day. As clinical pharmacists, we had to make an intervention, recommending discontinuation of one or more of these antiplatelet agents to prevent patient from bleeding. Although use of these medications was justified, risk vs. benefit supercedes all. The physician decided to discontinue the aspirin and warfarin therapy for patient safety and appreciated the pharmacist for recognizing the possible complications.
The College of Pharmacy already collaborates with MCG in a PGY1 pharmacy practice residency program in which four pharmacy residents receive intensive training that will facilitate learning in such areas as oncology, critical care, infectious diseases, and geriatric medicine. The new PGY1 program at Phoebe Putney will offer a similar experience for its new residents as pharmaceutical care generalists.
Phoebe Putney is a 455-bed hospital in Southwest Georgia that can provide residents with many clinical experiences through direct patient care in a variety of areas with very competent preceptors, said Carolyn Hunter, director of the pharmacy practice residency.
"Since there is a great need for pharmacists in this area, providing excellent experiences will enable the residents and students training here to consider remaining in this area so they could provide excellent pharmaceutical care to the Southwest Georgia patients," she added.
Teaching Certificate Program
Teaching others is a significant component of pharmacy practice and direct patient care. New this year, the residency program allows pharmacy residents to earn a teaching certificate from the University of Georgia as part of their residency training. They complete a structured teaching program that provides specific instruction on key facets of teaching, whether in classroom and small groups settings, in laboratory or multi-media demonstrations, or during clinical instruction.
"Only a handful of other colleges offer this type of certificate program for pharmacy residents," said Buck. "The development of teaching skills adds to the learning that occurs in preparing pharmacists to take better care of their patients and in improving communication skills."
"In order to be good clinicians, pharmacists must also be good teachers," he added. "Good communication is the key, since patients respond better to those who can communicate well."
Community Pharmacy Practice Residency
Case Study--A 57-year-old man expressed concern over the safety of over-the-counter medications. The resident taught him how to read OTC medication labels in order to recognize active ingredients and potential side effects, drug interactions, and drug-disease interactions of OTC medications. He felt the counseling session was a beneficial learning experience. Pharmacists have extensive OTC medication training and can intervene to improve patients? understanding of OTC medication use.
The College accepted its first community pharmacy practice resident in 2002 and now has two PGY1 community pharmacy practice residents, supported in part by Kroger, who work directly with patients in the retail setting. In the community practice residency programs the goal is to establish clinical pharmacy practice as a normal part of community practice. In addition to dispensing medications, residents are trained to educate and improve patients' quality of life through counseling sessions, patient education presentations, health fairs and screenings, medication therapy management and immunizations.
"Since more and more patients are using prescription and over-the-counter products, they require more counseling and help in managing drug use," said Buck. "The population is aging and a sizeable number do not have primary care physicians. Since pharmacists are more accessible, patients go to them with their medication questions."
Diseases such as diabetes, hypertension and coronary artery disease are increasing, and residents are trained to provide proficient direct patient care. They are accountable for promoting evidence-based, patient-centered therapy management programs that produce optimal drug therapy outcomes. A wellness clinic has been set up at an Athens Kroger to better serve patients; this is the first time this concept has been tried in retail pharmacy.
"We're trying to change the way pharmacy is practiced in chain drug stores by getting pharmacists more involved in learning new skills and educating the general public," he said. "If we can increase the demand for service, we hope insurance companies will then allow reimbursement for these services."
Future plans for the College's residency program, which is accredited by the American Society of Health-System Pharmacists, will focus on health priorities and needs of the state. These would include residencies in ambulatory care and in specialized practices where in-depth training is needed, such as critical care, oncology, infectious disease and emergency medicine. By 2012 the College expects to support more than 10 programs and 15 positions through the College of Pharmacy and/or affiliate institutions. Currently approximately 25 percent of College of Pharmacy graduates seek postgraduate residency training.