Zuckerberg San Francisco General Hospital and Trauma Center

Pharmacy Practice Residencies

Required Rotations

Elective Rotations (4 weeks each)

Required Rotations

General Medicine (6 weeks)

Preceptors: Julie Ma, Pharm.D., BCPS; Kathy Quach, Pharm.D., BCPS

ZSFG has five General Medicine teams, each composed of an attending physician, resident, interns, and students, that admit a variety of adult patients with complex, acute medical issues. In this rotation, the pharmacy resident will be responsible for identifying and resolving all medication therapy issues for patients and provide medication education to the team and patients. Residents will have the opportunity to develop their knowledge and skills in a wide array disease states, with specific focus on management of alcohol related complications, infectious disease management, pain management, and acute exacerbations of chronic disease states. The time commitment is 7am to 5pm, Monday to Friday (and Saturday if post-call). The resident will give in-services to nursing staff, pharmacy staff, and the medicine team.

Family Practice (6 weeks)

Preceptors: Tamara Lenhoff, Pharm.D., BCPS

Family Medicine has two teams, each composed of an attending physician, resident, interns, and medical students. The resident will be post call every other day Monday through Friday (and one weekend half-day if post-call). Similar to General Medicine, this service provides acute inpatient care for patients who are at least 18 years old and who have been seen by a primary care provider through one of our clinics. The main difference between Family Medicine and General Medicine includes managing more cardiac patients. Residents will be responsible for daily drug monitoring, developing a patient-centered regimen using evidence-based guidelines, and providing these recommendations to the team. Disease states covered during this rotation include: CHF, atrial fibrillation, NSTEMI, stroke, COPD/asthma, HIV, DKA, infectious diseases, and alcohol withdrawal. In addition, the resident is expected to assist the team in patient education and discharge facilitation. The pharmacy resident will also be responsible for providing an in-service to pharmacy staff and the family medicine team.

Emergency Medicine (6 weeks)

Preceptors: Joyce Go, Pharm.D. (main); Curtis Geier Pharm.D., BCCCP; Stephanie Komura, Pharm.D.

In this rotation, the pharmacy resident will experience first-hand the typical patient population at ZSFG: the underserved, low-income, and uninsured. The resident will treat patients of all ages, from pediatric to the very old. This service has a morning shift and an evening shift. The resident may also be asked to assist during medical, trauma, and stroke codes with medication selection, dosing, and procurement. ACLS certification (provided by our residency) will be required prior to starting this rotation. Common medications to prepare emergently may include: antiarrhythmics, vasopressors, antibiotics, antihypertensives, fibrinolytics, and antidotes. The resident will be responsible for calculating and verifying pediatric weight-based dosing. They will become familiar with Prothrombin Complex Concentrates for life-threatening hemorrhage with patients receiving anticoagulation. They will counsel patients on enoxaparin, warfarin, and the use of metered dose inhalers upon discharge from the ED. Additionally, they will have the opportunity to attend toxicology grand rounds once weekly, ride in an ambulance, and attend trauma review rounds once monthly. The resident will learn proper preparation of IV drips and set-up on a smart pump in ready to administer form. The resident will increase their knowledge of medications used during medical and stroke codes, procedural sedation medications, antidotes, methotrexate for ectopic pregnancy, antibiotics selection in the ED, reversal of anticoagulants. The pharmacy resident will be responsible for one physician and nursing in-service and one drug utilization evaluation.

Critical Care: Medical/Cardiac (MICU/CCU) (6 weeks)

Preceptors: Kristin Slown, Pharm.D., BCPS (main); Melissa Nguyen, Pharm.D., BCPS

This rotation allows for the provision of pharmaceutical care to complex critically ill patients with multiple medical problems. The medicine intensive care unit (MICU) is a 14-bed unit, and the MICU service averages 6-12 critically ill medicine patients. The MICU team is comprised of one attending (double board certified in pulmonary and critical care medicine), four third year medical residents, four medical interns, a clinical pharmacist, bedside nursing, a clinical nutritionist, a social worker, and respiratory therapist(s). The resident will be responsible for rounding with the MICU team, but will also manage the care of Cardiology ICU (CCU) patients. Both teams round at the same time, so rounding with both teams is not feasible.

The resident must learn to assume responsibility and accountability for all pharmacotherapy management issues for these patients. Generally speaking, the resident must provide the following pharmaceutical care services: participate in MICU multidisciplinary team rounds daily, daily patient profile review with medication/therapy problem identification and resolution, respond to drug information requests, provide clinical support to RNs, respiratory therapists and other ancillary services, help to fix distribution problems not resolved by inpatient pharmacy, conduct RN and/or MD in-service programs, provide medication education for patients discharged home from the ICU, participate in various critical care projects, attend committee meetings (e.g. Critical Care, Code Blue, Moderate Sedation, etc), attend afternoon rounds, and participate in daily patient presentations and/or topic presentations to pharmacy preceptor. This is a Monday-Friday 7am-5pm rotation. Of note, scheduled activities may vary in time/date as the ICU is a very dynamic environment with acute issues that may arise unexpectedly. The resident will also be responsible for one journal club and final PowerPoint presentation (addition or substitution of other projects may occur as determined by preceptor).

Core content which may be covered via patient experiences, discussions of reading material and/or case presentations includes, but is not limited to, the following: ICU analgesia, sedation and neuromuscular blockade, hemodynamic monitoring & pressors/inotropic support, sepsis/septic shock/systemic inflammatory response syndrome (SIRS), infectious complications (e.g. ventilator associated pneumonia (VAP)), venous thrombosis prophylaxis, gastrointestinal stress ulcer prophylaxis, fluid & electrolyte balance, acid/base disorders, acute medication overdoses, heart failure, myocardial infarction, etc.

Ambulatory Care (4 week)

Preceptors: Gideon Cayanan, Pharm.D., BCPS; Michelle Geier, Pharm.D., BCPP; Shin-Yu Lee, Pharm.D.

In the Adult Medicine Clinic, clinical pharmacists work collaboratively with a multidisciplinary group of providers that includes primary care physicians and specialists, medical residents, nurse practitioners, nutritionists, and social workers. This is a M-F 8:30am-5pm rotation. The clinical pharmacists operate under collaborative drug therapy management (CDTM) protocols in primary care, as well as in some specialty areas such as anticoagulation, anemia of CKD, and pain management. Skills the pharmacy resident will develop are: outpatient anticoagulation, management of all primary care disease states (i.e., heart failure, diabetes, atrial fibrillation) patient interview skills, documenting proper clinic notes, and 4th year pharmacy student mentoring from Touro and UCSF Schools of Pharmacy. Clinics include renal clinic, general medicine clinic, anticoagulation clinic, and "contract"/refill clinic.

Infectious Diseases (4-6 weeks)

Preceptor: Camille Beauduy, Pharm.D.

On this consult rotation, the pharmacy resident will round with the ID consult team daily and interface with the HIV consult team on an as needed basis. The resident alongside with the preceptor, will be responsible for daily activities of maintaining the Antimicrobial Stewardship Program, a program that has saved ZSFG millions of dollars per year by cutting down on unnecessary antibiotic use. This is a Monday through Friday rotation. The day begins with pre-rounding in the morning, then teaching, then rounds with the ID consult team at 1pm. The pharmacy resident will be responsible for fielding questions from both physicians as well as support all the clinical pharmacists from all services in our hospital. Skills you will develop: antimicrobial dosing and monitoring, ID-related treatment guidelines.

Administration (4 weeks and longitudinal)

Preceptors: Mark Jones, Pharm.D. (main); Jeanette Cavano, Pharm.D., CGP; David Woods, Pharm.D.; Julie Russell, Pharm.D.; Eugenio Ocampo, Pharm.D.; Linda Truong, Pharm.D., BCPS; Justin Quintal, Pharm.D., Jessica Galens, Pharm.D., MBA

During this experience the resident will be exposed to and participate in a variety of administrative areas important to pharmacy management in a public acute care hospital. The elements of this experience are medication safety, formulary management, regulatory affairs, informatics, and operations management. The resident will complete a formulary monograph, DUE, or drug class review, and present their report to the appropriate hospital committee. This experience may also entail developing and implementing a process improvement project, participating in the preparation for a regulatory survey, analyzing medication error or adverse drug event data, aiding in the improvement of a pharmacy informatics system, or development of a new clinical service function. During the dedicated 4-week portion of the experience, the resident will attend weekly management meetings. Longitudinally, the resident will also be an active participant in a Pharmacy and Therapeutics Subcommittee.

Elective Rotations (4 weeks each)

Critical Care: Trauma/Neuro (offered after completion of MICU/CCU rotation)

Preceptors: Kristin Slown, Pharm.D., BCPS (main); Melissa Nguyen, Pharm.D., BCPS

ICU encompasses a variety of services primarily including Trauma, Neurosurgery and Neurology patients. Serving the San Francisco and Marin County area, our Trauma Center excels in the management of patients with multiple injuries, burns, complex wounds, surgical infections, etc. The scope of neurosurgery and neurology practice includes patients with brain and spinal trauma, cerebrovascular and skull-based surgery, brain and spinal tumors, ischemic and hemorrhagic stroke, etc. ICU serves both adult and pediatric patients experiencing trauma or neurovascular injuries.

An ICU team is dedicated to managing pain/sedation/delirium and mechanical ventilation, while the primary services (i.e. trauma, neurosurgery, neurology, etc) manage the care for the remaining aspects of the patient. Pharmacy residents will primarily round with the ICU team but will also be responsible for frequently contacting the nurse practitioners and residents on the primary services with recommendations related to antibiotics, blood pressure management, etc. The census will vary between 14 to 25 patients and residents are expected to manage the care for all patients by the end of the rotation.

Many topics will be covered throughout this rotation via scheduled topic discussions with preceptor(s) and separate patient-centered discussions/presentations. Such topics will include, but are not limited to, general trauma care, surgical infections, ischemic stroke, hemorrhagic stroke, neurovascular monitoring, spinal cord injury, burn management, ventilator-associated pneumonia in the surgical patient, and pain management.

This is a Monday-Friday 7am-5pm rotation. In the morning you will pre-round, attend teaching rounds, and then round with the team at 9am. In the afternoon, you will meet with your preceptor to review patients and receive pharmacy teaching.

Skills you will develop are an increased familiarity and comfort with pain/sedation/delirium/neuromuscular blockade management, surgical infections and trauma/neurovascular related disease states; experience working in a multidisciplinary environment; improved time management skills through managing many different ICU services; increased knowledge of intravenous medications, primarily continuous infusions, used in the ICU environment.

Other projects you will be responsible for are one journal club and final PowerPoint presentation (addition or substitution of other projects may occur as determined by preceptor).

Psychiatry

Preceptors: Caroline Tsai, Pharm.D, BCPP; Hai-Au Luu, Pharm.D.

This inpatient psychiatric rotation is designed to develop the resident's knowledge and skills in the areas of patient interaction, psychiatric disorders, and psychotropic drug therapy. The psychiatric experience is unique in that drug therapy monitoring is less dependent on charged laboratory and physical finding. Rather, extensive and frequent patient interviewing is necessary to access changing mental status and to detect adverse drug effects. The resident will have opportunity to interact with patients with schizophrenia, bipolar disorder, depression, substance abuse disorders and/or personality disorders. This is a Monday-Friday 8:30 am to 5:00pm rotation. The pharmacy resident will participate in morning nursing reports, interdisciplinary team rounds, teaching rounds, patient interviews, Court hearing on the units, grand rounds, research seminars, evidence-based medicine/journal club discussion, and family meetings. The resident will present patients to the preceptor in the afternoon and interact with psychiatrics on a daily basis. Skills you will develop are an understanding of the basic skills in psychiatric setting, such as doing mental status exam, patient interview skills and gain knowledge in psychotropics including antipsychotics, antidepressants, mood stabilizers, anxiolytics and hypnotics. Other projects you will be responsible for are a psychopharm presentation to treatment team by the end of the rotation, may assist preceptor for a drug utilization evaluation project on the as needed basis, and mentoring student pharmacist(s) from UCSF.

Pediatrics

Preceptor: Julie Shih, Pharm.D.

The pediatric rotation includes two potential services - pediatric wards and the neonatal intensive care unit (NICU) - which can be tailored based on the resident's interest. The pediatric wards service includes any patient admitted to the hospital who is less than 17 years of age, and common conditions seen on this service include asthma, trauma, respiratory infections, appendicitis, and rule-out sepsis. This is a Monday through Friday rotation. In addition to daily morning interdisciplinary rounds, the resident will have the opportunity to attend social service rounds, radiology rounds, and pediatric grand rounds, real or mock codes. The resident will be expected to complete at least one project or presentation . During the rotation the resident will: expand knowledge of pediatric and neonatal-specific dosing, gain experience with family-centered rounds, use evidence-based literature to support drug recommendations, develop the ability to take pediatric-specific factors into consideration when making recommendations, and refine their ability to communicate effectively with an interdisciplinary team.

Acute Geriatrics

Preceptors: Leslie Ly, Pharm.D.

The ZSFG ACE (Acute Care for Elders) units were the first created in California hospitals due to an observed trend of decline in function of adults aged >65 years old post-hospitalization. The ACE model consist of multi-disciplinary rounds that include: a physician geriatrician, a pharmacist, a clinical nurse specialist in geriatrics, the patient's bedside RN, a dietician, a physical therapist, an occupational therapist and a social worker. The ACE team serves as a consult service, providing geriatric-specific recommendations daily to all patients >65 on the ACE units of the hospital. The resident will be expected to interview the assigned patients daily, review daily recommendations with the preceptor, and attend rounds on the ACE units. There will be scheduled topic discussions on management of the elderly patient and how it differs from a typical patient. Topics may include: fractures, delirium, pain management, incontinence, Parkinson's, and constipation. This is a Monday-Friday from 7:30am-4pm rotation. Additional skills the resident will develop include: communicating with blind or hard of hearing patients, involving caretakers in patient care, assessing for geriatric depression and cognition, and using interpreter services. The pharmacy resident will be responsible for at least one in-service to nursing staff and pharmacy staff on medication management in the elderly. Additionally, there will be a minimum of one falls assessment note and minimum one medication discharge of patient.

Oncology

Preceptor: Kathy Pang, Pharm.D. BCOP

On this rotation, the resident will work in an interdisciplinary setting with oncology fellows, attendings, nurses, and social workers. The service, primarily focusing on solid tumors and lymphomas, covers both inpatients and outpatients. In the outpatient setting, this rotation will involve going to oncology clinic and providing patient counseling and interacting with health plans and community pharmacies. Additionally, substantial time is spent on the inpatient management of oncology-related admissions, such as febrile neutropenia, hypercalcemia, and complications related to chemotherapy. This rotation is Monday-Friday, 9am-5pm. During the rotation, the resident can develop and gain experience in: working with an interdisciplinary team, patient education counseling, learning common chemotherapy regimens and side effects, understanding inpatient management of oncology-related issues, and writing prior authorizations. Additionally, there will be a presentation/education document for nursing, patients, or physicians.

Women's Health

Preceptors: Kristin Harter, Pharm.D.

Cardiology

Preceptor: Christina Wang, Pharm.D.

Cardiology is an elective rotation, four weeks of learning experience at ZSFG. The cardiology team is comprised of 1 attending, 2 cardiology fellows taking care of patients assigned to 4 team-lets led by a resident paired with an intern and may include medical students. Typically, the cardiology team will be responsible for the care of approximately 12 patients. The pharmacy resident on this rotation will be assigned to the cardiology team and will be responsible for ensuring safe and effective medication use for all patients admitted to the team. Routine responsibilities include: reconciling medications for all admitted patients, therapeutic drug monitoring, anticoagulation, drug information, and antimicrobial stewardship. The resident will also be responsible for providing education to patients being discharged, as requested by the team and one cardiology team education in-service, as well as a clinical pharmacist in-service to be completed within the four weeks of the rotation.

Advanced Emergency Medicine

Preceptors: Joyce Go, Pharm.D. (main); Curtis Geier Pharm.D., BCCCP; Stephanie Komura, Pharm.D.

Advanced Psychiatry

Preceptors: Caroline Tsai, Pharm.D, BCPP; Hai-Au Luu, Pharm.D.