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 laboratory and physical finding. Rather, extensive and frequent patient interviewing is necessary to assess 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. 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. In addition, the resident will receive training in performing mental status exam and patient interview, and gain knowledge in psychotropics including antipsychotics, antidepressants, mood stabilizers, anxiolytics and hypnotics. The resident will be responsible for a psychopharm presentation to treatment team by the end of the rotation, and assist preceptor for a drug utilization evaluation project on the as needed basis. During Block I, the resident will be working with LGBT/HIV team to gain knowledge on working with special populations. In Block II, the resident will be working with Asian focus team. The difference in cultural focus teams provides training in cultural, ethnic minority, sexual orientation, and gender-related issues. The resident will also have the opportunity to precept pharmacy students during block II.
Preceptor: Jason Wong, Pharm.D., BCPP
This learning experience is designed to provide exposure to patients’ transition of care from an acute inpatient psychiatric setting to the community. The San Francisco Behavioral Health Center (SFBHC) is located at 887 Potrero Ave. It is situated on the Zuckerberg San Francisco General Hospital campus. This facility is home to the Mental Health Rehabilitation Center (MHRC) and the Adult Residential Facility, an independent board-and-care facility. The MHRC is located on the 3rd floor of the SFBHC and is a 47 bed, locked psychiatric facility serving adult ambulatory clients with severe mental illness. The MHRC helps clients overcome the barriers to achieving their goal of recovery and move on to lower level of care in the community. The psychiatric pharmacy resident will be expected to work both independently and as part of an interdisciplinary healthcare team, providing monthly medication regimen reviews, treatment recommendations, documentation of services, and treatment follow-up with an interdisciplinary team consisting of an attending psychiatrist, primary care physician/nurse practitioner, nursing staff, and administration staff. The resident will be responsible to follow-up on psychiatric and primary care issues. At the end of the rotation, the resident will be required to present a short clinical case to the MHRC staff. In addition, the resident will work with the clinical pharmacist to facilitate a medication education group for clients once per week.
Preceptor: Betsy Yuan, Pharm.D., BCPP
This rotation in the Adult Inpatient Program (AIP) and Langley Porter Psychiatric Hospitals and Clinics is an acute inpatient experience that aims to further develop the PGY2 resident’s knowledge and skills in acute psychiatric care. The residents will learn the limits of psychotropic drug therapy, develop the skills to effectively interact with psychiatric patients, as well as common barriers to continuity of care. The Adult Inpatient Program is a locked, acute care, and general adult psychiatry unit consisting of 21 beds. As a tertiary-care hospital, the AIP has patients with treatment-refractory histories, unusual presentations, and challenging medical co-morbidity. Langley Porter is also unique in San Francisco in offering ECT and is the only remaining San Francisco hospital with a partial hospitalization program (PHP). Patients here are can be either on a voluntary or involuntary status and our average length of stay is eight to ten days with a wide range. Our two multidisciplinary teams consist of medical doctors and trainees, psychology fellows, geriatric fellows, nurses, social workers, rehab/occupational therapy staff, pharmacists, and pharmacy students. The rotation is designed to give the trainee a brief, yet in-depth experience in inpatient psychiatry, as well as common barriers faced in psychiatry.
Preceptor: Patrick Finley, Pharm.D., BCPP
This series of ambulatory care rotations is designed to provide further exposure to the psychopathology and management of mental illnesses in a variety of neuropsychiatric outpatient settings. As such, it is hoped that these clinical experiences will serve to reinforce therapeutic principles from previous acute care psychiatric rotations and provide the opportunity for the PGY2 resident to explore, exercise and enhance their role as direct healthcare providers. The resident will be expected to work both independently and as part of an interdisciplinary healthcare team, providing patient assessment, treatment recommendations, documentation of services, and treatment follow-up to adults and children suffering from a wide variety of mental illnesses. Clinical rotations will may include Child & Adolescent Medication Management Clinic, Autism Clinic, Bipolar Disorder Clinic, and the Medication Alliance Clinic (i.e., depression in primary care). Supervision of the resident in these clinics will fall under the purview of various psychiatrists but Patrick Finley PharmD will serve as the primary preceptor not only for the Medication Alliance Clinic, but also for the entire Learning Experience.
This ambulatory care rotation is designed to provide further exposure to the psychopathology and management of mental illnesses in a variety of department of public health psychiatric outpatient settings. As such, it is hoped that these clinical experiences will serve to reinforce therapeutic principles from previous acute care psychiatric rotations and provide the opportunity for the PGY2 resident to explore, exercise and enhance their role as direct healthcare providers. The resident will be expected to work both independently and as part of an interdisciplinary healthcare team, providing patient assessment, treatment recommendations, documentation of services, and treatment follow-up to adults suffering from a wide variety of mental illnesses. Clinical rotations will include South of Market Mental Health Clinic, Mission Mental Health Clinic and OMI. Supervision of the resident in these clinics will fall under the purview of various clinical psychiatric pharmacists. In addition, the resident will be expected to respond to drug information questions from the BHS Drug Information Service phone line.
This learning experience is designed to provide further exposure to medication-assisted treatment (MAT) of substance use disorders. The rotation will focus on the integration of substance use disorders treatment in multiple medical settings including specialty mental health clinics. The resident will be expected to work both independently and as part of an interdisciplinary healthcare team, providing patient assessment, treatment recommendations, and treatment follow-up to adults suffering from substance use disorders at the Office-Based Buprenorphine Induction Clinic (OBIC), Ward 93 (methadone maintenance clinic) and the UCSF Clinician Consultation Center for Substance Use. The resident will have weekly topic discussions on MAT for opioid use disorder, alcohol use disorder, and methamphetamine use disorders.
Preceptor: Gloria Wilder, Pharm.D.
The purpose of this operational component of residency training is for residents to gain exposure, knowledge and competency in the administration of behavioral health pharmacy services in non-acute care settings to the clients in the San Francisco Department of Public Health (SFDPH). The focus will be primarily upon the treatment of clients suffering from mental illnesses (and medication management of associated symptoms) and substance abuse disorders from a population perspective. The resident will be involved with the management and leadership responsibilities of SFDPH Department of Pharmacy on a weekly basis. During this time, the resident will work primarily under the supervision of the BHS Director of Pharmacy Services Behavioral Health Services, learning the Policies and Procedures of the SFDPH system, as well as the role of the Department of Pharmacy Services within the Behavioral Health System. Activities include promoting medication use improvement, regulatory preparedness, and electronic health records. Specific activities may include interfacing with community based service providers, quality management, information technology (IT), health professional peers, and clients. Examples include attending policy and planning meetings (e.g., BHS Medication Use Improvement Committee, preparation for DHCS Medi-Cal Mental Health Review), delivering presentations to the public, authoring drug information handouts for county clients, and designing and completing ad hoc projects assigned by the Pharmacy Director (eg. researching, organizing and leading stakeholders meetings to update medication storage policies in substance use treatment programs; developing informatics training and policies for prescribers for electronic prescribing of controlled substances.
This acute care elective rotation is designed to provide further exposure to the psychopathology and management of mental illnesses. The resident will be working closely with psychiatric consultation/liaison team to learn about psychiatric manifestation of medical disorders and management of psychiatric disorders in patients who are medically ill in the acute inpatient setting. It is hoped that this clinical experience will serve to reinforce therapeutic principles from previous psychiatric rotations (acute care and ambulatory care) and provide the opportunity for the PGY2 resident to explore, exercise, and enhance their role as team members, consultants, and providers. The PGY2 resident is responsible for reviewing pertinent patient information in the electronic medical record, as well as conducting patient interviews, in order to provide thorough patient assessments. The resident then works collaboratively with the team to create a treatment plan and provide monitoring recommendations and drug information.
Psychiatric Emergency Services (PES) at ZSFG is the primary provider of adult emergency mental health care as well as being San Francisco's only 24/7 dedicated psychiatric ER in the City and County of San Francisco. The service sees approximately 8,000 patients per year, of whom about 20% are voluntary walk-in patients. PES provides crisis stabilization, complete medical and psychiatric assessment and evaluation services, and initial treatment, if appropriate. The resident will be responsible for completing medication reconciliations as well as identifying and resolving medication therapy issues for patients in the short duration of a PES stay. The resident will gain knowledge on the selection and use of psychiatric emergent medications for acute agitation.
The inpatient forensic psychiatry service provides acute psychiatric care to patients from San Francisco County Jail. The jail unit is located in ZSFG and patients are usually admitted for acute psychiatric symptoms due to non-adherence to medications. The resident will gain knowledge on the legal aspects of working with forensic population and provide pharmaceutical services to treatment team.