Ambulatory Care Residency

The UC San Diego Medical Center (UCSDMC) includes inpatient, ambulatory care and home health facilities. Three inpatient teaching hospitals serve as the primary teaching sites for the UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego School of Medicine and for other professional programs in health sciences, including a clerkship program for fourth year SSPPS pharmacy students: Hillcrest Hospital, Thornton Hospital, and the Sculpizio Cardiovascular Center. These facilities support a full range and scope of medical and surgical specialties as well as general medicine and surgery units. The UCSDMC system also includes comprehensive ambulatory care, the Moores UCSD Cancer Center, a NCI designated comprehensive cancer center, and home health care programs, as well as 35 beds in the Child and Adolescent Psychiatry Services (CAPS).

The UCSDMC Department of Pharmacy is responsible for service to these hospitals, as well as six ambulatory care pharmacies and CAPS; in addition, a pharmacy home infusion service program is operated in support of the home health care program. The department is staffed by over 200 full time employees comprised of pharmacists, technicians, clerical and supportive personnel. Currently, we have 20 residents (12 acute and three ambulatory care PGY1, and five PYG2) and 60 fourth-year SSPPS pharmacy students, all of whom participate directly in the provision of patient care.

Pharmacists and pharmacy residents serve as members of interdisciplinary patient care teams on inpatient medical, surgical and intensive care units, with special emphasis on oncology, AIDS, transplant, trauma surgery, neonatology, infectious diseases and cardiovascular diseases. In the ambulatory care area our current areas of disease state emphasis are family medicine, anticoagulation, transplantation, diabetes, CKD, CHF and AIDS. Responsibility for these clinics is shared by the staff, full-time faculty, residents, fellows and students. Our Pharmacy Home Infusion Service staff, which includes pharmacists and nurses, provides care for a wide range of patients seen through the allied home health care programs. The Department also has formal programs in the areas of applied pharmacokinetics, antimicrobial monitoring and investigational drugs.

In support of our decentralized clinical pharmacy services, the department operates a 24-hour centralized drug distribution area. Drug distribution is provided through a house-wide, point-of-use unit dose system, which uses computer-actuated dispensing equipment and a barcode driven medication administration system (MAK/eMAR). All UCSDMC patients (ambulatory care, inpatient, and home care) are included in an integrated, computerized patient information system. Computer terminals are available in all patient care locations at the pharmacy offices. A computerized physician order entry system (CPOE) has been implemented. Pharmacists review and validate orders prior to dispensing.

• Orientation
• Family Medicine Clinic
• Anticoagulation Management Clinic
• Student Run Free Clinic
• Solid Organ Transplant Clinic
• Pain and Paliative Care Clinic
• Antiretroviral Clinic (HIV/Owen Clinic)
• Diabetes Clinic
• Psychiatry CLinic
• Moores Cancer Center Retail Pharmacy
• Teaching Conferences (P4 Student APPE Ambulatory Care Conferences)
• Administration Rotation
• Operations (23 days, which includes two minor and one major holiday weekend days)
• Teaching Certificate Program
  • Patient Directed Group Teaching: 1
  • Small Group Teaching: 5
  • Small Group Facilitation: 2
  • Journal Club: 1
  • Large Group Formal Presentation: 1
  • Patient Case: 2

Residents have the opportunity to choose two electives, each consisting of 4 weeks blocks. Residents may choose to duplicate a required learning experience or choose an elective. We offer elective training in a wide range of medical and surgical specialty areas, in both the inpatient and ambulatory care settings. There are currently more than 20 electives to choose from for these experiences.

The UCSD Medical Center is an Advanced Pharmacy Practice Experience (APPE) site for fourth-year Pharm.D. student candidates from the UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS). Our residents, clinical staff and faculty serve as preceptors for the pharmacy students during their Introductory Pharmacy Practice Experiences (IPPE). In addition, our residents serve as facilitators for the 3rd year Therapeutics conferences and 4th year patient care conferences. Didactic lectures are available and residents are encouraged to participate. The residents also provide lectures and presentations to physicians, nurses, pharmacists, pharmacy students and other allied health care providers.

Residents participate in the San Diego Pharmacy Residency Leaders (SDPRL) Teaching Certificate Program which includes a seminar series with residents from other county-wide residency programs. Seminar topics will focus on teaching and preceptor development. Seminar attendance is mandatory. One excused absence is allowed provided the make-up assignment is completed as assigned.

Residents will participate in the P-3 Therapeutics Course sequence of the SSPPS as facilitators in the case conferences. Two cases are prepared by the residents. As facilitators, residents are responsible for encouraging discussion, enhancing the learning experience and assuring that the students provide an effective analysis of the case focusing on the areas of clinical importance. One of the primary functions of the case conferences is to help develop the ability of the student to apply the information learned in the basic and applied sciences to patient care.

Each resident is expected to help design and complete one major project under the guidance of a project preceptor during the academic year. This project may be a medication use evaluation (MUE), a continuous quality improvement (CQI) project, pharmacokinetic evaluation, or another type of research project. Projects are presented at the SSPPS to students, faculty and UCSD staff. The project will be written in manuscript format and those suitable for publication will be submitted. Problem-solving skills are also developed through day to day activities and a variety of other projects.

Residents complete a longitudinal distribution and staffing rotation which averages two days per month. Residents also receive instruction regarding pharmacy policies and procedures that govern the preparation and distribution of medications, automation and related technology as well as how to use information technology to reduce errors and improve medication safety.

Residents will be required to attend various professional meetings throughout the year, which may include CSHP’s (California Society of Health System Pharmacists) Seminar and/or ASHP’s (American Society of Health-System Pharmacists) Midyear meeting at which they will participate in recruitment efforts.

Residents will be required to give educational lectures to their colleagues and students throughout their residency year as well as to other health care professionals as assigned while on rotations:

• Grand Rounds:
  

  Residents will present a 1-hour continuing education lecture to the Pharmacy staff and students based on a current or controversial drug-related topic, new drug or new drug application in which there is current literature for evaluation and discussion. Allied health professionals are welcome to attend. Presentations are accredited for continuing education through California Accreditation for Pharmacy Education (CAPE).

• Journal Club:
  

  Residents are required to critique and present an article regarding a current or controversial drug therapy topic.

• Staff Meetings:
  

  Residents are required to present at least one 5 – 10 minute presentation on a clinically relevant topic at the monthly Outpatient Pharmacy Staff Meetings.

• Outreach Presentation:
  

  Each resident participates in a community outreach program addressing the public regarding an area of disease prevention and wellness promotion.

• In-services:
  

  Residents are required to provide several medication and/or disease state in-services to medical teams, students, pharmacy preceptors and pharmacy staff as assigned. Topics will be based on requests by the nursing or medical staff, recommendations from the resident or assigned by the preceptor.

By consistently using an efficient and comprehensive pharmacy practice methodology, our graduating residents are leaders in medication safety and have enhanced patient outcomes by integrating patient- and disease-specific pharmacotherapy. Residents will have identified areas for improvement of the medication-use system and will have participated in the design and implementation of improvement recommendations. Our residents will have become proficient at preparing and dispensing medications according to the organization’s policies and procedures and will have demonstrated responsibility for the welfare and medication-related outcomes of the patient.

Our graduating residents will have been active members of health care teams and have been leaders in delivering patient-centered, evidence-based, pharmacy care to their patients. They will have completed necessary medication and patient monitoring plans to obtain optimal outcomes. Residents will have become proficient in documenting and communicating medication-related matters to appropriate team members and will have assisted other health care professionals in ensuring appropriate follow-up care.

Our graduating residents have effectively strengthened their knowledge, skills, and abilities in all key areas of practice management and leadership. These areas will include an understanding of medication distribution systems, and the medication use processes, including financial implications. Residents will have participated in organizational committees and will have improved their understanding and application of decision-making processes.

Our resident’s will have engaged in a formal practice-related investigation project utilizing project management skills. Residents will have developed time management skills and familiarity of technological systems to support this experience.

Our graduating residents have become proficient in educating health care professionals, patients, and students on medication-related topics. Our residents will be leaders as drug information resources.

Our graduating residents will be proficient in utilizing information technology to enhance efficiency, improve patient safety and provide optimal patient outcomes.