Pharmacy Residency

PGY2 Critical Care Residency

The PGY2 residency in critical care pharmacy is designed to transition PGY1 residency graduates from generalist practice to specialized practice that meets the needs of critically ill patients. PGY2 residency graduates exit equipped to be fully integrated members of the interdisciplinary critical care team, able to make complex medication and nutrition support recommendations in this fast-paced environment. Training focuses on developing resident capability to deal with range of diseases and disorders that occur in the critically ill. Special emphasis is placed on the complexities of multiple organ system failure and the difficulties imposed on care when patients require life-sustaining equipment. Graduates of the critical care residency are experienced in short-term research in the critical care environment and excel in their ability to teach other health professionals and those in training to be health professionals. They also acquire the experience necessary to exercise leadership for critical care practice in the health system.

Residency Goals

  1. Develop into an independent, competent, critical care practitioner with the ability to work with a multidisciplinary team to provide pharmaceutical care to patients in a range of critical care settings.
  2. Develop the knowledge and clinical skills to provide evidence-based pharmacotherapy recommendations for critically ill patients.
  3. Formulate a research question, develop methods and complete a short-term research project.
  4. Develop teaching and communication skills necessary to provide education to multidisciplinary critical care providers and trainees.
  5. Develop the essential skills necessary of a practice leader.

Training Site

The Hospital of the University of Pennsylvania is the largest institution within the University of Pennsylvania Health System (Penn Medicine) and is world-renowned for its clinical and research excellence, forging the way for new and better ways to diagnose and treat illnesses and disorders. HUP is a 764-bed-academic teaching hospital and tertiary referral center located in the heart of Philadelphia. The U.S. News and World Report have consistently ranked the Hospitals of the University of Pennsylvania (HUP) and Penn Presbyterian Hospitals (PPMC) nationally in many specialty areas including: Neurology and Neurosurgery, Cardiology and Heart Surgery, ENT, Nephrology, Orthopedics, and Pulmonology. The HUP Intensive Care Units are fully staffed by registered nurses, respiratory therapists, clinical nutritionists, pharmacists, medical students, residents, advanced practitioners, and fellows under the supervision of the attending medical physicians. There are currently 122 adult ICU beds within our CTSICU, NICU, SICU, MICU and CCU intensive care units. HUP is also home to a 45 bed ED, 17 bed “fast track” care area, and 17 bed ED Observation Unit with approximately 72,000 patient visits per year. HUP's reputation as a world leader in medical research and clinical care attracts the highest quality medical specialists from around the world. The supportive and collaborative environment encourages physicians and staff to keep reaching ahead to find new ways to improve the quality and length of life for everyone.

Learning Experiences

Required Rotations (36 weeks)

  • Orientation – 4 weeks
    • Consists of hospital and departmental training including pharmacokinetic and code training. BLS and ACLS will be scheduled during this time if not already certified. The resident will also be trained on the pharmacy teams covering the intensive care units as this is where their primary weekend staffing responsibility will fall.
  • Medical ICU – 8 weeks
    • The medical intensive care unit consists of a 24 bed ICU and a separate 8 bed ICU, set to open in October 2017 under the direction of the Pulmonary, Allergy, and Critical Care medicine division. The 24 bed unit is divided into two teams, consisting of multidisciplinary practitioners including physicians, nursing, clinical nutrition, pharmacy, and physical therapy. The 8 bed unit is a non-teaching service managed by advanced practitioners. The resident will participate in daily patient care rounds on one of the teams with the goal to develop proficiency in proactively solving problems and communicating effectively with all members of the healthcare team.
  • Surgical ICU – 6-8 weeks
    • The surgical ICU consists of 24 beds staffed by two multidisciplinary teams. The resident will be assigned to one team with the primary focus of optimizing pharmaceutical care for those patients. Common disease states encountered in the SICU include: necrotizing fasciitis, skin and soft tissue infections, wound infection, pancreatitis, intra-abdominal infection, sepsis, alcohol withdrawal, CRRT, and pain, agitation and delirium.
  • Cardiac Care Unit – 4 weeks
    • The Cardiac Care Unit consists of a 12 bed ICU under Cardiovascular Medicine. The unit is divided into two teams, Heart Failure and General Cardiology, with two attending physicians, but one set of fellows and residents. The resident will participate in daily patient care rounds with both teams with the goal to effectively and efficiently provide recommendations to the teams. Common disease states include cardiogenic shock, ACS, VAD, arrthymias, valvular disease, tamponade, ablations, impella devices, and balloon pumps.
  • Emergency Department – 4 weeks
    • The Department of Emergency Medicine provides clinical care in many exciting and diverse venues offering a remarkable breadth and depth of care for our patients. Its clinical services include disaster preparedness, emergency medical services, emergency ultrasound, hyperbaric medicine, observation medicine, resuscitation and critical care, toxicology, quality improvement and safety, trauma, and travel medicine. There is a high level of acuity in the HUP ED with a high admission rate to the hospital. The department has developed prioritized care for patients with cardiologic, neurologic, oncologic and traumatic emergencies. The resident will work parallel with a preceptor and with an expectation to take over the responsibility of the primary pharmacist towards the end of the rotation.
  • Heart and Vascular ICU - 4 weeks
    • The Heart and Vascular ICU consists of 32 beds fully staffed by two multidisciplinary teams. The resident will be responsible for rounding and providing pharmaceutical care to one of the teams as assigned by the preceptor. Common procedures and disease states encountered in the HVICU include: valvular replacement and repair, CAGB, cardiogenic shock, acute respiratory failure, VA and VV ECMO, VAD implantation, temporary ventricular assist devices, IABP, heart and lung transplant, endocarditis, aortic dissection, and heart failure.
  • Neurosciences ICU – 4 weeks
    • The NICU at HUP is a 22 bed ICU staffed by two fully supported teams. The resident will be responsible for rounding and providing pharmaceutical care to patients on one of the two teams. Common disease states encountered in the NICU include: subarachnoid hemorrhage, ischemic stroke, intracranial hemorrhage, status epilepticus, intracranial hypertension, CNS infections, and neurosurgical post-operative care.

Electives (12 weeks)

Depending on the elective, there are opportunities to have a brief two-week elective experience to gain exposure to a topic. The resident may also repeat any of the required rotations as an elective experience.

  • Solid Organ Transplant Surgery (liver or kidney)
  • Advanced Lung Disease service (lung transplantation)
  • Acute Heart Failure service (heart transplant service)
  • Antimicrobial Stewardship
  • General Infectious Diseases
  • Transplant or Oncology Infectious Diseases
  • Nutrition support
  • Bone Marrow Transplant or Oncology
  • Pain and Palliative Care
  • Trauma Surgical Critical Care (PPMC)
  • PPMC Critical Care Rotation (HVICU, or MICU)
  • Research
  • Toxicology

Longitudinal Experiences

Research/Scholarly Activities

  1. Identify a research question and develop methods to complete a critical care-related research project as part of the PGY1-PGY2 paired research program.
  2. Coordinate and develop, with the paired PGY1 resident, a poster outlining the methodology of the research project for presentation at the University Health Consortium Pharmacy Council meeting (PGY2) and the ASHP Midyear Clinical Meeting (PGY1).
  3. Submission of research project manuscript to a critical care journal.
  4. Submit abstract for poster presentation (research or case report) to SCCM or other national meeting (optional).
  5. Participate in writing a review article (optional).

Teaching/Education

  1. Assist in the mentoring of pharmacy residents, students and staff.
  2. Provide in-service education to nursing, pharmacy and/or physician and advanced provider staff.
  3. Develop presentations for Therapeutics Conference (3 required which can consist of journal club or case presentation formats).
  4. Attend critical care conferences including pulmonary/surgical critical care, cardiothoracic/cardiology and specialty conferences as assigned by the preceptor.
  5. Attend and present one topic discussion at the monthly Pharmacy Critical Care conference.
  6. Provide an ACPE-accredited presentation at Pharmacy Grand Rounds.
  7. Present SCCM journal club during residency year (optional).
  8. Instruct pharmacy students in didactic coursework at the University of the Sciences in Philadelphia (USP) or other academic setting (optional).
  9. Serve as primary preceptor for an IPPE or APPE student rotation (optional).
  10. Participate in the Teaching Certificate Program at USP (optional).

Leadership

  1. Prepare drug monographs (2 required) for formulary review at the UPHS Pharmacy and Therapeutics Committee.
  2. Develop drug or therapeutic guidelines and drug utilization reviews as needed.
  3. Participate in the clinical intervention program, adverse drug reaction reporting program and medication error program.
  4. Participate in department, hospital and clinical unit committees as assigned. Also serve as secretary of assigned Pharmacy and Therapeutics subcommittee.
  5. Certify in Basic Life Support and Advanced Cardiac Life Support. Respond to Code Call, Anesthesia Stat and Rapid Response requests as assigned.
  6. Attend and serve as secretary at the monthly Critical Care Pharmacy Residency meetings.
  7. Attend the ASHP Mid-year clinical meeting, Eastern States Residency Conference (optional), and SCCM Congress (optional) as funding allows.

Operational

  1. Provide weekend staffing coverage to an ICU practice area. ICU practice areas include the MICU/CCU, CTSICU, or SICU. Staffing responsibilities include: order verification and distribution of medication orders, provision of pharmacokinetic consult recommendations and attendance to all code, anesthesia stat, and rapid response calls for assigned units.

Program Director

Jaime Robenolt Gray, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist, Surgical Critical Care
Hospital of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
jaime.gray@uphs.upenn.edu

Application Requirements

Candidates interested in the program should submit the following to Phorcas:

  1. Academic transcripts from your pharmacy school (including pre-pharmacy college training)
  2. Letter of intent which addresses the following:
    • why you have chosen the Hospital of the University of Pennsylvania,
    • why you have chosen to pursue specialized training in critical care and
    • your residency and career goals.
  3. Curriculum vitae
  4. Three letters of recommendation (at least one from a clinical rotation preceptor, preferably from an ICU rotation)

All required application materials should be submitted to Phorcas by the deadline of January 2nd, 2018: