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MGH
PGY1 PHARMACY RESIDENCY
ROTATION
DESCRIPTIONS
updated 11/09
ACUTE
CARE
Residents will recommend patient-specific pharmacotherapeutic plans in conjunction with the assigned medical/surgical team, provide appropriate drug information, and communicate effectively.
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General
Medicine: Residents will be versed in physiology, pathophysiology, and anatomy. They will be responsible for the clinical presentation of patients, with emphasis on history, drug therapy, recommended drug therapy, interpretation of laboratory data and all pertinent information relative to the care of the patient. Residents will develop team-working skills and interactions, both educating and learning with other health care professionals: physicians, nurses, and all other disciplines required for complete patient care. All medical disease states are emphasized and are dependent on the patient population at the time of the rotation. Emphasis will be placed on cardiovascular (hyperlipidemia, hypertension), endocrine (diabetes, thyroid disorders), fluid/electrolyte disorders, gastrointestinal (cholelithiasis, inflammatory bowel disease, liver disease, pancreatitis, PUD), respiratory (asthma/COPD, acid-base disorders), hematological (anemias, coagulation disorders) and infectious diseases (abdominal infections, endocarditis, hepatitis, HIV, respiratory tract infections, skin and bone infection, sepsis, UTI). They will provide appropriate drug level monitoring and recommendations for cost-effective rational drug therapy. |
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Preceptors:
Anthony J. Fatalo, M.S., RPh, BCPS
Senior Attending Pharmacist
Interest: Cardiology, general medicine
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Cardiology/Cardiac
Care Unit:
Cardiac patients will present with angina, myocardial infarction, shock, hypertension, pulmonary hypertension, dysrhythmias, cardiomyopathy, myocarditis/pericarditis and valvular heart disease. The goal of this rotation is to advance the knowledge, skills, and abilities of the resident, with particular emphasis in cardiovascular drug therapy.
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Preceptors:
Christopher D. Lyman , Pharm.D.
Cardiology Lead Pharmacist
Residency: St. John's Hospital, Springfield, IL
Interest: Cardiology, critical care
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Medical
Intensive Care Unit: Critically ill patients with multi-system diseases will present with respiratory, cardiovascular, renal and/or hepatic failure and sepsis, requiring intensive monitoring. Infectious disease and respiratory strategies including ventilatory support will be used consistently, as well as sedation and paralysis management. Residents will understand guidelines for administration of frequently used intravenous medications, including antihypertensives, vasopressors/inotropes, electrolytes, and antibiotics. They will understand general dosing guidelines and therapeutic strategies for patients with renal and hepatic failure and make recommendations for dosage adjustments.
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Preceptors:
Krishna Shroff, Pharm. D.
Attending Pharmacist
Residency: Cardiology, UMass Memorial Medical Center
Interest:
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Surgical
Intensive Care Unit:
Critically ill patients with multi-system diseases will present with trauma and post-operative issues. Extensive use of vasopressors, inotropes, electrolytes, antibiotics, sedatives, analgesics, neuromuscular blocking agents, pain control, local anesthesia, post-operative nausea/vomiting medications are employed. The resident will also be exposed to mechanical ventilation, intravenous/intra-arterial lines and other invasive monitoring devices.
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Preceptors:
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Pediatrics:
The patient population ranges in age from infancy to adolescence and teenagers, with a variety of disease states pertinent to children, including: seizure disorders (including ketogenic diet), infectious disease (RSV, meningitis, HSV encephalitis, periorbital cellulitis), metabolic and congenital disorders, respiratory (asthma, croup), failure to thrive/eating disorders, GERD, cystic fibrosis, sickle cell anemia, Crohn's disease, and nephrotic syndrome. Considerations include dosage forms/preparations suitable for various age groups, differences in pharmacokinetic/-dynamic properties in pediatrics, and drugs that are relatively contraindicated in children. There is a daily lecture specific for pediatrics as well as morning report where new admits are discussed. There are few pediatric codes on the ward so we have mock codes at least once a month to help everyone be prepared for an event. |
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Preceptors:
B.
Robert Young, RPh
Senior
Attending Pharmacist
Interest:Pediatrics,
NICU, and pediatric critical care
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Pediatric
Intensive Care Unit: The MassGeneral Hospital for Children Pediatric Intensive Care Unit (PICU) is a 14-bed, multidisciplinary unit, which has distinguished itself by providing high quality care for critically ill infants, children and adolescents. Our patients present with a wide variety of life-threatening issues, such as severe infections, respiratory diseases, trauma, and post-operative care of various complex surgeries. |
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Preceptors:
Lois
F. Parker, RPh
Pediatric Lead Pharmacist
Interest: Pediatrics, Pediatric Critical Care, and Pain Management
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| Neonatal Intensive Care Unit: The Neonatal Intensive Care Unit is an 18-bed unit responsible for the care of newborns. Some of these babies were exposed to medications the mother took, including insulin, SSRI's, and magnesium sulfate. Other diseases/issues include: hypoxic ischemic encephalopathy, pneumonia, respiratory distress syndrome, infectious disease, electrolytes/nutrition, hyperbilirubinemia, congenital heart disease, metabolic disorders, seizures, use of ECMO, meconium aspiration, pulmonary edema, drugs and breast feeding, and drug monitoring. There is usually a lecture by a NICU expert every morning as well as morbidity rounds monthly. |
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Preceptors:
B. Robert Young, RPh
Senior Attending Pharmacist
Interest: Pediatrics, NICU, and pediatric critical care |
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Emergency
Medicine: Level 1 trauma center for adult, pediatric and burn patients; patients may present with a variety of disease states, which may include: stroke, MI, chest pain, abdominal disorders, infections, diabetic ketoacidosis, burns, trauma, poisonings/overdoses, SI/HI, illicit drug/alcohol withdrawal, and more. MGH ED sees, on average, over 250 patients a day. Pharmacy residents will understand concepts surrounding medications used in the above situations. Pharmacy residents may also deal with issues such as conscious sedation, motor vehicle accidents, trauma codes, adherence in homeless patients, post-exposure prophylaxis, treatment of sexual assault, obtaining medication histories, as well as other, unstated medical and medication situations. Pharmacy residents will be with the preceptor at all times; the preceptor reviews/approves all orders. Pharmacy residents will not assist with pediatrics unless the pediatric competency has been passed. They will not assist with codes unless competency passed (PALS for pediatric codes/ACLS for adults). The pharmacy resident will not be physically in the ED unless with preceptor.
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Preceptors:
Nancy
Balch, Pharm.D.
Senior Attending Pharmacist
Residency: Massachusetts General Hospital, Boston, MA
Interest: Emergency medicine, and influenza vaccination program and pneumococcal vaccination
program
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Ambulatory
Oncology:
This is typically a 6-week rotation designed to provide the resident with an opportunity to provide care to adult outpatients receiving chemotherapy/targeted therapy for their cancer. The rotation will concentrate on one or two cancer types, with an emphasis on cancer diagnosis and staging, treatment plan, monitoring and supportive care issues. Residents will round with clinicians to learn more about the specific cancer type, attend palliative care rounds, and work closely with clinic pharmacists around order processing, quality assurance, safety, and IV preparation. The resident will work closely with Clinical Lead Oncology Pharmacist on patient cases, drug information, and quality/safety initiatives. During the rotation, the resident will work on a research project and present to pharmacists and/or nursing. Opportunities exist for individual and group patient counseling and education.
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Preceptors:
Gayle Blouin, Pharm. D.
Ambulatory Oncology Lead Pharmacist
Residency: Dana-Farber Cancer Institute, Boston, MA
Interest: Pain and symptom management, end of life care
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OR
Pharmacy/Anesthesia: The resident will understand various types of surgery, including vascular, cardiac, thoracic, neurology, pediatric, burns, as well as same-day surgery, intubation and airway management and ECT. Medications the resident will become familiar with include induction agents, muscle relaxants, narcotics, antibiotics, and cardiovascular medications. Some specific solutions prepared for this area are: liposuction solution, kidney transplant solution, renal perfusion solution, and gastric by-pass solution. The resident may also become familiar with the OR pharmacy operations--role of the OR pharmacist/technician, control of controlled substances, and drug distribution. |
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Preceptors:
Kulwant Gill , Pharm. D.
OR Pharmacy Manager
Interest: Chemotherapy use in OR, Induction agents, muscle relaxants use in OR, narcotics and antibiotics use in OR.
Arvind
S. Shah, RPh
Senior Attending Pharmacist
Interest: Surgery, anesthesia, drug information and pain management
Audrey
Kennedy, RPh
Attending Pharmacist
Interest: Intra-operative drug administration, surgery, pain management,
drug information |
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| Psychiatry:
This will be an independent rotation. The resident will round daily with the psychiatry team. Residents will be exposed to the unique aspects of caring for the psychiatric population, focusing on the pharmacological treatment of specific diseases, including bipolar disorder, mania, schizophrenia, multiple personalities, drug overdose, drug abuse, GAD, and MDD. The resident will develop skills necessary to evaluate and treat the psychiatric patient, including patient interviewing, assessing patients using psychiatric rating scales and a more in-depth understanding of these disorders including the social and psychological impact these disorders have on their daily lives. Interdisciplinary patient care is highly evident in this patient population, involving psychiatrists, psychologists, social workers, OT, PT, pharmacists, nurses and nutritionists. |
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Preceptors:
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| Inpatient
Oncology:
The oncology rotation is a supervised clinical experience in which the resident develops the specialized knowledge base and practice competencies necessary to provide pharmacy care to cancer patients. It encompasses general principles of cancer treatment and chemotherapy, pharmacotherapy of common oncology/hematology disease states, pain management and supportive care.
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Preceptors:
Sami Ahmed , Pharm.D., BCPS
Oncology Lead Pharmacist
Residency: Massachusetts General Hospital, Boston, MA
Interest: Pediatrics, oncology, BMT, leukemia, sarcomas
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| Neurology/Neuro ICU :
MGH offers a residency rotation on the neurosciences ICU, exclusive for neurosurgery and neuromedicine patients. Diagnoses may include aneurysms, stroke, status epilepticus, Guillain-Barré syndrome, intracranial hypertension, cerebral vasospasm, and many other conditions warranting ICU admission. |
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Preceptors:
Michael
Bodock, RPh
Senior Attending Pharmacist
Interest: Neurology, emergency medicine, general medicine
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| Pain
Management:
The resident will round with the acute pain service, a consulting service staffed by interns, anesthesiology residents, and attendings from the MGH Pain Clinic. The rotation will provide the resident with an opportunity to interact with patients suffering from acute and chronic pain issues. Daily activities may include rounding, morning lectures/talks, and journal clubs .
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Preceptors:
Lois
F. Parker, RPh
Pediatric Lead Pharmacist
Interest: Pediatrics, Pediatric Critical Care, and Pain Management
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Infectious Disease: The resident provides technical and clinical information and communicates results of monitoring activities to nurses and physicians as required regarding the therapeutic actions, possible adverse reactions or interactions of antimicrobial agents. He/she develops, proposes and implements guidelines and programs for the improvement of antimicrobial utilization. He/she participates with nurses and physicians in all clinical activities as required. The resident performs daily patient rounds (M-F) to review new and changed anti-infective orders.
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Preceptor:
Petra Khoury Bassil, Pharm. D.
Medicine Lead Pharmacist
Residency: Massachusetts General Hospital
Interest: Infectious Disease
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New rotations may be created.
NON-ACUTE
CARE ROTATIONS
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Informatics:
The resident will understand the role of automation at MGH, Omnicell automated drug dispensing, database development, use of the Web for information dissemination, and computer-based training. They will also understand the hospital's Closed Loop medication system from an informatics perspective.
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Preceptors:
Ron
Imperiali, RPh
Associate Chief of Phamacy, Informatics
Interest: Computer-based training, database management, web publishing
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| Pharmacy Administration: Upon completion, the resident will increase understanding of the management of a pharmacy department, multi-disciplinary committees, teamwork and communication, legal issues, leadership development, activities of the chief pharmacy officer, the hospital and pharmacy vision from the Partners Healthcare perspective, Joint Commission, ASHP, the value of empowerment, budget planning, performance improvement, and human resources. |
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Preceptors:
Margaret
Clapp, M.S., RPh
Chief Pharmacy Officer
Residency: Massachusetts General Hospital, Boston, MA
Interest: Management, teaching and systems improvement
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Medication
Education Safety and Approval Committee:
The resident will understand the formulary approval process for both the acute care and ambulatory settings. The residents will participate in formal clinical and pharmacoeconomic evaluation of new drug therapies including financial impact on the institution. Additional responsibilities will include policy, procedure, and medication guideline development. The provision and documentation of drug information will be a responsibility of the resident throughout the year. |
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Preceptors:
Dena
Alioto, RPh
Director, Compliance
Interest: formulary management, diabetes,
cardiology, and critical care
Paul Arpino, Pharm.D., BCPS
Associate Chief of Pharmacy, Clinical Services
Residency: St. Thomas Hospital, Nashville, TN
Interest: Cardiology, critical care
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Clinical Trials
Pharmacy: The resident will gain an understanding of drug research at the MGH, including the role of the Human Research Committee at MGH, the role of the primary investigator and the role of the Clinical Trials Pharmacy. The resident will review protocols for the Clinical Trials Pharmacy Committee.
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Preceptors:
John
Vetrano, Pharm.D.
Associate Chief of Pharmacy, Clinical Trials Pharmacy
Interest: Research
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| Teaching Pharmacy Students: The resident will develop practice competencies in educating advanced pharmacy practice students at the MGH. Opportunities to teach at the local colleges of pharmacy are also available.
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Trisha LaPointe, Pharm.D., BCPS
Assistant Professor of Pharmacy Practice
Massachusetts College of Pharmacy-Boston
Residency: Massachusetts General Hospital, Boston, MA |
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| Medication Safety: The resident will review medication-related Safety Reports and revise fields such as Medication Class and Route, Specific Event type, Event Severity, and Where in the Process. The resident will develop the competency of performing a route cause analysis (RCA), including the identification of improvements that eliminate process variation. The resident will present the results of RCAs before the pharmacy QA team and propose process changes that eliminate unwanted process variation and raise the pharmacy standard of care. The resident will learn to collect, aggregate and analyze volumetric and error reporting data. |
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Mark Schnell, BSME
Director,
Pharmacy Quality & Safety
Interests:
Process Control, Root Cause Analysis, Continuous Improvement
Ronald R. Gaudette, MBA, RPh
Medication Safety Pharmacist
Interests: Medication Quality and Safety (Process analysis as it relates to assuring the five patient rights and continuous improvement)
International medical/surgical response
Community outreach to the homeless
Tanya John, Pharm.D.
Medication Safety Pharmacist
Interest: Pediatrics, medication safety, oncology
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STAFFING
| Staffing is an important part of the residency year. The pharmacy resident will be able to analyze key aspects of orders that need to be reviewed prior to verification based on clinical indicators, verify such orders, answer and document clinical interventions, including drug information requests, and adhere to current policies and procedures. The resident will understand pharmacy workflow and functions of personnel working in the production areas of the department. |
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Preceptors:
Colleen Collins, Pharm. D.
Clinical Lead Pharmacist
Interests:
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PROJECT
| The resident project, an investigation of a particular element of pharmacy practice, will be developed taking into consideration the resident's interests, department needs, and approval of pharmacy and residency directors, as well as the IRB. This project will usually take a number of months to complete. There will be several opportunities to present this work at national, regional, and local meetings. |
RESIDENCY ADVISORS/RESOURCES
Robert
K. Hallisey, Jr, M.S., RPh
Director, Clinical Systems Integration
Specialty Training: Institute for Health Care Improvement, Managing Excellence
and Quality Improvement
Interest: Cardiology, critical care, emergency medicine, and general medicine
Barbara
T. Irby, M.S., RPh
Diector, Experiential Education/Residency Director
Residency: Johns Hopkins Hospital, Baltimore, MD
Interest: Training and education of staff, residents and students
Erasmo
(Ray) Mitrano, M.S., RPh
Associate Chief of Pharmacy, Inpatient Operations
Interest: Management, automation, performance improvement
Joseph
P. Santoro, RPh
Senior Manager, Production
Interest: Nutritional support, chemotherapy, sterile products, and management
Dorothea Rudorf, PharmD, M.S.
Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy-Boston
Interest: Infectious Disease, general medicine, training and education of students and residents
Trisha LaPointe, Pharm.D., BCPS
Assistant Professor of Pharmacy Practice
Massachusetts College of Pharmacy-Boston
Residency: Massachusetts General Hospital, Boston, MA
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