A SUCCESSFUL RESIDENCY PROGRAM AT NY- PRESBYTERIAN HOSPITAL: 7 TH YEAR

1. A SUCCESSFUL RESIDENCY PROGRAM AT NY- PRESBYTERIAN HOSPITAL: 7TH YEAR Liz G. Ramos, BS, PharmD, BCPS Clinical Manager Critical Care/Infectious Diseases NY-Presbyterian Hospital Weill Cornell Medical Center

2. NY-PRESBYTERIAN HOSPITAL • 2,400 bed tertiary care teaching hospital • Comprised of two of the nation's most prestigious medical centers • Columbia University Medical Center • Weill Cornell Medical Center

3. How To Have A Successful Residency Program? • PHARMACY DEPARTMENT SUPPORT • RESIDENCY PROGRAM DIRECTOR • PRECEPTORS • Rotations available • FUNDING $$ • ASHP Accreditation • Salary • Recruitment

4. NewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellIntended Residency Outcomes After completion of the New York-Presbyterian Hospital Pharmacy Residency, the individual will fulfill the following: • Assume responsibility for providing optimal and comprehensive patient care in multiple care environments. • Demonstrate the aptitude needed for leadership and management of pharmacy practice. • Provide appropriate and timely medical information to health care professionals, patients and the community. • Demonstrate a commitment to building the skills necessary for professional development.

5. Required Rotations (32 weeks Total) Orientation & Training Drug Information* Internal Medicine Critical Care Infectious Diseases Pediatrics Practice Management Ambulatory Care Elective Rotations (12 weeks Total) Ambulatory Care Burn Unit Emergency Medicine HIV/AIDS Investigational Drugs Neonatal Intensive Care Nutrition Support Oncology/BMT Pediatric Critical Care Pediatric Oncology/BMT Solid Organ Transplantation (heart, lung, liver, kidney, pancreas) PGY-1: Rotations * 6 weeks

6. NewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellResidency Learning System • “The residents training will be designed, conducted, and evaluated using a systems-based approach” • Following the RLS Is a Means to Meeting 4 Principle Requirements (PGY1) • 4.1 Program Design • 4.2 Program Delivery • 4.3 Program Evaluation and Improvement • 4.4 Tracking of Graduates

7. “SHAPING” THROUGH FEEDBACK Perform task Decision to modify performance in specific way Feedback received Feedback related to previous performance

8. THE LEARNING PYRAMID Preceptor’s Role Facilitating Culminating Integration Coaching Practical Application Modeling Direct Instruction Foundation Skills and Knowledge

9. Preceptor Qualifications • NYS licensed • Routinely practice in that area • Complete preceptor orientation AND • PGY-1 • One of the following: • PGY1 + PGY2 + 6 mos experience • PGY1 + 1 year experience • 5 years experience • PGY-2 • One of the following: • PGY1 + PGY2 + 1 year experience • PGY1 + 3 years experience • 5 years experience

10. Drug Information Internal Medicine Medical Critical Care/ Infectious Diseases Critical Care - CTICU Nutrition Support Oncology/BMT Pediatrics Residency Program Solid Organ Transplantation, Renal Maria Dubs, PharmD Olga Hilas, PharmD, BCPS Liz G. Ramos, PharmD, BCPS Regina Lee, PharmD, BCPS Marc Roth, MS, RPh Cindy Ippoliti, PharmD Elena Mendez-Rico, PharmD Adrianne Hewryk, PharmD Demetrio Tappets, PharmD Clinical Managers (NY Weill Cornell Center)

11. Drug Information Infectious Diseases Infectious Diseases Infectious Diseases Medical Critical Care NeuroCritical Care Oncology/BMT Pediatric Critical Care Pediatric Oncology Pediatrics, General SOT, Cardiac/Lung SOT, Liver Martha Rumore, PharmD Greg Eschenauer, PharmD, BCPS Christine Kubin, PharmD, BCPS Kelly O’Neill, PharmD, BCPS Amy Dzierba, PharmD, BCPS Christine Lesch, PharmD, BCPS Lillian Chou, PharmD Enrico Ligniti, PharmD Ibis Lopez, PharmD Jason Topolski, PharmD Thresiamma Lukose, PharmD Stacey Balducci, PharmD Clinical Managers (Columbia University Medical Center)

12. NewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellDesign and Conduct of the Residency Program • Service Commitment • Distribution Functions • Drug Information • Pharmacokinetic Monitoring • Continuation of Clinical Services • AOC liaison Structure of Learning Experiences - Longitudinal

13. Evaluation Process NewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellProgram’s Assessment Strategy

14. RESITRAK – Evaluations…

15. RESITRAK – Evaluations…

16. RESITRAK – Evaluations… Learning Experience Preceptor Evaluation

17. NewYork-Presbyterian HospitalThe University Hospitals of Columbia and CornellEvaluation Process • Residency Activity Committee • Membership • Director, Drug Use Policy and Acquisition • Residency Program Directors • 4 Preceptors from New York Weill Cornell Center • 4 Preceptors from Columbia Presbyterian Center • Role • Set time for Current Resident’s input • Review Quarterly Evaluations • Review Effectiveness of Residency Program • Resident Evaluation • Preceptor Evaluation • Recommend Modifications to the Program

18. NewYork-Presbyterian HospitalThe University Hospitals of Columbia and Cornell Structure of Learning Experiences - Longitudinal • Medication Use Evaluation • Darbepoetin, Aminoglycosides, Levofloxacin, IVIG, Eplerenone, Caspofungin, Warfarin, Enoxaparin, Rifaximin, Daptomycin, Polymyxin B, CMV-IGIV, Compliance Surgical Px, Conivaptan, Fondaparinux and HIT, De-escalation from Zosyn, Hypoglycemia and sulfonylureas • Research Project • A Retrospective Review: Combination Antifungals in the Treatment of Invasive Aspergillosis • Development & Implementation of a PK monitoring Service • Comparison of a Continuous Insulin Infusion Protocol versus Sliding Scale Insulin in the ICU • Defining the management of post-operative nausea & vomiting in the post-anesthesia care unit • Retrospective review of the clinical, microbiological, and mortality endpoints of nosocomial candidemia before and after the availability of caspofungin and voriconazole • Erythropoetin in the intensive care unit • A randomized, open-label study to compare C2 v.s. C0 monitoring of cyclosporine microemulsion on the incidence and severity of rejection in kidney, liver, and heart transplant recipients • Effect of steroid-sparing immunosuppressive regimens on the morbidity and mortality of renal transplant patients infected with Hepatitis C • Evaluation of the Sepsis Guidelines • Review of the outcomes in invasive aspergillosis in patients treated with combination versus monotherapy at New York Weill Cornell Center and Columbia University Medical Center • Efficacy of palifermin for mucositis in hematopoietic stem cell transplant recipients • Timing to initiation of appropriate antifungal therapy • Antiretroviral medication errors in hospitalized patients • Inhaled epoprostenol use in acute respiratory distress syndrome • Impact of BK viremia and viruria in stem cell transplantation recipients • Clinical and microbiological outcomes in patients receiving tigecycline for infections due to multi-drug resistant organisms • Use of low-dose valganciclovir in high-risk renal transplant recipients • Minimizing cardiovascular risk among renal transplant recipients

19. PGY-2 Residencies: 2007 • PGY-2 Critical Care • Program Director: Amy Dzierba, PharmD, BCPS • PGY-2 Infectious Diseases • Program Director: Christine Kubin, PharmD, BCPS • PGY-2 Transplant • Program Director: Thresiamma Lukose, PharmD

20. PGY-2 Residencies: 2007 (Cont’d) • PGY2 Pharmacy Residency Program • Duration: 12-months • Positions: 1 • Starting Date: July 1, 2009 • Estimated Stipend: $50,000 • Interview Required: Yes

21. PGY-2 Critical Care Rotations… • Required Rotations: • Medical Intensive Care - Columbia 6 weeks • Surgical Intensive Care 6 weeks • Neurosciences Intensive Care 6 weeks • Cardiothoracic Intensive Care 6 weeks • Medical Intensive Care - Cornell 4 weeks • Elective Rotations: • Burn Intensive Care 4 weeks • Infectious Diseases 4 weeks • Coronary Care 4 weeks • Emergency Medicine 4 weeks • Solid Organ Transplant 4 weeks (heart, lung, liver, kidney, pancreas) • Neonatal Intensive Care 2-4 weeks • Pediatric Intensive Care 2-4 weeks • Nutrition Support 2-4 weeks

23. Recruitment…

25. NYPH – Pharmacy Website… http://nyp.org/pro/pharmacy/index.html

26. Pharmacy Residency: PGY-1 http://nyp.org/pro/pharmacy/pgy1.html

27. Pharmacy Residency: PGY-2 http://nyp.org/pro/pharmacy/pgy2.html

28. Funding- NYPH Residency Programs • In 2003, the Centers for Medicare & Medicaid (CMS) reaffirmed their support for Pharmacy Practice Residency programs by continuing to support Medicare1 • It is the “industry norm” for hospitals to generally hire only pharmacists who have completed a pharmacy practice residency to work directly in patient care1 • CMS views “hospital pharmacy” as a “specialty” of the pharmacy profession1 Reg. Sec. 413.85(e)

29. Funding- NYPH Residency Program (Cont’d) • Pharmacy Practice Residency program is eligible to receive payment for the following:1 • The clinical training costs incurred for the program • Classroom costs, but only those costs incurred by the provider for the courses that were included in the programs • The net costs of approved educational activities • Determined by deducting, from the total cost incurred by the hospital for these activities, any revenues the hospital receives from grants or tuition • Hospital’s total cost includes trainee stipends, compensation for preceptors and residency directors, and other direct and indirect costs of the activities as determined under Medicare cost-finding principles2,3 1. Reg. Sec. 413.85(iii) 2. Miller DE, Woller TW. Understanding reimbursement for pharmacy residents. Am J Health-Syst Pharm. 1998; 55:62-5. 3. Cortese Annecchini LM, Letendre DE. Funding of pharmacy residency programs-1996. Am J Health-Syst Pharm. 1998; 55:1618-9.

30. Conclusion • PHARMACY DEPARTMENT SUPPORT • DEDICATED PRECEPTORS • FUNDING • ASHP Accreditation • Salary • Recruitment

31. THANK YOU !!