Critical Care Specialty Residency

• Orientation/training/research: 2-4 weeks (duration determined by the resident’s previous work experience)
• Core ICU rotations: Surgical ICU – 6 weeks; Medical ICU – 6 weeks; Thornton ICU (mixed medical/surgical/cardiovascular) – 5 weeks; Burn ICU – 4 weeks
• Core ICU elective: 1 month (repeat SICU, BICU, Thornton ICU, or MICU rotation of resident’s choice)
• Electives: 1 month each (may repeat any of the ICU’s or other electives)
• Staffing: 12 weekends throughout the year (~1 shift/month) including 1 major and 1 minor holiday
• Research project and publication

PGY2 residents will gain the skills to function as the primary ICU pharmacist during their required core rotations (Surgial ICU, Medical ICU, Burn ICU, and Thornton ICU, which is a mix of surgical, medical, cardiovascular patients). During core ICU rotations, the resident will be trained to handle all aspects of the medication process from ordering to administration. Because core ICU rotations will focus on developing the skills necessary to effectively be the lead ICU pharmacist, they will primarily be assigned in the first half of the residency year. Rather than focusing on a specific team, the PGY2 resident will be expected to identify medication-related issues and manage the therapeutic plan of every patient in the unit, regardless of the primary service. The resident will be expected to build relationships with each medical team in the ICU and work proactively with the nurses and physicians to achieve efficient work flow and medication delivery. Daily activities will include: participation in rounds, carrying the Code Blue emergency pager, reviewing each patient’s profile for appropriateness of drug therapy, performing pharmacokinetic monitoring on all therapeutically monitored drugs (TDM), validating pharmacy orders on all ICU patients, and overseeing and directing PGY1 resident and pharmacy student activities. This integration of staffing and clinical services prepares residents for any type of practice environment they may encounter in their future jobs by emphasizing the development of essential skills required for an advanced pharmacy practitioner: independent practice skills, multi-tasking and prioritization.

There will be a total of 15 rotations that the resident can choose their five electives from. One of the electives must be a repeat core ICU rotation (e.g. SICU, BICU, MICU, Thornton ICU) of the resident’s choice. The other electives can be selected from the list below and any of the core ICU rotations may be repeated again as a general elective. This will allow the resident the flexibility to tailor their PGY2 experience to an area of interest. Elective rotations will generally be scheduled in the second half of the residency year (after the core ICU rotations are completed) and may be repeated if the resident desires additional experience.

Teaching is a large component of our program. PGY2 residents will have many opportunities to precept/teach and their training will include learning how to incorporate teaching into their clinical responsibilities. UC San Diego is a teaching institution affiliated with UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) and UCSD School of Medicine. The PGY2 resident will have multiple opportunities to precept 4th year SSPPS pharmacy students and PGY1 pharmacy practice residents, as well as to work with UCSD physician interns, residents and fellows on most, if not all, rotations. In addition, the resident will be asked to give many educational lectures to their colleagues throughout their residency year.

Grand Rounds: The resident will deliver a 1-hour CE lecture to the pharmacy staff regarding a topic in critical care. Allied health professionals are welcome to attend. Presentations are accredited for continuing education through California Accreditation for Pharmacy Education (CAPE).

ICU Clinical Forums: Residents are required to present 4 “mini” grand rounds and 4 journal club presentations during the year at our ICU Pharmacy Clinical Forum. The mini grand rounds are 20-minute lectures on various didactic topics related to the ASHP supplemental standard for an Advanced Practice Residency in Critical Care and will be relevant to the patient population the resident is currently involved with from a rotational perspective. The objective of journal club will be to select and critically review a recently published journal article related to critical care.

Critical Care Conference: The resident will lead/coordinate a weekly critical care conference with the ICU students and PGY1 residents. Topics may vary according to the discretion of the resident, but typically include: how to work-up/present patients, sedation/analgesia/paralytics, Surviving Sepsis, hemodynamics, antibiotic review, acid-base, ACLS. Leading the conference provides residents the opportunity to practice a variety of teaching styles and improves their understanding of and ability to teach fundamental ICU topics.

Skagg’s School of Pharmacy and Pharmaceutical Sciences: Involvement with UCSD’s School of Pharmacy will vary but the resident may choose to be a conference leader for one of the 3rd year therapeutics courses, present lecture(s) and/or create patient case presentations as part of the ICU elective course. The resident may be asked to write cases for therapeutics conference based on real patients and prepare exam questions based on the lectures presented. Residents will also have multiple opportunities to directly precept 4th year pharmacy students who are currently on rotation with the resident.

PGY2 residents have the option of participating 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. Alternatively, residents may select certain seminars to attend based on their interest areas.

The resident will be responsible for conducting 1 research project throughout the academic year that will be presented at the Western States Conference (Asilomar) or an equivalent conference and written up in manuscript form. A list of project ideas will be generated from the ICU preceptors and resident is expected to select a project during the first month of the residency year.

Publication:

The resident will be required to write a manuscript suitable for publication by the end of their residency year. The purpose of this requirement will be the development of scientific writing and communication skills. The types of publishable literature can include any of the following types of manuscripts:

• Case reports with a review of the literature
• Primary research /original research
• Medication Use Evaluation
• Meta-analysis of a disease state or therapy
• Review article

Staffing will be incorporated into the residency experience with weekend shifts that provide the opportunity for PGY2 residents to cover 1-3 ICU’s simultaneously. The PGY2 residents will be invited to staff 12 weekends (which includes 1 minor holiday weekend) PLUS 1 major holiday (Thanksgiving, Christmas, or New Year’s). The resident will get 13 paid days for holidays and 12 sick days for the academic year. Vacation time will be in accordance with GME rules and will be defined as 20 days of vacation PLUS 5 days for professional leave to attend meetings or conferences.

The residents will have the opportunity to attend various professional meetings throughout the year. Residents receive an annual travel stipend that is variable based on available funding. In the past, residents have received a set stipend for the year which they can use at their discretion for registration, travel, accommodations, etc. The cost of attending Western States (or an equivalent conference) will be deducted from the travel stipend, along with any other conferences the resident chooses to attend. Residents are encouraged to attend a specialty meeting (e.g. Society of Critical Care Medicine Annual Congress). Attendance at Western States Conference in Asilomar (or an equivalent conference to present their research) is mandatory.

Our graduating residents will effectively strengthen their knowledge, skills, and abilities in all key areas of practice management. These areas would include, among others, exploring their own professional growth improving the quality of one’s own self-assessment, developing effective negotiation skills to resolve conflicts, and demonstrating a commitment to advocacy for the optimal care of patients.

By consistently using an efficient and comprehensive pharmacy practice methodology, our graduating residents will become leaders in medication safety and have enhanced patient outcomes by integrating patient- and evidence-based disease-specific pharmacotherapy at the level of an advanced practitioner in various critical care settings.

Our graduating residents will become proficient in educating health care professionals, patients, and students on critical care topics. Our residents will also be able to provide concise and accurate responses to requests for critical care drug information from health care providers.

Our graduating residents will be engaged in multiple critical care related projects throughout the year including a continuous quality improvement (CQI) project and at least one formal research project. Enhanced project management skills and familiarity of technological systems will support the resident throughout these endeavors.

Our resident’s will actively participate in the management of medical emergencies throughout the year. They will undergo ACLS training (if not already certified) as well as complete our internal Department of Pharmacy Advanced Resuscitation Training competency and simulation. They will be oriented to the Code Blue policy and understand the pharmacist’s role in providing care as an active member of the interdisciplinary patient care team.