Residency
Ambulatory/Acute Care Pulmonary Medicine Rotation
Preceptor:
David Young, PharmD
Site Description:
The Pulmonary Medicine Clinic provides services to approximately 50 patients per week. Pulmonary medicine includes but is not limited to the following the following disease states: asthma, COPD, interstitial lung diseases, cystic fibrosis, sleep apnea, sarcoidosis, and lung transplant. Seven Pulmonologists who specialize in these different areas, nurses, medical assistants, a respiratory therapist and a clinical pharmacist work as a multi-disciplinary team in the clinic. You will become an integral member of the Adult Asthma and Adult Cystic Fibrosis Center teams during your rotation.
This rotation offers a unique patient care experience with respect to continuity as it involves providing clinical pharmacy services to both the inpatient and outpatient Cystic Fibrosis Teams. The inpatient Adult Cystic Fibrosis center provides care for 7-10 patients admitted for acute CF exacerbations.
Rotation Description:
You will provide patient education on disease state management, evaluate drug therapy regimens, provide recommendations for optimizing drug therapy, drug level monitoring, medication reconciliations, education/training of the Internal Medicine medical residents, Physician Assistant and Pharmacy students.
RLS Goals:
| Outcome R2: Provide evidence-based, patient-centered medication therapy management with interdisciplinary teams. | |
| Goal R2.1: | As appropriate, establish collaborative professional relationships with members of the health care team. |
| Goal R2.4: | Collect and analyze patient information. |
| Goal R2.6: | Design evidence-based therapeutic regimens. |
| Goal R2.7: | Design evidence-based monitoring plans. |
| Goal R2.8: | Recommend or communicate regimens and monitoring plans. |
| Goal R2.9: | Implement regimens and monitoring plans. |
| Goal R2.10: | Evaluate patients’ progress and redesign regimens and monitoring plans. |
| Goal R2.11: | Communicate ongoing patient information. |
| Goal R2.12: | Document direct patient care activities appropriately. |
| Outcome R5: Provide medication and practice-related education/training | |
| Goal R5.1 | Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public. |
| Outcome E7: Demonstrate additional competencies that contribute to working successfully in the health care environment. | |
| Goal E7.1: | Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues. |
| Goal E7.2: | Communicate effectively. |
| Goal E7.4: | Manage time effectively to fulfill practice responsibilities. |
Activities Evaluated:
| Rotation Activity | RLS Goal | Teaching Method |
| See adult asthma (average of 40/week) and cystic fibrosis patients (average 15/week) in the pulmonary medicine ambulatory clinic as a member of the multi-disciplinary pulmonary medicine team. | R2.1 R2.4 |
Direct instruction Coaching Modeling Facilitation |
| Round daily as a member of the multi-disciplinary cystic fibrosis medicine team on adult cystic fibrosis patients admitted for their acute exacerbations (average daily census of 10 patients). | R2.1 | Direct instruction Coaching Modeling Facilitation |
| Evaluate drug therapy regimens; Identify potential drug-related problems; Formulate a pharmacy care plan, and communicate this with the multi-disciplinary team and/or the patient. Revise both medication regimen and monitoring plans with each patient seen in clinic or followed daily during their hospital stay.
Perform pharmacokinetic analysis of once daily aminoglycoside and continuous infusion beta-lactam antibiotic regimens for inpatient cystic fibrosis patients; Communicating recommendations with the multi-disciplinary team and documenting interventions, medication reconciliation and vaccine screenings in the electronic medical record. |
R2.4 R2.6 R2.8 R2.9 R2.10 R2.12 E7.1 E7.2 |
Direct instruction Coaching Modeling Facilitation |
| Provide disease state education and patient-specific medication counseling to pulmonary medicine patients both in clinic and in the CF patients admitted to the hospital. | R5.1 E7.1 E7.2 |
Coaching Modeling Facilitation |
| The resident will update the preceptor weekly on their progress in patient care responsibilities as well as formal presentation preparation. The resident is expected to balance the rotation requirements with the other expectations of the residency program including meetings and staffing appropriately. | E7.4 | Modeling Coaching Facilitation |
Readings and Preparatory Work:
The latest "Standards of Care" for Asthma, COPD, Allergic Rhinitis, GERD, PUD, Cystic Fibrosis.
Project/Presentation Description:
Weekly (case presentations and topic/journal club discussions) and Daily (medication histories, clinical pharmacy visit documentation, pharmacokinetic consultation documentation, development of therapeutic plans, drug information for providers)
Typical Daily/Weekly/Monthly Activities:
Monday-Friday 8:30am-5pm
Evaluation:
The resident will receive verbal feedback on a regular basis throughout the rotation. There is a planned snapshot at 1 week for E7.1.1. There is a customized midpoint evaluation in ResiTrak addressing strengths and weaknesses. There is a final summative evaluation of all the goals and objectives noted above that is discussed and then entered in ResiTrak.
