Residency

Solid Organ Transplant Rotation

Preceptor:

Nicole Kenyon, PharmD, BCPS
Sabrina Lee, PharmD, BCPS
Lonnie Smith, PharmD
Crystal Truax, PharmD, BCPS

Site Description:

The solid organ transplant rotation offers both inpatient and ambulatory exposure to kidney, pancreas, liver, heart and lung transplant. The resident will have the unique opportunity to participate in the continuity of care from pre-transplant evaluation, post-surgical care, discharge counseling, and post-transplant clinic follow-up. Practice sites include surgical and medical intensive care units, general medicine and surgical floors, and outpatient transplant clinics. Outpatient clinics include:

Adult Kidney and Pancreas Pre- and Post-transplant
Adult Liver Pre- and Post-transplant
Adult Heart Pre- and Post-transplant
Adult Lung Pre- and Post-transplant

The transplant pharmacists operate as an integral part in the multidisciplinary transplant team that includes attending physicians, transplant surgeons, fellows, residents, nurse practitioners, nurse coordinators, social workers, financial counselors, and other important team members. Care of transplant patients is multifaceted and patients often have several comorbidities that expose the resident to different areas of internal medicine including, but not limited to, infectious disease, diabetes, and cardiology.

Rotation Description:

The primary focus of the rotation is for the resident to develop a comprehensive approach strategy to patient care. The resident will be responsible for direct patient care of post-transplant patients in both the inpatient and outpatient setting. Topics stressed include pharmacokinetics, monitoring, and management of immunosuppressive agents including toxicities and interactions, proper management and control of opportunistic infections, and prevention and treatment of rejection. By the end of the rotation the resident should have a strong understanding of transplant pharmacotherapy and current limits to graft and patient survival. By the end of the rotation, the resident will be expected to participate in transplant rounds, to efficiently work-up a patient in the outpatient setting and to complete a patient discharge counseling session.

The resident will also have the opportunity to participate in clinical research and transplant evaluation meetings, and enrollment and management of investigator-initiated and multicenter clinical trials. Weekly topic discussions will be held on a routine basis with the clinical pharmacists and transplant resident. Additional opportunities include journal club presentations and presentations to pharmacy and transplant staff. The resident may also have the opportunity to observe a transplant surgery, if desired.

RLS Goals:

R2.2 — Place practice priority on the delivery of patient-centered care to patients.
R2.8 — Recommend or communicate regimens and monitoring plans.
R2.10 — Evaluate patient's progress and redesign regimens and monitoring plans.
R5.1 — Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.
E7.1 — Use approaches in all communication that display sensitivity to the cultural and personal characteristics of the patients, caregivers, and health care colleagues.
E7.4 — Manage time effectively to fulfill practice responsibilities.

Activities Evaluated:

Rotation Activity	RLS Goal	Teaching Methods
Minimally, conduct 5 thorough patient interviews to determine current drug therapy and relevant medication history.	R2.2 R2.8 E7.1 E7.4	Modeling Coaching Facilitating
Evaluate medication therapy for assigned post-transplant recipients in ambulatory and inpatient settings. Identify medication-related problems. Communicate recommendations for modifying drug therapy directly to the provider for each patient assigned to the resident. For hospitalized patents, continue to modify and update the patients pharmaceutical care plan for the duration of each patient's stay. (Plans will be reviewed daily with the preceptor.)	R2.2 R2.8 R2.10 E7.1 E7.4	Direct Instruction Modeling Coaching Facilitating
Respond to drug information questions from solid organ transplant providers/preceptors and patients. Responses must be clear, concise, accurate and timely.	R2.2 R5.1 E7.4	Modeling Coaching
Minimally present one pre-transplant and one "Lunch and Learn" in-service to the transplant team.	R5.1 E7.1 E7.4	Modeling Coaching Facilitating
Provide effective discharge counseling for at least one newly transplanted patient with appropriate documentation.	R2.2 E7.1 E7.4	Modeling Coaching Facilitating

Core Topics to be Covered During Rotation:

Overview of immunosuppressive medications
Immunology of transplant
Opportunistic infections and prophylaxis
Overview of kidney and liver transplant
Post-transplant complications
Acute and chronic rejection

Elective Topics to be Covered During Rotation:

Organ allocation and donor types
Immunizations after transplant
Pregnancy after transplant
Post-transplant malignancies
Other transplant-related topics as identified by the resident

Project Description:

The resident may be asked to complete an additional project during the rotation. The choice of project will depend on the interests of the resident and the needs of the solid organ transplant team.

Sample Projects

Assist with current quality improvement projects
Assist with ongoing clinical research activities
Analyze trends on drug utilization in post-transplant recipients

Typical Schedule:

Typical hours are 8AM until 5PM.

Daily activities: work-up inpatients in preparation for rounds and/or discussion with preceptor, round with appropriate teams

Monday: Patient or topic discussion, liver selection conference
Tuesday: Adult post-kidney clinic, pre-transplant education (kidney)
Wednesday: Adult pre-transplant clinic, project time
Thursday: Adult post-kidney clinic, kidney selection conference
Friday: Journal club or topic discussion, adult post-liver clinic, clinical research meeting

Evaluation:

The resident will receive feedback on a regular basis from the transplant pharmacists. The resident will review their progress at the midpoint - emphasizing strengths and opportunities for improvement. On the last day, the preceptor will sit down with the resident for a full summative evaluation. Comments will be documented in ResiTrak.

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