Ralph H. Johnson VA Medical Center
Pharmacy Student Information
REQUIRED PAPERWORK FOR VA ROTATIONS
It is recommended that you contact your preceptor at least three weeks before your training date. There is a long list of forms and training the student must complete to be given a badge and VA computer access. Forms can be found at the following website: http://www.charleston.va.gov/Welcome_Residents_and_Students.asp
All forms must be submitted to Education Service at least two week prior to your scheduled clinical training date for things to run smoothly on your first day of rotation. Forward all items to Bryan Williams, Affiliations Coordinator, Suite CC201, 109 Bee St, Charleston, SC 29401, by email to email@example.com, or by fax to 478-274-5876.
CLINICAL ROTATION OPTIONS
ItRRotation Title: Adult Inpatient Medicine
Site Description: There are two internal medicine (IM) wards run by three IM teams for a total of 50 medicine beds. Each IM team includes an attending physician, 1 (PGY2 or PGY3) medical resident, 2 PGY1 interns, and medical students. Other disciplines that may be involved in the multi-disciplinary team include: pharmacy residents, pharmacy students, social worker, dietitian, case manager, and diabetic educator. Students are required to be on the floor for an eight hour shift with potential for after-hours work to complete projects and presentations.
The student is expected to be on the inpatient medicine ward Monday through Friday. They will be responsible for rounding with one internal medicine team daily, following all patients on that team, serving as a drug information resource for the team, providing targeted monitoring of high-risk populations (patients receiving therapeutic anticoagulation [including warfarin], aminoglycosides, and vancomycin), and screening all patients with impaired renal function. The student will also participate in daily patient discussions as well as topic discussions with the preceptor. All recommendations to the medicine team should be reviewed with the preceptor or pharmacist covering for the preceptor (in the case of preceptor absence) prior to bringing recommendations to the medicine team.
The student is also expected to attend morning report on Mondays, Wednesdays, and Fridays throughout the rotation. They will be responsible for developing and presenting an in-service to their team, preparing for and presenting at the inpatient journal club, and completing a weekly student workbook. Documentation of non-formulary requests, interventions, medication errors, and ADRs is also required. The student is also expected to participate in medication reconciliation by assisting with patient counseling upon discharge.
Rotation Title: Acute Care – Critical Care
Site Description: The medical and surgical intensive care units at the Ralph H. Johnson Veterans Affairs Medical Center offer the student the opportunity to experience specialized aspects of medical and surgical intensive care units. Clinical pharmacy services include, but are not limited to, anticoagulation monitoring, pharmacokinetic monitoring, medication reconciliation, daily pharmacotherapeutic monitoring, and daily rounding with the medical and/or surgical ICU teams. This rotation will provide students with the following educational opportunities: to round with the medical and/or surgical ICU teams; to assess, analyze, recommend, monitor, and modify drug therapy regimens; to provide clinical pharmacy services; to give presentations to health care professionals and/or patients; to utilize patient assessment skills, both physical and laboratory; and to assist in administrative functions of pharmacy. The goal of this rotation is to improve the student’s understanding and philosophy of all aspects of intensive care medicine in efforts to provide appropriate and optimal pharmaceutical care to this patient population.
Rotation Title: Geriatrics and Extended Care
Site Description: This rotation takes place at both the Department of Geriatrics and Extended Care (GEC) at the Ralph H. Johnson VA Medical Center and the Nursing Home Care Unit in West Ashley. The Geriatric programs that the student will have the opportunity to experience include primary care through the Geriatric Clinic, Nursing Home Care Unit, Home Based Primary Care (HBPC), Acute Care Geriatric Medicine (GEM Inpatient Service) and Hospice/ Palliative Care Consult Service (HPC). All services involve working with an interdisciplinary team consisting of physicians, nurses, pharmacists, dietary, physical therapy, social work and other medical students as well as medical and pharmacy residents. The goal of this rotation is to improve the student’s understanding and philosophy of all aspects of geriatric care in efforts to provide appropriate pharmaceutical care to this patient population in any health care environment including but not limited to ambulatory care, long term care, intermediate and acute care. Clinical pharmacy services include formulation of drug regimen reviews focusing on disease state management, anticoagulation monitoring, medication reconciliation, management of symptoms common at the end of life, and education of staff, patients, and their families.
Rotation Title: Ambulatory Care – Primary Care (Charleston, Trident, Goose Creek, Myrtle Beach, Beaufort, Savannah)
Site Description: The primary care clinics at the Ralph H. Johnson VA Medical Center offer a variety of experiences for the student to participate in chronic disease state management including anticoagulation, diabetes, hyperlipidemia, and hypertension. This rotation also helps the students improve their communication skills not only with patients, but with other members of health care team (physicians, physician assistants, nurse practitioners, nurses, pharmacists, etc.). The student will participate in counseling patients regarding their medication therapy, documenting clinical activities in the electronic medical record, and educating staff through presentations and drug information questions.
Rotation Title: Ambulatory Care – Cardiovascular Risk Reduction Clinic (Charleston, Goose Creek)
Site Description: The Cardiovascular Risk Reduction Clinic (CRRC) targets high-risk patients (HTN +/- DM and BP >140/90, DM LDL >100, CHD LDL >100 and DM with A1c >9%), who are 75 years of age or younger. Patients are scheduled for 15 minute appointments and emphasis is placed on aggressive medication changes with frequent follow-up, with patients referred to other clinics and providers on an as needed basis to assist with additional education. Students will be expected to participate in patient visits and complete progress notes in the electronic medical record. The student will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience for hypertension, diabetes, and hyperlipidemia.
Rotation Title: Ambulatory Care – Specialty Clinic, Anemia Clinic, HIV clinic, Pain Clinic, Rheumatology, and Psychiatry/Surgery
Site Description: The specialty clinics at the Ralph H. Johnson VA Medical Center offer a variety of experiences for the student to participate in the management of various disease states. This rotation also helps the students improve their communication skills not only with patients, but with other members of health care team. The student will participate in counseling patients, recognizing pertinent interactions with medication therapy, and answer relevant drug information requests and non-formulary requests related to specialty care. Clinical pharmacy services include anticoagulation monitoring, pharmacokinetic monitoring, medication reconciliation, anemia management, and non-formulary requests.
Rotation Title: Ambulatory Care - Pain Management
Pain Management is a 4-week learning experience at the Ralph H Johnson VA Medical Center for P4 students. There is an interdisciplinary pain team at the hospital that includes 2 attending physicians (anesthesiologists), 1 pain psychologist, 1 nurse practitioner, 1 clinical pharmacy specialist and 1 psychology technician. Other disciplines that may be involved in the multi-disciplinary team include: medical fellows and residents, psychology interns, pharmacy residents and students. The PharmD student is expected to be in the pain management clinic Monday through Friday for an eight hour shift with potential for after-hours work to complete progress notes, projects, and presentations. They will be responsible for following all patients as assigned by Dr. Abramczyk, serving as a drug information resource for the team, and presenting complex patient cases as assigned at the pain team meeting each Wednesday, and participating in daily patient discussions and topic discussions as they occur. The P4 student will be required to give one presentation in the area of pain management by the end of the rotation to further demonstrate competency.
Rotation Title: Central Inpatient Pharmacy
Site Description: The Ralph H. Johnson VA Medical Center is a primary, secondary, and tertiary care medical center that provides acute medical, surgical, and psychiatric inpatient care, as well as primary and specialized outpatient services. The Outpatient Pharmacy dispenses approximately 400 prescriptions per day at the hospital with another 3200 from the Centralized Mail Outpatient Pharmacy (CMOP). The Inpatient Pharmacy serves 98 total beds and provides an extensive Outpatient Chemotherapy Service.
Administration- Ambulatory Care Clinical Supervisor
Site Description: Students will work directly with the Ambulatory Care Clinical Supervisor during the rotation to oversee pharmacy operations in a wide range of clinics including anticoagulation, pharmacotherapy, anemia, cardiovascular risk reduction, and several community-based outpatient clinics across the state. Students will gain an understanding of how ambulatory pharmaceutical services play an important role in the overall hospital setting. During the month students will develop the skills to evaluate cost effective prescribing and formulary management. This rotation will provide students exposure to various leadership roles and management skills.
Administration- Institutional Pharmacy Director
Site Description: The Pharmacy Leadership and Administration rotation will expose the student to general administrative and clinical skills necessary to lead a complex tertiary care center with extensive inpatient, outpatient, and clinical pharmacy services. The rotation will provide the student with insight into key issues confronting pharmacy practice, specifically from the Pharmacy Chief/Director’s perspective. The student will develop knowledge and skills related to communication, decision making, productivity management, problem identification, problem solving, strategic planning, and policy development, as well as gain a general understanding of human resource management, financial management, labor relations and pharmacy regulations and law.
Rotation Title: Clinical Administration
Site Description: The Ralph H. Johnson VA Medical Center offers a variety of experiences for the student to participate in pharmacy clinical coordinator activities. While completing this rotation, students will actively participate in pharmacy quality improvement and cost savings activities, medication use evaluation, and P&T activities.