Curriculum
Overview
Learn more about BIDMC's PGY2 Infectious Diseases Pharmacy Residency Curriculum, including rotations, electives, longitudinal activities and Residency Preceptors.
Orientation
Each resident will attend a general one-day hospital orientation and a 3-day residency specific orientation during the first week of the residency. This is followed by a general orientation and training program. Additional ID/Stewardship training is scheduled longitudinally during individual clinical practice rotations. This training will prepare the resident for the service component of the residency as well as provide insight into the operational workflow, policies, and procedures of the pharmacy and medical center. Orientation to the College of Pharmacy will be coordinated in August. Stewardship pager coverage 5 hours weekly and every third weekend, plus a once weekly day/night coverage of a virtual pager for clinical questions.
Rotations
Required “core” rotations provide the resident with a broad experience in the provision of care to the hospitalized patient. A range of elective rotations allows the residents to customize their program to match their interests. Flexibility within the program allows residents to select elective rotations to maximize their exposure to their areas of interest. Active participation by the residents in designing their program is encouraged. In all areas to which the resident is assigned, they assume the role and responsibility of team members in the clinical service, as well as teaching and administrative aspects of the unit.
Required Rotations
Rotation description:
The Antimicrobial Stewardship (AST) rotation provides the resident with the opportunity to gain insight in the management of Infectious Diseases from the perspective of antibiotic resistance, evidence based practice, cost effectiveness, decreasing collateral damage and improving the selection of antibiotics throughout the institution. The resident will develop problem-solving skills relative to guidance of house staff in the selection of antibiotics, an evaluation of risk factors for drug resistance as well as antimicrobial pharmacokinetics and pharmacodynamics. The resident works with the Antimicrobial Stewardship team at daily rounds and independently, maintaining a responsibility to survey key drugs and infections in order to promote effective and evidence based use of antimicrobials with the ultimate goals of improving patient care and maintaining cost effectiveness. This includes setting durations of antibiotic therapy, ensuring compliance with hospital pathways and national guidelines. Additionally, surveillance of resistance throughout the institution will be important. The AST sees a wide variety of patients across the entire institution. The resident will also participate in the P&T antibiotic subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and ID Departments.
Rotation description:
The goal of this rotation is for the resident to gain insight in the management of a broad range of Infectious Diseases in the immunocompetent patient, develop problem-solving skills in therapeutics, and establishment of a firm knowledge base in antimicrobial pharmacokinetics and pharmacodynamics. The resident works with the Infectious Disease consult team and will be expected to attend daily rounds. The resident is responsible for optimizing anti-infective therapy for consult patients, including pharmacokinetic dosing and daily monitoring of anti-infective therapies. The ID consult service sees a wide variety of patients from many different backgrounds (medical, surgical, critical care, HIV, etc). The resident will also participate in the P&T antibiotic subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and Infectious Disease Departments.
Rotation description:
The Immunocompromised Infectious Diseases (ID) rotation provides the resident with the opportunity to gain insight and experience in the management of patients that are immunocompromised in terms of treatment and prophylaxis of Infectious Diseases. Specific problem-solving skills in the pharmacotherapy of these diseases are key learning experiences, as well as establishing a firm knowledge base in antimicrobial pharmacokinetics and pharmacodynamics. The resident works with the ID consult team at daily rounds, maintaining a responsibility to optimize anti-infective therapy for the consult patients. This includes dosing recommendations and daily monitoring of anti-infective therapies. The ID immunocompromised consult service sees patients on the East campus and those admitted to the Hepatobiliary Service as well as Solid Organ Transplant, Hematology-oncology, HSCT, etc). The resident will also participate in the P&T antibiotic subcommittee as well as in current medication use evaluations and other research activities within the Pharmacy and ID Departments.
Rotation description:
The OPAT rotation provides the resident with the opportunity to actively participate in the management of outpatients on chronic antibiotic therapy. The resident works with the transition team, ID inpatient consultants and OPAT intake providers to review discharge planning from BIDMC to home, rehab or other facilities to complete their therapy. This will include assessment of antibiotic choice, dose/interval, drug allergies/intolerances, patient acceptance, and duration. Additionally, the resident will assist with a monitoring plan and write an initial transition of care note in the OMR. The resident will also interview and educate the patient on the drug selection, instructions, expectations of the patient and lab follow up as well as directing them toward clinic follow up.
Rotation description:
The HIV/HCV Clinic rotation provides the resident with the opportunity to gain insight and practice in the management of outpatients with chronic infections, to develop problem-solving skills in the pharmacotherapy of these, and to broaden their knowledge base in antimicrobial/antiviral and antiretroviral pharmacokinetics and pharmacodynamics. The resident works with the Clinic team and independently, maintaining a responsibility to provide patient education, assess medication adherence, assess medication profiles, and to document quality initiatives. The clinic sees a wide variety of patients with unique comorbidities.
Rotation description:
The rotation incorporates collaborative work on quality measures related to infection prevention, tracking hospital acquired events and potentially responding to outbreaks or local public health issues. The resident may engage in surveillance, prevention and control projects. The resident should work towards independent data collection and analysis and is responsible for: Identifying the essential elements of the Infection Control dashboard for QA, including surgical prophylaxis, immunization, and hospital acquired infections as they relate to CMS and or state regulations.
Additionally, the resident will participate in a short report of activities that are relevant to pharmacy collaboration with the IC division including influenza tracking, CDC recommendations for antivirals and immunizations.
Rotation description:
This rotation provides training in clinical bacteriology, mycobacteriology, mycology, parasitology, virology, and infectious diseases serology. Residents can observe bench work in techniques and methods in diagnostic medical microbiology. Diagnostic techniques will also be included. Residents can also participate in weekly joint infectious disease-microbiology conferences. The resident will choose a topic of particular interest on which to give a presentation to medical and technical staff.
Rotation description:
MCPHS Virology and Anti-infectives course is a mandatory therapeutics curriculum item for PharmD candidates. The resident will act as the official teaching assistant for the course. The resident will attend all therapeutic lectures twice weekly. The resident will prepare and deliver a one-hour lecture in Infectious Diseases pharmacy practice. The resident will conduct tutoring sessions for students once weekly. The resident will write 4 case-based/ multiple-choice questions for each 2-hour and 2-3 questions for each 1-hour lecture to be posted on Blackboard. The resident will become familiar with policies for course coordination, syllabus development, early warning slips, make-up exams and policies for failing course; missing time; academic support; plagiarism).
Elective Rotations
Rotation description:
The Medical Intensive Care rotation offers residents an opportunity to develop the skills necessary to provide pharmaceutical care to the critically ill patient. During the MICU rotation, the resident will develop competencies in the areas of critical care pharmacology primarily related to anti-infective management, through direct patient care involvement. As an integral member of the multidisciplinary critical care team, the resident will actively participate in therapeutic decision making, drug therapy selection and appropriate dosing and monitoring of the critical care patient.
Rotation description:
The solid organ transplant rotation will allow the resident to gain experience in management of kidney, liver and pancreas transplant recipients and particularly related to Infectious Diseases problems. The resident will make daily rounds with both the liver and kidney transplant teams and will assist in the management of immunosuppressive medications as well as infectious diseases in the transplant patient. As part of the transplant team the resident will participate in intake meetings where the resident will be exposed to the evaluation process that takes place prior to listing a patient for transplant. In addition to clinical roles the resident will also be responsible for providing discharge counseling to all new transplant recipients. The resident may be given the opportunity to participate in pre transplant ID evaluations within clinic.
Rotation description:
The Hematology/Stem Cell Transplant block is an elective experience for PGY2 pharmacy residents. The two to four week rotation will include the clinical management of patients with hematology disease in the inpatient setting.
The inpatient Hematology/stem cell transplant service has an average of 25 patients. There are a wide variety of patients on the team, including acute leukemia, lymphomas and patients undergoing a stem cell transplant. The team consists of a hematology attending, a medical oncology fellow, three interns and the pharmacist. Patient rounds by the inpatient teams occur in the mornings between 8:00-8:30. The resident is responsible for pre-rounding on his or her assigned patients as well as rounding with his or her inpatient team. The resident will round with one of the interns and will be responsible for all patients. The resident should work towards independent medication management of the inpatient team and is responsible for the following particularly as they pertain to Infectious diseases treatment or prophylaxis in this high risk population:
- identifying and resolving medication therapy issues
- providing drug information to the rounding team members
- participating in discharge planning and patient education
Rotation description:
Focused on the management of Human Immunodeficiency Virus (HIV) and Pre-Exposure Prophylaxis (PrEP) in a primary care setting. A collaborative practice experience where residents work closely with primary care physicians, medical residents, nurse practitioners, nurses, medical assistants, specialty pharmacy liaisons, community resource specialists to ensure safe and effective use of HIV treatment and prevention medication for patients in the primary care setting. The pharmacist provides consultation for regimen changes based on safety, efficacy and/or patient preference. The pharmacist works under a collaborative drug therapy management (CDTM) protocol to order labs and medication under a referring or supervising physician. The pharmacist also assists in coordination of care with community resource specialists, other specialty providers and specialty pharmacy liaisons to assist with access to medications, and to address challenges related to adherence as they relate to other socioeconomic needs and coordination of care.
Rotation description:
Provides the resident further training and reinforcement of specific therapeutic decision-making for the immunocompromised host including prophylactic therapies based on risk assessment, directed therapies for opportunistic infections including fungal and viral. The resident will be tasked with vancomycin and aminoglycoside therapeutic drug monitoring, dosing and EMR notes. A specific unique addition is to evaluate weekly reports of new breakthrough viral infections, resistant mold infections and prolonged therapy plans for Hematology Oncology- Solid Organ Transplant patients. The resident works with the ID consult team at daily rounds, maintaining a responsibility to optimize anti-infective therapy for the consult patients. This includes dosing recommendations and daily monitoring of such therapies. The addition of another tier of metrics and resistance tracking in keeping with their Infection Control rotation will lend to further solidifying these skills for programmatic response. The resident reviews the schedule of patients for the Transplant ID Outpatient clinic and evaluates each patient for pre-transplant prophylaxis regimens, immunizations and drug interaction planning. The resident works with the Transplant ID Attending to address medication problems and a needs assessment for optimal adherence to complex regimens.
Rotation description:
For residents interested in career stewardship positions particularly as part of a multi-institution system, this rotation fosters independent and mentored activities that support network endeavors. With a multi-site stewardship model being built as part of a new network project, the resident will assist in idea generation and business planning for the initial launch and further maintenance for a more structured multisite program. This includes formulary review and harmonization, adjustments of evidence based guidelines to meet the needs of unique institutions, collaborative practice models (Pharmacy to Dose), rapid diagnostic and Microbiology resourcing, vaccine rollouts, and metrics for stewardship on a system level. In the infection control realm, this will engage the resident in further QI projects relative to surgical prophylaxis and pandemic response. As part of pandemic response, participating in the collaborative cross sectional meetings through literature research and presentation of findings from pre-publications and an understanding of the state DPH response will be required.
Longitudinal Experiences
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Activity |
Description |
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Administration/Management
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Research |
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Public Health |
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Program Improvement and Quarterly Assessments |
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Clinical Decision Support Evaluation |
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Systematic Adverse Drug Event Identification |
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Wellness Fair Participation |
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Journal Article Peer Review |
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