PGY-1 Residency Rotation Experiences

Required Rotations

Orientation (5 weeks)

Preceptor: Keith Hamm, PharmD, BCPS

Co-Preceptor: Karen Siegel, PharmD

The first five weeks of the resident’s time at Winter Haven Hospital will be spent acclimating to the hospital campus and obtaining hands-on experience with each service of the pharmacy department. During this time, the resident will become familiar with the workflow and technology utilized by the department (i.e., Cerner PowerChart, Cerner PharmNet, Pharmogistics, Pyxis, TheraDoc, Kit Check, etc.). Upon completion, the resident is expected be functional to the extent of licensure in providing pharmaceutical care to our patients. This experience provides the necessary foundation for a successful residency year. The orientation experience is developed by the Residency Program Director and the Pharmacy Operations Manager.

Critical Care (5 weeks)

Advanced Critical Care Elective (4 weeks)

Preceptor: Karen Siegel, PharmD

During this 5-week required learning experience, pharmaceutical care will be provided to patients in the 12-bed Medical Intensive Care Unit (MICU), 12-bed Surgical Intensive Care Unit (SICU), 12-bed Cardiac Intensive Care Unit (CICU) and 8-bed Cardiovascular Intensive Care Unit (CVICU). These ICUs provide comprehensive services for patients with single or multi-organ system failure, complex chronic illnesses, respiratory failure, poisoning and toxic ingestions, severe infections, hemodynamic instability and shock states, those recovering from general surgeries, and those who have undergone percutaneous coronary intervention (PCI). Critical patients are cared for by a multidisciplinary team to provide in-depth, targeted therapy based on each member's specific knowledge and training. The team is comprised of an intensivist, clinical pharmacist, dietician, care manager, respiratory therapist, social worker, and representatives from infection prevention and quality improvement. Of note, overnight critical care is managed by an off-site eICU team who remotely assess patients using cameras, television screens, and other electronic technology.

The resident will begin each day by preparing for multidisciplinary rounds, which begin in the SICU promptly at 10am Monday through Friday. The resident is responsible for monitoring assigned patients daily, following up on drug information questions, updating new and current patient profiles, providing pharmacokinetic dosing and monitoring, discussing assigned topics and patient care problem lists with the preceptor, and addressing any patient care medication needs in their assigned area(s). As the rotation progresses, the resident will assume complete responsibility for ensuring optimal evidence-based drug therapy outcomes for all patients in their assigned area(s). The resident can expect to gain a better understanding of managing critical patients throughout this learning experience.

Emergency Medicine (5 weeks)

Advanced Emergency Medicine Elective (4 weeks)

Preceptor: Amanda Leader, PharmD, BCPS

Co-Preceptor: Karen Thatcher, PharmD, BCPS

The Emergency Medicine experience is a 5-week required rotation designed to provide the resident with exposure to care of patients in the hospital’s emergency department (ED). Patient care areas covered include the 51-bed main ED, the 12-patient Vertical Bed Area or VBA (non-emergent visits), 6 psychiatric holding beds, and the 10-bed ED First Admit area or INPH (admitted patients holding for beds on one of the medical floors). Common disease states and conditions encountered during this experience can include sepsis, pneumonia, cerebrovascular accident (CVA), gastrointestinal bleeding, acute kidney injury, diabetic ketoacidosis, acute coronary syndrome, drug abuse and misuse, hypertensive crisis, seizures, and minor trauma, among many others.

The resident will have the opportunity to assist a multidisciplinary team in the initial resuscitation and stabilization of patients presenting with cardiac arrest and respiratory arrest. The resident will help with medication preparation during cardiopulmonary arrest (Code Blue), rapid sequence intubations (RSIs), stroke alerts (i.e. tPA), anaphylaxis episodes, seizures, and other emergent situations that may arise. The resident will also support the review and verification of all medications ordered in the ED and will be expected to assess for appropriateness based on patient-specific characteristics, goals of care, and differential diagnosis. Additionally, the resident will supervise and provide assistance to licensed practical nurses (LPNs) who obtain home medication histories in the ED. The resident will also be available to provide general assistance and drug information to emergency department physicians, physician assistants (PAs), nurse practitioners (ARNPs), and registered nurses (RNs) as needed.

ED pharmacist coverage is usually from around 8 am to around 9 pm Monday through Friday. The ED tends to be busier during the afternoon and evening, so it's recommended that the resident work a mixture of morning and evening shifts to experience a range of patient issues. ED pharmacist coverage has recently expanded to include 10 am to 4 pm on Saturdays and Sundays. Residents may be required to cover the ED during assigned staffing weekends once they complete the Emergency Medicine rotation.

Infectious Disease (5 weeks)

Advanced Infectious Disease Elective (4 weeks)

Preceptor: Steven Nelson, PharmD, BCPS

The Infectious Disease rotation is a 5-week required learning experience that will serve to develop the PGY1 resident's skill and competency in antimicrobial stewardship.  Focus will be placed on identifying patients appropriate for de-escalation of antibiotics and implementing change to positively affect patient outcomes.  The rotation will be broken down into three main categories: kinetics and dose optimization, antimicrobial stewardship, and patient case/topic discussions.

All nursing units are covered during this experience. The resident will also work with the preceptor to manage antibiotic stewardship and related automated alerts for patients in specific location. The resident may additionally be expected to help with antibiotic stewardship for critically ill patients admitted in the ICUs as assigned by the preceptor.

Internal Medicine (6 weeks)

Preceptors: Sharjeel Khan, PharmD and Laura Johnson, PharmD, BCPS

Co-Preceptors: Derek Dixon, PharmD, BCPS, Erika Rugay, PharmD, BCOP, and Karin Thatcher, PharmD, BCPS

The Internal Medicine rotation is a required, 6-week comprehensive learning experience designed to provide an introduction to general inpatient medicine. The resident will gain experience caring for patients with various acute and chronic disease states including asthma, COPD, atrial fibrillation, diabetes, hypertension, CHF, chronic kidney disease, and infections. The resident will also encounter orthopedic patients who are recovering from joint replacement surgery. The floors covered will alternate during the experience and can include medical/surgical units specializing in neurology, diabetes, cardiology, oncology, inpatient psychology, CHF, and orthopedics. The resident will be responsible for working up and monitoring patients daily on assigned floors, assessing medication regimens, identifying any medication-related problems, and developing recommendations to address these problems. Recommendations should be consistent with current evidence-based guidelines. The resident will also collaborate with physicians, nurses, dieticians, social workers, and other health care providers to ensure patients receive the best possible therapy with minimal adverse effects.