PGY2 Ambulatory Care Pharmacy Residency

Ambulatory Care (AC) Learning Experiences 1-4
Length of Learning Experiences - AC 1: 1.5 months; AC 2: 2 months; AC 3: 3 months; AC 4: 1 month
Advocate Medical Group - Southeast Clinic (Chicago, IL)
Preceptors:   Christie Schumacher, Pharm.D., BCACP, BCPS, BCCP, CDCES, BC-ADM, FCCP and Amanda Blackford, Pharm.D., BCPS

This is a primary care patient-centered medical home practice in which pharmacists provide comprehensive medication management for a variety of chronic diseases through a collaborative practice agreement. Pharmacists are responsible for assessing and managing chronic disease states, including but not limited to, heart failure, diabetes, hypertension, hyperlipidemia, asthma, COPD, anticoagulation and smoking cessation. Other responsibilities include answering drug information questions from patients and healthcare professionals, providing medication management consultation to physicians during primary care physician visits, providing medication reconciliation during post-hospital follow-ups, assisting in urgent care patient management, providing in-services on various pharmacy-related topics and assisting in the delivery of group diabetes education classes.

Publications related to primary practice site:

• Schumacher C, Moaddab G, Colbert M, Kliethermes MA. The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment. J Manag Care Spec Pharm. 2018;24(8):795-799.
• Pharmacist Involvement in a Patient-Centered Medical Home. PPMI Case Study. (broken link-page not found)
• Pharmacist Involvement Integral to Medical Home at Advocate Health.

Ambulatory Care Administration Learning Experience

Preceptor:  Mary Ann Kliethermes, Pharm.D., FAPhA

This rotation is a longitudinal administration learning experience that allows the resident to experience the variety of ambulatory care management activities performed by an ambulatory care pharmacist. It is the expectation that the activities that encompass this learning experience will occur both at the college and at the practice site. The primary preceptor will be responsible for working with the resident to ensure that appropriate activities to meet the objectives are identified and completed. Clinic-based activities may occur at the primary practice site, elective practice site or other locations, as appropriate, so that the preceptor can identify the most suitable activity for the resident. The resident will also participate in quarterly ambulatory care management topic discussions with a primary preceptor.

Midwestern University Curricula Learning Experience

Preceptor: Jill S. Borchert, Pharm.D., BCACP, BCPS, FCCP

Teaching and Learning Curriculum

The Teaching and Learning Curriculum (TLC) is a multifaceted teaching certificate program embedded in all of the College's residency/fellowship programs.  It is delivered through mini seminars, applied activities, and formative assessments at critical times throughout the year. The TLC is directed by the Center for Teaching Excellence. The goal of the TLC is to provide opportunities for pharmacy residents, fellows and new faculty members to gain the knowledge, attitudes, and skills they need to be effective teachers. All residents receive an adjunct appoint as Visiting Instructor in the Department of Pharmacy Practice. The residents implement what they have learned by teaching in the classroom and in the practice setting. During the residency experience, the residents begin to develop a personal teaching style, assess the effectiveness of various teaching methods and develop a teaching portfolio. The residents provide didactic instruction and serve as co-preceptors for pharmacy students. The residents have the opportunity to lecture in the Pharmacotherapeutics course sequence (~120 students) and facilitate various applied workshops in either Pharmacotherapeutics or Clinical Skills. The residents write exam questions and participate in item analysis of questions for the lecture they teach. Residents also participate as mentors and assist in coursework assessment in the Postgraduate Training Opportunities for Pharmacists, which is an elective course offered to second-year pharmacy students in the fall quarter. Other opportunities may be given to the residents depending on their professional interests. In the second half of the residency year, residents precept 1 to 2 students on Advanced Pharmacy Practice Experience (APPE) rotations.

Pharmacy Grand Rounds

The goal of Pharmacy Grand Rounds is to enhance the residents' ability to present complex concepts and scientific data in a clear, concise manner to a group of professional peers.  The audience consists of pharmacy residents, faculty, pharmacy practitioners, pharmacy students, and invited guests.  Each resident is required to give one formal presentation.  The resident is encouraged to select and discuss a current, clinically significant topic. The RPD and clinical site coordinators serve as project mentors. Each presentation is 25 minutes in duration plus 5 minutes for setup, questions and answers. Members of the audience are given an opportunity to evaluate the presentation using a standardized assessment instrument.  The resident is given feedback following the presentation by the RPD, clinical site coordinator(s) and/or identified content experts/mentors. Midwestern University College of Pharmacy accredits Pharmacy Grand Rounds for 0.5 contact hour of Accreditation Council for Pharmacy Education (ACPE) continuing pharmacy education credit, and thus, residents are expected to adhere to all instructions and guidelines related to developing an ACPE-accredited continuing pharmacy education activity.

Pharmacy Management and Leadership Curriculum

The Pharmacy Leadership and Management Curriculum (PMLC) is a series of application-based seminars focused on developing leadership and management skills.  Attendance and participation is expected of all residents, unless excused by the appropriate residency program director. The overall goal of the PMLC is to provide opportunities for pharmacy residents and fellows to gain the knowledge, attitudes, and skills they need to be effective leaders and managers within the profession of pharmacy. Individual seminars are scheduled throughout the year on campus. Several Midwestern University faculty will lead and facilitate these seminars.  In order to successfully complete the PMLC, residents must:

• Attend and participate in the live seminars. Absentees are expected to make up any missed activities.
• Chair or co-chair at least one College committee meeting during the year.  You will serve as a guest on one or more College committees during the year and are expected to chair or co-chair at least one committee meeting  during the year. 
• Participate in and submit evidence of involvement in a medication use process project.  Examples of such projects are protocol/clinical pathway development, formulary reviews, and medication use evaluations, etc.  Evidence includes any written deliverables (e.g., documents, slides, etc.) that demonstrate your involvement in the project.

Research Curriculum

The Research Curriculum (RC) is embedded in all of the College's residency/fellowship programs. The seminars are taught by College faculty and are interactive in nature.  The goal of the RC is to prepare and support residents in their required research projects and to assist them in developing research skills. Specific seminar topics are listed later in this document.

Research Project Learning Experience

Preceptor(s): Varies based on research project mentor(s)

The residents work closely with research mentors, clinical site coordinators and the RPD to devise and conduct a research project.  This investigational project should be in the form of original research, but may include the development, enhancement, or evaluation of some aspect of pharmacy services.  The residents must obtain institutional review board (IRB) approval from the site in which the research will be conducted in addition to IRB approval from MWU prior to initiating the project.  The research project is completed throughout the residency year.  As a result of completing this project, the residents gain expertise in developing scientific hypotheses, designing protocols, acquiring institutional review board approval, collecting data, coordinating the research process, analyzing and interpreting data and preparing abstracts and manuscripts.  The residents may gain experience writing grants depending on the availability of grant opportunities. The project must relate to practice or education and can be one or more of the following:

• Original research
• Development, enhancement or evaluation of patient care services

The clinical site coordinators and RPD will be responsible for determining whether a research project meets these following criteria:

• Project is a valuable and educational experience for the resident
• Project is valuable to the profession of pharmacy
• Project has a clear objective/hypothesis
• Adequate resources (time, funding, data) exist to complete the project within the defined time period
• Project can reasonably be completed by the end of the residency year
• Project is of publishable quality, and publication will be pursued

The residents present the project four times during the residency year:

• Fall Quarter: Research Project Proposal Seminar: Present the project to MWU faculty (20-30 minutes). The purpose is for the faculty to provide feedback that can be used to strengthen the project prior to finalizing the research protocol and submission to the necessary IRBs.
• Late March/Early April: Research Project Practice Presentations: Present the project results to faculty, residents and other guests in a similar format to what would be expected at Great Lakes Pharmacy Residency Conference. Attendees provide feedback to the residents that they can use to improve their presentation before it is submitted to Great Lakes Pharmacy Residency Conference.
• Early May: Kenneth Suarez Research Day: Poster presentation to faculty, peers and students at an annual event held on Midwestern University's Downers Grove campus. All pharmacy resident and fellow posters are judged, and the resident or fellow with the best poster receives a certificate of achievement and a monetary award from the Midwestern University Office of Research and Sponsored Programs.
• May: Illinois Pharmacy Residency Conference: Platform presentation to peers at the regional conference for all area pharmacy residents, preceptors and RPDs.

A final report summarizing the objectives, background, methods, results and discussion of the project must be submitted to the RPD prior to completion of the residency program (approximately mid-June). This report should be in a manuscript form suitable for publication.

Examples of previous resident research projects:

• Burke K, Schumacher C, Harpe, S. SGLT2 Inhibitors: A Systematic Review of Diabetic Ketoacidosis and Related Risk Factors in the Primary Literature. Pharmacotherapy. 2017;37:187-194.
• Bradley K, Schumacher C, Kliethermes MA, Borchert J, Anderson D. Tool for Assessing Ambulatory Care Pharmacist Practice (TAAPP): A Validity and Reliability Study. Am J Health Syst Pharm. 2018;75(23):1890-1901.
• Van Dril E, Schumacher C. Impact of Professional Continuous Glucose Monitoring by Clinical Pharmacists in an Ambulatory Care Setting. J Am Coll Clin Pharm. 2019;1-7. https://doi.org/10.1002/jac5.1088
• Van Dril E, Schumacher C, Kliethermes MA, Borchert J, Buros Stein A. Workload Evaluation of Clinical Pharmacists in the Ambulatory Care Setting (WORK-AC). J Am Coll Clin Pharm. 2020;1–13. https://doi.org/10.1002/jac5.1242  
• Van Dril E, Wesling M, Dela Pena L, Schumacher C. Advocating for the Pharmacy Profession Through Involvement in a Type 1 Diabetes Day Camp as a Pharmacy Residency Learning Experience. J Am Pharm Assoc. 2020;60(3):439-442.
• Benjamin T, Schumacher C. Letter to the Editor. Characterization of Risk Factors for Genitourinary Infections with Sodium Glucose Cotransporter-2 Inhibitors. Ann Intern Med. 2019;171(12):944.
• Benjamin T, Schumacher C. Characterization of Risk Factors for Genitourinary Infections with Sodium Glucose Cotransporter-2 Inhibitors. Pharmacotherapy. 2020. https://doi.org/10.1002/phar.2458

Chronic Care Elective Learning Experience

Length of Learning Experience - 1 to 2 months
Advocate - Medical Group West (Aurora, IL)
Preceptor: Lea dela Pena, Pharm.D., BCPS

This is a multi-specialty group practice in which pharmacists provide patient care for a variety of chronic diseases through a collaborative practice agreement. Patients are referred to the Health Management Department for pharmacy appointments for the management of diabetes, hypertension, hyperlipidemia, bone health and polypharmacy or other drug therapy problems. Pharmacists also provide initial assessment, education and management for patients newly referred to the Anticoagulation Clinic and provide care in an interprofessional medical home model. Other roles for the pharmacist include insulin pump teaching, Annual Wellness Visits, answering drug information questions and providing in-services.

Ambulatory Care Cardiology Elective Learning Experience

Length of Learning Experience - 1 to 2 months 
Advocate Medical Group – Evergreen
Preceptor: Dejan Landup, PharmD, BCPS

This is a primary care practice in which the pharmacist provides patient care for a variety of cardiology-focused disease states through a collaborative practice agreement. The rotation will focus on optimizing the outcomes of patients with chronic cardiovascular disease through the provision of evidence-based, patient-centered medication therapy. The resident will learn how to order and interpret important cardiology-related tests, such as electrocardiograms and echocardiograms. Other responsibilities include answering drug information questions from patients and healthcare professionals, providing medication management consultation to physicians during primary care physician visits, providing medication reconciliation during post-hospital follow-ups and assisting in urgent care patient management.  

Family Medicine Multispecialty Clinic Elective Learning Experience

Length of Learning Experience - 1 to 2 months 
Midwestern University MultiSpecialty Clinic
Preceptor:  Lisa Palmisano, Pharm.D., BCACP;  Jennifer Mazan, Pharm.D.

The clinical pharmacist, resident, and students are involved in the daily practices with the family/sports medicine clinic. In the family/sports medicine clinic, the pharmacist and the physician work together to enhance patient care.  Some of the collaborative visits include managing chronic disease states (i.e., diabetes, hyperlipidemia, hypertension, chronic pain, etc.), providing drug information, and patient education and counseling.  This elective experience offers the residents an opportunity to work directly with medical students and providers in providing collaborative patient care.

Infectious Diseases/HIV Clinic Elective Learning Experience

Length of Learning Experience - 1 to 2 months 
Northwestern Memorial Hospital 
Preceptor:  Milena Murray, Pharm.D., M.Sc., BCIDP, AAHIVP

The Northwestern Memorial Hospital Infectious Diseases Clinic is a multi-disciplinary setting composed of infectious diseases fellows, attending physicians, nurses, social workers and a pharmacist. The clinic serves over one thousand active patients that are treated for a spectrum of infectious diseases with the predominant patient population being treated for HIV. In addition, the majority of HIV-infected patients also receive their primary care for other chronic diseases at this site. This is an optimal setting for the pharmacist to work as part of a collaborative team to provide patient care. Pharmacists are involved in medication histories, patient and caregiver education, and the education of students, residents and fellows.

Academia Elective Learning Experience

Length of Learning Experience - 1 to 2 months 
Midwestern University College of Pharmacy
Preceptor:  Kathy Komperda, Pharm.D., BCPS

This elective learning experience is a concentrated advanced academia learning experience that allows the resident to practice skills required to function in an academic environment. This learning experience goes beyond the concepts in the Teaching and Learning Curriculum by engaging the resident in course development and/or revision as well as advanced assessment design. Engagement in college or departmental curriculum committee work is an expectation. Activities arising from these committees will be incorporated into the learning activities.  

American Diabetes Association Diabetes Camp

Preceptors:  Lea dela Pena, Pharm.D., BCPS;  Christie Schumacher, PharmD, BCPS, BCACP, BCCP, BC-ADM, CDCES, FCCP 

This is a week-long summer camp experience with a focus on education and medication management for children with type 1 diabetes mellitus (T1DM).  The camp is staffed by endocrinologists, endocrinology fellows, nurses, dieticians, and clinical pharmacists. Pharmacy residents assist with family and camper education, blood glucose monitoring, and medication administration and participate as a team member on the medical staff. This experience is designed to give the learner first-hand experience in managing children ages 4 - 9 with T1DM.  The learner is expected to collect camper information from caregivers/parents to facilitate the management of T1DM, educate the camper and parents on diabetes management, monitor camper blood glucose readings and adjust medication therapy based on carbohydrate consumption, physical activity and blood glucose levels throughout the day.  

Other Learning Experiences

Other elective learning experiences may be developed based on resident interest and preceptor availability.