ZSFG PGY1 pharmacy residency

PGY1 resident programs build upon Doctor of Pharmacy (PharmD) education and outcomes to develop pharmacy practitioners with knowledge, skills, and abilities as defined in the educational competency areas, goals, and objectives. Residents who successfully complete PGY1 residency programs will be skilled in diverse patient care, practice management, leadership, and education, and be prepared to provide patient care, seek board certification in pharmacotherapy (i.e. BCPS), and pursue advanced education and training opportunities including postgraduate year two (PGY2) residencies.

Zuckerberg San Francisco General and Trauma Center (ZSFG) is offering a one-year PGY1 residency in Acute Care. 

• ZSFG is the safety net hospital and only Level 1 Trauma Center for the vibrant City and County of San Francisco serving 100,000 patients each year.
• ZSFG serves a very diverse patient population and is known for its quality trauma, psychiatric, and HIV care.
• Our physicians are UCSF faculty and residents, and we are a training site for pharmacy residents and student pharmacists from UCSF School of Pharmacy. In this dynamic setting, the Department of Pharmacy Services provides quality patient-centered care with compassion and respect.

Residents will be required to complete the following: 

• P&T Sub-Committee involvement and presentation of a drug monograph 
• Medication use evaluation
• CE quality presentation
• Research project, results of the project will be presented at a regional conference for pharmacy residents 
• Staffing in a distributive role within the ZSFG inpatient pharmacy 
• Teaching certificate through UCSF

Preceptors: Joyce Go, PharmD; Curtis Geier, PharmD; Helen Hou, PharmD, BCEMP, BCPS

• The pharmacy resident will experience first-hand the typical patient population at ZSFG: the underserved, low-income, and uninsured. 
• This service has a morning shift and an evening shift.
• ACLS certification (provided by our residency) will be required prior to starting this rotation.
• The resident will learn proper preparation of IV drips and set-up on a smart pump in ready to administer form.
• The resident will increase their knowledge of medications used during medical and stroke codes, procedural sedation medications, antidotes, methotrexate for ectopic pregnancy, antibiotics selection in the ED, reversal of anticoagulants.
• The pharmacy resident will be responsible for one physician and nursing in-service and one drug utilization evaluation.
• The pharmacy resident is responsible for reviewing medication orders and patient electronic medical records. 
• The resident will interview patients for pertinent information (ie. medication reconciliation and allergies).
• Residents will be asked to assist with medical, trauma, and stroke codes by preparing emergent medications in ready-to-administer form. 
• They will assist with dosing recommendations and titrations with IV drips, and dosing and monitoring of patients undergoing procedural sedation. 
• Residents will be responsible for calculating and verifying pediatric weight-based dosing.
• The resident will become familiar with common antidotes for toxicologic emergencies, and reversal agents for life-threatening bleeds with patients on anticoagulation.
• The pharmacy resident will counsel patients on medication adherence, enoxaparin, warfarin, EpiPen, and use of metered dose inhalers upon discharge.
• Additionally, they will have the opportunity to attend toxicology grand rounds once weekly, ride in an ambulance, and attend trauma review rounds once monthly.

Preceptors: Amanda Roy, PharmD, BCIDP; Annie Kim, PharmD, BCIDP

• On this rotation, the pharmacy resident will serve as the ID pharmacy expert for the inpatient ID consult team and promote antimicrobial stewardship for all patients admitted at ZSFG.
• The ID consult team consists of one ID attending, two ID fellows, the ID pharmacist, plus a variable number of medicine and pharmacy learners.
• A typical day on this rotation consists of working up consult patients in the morning, reviewing patients with the preceptor at pharmacy pre-rounds, then providing ID pharmacy recommendations and input at ID consult rounds. In the afternoons, residents will follow-up on outstanding drug info questions and other issues from rounds, meet with their preceptor to discuss patients, and address any questions from other pharmacists and providers.
• Residents will also participate in stewardship activities including responding to requests for restricted antimicrobials, reviewing patients on broad spectrum antibiotics, and monitoring the positive blood culture list for all patients in the hospital. The pharmacy resident will also be responsible for fielding questions from physicians on non-ID consult patients as well as supporting the clinical pharmacists from all services in our hospital with antimicrobial related questions and issues.
• Residents will also have teaching and precepting opportunities which may include leading a journal club to the inpatient clinical pharmacists, completing topic discussions with the preceptors, performing an in-service to the ID consult team, and engaging in layered learning with other pharmacy learners, including IPPE students.

General Medicine 

Preceptors: Julie Ma, PharmD, BCPS; Kathy Quach, PharmD, BCPS; Leslie Ly, PharmD, BCPS

• The medicine team consists of an attending physician, resident, and interns.
• Routine responsibilities include: reconciling medications for all admitted patients, therapeutic drug monitoring, anticoagulation, drug information, and antimicrobial stewardship. 
• The resident will be responsible for providing discharge education to high-risk patients, and as requested by the team.
• The resident will be responsible for one Internal Medicine team education in-service, as well as a clinical pharmacist in-service 
• Pharmacy residents will have the opportunity to develop their knowledge and skills in a wide array disease states, with specific focus on management of alcohol related complications, infectious disease management, pain management, and acute exacerbations of chronic disease states. 

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Family Medicine

Preceptor: Tamara Lenhoff, PharmD, BCPS

• The family medicine team consists of an attending physician, resident, and interns.  The resident will be post call every other day.  Similar to General Medicine, this service provides acute inpatient care for patients who are at least 18 years old and who have been seen by a primary care provider through one of our clinics.
• Routine responsibilities include: reconciling medications for all admitted patients, therapeutic drug monitoring, anticoagulation, drug information, and antimicrobial stewardship.  
• The resident will be responsible for providing discharge education to high-risk patients, and as requested by the team.
• The pharmacy resident will also be responsible for providing an in-service to pharmacy staff and the family medicine team.
• Residents will have the opportunity to develop their knowledge and skills in a wide array disease states, with specific focus on management of alcohol related complications, infectious disease management, pain management, and acute exacerbations of chronic disease states.

Critical Care: Medicine/Cardiac

Preceptors: Kristin Slown, PharmD, BCCCP, BCPS; Melissa Nguyen, PharmD; Amy Logan, PharmD, BCPS

• This rotation allows for the provision of pharmaceutical care to complex critically ill patients with multiple medical problems.
• The Medical Intensive Care Unit (MICU) team is comprised of one attending, medical residents, medical interns, a clinical pharmacist, bedside nursing, a clinical nutritionist, a social worker, and respiratory therapist(s).
• The resident will be responsible for rounding with the MICU team, but will also manage the care of Cardiology ICU (CCU) patients.
• The resident must learn to assume responsibility and accountability for all pharmacotherapy management issues for these patients.
• The resident must provide the following pharmaceutical care services: participate in MICU multidisciplinary team rounds daily, daily patient profile review with medication/therapy problem identification and resolution, respond to drug information requests, provide clinical support to RNs, respiratory therapists and other ancillary services, help to fix distribution problems not resolved by inpatient pharmacy, conduct RN and/or MD in-service programs, provide medication education for patients discharged home from the ICU, participate in various critical care projects, and participate in daily patient presentations and/or topic presentations to pharmacy preceptor.
• The resident will also be responsible for one presentation to the pharmacy staff (addition or substitution of other projects may occur as determined by preceptor).
• Core content which may be covered via patient experiences, discussions of reading material and/or case presentations includes, but is not limited to, the following: ICU analgesia, sedation and neuromuscular blockade, hemodynamic monitoring & pressors/inotropic support, sepsis/septic shock/systemic inflammatory response syndrome (SIRS), infectious complications, venous thrombosis prophylaxis, gastrointestinal stress ulcer prophylaxis, fluid & electrolyte balance, acid/base disorders, acute medication overdoses, heart failure, myocardial infarction, etc

Preceptors: Gideon Cayanan, PharmD, BCPS; Michelle Geier, PharmD, BCPP

• In the Adult Medicine Clinic, clinical pharmacists work collaboratively with a multidisciplinary group of providers that includes primary care physicians and specialists, medical residents, nurse practitioners, nutritionists, and social workers.
• The clinical pharmacists operate under collaborative drug therapy management (CDTM) protocols in primary care, as well as in some specialty areas such as anticoagulation, cardiology, and pain management.
• Skills the pharmacy resident will develop are: outpatient anticoagulation, management of all primary care disease states (i.e., heart failure, diabetes, atrial fibrillation) patient interview skills, documenting proper clinic notes, and mentoring of pharmacy students from UCSF School of Pharmacy.
• Clinics include: cardiology, primary care, anticoagulation, and behavioral health 

Preceptors: Mark Jones, PharmD; Linda Truong, PharmD, BCPS

• During this experience the resident will be exposed to and participate in a variety of administrative areas important to pharmacy management in a public acute care hospital.
• The elements of this experience are medication safety, formulary management, regulatory affairs, informatics, and operations management.
• The resident will complete a drug monograph (or drug class review) and drug usage evaluation, and present their reports to the appropriate hospital committee.
• This experience may also entail developing and implementing a process improvement project, participating in the preparation for a regulatory survey, analyzing medication error or adverse drug event data, aiding in the improvement of a pharmacy informatics system, or development of a new clinical service function.
• During the dedicated portion of this experience, the resident will attend weekly management meetings.
• Longitudinally, the resident will also be an active participant in a Pharmacy and Therapeutics Subcommittee.

Preceptor: Tamara Lenhoff, PharmD, BCPS

• The resident will get the overall layout of the residency and be oriented to pharmacy department procedures and systems. 
• The resident will have training shifts in the unit dose area and be shown the pharmacist's role in workflow.  The resident will perform this role under the supervision of a preceptor. Responsibilities will be increased as appropriate in unit dose area with order entry/verification, unit dose checking and pharmacy technician supervision, etc. 
• Orientation will be divided in section sections: the first two weeks of residency, the resident will be in Orientation. Staffing training will be scheduled closer to the time when the resident has  obtained pharmacist licensure. 

Preceptors: Caroline Tsai, PharmD, BCPP; Hai-Au Luu, PharmD, BCPP

• This inpatient psychiatric rotation is designed to develop the resident's knowledge and skills in the areas of patient interaction, psychiatric disorders, and psychotropic drug therapy.
• The psychiatric experience is unique in that drug therapy monitoring is less dependent on charged laboratory and physical finding. Rather, extensive and frequent patient interviewing is necessary to access changing mental status and to detect adverse drug effects.
• The resident will have opportunity to interact with patients with schizophrenia, bipolar disorder, depression, substance abuse disorders and/or personality disorders.
• The pharmacy resident will participate in morning nursing reports, interdisciplinary team rounds, teaching rounds, patient interviews, court hearing on the units, grand rounds, research seminars, evidence-based medicine/journal club discussion, and family meetings.
• The resident will present patients to the preceptor in the afternoon and interact with psychiatrics on a daily basis.
• Skills you will develop are an understanding of the basic skills in psychiatric setting, such as doing mental status exam, patient interview skills and gain knowledge in psychotropics including antipsychotics, antidepressants, mood stabilizers, anxiolytics and hypnotics.
• Other projects you will be responsible for  include: psychopharmacy presentation to the treatment team by the end of the rotation, and possible assistance with preceptor for a drug utilization evaluation project

Preceptors: Christina Wang, PharmD; Cassandra Lei, PharmD, BCPS

• The Cardiology rotation provides residents the opportunity to develop their knowledge and skillset for managing patients with classic cardiovascular diseases states as well as its intersection with HIV, psychiatric comorbidities and illicit substances. These include, but are not limited to, acute coronary syndromes, heart failure, atrial fibrillation, syncope, cardiac arrest, cardiac arrhythmias, and pulmonary hypertension. 
• Residents will participate in daily rounds with the cardiology team with the opportunity to actively manage both floor and CCU patients. The cardiology team is responsible for the care of approximately 15 patients on average. 
• Residents will engage in shared decision-making to to reduce polypharmacy with in a socially complex and vulnerable population.
• Residents will participate in analytical review and application of primary and current literature to bring equitable cardiovascular care.
• Emphasis on teaching with in-services to the cardiology and clinical pharmacist teams.

Preceptor: Kristin Harter, PharmD

• The primary site for this experience is the 6th Floor Labor and Delivery unit at ZSFG, but the resident will have the opportunity to follow patients for the GYN consult service, the Women's Options Clinic, and the 5M Women's Health Clinic.  
• ZSFG delivers about 1,200 patients a year and the patient population is predominantly underserved, low-income, and uninsured.
• This rotation is designed to develop the resident's knowledge and skills in perinatal medicine, with the option of gaining knowledge and skills in gynecological conditions.
• The resident will work closely with OB/GYN medical doctors and residents, nurse midwives, anesthesia attendings and residents, family medicine residents, psychiatrists, clinical nurse specialists, nursing staff, clerical staff, and clinical pharmacists to promote optimal patient care within the various women's health services.
• In addition to daily pre-rounding and morning disciplinary rounds on the labor and delivery and postpartum units, the resident will have the opportunity to attend weekly HIVE rounds, weekly OB psych rounds, various weekly birth center leadership meetings, medical resident teaching sessions, applicable ground rounds, and at least one delivery of a baby.
• The resident will present patients to the preceptor daily in addition to having daily topic discussion.
• The resident will also be responsible for an in-service to the Pharmacy Department.  Time permitting, the resident will have the opportunity to provide an in-service to the nursing and/or medical staff.  

Preceptor: Julie Shih, PharmD, BCPPS

• The pediatric wards service includes any patient admitted to the hospital who is less than 17 years of age, and common conditions seen on this service include asthma, trauma, respiratory infections, appendicitis, and rule-out sepsis.
• Since the pediatric ward and the nursery teams round at the same time, the pharmacy resident will only round with the pediatric ward team, to maintain continuity of care during the rotation.  However, there is an option to learn about NICU patients peripherally, depending on the ward and nursery censuses.
• In addition to daily morning interdisciplinary rounds, the resident will have the opportunity to attend social service rounds, radiology rounds, and pediatric grand rounds, real or mock codes.
• The resident will be expected to complete at least one project or presentation.
• During the rotation the resident will: expand knowledge of pediatric and neonatal-specific dosing, gain experience with family-centered rounds, use evidence-based literature to support drug recommendations, develop the ability to take pediatric-specific factors into consideration when making recommendations, and refine their ability to communicate effectively with an interdisciplinary team.

Preceptor: Damian Peterson, BCPP, BCPS, APh

• Substance Use Disorders is an elective learning experience at Community Behavioral Health Services Pharmacy (CBHS), a specialty mental-health and substance use disorders pharmacy within the San Francisco Department of Public Health. This rotation focuses on providing low-barrier treatment for substance use disorders to some of our cities most marginalized individuals, who are at a disproportionately high risk of overdose death.
• The Pharmacy Resident will spend four days per week providing in-home psychiatric and substance use disorder treatment for previously unhoused individuals located in supportive housing sites throughout the city, and one day per week will be at the Maria X Martinez Health Resource Center (MXM), a walk-in urgent care clinic that primarily serves unhoused individuals.
• Responsibilities include initial assessments for appropriateness of treatment, starting and adjusting medications (e.g., buprenorphine, antipsychotics, mood stabilizers), providing referrals for other services, point-of-care testing, delivery and/or administration of medications, and management of chronic disease states and acute medical conditions.
• The resident will have the opportunity to spend time with the Office-Based Buprenorphine Induction Clinic (OBIC), Street Overdose Response Team (SORT), Opiate Treatment Outpatient Program (OTOP), and Sunset Mental Health Clinic. Other experiences may be available depending on resident interest, and preceptor availability.

Preceptors: Raymond Ho, PharmD, DABAT, Ben Tsutaoka, PharmD, DABAT

• Clinical Toxicology is an elective, five to six week learning experience at the California Poison Control System (CPCS) San Francisco Division located in ZSFG.  
• California Poison Control System is a 24 hour-a-day informational hotline serving California residents. CPCS San Francisco Division consists of medical toxicology attending physicians, medical toxicology fellows, and pharmacists specialized in clinical toxicology. 
• It is designated by the California Emergency Medical Services Authority and managed by UCSF School of Pharmacy, Department of Clinical Pharmacy.  CPCS operates from four UC-affiliated answering sites (UCSF/ZSFG, UCDMC, Valley Children's Hospital, and UCSD) managing approximately 350,000 calls per year. 
• CPCS San Francisco Division consists of medical toxicology attending physicians, medical toxicology fellows, and pharmacists specialized in clinical toxicology. 
• The pharmacists provide immediate, free, and expert telephone advice to both the lay public and health professionals regarding treatment and monitoring of exposures to poisonous or toxic substances.

Preceptor: Michelle Geier, PharmD, BCPP, APh; Reisel Berger, PharmD, BCPP; Suzannah Patterson, PharmD, BCPS; Yuna Song, PharmD, BCPP

• Psychiatry Ambulatory Care at Behavioral Health Services (BHS) is an elective learning experience at 3 different mental health clinics: South of Market Mental Health (SOMMH), OMI, and Chinatown/North Beach (CTNB).
• These 3 clinics are all part of the San Francisco Department of Public Health within the division of Behavioral Health Services.
• The psychiatric clinical pharmacists at BHS clinics provide services including managing a case-load of psychiatric patients, drop-in medication appointments (eg: for those who have missed past appointments), medication consultations for second opinions, medication education, medication groups, and medication reconciliation.
• The psychiatric clinical pharmacists work under a collaborative practice agreement under supervision of the clinic Medical Director.
• The psychiatric clinical pharmacists document in the electronic health record in compliance with requirements from California Medi-Cal medication support services and receive reimbursement for these services as a provider.

Preceptor: Mandy Sen, PharmD, BCGP, APh; Betty Liang, PharmD, AAHIVP; Kimmy Tam, PharmD, BCPS 

• Laguna Honda is a skilled nursing and rehabilitation center owned and operated by the San Francisco Department of Public Health. It was founded in 1866 and is one of the largest skilled nursing facilities in the United States, with 660 skilled nursing facility (SNF) beds, 11 acute beds and an outpatient psychiatric clinic. 
• The pharmacy located at Laguna Honda provides dispensing services and clinical pharmacy services 7 days a week and utilizes automated dispensing cabinets to ensure timely access to medications after hours. 
• The hospital features 13 neighborhoods or units that provide specialty services such as palliative care, HIV, memory care, and intensive rehabilitation.
• The PGY1 resident will have the opportunity to participate in the following clinical services but not limited to monthly medication regimen review, medication education to patients and and family, medication information consultation for clinicians, warfarin and vancomycin per pharmacy, antimicrobial stewardship, as well as formulary and quality management.

Preceptors: Kristin Slown, PharmD, BCCCP, BCPS; Melissa Nguyen, PharmD; Amy Logan, PharmD, BCPS

• At ZSFG, our surgical ICU is staffed by a multidisciplinary team.  The ICU attending physicians are double-board certified in critical care and either anesthesia, surgery, or neurology.  The ICU team consists of an attending physician, 1-2 fellows, residents (anesthesia, surgery, or emergency medicine), a dietician, respiratory therapists, nurse practitioners, bedside nurses and a pharmacist.
• Serving the San Francisco and Marin County area, our Trauma Center excels in the management of patients with multiple injuries, burns, complex wounds, surgical infections, etc. The scope of neurosurgery and neurology practice includes patients with brain and spinal trauma, cerebrovascular and skull-based surgery, brain and spinal tumors, ischemic and hemorrhagic stroke, etc.
• ICU serves both adult and pediatric patients experiencing trauma or neurovascular injuries.
• The surgical ICU is considered a mixed "open" and "closed" model with several teams managing different aspects of patient care in the "open" model. 
• An ICU team is dedicated to managing pain/sedation/delirium and mechanical ventilation, while the primary services (i.e. trauma, neurosurgery, neurology, etc) manage the care for the remaining aspects of the patient.
• Many topics will be covered throughout this rotation via scheduled topic discussions with preceptor(s) and separate patient-centered discussions/presentations. Such topics will include, but are not limited to, general trauma care, surgical infections, ischemic stroke, hemorrhagic stroke, neurovascular monitoring, spinal cord injury, burn management, ventilator-associated pneumonia in the surgical patient, and pain management.
• Skills you will develop are an increased familiarity and comfort with pain/sedation/delirium/neuromuscular blockade management, surgical infections and trauma/neurovascular related disease states; experience working in a multidisciplinary environment; improved time management skills through managing many different ICU services; increased knowledge of intravenous medications, primarily continuous infusions, used in the ICU environment.
• Other projects you will be responsible for are one presentation to the SICU team (addition or substitution of other projects may occur as determined by preceptor).

Preceptors: Joyce Go, PharmD; Curtis Geier, PharmD; Helen Hou, PharmD, BCEMP, BCPS

• The ADVANCED Emergency Medicine rotation is an extension learning experience at ZSFG of the required Emergency Medicine rotation
• The goal of this rotation is to develop a competent and independent emergency medicine clinical pharmacist who is able to care for the emergency department patient while acting as a fully integrated member of the emergency department medical team.  Pre-requisites for this rotation include: ACLS certification, completion of required emergency emergency rotation, knowledge of IV medication preparation, knowledge of using ED Omnicells and reconciling controlled substances. Familiarity and comfort with medication order entering, verification and facilitation will be expected.
• In addition to the activities performed in the Emergency Medicine rotation, the resident will have more teaching opportunities by facilitating case conferences and topic discussions for the ED staff (pharmacists, nurses, and physicians). 
• The resident will be responsible for providing the oncoming ED pharmacist, evening shift, or graveyard pharmacist with hand-off of current status of resus or critical patients (or any other sick patient in the department requiring follow-up). 
• The resident will be given more independence throughout this rotation to function as the primary ED clinical pharmacist for consults and resuscitations.  The resident will have the opportunity to partial or whole shifts in the ED if scheduling permits with preceptor backup.
• Additional activities during this experience include:
  • Poison Control Center rounds– weekly and statewide toxicology rounds monthly
  • Ambulance Shadow (if not already completed) 

Preceptors: Hai-Au Luu, PharmD, BCPP and Caroline Tsai, PharmD, BCPP

• The ADVANCED Acute Psychiatry rotation is an extension learning experience at ZSFG of the Acute Psychiatry rotation.
• The rotation provides an opportunity for the PGY1 Pharmacy Resident to participate with the management of psychiatric patients admitted to the acute inpatient psychiatric units for treatment of schizophrenia, bipolar disorders, major depressive disorders, substance-induced mood disorders, dementia, and/or personality disorders. The psychiatric pharmacy rotation is a five week experience designed to develop resident's knowledge and skills in the area of patient interaction, psychiatric disorders, and psychotropic drug therapy. 

• The pharmacy resident is a team member on a multi-disciplinary health care team. The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients and will work toward assuming transitions of care of the patients on the team throughout the learning experience.  

• The resident will interview patients with treatment team, attend multidisciplinary team rounds daily, review patient profile with medication/therapy problem identification and resolution, respond to drug information requests, provide clinical support to nursing staff or other ancillary services, conduct RN and/or MD in-service programs, provide medication education for patients, participate in various educational opportunities (i.e., teaching rounds, evidence-based medicine discussion, weekly psychopharmacology discussion,  grand rounds) and weekly patient presentations and/or topic presentations to pharmacy preceptor.

• If applicable, the pharmacy resident will have a role in precepting/teaching UCSF pharmacy interns.

• The learning experience provides the PGY1 residents with various opportunities to establish, demonstrate and improve their teaching skills.
• The learning experience will incorporate the requirements to complete the UCSF Teaching Certificate program.
• The resident will gain experience in facilitating small group conferences, preparing conference cases, writing and grading exams, providing didactic lecturing, and precepting students’ clinical rotations. 
• The teaching experience at UCSF School of Pharmacy (SOP) will specifically focus on small group facilitation skills and larger large-group presentations in the Neuroscience and Psychiatry block or Cardiovascular block 
• The resident will prepare a CE presentation to be given to pharmacists, pharmacy technicians, and pharmacy students.  The resident may additionally give the presentation virtually to CSHP members. 

• The resident will participate in our ZSFG Study Design series and will develop skills in adhering to a research timeline, designing and implementing appropriate study methodologies, conducting data collection and analysis, and summarizing research findings. 
• There are a wide variety of study designs that may be featured in the resident’s research project (e.g., prospective or retrospective cohort studies, longitudinal analyses, survey research, qualitative reviews, etc.)

• Residents will be assigned to cover pharmacy operations in the inpatient pharmacy on scheduled weekends.
• These shifts may be days or evenings and may include processing orders or preparing medicines for patients in adult medicine, pediatrics, intensive care units, the emergency department, psychiatry, long term care, and the mental health rehabilitation facility.
• The typical resident staffing schedule will include two 8-hr shifts every third weekend and 1 major holiday.
• The resident will receive one comp day on the week following their staffing shift.