ZSFG PGY2 Psychiatric Pharmacy Residency

PGY2 residency programs build upon Doctor of Pharmacy (PharmD) education and PGY1 pharmacy residency training to develop pharmacist practitioners with knowledge, skills, and abilities as defined in the educational competency areas, goals, and objectives for advanced practice areas. Residents who successfully complete PGY2 residency programs are prepared for advanced patient care or other specialized positions, and board certification in the advanced practice area, if available.

Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) is offering a one-year PGY2 residency in Psychiatric Pharmacy Practice. This is a collaborative program offered jointly by ZSFG, the San Francisco Department of Public Health Behavioral Health Services (SFDPH BHS) and the University of California San Francisco Department of Clinical Pharmacy to include a broad exposure to disease states across many populations.

ZSFG

• 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.

SFDPH BHS

• BHS is a division of the San Francisco Department of Public Health that provides ambulatory care psychiatric and substance abuse services for Medicaid and uninsured clients in San Francisco.
• BHS serves 31,000 individuals in 23 mental health clinics throughout San Francisco.
• BHS provides specialty mental health services for multiple age groups including child, youth and adolescents, transitional age youth, adults, and older adults.
• BHS provides a variety of levels of services including outpatient, intensive case management and ACT programs.

UCSF

• The UCSF rotations are based out of the Langely Porter Psychiatric Hospital and Clinics (LPPH&C) and UCSF primary care.
• UCSF experiences consist of adult and child outpatient services where there are over 20,000 visits per year.

Our program provides a unique opportunity to expose residents to patients served by the Department of Public Health as well as a patients at a University Medical Center. In both of these settings, the residents will have the opportunity to work with thirteen board certified psychiatric clinical pharmacists in acute care as well as ambulatory care. This broad exposure provides residents the training needed to work in a broad range of psychiatric pharmacy care settings.

• The in-patient psychiatric units are culturally and ethnically focused at ZSFG. Clinical specialties include the evaluation and treatment of Asians, Latinos, African Americans, people with HIV or AIDS, and gay/lesbian/transgender patients experiencing acute mental illness.
• The learning experience is designed to develop resident’s knowledge and skills in the area of patient interaction, psychiatric disorders, and psychotropic drug therapy in HIV/LGBT patient population.
• The rotation provides an opportunity for the 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 pharmacists provide medication education to psychiatric patients through one to one teaching on daily basis.
• The pharmacists serve as an expert for selection of psychotropics, medication reconciliation, monitoring of drug effects and providing drug information to multidisciplinary team.
• The psychiatric pharmacy resident is a team member on a multi-disciplinary health care team that consists of two attending psychiatrists, two PGY1 medical interns, medical students (MSIII or MSIV), nursing staff, social workers, occupational therapists, etc.

• The rotation provides opportunity for the resident to be on the Red treatment team, which focuses on the mental health treatment of Asians and African-Americans.
• The resident will also be rounding in PES several times a week to gain more experience in emergency psychiatric medicine.
• During this block the resident is also expected to precept pharmacy interns on the service.
• ZSFG Inpatient Psychiatry Block I for additional details about the inpatient patient population and role of the pharmacist.

• The resident will be oriented to the residency program structure.
• The resident will also spend time at the multiple of the San Francisco Department of Public settings to gain knowledge about the system of care.
• The resident will be trained in ZSFG inpatient pharmacy staffing.

• This learning experience will build on skills obtained in the BHS longitudinal learning experience by providing exposure to a greater number and variety of patients and locations.
• The outpatient mental health clinics include South of Market Mental Health, Mission Mental Health, Chinatown/North Beach, OMI Family Center, Central City Older Adults and Southeast Mission Geriatrics.
• Psychiatric clinical pharmacists work with the medical teams to provide comprehensive medication management under a collaborative practice agreement.
• The psychiatric clinical pharmacists generally meet with mental health clients for individual appointments. They 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.
• Some pharmacists may lead smoking cessation, clozapine and other groups. 
• The pharmacists are primary preceptors of UCSF School of Pharmacy APPE students.

• On the Permanent Housing Advanced Clinical Services (PHACS) team, the clinical pharmacist will be rotating through a variety of supportive housing buildings throughout the week for patient outreach in their homes.
• The primary role of the clinical pharmacist is to prescribe buprenorphine under a collaborative practice agreement and provide reduction (e.g., fentanyl testing strips, naloxone, safe injection supplies).
• The clinical pharmacist may assist with management of chronic disease states, acute medical conditions, and address any medication/insurance related questions or issues.
• On Delivery days the clinical pharmacist is responsible for counseling patients on new medication starts, dose adjustments, and triaging any other issues that arise.
• The resident will gain experience through assessing urine drug screens, counseling new buprenorphine starts, furnishing naloxone, furnishing nicotine replacement therapy and assessing client’s appropriateness for ongoing buprenorphine treatment.

• Designed to provide residents with experience in behavioral health pharmacy services administration, giving insight into key regulatory and administrative responsibilities as they impact behavioral health pharmacy practice.  
• The BHS Clinical Pharmacist Supervisor is responsible for planning, developing and directing the operation of clinical pharmacy services in the San Francisco Department of Public Health Behavioral Health Services. 
• Administrative areas ranges from providing leadership in developing and implement innovative pharmaceutical services to ensuring compliance with local, state and federal regulations. 
• The resident will gain experience in ongoing quality improvement through the review of medications errors throughout the system and providing recommendations to prevent future errors.

• The learning experience will be at Langley Porter Psychiatric Institute outpatient clinics and UCSF primary care clinics.
• Clinical rotations may include Child & Adolescent Medication Management Clinic, Autism Clinic, Early Psychosis Clinic, Bipolar Disorder Clinic, Anxiety Disorder Clinic, Partial Hospitalization Program, Geriatric Psychiatry Clinic, the Medication Alliance Clinic (i.e., Depression Clinic in Primary Care), and UCSF Primary Care Pharmacist Clinic (Hypertension, Mental Health, Tobacco Cessation in Primary Care).
• Psychiatric clinical pharmacists work with the medical teams to provide comprehensive medication management through collaborative practice agreements and recommendations to the medical team.
• The psychiatric clinical pharmacists either meets with mental health clients for individual appointments or jointly with the client's prescriber.
• They may document in the encounter in the electronic health record.

• Laguna Honda Hospital and Rehabilitation Center’s rotation is a required 4 week learning experience focusing on clinical pharmacy activities and direct patient care in older psychiatric adults. 
• LHH was founded in 1866 and is one of the largest skilled nursing facilities in the United States with 780 beds and an outpatient psychiatric clinic.  The hospital features 13 neighborhoods or units that provide specialty services such as palliative care, HIV, memory care, and intensive rehabilitation. 
• The clinical pharmacist and PGY2 resident participate in the following clinical services but not limited to: monthly medication regimen review, medication education for patients and family, medication information consultation for clinicians, clinical monitoring, and formulary and quality management. 

• The learning experience provides the PGY2 resident 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 six-unit Neuroscience and Therapeutics course
• In addition, the resident will serve as an APPE preceptor for SOP students enrolled in the Psychiatric Acute Care rotation at Zuckerberg San Francisco General (ZSFG) and Behavioral Health Services (BHS).

• Under the direction of the BHS Chief Medical Officer, the Medication Use Improvement Committee (MUIC) serves as the oversight body for Medication Support services and provides the BHS Office of Quality Management with policy advisement.
• The committee consists of psychiatrists and includes representatives of System of Care providers including physicians and nurse practitioner(s), BHS administrative personnel, BHS pharmacy staff and BHS Quality Management personnel.
• MUIC’s scope includes issues related to medications including: patient education and compliance; medication safety; formulary management; Medication Use Evaluations; drug therapy protocols/guidelines; distribution and storage of medications at BHS facilities; pharmaceutical industry and medical devices industry related policies and procedures; and responding to medication-related issues identified by the BHS Risk Management Committee.
• The role of the pharmacist is to be an active member of MUIC and to provide clinical psychiatric pharmacy expertise.
• The resident will be the leader of a subcommittee and be responsible for arranging meeting times, developing agendas, assigning roles and leading meetings.

• The learning experience is at South of Market Mental Health (SOMMH) which is an ambulatory specialty mental health clinic.
• The majority of SOMMH clients reside in the South of Market, Tenderloin and Western Addition neighborhoods.
• Because the clinic is located nearby several shelters, many clients are homeless at the time of enrollment.
• Approximately half of the clients served have a psychotic disorder, and the majority is dually diagnosed with a major mental illness and one or more substance use disorders.
• The psychiatric clinical pharmacists work under a collaborative practice agreement and document in the electronic health record in compliance with requirements from California Medi-cal medication support services to receive reimbursement for these services as a provider.
• The pharmacists are primary preceptors of UCSF School of Pharmacy APPE students at SOMMH.

• 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 fourth weekend.
• The resident will receive one comp day on the week following their staffing shift.

• The resident will be responsible for selecting, conducting, completing and presenting a research project that may involve data, facilities or patient care activities within SFDPH.
• 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.)

• The resident will be working closely with the psych consultation/liaison (C/L) team to learn how to evaluate psychiatric manifestations of medical disorders and develop techniques to manage primary psychiatric disorders for patients who are medical hospitalized in collaboration with other disciplines.
• The service includes 2 faculty attending psychiatrists, nurses, as well as residents, and medical students.
• The pharmacy resident is expected to serve as a member of psych C/L team, assisting physicians for drug information questions, medication reconciliation, and providing education to patients or necessary inservices to medical students.

• The rotation provides an opportunity for the PGY 2 Psychiatric Pharmacy Resident to participate with the management of psychiatric patients admitted to the forensic unit (7L) and to psychiatric emergency service (PES) for acute stabilization.
• Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) is the largest provider of acute psychiatric care and the only psychiatric emergency service in San Francisco.
• The learning experience is designed to develop resident’s knowledge and skills in the areas of forensic system, acute psychiatric emergency, assessment of patients, and medication reconciliation.

• The rotation provides an opportunity for the resident to participate with the management of psychiatric patients admitted to psychiatric emergency service (PES) for acute stabilization.
• The learning experience is designed to develop resident’s knowledge and skills in the areas of acute psychiatric emergency, assessment of patients, and medication reconciliation.
• The clinical pharmacist  is responsible for ensuring safe and effective medication use for all patients admitted to PES and the ED.

• The primary site for this experience is in the 2nd Floor Family Birth Center units, but the resident will have the opportunity to follow patients for the GYN consult service, the Women’s Options Clinic (6G), the 5M Obstetric, Midwifery, and Gynecology Clinic, Team Lily, the OB psychiatric service, and HIVE. 
• There are 284 acute inpatient hospital beds in the hospital, 21 beds of which are on the Labor and Delivery and Post-Partum units.  ZSFG delivers between 1,200 and 1,500 babies a year and the patient population is underserved, low-income, and uninsured.   Each women’s health service is multidisciplinary.
• The resident will work closely with OBGYN medical doctors, nurse midwives, anesthesia attendings and residents, medical residents, family medicine doctors, psychiatrists, clinical nurse specialists, nursing staff, clerical staff, and the clinical pharmacist to provide high quality health care with compassion and respect to patients within the various women’s health services. 
• The resident will be responsible for identifying and resolving medication therapy issues for patients abd will work toward assuming care of all patients on the Labor and Delivery and Post-Partum units throughout the learning experience. 

• The learning experience will build on skills learned during the BHS SUD learning experience by providing additional independence and precepting.
• See the BHS SUD learning experience for additional details about the service

• This learning experience is at UCSF Medical Center, Parnassus Campus on Neurology Service.
• Typically, residents will be responsible for the care of approximately 10-20 acute care, TCU and ICU patients.
• Patients seen on the Neurology service are evaluated and treated for a wide array of neurological disorders such as seizure disorders, encephalitis/meningitis, headache/migraine, neuromuscular disorders, myasthenia gravis, multiple sclerosis, chronic inflammatory demyelinating polyneuropathies, autoimmune diseases, movement disorders, cerebellar disorders, and other rare neurodegenerative diseases.
• Neurology service has an interdisciplinary team that follows each patient, of which the pharmacist or pharmacy resident is a team member.
• The resident will participate in daily multidisciplinary and attending rounds, medication reconciliation, daily review and management of medications, ordering of relevant labs/drug levels per pharmacy protocol, discharge facilitation, and providing effective medication education to patients and caregivers.

• The resident will gain experience in academia by working with a UCSF School of Pharmacy professor during the neuropsychiatric block of therapeutics.