PGY2 Pharmacy Residency (Infectious Diseases) Greenville - Rotation Descriptions

The Infectious Diseases Consult Service is utilized by all of the various services in Prisma Health – Upstate GMMC Hospital to participate in the care of patients with difficult to manage infectious diseases.  The service is a multi-disciplinary team consisting of an infectious disease attending physician and fellow, internal medicine residents, medical students, and a pharmacist. The residents gain experiences managing diverse patient population with a wide range of infectious diseases and backgrounds.  Disease states commonly encountered include pneumonia (community and hospital acquired), urinary tract infections, bacteremia/sepsis, hepatitis/cirrhosis, human immunodeficiency virus, osteomyelitis, endocarditis, sexually transmitted diseases, opportunistic infections, meningitis, and various fungal infections.

The Hematologic Malignancies/Adult Oncology rotation is an elective option for PGY2 residents.  This rotation involves the provision of direct pharmaceutical care to patients with a variety of hematologic malignancies including, but not limited to, leukemia, lymphoma, and multiple myeloma.  Based on patient census and the interest of the resident, bone marrow transplant and/or solid tumor pharmacotherapy may be included.  The resident will obtain knowledge and experience as it relates to the general principles of oncology pharmacy practice, including oncologic supportive care issues and management of infections in the immunocompromised host.

The Prisma Health Antimicrobial Stewardship Program (ASP) is a coordinated system level program that promotes appropriate use of antimicrobial therapy, reduces microbial resistance, decreases the spread of infections caused by multidrug-resistant organisms, and improves patient outcomes. The multidisciplinary program is led by an ID trained pharmacist and an ID physician.  Residents on this rotation will complete targeted antimicrobial stewardship reviews and make patient specific recommendations to the primary teams, provide education to various services regarding antimicrobial stewardship topics, and complete antimicrobial stewardship related quality improvement projects for the system. Topics focused on during this rotation include antimicrobial stewardship principles; diagnostic testing performed in the microbiology laboratory; urinary tract infections/asymptomatic bacteriuria; bloodstream infections, antimicrobial resistance; respiratory infections.

The resident will spend one month focused on ASP initiatives at one of our 7 community hospitals and work with the ID telemedicine service. This experience will allow the resident to gain insight into the challenges and opportunities that smaller hospitals offer.

The learning experience will be a calendar month long rotation focusing on acute management of critically ill patients within the emergency department (ED) at Prisma Health – Upstate Greenville Memorial Hospital. The patient population to which the resident will be exposed during this learning experience covers all age ranges from pediatrics to geriatrics. The learning experience will be targeted at exposing the resident to the role of a clinical specialist within the emergency department. The resident will be pushed towards expertise in managing acutely critically ill patients with a focus on trauma, stroke, acute coronary syndrome, sepsis, antimicrobial management and toxicologic emergencies. The rotation will have a focus on policy implementation for disaster preparedness, along with logistical analysis of implementation of standard policies within the emergency department.

The resident will assist ID providers in selecting appropriate antimicrobial therapy for various disease states seen in the ambulatory setting (eg. HIV/AIDS, bone and joint infections, and diabetic foot infections). They will also provide medication counseling, medication reconciliation, and answers to drug information questions.

The Medical Teaching Service (MTS) experience creates a foundation for pharmacy residents on an inpatient general medicine service. The team consists of an attending physician, medical residents, interns, and students. The resident will attend patient care rounds and teaching rounds on a daily basis and present developed therapeutic plans for each of his/her patients to the preceptor on a daily basis, provide patient counseling on medications and disease-states, obtain medication histories, write pharmacokinetic and therapeutic consult notes as necessary, participate in journal club, and give formal presentations to the preceptor. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses, and pharmacists.  Topics commonly encountered and/or discussed throughout the rotation include pneumonia, urinary tract infections, bacteremia/sepsis, chronic obstructive pulmonary disease, heart failure, venous thromboembolism, angina/myocardial infarction, stroke, seizure disorders, acute and chronic renal failure, peptic ulcer disease, gastroesophageal reflux disease, pancreatitis, hepatitis/cirrhosis, diabetes, anemia, fluid-electrolyte disorders, acid-base disorders, human immunodeficiency virus, dementia, and liver disease.

The clinical on-call/pharmacokinetics longitudinal experience provides on-call consult service and code response at Prisma Health – Upstate GMMC Hospital. The on-call consult service is designed to provide consistent clinical resources to GMH healthcare providers in a timely manner. The resident will design, monitor, and evaluate evidence-based patient-specific therapies involving clinical pharmacokinetics, drug information questions, investigational drug services, therapeutic outcomes program, formulary management, clinical services cross-coverage and additional pharmacotherapy consults.

The knowledge and experiences gained in this Teaching Certificate Program will be applicable in strengthening the resident’s teaching skills and overall effectiveness regardless of the practice setting.  The program will consist of various experiences during the residency year.  These experiences will include attendance at and participation in a lecture seminar series on pedagogy topics; reading assignments; formal teaching experiences including didactic presentations, small-group facilitation, experiential teaching; evaluations and feedback of teaching; and development of a teaching portfolio. A certificate of completion will be awarded to the resident by University of South Carolina School of Pharmacy after all requirements are satisfactorily met. (If not already received during PGY1 year). More information about this program can be found at this website: Clinical Teaching Certificate - College of Pharmacy | University of South Carolina (sc.edu)

The Critical Care Teaching Services (CCTS) are multi-disciplinary teaching services that may consist of critical care board certified attending physicians, pulmonary critical care fellows, advanced practice practitioners, internal medicine interns and residents, medical students, and clinical pharmacy specialists. The average daily patient census for the CCTS teams are on average 15-20 patients, with most patients receiving mechanical ventilation.  Disease states range from COPD exacerbations, community and hospital acquired pneumonias, drug overdoses, acute neurological events, sepsis resulting from various infections, pulmonary embolus, and adult respiratory distress syndrome, as well as cardiac arrest and many other disease states.

The ID clinic has a robust OPAT program for patients on long-term home IV antibiotics. The resident will help support this program by designing outpatient regimens, evaluating weekly labs, and patient follow up as needed. The resident will also identify inpatients who are close to discharge to recommend appropriate antimicrobial therapy plans to avoid prolonged admissions and facilitate medication access as needed.

This four-week clinical rotation takes place within all units of the Prisma Health Upstate Children's Hospital on the Greenville Memorial Medical Campus. The patients seen may range in age from newborns to young adults and will include all patients on the Pediatric Infectious Disease consult list.  The ASP pharmacist works in collaboration with the pediatric infectious diseases physicians, other pediatric clinical pharmacists and microbiology personnel to design, monitor and evaluate evidence-based, patient specific, anti-infective treatment plans for patients encountered on the rotation.  This rotation will provide an opportunity for residents to gain insight into the management of common infections and selection of initial antimicrobial therapy, antimicrobial utilization at our institution, and related antimicrobial hospital guidelines and policies. The resident will also improve their confidence and negotiation skills when discussing anti-infective choices with other medical providers and pharmacists.  The major goal for the resident is to learn principles of antimicrobial therapy that can be applied to any future practice area. The resident's learning will be enhanced by twice weekly topic discussions with the preceptor, led by the resident covering a variety of commonly encountered pediatric disease states. 

The preceptorship experience gives pharmacy residents an opportunity to participate as the direct preceptor / mentor for a pharmacy student’s clinical rotation while at Prisma Health – Upstate. It is designed to develop the resident’s clinical preceptorship and mentorship skills through direct precepting of pharmacy students, designing an individualized student curriculum, conducting pharmacotherapy discussions, and providing feedback/evaluations to students. The resident will precept in a familiar setting on the Infectious Diseases Consult Service.

Residents are required to be primarily responsible for at least one major project. The goal of this assignment is to gain experience in various aspects of research methodology. The objectives of the major project include defining a research idea, protocol development, submission to the Institutional Review Board, data collection, data analysis, and presentation/publication of results. The residents are required to present their projects at the Southeastern Residency Conference (SERC) which occurs yearly at the end of April.

The Surgery / Trauma Critical Care Teaching Service (SCCTS) is a multi-disciplinary teaching service consisting of a general surgery / critical care board certified attending physician, surgery critical care fellow, upper-level surgical resident, surgical intern, and a clinical pharmacy specialist. The SCCTS team provides critical care services to neurosurgical, general surgical, trauma, thoracic, and vascular patients in the intensive care units at a Level I Trauma Center. The average daily census for the SCCTS ranges from 15-30 patients depending on consultations. Disease states managed include traumatic brain injuries, acute spinal cord injuries, sepsis resulting from a multitude of causes, adult respiratory distress syndrome, acute alcohol withdrawal, blunt trauma, aortic aneurysms, as well as many other disease states.

The Kidney Transplant rotation is an elective option for PGY-1 and PGY-2 residents. This month-long clinical rotation includes both inpatient and outpatient components. The purpose of this rotation is for the resident to gain experience and knowledge on managing a kidney transplant patient from pre-, peri-, to post-op. The kidney transplant service consists of a transplant surgeon attending, transplant nephrologist, transplant dietician, and a Clinical Pharmacy Specialist. It may also include interns and/or medical students. This team directly admits patients that have been offered to receive a kidney transplant from a deceased donor.  Patients are also admitted that may have complications from their kidney transplant (for example: rejection, infection, post op surgical complications). This team also provides care in the outpatient kidney transplant clinic to evaluate patients pre- and post-transplant. In this setting the team also includes transplant coordinators, transplant social workers, and medical assistants.