Clinical Pharmacy Practice

Thao K. Huynh, PharmD, BCOPAssistant Professor

Department of Pharmacy and TherapeuticsUniversity of Pittsburgh School of Pharmacy

Email: t.huynh@pitt.edu

Outline• Post-graduate year 1 (PGY1) residency• Post-graduate year 2 (PGY2) residency• Career ladder

Post-Graduate Year 1 (PGY1) in Hospital Pharmacy• Job • Flexibility & adaptability to change career path

• Promotion• Faculty, management, clinical roles

• Networking opportunities • Find mentors• Expand resource base

• Achieve professional vision• Develop leadership skills • Find areas of interests

Why do a residency?

ASHP: https://www.ashp.org/DocLibrary/Residents/Why-Residency-Brochure.aspx

PGY1 Programs• Community• Managed care• Combined programs (PGY1 & 2)• Community administration • Health system administration (MS in Business)• Medication systems & Operations• Pharmacotherapy • Pharmacy informatics• Specialty pharmacy

PGY1 Program Match Rates 2016• Number of residencies participate in the match: 1,163• Number of positions offered in the match: 3,312• Applicants enrolled in the match: 5,655 students• Applicants participated in the match: 4,609 students

• Applicants matched: 3,041

~66%

PGY1 Program Structure• Required Learning Experiences

• Ambulatory care• Critical care• Internal medicine• Nutrition Support• Pharmacy Administration• Clinical Precepting

• Required Longitudinal Learning Experiences• Hospital Pharmacy Operations• Multidisciplinary Committee• Resident Research Series• Underserved clinics

• Select Elective Learning Experiences• Cardiology• Critical Care (Medical, Trauma/Surgical,

Cardiac Care, Transplant)• Infectious Diseases• Solid Organ Transplantation• Family Medicine• Health System Formulary Management• Palliative Care• Psychiatry• Oncology

After PGY1?• PGY2• Hospital practice• Clinical pharmacist

• Fellowship training (Oncology – 2 years)• 1 year oncology practice• 1 year oncology research

PGY2 Programs• Ambulatory care• Cardiology• Corporate pharmacy leadership• Critical care• Drug information• Emergency medicine• Family medicine • Geriatric • HIV• Infections diseases• Internal medicine• Medication use safety

• Neonatology• Nephrology• Neurology• Nutrition support• Oncology• Outcomes & analytics• Pain management & palliative care• Pediatric• Pharmacogenetics • Pharmacy informatics• Psychiatric • Solid organ transplant

PGY2 Program Match Rates 2016• Number of programs participate in the match: 764• Number of positions offered in the match: 681• Applicants enrolled in the match: 1,058 students• Applicants participated in the match: 829 students

• Applicants matched: 580

~70%

PGY2 Oncology Program Structure• Required Learning Experiences• Inpatient Hematology (2 months)• Inpatient Oncology (2 months)• Inpatient Stem cell transplant (2

months)• Outpatient clinic (2 months)• Investigational Drug Service (1

month)• Research (1 month)

• Required Longitudinal Learning Experiences• Outpatient clinics

• Select Elective Learning Experiences• Pediatrics• Nutritional Support• Outpatient stem cell transplant• ID

After PGY2?• Fellowship (1-2 years)

• Drug companies or hospital• Research

• Hospital practice• Clinical specialist

• Academia• Faculty with clinical practice

• Administration • Oncology manager of cancer center• NCCN Guideline development• FDA • Drug companies

Clinical Oncology Specialist Practice: Clinical• Clinical rounds with the medical team• Patient counseling on chemotherapy • Supportive care for chemotherapy recommendations• Chemotherapy order review

• Indication (ex. Metastatic breast cancer HER2/neu-positive, ER/PR-negative)• Lab values • Dosing • Premedications (hypersensitivity reactions, nausea and vomiting, other indications)

• Discharge counseling • Neutropenic precautions • Adverse effect management

Clinical Oncology Specialist Practice: Administration• Chemotherapy protocol

development

Clinical Oncology Specialist Practice: Administration• Medication error reporting • Chemotherapy hospital committees • Procedure development

Clinical Oncology Specialist Practice: Teaching• Formal• Pharmacy students at School of Pharmacy • Medical students at School of Medicine

• Informal • Pharmacy student precepting • Pharmacy resident precepting • Medication resident education• Oncology medical fellow education• Nursing education • Pharmacist education

Clinical Resources for Oncology Pharmacy

References• Organizations• Hematology/Oncology Pharmacy Association (www.hoparx.org)

• Reference handbooks• Drug information handbook for oncology

• Online references• ASCO guidelines (http://jco.ascopubs.org/site/misc/specialarticles.xhtml) • NCCN guidelines (www.nccn.org) • Global RPh (http://www.globalrph.com/oncology_dilution.htm)• Drug calculators (http://www.globalrph.com/medcalcs.htm)

• Pharmacy Meetings

Patient Case Discussion

Pharmacy Education System in United

StatesThao K. Huynh, PharmD, BCOP

Assistant ProfessorDepartment of Pharmacy and TherapeuticsUniversity of Pittsburgh School of Pharmacy

Email: t.huynh@pitt.edu

Outline• Background on US education system• Pharmacy school statistics• Admission requirements to pharmacy school• Pharmacy school curriculum and accreditation • Post-Pharmacy school graduation career avenues

Background on US Education system

Primary and Secondary Education

•Public and private•Graduate with high school diploma

Undergraduate Education (~4 years)

•Public and private•Graduate with Bachelor degree •BS: Bachelor of Science•Many others

Graduate Education (~2-4 years)

•Pharmacy (4)•Medical (4)•Law (2-3)•Dental (4)•Masters programs (2)•PhD programs (4-5)

Direct Pharmacy Admission: 2 years undergraduate + 4 years graduate

Pharmacy School Statistics• 2000: 80 colleges and schools of pharmacy accredited• July 2015: 132 colleges and schools of pharmacy accredited; 3

precandidate status• 69 private institutions • 66 public supported universities

Pharmacy School Statistics• Degrees offered • 135 colleges and schools will offer Doctor of Pharmacy (PharmD) degree• 8 colleges and schools will offer Doctor of Pharmacy degree + post Bachelor

of Science (BS) degree• 73 offer Master of Science (MS) and/or Ph.D. in pharmaceutical sciences

• Faculty members• 6,292 full-time • 286 part-time

Pharmacy Student Statistics• First professional degree enrollment (2 years undergraduate

+ 4 years pharmacy school)• 63, 460 students• 61.4% females• 13.6% minorities

• Graduates with BS in pharmacy enrolled in pharmacy schools• 936 students

• Decreasing student enrollment over past few years

Pharmacy Student Statistics• 2014-2015 graduation statistics• 13,994 PharmD degrees awarded• 61.6% female; 39.4% males

• 273 post-BS PharmD degrees awarded• 561 PhD degrees awarded • 55.6% males • 44.4% females

Growth in Pharmacy Education

Admission Requirements to Pharmacy School• Minimum of two years pre-professional courses (62 credits of

academic prerequisites) at an accredited USA institution for a letter grade • 8 credits biology (1 year of lecture and lab)• 8 credits general chemistry (1 year of lecture and lab)• 8 credits organic chemistry (1 year of lecture and lab)• 3-4 credits calculus (1 course covering derivative and integral functions)• 3-4 credits statistics • 6 credits English composition • 24 credits electives (12 in humanities; 12 in social sciences)

University of Pittsburgh School of Pharmacy

Admission Requirements to Pharmacy School• May-September: Pharmacy College Admission Test (PCAT)• July-November: Pharmacy College Application Service (PharmCAS)

• 1 application to many PharmD degree programs • GPA, PCAT scores, transcripts, references• Supplemental application

• Personal essay for why student is applying to pharmacy school and why the student is applying to University of Pittsburgh School of Pharmacy

• December-February • Pharmacy school admission interviews (by invitation only)

• April• Admission decisions finalized

University of Pittsburgh School of Pharmacy

Pharmacy School Curriculum and Accreditation• Professional year 1 (P1)

Term 1 Term 2Profession of pharmacy 1a (4)Experiential learning 1 (1)Anatomy & Physiology 1 (3)Biochemistry 1 (3)Principles of Drug Action (4)

Profession of pharmacy 2a (4)Experiential learning 2 (1)Anatomy & Physiology 2 (3)Biochemistry 2 (3)Drug Development 1b (4)

Pharmacy School Curriculum and Accreditation• Professional year 2 (P2)

Term 1 Term 2Profession of pharmacy 3a (3)Experiential learning 3 (1)Pharmacotherapy of Infectious Disease 1b (4)Pharmacotherapy of Cardiovascular Disease (4)Drug Development 2b (4)

Profession of pharmacy 4a (4)Experiential learning 4 (1)Pharmacotherapy of Infectious Disease 2b (4)Drug Development 3b (4)Gastroenterology/Nutrition (2)Advanced Pharmaceutical Care 1 (1)

Pharmacy School Curriculum and Accreditation• Professional year 3 (P3)Term 1 Term 2Profession of pharmacy 5b (3)Experiential learning 5 (1)Immunology (3)Pulmonology/Rheumatology (2)Endocrinology (3)Professional Elective (3)

Profession of pharmacy 6b (2)Experiential learning 6 (1)Oncology/Hematology (3)Neurology/Psychiatry (4)Advanced Pharmaceutical Care 2 (2)Professional Elective (3)

Pharmacy School Curriculum and Accreditation• Professional year 4 (P4)• Advanced pharmacy practice experience• 1 Inpatient Acute Care Rotation (Oncology, Cardiology, ID, Critical Care,

Pediatrics, etc)• 1 Ambulatory Care Rotation (Anticoagulation, Diabetes, Hypertension,

Geriatrics, etc)• 1 Inpatient Acute Care Rotation or Ambulatory Care Rotation• 1 Community Pharmacy Rotation • 1 Hospital/Health System Pharmacy Rotation • 2 Elective Rotation (consulting, FDA, academic, research, managed care,

international)• PharmD Seminar

Areas of Concentration• Pharmacy Business Administration• Research• Global Health• Pediatrics• Community Leadership, Innovation, and Practice• Pharmacotherapy Scholars

Pharmacy Education in the Classroom

Simulation in Pharmacy Education

Student Pharmacy Organization

Post-Pharmacy School Graduation Career Avenues • Community pharmacy (~60%)

• Post-graduate year 1 (optional)• Hospital pharmacy (~30%)

• Post-graduate year 1 (optional)• Post-graduate year 2 (optional)

• Other (~10%)• Fellowship training (2 years)

• Research • Drug companies

• FDA• Consulting • Managed care

• Post-graduate year 1 (optional)

Clinical Practice