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Introduction to the PGY2 Emergency Medicine Program

The University of California San Francisco (UCSF) offers a PGY2 Emergency Medicine residency program designed to build upon Doctor of Pharmacy (PharmD) education and PGY1 pharmacy residency training. This program aims to develop pharmacist practitioners with advanced knowledge, skills, and abilities in emergency medicine.

Purpose

The purpose of the PGY2 Emergency Medicine residency program is to provide residents with the necessary training to become specialists in emergency medicine pharmacy practice. The program focuses on developing residents' expertise in various emergency care settings, including the emergency department, critical care, mass casualty incident, and disaster response/preparedness.

Description

The emergency medicine pharmacy residency is a one-year specialty residency that allows residents to practice in a university-affiliated tertiary care, academic teaching hospital with 790 beds. The ED pharmacy team is a well-integrated service that has existed for over a decade. The ED is located in an urban setting and has an estimated 45,000 visits per year. Many patients are medically complex and representative of the San Francisco community and UCSF tertiary specialties.

General Emergency Department Description

• Two ED campuses (Parnassus and Mission Bay)
• 60 Bed Parnassus ED
  • 16 Bed Accelerated Care Unit (ACU)
  • 10 Bed Clinical Decision Unit (CDU)
• Comprehensive stroke care center
• Age Friendly ED (special focus on unique needs of patients 65 years of age and older)

ED Pharmaceutical Services

• Bedside direct patient care participation (e.g., resuscitation, intubation, procedural sedation, STEMI, ECMO, stroke, sepsis)
• Emergent medication procurement, preparation, administration
• Prospective ED order verification
• Clinical consultations for all ED/CDU/ACU patients
• Vaccine screening and administration
• Discharge culture follow-up
• Formulary, medication safety, and quality improvement projects
• Emergency care of unique patient populations (e.g., transplant, oncology, psychiatry, substance use disorders, toxicology, pulmonary hypertension)

Learning Experiences

Rotations

• Core Rotations:
  • Emergency Medicine (Longitudinal 12 months)
  • Poison Control Center (6 weeks)
  • Trauma and Surgical Intensive Care (4 weeks)
  • Pediatric Emergency Medicine (6 weeks)
  • Adult Infectious Disease (4 weeks)
  • Research (Longitudinal 12 months)
  • Teaching (Longitudinal 12 months)
  • Quality Improvement (Longitudinal 12 months)
  • Operational Staffing (Longitudinal 12 months)
• Electives:
  • Pediatric ICU/Neonatal ICU (4 weeks)
  • Medical/Surgical ICU (4 weeks)
  • Neurocritical Care (4 weeks)
  • Emergency Medical Services (2 weeks)
  • FEMA Mass Casualty Incident Training (1 week)
  • Off-site Emergency Medicine/Trauma (1 week)

Staffing

• Operational staffing occurs longitudinally and takes place approximately every third weekend spanning throughout the residency year for a total of 17 weekends, in addition to one major holiday and two minor holidays.
• Residents staff in 2 areas:
  • IV Satellite: 6 weekends
  • Emergency Medicine Clinical Service: 11 weekends

Research

• The Residency Program Director collects project proposal submissions from clinical pharmacists for consideration as a resident research project on an annual basis in the Spring.
• Projects are reviewed for feasibility, appropriateness of timeline, potential value that may focus on clinical pharmacist services, quality improvement initiatives such as drug safety, optimal medication use, cost-effective drug use, and efficient, safe and effective medication preparation, delivery, and administration.
• PGY2 residents participate in the UCSF Research Certificate Program and will gain skills in adhering to a research timeline, creating an appropriate study design and methodology, completing data collection and analysis, and summarizing research findings.

Teaching

• Teaching is a focus of the residency at UCSF, and residents receive a Teaching Certificate upon program completion if they complete the required elements of the program.
• Residents receive training in teaching methodology, precepting, and small group conference facilitation through a variety of educational seminars that are planned during the year.
• Teaching opportunities may include:
  • Precepting of PGY1, APPE, and IPPE students on clinical rotations and project-based work
  • Precepting of PGY3 and PGY4 Emergency Medicine physician trainees
  • Inter-professional education through Emergency Medicine conference
  • Large group teaching
  • Small group teaching
  • Simulation lab

Code Response

• Pharmacy residents are integral members of the inter-professional emergency response care team.
• All pharmacy residents will become certified in Advanced Cardiovascular Life Support (ACLS), and receive hands-on code training by the Emergency Medicine Pharmacy team.
• Residents respond to Code Stroke, Code Sepsis, and Code Blue to ensure appropriate drug selection and administration, timeliness of medication retrieval and preparation, adjusting medication dosages, and monitoring for response.

Simulation

• The UCSF Residency Training Program has developed and implemented a longitudinal simulation curriculum for PGY1 Pharmacy residents to increase confidence and competence during various emergent situations.
• The program utilizes the Kanbar Center for Simulation and Clinical Skills, a high-fidelity simulation center within UCSF.
• Throughout the residency year, residents participate in 4 simulation lab sessions, each covering 4 cases.
• Clinical pharmacist content experts are invited to the sessions to lead the residents through a debrief of the simulation session and allow for discussion of advanced clinical topics.