Program Year
2019/2020
PGY1 Managed Care Pharmacy Residency Find Alignment and Balance through Managed Care 8142019
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK
I.
HPSJ PGY1 MANAGED CARE PHARMACY RESIDENCY INTRODUCTION Welcome to the HPSJ PGY1 Managed Care Pharmacy Residency, we are pleased you have chosen to participate in our residency program. In response to the changes in healthcare delivery systems, emerging reimbursement trends, and increasing recognition of the need to improve and document drug therapy outcomes, the Health Plan of San Joaquin PGY1 Managed Care Pharmacy Residency prepares pharmacists for leadership roles in the managed care setting. The program is designed to provide a solid foundation in population-based pharmaceutical care. Primary emphasis is placed on the development and implementation of medication use management initiatives and policies, clinical/disease management programs, formulary management, pharmacoeconomic and outcome assessment, strong clinical and data analytics, drug information, effective communication and teaching/mentoring skills. The PGY1 Managed Care Pharmacy Residency conducted by Health Plan of San Joaquin in French Camp, CA has an accreditation candidate status with American Society of Health-System Pharmacists (ASHP). As such, the program incorporates ASHP’s PharmAcademic Residency Evaluation system, goals and objectives, and evaluation processes. The specific goals and objectives that have been identified for the program have been selected from the Required and Elective Educational Outcomes, Goals, Objectives, and Instructional Objectives for Postgraduate Year One (PGY1) Managed Care Pharmacy Residency Programs. HPSJ pharmacy residents will have obtained the training required to become a pharmacist who can assume a clinical position in a managed care setting. These pharmacists would be qualified to perform duties in Formulary Management, Clinical Data Analysis, Prior Authorization Review, Disease Management, and Preceptorship of Residents and Advanced Pharmacy Practice Experiences (APPE) Students.
II.
STATEMENT OF PURPOSE To build upon the Doctor of Pharmacy (Pharm.D.) education and outcomes to develop managed care pharmacist clinicians with diverse patient care, leadership and education skills who are eligible for board certification and postgraduate year two (PGY2) pharmacy residency training. A managed care pharmacy residency will provide systematic training of pharmacists to achieve professional competence in the delivery of patient care and managed care pharmacy practice.
III.
RESIDENCY ADVISORY COMMITTEE (RAC) The Residency Advisory Committee is established in accordance with the American Society of Health�Systems Pharmacists (ASHP) Accreditation Standards for Residency Programs. Committee members are determined by the Residency Program Director and are established prior to each residency year for the upcoming residency year. Purpose: The purpose of the RAC is to guide the overall pharmacy residency program at HPSJ with respect to the established ASHP Accreditation Standards. This includes maintaining standards with
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK respect to qualifications of the training site, residency program directors and preceptors, and resident selections, as well as the residency training program and pharmacy service, resident and program evaluations, and certification. The executive committee serves as the decision‐making body with regards to the program and represents the advisory board in their decisions. Responsibilities and Functions: In conjunction with the residency program director: Conduct an annual program evaluation for continuous quality improvement of the program based on program evaluations and feedback from the resident and preceptors. Direct the RPD to develop and implement program improvements to respond to the program assessment results. Reviews, maintains, and assures that each residency program is in compliance with current ASHP accreditation standards. Maintains, reviews, and approves the annual Residency Program Handbook. Annually reviews the qualifications of the Residency Program Director(s) (RPD), Residency Coordinator (RC) and preceptors and establishes their functions and responsibilities. Assures that overall residency program goals and specific learning objectives are met, training schedules are maintained, appropriate preceptorship for each period of training (rotation) is provided, and resident evaluations are conducted. Establishes residency applicants’ requirements, applicant procedures, and formal review process for evaluation and selection of the resident. Reviews, maintains, and updates the educational and experiential learning experiences of the residency program(s) which will also be consistent with the current ASHP guidelines and Residency Learning Model. Reviews the incoming resident’s development plan, training schedule, progress, and learning objectives quarterly. In conjunction with other identified experts in research, reviews potential residency research proposals for feasibility, research design, and unique contribution to the literature. Conducts corrective actions and dismissals as necessary, under the advisement of the Residency Program Director(s). Meetings and Minutes: The RAC will meet at least annually (or more frequently as needed) and will maintain a permanent record of its proceedings and actions. Quorum is reached if at least half of the RAC is present. Minutes of each meeting will be prepared by a designated pharmacy team member and be maintained by the RPD/RC. In the month prior to a new resident beginning their residency with HPSJ, the RAC must convene and perform an annual program evaluation to continually evaluate the program’s progress and areas of improvement. Each member of the RAC is expected to: Act as an advocate for the resident Provide expertise for the residency project (when possible) or identify other appropriate resources Provide feedback and suggestions on the current structure of the residency program, and offer possibilities for future direction The members of the RAC include: HPSJ Director of Pharmacy HPSJ PGY1 Managed Care Residency HPSJ Resident Handbook
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HPSJ Residency Program Director HPSJ Residency Coordinator HPSJ Director of Clinical Analytics HPSJ Chief Medical Officer HPSJ Medical Director SJGH Clinical Pharmacist Current HPSJ Resident Note: Preceptors not included in the above list as RAC members have open access to attend RAC meetings and provide feedback for continuous improvement of the residency program.
GOALS AND OBJECTIVES 1. Competency Area R1: Patient Care a.
b.
c.
Goal R1.1: Provide safe and effective patient care services including medication management, health and wellness programs, and disease state management following the JCPP Pharmacists’ Patient Care Process. Services are provided to a diverse range of patients in collaboration with the health care team. i . Objective R1.1.1: (Responding and Applying) Demonstrate responsibility and professional behaviors as a member of the health care team. ii . Objective R1.1.2: (Responding and Applying) Interact effectively with individual patients and caregivers. iii. Objective R1.1.3: (Valuing and Analyzing) Collect relevant subjective and objective information for the provision of individualized patient care. i v. Objective R1.1.4: (Analyzing) Analyze and assess information collected and prioritize problems for provision of individualized patient care. v. Objective R1.1.5: (Valuing and Creating) Design a safe and effective individualized patient centered care plan in collaboration with other health care professionals, the patient, and caregivers. vi . Objective R1.1.6: (Applying) Implement medication therapy plan in collaboration with other health care professionals, the patient, and caregivers. vii . Objective R1.1.7: (Evaluating) Monitor and evaluate the effectiveness of the medication therapy plan and modify the plan in collaboration with other health care professionals, the patient, and caregivers as required. viii . Objective R1.1.8: (Valuing and Applying) Collaborate and communicate effectively with patients, family members, and caregivers. i x. Objective R1.1.9: (Valuing and Applying) Collaborate and communicate effectively with other health care team members. x. Objective R1.1.10: (Applying) Document patient care activities appropriately and efficiently. Goal R1.2: Provide safe and effective medication-related patient care when patients transition between care settings. i . Objective R1.2.1: (Analyzing) Identify needs of individual patients experiencing care transitions. ii . Objective R1.2.2: (Applying) Manage and facilitate care transitions between patient care settings. Goal R1.3: Support safe and effective access to drug therapy for patients. i . Objective R1.3.1: (Evaluating) Assess whether network retail, mail order and specialty pharmacies follow best practices and the organization’s policies and procedures.
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK ii . Objective R1.3.2: (Applying) Manage aspects of the medication-use process related to
formulary management. iii. Objective R1.3.3: (Applying) Participate in the review of medication event reporting
and monitoring.
i v. Objective R1.3.4: (Evaluating) Assess how the organization utilizes appropriate and
d.
ongoing measures to assess patient satisfaction levels with services provided at network retail, mail order, and specialty pharmacies. Goal R1.4: Design and implement medication-related programs and interventions that contribute to public health efforts or population management. i . Objective R1.4.1: (Valuing and Applying) Design and/or deliver programs for members that focus on health improvement, wellness, and disease prevention (e.g., immunizations, health screenings). ii . Objective R1.4.2: (Valuing and Applying) Design and/or deliver programs for members that support quality measures to improve outcomes of medication therapy.
2. Competency Area R2: Leadership and Management a.
b.
c.
Goal R2.1: Manage services of the managed care pharmacy practice environment. i . Objective R2.1.1: (Applying) Manage patient care services at the managed care practice site. ii . Objective R2.1.2: (Applying) Participate in organizational level management activities, functions, and/or decision-making. iii. Objective R2.1.3: (Understanding) Identify relevant external factors that influence or impact managed care practice and identify appropriate strategies to adjust, comply, or improve. i v. Objective R2.1.4: (Creating/Evaluating) Evaluate an existing collaborative practice agreement or, if not available, create a new one, in order to understand the implementation process for a state- based protocol to expand the scope of practice for pharmacists. v. Objective R2.1.5: (Understanding) Identify and define ways in which medication management is provided in various managed care settings, lines of business (e.g., commercial, Medicare) and with diverse patient populations. vi . Objective R2.1.6: (Understanding) Explain, or demonstrate understanding of, the patient intake process for specialty pharmacy patients. vii . Objective R2.1.7: (Understanding) Demonstrate understanding of Risk Evaluation and Mitigation Strategies (REMS) for patients receiving specialty pharmacy medications. viii . Objective R2.1.8: (Understanding) Demonstrates understanding of how specialty pharmacies fulfill prescriptions/medication orders for patients. Goal R2.2: Demonstrate personal and professional leadership skills. i . Objective R2.2.1: (Applying) Manage oneself effectively and efficiently. ii . Objective R2.2.2: (Applying) Apply a process of on-going self-evaluation and personal performance improvement. iii. Objective R2.2.3: (Applying) Demonstrate personal, interpersonal, and teamwork skills and behaviors critical for effective leadership. i v. Objective R2.2.4: (Applying) Demonstrate commitment to the profession through active participation in the activities of a national, state, and/or local professional association. v. Objective R2.2.5: (Applying) Demonstrate personal leadership qualities essential to operate effectively within the organization and utilize them to advance the profession and practice of pharmacy. Goal R2.3: Demonstrate management skills.
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK i . Objective R2.3.1: (Understanding) Explain factors that influence departmental
planning. Objective R2.3.2: (Analyzing) Demonstrate understanding of the elements of the Joint Commission of Pharmacy Practitioners Pharmacist Care Process and its relationship to the healthcare system. Goal R2.4: Maintain confidentiality of patient and proprietary business information. i . Objective R2.4.1: (Applying) Observe legal and ethical guidelines for safeguarding the confidentiality of patient information. ii . Objective R2.4.2: (Applying) Observe organizational policy for the safeguarding of proprietary business information. iii. Objective R2.4.3: (Understanding) Explain the relationship between the health plan and the delivery system functions of managed care. Goal R2.5: Demonstrates understanding of unique aspects of providing evidence-based, patient-centered medication management with interdisciplinary teams in the managed care environment. i. Objective R2.5.1: (Analyzing) Compare and contrast the provision of medication management in the various managed care environment. Custom Goal: Maintain active involvement in local, state, and national pharmacy organizations. i. Support AMCP-Pacific chapter in promoting and educating Managed Care Pharmacy to students. Custom Goal: Prepare personal mission, vision, goals, and values statements. i. (Valuing) Develop a set of personal core values and personal goals along with specific objectives designed to accomplish those goals. ii. (Valuing) Review progress toward achieving personal goals at least every four months. iii. (Valuing) Write a personal mission and vision statement. Custom Goal: Read 7 Habits of Highly Effective People. i. (Synthesis) Read, understand, and apply 7 Habits of Highly Effective People. ii.
d.
e.
f.
g.
h.
3. Competency Area R3: Advancing Managed Care Practice and Improving Patient Care a.
Goal R3.1: Demonstrate ability to manage formulary and utilization management strategies, as applicable to the organization. i. Objective: R3.1.1: (Understanding) Explain the organization’s process for tracking the progress of drugs in the development pipeline. ii. Objective R3.1.2: (Creating) Prepare a drug class review or monograph. iii. Objective R3.1.3: (Analyzing) Identify opportunities for implementation of utilization management strategies. iv. Objective R3.1.4: (Creating) Develop and implement clinically appropriate utilization management criteria (e.g. Prior Authorization, Step Therapy, Quantity Limits, and Drug Utilization Review (DUR) edits to enhance patient care. v. Objective R3.1.5: (Applying) When appropriate, present the recommendations contained in a drug class review or monograph and/or utilization management criteria to members of the P&T Committee. vi. Objective R3.1.6: (Evaluating) Participate in the organization’s process for evaluating the impact of implementation of formulary and/or utilization management changes on patient care. vii. Objective R3.1.7: (Applying) Exercise skill in basic use of databases and data analysis. viii. Objective R3.1.8: (Creating) Develop and propose recommendations to the appropriate committee based on the use of electronic data and information from internal information databases, external online databases, and the Internet.
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK b.
c.
d.
Goal R3.2: Design and implement clinical programs to enhance the efficacy of patient care. i. Objective R3.2.1: (Understanding) Explain the organization’s process for designing clinical programs. ii. Objective R3.2.2: (Creating): Design or update an existing clinical program. Goal R3.3: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients, health care providers, or plan sponsors. i. Objective R3.3.1: (Creating): Formulate a systemic, efficient, and thorough procedure of retrieving and selecting the appropriate drug information. ii. Objective R3.3.2: (Evaluating): Formulate responses to drug information requests based on analysis of the literature. Goal R3.4: Demonstrate ability to evaluate and investigate practice, review data, and assimilate scientific evidence to improve patient care in a managed care setting. i. Objective: R3.4.1: (Creating) Identify and design a practice related project to improve patient care in a managed care setting. ii. Objective R3.4.2: (Applying) Implement a practice related project to improve patient care in a managed care setting. iii. Objective R3.4.3: (Evaluating) Assess a practice related project to improve patient care in a managed care setting. iv. Objective R3.4.4: (Creating) Effectively develop and present, orally and in writing, a final project report.
4. Competency Area R4: Teaching, Education, and Dissemination of Knowledge a.
V.
Goal R4.1: Provide effective education and/or training. i. Objective R4.1.1: (Creating) Design effective education and/or training activities based on the learners’ level and identified needs. ii. Objective R4.1.2: (Applying) Use effective presentation and teaching skills to deliver education programs to targeted audiences including patients, caregivers, and members of the community; health profession students; pharmacists; and other health care professionals. iii. Objective R4.1.3: (Applying) Develop effective written communication skills to provide educational information to multiple levels of learners including patients, caregivers, and members of the community; health profession students; pharmacists; and other health care professionals. iv. Objective R4.1.4: (Evaluating) Appropriately assess effectiveness of education.
INSTRUCTIONAL DESIGN AND ORGANIZATION The 12-month (July 1st to June 30th) HPSJ Managed Care Pharmacy Residency consists of activities developed by faculty from Health Plan of San Joaquin (HPSJ), University of the Pacific (UOP) and San Joaquin General Hospital (SJGH). Functionally, the Residency is divided into 7 blocks, 2 are of limited time and 5 are longitudinal. A range of specific activities has been designed within each of the blocks to ensure that residents are afforded maximum learning opportunities across the full scope of managed care pharmacist roles. Please see the Learning Experience Descriptions for the full block descriptions.
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK Block I: Pharmacy Operations / Orientation Duration: 1 Month Preceptor: Garrett Description: This one-month block orients new residents to HPSJ, its programs, PharmAcademic Residency Evaluation system, and other blocks. The resident will learn about the HPSJ formulary, prior authorization process P&T committee and review process, and read 7 Habits of Highly Effective People. Block II: Medication Use Management and Clinical Analytics Duration: 1 Month Preceptor: Garrett Description: This block will help the resident more fully develop their clinical analytical skills. The resident will take part in a pharmacy network analysis, fraud/waste/abuse analysis, and pharmaceutical spend and trend analysis. Longitudinal I: Ambulatory Care Duration: 6 Months Preceptor: Arquiette Description: The resident will practice their clinical skills in the ambulatory care clinics at San Joaquin General Hospital. The resident will see patients in the Congestive Heart Failure, Diabetes, and Anticoagulation Clinics, create individualized plans, give patient education, and monitor patients for therapeutic outcomes. Each clinic will occur over an 8 week time frame, with the resident attending clinic for about 4 hours per week. Longitudinal II: Duration: Preceptor: Description:
Teaching and Mentoring 5 Months Le A key focus of this residency is preparing the resident to contribute to future generations of pharmacists. The resident will act as a preceptor for APPE students on Ambulatory Care and Managed Care Rotations. The resident will be involved in the development, facilitation, and improvement of the 2nd year Practicum class at University of the Pacific. The resident will also give a lecture (if possible).
Longitudinal III: Duration: Preceptor: Description:
Clinical Program Development 11 Months Le In this longitudinal block, the resident will develop clinical programs centered around disease management and/or quality improvement. This will require research into need for the program, efficacy of the interventions, and what clinical outcomes need to be measured.
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK Longitudinal IV: Duration: Preceptor(s): Description:
Leadership and Management 11 Months Le Throughout the residency, the resident will be developing leadership and management skills. In this block, the resident will document individualized personal mission, vision, goals, and values and re-evaluate quarterly. The resident will also meet with HPSJ leadership to discuss how they lead a Health Plan in this era of health care.
Longitudinal V: Clinical Practice and Project Management Duration: 11 Months Preceptor(s): Le Description: The resident will be trained throughout the year on the clinical pharmacist aspects of managed care pharmacy. One of the most valuable skills the resident will learn during their training is project management and the art of managing multiple competing priorities. The resident will be expected to stay organized while completing the residency project, completing prior authorizations, doing drug information questions, reviewing drug policies for the P&T committee meetings, communicating updates to members and providers, managing the formulary, precepting APPE students, and completing other projects as they come up in the organization.
VI.
STANDARD RESIDENCY PROJECTS The following is a sample of the projects the resident may complete during the residency program. Some projects may be required. Publish an article in a peer reviewed journal Design a pharmacy department quality improvement project Educational talks to providers, patients, HPSJ staff and/or the community Design clinical, disease management programs Prepare and present Drug Monographs and Class Reviews at P&T Meetings Author Provider Newsletter articles Deliver pharmacology lecture to SJGH Family Practice Residents Perform Pharmacy expenditure analysis Answer formal drug information questions Present CE program for CSHP and WSC Facilitate Practicum Class for P2 University of the Pacific Students Participate in budget analysis and trending
VII.
ACCREDITATION The HPSJ Managed Care Pharmacy Practice Residency is currently in process of obtaining accreditation by ASHP in partnership with AMCP. We are currently in candidate status which is defined by ASHP as: status granted to a program that has a resident(s) in training, has applied to
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK ASHP for accreditation, and is awaiting the official site survey, and review and evaluation by the COC. Once accreditation is obtained, ASHP will retro-date the accreditation to the date that candidate status was obtained by the program. Our ASHP Matching program code number is 268314.
VIII.
ASSESSMENT AND EVALUATION The resident’s progression toward achievement of the program’s required educational goals and objectives will be evaluated via the following key assessments: a. Initial, b. Formative (regular, on-going), and c. Summative evaluation. Initial Assessment: An initial assessment of the new resident’s knowledge and skills will be completed as a part of the resident’s orientation and training. The results of the assessment will be documented and integrated into the resident’s development plan and will be taken into consideration when determining the learning experiences/activities in the program’s overall plan. Formative Assessments: The resident will receive ongoing feedback (verbally and in writing) from preceptors during each rotation/block, or quarter (if longitudinal) about their progress and how they can improve. Summative Evaluations: At the conclusion of each learning experience, preceptors will provide the resident with an assessment on the extent of their progress toward the program goals and learning objectives. The ASHP PharmAcademic® evaluation system is used to administer both preceptor evaluation and resident self-evaluation at the completion of each learning experience and on a quarterly basis. Email reminders will be sent 1 week prior to evaluation due dates. The preceptors/RPD and resident are then expected to meet to discuss the evaluation. RPD will sign off all completed evaluations. The Resident Customized Development plan (using modified ASHP-template) will be updated to reflect on desired changes discussed quarterly. Mandatory evaluations include: 1. Preceptor assessment of Resident performance and progress towards learning objectives. 2. Resident self-evaluation of performance. 3. Resident evaluation of preceptors and learning experiences. Evaluation Ratings Defined: Needs Improvement (NI): o Deficient in knowledge/skills in this area o Often requires assistance to complete the objective HPSJ PGY1 Managed Care Residency HPSJ Resident Handbook
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o Unable to ask appropriate questions to supplement learning Satisfactory Progress (SP): o Adequate knowledge/skills in this area o Sometimes requires assistance to complete the objective o Able to ask appropriate questions to supplement learning o Requires skill development over more than one rotation Achieved (ACH): o Fully accomplished the ability to perform the objective o Rarely requires assistance to complete the objective; minimum supervision required o No further developmental work needed Achieved for Residency (ACHR): o Resident consistently performs objective at Achieved level, as defined above, for the residency.
Evaluation Due Dates: All Evaluations are due by the end of rotation (if block) or quarter (if longitudinal), and preceptors are required to schedule time for evaluations during the last week of the block/quarter. The RPD/RC is responsible for ensuring that evaluations are completed in a timely fashion (via web-calendar alerts, email reminders, verbal reminders, etc). The latest date to complete an evaluation is 7 days from the due date. Quarterly Progress Reviews and Self Evaluations: In addition to individual longitudinal learning experiences, the RPD will evaluate overall progress of the Resident for all goals and objectives via the PharmAcademic® evaluations as well as assess the progress of the resident toward completion of all the requirements for successful completion of the residency. The resident will document their status in achieving each goal and objective at the end of each learning experience. If any changes or alterations to the schedule are needed after review of the evaluations, the RPD will make adjustments accordingly. The resident will complete the Pharmacy Resident Quarterly Progress Report at the beginning of the residency and at each quarter thereafter of the residency program and submit it (electronically) to their respective Residency Program Director. The progress report will include updates in relation to short- and long-term projects, short- and long-term career goals, current personal and professional strengths, current personal and professional areas of improvement, and any learning interests related to a required or elective learning opportunity. The progress report will be the basis for discussion between the resident and RPD at each quarterly meeting. When opportunities for improvement and appropriate action plans are identified, this will be documented on the Resident Customized Development Plan by the RPD. Resident Customized Development Plan: It is HPSJ’s goal to customize the residency program to the Resident’s specific skills and interests when appropriate. The RPD and, when applicable, preceptors will customize the training program for the resident based upon an assessment of the resident’s entering knowledge, skills, attitudes, abilities and the resident’s interests. Any discrepancies in assumed entering knowledge, skills, attitudes, or abilities will be accounted for in the resident’s customized plan. Similarly, if a criteria-based assessment of the resident’s performance of one or more of the required educational objectives is performed and judged to indicate full achievement of the objective(s), HPSJ will modify the resident’s program accordingly. This would result in changes to both the resident’s educational goals and objectives and to the
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK schedule for assessment of resident performance. The resulting customized plan must maintain consistency with the program’s stated purpose and outcomes. Customization to account for specific interests must not interfere with achievement of the program’s educational goals and objectives. The customized plan and any modifications to it, including the resident’s schedule, will be shared with the resident and all preceptors. End of Year Self-Assessments: At the end of each residency year, the resident will complete a selfassessment. The End of Year Self-Assessment shall include: Review of accomplishment of educational outcomes of the program (PharmAcademic) Final review of the customized plan (with ASHP-modified template) Strengths discovered during residency Areas for improvement found during residency Career goals Life-long learning plan Program Changes Based on Preceptor/Resident Feedback: The overall program is reviewed and modified annually. However, changes may be made to the program based on feedback from preceptors or the Resident off-cycle from the RAC review as well. Type of Evaluations: Evaluations should be qualitative, summarizing performance on objectives rather than listing what was accomplished. Examples of Qualitative Evaluations: Objective Narrative (Qualitative) Objective R1.1.10: (Applying) • Continues to be thorough & concise in documenting Document patient care activities SOAP notes. Has added vocabulary for documenting appropriately and efficiently. pediatric subjective data. • Needs to concentrate on using appropriate abbreviations & condensing descriptions. Objective R1.1.7: (Evaluating) • Needs to pay more attention to trends in the Monitor and evaluate the monitoring data effectiveness of the medication • Needs to pay more attention to factors therapy plan and modify the plan regarding a particular patient that may make in collaboration with other certain of the monitoring data unreliable health care professionals, the patient, and caregivers as required.
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HPSJ PHARMACY RESIDENCY PRECEPTORS Matthew Garrett, Pharm.D. Director, Pharmacy (since 2018) Pharm.D. from University of California, San Francisco – 2008 Adjunct Professor, University of the Pacific – since 2018 B.A. Chemistry, California State University, Fresno – 2004 Guest Lecturer – Rehab 204A – Medical Aspects of Psychiatric Disability and Basic Pharmacology – California State University, Fresno – 2012 to 2016 NhuAnh Le, Pharm.D. Manager, Pharmacy Initiatives (since 2018) Pharm.D. from the University of the Pacific - 2015 ASHP-accredited PGY-1 Managed Care Pharmacy Practice Residency, Health Plan of San Joaquin - 2016 Adjunct Professor, University of the Pacific – since 2018 Johnathan Yeh, Pharm.D. Director of Clinical Analytics (since 2011) Pharm.D. from University of Southern California – 2007 B.S. Biochemistry, University of California, Los Angeles – 2003 ASHP/AMCP-accredited Managed Care Pharmacy Practice Residency, HPSJ – 2008 Adjunct Professor, University of the Pacific – since 2009 Allen Shek, Pharm.D. Associate Dean of Professional Programs and Professor of Pharmacy Practice, University of the Pacific Pharm.D. from University of Illinois at Chicago (UIC) – 1998 B.S. Pharm. from State University of New York at Buffalo – 1991 ASHP-accredited PGY2 Primary Care Specialty Residency, UIC – 1999 Jered Arquiette, Pharm.D., BCPS-AQ ID Clinical Pharmacist and Residency Program Coordinator, San Joaquin General Hospital (since 2009) Pharm.D. from the University of the Pacific - 2008 ASHP-accredited Pharmacy Practice Residency, San Joaquin General Hospital – 2009 Adjunct Professor, University of the Pacific – since 2010 Board Certified Pharmacotherapy Specialist – since 2009
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TRAINING SITES Health Plan of San Joaquin (HPSJ) HPSJ is a publicly funded, not-for-profit, managed care health plan designed by and for the people of San Joaquin County and Stanislaus County. Licensed as a Health Maintenance Organization under the State of California’s Knox-Keene Act, HPSJ contracts with the California Department of Health Care Services and California Department of Managed Health Care for care of persons on Medi-Cal in San Joaquin County and Stanislaus County. HPSJ is also NCQA (National Committee for Quality Assurance) accredited. HPSJ's primary focus is on improving the health and well-being of those it serves. HPSJ's provider network includes over 140 Primary Care Physicians, 500 specialist and ancillary providers, all acute care hospitals in San Joaquin, Stanislaus, and Merced Counties, and several referral centers in San Francisco and Sacramento for specialized care. Pharmacy benefit, utilization management, disease management and clinical initiatives are all performed internally.
San Joaquin General Hospital (SJGH) SJGH is a 196-bed public facility operated by San Joaquin County. The main, state-of-the-art facility opened in 1995. The inpatient census generally ranges from 100 to 140. The hospital is a Level III trauma center and a certified stroke center. In addition to intensive care and medical/surgical units, the hospital houses a 32-bed Level III intensive care nursery, a labor and delivery unit, a pediatrics unit and an 11-station dialysis unit. The campus also includes several ambulatory clinic areas. The San Joaquin General Hospital Pharmacy Department employs over 48 full-time employees of professional and support personnel. A full range of inpatient services is provided, including pharmacotherapy monitoring. Ambulatory care pharmacists participate in anticoagulation, heart failure and diabetes clinics. The hospital is a training site for Family Practice, Surgery, Internal Medicine, Transitional medical and Pharmacy residents, as well as a major regional training site for pharmacy clerkship students from University of the Pacific.
University of the Pacific - Thomas J. Long School of Pharmacy and Health Sciences (UOP) University of the Pacific (UOP) offers an accelerated, first in the nation, eight-semester Doctor of Pharmacy program, which is accredited by Accreditation Council for Pharmacy Education (ACPE). Pacific's pharmacy school is success-centered, leadership-focused and has one of the most powerful and influential alumni networks. The accelerated curriculum includes a total of 1,740 experiential hours to prepare students to be practice ready pharmacists in a variety of practice settings, including but not limited to community pharmacy, hospital pharmacy, clinical pharmacy, ambulatory care, specialty pharmacy, managed care, pharmaceutical industry, academia and public policy/service.
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TERMS AND CONDITIONS OF THE RESIDENCY PROGRAM I.
LICENSURE REQUIREMENTS During the course of the residency, the resident accepts full responsibility and accountability as a Clinical Pharmacist at the Health Plan and Pharmacy Clinics at SJGH. Therefore, the resident must obtain licensure to practice as a pharmacist in the state of California, either before the start of the residency or within 90 days of the start of the residency. To expedite licensing, residents must be eligible for licensure in the state of California at the start of the residency (July 1st). The resident must make at least one attempt at both the North American Pharmacist Licensure Examination (NAPLEX) and California Pharmacist Jurisprudence Exam (CPJE) by no later than August 15th of the applicable academic year. The resident must have a valid California Pharmacist license no later than 120 days into the applicable academic year. For residents who are licensed in other states for which the state of California recognizes reciprocity, the resident will only be expected to sit for the CPJE. However, that individual will be responsible for transferring his or her license to California by no later than 90 days from the start of the residency program. For residents licensed in a state or territory for which reciprocity is not recognized, the same requirements will exist as for unlicensed individuals. In the event that the resident does not pass either of the exams on the first attempt, subsequent attempts must be made at the closest intervals allowed by current law. The resident is required to have passed both the NAPLEX and CPJE no later than 90 days of the start of the residency program. Within two weeks upon notification that a passing score has been received for both components of the licensing exam, the resident must immediately obtain a valid license by paying the licensing fee. However, if the resident has not passed both exams and is not scheduled for a retake of either exam by the 90 day mark, a modified plan for the resident will be developed with a goal licensure date within 120 days of the start of the program. The modified plan will include a detailed study schedule for areas of weakness, specific dates that testing must occur by, and reiteration of licensure requirements and deadlines. The resident will be afforded time off for the first attempt at either exam. After that, the resident will be required to use accumulated vacation time to cover time missed for the exams. The consequences for failure to meet the above deadlines will be determined on a case-by-case basis and may include suspension from the program pending licensure (in the form of leave without pay) or dismissal from the program. Time spent on suspension from the program will need to be made up before the resident can graduate from the managed care pharmacy residency program. The resident may be suspended for up to four (4) weeks and their contract would be extended the same amount of time to offset their suspension. Exceptions to the deadlines listed above may be made on an individual basis, and will require the approval of the RAC via a majority consensus. The RAC will agree on a reasonable deadline for licensure with the expectation that it will be met. However, the reasonable deadline may not HPSJ PGY1 Managed Care Residency HPSJ Resident Handbook
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK exceed 150 days from the start of the residency program. Failure to meet the negotiated deadline will result in termination from the residency program. The resident initially assumes financial responsibility for all costs associated with licensing including but not limited to review courses or materials, the exam and processing fees, and the license and/or transfer fee. Upon starting their residency at HPSJ, HPSJ will reimburse the resident for costs associated with licensing that occur during their residency term. However, any exam retake fees and study material are excluded from reimbursement.
II.
REQUIREMENTS FOR SUCCESSFUL COMPLETION OF THE PROGRAM All of the following must be completed to successfully complete the HPSJ PGY1 Managed Care Pharmacy Residency and receive a certificate of completion: Complete 12 full months of training; Read the 7 Habits of Highly Effective People; Prepare personal mission/vision/goals that are reviewed on a quarterly basis; Staff as a Clinical Pharmacist Reviewer for at least 4 continuous weeks between May to June of the residency program; Attain an “achieved” rating on the final evaluations for the following critical core goals and objectives: o Precept at least one APPE student as the primary preceptor; o Complete at least 1 drug monograph, 1 class review, and 1 drug utilization review and present them at the Pharmacy and Therapeutics committee meetings; o Perform and create a Pharmacy Expenditure Analysis/Report; o Complete Ambulatory Care Rotations at San Joaquin General Hospital; o Complete a longitudinal residency project that is in final manuscript format ready to be presented to the RAC and possibly for publication; Obtain a teaching certificate; Complete 90% of the goals and objectives in PharmAcademic TM with a status of “Achieved”.
III.
PRINCIPLES OF THE RESIDENCY PROGRAM Principle 1: The resident will be a pharmacist committed to attaining professional competence beyond entry-level practice. Principle 2: The pharmacy residency program will provide an exemplary environment conducive to resident learning. Principle 3: The resident will be committed to attaining the program’s educational goals and objectives and will support the organization’s mission and values. Principle 4: The resident’s training will be designed, conducted, and evaluated using a systems-based approach. Principle 5: The RPD and most preceptors will be professionally and educationally qualified pharmacists. Some preceptors may be non-pharmacists who are content matter experts. The RPD and all preceptors must be committed to providing effective training of residents.
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK Principle 6: The organization conducting the residency will meet accreditation standards, regulatory requirements, and other nationally applicable standards and will have sufficient resources to achieve the purposes of the residency program. Principle 7: The practice environment will be organized effectively and will deliver comprehensive, safe, and effective services.
IV.
OBLIGATIONS AND EXPECTATIONS OF THE RESIDENT The Resident’s primary professional commitment must be to the residency program; Residents must be committed to the values and mission of the organization conducting the residency program (HPSJ); Residents must be committed to completing the educational goals and objectives established for the program; Residents must seek constructive verbal and documented feedback that directs their learning; The resident must abide by the terms and conditions of the MATCH program; Residents must be committed to making active use of the constructive feedback provided by residency program preceptors; The resident will contribute to team discussions, sharing his/her knowledge willingly and collaboratively; The resident will model professional behavior and conduct that is reflective of the HPSJ mission and values; The resident agrees that no person at this site will solicit, accept, or use any ranking-related information from any residency applicant during any application cycle; Residents will act with integrity, honesty and fairness, remaining mindful of the duty of trust HPSJ has to it employees, and to its providers, employers and members; Acceptance by resident of the terms and conditions set forth by this document, the ASHP/AMCP Accreditation Standards, and HPSJ policies. Acceptance of these terms must be documented prior to the beginning of the residency; Be in prompt attendance for all assigned rotations, scheduled meetings, conferences, and seminars; Professional attire always (ties for men) except for Casual Fridays (business casual); o Professional attire is required on Fridays if interacting with patients or formal presentations are being given Complete projects within deadline or give reasonable notification of delays; Notify the Residency Program Director and preceptor of any absence due to illness; Submit all leave requests to the RPD and RC as soon as possible; Complete a minimum of twelve months of training; Complete all residency requirements within the residency year.
V.
OBLIGATIONS AND EXPECTATIONS OF THE RESIDENCY PROGRAM The residency program will be at minimum 12 months in length. The residency program director (RPD) will ensure that neither the educational outcomes of the program nor the welfare of the resident or the welfare of patients are compromised by HPSJ PGY1 Managed Care Residency HPSJ Resident Handbook
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VI.
excessive reliance on residents to fulfill service obligations. Providing residents with a sound academic and clinical education must be planned and balanced with concerns for patient safety and resident well-being. This program complies with the current duty hour standards of the Accreditation Council for Graduate Medical Education (ACGME) and ASHP. The residency program will adhere to the rules of the Resident Matching Program (RMP) process set forth in Rules for the Resident Matching Program. The RPD will provide residents who are accepted into the program with a letter outlining their acceptance to the program. The residency program will provide a sufficient complement of professional and technical pharmacy staff to ensure appropriate supervision and preceptor guidance to all residents. The residency program must provide residents an area in which to work, access to appropriate technology, access to extramural educational opportunities (e.g., AMCP national meetings, ASHP Midyear Clinical Meeting, other pharmacy association meetings, a regional residency conference), and sufficient financial support to fulfill the responsibilities of the program. Policies concerning professional, family, and sick leave and the effect such leaves would have on the resident’s ability to complete the residency program must be documented. The RPD will award a certificate of residency to those who complete the program. Reference must be made in the residency certificate regarding the programs is accreditation status by ASHP in partnership with AMCP. This residency site agrees that no person at this site will solicit, accept, or use any rankingrelated information from any residency applicant The RPD will ensure the program’s compliance with the provisions of the current version of the ASHP Regulations on Accreditation of Pharmacy Residencies.
SALARY AND BENEFITS The Pharmacy resident is hired on a one-year contract basis, with a salary of $45,000 per annum plus benefits that would be provided to a regular full-time employee. Expenses are covered for registration and travel to the annual CSHP Seminar, AMCP Educational Conference, and Western States Regional Residency Conference.
VII.
TIME OFF AND LEAVE The Managed Care Pharmacy Practice Residency is an intensive one-year training period, and thus prolonged or excessive absence from the training site is not conducive to achieving the educational objectives of the program in a timely manner. Time off is accrued by pay period as with all other HPSJ employees. The resident must request leave at minimum 2 weeks in advance, in writing (email is acceptable), to the RPD. The resident cannot take more than 10 days Paid Time Off (PTO) during the course of the Residency Program. The resident cannot take more than 5 days off within one given month, including the use of the 9 holidays, 4 accrued floating holidays, and 10 accrued PTO days. Any unused, accrued PTO will be paid to the resident at the end of the residency.
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK The consequences of utilizing time off over and above the annual allotment will be handled on an individual basis, but may include either delayed completion of the residency program if it is determined that the missed time has had a detrimental effect on the residents’ completion of training competencies or termination/dismissal from the program. Time off will not be approved during the final three weeks of the residency.
VIII.
SICK LEAVE If sick leave is necessary during the residency year, accrued PTO and/or any accrued float holidays may be used (as with all HPSJ employees). Unplanned sick leave must be reported as soon as you determine you will not be able to come to work and preferably at or prior to the beginning of your scheduled tour of duty, but in any event, not later than 2 hours thereafter. It is the resident's responsibility to directly notify the immediate supervisor and preceptor of their rotational area, the Residency Program Director, and the Residency Coordinator. The resident must call in sick for each consecutive day of illness. Residents cannot miss more than 5 days in any 1 month (due to use of holidays, PTO, and float holidays) and need to plan accordingly. Sick leave may also be used for family care or adoption‐related purposes. “Leave without pay” (LWOP) is only granted at administrative discretion by the Residency Program Director. As stated previously, any time off from the program above and beyond what is allotted and accrued by the resident can be considered terms for dismissal from the program.
IX.
TIME COMMITMENT A residency is a full‐time obligation. It provides an exceptional learning opportunity that demands considerable time commitment from the resident to meet the residency requirements for certification. The resident must manage his/her activities external to the residency so as not to interfere with the program. It is expected that a minimum of 2,100 hours will be required to successfully complete the program. Some of the program activities and the estimated time requirements are listed below. Residents are expected to spend the majority of their time in managed care related activities. A minimum of 8 hours/day will be spent on managed care activities. Time spent attending scheduled meetings, presentations, etc. will be considered managed care activities. Additional time dedicated to completing presentations, assignments, and the residency research project will likely be necessary but dependent on the resident’s time management abilities. This time will vary throughout the year.
X.
DUTY-HOURS In accordance with the ASHP duty-hour requirements for pharmacy residents, HPSJ will monitor residency duty-hours. Duty-hours must be limited to 80 hours per week, averaged over a four‐week period, inclusive of all in‐house activities and any moonlighting. Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). Additionally, residents should have 10 hours between scheduled duties, but MUST have 8 hours minimum HPSJ PGY1 Managed Care Residency HPSJ Resident Handbook
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MANAGED CARE PGY1 PHARMACY RESIDENCY PROGRAM RESIDENT H ANDBOOK between duty periods. It is important to note that HPSJ operates via standard business hours of approximately 8AM to 5PM daily. However, any continuous duty periods of residents shall not exceed 16 hours. The maximum allowable duty assignment must not exceed 24 hours if it ever does occur. Any in-house or at-home Call Programs that the resident participates in will also abide by the ASHP duty-hour requirements. The pharmacy resident will keep track of times of arrival and departure each day, as well as hours worked. This will be entered into an electronic spreadsheet (Duty-Hours Form) to be distributed to the Director of Pharmacy and the RPD/RC on a monthly basis. Hours will be reviewed and signed‐off by the resident and the RPD/RC on the first of each month. Further details regarding duty-hour requirements can be found at https://www.ashp.org//media/assets/professional-development/residencies/docs/duty-hour-requirements.pdf.
XI.
OUTSIDE EMPLOYMENT DURING RESIDENCY (MOONLIGHTING) The resident’s primary professional commitment must be to the residency program. A residency is a full‐time obligation. It provides an exceptional learning opportunity that demands considerable time commitment from the resident to meet the residency requirements for certification. The resident must manage his/her activities external to the residency so as not to interfere with achieving the educational goals and objectives of the residency program. For this reason, the resident is advised to refrain from outside employment during the residency year, if possible, or at least to keep outside employment commitment to a reasonable number of hours to allow the resident to optimize learning from the residency program. Should the resident elect to gain outside employment, it can only occur during non‐residency hours. A clear distinction must be made between employment and residency responsibilities. It cannot occur during other required attendances, such as the Western States Conference. The Director of the Residency Program will advise the resident to refrain from outside employment should it become apparent that it is interfering with the residents’ ability to meet the demands of the residency program. All hours worked during the residency, including outside employment of any kind must be tracked and logged on the resident’s Duty Hours form. Please note that internal moonlighting is not allowed.
XII.
PROFESSIONAL SELF RESPONSIBILITY Residents are expected to take responsibility for their own professional behavior during all aspects of the residency program. Residents are expected to perform within the guidelines provided by the organization and pharmacy department’s policies and procedures. Residents are expected to strive for good time management and as such, to be in prompt attendance for all assigned blocks, scheduled meetings, conferences, and presentations. Residents should complete projects within the stated deadline or give a reasonable notification of delays to those in expectation of the project. For each rotational experience, residents are expected to notify their rotation preceptor 1 week in advance of rotation starting date. Residents must take it upon themselves to solicit constructive verbal and documented feedback (e.g., evaluations) from their preceptor prior to the completion of each rotation (or at most within 1 week after the rotation). This includes reminding preceptors for feedback throughout the rotation (verbal), at the midpoint (optional), and at the completion of the rotation (required). In turn, each resident is required to provide rotation and preceptor evaluations within one week of the assigned due date of the evaluation or completion of each assigned rotation (whichever comes first). HPSJ PGY1 Managed Care Residency HPSJ Resident Handbook
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XIII.
PROFESSIONAL MEETINGS Residents are required to attend three professional meetings every year: CSHP Seminar, the AMCP Educational Conference, and the Western States Residency Conference (WSC). Most years this is the equivalent of 7 or 8 days of meetings (not including weekends). The resident will not be required to use vacation time to attend these meetings, unless the resident chooses to arrive at the conference venue prior to the start or stay after the final conference date for personal reasons. The resident may choose to attend other additional professional meetings with prior approval of the RPD/RC. Time off for these additional meetings will be handled on an individual basis, and may require use of accrued PTO. Job interviews and other professional activities outside of the three required professional meetings will require use of accrued PTO.
XIV.
DISMISSAL FROM THE RESIDENCY PROGRAM While a resident at HPSJ, the resident is held to the standards of HPSJ employees, and any actions that would result in termination from HPSJ would also result in dismissal from the HPSJ Residency Program. HPSJ’s grounds for termination are outlined by the HPSJ Human Resources Policies and Procedures. Additionally, if the resident fails to meet the licensure requirements as outlined above may be grounds for dismissal. Excessive time-off beyond what is allotted may be considered grounds for dismissal. Exceptions will be reviewed on a case-by-case basis.
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