Clinical Pharmacy Practice - Thao's presentation

1. Clinical Pharmacy Practice
Thao K. Huynh, PharmD, BCOP
Assistant Professor
Department of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Email: t.huynh@pitt.edu

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

3. 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

4. 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

5. 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%

6. 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

7. After PGY1?
• PGY2
• Hospital practice
• Clinical pharmacist
• Fellowship training (Oncology – 2 years)
• 1 year oncology practice
• 1 year oncology research

8. 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

9. 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%

10. 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

11. 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

12. 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

13. Clinical Oncology Specialist Practice:
Administration
• Chemotherapy protocol
development

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

15. 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

16. Clinical Resources for
Oncology Pharmacy

17. 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

18. Patient Case Discussion

19. Pharmacy Education System
in United States
Thao K. Huynh, PharmD, BCOP
Assistant Professor
Department of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Email: t.huynh@pitt.edu

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Growth in Pharmacy Education

27. 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

28. 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

29. Pharmacy School Curriculum and
Accreditation
• Professional year 1 (P1)
Term 1 Term 2
Profession 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)

30. Pharmacy School Curriculum and
Accreditation
• Professional year 2 (P2)
Term 1 Term 2
Profession 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)

31. Pharmacy School Curriculum and
Accreditation
• Professional year 3 (P3)
Term 1 Term 2
Profession 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)

32. 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

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

34. Pharmacy Education in the Classroom

35. Simulation in Pharmacy Education

36. Student Pharmacy Organization

37. 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