Critical Care

Cardiac Surgical Intensive Care Unit: During this one month rotation, residents will be responsible for patient care in the cardiac surgery intensive care unit, helping to ensure adherence to clinical practice guidelines and standards of care. Residents will be exposed to a wide variety of cardiac surgical procedures and mechanical circulatory support devices, with a heavy emphasis on physiology. PGY1 residents completing this rotation will develop the knowledge and skills necessary to care for critically ill patients. PGY2 residents completing this rotation will refine critical care skills in an environment that emphasizes independence in order to form the foundations of their own clinical practice.

Medical Intensive Care Unit: The one month Medical Intensive Care Unit rotation provides exposure to a diverse patient population encompassing a variety of disease states. The experience is designed for pharmacy practice residents to develop baseline skills and knowledge to practice critical care medicine through an approach utilizing evidence-based medicine. This will be accomplished through designing therapeutic regimens that incorporate the principles of the evidence-based medicine, implementing monitoring plans that effectively evaluate the patient's response to therapy, establishing a collaborative relationship with the interdisciplinary team and participating in continuous adherence to the health-systems' medication use guidelines, policies and procedures.

Neurosciences Intensive Care Unit: The Neuroscienes ICU is a high acuity ICU that oversees the care of a variety of patients. During this one month rotation, residents can expect to gain experience managing stroke, intracranial hemorrhage, status epilepticus, meningitis, ICP crisis, and post-op neuro intervention procedures. In addition to neuro critical care, residents can develop their baseline critical care skills utilizing evidence-based medicine and designing therapeutic regimens with appropriate monitoring parameters. Residents will also be able to practice establishing a collaborative relationship with the interdisciplinary team and are offered opportunities to precept students. 

Pediatric Intensive Care Unit: The Pediatric Critical Care Unit at Mount Sinai Hospital consists of two medical teams dedicated to the care of pediatric patients with acute life-threatening conditions. To care for this fragile patient population during this one month rotation, residents will learn how to apply the basic principles of pediatric pharmacotherapy to the changing pharmacokinetics of critically ill patients. Depending on interest and prior experience, residents may also have the opportunity to round in the Pediatric Cardiac Intensive Care Unit (PCICU) which will provide exposure to the management of congenital heart disease as well as patients receiving extracorporeal life support.

Surgical Intensive Care Unit: During this one month rotation, residents will be responsible for patient care in the surgical intensive care unit, helping to ensure adherence to clinical practice guidelines, standards of care, and core measures. Residents will also be responsible for responding to medical emergencies both within the ICU and throughout the hospital as necessary. PGY1 residents completing this rotation will develop the knowledge and skills necessary to care for critically ill patients. PGY2 residents completing this rotation will refine critical care skills in an environment that emphasizes independence in order to form the foundations of their own clinical practice.

Drug Information

Drug Information is a 12-month longitudinal rotation intended to expand the resident’s knowledge and skills in the provision of drug information, including comprehension of medical inquiries, retrieval of appropriate information, development of effective systematic searches, evaluation of medical literature, and enhancement of both verbal and written communication skills.

Emergency Medicine

This one month rotation is designed to develop the resident's skills in Emergency Medicine pharmacotherapy and expose the resident to a wide array of topics including but not limited to stroke/STEMI response, cardiac arrest/ACLS, toxicological emergencies, sepsis/early goal-directed therapy, status epilepticus, acute cardiopulmonary emergencies, hypertensive crises, and endocrine emergencies. During this rotation, the pharmacy resident will function as a member of the multidisciplinary team to provide pharmocotherapeutic support and education, respond to stroke/sepsis/STEMI/ACLS code alerts, identify drug-related problems, effectively communicate recommendations to providers, and participate in topic discussions designed to expand knowledge base. Residents will also have many opportunities to improve their direct patient care skills through patient education and medication reconciliation.

Geriatrics

This is a 4 week experiential rotation on the Mobile Acute Care for the Elderly (MACE) service with the Dept. of Geriatrics at Mount Sinai Hospital. MACE is a specialized, interdisciplinary service that includes an attending geriatrician, geriatrics fellow, nurse coordinator, pharmacist and social worker providing state-of-the-art care for frail elderly patients who are hospitalized with acute illnesses and complex needs. Other members include pharmacy and medical students. This experience is intended to expose the pharmacy resident to various aspects of clinical pharmacy practice and principles of geriatric medicine in the inpatient hospital setting.  Under the direct guidance of Dr. See, the resident will help optimize drug therapy in our MACE patients using evidence based medicine and excellent drug information skills. They will conduct patient-specific assessments, evaluate patient drug therapy regimens, identify and resolve drug related problems, select drug therapy regimens, prospectively monitor therapy, and provide patient and health professional education.

Infectious Diseases

For PGY1s: The required one month Infectious Diseases I rotation is designed to expose the resident to a wide variety of infectious disease topics, with a focus on those most commonly affecting hospitalized patients. Through topic discussions, patient review, infectious diseases consult rounds, and microbiology rounds, the resident will develop a basic understanding of clinical microbiology, the utilization and spectrum of activity of antibiotics, pharmacokinetic and pharmacodynamics properties and adverse effects of antibiotics. The resident will learn a systematic approach to evaluate each patient so that they will have an understanding of pathophysiology, presentation, diagnosis and treatment of the disease states that are covered. As a member of the infectious diseases consult team, the resident is expected to learn to effectively communicate with other healthcare professionals and patients so that they can discuss and defend their recommendations using evidence-based, patient-specific data.  There is also an elective Infectious Diseases II rotation that can be catered to the resident’s interests including rounding with the General ID consult team, transplant ID consult team, oncology ID consult team, or HIV team. Residents will also have the opportunity to attend infectious diseases attending rounds, case conferences, and pediatric and/or adult infectious diseases journal clubs.

For PGY2s (non-ID): The Infectious Diseases rotation is structured to best fit the needs of the specialty resident and participate on multidisciplinary rounds with the most appropriate ID consult team. For example, the oncology PGY-2 would join the oncology ID consult team and the transplant PGY-2 would join the solid organ transplant ID consult team. Through topic discussions, patient review, infectious diseases consult rounds, and microbiology rounds, the resident will further develop and build upon their existing understanding of clinical microbiology and antimicrobial usage as well as expand his/her experience and knowledge of the prophylaxis and/or treatment of ID-related complications and opportunistic infections in patients of their chosen specialty. Residents will also have the opportunity to attend infectious diseases attending rounds, case conferences, and pediatric and/or adult infectious diseases journal clubs.

Investigational Drug Service

The resident will provide pharmacy support for clinical research activities. The resident will create pharmacy procedures specific to each clinical trial, conduct pharmacy reviews of research protocols, and learn about Good Clinical Practices (GCP), Good Manufacturing Practices (GMP) and other regulations and laws. The resident will prepare, dispense, and maintain accountability of investigational agents. The resident will also provide in-service on novel investigational agents and new protocols.

Nephrology

The pharmacy resident is part of a comprehensive member of the interdisciplinary team. The pharmacy resident is to develop a well-thought out patient-centered pharmacotherapy regimen, gain clinical competency, involve in direct patient care, daily round with team of physicians, medical residents, medical students, other healthcare providers, and provide evidence-based pharmacotherapy regimens. The resident is responsible for a patient’s drug-related needs and to achieve positive patient outcomes. The resident is expected to be motivated, enthusiastic, and to participate completely in his/her learning process.

Oncology

Bone Marrow Transplant (Inpatient): This one month enables pharmacy residents to provide comprehensive medication management to patients receiving hematopoietic stem cell transplant (HSCT) and adoptive cellular therapy (ACT). Residents are expected to provide evidence-based recommendations on daily patient rounds and to work collaboratively with medical, nursing, and pharmacy staff to optimize medication therapies. During this time, residents will provide patient counseling on high-dose conditioning chemotherapies and discharge medication teaching. Residents will have the opportunity to expand their knowledge of the pharmacology and therapeutics used to manage the complications of HSCT/ACT (graft-vs-host-disease, opportunistic infections, cytokine release syndrome, etc.).

Bone Marrow Transplant (Outpatient): This one month rotation enables pharmacy residents to provide comprehensive medication management to patients following hematopoietic stem cell transplant (HSCT) and/or cellular therapy. Residents are expected to provide evidence-based recommendations and to work collaboratively with medical, nursing, and pharmacy staff to optimize medication therapies. During this time, residents will provide counseling on patient’s home medications. Residents will have the opportunity to expand their knowledge of the pharmacology and therapeutics used to manage the long-term complications of HSCT (graft-vs-host-disease, opportunistic infections, vaccinations post-HSCT, etc.).

Oncology Investigational Drug Service: The resident will provide pharmacy support for clinical research activities. The resident will create pharmacy procedures specific to each clinical trial, conduct pharmacy reviews of research protocols, and learn about Good Clinical Practices (GCP), Good Manufacturing Practices (GMP) and other regulations and laws. The resident will prepare, dispense, and maintain accountability of investigational agents. The resident will also provide in-service on novel investigational agents and new protocols.

Leukemia: During this one month rotation, residents will have an opportunity to learn about current approaches to manage various types of leukemia (acute lymphocytic leukemia, acute myeloid leukemia, acute promyelocytic leukemia, chronic myeloid leukemia), pre-leukemic disorders (myeloproliferative disorders, myelodysplastic syndromes), and supportive care managements (infectious complication, tumor lysis syndrome, chemotherapy-induced nausea/vomiting).  Residents will participate in daily patient rounds with leukemia team and provide evidence-based drug information in a timely manner to medical, nursing and pharmacy staff upon their medication-related inquiry. Residents will also provide education to patients on the common side effects and management of chemotherapy regimen.  

Multiple Myeloma: This one month rotation enables pharmacy residents to provide comprehensive medication management to patients receiving chemotherapy for multiple myeloma. Residents are expected to provide evidence-based recommendations on daily patient rounds and to work collaboratively with medical, nursing, and pharmacy staff to optimize medication therapies. During this time, residents will provide patient counseling on various chemotherapies and discharge medication teaching. Residents will have the opportunity to expand their knowledge of the pharmacology and therapeutics used to manage the complications of multiple myeloma (e.g. hypercalcemia, spinal cord compression, neutropenic fever, infections, tumor lysis syndrome, mucositis).

Pharmacogenomics: A one month clinical pharmacogenomics rotation is an exciting and rare opportunity. Pharmacy residents and students will learn to evaluate pharmacogenomics literature, identify commonly prescribed medications listed in the FDA Table of Pharmacogenomic Biomarkers in Drug Label and suggest alternative agents and/or appropriate doses for patients with high risk genotypes. Residents/students will also familiarize themselves with CLIPMERGE – the Mount Sinai platform for genome-informed clinical decision support.

Pediatrics

This one month rotation is designed to allow for the development of the pharmaceutical approach to the general pediatric patient. Pediatric and adolescent patients have special pharmaceutical care needs because of the changes that occur as they mature. This is further complicated by the unavailability of reliable information regarding appropriate dosing. More than 75% of medications carry the FDA warning: safety and efficacy in children have not been established. Ethical, logistical and technical difficulties hamper conducting well-designed pediatric trials. This often times forces a clinician to extrapolate information from results obtained from adult trials. The need for adjustments in the dose and dosage interval changes as the child matures, resulting in the need for careful drug therapy and monitoring. These challenges and limitations will be discussed. Common pediatric disease states and drug therapy topics, including differences in pharmacokinetic and pharmacodynamic parameters, will be reviewed. Emphasis will be placed upon the rationale use of drug therapy in the patient treatment plan.

Solid Organ Transplant

Heart: This one month transplant rotation provides an opportunity to advance clinical skills within the context of a multidisciplinary team. The clinical pharmacist provides comprehensive therapy optimization including prevention and management of rejection and infection along with other complex comorbidities. This rotation also highlights the pharmacist's role in navigating transitions of care medicine as patients arrive from home on admission, require post-operative care in intensive care units, and progress to step down floors prior to discharge. Additionally, this rotation provides a strong patient education opportunity to prepare recipients to take charge of a new and complex medication regimen.

Kidney:  Kidney Transplant rotation is a one month inpatient rotation designed to develop the knowledge, skills, and attitudes required to provide comprehensive care to recipients of kidney and pancreas transplants. During this rotation the resident will join the kidney/pancreas transplant team on daily multidisciplinary rounds and be actively involved in managing the medication therapy for this population. The resident will also assist with the provision of medication teaching to all new transplant patients and meet with the preceptor on a routine basis to review transplant topics as well as patient cases.

Liver/Small Bowel: The one month liver transplant rotation is a fast-paced, patient centered clinical experience. During this rotation, pharmacy residents will gain and apply knowledge of pharmacotherapy associated with the care of solid organ liver transplant patients. The residents will work closely with pharmacy personnel and the multidisciplinary team to managing disease states and provide patient education. The solid organ liver transplant rotation is a great opportunity to enhance the resident’s knowledge of transplant pharmacotherapy and patient-focused care.

Lung Transplant: The lung transplant rotation is one-month inpatient rotation designed to develop the knowledge, skills, and attitudes to acquire competency in patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice applicable to the pharmacist dealing with transplant patients. The lung transplant rotation may be used to fulfill the required Immunocompromised Patient Populations Learning Experience for PGY1 residents.  The resident will join the lung transplant multidisciplinary team on daily rounds and be involved in comprehensive management of drug therapy in this population.  The resident will meet with the preceptor on a daily basis, or as deemed appropriate by the preceptor, to review transplant topics and discuss patient cases. The resident will also be responsible for helping provide medication teaching for all new lung transplant patients, as well as completing assigned reading on various disease states and appropriate pharmacotherapy.  Any additional in-services or special projects will be discussed with the resident at the beginning of the rotation. The lung transplant service rounds on fresh post-op transplant patients as well as transplant patients that are re-admitted for transplant related issues.  The lung transplant team consists primarily of the attending transplant surgeon and transplant pulmonologist, pulmonary and critical care fellows, the surgical fellow, inpatient transplant physician assistant, transplant social worker, and transplant dietician.  Patients may be located throughout the hospital but the majority of patients are located in the CSICU, CVU or in 6W.

Departmental Administration

The Departmental Administration rotation is a required 2 week rotation for PGY1 residents.  During this rotation, the resident will attend meetings with the preceptors and assist in budget development.  The Department of Pharmacy provides all medication management services to all inpatients at Mount Sinai Hospital as well as oncology, non-oncology and genetics ambulatory infusion areas.  Leadership of the department is provided by one senior director and 3 directors for operations, clinical services and medication safety.  Compliance with all regulatory requirements, budgetary management, safety and operational functionality drive all of the decisions and activities of the department. Ensuring adequate staffing, managing labor and HR issues, and adequate inventory in all locations is the responsibility of the operational director.  The clinical director is responsible for regulatory compliance, education, formulary management and clinical practice.  The medication safety director is responsible for medication incident review, implementation of safe practices, and regulatory compliance related to these topics.  Residents will be engaged in budget planning, formulary impact assessment, human resource review and labor relations topics. 

Staffing

Pharmacy Services at Mount Sinai Hospital are provided in a decentralized model. Pharmacy satellites in pediatric medicine, pediatric critical care, adult medicine, adult critical care, adult oncology, perioperative services and ambulatory infusion provide the majority of direct patient care. Centralized IV admixture, Pyxis filling, cart filling, chemotherapy preparation and TPN management, along with controlled substance management and non[1]sterile compounding are also provided. Specialized clinical pharmacy managers provide direct patient care for high risk service lines such as oncology, transplant, infectious disease, clinical trials, critical care and pediatrics. In order to ensure all residents obtain adequate experience with sterile product preparation, all residents will staff for one month in IPD after they successfully complete their sterile product competencies.  PGY1 residents will rotate for 3 months in each of our major pharmacy areas – main pharmacy, pediatrics, adult critical care, adult med/surg.