CoxHealth PGY2 Ambulatory Care Pharmacy Residency
ASHP-Accredited since 2012
ASHP Program Code: 64015
National Matching Service Code: 665065
Scope
CoxHealth is the region’s only locally owned, not-for-profit health system, serving a population of over 1 million. Our 6-hospital organization has facilities in Springfield, Branson, Monett, and Lamar, and more than 80 physician clinics in the region.
The CoxHealth PGY2 Ambulatory Care Pharmacy Residency learning experiences are primarily located in Cox Medical Group and Ferrell Duncan clinics in Springfield, Missouri. Additional learning experiences occur at Faith Community Health in Branson and in partnership with University of Missouri-Kansas City School of Pharmacy at Missouri State University.
Please refer to the CoxHealth About Us page for additional information and specific facts regarding our facilities.
Residency Overview
Please refer to the CoxHealth Pharmacy Residencies Manual
Program Description
ASHP PGY2 Program Purpose - PGY2 pharmacy residency programs build on Doctor of Pharmacy (Pharm.D.) education and PGY1 pharmacy residency programs to contribute to the development of clinical pharmacists in specialized areas of practice. PGY2 residencies provide residents with opportunities to function independently as practitioners by conceptualizing and integrating accumulated experience and knowledge and incorporating both into the provision of patient care or other advanced practice settings. Residents who successfully complete an accredited PGY2 pharmacy residency are prepared for advanced patient care, academic, or other specialized positions, along with board certification, if available.
In addition to the ASHP PGY2 Program Purpose, further emphasis is placed on preceptor development, patient-centered care and education, and interdisciplinary care for chronic disease state management.
- Number of Residency Positions Available: 3
- Duration of Appointment: 12 month
- Salary: $53,081 for 12-month appointment
Staffing Requirements
- Residents will staff 1 Saturday shift per month and one other staffing activity per month (examples may include an immunization clinic or a Sunday shift)
- No required holidays, but must take ETO for any non-worked holidays
- Taking project days on holidays does not result in holiday pay
Program Structure
Note: All learning experience durations may be modified at the discretion of the Residency Program Director to best meet the needs of the individual resident. Any changes from the typical duration will be documented in the quarterly Resident Development Plan.
Teaching Certificate Program
A teaching certificate program through the University of Missouri-Kansas City is available and encouraged for all residents, but is not a requirement of the residency. Cost will be covered by the residency program should a resident choose to enroll.
Schedule
| Time Frame | Resident 1 | Resident 2 | Resident 3 |
|---|---|---|---|
| Time Frame 3 weeks | Resident 1 Orientation | Resident 2 Orientation | Resident 3 Orientation |
| Time Frame 10 weeks | Resident 1 Medically Underserved | Resident 2 Extra Primary Care x 5 Weeks, Academia x 5 Weeks | Resident 3 Managed Care |
| Time Frame 11 weeks (midyear) | Resident 1 Specialty | Resident 2 Managed Care | Resident 3 Academia x 9 Weeks, Extra Primary Care x 1 Week |
| Time Frame 2 weeks | Resident 1 Project Time | Resident 2 Project Time | Resident 3 Project Time |
| Time Frame 10 weeks | Resident 1 Extra Primary Care x 4 Weeks, Academia x 6 Weeks | Resident 2 Specialty | Resident 3 Medically Underserved |
| Time Frame 10 weeks | Resident 1 Medically Underserved | Resident 2 Managed Care | Resident 3 Specialty |
| Time Frame 5 weeks | Resident 1 Flex Time | Resident 2 Flex Time | Resident 3 Flex Time* |
| Time Frame 1 week | Resident 1 Wrap-Up | Resident 2 Wrap-Up | Resident 3 Wrap-Up |
*(Residents may choose to extend rotations or take elective time during the course of the year. Preceptors may require extended time on rotations to achieve residency required objections as an alternative.)
Academia: Steeplechase Clinic and UMKC School of Pharmacy at MSU Activities (Billings)
| Mon | Tues | Wed | Thurs | Fri | |
|---|---|---|---|---|---|
| Morning 8:30–12:00 | Clinic | Mon Clinic | Tues Topic Discussion | Wed Clinic | Thurs Top Drugs |
| Afternoon 1:00–5:00 | Clinic | Mon Clinic | Tues Academic Project Time | Wed Clinic | Thurs Academic Project Time |
Managed Care: Ferrell Duncan Clinic (Porter/TBD with New Hire) and Senior Health (Hawkins)
| Senior Health | T–Th 8:00–4:30 |
|---|---|
| Senior Health FDC | T–Th 8:00–4:30 M, F 8:00–4:30 |
Medically Underserved: Family Medical Care Center (Heffern) and Faith Community Health (Burney)
| FMCC | M–W, F 8:00–4:30 |
|---|---|
| FMCC FCH | M–W, F 8:00–4:30 Th 8:300–4:30 |
Specialty: Overseen by Heffern
| Monday | Tuesday | Wednesday | Thursday | Friday |
|---|---|---|---|---|
| Monday TBD* | Tuesday TBD* | Wednesday Heart Failure Clinic | Thursday Endocrinology | Friday TBD* |
*Other sites to be determined based on resident interests.
Elective time is assigned during the Specialty block and residents may also opt to use their flex time toward electives providing the resident is in good standing and deemed ready for independent practice prior to this learning experience per Ambulatory Care – Residency Advisory Committee (AC-RAC). Electives are specific areas for tailoring to residents interests. The following list of elective options with suggested preceptors is not all-inclusive:
- Longitudinal Academia (Paul Gubbins & UMKC Faculty)^
- Family Medicine Service (Chelsea Landgraf, PharmD, BCPS, BCACP)^
- Pain Management (Thomas Gregory, PharmD, BCPS, CPE, FASPE)^
- Community Pharmacy Administration (Brittany Sturgeon, PharmD)
- Oncology (Andrea Prince, PharmD, BCACP)
- Population Health Informatics (April Porter, PharmD, BCACP)
- Specialty (Mary Ann Bennett, PharmD)
- Psychiatry (Jeff Bowers, RPh, BCPP)^
- Emergency Room (Laura MacCall, PharmD, BCPS)
- Meds to Bed/Transitions of Care (Lin Chen, PharmD/Brian Grace, PharmD^)
^Completed PGY2 Elective by past residents
Longitudinal Rotations:
- Business Plan
- Collaborative Practice Agreement/Credentialing and Privileging
- Education
- Leadership
- Research 1 and 2
- Staffing
Expected AC PGY2 Progression through all Primary Care Rotations
Primary Care rotations include: Chesterfield, Family Medical Care Center, Ferrell Duncan Clinic, Medical Mile, Senior Health and Steeplechase Clinics.
First Rotation Block
Orientation provides approximately two weeks of direct instruction and role modeling, or more if needed. Preceptor transitions into more of the coaching and facilitating phase for the following 2-4 weeks once the resident is showing competence in the areas as listed below. Preceptor is available on site most days in the beginning of the rotation and will be readily available via other means as needed.
First Rotation Block: Expectations
Documentation
The resident will:
- Become aware of the different types of documentation and choose the correct one based on the type of interaction
- Be able to update the medication list
- Propose/order medications to be sent to the pharmacy
- Modify notes listed in the chart
- Forward notes to appropriate individuals
- Manage own desktop to provide timely responses
- Review preceptor’s desktop as directed and if needed
- Send notes to preceptor to cosign until otherwise directed
- Patients being seen using a CPA must continue to be cosigned by preceptor
- Track productivity and metrics as instructed
Interprofessional Collaboration
The resident will:
- Be introduced to the providers and staff
- Communicate effectively with the team regarding patient care needs
- Collaborate with providers to find evidence based therapies
- Advocate on the patient’s behalf for alternative therapies when needed
- Interact with staff to build relationships within the clinic
- Discuss patient care with preceptor prior to provider/team discussion until otherwise directed
- Present clinical pearls with other health care professionals and learners as desired within the site with preceptor oversight and feedback until otherwise directed
Patient Care
The resident will:
- Interview patients (and caregivers) to gather history of condition and medications
- Discuss therapeutic options and recommendations with the patient
- Counsel patient on condition and medications
- Design a therapeutic plan based on concerns and needs of the patient
- Adjust care plans when needed
- Monitor care plans in appropriate time periods
- Discuss all patient care with preceptor until otherwise directed
- Track disease states encountered per the disease state tracker with direct patient care encounters, consultative requests, and teaching opportunities available at the site
Responsibilities
The resident will:
- Effectively balance their time to incorporate administration time to complete other resident responsibilities (ex. Research, leadership meetings, etc.) while patient care is completed in a timely manner and appropriately covered with mutual agreeance of preceptor and learners if needed
- Discuss feedback with preceptor regarding self-performance on areas listed above on a regular basis, with being encouraged to meet at least every 1-2 weeks
Preceptor will determine when the resident has achieved appropriate growth to practice more independently and inform the resident when this has been accomplished.
Preceptor will review disease state tracker on a regular basis, encouraged every 1-2 weeks. The preceptor will facilitate additional disease states as needed. RPD will review disease state tracker at the end of each quarter. AC-RAC will decide a minimum patients needed to achieve competence in more commonly seen disease states.
AC-RAC will review resident performance towards the end of the block to determine whether the resident can progress to the specialty block.
If the resident is not deemed ready for independent practice within the specialty block, the resident will either need extend the current learning experience and/or delay starting the specialty block until later in the year.
No objectives should be achieved within the first block. ‘Satisfactory progress’ is acceptable and expected for this stage in residency.
Second Rotation Block
Orientation is completed using the 4 preceptor roles in an approximate 4 week or less period with most focus on coaching and facilitating. The expectation is that the resident needs preceptor input and oversight less than 50% of the time after the orientation period. The preceptor will be readily accessible at all times.
Second Rotation Block: Expectations
Documentation
The resident will:
- Be expected to complete the same steps as in first block with consistency
- Take more ownership in the documentation process with less preceptor oversight needed, especially for core disease states (e.g. diabetes, hyperlipidemia, hypertension, etc.)
Interprofessional Collaboration
The resident will:
- Be expected to complete the same steps as in the first block with consistency
- Be able to participate in patient care with less oversight from preceptor on more familiar disease states
- Discuss less familiar disease states with preceptor until otherwise directed
- Identify new opportunities for collaboration within the site and determining sustainability of those services
Patient Care
The resident will:
- Be expected to complete the same steps as in first block with consistency
- Be able to practice more independently with less preceptor oversight
Responsibilities
The resident will:
- Be expected to complete the same steps as in first block with consistency
- Advocate for additional administration time if and as needed
- Take more ownership of the feedback sessions with self-assessment built in and to ask pointed questions to gain preceptor insight including feedback on site practice
Preceptor will determine when the resident has achieved appropriate growth to practice more independently and inform the resident when this has been accomplished.
Preceptor will review disease state tracker on a regular basis, encouraged every 1-4 weeks. The preceptor will facilitate additional disease states as needed. RPD will review disease state tracker at the end of each quarter. AC-RAC will decide a minimum patients needed to achieve competence in more commonly seen disease states.
AC-RAC will review resident performance towards the end of the block to determine whether the resident can progress to the specialty block if not yet completed.
If the resident is not deemed ready for independent practice within the specialty block, the resident will either need extend the current learning experience and/or delay starting the specialty block until later in the year.
Some individual objectives may be achieved if resident is able to confidently complete areas of patient care with very minimal preceptor oversight. Completion of objectives for residency will be reviewed at the end of the three blocks at AC-RAC before completing for residency.
Third Rotation Block
Orientation is completed using the 4 preceptor roles in an approximate 4 weeks or less period with most focus on coaching and facilitating. The expectation is that the resident needs preceptor input and oversight of less than 25% of the time after the orientation period. The preceptor will be readily accessible at all times.
Third Rotation Block: Expectations
Documentation
The resident will:
- Be expected to perform the same steps as in the first and second blocks with confidence
- Take more ownership in the documentation process with little preceptor oversight needed for any disease states
Interprofessional Collaboration
The resident will:
- Be expected to perform the same steps as in the first and second blocks with confidence
- Participate in patient care with little preceptor oversight needed for any disease states
Patient Care
- Be expected to complete the same steps as in first and second blocks with confidence
- Be able to practice more independently with little preceptor oversight needed
Responsibilities
The resident will be expected to complete the same steps as in first and second blocks with confidence.
Preceptor will determine when the resident has achieved appropriate growth to practice more independently and inform the resident when this has been accomplished.
Preceptor will review disease state tracker on a regular basis, encouraged every 1-4 weeks. The preceptor will facilitate additional disease states as needed. RPD will review disease state tracker at the end of each quarter. AC-RAC will decide a minimum patients needed to achieve competence in more commonly seen disease states. AC-RAC will review resident performance towards the end of the block to determine whether the resident can progress to the specialty block if not yet completed.
If the resident is not deemed ready for independent practice within the specialty block, the resident will either need extend the current learning experience and/or delay starting the specialty block until later in the year.
Remaining individual objectives should be achieved once resident is confidently able to complete areas of patient care with very minimal preceptor oversight.
AC-RAC will review resident performance at the completion of primary care blocks to achieve entire R1 goal.
Additional Training
Additional training will be provided on specific blocks that will also be assessed within objectives:
The academia block will include precepting other learners (e.g. IPPEs, APPEs, or PGY1s) in some degree.
The medically underserved block will include care of the medically underserved as well as working within a family medicine residency clinic. Precepting may also be included.
The managed care population block will include more care of the older adult and more concentrated population health efforts.
Requirements for Completion of the Program and Certification
Residency program director will meet with each resident on a quarterly basis to review the resident development plan, the status of residency objectives, disease state tracker and longitudinal requirements for residency graduation.
| Item | Date Expected |
|---|---|
| Item Incoming CV | Date Expected Orientation |
| Item Outgoing CV | Date Expected Wrap-Up |
| Item Incoming APR | Date Expected Orientation |
| Item Outgoing APR | Date Expected Wrap-Up |
| Item MO License | Date Expected Prior to start |
| Item BLS | Date Expected Prior to start |
| Item Teaching Certificate (if completed in PGY1) – NOT required for residency | Date Expected Prior to start |
| Item PGY1 Certificate | Date Expected Orientation |
| Item PGY2 Certificate | Date Expected Wrap-Up |
| Item Complete 12 months of residency without exceeding 17 days of ETO and 10 days of professional leave | Date Expected Wrap-Up |
| Item Complete all PharmAcademic evaluations | Date Expected Throughout residency year, wrap-up |
| Item Upload all required documents in online Resident Binder | Date Expected Throughout residency year, wrap-up |
| Item Grand Rounds | Date Expected First half of residency year |
| Item Patient Case Presentation | Date Expected First half of residency year |
| Item Journal Club Presentation | Date Expected First half of residency year |
| Item FMR Interprofessional Presentation | Date Expected Second half of residency year |
| Item Research Project | Date Expected Throughout residency year |
| Item Research Poster: Version 1 (ex: OAPA and/or ASHP) / Version 2 (ex: MSHP and/or FMR) | Date Expected First half of residency year / Second half of residency year |
| Item MPRC Presentation | Date Expected Last quarter of residency year (~May) |
| Item Research Manuscript | Date Expected Wrap-Up |
| Item Business Plan Presentation | Date Expected Second half of residency year |
| Item Business Plan Write Up | Date Expected Wrap-Up |
| Item Second Scholarly Project | Date Expected At any point in residency year |
| Item DI questions for department | Date Expected Throughout residency year (~2/year) |
| Item 90% of objectives achieved | Date Expected Quarterly with RPD, Wrap-Up |
| Item CPA | Date Expected At any point in residency year |
| Item Teaching Philosophy | Date Expected During academia rotation |
| Item Lead at least 2 Topic Discussions (on different topics) for PGY1/APPE/IPPE/PA/NP students using site-approved content | Date Expected During academia rotation |
| Item Prepare and deliver at least 1 education activity to PGY1/APPE/IPPE/PA/NP students, separate from a previously assigned Topic Discussion, Journal Club, Case Presentation or Grand Rounds | Date Expected During academia rotation |
| Item Design at least 1 multiple-learner rotation calendar | Date Expected During academia rotation |
| Item Full cycle of a topic for FMR pearls | Date Expected During FMCC rotation |
| Item Attend 2 Leadership Meeting | Date Expected Throughout residency year |
| Item Attend 2 Pop Health Meetings | Date Expected Throughout residency year |
| Item Complete Staffing requirement completed (11 shifts) | Date Expected Throughout residency year |
| Item Attend 10 PGY2 topic discussions | Date Expected Throughout residency year |
| Item Maintain disease state tracker | Date Expected Throughout residency year, quarterly with RPD |
| Item Lead 2 Pharmacy Practice Topic Discussions | Date Expected Throughout residency year |
| Item Participate in residency recruitment activities including interviews | Date Expected Throughout residency year |
| Item Other Optional Projects (ex: academic lectures, applied skills labs, grant application, etc.) | Date Expected Quarterly with RPD |