PGY2- Psychiatric Pharmacy Practice Clinical Rotation Descriptions
CORE EXPERIENCES: (Required)
Adult Inpatient Psychiatry (6 weeks) at LAC+USC Psychiatry at Augustus F. Hawkins/MLK Medical Center
Preceptor: Julie A. Dopheide, PharmD, BCPP
The goal of this core experience is to allow the resident to intensively manage more challenging patients while integrating into the psychiatric treatment team. Dr. Dopheide will be the primary preceptor but the resident will lead medication education group, and assist in supervising students. He or she will provide evidence based recommendations on optimizing drug therapy while further developing interview skills, clinical assessment skills and patient and staff education skills. The resident will co-lead conferences with Dr. Dopheide and document clinical activities in the chart. Adverse drug reactions, medication errors and all clinical interventions will be recorded in the pharmacy computerized databases including the patient safety network (PSN) and Quantifi (pharmacy intervention tracking system). The resident will expand and solidify their knowledge base in psychopharmacology.
Supervisory Role – Adult Inpatient Psychiatry (6 weeks) at LAC+USC
Preceptor: Julie A. Dopheide, PharmD, BCPP
This 6 week experience will involve semi-independent precepting of 4th level Pharm.D. students. The students will directly monitor all of the patients and the resident will meet with them daily for supervision and guidance. The resident will be the role model, lead case presentations, all conferences and will conduct mid-term and final examinations with students (with input and assistance from Dr. Dopheide). The goalsare twofold: 1) Provide the residentwith the experience of leading anacute care clinical pharmacy service on a general inpatient unit while teaching and supervising PharmD students.
Center for Community Health (CCH) Safety Net Clinic
Preceptor: Julie Dopheide, PharmD and Paul Gregerson, MD.
Provide primary care for outpatients with psychiatric illness while collaborating with their primary care providers to optimize each patient’s overall mental and physical health. The approved protocol developed in 2008 calls for all referred patients to have a psychiatric diagnosis, however, the resident will work with the consultant psychiatrist and primary care physician to clarify the psychiatric diagnosis when necessary. The resident gains experience in addressing each patient’s individual needs and coordinating overall care which often includes making referrals for housing, psychotherapy and substance abuse recovery.
SELECTIVE OPTIONS (Must select 3, can fit up to 6 experiences if abbreviated)
LAC+USC Child/Adolescent Psychiatry (Clinic) (6-8 weeks), can be combined with Juvenile justice possibly?
Preceptor: Chris Snowdy MD and Julie Dopheide, PharmD, BCPP
The resident will work with attending staff and child fellows at the LAC+USC child/adolescent clinic and participate in patient assessment, family counseling, and behavioral modification. The resident will present didactic lecture(s) on topics in psychopharmacology with preceptor supervision. The resident will attend didactic instruction on Thursdays with the child fellows. The resident will participate actively in the Pediatric Psychotropic Guidelines committee meetings at the Department of Mental Health.
Consultation and Liaison Psychiatry (4-6 weeks) at LAC+USCMedicalCenter
Preceptor: Susie Park, PharmD, BCPP
The psychiatric pharmacy resident will see patients with the psychiatry resident and assess and manage psychiatric illness in individuals with acute medical conditions (eg. heart failure, cancer, trauma, burn victims, acute infections, HIV, autoimmune diseases, renal failure, etc.) while they are receiving treatment for these conditions in the hospital. The resident will gain experience as a psychiatric consultant in an acute care hospital and will serve as a drug information resource in the hospital. The resident gains first hand experience on psychotropic dosage adjustment in organ failure, the clinical significance of drug interactions in the medically ill patient and the unique side effects experienced by medically ill patients.
Geriatric Behavioral Health – Caremore, Irvine, LAC+USC
Preceptors: Jim Rose PharmD and Joseph Pratty, MD (Caremore), Helena Chui, MD and Freddie Segal (LAC+USC and Rancho Los Amigo Rehabilitation Center), Brad Williams, PharmD, (UC Irvine)
The resident has the opportunity to participate in patient assessment with a world-renowned expert in vascular dementia, (Helena Chui) at LAC+USC and Rancho Los Amigos. Evaluation for traumatic brain injury and other some other neurologic disorders is also a part of the LAC+USC component of this rotation. At UC Irvine, the resident works with a multidisciplinary team to evaluate a patient with suspected dementia. Psychological and psychosocial evaluations are a unique feature of this experience as the team of experts spends the entire day assessing one patient. The resident provides education to the patient and family. At Caremore, the resident has the opportunity to assess medication regimens and make recommendations for optimization to both MD’s and nurse practitioners.
Geriatrics Psychiatry at LAC+USC Medical Center (not available for 2015-2016)
Preceptor: Glen Stimmel, Pharm.D, BCPP
The resident will see patients with the Geriatrics fellow or third year medicine residents and provide consultation on managing depression, anxiety, insomnia and other conditions in a primary care geriatrics population. The resident will become aware of how psychiatric illness presents differently in an elderly population along with dosing and side effect sensitivities. The resident will develop patient counseling skills for older adults and learn to work with Geriatrics fellows, medical residents, and geriatrician attending faculty to manage the overall care of the patient.
Emergency Psychiatry at LAC+USCMedicalCenter
Preceptor: Julie Dopheide, PharmD and Psychiatric Emergency Services Medical Staff
The pharmacy resident will work with the psychiatry resident to assess and manage acute psychiatric illness.
The resident will gain experience seeing severe symptomatology and recommending optimal treatment based on symptoms and individual patient parameters. The resident will take medication histories and be able to differentiate drug-induced psychosis from schizophrenia, bipolar mania, and acute depression.
Substance Abuse/Addiction Medicine – Veteran’s Healthcare System, Downtown Los Angeles.
Preceptor: Daily supervision by Ed Moore MD and weekly and as needed discussions with Julie Dopheide, PharmD. The resident will become part of the substance abuse recovery team and manage the health of patients taking naltrexone, methadone, acamprosate and other psychotropics designed to decrease craving and facilitate recovery. The resident will participate in any ongoing research that the team is working on. The resident will conduct psychoeducation grouops for patients.
Behavioral and Developmental Pediatrics at Children’s Hospital Los Angeles and Pomona Regional Center
Preceptor: Susan Turkell, MD with weekly discussions with Julie Dopheide, PharmD.
The resident will gain experience working with an interdisciplinary team led by a Pediatrician and a Psychiatric pharmacist. The resident will see patients ranging from 4 years old to young adulthood with a wide array of diagnoses including autism, pervasive developmental disorder, ADHD, OCD, Tourette’s, bipolar disorder, schizophrenia, mental retardation and psychiatric illness. The resident will present cases and drug therapy topics to the team.
Edelman Children’s Court
Precptor: Jane Tran-Tesoro, PharmD, BCPP
The resident will work with the court system in assessing the appropriateness of psychotropic medication for youth who are in detention or who are under the care of the state. The resident will provide psychoeducation on the appropriate use of medications in children and adolescents. The resident will attend pediatric psychotropic guidelines meetings at the department of mental health.
Juvenile Justice at Eastlake Juvenile Detention Center
Preceptor: Julie Dopheide, PharmD, and Soe Moe Kyaw MD.
The resident will work with probation and clinical staff to optimize psychotropic drug therapy for youth in juvenile detention. The resident will oversee appropriate drug therapy monitoring for youth with a wide range of neuropsychiatric diagnosis. The resident will attend meetings to assist with guideline development on psychiatric pharmacotherapy for youth.
Child/Adolescent Psychiatry –LAC+USC
Preceptor: Julie Dopheide, PharmD, BCPP and Maria Goldstein, MD.
The resident will be a part of the multidisciplinary inpatient team caring for children and adolescents with a wide array of psychiatric illnesses including schizophrenia, bipolar disorder, depression, substance abuse, attention-deficit hyperactivity disorder, conduct disorder and eating disorders.
Eating Disorders- BHC Alhambraor Bella Vita Center
Preceptor: Julie Dopheide, PharmD, BCPP with input from Patricia Pitts PhD and supervising MD.
The resident will participate in the evaluation and treatment of patients with eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder and mixed eating disorders. The resident will gain an appreciation for the importance of non-pharmacological interventions to treat these disorders (dialectical behavioral therapy) The resident will provide psychoeducation to patients, their families and medical staff.
Neurology Clinics
Preceptors: Mark Lew MD, Laura Kalayjian MD, Soma Sahai MD; weekly discussions with Julie Dopheide, PharmD
The resident will see patients with refractory epilepsy, movement disorders and a wide array of other neurological conditions including migraine, stroke, Huntington’s chorea, and Parkinson’s disease. The resident will learn how to differentiate drug-induced movement disorders from idiopathic conditions. The resident will gain experience in the dosing and monitoring of anticonvulsants used for multiple seizure types.
Kaiser Permanente – Behavioral Health – Pasadena
Preceptors: Kathrine Roe, PharmD, BCPP, Janet Aiso, PharmD, MBA and Glen Stimmel, PharmD,
The resident will work alongside Dr. Roe providing MTM/CMM services patients with anxiety, depression, and insomnia. The resident will participate in face-to-face interviews and telehealth clinical services. There may be an opportunity to visit the partial hospitalization program in addition to Kaiser’s inpatient service in China town as well.
Keck Medical Center of USC – Consultation and Liaison Service
Preceptor: Erin Knox, PharmD.
The resident will work with the psychiatry residents and attending under the supervision of the preceptor to provide psychiatric drug therapy consultation to patients with acute care medical conditions. The resident will participate in weekly treatment planning, conduct medication groups as needed and supervise students on rotation.
PAREXEL – California Clinical Trials Medical Group
Preceptors: Larry Ereshefsky, PharmD, BCPP, FASHP and Brett English PharmD, PhD.
This rotation will provide the post-doctoral trainee (PharmD, RPh), currently engaged in a clinical residency or fellowship program with the opportunity to ‘embed’ in a clinical research environment. PAREXEL’s Los Angeles Unit in Glendale is uniquely capable of providing a unique educational and experiential environment.
Participate in Psychiatric Pharmacy Business Meeting
A residency retreat is conducted in June to discuss individualizing the residency according to the resident’s career goals and the clinical and teaching needs of LAC+USC. This 8 hour planning meeting is typically off-site to allow for minimal interruptions. Quarterly business meetings are also held in order to provide the resident with feedback on presentations, teaching and to discuss topics in neuropsychiatric pharmacy. The CNS module course coordinator attends these meetings to review the resident’s lecture prior to presentation in the PharmD Curriculum as well. Each resident
Didactic Coursework
The PGY-2 Psychiatric Pharmacy resident will attend didactic lectures/case presentations and seminars with the LAC+USC psychiatry residents and attendings throughout the year. Topics include the clinical psychiatric interview, mental status examination, diagnostic formulation of all major DSM-5 psychiatric disorders, pharmacokinetics and pharmacodynamics of the psychotropics, cultural issues in psychiatry, psychopharmacology of pregnancy, medical/legal issues in psychiatry, assessing and preventing suicide, psychological assessment.
If the resident has not previously attended the research and teaching skills courses offered by USC, these courses are required.
Research Project
The resident will collaborate with faculty to develop a clinical research project. The resident will discuss project ideas with psychiatric pharmacy faculty and preceptors to identify a worthwhile project that has scientific and clinical merit. Dr. Steven Chen and Dr. William Gong work with the resident to develop a project and present it to peers and faculty for feedback. Both Drs Chen and Gong guide and supervise the resident’s research along with their primary preceptor. Residents are required to present a poster at the College of Psychiatric and Neurologic Pharmacists Annual meeting. Presentation at the Western State’s Conference for Pharmacy Residents and Lecturers is optional.The project must be submitted for publication prior to residency completion.