As a specialty, infectious diseases (ID) encompasses a large cross section of patients and disease states. The ID clinical pharmacist works with physicians, pharmacists, nurses, social workers, and other healthcare practitioners to provide optimal care for patients with infectious diseases. The resident will develop the skills to participate in antimicrobial stewardship activities, interpret microbiology results, formulate pharmacotherapeutic plans that include appropriate anti-infective selection, dosing, and monitoring, perform therapeutic drug monitoring when necessary, respond to drug information questions, and report any adverse events. The resident will learn to solve problems proactively and communicate effectively with patients and other healthcare providers. The goal of the Infectious Diseases Specialty Residency is to effectively train practicing pharmacists to meet the needs of patients and the healthcare industry as a clinical pharmacy specialist in infectious diseases.
Program Purpose Statement
The PGY2 Infectious Diseases pharmacy residency program at the Hospital of the University of Pennsylvania builds on the Doctor of Pharmacy (PharmD.) education and PGY pharmacy residency program to contribute to the development of clinical pharmacists in infectious diseases. The PGY2 Infectious Diseases pharmacy residency program provides 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 the PGY2 Infectious Diseases pharmacy residency program at the Hospital of the University of Pennsylvania are prepared for advanced patient care, academic, or other specialized positions, along with board certification.
The Penn ID Division is recognized for excellence in clinical care, research, and education. The expertise of the Division's faculty is complementary to their strong inpatient and outpatient programs in HIV medicine; infections in solid organ and bone marrow transplant recipients; healthcare epidemiology and antimicrobial stewardship; antimicrobial resistance; viral hepatitis; tuberculosis; travel medicine; and global health. In addition, the ID faculty are nationally and internationally renowned leaders in scientific investigation including bench science, translational and epidemiologic research, clinical trials, health policy, and public health and hold numerous leadership positions within national and international organizations, guidelines panels, and scientific committees.
There are five ID consult services, consisting of two general ID services, two solid organ transplant services, and one oncology consult service as well as an ID-primary service medicine team that essentially cares for HIV patients. The general ID consult service is composed of an ID attending physician and an ID fellow. Other members of the team may include up to two medical residents, up to two medical students, and up to two pharmacy representatives split amongst a clinical pharmacy specialist, a PGY2 ID resident, a PGY resident, and a pharmacy student. Patients span services, inpatient locations, and levels of acuity.
- In collaboration with the health care team, provide comprehensive medication management to patients with infectious diseases following a consistent patient care process
- Ensure continuity of care during infectious diseases patient transitions between care settings
- Manage antimicrobial stewardship activities
- Demonstrate ability to manage formulary and medication-use processes for infectious diseases patients, as applicable to the organization and antimicrobial stewardship program
- Demonstrate ability to conduct a quality improvement or research project
- Manage and improve anti-infective use process
- Establish oneself as an organizational expert for infectious diseases pharmacy-related information and resources
- Demonstrate leadership skills for successful self-development in the provision of care for infectious diseases patients
- Demonstrate management skills in the provision of care for infectious diseases patients
- Provide effective medication and practice-related education to infectious diseases patients, caregivers, health care professionals, students, and the public (individuals and groups).
- Effectively employ appropriate preceptor roles when engaged in teaching students, pharmacy technicians, or fellow health care professionals about care of patients with infectious with infectious diseases
- Manage and facilitate delivery of medications to support safe and effective drug therapy for infectious diseases patients
The infectious diseases pharmacy resident will have a total of 11 (plus institution orientation) or 12 month-long rotations throughout the year. There are 10 core rotations that are required and one to two elective rotations are possible.
- Antimicrobial Stewardship (required, 3 one month rotations)
The Antimicrobial Stewardship Program (ASP) was first established in the early 1990's and is currently operated by five infectious diseases (ID) trained pharmacists and three ID physicians. The ASP utilizes many of the recognized stewardship modalities, including (but not limited to) prior approval, post-prescription review with feedback, dose optimization, IV to oral conversion, and indication-specific treatment guidelines.
During this first Antimicrobial Stewardship rotation, the resident will be introduced to the prior approval process and become familiar with the ilύm Insight® application provider requests, the antibiotic stewardship note within PennChart, and documentation of workload in the ASP log. The resident will begin to evaluate requests submitted via the ilύm Insight® application and sign out requests with the preceptor prior to speaking with the requesting provider and give their assessment of the appropriateness of the request as well as providing a complete response.
During this second Antimicrobial Stewardship rotation, the resident will expand their stewardship activities to include the post-prescription review of current antimicrobial regimens and stewardship rounds in addition to continuing to evaluate prior approval requests. The resident will be introduced to the alerts in ilύm Insight® and TheraDoc® that are used to identify possible post-prescription interventions. The ID attending on stewardship rounds will be notified of resident participation so that the resident is included in correspondence for meeting times. Documentation in PennChart and the stewardship log will also be reviewed. The resident will continue to evaluate prior approval requests being given more independence to evaluate requests without preceptor sign-out.
During this last Antimicrobial Stewardship rotation, the resident will be expected to function independently as the primary stewardship pharmacist. Less emphasis will be placed on the day-to-day activities of a stewardship program and will focus on the administrative activities such as reviewing national stewardship requirements and metrics associated with stewardship outcome measurements, and leading the Antibiotic Subcommittee meetings.
- General Infectious Diseases (required, 2 one month rotations)
The general ID consult service is composed of an ID attending physician and an ID fellow. Other members of the team may include up to two medical residents, up to two medical students, and up to two pharmacy representatives split amongst a clinical pharmacy specialist, a PGY2 ID resident, a PGY resident, and a pharmacy student. Patients span all services, inpatient locations, and levels of acuity.
This is the first core rotation of the year with the purpose of establishing the resident as part of the infectious diseases team. The role of the ID pharmacist within the ID consult team is to evaluate antimicrobial treatment regimens and make recommendations to the team based on patient-specific criteria such as allergies, weight, renal function, site of infection, organism and if known, susceptibility, and concomitant medications. The ID pharmacist also communicates ID consult recommendations to the pharmacy specialist or unit-based clinical pharmacist caring for the patient and coordinates inclusion of the patient into the infectious diseases transition service if necessary. ID consult rounds are typically in the afternoon, so mornings are devoted to updating patient information, patient discussions, and ID topic discussions. The second general ID consult rotation of the year will focus on having the resident independently manage all responsibilities of the ID pharmacist while rounding with the consult team, with only indirect preceptor facilitation.
- Infectious Disease Transition Care (required, one month)
The Infectious Diseases Transition Service (IDTS) is managed by a rotating team of infectious diseases (ID) pharmacists, two pharmacy technicians, and an ID physician champion. The program is centered around transition of patients discharged on outpatient parenteral antimicrobial therapy (OPAT) from the inpatient to outpatient setting. The IDTS team works in conjunction with the HUP ID outpatient clinic, several home infusion companies, skilled nursing facilities, etc. to facilitate the care of OPAT patients. The purpose of this core rotation is to gain experience in managing the challenges and complexities of OPAT and improve communication skills by coordinating care with ID providers, home infusion companies, etc.
- Infectious Diseases Primary Service (required, one month)
The ID primary service is composed of an ID attending physician, a medical resident, and two medical interns. Other members of the team may include up to two medical students, and up to two pharmacy representatives split amongst a clinical pharmacy specialist, a PGY2 ID resident, a PGY pharmacy resident, and a pharmacy student. Since this is a medicine team, patients are generally HIV patients but may include other non-infectious diseases patients. The ID resident will collaborate with the members of the ID team, the primary medical/surgical team, pharmacy, nursing, and the patient to ensure antimicrobial therapy recommendations are initiated safely and effectively and in a timely manner, provide responses for all drug information requests and repor t any adverse effects encountered throughout the rotation.
- Microbiology (required, one month)
Clinical microbiology relates the principles, theory, and technologies of clinical microbiology and its many disciplines to the practice of clinical medicine to answer a variety of questions related to diagnosis, treatment and management of infectious diseases. Residents will gain a working and theoretical knowledge in the following areas: specimen collection and processing, isolation and identification of medically important bacteria, fungi, viruses, mycobacteria, and parasites, and antimicrobial susceptibility testing and mechanisms of resistance. The rotation takes place during the first month of a three-month block that is scheduled for the pathology residents. The purpose of this core rotation is to develop an advanced knowledge base in microbiology and be able to link clinical microbiology to clinical activities. The PGY2 Infectious Diseases resident will be able to apply the knowledge they have gained on future clinical rotations. The resident will also strengthen their communication skills by presenting a topic(s) at microbiology plates rounds to an audience with a diverse educational backgrounds.
- Oncology Infectious Diseases (elective, one month)
The oncology ID consult service is composed of an ID attending physician and sometimes an ID fellow. Other members of the team may include a medical student, medical resident and up to two pharmacy representatives split amongst a clinical pharmacy specialist and a PGY2 ID resident. Patients are typically limited to the liquid oncology services, however could span other inpatient locations and levels of acuity. The ID pharmacy resident will be expected to independently attend rounds daily, discuss any potential therapeutic issues with the preceptor, and assist the oncology ID consult service with antimicrobial selection and dosing. The ID resident will also assist with therapeutic drug monitoring of vancomycin and aminoglycosides and voriconazole and posaconazole, where appropriate. The ID resident will collaborate with the members of the oncology ID team, the primary medical/surgical team, pharmacy, nursing, and the patient to ensure antimicrobial therapy recommendations are initiated safely and effectively and in a timely manner.
- Solid Organ Transplant Infectious Diseases (elective, one month)
The transplant ID consult service is composed of an ID attending physician and typically an ID fellow. Other members of the team may include a medical student, fellows from the solid organ transplant services (such as kidney, liver, heart, lung) and up to two pharmacy representatives split amongst a clinical pharmacy specialist and a PGY2 ID resident. Patients span all services, inpatient locations, and levels of acuity. The role of the ID resident within the transplant ID consult team is to evaluate antimicrobial treatment regimens and make recommendations to the team based on patient-specific criteria such as allergies, weight, renal function, site of infection, organism and if known, susceptibility, and concomitant medications. The resident also communicates transplant ID consult recommendations to the pharmacy specialist or unit-based clinical pharmacist caring for the patient and coordinates inclusion of the patient into the infectious diseases transition service if necessary.
- Infectious Diseases Ambulatory Care (two to four week introduction, then longitudinal)
The Infectious Diseases (ID) Outpatient Practice is a multidisciplinary practice that sees ID/Oncology, ID/Transplant, HIV, Hepatitis C, HIV/Hepatitis C co-infection, Mycobacterial disease, Hospital Discharges/Transition Service (various infections), Travel Medicine and others. The clinical staff includes ID Attendings, ID Fellows, Nurse Practitioners (3), Nurses, Medical Assistants, Pharmacists, Social Work, Psychology, Community Health Workers, and a Nutritionist. The pharmacy resident is responsible to attend and actively participate in ID Practice staff and clinical practice meetings, identify and resolve medication therapy issues, and proactively assist with medication-related care of patients followed by the ID Practice throughout the learning experience. The resident will attend the morning interdisciplinary huddles to coordinate medication–related efforts with the team. This rotation requires the resident to document any identified, and/or resolved medication therapy issues of all patients seen at clinic throughout the learning experience.
Longitudinal rotation experiences:
- Adverse drug event reporting
- Antibiotic subcommittee of P&T
- Research project
Other longitudinal experiences:
- Assist in mentoring and serving as an infectious diseases pharmacy role model to pharmacy students, other residents, and pharmacy staff
- Act as an integral part of the team taking care of patients in both the inpatient and outpatient clinic settings by providing education to nurses, physicians, and patients
- Actively be involved in medication reconciliation at admission and discharge
- Present journal clubs and patient case presentations as part of the Residency Program’s Therapeutics Conference
- Certify in Basic Life Support and Advanced Cardiac Life Support. Respond to code call, anesthesia stat, and rapid response emergencies as assigned
- Deliver a pharmacy continuing education presentation to members of the pharmacy department
- Submit an abstract for poster presentation at the ASHP Midyear Clinical Meeting
Shawn Binkley, BS, PharmD, BCIDP
Clinical Pharmacy Specialist, Infectious Diseases
Hospital of the University of Pennsylvania
3400 Spruce Street, Ground Rhoads
Philadelphia, PA 19104
- Shawn Binkley, BS, PharmD, BCIDP
- Stephen Saw, PharmD, BCIDP
- Vasilios Athans, PharmD, BCPS, BCIDP
- Tiffany Lee, PharmD, BCIDP
- Sonal Patel, PharmD, BCIDP
- Amelia Graziani, BS, PharmD
- Michelle Peahota, PharmD, BCPS, BCIDP
Candidates interested in the program should apply through PhORCAS
- Academic transcripts from your School of Pharmacy
- Letter of Intent which addresses the following:
- Why you have chosen the Hospital of the University of Pennsylvania
- Why you have chosen to pursue specialized training in infectious diseases
- Your residency and career goals
- Curriculum vitae
- Three letters of recommendation should be submitted through the PhORCAS system from the following:
- Clinical rotation preceptor, preferably from an ID rotation
- PGY1 Residency Program Director
- Other clinical preceptor
All required application materials should be submitted to PhORCAS by deadline of January 4th.