PGY-2 Critical Care Pharmacy Residency

The PGY-2 Critical Care Pharmacy residency program at MUSC is a one-year post-graduate training program designed to prepare critical care specialists. Residents who complete the program are qualified to accept a position and practice in a variety of critical care environments including, but not limited to: medical, surgical-trauma, neurosurgical, cardiothoracic, emergency medicine, and transplant. As part of the extensive training residents will receive, they will be able to identify, prevent, and resolve medication-related problems, participate as active members of a multidisciplinary healthcare team, provide education to various healthcare providers and patients, conduct effective research and medication-use-evaluations, and demonstrate leadership skills.

Graduating PGY-2 Critical Care residents who successfully complete the one year program will:

  • Be able to effectively manage all of the pharmaceutical care needs of a complex critically ill medical or surgical patient in an academic medical center or advanced community hospital.
  • Residents will also obtain the skill set required to precept PharmD candidates on rotation, develop and modify protocols/guidelines, present educational series to healthcare staff, and actively participate as part of a multidisciplinary team.

The Critical Care residency program is designed to provide the flexibility to adapt to the resident’s specific learning needs and career goals. The training is provided through concentrated clinical rotations and longitudinal experiences.

There are 7 required clinical learning experiences plus a mandatory research month and orientation month for residents coming from PGY-1 programs outside of MUSC

Learning Experience and Rotation Length

Orientation (July of each year) | 1 month
Research (December of each year) | 1 month
Medical Intensive Care Unit (MICU) | 2 months
Cardiothoracic Intensive Care Unit (CTICU) | 1 month
Surgical Trauma Intensive Care Unit (STICU) | 1 month
Transplant (Inpatient) which entails either abdominal or heart-lung transplant | 1 month
Neurosciences Intensive Care Unit (NSICU) | 1 month
Medical Surgical Intensive Care Unit (MSICU) | 1 month
Clinical On-call | Longitudinal
Operational Staffing | Longitudinal
Journal Club | Longitudinal
Critical Care Lecture Series | Longitudinal
Research and Medication Use Evaluation | Longitudinal
Seminar | Longitudinal
Hospital or Pharmacy Committee Involvement | Longitudinal

The program is flexible in its design to offer the following elective rotations

Elective Learning Experiences Rotation Length

Emergency Medicine | 1 month
Cardiac Intensive Care Unit (CICU) | 1 month
Antimicrobial Stewardship | 1 month
Infectious Diseases Consult | 1 month
Benign Hematology Consult | 2 weeks – 1 month
Malignant Hematology | 1 month
Pediatric Intensive Care Unit (PICU) | 1 month
Pediatric Cardiac Intensive Care Unit (PCICU) | 1 month.

Required Rotation Preceptors
Joe Mazur, PharmD, BCPS
B.S. Pharmacy: University of Manitoba 1990
PharmD: Wayne State University 1995
Fellowship Critical Care/ID: Henry Ford Hospital 1996
Medical Intensive Care Unit
mazurj@musc.edu

Jaclyn M. Hawn, PharmD
PharmD: The Ohio State University 2016
PGY1: Cleveland Clinic 2017
PGY2 Critical Care: Cleveland Clinic 2018
Cardiovascular Intensive Care Unit/ CT Surgery
hawnj@musc.edu

Carolyn A. Magee, PharmD, BCCCP
PharmD: University of Kansas 2015
PGY1: University of Kentucky Health Care 2016
PGY2 Critical Care: University of Kentucky Health Care 2017
Medical Surgical Intensive Care Unit
mageeca@musc.edu

Ron Neyens, PharmD
PharmD: South Dakota State University 2004
PGY1: University of Utah 2005
PGY2 Critical Care: University of Florida Health Jacksonville 2006
Neurocritical Care Unit
neyens@musc.edu

Melanie N. Smith, PharmD, BCPS, BCCCP
PharmD: University of Arkansas for Medical Sciences 2015
PGY1: University of Florida Health Jacksonville 2016
PGY2 Critical Care: Medical University of South Carolina 2017
Surgical-Trauma Intensive Care Unit
smitmela@musc.edu

Holly B. Meadows, PharmD, BCPS
PharmD: University of North Carolina Eschelman School of Pharmacy 2009
PGY1: Medical University of South Carolina 2010
PGY2 Transplant: Medical University of South Carolina 2011
Solid Organ Transplant
barrier@musc.edu

Neha Patel, PharmD, BCPS
PharmD: St. Louis College of Pharmacy 2007
PGY1: Medical University of South Carolina 2008
PGY2 Transplant: Medical University of South Carolina 2009
Solid Organ Transplant
paten@musc.edu

Caroline Perez, PharmD, BCPS
PharmD: University of North Carolina-Chapel Hill 2015
PGY1: Virginia Commonwealth University Health System 2016
PGY2 Transplant: Medical University of South Carolina 2017
Solid Organ Transplant
perezca@musc.edu

Additional Elective Preceptors
Barbara S. Wiggins, PharmD, CLS, BCPS, BCCCP, FNLA, FAHA, FCCP, FACC
B.S. Pharmacy: St. Louis College of Pharmacy 1993
PharmD: Medical College of Virginia 1998
Fellowship Cardiology and Emergency Medicine: Virginia Commonwealth University 1999
Cardiovascular Intensive Care Unit
wiggib@musc.edu

Chara Calhoun, PharmD, BCPS
PharmD: Purdue University College of Pharmacy 2013
PGY1: Mission Hospital 2014
PGY2 Emergency Medicine: Mission Hospital 2015
Emergency Medicine
calhouncd@musc.edu

Kyle Weant, PharmD, BCPS, BCCCP, FCCP
PharmD: University of North Carolina – Chapel Hill 2003
PGY1: University of Kentucky HealthCare 2004
PGY2 Critical Care: University of Kentucky HealthCare 2005
Emergency Medicine
weant@musc.edu

Krutika N. Mediwala, PharmD, BCPS. BCIDP
PharmD: South Carolina College of Pharmacy, USC 2015
PGY1: University of Kentucky HealthCare 2016
PG2 Infectious Diseases: University of Kentucky HealthCare 2017
Antimicrobial Stewardship/ID Consult
mediwala@musc.edu

Brian R. Raux, PharmD, BCPS, BCIDP
PharmD: Northeastern University 2016
PGY1: Medical University of South Carolina 2017
PGY2 Infectious Diseases: Medical University of South Carolina 2018
Antimicrobial Stewardship/ID Consult raux@musc.edu

Lauren Haney, PharmD, BCPS, BCPPS
PharmD: Medical University of South Carolina 2007
PGY1: Medical University of South Carolina 2008
PGY2 Pediatrics: Medical University of South Carolina 2009
Pediatric Cardiac Intensive Care Unit
haneyl@musc.edu

Jill Thompson, PharmD, BCPPS
PharmD: University of Tennessee Health Science Center 2001
PGY1: University of Tennessee Health Science Center & Le Bonheur Children’s Medical Center 2002
PGY2 Pediatric Critical Care: University of Tennessee Health Science Center & Le Bonheur Children’s Medical Center 2003
Pediatric Intensive Care Unit
thompsam@musc.edu

Andy Maldonado, PharmD, BCOP
PharmD: University of Georgia 2010
PGY1: Grady Health System 2011
PGY2 Oncology: Grady Health System 2012
Malignant Hematology/BMT
perand@musc.edu

Charles Greenberg, MD - Benign Hematology
MD: Drexel University College of Medicine
Residency: University of Minnesota
Fellowship: University of California, San Francisco
Hematology/Oncology- Blood and Lymphatic
greenbec@musc.edu

Each preceptor will be responsible for the coordination of their own learning experience. The learning experience will be modified accordingly, with the assistance of the RPD, to ensure the resident achieves the assigned goals. The preceptor is expected to exhibit the characteristics and aptitude necessary for residency training, including the four key preceptor roles when teaching clinical problem solving (instruction, modeling, coaching and facilitation). The resident’s activities will be monitored, and they will be provided with formative and summative evaluations, with the over-arching goal of advancing the resident’s competency on the specific assigned learning objectives.

The specific preceptor responsibilities are as follows:

  • Understand the resident’s responsibilities to the residency teaching experience and to ongoing activities such as projects, presentations, student discussions, manuscript preparation.
  • Develop and maintain goals and objectives for the specific residency learning experience(s).
  • Review the resident’s training plan and resident’s previous performance and modify the learning experience accordingly.
  • Orient the resident to the rotation’s setting and monitor/evaluate/critique the resident’s performance during the experience.
  • Provide the resident a midpoint in written and verbal format, and be able to complete the final summary PharmAcademic™ evaluation by month’s end as outlined in the residency manual.
  • Advise the RPD of any appropriate interventions that may be needed relevant to the resident’s performance.
  • Actively participate in an annual feedback session in which preceptors and the RPD consider overall program changes based on evaluations, observations, and direct resident feedback and surveys.

The Residency Advisor(s) are appointed by the Residency Program Director (RPD) and are responsible for the supervision, guidance and on-going evaluation of the resident’s progress throughout the residency. Advisors serve as the resident’s advocate and can be a sounding board for the resident, foster professional development, assist with future career planning, provide support and encouragement through difficult times, and share in rewarding times in the residency. Essentially, they serve as formal appointed mentors.

The residents’ role is that of a student, novice practitioner, and emerging clinician and/or administrator. The resident is to participate in ongoing clinical and administrative services with the assistance of the residency preceptor and develop their skill set into a competent clinical practitioner and/or future administrator. The resident must accept and apply qualitative feedback in addition to performing self-evaluations on their performance.

To promote an effective and productive residency experience, the relationship between a resident and rotation preceptor must be highly communicative, and a meaningful dialogue must be achieved.

Specifically, the resident will:

  • Initiate discussion of the resident development plan and identified focus areas for improvement, encouraging ownership in self-development. This is expected to occur on the first day of each new clinical rotation.
  • Sign off on the learning experience orientation form in PharmAcademicTM on the first day of
    each new clinical rotation.
  • Understand the preceptor’s expectations for daily activities, services provided and preceptor contact.
  • As outlined by the clinical preceptor, provide a detailed account of activities as they relate to the goals and objectives of the learning experience.
  • Maintain active communication with the preceptor, advisor and/or RPD concerning any planned off-service activities (eg. meetings, seminars, projects, staffing, on-call commitments) that the resident will be participating in during the rotation. Leave requests must be approved at a minimum of 30 days in advance to any rotation and the resident is required to complete a minimum of 15 days on each one-month rotation.
  • Maintain strict deadlines with PharmAcademic™ activities-- outlined in the MUSC residency manual – see table for specific deadlines. This involves clinical rotation evaluations, project/research work, mini-MUE work, seminar preparation, any additional talk or in- service/presentation that will require preceptor feedback, and monthly updates to the concurrent uploaded documents. No PTO or administrative leave requests will be granted unless ALL due PharmAcademic™ evaluations are completed.
  • Maintain the disease-state appendix for review each quarter with the advisor and RPD (see appendix).
  • Complete the critical care residency monthly report (see appendix) each month and submit to the residency advisor at a minimum of 1 week PRIOR to the monthly critical care residency group meeting.
  • Participate in pharmacy functions (eg. rounds, patient care conferences, lectures, departmental meetings, clinical staff meetings, assigned committee meetings, journal clubs, critical care educational series, seminars, RITEs, and APP/research certificate activities) in accordance with the MUSC residency manual and as outlined below.

Each critical care resident will participate in the Pharmacy On-Call Service. Call will be divided into two different shifts: begins Friday at 0800 and ends Monday at 0759 OR begins Monday at 0800 and ends Friday at 0759. If assigned to a weekend call shift, residents must be present on site for a minimum of 8 hours each Saturday and Sunday. When on-call, the resident is responsible for ensuring all consultations and follow-up are completed and logged into the RedCap database.
Critical Care residents will serve as the primary backup for PGY-1 Pharmacy Resident colleagues after they are deemed competent.

Each critical care resident will participate in operational staffing at either the Ashley River Tower or the Main Hospital. Staffing will consist of one weekend (16 hours) per month in the designated area. During this experience, residents will function as a clinical pharmacist providing pharmaceutical care for patients admitted to the designated service line. This experience will consist of order verification, pharmacokinetics, anticoagulation monitoring, medication reconciliation, discharge medication review, patient counseling, and emergency response.

Each critical care resident is expected to plan and participate in the monthly critical care journal club. These journal club experiences will be attended by critical care, emergency medicine, and transplant preceptors as well as critical care, emergency medicine, transplant, interested PGY-1 residents, and students on critical care rotations. Planning each journal club will be rotated monthly between each critical care resident. Residents are responsible for the following:

  • Presenting an article during the first journal club of the year.
  • Reserving a room each month.
  • Identifying 3 presenters no later than the end of the 1st week of each month and communicate expectations to presenters.
  • Identifying 3 articles and seeking preceptor approval of all chosen articles no later than the end of the 1st week of each month.
  • Sending calendar invites to all preceptors and interested residents with attached articles no later than the end of the 1st week of each month.
  • Leading discussions for each journal club presented during the month they are responsible for planning. Both critical care residents are expected to read articles and prepare discussion points prior to journal club. Preceptors will be available to facilitate and clarify points of contention.

Any deviation from scheduled journal club dates should be discussed with RPD and/or residency advisor PRIOR to rescheduling or cancelling.

Each critical care resident is expected to participate in the weekly critical care education series. These educational experiences will be attended by critical care preceptors (and other preceptors as appropriate) and physicians depending upon the topic. These experiences are designed to cover basic critical care topics considered essential to the development of a well-rounded critical care practitioner and will prepare the resident to sit for the BCCCP exam immediately upon completion of the residency program. Residents are responsible for the following:

  • Attending all weekly critical care education series presentations. Any missed meetings should be discussed with the RPD and/or residency advisor PRIOR to the meeting time.
  • Being prepared to discuss each weekly topic by reading assigned articles (located in MUSC Box) and reviewing appropriate disease states.
  • Presenting 3 topics throughout the residency year. Topics will be identified and assigned at the beginning of the residency year. Residents are encouraged to consider timing when picking topics to prevent overlap with seminar or RITE preparation. Topics should be presented in a formal fashion with Power-point slides and should encourage audience participation and engagement.
  • Residents should identify the assigned preceptor for the topic they would like to present. They should work with the assigned preceptor to identify appropriate articles for dissemination (uploading via MUSC Box) to the group and should establish an appropriate timeline for preparation and review of the presentation. It is expected that the presentation is finalized, and preceptor approved at a minimum of 1 week in advance to the assigned meeting time.

Each critical care resident is expected to complete a longitudinal research project fit for publication with the mentorship of one or more research advisor(s). The residents may select a project provided by the critical care preceptors or create their own project with approval from the RPD, residency advisor, and research project mentor. Residents are required to participate in all steps in the research process and will be expected to:

  • Submit a research project timeline to the research mentors and to adhere to all established deadlines. If circumstances dictate a change in the timeline, this must be discussed with the RPD, program advisor, and research project mentor(s). At a minimum, all data collection is expected to be completed and ready for analysis by the end of December (assigned research project learning experience).
  • Submit an IRB (if not already approved via the flipped research model)
  • Participate in data collection
  • Participate in statistical design and analysis
  • Prepare and formally submit a manuscript to an appropriate peer-reviewed journal by the end of the residency year. This is an expectation to successfully complete the training program. If unforeseen circumstances limit the ability to do so, this must be discussed with the RPD, program advisor, and research project mentor(s).
  • Present research at a national critical care meeting and/or the local pharmacy research showcase.

Each critical care resident is expected to participate in a medication use evaluation relevant to care of ICU patients with a focus on cost savings and/or quality improvement. The medication use evaluation should:

  • Identify problems and opportunities for improvement and analyze relevant background data.
  • Evaluate data generated by health information technology or automated systems to identify opportunities for improvement.
  • Utilize best practices to identify opportunities for improvement.
  • When needed, make medication-use policy recommendations based on a review of practice standards, guidelines, and other evidence (e.g., National Quality Measures, Institute for Safe Medication Practice alerts, Joint Commission sentinel alerts, etc…)

Each resident should contribute equally to the medication use evaluation. Residents will be responsible for:

  • Arranging meetings with preceptor mentors
  • Data collection and analysis
  • Presenting MUE data to pharmacy administration and appropriate committees (i.e. Critical Care Quality)
  • Adhering to all deadlines established by the critical care preceptors.

Each critical care resident is expected to participate in the MUSC Resident seminar series to complete outcome R4: teaching, education, and dissemination of knowledge. The resident is expected to:

  • Identify a subject related to critical care pharmacotherapy for appropriate dissemination of knowledge to pharmacists and pharmacy residents.
  • Identify a preceptor mentor deemed to have expertise in the topic of interest.
  • Work with the assigned preceptor to establish an appropriate timeline for preparation and review of the presentation. It is expected that the presentation is finalized, and preceptor approved at a minimum of 1 week in advance to the assigned meeting time.
  • Identify preceptors to evaluate presentation style/technique.

Each critical care resident is expected to participate in pharmacy or Integrated Centers of Clinical Excellence (ICCE) committee to complete outcome R3: leadership and management. The resident is expected to:

  • Work with the RPD and advisor to identify an appropriate committee for participation at the beginning of the residency year. It is an expectation that one critical care resident participates in the pharmacy practice committee and one participates in the pharmacy on- call committee. All other committees will depend upon both the pharmacy departments current needs as well as the resident’s individual interests.
  • Attend all committee meetings as assigned throughout the year.
  • Actively participate in committee proceedings (i.e. agenda and minute preparation, sub- committee participation, protocol development, medication use evaluation, communication within the pharmacy department regarding committee activities, etc…).
  • Institutional committee participation may be substituted with active involvement with national or international critical care or pharmacy organization committees at the discretion of the RPD and advisor.

Each critical care resident is expected to participate in the academician preparation program (APP) and research certificate program unless completed as part of their respective PGY1 residency training program.

The resident is expected to successfully complete and achieve all of the required outcomes according to ASHP Educational Outcomes, Goals and Objectives for PGY2 Pharmacy Residencies in Critical Care. This will include the following under the “achieved category”:

  • Outcome R1: Patient care
  • Outcome R2: Advancing practice and improving patient care
  • Outcome R3: Leadership and management
  • Outcome R4: Teaching, education, and dissemination of knowledge

The resident is expected to demonstrative proficiency in 90% or above of all activities linked to these specific outcomes via the various goals and objectives assigned from the learning experiences to successfully complete the MUSC PGY2 critical care residency program. The resident will observe, learn, act, and then master a particular activity which will deem the resident as achieving that goal. This again will be highly individualized and not applied to every resident in exactly the same manner.

For the various elective outcomes, goals, and objectives for PGY2 Pharmacy Residencies in Critical Care, the resident will have to select a minimum of one outcome and demonstrate proficiency in all assigned activities linked to these specific outcomes via the various goals and objectives assigned from the learning experiences to successfully complete the MUSC PGY2 critical care residency program. These include the following outcomes:

  • Outcome E1: Academia
  • Outcome E2: Added leadership and practice management skills
  • Outcome E3: Mass casualty.
  • Invitation for on-site interview
    • Following receipt of the full application packet as outlined on http://academicdepartments.musc.edu/pharmacy_services/residency/ candidates will be screened using the MUSC PGY2 critical care residency screening tool
    • The top 5 to 7 candidates will be brought in for an on-site interview will be decided on collaboratively by the Critical Care/Transplant PharmD group (Joe Mazur –RPD, Ron Neyens, Barbara Wiggins, Carolyn Magee, Melanie Smith, Jaclyn Hawn, Neha Patel, Caroline Perez, Holly Meadows) based on objective scoring criteria from the MUSC PGY-2 critical care residency screening tool and midyear interviews for off-site candidates and internal discussions for internal candidates.
    • Internal candidates are screened once their application is received and the Critical Care/Transplant PharmD group determines if an interview should take place prior to midyear
  • On-site interviews
    • Include interviews with the multidisciplinary team including behavioral based questions and each interviewer will provide an interview score
    • Interview scores are collated and added to the pre-interview screening score
    • Candidates are then ranked and discussed by the Critical Care/Transplant PharmD group to determine the final ranking of candidates
  • Criteria for selection
    • Following internal candidate interviews prior to midyear the Critical Care/Transplant PharmD group meets and determines if an offer for the PGY2 position should be made prior to midyear or if they would like to wait until all candidates are evaluated at midyear
    • For external and internal candidates wishing to partake in the match, final ranking is determined by the combined score of the pre-interview screening tool and on-site interview score along with expert opinion from the Critical Care/Transplant PharmD group.