Ambulatory Care / Psychiatric Pharmacy

Postgraduate Year 1

This PGY1 Pharmacy Practice Residency at USC provides residents with comprehensive pharmacy practice training and experience in a variety of ambulatory care settings including a longitudinal experience in psychiatry. The program prepares residents to:

  • Implement or advance an outpatient comprehensive medication management program in any setting including community / safety net clinics, government healthcare organizations, private medical groups, hospital-based clinics, health maintenance organizations, outpatient pharmacies, and remote telehealth programs by aligning organization needs with appropriate clinical pharmacy services and resources.
  • Serve as an adjunct professor for schools of pharmacy, and progress towards joining the faculty of a school of pharmacy. Completion of this residency program will result in the development of basic skills in clinical practice, teaching (including a teaching certificate), and research, all of which are key elements of university employment.
  • Enter into USC’s PGY2 Psychiatric Pharmacy Residency Program to further develop knowledge and skills necessary for a career in psychiatric pharmacy practice. This position has the option to pre-commit to the PGY-2 psychiatric pharmacy residency position. The faculty and resident make this decision in November of the the PGY-1 year.

USC has transitioned its PGY-1 pharmacy practice (psychiatry) residency from an acute care focus to an Am Care focus in order to better prepare graduates to provide comprehensive medication management to patients with a variety of chronic medical and psychiatric conditions.

Graduates of USC’s PGY1/PGY2 psychiatric pharmacy program have pursued careers in academia, clinical practice, managed care, industry and pharmacy administration.

Practice Settings and Required Learning Experiences

General chronic disease state management and practice management / administration (~6-9 months)

General chronic disease state management training is provided through two sets of training sites: (1) The Edward R. Roybal Comprehensive Health Center (ERRCHC), one of the largest outpatient clinics in the Los Angeles County system that includes a multitude of medical subspecialty services, and (2) USC-affiliated safety net clinics including QueensCare Family Clinics, LA Christian Health Center and AltaMed Health Services.

These sites offer similar experiences including the management of high-risk patients with the most common chronic illnesses (e.g., diabetes, hypertension, dyslipidemia, asthma / COPD, heart failure), little to no insurance, low income, and low health literacy. The ERRCHC operates a state-of-the art pharmacy using the P2000 pharmacy dispensing system. This fully computerized system includes multiple stages of technology-supported verification of medication accuracy and safety, and an intake / counseling area where potential medication errors are clarified. The resident will have the opportunity to participate in all stages of the medication fill process, particularly the intake / counseling area to serve as the reconciler of potential prescription problems. The end result is that the resident will be able to function as a pharmacist in a contemporary outpatient pharmacy.

In the safety net clinics, additional emphasis is placed on managing chronic illnesses for patients who cannot afford to pay for medical services or medication. Our safety net clinics have been recognized by three national organizations for clinical pharmacy practice excellence (ASHP, APhA, AACP). In addition, our safety net clinic pharmacists are actively involved as founders, co-chairs, faculty, and presenters in the national Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) developed by the Health Resources and Services Administration (HRSA), the first-ever government-led effort to spread clinical pharmacy across the nation. Our program developed the tool adopted by PSPC teams to track medication therapy interventions and describe the medication-related problems (including medication safety issues) identified and resolved by pharmacists.

A $12 million grant from the Center for Medicare and Medicaid Innovation (CMMI) enables the School to this year offer 11 (out of 15 total) residency positions in AltaMed Health Services. The grant is evaluating the impact of integrating clinical pharmacy teams (clinical pharmacist, resident, clinical pharmacy technician) into AltaMed medical homes as a cost-effective approach to achieving the Triple Aim – improve patient care, improve health care quality, and reduce per capita health care costs – when compared to “usual care” AltaMed sites. The projected return on investment of $43 million over three years should demonstrate to the Center for Medicare and Medicaid Services (CMS) that clinical pharmacy services are an essential component of for every healthcare team.

This project provides residents with a unique opportunity to be part of a groundbreaking program for the profession of pharmacy. The AltaMed locations that are currently offering clinical pharmacy services are in Huntington Beach, Santa Ana Main, Santa Ana Bristol, Pico Rivera, West Covina, El Monte and East Los Angeles/Boyle Heights, PACE Grand Plaza, PACE El Monte, and PACE East Los Angeles. The PACE programs provide comprehensive services to very high-risk seniors, adding a significant geriatric experience to our program.

Applicants for this residency program will work primarily at LA County/USC-based sites but may rotate through AltaMed sites. The goals and experiences are very similar regardless of where the resident is placed.

USC School of Pharmacy has a history of excellence in psychiatric pharmacy residency training since the first residency was offered in 1974. The PGY-1 Am Care/Psychiatry resident will spend 6 weeks in inpatient psychiatry as part of a multidisciplinary treatment team in order to develop skills in acute care patient assessment and the pharmacotherapeutic management of schizophrenia, bipolar disorder, major depression with psychosis and substance abuse.

Goals for this set of learning experiences are to:

  • Goal R1.1: Identify opportunities for improvement of the organization’s medication- use system.
  • Goal R1.2: Design and implement quality improvement changes to the organization’s medication-use system.
  • Goal R1.3: Prepare and dispense medications following existing standards of practice and the organization’s policies and procedures.
  • Goal R1.4: Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system.
  • Goal R1.5: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients and health care providers.
  • Goal R2.1: As appropriate, establish collaborative professional relationships with members of the health care team.
  • Goal R2.2: Place practice priority on the delivery of patient-centered care to patients.
  • Goal R2.3: As appropriate, establish collaborative professional pharmacist-patient relationships.
  • Goal R2.4: Collect and analyze patient information.
  • Goal R2.5: When necessary, make and follow up on patient referrals.
  • Goal R2.6: Design evidence-based therapeutic regimens.
  • Goal R2.7: Design evidence-based monitoring plans.
  • Goal R2.8: Recommend or communicate regimens and monitoring plans.
  • Goal R2.9: Implement regimens and monitoring plans.
  • Goal R2.10: Evaluate patients’ progress and redesign regimens and monitoring plans.
  • Goal R2.11: Communicate ongoing patient information.
  • Goal R2.12: Document direct patient care activities appropriately.
  • Goal R3.1: Exhibit essential personal skills of a practice leader.
  • Goal R3.2: Contribute to departmental leadership and management activities.
  • Goal R3.3: Exercise practice leadership.
  • Goal R6.1: Use information technology to make decisions and reduce error.
  • Goal (custom): Provide optimal drug therapy at no-cost or low-cost for patients who cannot afford to pay for medications.

Disease / medication-focused clinics (Between 3 weeks and 3 months)

Required experiences in disease / medication-focused clinics include anticoagulation, HIV, and geriatrics / depression. The majority of these experiences take place at the Los Angeles County (LAC)+USC Medical Center. Goals for these learning experiences are subsets of the goals listed above for general ambulatory care, but focused on the particular disease or drug involved. These goals are specified in the ResiTrak learning description system and are consistent with the individual preceptor syllabi.

Required Longitudinal Learning Experiences

Psychiatric Pharmacy Clinic

The PGY1 Am Care/Psychiatric pharmacy resident will provide comprehensive medication management at LAC+USC’s psychiatric clinic under the supervision of psychiatric pharmacy faculty and attending psychiatrists. The resident will also take part in discussions and seminars provided by USC Keck School of Medicine’s department of psychiatry.

Teaching

All residents in the School of Pharmacy program participate in various patient care, teaching and educational activities, including:

  • Coordinating courses with faculty mentors
  • Giving lectures and conducting small group discussions to first, second and third year pharmacy students
  • Serving as a preceptor and role model for the students during their clinical clerkships
  • Precepting volunteer students at health fairs and other community service events

In addition, a teaching certificate is offered which requires specific teaching activities and evaluation of these activities. The teaching certificate offered by USC is consistent with national pharmacy education standards.

The goals for this learning experience, assessed longitudinally during the residency year, include:

  • Goal R5.1 Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.
  • Goal R6.1: Use information technology to make decisions and reduce error.
  • Goal (custom): Provide effective lectures to pharmacy students in the classroom setting.
  • Goal (custom): Serve as an effective leader and mentor in small group student discussions.

Research

Research classes and seminars are provided to residents. During the year, residents are required to:

  • Receive training in the Institutional Review Board’s study application process.
  • Complete a residency project
  • Present the project’s findings at the Western States Conference for Pharmacy Residents, Fellows and Preceptors
  • Submit a manuscript for publication prior to the end of the residency

Specific goals for this learning experience are:

  • Goal E1.1: Design, execute, and report results of investigations of pharmacy practice related issues.
  • Goal E1.2 Participate in clinical, humanistic and economic outcomes analyses.

Elective Learning Experiences

An inpatient psychiatry experience will be woven into the program to allow the resident to work with the PGY-2 program director. Elective learning experiences are available both within USC and its affiliates include Community Pharmacy Practice, Cardiology and Emergency Medicine. Syllabi and learning goals for these experiences are provided directly from the primary preceptor.

Electives are integrated into the longitudinal schedule (e.g., 1 day per week for 12 weeks) or provided as a separate block (e.g., 3 to 4 weeks at the elective practice site), depending on the particular elective. The residents may choose up to 2 elective experiences, but more may be provided depending on each resident’s particular goals.

Resident Training Seminars

Residents in the USC programs receive expert training on a variety of important topics through weekly residency seminars and monthly meetings that include all preceptors and residents. Topics presented include:

  • Instruction on being an effective teacher and small group discussion leader
  • Research design and methodology, including presentation skills
  • Physical assessment skills
  • Journal clubs – The residents maintain a journal surveillance program, identifying and sharing articles relevant to ambulatory care practice. Each resident is assigned one or two journal to follow, rotating throughout the year. The articles are shared and discussed via Google Groups with all residents and affiliated ambulatory care faculty.
  • Updates on recently approved medications or therapeutic controversies
  • Overview of healthcare reform initiatives and legislation and the impact of clinical pharmacy practice
  • Grantsmanship

Contact Us

If you have questions or need additional information, please contact:

Steven Chen, PharmD, FASHP, FCSHP
Hygeia Centennial Chair in Clinical Pharmacy
Program Director, Pharmacy Practice Residency-Ambulatory Care
Associate Professor of Clinical Pharmacy
Faculty Fellow, Center for Excellence in Teaching
1985 Zonal Avenue
Los Angeles, California 90089-9121
Telephone: (323) 442-1556
Email: chens@usc.edu

Julie A. Dopheide, PharmD, BCPP
Program Director, PGY2 Psychiatric Pharmacy Residency
Associate Professor of Clinical Pharmacy
1985 Zonal Avenue
Los Angeles, California 90089-9121
Telephone: (323)-442-1454
Email: dopheide@usc.edu

William C. Gong, PharmD, FASHP, FCSHP
Director, Residency and Fellowship Training
Associate Professor of Clinical Pharmacy
University of Southern California
School of Pharmacy
1985 Zonal Avenue
Los Angeles, California 90089-9121
Telephone: (323) 442-2625
Email: wgong@usc.edu