Ambulatory Care

Postgraduate Year 1

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

  • Practice as clinical pharmacists with the ability to initiate a new disease state / medication therapy management program or contribute to the success of an existing program in any outpatient setting, e.g., community clinics, government-run healthcare organizations, outpatient pharmacies, and managed care organizations.
  • 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 requirements of university employment.
  • Enter into a PGY2 Residency Program or fellowship program to continue developing skills and knowledge necessary for specialty practice and related expertise.

Graduates of the program have pursued careers in a broad variety of organizations including safety net clinics, government health care systems, community hospitals, teaching medical centers, private physician practice groups, managed care organizations, pharmaceutical industry, and academia.

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.

These sites have several similarities including service to patients with the most common chronic illnesses (diabetes mellitus, 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 3 national organizations for clinical pharmacy practice excellence (ASHP, APhA, AACP). In addition, our safety net clinic pharmacists are actively involved as founders, co-chairs 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.

A $12 million grant from the Center for Medicare and Medicaid Innovation (CMMI) enables the School to this year offer 10 (out of 15 total) residency positions in AltaMed clinics. The grant is evaluating the impact of integrating clinical pharmacy teams (clinical pharmacist, resident, clinical pharmacy technician) into AltaMed medical homes as a way to achieve the triple CMMI aim – improve preventative care, improve health care quality, reduce total health care costs – when compared to “usual care” AltaMed sites. This project is expected to yield a return on investment of $43 million over three years, expressly demonstrating to the Center for Medicare and Medicaid Services (CMS) that clinical pharmacy services are essential and must be included in budget planning.

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, Pico Rivera, West Covina, El Monte and East Los Angeles/Boyle Heights.

Applicants for this residency program may be placed at either the AltaMed sites or the LA County/USC-based sites. The goals and experiences are the same regardless of where the resident is placed, as residents in AltaMed sites are able to spend time in the LA-County-based sites and vice versa.

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

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

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:

  • 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

Elective learning experiences are available both within USC and its affiliates include Community Pharmacy Practice, Psychopharmacy, 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. 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. These seminars 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.

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:

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: ,