Pharmacy Residency Programs
PGY-2 Ambulatory Care Residency
Residency Program Director
Contact Information:
rwittenberg@ucdavis.edu
UC Davis Health
Pharmacy Department
2314 Stockton Blvd, Room 1310
Sacramento, CA 95817
Becks Wittenberg, PharmD, BCACP, AAHIVP
Senior Pharmacist, Infectious Diseases Specialty
Associate Professor, UCSF School of Pharmacy, UC Davis School of Medicine
2021-2022 Residents:
Ellen Berkley, PharmD
Aletha Loeb, PharmD
Program Purpose
PGY2 pharmacy residency programs build on Doctor of Pharmacy (PharmD) education and PGY1 pharmacy residency programs to contribute to the development of clinical pharmacists in specialized areas of practice. PGY2 residencies provide residents with opportunities to function independently as practitioners by integrating and incorporating accumulated experiences and knowledge into the provision of patient care or other advanced practice settings. Residents who successfully complete an accredited PGY2 pharmacy residency are prepared for advanced patient care, academic, or other specialized positions, along with board certification, if available.
Program Structure
The PGY2 Ambulatory Care Residency is a full-time, one-year commitment, beginning on July 1 and ending June 30, unless alternative dates are pre-arranged.
Program Overview
The Post Graduate Year Two (PGY2) Ambulatory Care Pharmacy Residency at UC Davis Health is designed to provide PGY1 graduates the opportunity to accelerate growth beyond generalist practice and further the development of specialized care in areas specific to the needs of ambulatory patients. It is assumed that the resident has already achieved a basic level of competence commensurate with that of a PGY1 Pharmacy Residency. The PGY2 residency focuses on developing the knowledge, attitudes, training, and skills necessary to cultivate pharmacists who are competent and compassionate practitioners who are prepared for a role as an ambulatory care pharmacist.
The PGY2 residency has a strong emphasis on developing leaders in pharmacy who are poised to contribute to the development and expansion of ongoing or new ambulatory care service lines. Graduates of the residency have the capability to design, implement, and secure collaborative interdisciplinary practice agreements necessary to establish new areas of ambulatory practice and expand current clinical practice. Graduates are empowered to treat and appropriately triage the most complex chronic and acute illnesses presented by ambulatory patients. Patient care is provided within the context of a long-term health care partnership with both patients and health care providers that emphasizes health improvement and disease prevention. Completion of this PGY2 Ambulatory Care Residency will provide the practitioner the advanced critical thinking skills and clinical knowledge necessary to practice as an ambulatory care pharmacotherapy expert, to enhance ambulatory care services as a clinical coordinator, and/or to share skills with others by serving as an adjunct faculty member. Moreover, program graduates will be primed for ambulatory practice leadership to service as experts in medication prescribing.
Although the primary goal of the residency is listed above, there are options for emphasis in this residency program. With any one of the below areas of emphasis, an intensive immersion in direct patient care in the ambulatory environment is required to complete the residency. The resident may choose to emphasize in one of the following:
- Management – Includes learning experiences tailored towards a future career as a pharmacy manager in Ambulatory or Specialty Pharmacy Settings
- Academia – Includes experiences with faculty from the UCSF School of Pharmacy and extended time as primary preceptor for students and residents
- Specialty Pharmacy – Includes a minimum of 12 weeks working with an established specialty pharmacy program to explore the clinical and administrative aspects of a successful specialty pharmacy
- Primary Care – Includes extended time in primary care and population management within the UC Davis Health Primary Care Network and/or One Community Health
UC Davis Health and Ambulatory Care Pharmacy Services
UC Davis Health is a nationally recognized academic medical center offering primary care for all ages, specialty care in over 150 fields, and the latest treatment options and expertise for the most complex health conditions. Some highlights include:
- Rated Sacramento’s top hospital
- Nationally ranked in multiple specialties
- Home of the nationally ranked Children’s Hospital
- Receiving top honors for nursing excellence
- HIMSS level 7 recognition for advanced technology that improves care
- Region’s only Level I trauma center for both adults and pediatrics
- Regional burn center
- NCI-designated comprehensive cancer center
Ambulatory care pharmacists manage patient care under collaborative practice agreements in a variety of disease states and interdisciplinary clinic settings, including:
- Primary Care in the UC Davis Primary Care Network
- Primary Care at One Community Health
- HIV/AIDS at One Community Health
- Specialty Clinics across UC Davis Health
- Cardiology
- Dermatology
- Endocrinology
- Gastroenterology
- Hepatology
- Infectious Diseases
- Neurology
- Oncology
- Pediatrics
- Pulmonology
- Rheumatology
- Renal Transplant
Program Design
The UC Davis Health PGY2 Ambulatory Care Residency is designed to meet the educational goals and objectives, as outlined by the ASHP PGY2 Ambulatory Care Residency Accreditation Standard.
Educational Outcomes Required by the Accreditation Standard:
R1. Patient Care
R2. Advancing Practice and Improving Patient Care
R3. Leadership and Management
R4. Teaching, Education, and Dissemination of Knowledge
Electives may be added based on available resources and resident interest
This residency will offer the resident the opportunity to rotate through UC Davis Health pharmacist-run primary care and specialty clinics.
Patient care is provided in multidisciplinary settings and ambulatory care pharmacy residents will interact with clinical pharmacists, pharmacy technicians, physicians, nurses, discharge planners, dietitians, respiratory therapists, patients, and caregivers to provide comprehensive care to patients in ambulatory care. Daily activities will include interviewing and managing patients in the clinic setting, providing additional phone based or web-based care to patients, reviewing clinic policies for appropriateness, and implementing quality assurance programs for current and new clinics. The ambulatory care resident will be expected to be proficient at working in the clinics they rotate through, from time to time, will be expected to work as a pharmacist in that setting in order to understand firsthand the best way to implement policies/procedures that affect staff and to provide professional growth. Residents and RPD’s will determine the need to shorten or lengthen certain rotational opportunities and target areas for growth as the residency progresses.
UC Davis Health PGY2 Ambulatory Care Residency Learning Experiences
The residency learning experiences will primarily be divided into block rotations and longitudinal learning experiences. While most rotations will be 4 weeks in duration, the residency year will include at least one 12-week rotation to allow for ambulatory care residents to follow patients longitudinally, engage in continuity of care, and gain autonomy in the clinic setting. Rotation schedules will be determined based on availability and resident interests. Rotation schedules will be designed to include all required CAGOs as well as a variety of clinical experiences and environments. A minimum of 8 months will be spent in direct patient care experiences. Rotation schedules will be adjusted and updated quarterly, in conjunction with preparing the updated development plan.
- Rotations can be extended or repeated per the resident’s interests
- Additional electives may be developed based on resident’s interests
- Project time will be coordinated through the year as arranged with the PGY2 Ambulatory Care program director
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Required Experiences |
Length |
Overview |
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Orientation/training |
4 weeks | Orientation to UC Davis Health and PGY2 Ambulatory Care residency program. Activities may be adjusted, based on the resident’s previous experience and knowledge of UC Davis Health. |
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Specialty Ambulatory Care Clinic Part I and II
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Two Blocks 4weeks each |
The Specialty Ambulatory Care Clinic rotation will be a two-part rotation that will allow the resident to expand their breadth of clinical knowledge and learn the pharmacist’s role in a variety of specialty clinics. This is a selective rotation in which residents may choose to focus their learning in a single clinic each block, or may combine up to 3 specialty clinics in a block pending disease state complexity/compatibility and preceptor availability. Part I the resident will work closely with the specialty pharmacist to gain understanding of the specialized medications and become familiar with the structure, goals, and practices of a specialty pharmacy service. This includes facilitating care of specialty patients, interacting with an interdisciplinary team, and abiding by regulatory agency guidelines. For Part II, the resident will serve as the primary preceptor for any pharmacy interns or PGY1s that are on rotation and take a primary role in facilitating the care of patients on the service. |
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Primary Care
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(4 weeks) | The focus of this rotation is primary care and it is a selective rotation which can be pursued in a variety of settings. The Primary Care Network Clinics focus on the pharmacist’s role in a patient centered medical home model and incorporate population health driven care. Experiences at the other clinics allow the resident to utilize their primary care skills in specific patient populations, namely HIV/AIDS population at One Community Health, geriatric population in the Health Aging Clinic, and a renal transplant population in the Renal Transplant Clinic. |
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Longitudinal Clinical Care |
12 weeks | This longitudinal experience allows the resident to select 2-3 clinic areas of interest to focus on. Through this longitudinal rotation, residents are expected to gain depth of clinical expertise and growth towards becoming an autonomous pharmacist with skills in facilitating all aspects of the service, delegation to pharmacy team members, and integration into the multidisciplinary team. |
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Ambulatory Care Management |
4 weeks | The resident will work directly with Ambulatory Care Management to improve the quality of care in specific ambulatory care areas. The resident may be involved in activities such as writing a proposal for new services and/or preparing to start a new service, including identification of stakeholders, setting up the logistics and implementing the program, as well as doing a reassessment of the plan and making any necessary changes. May be extended to 12-week block experience if resident emphasis is management. |
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Ambulatory Care Service Expansion |
4 weeks | This rotation will augment the skills and knowledge gained during the Ambulatory Care Management rotation. The resident will have the opportunity to participate in one or more aspects of ambulatory care service line expansion: shadow a clinic and interview staff to perform a needs assessment for pharmacist presence, development of a business case, discussion with clinic stakeholders in possible areas of expansion, and integration into the clinic and its care team as a pharmacist presence is piloted, and development of the clinic structure, workflow, and tools. |
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Research and Scholarship |
52 weeks | The resident will be expected to complete a project selected and agreed upon by the resident and RPD. Attention to the deliverables set forth by the Research oversight committee facilitates successful completion of the project. |
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Teaching |
52 weeks | The resident will serve in the layered learning model as a mentor and preceptor to PGY1 residents and pharmacy interns while on rotation. The resident will have opportunities to deliver a didactic lecture(s). The resident is expected to complete the teaching certificate offered at UC Davis Health if not completed during their PGY1 year at UC Davis Health or equivalent teaching certificate elsewhere. |
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Medication Safety |
52 weeks | The resident will explore systems in ambulatory care, assess their vulnerability to medication errors, and design targeted action plans to address these vulnerabilities. These findings will be presented to and reviewed by the P&T Ambulatory Care Sub-Committee. |
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Resident Chair Responsibilities |
52 weeks | Residents will have chair responsibilities to serve on either the P&T Ambulatory Care Sub-Committee or the Ambulatory/Outpatient Care Leadership Committee (“The Control Room”). |
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Staffing/Service |
52 weeks | The resident will oversee the staffing schedule for the year for all Ambulatory Care residents. The staffing shifts will be after-hours and weekend coverage for TOC, Primary Care, and/or the Anticoagulation Clinics. |
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Specialty Ambulatory Care Clinic III |
4 weeks | This third elective rotation in specialty pharmacy will allow residents to delve deeper into a specialty area they have already experienced or gain experiences in a new specialty setting. The resident will continue to build on gaining autonomy as a specialty pharmacist and gaining a deeper understanding of disease state management, clinic operations, and regulatory compliance. |
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HIV/AIDS One Community Health |
4 weeks | A rotation opportunity to work with the pharmacist specialist at One Community Health to gain skill in providing care to patients with HIV/AIDS in a Federally Qualified Health Center. The resident will practice under a variety of collaborative practice agreements and work with under-served populations. |
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CMM Family Practice |
4 weeks | The resident will spend time working with a trained pharmacist to master the main concepts of comprehensive medication management (CMM). After completing this rotation, they may use this experience, along with their experience with formulary management to improve the care at the University through in-services to medical residents or the development of training programs for nurses and pharmacists. |
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Pain, Substance Use Disorder, and Opioid Stewardship Clinic |
4 weeks | This rotation focuses on specialized clinical care in the areas of chronic pain and substance use disorder management in the clinic setting, including withdrawal symptom management, medications for addiction treatment, opioid management, and multi-modal pain management. |
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Academia I and II |
4 weeks | For the resident with the emphasis in Academia, this rotation series provides the opportunity to work with a pharmacy faculty member at UCSF to learn the skills to practice in an academic environment. |
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Ambulatory Care Management II |
4 weeks | For the resident with emphasis in Management, additional time with pharmacy managers will allow the resident the opportunity to assume a greater role in developing new services, the budget process and personnel management. |
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Specialty Pharmacy Management |
4 weeks | For residents emphasizing in management or specialty pharmacy, this experience provides the opportunity to participate in the management of specialty pharmacy clinics and dispensing processes, as well as the regulatory processes for specialty accreditation. |
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Residency Continuous Quality Improvement |
4 weeks | Residents will have the opportunity to develop curriculum, policies, or other elements of residency program design to be used in the continuous improvement of pharmacy residency education at an academic medical center. |
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International Rotation |
2 weeks | Residents who choose to participate will be offered a chance to provide pharmaceutical care to patients during a Medical Mission trip. |
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Inpatient Behavioral Health |
4 weeks | Residents will participate alongside an interdisciplinary clinical team on the inpatient behavioral health unit to optimize therapy and transitions of care. Residents will gain familiarity with psychotropic medications and provide recommendations, monitoring, stewardship, and utilization of these medications. |
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Inpatient Cardiology |
4 weeks | Residents will manage the inpatient heart failure service to optimize therapy through guideline directed medical therapy and transitions of care. Residents will work directly with the heart failure attending, hospitalist, and heart failure coordinator on this attending only service. The resident will also cover patients with pulmonary hypertension and any additional patients followed by the hospitalist on service. |
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Inpatient Pediatrics |
4 weeks | Residents will develop pharmacotherapy and disease state knowledge in the acute, non-ICU pediatric population. This experience will emphasize the resident’s role as a pharmacist in a multidisciplinary team and allow them to gain autonomy as the primary pharmacy specialist on patient care rounds. |
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Solid Organ Transplant Inpatient/ Amb Care Hybrid |
4 weeks | Residents will manage patients on the solid organ transplant hospital service and post-transplant hospital discharge clinic. Residents will optimize therapy and transitions of care with a multidisciplinary team, with an emphasis on immunosuppressant pharmacotherapy and pathophysiology in this unique population. |
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Emergency Medicine |
4 weeks | The resident will work with the ED pharmacist attending on service to manage medications during codes/medical emergencies, verify orders, and give recommendations to the team. The ED may help the resident understand the transition from home to inpatient or from ED to home, in addition to allowing the resident to learn to work in a fast-paced and hands-on environment. |
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Toxicology/Poison Control |
4 weeks | The California Poison Control System is a 24-hour-a-day information hotline serving residents statewide in California. Residents will develop proficiency in clinical skills essential to toxicology and gain skills in managing poisoned patients. |
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Refill Clinic |
4 weeks | Review refill clinic protocols and assume the role of the pharmacist. Assist with insurance appeals, quality assurance projects or protocol updates. |
Proposed Calendar of Activities
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Quarter 1 |
Quarter 2 |
Quarter 3 |
Quarter 4 |
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July
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November
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February
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May
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August/September
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December
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March
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June
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October
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January
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April
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Final week
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Longitudinal Activities |
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UC Davis Health PGY2 Ambulatory Care Resident’s Role in Teaching:
UC Davis Health offers many opportunities for both clinical and didactic teaching. The resident will be responsible for assisting preceptors with clerkship teaching for University of California, San Francisco pharmacy students, University of the Pacific pharmacy students and UC Davis Health PGY1 pharmacy residents.
The resident will assume the primary preceptor role for UCSF pharmacy students during their rotations in the latter part of the residency. The resident will be required to prepare an ACPE accredited pharmacy grand rounds presentation or department competency on a Preceptor development topic, based on the resident’s interests and a department needs assessment. In addition, the PGY2 Ambulatory Care Resident may choose to participate in academic teaching, as requested by regional schools of pharmacy, with the approval of the PGY2 Ambulatory Care Residency Director.
Residency Research Project:
All UC Davis Health PGY2 residents are required to complete a research project and present their research in a podium presentation at the UC Collaborative Conference or other Regional meeting. In preparation for conducting their research project, the resident will be complete UC Davis Health IRB-required training and certification. The resident will prepare a project proposal, which will be reviewed and approved by the UC Davis Medical Center Pharmacy Residency Oversight Committee (PROC). The resident will also submit their project to the Pharmacy and Therapeutics Committee. They will submit to IRB for review, before embarking on their research. Upon completion of the project, the resident will be required to summarize their research project for the Departmental newsletter and prepare a manuscript. PGY2 residents will submit their manuscript for publication and prepare an electronic poster suitable for submission.
Committee Assignments:
The PGY2 Ambulatory Care resident will participate in various committee activities, as assigned by the PGY2 Ambulatory Care residency director. Assignments will be determined based on current department initiatives. The purpose of the resident’s committee involvement is to ensure the resident gains exposure to the ambulatory care pharmacists role in activities related to quality-improvement, medication safety, safe handling of hazardous drugs, guideline development and assessment/implementation of technology and automation within the institution and pharmacy department. Committees in which ambulatory care pharmacists play a key role at UC Davis Health include: Thrombosis Subcommittee Meeting, Pharmacy and Therapeutics committee, Specialty Pharmacy Quality Management, and their sub-committees.
Ambulatory Care Service Project:
The PGY2 Ambulatory Care resident, if interested, may participate in a project designed to provide education and information to ambulatory care providers and/or patients on a topic related to wellness, screening and/or prevention of a chronic disease.
Professional Development:
The PGY2 Ambulatory Care resident is encouraged to maintain an active role in pharmacy professional organizations. The resident is strongly encouraged to become a member of the California Society of Health Systems Pharmacists (CSHP), American Society of Health Systems Pharmacists (ASHP) and the American College of Clinical Pharmacists (ACCP) and attend their annual meetings. The resident will be provided with some financial support from the institution and professional leave time to facilitate participation in professional development activities.
Pharmacy Department Service:
The PGY2 Ambulatory Care resident will be expected to provide pharmacy department service hours. This expectation will be met primarily by providing staffing at UC Davis Health. Staffing includes afterhours experiences in transitions of care and weekend experiences in the Primary Care Clinic and Anticoagulation Clinic. The PGY2 Ambulatory Care will provide preceptorship to PGY1 residents during staffing. It is anticipated that the PGY2 resident will offset a staff pharmacist in a clinic setting once competency is established.
Required Competencies:
Residents function as licensed pharmacists in patient care activities. As such, minimum knowledge in a variety of areas must be assured. Within one month of starting the Residency, the resident must complete competencies required of all clinical pharmacists. Basic Cardiac Life Support (BCLS) certification is required and ACLS training will be provided if the resident is not previously certified.
Resident Portfolio:
Each resident must maintain a portfolio containing all information from the residency year including yet not limited to: copies of papers or projects done during rotations, lectures given, research project manuscript, protocols developed, P&T drug monograph, and MUE. The portfolio shall be maintained in Pharm Academic.
Fringe Benefits:
Health, Dental and Vision insurance for resident and dependents, 24 days of Paid Time Off (PTO), plus 6 days Extended Sick Leave, and 4 days for Professional Development. Travel funds (~$2500) are included in the base salary. There is a stipend for scrubs. Use of leave is subject to approval by the RPD consistent with Medical House Staff Policies and Procedures.
Resident Personnel Policies:
The following policies can be located in the Pharmacy Resident Personnel Manual
- Resident Qualifications
- Early Commitment Policy
- Pre-employment drug testing
- Health insurance and Benefits
- Licensure requirement for 2/3 of the residency year
- Moonlighting
- Duty hours
- Tracking of duty hours
- Professional, family, and extended leave policies
- Dismissal policy and consequences of failure to progress
Requirements for successful completion of the residency:
- California license obtained per residency policy
- Successful completion of all required learning experiences and associated assignments
- Successful completion of all required rotations/learning experiences with no outstanding ‘Needs Improvement’ on any required rotation goals or objectives and a minimum of 80% reaching ‘Achieved’ by the end of the residency year
- Completion of required competencies as assigned, including BLS, ACLS, and/or PALS as appropriate
- Completion of a research project
- Presentation of research project at UC Collaborative Conference (or equivalent)
- Preparation of manuscript and virtual poster for research project, suitable for publication
- Pharmacy Grand Rounds or Preceptor Development presentation
- Completion of one of the following: Protocol, CPA, Guideline, Staff Competency, MUE, Drug Monograph, or CQI project (plus presentation)
- Completion of Medication Safety longitudinal project and presentation
- Successful development of new learning experience or major revision
- Completed staffing requirements as outlined by the residency program description
- Active participation in UC Davis Health committees as assigned (80% attendance to chairing committee and 50% attendance to non-chaired ambulatory committee)
- Precepting PGY-1 residents and students
- Completion of the PGY-2 Ambulatory Residency Disease State Appendix to the minimum standard
- Completed end-of-year self-assessment and residency program assessment
- Resident closeout completed in Pharm Academic with portfolio attachments uploaded
- A minimum of 12 months training inclusive of standard vacation, professional and sick leave
Pharmacy Residency training programs at UC Davis Health are conducted under the licensed entity within UC Davis Health which is UC Davis Medical Center.
