EDUCATION

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TORONTO GENERAL HOSPITAL/ ST. MICHAEL'S HOSPITAL DEPARTMENTS OF PHARMACY SERVICES

HIV SPECIALTY RESIDENCY PROGRAM

HIV PRIMARY CARE/AMBULATORY CARE ROTATION OUTLINE

Rotation Name: 

  • ambulatory care (hiv)

Rotation Site: 

    The health centre at 410, st. michael's hospital, 410 Sherbourne Street

Preceptor Name:

    Tony Antoniou

Preceptor Title:

    Residency Preceptor

Rotation Duration:

    12 weeks

Brief Description of Rotation, Preceptor and Rotation Site

Rotation:

    pharmaceutical care in an ambulatory care setting

Preceptor:

    affiliated with the hiv ambulatory program, department of family and community medicine, st.michael's hospital

Site:

    the health centre at 410  located in downtown toronto

     our catchment area is diverse and spans a wide spectrum including Rosedale (the most   affluent neighbourhood in the city) to  regent park

     the neighbourhood around the wellesley hospital has groups of patients form many   different backgrounds.  Individuals and particular populations of people in our   neighbourhood have by custom and tradition been neglected by the health care system   and providers of services: the gay and lesbian community, people without permanent   residences, transient populations who move from shelter to shelter, refugees and new   immigrants to canada, first nations canadians, persons who have been through the   correctional services system and people with major mental health disabilities.  The  hospital is unique in being situated in a neighbourhood in which just about every disconnected group resides.

     the patient groups seen at the health centres include persons infected  with hiv,   addicts, pregnant and post-natal women, new born infants and children, refugees,   immigrants (in particular, the Tamil population), and many senior citizens in the area.

     a comprehensive interdisciplinary approach (include medicine, nursing, social work,   pharmacy, dietician, occupational therapy, and community services) is utilized to provide   primary patient care.

Rotation Goals:

    To allow the student to acquire and/or reinforce and practise applying disease, drug and patient facts and concepts which are required to manage complex drug-related problems which occur in the patients seen by a specialty service.

    To allow the student to acquire and practice applying additional knowledge, skills and values required to provide pharmaceutical care to patients.

Rotation Objectives:

At the completion of this rotation, the resident will be able to:

    1. Comprehend the role and functions of a pharmacist in caring for the relevant patient's drug- related needs.

    2. Effectively communicate (verbally and in writing) with patients/family and health care professionals for the purpose of identifying, solving and preventing drug-related problems.

    3. Effectively and efficiently collect relevant patient, drug and disease information.

    4. Accurately and efficiently integrate and analyse the above information for the purpose of identifying all of a patient's drug-related problems.

    5. Identify and clearly state all actual and significant potential drug-related problems in a patient.

    6. Determine the appropriate clinical and pharmacotherapeutic outcomes for each drug-related problem identified.

    7. Access and analyse the relevant patient, drug and disease information required to select the appropriate therapeutic alternative for each drug-related problem.

    8. Develop a therapeutic plan aimed at resolving or preventing each drug-related problem.

    9. Develop a monitoring plan which will assess whether the patient is progressing towards the predetermined outcomes.

    10. Implement and effectively follow-up the therapeutic and monitoring plans for each drug-related problem.

    11. Demonstrate the require degree of drug and disease knowledge in the following area:

 HIV (general):

    • epidemiology, pathogenesis, surrogate markers, natural history and spectrum of disease
    • hiv therapy: antiretrovirals, reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, immunomodulators, complementary therapy, and other investigational agents
    • opportunistic infections (ois) in hiv prophylaxis, treatment: pneumocystis carinii pneumonia (pcp), toxoplasmosis, cryptococcal meningitis, mycobacterium avium complex (mac), cytomegalovirus (cmv), tuberculosis, candidiasis, intestinal parasites and others
    • other aids associated conditions: aids dementia complex (adc), peripheral neuropathy, pain control, weight loss/cachexia, diarrhea, psychiatric and others
    • medication-related issues in hiv: drug-disease considerations, drug interactions, adverse drug reactions, medicated costs/acquisition
    • hiv in specific patient population: women, children, intravenous drug users (ivda), health workers and others

    13. Demonstrate understanding of the following patient related non-therapeutic knowledge as it pertains to the patients encounter in the rotation:

    • ethical issues
    • cultural issue
    • socioeconomic issues
    • legal issues (eg. consent to treat, substitute decision making, mandatory hiv testing etc.)
    • role of hiv community support/aids service organizations
    • importance of multidisciplinary care, "seamless" care

    14. Demonstrate comprehension of the role and functions of a pharmacist in caring for patients' drug-related needs.

    15. Demonstrate following patient-related non-therapeutic skills:

    • patient/family interview  compliance assessment
    • patient education   pharmacokinetic dosing 
    • case coordination

    16. Undertake independent self-directed learning by utilizing resources appropriately, completing learning within the required time frame and appropriately identifying when assistance is required from the preceptor.

    17. Provide well-prepared and organized case, therapeutic &/or teaching presentations, including presenting the information at the appropriate depth and answering questions in an accurate, thorough, clear, succinct manner.

    18. Function as a responsible, reliable, representative of the residency program.

    19. Demonstrate motivation and enthusiasm for patient care and learning.

    20. Able to evaluate and respond to constructive feedback in a positive manner and attempted to modify behaviours as recommended.

    21. Provide accurate and relevant drug information to other health-care members in a timely manner.

Student Responsibilities:

    1. Provide clinical pharmacy services to the patients selected by the student and preceptor according to the rotation objectives and the student's experience and interest.  The number of patients selected vary from student to student.

    2. Presentations: Present multidisciplinary inservices.

    3. As discussed with preceptor, write a case report, patient drug information sheets and/or short drug information note.

Student Schedule:

  1. Attend team rounds 2 times per week. Specific rounds include:
  2. team a (Wednesday 1-2pm) /team b rounds (thursday 1-2 pm)
  3. Meet with preceptor 3-5 times weekly.
  4. Attend the following educational rounds:
  5. wh hiv rounds (tuesday 12-1 pm)
  6. tgh hiv rounds (monday 12-1 pm, optional)
  7. dfcm grand rounds, st. Michael's hospital (thursday 8-9 am, optional)
  8. Pharm.D. seminar, the faculty of pharmacy (Monday 4-5 pm, optional)

Student Assessment:

    Students will be assessed on their ability to fulfil the rotation objectives and will be assigned a grade of honours, pass or fail.  Students will receive a mid-rotation and final rotation assessment of the following  nature (e.g. discussion of mock cases or actual patients, case presentations).