EDUCATION

Go to other sections:

TORONTO GENERAL HOSPITAL/ ST. MICHAEL'S HOSPITAL DEPARTMENTS OF PHARMACY SERVICESHIV SPECIALTY RESIDENCY PROGRAM

ROTATION OUTLINE

Elective Clinical Rotation

Resident Name:

Preceptor Name:

    Dr. Colin Kovacs

Rotation Dates:

Rotation Type:

    Elective- Medicine   

Rotation Site:

    70 Carlton Street, phone 416-465-0856

BRIEF DESCRIPTION OF ROTATION, PRECEPTOR AND ROTATION SITE: (please complete)

  • My practice has several hundred patients mostly homosexual and mostly HIV infected.
  • There is probably only approximately 10-15 % of patients who are not on some form of HAART therapy due to adherence issues, drug issues, long term slow progressors or the unusual patient who adamantly refuses any intervention (based on a belief system that HIV doesn't cause AIDS or that these medications are part of a conspiracy theory).
  • Of the remaining greater than 80%, most patients have been durably suppressed by RTPCR to levels below 20 copies. I have about thirty to forty patients who have presumptive high level phenotypic resistance despite quintuple to septatuple regimens.
  • In the former group, I have started to do lymphapheresis on patients who have been historically compliant, with good quantitatble change in their CD profile via the NIH. I am not sure what we will do if some of them display low level viral replication in terms of medication vs. immunostimualtory therapy.
  • In the latter group, I have started preliminary discussions with Glaxo, Abbott, DupontMerck and with Gilead to start a salvage therapy with the following compounds:
  • Efavirenz (DMP-266, Sustiva) / abacavir (1592U89) / Adefovir / amprenavir (141W94)  / ABT 378

ROTATION GOAL:

    Please check the goals which apply to this rotation

    • To allow the resident to acquire and/or reinforce and practice applying disease, drug and patients facts and concepts which are required to manage complex drug-related problems which occur in the patients seen by a specialty service.
    • To expose the resident to a practice site through which pharmacists may potentially provide pharmaceutical care and to allow the resident to acquire the knowledge and skills required to function within the environment (e.g. independent consulting pharmacists, Home Care, Public Health Department, innovative community practice settings).
    • The resident may spend 100% of time doing clinical work. If desired, the resident may also be involved in research areas on pharmacokinetics of new drugs and possible side-effects and toxicities

ROTATION OBJECTIVES

    Please indicate if not relevant for this rotation.

    A: Patient care specific objectives

    1. Effectively communicated with patients/family and health care professionals (verbal and/or written).

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

    3. Identify actual and potential drug-related problems.

    4. Demonstrate problem solving skills when required.

    5. Develop a therapeutic plan (drug +/- non pharmacology regimen).

    6. Develop a monitoring plan.

    7. Be able to implement the therapeutic and monitoring plans.

    B: Knowledge related objectives:

    1. Demonstrate the required degree of drug and disease knowledge in the following areas:

    (PLEASE COMPLETE - can be updated during the rotation)

    • side-effects/toxicities of medications
    • pharmacokinetic drug interactions
    • adherance issues

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

(PLEASE COMPLETE - can be updated during rotation)

Check off if applicable to this rotation:

      ethical issues -----------------------------

      cultural issues -----------------------------

      socioeconomic issues -----------------------------

C. Objectives relating to general skills and attitude:

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

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

    (PLEASE COMPLETE - can be updated during rotation)

    Check off if applicable to this rotation:

    • patient/family interview
    • comliance assessment
    • patient education
    • pharmacokinetic dosing
    • case coordination
    • other:

    3. 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.

    4. 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.

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

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

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

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

Resident Responsibilities:

Check off  if applicable

    1. I see about 100 HIV patients weekly, the resident would be able to see as many patients as they wish. The resident would provide clinical pharmacy services to the patients selected by the resident and preceptor according to the rotation objectives and the resident's experience and interest.  The number of patients selected vary from student to student, but an estimate of the expectation is _________________ patients/week.

Additional responsibilities as defined by preceptor.

    2. Ongoing support for patients. 

Resident Schedule:

Check off if applicable

    1. Attend physician rounds ___1___ times per week.  Specific rounds include:

      . (to be completed by preceptor)

    2. Meet with preceptor ______ times per week or______ times per day.  Specific meetings include: (to be completed by preceptor)

    The preceptor is in his office all day and would be available to discuss, review, consult with at any time.

    3. Attend the following educational rounds: (to be completed by preceptor)

    . The Toronto Hospital HIV rounds (Monday 12:00-13:00h) 

Resident Assessment:

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

Additional Information about the rotation:

    Availability of housing if rotation is off-site: _________________________

    Transportation to site: _________________________

    Availability of funding to assist resident if rotation is off-site: _________________________

 

    Special related activities which may be available at specific times of the year:_________________

    Other information:___________________________________________