PGY1 Pharmacy Residency Program: Ambulatory Care Setting
ASHP Program Code: 84102
National Matching Services Code: 292013
This program is a newer PGY1 pharmacy residency program that started in 2022.
Accreditation
This PGY1 pharmacy residency program at Billings Clinic is in candidate accreditation status with the American Society of Health-System Pharmacists (ASHP). Residents who successfully complete this program prior to it being fully accredited by ASHP will receive an updated graduation certificate once accreditation has been achieved.
Program in the Ambulatory Care Setting: Curriculum Overview
Residents spend their year gaining experience in a variety of pharmacy practice settings and specialty areas.
Orientation and Drug Information
The first 5 weeks of the PGY1 residency program are dedicated to the Orientation and Drug Information (DI) rotations. Orientation focuses on educating residents on policies, procedures, expectations, schedules, and project requirements; developing goals for residency; and familiarizing residents with Billings Clinic and the Pharmacy Department. Residents also learn how to use PharmAcademic™ (electronic evaluation system) during Orientation. The DI rotation refreshes residents on the skills necessary for answering clinical questions and analyzing literature. Residents continue to build upon these skills in their longitudinal DI experience.
Pharmacy Practice
The Pharmacy Practice rotation starts after Orientation/DI and helps residents become confident in the use of pharmacy information systems, evaluation of prescriber orders, and the utilization of the integrated dispensing system, and general pharmacy workflow. Billings Clinic residents are trained on all technology and information systems relevant to their practice area.
Clinical Training
Residents spend the remainder of their PGY1 residency program participating in various clinical rotations. Residents are exposed to all aspects of patient care using an integrated approach. Residents work in a dynamic, educationally-stimulating residency environment as they mentor student pharmacists from several colleges of pharmacy during both their introductory and advanced pharmacy practice experience rotations at Billings Clinic. Residents interact regularly with intern, resident, and attending physicians from the Billings Clinic Internal Medicine Residency Program. They may also interact with psychiatry residents and nursing residents.
Core Rotations (Required)
Core Rotations
- Anticoagulation: 5 weeks + longitudinal
- Cardiology: 5 weeks
- Primary Care: 5 weeks + longitudinal
- Psychiatry (inpatient): 5 weeks
- Orientation/Drug Information: 5 weeks
- Pharmacy Practice: 6 weeks
Selective Rotations (Residents must choose three)
Residents rank the rotations in order of preference. Whenever possible, residents are scheduled for their top choices of selective rotations.
- Medication Reconciliation/Transitions of Care: 4 – 5 weeks
- Neurology: 4 – 5 weeks
- Oncology - Oral: 4 – 5 weeks
- Pediatrics: 4 – 5 weeks
- Specialty Pharmacy: 4 – 5 weeks
Longitudinal Experiences (Required)
- Anticoagulation
- Primary Care
- Drug Information
- Pharmacy Academia
- Pharmacy Administration
- Research
- Process Improvement
- Staffing
Elective Rotations
Billings Clinic wants each resident’s experience to be unique and tailored to their interests. Residents are encouraged to discuss ideas for elective rotations with the Residency Program Director as early as possible. Residents have one 4-week block allotted for an elective rotation. Options include choosing another selective rotation area, going back to a core rotation area for an enhanced experience, or designing a customized rotation.
Flexible and Project Times
Flexible Time
Residents are also allotted 2 weeks of "flexible" time in their year, which can be used for vacations, project time, and/or extending a rotation. These flexible weeks are scheduled around the Christmas and New Year’s holidays.
Project Time
Once residents start clinical rotations, they are allotted approximately one-half day per week or one full day every other week for project time, which may be used for research, meetings, or other residency assignments. Additionally, residents have up to 2 dedicated weeks for research/project time in the second half of the year.
Yearly Schedule Overview
| Weeks |
Rotation(s) |
| 1-5 |
Orientation/Drug Information (concentrated portion) |
| 6-9 |
Pharmacy Practice |
| 10-14 |
Rotation 1: Primary Care Clinic |
| 15-18 |
Rotation 2: Anticoagulation Clinic |
| 19-23 |
Rotation 3: Cardiology Clinic |
| 24 |
ASHP Midyear Clinical Meeting |
| 25 |
Research/Project Time |
| 26-27 |
Flexible Time |
| 28-32 |
Rotation 4: Psychiatry (Inpatient) |
| 33 |
Research/Project Time |
| 34-38 |
Rotation 5: Selective Rotation |
| 39-43 |
Rotation 6: Selective Rotation | Montana Pharmacy Assoc. Spring Seminar |
| 44-47 |
Rotation 7: Selective Rotation | Mountain States Conference |
| 48-51 |
Rotation 8: Elective Rotation |
| 52 |
Wrap Up/Graduation |
Staffing Requirements
Residents are required to staff on a rotating basis approximately every 3rd weekend throughout the year. Staffing includes weekend shifts in the Atrium Pharmacy (outpatient), which is the only 24-hour pharmacy in Billings, MT and is located within Billings Clinic hospital. Additionally, residents are each required to staff 1 holiday (usually New Year’s Day or Memorial Day).
Program in the Ambulatory Care Setting: Rotation Opportunities
Residents are exposed to a wide variety of areas and have different options to customize their residency year. Billings Clinic aims to make its residents well-rounded leaders in pharmacy practice. Most rotation blocks are 5 weeks, while others are typically 4 weeks.
Core Patient Care Rotations/Experiences (Required)
Anticoagulation
- Location: Billings Clinic operates two pharmacist-run Anticoagulation Clinics (ACC) in Billings, one on the downtown campus and one at the West End branch clinic. Anticoagulation services are provided by two pharmacists at the downtown location and by one pharmacist at the West End from 0730 – 1600 on weekdays. Pharmacists provide anticoagulation management of warfarin using a collaborative practice model. They conduct both in-person visits and telephone consultations. Pharmacist monitoring of direct oral anticoagulants (DOAC) is currently being developed.
- Residents have both a block rotation and longitudinal experience (half-day once a week) in anticoagulation. They become proficient in categorizing disease risk factors; anticoagulant initiation, titration, and discontinuation; laboratory monitoring; and educating patients regarding dosing, drug interactions, and lifestyle modifications. Residents see a mixture of new start and continuing anticoagulation patients and provide in-depth education to patients newly starting warfarin.
Cardiology
- Location: The Ambulatory Cardiology pharmacist provides pharmacy services in the outpatient Cardiology Clinic from 0800 – 1630, Monday – Friday. The pharmacist conducts comprehensive medication management of patients with various cardiac conditions, focusing on heart failure and hospital follow-up following a cardiac-related event.
- Residents see patients in clinic with the cardiology pharmacist and cardiology providers, depending upon the visit type. Residents interview patients, conduct medication profile reviews, and make therapy recommendations based on evidence-based guidelines and patient-specific factors. They become proficient in medication initiation, titration, and discontinuation; laboratory monitoring; and educating patients. Residents may also observe various cardiac-related procedures (e.g., catheterization, cardioversion) as time and availability allow.
Primary Care
- Location: Billings Clinic has pharmacists integrated into the three Internal Medicine/Family Medicine primary care clinics within Billings (downtown, Heights, and West End). Medication Therapy Services (MTS) is provided by one pharmacist at each clinic location from 0730 – 1600 on weekdays. The MTS clinic is a pharmacist-directed, disease-state focused ambulatory care practice that uses a collaborative practice model between pharmacists and providers. The clinic involves protocol-driven, collaborative drug therapy management of patients with diabetes mellitus, hyperlipidemia, hypertension, asthma, COPD, and tobacco dependence; providing medication management services for bariatric patients; conducting pharmacogenomic consultations; and comprehensive medication management. Patients are scheduled between the hours of 0800 – 1630 (Monday – Friday). Pharmacists conduct patient visits face-to-face in clinic and via telephone.
- Residents have both a block rotation and longitudinal experience (half-day once a week) in primary care. They are responsible for comprehensive care of the patients as well as integrating into the MTS Clinic. Residents become proficient in categorizing disease risk factors; medication initiation, titration, and discontinuation; laboratory monitoring; and educating patients regarding lifestyle modifications. They are regularly responsible for answering drug information questions and periodically educating clinic staff. There is also opportunity to interact with the Internal Medicine Residency physicians.
Psychiatry (Inpatient)
- Location: Psychiatry (Psych) is centered in the Psych Center. The Psychiatric Adult Treatment Unit provides inpatient services for adults, including geriatric care for adults who are transitioning between hospital psychiatric inpatient care and nursing home level care. Adolescent (ages 6 – 17 years) services are provided in the Psychiatric Youth Treatment Unit. The Youth Partial Hospitalization Program provides outpatient treatment and education for children and adolescent ages 7 – 17 years who can benefit from active treatment in a therapeutic setting. The Psychiatric Stabilization Unit is an observation unit that cares for patients who require acute mental illness stabilization but do not need to be admitted to the Psych Center. Pharmacy services in the Psych Center are provided by two decentralized pharmacists from 0800 – 1630 (weekdays).
- In order to provide residents with a diverse residency experience, they will complete an inpatient-focused rotation in the Psych Center. Residents round with the Psych pharmacist(s) and psychiatric hospitalists throughout the day. They also assist with the Psych pharmacists’ clinical duties (e.g., order processing, pharmacist-driven protocols, multidisciplinary rounds, patient interviews and counseling) and participate in Project ECHO sessions. Residents interact frequently with the Psychiatry residents.
Selective Patient Care Rotations (Options)
Medication Reconciliation/Transitions of Care
- Location: Medication Reconciliation/Transitions of Care (MR/TOC) is centered around the MR/TOC pharmacy service, which focuses on medication management during hospital transitions of care. The MR/TOC pharmacists are available 0730 – 1900 on weekdays and 0800 – 1830 on weekends. The MR-MED pharmacist’s daily activities include reconciling medication lists for patients transferring to a skilled nursing facility, obtaining accurate medication histories for complicated medical patients, interacting with hospitalists, and reconciling medications. The MR-SURG pharmacist’s daily activities include reviewing, organizing, and prioritizing MR-SURG consults; interacting with admission-discharge-transfer (ADT) nurses, surgeons, and their midlevel practitioners; obtaining accurate medication histories; and reconciling medications. The MR-F pharmacists’ assists with the workload of the MR-MED and MR-SURG pharmacists and helps prioritize tasks for the team.
- Residents enhance their patient interviewing and counseling skills as well as increase their therapeutic medication management knowledge and skills. Residents review patients’ home medications, inpatient orders, vitals, labs, and any other pertinent information to accurately and safely reconcile medications at hospital admission and discharge using the established protocols for the MR/TOC service.
Neurology
- Location: The Specialty Neurology pharmacist provides pharmacy services in the outpatient Neurology Clinic from 0800 – 1630, Monday – Friday. The pharmacist conducts comprehensive medication management of patients initiating and continuing specialty medications for neurological conditions (e.g., multiple sclerosis, MDA, SMA). They also coordinate medication dispensing with the Billings Clinic Specialty Pharmacy or other specialty pharmacies and infusion centers, depending upon the medication.
- Residents see patients in clinic with the neurology pharmacist and providers. Residents interview patients, conduct medication profile reviews, and make therapy recommendations based on evidence-based guidelines and patient-specific factors. Residents conduct follow-up with patients, including new start patients, to monitor tolerance to treatment. They become proficient in medication initiation, titration, and discontinuation; laboratory monitoring; and educating patients.
Oncology - Oral
- Location: The Specialty Oral Oncology pharmacists provide pharmacy services in the outpatient Medical Oncology Clinic from 0700 – 1800, Monday – Friday. The two pharmacists work under a collaborative practice agreement with medical oncology, hematologic oncology, and gynecologic oncology providers to conduct comprehensive medication management of patients receiving oral oncolytics. They also coordinate medication dispensing with the Billings Clinic Specialty Pharmacy or other specialty pharmacies, depending upon the medication.
- Residents see patients in clinic with the oncology pharmacist and providers. They are involved with in-person, virtual, and telephonic visits with patients. Residents interview patients, conduct medication profile reviews, and make therapy recommendations based on evidence-based guidelines and patient-specific factors. Residents conduct follow-up with patients, including new start patients, to monitor tolerance and adherence to treatment. They become proficient in oral oncology medication review, dose titration, and discontinuation; laboratory monitoring; side effect monitoring and management; and patient education.
Pediatrics
- Location: The Pediatric Clinical Pharmacist Specialist provides pharmacy services in the outpatient Pediatric Specialty Clinic from 0730 – 1600, Monday – Friday. The pharmacist conducts comprehensive medication management of patients initiating and continuing specialty medications for various pediatric disease states (e.g., pulmonology/cystic fibrosis, neurology/muscular dystrophy, endocrinology, cardiology, hematology/oncology, gastrointestinal, pediatric infusions, and pharmacogenomics) through a collaborative practice agreement. The Pediatric Clinical Pharmacist Specialist also coordinates medication dispensing with the Billings Clinic Specialty Pharmacy or another approved specialty pharmacy, depending upon the medication.
- Residents see patients in clinic with the pediatric pharmacist and providers, depending upon the visit type. They will be involved with in-person, virtual, and telephone visits with patients. Residents will work up patients, conduct patient and parent interviews, conduct medication profile reviews, and make therapy recommendations based on evidence-based guidelines and patient-specific factors. They become skilled in utilization of pediatric specific resources; pediatric medication initiation, titration, and discontinuation; laboratory monitoring; side effect monitoring and management; and providing education to patients and caregivers.
Specialty Pharmacy
- Location: Billings Clinic Specialty Pharmacy (BCSP) is located a few blocks from the downtown campus (Broadwater building). The pharmacy provides high quality pharmacy care of chronic, rare, or complex conditions that require specialty medications. Specialty medications typically require special handling, administration, or monitoring beyond that which a traditional retail pharmacy can provide. The pharmacists counsel patients, conduct medication therapy management (MTM) consultations, and ensure appropriate dosing and monitoring of specialty medications. BCSP dispenses and monitors specialty medications for a variety of conditions, including cancer, cystic fibrosis, hepatitis C, hyperlipidemia, multiple sclerosis, and much more. Pharmacists working at the BCSP complete both dispensing and clinical monitoring of specialty medications, depending upon their shift.
- Residents work with the pharmacists to complete their clinical and dispensing duties. They may also conduct risk assessment; therapy management; and formulary reviews of different specialty medications. Residents interview patients, conduct medication profile reviews, and make therapy recommendations. They become proficient in medication review, laboratory monitoring, patient counseling, and care coordination.
Other Experiences (Required)
Orientation: 5 Weeks
- Orientation is one of the first learning experiences for all PGY1 pharmacy residents. It is started simultaneously with the Drug Information – Concentrated rotation and consists of regular meetings between the Residency Program Director and residents. Orientation focuses on educating residents on policies, procedures, expectations, schedules, and project requirements; determining each resident’s individual professional experiences to-date and developing goals and a customized development plan for residency; discussing PharmAcademic™ (electronic evaluation system); and familiarizing the residents with Billings Clinic and the Pharmacy Department.
Pharmacy Practice: 6 Weeks
- Pharmacy Practice is centered in the outpatient Atrium Pharmacy, which is the only 24-hour pharmacy in Billings and is located within Billings Clinic hospital. Pharmacist coverage in the Atrium Pharmacy is provided by four pharmacists on weekdays and two pharmacists on weekends. Weekday coverage is provided by Atrium pharmacists from 0600 – 2230, and weekend coverage is provided from 0700 – 2130. After hours coverage is provided by the inpatient night pharmacists and outpatient night pharmacy technician. On weekdays, there are also pharmacist shifts that provide Meds-to-Beds discharge prescription service and Medication Therapy Management (MTM).
- Pharmacy Practice is the second learning experience for all PGY1 pharmacy residents and starts after the Orientation and the Drug Information – Concentrated rotations. Residents become confident in the use of pharmacy information systems, evaluation of prescriptions, and the utilization of the integrated dispensing system. Residents develop sufficient skills in dispensing, prescription and insurance coverage troubleshooting, workflow management, patient counseling, and provider interaction. They learn relevant policies and procedures, so they can function appropriately within the pharmacy during their longitudinal staffing shifts.
Drug Information - Longitudinal: 12 Months
- Drug Information (DI) has two components: a 5 -week concentrated rotation followed by a longitudinal component throughout the remainder of the residency year.
- The DI Concentrated rotation runs concurrently with the Orientation rotation and is stretched throughout the first 5 weeks of residency. It consists of weekly meetings between the preceptor, Residency Program Director, and residents. The DI Concentrated rotation focuses on the skills necessary for formulating written DI responses. Residents also learn to lead professional journal article discussions and gain experience presenting on different drug information topics.
- The DI Longitudinal experience is a continuation and augmentation of concepts introduced in the DI Concentrated rotation. Residents advance their ability to critically evaluate literature and its application to practice; provide timely and accurate drug information responses to providers, nurses, other interested healthcare professionals, and patients; lead professional discussions on journal articles; and have topic discussions on literature evaluation and biostatistics in an effort to prepare to successfully pass the Board of Pharmaceutical Specialties’ Pharmacotherapy examination following the completion of the residency year.
Pharmacy Academia - Longitudinal: 12 Months
- Pharmacy Academia is a multi-faceted experience aimed to prepare residents to effectively educate others. Residents are involved in a variety of teaching activities throughout their year including didactic lectures; literature presentations; in-services; patient case presentations; topic discussions; and other types of education for patients, providers, and other healthcare professionals. Residents present lectures at Pharmacy Grand Rounds (twice), which is a community-wide continuing education program. Similarly, residents present once each at Nursing Grand Rounds and Physician Grand Rounds (internal continuing education programs) and are guest lecturers for the Rocky Mountain College Master of Physician Assistant Studies program. Additionally, residents gain experience with precepting and mentoring student pharmacists during their experiential rotations at Billings Clinic. Residents serve as resources for the student pharmacists and provide guidance, if needed, with presentations, projects, drug information responses, medication use evaluations, and much more. During times in the year, residents may be assigned as the primary preceptor for student pharmacists. Residents also have the opportunity to obtain the ASHP Teaching Certificate for Pharmacists.
Pharmacy Administration - Longitudinal: 9 - 10 Months
- Pharmacy Administration focuses on developing residents as leaders, improving their project management skills, and providing them with exposure to various pharmacist administrative roles as well as instituting departmental and organizational changes. Residents work closely with the preceptor and other members of the Pharmacy Leadership team to implement positive changes in the medication-use process through committee meeting attendance; observation of relevant activities; drug monographs/formulary reviews; conducting medication use evaluations; reviewing medication errors; and developing/updating clinically-oriented policies, protocols, guidelines, pathways, or electronic order sets. They gain exposure to different aspects of pharmacy operations and the medication-use system, including clinical programs, budgeting, staffing, evaluations, formulary and inventory management, renovations, regulatory compliance, and much more.
Research - Longitudinal: 12 Months
- Research focuses on helping residents develop and complete at least one major project (typically research) on some element of pharmacy practice, utilizing the support and guidance of experienced project advisors. Residents are provided direction through each step of their projects, including the Institutional Review Board approval process and completion of project manuscripts. The primary purpose of the learning experience is to provide residents with experience in development, implementation, analysis, and presentation of a major project. Residents gain skills in project management and team leadership. Projects should be feasible, interesting, novel, ethical, and relevant. Projects may be each resident’s own choice or selected from a list of potential projects compiled by the program. All research projects have a pharmacist preceptor as the primary co-investigator but often have 3 – 4 members composing the research team. To help residents prepare, they participate in discussions on research-related topics with the Residency Program Director (RPD) during their Orientation rotation. Residents present their initial project background and methodology at ASHP Midyear Clinical Meeting in December (poster format) and formally present their results at the Montana Pharmacy Association Spring Seminar in April and Mountain States Conference in May. Prior to the end of the residency program, residents are required to submit a final project manuscript of publishable form to their project teams and the RPD.
Process Improvement - Longitudinal: 3 - 6 Months
- The Pre- and Post-Intervention Project is a required longitudinal learning experience that lasts approximately 3 – 6 months. During the year, residents develop and complete at least one project that includes implementing a change (e.g., protocol, process improvement) and assessing data pre- and post-implementation of the change. This is a separate project from the residents’ research/major project and is typically smaller in scope. It also differs from the residents’ medication use evaluations (MUEs). The primary purpose of the Pre- and Post-Intervention Project learning experience is to provide residents with the skills necessary to identify opportunities for improvement within the medication-use system and subsequently design, implement, and assess changes therein. Residents gain skills in project management and team leadership. Usually, residents’ Pre- and Post-Intervention projects are focused within the Pharmacy Department, but residents may work on interdepartmental projects. Projects should be feasible, relevant, and based on best-practice standards. All projects have a primary pharmacist preceptor but typically include a team of 2 – 3 people.
Staffing - Longitudinal: 9 Months
- Staffing is a continuation and augmentation of concepts introduced in the Pharmacy Practice rotation. The focus of the Staffing longitudinal learning experience is on the provision of outpatient pharmacist services in the Atrium Pharmacy. Specifically, the experience incorporates prescription processing (including insurance troubleshooting), medication dispensing, workflow management, patient counseling, provider interaction, and as well as clinical pharmacy services. Since a primary goal of the learning experience is to develop the residents’ abilities to practice all aspects of patient are independently, residents are required to staff approximately every third weekend. Residents will work a mix of early (0700 – 1730) and late (1100 – 2130) shifts. Residents also staff one holiday (usually New Year’s Day or Memorial Day). Residents are allotted one day off (typically Mondays or Fridays) for working their weekends.
Educational Goals and Objectives
Billings Clinic has selected the following educational competency areas:
- R1: Patient Care
- R2: Advancing Practice and Improving Patient Care
- R3: Leadership and Management
- R4: Teaching, Education, and Dissemination of Knowledge
Competency areas R1 through R4 are required for all ASHP-accredited PGY1 pharmacy residency programs. For more information about the ASHP PGY1 pharmacy residency program educational competency areas or the specific goals and objectives under each competency area, please visit the ASHP website.
