Pharmacy Services

Pharmacy Services Residency

Internal Medicine I

 (PGY1 Rotation - Acute Care 1st Rotation)


Jennifer Babin, PharmD, BCPS
Ashley Crosby, PharmD, BCPS
Amanda Gallegos, PharmD, BCPS
Adya Mishra, PharmD, BCPS
Katie Nighorn Scerbo, PharmD
Heather Nyman, PharmD, BCPS
Kristine Ferreira, PharmD, BCPS – in training

Site Description:

The internal medicine service at the University of Utah Hospital currently consists of six teams, with potential to expand to seven teams in the near future. Four teams consist of an attending, resident, two intern physicians and medical students. The other two teams are composed of an attending and advanced practice clinician (either a physician assistant or nurse practitioner). Each internal medicine team consists of up to 22 patients with a total census of up to 135 internal medicine patients throughout the hospital. The majority of internal medicine patients are located on one of three internal medicine units (AIMA, AIMB, or WP5), however patients can be located throughout the hospital. Common reasons for admission include infection, coagulopathies, pulmonary dysfunction, liver dysfunction, and renal failure. Patients often present with multiple disease states and complicated drug regimens.

Role of the pharmacist:

The Internal Medicine pharmacist functions as part of a multidisciplinary team. Primary responsibilities include daily review of medication profiles, patient educations, reconciliation of home medications and improving medication dosing and utilization in all patients.

Resident Expectations:

Residents contribute to patient care by monitoring patients, reviewing med recs, making recommendations to the medical team to improve care, and by facilitating the delivery of medications. Residents will round with one of the internal medicine teams and will be expected to serve as that team’s pharmacist. Residents are expected to come in early enough to be able work up assigned patients prior to rounds. Residents are expected to follow through on patient care recommendations and monitoring tasks daily prior to leaving rotation. Residents are expected to participate in handoffs.

Residents are expected to prepare presentations or drafts by the due date for review by the preceptor. Presentations include daily patient presentations, bi-weekly topic discussion, weekly formal case presentations, one journal club, and one educational presentation/in-service.

Activities Evaluated and Taught:

RLS Objective

Rotation Activity

Teaching Method

Goal R1.1 In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple co-morbidities, high-risk medication regiments, and multiple medications following a consistent patient care process

OBJ R1.1.1 Interact effectively with health care teams to manage patients’ medication therapy

Residents will act as an effective member of the medication-use safety team to ensure the safety and welfare of the patient. Examples: assisting physicians with medication dosing/route, assisting nursing staff with questions such as IV compatibility.

Residents will round daily with one of six internal medicine teams. Residents will have the option of rounding with the preceptor the first day but will round independently for the remainder of the rotation, which will allow the resident to establish a collaborative, professional relationship with members of their medical team. The number of patients will vary daily, but each internal medicine team can have a maximum of 22 patients.

Direct Instruction

OBJ R1.1.2 Interact effectively with patients, family members, and caregivers

Residents will complete admission medication histories, provide anticoagulation educations and provide medication counseling to patients and their families when appropriate.


OBJ R1.1.4 Analyze and assess information on which to base safe and effective medication therapy

Residents will take into account each patient’s comorbidities, allergies, weight, laboratory values, vitals, renal function, hepatic function, and current medications prior to recommending a new drug therapy.

Modeling, Coaching, Facilitation

OBJ R1.1.5 Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)

Residents will adjust medication recommendations based on changes in patient’s conditions (ie. SCr, BP, BG, drug levels, labs, cultures)


OBJ R1.1.7 Document direct patient care activities appropriately in the medical record or where appropriate

Residents will document anticoagulation educations, medication histories, pain management, iVents or Handoffs, and pharmacokinetic notes (when applicable) on patients.

Direct Instruction

OBJ R1.1.8 Demonstrate responsibility to patients

Residents will evaluate each patient thoroughly and follow-up on recommendations and medication management of the patient throughout the day.


Goal R1.2 Ensure continuity of care during patient transitions between care settings

OBJ R1.2.1 Manage transitions of care effectively

Residents will update pharmacy pass-off notes daily to ensure continuity of care during transitions of care. If information needs to be communicated in a timely manner, resident will call or page the new pharmacist with the information. Residents will also review patient’s discharge medication list to ensure proper medications are continued or stopped upon discharge.


Goal R3.1 Demonstrate leadership skills

OBJ R3.1.1 Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership

Residents will make recommendations during rounds after formulating evidence-based therapeutic regimens for all patients on their internal medicine team. Residents will present patients to the preceptor daily and make follow-up recommendations with their internal medicine team if needed after rounds.


Project Description:

  1. Case presentation (weekly)
    • Patient presentation in SOAP note format
    • Topic presentation that focuses on a specific disease state relevant to a patient
    • Formal hand-out and presentation
  2. Topic discussion (weekly)
    • Formal hand-out and presentation
    • Examples of topics: AKI, alcoholic hepatitis, anemia, pneumonia
  3. Journal Club (1)
    • Topic must be related to internal medicine
    • Article published within the last year
    • Likely to impact patient care
    • Formal hand-out and presentation
  4. Inservice presentation (1)
    • Examples of past topics include: DVT prophylaxis, insulin review, bowel regimens, overview of QTc prolonging medications, antibiotic coverage, overview of NOACs
    • Formal hand-out and presentation

Typical Daily/Weekly/Monthly Activities:

A typical day will be 0700-1530 but additional hours are usually necessary to complete projects, readings for topic discussions, journal club and attend meetings.

  • 0700-0900 Round preparation- patient monitoring and med reconciliations
  • 0900-1200 Internal medicine rounds
  • 1300-1400 Patient presentations- identify and resolve follow-up issues with medical team
  • 1400-1500 Topic discussion with preceptor
  • 1500 + Additional time to work on medication reconciliations, projects, topic discussions and resolve any remaining follow-up issues with medical team


The resident will receive feedback on their progress each day as they discuss patients with the preceptor. The preceptor will provide formative feedback for case presentations, journal clubs and in-service. There will be a snapshot of their progress at 2 weeks and a summative evaluation of strengths, areas for development, and specific feedback to take to the next rotation. A formal final summative evaluation will occur on the last day of rotation.

Updated September 2017