Frequently Asked Questions - VA Nebraska-Western Iowa Health Care System
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VA Nebraska-Western Iowa Health Care System

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Frequently Asked Questions

Application and Interview Questions

How many pharmacy residents are there each year?
- 2 PGY1 positions
- 1 PGY2 Ambulatory Care position
- The three residents share an office space and work on a variety of projects together throughout the year

How do I apply?
Please see link below for more information regarding the application process.
     - Application Information

Requirements
     - US citizen
     - Doctor of Pharmacy Degree from ACPE-Accredited School of pharmacy
     - Eligible for pharmacist licensure in the US or District of Columbia
     - Minimum GPA of 3.0 or above during didactic pharmacy coursework. For schools with pass/fail grading approach, all courses must be listed as ‘pass’ with no repeated courses.

Applications are completed online through PhORCAS, the web-based pharmacy residency application system, which opens in November. Candidates should include a letter of intent, transcripts from their College of Pharmacy, and three references.

Specifications for PGY2 candidates:
     - Of the three submitted references, one should be from PGY1 RPD
     - Supplemental Requirement: Include a PDF of PharmAcademic evaluation from an Ambulatory Care rotation (preferably a primary care, PACT or medical home model clinic) completed during PGY1 year
     - Upon completion of PGY1, provide proof of graduation from ASHP-accredited PGY1 pharmacy residency program

Are PGY1 residents eligible for early commitment to the PGY2 program?
- Eligibility: Residents currently completing a PGY1 program within the NWIHCS (Omaha, Lincoln or Grand Island campuses).
- PGY1 and PGY2 programs must be completed in consecutive years.
- Applications: Candidates will provide letter of intent, CV, letter of recommendation forms from PACT preceptor and RPD. Applications submitted directly to RPD and are due in November.
     - Candidates must complete at least one PACT (primary care) rotation prior to application
- Notification: ASHP’s deadline for early commitment notification is in mid-December.

What will the format of the interview be this year?
Virtual interviews will be available with our pharmacy team. We anticipate video participation through Microsoft Teams (or other platform) so that candidates will have the opportunity to meet and interview with many of our pharmacy preceptors. Prior to the video interviews, a ‘test’ call will be conducted to ensure any technological glitches have been resolved. At this time, we cannot guarantee onsite interviews will be available. As we approach interviews in February, the situation will be re-evaluated to determine if candidates can safely be interviewed in person.

What should I expect during the interview?
The interview day consists of meeting with the residency program director, members of the management team, preceptors, and current residents. Candidates may be required to present a brief oral presentation and/or discuss a clinical case with an interview panel. Interview days may be conducted with more than one candidate at a time, however all actual interview panels will be conducted individually.

Program Questions

What are the strengths of this program?
-
Well-developed clinics – Pharmacy practice is rather progressive within the VA system and at this facility. Pharmacists have a general scope of practice (versus disease specific) and practice using the entire spectrum of that scope. Pharmacists routinely manage diabetes, hypertension, hyperlipidemia, polypharmacy, hyper/hypothyroidism, tobacco cessation, COPD, CHF, and other disease states. The pharmacy department continually works to evaluate the services we provide and expand into new areas as able. This year, our PGY2 resident is working on a project that will expand the role of gout management within the PACT setting, which is another example of a disease state that is covered by a pharmacist’s scope.

- Large volume of patients – We have three pharmacy clinics onsite, each with three primary care providers. On most days, a PACT pharmacist cares for 10-14 patients in our face-to-face, phone, and video clinics. Despite COVID, we have been able to maintain about half of our face-to-face visits, which helps foster relationship building, communication skills, and clinical assessment.

- The Community Living Center (CLC) provides sub-acute/step-down care for patients discharging from more acute settings. Not every VA has a CLC and Grand Island is the only campus with the NWI health care system that has a Community Living Center. In this unique environment, pharmacists are a part of a varied interdisciplinary team including providers, nursing, social work, and dieticians. The medical team rounds daily. Since the length of stay is longer compared with a more traditional acute care setting, pharmacists/residents have the opportunity to get to know the patients better and manage not only the acute needs, but also chronic diseases. Residents also gain experience in hospice/palliative care, managing medical, physical and emotional needs at the end of life.

- Autonomy – Because of our high-volume clinics, residents have many opportunities for direct patient care early in the year. This repetition and experience leads to increased autonomy for our residents earlier on in their training. A goal of this program is to help residents develop into confident practitioners who are able to critically think through situations and independently develop assessments/plans.

- Engagement from the preceptors – Many of our preceptors have been a part of this program for 10 or more years. We have a close-knit pharmacy team which has helped develop a positive work culture. Preceptors are truly invested in our residents and are very experienced in their areas of practice. We are able to provide a supportive environment for our residents in all areas of pharmacy practice. This family-like community extends beyond just pharmacy – our nurses and providers are also invested in our residents and consistently seek out our trainees for clinical input. The turnover of employees at this facility is very low; once staff start their careers in Grand Island, they tend to stay because of this small-town, tight-knit feel at work.

Is a teaching certificate program available?
Yes, through Creighton University. Completion is optional; however most residents choose to participate. The program starts in August and runs longitudinally throughout the year.

What types of projects do the residents complete throughout the year?
- Research or Quality improvement project
- PGY1: Inverse project model (pick up where last years’ residents left off and complete by January 1st, then develop a new topic to start for next year’s class)
- PGY2: This project usually relates to an expansion or development of a new ambulatory care service (for example, our PGY2 resident this year is working on expanding the role of gout management with the primary care setting)
     - MUE
     - Management-related projects
     - Group Patient Presentations
     - Journal Clubs
     - Newsletter
     - Clinical Pearls
     - Nursing/Provider Presentations

How many core and elective rotations are there?
The residency year consists of longitudinal experiences that run all year, along with rotations that are typically 4-weeks in length. At the beginning of the year, residents will participate in orientation for the first few weeks before operational and clinical rotations begin.
- PGY1 – 4 electives, 1 of which is non-direct patient care
- PGY2 – 3-4 elective blocks

Are all rotations at the Grand Island VA?
- PGY1s – While all required rotations are based in Grand Island, there are some elective opportunities at other VA sites within the NWI system, including Omaha, Lincoln, and North Platte.
- PGY2 – The PGY2 program is designated as multi-site. Residents will be required to complete a rotation at the North Platte satellite clinic (housing subject to availability) and at the Omaha campus in the Pain/Whole Health Clinic (housing is not provided). Residents may elect to complete an additional 8 weeks away from the primary campus in Grand Island, however housing is not provided.
- We continue to explore opportunities that can be completed virtually to minimize travel time and housing expenses.

Do residents need to have a Nebraska pharmacist license?
No, residents may obtain pharmacist licensure in any of the 50 U.S. states or District of Columbia by October 1st

Can residents earn extra income through dual appointment?
-
PGY1 – No, however residents can choose to moonlight outside of the VA (must be licensed in Nebraska). Duty hours, including moonlighting hours, are tracked monthly, per ASHP.
- PGY2 – Yes. PGY2 residents can apply for dual appointment through the VA. During dual appointment, residents will earn pharmacist wages for their time working on processing pending prescriptions, therapeutic interchanges, conversions or other pharmacy initiatives.

What are the staffing requirements?
-
The Grand Island VA pharmacy is currently open 8:00-5:00 Monday, Wednesday, Thursday and Friday with extended hours on Tuesdays, 8:00-6:30.
- PGY1 residents will be required to staff in pharmacy about 20-25 hours per month. Hours are subject to change based on the needs and hours of the facility.
- As above, PGY2 residents may use their dual appointment for staffing. Hours are completed from the VA campus, but are flexible and do not need to be completed during pharmacy’s normal business hours.

Will I have the opportunity to precept college of pharmacy students?
The Grand Island VA serves as a rotation site for local college of pharmacy students, such as students from UNMC. Precepting is incorporated into clinical rotations when students are on site. There are also opportunities for the PGY2 resident to help precept the PGY1s.

How is progress tracked and feedback provided throughout the year?
Feedback is provided both in person, as well as through PharmAcademic. At the beginning of a rotation, residents are given a list of goals and objectives to meet. The rotation preceptor will work with residents to make sure they are progressing appropriately and will give feedback at the midpoint/conclusion of the rotation, as well as informally throughout. Regarding progress, residents meet with the RPD quarterly to discuss their overall progress. If issues arise, these will be communicated to the resident prior to the quarterly meeting. Residents also meet with the RPD for a monthly check in, at which time progress can also be discussed.

Do the residents have a designated office space?
Yes, the PGY1/PGY2 residents share a private office on the 5th floor of the hospital

What kinds of jobs have former residents taken?
- Please see this link for more information: Former and Current Residents
- PGY1 – The PGY1 program is flexible and diverse. Graduates have entered most any area of pharmacy practice. From ambulatory care to inpatient; from infectious disease to management – the well-rounded experience prepares graduates for any avenue. During the quarterly meetings with the RPD, we discuss career goals and job prospects. If needed, we will adjust the schedule to ensure residents are fully prepared for the next avenue.
- PGY2 – Last year was the first year of this program – we were very fortunate to keep our inaugural PGY2 graduate within our healthcare system as a pain management specialist in Omaha. As we continue to expand pharmacists’ role in specialty care, we will work with our residents to ensure exposure to areas of interest in the hopes of preparing them for desired areas of practice following completion of residency.
- Grand Island has bike trails throughout the community and several parks as well. There are 3 golf courses in town, in addition to small lakes, rivers and other outdoor attractions.

What do you look for in a resident?
Flexibility and initiative are keys for success. Our residents are involved in a variety of experiences throughout the year, so we consistently look for self-starters who will take the reins on their learning and project deadlines. We also look for individuals who have a solid base of clinical knowledge, good communication skills, and those who are enthusiastic about our population and the experiences we can provide. Those looking for a close-knit, family feel in a progressive pharmacy setting will do well in this environment.

What major changes do you anticipate in the coming year?
- PGY1 – In an effort to insure a very general and flexible year, we are decreasing from three required PACT (primary care clinics) rotations down to two required rotations. Residents can choose to complete a third PACT rotation as an elective. As a result of this change, residents will now have four elective opportunities. One elective will be a non-direct patient care experience (i.e. residency management, infusion, academia, home-based primary care, academic detailing, patient/medication safety). This will help ensure residents have some flexibility in elective choices, while maintaining a general experience to prepare graduates for any avenue of pharmacy practice.
- PGY2 – We are in our second year of this program, so we continue to develop our opportunities available for advanced experiences in ambulatory care.  We are working with our specialty clinics at the Omaha VA as we continue to push pharmacy practice into new areas. In the coming year, we anticipate further developing our role and coordinating opportunities with multiple specialty clinics to insure a robust experience.

What is there to do in Grand Island NE?
Grand Island is a smaller community of about 50,000 but has recently grown in amenities available for young professionals. The downtown area has come alive with unique eats, bars, boutiques, and lofts. Grand Island has three local breweries, plus there are several vineyards in the area. Thursday trivia night at Prairie Pride Brewery has been a resident favorite the past several years. Lincoln, the state’s capital, is a short 90-minute drive away. Also, the state fair is held in Grand Island, which has been a fun activity for residents to attend in the past.