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VA Nebraska-Western Iowa Health Care System

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PGY-1 Pharmacy Residency Program - Lincoln

The VA clinic in Lincoln Nebraska features a strong ambulatory care environment with supportive preceptors and medical staff. VA Lincoln has had clinical pharmacy services since 1984, starting with anticoagulation clinic, later adding “pharmacy clinic” and then adapted the PACT (medical home) model in 2013. Pharmacists are part of an interdisciplinary team and carry a scope of practice which allows them to order medications, laboratory and diagnostic tests, consult other services, and develop therapeutic and monitoring plans for patients. Visits are completed in person, over the phone or via video care. The Lincoln VA pharmacy services include: Primary care (3 PACT clinics), Primacy care remotely to small outpatient clinics (CBOCs) (telehealth to Holdrege and Shenandoah), Anticoagulation clinic for warfarin and DOAC monitoring, Mental health clinic, outpatient infusion and outpatient dispensing pharmacy. We employ 15 pharmacists and three technicians, including a site manager, a PACT pharmacist at our Norfolk campus CBOC, a pharmacoeconomic pharmacist, one 50:50 Creighton faculty professor and a patient safety and data management pharmacist.

PACT pharmacists have a scope of practice for primary care and most commonly manage: COPD/Asthma, Smoking Cessation, Heart Failure, Osteoporosis, Hypertension, Hypothyroidism, Anticoagulation (warfarin and DOACs), OEND and naloxone distribution and hypercholesterolemia. They also provide medication reconciliation, answer e-consult medication questions and complete prior authorization (non-formulary request) approvals or denials. Individual pharmacists manage pain, mental health, and women’s health. 

Services available to Veterans at the Lincoln VA include:

  • Primary Care (~11 providers)
  • Radiology
  • Laboratory
  • Dental
  • Physical therapy
  • Mental Health
  • Dermatology
  • Urology
  • Ophthalmology
  • Wound Care
  • Nutrition and MOVE! Weight loss clinic
  • Respiratory Therapy
  • Whole Health coaching
  • Outpatient dispensing Pharmacy
  • Outpatient infusion clinic

Lincoln VAMC accepted its first two residents the 2011/2012 residency year and was granted accreditation in 2011. We have had 16 graduates of our program, after graduation 13 have been hired for VA positions and 14 were hired in ambulatory care pharmacy with two going on to a PGY2 residency (mental health, and Ambulatory Care). PGY1 Residents at the Lincoln VA can early commit to the PGY2 Amb Care residency program at the Grand Island VAMC.

The Grand Island PGY2 Ambulatory Care residency offers longitudinal rural ambulatory care practice, along with Mental Health, Pain Management/whole health training and academic detailing. Residents will complete electives at any of the 3 campuses in Nebraska and precept PGY1 residents along with APPE students.

Residents have the choice to complete a teaching certificate class offered by Creighton University. This program offers a monthly seminar series throughout the residency year. Participants complete online modules, assess their own teaching experiences and develop a teaching portfolio as a requirement for this certificate. Residents will review pre-recorded lectures and are responsible for creating one month’s topic review, and self-assessment questions. Topics include: 1. Developing a teaching philosophy and portfolio, reflecting on activities, 2. methods to assess student learning (creating and using tools to assess learning and teaching), 3. developing and giving a quality lecture, 4. Precepting role modeling and mentoring, 5. Giving and receiving feedback, 6. Teaching Distance Learners, 7. Facilitating classroom learning: applying adult learning and active learning principles, 8. Writing: From an Idea to Publication, 9. Pharmacy Professional Competency evaluation, Lifelong learning and Academic careers in Pharmacy: What do I need to know?.

Residents other teaching opportunities include co-precepting UNMC and Creighton University APPE students while in primary care MTM clinic, writing articles for pharmacy service’s newsletters, presenting two in-services for VA staff, clinical pearls at pharmacy staff huddles, a journal club and patient case presentation. You may also choose to complete an Academia elective rotation with UNMC or Creighton University.

Residents complete an inverse-order research project. Residents start out the year with data collection from a project started by the previous year’s resident class. This allows the resident to present a completed project at ASHP Midyear Clinical meeting at the Federal Forum on Sunday. Then while at midyear, the residents can view other resident’s projects and take what they have learned about the Lincoln Campus over the first half of the residency year to develop a new research project to start in December. Other research project requirements include a poster presentation at the VA NWI Pharmacists retreat in April, a Power point presentation at the Midwest Pharmacy Residency Conference in May, and a final written manuscript.

Inverted Research Handout

Residents have limited staffing requirements in our outpatient dispensing pharmacy. Residents are required to work every other Wednesday 8am to noon and 4:30 to 6:30pm and Saturdays 8am to noon alternating every other month with one Saturday or Two Saturdays. Residents have office time for projects every other Wednesday noon to 4:30pm.

Residency Certificate Minimum Requirements:

  1. 12 month Full-Time Commitment
  2. Program Goals/Objectives—80% of goals marked as a "5", No goals marked a "1 or 2" by end of the year. (1=entry level student level, 2=student level, 3=entry resident level, 4=resident level, 5=entry pharmacist level)
  3. Completion of all PharmAcademic evaluations
  4. Completion of all assigned projects
    1. Two 30minute or Three 15minute presentations
    2. DUE or MUE
    3. Drug class review, Drug monograph, treatment guideline or protocol.
    4. Clinical pearls (5)
    5. Journal club(1) and patient case (1) presentations
    6. Newsletter article completion of assigned month
    7. Optional teaching certificate program completion (ie if you chose to sign-up for this program, you complete it)
    8. VADERS reporting complete as assigned.
  5. Research/Quality Improvement project completion
    1. Poster Presentation
    2. Written into manuscript format
  6. Satisfactory completion of all required rotations.       If a rotation is not satisfactorily completed, appropriate remedial work must be completed as determined by the preceptors and program director.
  7. Compliance with all institutional and departmental policies.
  8. Final Performance Rating of Fully Successful or better.

*All of the above must be completed with a satisfactory rating, or residents will have to repeat until he or she can demonstrate that he/she can complete the task at a resident appropriate level.


Click here to see our current residents' schedules, rotation descriptions and program design - please note that each schedule is customized based on electives chosen.



Contact

Veronica Kuhlmann, PharmD
Lincoln Residency Program Director
402-489-3802 Ext. 9-6514
veronica.kuhlmann@va.gov