PGY-2 Critical Care Rotations

The Cardiac Surgery rotation is one-month in duration at Morristown Medical Center, known for having the largest cardiac surgery program in New Jersey. The rotation consists of a 14-bed CPACU and 10-bed CVICU that services post-operative cardiac and thoracic patients. The resident will work with a multidisciplinary team that includes but is not limited to cardiac surgeons, intensivists, physician assistants, nurse practitioners, respiratory therapists, and case managers. The resident will be responsible for identifying medication therapy issues and developing pharmacotherapy plans for patients following coronary artery bypass surgery, valve replacement, Maze procedure, and many others.

Emergency Medicine at Morristown Medical Center is a month-long rotation where the CC resident will be exposed to various critical disease processes at the point of entry to the hospital. Through code response (cardiac arrest, STEMI, stroke, trauma) and patient care during critical procedures (RSI, moderate sedation, arrhythmia management) the resident will understand and embody the role of the pharmacist at the bedside. In addition, an emphasis will be made on the importance of transition of care management between the Emergency Department and ICU environments. There will be opportunities to provide education to other disciplines in an academic emergency department that is responsible for the training of emergency medicine physicians, nurses, and pharmacists.

The infectious diseases rotation will take place at Overlook Medical Center or Morristown Medical Center. Residents will follow patients that qualify for antimicrobial stewardship review and participate in interdisciplinary management of various infections. During this rotation, residents will build upon evidence- and guideline-based approaches for the management of common infectious disease conditions and will also perform pharmacokinetic monitoring of antimicrobials.

The Medical Intensive Care I learning experience is a one-month rotation at Overlook Medical Center that focuses on establishing the core concepts of critical care pharmacotherapy.  The resident rounds in a 20-bed MICU with an academic teaching team led by a pulmonary critical care attending.  The resident guides the team in drug selection and dosing, antimicrobial management and stewardship, therapeutic drug monitoring, and drug information.  The resident gains exposure to a wide variety of disease states and topics including sepsis and septic shock, acute respiratory failure (asthma, COPD, acute respiratory distress syndrome), decompensated heart failure and cardiogenic shock, substance withdrawal syndromes, hemodynamics, and many others.  MICUI directs the resident to key landmark trials in critical care medicine and prepares the resident for the advanced MICUII learning experience.

Medical Intensive Care II emphasizes the understanding and management of problems specifically related to critically ill medical patients. Identification of patient problems and application of clinical therapeutics to the critically ill patient will be stressed. Specific topics discussed include hemodynamic and physiologic monitoring, pharmacokinetic monitoring and infectious problems in critically ill patients.  During the critical care rotation, residents will round with the medical team in a 10-bed MICU at Morristown Medical Center.

Transitional critical care is a one-month learning experience at Overlook Medical Center in the medical intensive care unit that prepares the resident for independent practice.  During the final month of training, the resident manages patients on the MICU teaching service without pre- or post-rounding and responds as the sole pharmacist to code blue and code stroke situations.  Preceptors are available for questions or consults, but are not routinely following patients on a daily basis.  The goal is to simulate an environment where the resident becomes accustomed to making decisions on their own.  The resident is also expected to prepare and organize educational topics for medical residents and learners on rotation with the MICU multidisciplinary team.

Surgical Intensive Care Unit I (SICUI) rotation is a month-long learning experience at Morristown Medical Center. The SICU is a 22-bed unit for critically ill trauma and surgery patients. The multidisciplinary team consists of a trauma attending, surgical resident, emergency medicine resident, clinical pharmacy specialist, bedside nurse, and respiratory therapist. The resident will be exposed to a wide variety of disease states commonly encountered in the adult SICU setting and will become familiar with the pharmacokinetics/pharmacodynamics of the drugs used in this setting. Common disease states in which residents will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience may include, but are not limited to traumatic brain injury/intracranial hemorrhage, surgical antimicrobial prophylaxis, surgical infectious complications, nutrition and fluid/electrolytes management.

Trauma/Surgical Intensive Care II (SICUII) rotation is a month-long learning experience at Morristown Medical Center SICU. The resident will continue to be a part of the multidisciplinary team caring for trauma and surgery patients. This rotation will have a larger focus on nutrition in critically ill patients, spending time with SICU dietitian and designing and redesigning nutrition regimens in those patients. 

The cardiology rotation is designed to give residents an opportunity to experience various cardiology and cardiac critical care areas like heart failure and the cardiac care unit (CCU). Responsibilities of this rotation include, but are not limited to, attending rounds daily in the CCU, identification and resolution of any medication-related issues, evaluation of medical regimens for appropriateness and patient counseling. Upon completion of this rotation, residents will better understand the role clinical pharmacists play in the management of acute care cardiology.

The Neurosciences Intensive Care (Neuro-ICU) rotation is a one-month learning experience at Overlook Medical Center, the flagship site of the Atlantic Neuroscience Institute and a designated Comprehensive Stroke Center.  Residents help manage pharmacotherapy for a spectrum of critically ill neurologically injured patients ranging from acute ischemic stroke, ruptured brain aneurysms, intracranial hemorrhage, status epilepticus, post-operative neurosurgical oncology patients and many others.  The resident works collaboratively with a multidisciplinary team of neurosurgeons, neurointensivists, advanced practice providers, and nurses to deliver the highest quality care in our renowned Neuro-ICU.  Residents will focus on drug selection and dosing, identification of drug interactions, therapeutic drug monitoring, and management of drug-related adverse events.

This rotation is designed to provide residents with an understanding of disease states and conditions commonly seen in the pediatric intensive care unit.  Emphasis will be placed on the therapeutic management of pediatric intensive care patients and the unique pharmacological/pharmaceutical requirements of these patients.  This rotation will also provide an opportunity to participate in pediatric emergencies as well as in the management of enteral and parenteral nutrition.  

This month-long learning experience is designed to build upon prior rotation experiences and develop new skills in toxicology through the care of toxicologic patients at the NJ Poison Control Center (PCC), bedside care at MMC ED, and topic discussions. The resident will also be exposed to the role of the PCC in the healthcare and the community. Emphasis will be placed on physical exam and patient evaluation, pharmacodynamics and toxicokinetics, supportive care, and antidote therapy.

The Teaching and Learning Certificate Program affiliated with Rutgers University Ernest Mario School of Pharmacy is a longitudinal experience designed to educate pharmacy professionals on teaching styles and methodology related to multiple facets of didactic and clinical teaching.  Residents attend lectures or seminars with Rutgers faculty on a monthly basis.  They are expected to create their own teaching philosophy, design a rotation, and serve as the primary preceptor for a pharmacy student at their respective sites.  The Teaching and Learning program is an excellent opportunity to network with other pharmacy residents and pharmaceutical industry fellows from across the state of New Jersey.  Residents are encouraged to participate unless they have received a teaching certificate from a different program during their PGY-1 year.

The PGY-2 Critical Care Clinical Staffing rotation is a longitudinal learning experience at Overlook Medical Center consisting of both clinical and operational responsibilities every other weekend throughout the year.  The resident participates in order verification and dispensing activities during the beginning of the program.  As the resident progresses, they prioritize weekend clinical duties including rounding with the medical ICU team and providing pharmacy coverage for Code Blue and Code Stroke situations.  

Practice Management is a longitudinal learning experience designed to hone the resident’s skills beyond direct patient care.  Residents will actively participate in the Critical Care Committee at Overlook Medical Center, complete a medication use evaluation, present a formal lecture for medical residents during their education series, and prepare and present a one-credit hour ACPE-approved continuing education presentation on a critical care topic.  As a result of these experiences, residents will have the opportunity to contribute to critical care practice both within and outside Atlantic Health System.

The research learning experience provides an opportunity for the resident to complete a clinical research project related to critical care medicine. The resident will utilize research skills obtained from PGY-1 residency training to take the lead role executing a longitudinal research project from start to finish. The resident will work with at least one pharmacy research advisor who will guide them through the process of completing the project from study design, Institutional Review Board submission, data collection/analysis, and manuscript preparation. Resident research will be presented locally as well as at the Eastern States Residency Conference and other professional meeting platforms (if applicable). By the end of the residency year, the resident is expected to have a completed research manuscript in submission-ready form for peer-reviewed publication.