Transcription

NORTH MEMORIAL HEALTHDEPARTMENT OF PHARMACY SERVICESPGY-1 ASHP AccreditedPharmacy Residency ProgramResidency Candidate Guide2021-2022

TABLE OF CONTENTSSECTION I: IntroductionA. About North MemorialB. Contact Information34SECTION II:A.B.C.D.E.F.G.H.FoundationPurpose and PhilosophyRecruitment & Selection of ResidentsIndividualized Plan DevelopmentProgram Competency AreasProgram Goals and ObjectivesProgram StructureResidency Advisory CouncilPreceptors5566791011SECTION III:A.B.C.D.E.F.G.H.I.J.K.Human ResourcesSalary and BenefitsMeeting ReimbursementTime OffEmploymentPharmacy License & VerificationVaccinationsDuty-Hour RequirementsExternal Employment (Moonlighting)Leave of AbsenceDisciplinary Action and DismissalDress Code1212121212121313131414SECTION IV:A.B.C.Activities and RequirementsResidency Experiences and ActivitiesRequirement for CompletionResidency Project151718SECTION V:A.B.C.D.E.Development and EvaluationRotation Learning Education DescriptionRotation DevelopmentPreceptor RolesResident and Residency Program EvaluationsEvaluation Responsibilities1818191920APPENDICIESA. Resident Requirement Tracking FormB. Resident Experience, Skills, Interest Inventoryand Biography2last updated 7/2021

SECTION I: INTRODUCTIONA. About North MemorialFor more than 50 years, North Memorial has served the Twin Cities area with compassionatecare. Today, North Memorial Health is a Level I Trauma Center and the largest independenthealth care system in the Twin Cities. We are affiliated with Maple Grove Hospital in MapleGrove, MN. North Memorial is a comprehensive stroke center and a recipient of the Elite StrokeCare Award from the American Heart and American Stroke Association. North Memorial waslisted as one of just 11 hospitals in Minnesota to rank in the top 10 percent for patient safety inthe U.S. Affiliated with the University of Minnesota's Family Practice Resident Program andCollege of Pharmacy, North Memorial offers a wide array of comprehensive inpatient andoutpatient services from birth through adulthood. Pharmacy practice is decentralized, utilizes anelectronic medical record (EPIC ), and employs automated dispensing cabinets to dispense themajority of medication doses. The entire pharmacy department was completely remodeled in2015.North Memorial Health consists of: North Memorial Health, a Level I Trauma Center and certified primary stroke centerNorth Memorial Ambulance, a CAAS accredited service that currently provides the majority ofambulance and emergency care for the northwest corridor of the Twin Cities metro area and portions ofgreater Minnesota and western Wisconsin North Memorial also operates one of the largest hospital-basedambulance services in the country with eight helicopters and 115 ground ambulancesNorth Memorial Air Care, with flight crews based in Lakeville, Bemidji, Brainerd, Princeton andRedwood Falls, MN; as well as Siren, WI.North Memorial Clinics, with 13 primary care locations throughout the northwestern Twin Cities metroareaNorth Memorial Heart & Vascular Institute, providing a full continuum of cardiac and vascular care topatients throughout Minnesota and western Wisconsin.Humphrey Cancer Center, a comprehensive cancer center in Robbinsdale.Hope Chest Breast Center of North Memorial, a comprehensive breast center in Robbinsdale.Key Facts Founded: 1954 Number of licensed beds: 518 Number of Employees: over 5,000 CMS accredited by Det Norske Veritas (DNV)3last updated 7/2021

The North Memorial Mission, Vision and ValuesMission statement of North Memorial: “Empowering our customers to achieve their best health”Vision statement of North Memorial: “Together, health care the way it ought to be”’Values of North Memorial:Inventiveness: We believe in solving problems creatively and thinking differently aboutwhat is possible. We are empowered to think in new ways and contribute to positive change in our organizationWe anticipate customer needs and find innovative solutions.We see challenges and change as opportunities to learnWe embrace changeWe work in an environment where risking failure is acceptable when exploring new and better waysto serve our customers while continue to practice evidence-based care.Accountability: We believe every team member is empowered to meet our customers'needs including helping them make choices about their health. We understand our individual roles and take responsibility for meeting the diverse needs of ourcustomersWe are empowered to help customers make choices about their care.We set high performance expectations and hold ourselves and our teams responsible for the quality ofour work and the results we achieve as a system.We accept our mistakes and learn from themWe show up every day ready to do our best because we understand that together we are better thanthe sum of our parts.Relationships: We create engagement with customers and team members through strongcommunication, partnering and respectful interactions. We involve customers in decisions about their health and encourage them to take responsibility forhealthy life choicesWe work with the entire care team to establish shared goals that reflect the customer priorities.We promote open dialogue and share knowledge with our customers and team members.We demonstrate respect for customers and fellow team membersWe count on and support one another individually and as part of the team.B. Contact InformationFor more information about North Memorial Healthcare, please access our website al.com/pharmacy-practice-residency/4last updated 7/2021

SECTION II: FOUNDATIONA. Purpose and PhilosophyThe purpose of PGY1 pharmacy residency programs is to build on the Doctor of Pharmacy(Pharm.D.) education and outcomes to contribute to the development of clinical pharmacistsresponsible for medication-related care of patients with a wide range of conditions, eligible forboard certification, and eligible for postgraduate year two (PGY2) pharmacy residency training.Our residency program aims to develop graduate pharmacists into independent pharmaceuticalcare practitioners in acute care settings, potential educators or adjunct faculty, and/or ready forfurther training in PGY2 residency or fellowship programs. Residents interact with a variety ofhealthcare professionals including pharmacists, pharmacy specialists, physicians, medicalresidents, physician assistants, nurse practitioners, respiratory therapists, dieticians, socialworkers and other healthcare professionals. The residency offers a full range of experiences inareas including: Critical Care, Trauma, Cardiovascular, Infectious Diseases,Hematology/Oncology, Psychiatry, Administration/Practice Management, Internal Medicine,Transitions of Care, Neonatal Intensive Care, Nutrition, Emergency Medicine, and Informatics.In addition, residents gain valuable experiences through multidisciplinary rounds, medicationuse evaluations, patient consults, and staffing. Residents will also have the opportunity tocomplete a quality improvement project, precept Doctor of Pharmacy Students on rotations (bothAPPE and IPPE) and provide in-services to pharmacy as well as other health care providers.Residency training also offers other advantages: A competitive advantage in the job market – More and more employers recognizethe value of residency training. A pharmacist who has completed a residency willhave a clear advantage over applicants who have not. Networking opportunities – Many opportunities arise for residents to establish orexpand their network of professional acquaintances and contacts includingpreceptors and other residents. Career planning – While training, most residents gain a clearer picture of what typeof practice best suits them. Residency preceptors are committed to providingpersonal attention to assist each resident in further defining professional goals.The ASHP accreditation standard provides criteria that every program must meet to receive andmaintain accreditation. Working within the required standards and accentuating our strengths,our philosophy is to provide a program that is flexible and tailored to meet the needs of theindividual resident. Our mission is to help develop practitioners who provide compassionate,remarkable pharmaceutical care.B. Recruitment and Selection of ResidentsNorth Memorial Residency Program adheres to the Rules for the ASHP Pharmacy ResidentMatching Program. This residency site agrees that no person at this site will solicit, accept,or use any ranking related information from any residency applicant.Applicants to the pharmacy residency program must be: licensed or be eligible for licensurein MN, have graduated or candidates for graduation from an ACPE accredited School ofPharmacy (or one pursuing accreditation) or have a Foreign Pharmacy GraduateEquivalency Committee (FPGEC) certificate from the National Association of Boards ofPharmacy (NABP) and be a highly motivated pharmacist who desires advanced educationand training. To apply a transcript from the School of Pharmacy, three reference letters,5last updated 7/2021

letter of intent, CV is required. Applications must be received by the January 3rd, 2022deadline to be considered for the residency program beginning July 5th .A standardized, pre-interview assessment tool is used to evaluate the candidates who applyto the residency program. Candidates are ranked based on their pre-interview assessmentscores and applicants will be invited to interview starting with the highest ranked applicantand moving to the lowest ranked applicant until the number of interview slots allocated forthe year is filled. During the interview, candidates will rotate through groups of preceptorsfrom various learning experiences, being asked a series of standard questions in each group.Candidates are scored based on established criteria. After the interview process iscompleted, the interviewers will meet to discuss and evaluate each candidate. A postinterview scoring rubric is used in candidate discussion of applicants fit with the program.The RPD will submit the final rank list to the matching program.If the residency does not match with the allotment of residents, the Phase II interviewprocess will be enacted. Candidates will be required to apply through PhORCAS, with theapplication deadline based on the timeframe of the original process and the specific deadlinedate to be determined at that time. This will likely be set for seven (7) days after the reopening of the application. The same standardized, pre-interview assessment tool will beused to evaluate candidates for an interview. Six (6) video-conference interviews per openresidency spot will be offered starting with the highest ranked applicant moving to thelowest ranked applicant until the number of video-conference interview slots are filled. Thevideo-interview conference will have a similar panel of interviews including RPD, residencycoordinator, clinical pharmacist, leadership representation, and preceptor representation.Interviews will be scored using the same pre-defined process. The RPD will submit the finalrank list to the matching program.C. Individualized Plan DevelopmentDuring the first week of the residency, each resident is required to complete an initial selfassessment form (Experience, Skills, and Interest Inventory). The Residency Program Director(RPD) and resident will review the form together and create a customized residency plan for theup coming year based on the needs and interests of the resident. The plan will be completed bythe end of orientation.The resident will reassess the validity of the plan as part of their overall self-assessments theycomplete every other month. The resident must review the plan with the RPD to determine ifthere should be any changes made. The plan will be reviewed quarterly by preceptors throughPharmAcademic.D. Program Competency AreasCompetency Area R1: Patient CareCompetency Area R2: Advancing Practice and Improving Patient CareCompetency Area R3: Leadership and ManagementCompetency Area R4: Teaching, Education, and Dissemination of KnowledgeCompetency Area E5: Management of Medical Emergencies6last updated 7/2021

E. Program Goals and ObjectivesThe residency program will provide each resident with specific learning/practice experiencesdesigned to enable the resident to expand the scope of his/her practice skills. These experienceswill be varied in nature, but with an overall emphasis on patient care and the pharmacist’sresponsibility to providing safe and effective patient outcomes related to pharmacotherapy.Specific educational goals for our PGY1 pharmacy practice residency are:Patient CareGoal R1.1:In collaboration with the health care team, provide safe and effective patientcare to a diverse range of patients, including those with multiple co-morbidities,high-risk medication regimens, and multiple medications following a consistentpatient care process.*Objective R1.1.1: (Applying) Interact effectively with health care teams tomanage patients’ medication therapy.Objective R1.1.2: (Applying) Interact effectively with patients, family members,and caregivers.Objective R1.1.3: (Analyzing) Collect information on which to base safe andeffective medication therapy.*Objective R1.1.4: (Analyzing) Analyze and assess information on which tobase safe and effective medication therapy.*Objective R1.1.5: (Creating) Design or redesign safe and effective patientcentered therapeutic regimens and monitoring plans (care plans).*Objective R1.1.6: (Applying) Ensure implementation of therapeutic regimensand monitoring plans (care plans) by taking appropriate follow-up actions.*Objective R1.1.7: (Applying) Document direct patient care activitiesappropriately in the medical record or where appropriate.Objective R1.1.8: (Applying) Demonstrate responsibility to patientsGoal R1.2:Ensure continuity of care during patient transitions between care settings.Objective R1.2.1: (Applying) Manage transitions of care effectively.Goal R1.3:Prepare, dispense, and manage medications to support safe and effective drugtherapy for patients.*Objective R1.3.1: (Applying) Prepare and dispense medications following bestpractices and the organization’s policies and procedures.Objective R1.3.2: (Applying) Manage aspects of the medication-use processrelated to formulary management.*Objective R1.3.3: (Applying) Mange aspects of the medication-use processrelated to oversight of dispensing.Advancing Practice and Improving Patient CareGoal R2.1Demonstrate ability to manage formulary and medication-use processes, asapplicable to the organization.Objective R2.1.1: (Creating) Prepare a drug class review, monograph, treatmentguideline, or protocol.Objective R2.1.2: (Applying) Participate in a medication-use evaluation.Objective R2.1.3: (Analyzing) Identify opportunities for improvement of themedication-use system.Objective R2.1.4: (Applying) Participate in medication event reporting andmonitoring.7last updated 7/2021

Goal R2.2:Demonstrate ability to evaluate and investigate practice, review data, andassimilate scientific evidence to improve patient care and/or the medication-usesystemObjective R2.2.1: (Analyzing) Identify changes needed to improve patient careand/or the medication-use system.Objective R2.2.2: (Creating) Develop a plan to improve patient care and/or themedication-use system.Objective R2.2.3: (Applying) Implement changes to improve patient care and/orthe medication-use system.Objective R2.2.4: (Evaluating) Assess changes made to improve patient care orthe medication-use system.*Objective R2.2.5: (Creating) Effectively develop and present, orally and inwriting, a final project report.Leadership and ManagementGoal R3.1:Demonstrate leadership skills.Objective R3.1.1: (Applying) Demonstrate personal, interpersonal, andteamwork skills critical for effective leadership.Objective R3.1.2: (Applying) Apply a process of ongoing self-evaluation andpersonal performance improvement.Goal R3.2:Demonstrate management skills.Objective R3.2.1: (Understanding) Explain factors that influence departmentalplanning.Objective R3.2.2: (Understanding) Explain the elements of the pharmacyenterprise and their relationship to the health care system.Objective R3.2.3: (Applying) Contribute to departmental management.*Objective R3.2.4: (Applying) Manage one’s own practice effectively.Teaching, Education, and Dissemination of KnowledgeGoal R4.1:Provide effective medication and practice-related education to patient,caregivers, health care professionals, students, and the public (individuals andgroups).Objective R4.1.1: (Applying) Design effective educational activities.Objective R4.1.2: (Applying) Use effective presentation and teaching skills todeliver education.Objective R4.1.3: (Applying) Use effective written communication todisseminate knowledge.Objective R4.1.4: (Applying) Appropriately assess effectiveness of education.Goal R4.2:Effectively employ appropriate preceptor roles when engaged in teachingstudents, pharmacy technicians, or fellow health care professionals.Objective R4.2.1: (Analyzing) When engaged in teaching, select a preceptorrole that meets learners’ educational needs.Objective R4.2.2: (Applying) Effectively employ preceptor roles, asappropriate.Management of Medical EmergenciesGoal E5.1:Participate in the management of medical emergencies.*Objective E5.1.1: Exercise skill as a team member in the management ofmedical emergencies according to the organization’s policies.*Denotes those objectives that mustbe “achieved” for successful completion of residency8last updated 7/2021

F. Program StructureRotationsRequired RotationsOrientation (5 weeks)Internal Medicine (4 weeks)Critical Care (8 weeks)Emergency Medicine (4 weeks)Cardiovascular &Anticoagulation (4 weeks)Longitudinal Rotations(Required)Clinical Staff Pharmacist (1 year)Research/Project (1 year)Medication Safety (3 months)Infectious Diseases &Antibiotic Stewardship(4 weeks)Administration (4 weeks) Elective Rotations(2-4 weeks)Healthcare AnalyticsHematology & OncologyNeonatal Intensive CareTransitions of CareGeriatrics, PainManagement, andNutritionInpatient PsychiatryCritical Care IIInfectious Disease IIEmergency Medicine IIMost rotation hours will occur during the day shift except for the emergency departmentrotation and staffing which may involve evening hours. There may be opportunities and/orrotation expectations outside of these hours. The Residency Director or Coordinators willprovide residents with adequate notification of hours prior to these experiences.In general, the elective rotations are 2-4 weeks in length. However, the career goals andinterests of the resident can influence the time spent in elective rotations which is reflectedin the custom plan for each resident.Individualization of the resident schedule based on interests will be accommodated as bestas possible, however no more than 1/3 of the 12-month residency may be in one area.Based on the interests of resident’s additional rotations currently not offered may bedeveloped with the RPD during the resident’s time at North Memorial. The development ofthis elective rotation will only be an option if the resident has satisfactorily progressedthrough all required rotations at North Memorial.Staffing and Service Commitment Basic training (Orientation) will take place during the first 6 weeks of the residency. Each resident will train with a hospital pharmacy practice preceptor as assigned. After the basic training period, the resident program director (RPD), hospital pharmacypractice preceptor and the resident will mutually determine if the resident is ready tofunction independently as a pharmacist based on the Orientation Assessment of Proficiencycriteria and area specific items that may be added. If the resident is not ready to function independently at the conclusion of the training period,the following actions will occur:o A list of deficiencies will be developed by the preceptor and resident.o A specific plan will be outlined by the preceptor and the resident to provideadditional training/experience in the area(s) of weakness.o A copy of this plan will be maintained by the RPD and progress will be re-evaluatedon a weekly basis. Residents will be evaluated by their hospital pharmacy practice preceptors on a quarterlybasis. Residents will generally staff every other weekend on a rotating basis. Hours will be postedon the pharmacist schedule. Staffing hours can be day or evening. The shifts may be 8-10hours in duration depending on the staffing needs of the pharmacy9last updated 7/2021

Holiday staffing: Residents are required to work 3 holidays a year. Holiday shiftsmay include: Thanksgiving, day after Thanksgiving, Christmas Eve, Christmas Day,New Years, 4th of July. If the holiday falls on a scheduled weekend to work, the resident will beexpected to work that weekend. Please note: Christmas Eve and New Year Eve begin at 3 PM. A residentwould be expected to work their regularly scheduled weekend hours duringthe day shifts of these dateso If the resident needs off on his/her weekend to work, it is the resident’sresponsibility to trade with another resident or staff pharmacist who can work theassigned shift. The resident may not give away their shift to a casual or part timepharmacist.The resident will be involved in various service commitments on behalf of the pharmacydepartment. These commitments occur at various parts of the year and may include, but arenot limited to: North Memorial Safety Fair, vaccination clinic.o G. Residency Advisory CouncilNorth Memorial’s Residency Advisory Council (RAC) consists of the RPD, the program corepreceptors, and the current residents. The RAC is chaired by the RPD or designee and will bescheduled to meet on a regular basis. The purpose of the RAC is to offer guidance to theresidency program and maintain adherence to the ASHP Standards. In conjunction with theRPD, the RAC supports the residency with the following: Review, maintain, and assure that the residency program follows current ASHPaccreditation standardsReview the annual Residency Program ManualAnnual review of the qualifications of residency preceptorsAnnual review of residency’s policies, objectives, learning experiencesAssure that the overall residency program goals and specific learning objectives are met,training schedules are maintained, appropriate preceptorship for each rotation is providedand resident evaluations are conductedReview residency applicants’ requirements and participate in the formal review process forevaluation and selection of the incoming resident.Annual review of the incoming resident’s individualized plan for residency, trainingschedule and quarterly reviews the resident’s progress in the residencyEngages in preceptor development /educationConducts corrective action and dismissals as necessary with RPDReviews residency research projects with residents at various stages of development forfeasibility, research design, and presentation.10last updated 7/2021

H. PreceptorsPreceptors at North Memorial are defined in select categories. Each group of preceptors has aunique role in the development of residents and all are vital to the success of our program.Everyone in the pharmacy department brings a slightly different perspective about their rolesand the pharmacy profession which enhances the exposure and learning opportunities of ourresidents. All members of the department of pharmacy are expected to support the residencyprogram. Core Preceptor: core preceptors are the pharmacy professionals who serve as the primarypreceptors for the residency and meet all preceptor requirements of ASHP. Core preceptorsmust spend a significant amount of their time practicing in their identified areas. They mustalso practice in the area of their rotation during the time residents are being trained. Everyrotation has an assigned core preceptor.Core Preceptors will achieve and maintain the standards set in the ASHP PreceptorAcademic and Professional Record. This form will be updated yearly and maintained by theRPD/designee. Core preceptors will develop and maintain the rotation LEDs. Preceptor in Training: a preceptor in training is a pharmacy professional who is in theprocess of completing all preceptor requirements of ASHP and/or assists the core preceptorin select rotations. Staff Preceptor: staff preceptors are all other pharmacy professionals who are not core or apreceptor in training. North Memorial considers them very valuable in the residents learningprocess and they are expected to participate in residency activities. Non-pharmacist Preceptor: non-pharmacist professionals (ex. MD, RT, RD) who interactclosely with the resident during select rotations. Non-pharmacist preceptors are veryimportant in the resident’s development. The non-pharmacist preceptors are expected toassist in the structure of select rotations and assist in resident evaluations.Core PreceptorsAndrea Leo, Pharm.D.Chad Novak, Pharm.D., BCCCPEmily Herstine, Pharm.D., BCPSJames Bischoff, Pharm.D., BCPSMarguax Hamilton, Pharm.D.,Laura Akerman Pharm.D., BCPSLesia Tchobaniouk, Pharm.D.Mike Waldt, Pharm.D., MS., BCSCPNatalie Kravchenko, Pharm.D. BCPSNick Schutz, Pharm.D.Sarah Hayes, Pharm.D., BCOPTamara Berg, Pharm.D., BCPSTodd Burkhardt, Pharm.D., BCPSRotationsNeonatal Intensive Care (NICU)Cardiovascular & AnticoagulationRPD/Infectious Diseases & Antimicrobial Stewardship (I&II)Critical Care (TNICU), Advanced Critical CareInternal MedicineCritical Care (CVICU)Inpatient PsychiatryMedication Safety/AdministrationEmergency Medicine (I&II)Healthcare AnalyticsHematology & OncologyClinical Staff Pharmacist/Transitions of CareGeriatrics, Pain management, & Nutrition11last updated 7/2021

SECTION III: HUMAN RESOURCESA. Salary & BenefitsSalary will be 45,000 for class of 2021-2022. Benefits will be consistent with NMH NonContract Employees.B. Meeting ReimbursementMeeting reimbursement will be completed for conferences required by the residency program. Amaximum of 3,000 annually will be reimbursed. A portion of the 3,000 total reimbursementwill come from NMH Non-Contract Employees benefits.C. Time Off Paid time off (PTO) accrual and paid holidays will be consistent with NMH Non-Contractbenefits. This time can be taken as personal days, vacation days, sick days, holidays andeducational meetings that are outside those sponsored by the residency program. Requests for days off must be emailed to the rotation Preceptor and RPD in advance. Thefinal decision for approval lies with the preceptor. To maximize the residents learning experience in each rotation, residents are limited to 2days off per rotation, under the discretion of the preceptor (this includes sick, holiday orpersonal time off). Absences greater than 5 days per rotation are considered excessive andwill be reviewed by the RPD for impact on successful completion of the rotationrequirements. Pre-scheduled vacations are encouraged and may be accommodated throughadjustment of the resident’s rotation schedule when possible. Residents are able to take up to 9 project days throughout the year. These dates are set on the3rd Monday of each month starting in September (excluding December). A resident has theoption to decline project days and instead participate in an additional day of the assignedrotation in coordination with the preceptor. Residents are expected to be onsite on projectdays unless otherwise arranged with the RPD.D. EmploymentThe residency is 12 months in length beginning July 5th and ending July 5th, unless otherwisearranged with the RPD. Residents are classified as regular, full-time, non-contract employees ofNorth Memorial Health Hospital. The resident is required to comply with the hiring practices ofNMHH and receives orientation through the North Memorial HR Department All pre-employment checks and screening must be completed prior to start date of theresidency candidate unless otherwise arranged with the RPD.E. Pharmacy Licensure & VerificationPharmacy licensure in Minnesota is a requirement for pharmacy practice residents at NMHH.Upon notification of successful completion of the NAPLEX and/or law exam, the resident willprovide documentation of licensure to the residency program director. Failure to obtain Minnesota licensure by August 1st will result in a review of theresident’s status and possible implementation of a remediation program to aid theresident in passing the NAPLEX and/or law exams. The residency program must ensure that a minimum of 2/3 of residency is completed asa pharmacist licensed to practice in the program’s jurisdiction. Failure to obtainMinnesota Pharmacist licensure by October 1 will result in dismissal from the residency.F. VaccinationsResidents will be expected to adhere to immunization requirements of North Memorial. Theseimmunization records include: TB screening, MMR, Varicella, Tdap, Hepatitis B, Influenza.12last updated 7/2021

G. Duty-Hour RequirementsRefer to ASHP Duty-Hour Requirements for Pharmacy s/Pharmacy-Specific-Duty-Hours.pdfDuty hours are defined as all scheduled clinical and academic activities related to the pharmacyresidency program. Duty hours do not include: reading, studying, and academic preparationtime for presentations and journal clubs; travel time to and from conferences; and hours that arenot scheduled by the residency program director or a preceptor.Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive ofall in-hours call activities and moonlighting. Documentation of Duty Hours will be through the RMS system.o www.new-innov.com Documentation of vacation hours will be through NMH MyTime ApplicationH. External Employment (Moonlighting)The resident’s primary professional commitment must be to the residency program. A residencyis a full-time obligation.

PharmAcademic. D. Program Competency Areas . Competency Area R1: Pat ient Care . Competency Area R2: Advancing Practice and Improving Patient Care . Competency Area R3: Leadership and Management . Competency Area R4: Teaching, Education, and Dissemination of Knowledge .