By: Mahdieh Danesh Yazdi
Dr. Elizabeth Palillo graduated from the University of Connecticut in 2006. She then worked as a manager at CVS for a year and a half, and eventually moved to New York, where she worked at two other CVS stores. Dr. Palillo then left CVS and joined Bronx-Lebanon Hospital as a staff pharmacist, where she became an IV room manager after six months. She left that position and began working at Beth Israel Medical Center in June of 2010. Dr. Palillo is a currently a clinical pharmacy manager at Beth Israel Medical Center. She also serves as the residency program contact and the pharmacy ambassador.
Q: Please describe the residency program at BIMC.
A: We have four positions every year. The program has been in existence for about 15 years or so at least; so, it is an established program. I am the critical care preceptor, as well as the overall program contact. We have four faculty members from St. John’s University and one faculty member Touro College. Dr. Cohen just joined the emergency department; so, starting next year’s residency, she will be taking residents. Lina [Ngai] (clinical pharmacy manager), I, and others are preceptors. We have an ambulatory care practice, oncology ambulatory care practice, ambulatory care practice through our HIV clinic over at St. Luke’s-Roosevelt (SLR), and then we have the standard inpatient floors: infectious diseases, general medicine, and critical care units: pediatrics, MICU, NICU, and basically everything else you can think of.
Q: What rotations do the residents have to do? What are their core rotations and what are their elective rotations?
A: Our core rotations are family medicine, one critical care unit, pediatrics, an infectious disease (ID) capacity or an antimicrobial stewardship, and one ambulatory rotation. Electives could be geriatrics, administration, and investigational drugs. Residents can repeat any previous rotation that they enjoyed, and can experience another critical care unit as an elective. Pain management / palliative care is also available as an elective.
Q: What is the responsibility of a pharmacy resident on the rotations?
A: It varies based on who the preceptor is. I can give you information specific to my rotation and in general. When pharmacy residents are on the floor, they are always with their preceptor or have their preceptor nearby to supervise. You round with the team; so, you are responsible for your pre-round on your patients, and need to be adequately prepared with all profiles and all drug problems before you even start. When you go on rounds with the team, you actively participate, make recommendations, and field questions from the team. Then, you would be responsible for following up with any issues that came up during rounds throughout the day. You are a liaison to the unit.
So, for example, Nicole Glasser is a resident currently on her surgical intensive care unit (SICU) rotation. We round in the morning, and she spends the rest of the day following-up on issues discussed in the morning and answering any questions that come up. The rest of the medical team reaches out to her, and she is responsible for answering their questions.
Q: The Beth Israel Medical Center residency program is known for having an extensive managerial portion. Can you please give us some details about this aspect of the residency?
A: The way we have set up our program is that we utilize our weekend staffing component and make it managerial. Our residents divide the weekends; we have four residents; so, each resident ends up working every fourth weekend.
For the first month or two, in July and August, two residents work on each weekend with a manager, and learn how to run the department. In September, we break it down to two residents each weekend. By October, or sooner if the residents are ready, one resident works solo. They are responsible for triaging every issue that comes up during the weekend: sick calls, doctors’ questions, Pyxis problems, borrowing medications from other hospitals, approving non-formulary requests, and answering drug information questions.
Anything that comes up from Friday 9 PM to Monday 8 AM is the residents’ responsibility. They have a pager, and can be paged by the staff. They always have a manager who works as their backup off-site. If they have any issues, they can call the back-up manager for help. But, really, they run the entire department. So, by the time they graduate, they would have had 10 months of solo experience and a full year of managerial experience, which is an experience most facilities do not offer.
Most institutions utilize the weekend for staffing; what we do instead is have them staff for four hours one night each week. ASHP requires some kind of service commitment as part of the program, as well. In order to be an effective clinical pharmacist you need to know the ―nuts and bolts‖ of staffing and how things work. Our residents staff between 4 to 8 PM or 5 to 9 PM, depending on their rotation, one night per week.
Q: Beth Israel does not currently have a PGY-2 residency. Is the hospital considering a PGY-2 residency program?
A: Dr. See and the family medicine department are very interested in doing that. They have gotten as far as drafting proposals, and I believe that that is the most current level. It takes at least one year to go as an unaccredited program. So, you would have to pull in someone to do your program for a year, and then get accredited.
At this point, we are at least three years out before we have a PGY-2 program.
Q: Do you think that a residency is something that every pharmacy student should look into? How do you think it could impact one’s career?
A: Yes, I do believe that it is something that every pharmacy student should consider. It should at least be something that they are informed about (to know exactly what it entails) so that they can make an informed decision. If they want to work in a hospital in any capacity, they should consider it. If they are interested in working outside of community pharmacy one day, even if not right away, they should consider it. Now, they even do community residencies, which make you a better community pharmacist.
So, all students should consider it. However, it is going to be competitive because there are not enough positions out there.
Q: Rho Chi recently hosted a mock residency interview event and students received interview feedback from several faculty members. What do you look for as an interviewer in an applicant? What would you suggest for underclassmen considering residency?
A: In as much control you have over your experiential rotation selection, select challenging rotations. I know you have core rotations and very little flexibility, but do not take the same rotation twice. I see many curriculum vitas (CVs) with two ambulatory care rotations or two internal medicine rotations or two general practice rotations. I want to see some specialty, oncology, or pediatrics. I want see that you took the initiative to take something outside of the mandated list. If there is any way to get involved in research (and I know it is challenging as a student to shadow in a lab, do a poster presentation, or present a clinical pearl), experiences like that matter. Outside involvement is also important to me, as I want to see people who will give back to the profession and have other interests. I want them to show me that they can multi-task and have leadership qualities. Your interview will develop as your CV builds and you go on rotations. Much of the interview will be in the context of your CV, and you should be able to speak about your experiences. So, pick good rotations – try to have at least one major clinical rotation so that you can speak about journal clubs and case presentations and things of that sort. If you have not done any of those, it will be hard in the interview to show that you have clinical skills.
In terms of a future residency, I would tell students that studying is important but developing one’s self is more pertinent. Your A’s and 100’s will not get you through an interview – you need to learn how to communicate. Time in pharmacy school should be spent expanding outside the books, learning how to communicate, involving yourself in activities, and networking because these are things that are going to get you through an interview. You may have a 4.0 on paper, but what is different about you? If you cannot speak to me, I am not going to want you as a resident. The only way to develop those kinds of skills is to spend time outside the school, even if it is just attending a professional event, or going on to the ASHP website and familiarizing yourself with professional developments. I believe these are the things that would set you apart.
Q: Finally, how do students apply for the Beth Israel residency program?
A: All ASHP accredited programs must have a set application process for students, which is available on the ASHP website. For our program, by January, you must submit: an essay stating your reasons for doing a residency, three letters of recommendation, your official transcript from school, and your professional CV. Those should be mailed to me by January 13th. Once we receive all the materials, we sort through them internally. We try to interview about 30 or so candidates, and this depends on the number of applicants. Last year, we had approximately 60 candidates.
We interview applicants within a two-week timeframe. An on-site interview is required for our program. In the end, through the Matching process, we make a list of people we are willing to take and submit it to ASHP (and the prospective resident does the same). ASHP takes both lists and favors the residents’ choices.
For more residency information please visit: www.ashp.org
For information about the Beth Israel residency program, please visit: http://www.wehealnewyork.org/professionals/bi_pharmresidency/program.html