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Thank you for completing this supplemental application for our PGY2 Critical Care Pharmacy residency. Your answers will be used to supplement the application materials uploaded to PhorCas. We appreciate your time!

I currently:

Am completing a PGY1 Pharmacy residency
Work as a staff pharmacist in an inpatient setting
Work as a staff pharmacist in an ambulatory setting

The ASHP Code for my PGY1 residency is/was (can be found via https://accreditation.ashp.org/directory/#/program/residency)

Please enter the ASHP code
My PGY1 residency is in candidate status
My PGY1 residency is/was unaccredited

Type of hospital or hospital system where I am completing (or previously completed) my PGY1 residency or currently work is:

Academic
Community

Location of hospital or hospital system where I am completing (or previously completed) my PGY1 residency or currently work is:

Urban
Suburban
Rural

Over the course of your PGY1 year, please describe your staffing experience for ICU-level patients (excludes learning experience/rotation experience). Please include both operational and clinical responsibilities. If you have already completed your PGY1 residency and have been working since, please describe your daily activities with relation to ICU-level patients.

Over the course of your PGY1 year, please describe your staffing experience for non-ICU-level patients (excludes learning experience/rotation experience). Please include both operational and clinical responsibilities. If you have already completed your PGY1 residency and have been working since, please describe your daily activities with relation to non-ICU-level patients.

Did your PGY1 program have a formal program aimed at improving your pharmacy precepting and teaching skills (sometimes called a teaching certificate program)?

Yes
No

Please describe your teaching philosophy. Please use examples of the type of preceptor you do, and don't, want to emulate.

Please describe the ICU model (open/closed) at your PGY1 hospital or current institution.

Closed ICU definition: only one service admits and writes orders on patients
Open ICU definition: multiple services have admitting privileges for ICU patients
Some ICUs were open and some were closed

Are ICU pharmacists at your PGY1 hospital or current institution service or unit-based?

Service-based
Unit-based
Combination
We do not have dedicated ICU pharmacists

At your PGY1 site (or most current practice site if you are a current practicing (non-resident) pharmacist), please check all the responsibilities that ICU pharmacists are responsible for. Please also designate all the activities you have observed, or actively completed, for ICU patients.

<span style="font-size:19px;"><span style="font-family:Arial,Helvetica,sans-serif;">At your PGY1 site (or most current practice site if you are a current practicing (non-resident) pharmacist), please check all the responsibilities that ICU pharmacists are responsible for. Please also designate all the activities you have observed, or actively completed, for ICU patients.</span></span><o:p></o:p>
	ICU Pharmacist Responsibility	Personally Observed or Completed	Not an ICU Pharmacist Responsibility at my Hospital


	Please select all that apply	Please select all that apply	Please select all that apply
Order verification
Pharmacokinetic monitoring of antiinfectives
Pharmacokinetic monitoring of antiepileptics
Medication distribution within the unit
Formal pharmacist consults (i.e. pain, anticoagulation)
Interdisciplinary rounding
Respond to code events
Protocolized pharmacist management of hypo/hyperglycemia
Protocolized pharmacist management of pain, agitation or delirium

Which specialized ICU devices are available at your PGY1 institution or current institution (e.g. CRRT, ECMO, VADs, etc.)

CRRT
ECMO
Other mechanical circulatory devices (i.e. VADs)
Other

What type formalized code response teams exist at your PGY1 hospital or current institution?

Cardiac arrest codes (i.e. Code Blue)
Code Stroke (i.e. ischemic)
Code Brain (i.e. hemorrhage)
Code Sepsis
Code ECMO
Code STEMI
Other, please describe

Are pharmacists at your PGY1 hospital or current institution required to respond to cardiac arrest codes?

Yes
No
Yes, but only during certain hours

Please tell us the name of the EMR system you use at your current institution.

Epic
Cerner
CPRS
Other