PURPOSE STATEMENT: The overall goal of the program is to develop competent emergency medicine (EM) pharmacy practitioners with an emphasis on clinical knowledge, skills, teaching and research necessary for independent emergency medicine pharmacy practice. The residency is based at the USC School of Pharmacy. The Department of Emergency Medicine at Los Angeles County + USC (LAC+USC) Medical Center will serve as the primary training site for the resident.

OVERVIEW: The resident will spend at least 6 months in the ED. The remainder of the time will be allocated to areas complementary to Emergency Medicine such as critical care (e.g. MICU, SICU, Burn ICU, Thoracic, Neuro/Neurosurgery ICU, CCU), Toxicology, Infectious Diseases, Cardiology, Psychiatry ED and Pediatrics (ED, Neonatal ICU). Experiences also exist for those wanting experience in primary care (e.g. Walk-in Clinic Room 1050, ED Fast Track clinic), management, Drug Information/DUE. To see a sample schedule click here.
In a traditional sense the program has very little staffing requirements and nearly all weekends are free. However, independent practice skills are developed through per diem hours available at USC University Hospital. The residents are thus able to supplement their salaries. Salary for the residency is $39,000 for the year with two weeks vacation and medical benefits. Approximately two weeks are dedicated for attendance at professional meetings.

CLINICAL SERVICE: Responsibilities of the ED/ICU pharmacy resident will include provision of direct patient care in the ED (e.g. consultative and bedside care for emergent and urgent pharmacotherapeutic and toxicologic problems, evaluation and assessment of drug-related problems and drug-induced disease, medication histories, discharge counseling,), provision of drug information for physicians, nurses and patients, as well as investigation/reporting of adverse drug events for ED patients. The resident will also participate in the DEM-based hospital wide Code Blue (cardio-pulmonary resuscitation) team. Opportunities exist for focusing both on critically ill as well as ambulatory patients.

EDUCATIONAL OPPORTUNITIES: Beyond coursework provided for all pharmacy residents at USC (e.g. physical assessment, teaching skills, research methods, and pharmacy management/administration), the emergency medicine pharmacy resident will attend DEM Core Lectures for EM residents, participate in regularly scheduled EM Grand Rounds, Journal Club and Research Meeting.

TEACHING: The resident will have the opportunity to provide both formal didactic lectures to EM residents, ED nurses and Pharmacy Department staff. Residents play a highly visible and crucial role in the PharmD program. Students view residents as highly approachable role models. The residents meet with third year students at weekly Therapeutics Modules discussion groups. Residents also act as co-preceptors with faculty supervising fourth year students on clerkships in the ED. To develop the skills necessary to be "Clinician Educators" we have implemented a series of seminars to train residents in teaching skills.

RESEARCH: The resident will be expected to complete and submit for publication a research project. The research project is presented at the annual Western States Residency Conference.
Never been to Los Angeles? Despite what you may think, many days look like this beautiful evening looking from the campus to downtown.

Los Angeles County+University of Southern California (LAC+USC) Medical Center (Picture of LAC+USC Medical Center) Founded in 1878, the LAC+USC Medical Center is the primary teaching facility of the USC School of Pharmacy and Keck School of Medicine. It ranks among the largest acute care hospitals in America. LAC+USC Medical Center is located in the center of the city of Los Angeles, adjacent to the downtown area. The campus consists of several buildings, with the General Hospital, a beautiful Art Deco structure, towering above the rest. The campus of the medical school and pharmacy school (Health Sciences Campus), a modern, beautifully landscaped cluster of buildings surrounding a central courtyard, is immediately adjacent to the County campus. Physicians and students move readily between the two campuses throughout the day. As the largest community provider of healthcare in the community, LAC+USC Medical Center:

• Provides more than 28% of the trauma care in L.A. County
• Operates one of only three Burn Centers in L.A. County
• Cares for 50% of the men, women, and children with stage III HIV/AIDS in the region, and about 35% of the HIV/AIDS patients in the County
• Provides 50% of the Sickle Cell care in L.A. County
• Provides one of the few Level III Neonatal Intensive Care Units in Southern California
• Provides Emergency, Inpatient, and Outpatient Services for the most acute mentally ill men, women and children in Los Angeles County
• Provides ongoing clinical training for nearly 1,500 health care professionals, including over 870 medical residents in virtually every medical specialty, 160 students in its School of Nursing; and a cadre of allied health professionals such as Pharmacists, Midwives, Physician Assistants, Physical, Occupational, Speech and Respiratory Therapists, Dietitians, Podiatrists, Laboratory and Radiologic Technologists.

The Emergency Department at LAC+USC Medical Center:

LAC+USC Medical Center is a level I trauma center. The Department of Emergency Medicine (DEM) is an autonomous clinical and academic department within LAC+USC Medical Center and Medical School. It has responsibility for initial triage, evaluation, management, and disposition of approximately 400-500 patients daily (approx. 160,000 ED visits/year) with the complete spectrum of adult medical and surgical problems as well as pediatric trauma. It is functionally divided into three areas: Major medical/trauma (Room 1350), Minor Medical/Trauma (Room 1060) and ED Walk-in (Room 1050). However, there is also an ED run Jail Service, Chest Pain Unit. (click here for description of the areas) The department has one of the country's largest and oldest EM residency training programs with 54 residents in years PGY2-PGY4. (click here for link to residency description) Patients who visit the LAC+USC DEM are largely indigent, have chronic diseases, multiple medical problems and have variable compliance. The patient population is quite mixed but includes a significant Hispanic population, a substantial working class population and a large number of indigent patients. Since the County Hospital is tasked with providing care for all those who cannot afford it elsewhere, the mean socioeconomic level tends to be low with the attendant problems of chronic poor health maintenance, variable compliance, and lack of support systems. Superimposed on this demography is a high incidence of gang and drug related violence and vehicular injury leading to a large volume of both penetrating and blunt major and minor trauma. Patients who visit the LAC+USC DEM have multiple medical problems and are a pharmacotherapeutic challenge. You will see a broad variety of diseases and complications of drug therapy. In a typical week you may encounter emergencies relating to diabetes, asthma/COPD, congestive heart failure, myocardial infarction, a variety of tropical and infectious diseases including in immuno-compromised hosts, seizure disorders, toxicology cases, a variety of withdrawal syndromes, and trauma cases. A disproportionate number of patients seen in the ED are admitted (60%) to ICU or continuously monitored (CMA, or step-down) beds. LAC+USC Medical Center has over 100 ICU beds which are continuously at 100% occupancy. Thus many critically ill patients remain in the ED waiting for an ICU bed for extended periods of time. Thus a significant amount of time is spent ensuring optimal pharmacotherapy for those patients as well as others who have been admitted but are awaiting to be transferred to an in-patient bed. Pharmacy Clinical Services in the ED Pharmacy practice in the ED was initiated in 1997. Over the past 6 years, pharmacy practice in the DEM has encompassed teaching, research and clinical services. Consultations are provided for drug-related problems and management issues, toxicology cases, and optimization of pharmacotherapy for admitted and discharged patients.

• Consultative and bedside pharmaceutical care in the Major Medical / Trauma (Main Admitting) Area of the ED
• Consultation for toxicologic exposures
• Medication histories
• Provision of drug information for physicians, nurses and pharmacists
• Evaluation and assessment of drug-related problems and drug-induced disease
• Provision of discharge counseling
• Investigation and reporting of adverse drug reactions and adverse drug events
• Provision of in-services for physician/nurse/health care provider
• Participation in DEM-based hospital wide Code Blue (resuscitation) Team
• Development of clinical guidelines and pathways. Examples include:

o Ethanol-withdrawal
o Rapid Sequence Intubation
o Hypertension in the ED

Pharmacy Research Activities DEM Research Page: Click for link

Examples of research protocols include:

• Sepsis-related adrenergic and vasopressin receptor desensitization
• Sedation and neuromuscular blockade
• Optimization of anticonvulsant drug loading
• Immunization

Teaching Opportunities

• Doctor of Pharmacy (Pharm.D.) students on clerkship rotation (Level IV)
• Pharm.D. student didactic lectures in Level I, II and III
• Emergency Medicine Residents (PGY2, PGY3, PGY4)
• Other health care providers (e.g. Nurses, Physician Assistants)
• Other rotating health care provider students (e.g.: medical students, ED nursing program students, physician assistant students, etc.)

To see the residency syllabus, learning objectives, and evaluation forms; click on the appropriate link.

The Program Director is Maria Rudis, Pharm.D.:to see her biosketch click here

Need directions to the campus? Click here for map.
Need an application?  Click here for Adobe PDF version of application
Need forms for letters of reference?   Click here for Adobe PDF version Licensure in California ultimately is required for the residency certificate. Plan to check the Board of Pharmacy for recent updates.Click here. and here

For more information, please contact:
Maria I. Rudis, Pharm.D., FCCM, DABAT, BCPS
Director, Emergency Medicine / Critical Care Pharmacy Residency Program
Assistant Professor of Clinical Pharmacy and Clinical Emergency Medicine
University of Southern California School of Pharmacy

---

This page last updated on January 2004.