Q&A with an Infectious Disease PGY-2 Pharmacy Resident

Veronica Zafonte, PharmD, is a post-graduate year 2 (PGY-2) infectious diseases pharmacy resident at the University of Rochester Medical Center — Strong Memorial Hospital in Rochester, NY. Dr. Zafonte completed her PharmD degree at the Philadelphia College of Pharmacy in Philadelphia, PA, and her PGY-1 training at Winthrop University Hospital in Mineola, NY. Upon completion of her second year of residency, she hopes to work as an inpatient clinical infectious diseases pharmacy specialist within an academic medical center.

Q: Why did you decide to pursue a PGY-1 and PGY-2 pharmacy residency?

A: During pharmacy school, I took a microbiology course and was instantly fascinated by the impact bacteria could make on the human body. The course emphasized the basics of antibiotic spectrum and communicable diseases such as tuberculosis.

Given my interest, I had approached my advisor and inquired how I could incorporate more infectious diseases (ID) into my schooling and that’s when I learned that I could become an ID pharmacist. As I went on to my professional years of pharmacy school, I was fortunate to have mentors who helped me understand the importance of completing a PGY-1 and PGY-2 pharmacy residency to fulfill my career goal to become a competent and qualified ID pharmacist.

Q: What is the structure of your residency program?

A: The PGY-2 program that I am participating in offers a variety of inpatient and outpatient ID experiences. I started the year in the microbiology lab to gain insight on the technology my institution uses to identify different microorganisms and determine antimicrobial susceptibilities.

I completed a 6-week rotation in antimicrobial stewardship where I carried the antimicrobial approval pager, reviewed the list of restricted antimicrobials, and met with the mid-level providers (physician assistants and/or nurse practitioners) for antibiotic rounds. I also had my first of 3 adult ID consult rotations. This was a great opportunity for direct patient care and building relationships with the ID providers.

At my institution there are 3 adult ID consult teams: general ID, general ID and HIV, and transplant ID, as well as pediatric ID. I am currently working on my outpatient rotation and am responsible for managing our outpatient parenteral antibiotic therapy (OPAT) service, where I perform therapeutic drug monitoring, review of antimicrobial agents and meet with the OPAT attendings to discuss patients. My program also offers a variety of elective rotations: such as bone marrow transplant (BMT), medical ICU, solid organ transplant (SOT), plus many more.

Q: What are your day-to-day tasks?

A: My day-to-day tasks vary depending on my rotation and clinical responsibilities and expectations for that rotation. One of my routine daily tasks includes prospective monitoring of patients with Staphylococcus aureus bacteremia. Each day I run a microbiology report to identify all of the patients who have positive blood cultures with S aureus and review the patient’s clinical course to ensure that they are receiving optimal antibiotic therapy. I also routinely share the responsibility of the emergency department (ED) culture surveillance and follow-up program with my co-residents in the PGY-2 emergency medicine pharmacy residency. We review the results of cultures that were obtained in the ED on a daily basis to ensure that patients receive optimal antimicrobial treatment.

When I am on a direct patient care rotation, such as infectious diseases consult service, my day will start with a thorough review of each patient on the service to identify pharmacotherapy-related problems and needs. Later in the day, I attend multidisciplinary patient care rounds, where I am the pharmacist for the team. I am responsible for activities such as, monitoring the efficacy and safety of the antimicrobial regimen, evaluating drug-drug interactions, IV-to-PO conversions, responding to drug information requests, and pharmacokinetic monitoring for my patients.

Q: What are the benefits of completing a PGY-2 residency? What about the disadvantages?

A: The completion of a PGY-2 residency offers you the opportunity to become a drug expert and leader in your specialty. At this time in my career, I am unable to identify any disadvantages in completing a PGY-2 residency.

Q: How did you decide your PGY-2 residency program was the right fit for you?

A: When I set out to look at programs, I knew I wanted to complete my residency at a large academic medical center that offered inpatient and outpatient ID experiences, exposure to the care of immunocompromised patients, and teaching opportunities. I found all of these qualities in my current residency, but I knew at my interview this was the right fit for me.

Not only did my current residency program offer all the clinical experiences I was looking for, but once I met all the preceptors at my interview I could tell that they work as a collaborative and cohesive group that cares about teaching and I felt they would make me feel a part of the team.

Q: What opportunities does a PGY-2 infectious disease resident have after completion of the residency?

A: The Joint Commission’s new Medication Management (MM) 09.01.01 standard for hospital antimicrobial stewardship became effective January 1, 2017. This is a great opportunity for employment of ID pharmacists. Other opportunities include OPAT, HIV or ID clinics, and academia.

Q: What advice do you have for students looking to pursue a residency in infectious disease?

A: Develop a sense of time management as a student; learning it now it will help you later. It is very important to make time for yourself, especially as a resident. The days are long and your “to do” list may seem endless. You need to find time to relax and unwind whether that’s going to dinner with friends, working out, watching TV or simply taking a nap.

Get involved: join an organization, take on a leadership position — this will help you to develop skills you will use for the rest of your life, such as communication and delegating tasks and responsibilities.

If you know you’re interested in ID as student try to enroll in an infectious diseases elective or take an ID related APPE rotation, it will show consistency of interest and will help to develop the fundamentals of ID pharmacy.

Finally, find a mentor to help with your career goals. I was really fortunate that I had mentors who took an interest in me and helped to provide guidance on different career options, design my APPE rotation schedule and help me develop my CV.