Internal Medicine at South Texas Veterans Health Care System

South Texas Veterans Health Care System, Audie Murphy Hospital in conjunction with College of Pharmacy, The University of Texas at Austin

Mark Wong, Pharm.D., BCPS
Residency Program Director
SICU/ Medicine Clinical Pharmacy Specialist
Acute Care Clinical Pharmacy Program Manager
South Texas Veterans Health Care System
7400 Merton Minter Blvd (119)
San Antonio, TX 78229
Email: Mark.Wong@va.gov

The Internal Medicine Pharmacy Residency is designed to provide a training opportunity for individuals desiring to enhance their clinical competency in the field of internal medicine. The 12-month training period heavily emphasizes inpatient acute care rotations with a longitudinal ambulatory care rotation. The program was started in 2012 and has a history of many successful graduates who have accepted clinical pharmacy specialist positions at both VA and non-VA hospitals, as well as university faculty and ambulatory care positions.

The South Texas Veterans Health Care System (STVHCS) provides for the health care needs of Veterans in San Antonio and the outlying areas. The PGY2 Internal Medicine program is located at the Audie L. Murphy (ALM) Memorial Hospital. ALM is a 467-bed facility providing primary, secondary and tertiary health care in medicine, surgery, psychiatry, and rehabilitation medicine. It also supports a 50-bed (approximately) Community Living Center, a 30-bed Spinal Cord Injury Center, and a 12-bed polytrauma rehabilitation unit.  In addition, our  Geriatric Research, Education & Clinical Center is a “Center of Excellence.”

The Pharmacy Service offers 24-hour coverage, centralized unit-dose drug distribution, a complete IV-admixture program, and clinical services across many specialties and levels of care.  Pharmacies are located in some outpatient clinics and operate during clinic business hours. The Clinical Pharmacy Program employs over 100 clinical pharmacy specialists.

The resident spends a minimum of four months rounding with one of the medicine teaching teams at ALM, and if available at the affiliated county teaching hospital, University Health (UH) System Hospital. Medicine teams at the facility typically consist of an attending physician, medicine resident, two medical interns, medical students, and a clinical pharmacy specialist. This team typically cares for 5-18 patients daily. As a member of the team, the pharmacy resident is responsible for completing an accurate medication reconciliation on admission and discharge, participating in the design and implementation of appropriate therapeutic regimens, monitoring the outcome of therapy, assisting in the application of pharmacokinetic principles to individualize therapy as needed, and in the provision of patient education on discharge. Also, depending on preceptor availability, the resident will have opportunities to co-precept PGY1 residents or pharmacy students as well as potentially provide lectures to pharmacy students at a local college of pharmacy.

The resident will also have the opportunity to rotate through the Medical ICU and/or Surgical ICU to enhance their critical care experience. 

Elective learning experiences are available including Inpatient Medicine (University Hospital), Infectious Disease Consults, Cardiology Heart Failure Clinic, Inpatient Cardiology (University Hospital), Neurology, and Emergency Medicine. Other elective learning experiences may be developed based on resident interest and preceptor availability. Residents will be required to have a Texas Pharmacy License for non-VA rotations.

In addition to the monthly rotations, the resident will have a longitudinal experience in the Geriatric ambulatory care clinic for one half-day per week for approximately nine months. Here the resident learns how to care for geriatric patients in an ambulatory care setting. The resident is responsible for participating in the design and implementation of the appropriate therapeutic regimens, monitoring the outcome of therapy, and intensive patient counseling.

As part of the longitudinal experience in practice management, the resident will be responsible for handling multiple projects and presentations.  The resident will be required to have an independent research project in an area of internal medicine. In addition, the resident is expected to participate in ongoing collaborative research projects. During the residency, the resident will learn the journal submission process and will be required to develop a manuscript that is appropriate for publication submission. This can be a book chapter, case report with literature review, review article, or original research article.

The resident is jointly appointed as a Clinical Instructor in the Department of Pharmacology, The University of Texas Health Science Center at San Antonio, and the College of Pharmacy, The University of Texas at Austin. In this capacity, the resident may be asked to help participate in didactic lectures or in pharmacotherapy lab discussions.  Along with the other residents, the resident will present on a topic of their choice to the other residents and faculty during the year.  During the course of the year, readings will be assigned and discussed with the resident. The resident will also participate in the journal clubs and discussions set forth by the primary preceptors or director.

The residency program will follow the goals and objectives set forth by ASHP.