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This is incredibly disappointing and demonstrates a clear lack of understanding at the leadership level regarding the education and training of the multidisciplinary, allied-health, clinical team members involved in emergency care.
1/however many tweets this takes https://twitter.com/hrh_approved/status/1301863883855011840
1/however many tweets this takes https://twitter.com/hrh_approved/status/1301863883855011840
Though directed at PAs/NPs, this statement seems related to @aaeminfo's 2019 stance on advanced practice providers, which unfortunately included PharmDs ( https://www.aaem.org/resources/statements/position/updated-advanced-practice-providers).
So, let's review the role of the EM Pharmacist and explore related residencies/fellowships.
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So, let's review the role of the EM Pharmacist and explore related residencies/fellowships.
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We covered the training of Emergency Medicine pharmacists on @ALiEMteam back in 2014: https://www.aliem.com/training-of-em-pharmacist/
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In brief, to be an EM Pharmacist, the traditional path is:
4 yrs undergraduate
4 yrs Doctor of Pharmacy
1 yr PGY-1 pharmacy residency
1 yr PGY-2 EM residency
Residencies have existed for more than half a century and are accredited by @ASHPOfficial https://accreditation.ashp.org/directory/#/program/residency
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4 yrs undergraduate
4 yrs Doctor of Pharmacy
1 yr PGY-1 pharmacy residency
1 yr PGY-2 EM residency
Residencies have existed for more than half a century and are accredited by @ASHPOfficial https://accreditation.ashp.org/directory/#/program/residency
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Some of us are crazy (eg, yours truly) and additionally complete 1-2 year fellowships in subspecialty areas such as clinical toxicology. https://pubmed.ncbi.nlm.nih.gov/21378295/
https://www.clintox.org/resources/toxicology-residency
Fellowships have also existed for decades.
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https://www.clintox.org/resources/toxicology-residency
Fellowships have also existed for decades.
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Of note, pharmacy residencies and fellowships are directed by pharmacists (with rare exceptions), not in conflict with this joint statement.
Here's our PGY-2 EM pharmacy residency at @MassGeneralNews @MassGeneralEM https://www.massgeneral.org/education/pharmacy-residency/pgy2-emergency-medicine
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Here's our PGY-2 EM pharmacy residency at @MassGeneralNews @MassGeneralEM https://www.massgeneral.org/education/pharmacy-residency/pgy2-emergency-medicine
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The most concerning part of the joint statement is the declaration that training must be "physician-led." Is a physician more qualified than a pharmacist to educate on medication therapy, dosing, monitoring, interactions, adverse events, etc in an ED patient?
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We are a team, with complementary skill sets, caring for complex patients together. Effective collaboration on education/training is happening every day all over the country in EDs. Why is it not being recognized by the organizations that serve them?
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At @MassGeneralEM, our ED pharmacist team is integral to the care of patients and has a large, active role in the education and training of our amazing @EMRES_MGHBWH residents. https://www.massgeneral.org/emergency-medicine/divisions-centers-and-programs/emergency-pharmacy/
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We have a @MassGeneralEM PharmD on the @harvardmed faculty in the Department of EM, highlighting the integral role they play in education. We also contribute significantly to the @EMRES_MGHBWH toxicology rotation in collaboration with @Harvard_Tox.
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Two major, national medical organizations published position statements on the role of the EM pharmacist:
@ACEPNow in 2015: https://www.acep.org/patient-care/policy-statements/clinical-pharmacist-services-in-the-emergency-department/#sm.00016pch04325crhxjg1ldmtfalsl
@acmtmedtox in 2018: https://pubmed.ncbi.nlm.nih.gov/29075954/
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@ACEPNow in 2015: https://www.acep.org/patient-care/policy-statements/clinical-pharmacist-services-in-the-emergency-department/#sm.00016pch04325crhxjg1ldmtfalsl
@acmtmedtox in 2018: https://pubmed.ncbi.nlm.nih.gov/29075954/
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Guidelines on Emergency Medicine Pharmacist Services are published and updated by @ASHPOfficial @ASHP_EMPharm (most recently in 2020): https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/emergency-medicine-pharmacist-services.ashx?la=en&hash=6503B2C3B0F5382A00FD3FCC9190E803D6C4BA2F
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Nationally, EM PharmDs teach at EM conferences, co-author EM white papers/position statements, and serve on EM committees. Flip through the @emresidents guides (eg, Pain Management, Antibiotic, PressorDex) and count how many PharmDs are editors.
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Final thought:
Though this joint statement was not (necessarily) intended for PharmDs, it certainly will affect them and was written without collaboration from this important allied-health component of the EM care team.
I agree that words do matter.
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Though this joint statement was not (necessarily) intended for PharmDs, it certainly will affect them and was written without collaboration from this important allied-health component of the EM care team.
I agree that words do matter.
/end
