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We are excited to implement the first of many future interviews with residency program directors within the CPNP community, in order to highlight the features that make each of these programs noteworthy and unique. This month, we feature Dr. Jeff Gold, program director for the PGY2 psychiatric pharmacy residency program at the VA Eastern Colorado Healthcare System.

CPNP: Tell us a bit about yourself and your background.

Dr. Gold: I have worked at the Denver VA in mental health for over ten years, and I love my job more with each passing day. Serving veterans, the mentally ill, and marginalized populations is important to me. I started the PGY2 Psychiatric Pharmacy Practice Residency in 2012 to share this passion. I also share it with students and psychiatry residents at the University of Colorado (CU) Schools of Pharmacy and Medicine. I myself graduated from the CU School of Pharmacy in 2007, and it feels good to give back to my Alma Mater in this way.

CPNP: Please tell us about your practice and practice site.

Dr. Gold: I am based out of the Denver VA Medical Center and serve as the mental health prescriber for a panel of veterans living in rural Colorado via telehealth. I also co-facilitate a benzodiazepine taper clinic based out of Denver.

CPNP: And could you tell us about your residency program? What are the core rotations there?

Dr. Gold: We have six psychiatric pharmacist preceptors within our program, including myself. To work with such a thoughtful and compassionate team on daily basis is inspiring. Preceptors are the most important aspect of a residency. I am proud to say that we have an exceptional team that cares for each other like family and three of our preceptors are former graduates of our program. The residents here, past and present, are a part of our family. In every interaction on every rotation we want them to feel that.

With respect to rotations, all learning experiences that take place on-site have a strong interdisciplinary approach. The Denver VAMC is an academic teaching hospital and is affiliated with the University of Colorado Health Sciences Center. Our core rotations include twelve weeks of inpatient psychiatry and eighteen weeks of outpatient psychiatry divided among three different learning experiences: tele-mental health, general outpatient psychiatry, and residential treatment. Residents are then able to choose from many elective experiences, such consultation-liaison psychiatry, neurology, substance abuse, pain, academia, forensics, FDA, child/adolescent psychiatry, and have the opportunity to create their own learning experience that we call the “choose your own adventure” rotation.

CPNP: Interesting. Please tell us more about that.

Dr. Gold: Many of our elective rotations have been put together by past residents as a part of the “choose your own adventure” learning experience. Forensics, the FDA, child/adolescent psychiatry, and academia are now offered because of the past residents that built such rotations. I welcome any resident in our program to create for themselves an opportunity that they want to have. This provides the resident with the chance to learn about navigating administrative issues, negotiating resources, and building a new role. After all that, they get to go on a rotation in a field of psychiatric pharmacy that interests them and that they created from the ground up.

CPNP: What other novel features would you highlight about your program?

Dr. Gold: Our program offers residents some introductory experiences in psychotherapy. Understanding the different modalities of therapy and their utility is very important. Many of the skills needed by a therapist are valuable for psychiatric pharmacy practice as our profession expands into more direct care. Residents in our program have many opportunities to work alongside our colleagues in social work and psychology. Residents have the opportunity to co-facilitate a twelve-session cognitive processing therapy modules for PTSD with a supervising therapist. We also encourage residents to seek their own therapy if they so desire. We understand the value that such a practice has personally and professionally, and are flexible in accommodating such time.   

CPNP: Are there teaching opportunities?

Dr. Gold: Our program is affiliated with both the CU and Regis Schools of Pharmacy and the CU Department of Psychiatry. I am the course coordinator of ‘Introduction to Psychopharmacology’ for the psychiatry residency program at the school of medicine, and teach several lectures at the CU School of Pharmacy throughout the year. The PGY2 psychiatric pharmacy residents attend didactic sessions every Wednesday morning alongside the psychiatry residents, and have the chance to teach pharmacotherapy at the schools of pharmacy throughout the academic year. If this is an area of interest for the resident, they can choose to have an elective in academia.

CPNP: Tell us about your current residents and what they are doing. What do they like best about the site?

Dr. Gold: Dr. Kluemper is on a rotation in Pain Management, and Dr. Newby is working in the Substance Abuse Treatment Program. Both residents were attracted to our program based on the learning environment of our program and diversity of self-directed experiences we offer. In January of 2018, Dr. Kluemper and Dr. Newby will be on an eight-week rotation at the Regis School of Pharmacy teaching all the psychiatric pharmacy content with course coordinator responsibilities. It should be a tremendous experience for them and they are excited about it.

CPNP: A rewarding experience for a residency program director is the ability to see the careers of your past trainees blossom as each one carves out his or her role in the pharmacy world. Where are some of your past residents currently practicing, and what do they do there?

Dr. Gold: I keep in touch with all past residents. Of the ten who have graduated thus far, I would say eight of them have their ideal job. Seven of them work full time as a psychiatric clinical pharmacy specialist for the VA. One past resident works at the FDA in the department of pharmacovigilance examining psychotropic medication safety. We are very proud of where our residents have gone after graduation.

CPNP: What is your philosophy regarding the overall residency experience? What do you want your current residents to really take away from their experience with your program?

Dr. Gold: The patient experience is more than just evidence-based medicine. It is emotion, not logic, which most often governs our decision making. I want residents to leave our program with attention to this as well as a solid foundation in psychiatric pharmacy. If it was all as easy as implementing an intervention based on scientific evidence, the practice of medicine, and life itself for that matter, would be so much more simple. Yet we all know pain, loss, and trauma each in a unique way, and go about our lives trying to protect our vulnerable hearts. It is because of this that personal experience, differing core values, and relational dynamics guide interventions, not just best scientific practice. It has become a personal goal, and methodology when training residents, to highlight that a pharmacist should be mindful of this while delivering evidenced-based pharmacotherapy. We can listen to our patients, attempt to understand their motivations, and show that we value their perspective. In doing so, we form a relationship with the patient where we work together to develop the best patient-centered care plan. There is certainly a moment when a patient takes a medication, on a subconscious if not conscious level, that they think about the people involved in giving them that medication. How they feel about us influences how they feel about the treatments we provide. The pill is us.

CPNP: Thank you so much for your time and desire to share your passion for mental health care with those you serve and those you train. What is one piece of advice you could give to any prospective PGY2 mental health residents?

Dr. Gold: During residency you will be exposed to so many different people, as patients and/or peers. Each person has something unique to offer you. Do your best to make every interaction into a meaningful experience that you can learn from. Use the opportunity to think about who and how you want to be professionally. This is the time build your sense of best practice.

Keep an eye out in the future as we look to feature other great residency programs in later issues.

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