Partners in health
A shared-responsibility model between the College of Pharmacy & UF Health is elevating the pharmacy profession.
he might be in her office at UF Health Shands Hospital, getting ready for rounds or reviewing patient data. He might be across campus at the College of Pharmacy building, preparing to teach a course.
But Veena Venugopalan, Pharm.D., and Kenneth Klinker, Pharm.D., are never more than a phone call, email or text apart. Their paths cross on most days, usually more than once. Typically, she updates him on what’s happening in the hospital and he fills her in on their students and joint research projects. But sometimes, it’s the other way around. It’s all part of sharing the same job.
Klinker and Venugopalan are part of a new academic partnership model that pairs two pharmacists to serve the needs of both the College of Pharmacy and UF Health Shands Hospital in one medical specialty. Instead of hiring a pharmacist to treat and monitor patients and another to teach students and lead research studies, Klinker and Venugopalan share all these duties together, as a team. The two positions are funded equally by the college and UF Health, with the work divided in a 70-30 split. One person bears 70 percent of the academic responsibilities and 30 percent of the clinical duties, while their partner’s role is 70 percent clinical and 30 percent academic.
Creating these partnerships ensures that each pharmacist gets protected time to provide high-level care to patients, teach and mentor students, and conduct research in their specialty, said John Gums, Pharm.D., associate dean for clinical and administrative affairs in the College of Pharmacy. Students benefit, he said, because they get to work closely with clinical pharmacists who are still actively engaged in clinical practice. And patients benefit because each specialized team is focused not only on taking care of individual patients in the hospital, but also on devising new processes and protocols to improve care across the institution.
“For many years, hospital-employed clinical pharmacists have participated in our pharmacy student teaching process, be it delivering a lecture or serving as a clinical preceptor for students, but their jobs were increasingly more demanding, which limited their time to teach,” Gums said. “At the same time, our clinical faculty were being asked to do more and more teaching to the point they had difficulty finding time to practice. For clinical faculty, if you don’t practice, you become less of an expert in the classroom.
“[This model] is a win-win. This is the type of opportunity many pharmacists have wanted, but for many years did not exist. They want to practice, but they also want the opportunity to share their knowledge and explore their research interests.”
Kenneth Klinker, Pharm.D., and Veena Venugopalan, Pharm.D., specialize in infectious diseases and form a partnership in a new shared-academic model that supports the UF College of Pharmacy and UF Health Shands Hospital.
THE FIRST TEAM
Klinker and Venugopalan, who both specialize in infectious diseases, were the first team established as part of the model. Klinker was hired as a clinical associate professor in August 2015. He took on the 70 percent academic/30 percent clinical role, while Venugopalan, who started a few months later in January 2016, holds the 70 percent clinical/30 percent academic role.
“We work well as a group and that partnership has been key here,” Venugopalan, a clinical assistant professor of pharmacotherapy and translational research, said. “We have done a good job of realizing that each person brings something to the table, and each person’s piece makes up a whole.”
The idea to start a model like this came after Julie Johnson, Pharm.D., became dean of the college in 2013. One of her goals was to strengthen the relationship between the college and the hospital, Gums said.
Together, hospital and college leaders worked on what the model would look like, holding town hall meetings with college and hospital staff to discuss how it could work.
“[Our discussions] grew into a working model, which we called the 70-30 model. The concept was to create partnerships in various therapeutic areas that would benefit the hospital and college,” said Gums, who has helped shape the shared responsibility model with other UF and UF Health leaders. “We sat down with hospital pharmacy leadership and investigated areas where we both had needs. We identified a list of therapeutic specialties to target first.”
First on that list was infectious diseases, which includes not only managing patients with infectious conditions, but also ensuring the hospital is administering antimicrobial therapies responsibly. Already a clinical pharmacist at the hospital, Klinker expressed interest in being part of the new partnership. He liked the idea of being able to pursue teaching and research without having to give up his clinical practice.
“For me, I have been a pharmacist for 20 years, and at this point in my career, I had a fund of knowledge I wanted to share,” he said. “When the dean opened this process, it made sense to me. I would be able to develop new skills, interact more with students and researchers, and still practice.
“Balancing these activities helps my teaching because everything comes from real world experience. It allows me to stay current.”
The pair has spent much of the first 18 months focused on developing their team. For a model like this to succeed, the partnership has to be strong, Klinker said.
“When you have a split-funded position, those people have to speak the same language,” he said. “We have to be consistent in what we do in clinical practice, how we teach and develop research.”
All the time college and hospital leaders spent developing the program at the outset, defining the roles and carefully crafting the team, are a big part of what has made it successful, Klinker said.
“Everyone has to be on the same page,” he said.
In addition to allowing pharmacists to teach and practice at the same time, working as a team also gives each faculty member a built-in collaborator and support system. This helps each be more productive and is allowing them to expand the scope of their projects. For example, Klinker has taken the lead in their collaboration with College of Pharmacy researcher Charles Peloquin, Pharm.D., a professor of pharmacotherapy and translational research, whose lab conducts therapeutic drug monitoring. The lab’s unique tests allow clinicians to better understand how each dose of a medication affects an individual patient — including how well it is absorbed and metabolized by the body.
Klinker has worked closely with Peloquin’s team to develop processes and implement policies to monitor the use of antimicrobial medications in the hospital. Now that Venugopalan is on board, she brings a different eye to the work, suggesting patients and clinical units that might benefit from this testing.
“We are one of the only institutions nationally that is performing antibiotic drug monitoring using this technology,” Venugopalan said. “From a clinical standpoint, assessing and optimizing antibiotic dosing is critical in our high acuity patient population. The drug monitoring offered by Dr. Peloquin’s lab has given us the unique opportunity to individualize antibiotic therapy. We are getting ready to review our data and evaluate outcomes. We feel certain that the results of this program will reveal benefits to both patient treatment and the quality of care.”
Klinker also supports the projects Venugopalan leads. She has started working with infectious disease residents to develop an algorithm to help improve antibiotic use for managing skin and soft tissue infections.
“Whether we are developing a policy for the hospital or a new teaching module, we provide feedback to each other on how to make it better, how to look at it differently. When we look at projects, they are better developed because two of us are involved,” he said. “To me the more eyes the better.”
Chris Campbell, Pharm.D., a clinical assistant professor of pharmacotherapy and translational research, works with pediatric patients in the shared-responsibility model.
EXPANDING THE PROGRAM
In the year since Klinker and Venugopalan formed the first team, two more teams have been established — one for critical care and one for pediatric intensive care. Each team’s work is a little different, tailored to meet the specific needs of its specialty, but the goal remains the same — strengthening research, patient care and education across both institutions.
The most recent team hired — for pediatrics — comes to Gainesville with its own unique partnership already in place. Chris Campbell, Pharm.D., who came to UF in August after completing his residency, holds the 70 percent clinical role. His partner, Kalen Manasco, Pharm.D., a clinical professor of pharmacotherapy and translational research, also happens to be his former residency director.
“I’m excited to work with her,” Campbell, a clinical assistant professor of pharmacotherapy and translational research, said. “When I was hired, they were looking for the other person to be more seasoned in the faculty role. She is a good fit for that. She can help guide curriculum changes and can help mentor me as well.”
Manasco, who completed her residency at UF 15 years ago, joined Campbell in March. The position appealed to her because she likes the idea of both institutions having a stake in each pharmacist’s development. She’s always been on the academic side, and although she practiced in a hospital, it was not the same as being part of both institutions.
“This is what I like about being a clinical practice faculty member,” she said. “I get to practice and have a foothold in the hospital and focus on teaching and being a preceptor at the same time.”
During his first seven months here, Campbell has focused on working with patients in the pediatric intensive care unit. Now that he and Manasco are both on board, they will work to reinvigorate the pediatrics curriculum for pharmacy students and reestablish an elective in pediatrics, which has not been offered for a few years.
With the infectious diseases, critical care and pediatrics teams now established, college and hospital leaders are looking toward other specialties that may be a fit for the model, including hematology/oncology, internal medicine and neurology. They also are looking for opportunities to export the idea to other institutions, particularly UF Health Jacksonville.
Eventually, Gums said they would like to see if the model results in improved quality and efficiency of care, but for now they are focused on measuring how this benefits students, patients and the overall culture of collaboration between the college and hospital.
“We have seen this partnership extend from the clinical environment to leadership. One of the hospital’s pharmacy leaders is now an associate chair in the college’s clinical practice department,” he said. “That is a very tangible example of how the model has fostered different ways we connect with each other.”
For Klinker and Venugopalan, the benefits so far have been immeasurable; they emerge every time one of them has to answer an important decision. Instead of going it alone to solve a problem, they lean on each other.
“I am just lucky to have Veena,” Klinker said. “I am fortunate to have an experienced clinician who is calm and rational. The team has to function as one. That is important to the success of this model.”
Adds Venugopalan, “We both have a good understanding of what the other needs to be successful, and we are invested in each other’s success. That is, in essence, the goal of the shared faculty model.”
