TRAIN Pharmacy Grant
Thrombosis/Hemostasis Residency Award and Innovation Network

Spring 2024 Application Cycle

Question Title

* 1. Applicant Information:

Organization Name

Department

First Name

Last Name

Degree

Title

Phone Number

Question Title

* 2. How many total PGY2 pharmacy resident and fellowship positions does your health system currently have?

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* 3. Which of the following PGY2 pharmacy residency programs are currently available at your health system (check all that apply)?

Ambulatory Care

Cardiology

Critical Care

Emergency Medicine

Geriatrics

Infectious Disease

Informatics

Internal Medicine

Investigational Drugs and Research

Medication Use Safety and Policy

Neurology

Oncology

Pediatrics

Pharmacotherapy

Other (please describe)

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* 4. If your organization currently offers a Pharmacist Fellowship program, please describe it here:

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* 5. Please describe your candidate recruitment plan (including do you offer early commitment)- word limit 1,000 characters:

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* 6. Please describe baseline requirements you seek in residents:

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* 7. Is your institution an Anticoagulation Forum Center of Excellence (this is not a requirement)?

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* 8. Program Description:
Please upload a description of your potential residency program, including:

1. Brief curriculum outline and learning experiences you intend to offer. Distinguish between required and elective experiences, and indicate whether each is a formal block or longitudinal.

2. The institution’s current service(s) in thrombosis and hemostasis management

3. The pharmacy department’s involvement in managing thrombosis and hemostasis

4. Description of any current or planned thrombosis and hemostasis stewardship activities

5. Potential preceptors to be involved in residency training (include a short bio of each primary preceptor and the related rotation). Please also identify a proposed residency program director.

6. Research opportunities for the resident

File size limit is 16MB

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* 9. Budget:

Note: The grant award is $120,000 paid over 2 years and is meant to provide budget support towards 1 resident in each of the 2 academic years. Additional institutional support will be needed to augment the TRAIN grant funding.

Salary:

Preceptor Support:

Institutional Overhead (maximum 10% of grant award):

Conference Support, including registration and travel:

Other: (if none enter N/A)

If you entered an amount in Other, please describe, otherwise enter N/A:

Total Budget (Maximum $120,000):

Please upload 2 letters in support of this training program:

Question Title

* 10. Director of Pharmacy

File size limit is 16MB

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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Question Title

* 11. Physician champion with practice focus in thrombosis and hemostasis

File size limit is 16MB

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

TRAIN Pharmacy GrantThrombosis/Hemostasis Residency Award and Innovation NetworkSpring 2024 Application Cycle

Question Title

* 1. Applicant Information:

Question Title

* 2. How many total PGY2 pharmacy resident and fellowship positions does your health system currently have?

Question Title

* 3. Which of the following PGY2 pharmacy residency programs are currently available at your health system (check all that apply)?

Question Title

* 4. If your organization currently offers a Pharmacist Fellowship program, please describe it here:

Question Title

* 5. Please describe your candidate recruitment plan (including do you offer early commitment)- word limit 1,000 characters:

Question Title

* 6. Please describe baseline requirements you seek in residents:

Question Title

* 7. Is your institution an Anticoagulation Forum Center of Excellence (this is not a requirement)?

Question Title

Question Title

* 9. Budget:Note: The grant award is $120,000 paid over 2 years and is meant to provide budget support towards 1 resident in each of the 2 academic years. Additional institutional support will be needed to augment the TRAIN grant funding.

Question Title

* 10. Director of Pharmacy

Question Title

* 11. Physician champion with practice focus in thrombosis and hemostasis

Question Title

* 12. Please provide any additional information that you would like to share with the Anticoagulation Forum selection committee:

TRAIN Pharmacy Grant
Thrombosis/Hemostasis Residency Award and Innovation Network

Spring 2024 Application Cycle

* 9. Budget:

Note: The grant award is $120,000 paid over 2 years and is meant to provide budget support towards 1 resident in each of the 2 academic years. Additional institutional support will be needed to augment the TRAIN grant funding.