APPE Adult-Med Remote Learning Experience Summary

Learning Experience Adult Medicine/Institutional Advanced Pharmacy Practice Experience

Length 4 weeks
Brittany Behrens, PharmD, PGY1 Email: bbehrens@lhn.net
Christina Ford, PharmD, RN, PGY1 Email: cford3@lutheran-hosp.com
Preceptor(s)* Ryan Teagno, PharmD, MBA, PGY1 Email: rteagno@lhn.net
Jennifer McComb, PharmD Email: jmccomb@lutheran-hosp.com
Nora Klemke, PharmD Email: nklemke@lhn.net
*One of the above preceptors will be assigned as primary preceptor for evaluation. The PGY1 residents are the collaborative preceptors in
creating this remote experience
*In case of illness, please email your primary preceptor by 7am.
Rounds preparation – Daily – Time varies
Preceptor(s) Interaction Rounds – Daily – Time varies
Patient and Topic Discussions – at least 3x each week - Afternoon (specific time varies)
Brittany Behrens – (815)545-7465
Phone Number(s) Christina Ford – (260)433-8909
Ryan Teagno – (260)350-7449
General Description of Learning Experience
The acute care Adult Medicine/Institutional APPE is a 4-week remote-learning experience based on the Lutheran Hospital campus. Through
facilitation by the in-house preceptors, the rotation offers students the opportunity to practice and provide medication therapy management for
acute-care patients with various disease states. Astute clinicians must possess a solid knowledge base of both disease pathophysiology, best
practices, and respective pharmacological therapies. This rotation prepares students to independently conduct such activities through guidance,
encouragement, practice, and constructive evaluation.

The rotation schedule has been developed by your resident preceptor team for this remote learning experience. Patient cases and topic
discussions will be held daily and will include frequent Google Hangout or phone interactions with the preceptors. As a remote learning
experience, the preceptor(s) and the APPE student must be electronically accessible and have internet access during the hours of 7:00 am to
3:30 pm.
Disease States
Disease state topic discussions and select article readings will be used to help develop the student’s patient care skills related to the
adult/medicine population. Topics include, but are not limited to:
Core Internal Medicine Topics:
Alcohol withdrawal Antimicrobial stewardship
Asthma/COPD Infectious diseases
Chronic renal failure/dialysis Acute kidney injury
Diabetes Mellitus Hypertension
DVT/PE (focus on anticoagulation) Heart failure
Gastrointestinal bleeding (esophageal varies and peptic ulcers) Total parenteral nutrition
Institutional Topics:
IV room verification Pyxis management
Suggested Additional Topics:
Gout Seizures
HIV/AIDS and opportunistic infections Thyroid disorders
Hyperlipidemia Osteoporosis (focus on steroid-induced)
Goals and Objectives
Upon completion of this rotation, the student shall be able to:
Show a fundamental knowledge of internal medicine topics and exemplify growth throughout the rotation
Develop and expand medication knowledge
Knowledge
Detect and manage potential or actual drug related problems
Recognize pharmacist interventions
Enhance verbal and written communication skills through discussions, recommendations, and education
Present a detailed patient case with pertinent information to make a treatment plan recommendation
Skills
Analyze patient laboratory values, medication profile, and vital signs for appropriate clinical assessment
Be prepared for rotation activities as specified
Display appropriate use of the electronic medical record in accordance with HIPPA law.
Use effective and appropriate communication with ease of accessibility during the rotation hours of 7-3:30 pm
Professional Maintain a professional appearance, sound, and background during video media interactions/presentations
Complete assignments according to deadline
Maintain ability to provide and receive constructive feedback
Course objectives Educational Educational activities Assessment measure(s)
outcome(s)
1. Discuss etiology, pathophysiology, Patient assessment, Assigned readings, topic Preceptor evaluation of
symptomology, diagnosis, prognosis, and medication therapy discussions, patient case educational activities
related drug/non-drug treatment of major management review, topic discussions
disease states seen in Adult Medicine
2. Independently gather, monitor, and assess Professionalism, Patient case review, Preceptor evaluation of
pertinent patient information such as: critical thinking, documentation of educational activities
medication history, physical findings, communication, interventions in Cerner
laboratory tests, and pharmacokinetic data to patient assessment,
recommend optimal drug therapy medication therapy
management
3. Present accurate patient information in a case Communication, Patient case review, case Preceptor evaluation of
presentation format to answer a drug related patient assessment, presentations educational activities
question using primary literature medication therapy (formal/informal), daily
management, preceptor discussions
guideline and primary
literature review
4. Identify, prevent, and resolve potential drug- Critical thinking, Documentation of Preceptor evaluation of
related problems through monitoring of basic communication, pharmacotherapy plans in educational activities
pharmacokinetic and pharmacodynamic medication therapy handoff notes, documentation
parameters management, patient of interventions in Cerner
assessment
5. Formulate dosing regimens for pharmacy Critical thinking, Nutrition electrolyte Preceptor evaluation of
consults such as antibiotic therapy, TPN, protocol and literature monitoring, renal adjustments, educational activities
anticoagulation, and analgesic therapy review, patient coagulation monitoring, drug-
assessment drug interactions
6. Counsel and educate mock patient(s) and/or Professionalism, Direct patient care, Preceptor evaluation of
caregivers on the appropriate use of leadership, critical documentation of educational activities
medications thinking, interventions in Cerner
communication, drug
information, public
health
7. Comprehend and practice pharmacist Professionalism, Cerner review and Preceptor evaluation of
 interventions as a core member of an leadership, documentation with educational activities
interdisciplinary team communication facilitation by preceptor
8. Independently document complete and Critical thinking, Documentation in Cerner via Preceptor evaluation
accurate pharmacist interventions organization, written progress note and/or
communication pharmacist communication
9. Participate and recognize the operations of the Professionalism, Discussion/images of order Preceptor evaluation
in-patient pharmacy practice listening and entry, IV room, controlled
question-formation substance Pyxis©, pharmacy
skills, process satellites
adherence
Expectations of the Student
The APPE student will initially be assigned ~5-10 patients and will gradually increase to the goal of monitoring one nursing unit by the end of the
rotation. In addition, the level of independent functioning with the team (drug information questions, interventions, teaching) will be monitored
and is expected to increase as the rotation progresses. Preceptors are readily available as resources for questions during the day (7-3:30 pm).
Core daily activities include, but are not limited to; medication history, provision of drug information, pharmacotherapy interventions, daily
patient documentation, IV-PO medication recommendations, and anticoagulation patient counseling practice with the preceptor. The student
may remotely present a journal club, lead an informal patient specific disease state topic, and give a formal patient case presentation using
primary literature to answer a drug related question via Google Hangouts.
Required Rotation Activities for the Remote Learning Experience
Progress notes in Preceptor will check off and monitor the student with his or her note and sign once they agree with the student’s
Cerner assessment
Patient reviews/topic
Be prepared for topic discussions by reading the required readings suggested by the preceptor
discussions
One page front and back or two pages one-sided maximum
Journal Club
Length: 30 minutes (20 – 25 min presentation, 5-10 min Q/A)
presentation to
students/preceptors (If Select a recent article (within last 6 months to 1 year) relevant to internal medicine practice (preferably related to
assigned) patient care on rotation)
Article will be approved by the specified preceptor
Formal patient Approximately 30 minutes total with 5-10 minutes for question/answers
presentation to
Create slides which can be used either in a presentation format or as handouts
students/preceptors (If
assigned) Present a patient case with in-depth discussion on at least one disease state and answers a clinical question
Evaluation
Midpoint Evaluation – Students must complete a self-assessment at the midpoint. Completion of this document should be timely as it is utilized
by the preceptor in completing their midpoint assessment of student.
Final Evaluation – Student must complete a self-assessment at the end of the experience. Completion of this document should be timely and
discussed with the preceptor as part of the end of experience evaluation submitted by the preceptor.
Student Evaluation of the Site and Preceptor – Students will complete evaluations of the preceptor at the end of the experience.
Potential criteria for evaluation:
 Displays improvement in the goal/objective from the start to the end of the rotation
 Performance is satisfactory to what a preceptor would expect of a PharmD candidate

Communication
The APPE student will have frequent contact with preceptor(s) throughout the day via phone/internet media. The following are additional
communication expectations of the student:
Frequent scheduled
Students are to be timely and prepare/prioritize questions or problems to discuss during scheduled meeting times
meeting times
Google Hangout Students are to use Google Hangout as the presentation modality approved by Lutheran Hospital
Students are expected to read emails at the beginning, middle and end of each day at a minimum for ongoing
Email
communication. This is appropriate for routine, non-urgent questions and problems.
Phone Appropriate for urgent questions pertaining to patient care. See above for various team member phone numbers.
Technology Policy
The APPE student may use electronic devices (iPad, cell phone, etc.) for remote learning communication, presentation, and drug information
review from a reputable app or website (i.e. Micromedex, Lexicomp).

Posting of any information about patients, preceptors, or the rotation onto social media is forbidden, even if no names are included. Details
of the rotation may give away patient identity which is a strict violation of HIPAA

As always, be extremely cautious when clicking on email attachments or links in emails (either work or personal reasons)
Professionalism
Patients and colleagues come in many different forms and from many different backgrounds/cultures; please be
Diversity
respectful at all times of the diversity in the workplace.
Dress Code Professional dress is required during video chats, typically business formal (i.e. slacks, shirt and tie for gentlemen;
 slacks/skirt, blouse for women; please be respectable with skirt length if worn), pay attention to camera angle for
appropriate self-representation
Be open to constructive feedback from preceptors and modify behavior if necessary; when providing preceptor
Feed back feedback, be constructive and professional with comments. Self-assessment to be completed a minimum of twice
during the rotation (midpoint and final evaluation)
Especially important for a remote-learning experience from your own home
Motivation Must demonstrate a willingness to learn
Actively seek knowledge, ask questions, and practice self-guided learning
Privacy Respect the privacy of patients and follow all HIPPA regulations
Punctuality Arrive electronically to meetings on time and meet deadlines for all assignments
All recommendations must be discussed with the assigned preceptor prior to communication with any other health
Legal professional
Do not practice outside the legal scope of a pharmacy student