DEPARTMENT OF CLINICAL

PHARMACY PRACTICE
 CLINICAL PHARMACY/ CLERKSHIP/INTERNSHIP MANUAL DEPARTMENT OF
CLINICAL PHARMACY PRACTICE.

INTRODUCTION:

This Clerkship/Internship Manual of the Department of clinical Pharmacy practice, BLDEA’s

SSM College of pharmacy & Research centre has been designed to educate and train the students
in the detection and management of drug-related problems and to assist the students in applying
the acquired knowledge in the promotion of rational drug therapy. The internship is prepared to
provide academically supervised clinical experiences which will give the interns a better
knowledge of the most current and appropriate methods of collecting and applying clinical
information concerning the therapeutic and toxic effects of drugs. The clinical practice
experience in clerkships is a different learning experience than dictated courses. There will be
numerous opportunities to gain an appreciation and understanding of the concept of
pharmaceutical care as well as share in the ultimate responsibility for patient care outcomes. The
Department of Pharmacy at SSM College of pharmacy provides an experiential learning
environment which will assist our interns to become confident, caring and ethical pharmacy
practitioners with the ability to think critically and apply their knowledge and skills in the best
interest of their patients, regarding individualized pharmacotherapy planning, intervention and
outcome evaluation. The clinical experiences imparted on interns by well qualified and
experienced preceptors will help them to enter their choice of clinical specialty, to continue
successfully in their lifelong learning and practice and to meet their responsibilities as a health
care practitioner to patients and the society.

2. MISSION

 To provide an experiential learning environment which will assist our students to become
confident, caring, ethical pharmacy practitioners with the ability to think critically and
apply their knowledge and skills in the best interest of their patients regarding
individualized pharmacotherapy planning, intervention and outcome evaluation. The
clinical experiences we provide will help students to enter their choice of clinical
specialty, to continue successfully in their lifelong learning and practice, to meet their
responsibilities to patients and the society.

3. GOALS

i. To develop a sufficient, relevant, and experiential knowledge base to utilize

appropriate resources necessary to provide direct patient care regarding individualized
therapeutic planning, intervention and evaluation.
ii. To master the clinical skills necessary to assume accountability and responsibility for
therapeutic outcomes in the process of providing pharmaceutical care.
 iii. To develop professionalism and interpersonal skills as a member of team of health
care providers, necessary for the provision of optimal patient care and pharmacy
services.

4. OBJECTIVES

This clerkship/internship will help and prepared the students for their future professional
pharmacy practices. The details are mentioned below;

4.1 MANAGEMENT OF DISEASE STATES AFTER SUCCESSFUL COMPLETION OF

THE CLERKSHIP, THE STUDENT WILL BE ABLE TO:

1. Take and record the patient history and record the findings of clinical examination.

2. Interpret the information from the patient's laboratory examination in assessing the disease
state (s) and reaching/confirming the final diagnosis of the patient.

3. Discuss the currently acceptable options of investigation and treatment for the patient's disease
state based on the best evidence available.

4. Utilize information from from1, 2, and 3 in formulating a individualized therapeutic plan for
the patient, which will include:

a. Therapeutic objectives, with end point of the therapy.

b. Pharmacologic and non pharmacologic treatment.

c. Follow up evaluation plan.

d. Evaluation of therapeutic outcomes.

5. Discuss various therapeutic options with the patient (if feasible) as well as with the other
health care providers, if asked for

6. Discuss potential drug-disease, drug-drug, drug-laboratory test, and drug-dietary problems

prior to making recommendations on drug therapy. These recommendations will include:

a. Selection of Drug (s) or non drug therapy

b. Dosage

c. Route of Administration

d. Frequency of Administration

e. Duration of Therapy

f. Drug dosage Adjustment Consultation.

 4.2 PATIENT MONITORING AFTER SUCCESSFUL COMPLETION OF
THE CLERKSHIP THE STUDENT WILL BE ABLE TO:
1. Monitor daily progress of the patient's disease state (s) and drug therapy based upon relevant
laboratory data, physical findings, subjective findings, and consultation with medical team.

2. Identify existing or potential adverse reactions and/or treatment of failures, provide

assessment and recommend management approaches.

3. Utilize the medication history and patient's medical record to identify drug incompatibilities,
interactions, and abuses to assess their clinical significance and to discuss potential solutions.

4. Apply pharmacokinetic dosing principles to dosing of selected drugs and monitor specific
drug therapy.

4.3 PATIENT CHART/DATA REVIEW AFTER SUCCESSFUL

COMPLETION OF THE CLERKSHIP THE STUDENT WILL BE ABLE
TO
1. Demonstrate the ability to retrieve required information from the medical record (paper or
electronic) and assess patient specific information necessary for drug therapy monitoring. In that
regard, student will familiarize him/herself with regard to:

a. Chart arrangement.

b. Specific types of information contained therein. For example, admission note history and
findings from Physical examination, physician order, laboratory results, progress notes.

c. Medication administration record, diabetic management sheet and patient file etc.

d. Medical abbreviations.

2. Plan interventions based on the information retrieved, if asked for 3. Present the information
in a concise and complete manner.

4.4 LABORATORY FINDINGS:

After successful completion of the clerkship the student will be able to:

1. Recognize the significance of both normal and abnormal laboratory tests and reports.

2. Interpret the lab findings regarding to the patient disease state (s), in diagnosis and follow up
evaluation
3. Utilize the lab finding in formulating the individualized drug therapy plan, follow up
evaluation and identifying the drug therapy problems.

4.5 MEDICATION HISTORY

After successful completion of the clerkship the student will be able to, Obtain through direct
interview, a patient medication history to identify: prescription and nonprescription usage,
medications administration habits, procurement sources for drugs, compliance with prescribed
therapy, and previous adverse drug reactions or allergies.

4.6 DRUG INFORMATION AFTER SUCCESSFUL COMPLETION OF THE

CLERKSHIP THE CLINICAL PHARMACY STUDENT WILL BE ABLE TO:

1. Apply skills related to utilizing the drug information resources to answer questions related to
drug use and toxicity.

2. Demonstrate the ability to retrieve, evidence based drug information, critically evaluate and
utilize when providing answer to a question.

3. Respond to drug information requests appropriately and in a timely manner.

4. Communicate information verbally and in written.

4.7 DISCHARGE MEDICATION COUNSELING

Prior to counseling a patient, the student should have a comprehensive understanding of the
medication to be discussed, including the drug’s indications, mechanism of actions,
pharmacology, appropriate use and administration, storage, common adverse effects and
precautions. The student should review this information with the preceptor prior to interacting
with the patient. After successful completion of the clerkship the Clinical Pharmacy student will
be able to:

1. Provide organized and individualized instruction to patient about their diseases and drugs
prescribed to improve the patient's understanding and willingness to accept proper treatment.

2. Advise patients on proper utilization of prescription and nonprescription drugs including

expected drug effects and potential drug-drug, and drug-dietary interaction warning, storage, etc.

INTERNSHIP
(1) Internship is a phase of training wherein a student is expected to conduct actual practice of
pharmacy and health care and acquires skills under the supervision so that he or she may become
capable of functioning independently.

(2) A student shall be permitted to start the internship only after having passed in theory and
practical of all subjects of all the previous years.

(3) Every student has to undergo one-year internship as per Appendix-C to these regulations

Award of Degree:
a) A candidate who has passed in all the subjects of Pharm.D course has successfully
completed the Internship (as described in appendix C) will be eligible for the award of
Pharm. D degree.

Practical training:
1. Hospital posting ― Every student shall be posted in constituent hospital for a period of not
less than seventy five hours to be covered in not less than 200 working days in each of second,
third & fourth year course. Each student shall submit report duly certified by the preceptor and
duly attested by the Head of the Department or Institution as prescribed. In the fifth year, every
student shall spend half a day in the morning hours attending ward rounds on daily basis as a part
of clerkship. Theory teaching may be scheduled in the afternoon.

2. Project work:

1. To allow the student to develop data collection and reporting skills in the area of community,
hospital and clinical pharmacy, a project work shall be carried out under the supervision of a
teacher. The project topic must be approved by the Head of the Department or Head of the
Institution. The same shall be announced to students within one month of commencement of the
fifth year classes. Project work shall be presented in a written report and as a seminar at the end
of the year. External and the internal examiners shall do the assessment of the project work.

2. Project work shall comprise of objectives of the work, methodology, results, discussions and
conclusions.

3. Objectives of project work ―

The main objectives of the project work is to―

(i) show the evidence of having made accurate description of published work of others
and of having recorded the findings in an impartial manner; and
(ii) (ii) Develop the students in data collection, analysis and reporting and interpretation
skills.
4. Methodology ― To complete the project work following methodology shall be adopted,
namely: ―

(i) Students shall work in groups of not less than two and not more than four under an
authorized teacher;

(ii) Project topic shall be approved by the Head of the Department or Head of the Institution;
(iii) project work chosen shall be related to the pharmacy practice in community, hospital and
clinical setup. It shall be patient and treatment (Medicine) oriented, like drug utilization
reviews, Pharmacoepidemiology, pharmacovigilance or Pharmacoeconomics;

(iv) Project work shall be approved by the institutional ethics committee;

(v) student shall present at least three seminars, one in the beginning, one at middle and one
at the end of the project work; and

(vi) two-page write-up of the project indicating title, objectives, methodology anticipated
benefits and references shall be submitted to the Head of the Department or Head of the
Institution.

Reporting ―
(1) Student working on the project shall submit jointly to the Head of the Department or
Head of the Institution a project report of about 40-50 pages. Project report should include a
certificate issued by the RGUHS recognized teacher, Head of the Department as well as by
the Head of the Institution

(2) Project report shall be computer typed in double space using Times Roman font on A4
paper. The title shall be in bold with font size 18, subtitles in bold with font size 14 and the
text with font size 12. The cover page of the project report shall contain details about the
name of the student and the name of the authorized teacher with font size 14.

(3) Submission of the project report shall be done at least one month prior to the
commencement of annual or supplementary examination.

Evaluation―
The following methodology shall be adopted for evaluating the project work―

(i) Project work shall be evaluated by internal and external examiners.

(ii) (ii) Students shall be evaluated in groups for four hours (i.e., about half an hour for a group
of four students).
(iii) (iii)Three seminars presented by students shall be evaluated for twenty marks each and the
average of best two shall be forwarded to the university with marks of other subjects.
 (iv) Evaluation shall be done on the following items: Marks
a) Write up of the seminar (7.5)
b) Presentation of work (7.5)
c) Communication skills (7.5)
d) Question and answer skills (7.5)
Total (30 marks)

SPECIFIC OBJECTIVES OF INTERNSHIP

i) To provide patient care in cooperation with patients, prescribers, and other
members of an inter professional health care team based upon sound therapeutic
principles and evidence-based data, taking into account relevant legal, ethical, social
cultural, economic, and professional issues, emerging technologies, and evolving
biomedical, pharmaceutical, social or behavioral or administrative, and clinical
sciences that may impact therapeutic outcomes.
ii) to manage and use resources of the health care system, in cooperation with
patients, prescribers, other health care providers, and administrative and supportive
personnel, to promote health; to provide, assess, and coordinate safe, accurate, and
time-sensitive medication distribution; and to improve therapeutic outcomes of
medication use.
iii) to promote health improvement, wellness, and disease prevention in co-operation
with patients, communities, at-risk population, and other members of an
interprofessional team of health care providers.
iv) To demonstrate skills in monitoring of the National Health Programmes and
schemes oriented to provide preventive and promotive health care services to the
community.
v) to develop leadership qualities to function effectively as a member of the health
care team organized to deliver the health and family welfare services in existing
socioeconomic, political and cultural environment.
vi) To communicate effectively with patients and the community.

CLINICAL PHARMACY (PRACTICAL) Practical: 3 Hrs. /Week

Students are expected to perform 15 practicals in the following areas covering the topics dealt in
theory class.

a. Answering drug information questions (4 Nos)

b. Patient medication counselling (4 Nos)

c. Case studies related to laboratory investigations (4 Nos)

d. Patient medication history interview (3 Nos).

ASSIGNMENT:
Students are expected to submit THREE written assignments (1500 – 2000 words) on the topics
given to them covering the following areas dealt in theory class.

Drug information, Patient medication history interview, Patient medication counselling, Critical
appraisal of recently published articles in the biomedical literature which deals with a drug or
therapeutic issue.

FORMAT OF THE ASSIGNMENT:

1. Minimum & Maximum number of pages.

2. Reference(s) shall be included at the end.

3. Assignment can be a combined presentation at the end of the academic year.

4. It shall be computer draft copy.

5. Name and signature of the student.

6. Time allocated for presentation may be 8+2 Min.