2020-2021 | APPE Student Manual

Ambulatory Care Rotation

Saint Joseph Health System
Primary Preceptor: Molly Corder, PharmD
Site Description & Opportunities

Trinity Health Network is one of the largest non-profit Catholic health systems in the nation;
encompassing 94 hospitals housed in 22 states.
Saint Joseph Health System (SJHS) consists of 2 acute care hospitals, several rehabilitation
centers, skilled nursing facilities, and multiple clinics throughout north central Indiana.
Saint Joseph Family Medicine Center (FMC) & Family Medicine Faulty Physicians Clinic
(FMFP) are where you will be conducting your learning experience. This is located in
Mishawaka, IN on the fourth floor of the Medical Office Building, attached to Saint Joseph
Regional Medical Center (SJRMC).
You will find a collaborative network of practitioners working in the Saint Joseph Graduate
Medical Education Program; including family medicine residents, pharmacy residents,
podiatry residents, and sports medicine fellows. Operating hours of the resident run clinics
typically operate Monday through Friday 8 am to 5 pm.
Ambulatory Care Pharmacists work in a variety of different settings and provide a number of
different services for our patients, both independently and collaboratively at Saint Joseph Health
System:
o Anticoagulation Management o Diabetes Management
o Dyslipidemia Management o Diabetes Education Classes
o Smoking Cessation o Heart Failure Clinic
o Asthma/ COPD Clinic o Medicare Annual Wellness Visits
o Weight Loss Management o Medication Adherence
o Team Pharmacist o ID Clinic
o Pharmacotherapy Clinic o Medication Therapy Management

The Advance Pharmacy Practice Experience (APPE) rotation will provide you with a number
of ambulatory care experiences including shadowing and working in pharmacist driven clinics,
working on an interdisciplinary team, creating pharmacotherapy treatment plans, and extensive
opportunity to practice your communication skills.
Molly Corder, PharmD
PGY-1 Pharmacy Resident
Ambulatory Care
molly.corder001@sjrmc.com
(574) 335-6566
Yassmeen Marzuq, PharmD
PGY-1 Pharmacy Resident
Acute Care
yassmeen.marzuq@sjrmc.com
Stephanie McAfee, PharmD
PGY-2 Pharmacy Resident
Ambulatory Care
stephanie.mcafee@sjrmc.com
(574) 335-6493
Ed Sheridan, PharmD,
BCPS, BCACP
Director, Graduate Pharmacy
Education & Ambulatory Pharmacy
Services
sheridane@sjrmc.com
(574) 335-6514
Chris Gildea, PharmD,
BCACP, CDE
Ambulatory Care Pharmacist
christopher.gildea@sjrmc.com
(574) 335-4679
Diana Mechelay, PharmD,
BCPS, BCACP, CTTS
Ambulatory Care Pharmacist
diana.mechelay@sjrmc.com
(574) 335-6491
Katie Clark, PharmD,
BCPS
Ambulatory Care Pharmacist
katherine.clark@sjrmc.com
(574) 335-7074
Faria Chaudhry, PharmD
PGY-1 Pharmacy Resident
Ambulatory Care
faria.chaudhry@sjrmc.com
(574) 335-6567
Miranda MacFarlane, PharmD
PGY-2 Pharmacy Resident
Ambulatory Care
miranda.macfarlane@sjrmc.com
(574) 335-6490
Jason Isch, PharmD,
BCACP, CTTS
Assistant Professor of Pharmacy
Practice Manchester University
jisch@manchester.edu
(574) 335-6520
Ed Battjes, PharmD,
BCACP, BC-ADM, CDE
Manager, Ambulatory Pharmacy
Services
battjese@sjrmc.com
(574) 335-6513
Carolynn Horn, PharmD,
BCPS, BCACP
Ambulatory Care Pharmacist
Carolynn.horn@sjrmc.com
(574) 335-5070
Brittany Oliver, PharmD,
BCPS
Ambulatory Care Pharmacist
brittany.oliver@sjrmc.com
(574) 335-6524
Lauren McNace, PharmD,
BCPS, BCACP
Ambulatory Care Pharmacist
lauren.mcnace@sjrmc.com
(574) 335-6563
 Learning Objectives
By the end of this rotation, you should be able to competently:
➢ Identify a patient’s medication related problems & needs
➢ Prioritize a patient’s healthcare problem list
➢ Assess a medication regimen for efficacy & feasibility
➢ Develop an evidence based treatment plan, that includes but is not limited to:
o Pharmacotherapy regimen
o Non-pharmacologic recommendations
o Monitoring
o Follow up
➢ Demonstrate effective communication with members of the healthcare team:
o Verbally
o Electronically
➢ Demonstrate effective communication with patient and/ or caregiver:
o Educate patient
o Lead a patient appointment
o Assess patient’s understanding
o Assess patient’s adherence
➢ Interpret labs and recommend medication adjustments
➢ Collaborate with healthcare team as the medication expert

Prior to your First Day with Us You Should:

o Read entire rotation manual and come up with any questions you may have
o Complete “Getting to Know You” exercise
o Read & sign Confidentiality Agreement Form
o Complete Student Rotation Requirements as seen in first email
o Bring with you the completed documents described in first email
o Notify primary preceptor with any anticipated conflicts
Professionalism Standards
o Adhere to applicable policies and procedures set forth by Saint Joseph
Regional Medical Center including, but not limited to, patient confidentiality and
dress code
o Adhere to rotation calendar (subject to change)
o Participate in rotational activities for a minimum of 40 hours per week
o Present during assigned times designated by preceptor
o Address conflicts with rotational activities 2 weeks in advance (if possible)
o Consult your Office of Experiential Education with conflicts
o Follow your College of Pharmacy’s APPE Manual for specific graduation
requirements, objectives, and expectations

Ambulatory Care Pharmacy Clinic

The student will have the opportunity to work in various ambulatory care pharmacy
clinic experiences, however the preparation for and role within each clinic should be
universal. As such, the student is expected to complete the following actions before or
after attending a clinic:
o Using the appropriate monitoring form, evaluate all patients assigned to that
clinic.
o It is expected that at least 48 hours prior to the students scheduled clinic
experience, the student will reach out to the clinic preceptor to determine a
time to meet to discuss patients.
o Arrive to discuss patients with the clinic preceptor at a predetermined time with
all necessary materials to discuss the patients: patient’s medication list, copy of
completed patient workup form, and an assigned laptop.
o During clinic, if the student is not actively leading the interaction, the student
should be documenting the interaction for both subjective and objective
information.
o If a preceptor assigns additional work, it is your responsibility to complete this
and set up a time for discussion
o After the clinic, the student should take direction from that clinic preceptor as to
which patient interactions to document. The student should take initiative to set
a follow up time with the clinic preceptor to review the completed
documentation.
o At the end of the pharmacy rotation, the student should be able to successfully
lead, either partly or fully, an entire patient interaction.

Medical Resident Clinic

The student will potentially have the opportunity to work alongside the family medicine
residents during one-half of their clinic day.
Prior to attend clinic, the student is expected to complete the following:
o Using the appropriate monitoring form, evaluate all patients assigned to that
clinic half day (except well-child visits and well-women visits).
o Print out all of the patient's medications list.
 o Set up time to discuss patients evaluated with pharmacy preceptor (please
reach out to preceptor at least 48 hours before scheduled medical resident
clinic time). During this time, the student and preceptor will develop a list of
potential recommendations for each patient during the half-day of clinic.
o During this experience, the student is expected to:
o Complete medication reconciliation using paper printout of the patient's
medication list and inform medical resident and nursing team members
of results to update the patient's chart in the electronic health record.
o (If applicable), provide medication counseling and education to patients
utilizing appropriate patient literature or demonstration devices
o (If applicable), answer drug information questions. Depending on the
significance of the question, provide the answer to the individual who
asked AFTER reviewing the answer with the pharmacy preceptor.
o Discuss pre-approved (already discussed with pharmacy preceptor)
recommendations with medical resident

Student Learning Experiences/ Potential Assignments

In addition to the experiences listed below, there could be other opportunities the
APPE student might be asked to participate in or complete. If you have something
you are interested in, discuss this with primary preceptor.

Informal Topic Discussion

o (15-30 minutes)
o The APPE student will collaborate with their primary preceptor to determine the
topics of 1-4 topic discussions throughout their rotation. This informal
discussion may take place with just the primary preceptor; however, others
may be invited to attend
o It is expected that the APPE student will research and be prepared to lead a
discussion surrounding the determined topic.

SJHS Bi-Monthly Newsletter

o If applicable, the student may be asked to create a half-page quick and easy-
to-read summary for possible publication in the SJHS bi-monthly newsletter.

Disease State/Formal Topic Discussion Presentations

o (30 minutes max, 20-25 minutes for presentation and 5-10 minutes for
questions)
o The APPE student will collaborate with their primary preceptor to determine the
topics of 1-4 topic discussions throughout their rotation. These will take place
in a small group setting (possibly with just the APPE student and their primary
preceptor).
o It is expected that the APPE student will research and develop an educational
resource covering the topic.
o (Possibly supplemented by a PowerPoint or other presentation style) while
incorporating an interactive component.
Formal Patient Case Presentation
o (30 minutes max, 20-25 minutes for presentation and 5-10 minutes for
questions)
o The APPE student will identify one patient case to present by their second
week of the rotation. This presentation will briefly cover the patient and clinical
decision, review a disease state and guideline driven medications, and at least
2 clinical trials or reviews.
o If the APPE student is unable to identify or locate appropriate references, they
will approach their primary preceptor for additional assistance. Class notes are
not an appropriate reference and all references must be cited.
o It is required that the presentation include some form of audience engagement.

Clinical Trial Presentation

o (30 minutes max, 20-25 minutes for presentation and 5-10 minutes for
questions)
o The APPE Student will be assigned 4 clinical trials within the scope of one
disease state to formally evaluate. They will then fill out a provided worksheet
(located on Google Drive), breaking the trials down into key points.

Journal Club
o (20 minutes)
o The APPE Student will be assigned a journal article which they must formally
evaluate using provided journal club template. If the journal club is not
assigned, the APPE student must identify three journal articles related to
ambulatory care (within the past year preferably) and submit them by the first
Thursday of their APPE experience to their primary preceptor. The final journal
club article will be selected by the primary preceptor by the first Friday of their
experience.
o The APPE Student will then be required to prepare a 1 page (front and back)
handout and present over their findings

Oral Examination
o (30 minutes)
o At the start of the rotation, the APPE student will be expected to participate in a
Beginning of Block Oral Exam, which the candidate will be provided 30 minutes
to work up a mock patient case using drug information sources as needed.
o Prior to presenting the case, the student will have the ability to ask 3 questions
that they have which will help them guide their clinical decision making. They
will then present the case to team members for evaluation.
o At the end of the rotation, the APPE student will be expected to participate in
an End-of-Block Oral Exam following the same procedures described above.
Patient Care Questions or Drug Information Questions
o If follow up questions must be addressed, the student will have 24-48 hours (or
otherwise determined by the preceptor) to e-mail both the preceptor involved
and their primary preceptor the response.

Diabetes Education Group Class Presentation

o Depending on the time of year and availability, there is a possibility the student
will be asked to present a portion of the Diabetes Group Class held at this site.
o The student will be provided the slides, handouts, and any interactive portion
necessary to complete the session.

Saint Joseph Health System Project Management

o Depending on the time of year and availability, there is a possibility the student
will be asked to work on a project for Saint Joseph Health System.

1. WHAT ARE YOUR CAREER GOALS AFTER PHARMACY

SCHOOL?

2. DO YOU WANT TO DO A RESIDENCY?

3. WHAT PHARMACY EXPERIENCE DO YOU ALREADY HAVE? (EX:

WORK, ROTATIONS, PROFESSIONAL ORGANIZATIONS)

4. LIST 3 OF YOUR STRENGTHS

5. LIST 3 WEAKNESSES YOU WOULD LIKE TO WORK ON DURING

THIS ROTATION

6. WHAT DO YOU WANT TO GET OUT OF THIS ROTATION?

7. IS THERE ANYTHING YOU WOULD LIKE TO DISCLOSE WITH ME

TO HELP YOU HAVE A SUCCESSFUL ROTATION?
 Orientation Checklist
Introduction of preceptor(s) and other staff ___
General tour of the facility & discuss spaces where students can work ___
Collect & review student rotation requirements (Save w/ name & year) ___
✓ Confidentiality Agreement
✓ Health Stream online training email confirmation
✓ Current CPR (or BLS) documentation
✓ Documentation of immunizations (rubella, chicken pox,
hepatitis B, flu)
✓ Documentation of recent PPD w/in 12 months from rotation
start
✓ CoaguChek INR monitoring quiz results
Discuss professional appearance & behavior standards ___
Discuss time commitment for rotation ___
Review guidelines for reporting/ requesting absence from rotation ___
Review “Getting to Know You” exercise ___
Review clinical experience expectations & rotation calendar ___
o Discuss google drive
o Access to:
• Monitoring forms
• Rubrics
• Diabetes Education Group Class Information
Review expectations w/ presentations & projects ___
Electronic Medical Record Training ___
o Distribute laptop & name badge (check for access)
o How to find the clinics on MHIN
o How to work up patients-(evaluate notes from providers, meds,
labs, etc.)
o How to document on chart
o Review drug information references
Physical skills assessment ___
o Blood pressure/ pulse
o INR Point of Care

Preceptor: ____________________________________________________________

Student: ______________________________________________________________