Letters
Continued from page 906
and an ability to facilitate the required
teaching opportunities for residents tend
to be the most popular mentors sought
by residents. This leads to many faculty
members mentoring multiple residents
and a reduced ability to provide residents
with the desired amount of feedback.
Although Wright et al.1 recommended
that mentors be faculty members at a
college of pharmacy, we find this not al-
ways feasible due to our large number of
participants. Instead, the mentor quali-
fications we recommend to IPTeC par-
ticipants include didactic teaching ex-
perience, significant teaching outside of
the classroom, and previous completion
of a teaching and learning curriculum,
in addition to commitment to develop-
ing postgraduate pharmacist trainees,
which more resemble those outlined
previously by American College of Clin-
ical Pharmacy.2 Inclusion of nonfaculty
mentors is especially beneficial to par-
ticipants more interested in experiential
teaching roles.
A final challenge lies in maintaining
deadlines. Mentors are often provided
insufficient time to review residents’
teaching material. In addition, as dead-
lines approach, mentors with multiple
residents experience voluminous labor.
Furthermore, mentors have expressed
confusion as whether it is the mentor’s
or resident’s role to hold residents ac-
countable for these deadlines. We have
found that striking the appropriate bal-
ance between available resources (i.e.,
mentors) and program expectations
(e.g., feedback frequency) is crucial.
IPTeC requires one midpoint and one fi-
nal teaching portfolio review as opposed
to the quarterly feedback suggested in
recent guidelines.1
We agree with recent recommenda-
tions that mentor–mentee relationships
serve as a key component of teaching and
learning curricula.1,2 However, facilitat-
ing such relationships presents challeng-
es. The IPTeC program has incorporated
several strategies to manage these chal-
lenges, which may be beneficial to simi-
lar programs attempting to implement
mentor–mentee relationships.
1. Wright EA, Brown B, Gettig J et al. Teach-
ing and learning curriculum programs:
recommendations for postgraduate phar-
macy experiences in education. Am J
Health-Syst Pharm. 2014; 71:1292-302.
2. Havrda DE, Engle JP, Anderson KC et al.
Guidelines for resident teaching experi-
ences. Pharmacotherapy. 2013; 33:e147-61.
3. Gonzalvo JD, Ramsey DC, Sheehan AH,
Sprunger TL. Redesign of a statewide
teaching certificate program for pharmacy
residents. Am J Pharm Educ. 2013; 77:1-7.
Kirk E. Evoy, Pharm.D., Pharmacy Resident
Saint Joseph Regional Medical Center
Mishawaka, IN
kirkevoy@gmail.com
Kendra M. Malone, Pharm.D., Pharmacy
Resident
Eskanazi Health
Indianapolis, IN
Jasmine D. Gonzalvo, Pharm.D., BCPS,
BC-ADM, CDE, Clinical Associate
Professor of Pharmacy Practice and
Clinical Pharmacy Specialist, Primary
Care
Incorporating the Pharmacy Practice Model
Initiative into advanced pharmacy practice
experience rotations
T he Pharmacy Practice Model Initiative
(PPMI) is a patient-centered model
that aims to advance the practice of
pharmacy by encouraging pharmacists to
take a larger role in direct patient care.1
An expanded pharmacist role necessi-
tates a redistribution of responsibilities
through increasing the use of pharmacy
staff at all levels of education and prac-
tice. The PPMI also proposes that phar-
macy students and technicians perform
distributive tasks, allowing pharmacists
more time to focus on clinical aspects.
By adopting cutting-edge technology
to decentralize pharmacists, expanding
the role of pharmacy technicians, allow-
ing student pharmacists to make guided
interventions, and promoting special-
ized knowledge acquisition through the
completion of pharmacy residencies, in-
stitutions will allow pharmacists to have
a more direct role in interprofessional
patient care.
Am J Health-Syst Pharm—Vol 72 Jun 1, 2015
Purdue University College of Pharmacy
Indianapolis, IN
Darin C. Ramsey, Pharm.D., BCPS,
BCACP, Associate Professor of Pharmacy
Practice
Butler University College of Pharmacy
Indianapolis, IN
Amy H. Sheehan, Pharm.D., BCPS,
Assistant Professor of Pharmacy
Practice
Purdue University College of Pharmacy
Indianapolis, IN
Tracy L. Sprunger, Pharm.D., BCPS,
Associate Professor of Pharmacy Practice
Butler University College of Pharmacy
The authors have declared no potential
conflicts of interest.
DOI 10.2146/ajhp140873
As the practice of pharmacy evolves, it
is important to maintain and strengthen
pharmacy department leadership, re-
sponsibility, accountability, and infra-
structure. Key components of leadership
include mentoring students who will
soon become practitioners involved in
expanding the patient care role of the
pharmacist. Concurrently, pharmacists
should incorporate students into the
provision of pharmacy services while
continuing to ensure medication safety.
With proper guidance, students can ad-
vance the role of the pharmacist and pos-
itively affect patient outcomes. A recent
study demonstrated that student phar-
macists had a positive impact on sev-
eral Hospital Consumer Assessment of
Healthcare Providers and Systems scores
in the “communication of medication”
domain.2 The use of student pharmacists
also decreased the load of patients per
pharmacy staff member from 30:1 to 7:1.
909
 Letters
Northwestern Memorial Hospital
(NMH) is an 894-bed academic medical
center in Chicago, Illinois. The pharmacy
department currently accepts students
from 10 colleges of pharmacy to its ad-
vanced pharmacy practice experience
(APPE) rotation programs: Butler Uni-
versity, Chicago State University, Creigh-
ton University, Drake University, Mid-
western University, Purdue University,
Roosevelt University, Rosalind Franklin
University, Southern Illinois University
in Edwardsville, and University of Illinois
at Chicago. This unique collaboration
provides students and preceptors from
different educational backgrounds and
school affiliations with an opportunity
to work together during the same rota-
tion and care for patients, according to
the PPMI, in a patient-centered model.
Students often work together to evaluate
patients and complete assigned projects.
They also assemble for daily lunch meet-
ings and interactive educational confer-
ences where they have opportunities to
network formally and informally. By
incorporating student pharmacists and
pharmacy residents into the interpro-
fessional team and entrusting them to
make knowledge-specific and skill-
specific clinical decisions independently,
NMH facilitates a strong educational
environment for students in addition
to providing pharmacists the flexibility
to focus on more challenging clinical
dilemmas.
To evaluate the PPMI and multischool
learning environment-related benefits of
NMH’s APPE rotation, a 30-question sur-
vey was administered to student pharma-
cists and preceptors during a six-month
period in 2013. Survey responses indicat-
ed that the diverse learning environment
provided students with benefits that they
would not normally receive from a rota-
tion site affiliated with only one college
of pharmacy. Results indicated that stu-
dents were amenable to the added work-
load and responsibility that the PPMI-
based rotation model required of them.
Students were often willing to work with
and report to more than one preceptor
as well as work with preceptors from
other colleges of pharmacy. This allowed
910 Am J Health-Syst Pharm—Vol 72 Jun 1, 2015
a student’s primary preceptor to have
more flexibility and time to perform his
or her clinical duties in accordance with
the PPMI. The provision of a variety of
engaging daily conferences and multi-
school interactions that students view as
beneficial allows them to function and
learn more effectively as well as make
valuable networking connections.
We believe that this model is an ef-
fective way to transition toward PPMI-
centric student teaching and that ad-
ditional research on the impact of the
PPMI on students should be conducted.
1. Shane R. Critical requirements for health-
system pharmacy practice models that
achieve optimal use of medicines. Am J
Health-Syst Pharm. 2011; 68:1101-11.
2. Delgado O, Kernan W, Knoer S. Advancing
the pharmacy practice model in a commu-
nity teaching hospital by expanding stu-
dent rotations. Am J Health-Syst Pharm.
2014; 71:1871-6.
Jacob Bierman, Pharm.D., Postgraduate
Year 1 Pharmacy Resident
CVS/Caremark
CVS Health
Irving, TX
jbierman41@midwestern.edu
Rachel Ralph, Pharm.D., Postgraduate
Year 1 Pharmacy Resident
Department of Pharmacy
Northwestern Memorial Hospital
Chicago, IL
Convulsions associated with moxifloxacin
F luoroquinolones are generally well tol-
erated but can cause central nervous
system (CNS) toxicities.1 We are unaware
of published case reports of moxifloxacin
causing new-onset convulsions, though
one case associating the drug with sei-
zures in a patient with a history of epi-
lepsy has been reported.2 We report a case
of new-onset convulsions associated with
the use of moxifloxacin.
A 45-year-old perimenopausal wom-
an appeared at an occupational medicine
clinic after completing a 14-day course
of cephalexin for persistent sinus symp-
toms, which included sinus and ear pain,
Allyson Greenberg, Pharm.D., Clinical
Staff Pharmacist
Pharmacy Department
Advocate Illinois Masonic Medical Center
Chicago, IL
Michael Postelnick, B.S.Pharm, BCPS
(AQ-ID), Clinical Manager
Department of Pharmacy
Northwestern Memorial Hospital
Despina Kotis, Pharm.D., FASHP, Director
Department of Pharmacy
Northwestern Memorial Hospital
Nancy Fjortoft, Ph.D., Dean
Chicago College of Pharmacy
Midwestern University
Downers Grove, IL
Miriam A. Mobley Smith, Pharm.D.,
FASHP, Dean and Professor
College of Pharmacy
Chicago State University
Chicago, IL
When this communication was written,
Drs. Bierman and Greenberg were pharma-
cy students at the Chicago College of Phar-
macy, Midwestern University, Downers
Grove, IL, and Dr. Ralph was a pharmacy
student at the College of Pharmacy, Univer-
sity of Illinois at Chicago, Chicago, IL.
The authors have declared no potential
conflicts of interest.
DOI 10.2146/ajhp140399
congestion, and low-grade fever. The
clinic visit revealed a purulent discharge
from her left tympanic membrane on oto-
scopic examination, but the remainder of
the physical examination, including neu-
rologic testing, was normal. The patient
had a history of treated hyperthyroidism
and seasonal allergies. Moxifloxacin 400
mg orally once daily was prescribed. The
patient returned to the same clinic the next
day after taking one dose of moxifloxacin.
She reported that within one hour of tak-
ing the dose, she felt nauseated, nervous,
anxious, and agitated. She described feel-
Continued on page 912
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