LEARNING DESCRIPTION – AMBULATORY CARE ROTATION

PRECEPTOR INFORMATION

Primary Preceptor: Mallory Carter, PharmD

 PGY1 Pharmacy Resident – Ambulatory Care
 Email: mallory.carter@sjrmc.com
 Office Phone: (574) 335-6567
 Cell Phone: (317) 263-4906

SITE INFORMATION

Primary Site: Saint Joseph Family Medicine Center

 611 East Douglas Rd. Suite 407
Mishawaka, IN 46545

The Saint Joseph Health System (SJHS) is a member of Trinity Health Network, the fourth largest
Catholic healthcare system in the country.

The Saint Joseph Family Medicine Center (FMC) and Family Medicine Faculty Physicians Clinic
(FMFP) is where your ambulatory care experience will primarily take place. This site houses the Saint
Joseph Graduate Medical Education Program that consists of family medicine residents, pharmacy
residents, podiatry residents, sports medicine fellows, and the faculty of these residents and fellows.
The FMC and FMFP provides comprehensive and collaborative primary care to families all around the
Michiana area. The operating hours are 8am to 5pm Monday through Friday.
ROTATION OVERVIEW

The primary goal of this rotation is to manage the pharmacotherapy of a variety of disease states in
an interdisciplinary ambulatory care/outpatient setting. You will gain experience in patient care and
education, in collaboration with other healthcare professionals, and in a variety of different chronic
disease states. You will develop skills to assess medication regimens, provide recommendations for
therapy, monitor therapy, and communicate effectively with other providers and with patients.
Ambulatory care focuses on patients with chronic disease states that require chronic management.
As such, you will encounter:

 Hypertension  Heart Failure

 Diabetes  Atrial Fibrillation
 Hyperlipidemia  Depression/Anxiety
 Anticoagulation  Thyroid Disorders
 COPD/Asthma  Public Health (smoking cessation,
immunizations)

Ambulatory Care Pharmacists work in many different clinic sites and often independently manage a
variety of disease states. These pharmacists often practice under Collaborative Practice Agreements
that allow them to order labs, write prescriptions, and make clinical decisions underneath an
authorizing provider. You will participate in this interdisciplinary approach to patient care. You may
have the opportunity to provide services in any of the following:

 Anticoagulation Clinic  Dyslipidemia Management

 Diabetes Clinic (and Classes)
 Medicare Annual Wellness Visit Clinic
 Weight Loss Clinic
 PGY1 Pharmacy Resident Clinic
o Smoking Cessation
o Polypharmacy
o Medication Therapy Management
 Medication Adherence Service
 Transitions of Care Service
 Asthma/COPD Clinic
 Heart Failure Clinic
 Infectious Disease Clinic
 Home Infusion Management
 Team Pharmacist

GENERAL EXPECTATIONS

Before the first day:

 Read the rotation manual and notify the primary preceptor of any potential or expected
conflicts.
 Complete and return the “Getting to Know You Questionnaire.”
 Briefly review disease states commonly seen in ambulatory care (see list above).
 Provide necessary documentation to primary preceptor:
o CPR/BLS
o Drug Screen
o Background Check
o Vaccination Record
o PPD/Tuberculosis Titer
o Confidentiality agreement
During the rotation:
 Participate in rotation activities for a minimum of 40 hours per week.
 Be proactive, be prepared, and be positive.
 Be active and engaged in patient care encounters, learning activities, and discussions.
 Complete all assigned projects and presentations thoroughly.

Professionalism:
 Act in accordance with Saint Joseph Health System policies and procedures.
o Patient confidentiality
o Dress code
 Be a trustworthy representative of the pharmacy profession.
 Be respectful of people and environments.
 Address conflicts or areas of concern directly and professionally.

LEARNING OBJECTIVES

By the end of this rotation, you should be able to:

1. Describe the pathophysiology and pharmacologic treatment of the disease states commonly
seen in the ambulatory care setting.

2. Evaluate primary literature and explain how it informs treatment guidelines. Assess current
literature for applicability to practice.

3. Obtain a medication history and perform a medication reconciliation for a patient. Collect
objective and subjective information from a patient interview and chart review.

4. Evaluate patient-specific factors (adherence, cost, contraindications, drug interactions,

adverse effect profile, labs, vitals, etc.) and appropriately select individualized pharmacologic
therapy.

5. Develop an evidence-based patient care plan that includes pharmacologic and non-
pharmacologic therapy, monitoring, and follow up recommendations.

6. Assess a patient’s pharmacotherapy regimen for appropriateness and make recommendations

for changes, if necessary.

7. Evaluate a patient’s health literacy and provide effective education/counseling. Assess patient
understanding.

8. Communicate effectively and respectfully to other healthcare providers.

9. Provide drug information services to other healthcare providers in an efficient and succinct
manner.
CLINIC EXPERIENCE EXPECTATIONS

You will have the opportunity to work in a variety of clinics that each specialize in a particular disease
state. These clinics may look slightly different in practice and topic; however, the preparation and role
of the pharmacist in each one is similar. It is expected that you do the following.

Before clinic:
 Reach out to the preceptor at the site at least 48 hours in advance. Arrange a time and place
to meet to discuss patients before clinic.
 Thoroughly work up/evaluate the patients to be seen in clinic that day. Use an appropriate
monitoring form.
During clinic:
 Perform medication reconciliations as directed.
 Be engaged in patient interactions. If not actively participating, take notes and be prepared to
discuss afterwards.
 Perform any additional work assigned by the preceptor. Respond to drug information
questions if applicable.
After clinic:
 Document the patient encounters appropriately, as directed. Ensure this is reviewed by the
preceptor.
 Follow up with any questions or concerns from the patient or the preceptor.

The goal is for you to be able to fully or partially lead patient interactions by the time you complete
this rotation.

PROJECTS/PRESENTATIONS/ASSIGNMENTS

These activities are meant to enhance your knowledge, understanding, and communication skills. You
may not complete every activity listed here, and there may be some activities that you do complete
that are not included on this list. Let your primary preceptor know if there is something you are
interested in that is not listed below. Examples of these assignments are on the Google Drive.

Topic Discussions
 Informal (15-30 minutes)
o 1-4 Student-led discussions
o Create a 1-page handout
 Formal (30 minutes with questions)
o Visual presentation
o Create a handout
o Include an interactive activity

Journal Club/Clinical Trial Presentation (30 minutes with questions)

 Clinical Trial
o Evaluate 3-4 clinical trials for one particular disease state
 Complete the table provided in the Google Drive
 Provide an analysis of the implications of the trials
o Include an interactive activity
  Journal Club
o Evaluate a journal article using the template provide in the Google Drive
 Provide 3 articles to your primary preceptor at least 1 week prior to your
presentation. Should be ambulatory care related and published within the last
year.
o Include an interactive activity

Formal Patient Case Presentation (30 minutes with questions)

 Identify an interesting patient you have worked up by the 2nd week of rotation
 Introduce the patient and clinical decision, then review the disease state, guideline-directed
therapy, and include 2 clinical trials for completeness.
 Cite references
 Include an interactive activity

Oral Examinations (30 minutes)

 Beginning and end of the block
 Work up a mock patient case. May use resources.
 Present the patient and respond to questions from the pharmacy team.

Patient Care and Drug Information Questions

 Healthcare providers will ask you drug information questions throughout the course of the
month. This typically occurs when you are on team with the family medicine residents, serving
as their drug information resource.
 Respond to follow-up questions from preceptors within 48 hours, as applicable.

FORMAL EVALUATIONS

Midpoint Evaluation
 At the end of the 2nd week of rotation, you will sit down with your primary preceptor to
discuss your performance, progress, and goals.
 Come prepared with areas of strength and areas for improvement.
 Work with your preceptor to set realistic and measurable goals for your remaining time.

Final Evaluation
 At the end of the rotation, you will sit down with your primary preceptor to evaluate your
performance and to offer your evaluation of the preceptor and site.
 Complete your required reflections ahead of time. Come prepared.
 Be honest, constructive, and professional in your feedback as we will be in ours.

Your projects/presentations will be evaluated via rubrics by a variety of pharmacy personnel

(preceptors, ambulatory care team, residents, other students).

Most likely, there will be informal evaluations at the end of week 1 and 3 as well. The goal of these
sessions is to provide informal feedback and reflection that you can use immediately.
ROTATION POLICIES

 Academic Integrity
 Disability and Accommodation
 Religious Observance and Accommodation
 Absence and Emergency
 Title IX Discrimination and Harassment

ORIENTATION CHECKLIST

 General tour of hospital/clinic and student workspaces

 Introduce preceptors and pertinent staff members

 Collect and review rotation requirements

o Confidentiality agreement
o Documents listed under expectations
o HealthStream email confirmation

 Review rotation calendar

 Discuss expectations
o Professionalism
o Projects/assignments/presentations
o Clinic sites
o Review Google Drive

 Review “Getting to Know You” Questionnaire

 EMR Training/Applicable HR Training

 GETTING TO KNOW YOU QUESTIONNAIRE

1. What are your future career plans (even tentatively)?

a. Are you interested in pursuing a residency? If so, what kind?

2. What pharmacy experience do you have (working, prior rotations, professional organizations,
volunteer experience, etc.)?

3. List 3 strengths you bring to this rotation:

4. List 3 areas in which you hope to improve while on this rotation:

5. What do you hope to achieve upon the completion of this rotation?

6. List a few topics you are interested in learning more about:

7. How do you like to learn and receive feedback?

8. Is there anything I should know to ensure you have a successful rotation?