Teaching Experience Log

Name Institution Program type Funding by academic institution (any %)

Emily Costello Ascension St. Vincent - Indianapolis 1 = PGY1 2 = No
Didactic Teaching
If "College of
Would you have
Location (Institution/Setting) Pharmacy," please Delivery (Select the If any “other” responses Time
Date Type of Teaching (Select the BEST fit) Target audience completed this if
Select the BEST fit list. If "Other," BEST fit) selected, please explain here. (hours)
not part of IPTeC?
describe location.
9/22/2023 2 = Instruction for health professionals 3 = Practice setting (community,
N/Aclinic, hospital, industry,
2 = Online
regulatory,
synchronous
etc.) 2 = Healthcare professionals 1 = Yes N/A 0.5
11/21/2023 2 = Instruction for health professionals 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 2 = Healthcare professionals 1 = Yes N/A 0.5
3/1/2024 2 = Instruction for health professionals 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 2 = Healthcare professionals 1 = Yes N/A 1
5/20/2024 2 = Instruction for health professionals 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 2 = Healthcare professionals 1 = Yes N/A 1
Total 3 2 hours required

Small Group Teaching

If "College of
Would you have
Location (Institution/Setting) Pharmacy," please Delivery (Select the If any “other” responses Time
Date Type of Teaching (Select the BEST fit) Target audience completed this if
Select the BEST fit list. If "Other," BEST fit) selected, please explain here. (hours)
not part of IPTeC?
describe location.
8/30/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
9/6/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
9/20/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
10/11/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
10/18/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
10/23/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 1
10/25/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
11/15/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
11/29/2023 2 = Discussion-based course (i.e., case studies course,
1 = College
etc.) of Pharmacy Butler University 1 = In-person 1 = Students 1 = Yes N/A 4
Total 33 3 hours required
Precepting/Co-precepting

Location of precepting Would you have

Delivery (Select the If any “other” responses Time
Date Type of Teaching (Select the BEST fit) (Institution/Setting). Select Learners precepted completed this if
BEST fit) selected, please explain here. (hours)
the BEST fit not part of IPTeC?

8/31/2023 2 = Co-precepting (contributes to parts of design,2 delivery,

= Institutional
or assessment of rotation) 1 = In-person 2 = APPE student 1 = Yes N/A 0.5
9/25/2023 2 = Co-precepting (contributes to parts of design,2 delivery,
= Institutional
or assessment of rotation) 1 = In-person 2 = APPE student 1 = Yes N/A 2
11/22/2023 2 = Co-precepting (contributes to parts of design,2 delivery,
= Institutional
or assessment of rotation) 1 = In-person 2 = APPE student 1 = Yes N/A 0.5
1/11/2024 2 = Co-precepting (contributes to parts of design,2 delivery,
= Institutional
or assessment of rotation) 1 = In-person 1 = IPPE student 1 = Yes N/A 7
2/17/2024 1 = Primary preceptor (lead in design, delivery, AND
2 = Institutional
assessment of a rotation) 1 = In-person 1 = IPPE student 1 = Yes N/A 7
2/18/2024 1 = Primary preceptor (lead in design, delivery, AND
2 = Institutional
assessment of a rotation) 1 = In-person 1 = IPPE student 1 = Yes N/A 7
Total 24 6 hours required

Experiential Didactics
If "College of
Would you have
Location (Institution/Setting) Pharmacy," please Delivery (Select the If any “other” responses Time
Date Type of Teaching (Select the BEST fit) Target audience completed this if
Select the BEST fit list. If "Other," BEST fit) selected, please explain here. (hours)
not part of IPTeC?
describe location.
10/4/2023 3 = Journal club facilitation 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 5 = More than one of the above 1 = Yes 0.5
10/12/2023 7 = Other 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 1 = IPPE student 1 = Yes IPPE student orientation 2
10/13/2023 7 = Other 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 1 = IPPE student 1 = Yes IPPE student orientation 1
1/3/2024 2 = Topic discussion evaluation 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 1 = IPPE student 1 = Yes 0.5
1/5/2023 7 = Other 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 1 = IPPE student 1 = Yes IPPE student orientation 1
3/12/2024 1 = Topic discussion facilitation 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 2 = APPE student 1 = Yes 1
4/2/2024 3 = Journal club facilitation 3 = Practice setting (community,
N/Aclinic, hospital, industry,
1 = In-person
regulatory, etc.) 2 = APPE student 1 = Yes 0.5
Total 6.5 6 hours required
Total teaching time 66.5