APPE Ambulatory Care Rotation

Preceptor:
Jordan Clark, PharmD
Cell phone: 317-364-6087
Email: jachenba@butler.edu

Locations:

Schedule: see provided calendar

 Monday – Friday: 8:00 am - 5:00 pm (typical requirements)
 This is a minimum requirement, and patient care or projects may lead to longer hours
before or after this scheduled time. Students are responsible for documenting exact
hours spent on the rotation.

Description:
The Ambulatory Care Clinic provides Doctor of Pharmacy students an opportunity to interact with
physicians, pharmacists, social workers, nurses, medical assistants and other office staff to
provide care to patients of all ages. Students on this rotation will collaborate with physicians and
other healthcare staff to optimize medication regimens and provide patient education on
medications and disease states. Students will be required to use therapeutic principles,
pharmacokinetics, as well as problem identification, problem solving, documentation,
communication, and drug information skills. The Doctor of Pharmacy student will be involved in
the care of patients though collaborative drug therapy management (CDTM) agreements in a
variety of chronic disease states and medication management as referred.
The various appointment types seen in clinic are summarized below:

Type of Patient Description

Care Navigation High-risk patients based on previous or future predicted costs and identified by
insurance algorithms. Goal is to reduce / prevent healthcare costs.
Collaborative Drug Patients referred specifically to the pharmacy to manage one of the disease
Therapy states found in out CDTM (asthma, cholesterol, DM, HTN, COPD, smoking
cessation, etc.)
Medicare Annual Annual preventative visit that is offered to patients with Medicare once yearly.
Wellness Visits Goal of these appointments is to identify and close care gaps such as screenings
and labs.
Medicare Part D Patients wanting to change Medicare Part D or Advantage Plans during open
enrollment. Goal is to ensure patient is on the most affordable plan for his/her
medications
Medication Review General medication review patients. In general, tend to be older/more confused
on medications. Similar to an MTM or CMM appointment in the community
setting.
Miscellaneous Any patient that a provider refers. Typically these are “curbside” or “on-the-fly”
consults
Transitions of Care Patients who have been discharged from the hospital in the past 14 days. Goal is
to reconcile medications, educate, and prevent readmissions.

Objectives: Please consult your college of pharmacy’s APPE Handbook for specific objectives
assessed during the rotation.

Competencies & Outcomes:

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Upon successful completion of the rotation, the Doctor of Pharmacy student should be able to:
1) Discuss the pathophysiology, etiology, symptomatology, pharmacotherapy, and
monitoring parameters for those disease states commonly seen in ambulatory care ,
including, but not limited to:
Asthma COPD Diabetes
Dyslipidemia GERD Hypertension
Hypothyroidism Medicare Annual Wellness Visits Osteoporosis
Seasonal Allergies Tobacco Cessation Vaccinations

2) Utilize the patient’s medical record to identify and develop a plan for the following:
 Patient education
 Medication management
 Medication/disease state monitoring
 Adherence assessments
 Gaps in care (immunizations, labs, preventative screenings/exams)
 Referrals to additional providers where needed
 Pharmacy clinic follow up

3) Gain confidence in interviewing and educating patients regarding various disease states
and medications.

4) Professionally and effectively communicate pharmaceutical and health-related information

and collaborate with other healthcare professionals to ensure quality patient care.

 Demonstrate professional and appropriate communication (i.e. verbal and written) with
healthcare professionals
 Write clinical notes in charts for every patient encounter and have them co-signed by a
pharmacist

5) Critically evaluate literature in order to formulate responses to drug information questions.

All drug information questions are to be answered in a timely fashion – particularly when
the question is of an urgent nature or involves direct patient care.

6) Utilize resources to address medication-related issues such as formulary concerns and

other cost-saving initiatives

7) Participate in other projects as assigned during project week. (see below)

Assignments/Required Activities:
Note: it is the student’s responsibility to keep track of when assignments are due.
The preceptor will not give reminders about this. Please refer to your calendar for
due dates. If you have questions regarding an assignment or want help selecting a
topic, it is YOUR responsibility to discuss this with the preceptor. (Not all of the
following assignments may apply for a given rotation block.)

1) Practice site orientation (if applicable)

2) Attendance (minimum of 160 hours in a 4 week rotation). Documentation of hours on

your monthly calendar is recommended. The hours may be signed off by the preceptor
weekly if there is reason to believe a student may risk being deficient in his/her hours.

3) Work towards completion of your Skills-Based Competencies Form. It is the student’s responsibility to get
preceptor’s signature for competencies by the end of the rotation.

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4) Design or redesign safe and effective patient-centered therapeutic regimens and
monitoring plans (care plans) for ambulatory care patients on a daily basis.

5) Meet with the preceptor to review patients and assigned drug or disease-related topics on
a daily basis. Have patients “worked up” by 8:00 am or before earliest
appointment time for the day. The student must complete any assigned readings in
advance and be prepared to actively participate in discussion.

6) Assist the physicians and nurses by performing literature searches and providing answers
to specific questions as well as drug information that is pertinent to the care of patients.

7) Provide medication counseling to patients as appropriate (insulin, inhalers, etc.).

8) Facilitate medication adherence and follow-up appointments through:

 Medication adherence phone calls

 Updating the pharmacy consult spreadsheet on pharmacy clinic days

 Contacting patients who canceled or “no-showed” to reschedule them

9) Prepare two topic discussions. The student should prepare a typed handout (no more
than 4 pages) summarizing the topic or disease state/drug and treatment assigned to
them at the beginning of the rotation. Other topics may be led by preceptor. Students are
expected to attend and actively participate in topic discussions throughout the experience.
Students are expected to prepare ahead of time (i.e. review guidelines, assigned readings,
etc.) and fully participate in all discussions. Topics may include, but are not limited to:
a. Anticoagulation n. Immunizations
b. Asthma o. Ambulatory infectious diseases
c. Atrial fibrillation p. Menopause/Hormone
d. COPD Replacement Therapy
e. Coronary Artery Disease q. Obesity
f. Contraception r. Osteoarthritis
g. Depression & Anxiety s. Osteoporosis
h. Diabetes mellitus t. PUD & GERD
i. Dyslipidemia u. Rheumatoid arthritis
j. Gout v. Seizure disorders
k. Heart failure w. Smoking Cessation
l. Hypertension x. Testosterone Replacement
m. Health Maintenance y. Thyroid disorders

10) Read one journal article and present to preceptor during the month using university or
site template.

11) Present one formal oral presentation: Student will prepare and deliver one formal oral
presentation to preceptor and health care professionals, which may include medical
residents and faculty or other clinical pharmacy specialists. The presentation should be 20-
25 minutes in duration and should include power point slides with a handout (may be
printed slides). The students may select their own topic, which should include a patient
case followed by a drug/disease discussion, a “hot topic” in pharmacy, or a disease state.
Topics must be approved by the preceptor prior to development of the presentation. Topics
should be specific (i.e. “treatment of diabetic nephropathy” instead of diabetes or
“essential hypertension” instead of hypertension). Students are expected to submit a
rough draft of their slides with references to the preceptor at least 5 days prior

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 to the presentation date for review. Students are expected to field questions from the
audience to the best of their knowledge. ‘

12) *End-of-block exam on topics discussed throughout the month or seen while on rotation. No references are
allowed during the exam. Students will be allowed a calculator if needed. Students will have 1 hour to review
the exam and answer the questions. Afterwards, the exam will be reviewed verbally with the preceptor.

13) Others assignments- may be given by the preceptor based on patient care needs and
student progress

*These assignments may or may not be applicable each month.

Policies:
 Please refer to the Doctor of Pharmacy Rotation Manual.

1. Confidentiality: Maintain patient confidentiality at all times. Do not discuss patient

cases with other students not currently treating the patients. Remember to avoid
discussing your rotation activities in public areas. Also, make sure that others cannot view
patient’s information on your computer screen if it is left in public areas.

2. Accommodations for Disabilities: Written notification of any documented disabilities

must be given 2 weeks prior to the rotation. No accommodations will be guaranteed if not
brought to the preceptor’s attention prior to this time.

3. Professional Responsibility: Consider your rotation to be your job. Coming unprepared,

late or in unprofessional attire is NOT appropriate! Your patients are counting on you.

4. Academic Integrity/Plagiarism: Any dishonesty or plagiarism during the rotation is

grounds for failure of the rotation.

5. Incivility: Any acts of incivility such as rude, sarcastic, disruptive behavior, threats or
damage to property will not be tolerated. Any such act will be grounds for failure of the
rotation.

6. Drug/Alcohol Abuse Policy: Failure to abide by this policy and coming to work under the
influence of drugs or alcohol is grounds for failure of the rotation.

Professionalism/Attitude:
Remember that you are representing the clinic site, your University, as well as your preceptor.

Reviewing Clinical Interventions:

All clinical recommendations that will be made to the physicians are to be reviewed with
preceptor prior to discussion with the physician. Following all approved interventions, it is the
responsibility of the student to discuss the recommendation with the physician in an appropriate
manner. If patient-specific question arises during a patient care visit regarding medications, drug
info question, etc; it is the responsibility of the student to find the answer. If you are unsure of
the answer – the most appropriate answer is “I’m not sure, let me get back to you.” If the
question is time sensitive, I may suggest an answer.

Assignments:
All assignments should be completed by the time you enter the building on the morning of the
day they are due. Working on the assignments during the day when they are due may result in
failure of the assignment. (Exceptions: photocopying handouts, rehearsing presentation if time
permits)

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Missed Days:
Please refer to the Doctor of Pharmacy Manual for the excused/unexcused policy. In the event of
an unexpected absence from the site, for any reason, the student is required to contact the
preceptor prior to 7:45 am on the day of the absence. Failure to do so will result in a
documented warning, after which the second time may result in failure of the rotation. If there is
an expected absence, which is known to the student prior to the start of the rotation, the student
is required to contact the preceptor in advance to discuss the expected absence. The student is
required to make up all missed says of the rotation, unless otherwise approved by the preceptor.

Keys to Success:
 BE FLEXIBLE! In health care, not everything goes as originally planned. Depending on the
patient show rate and complexity, you may be more or less busy than anticipated. Some
activities may need to be rescheduled at times due to patient care needs. Remember –
patient care is our number one responsibility.
 Practice good time management
 Feel free to think out loud with your preceptor. With other providers say “I do not know, but I
will look it up for you” and review information with me prior to discussion.
 Be cognizant of patient confidentiality and professional conduct
 Be polite and courteous to all heath care professionals
 Ask a lot of questions

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I, ___________________________________ (student’s name, printed), have read my ambulatory care
rotation syllabus in full. I understand all expectations and assignments outlined in this syllabus.
My preceptor gave me an opportunity to ask questions regarding information in this syllabus. I
am aware that I am able to continue to ask my preceptor questions regarding information in this
syllabus as they arise.

Student Signature: _______________________________________ Date: _______________

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