Ambulatory Care APPE Rotation

Butler University COPHS

Indianapolis, IN
Preceptor
Primary Preceptor

Contact Information
Office
Phone
Numbers

Heather Folz, PharmD

Adjunct Professor of Pharmacy Practice
Clinical Pharmacy Specialist, Ambulatory
Care
Email: hfolz@butler.edu
Personal:
hnfolz0707@email.campbell.edu

Healthy
Horizon
s

Office: 317-9408143
Cell: 919-8192264

Clinics
Main Site: Heathy Horizons
(Butler Employee Wellness)
COPHS: 4600 Sunset
Ave, Indianapolis, IN
46208
Mondays: Richard L.
Roudebush VAMC (Green Team
Primary Care)
Parking: 2669 Cold
Spring Road,
Indianapolis 46222
Wednesdays: Community
Health Network Family Medicine
FMC: 10122 East 10th
Street #100,
Indianapolis, IN 46229

Description
This ambulatory care advanced pharmacy practice (APPE) rotation exposes the
student to clinical pharmacy services in an outpatient setting and academia. The
main site of this program is an employee wellness clinic; thus, the rotation is designed
to give students an understanding of disease prevention and wellness screenings in
addition to chronic disease state management and related pharmacotherapy. Daily
activities will emphasize supervised direct patient care through the provision of
lifestyle, medication, and disease state counseling, comprehensive review of patient
profiles, and documentation within the medical record (limited to Healthy Horizons).
Therapeutic areas of focus include diet and physical activity, cancer screenings,
diabetes, dyslipidemia, hypertension, weight management, and smoking cessation.
The APPE student will also enhance professional communication skills with various
healthcare professionals including physicians, physician assistants, nurses, nurse
practitioners, pharmacists, and other faculty members. Students will gain further
understanding of various disease states and interventions in an ambulatory care
setting by completing topic discussions, personal reflections, presentations, and other
activities.
Goals & Objectives
Upon completion of this rotation, the student should be able to demonstrate his/her
ability to:

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1. Apply practice guidelines in a patient specific manner with an emphasis in

prevention
2. Interpret lab values and accordingly recommend appropriate action
3. Determine monitoring parameters and therapeutic endpoints for medication
therapy
4. Adequately obtain medication and allergy histories and perform medication
reconciliation
5. Thoroughly review medication profiles for:
a. Therapeutic indication
b. Drug-drug, drug-disease, drug-food, and drug-lab interactions
c. Appropriate dose, route, and frequency of administration
d. Therapeutic duplications
e. Timeliness of refills/non-compliance
f. Current OTC medication use
g. Contraindications for drug therapy
h. Adverse drug reactions/adverse drug effects
6. Advise health care professionals on appropriate drug therapy based on clinical
efficacy, safety, and cost-effective prescribing. AFTER preceptor verification of
accuracy and appropriateness of information, provide medication information
to health care professionals and patients including:
a. Potential side effects
b. Medication interactions
c. Appropriate dose and frequency
d. Contraindications
7. Effectively communicate with various healthcare professionals and patients.
8. Document clinical activities (i.e. SOAP notes, medication reviews, medication
counseling, allergies/adverse reactions, etc.) in the electronic medical chart
(Titanium) following institution specific policies and procedures. NOTE: Avoid
unapproved abbreviations, first person pronouns, typos, and
informal/slang language.
9. Successfully deliver presentations consistent with expected levels of competency
for a clerkship student, including:
a. Comprehensive literature review with reputable references listed
appropriately
b. Demonstration of sufficient preparation and practice
c. Effective use of Microsoft PowerPoint program
d. Provision of supplementary handout

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NOTE: all recommendations/suggestions (both written and verbal) involving

patient care MUST first be discussed with a pharmacy preceptor.
Pharmacy Program Student Learning Outcomes (SLOs)
1. Promote health improvement, wellness and disease prevention.
2. Apply knowledge and skills to make appropriate decisions regarding the safe
and effective use of medications or the need for referral to other health care
providers. These decisions should include consideration of social, economic and
cultural factors.
3. Find, understand, analyze evaluate and use information to make informed and
rationale decisions.
4. Effectively communicate pharmaceutical and health-related information and
collaborate with other healthcare professionals to ensure the provision of quality
patient care.
5. Practice independent learning and modify ideas and behaviors based on newly
acquired knowledge.
6. Manage pharmacy operations including human facilities and fiscal resources to
deliver quality patient care.
7. Demonstrate ethical conduct in personal and professional settings and respect
and exhibit empathy for patients differences, values and preferences.
Overview of Clerkship Activities
Minimum Expectations
The clerkship student is expected to:
1. Review patient lists prior to clinic attendance*
2. Ensure any documentation that occurs in the electronic medical record is
completed according to institution policies*
3. Communicate with the primary preceptor on a daily basis in person or via email
when appropriate
4. Complete all assignments, topic discussions, and formal presentations by assigned
deadlines
5. Demonstrate competence through satisfactory completion of end-of-block
examination(s)
6. Display efficient drug information retrieval skills using common, reputable
resources (i.e. Micromedex, UpToDate, PubMed, Lexicomp, Pharmacists Letter,
Natural Medicines, etc.)
7. Exhibit an attitude of professionalism, maturity, and politeness
8. Develop an appropriate amount of professional confidence Say I dont know, but
I will be happy to look that up for you. instead of providing incorrect or irrelevant
information

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9. Exert independence in performing assigned activities

10. Notify primary preceptor with suggestions for rotation improvement on a
continual basis
*Denotes Healthy Horizons specific expectations due to limited EMR access at other
sites
Schedule
Detailed schedule will be provided on the first day of the rotation
Please account for delays in transportation due to parking or traveling to off-site
locations
Students are expected to arrive each day by 8AM and stay in clinic until 5PM or
later if patient related responsibilities require (hours will very)
Project time will be on-site unless otherwise approved by the preceptor.
Clerkship Activities
Daily clerkship activities while in clinic, assignments, formal presentations, and
therapeutic discussions will provide a heavy emphasis on pharmacology and
treatment in the following areas:
Diet
Physical Activity
Prevention Screenings
Diabetes
Hyperlipidemia
HTN
Smoking cessation
Weight Management
Potential exposure:
anticoagulation,
COPD/Asthma, Transitions
of Care
Assessing Outpatient Medications Lists
The development of an accurate medication list is one of the most important aspects
outpatient care, especially those in an ambulatory care setting. Determining and
evaluating this medication list can often be difficult, and at times a daunting task for
students. Use the steps below to help to more objectively assess patients on this
rotation.
Determining medication appropriateness:
1. Do all medications have an indication?
2. Do all indications have a medication (is a medication needed)?
Evaluating medication lists:
1. Determine the current list of medications prescribed to a patient

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2. Based on this list, what information do you want to know about each medication
(i.e. the dose, frequency, time of day taken/administered, side effects, relation
to a meal, proper administration technique, etc.)
3. What questions would you need to as the patient to determine the needed
information from Step 2?
4. What is the next most logical change, if a medication change is needed?
a. If a medication change is needed, what is the magnitude of the change for
the patient (i.e. simply increasing the dose of an existing medication vs.
adding a new multiple-time per day dosed medication)
Required Assignments (see calendar for specific deadlines)
1. 10 minute formal presentation using Microsoft PowerPoint slides and with relevant
handout
Presentation topic is due to the preceptor by end of the 1st rotation week
Intended audience will typically be clinical pharmacists, physicians, and/or
clerkship students
May consist new drug or guideline update or other area relevant to outpatient
care
Presentation will be given twice: 1) ungraded for feedback only 2) final
presentation to display application of feedback
Written or electronic handout for the audience is required
A minimum of 3 references should be used and cited
2. SMART goal Reflection
The purpose of this activity is to promote the learners ability to self-assess and
promoted greater understanding and empathy for patients
2-3 SMART goals should be identified by student during the first 1-3 days of
rotation
Using Appendix B, the student will journal on progress with goals during the
course of the rotation (minimum of 6 entries) then complete final reflection
3. 60-120 minute topic discussions
At least one formal disease state discussions to preceptor(s) and/or fellow
students is required
Any assigned readings should be completed prior to designated topic discussion
date and time
A written handout summarizing the disease and treatment using the available
national guidelines should be developed to be used during the discussion (there
is no firm page limit to the handout)
Additional requirements:
o Should NOT be a regurgitation of your class notes
o Should include relevant primary literature and GUIDELINES for the topic
presented
o Information in the written handout should be properly referenced
o Should include information on intra-class medication differences

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o Should be used as an opportunity to learn new information about your topic

4. End of block short-answer assessment
Will reflect many of the new facts and follow up points learned throughout the
rotation
Minimum competence must be demonstrated to pass the rotation
5.

Patient counseling exercise

Will expose students to a multitude of medical devices and dosage forms for an
opportunity for hands-on practice with many devices commonly used in an
ambulatory care or community pharmacy practice setting
Instructs students to about how independently research and practice proper use
of a variety of medical devices and proper counseling techniques
Provides feedback and suggestions for improvement on students patient
counseling skills for complicated medication administration techniques, dosing
calculations, and dietary modifications

Other Projects:
As an effort to incorporate the student into the practice of the preceptor, students
may be offered the chance to assist the preceptor with some of his responsibilities.
Students will also be included on as many preceptor meetings, teaching
responsibilities, and other activities as possible.
Policies and Student Responsibilities
Please refer to your Doctor of Pharmacy manual for a more extensive list and
explanation
of
policies
and
student
responsibilities.
Butler
COPHS
policies/responsibilities will be strictly enforced on this rotation. Violation of any of
the policies/responsibilities may result in failure of the Ambulatory Care rotation.
Professional Responsibilities:
1. Academic Integrity: Academic dishonesty in all its manifestations will not be
tolerated. Students falsifying patient information will be subject to disciplinary
action and possible rotation failure.
2. Plagiarism: Plagiarism will not be tolerated on this rotation.
plagiarism will result in rotation failure.

Any act of

3. Ethics: Students should act in an ethical manner by acknowledging that the

patient, family members, other health care providers or any other person with
whom they are in contact has the right to their own opinion and understanding of
a situation. Patients have a right to know all aspects of their care and be
incorporated into decisions related to that care. There is to be no judgment of the
person regarding their decisions.

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4. Respect: Students will treat all people with whom they interact with dignity and
importance. If a student repeatedly acts in a manner that does not show respect
to those involved, this behavior will be evaluated, and may result in a failure of
the rotation.
5. Confidentiality/HIPAA: The student will have access to personal and private
information throughout the course of this rotation. All such information must be
kept confidential.
Remember NOT TO:
a. Discuss patient information in any public area (cafeteria, hallways,
elevators, etc.) or with friends or family
b. Leave patient information unattended in your workspace or up on any
computer screens
c. Take patient information off the premises.
Remember TO:
a. Discard all patient identifying material in labeled HIPAA bins located
throughout the hospital
b. Remove all patient names from information presented during formal
presentations or other assignments
6. Absence(s): Two excused absences will be allowed per each four-week clerkship
rotation period. Excused absences must be approved in advance by the primary
preceptor and assigned clinic preceptor for the day absent. Any additional
absences may need to be made up at the preceptors discretion. Excessive
absence from the clerkship rotation may result in failure of the rotation.
7. Dress Code: Professional attire, including a nametag is required. Short white
coat may be required in certain situations.
8. Cell Phone Use: Use of cell phones or smart devices is limited to purposes of
drug reference. They are not to be utilized for other functions during rotation
hours.
Minimum Ambulatory Care Competencies
Upon completion of the Ambulatory Care Rotation, the Doctor of Pharmacy student
will need to show satisfactory progress or proficiency in the following areas to pass
this rotation:
1. Rotation objectives as listed above
2. General understanding of common disease states in relationship to the
ambulatory care setting
a. Pathophysiology
b. Etiology

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c. Symptomatology
d. Pharmacotherapy
e. Monitoring parameters
3. Professionalism
a. Demonstrates punctuality during rotation hours and regarding assigned
projects
b. Interacts with patients and other health care workers in a professional
manner
c. Appears motivated and comes to rotation prepared
d. Professional attire
4. Time Management
a. Complete and submit assignments on time. All assignments should be
completed the morning they are due. Working on assignments during the
day they are due may result in failure of the assignment. (Exceptions:
photocopying handouts, rehearsing presentation if time permits)
b. Utilize time appropriately to collect pertinent data needed for patient
discussions and counseling
c. Complete electronic progress notes for preceptor review in a timely
manner (same day as patient appointment)
5. Drug Information Skills
a. Recognition of appropriate references in various situations
b. Ability to retrieve appropriate sources of information
c. Demonstrates understanding of literature
d. Critically evaluate applicable literature
e. Application of literature to patient care
f. Appropriate recommendations
6. Communication Skills
a. Written (drug information questions, journal club, presentation handout,
progress notes, medication calendars, etc.)
b. Verbal (daily with health care workers, patients, preceptors and
presentations, etc.)

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Appendix A

APPE Ambulatory Care Rotation

Oral Presentation
Pharmacy Student Oral Presentation Evaluation Form (Adapted
from Eskenazi Health)
Presentation Title:
Student:
KEY: SD = strongly disagree; D = disagree; A = agree; SA = strongly agree

S
D
D
CONTENT / KNOWLEDGE / LITERATURE
1. Clearly identifies and presents
pertinent background information
relative to the topic
2. Has a command of the subject
area and topic presented.
3. Selects appropriate literature for
review and inclusion (i.e. primary
literature if available, RCTs
preferred, etc.) or indicates a lack of
literature.
4. Accurately summarizes and
applies selected literature
appropriately to the topic.
5. References are appropriately
utilized and do not contain
formatting errors.
ORGANIZATION / MATERIALS
1. Stated learning objectives were
well-written (specific and
measurable) and appropriate.
2. Learning objectives were met by
the presentation.
3. The program subject and degree
of detail were appropriate for the
audiences level of knowledge.
4. Handout was appropriate, wellprepared, and contained no errors.
5. Visual aids were well-prepared,
visually appealing, easy to read,
and contained no errors.
6. Visual aids were used effectively
and enhanced the overall
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S
A

Comments

presentation (i.e. animations were

not distracting, graphics contributed
to talk).
7. The presentation was organized
and presented in a logical fashion.
8. Transitions were used effectively
to connect topic areas.
SPEAKER /COMMUNICATION
SKILLS
1. The speaker maintained
appropriate eye contact throughout
the presentation.
2. Utilization of notes or reading
from the screen was not excessive
or distracting.
3. The speaker spoke in a strong
voice and at an appropriate pace
throughout the presentation.
4. Distracting mannerisms were
avoided (ums, uhs, etc.).
5. Information was presented
concisely, with authority, and in an
organized manner.
6. The presentation was unbiased
and provided a fair balance of
information.
KEY: SD = strongly disagree; D = disagree; A = agree; SA = strongly agree

S
D

S
A

Comments

CONCLUSIONS / QUESTIONS
1. The presentation topic was
current and relevant to the practice
of pharmacy.
2. Stated conclusions and
recommendations were appropriate
given the literature presented.
3. Answered questions logically and
was able to theorize when unsure of
answers.
4. Accuracy/depth of answers
corresponded with the expected
competency level of the student.
5. The program subject and degree
of detail were appropriate for the
time allotted.
Additional comments regarding the quality of the content and organization of the
presentation (not speaker):

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Additional comments regarding the speakers presentation style:

After reviewing the students overall performance, it is my opinion the student [PASSED /
DID NOT PASS] this oral presentation.
Reviewer: __________________________________________

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Date: ____________________

Appendix B

APPE Ambulatory Care Rotation

SMART goal Assignment
SMART goal Assignment

Consider your health portfolio results and our discussion on the different areas of health
and wellness. Create 2-3 SMART goals that you would like to work on for the next week
and complete the following assignment.
My health and wellness goals
1.
2.
3. (optional)
On a scale from 0-10, with 0 being not confident at all and 10 being extremely confident,
my confidence in meeting these goals is __________
Anticipated challenges (i.e. weather,
time, )

How I will address this challenge

Journal
As you work toward your 2 health goals, choose at least 3 days to write a short reflection
(3-5 sentences) on your progress.
Entry #1 (date____/____/2016)
Entry #2 (date____/____/2016)
Entry #3 (date____/____/2016)
Entry #4 (date____/____/2016)
Entry #5 (date____/____/2016)
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Entry #6 (date____/____/2016)
Final Reflection
Reflecting on the past week, write a paragraph (at least 6 complete sentences no more
than a page) about the experience. Include challenges you faced and if they were the
same or different than you anticipated. Describe your progress (no progress, work in
progress, achieved, maintenance). What things did you find beneficial with meeting your
goals? Were your goals easier or harder than you anticipated? Would you keep your
same goals if you could go back and change them?

**To be returned to the primary preceptor by Wednesday of Week 1 of the

rotation**
Signature of Agreement and Understanding
I, _____________________________ , have read and understand all the information and
instructions included within this syllabus. Failure of this APPE rotation may be possible if I
fail to meet the minimum requirements or established deadlines.
Student Signature _________________________________________ Date ________________

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