Teaching Experience Log

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

Michael Commons Franciscan Health Indianapolis 1 = PGY1 2 = No
Didactic Teaching

If "College of Pharmacy,"
Location (Institution/Setting) Select the Delivery (Select the BEST Would you have completed this If any “other” responses
Date Type of Teaching (Select the BEST fit) please list. If "Other," Target audience Time (hours)
BEST fit fit) if not part of IPTeC? selected, please explain here.
describe location.

11/30/2023 2 = Instruction for health professionals 5 = Other Continuing Education (CE) 3 = Online asynchronous 3 = Both of the above 1 = Yes 1 hour
3/12/2023 1 = Classroom-based instruction for learners
3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 2 = Healthcare professionals 1 = Yes 1 hour
4/25/2024 2 = Instruction for health professionals 4 = Professional conference (Great Lakes, IPA, ASHP, national event, etc)1 = In-person 3 = Both of the above 1 = Yes 0.5 hour

Total 2.5 2 hours required

Small Group Teaching

If "College of Pharmacy,"
Location (Institution/Setting) Select the Delivery (Select the BEST Would you have completed this If any “other” responses
Date Type of Teaching (Select the BEST fit) please list. If "Other," Target audience Time (hours)
BEST fit fit) if not part of IPTeC? selected, please explain here.
describe location.

1/19/2024 2 = Discussion-based course (i.e., case studies

1 = College
course,
of etc.)
Pharmacy Butler University 1 = In-person 1 = Students 2 = No 2
1/26/2024 2 = Discussion-based course (i.e., case studies
1 = College
course,
of etc.)
Pharmacy Butler University 1 = In-person 1 = Students 2 = No 2
2/9/2024 2 = Discussion-based course (i.e., case studies
1 = College
course,
of etc.)
Pharmacy Butler University 1 = In-person 1 = Students 2 = No 2
3/22/2024 2 = Discussion-based course (i.e., case studies
1 = College
course,
of etc.)
Pharmacy Butler University 1 = In-person 1 = Students 2 = No 2
3/29/2024 2 = Discussion-based course (i.e., case studies
1 = College
course,
of etc.)
Pharmacy Butler University 1 = In-person 1 = Students 2 = No 2
4/19/2024 2 = Discussion-based course (i.e., case studies
1 = College
course,
of etc.)
Pharmacy Butler University 1 = In-person 1 = Students 2 = No 2
Total 12 3 hours required
Precepting/Co-precepting

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

7/31/23-8/25/23 2 = Co-precepting (contributes to parts of

2 =design,
Institutional
delivery, or assessment of rotation) 1 = In-person 2 = APPE student 1 = Yes 10
10/23/23-11/17/241 = Primary preceptor (lead in design, delivery,
2 = Institutional
AND assessment of a rotation) 1 = In-person 2 = APPE student 1 = Yes 80
5/6/24-5/31/24 1 = Primary preceptor (lead in design, delivery,
2 = Institutional
AND assessment of a rotation) 1 = In-person 1 = IPPE student 1 = Yes 50
Total 140 6 hours required

Experiential Didactics

If "College of Pharmacy,"
Location (Institution/Setting) Select the Delivery (Select the BEST Would you have completed this If any “other” responses
Date Type of Teaching (Select the BEST fit) please list. If "Other," Target audience Time (hours)
BEST fit fit) if not part of IPTeC? selected, please explain here.
describe location.

8/4/2023 1 = Topic discussion facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 2 = APPE student 1 = Yes 0.5
8/10/2023 1 = Topic discussion facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 2 = APPE student 1 = Yes 0.5
8/16/2023 1 = Topic discussion facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 2 = APPE student 1 = Yes 0.5
8/22/2023 5 = Patient case presentation lead 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.5
9/21/2023 3 = Journal club facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.7
10/16/2023 3 = Journal club facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.7
11/16/2023 5 = Patient case presentation lead 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.5
1/24/2024 5 = Patient case presentation lead 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.5
2/20/2024 3 = Journal club facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.7
5/7/2024 1 = Topic discussion facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 1
5/9/2024 1 = Topic discussion facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.5
5/21/2024 1 = Topic discussion facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.5
5/23/2024 1 = Topic discussion facilitation 3 = Practice setting (community, clinic, hospital, industry, regulatory, etc.)
1 = In-person 5 = More than one of the above 1 = Yes 0.5
Total 7.6 6 hours required

Other teaching experiences

If "College of Pharmacy,"
Location (Institution/Setting) Select the Delivery (Select the BEST Would you have completed this If any “other” responses
Date Type of Teaching please list. If "Other," Target audience Time (hours)
BEST fit fit) if not part of IPTeC? selected, please explain here.
describe location.
Total 0

Total teaching time 162.1