Learning Description:

Ambulatory Care Clinic

Pharmacy Student Rotation

Primary Preceptor Information

Kiara Torres García, PharmD
PGY1 Pharmacy Resident – Ambulatory Care
Email: kiara.torresgarcia001@sjrmc.com
Office Phone: (574) 335-6524
Overview

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

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 the rotation, you should be able to:
1. Describe the pathophysiology and pharmacologic treatment of the disease states commonly seen in
the ambulatory care setting (see above).

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
Before Clinic: Preparation
1. 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.
2. Thoroughly work up/evaluate the patients to be seen in clinic that day. Use an appropriate monitoring
form.
The goal is for you to be able to fully or
During Clinic: Patient Encounters partially lead patient interactions by
1. Perform medication reconciliations as directed. the time you complete this rotation.

2. Be engaged in patient interactions. If not actively participating, take notes and be prepared to discuss
afterwards.
3. Perform any additional work assigned by the preceptor. Respond to drug information questions if
applicable.
After Clinic: Documentation
1. Document the patient encounters appropriately, as directed. Ensure this is reviewed by the preceptor.
2. Follow up with any questions or concerns from the patient or the preceptor.

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. Provide a copy of your rough draft to
your preceptor 48 hours before your presentation for feedback.

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 provided 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 2 nd 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.

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.
Orientation Checklist
□ General tour of hospital/clinic and student workspaces

□ Introduce preceptors and pertinent staff members Rotation Policies

• Academic Integrity
□ Collect and review rotation requirements
o Confidentiality agreement • Disability & Accommodation
o Documents listed under expectations • Religious Observance
o HealthStream email confirmation
• Absence & Emergency
□ Review syllabus • Title IX Discrimination and
Harassment
□ 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. Future Career Plans
• What setting do you envision yourself working in within the next five years?

• Are you interested in pursuing additional training, such as a PGY1 residency or fellowship?

• Are you considering specializing in a certain therapeutic area within ambulatory care, such as diabetes,
cardiovascular disease, or anticoagulation?

2. Strengths and Weaknesses

• What would you consider your strong suits? List 3.

• What skills or knowledge areas do you feel could benefit from focused improvement during this
rotation?

3. Special Interests in Healthcare

• Is there a specific disease state that you are especially interested in, such as hypertension, diabetes, or
lipid management?

4. Learning Style Preferences

• Do you prefer hands-on learning, lectures, or a mix of both?

• How do you like to receive feedback (i.e. Immediately, daily, weekly)?

5. Bonus
• Is there anything I should know to ensure you have a successful rotation?