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University of Illinois at Chicago
College of Pharmacy
PHAR 371 MANUAL
AMBULATORY CARE
ADVANCED PHARMACY
PRACTICE EXPERIENC...
Fax: (312) 996 - 0379
Updated 6/09
2
PHAR 371
Ambulatory Care Advanced Pharmacy Practice Experience (Clerkship)
INTRODUCTION
The Ambulatory Care Advanced Pharm...
CONTACT INFORMATION
If the student has any questions/concerns throughout their rotation experience, they should contact th...
GOALS AND OBJECTIVES
Goals
The Ambulatory Care Advanced Pharmacy Practice Experience (PHAR 371) is designed to build upon
...
COURSE STRUCTURE AND REQUIREMENTS
Each student will be assigned to a clinical faculty member, affiliated with the Universi...
COURSE STRUCTURE AND REQUIREMENTS (CONTINUED)
Project Time
Project time will be provided for completion of written assignm...
PROFESSIONALISM
In accordance with Medical Center policy and Health Insurance Portability and Accountability Act
(HIPAA) r...
FAILURE
Since clinic performance is the most important part of the Ambulatory Care experience, it will be
possible for a s...
course.
Specific activities involved in therapeutic drug monitoring are:
1. Identifying the need for drug therapy.
2. Sele...
SOAP NOTE FORMAT (Example)
S: ____ y/o M/F presents to the _______ Clinic for ____________________________
PMH: __________...
A: Number each assessment. Assess severity, potential causes, and goals of therapy, if applicable.
1.
2.
P: Number each pl...
MEDICATION COUNSELING
A professional responsibility of the pharmacist is to provide clear, concise, accurate and useful
in...
STATEMENT ON PLAGIARISM1
"In plagiarism, an author passes off as her or her own the ideas, language, data, graphics, or ev...
Uniform Requirements for Manuscripts Reference Styles Updated October 2001
1) References should be numbered consecutively ...
Books and Other Monographs
1. Personal author(s)
Ringsven MK, Bond D. Gerontology and leadership skills for nurses. 2nd ed...
GRADING AND EVALUATION
The final letter grade is determined by the following components:
AMBULATORY CARE CLINIC PERFORMANC...
DRUG INFORMATION REQUEST
The ability to provide drug information to patients and other health professionals is an importan...
JOURNAL CLUB+/-TOPIC DISCUSSION (UIC sites) and JOURNAL CLUB (non-UIC sites)
Each student is required to present and parti...
SPECIAL PROJECT (non-UIC sites)
Students at non-UIC sites are expected to complete a project assigned by the clinic precep...
PRESENTATION
To fulfill the requirements of the rotation, each student is expected to deliver a formal presentation. This
...
PHAR 371
AMBULATORY CARE CLINIC PERFORMANCE EVALUATION FORM
Student Name:___________________________ Preceptor Name:______...
Formulating a Plan
• Formulate appropriate action when the use of a
drug is contraindicated or indication unknown
• Formul...
Communication Skills with Health Care/Other
Professionals
• Organize information to prepare for discussion with
profession...
PHAR 371
DRUG INFORMATION REQUEST EVALUATION FORM
Student Name:____________________________Topic:_________________________...
PHAR 371
JOURNAL CLUB + TOPIC DISCUSSION EVALUATION FORM (UIC sites)
Student Name:________________________Article/Topic:__...
PHAR 371
JOURNAL CLUB EVALUATION FORM (UIC and non-UIC sites)
Student Name:________________________Article/Topic:_________...
PHAR 371
SPECIAL PROJECT EVALUATION FORM (non-UIC sites)
Student Name:___________________________ Project:________________...
PHAR 371
PRESENTATION EVALUATION FORM
Student Name:____________________________ Topic:_________________________________
Ev...
PHAR 371
2009-2010
FINAL COURSE GRADE
Student Name:____________________________________________________
Preceptor Name:___...
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  1. 1. University of Illinois at Chicago College of Pharmacy PHAR 371 MANUAL AMBULATORY CARE ADVANCED PHARMACY PRACTICE EXPERIENCE (APPE) Kristen Goliak, Pharm.D. kgoliak@uic.edu Clinical Assistant Professor Director, Advanced Pharmacy Practice Experiences Department of Pharmacy Practice University of Illinois at Chicago College of Pharmacy Phone: (312) 355 - 1559
  2. 2. Fax: (312) 996 - 0379 Updated 6/09 2
  3. 3. PHAR 371 Ambulatory Care Advanced Pharmacy Practice Experience (Clerkship) INTRODUCTION The Ambulatory Care Advanced Pharmacy Practice Experience (clerkship) is a core rotation (4 credit hours) and is a full-time commitment (40+ hours/week) for 6 weeks. Students are assigned to an ambulatory care pharmacy practice setting under the supervision of a faculty preceptor at the University of Illinois Medical Center at Chicago or with a faculty preceptor affiliated with the UIC College of Pharmacy. This clerkship allows the student to observe and participate in activities involving the delivery of quality, comprehensive pharmaceutical care. The student will be actively involved in, and will serve as an integral part of, the health care team. Experience in the drug use process through drug therapy monitoring, patient education and interviewing, inter-professional communications, active decision-making and application and refinement of therapeutic problem solving skills should result at the end of the six-week module. 3
  4. 4. CONTACT INFORMATION If the student has any questions/concerns throughout their rotation experience, they should contact the appropriate individuals below: UIC College of Pharmacy APPE administrative issues: Kristen Goliak, Pharm.D. Director, Advanced Pharmacy Practice Experiences (312) 355-1559 kgoliak@uic.edu UIC site specific clerkship issues (e.g., questions, morning conferences, absences, etc.): Jessica Michaud, Pharm.D, BCPS Clinical Pharmacist, University of Illinois Medical Center at Chicago Clinical Assistant Professor, University of Illinois at Chicago College of Pharmacy Pager #1596 jmichaud@uic.edu Louise Parent-Stevens, Pharm.D., BCPS Clinical Pharmacist, University of Illinois Medical Center at Chicago Clinical Assistant Professor, University of Illinois at Chicago College of Pharmacy Pager #4992 lstevens@uic.edu or Individual Rotation Site Preceptor(s) Non UIC APPE Sites Rotation Site Preceptor(s): UIC PAGING OR TELEPHONE SYSTEM To page someone from a UIC University phone:  Dial 136  Enter ID Number to page: XXXX  Enter call back number, i.e. 3-XXXX, 5-XXXX, 6-XXXX To page someone from an outside phone:  Dial 312-996-2242  Enter ID number to page: XXXX  Enter call back number, i.e. XXX-XXX-XXXX To page someone and have them call you back while holding:  Dial 312-996-2133  Operator will ask you for ID number to page and your name  Hold on line for several minutes while operator contacts person via page, and person calls that number back 4
  5. 5. GOALS AND OBJECTIVES Goals The Ambulatory Care Advanced Pharmacy Practice Experience (PHAR 371) is designed to build upon the skills and concepts attained in your didactic coursework at the College of Pharmacy, through the experiential classes and other clerkship experiences. The goals of this clerkship are to provide experience for the student to: enhance knowledge of ambulatory care pharmacy practice, apply didactic knowledge to patient care, refine problem solving and decision making skills, manage drug therapy, strengthen verbal and written communication skills, and further develop competency in pharmacy practice. Objectives At the end of the clerkship, the student will demonstrate the ability to: 1. Define the philosophy of clinical pharmacy practice, emphasizing its application in the ambulatory care environment. 2. Display professional orientation, attitudes, ethical standards, and values required to deliver pharmaceutical care. 3. Gather, organize and assess information to identify potential and/or ongoing patient therapeutic problems and the root cause of the problems. 4. Integrate information as needed to design, recommend, implement, monitor and evaluate patient- specific pharmacotherapeutic regimens to prevent or resolve medication-related problems. 5. Collaborate with physicians, other health care professionals, patients and/or their caregivers to formulate a pharmaceutical care plan. 6. Recommend appropriate drug therapy. 7. Refer patients to other health care professionals, where appropriate. 8. Communicate effectively with patients in interviews, educational sessions and provision of medication counseling. 9. Respond to information requests from patients and health care professionals through appropriate drug literature retrieval, evaluation, interpretation and clinical application. 10. Communicate effectively with other health care professionals in both written and verbal format. 11. Identify the special therapeutic considerations involved in the management of the ambulatory patient. 12. Participate in the medication errors and adverse drug reaction reporting system’s process. 13. Use appropriate communication skills when interacting with faculty preceptors, patients, pharmacy staff and other health professionals. 14. Organize and plan time effectively. 15. Learn in a self-directed manner. 5
  6. 6. COURSE STRUCTURE AND REQUIREMENTS Each student will be assigned to a clinical faculty member, affiliated with the University of Illinois at Chicago College of Pharmacy, who is responsible for teaching and evaluating the student’s practice skills. Students will learn the concept of the total drug use process by participating in all clinic and conference activities as required by the faculty preceptor. Students may also be required to attend grand rounds, journal clubs or other meetings that will enhance their learning experience. Requirements The basic requirements of the course are 1) participation in clinic, 2) participation in Morning Conference (UIC sites only) 3) Drug Information Request, 4) Journal Club (UIC sites) or Journal Club and Special Project (non-UIC sites), and 5) Presentation. It is the student’s responsibility to complete all the requirements of the rotation. Failure to do so will result in a grade of “incomplete” until all requirements are satisfied. Morning Conference (UIC sites only) Students at UIC sites will meet each morning at 8AM for Morning Conference. The conferences, which last for 50-60 minutes, are designed to encourage student participation in discussions of therapeutic management, patient management, and/or problem solving, which occurs in ambulatory pharmacy practice. Please refer to the schedule provided on the first day of the module for a list of discussion topics. It is expected that the students have reviewed their notes on the daily topics before arriving to morning conference. Students will be required to utilize the skills learned in introductory and intermediate pharmacy practice experiences to facilitate understanding and participation in these discussions. Attendance is mandatory, and students must sign in when they arrive. If the University cancels classes for inclement weather, then morning conference will be cancelled, but the student is expected to contact his/her preceptor to determine whether to attend clinic. 6
  7. 7. COURSE STRUCTURE AND REQUIREMENTS (CONTINUED) Project Time Project time will be provided for completion of written assignments, projects, and clerkship objectives during the regular clerkship schedule. Depending on the clinic, each student will have an average of 1- 3 half-day sessions of project time per week. Students are expected to be in the library, in the student computer center, working with faculty, or working at home on clerkship assignments during project time. Students are not to be at their job during this time. Abuse of project time may result in its alteration or cancellation at any point during the clerkship. ABSENCES/TARDINESS Consistent with clerkship policy and procedures, absences or tardiness to morning conference, clinic or other clerkship-related activities will result in point deductions from the student’s final point total for the clerkship for each incidence, based on the specific circumstances. See Grading & Evaluation page for specifics. Promptness is expected for all activities and responsibilities. Notification of the course coordinator and your preceptor prior to the absence will be considered an excused absence for legitimate reasons. Failure to notify the course coordinator and your preceptor before the occurrence will result in an unexcused absence and may result in failure of the clerkship. Absences from clinic or morning conference may result in a make-up assignment to be assigned by the preceptor, or students may be asked to make up the missed clinic time. In the event of an illness, you should notify your preceptor that you are unable to report to clinic and notify a course coordinator that you will be missing Morning Conference. Students will need to have a valid reason for an excused absence. Active participation is expected from all students (i.e., students should not be sleeping during this time). 7
  8. 8. PROFESSIONALISM In accordance with Medical Center policy and Health Insurance Portability and Accountability Act (HIPAA) regulations, it is expected that the student will respect the rights of all patients by insuring confidentiality of medical information. Medical records may not be removed from the confines of the institution. Students cannot make copies of patient records in any form, nor print information from Gemini (or other patient information databases). All efforts must be made to ensure the confidentiality and security of patient-specific protected health information (PHI). Additionally, in accordance with Medical Center policy and in consideration of patients and their families, students’ dress must meet professionally acceptable standards. White coats displaying the College of Pharmacy nametag and the University ID are required, unless otherwise specified by your preceptor. Shirts and ties are preferred for male students. Female students should wear socks or nylons. Also, athletic shoes and jeans are not appropriate. EVALUATION (See evaluations at the end of the manual) Evaluations are performed to share information with the student on his/her overall clerkship performance. An evaluation is necessary to: identify the student's strengths, identify performance areas which require modification, and to identify individual learning needs for the remainder of the clerkship. Each student must demonstrate a minimally competent level of clinical practice in the course objectives to complete the advanced pharmacy practice experience. A formal oral and written performance appraisal (evaluation) will be done during week 3 or 4 and at the completion of the clerkship module. These evaluations are designated as mid-module and final. The mid-module evaluation does not assign a course grade. This formative evaluation is designed to give the student feedback on his/her performance to date and specific suggestions for successful completion of the clerkship requirements, where needed. During the final, summative evaluation, the clerkship final course grade will be assigned. 8
  9. 9. FAILURE Since clinic performance is the most important part of the Ambulatory Care experience, it will be possible for a student to receive a D grade if he/she receives a majority of 4’s on the Clinic Performance scale, or an E grade if a majority of 2’s are received, regardless of other grades on projects, etc. If a student’s performance worsens from the mid-module to the final evaluation, it is also possible for a student to fail the clerkship. A student who has an excessive number of absences (excused or unexcused) may be issued an incomplete by their preceptor and may be asked to make up missed clinic time during school breaks. Once the student has completed the assigned requirements, they will then be issued a final grade for the course. This may also be conveyed as a lack of professionalism and reflected in the final evaluation. Preceptors are required to notify Kristen Goliak, Director of APPE at the mid-module evaluation if a student receives a grade of ≤45 points on the clinical evaluation or is in danger of failing the rotation due to other clerkship requirement reasons. Dr. Goliak can be reached at 312-355-1559 or by e-mail at kgoliak@uic.edu. THERAPEUTIC DRUG MONITORING Therapeutic drug monitoring is an essential component of the pharmacist's responsibility, and a critical part of the drug use process. Accurate monitoring insures appropriate and cost effective pharmaceutical care for all patients. Therapeutic drug monitoring involves the maintenance, modification, or discontinuation of a drug based on its efficacy, therapeutic activity, adverse effect profiles, and patient response. This is achieved through the use of the patient's medical record, laboratory data, patient interviews, discussions with other health professionals, and the patient's clinic 9
  10. 10. course. Specific activities involved in therapeutic drug monitoring are: 1. Identifying the need for drug therapy. 2. Selecting a drug of choice. 3. Selecting the appropriate product, dose, interval and route of administration (i.e., regimen). 4. Assuring proper drug administration. 5. Identifying parameters used to monitor efficacy, therapeutic response, and toxicity. 6. Screening for potential drug interactions or contraindications to therapy. 7. Identifying therapeutic goals and a reasonable time frame to meet these goals. 8. Identifying those factors that necessitate drug regimen adjustment. 9. Evaluating drug therapy outcomes. 10. Selecting and recommending therapeutic alternatives when appropriate. It is expected that the student can utilize the SOAP format for each problem on the patient's problem list. 10
  11. 11. SOAP NOTE FORMAT (Example) S: ____ y/o M/F presents to the _______ Clinic for ____________________________ PMH: ___________ x ____ years, etc. FmHx: Grandparents, parents, siblings, as applicable SocHx: EtOH: yes/no, how often, how many, what kind (beer/wine/liquor) Smoking: yes/no, how many per day, how long, or how long not smoking Drugs: yes/no, what kind Diet: Exercise: Allergies: include presence or absence of allergies, symptoms, interventions, and significance (if allergy present) Current Medications (as the patient takes them); for each medication (prescription and OTC) include the brand and/or generic name, indication, dose, regimen, duration of therapy, any complications, and time of last dose (when appropriate) Patient Complaints/Wellness: Communicate what you discussed with the patient about their disease state(s) include efficacy, side effects, and compliance O: BP ____/____ (R/L arm, sitting/standing, large/small cuff); P_____ Wt _____ Pertinent physical exam findings: Labs: SMBG, Peak flow, other Diagnostics: CXR, EKG, etc. 11
  12. 12. A: Number each assessment. Assess severity, potential causes, and goals of therapy, if applicable. 1. 2. P: Number each plan. Include your current recommendations based on the patient’s clinical course and previous drug regimens. 1. 2. Alternative format for Assessment (A) and Plan (P) A/P: Number each assessment. Assess severity, potential causes, and goals of therapy, if applicable. Bullet point (or otherwise designate) your current recommendations, underneath the assessment, based on the patient’s clinical course and previous drug regimens. 12
  13. 13. MEDICATION COUNSELING A professional responsibility of the pharmacist is to provide clear, concise, accurate and useful information to patients regarding their drug therapy regimens. This responsibility is one that requires effective communication between the pharmacist and the patient. Communication takes the form of both verbal and non-verbal messages. Verbal Verbal messages need to be conveyed in: 1. Patient oriented language (use words to which the patient can attach meaning) 2. A clear and concise format (provide information that can be easily interpreted and followed) 3. Accurate terms (limit the ambiguity of your message) 4. An appropriate volume and tone (encourage trust; demonstrate confidence) Non-Verbal Audiovisual aids (enhance the spoken word; supplement demonstration of techniques; assist in explaining complicated regimens; address specific non-compliant behaviors) To convey the necessary information, the pharmacist should provide the following during consultation: • Name of medication • Strength of medication • Indication for medication • Directions for use and administration techniques • Storage requirements • Common side effects • Self-monitoring techniques • Importance of adherence to regimen • Directions for follow-up • Review of any written information concurrently distributed • Refill information (if applicable) 13
  14. 14. STATEMENT ON PLAGIARISM1 "In plagiarism, an author passes off as her or her own the ideas, language, data, graphics, or even scientific protocols created by someone else, whether published or unpublished. Plagiarism of published work violates copyright laws as well as standards of honesty and collegial trust and may be subject to penalty imposed by a court should the holders of the copyright bring suit. Four common kinds of plagiarism have been identified: (1) direct verbatim lifting of passages, (2) rewording ideas from the original in the purported author's own style, (3) paraphrasing the original work without attribution, and (4) noting the original source of only some of what is borrowed." 1 : Iverson C (Chair), Dan B, Glitman P, King L, et.al., ed. The American Medical Association Manual of Style, 8th Ed. Baltimore, MD. Williams & Wilkins, 1989. Please note that plagiarism will result in failure of the assignment in which the plagiarism occurred and may also result in failure of the clerkship. 14
  15. 15. Uniform Requirements for Manuscripts Reference Styles Updated October 2001 1) References should be numbered consecutively in the order in which they are first mentioned in the text. 2) Use the reference style of the National Library of Medicine, including the abbreviations of journal titles. 3) Provide complete data for each reference. 4) Ensure that URL's used as references are active and available (the references should include the date on which the author accessed the URL). 5) Do not use ibid. or op cit. The sample references below conform to the style specified by the Uniform Requirements agreement. Articles in Journals 1. Standard journal article List the first six authors followed by et al. Vega KJ, Pina I, Krevsky B. Heart transplantation is associated with an increased risk for pancreatobiliary disease. Ann Intern Med 1996 Jun 1;124 (11):980-3. As an option, if a journal carries continuous pagination throughout a volume (as many medical journals do) the month and issue number may be omitted. Vega KJ, Pina I, Krevsky B. Heart transplantation is associated with an increased risk for pancreatobiliary disease. Ann Intern Med 1996;124:980-3. More than six authors: Parkin DM, Clayton D, Black RJ, Masuyer E, Friedl HP, Ivanov E, et al. Childhood leukaemia in Europe after Chernobyl: 5 year follow-up. Br J Cancer 1996;73:1006- 12. 2. Organization as author The Cardiac Society of Australia and New Zealand. Clinical exercise stress testing. Safety and performance guidelines. Med J Aust 1996; 164: 282-4. 3. No author given Cancer in South Africa [editorial]. S Afr Med J 1994;84:15. 4. Volume with supplement Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and occupational lung cancer. Environ Health Perspect 1994;102 Suppl 1:275-82. 5. Issue with supplement Payne DK, Sullivan MD, Massie MJ. Women's psychological reactions to breast cancer. Semin Oncol 1996;23(1 Suppl 2):89-97. 6. Volume with part Ozben T, Nacitarhan S, Tuncer N. Plasma and urine sialic acid in non-insulin dependent diabetes mellitus. Ann Clin Biochem 1995;32(Pt 3):303-6. 7. Issue with part Poole GH, Mills SM. One hundred consecutive cases of flap lacerations of the leg in ageing patients. N Z Med J 1994;107(986 Pt 1):377-8. 8. Type of article indicated as needed Enzensberger W, Fischer PA. Metronome in Parkinson's disease [letter]. Lancet 1996;347:1337. Clement J, De Bock R. Hematological complications of hantavirus nephropathy (HVN) [abstract]. Kidney Int 1992;42:1285. 15
  16. 16. Books and Other Monographs 1. Personal author(s) Ringsven MK, Bond D. Gerontology and leadership skills for nurses. 2nd ed. Albany (NY): Delmar Publishers; 1996. 2. Editor(s), compiler(s) as author Norman IJ, Redfern SJ, editors. Mental health care for elderly people. New York: Churchill Livingstone; 1996. 3. Organization as author and publisher Institute of Medicine (US). Looking at the future of the Medicaid program. Washington: The Institute; 1992. 4. Chapter in a book Phillips SJ, Whisnant JP. Hypertension and stroke. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis, and management. 2nd ed. New York: Raven Press; 1995. p. 465-78. 5. Conference proceedings Kimura J, Shibasaki H, editors. Recent advances in clinical neurophysiology. Proceedings of the 10th International Congress of EMG and Clinical Neurophysiology; 1995 Oct 15-19; Kyoto, Japan. Amsterdam: Elsevier; 1996. 6. Conference paper Bengtsson S, Solheim BG. Enforcement of data protection, privacy and security in medical informatics. In: Lun KC, Degoulet P, Piemme TE, Rienhoff O, editors. MEDINFO 92. Proceedings of the 7th World Congress on Medical Informatics; 1992 Sep 6-10; Geneva, Switzerland. Amsterdam: North-Holland; 1992. p. 1561-5. Other Published Material 1. Newspaper article Lee G. Hospitalizations tied to ozone pollution: study estimates 50,000 admissions annually. The Washington Post 1996 Jun 21;Sect. A:3 (col. 5). 2. Dictionary and similar references Stedman's medical dictionary. 26th ed. Baltimore: Williams & Wilkins; 1995. Apraxia; p. 119-20. Unpublished Material 1. In press (Note: NLM prefers "forthcoming" because not all items will be printed.) Leshner AI. Molecular mechanisms of cocaine addiction. N Engl J Med. In press 1996. Electronic Material 1. Journal article in electronic format Morse SS. Factors in the emergence of infectious diseases. Emerg Infect Dis [serial online] 1995 Jan-Mar [cited 1996 Jun 5];1(1):[24 screens]. Available from: URL: http://www.cdc.gov/ncidod/EID/eid.htm [accessed Jan 3, 2005] 2. Monograph in electronic format CDI, clinical dermatology illustrated [monograph on CD-ROM]. Reeves JRT, Maibach H. CMEA Multimedia Group, producers. 2nd ed. Version 2.0. San Diego: CMEA; 1995. 35. Computer file Hemodynamics III: the ups and downs of hemodynamics [computer program]. Version 2.2. Orlando (FL): Computerized Educational Systems; 1993. A complete version of this excerpted document may be copied and distributed without charge for not-for-profit, educational purposes. A digital version is available at the ICMJE web site (www.icmje.org). 16
  17. 17. GRADING AND EVALUATION The final letter grade is determined by the following components: AMBULATORY CARE CLINIC PERFORMANCE Includes problem identification and solving skills, monitoring skills, learning skills, communication skills, and initiative as assessed by clinic preceptor. Clerkship performance will be evaluated during week 3-4 (mid-module) and at the end of week 6 (final) by your preceptor. Only the final evaluation will count toward your final course grade (70 points possible). ASSIGNMENTS Drug Information Request (10 points possible) Journal Club (UIC sites) (10 points possible) Journal Club (non-UIC sites) (5 points possible) Special Project (non-UIC sites) (5 points possible) Presentation (10 points possible) DEDUCTIONS Two points will be deducted from the final point total for each instance that the student is > 10 minutes late to Morning Conference in excess of one time. Five points will be deducted from the final point total for each unexcused absence to Morning Conference. Per clerkship policies and procedures, any unexcused absences from your assigned clinic can result in a failing grade for the rotation. At the discretion of the course coordinators, students with ≥ 2 excused absences (from Morning Conference will be given a make-up assignment, relative to the missed topics, to be submitted to the preceptor by the end of the rotation or an assigned due date. UIC Sites Grading: Requirement Maximum Ambulatory Care Clinic Performance 70 points Drug Information Request 10 points Journal Club 10 points Presentation 10 points TOTAL: 100 points Non-UIC Sites Grading: Requirement Maximum Ambulatory Care Clinic Performance 70 points Drug Information Request 10 points Journal Club 5 points Special Project 5 points Presentation 10 points TOTAL: 100 points GRADING SCALE A 90 Final Course Points or greater B 80-89 Final Course Points C 70-79 Final Course Points D 60-69 Final Course Points E 59 Final Course Points or less 17
  18. 18. DRUG INFORMATION REQUEST The ability to provide drug information to patients and other health professionals is an important clinical practice skill. Responses to requests for drug information can be provided verbally or in a written format. Each pharmacist ultimately develops his/her own style built upon general guidelines for providing drug information. The following general guidelines are presented as that, only guidelines, since a standardized approach to providing drug information to all questions in every situation does not exist. Although drug information is continuously provided as part of pharmacy practice, one drug information paper will be graded formally. The required written assignment should be double-spaced and about 4-6 pages in length, but could be longer or shorter depending on the topic, available good quality literature, and preceptor preference. When formulating a verbal or written response to a drug information request: 1. Develop a search strategy: Search tertiary, secondary and primary literature using key terms. MEDLINE search is a must. Use current textbooks and other references. 2. Restate question or request: include a brief statement of the problem or issue and circumstances under which it has occurred. 3. Provide introductory statements (background): Certain requests can be more clearly defined if a brief introductory or background section is included. This section can also serve to clarify any terminology that will be discussed in the consult. 4. Describe literature support (body): Based on the tertiary, secondary, and primary literature searched, describe pertinent information to answer the request. The body of the response should contain a concise, unbiased, and accurate summary of your findings. When reporting data from clinical trials and/or case reports, remember to include information regarding number of subjects, treatment protocols, outcomes of therapy, adverse effects, and any deficiencies in study design. Also, tables, charts or graphs may be helpful in clarifying your literature. Be certain to include a critique of the articles that are cited in your paper. 5. Formulate an appropriate conclusion: This section should include a brief overall summary of the information presented. Any recommendations for the management of the requestor's problems should also be noted (e.g. what would you recommend for the patient in question?). Your conclusion should answer the question posed in your introduction and reflect the information presented in the body of your consult. 6. List cited references: Any and all significant statements in the body of the consult should be referenced. References are numbered in the order in which they are utilized. When listing references, refer to the Uniform Requirements for Manuscripts Reference Styles of the National Library of Medicine (examples attached to this manual). Failure to properly reference information constitutes plagiarism and may result in a failing grade on the paper and/or failure of the course. A minimum of 5 reference sources should be cited. 18
  19. 19. JOURNAL CLUB+/-TOPIC DISCUSSION (UIC sites) and JOURNAL CLUB (non-UIC sites) Each student is required to present and participate in a formal “Journal Club”. This requirement will be based on a presentation and critique of pivotal trials published in the medical literature. Journal clubs are designed to help students learn to read and evaluate journal articles with a critical eye, keep abreast of recent discoveries and interventions in medical science, and enhance their ability to be life- long scholars. The presenting student will lead the discussion. Non-presenting students are expected to prepare for discussion by reviewing the article prior to class. The presenter should understand and be familiar with all aspects of the study discussed. The student should obtain the approval of the preceptor prior to distributing the chosen article to ensure appropriate articles for discussion. In conjunction with the presentation of literature (Journal Club), students at UIC sites may be asked to discuss a topic (Topic Discussion) related to the journal article. This discussion is meant to teach the other students about the topic in a way that invites participation by the audience. The Journal Club+/- Topic Discussion should last 25-30 minutes. There should be enough time for a good discussion about the article and topic, including a question and answer session. When presenting a Journal Club, the student should: 1. Provide and distribute a copy of the article to be discussed at least 2 weekdays prior to the scheduled presentation. 2. State the elements of the trial in proper order, i.e. background, purpose, methods, results, conclusions and applications. 3. Summarize the methods, including patient population, inclusion/exclusion criteria, blinding/randomization, regimens, monitoring, evaluation, endpoints, statistics. 4. Present the results and conclusions, which should not be solely a reiteration of the author's conclusion but also a product of the presenter's thoughts. 5. Apply the information to clinical practice (i.e., clinical relevancy). 19
  20. 20. SPECIAL PROJECT (non-UIC sites) Students at non-UIC sites are expected to complete a project assigned by the clinic preceptor. The topic (to be chosen by the preceptor assigned to the student) may include things like a new drug review, a patient education leaflet, an in-service to area staff, new clinical program development, outreach education, etc. The student is expected to sit down with the preceptor to delineate the assigned topic and discuss the objectives of the assignment. Your preceptor may ask you to present your project to other faculty or clinic members. Examples: • New drug review should include indications, doses, side effects, advantages over other therapies, a brief summary of clinical trials, and cost. • Patient education leaflet should include description of disease state, symptoms and course of the disease, treatment options (pharmacological and non-pharmacological) and any other pertinent information such as special tests or prevention. • In-service should include points of general importance, information specific to the discipline being in-serviced (e.g. nurses: monitoring parameters, drug administration guidelines, physicians: indications for use, dosage adjustments, monitoring parameters), pertinent patient education. • Outreach education could include the following: medication and immunization-related community outreach education, completion of service learning reflective logs, reflective discussion sessions and any other related activities. 20
  21. 21. PRESENTATION To fulfill the requirements of the rotation, each student is expected to deliver a formal presentation. This presentation may focus on the student’s Drug Information Request, Journal Club+/-Topic Discussion or Journal Club, Special Project, or another rotation-specific topic. This will be the choice of the student’s preceptor and will be assigned by him/her. The student will present a 20-minute power point presentation with 10 minutes for a question/answer session. The presentation should include learning objectives for the audience. A handout consisting of a copy of the slides should be provided to each audience member, and a copy of the references should also be made available. It is the student’s responsibility to complete the formal presentation requirement of the rotation. In the event the student must make up this assignment due to an unforeseen circumstance, it may be necessary to deliver the presentation in the early morning, evening, or weekend hours at the discretion of the preceptor. Failure to do so will result in a grade of “incomplete” until this requirement is satisfied. 21
  22. 22. PHAR 371 AMBULATORY CARE CLINIC PERFORMANCE EVALUATION FORM Student Name:___________________________ Preceptor Name:_______________________ Date:__________ Module:_______ Check One: Midmodule_____ Final______ Grading Scale 10 = The student always performs tasks and activities related to the objective at an above average level. The student requires minimal supervision. 8 = The student usually performs tasks and activities related to the objective at an above average level. The student requires moderate/minimal supervision and occasional intervention. 6 = The student usually performs tasks and activities related to the objective at an average level. The student requires moderate supervision and frequent intervention. 4 = The student usually performs tasks and activities related to the objective at a below average level. The student requires frequent supervision and consistent intervention. 2 = The student consistently performs tasks and activities related to the objective at an unacceptable level. The student requires constant supervision and intervention. Objectives Score Comments Patient Assessment • Obtain medication history – evaluate for drug interactions, compliance • Obtain patient information – current/chronic medical problems, pertinent physical exam, laboratory data • Formulate a complete patient problem list • Evaluate drug information needs of patient/representative 2 4 6 8 10 Monitoring Skills • Determine the parameters that need to be monitored (laboratory and physical) to prevent adverse drug events and to evaluate effectiveness of therapy • Recommend/order necessary monitoring tests • Determine if all medications have an indication and all problems are treated 2 4 6 8 10 22
  23. 23. Formulating a Plan • Formulate appropriate action when the use of a drug is contraindicated or indication unknown • Formulate appropriate action when noncompliance is detected • Determine desired therapeutic endpoints • Formulate a therapeutic regimen involving drug and non-drug therapy • Determine appropriateness of a prescriptions’ dose, dosage form, route of administration and frequency • Use literature evaluation skills in the drug use decision-making process (i.e. gathering data to support recommendations) • Influence the health and behavior of consumers towards preventive care • Identify and perform necessary screening tests or preventive care 2 4 6 8 10 Documentation Skills • Design a method for documenting recommendations based on professional and practical considerations • Write accurate and concise notes in patient’s medical record • Write a complete prescription (excluding physician’s signature) including all components legally required • Assess patients’ educational needs and provide appropriate education • Document recommendations for drug and non-drug therapy 2 4 6 8 10 Communication Skills with Patients • Organize information to prepare for discussion with patient • Verbally explain drug or poison information to patients • Communicate assessment, plan and results of monitoring to patient/patient representative • Listen to patient and identify and resolve problems or concerns • Use appropriate verbal and non-verbal communication skills when speaking to patients • Participate readily in MMSOA and complete associated assignments, if applicable 2 4 6 8 10 23
  24. 24. Communication Skills with Health Care/Other Professionals • Organize information to prepare for discussion with professionals • Provide appropriate verbal/written drug information to professionals • Communicate assessment, plan, results of monitoring and any patient problems to professionals • Use appropriate verbal and non-verbal communication skills when speaking to professionals • Communicate with third party payers to determine or verify coverage • Use a systematic and efficient procedure to retrieve appropriate drug information to satisfy a drug information request 2 4 6 8 10 Ethics/Professionalism/Organization • Ensure patient confidentiality • Exhibit reliability – complete assigned tasks, arrive on time • Handle detail • Accomplish extra assignments, projects, or activities in an accountable, complete, and accurate manner • Respond maturely to constructive criticism 2 4 6 8 10 Total Points (70 points possible) __________ Which clinical skills does the student perform at the highest level? Which clinical skills does the student need to modify? Student Signature________________________________________ Date_______________ Preceptor Signature_______________________________________ Date_______________ 24
  25. 25. PHAR 371 DRUG INFORMATION REQUEST EVALUATION FORM Student Name:____________________________Topic:__________________________________ Evaluator:________________________Date due:___________ Date submitted:_______________ Evaluate the Drug Information Request on a scale of 0.2 (poor) to 1 (excellent): Score Comments Format and Organization Formatted as outlined in manual, including introduction, restatement of question, description of literature support, and conclusion 0.2 0.4 0.6 0.8 1 Writing well-organized with good continuity 0.2 0.4 0.6 0.8 1 Content Appropriate search strategy used to obtain appropriate number of articles that are current and of good quality; sources referenced correctly 0.2 0.4 0.6 0.8 1 Adequately addressed background data, epidemiology, pathophysiology, pharmacokinetics, and therapeutics 0.2 0.4 0.6 0.8 1 Study design and number and types of patients are described in adequate detail 0.2 0.4 0.6 0.8 1 Assessment of strengths and weaknesses of studies performed and appropriate 0.2 0.4 0.6 0.8 1 Appropriate conclusions were made regarding the quality and usefulness of the studies 0.2 0.4 0.6 0.8 1 Fully answers question, and answer reasonable based on data/patient presented 0.2 0.4 0.6 0.8 1 Communication Writing rational, direct, and concise but complete 0.2 0.4 0.6 0.8 1 Correct grammar and spelling 0.2 0.4 0.6 0.8 1 Total Points (10 points possible) __________ 5% deduction for each clerkship day that assignment is late Minus __________ points Final Score __________ Student’s Signature____________________________________ Date______________ Evaluator’s Signature___________________________________ Date______________ 25
  26. 26. PHAR 371 JOURNAL CLUB + TOPIC DISCUSSION EVALUATION FORM (UIC sites) Student Name:________________________Article/Topic:___________________________________ Evaluator:________________________________Module/Date:_______________________________ Evaluate the Journal Club/Topic Discussion on a scale of 0.2 (poor) to 1 (excellent): Score Comments Journal Club - Format and Organization Points presented logically and in an organized manner, including orientation of audience to data tables/graphs 0.2 0.4 0.6 0.8 1 Journal Club - Content Thorough review of article was provided with appropriate quantity of data presented 0.2 0.4 0.6 0.8 1 Critique of study was appropriate (study strengths and weaknesses were identified) 0.2 0.4 0.6 0.8 1 Clinical relevance and applications discussed, including identification of important subpopulations 0.2 0.4 0.6 0.8 1 Appropriately prepared in order to understand information well and answer questions 0.2 0.4 0.6 0.8 1 Topic Discussion - Format and Organization Information presented was well-organized 0.2 0.4 0.6 0.8 1 Topic Discussion - Content Appropriate depth and breadth of topic covered, including clinical applications 0.2 0.4 0.6 0.8 1 Good knowledge and understanding of topic, including presentation of accurate information 0.2 0.4 0.6 0.8 1 Journal Club and Topic Discussion - Communication Able to communicate important information in an understandable way using facilitated discussion and in the allotted time 0.2 0.4 0.6 0.8 1 Uses eye contact and correct grammar and proper syntax at an appropriate volume and pace (not rushed or garbled) 0.2 0.4 0.6 0.8 1 Total Points (10 points possible) __________ Student’s Signature____________________________________ Date______________ Evaluator’s Signature___________________________________ Date______________ 26
  27. 27. PHAR 371 JOURNAL CLUB EVALUATION FORM (UIC and non-UIC sites) Student Name:________________________Article/Topic:___________________________________ Evaluator:________________________________Module/Date:_______________________________ Evaluate the Journal Club on a scale of 0.2 (poor) to 1 (excellent): Score Comments Format and Organization Points presented logically and in an organized manner, including orientation of audience to data tables/graphs 0.2 0.4 0.6 0.8 1 Content Thorough review of article was provided with appropriate quantity of data presented 0.2 0.4 0.6 0.8 1 Critique of study was appropriate (study strengths and weaknesses were identified), and clinical relevance and applications discussed, including identification of important subpopulations 0.2 0.4 0.6 0.8 1 Communication Able to communicate important information in an understandable way using facilitated discussion and in the allotted time 0.2 0.4 0.6 0.8 1 Uses eye contact and correct grammar and proper syntax at an appropriate volume and pace (not rushed or garbled) 0.2 0.4 0.6 0.8 1 Total Points (5 points possible) Multiply x 2 if UIC site (10 points possible) __________ Student’s Signature____________________________________ Date______________ Evaluator’s Signature___________________________________ Date______________ 27
  28. 28. PHAR 371 SPECIAL PROJECT EVALUATION FORM (non-UIC sites) Student Name:___________________________ Project:_________________________________ Evaluator:_______________________________ Module/Date:____________________________ When assigning a project, record 3 project objectives in the space provided below. Then evaluate the Special Project based on a scale of 0.2 (poor) to 1 (excellent): Objective Score Comments 1. 1 2 3 4 5 2. 1 2 3 4 5 3. 1 2 3 4 5 Total Points (15 points possible) __________ Divide by 3 (5 points possible) __________ 5% deduction for each clerkship day that assignment is late Minus __________ points Final Score __________ Student’s Signature____________________________________ Date______________ Evaluator’s Signature___________________________________ Date______________ 28
  29. 29. PHAR 371 PRESENTATION EVALUATION FORM Student Name:____________________________ Topic:_________________________________ Evaluator:_______________________________ Module/Date:__________________________ Evaluate the Presentation on a scale of 0.2 (poor) to 1 (excellent): Score Comments Format and Organization Presentation had an introduction, learning objectives, and conclusion 0.2 0.4 0.6 0.8 1 Information is organized in a logical manner 0.2 0.4 0.6 0.8 1 Content Appropriate number of studies (if applicable) or sources that are current and of good quality; sources referenced correctly and provided 0.2 0.4 0.6 0.8 1 Information is accurate 0.2 0.4 0.6 0.8 1 Information is conclusive and pertinent 0.2 0.4 0.6 0.8 1 Communication Uses eye contact and correct grammar and proper syntax at an appropriate volume and pace (not rushed or garbled) 0.2 0.4 0.6 0.8 1 Slides easy to read, well-organized, and concise; handout provided 0.2 0.4 0.6 0.8 1 Correct grammar and spelling 0.2 0.4 0.6 0.8 1 Response to questions informed/authoritative 0.2 0.4 0.6 0.8 1 Presentation covered in time allotted 0.2 0.4 0.6 0.8 1 Total Points (10 points possible) __________ Student’s Signature____________________________________ Date____________________ Evaluator’s Signature___________________________________ Date____________________ 29
  30. 30. PHAR 371 2009-2010 FINAL COURSE GRADE Student Name:____________________________________________________ Preceptor Name:__________________________________________________ Module: ___________ Date: ____________ Clinic:______________________ Ambulatory Care Clinic Performance (70 points possible) __________ points Drug Information Request (10 points possible) __________ points Journal Club (10 points possible) (UIC sites) __________ points Journal Club (5 points possible) (non-UIC sites) __________ points Special Project (5 points possible) (non-UIC sites) __________ points Presentation (10 points possible) __________ points TOTAL (100 points possible) __________ points EXPECTED FINAL LETTER GRADE (may change after deductions taken) _______ Student APPE Portfolio updated _______ (faculty initials) For Coordinator Use Only **Deductions** (-)_________ points FINAL LETTER GRADE __________ GRADING SCALE: A 90 Final Course Points or greater B 80-89 Final Course Points C 70-79 Final Course Points D 60-69 Final Course Points E 59 Final Course Points or less Total # of days missed during rotation: ________ days 30

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