LEARNING DESCRIPTION – AMBULATORY CARE ROTATION

PRECEPTOR INFORMATION

Primary Preceptor: Nicholas Buttermore, PharmD and Jason Isch, PharmD

 PGY1 Pharmacy Resident – Ambulatory Care
 Email: [email protected]
 Office Phone: (574) 335-6563
 Cell Phone: (260) 573-3891

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 not-for-profit, multi-hospital health system located in North Central
Indiana. We are the fourth largest system apart of the Trinity Health Network.

During your rotation, you will be primarily at both the Saint Joseph Family Medicine Center (FMC) and Family
Medicine Faculty Physicians Clinic (FMFP). The FMC is housed by both a family practice network and the
Graduate Medical Education (GME) program. Our GME program is comprised of family medicine, podiatry,
and sports medicine residents – allowing for a multidisciplinary team experience in the ambulatory care setting.
Both FMC and FMFP clinics are open between the hours of 8 am to 4:30 pm Mondays through Fridays.
ROTATION OVERVIEW
The primary goal during your time at the SJFMC will be to engage in the provision of excellent care as an
ambulatory care pharmacist amidst an interdisciplinary team of medical students and professionals. The Saint
Joseph Pharmacy team operates under a variety of collaborative practice agreements to offer robust services.
CPAs enable our team to provide care for patients, including writing prescriptions, ordering labs, and altering
medical therapy via the authorization of our family providers. The following are common disease states you
will encounter throughout your rotational experience here. You are encouraged to familiarize yourself with the
following areas to optimize your time and learning experience here:

 Hypertension  Heart Failure

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

During your rotational experience at the SJFMC you will participate in a variety of ambulatory care experiences
centered around the following disease management clinics:

 Anticoagulation Clinic  Medication Adherence Service

 Diabetes Clinic  Transitions of Care Service
 Medicare Annual Wellness Visit Clinic  Heart Failure Clinic
 PGY1 Pharmacy Resident Clinic  Infectious Disease Clinic
o Smoking Cessation  Home Infusion Management
o Polypharmacy  Family Medicine Team Pharmacist
o Medication Therapy Management  Diabetes Classes

GENERAL EXPECTATIONS

Before the first day:

 Complete the “Getting to Know You Questionnaire” listed at the bottom of this document
 Review and reflect on the above disease states to prepare a plan of areas to focus on during your time at
SJFMC.
 Complete the rotational checklist below and provide the following required registration materials to your
primary preceptor:
o Current CPR/BLS
o Recent 8 Panel Drug Screen (within 12 months from rotation)
o Criminal Background Check
o Vaccination Record including:
 Rubella, Chicken Pox, and Hepatitis B
o PPD/Tuberculosis Titer
o Confidentiality agreement
o COVID Proof of Vaccination

During the rotation:

 Bring a positive, open, and willing attitude to learn, grow, and engage in pharmacy practice.
  Communicate thoroughly and regularly with your primary preceptor to ensure you can make all
rotational schedules and meet the weekly 40hr requirement.
 Maintain an open mind and engaged demeanor during patient encounters and discussions.
 Complete all assigned projects and presentations to the best of your ability.

Professionalism:
 Act in accordance with Saint Joseph Health System policies and procedures.
o Dress code expectations:
 Students may either wear business casual attire or black scrubs. Shoe wear is expected to
be closed toe and clean.
o Timeliness:
 Aim to arrive 10-15 minutes early every day to avoid tardiness and optimize learning
time.
 Adhere to the laws of HIPAA, maintaining patient confidentiality and dignity.
 Be respectful of the student learner space and patient clinic rooms.
 Maintain clear and consistent modes of communication between your primary preceptor and other staff
you will be engaged in during clinic days to set expectations and readiness.

LEARNING OBJECTIVES

By the end of this rotation, you should be able to:

1. Identify and utilize current practice guidelines to describe course of therapy and best practice in the
management of common ambulatory care disease states.

2. Analyze relevant primary literature for its utility on guiding clinic practice decision making.

3. Ask the appropriate probing questions to optimize timeliness and to thoroughly collect subjective patient
information including but not limited to: past medical history, social history, current medication list and
adherence, lifestyle interventions, and other pertinent subjective information during clinic days.

4. Generate an evidence-based patient care plan utilizing clinical practice guidelines, primary literature,
and patient information during clinic days.

5. Assess a patient’s current pharmacotherapy regimen for safety and efficacy and synthesize a plan for
alternative therapy or therapy modification when necessary.

6. Collect relevant past medical history, lab work, and encounter information in EPIC to work up and
present patients prior to clinic visits – see calendar for times

7. Implement motivational interviewing techniques during ambulatory care patient visits to promote
change talk regarding lifestyle modifications. [Blooms: apply]

CLINIC EXPERIENCE GUIDELINES

Below is a general outline for expectations from the learner in preparing for clinic, participating in clinic, and
working up patient encounters after clinic visits. You are encouraged to clarify expectations with each preceptor
and site before every visit.

Before clinic:
 Email the preceptor you are paired with the clinical experience at least 48 hours before hand to clarify
meeting times, expectations, and patients to work up before clinic time.
 Work up patients utilizing EPIC, the provided monitoring form, and any other materials your preceptor
deems fit in order to present the patient before clinic visits and discuss a treatment plan.

During clinic:
 Opportunities will vary by clinic, but potential roles in visits may include:
o Medication reconciliation
o Collection of Blood Pressures
o Collection of A1C or INR blood samples
o Provision of patient counseling on new medications
o Collection of other subjective information
 When not actively participating in clinical visits, the student is expected to be taking notes for discussion
after the visit on aspects of the visit, information being collected, and their assessment of a potential
treatment plan or counseling points.

After clinic:
 Document patient encounters utilizing a SOAP Note layout format. Other sheets or documents may also
be provided for utilization by the preceptor dependent on the clinic and site.
 Provide answers via in-person meetings or email to the preceptor regarding any drug information
questions or other follow-up questions presented before, during, or after clinic visits.

Throughout the rotation, it is expected for the student to transition away from a passive, shadowing role into an
active role in patient encounters. Students are encouraged to lead part or complete visits dependent upon
experience and confidence level throughout the rotation.

PROJECTS/PRESENTATIONS/ASSIGNMENTS

The following activities are expected to be completed throughout the rotational experience in order to expand
upon clinic knowledge and presentation skills. These projects will be discussed in greater depth by the primary
preceptor during orientation and throughout the month. When completing these projects, provide a “near-final”
copy of the presentation to your primary preceptor for evaluation at least 48 hours before the assigned due date /
presentation date for feedback.

Informal Topic Discussions (15-30 minutes)

 1-4 Student-led discussions
 Discuss with primary preceptor at the start of rotation on areas of interest or areas you wish to become
more knowledgeable about.
 Create a 1-page handout

Formal Patient Case Presentation (30 minutes with questions)

 Identify an interesting patient you have worked up by the 2nd 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)

 Completed at the beginning and end of block
 This activity is intended to serve as a hallmark of a students progress throughout the rotation.
 Evaluate a provided patient case using any resources over the course of 15 minutes to present a patient
and answer any clinic questions presented by the pharmacy staff.

FORMAL EVALUATIONS

Midpoint Evaluation
 Completed during the 2nd week of rotation, you will sit down with your primary preceptor to discuss
your performance, progress, and goals during the rotation.
 Utilize SMART goals to generate a list prepared ahead of time for discussion.

Final Evaluation
 Completed at the end of the rotation, you will sit down with your primary preceptor to evaluate your
performance, progress, and goals. It is encouraged that you bring feedback for the site and experience as
well.
 Be open, honest, constructive, and professional during feedback.

Feedback and informal evaluations will be completed organically and longitudinally throughout the entirety of
the rotation. Preceptors will commonly provide feedback after patient interactions or at the end of the day.
During experiences, projects, and presentations, reflect on areas that went well, areas that can be improved
upon, and things you would like to do differently the next time.

Be proactive in reaching out for feedback. It is encouraged that you are receptive to ongoing feedback to nurture
a stronger experience and accelerate your learning and growth as a pharmacist.

ROTATION POLICIES

 Academic Integrity
 Disability and Accommodation
 Religious Observance and Accommodation
 Absence and Emergency
 Title IX Discrimination and Harassment

ORIENTATION CHECKLIST
 General tour of hospital/clinic and student workspace

 Introduce preceptors and pertinent staff members

 Collect and review rotation requirements

o Confidentiality agreement
o Documents listed under expectations
o HealthStream email confirmation

 Review “Getting to Know You” Questionnaire

 Review rotation calendar

 Discuss expectations
o Professionalism
o Projects/assignments/presentations
o Clinic sites
o Review Google Drive

 Beginning of Oral Block

 Read/review key topics and therapeutic guidelines for rotation

 EMR Training/Applicable HR Training

 GETTING TO KNOW YOU QUESTIONNAIRE

1. What are your future career plans (even tentatively)?

a. Are you interested in pursuing a residency? If so, what kind?

2. What pharmacy experience do you have (working, prior rotations, professional organizations, volunteer
experience, etc.)?

3. List 3 strengths you bring to this rotation:

4. List 3 areas in which you hope to improve while on this rotation:

5. What do you hope to achieve upon the completion of this rotation?

6. List a few topics you are interested in learning more about:

7. How do you like to learn and receive feedback?

8. Is there anything I should know to ensure you have a successful rotation?

 GENERAL MONITORING FORM

Overview:
Patient Name: DOB/Age: Date of last PCP visit/Hosp:

Reason for Visit: Allergies: Tobacco: Y/N Alcohol: Y/N

Vitals:
- Weight
o First: Date: BMI:

o Second: Date: BMI:

o Third: Date: BMI:

- Blood Pressure & Pulse:

o First: Date:

o Second: Date:

o Third: Date:

Labs:
- CMP / BPM (Date Obtained: Active Orders: Y/N)
o Na+: o SCr: o eGFR:
o Cl-: o Glucose: o CrCl:
o BUN: o AST/ALT:

- Lipid Panel (Date Obtained: Active Orders: Y/N)

o TC: o HDL:
o LDL: o TG:

- CBC (Date Obtained: Active Orders: Y/N)

o WBC: o Hct: o Plts:
o RBC: o Hbg:

- INR (and date): - Microalbumin: - A1C (and date):

o First: o UACR: o First:
o Second: o Second:
o Third: o Third:

- Other Labs:
o
o Thyroid: o Microbiology: o ABG:
o LFTs: o Pregnancy test: o aPTT:
o Urinalysis: o CRP:
Procedures / Misc:
- Cardiology:
o TEE/EF:

o BNP:

o EKG/QT:

- Osteoporosis:
o BMD:

o FRAX

- Screenings:
o Colonoscopy (Date performed: Next Due: )

o Lung Cancer CT (Date performed: Next Due: )

o AAA (Date performed: Next Due: )

- Women’s Health:
o PAP Smear: (Date performed: Next Due: )

o Mammogram: (Date performed: Next Due: )

- General Wellness:
o Dental Exam:

o Eye Exam:

o Foot Exam:

Immunizations (Date Received and Next Due):

- Flu:

- COVID-19:

- PCV13:

- PPSV23:

- PCV20 / 15:
 - Hep B:

- Tdap/TD:

Encounter Notes:
PCP Visit / Hosp Date Overview of Encounter Med Changes?

Problem Prioritization:
Problem Relevant Labs Meds Plan
777Problem Relevant Labs Meds Plan
CALENDAR OVERVIEW (TBD: PROVIDED AT ORIENTATION)

Time w/ Primary Preceptor Time w/ Alternative Preceptor Work Project Time

Preceptors Email Sites/Addresses

Nick Buttermore – PGY1 [email protected] FMC
(Primary) 611 E Douglas Rd Ste. 407, Mishawaka, IN 46545

Olivia Ramey – PGY2 [email protected] FMC

(Primary) 611 E Douglas Rd Ste. 407, Mishawaka, IN 46545
Elm Rd. Clinic
60101 Bodnar Blvd Ste 100B, Mishawaka, Indiana 46544
Jason Isch [email protected] FMC
611 E Douglas Rd Ste. 407, Mishawaka, IN 46545
OLOR
234 Chapin St Ste 1, South Bend, IN 46601
Zach Martin – PGY2 [email protected] FMC
611 E Douglas Rd Ste. 407, Mishawaka, IN 46545
OLOR
234 Chapin St Ste 1, South Bend, IN 46601
Mallory Carter – PGY2 [email protected] FMC
611 E Douglas Rd Ste. 407, Mishawaka, IN 46545
River Park
1122 S Ironwood Dr, Mishawaka, IN 46544
Kiara Torres Garcia- PGY1 [email protected] FMC
611 E Douglas Rd Ste. 407, Mishawaka, IN 46545

Katie Clark [email protected] Elm Rd

60101 Bodnar Blvd Ste 100B, Mishawaka, Indiana 46544
Heart Failure Clinic
611 E Douglas Rd (2nd floor), Mishawaka, IN 46545
Ed Sheridan [email protected] FMC
611 E Douglas Rd Ste. 407, Mishawaka, IN 46545

Diana Mechelay [email protected] FMC

611 E Douglas Rd Ste. 407, Mishawaka, IN 46545