Advanced Pharmacy Practice Experience Syllabus
Inpatient-Acute Care
PPR 7410
Experience Name: Internal Medicine
Experience Category: Inpatient/Acute Care, Patient Care Core
Experience Site: Detroit Receiving Hospital (DRH)
Experience Preceptor(s):
Justine S. Gortney, PharmD, BCPS
Assistant Professor (Clinical) at EACPHS
Clinical Pharmacy Specialist at DRH
Pager: 313-745-0203; ID 5367
College Office: 313-993-8196
Personal Cell (Emergency only): 734-787-2448
Experience Site and Pharmacy Services Description:
Detroit Medical Center- Detroit Receiving Hospital
4201 St. Antoine Blvd.
Detroit, MI 48201
(313) 745-3000
https://www.dmc.org/
The Detroit Medical Center (DMC) is an integrated academic health care center with over 2,000 hospital
beds serving the people of southeast Michigan. The health center is composed of seven hospitals, two
nursing centers, and approximately 150 outpatient facilities. Our 100-acre Central campus in the heart of
Detroit is the hub of the DMC consisting of Children’s Hospital of Michigan, Detroit Receiving Hospital
and University Health Center, Harper University Hospital, The Rehabilitation Institute of Michigan,
Hutzel Women’s Hospital and Karmanos Cancer Hospital. The Northwest region contains Sinai-Grace
Hospital and the Oakland region contains Huron Valley-Sinai Hospital.
Detroit Receiving Hospital and University Health Center (DRH/UHC) is a world-class Level I
trauma center with specialized units for spinal cord injury, traumatic brain injury, burn, and psychological
trauma. The 340-bed inpatient and 92-bed emergency services facility specializes in the critical care of
emergency patients. University Health Center is one of the largest multi-disciplinary outpatient facilities
in the country. More than 200,000 patients are seen annually. This nine-story facility offers a full range of
ambulatory care services including 12 primary care and more than 25 medical specialties.
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Experience Description:
This rotation will provide the APPE student an opportunity to participate in the medical
management of acute care patients assigned to the medicine service at Detroit Receiving
Hospital (DRH). There are four medicine teams at DRH, and the student will be assigned to one
team for the duration of the rotation. Teams typically cover four to 15 patients and are
responsible for the comprehensive care of the patient. The patient population is variable in age,
gender, and ethnicity and common disease states include but are not limited to CAP, UTI, DFU,
DM emergencies, VTE, HIV, asthma, COPD, pancreatitis, liver disease, atrial fibrillation, HF,
HTN, HIV, and substance abuse. For assigned patients, the student will be responsible for
comprehensive medication management and evaluation of the patient. As necessary, they will
also participate in the provision of department of pharmacy services including pharmacokinetic
dosing, anticoagulation, and patient counseling. Site hours may vary by day and load of patient
care service, but are typically 7:30-5pm.
Though the student will be assigned patients for comprehensive pharmacotherapy evaluation, it
is expected that the student is aware of other patient needs on the team and evaluates the
following parameters for every patient on the team prior to rounds:
1)
2)
3)
4)
5)
Need for renal dose adjustment of drugs
Criteria monitored drugs and microbiology data
Eligibility for IV to PO switch
Blood glucoses and insulin requirements
Medications requiring pharmacy consult including drug administration within past 24
hours, day of therapy, and scheduled/obtained monitoring
6) Need for stress ulcer prophylaxis or VTE prophylaxis
7) PRN medication use of opiates, IV antiemetics, and antipsychotics
Experience Competencies:
1. Gather, generate, and organize relevant patient or population specific data. (ABO 1.1)
2. Interpret relevant patient or population specific data. (ABO 1.2)
3. Identify pharmacotherapy problems. (ABO 1.3)
4. Work effectively as a member of an interprofessional team. (ABO 1.4)
5. Develop a therapeutic plan, utilizing a comprehensive knowledge of the biomedical and
pharmaceutical sciences, evidence based literature, emerging technologies, and evolving
changes in the health sciences. (ABO 1.5)
6. Incorporate the potential effects of the patient’s health literacy, psychosocial, economic, and
cultural background into the therapeutic plan. (ABO 1.6)
7. Identify therapeutic outcomes. (ABO 1.7)
8. Implement the pharmacotherapeutic plan. (ABO 1.8)
9. Monitor outcomes and modify therapeutic plan as needed. (ABO 1.9)
10. Document pharmaceutical care activities and associated outcomes. (ABO 1.10)
11. Deliver comprehensive pharmaceutical care in a legal and ethical manner. (ABO 1.11)
12. Demonstrate professional skills, attitudes, and values and a sense of personal responsibility to
patients, patients’ agents, and other health care providers. (ABO 1.13)
13. Manage a successful patient-centered practice (including being compensated for services and
providing medication therapy management). (ABO 1.14)
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14. Utilize informatics, epidemiologic and pharmacoeconomic data, medication-use criteria,
medication use review and risk reduction strategies to develop disease prevention and
management programs in order to provide patient and population based care. (ABO 1.15)
15. Retrieve, analyze and interpret scientific literature to disseminate drug information to
patients, patients’ agents, health care professionals, administrators, policy makers, payers,
and the public. (ABO 1.16)
16. Communicate effectively and persuasively with patients, patients’ agents, health care
professionals, administrators, policy makers, payers and the public. (ABO 1.17)
17. Promote the availability of effective health and disease prevention services in a legal and
ethical manner. (ABO 3.1)
18. Apply population specific data, quality assurance strategies, informatics and research
processes to identify and resolve public health problems. (ABO 3.2)
19. Maintain professional competence by identifying and analyzing emerging issues, products,
and services. (ABO 4.1)
20. Possess the skills and attitudes required to be a motivated, self-directed, independent, lifelong learner. (ABO 4.2)
Experience Plan and Activities:
This required practice experience is designed to give the student a basic understanding of disease
states encountered in internal medicine. This course will stress the application of therapeutics in
patient care and require the student to develop skills in taking medication histories, monitoring
patients, participating in chart documentation and hospital programs, interacting with healthcare
personnel of all disciplines, providing drug information, and patient education.
Daily responsibilities will include individual patient evaluation, meeting with preceptor, and
medicine team rounds. Based on a calendar of events, the student may participate (or present) in
several other activities during the rotation including journal clubs, journal survey, formal patient
case presentation, disease state discussions, and potentially MUE or research based activities
(rotation specific) as determined by the preceptor.
Requirements for specific events (if scheduled during rotation):
A journal club article should be chosen from recent literature (last 6 months), be pertinent to an
internal medicine topic, be of clinical research (primary literature) in nature, and from a
reputable pharmacy or medical journal. The preceptor must approve chosen article at least one
week prior to presentation. The article should be distributed to others a minimum of 3 days prior
to the scheduled journal club discussion. When making a summary handout for the group, the
handout may be a maximum of one page front and back. It is encouraged that students refer to
tables and graphics in the article during the facilitation of discussion.
A patient case presentation to an audience will be selected together by the preceptor and
student. The presentation should be in PowerPoint format and should be 20 to 25 minutes in
length as to allow time for questions. Handout materials should be provided to everyone
attending. The presentation should include a title, learning objectives, patient based disease-state
presentation, and references (listed in AJHP format). The presentation should be based on a
patient case the student has followed and should include an overview of the patient case,
presentation of drug-related problem or disease state and therapy, and its application to the
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patient case. Topic with patient case should be submitted to the preceptor at least one week prior
to presentation.
Rules and Regulations:
It will be expected that the student will follow the rules and regulations in relationship to
conduct, patient confidentiality, and dress code as specified by both the Eugene Applebaum
College of Pharmacy and Health Sciences and the Detroit Medical Center. Violations of such
will be handled on an individual level in compliance with the Pharmacy Practice Experiences
Policy and Procedures Manual for EACPHS and the College’s Code of Professionalism and
Honor.
Competencies for the Rotation:
Competencies
1.
Gather, generate, and organize relevant patient or population specific data. (ABO 1.1)
Activities:
 For assigned patients identify relevant lab, medication administration, general monitoring,
medication specific monitoring data and healthcare provider assessment/communication
Access general and hospital-specific guidelines pertinent to care of assigned patients
 Participate in the identification and evaluation of patient data as required by MUE project or
research.
2.
Interpret relevant patient or population specific data. (ABO 1.2)
Activities:
 Interpret culture and sensitivity data, drug levels, diagnostic test results, and other relevant
laboratory data to evaluate such parameters as liver function, renal function, fluid status,
acid/base balance, hematopoetic and coagulation status, and adverse reactions,
 Identify important deviation from the medication therapy plan and implementation
 Summarize the clinical problems, associations, and progression in response to treatment
plan
3.
Identify pharmacotherapy problems. (ABO 1.3)
Activities:
 List the DRPs for each assigned patient
4.
Work effectively as a member of an interprofessional team. (ABO 1.4)
Activities:
 Attend team activities
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 Prepare for active participation in team activities
 Verbally communicate with team regarding care of assigned patients particularly as it
relates to the medication therapy
 Respond to the questions and requests for information from the team
5.
Develop a therapeutic plan, utilizing a comprehensive knowledge of the biomedical and
pharmaceutical sciences, evidence based literature, emerging technologies, and evolving
changes in the health sciences. (ABO 1.5)
Activities:
 Develop a plan for each DRP that includes the therapeutic goal, specific therapy, and
monitoring parameters (what, when, frequency and target/endpoint)
 Provide or site literature to support the plan
 Demonstrate comprehension of the clinical problems and pharmacotherapy for assigned
patients and in general for patients commonly seen in this clinical setting.
 Demonstrate comprehension of the application of the pharmacotherapy and applicable
treatment guidelines specific to the clinical factors of assigned patients
6.
Incorporate the potential effects of the patient’s health literacy, psychosocial, economic,
and cultural background into the therapeutic plan. (ABO 1.6)
Activities:
 For assigned patients, consider cultural and social factors that might influence the
pharmacotherapeutic plan and/or its implementation
7.
Identify therapeutic outcomes. (ABO 1.7)
Activities:
 Develop a plan for each DRP that includes the therapeutic goal, specific therapy, and
monitoring parameters (what, when, and target/endpoint)
8.
Implement the pharmacotherapeutic plan. (ABO 1.8)
Activities:
 Communicate the plan and rationale to the appropriate pharmacist preceptor, pharmacist,
physician, and/or other health care professionals.
 Communicate the plan to the team
 Participate in order entry or order review and evaluation as appropriate
 Write/enter a progress note on the plan as appropriate
Provide patient education as needed and/or required by preceptor and/or hospital policy
9.
Monitor outcomes and modify therapeutic plan as needed. (ABO 1.9)
Activities
 Develop a plan for each DRP that includes the therapeutic goal, specific therapy, and
monitoring parameters (what, when, frequency and target/endpoint)
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10. Document pharmaceutical care activities and associated outcomes. (ABO 1.10)
Activities:
 Write/enter the therapy and /or monitoring (e.g. verbal order) as appropriate on the record
 Write/enter a progress note on the plan as appropriate
 Document activities as required for practice site and college
11. Deliver comprehensive pharmaceutical care in a legal and ethical manner. (ABO 1.11)
Activities:
 Implementation of the pharmacotherapeutic plan including written and oral communication
with healthcare providers and patients is completed legally and ethically.
 Exercise appropriate patient and institutional confidentiality
 Abide by institutional rules and guidelines
12.
Demonstrate professional skills, attitudes, and values and a sense of personal
responsibility to patients, patients’ agents, and other health care providers. (ABO 1.13)
Activities:
 Participate in a prepared and timely manner in all assigned activities
 Communicate in a prepared, timely, and professionally appropriate manner
 Complete the implementation of the pharmacotherpeutic plan including communication
(written and oral), monitoring for outcomes, and documentation
13.
Manage a successful patient-centered practice (including being compensated for services
and providing medication therapy management). (ABO 1.14)
Activities:
Provide patient-centered care to patients on assigned medicine service at DRH.
14.
Utilize informatics, epidemiologic and pharmacoeconomic data, medication-use criteria,
medication use review and risk reduction strategies to develop disease prevention and
management programs in order to provide patient and population based care. (ABO 1.15)
Activities:
 Describe the role and responsibility of pharmacists in the development and implementation
of medication-use guidelines in the institution.
 Review and comment on a medication-use guideline in use at the institution
 Develop and implement MUE project on specific medication or group as directed
 Participate in medication or disease related research as requested per preceptor and/or
department of pharmacy.
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15.
Retrieve, analyze and interpret scientific literature to disseminate drug information to
patients, patients’ agents, health care professionals, administrators, policy makers,
payers, and the public. (ABO 1.16)
Activities:
 Respond to the questions and requests for information from the team
 Review assigned journal updates and participate in DRH journal survey
 Evaluate and present journal club article to peers and pharmacists
16.
Communicate effectively and persuasively with patients, patients’ agents, health care
professionals, administrators, policy makers, payers and the public. (ABO 1.17)
Activities:
 Provide presentations at meetings (journal club, in-service, presentation of patients)
 Communicate as part of daily activities with staff and preceptor
 Communicate care plan and rationale to the appropriate pharmacist preceptor, pharmacist,
physician, and/or other health care professionals
 Communicate the care plan to the team
 Communicate with patients and their friends/family members as appropriate in the provision
of care (and following HIPAA requirements)
 Write/enter the therapy and /or monitoring (e.g. verbal order) as appropriate on the record
 Write/enter a progress note on the plan as appropriate
17.
Promote the availability of effective health and disease prevention services in a legal and
ethical manner. (ABO 3.1)
Activities:
 Communicate as appropriate vaccination, smoking cessation, and weight control
recommendations.
18.
Apply population specific data, quality assurance strategies, informatics and research
processes to identify and resolve public health problems. (ABO 3.2)
Activities:
 Participate in obtaining medication histories or performing medication reconciliation as
needed.
19.
Maintain professional competence by identifying and analyzing emerging issues,
products, and services. (ABO 4.1)
Activities:
 Demonstrate knowledge and understanding of current literature as it relates to care of
assigned patients and in general to care of patients in this setting.
20.
Possess the skills and attitudes required to be a motivated, self-directed, independent,
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life-long learner. (ABO 4.2)
Activities:
 Demonstrate the desire and ability to independently organize activities/time to fulfill
responsibilities
 Demonstrate the desire and ability to independently identify, gather and apply the most
current information needed to develop pharmacotherapy plans and problem-solve for assigned
patients and respond to information requests
 Demonstrate the desire to fill personal knowledge gaps to obtain a better understanding of
the clinical problems and pharmacotherapy for patients in this setting
 Develop a plan to keep informed of medication-related research and published medical
literature
Preceptor-Student Interaction:
Students are to review the syllabus prior to the initial meeting. It is expected that the
student will meet with his/her preceptor or the preceptor’s pharmacist representative (if
preceptor not seeing patients that day) to discuss patients daily. The student will also be
meeting with the preceptor or other faculty member at least twice weekly for diseasestate discussions. Finally, it is expected that the student attends assigned activities
including student and/or resident journal club, journal survey, department case
presentation, medicine grand rounds (on special occasion as required by preceptor), and
other pertinent learning opportunities. At intervals including the onset, midpoint and
completion points of the experience, students are to reflect on the various activities and
overall experience.
Special Learning Needs:
If you have a documented disability that requires accommodations, you will need to register with
Student Disability Services for coordination of your academic accommodations. The Student
Disability Services (SDS) office is located at 1600 David Adamany Undergraduate Library in the
Student Academic Success Services department. SDS telephone number is 313-577-1851 or 313577-3365 (TTY: telecommunication device for the deaf; phone for hearing impaired students
only). Once you have your accommodations in place, please make an appointment with the
course coordinator to discuss you special needs. Student Disability Services’ mission is to assist
the university in creating an accessible community where students with disabilities have an equal
opportunity to fully participate in their educational experience at Wayne State University.
Academic Misbehavior:
In any instance of academic misbehavior occurring in the course as defined in the University
Student Code of Conduct
http://www.doso.wayne.edu/judicial/Student%20Code%20of%20Conduct%20Brochure.pdf or
the Pharmacy Honor Code http://www.cphs.wayne.edu/pharmd/pharmacy_honor_code.doc,
either the assignment/activity or the final course grade can be downgraded and / or additional
charges such as disciplinary reprimand, probation, suspension, expulsion or other action can be
implemented. For additional information and student rights, please refer to the
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www.doso.wayne.edu/judicial/index.html webpage; especially the Student Code of Conduct
Brochure and the Section 10.1 of the Student Code of Conduct links.
Evaluation Process and Form:
Verbal evaluation of the student’s performance will be provided continually throughout the
experience. Written evaluation of the student’s performance will be performed at the mid-point
of the experience (i.e. at the end of 3 weeks) and at the end of the experience.
Midpoint and final evaluation should include the student’s assessment of their progress.
Evaluation will be done via online mechanism provided by the College of Pharmacy and also
incorporates specified competancies and listed activities per syllabus.
This syllabus must be reviewed and signed by the preceptor and student within 3 days of the
beginning of rotation.
Student signature and date:
______________________________________________________
Preceptor signature and date: ______________________________________________________
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Competency Evaluation Scale and Grading
Verbal evaluation of the student’s performance will be provided continually throughout the
experience. Written evaluation of the student’s performance will be performed at the mid-point
of the experience (i.e. at the end of 3 weeks) and at the end of the experience. Midpoint and final
evaluation should include the student’s assessment of their progress.
Competency
achieved with
OUTSTANDING
performance
Competency
achieved with
CONSISTENT
performance
4
Student demonstrated
EXCELLENT skills in
this area; assignment
requirements ALWAYS
completed at a level
ABOVE the minimum
requirements; completed
most complex tasks
independently; and
completed all basic and
routine tasks
independently.
B
F
Competency
NOT met
Not
Applicable
NA
3
2
1
Student demonstrated
SATISFACTORY skills
in this area; assignment
requirements
CONSISTENTLY MET;
required limited
prompting to complete
complex tasks; and
completed most basic
and routine tasks
independently.
Student NEEDS
IMPROVEMENT in this
area; assignment
requirements NOT
CONSISTENTLY MET;
required guidance/directed
questioning to complete
complex tasks; was
somewhat independent in
completing basic and
routine tasks.
Student needs
SIGNIFICANT
improvement; assignment
requirements NOT MET
the majority of the time;
required
guidance/extensive
questioning/prompting to
complete basic and
routine tasks
Grade
A
Competency
NOT
CONSISTENTLY
achieved
Criteria






No more than four competencies scored as 3, all others scored as 4 AND
No competencies scored as less than 3
No more than three competencies scored as less than 3 AND
No competencies scored as less than 2
Receive a score of 1 on ANY competency OR
Receive a score of less than 3 on four or more competencies
Preceptor Comments:
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