PHRM 8141
Advanced Pharmacy Practice Experience
Ambulatory Care
Course Syllabus
Preceptor
Include title & credentials
Practice Site Address
Office Telephone
Other Telephone (optional)
Email
Hours
Description of Ambulatory Care APPE
This required advanced pharmacy practice experience (APPE) involves the student in the provision of
clinical pharmacy services in the ambulatory care setting. Responsibilities include providing drug therapy
for disease states commonly encountered in the outpatient setting; providing drug regimen reviews; and
interviewing patients to elicit drug histories, health status, and adherence to therapy. A significant aspect
of this rotation will pertain to the long-term management of chronically ill patients.
The experience in ambulatory care is designed to provide student pharmacists with advanced training and
experience in the outpatient management of patients with commonly encountered chronic diseases such
as, but not limited to, diabetes, hypertension, cardiovascular diseases, dyslipidemia, thromboembolic
disorders, pulmonary diseases, and endocrinology issues. The experience is designed to allow students to
apply didactic knowledge to patient care and build general professional abilities developed in the preceding
professional years. Also, the experience is designed to instill in the student an appreciation for how
pharmacists may be involved in managing both the cost and quality of patient care in an ambulatory care
setting.
Course Meeting Times
This course is scheduled to meet for one calendar month with a minimum of 160 hours spent on activities
directly related to the objectives identified below. The preceptor has the authority to determine specific
meeting time parameters within the aforementioned schedule. See the PCSP Bulletin (p.31) for the
Experiential Policy for Attendance and Absence.
Hours: State hours the student is to be on site, including situations where student may
need to stay after hours. Specify lunch & departure times. Time at lunch does not count
toward hours spent at site.
Provide daily schedule indicating when different
activities or breaks may take place. Include time to meet with the student to discuss the
student’s performance and make recommendations for improvement. Attach a weekly
calendar.
Daily Schedule/Assignment Calendar:
PHRM 8141, Ambulatory Care APPE
Syllabus (Revised 03-25-13)
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Pre-Arrival Instructions & Logistics for Students:
• Describe or outline specific department or site requirements. For example, “HIPPA
•
•
training to be conducted by district office or PIC on Day 1 of rotations.”
List information such as directions to facility, parking instructions, and other site
requirements.
Provide information (links or attached reading material) about any topics that the
student should review prior to the start of the rotation.
Ambulatory Care APPE Objectives/Goals
During the experience, the student will:
1. Appreciate the role of a pharmacist in providing pharmaceutical care to the ambulatory patient
population.
2. Ensure the safe and effective use of prescription and non-prescription medications to achieve
positive patient outcomes.
3. Demonstrate appropriate and effective written, verbal, and non-verbal communication skills in all
interactions with patients and other healthcare professionals.
4. Effectively interact and communicate with patients to gather pertinent information to determine
appropriateness of medications and to create an individualized pharmaceutical care plan that
includes monitoring of medications and disease states and appropriate follow-up.
5. Appropriately and accurately document all patient care-related activities in the manner specified
by the healthcare setting and preceptor.
6. Use physical assessment skills to evaluate and monitor drug therapy.
7. Counsel patients and/or caregivers on appropriate prescription and non-prescription medication
use, medical devices, and disease state-specific information.
8. Use drug information and literature review skills to provide patient-specific and general drug
information.
9. Demonstrate an understanding of the present status and future potential of the pharmacist in an
ambulatory healthcare setting.
10. Demonstrate professional behavior in all interactions with healthcare providers, patients, students
and preceptors.
11. Conduct a patient interview.
12. Assess the patient's medication adherence.
13. Identify non-adherence and initiate strategies to correct the patient behavior.
14. Review the medication record to gather drug therapy information including pertinent patient
factors, social history, medication history, disease states, concurrent therapies, and response to
prior therapies.
15. Assimilate pertinent information to create individualized drug regimens based on the purpose of
the medication(s), concurrent diseases and drug therapies, pharmacokinetic parameters of the
drugs, cost-effectiveness, and the patient's clinical condition.
16. Determine appropriate monitoring parameters and therapeutic endpoints and prospectively
monitor drug therapy for the safe and efficacious use of the prescribed medications.
17. Interpret patient-specific laboratory data accurately.
18. Assess the acuteness and severity of reported symptoms, act on this assessment by reassuring
the patient, initiating or adjusting medication when appropriate, and referring the patient to
another health-care practitioner.
19. Manage a patient’s drug therapy by advising health care providers in the design of a rational
pharmacological or non-pharmacological treatment plan, using established therapeutic protocols,
and/or initiating or adjusting drug therapy under the supervision of the preceptor or healthcare
provider.
20. Provide cost-effective, affordable recommendations for medication regimens to healthcare
providers and patients.
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Syllabus (Revised 03-25-13)
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21. Operate and teach the use of medical devices to assist in the management and monitoring of
chronic disease states.
22. Educate and counsel patients, the general public, and health care providers in the proper use of
medications and drug delivery systems.
23. Identify ethical dilemmas and develop an appropriate plan to manage the dilemma.
24. Use a professional manner to effectively counsel patients, caregivers or both on medication use
incorporating verbal and written information.
25. Relate and demonstrate the value of pharmacy care to patients and other health-care providers.
26. Participate in disease state management programs.
27. Develop an appreciation for the ambulatory care pharmacy services, including physical
accommodations required for optimal patient care, appropriate use of pharmacy and medical
reference sources, role of computers for administrative and patient care activities, professional
and supportive personnel required to deliver optimal patient care, interrelationships between
pharmacists and other health care services and providers, and the necessity for efficiency in
patient care operations.
Ambulatory Care APPE Competencies:
Experiential activities are matched to the PC 12 Competencies, which are based on the ACPE
competencies. Using the aforementioned objectives as a guide, consider student activities
applicable to your practice setting; then to standardize student achievement for your
experience, use specific metrics when assessing competence.
PC 12 COMPETENCIES:
1. Communication
2. Evidence-based Decisions in the Practice of Pharmacy
3. Problem Prevention and Solving
4. Dispensing of Pharmaceuticals
5. Providing Pharmaceutical Care to Individual Patients
6. Providing Pharmaceutical Care to Patient Populations
7. Inter-professional Interaction and Teamwork
8. Ethical and Legal Judgment
9. Personal and Professional Growth
10. Management Skills
11. Advancement of Pharmacy and Health Care
12. Promotion of Health and Public Welfare
Examples:
1. Patient Communication
 Conduct medication histories [min of 10]
 Provide counseling for medication(s) and/or medical device(s) [min of 5]
2. Patient Case presentations
 Present informal individualized patient care plans to preceptor [min of 10]
 Present a formal individualized, evidence-based, patient care plan to preceptor [min of 1]
3. Patient care documentation
 Document pharmacist-patient encounters using the SOAP format [min of 10]
4. Patient care activities
 Perform various physical assessment skills on patients [min of 10]
5. Educational presentation
 Prepare and present a medication or disease state-related topic to the preceptor and an audience
of other healthcare professionals (e.g., physicians, nurses, physician assistants, other healthcare
staff) [min of 1]
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6. Drug information and literature review
 Prepare a written summary of clinical trial(s) evaluating medical therapy that applies to a
patient case [min of 1]
 Address drug information requests from healthcare providers and/or patients [min of 2]
Assessment Methods
The student pharmacists on an Ambulatory Care APPE will be assessed for achieving the APPE objectives
and competencies subjectively and objectively by the preceptor. Preceptors are to evaluate the student
based on objective materials and subjective assessment and are required to complete a formative midpoint evaluation and a summative final evaluation using E-Value.
(OPTIONAL) Objective evaluations may include, but are not limited to:
1. Communication Evaluation Form
2. Presentation Evaluation Form
3. Drug Information Request Form
The optional objective evaluation forms identified above are available to preceptors who
choose to utilize them. The subjective assessment shall include the competencies as
determined by the Office of Experiential Education at Presbyterian College School of
Pharmacy.
Students will receive a letter grade as determined in the final evaluation. To satisfactorily complete the
Ambulatory Care APPE, students must receive a grade of C or higher, complete the competency checklist,
and upload the requested materials in their online portfolio (MyFolio).
Grading Scale:
93 - 100%
90- 92%
87 - 89%
83 - 86%
80 - 82%
77- 79%
70- 76%
60- 69%
<60% F
A
AB+
B
BC+
C
D
(Grading scale approved by PCSP faculty)
Types of Patients
The student on an Ambulatory Care APPE should expect to encounter patients with disease states that
include, but are not limited to:
 Diabetes mellitus
 Other endocrine disorders
 Hypertension
 Dyslipidemia
 Venous thromboembolism
 Cardiovascular diseases
 Pulmonary diseases
 Musculoskeletal disorders
 Renal diseases
 Cardiac rhythm disorders
 Gastrointestinal disorders
 Psychiatric disorders
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 Neurologic disorders
 Pain management
Level of Student Responsibility
The student on an Ambulatory Care APPE is expected to have face-to-face interaction with patients under
the supervision of a pharmacist preceptor or a healthcare provider. The student is expected to interact in
a professional manner with other healthcare professionals and patients.
Type of Setting for the APPE
An Ambulatory Care APPE should occur in a healthcare setting, a hospital-based clinic, outpatient
physician clinic, free medical clinic, or a setting in which patients are evaluated by other healthcare
professionals on an outpatient basis.
Student Professionalism & Code of Conduct
A student pharmacist on an Ambulatory Care APPE is expected to follow the rules, policies, and
procedures pertaining to the Honor Code and professional standard at Presbyterian College School of
Pharmacy. Any violation of the Honor Code (e.g., cheating, plagiarism, falsification, withholding
information, tampering with records, etc.) or the professional standards (e.g., unprofessional behavior,
including tardiness, absences, behavior, appearance, etc.) will be reported immediately upon discovery
and will be dealt with per Presbyterian College School of Pharmacy policy and procedure.
Special Accommodations
Any student pharmacist on an Ambulatory Care APPE who has a disability that may prevent him/her from
fully demonstrating his/her abilities should inform the preceptor personally as soon as possible to discuss
accommodations necessary to ensure full participation and facilitate his/her educational opportunities.
Student Responsibilities During the Experience
Please detail specific competency-based student activities as needed. Apply, edit, delete,
and/or replace those examples listed below as you deem appropriate.
1. Ambulatory Care Discussions
a. There will be a series of ambulatory care discussions in order to review pertinent literature
impacting patient care and discuss patient case(s). These discussions will be organized and
conducted by faculty members.
b. The ambulatory care discussions include:
i. Anticoagulation issues
ii. Evidence-based medicine
iii. Heart Failure
iv. Respiratory disorders
2. Formal Patient Case (with drug literature review)
a. Student pharmacists need to learn how to appropriately evaluate and apply clinical guidelines
and evidence-based medicine in devising treatment plans for patient care. In addition,
student pharmacists need to understand how to tailor and design a treatment plan for an
individual patient based on the patient’s medical/surgical, family and social history; drug
allergies; subjectively obtained information; objectively obtained information, including
physical assessment findings, laboratory tests and other medical procedures; and incorporate
the long-term goals for the patient based on his/her disease states.
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b. The student pharmacist will document and formally present at least one (1) patient case with
a review of a clinical trial to the preceptor over the course of the Ambulatory Care
experience. The preceptor will approve the patient and journal article for the student
pharmacist to present to assure the patient difficulty and journal article is appropriate for the
student.
c. The student pharmacist will prepare a handout of the patient case that includes the following
components: history of present illness, past medical and surgical history, social and family
history, drug allergies, physical assessment findings, laboratory tests and other medical
procedures, a problem list, goals of therapy for each disease state, a detailed assessment of
medical problems incorporating evidence-based medication and nationally recognized clinical
guidelines, and an appropriate plan of care including monitoring and follow-up.
d. The student pharmacist will critically review and describe at least one (1) clinical trial
evaluating a medical therapy that applies to the patient case. The clinical trial should be a
clinical evaluation of medical therapy and not a review article of a treatment or disease state.
The clinical trial review will be included in the handout and presentation and applied to the
patient case. The student pharmacist will use proper referencing and list all textbooks or
electronic databases used.
e. The preceptor and audience will evaluate the student using the Presentation Evaluation
Form. The preceptor will discuss the results of the assessment with the student and discuss
his/her performance with constructive comments to improve his/her skills.
3. Clinic Participation
a. Patient communication is a key skill in conducting patient care in an outpatient environment.
Student pharmacists on an ambulatory care experience should have multiple interactions with
patients on various levels to further enhance their communication skills. A preceptor should
formally review various interactions to assure the student pharmacist demonstrates
appropriate verbal and non-verbal communication skills, uses lay-language, communicates
pertinent and accurate information, and meets the needs of the patient by verifying
understanding and providing any additional information.
i. Medication Histories: The student pharmacist will perform and document at least ten
(10) medication histories in patients prescribed at least five (5) prescription agents over
the course of the Ambulatory Care experience. The student pharmacist will appropriately
document the patient encounter, in a manner suitable for the healthcare environment.
The preceptor will observe and evaluate the student using the Communication Evaluation
Form and discuss with the student pharmacist his/her performance with constructive
comments to improve his/her skills. The preceptor will evaluate at least two (2)
medication histories, with one evaluation occurring prior to mid-point and one after midpoint to determine growth in the skill. Encounters should be evenly dispersed throughout
the experience.
ii. Medication or Product Counseling Sessions: The student pharmacist will complete and
document at least five (5) medication or product counseling sessions over the course of
the Ambulatory Care experience. The preceptor will work with the student pharmacist to
determine appropriate medications and/or products to counsel. Example of potential
medication or products includes glucometers and lancing devices, inhalers, peak flow
meters, spacers, and medications with devices (e.g., insulin, Forteo, Byetta). The
preceptor will observe and evaluate the student using the Communication Evaluation
Form and discuss with the student pharmacist his/her performance with constructive
comments to improve his/her skills. The preceptor will evaluate at least two (2)
medication/product counseling sessions, with one evaluation occurring prior to mid-point
and one after mid-point to determine growth in the skill.
b. Patient care activities are a central component of an ambulatory care experience. Student
pharmacists need to learn how to appropriately and professionally interact with patients in an
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outpatient setting to obtain the necessary information to make informed medication-related
decisions and therapeutic plans. All student-patient interactions should be reviewed and
evaluated by the preceptor to assure appropriate information was attained and assessed. The
preceptor will evaluate the student pharmacist by directly observing a select number or all of
the student-patient interactions or through an informal presentation of the patient and
medical issues by the student pharmacist and to the preceptor before a plan of care is
implemented.
i. Informal Patient Case Presentations: The student pharmacist will informally present at
least five (5) patient cases to the preceptor over the course of the Ambulatory Care
experience. Ideally, all student-patient interactions should be informally presented to the
preceptor. Student pharmacists will review patient information prior to seeing a patient
and ask appropriate questions of the patient to assess chronic diseases and current drug
therapy for effectiveness and safety. Student pharmacists should be able to succinctly
present an overview of a patient encounter with their individualized plan for care to the
preceptor. The individualized plan of care for a patient should include recommendations
for and implementation of comprehensive and logical drug therapy plans, preventative
pharmacologic and non-pharmacologic therapies, and appropriate monitoring parameters
and intervals for optimizing drug efficacy and safety. Student pharmacists will be able to
justify recommendations with supporting evidence from appropriate sources.
ii. Pharmacist-Patient Encounter documentation (SOAP notes): The student pharmacist will
document at least ten (10) student pharmacist-patient encounters utilizing the SOAP
format over the course of the Ambulatory Care experience. Student pharmacists will use
subjective and objective data to identify disease and drug-related problems and to
develop a complete and prioritized problem list, including untreated problems. Student
pharmacists will be able to integrate subjective and objective material to formulate a
patient-specific evidence-based therapeutic plan. All encounter documentation (e.g.
SOAP notes) will be reviewed and evaluated by the preceptor with constructive
comments to improve their skills. Student pharmacists should be recommending and
implementing comprehensive and logical drug therapy plans, preventative pharmacologic
and non-pharmacologic therapies, and appropriate monitoring parameters and intervals
for optimizing drug efficacy and safety. Student pharmacists will be able to justify
recommendations with supporting evidence from appropriate sources. Encounters should
be evenly dispersed throughout the experience.
iii. Physical Assessment Activities: The student pharmacist will perform and appropriately
document at least ten (10) physical assessment activities over the course of the
Ambulatory Care experience. Documentation will be in a manner suitable for the patient
care interaction and healthcare environment. Examples of patient assessment activities
may include taking a blood pressure, measuring a pulse, edema assessment, or a lung
exam. The preceptor will observe and evaluate the student measuring a blood pressure
and pulse using the Blood Pressure Evaluation Form and discuss with the student
pharmacist his/her performance with constructive comments to improve his/her skills.
The preceptor will evaluate the student’s technique at least twice during the experience,
with one assessment prior to mid-point and one after mid-point to determine growth in
the skill.
4. Drug Information Questions
a. Student pharmacists need to learn how to respond to drug information requests and to tailor
the response depending on the requestor (e.g., patient, pharmacist or healthcare provider).
Student pharmacists also need to understand that not all drug information requests can be
found using tertiary sources, such as drug information texts and databases, and require
reviewing and evaluating primary scientific literature.
b. The student pharmacist will document at least two (2) drug information requests that
requires reviewing and evaluating the primary scientific literature over the course of the
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c.
Ambulatory Care experience. At least one (1) request will originate from a healthcare
provider (e.g., physician, nurse practitioner, physician assistant).
The drug information request and response will be documented on the Drug Information
Request Form. The responses will be reviewed by and discussed with the preceptor. The
form should be filled out completely and include proper referencing.
i. The student pharmacist will record all pertinent information from the staff member on
the DI question form and proceed with researching the appropriate information for
answering the DI question.
ii. All references will be recorded on the provided DI question form. Any printed sheets of
reference material will be attached to the DI question form.
iii. The student pharmacist will review the planned response with the preceptor prior to
reporting backing to the requesting staff member.
5. Pharmacy Presentation
a. The student pharmacist will present at least one in-service presentation on a medication- or
disease state-related topic, approved by the preceptor, over the course of the Ambulatory
Care experience and to an audience chosen by the preceptor.
b. The preceptor determines the presentation date/time.
c. The presentation will be a minimum of 10 minutes in length and should not exceed 30
minutes. The student pharmacist will prepare a handout that is at least 2-pages in length and
that includes all sources used with appropriate referencing. A presentation using PowerPoint
slides may be required depending on the preceptor and capabilities of the site.
d. Example audiences include the preceptor and peer students, healthcare providers, nursing
staff, other healthcare staff.
e. The presentation will be reviewed and evaluated using the Presentation Evaluation Form. The
preceptor will review the presentation with the student pharmacist and provide constructive
comments in order for the student to improve upon their skills.
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