Internal Medicine Learning Activities:
Preceptor: XXXX, Pharm.D., Clinical Specialist, Internal Medicine
Office: 4S-115
Hours: 7-3:30
Pager: 555-1234
1) General Description
Internal Medicine (IM) is a required, six week learning experience at the University Medical
Center. There are 200 IM beds in the hospital, housed on 4 different units. There are four IM
teaching teams. Each of the teaching teams includes an attending physician, a PGY2 or
PGY3 medical resident, 2 PGY1 medical interns, and medical students (MSIII or MSIV).
Other disciplines on the team include the clinical pharmacy specialist or clinical pharmacist,
pharmacy students, a respiratory therapist, a clinical dietitian and the primary nurse. Nonteaching teams are primarily hospitalist-based and pharmacists work regularly with them to
identify and resolve medication-related problems for all patients.
The clinical pharmacy specialist on the team is responsible for ensuring safe and effective
medication use for all patients admitted to the team, including active participation in work
and attending rounds daily; collaboration with decentralized pharmacists to assure timely
medication availability; education of patients and their family members, education of
physicians and nurses, and education of pharmacy trainees; participation in the pharmacy
department on-call program; and, participation on organizational, pharmacy department and
nursing unit-based medication policy and continuous quality improvement committees.
The pharmacy resident is responsible for identifying and resolving medication therapy issues
for patients and will work toward assuming care of all patients on the unit throughout the
learning experience. The resident will provide and document therapeutic drug monitoring
services for patients on their team receiving drugs requiring monitoring including, but not
limited to, aminoglycosides and vancomycin. Documentation must be completed on the day
service was provided. The resident is responsible for providing and documenting education
to patients on their team who will be discharged receiving anticoagulation. Education and
documentation must be provided no later than the day of discharge. The resident is
responsible for completing non-formulary drug consults, within 48 hours of the request.
Good communication and interpersonal skills are vital to success in this experience. The
resident must devise efficient strategies for accomplishing the required activities in a limited
time frame.
2) Disease States
Common disease states in which the resident will be expected to gain proficiency through
literature review, topic discussion, and/or direct patient care experience including, but not
limited to:
 Neurological disorders
o Parkinson’s disease, epilepsy, pain
 Cardiovascular disorders
o Hypertension, heart failure, stroke, hyperlipidemia
 Renal disorders
o Acute renal failure, glomerulonephritis
 Respiratory disorders
o Asthma, COPD
 Gastrointestinal disorders
o GERD, PUD, pancreatitis, hepatitis
 Endocrinologic disorders
o Diabetes Mellitus, thyroid disorders
 Infections diseases
o UTI, pneumonia, endocarditis, skin and soft tissue infections, bone and
joint infections
3) Goals and Objectives
The goals selected to be taught and evaluated during this learning experience include:
R1.4 “Demonstrate ownership of and responsibility for the welfare of the patient by
performing all necessary aspects of the medication-use system.”
R1.5 “Provide concise, applicable, comprehensive responses to requests for drug
information from patients, health care providers and the public.”
R2.1 “As appropriate, establish collaborative professional relationships with members of
the healthcare team.”
R2.2 “Place practice priority on the delivery of patient-centered care to patients”
R2.4 “Collect and analyze patient information.”
R2.6 “Design evidence-based therapeutic regimens.”
R2.8 “Recommend or communicate regimens and monitoring plans.”
R2.12 “Document direct patient care activities appropriately.”
R5.1 “Provide effective medication and practice-related education, training, or
counseling, to patients, caregivers, health-care professionals, and the public.”
4) Activities
The activities assigned to this learning experience reflect the activities a pharmacist
working in this environment are expected to be able perform. These activities were also
selected to help you work toward achieving specific objectives which in turn will help
you achieve the goals assigned to the learning experience. There is not usually one
discrete activity assigned to help achieve an objective and/or goal.
Familiarize yourself with the objectives associated with each goal
(http://www.ashp.org/DocLibrary/Accreditation/PGY1-Goals-Objectives.aspx). Your
achievement of the goals of the residency is determined through assessment of your
ability to perform the associated objectives. The table below demonstrates the
relationship between the activities you will perform on the learning experience and the
goals/objectives assigned to the learning experience.
Activity
Accurately gather, organize, and analyze patient specific information on assigned
patients prior to pre-rounds with preceptor. For non-teaching services, review
profiles to identify medication-related problems to discuss with hospitalist.
 Identify medication related problems
 Recommend solutions to identified problems to preceptor and/or team
 Prioritize problems for concise discussion with preceptor and/or the team
Objectives
Covered
R1.4.1
R2.2.1
R2.4.1
R2.4.2
R2.6.1
R2.6.2
R2.8.1
Meet with preceptor for pre-rounds @ 8:30 daily for teaching services. For nonteaching services, meet with preceptor for pharmacy rounds @8:30 daily.
R2.4.3
R2.6.1
R2.6.2
R2.8.1
Actively participate in IM teaching service team rounds @ 9:30 daily.
R1.5.6
For non-teaching services, meet with each hospitalist covering services to resolve R1.5.7
issues. (May round with them when feasible.) Based on potential medication
R2.1.1
related problems identified by working up your patients, be prepared to:
R2.4.1
R2.4.2
 Recommend solutions to identified problems
R2.6.1
 Respond to drug information questions verbally
R2.6.2
 Follow up on medication related problems identified during rounds.
R2.8.1
Determine when the information is needed and assure you provide the
R5.1.1
follow up information within the appropriate time frame.
Compose an accurate, concise progress note documenting direct patient care
activities within time frame to be useful.
 Recommendations to improve the patient’s treatment plan or drug therapy
monitoring
 TDM consults – documentation must be completed on the day service was
provided
 Non-formulary drug requests – within 24 hours of request
 Medication reconciliation – admission, transfer, and discharge – within 24
hours of transition of care
2.4.1
2.12.1
2.12.2
Provide and document therapeutic drug monitoring services for patients
receiving drugs requiring monitoring including, but not limited to,
aminoglycosides and vancomycin.
R2.4.1
R2.6.1
R2.6.2
R2.8.1
R2.12.1
Activity
Identify and report medication events (ADE or medication errors). May be
initiated by pharmacy personnel or by other health care professionals.
Participate in MUE activities or other outcomes measures for patients on service.
Attend teaching discussion sessions in afternoons when applicable.
Respond to team, patient or family requests for drug information, and document
question and response in the DI database on a timely basis.
Provide weekly “mini-in-service” drug information on rounds on topics
requested by the team.
Provide and document education to assigned patients discharged from the
hospital on anticoagulants.
Objectives
Covered
R2.12.2
R2.4.1
R2.4.2
R2.12.1
R2.12.2
R2.12.1
R2.12.2
R1.5.1
R1.5.2
R1.5.3
R1.5.4
R1.5.5
R1.5.6
R2.12.1
R1.5.6
R2.1.1
R5.1.1
R5.1.3
R5.1.4
R5.1.5
R5.1.6
R1.5.6
R2.12.1
R2.12.2
R5.1.1
R5.1.5
R5.1.6
5) Preceptor Interaction
Daily:
8:30
Pre-rounds with resident
9:30
Team rounds with resident and team
1:00 – 2:00 Preceptor office hour available for topic discussions,
reviewing progress notes, patient updates, etc.
6) Communication:
A. Daily scheduled meeting times: Residents to prioritize questions and problems to
discuss during scheduled meeting times as listed above.
B. E-mail: Residents are expected to read e-mails at the beginning, middle and end of
each day at a minimum for ongoing communication. This is appropriate for routine,
non-urgent questions and problems.
C. Office extension: Appropriate for urgent questions pertaining to patient care.
D. Pager: Residents to page preceptor for urgent/emergency situations pertaining to
patient care
E. Personal phone number: Provided to resident at time of learning experience for
emergency issues.
Expected progression of resident responsibility on this learning experience:
(Length of time preceptor spends in each of the phases will be customized based upon
resident’s abilities and timing of the learning experience during the residency training
year)
Day 1: Preceptor will review IM learning activities and expectations with resident.
Week 1: Resident to work up approximately 1/3 of the team’s patients and present to
preceptor daily. Preceptor to attend and participate in team rounds with resident,
modeling pharmacist’s role on the health care team.
Week 2: Resident to work up approximately half of the team’s patients and discuss problems
with preceptor daily. Preceptor to attend team rounds with resident, coaching the
resident to take on more responsibilities as the pharmacist on the team.
Weeks 3-6: Each week the resident is expected to take over the responsibility of working up
more of the team’s patients, continuing to discuss identified problems with
preceptor daily. Once the resident is able to take responsibility for all patients
assigned to the team, the preceptor will no longer attend team rounds, but will
continue to facilitate the resident as the pharmacist on the team.
7) Evaluation Strategy
Resitrak will be used for documentation of scheduled evaluations (both formative and
summative per the chart below). For all evaluations completed in ResiTrak, the resident
and the preceptor will independently complete the assigned evaluation and save as draft.
The resident and the preceptor will then compare and discuss the evaluations. This
discussion will provide feedback both on performance of the activities and the accuracy
of the resident’s self-assessment skills. Evaluations will be signed in ResiTrak following
this discussion.
 Formative evaluations/ResiTrak Snapshots: These scheduled snapshots were preselected to provide feedback to residents on patient care activities in which the
typical resident will benefit from specific feedback on their performance.
Selection of snapshot may change based on resident’s performance. The snapshot
should be completed based upon 1 patient/experience, not as an overall, general
evaluation of their performance.
 Summative evaluations: This evaluation summarizes the resident’s performance
throughout the learning experience. Specific comments should be included to
provide the resident with information they can use to improve their performance
in subsequent learning experiences.
 Preceptor and Learning Experience evaluations must be completed by the last day
of the learning experience.
What type of evaluation
Formative + Formative Self
Formative + Formative Self
Formative + Formative Self
Summative
Summative Self-evaluation
Preceptor, Learning Experience
Evaluations
Snapshot
R1.4.1
R2.6.2
TBD
© 2012 American Society of Health-System Pharmacists
Who
Preceptor, Resident
Preceptor, Resident
Preceptor, Resident
Preceptor
Resident
Resident
When
End of week 2
End of week 4
End of week 5
End of learning experience
End of learning experience
End of learning experience