Building a Hospital
Internship Program
Approved by
The Minnesota Society of Health System Pharmacists
Last Updated 2/23/09
Table of Contents
Introduction……………………………………………….…page 2
Intern Capabilities………………………………………...…page 3
Preceptor Requirements………………………………..……page 6
Creating a Budget……………………………………………page 7
Recruitment……………………………………………….…page 8
Progression & Evaluation……..……………………………..page 9
Appendix: Sample Position Description...………………....page 10
References…………………..……………….…………..…page 13
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Introduction
Why is it important to develop an internship program?
Hospital pharmacy internship programs have the potential
to benefit the student and the institution. From the student’s
perspective, many are interested in participating in hospital
internships that allow them to utilize and expand upon the
knowledge they have learned in the classroom.1 Students also look
to learn new clinical and practical skills that are not covered in the
classroom.2 Finally, students have opportunities to meet and
network with others practicing in health-system pharmacy.
Developing a challenging and practical hospital internship
program also benefits an institution. First, it allows an institution
to help develop future practitioners1. Guiding students through an
internship program helps them grasp concepts early on and better
prepares them to work as pharmacists. Second, interns can help
advance pharmacy services. 1 This may be particularly
advantageous when trying to meet the American Society of HealthSystem Pharmacist’s (ASHP) 2015 Initiatives or Best Practices
and The Joint Commission’s National Patient Safety Goals.
Interns can either directly develop new services or interns can help
indirectly by filling some of the pharmacists’ roles while the
pharmacists work on developing new services. Third, although
students are traditionally thought to learn from pharmacists,
students can also share new information they have learned in the
classroom with pharmacists.1 This mutual learning may benefit the
institution. Lastly, strong internship programs allow institutions to
develop students’ interest in hospital pharmacy, leading to
improved recruitment and retention.1
How can I develop a strong hospital internship program?
MSHP recognizes the need for information that outlines an
appropriate internship program. Rather than providing a research
paper, our intent is to provide practical tools to assist you in
developing an internship program. While no two programs are
exactly alike, certain elements should be in place to suit the needs
of the institution and intern. This document is designed to
highlight key areas to address. In addition to this document, it may
be beneficial to contact other program directors to answer any
additional questions you may have.
2
Intern Capabilities
As the Minnesota Board of Pharmacy (MN BOP) dictates,
pharmacy students become interns after completion of the first
academic year. However, students can be hired before they
officially become interns. Students currently in their first year of
pharmacy school can be trained in all aspects of technician duties
or basic hospital operations. Table 1 describes learning objectives
in these areas.
Table 1: Basic Pharmacy Operations3,4,5
o Understand processes and elements of medication dispensing
systems (including automation)
o Understand use of medical records
o Fill medication orders in scheduled batches and first fill area
o Pre-package and label medications
o Dispose of waste in compliance with applicable regulations
o Compound extemporaneous products
o Demonstrate proper aseptic technique
o Compound intravenous sterile products (including TPNs)
o Restock medication trays and kits
o Triage phone calls
o Understand proper handling of controlled substances
o Understand assignment of expiration dating
o Check work performed by technicians (Tech-Check-Tech)
o Attend regular intern meetings
Upon becoming interns, students can perform any duties
performed by a pharmacist under the supervision of their
preceptor. Supervision, as defined by the MN BOP Rule
6800.5100 Subp. 8, “means that in the pharmacy where the intern
is being trained, a registered pharmacist designated as preceptor or
another registered pharmacist shall be in continuous personal
contact with and actually giving instructions to the intern during all
professional activities of the entire period of the intern's
internship.” Although technicians also require pharmacist
supervision, MN BOP Rules allow interns to perform activities that
go above and beyond that of a technician (to see a complete list of
MN BOP Rules surrounding internships, please see their website
at: http://www.phcybrd.state.mn.us/). Table 2 provides examples
of some advanced activities that interns have performed at various
institutions across the country.
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Table 2: Advanced Intern Activities3,4,5
o Perform medication reconciliation/inpatient medication
admission histories
o Enter and review medication orders
o Retrieve and interpret lab values
o Engage in multidisciplinary actions (such as patient care
rounds)
o Provide discharge counseling/reconciliation and prepare
medication discharge lists
o Answer drug information requests made by other health care
professionals
o Perform TPN order entry and verification
o Identify candidates for possible IV to PO conversion
o Review patient charts for possible adverse drug reactions
o Monitor patient therapy according to the scope of practice
within the institution (electrolytes, TPNs, anticoagulation,
renal dose adjustments, etc)
o Screen patients for eligibility for influenza and pneumococcal
immunizations
o Assist pharmacist in codes after taking the ACLS competencies
o Shadow pharmacists in areas of interest
o Present patient cases
The anticoagulation service at St. Mary’s Medical Center
in Duluth, Minnesota is one example of an advanced service to
which pharmacy interns can contribute. On weekends, the intern
first meets with the clinical pharmacist. Based on the intern’s
experience level and the projected workload for the day, the duties
are divided between the intern and the pharmacist.
Anticoagulation activities performed by the intern may include:
assuring the last dose was given, interpreting labs (including INR,
platelets, hemoglobin), evaluating for signs/symptoms of bleeding
or clotting, monitoring for changes in diet, and checking for drug
interactions. For new patients, the intern may be responsible for
the entire preliminary workup of the patient including reviewing
the patient’s chart and history and interpreting anticoagulation
goals and indications. Interns will present their findings to the
pharmacist and work with him/her to determine an appropriate
anticoagulation dose. Upon discharge, interns provide
anticoagulation counseling and help determine where the patient
will receive INR monitoring.
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Although it may not seem intuitive, many institutions
already partake in a variety of activities in which intern
participation can be extended. Table 3 lists some of these activities.
Table 3: Activities Extended to Interns3,4,5
o Perform a DUE/DUR
o Give a presentation (to pharmacists for CE credit, to pharmacy
staff as general education)
o Perform quality assurance initiatives
o Create drug information charts/cards
o Participate in journal club and case reviews
o Develop and implement guidelines, protocols, policies, or
procedures
o Participate in formulary or P & T committee meetings
The application of the activities listed in the tables above
will vary across institutions. The Appendix provides a sample
intern position description from the University of Minnesota
Medical Center, Fairview.
5
Preceptor Requirements
The MN BOP has several rules surrounding the
requirement for obtaining and maintaining a preceptor certificate
(Rule 6800.5350). Table 4 highlights the requirements that
pharmacists must fulfill.
Table 4: Preceptor Requirements
o Obtain and renew certification every two years
o Participate in an instructional program specifically for
preceptors, provided by or approved by the MN BOP, within
the previous 24 months
o Participate in the college-based externship program of the
University of Minnesota, College of Pharmacy as an approved
preceptor or complete at least 4,000 hours of pharmacy practice
after licensure, with at least 2,000 hours of that pharmacy
practice after licensure as a pharmacist in Minnesota
o Practice at least 20 hours per week as a pharmacist
o Have a history of exemplary practice with respect to
compliance with state and federal laws
o Assist the intern in fulfilling the competencies of the internship
requirement
ASHP provides additional information on how to be an
effective teacher and preceptor, training students to become
competent pharmacists. To read more about this topic, please visit
ASHP’s Preceptor Information Web site at
http://www.ashp.org/Import/MEMBERCENTER/NewPractitioners
Forum/DevelopmentalResources/PreceptorInfo.aspx.
6
Creating a Budget
With increasing healthcare-related costs and target
margins, it can be difficult to create new positions or expand
current ones. The following are two possible ways to approach
creating a budget for interns. First, one can split technician or
pharmacist shifts in order to create intern positions. For example,
a pharmacist wants change from a 0.8 FTE to a 0.6 FTE. It can be
difficult to find a casual pharmacist to fill the remaining 0.2 FTE.
In order to alleviate this problem, one can hire an intern as a 0.2
FTE to supplement the role of the pharmacist.
Another solution would be to lobby with upper
management for intern positions. One can present a case for labor
cost savings, recruitment savings, and retention upon graduation.
An unpublished time study was conducted at Abbott
Northwestern Hospital in Minneapolis, Minnesota in 2008. During
the study, pharmacy interns recorded the types of activities they
performed and the amount of time they spent doing each activity.
The amount of time interns spent on particular activities was
compared to the cost associated with pharmacists or technicians
performing the same activities. This study showed that interns are
cost-effective, flexible additions to the pharmacy and healthcare
team.
7
Recruitment
Recruiting interns to your program can be tricky and time
consuming. The key is to use more than one communication
method and to use communication lines that students utilize. Table
5 lists several options for drawing attention to open intern
positions.
Table 5: Recruitment Techniques3
o Send a letter to the students utilizing a pharmacy school’s
student services
o Post open positions online
o Advertise at an MSHP meeting
o Participate in mentor programs
o Post or email announcements at a pharmacy school (with
permission from student services)
o Attend student organization meetings
o Utilize student organization websites
(eg., http://www5.pharmacy.umn.edu/mpsa/index_files/internresid.htm)
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Progression & Evaluation
Transitioning interns as they progress through pharmacy
school can be a difficult task. It is important to recognize that as
interns progress through school, their skill level progresses along
with their knowledge base. Interns look to utilize work experience
to gain clinical experience and refine their skills. Institutions are
also constantly looking for ways to improve care and minimize
costs. The combination of student eagerness and a need to
improve care can be beneficial for an intern and an institution.
Intern expectations can be increased gradually as they
progress through school. For example, interns can start out
performing basic technical operations and progress to clinical
activities. The clinical activities can be tailored to an institution’s
needs.
One may evaluate an intern’s performance as you would an
Advanced Pharmacy Practice Experience (APPE) student. A list
of objectives an APPE student must complete at the University of
Minnesota, College of Pharmacy can be found at:
http://www.pharmacy.umn.edu/pharmd/prod/groups/cop/@pub/@c
op/@pharmd/documents/asset/cop_61323.pdf.
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Appendix:
Sample Position Description
Pharmacist Development Program Summary
University of Minnesota Medical Center, Fairview
What is Fairview?
Fairview is one of the largest not-for-profit health care systems in
Minnesota, consisting of seven hospitals and multiple clinics. The
University of Minnesota Medical Center, Fairview and University of
Minnesota Children’s Hospital, Fairview are part of the Fairview
health-system and includes both the Riverside and University
campuses which are separated by the Mississippi River. The
University of Minnesota Medical Center, Fairview and University of
Minnesota Children’s Hospital, Fairview is a multidisciplinary
teaching hospital with expertise in several areas including organ
transplant, blood and bone marrow transplant, behavioral sciences,
cardiology, neurosciences, oncology, and pediatrics.
What is the Pharmacist Development Program’s objective and design?
The objective of the program is to provide pharmacy students the
opportunity to work at a large academic medical center, learning the
operations of a hospital pharmacy and building clinical knowledge.
Each year of the program correlates with the year of pharmacy
school that the student is enrolled. The first year will be dedicated to
learning the operations of the hospital pharmacy working as a
pharmacy technician. As the student progresses through school, they
will become more involved with patient care by directly assisting
pharmacists with clinical responsibilities on the patient care units.
An assigned mentor and the inpatient supervisor will be responsible
for evaluating the students’ progress.
What are the Student/Intern Requirements?
1. Be currently enrolled in a four-year Doctor of Pharmacy
Program and in good academic standing
2. Maintain updated pharmacy internship status with the Minnesota
Board of Pharmacy after completion of the first year of
pharmacy school coursework
3. Be able to work every other weekend
4. Attend monthly workshops to enhance clinical pharmacist skills
5. Attend monthly mentor/preceptor meetings to discuss school and
program progress
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What are the goals of the program and what will I be doing each year?
First Year
Goal: To work as an accurate and efficient technician, with a
good understanding of the inpatient pharmacy distribution
system.



Central responsibilities
o Dispense first fill medications with
appropriate labeling
o Prepare unit dose prepackaging and labeling
per legal requirements
o Prepare oral syringes
o Understand proper handling of controlled
substances
o Refill and update code trays
Sterile products area responsibilities
o Perform proper laminar airflow hood
cleaning
o Prepare sterile products using aseptic
technique
o Perform and apply general pharmaceutical
calculations
Decentral responsibilities
o Understand the principles of medication
charges and credits
o Refill the Pyxis machine and maintain
necessary quality assurance checks
o Deliver medications to patient floors
o Assist in relocating missing medications
o Understand the use of a Medication
Administration Record (MAR) and be able
to find appropriate information in a patient’s
chart
Second Year:
Goal: To work as a decentral technician, while applying new
pharmacotherapy skills in the clinical setting.


Central responsibilities
o Certification in tech-check-tech (TCT)
Additional decentral responsibilities (built upon 1st
year)
o Understand UMMC, F policies and
procedures
o Medication order entry
o Renal dosing
o Monitor electrolyte replacement therapy
o Assist with projects
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Third Year:
Goal: To work as a pharmacy intern, assisting in all applications
of the inpatient pharmacy.


Central responsibilities
o Assist the central pharmacists by checking
first doses, syringes, code trays, and
repackaging
o Assist the central total parenteral nutrition
(TPN) pharmacist with TPN order
verification and checking TPN additives
o Perform TPN order entry
o Mentor 1st and 2nd year students
Decentral responsibilities
o Attend all codes while assisting with
pharmacist responsibilities, after completion
of the Advanced Cardiac Life Support
(ACLS) competency
o Perform inpatient medication admission
histories
o Assist pharmacists with daily profile
reviews
o Assist pharmacists with renal dosing
o Assist pharmacists with TPN monitoring
o Assist the pharmacist with clinical
interventions as appropriate
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References
1. Cilla DD Jr, Manolakis ML. Making the most of an internship:
A guide for interns and preceptors. Am Pharm. 1986; 26:72-7.
2. Grussing P, Norwood GJ, Holstrom, and Fitch J. Pharmacy
internship in Minnesota: Outgrowth of an extensive evaluation
program. Am J Pharm Educ. 1976; 40:28-33.
3. Contributory Experience from the following Intern Programs:
o Abbott Northwestern Hospital (Minneapolis, MN)
o Mayo Clinic (Rochester, MN)
o Ohio State University Medical Center (Columbus, OH)
o St. Mary’s Medical Center (Duluth, MN)
o University of Minnesota Medical Center-Fairview
(Minneapolis, MN),
o United Hospital (St. Paul, MN)
o University of Wisconsin Hospital (Madison, WI)
4. Skledar SJ, McKaveney TP, Ward CO, Culley CM, Ervin KC,
Weber RJ. Advanced practice internship: Experiential learning in a
drug use and disease state management program. Am J Pharm
Educ. 2006; 70:Article 68.
5. Clark J. Developing the future of pharmacy through healthsystem pharmacy internship programs. Am J Health-Syst Pharm.
2007; 64:952-954.
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