HOSPITAL
Pharmacy Practice Residency
Internal Medicine
Learning Experience Description
Preceptor Contact: Name
Office:
Hours:
Phone:
Email:
General Description:
Internal Medicine is a required four week learning experience at HOSPITAL Hospital.
The patient locations will be throughout the hospital. Because the rotation is nonteaching, the pharmacist works with the hospitalists and nurse to resolve any medicationrelated issues. The pharmacist location is unit-based. There are 5 pharmacists that staff
the medicine units.
The pharmacy resident will round on the patients Monday through Friday. Patient care
responsibilities include verifying medication orders, educating patients and family
members, educating physician and nurses, educating pharmacy students, and participation
in daily nurse huddles on assigned units. The resident will work throughout the
experience to assume care of all patients to the assigned units (max ~35 patients).
Disease states:
Please refer to Disease state list (page 5)
Residency goals:
Taught: 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 2.10, 2.12, 5.1
Evaluated: 2.4, 2.5, 2.8, 2.9, 2.10, 2.12
2.4: (Analysis) Collect and analyze patient information
2.5: When necessary, make and follow up on patient referrals.
2.8: Recommend or communicate regimens or monitoring plans
2.9: Implement regimens and monitoring plans.
2.10: Evaluate patients progress and redesign regimens and monitoring plans
2.12: Document direct patient care activities appropriately
Activities:
The activities assigned coincide with responsibilities of a decentralized unit based
pharmacist. The activities assigned will help you work to achieve specific objectives
which will help you achieve goals in the learning experience.
Activity
Accurately gather, organize and analyze
patient specific information through profile
review and discussion with healthcare
Assessment
Review of residents
patient monitoring
form; evaluation
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Objective Covered
2.4.1
2.4.2
HOSPITAL
provider, patient or caregiver.
Identify medication-related problems for
discussion with preceptor.
Outline patients’ healthcare needs on patient
monitoring form
through patient
discussion
Review of patient
monitoring form,
evaluate through
daily discussion.
Produce and recommend to physicians and
Feedback from IM
healthcare team therapeutic plan including
physicians; review
monitoring
of clinical
documentation;
Choose correct order and/or monitoring
evaluate through
parameters (ex: medication or labs) based on patient discussion.
procedures or as directed by physician
Practice effective educational techniques to
Direct observation
hospitalized patients and/or caregivers on
new medications, CHF and disease state
management, and Coumadin
Identify appropriate patients for medication- Audit clinical
targeted patient counseling
documentation
(iVents, consult
Choose accurate and concise progress notes notes)
documenting direct patient care activities
within appropriate time frame
Recognize appropriate means of
documentation for patient care related
activities including: Adverse Event
Reporting System, inpatient notes, and
iVents.
Discriminate patient care needs that need to
be referred to other health care providers
including dietician or DM educator.
2.4.3
2.8.1
2.9.1
2.9.2
2.12.1
2.12.2
2.12.3
Discussion with
resident
2.5.1
2.5.2
Assess progress towards therapeutic goals
Review iVents for
medications, review
pharmacy consult
specific notes
(including
vancomycin).
2.10.1
Revise therapeutic plan as necessary to meet
the therapeutic goals
Review notes
pharmacy consult
notes for
2.10.2
Design a follow up plan
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vancomycin.
Discussion with the
resident during
patient discussion.
Preceptor Interaction:
Daily:
07:30 – Brief meeting to discuss day’s activities and outstanding assignments
12:00-13:00- Preceptor meets with resident to discuss patients or topic discussion.
Resident should be prepared to discuss pharmacotherapeutics, transition of care,
pathophysiology, pharmacology, and counseling. Preceptor will provide reading material
for topic discussion. Resident will assume the responsibility of leading the topic
discussion. The preceptor will ask questions to ensure understanding of learning
material.
Communication:
Daily scheduled meeting times: Resident to prioritize problems and questions for
preceptor.
Email: Residents are expected to stay current with emails throughout the day. Email
communications are appropriate for non-emergent, routine problems or questions.
Office extension: Appropriate for use for urgent questions pertaining to patient care.
Pager: Residents to page preceptor for urgent/emergent situations pertaining to patient
care.
Personal phone number: Provided to resident at time of learning experience for
emergency issues.
Expected progression of resident:
Day 1: Preceptor will review learning activities and expectations with resident.
Weeks 1-2: Resident to work up ½ of patient assigned units, develop complete and
thorough care plan for patients, and provide patient counseling for 2-3 patients daily.
Week 3-4: Resident to work up all of patients on assigned units, develop complete and
thorough care plans, and provide patient counseling to 5-6 patients daily.
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 preceptor will 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.
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Formative/Snapshots: These scheduled snapshots were pre-selected to provide feedback
to residents on patient care activities in which the typical resident will benefit from
specific feedback on their performance. The snapshot should be completed based upon 1
patient/experience, not as 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 se to improve their performance in subsequent
learning experiences.
A verbal midpoint evaluation will be completed half-way through the rotation to identify
strengths and weaknesses. If deemed necessary by the preceptor, a formal midpoint will
be added to the ResiTrak system.
Preceptor and Learning Experience evaluations must be completed by the last day of the
learning experience.
What type of evaluation
Snapshot 2.4.1
Snapshot 2.8.1
Summative
Summative
Preceptor, rotation
[PT] = Patient seen on rounds
[DIS] = Topic discussion
#
1.
2.
3.
4.
5.
a
b
c
d
e
f
g
6.
7.
Who
Preceptor, Resident
Preceptor, Resident
Resident (Self)
Preceptor
Resident
When
End of week 1
End of week 3
End of learning experience
End of learning experience
End of learning experience
[PT+] = Multiple patients seen on rounds
[TALK] = Resident presented this topic
Disease state
Hypertension
Congestive Heart Failure
Angina
Atrial Fibrillation
Thromboembolic Disorders and Anticoagulation Issues
DVT Prophylaxis
DVT Treatment
Pulmonary Embolism
Heparin Induced Thrombocytopenia
Hypercoaguable States
Heparin and LMWH
Warfarin
Asthma
Chronic Obstructive Pulmonary Disease
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PT
PT+
DIS
TALK
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8.
9.
10.
11.
12.
a
b
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
GI Bleeding and Peptic Ulcer Disease
GERD
Cirrhosis and Hepatic Encephalopathy
Acute and Chronic Renal Failure
Substance Abuse
Alcohol withdrawal
Cocaine
Diabetes Mellitus
Community Acquired Pneumonia
Hospital Acquired Pneumonia
Urinary Tract Infections
Cellulitis
Osteomyelitis
Clostridium Difficile Colitis
Sickle Cell Anemia
Acute and Chronic Pain Management
Basic Clinical Monitoring
Therapeutic Drug Monitoring
Intravenous Medication Guidelines
Hospital Formulary and Restricted Drugs
Other:
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