ProfJameson.com

Ferris State University | College of Pharmacy | Professor of Pharmacy Practice


Ambulatory Care Rotation Syllabus PHPR 602-603
Ferris State University

John Jameson, Pharm.D., BCPS, FASHP
Office Phone: 616-685-6655
Voice Pager: 616-951-1386
Email: John@Profjameson.com
Fax: 512-366-9941

Dr. J's Welcome

Welcome to your ambulatory care rotation and the Wege Family Medicine clinic. This rotation is designed to cultivate a passion in pharmacists for improving patient care through correctly identifying medication problems and finding the best solutions. After completing this rotation you should have knowledge of the pharmacotherapy for common medical conditions in Ambulatory Care. But more importantly, you will learn how to apply that knowledge to the benefit of your patients. I will give you freedom to shape the rotation into the learning experience that fits your unique style and needs.

The Role of the Student

On this rotation you will be treated as a practitioner/learner. In a few short months you will be an independent practitioner faced with real patients and real problems. Unfortunately textbook answers only work for textbook patients, therefore, you must develop your ability to assess problems and create solutions. In order to solve problems, you will need to identify and correct your knowledge and skill deficits along the way. Perhaps an example will help:

While hanging out in the Family Medicine clinic, you interview a 65 year old lady with uncontrolled hypertension on 3 medications. A textbook approach might be to simply add another drug. But you are a self directed learner so.....

  • You realize you don’t know the common drug and non-drug causes of uncontrolled hypertension. So you look those up and re-evaluate the patient.
  • You realize that asking the patient “Do you take your medications every day” is not an effective skill in assessing compliance (they always say yes). So you find your instructor and drag him with you to demonstrate a better method.
  • You discover the patient has none of the common causes of uncontrolled hypertension AND they take their medications regularly AND their blood pressure is still 180/110. Before running back to your instructor you look up the pharmacology of the current medications and form a hypothesis as to the medication “most likely to succeed”. Then you run to your instructor for back up.


This most likely will create anxious moments and require a student to; yes I know this is radical thought, think critically. (See anxiety/learning curve below) Your job as a learner includes soliciting feedback as much as possible creating an environment to maximize the value of your educational dollar. All activities serve two purposes, both to improve patient care and to develop problem solving skills for you. Don’t plan on memorizing how to manage a patient (how has that worked for you so far?); plan on thinking!!

The Role of the Professor

So what do you need me for? As in the example above, my role should be that of a resource, coach, and role model. My role is not to spoon feed you information to memorize. I will make sure you have the opportunity to observe me seeing patients, evaluating problems and serving as a consultant to physicians and nurses.

Unique Features

Every rotation contributes something different to your education, based on the interests and abilities of the instructor. The following are areas that are emphasized on my version of ambulatory care.
  • Humor. Believe it or not, fun, humor and professionalism are not mutually exclusive qualities.
  • Diabetes Management
  • Pharmacokinetic concepts
  • Practical Literature evaluation
  • Motivational Interviewing skills
  • Mechanisms and Side Effects (This Is Big)
  • Notice I didn’t say: detailed SOAP notes, HIV, oncology or the virtues of psyche drugs.
My role as faculty can be summed up by William Butler:”Education is not the filling of a pail, but the igniting of a fire”.

Course Goals and Objectives

By now you should not be surprised to find that you (not the instructor) will generate the objectives for this course.

An Analogy

Students generally are a bit short on cash. Yet you are paying somewhere in the neighborhood of $100 per day to be here!! Since you are in charge of your education, shouldn't you be determined to get $100 worth every day? Or better yet, $200 worth! That is why this section is purposely left blank. You should consider your personal objectives for this rotation.

 

As I like to say, try to get maximum value for your educational dollar.
If you need ideas here is a link to a list of Bloom’s taxonomy of learning with examples and Ferris’s predefined objectives, but these are only ideas and should be used as such. All students come with different levels of knowledge and experience. Customizing topics and learning experiences is something I am good at, however I need your help to make this happen. Two resources that will help you are Bloom's Taxonomy and Ferris' Generic Ambulatory Care Objectives

Evaluations

The goal of evaluations is to give you feedback regarding strengths and weaknesses and help you identify strategies to correct the weaknesses. Your evaluations will be based on preceptor, staff and self observations during patient discussions and patient care activities. Whenever possible, examples will be provided. For type A personalities who have anxiety issues with the lack of percentage breakdown, the following is meant to ease your anxiety. (i.e – see bell shaped anxiety/learning curve above)

Clerkship evaluation:
  • Communication Skills (20%)
  • Knowledge of Disease Pathophysiology and Treatment
  • Patient specific pharmacotherapy (35%)
  • Drug information skills and interpretation (15%)
  • • Professionalism (30%)

Formal Topic Presentation (10%)

Journal Clubs / Quizzes / Writing Assignments (10%)

Final Exam (15%)

Ambulatory Care Logistics 101

Daily activities include patient care daily 8:20 to noon and 1 to 5 PM every day except Tuesday Morning conference time and scheduled time with the preceptor. A typical week includes accompanying residents during office visits, attendance at Family Practice Noon conference every day except Tuesday, seeing patients for medication histories and interventions, providing drug information for attendings and residents, and Family Medicine grand rounds on Tuesday mornings.

Required Stuff

  • Meetings with the preceptor will occur regularly to discuss patient care activities. You will be able to summarize the patient’s medical history, findings of patient interview, relevant medical and laboratory information, and provide their assessment and pharmaceutical care plan (i.e., problem list, treatment plan, efficacy and toxicity monitoring plan, and expected end-points of therapy). A strategy for implementing their care plan should also be discussed.

  • A minimum of two patient interactions will be observed by the preceptor.

  • You will also have the opportunity to present 3 formal Journal clubs throughout the two months

  • You will present one formal topic discussion usually given to the Family Practice residents noon conference.  Details of the Topic Presentation Here


  • Each student will need to test their own blood glucose and self administer a dose of saline to simulate insulin administration. This is intended to help students be able to properly counsel patients with diabetes.

  • Students will have the opportunity to submit information for the Toomanymeds.com website. This website is a resource for both patients and health care professionals with information pertaining to medications and their uses.

Details, Details

  • The HIPAA privacy rule is an example of government bureaucracy run amok, but it is important that you abide by the HIPAA rules. If not, I have to deal with angry administrative people. AND... people have a right to go to the hospital and expect that curious health care professionals will not snoop in their information if they are not involve and that they will not share information when they are involved.

  • Parking, copying privileges etc. will be discussed on the first day and while parking arrangements are also slightly annoying just be sure to park where you are suppose to. As a self-directed learner, you will realize that learning is facilitated by a happy preceptor.


Office Hours

I am available for discussions pretty much all the time during business hours. Epiphanies at 3 am or on weekends can wait till the next business day and I will be happy to discuss with you.

Resources and Tools

  • Too Many Meds website
  • www.Profjameson.com ( you are here)
  • Google calendar will be used to provide a framework for student’s schedule. (Due adaptations as opportunities arise and individual student’s learning requests this is subject to frequent changes)
  • Forms You May Find Helpful


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