Goal

To integrate basic pharmacy-related concepts through patient care activities, discussions, and selected exercises in a critical care setting.

Objectives

• Demonstrate a comprehensive understanding about the clinical use, pharmacokinetics, route of administration, adverse effects, and drug interactions of the following
  • Sympathomimetics: epinephrine, norepinephrine, isoproterenol, dopamine, dobutamine, and phenylephrine
  • Parasympatholytics: atropine
  • Anticoagulants: heparin, warfarin, thrombolytic agents
  • Vasodilatory agents: nitroglycerin, sodium nitroprusside
  • Blood products: plasmanate, albumin, hetastarch, crystalloid
• Discuss the pathophysiology, associated laboratory and physical findings, and recommend the therapeutic maneuvers for the following disease entities
  • Septic shock
  • Cardiogenic shock
  • Acute respiratory distress syndrome
  • Pulmonary embolism
  • Deep vein thrombosis
  • Acid-base balance and arterial blood gases
  • Fluid and electrolytes
  • Toxicological emergencies

The administrative rotation in the Doctor of Pharmacy program aims to provide students with hands-on experience in managerial and administrative aspects of pharmacy practice. The rotation lasts for six weeks and focuses on applying management principles in a professional pharmacy setting.

Students can choose from various sites for the rotation, including hospitals, community pharmacies (independent and chain), health maintenance organizations, managed care programs, third-party programs, and manufacturers. The content of the rotation is flexible and tailored to each site's strengths.

During the rotation, students and preceptors collaborate to select objectives from a provided menu and site-specific objectives. Approximately six objectives are typically chosen, with each objective being addressed for about one week, although this timeframe can vary. A schedule with assignments and due dates is developed to guide the rotation.

In addition to assignments given by the preceptor, students are required to write a case study on managerial problem-solving. This includes describing the problem, exploring available options, weighing their pros and cons, explaining the chosen alternative, and discussing the decision-making process.

At the midpoint and end of the rotation, students undergo formal evaluations, considering factors such as attendance, initiative, response to feedback, completion of assignments, and achievement of objectives.

The objectives cover six categories:

1. Operations: Establishing policies and procedures, optimizing drug distribution systems, utilizing pharmacy-related computer applications, creating organizational charts, ensuring compliance with regulations, and implementing security measures.
2. Personnel Management: Developing and implementing personnel policies, defining job descriptions, recruiting and evaluating personnel, conducting training programs, supervising job performance, and managing wages and benefits.
3. Purchasing and Inventory Control: Setting drug quality specifications, formulating purchasing policies, preparing and reviewing purchase orders, implementing inventory control systems, and understanding purchasing groups and contract buying.
4. Financial Management: Establishing pricing structures, conducting cost analysis, managing accounts receivable, budgeting, and analyzing fiscal performance reports.
5. Marketing and Strategic Planning: Planning advertising and marketing strategies, designing efficient pharmacy layouts, introducing innovative services, assessing costs and benefits of services, and participating in contract negotiations.
6. Clinically Oriented Administrative Functions: Implementing total quality management, conducting drug usage evaluations, developing and publishing drug product formularies, and participating in pharmacy and therapeutics committee functions.

The objectives were derived primarily from the APhA Community Pharmacy Residency Program: Programmatic Essentials.

Goal

To integrate basic pharmacy-related concepts and cardiology patient care through patient care activities, discussions, and selected exercises.

Objectives

Demonstrate a comprehensive understanding about the clinical use, pharmacokinetics, route of administration, adverse effects, and drug interactions of the following:

• Antidysrhythmic drugs: quinidine, procainamide, disopyramide, lidocaine, tocainide, mexiletine, flecainide, bretylium, amiodarone, beta blockers, verapamil, diltiazem, ethmozine, propafenone, and digoxin
• Inotropic agents: digoxin, amrinone, and milrinone
• Antihypertensives: diuretics, beta blockers, prazosin, methyldopa, guanadrel, hydralazine, clonidine, guanabenz, captopril, minoxidil, guanethidine, sodium nitroprusside, diazoxide, and calcium channel antagonists
• Antianginal agents: nitrates, beta blockers, and calcium channel antagonists
• Anticoagulants and antiplatelet drugs: heparin, warfarin, aspirin, dipyridamole, sulfinpyrazone, and thrombolytic agents
• Sympathomimetics: epinephrine, norepinephrine, isoproterenol, dopamine, dobutamine, and phenylephrine
• Parasympatholytics: atropine
• Vasodilating agents: nitrates, hydralazine, prazosin, captopril, minoxidil, nifedipine, sodium nitroprusside, nitrates, enalapril

Discuss the pathophysiology, associated laboratory and physical findings, and recommend the therapeutic maneuvers for the following disease entities:

• Acute myocardial infarction
• Angina pectoris including effort angina, Prinzmetal's angina, and unstable angina
• Supraventricular dysrhythmias: atrial fibrillation, atrial flutter, multifocal atrial tachycardia, PSVT
• Ventricular dysrhythmias: ventricular tachycardia, ventricular fibrillation, Torsades de Pointes
• Pre-excitation syndromes: Wolf-Parkinson-White
• Atrioventricular blocks
• Heart failure
• Hypertension

Goals

To develop an extensive knowledge base of the pharmacokinetics of drugs that are commonly monitored in patients and achieve competence in the application of pharmacokinetic principles to patient care situations.

Objectives

• Define the following pharmacokinetic terms: elimination rate constant, half life, volume of distribution, clearance, one-compartment model, two-compartment model, first-order elimination, and zero-order elimination.
• Identify the therapeutic range, average half-live, and average volume of distribution for all routinely monitored drugs including aminoglycosides, vancomycin, digoxin, quinidine, procainamide, lidocaine, theophylline, phenobarbital, phenytoin, valproic acid, carbamazepine, and primidone.
• Identify the appropriate equation to use in each of the following situations: IV bolus, continuous IV infusion, intermittent IV infusion, multiple oral dosing, and oral dosing with controlled release products.
• Given a specific patient case, calculate the elimination rate constant, volume of distribution, half-life, and clearance prospectively based on average population parameters as well as retrospectively based on serum drug concentrations for the drugs listed in objective #2.
• Given a specific patient case, estimate lean body weight, adjusted body weight, creatinine clearance, and a measured creatinine clearance (with urine collection data).
• Review a patient's medical history and drug therapy and assess the indications for drug therapy, the patient's response to therapy, presence or potential for adverse effects, and appropriateness of monitoring.
• Discuss the effects of renal disease, liver disease, cardiac disease, and obesity on the pharmacokinetics of the drugs listed in objective #2.
• Describe the differences between peritoneal dialysis, hemodialysis and hemoperfusion and the effect of these procedures on the clearance of the drugs listed in objective #2.
• Given a specific patient, identify potential pharmacokinetic drug interactions and discuss the significance of these.
• Discuss Bayesian pharmacokinetic analysis and the role of this method in patient care.
• Evaluate the medical literature with respect to study design and analysis of pharmacokinetic data.
• Utilize appropriate written and verbal communication skills when providing recommendations to patients and health care professionals.

The emergency medicine rotation is a six-week program that introduces students to clinical practice in the emergency department. The focus is on developing evaluation skills, history-taking, and using ancillary services effectively. Students also observe specialized procedures and learn about clinical pharmacy services in emergency settings.

By the end of the rotation, the student should be able to:

• Identify appropriate responsibilities, duties, and tasks of a clinical pharmacist in an emergency department.
• Demonstrate proficiency in obtaining relevant patient history and utilizing ancillary services for emergency assessment and management.
• Describe research methodologies in emergency medicine relevant to clinical pharmacy practice.
• Possess in-depth knowledge of common therapeutic agents used in the emergency department.

During the rotation, the student is responsible for attending all scheduled shifts in the emergency department, participating in department-sponsored rounds and conferences, and engaging in other relevant didactic experiences. At the conclusion of the rotation, the student is expected to provide a written evaluation of their experience.

Goal

Develop pharmacists who can effectively manage and educate patients with diabetes and related conditions.

Objectives

• Understanding the pathophysiology and differentiating between Type 1 and Type 2 diabetes
• Diagnosing diabetes and managing complications.

Pharmacists should be knowledgeable about: 

• Nutrition guidelines
• Drug therapy for glucose and comorbid conditions
• Benefits and precautions of exercise for diabetic patients.
• Monitoring diabetes involves physical exams, blood glucose monitoring, and appropriate laboratory tests.

Patient education is essential, including designing educational plans, survival skills education, and addressing various learning styles. The overall aim is to create proficient pharmacists with good communication skills, a commitment to lifelong learning, and professionalism.

The goal of the Geriatrics/Gerontology rotation is to develop pharmacists who can effectively manage drug therapy and provide drug information in the context of pharmaceutical care for elderly patients.

The objectives include:

• Understanding the physiological changes that occur with aging and their impact on medication in the elderly
• Communicating drug therapy information to healthcare professionals
• Describing therapeutic interventions and monitoring parameters for various common diseases in the elderly, including Angina Pectoris, Bowel/Bladder Incontinence, Common Anemias, Congestive Heart Failure, Dementias, Depression, Diabetes Mellitus, Hypertension, Hypnotic Use in the Elderly, Arrhythmias, and Insomnia. 
• Familiarizing students with the role of clinical pharmacists in geriatric healthcare teams
• Learning the various federal and state rules and regulations pertaining to the provision of pharmaceutical services in a long-term care facility.

The student's responsibilities during the rotation include active participation in medical or pharmacy rounds, patient care planning, and in-service presentations. They will engage in discussions with the instructor about specific patients and disease states and assist less experienced students in their rotations.

The student is expected to provide drug information or pharmacokinetic consultations to healthcare staff, monitor drug therapy for patients during resident care conferences, complete assigned readings and quizzes, and participate in pharmacy case conferences on a weekly basis.

Goal

To integrate basic pharmacy-related concepts and oncology patient care through patient care activities, discussions, and selected exercises.

Objectives

• Neoplastic Diseases
  Understand disease course, staging, and treatment options for various malignancies.
• Antineoplastic Agents
  Discuss pharmacology, dosing, and adverse reactions of cancer chemotherapeutics.
• Radiation Therapy and Surgery
• Discuss the role of diagnostic, palliative, and curative radiation therapy and surgery in cancer management and understand the monitoring and management of the complications associated with radiation therapy and surgery.
• Nausea and Vomiting
  Discuss physiology, antiemetics, and appropriate therapy. Know the relative onset, duration, and severity of nausea and vomiting with different chemotherapeutic agents. Describe nondrug methods for antiemetic control.
• Pain Control
  Cover pain pathophysiology, analgesics, and non-pharmacologic methods.
• Mouth Care
  Address oral hygiene, agents causing issues, and supportive care.
• Nutrition
  Assess and manage nutritional needs, including enteral and parenteral nutrition.
• Transfusion Therapy
  Discuss the use of blood products in cancer therapy including red blood cells, white blood cells, and platelets, and suggest premedication regimens to help reduce hypersensitivity reactions to blood products.
• Infectious Disease
  Describe the types of bacterial and nonbacterial infections seen in patients with cancer and discuss the role of infection prevention in patients with cancer. Students will also recommend and monitor appropriate antibiotic therapy in patients with cancer with respect to patient specific factors.
• Extravasation
  List drugs that are vesicants and understand the management of extravasation.

Goal

To provide the pharmacy student with an introduction to the treatment of infectious diseases.

Objectives

• Discuss indications for major classes of anti-infectives.
• Recommend specific anti-infectives and doses for infectious processes.
• Understand rational use of antimicrobial agents for surgical prophylaxis.
• Understand rational use of antimicrobial, antiviral, and antifungal agents for immunocompromised patients.
• Understand rationale for selecting specific antimicrobial, antiviral, and antifungal regimens.
• Discuss rational use of combination anti-infective therapy.
• Discuss pathophysiology and pathogenesis of infectious diseases.
• Discuss the role of a consult service.

Responsibilities

• Attend the hospital Monday through Friday from 8:00 a.m. to 5:00 p.m.
• Participate in infectious disease rounds.
• Monitor assigned patients on the infectious disease consult service.
• Provide drug information to house staff and attending physicians.
• Deliver overviews of specific anti-infectives or classes on rounds.
• Regularly meet with preceptor to review patients and therapy.
• Attend microbiology rounds and infectious diseases clinic.
• Perform other assigned functions by the preceptor.

Preface

The primary purpose of the internal medicine rotation is to develop an understanding of pharmacotherapy for the patients followed by internal medicine. Both ambulatory care and inpatient management may be available. An ancillary goal is to allow the student to develop the ability to effectively gather and disseminate information, and communicate with patients, nurses, physicians, pharmacists, and other health care practitioners specific information necessary in the care of patients.

At the beginning of this rotation, the preceptor and student will review the objectives. In addition, the student is expected to develop his/her own objectives. The preceptor and student will review particular topics for reading/discussion. These topics should be primarily based on improving the individual's weaknesses and strengths as viewed by both student and preceptor.

Objectives

At the completion of PhPr 810A, the student should be able to:

• Demonstrate the ability to identify specific drug-related problems for patients with acute and/or chronic illness.
• Authoritatively discuss the pathophysiology of patient's illness.
• Authoritatively discuss the therapeutic plans of the patients encountered on the medical services and in the clinics.
• Identify optimal variables for monitoring patients including the identification of adverse drug reactions.
• Conduct monitoring of patient's drug therapy.
• Write a complete and formal drug therapy consult note.
• Provide patient education regarding the optimal use, expected outcomes, and adverse effects of drug therapy regimens.
• Work with other health care professionals to ensure the safe, correct, and cost-efficient administration of medications.

Responsibilities

The responsibilities of the students during this rotation shall include the following:

• Closely follow patients from a medical team as assigned by the preceptor.
• Closely review all the drug therapy of each patient being followed including pharmacology, toxicology, pharmacokinetics, drug interactions, and monitoring parameters. From these data, a therapeutic plan will be developed.
• Write progress notes on patients. (Consult preceptor regarding limitations to student generated progress notes at the institution.).
• Evaluate serum drug concentrations for patients being followed.
• Document all patient care activities in manner outlined by the preceptor.
• Prepare and give a formal presentation. To meet this objective at least one presentation shall be given during each PhPr 810 rotation. A copy of the outline developed for the presentation must be submitted to the director of experiential programs with the final evaluation and grade.
• Attend patient conferences, pharmacy in-service presentation and pharmacists' meetings.

Expected areas of emphasis

The different sites may have different patient populations that make defining disease processes that must be followed impossible. Students are expected to participate in the care of variety of patients. Some areas of emphasis can be established, however, that will be consistent between sites. The following areas should be part of an educational plan the student and preceptor develop. These areas of emphasis should focus on drug literature evaluation. Any of these six areas can form the basis of the required presentation.

Evaluations

The student should expect feedback on a regular basis (i.e. daily). Feedback is intended to provide assistance in improving the quality of the student's pharmacotherapeutic skills. Each student will also have an evaluation completed during the rotation that will retrospectively assess progress. Each student will perform a self-evaluation at the third and sixth week. The evaluation will be simultaneously performed by the preceptor. The preceptor and the student will compare and discuss the evaluation before a final evaluation and grade is completed.

Goals

• Provide general understanding of specialized nutrition support.
• Develop skills in patient assessment, monitoring, and formulation of parenteral nutrition.
• Improve proficiency in communication with healthcare professionals and patients.

Objectives

• Evaluate appropriateness of parenteral nutrition.
• Estimate caloric and protein requirements and formulate parenteral nutrition plans.
• Discuss options for controlling hyperglycemia in patients on parenteral nutrition.
• Recognize different amino acid formulas and their recommendations.
• Understand fluid and electrolyte balance and effects of medications.
• Recommend adjustments in electrolyte provision.
• Discuss monitoring parameters for patients on parenteral nutrition.
• Interpret blood gas values related to nutrition formulation.
• Recognize differences between adult and pediatric guidelines.
• Discuss issues related to medications and tube feeding.
• Write chart notes using SOAP format.
• Gather patient data and present recommendations.
• Give an in-service presentation on a selected topic.

Responsibilities

• Attend daily nutritional support rounds and clinical conferences.
• Interact with healthcare professionals.
• Review charts, collect data, and make recommendations for parenteral nutrition patients.
• Write daily progress notes.
• Coordinate pharmaceutical care with pharmacists or medical teams.
• Discuss patients and nutrition-related topics with the preceptor.
• Provide information on the patient's overall therapy, especially related to nutrition support.
• Deliver an in-service presentation on a chosen topic.

Goals

• To expose the student to specialized outpatient settings.
• To increase the pharmacy student's ability to integrate previously acquired knowledge so as to make appropriate professional decisions relative to safe and effective drug use.
• To increase the pharmacy student's proficiency in communication techniques in order to facilitate interaction with patients and other health care professionals.
• To improve the pharmacy student's problem solving skills and professional judgment.

Objective

At the completion of this rotation, the student should have performed the stated objectives of the rotation site at a satisfactory level.

General Guidelines

• The first day should include a tour of the facility and a discussion of the rotation goals and objectives, rotation schedule, preceptor's expectations, and the student's previous experience and personal goals for the rotation. 
• The preceptor should provide information regarding areas of the department or institution they will be working in and the individuals to report to in a timely manner. The student should also attend conferences and meetings as assigned by the preceptor.
• The preceptor and student should meet on a regular basis to discuss rotation activities, clinical problems, or other appropriate topics. The student should keep a list of questions and topics to discuss at these times. It is recommended that these meetings comprise at least five hours per week.
• At least one in-service or small project should be done by the student during the rotation. The audience and topic should be decided upon the preceptor and the student early in the rotation.
• At attempt should be made by the preceptor to individualize the experience based on the student's background.

Goals

• To provide the student with an understanding of pediatric patient care in the clinical setting.
• To develop a knowledge base of common pediatric disease states and their therapy.
• To learn to apply therapeutic and pharmacokinetic principles to the pediatric patient.
• To develop an appreciation of the pharmacist's role in monitoring drug therapy in the pediatric patients.
• To be able to evaluate the appropriateness of drug therapy in pediatric illnesses.
• To be able to interact with the pediatric care system as a participant.
• To develop an understanding of drug dosage and formulation problems unique to pediatric drug therapy.

Objectives

At the completion of this rotation, the student should be able to:

• Recognize adverse drug reactions and be able to recommend appropriate treatment and alterations in therapy.
• Discuss the pathophysiology and usual clinical course of a patient's disease state.
• Discuss, in detail, the therapy of a patient's disease state, including rational selection of therapy, pharmacology of the drugs used, efficacy of therapy, monitoring parameters, and potential adverse effects.
• Use basic pharmacokinetic principles and drug levels in the recommendation of initial therapy and subsequent dosage adjustments.
• Select and interpret parameters used to monitor therapeutic response for pediatric patients.

Responsibilities

The responsibilities of the student during this rotation shall include the following:

• Attend daily patient work rounds in addition to attending rounds and x-ray rounds, and other educational pediatric conferences as may be scheduled.
• Provide drug information when appropriate to other members of the health care team.
• Monitor patients' drug therapy for therapeutic effect, adverse drug reactions, and drug interactions.
• Provide patient counseling and education concerning drug therapy during hospitalization and at discharge, where possible.
• Participate in formal and informal consultations, including detailed literature searches.
• Evaluate the literature on a specific topic pertaining to a patient's therapy.
• Provide in-service education for health professionals, when appropriate.
• Attend conferences that pertain to drug therapy and patient care.
• Participate in emergency situations, when possible, including the preparation of emergency drugs and provision of drug information.

Goal

The rotation, which takes place at the Arizona Poison and Drug Information Center, will introduce the student to the operation of a poison information service and provide opportunities for the student to develop the knowledge base and skills in clinical toxicology.

Objectives

The student, on this six-week rotation experience, will be expected to:

• To learn about the various administrative aspects of poison center operation including:
  • Organizational structure
  • Financing
  • Policy and procedure development, implementation, and revision
  • Accreditation criteria
  • Staff proficiency criteria
  • Quality assurance
• To observe and participate in the administration of commonly employed systemic and external decontamination procedures for poisonings and other first aid measures in the emergency room setting.
• To develop proficiency in the use of all reference materials commonly used by PCC staff including computerized information sources.
• To become familiar with the legal and ethical aspects of PCC operation; i.e., PCC consultant and staff liabilities and legal obligations in the provision of poison and drug information to health professionals and the lay public.
• To examine the literature supporting current guidelines for the treatment of commonly occurring poisonings and toxic exposures; e.g., iron, TCAs, acetaminophen, aspirin, NSAIDs, alcohols, narcotics, venomous bites and stings, etc.
• To participate in toxicology rounds/conferences and the toxicology consult service.
• Under supervision of a poison information specialist, respond to actual poison information and treatment referral assistance.
• Under supervision, formulate assessment of cases and recommendations for treatment of poisoning and toxic exposure cases.
• Conduct follow-up calls, reporting of findings, documentation of outcomes in cases of poisonings, and toxic exposures.
• Participate in and contribute to didactic efforts (i.e., clinical toxicology rounds, case reviews, conferences, etc.) during the course of this clerkship.

Goal

• Provide understanding of recognition, diagnosis, and treatment of neuropsychiatric disorders.
• Train in safe and effective use of psychotropic medications.
• Focus on pain management concepts for some rotations.

Objectives (Psychiatry Rotation):

• Conduct patient interviews and mental status examinations.
• Assess patients for substance abuse, addiction, and noncompliance.
• Discuss clinical use, pharmacokinetics, adverse effects, and drug interactions of various medication classes.
• Collect relevant laboratory data and identify drug-induced abnormalities.
• Recognize potential drug-drug interactions and minimize adverse effects.
• Identify symptoms and diagnostic criteria for common psychiatric disorders.
• Initiate and monitor pharmacotherapy for psychiatric and neurologic disorders.
• Discuss pathophysiology, clinical diagnosis, and pharmacotherapy of specific disorders.
• Review and evaluate relevant literature.
• Provide medication education and counseling.
• Serve as an educational resource and conduct research activities.
• Provide pharmaceutical care services under supervision.

Objectives (Pain Management Rotation):

• Summarize pathology, etiology, and natural history of chronic pain problems.
• Understand pain-sensing nervous system and pharmacology.
• Differentiate types of pain and implications for pharmacotherapy.
• Explain pain assessment and common pitfalls.
• Identify adverse effects and monitoring parameters for pain medications.
• Discuss addiction and tolerance in pain management.
• Explore different mechanisms and pharmacotherapy for pain.
• Address barriers and WHO analgesic ladder for cancer pain.
• Design plans for initiating, monitoring, and discontinuing pain therapy.
• Monitor adverse effects and consider alternative pain management therapies.
• Assess non-pharmacological treatments and invasive procedures.
• Understand dosing conversion and epidural analgesia.
• Describe spinally administered medications for acute pain.
• Name antidepressants and anticonvulsants used for chronic pain.
• Recommend patient-controlled analgesia regimens and monitoring parameters.

Overall, the rotations aim to provide comprehensive knowledge and skills in neuropsychiatry, including the use of psychotropic medications, and specific focus on pain management in some rotations.

Goals

The primary purpose of the pulmonary rotation is to develop an understanding of pharmacotherapy for patients with primary lung disease who are admitted to the wards and intensive care units of the institution. An ancillary goal is to allow the student to develop the ability to effectively gather and disseminate information, and communicate with patients, nurses, physicians, pharmacists and other health care practitioners specific information necessary in the care of acutely ill patients.

At the beginning of this rotation, the preceptor and student will review the objectives. The student is expected to develop his/her own objectives at the start of the rotation. The preceptor and student will review particular topics for reading/discussion. These topics should be primarily based on the individual's weaknesses and strengths as viewed by both the student and preceptor.

Objectives

At the completion of this rotation, the student should be able to:

• Present cases and discuss the management of patients with various pulmonary diseases.
• Discuss pathophysiology and management of patients with asthma and COPD.
• Discuss the pharmacotherapy of the various respiratory diseases including pharmacokinetics, adverse events, and cost-benefit data.
• Discuss the drug therapy of plural effusions.
• Educate a patient on the proper use of aerosolized therapy.

Responsibilities

The responsibilities of the student during this rotation shall include the following:

• Closely follow patients from the consulting service as assigned by the preceptor.
• Closely review all the drug therapy of each patient being monitored including pharmacology, toxicology, pharmacokinetics, drug interactions, and monitoring parameters. From these data, a therapeutic plan will be developed.
• Write progress notes on patients.
• Evaluate serum drug concentrations for patients being followed.
• Document all patient care activities as required.
• Attend patient conferences, pharmacy in-service presentations and pharmacists' meeting.
• Review and discuss a topic as selected by the preceptor and student once weekly.

Evaluation

Students will be evaluated on an objective and subjective basis. Objective evaluation will be based on the preset expectations discussed at the beginning of the rotation. Subjective evaluation will be based on enthusiasm, inquisitiveness, logical thinking, professionalism, and a willingness to do more than the minimum amount of work. Students will be informed of their progress at the midpoint and end of the rotation unless the preceptor feels more frequent formal evaluations are necessary.

Goals

The primary purpose of the renal rotation is to develop an understanding of pharmacotherapy for patients with renal disorders who are treated in outpatient clinics and admitted to the wards and intensive care units of an institution. An ancillary goal is to allow the student to develop the ability to effectively gather and disseminate information, and communicate with patients, nurses, physicians, pharmacists, and other health care practitioners specific information necessary in the care of chronically ill patients.

At the beginning of this rotation, the preceptor and student will review the objectives. The student is expected to develop his/her own objectives at the start of the rotation. The preceptor and student will review particular topics for reading/discussion. These topics should be primarily based on the individual's weaknesses and strengths as viewed by both the student and preceptor.

Objectives

At the completion of this rotation, the student should be able to:

• Present cases and discuss the management of patients with the following renal disorders.
  • Acute renal failure
  • Chronic renal failure
  • Acid-base disorders
  • Fluid and electrolyte disorders
  • Renal dialysis
  • Nephrolithiasis
  • Nephrotic syndrome
  • Glomerulonephritis
  • Kidney transplantation
• Discuss pathophysiology of patients with renal disorders.
• Discuss the pharmacotherapy of the various renal diseases and kidney transplant including pharmacokinetics, adverse events, and cost-benefit data.

Responsibilities

The responsibilities of the student during this rotation shall include the following:

• Closely follow patients from the consulting service as assigned by the preceptor.
• Closely review all the drug therapy of each patient being monitored including pharmacology, toxicology, pharmacokinetics, drug interactions, and monitoring parameters. From these data, develop a therapeutic plan.
• Write progress notes on patients.
• Evaluate serum drug concentrations for patients being followed.
• Document all patient care activities as required.
• Attend patient conferences, pharmacy in-service presentations, and pharmacists' meetings.
• Review and discuss a topic as selected by the preceptor and student once weekly.
• Prepare and give a formal presentation.

Goals

The research rotation is intended to provide an opportunity for doctor of pharmacy students to acquire experience in the various aspects of research as outlined in this document. The rotation is a six-week experience in which the student can participate in the research process. Students in the PharmD/PhD program may select two-research rotations.

Because six weeks are not sufficient time to become an experienced researcher, the intent is to expose the student to as many aspects of research as possible.

The rotation may be completed with faculty from various disciplines within the College of Pharmacy such as medicinal chemistry, pharmaceutics, pharmacology, toxicology, and pharmacy practice and pharmacy administration. Research rotations may also be available with off-campus preceptors engaged in research.

This list of objectives is intended to provide both the preceptor and the student with an idea of what can be expected during a clerkship. The objectives are guidelines and are written to allow flexibility in the rotation experience.

Outline of the Rotation Experience

Prior to the clerkship, the preceptor and student should design a rotation schedule that identifies the specific activities the student will perform during the six-week period. The activities included in the schedule should be part of the actual ongoing research the preceptor is conducting. At the beginning of the rotation, the student and preceptor should review the objectives and the schedule. At the end of the rotation, the student will meet formally with the faculty member to review his or her experiences and the level of accomplishment for the objectives.

All students participating in the research rotation should make a formal presentation of results. This presentation should be advertised in advance within the College, particularly to graduate students and faculty.

Objectives

At the completion of this rotation, the student should be able to:

• Prepare a one-page outline of a research protocol including goals, objectives, significance, background, study design, methods, time table, statistical analysis plan and budget.
• Perform statistical analysis of a set of sample data using one of the available statistical programs such as SPSS, SYSTAT, BMDP, or SAS.
• Maintain and manage data in spreadsheet programs such LOTUS 1-2-3, Excel, or Access.
• Review and describe the contents of the submission documents that would be required for approval of a pilot project involving human subjects and/or animal experimentation.
• Calculate the appropriate statistical results on one sample of research data covering at least one of the following: chi-square, t-test, regression, correlation, or analysis of variance. Understand how to use statistical consultants.
• Develop a research design (diagram) to test a pharmaceutical research question including a problem that allows or requires random selection, random assignment, crossover design, or repeated measures, etc.
• Draft a hypothesis statement related to a selected research question and pharmaceutical theory providing both the null hypothesis and the alternate research hypothesis.
• Prepare a one-page outline of a publication of sample research findings including an introduction, background, methods, results, discussion, and conclusions. Attached to the outline should be a draft of a well-labeled, key table providing sample results and statistical tests.
• Prepare and give a formal presentation of research results collected during the rotation.

Goals

• To expose the student to nontraditional settings.
• To increase the pharmacy student's ability to integrate previously acquired knowledge so as to make appropriate professional decisions relative to safe and effective drug use.
• To increase the pharmacy student's proficiency in communication techniques in order to facilitate interaction with patients and other health care professionals.
• To improve the pharmacy student's problem solving skills and professional judgement.

Objectives

At the completion of this rotation, the student should have performed the stated objectives of the rotation site at a satisfactory level. Each site must use goals and objectives that have been approved by the College.

General Guidelines

• The first day should include a tour of the facility and a discussion of the rotation goals and objectives, the preceptor's expectations, the student's expectations, and the grading system.
• During the first week, the student should receive a rotation schedule that includes areas to work in and individuals to report to for the six-week period. The student should attend conferences and meetings as assigned by the preceptor.
• The assigned preceptor and student should meet on a regular basis for a minimum of five hours per week. The student should keep a list of questions and topics to discuss at that time.
• At least one in-service or small project should be done by the student during the rotation. The audience and topic should be decided upon by the preceptor and the student early in the rotation.
• An attempt should be made by the preceptor to individualize the experience based on the student's background.

Goals

• Familiarize with clinical pharmacy services for surgery patients.
• Provide accurate drug information to surgeons and healthcare professionals.
• Understand medications involved in surgery, particularly antibiotic therapy, nutritional support, and pain management.

Objectives

• Obtain complete and accurate drug histories and present patient case histories effectively.
• Communicate appropriately with patients and healthcare professionals.
• Conduct literature searches and present findings related to disease, medication, or surgery.
• Allocate sufficient time for patient care responsibilities.
• Interact with other healthcare professionals.
• Understand pathophysiology and pharmacology of surgery medications, especially antibiotics and pain management.
• Comprehend acid-base balance, fluid, and electrolyte therapy principles.
• Gain a general understanding of parenteral and enteral nutrition in surgical patients.
• Recognize and monitor adverse medication effects and make informed decisions for prevention and treatment.
• Understand drug controversies in specific clinical situations.
• Calculate creatinine clearance and consider the effects of renal and/or liver disease on medication dosing.
• Calculate appropriate doses for surgery medications, focusing on antibiotics and pain relievers.
• Answer medication-related questions accurately based on relevant facts.
• Conduct prompt and accurate literature searches to address healthcare professionals' questions.
• Maintain patient confidentiality and prioritize monitoring of patient medications.

Responsibilities

• Attend daily morning rounds with the assigned surgery team.
• Attend clinical pharmacy conferences and morbidity and mortality rounds if applicable.
• Respond promptly and accurately to questions from healthcare professionals.
• Initiate interactions with other healthcare professionals.
• Document drug reaction forms for undesired effects.
• Conduct literature searches on surgery topics and present findings.
• Monitor and make decisions on nutritional support, particularly total parenteral nutrition (TPN).
• Maintain professionalism when interacting with patients and healthcare professionals.
• Obtain complete and accurate medication records for each patient.
• Present patient-related information accurately during rounds.
• Evaluate medications for assigned surgery patients thoroughly and accurately.

• The rotation aims to provide practical experience in clinical pharmacy services for surgery, focusing on medication management, patient care, and communication with healthcare professionals.