Professional Year 4

Advanced Pharmacy Practice Experience (APPE)

The APPE portion of the curriculum comprises more than 25% of the curricular length.  All students are required to take a minimum of 9 APPEs.  Each rotation is a minimum of 5 weeks in duration.  Six of the 9 APPE rotations must involve direct patient care and may occur in various clinical areas (e.g., medicine, cardiology, infectious disease). One of the six must occur in an ambulatory care setting.  Two of the remaining APPE rotations must occur in community and institutional pharmacy practice settings. The final two APPE rotations may be taken in any rotation area.

 

 

YEAR 4
First Term Second Term Third Term
PHRP-611 Clinical Rotation I       5(0-5) PHRP-614 Clinical Rotation IV    5(0-5) PHRP-617 Clinical Rotation VII 5(0-5)
PHRP-612 Clinical Rotation II 5(0-5) PHRP-615 Clinical Rotation V 5(0-5) PHRP-618 Clinical Rotation VIII   5(0-5)
PHRP-613 Clinical Rotation III 5(0-5) PHRP-616 Clinical Rotation VI 5(0-5) PHRP-619 Clinical Rotation IX 5(0-5)
Total Clinical Rotations                 15 Total Clinical Rotations                15 Total Clinical Rotations                 15

 

CORE ROTATIONS
1. Internal Medicine                                                        
2. Critical Care
3. Advanced Community Pharmacy Practice
4. Advanced Institutional/Inpatient Pharmacy Practice                                                
ELECTIVE ROTATIONS
1. Nephrology
2. Solid Organ Transplant
3. Oncology/Hematology
4. Pediatrics
5. Hepatology
6. Neonatal
7. Evidence Based Medicine
8. Pharmacy Administration
9. Drug Information Center
10. Pharmacoeconomics and Formulary Management
11. Surgery
12. Drug Manufacturing
13. Drug Company
14. Medication Safety
15. Pharmacy Quality Assurance
16. Infectious Diseases
17. Academia
18. Informatics
19. Advanced Institutional Outpatient
20. Cardiology

 

CORE ROTATIONS

1. INTERNAL MEDICINE (IM). Internal medicine rotation is one of the important core rotations that uses floor-based practice model to give the interns the opportunity to participate in direct patient care activities and gain experience practicing as a clinical pharmacist. This rotation allows the provision of evidence-based patient-centered care to patients admitted to a General Medicine Service. The student become fully integrated into the general medicine interdisciplinary team, round daily with the preceptors and medical team and focus on management of drug therapy in patients with multiple medical problems. The students will have the opportunity to provide antibiotic and anticoagulation dosing services, initiate and monitor TPNs, offer medication counseling to patients, and engage in topic discussions with the preceptor. 

2. CRITICAL CARE (ICU). The primary goal of this rotation is to enhance the student medication and disease state knowledge within the critically ill patients and successfully apply this knowledge in order to positively impact patient care. The rotation functions to provide pharmacotherapy management of various disease states within the medical intensive care unit such as sepsis/ septic shock, respiratory failure, pain etc. Additionally, the student will have the opportunity to work closely with the preceptor to identify and resolve medication therapy issues for ICU patients. He /She will also be responsible for providing and documenting therapeutic drug monitoring services for patients on their team. Giving the critical states of the patients in the ICU, the students is expected to assume responsibility and accountability for all pharmacotherapy management issues for their assigned patients.

3. ADVANCED COMMUNITY PHARMACY PRACTICE. The student will function as a trainee under the immediate supervision of a licensed pharmacist. He/she should carry out all the professional functions and services the pharmacist assigns him/her to render within the community pharmacy. Students will expose to non-prescription, herbal and cosmetic pharmaceutical products. In addition, the students will have the opportunity to involve in all aspects of the community pharmacy activities including but not limited to medication dispensing, patient counselling, inventory control, and extemporaneous pharmacy compounding whenever available.

4. ADVANCED INSTITUTIONAL/INPATIENT PHARMACY PRACTICE. Under the supervision of the preceptor, the student will provide direct patient-centered care in the institutional settings. The student will experience the operation and management of institutional pharmacy systems and the functions and responsibilities of a pharmacist in the different inpatient area including long-term, cardiology, intensive care, pediatric oncology etc. Students will have the opportunity to be involved in all aspects of the medication use process and drug distribution and delivery in the institutional setting in order to fulfill the following objectives.

 

ELECTIVE ROTATIONS

1. NEPHROLOGY. In the nephrology rotation the student will spend the majority of the time in the nephrology floor providing care to patients with acute kidney injury, chronic kidney disease and metabolic and electrolyte disorders.  The student will have the opportunity to participate in the evaluation and management of various diseases of kidney in addition to patients’ status post renal transplant. Depth of exposure will be in providing pharmaceutical care services to a patient with renal insufficiency (acute or chronic) including drug selection, pharmacokinetic consultation and drug adjustment. Prevention of renal disease or further renal damage will also be addressed in this rotation.

2. SOLID ORGAN TRANSPLANT. This solid organ transplant elective rotation will learn students how to care for patients as they prepare to receive a transplant, during the acute care phase of transplantation, and in the ongoing primary care role after transplant as the pharmacist works with the patient to sustain the survival of the transplanted organ, manage diseases that occur or reoccur post-transplant, and enhance the patient’s general health and wellness.

Under the supervision of a clinical pharmacist, the students will provide pharmaceutical care services to patient underwent solid organ transplant with deep focus on immune suppressants and on management of immunocompromised patients and transplant-related complications are also addressed in this rotation. 

3. ONCOLOGY/HEMATOLOGY. In this rotation the student will practice as a member of a multidisciplinary healthcare team caring for cancer patients. This rotation will give the student a focused look at chemotherapy/oncology patients and their special needs, treatment involving chemotherapy, managing side-effect of therapy and palliative care needs. The students will gain skills and knowledge through variety of patient care activities, discussion and selected exercise. 

4. PEDIATRICS. The primary emphasis of this rotation is to develop problem-solving skills in pediatric pharmacotherapy. This can be achieved through establishment of a strong knowledge base in pediatric pharmacology and pharmacokinetics in order to enhance the success of therapeutic plan. The rotation will include variety of activities related to pediatric population such as evaluating literature, interviewing patients or caregiver if needed, interpreting clinical and laboratory data, assessing drug therapy, making recommendations for and monitoring drug therapy, in addition to utilizing the evidence-based to assess for decision making.

5. HEPATOLOGY. This hepatology elective rotation designed to expand the student’s knowledge in hepatology and providing an educational environment for student that provides the opportunity to learn the clinical skills related to of end stage liver disease and liver complications.

Under the supervision of a clinical pharmacist, the students will provide experience and training in providing services for patients with liver diseases, complications of liver cirrhosis, viral hepatitis (hepatitis A, B and C), obstructive jaundice,  chronic pancreatitis and drug induced liver toxicity.

6. NEONATAL. The purpose of this rotation is to develop problem-solving skills in neonatal pharmacotherapy. The students will engage in active learning about neonatal intensive care topics and directly participate in providing a complete pharmaceutical care services and in resolution of medication-related problems in critically ill neonates. The rotation will include variety of activities related to neonatal ICU such as evaluating pertinent literature, interpreting clinical and laboratory data, assessing drug therapy, making recommendations for and monitoring drug therapy, in addition to utilizing the evidence-based to assess for decision-making.

7. EVIDENCE BASED MEDICINE. The purpose of the Evidence Based Practice rotation is providing a comprehensive evidence-based update in the management of common disease states. The student will be required to search of the latest evidence and discuss them in group with his/her peer. In addition to the reading, the rotation will also include presentations, and scientific writing requirements in a close supervision with a preceptor.

8. PHARMACY ADMINISTRATION. This rotation is designed to provide the student with the opportunity to experience and learn from the many challenges facing pharmacy administration. During this rotation, the student will work with one or more members of the pharmacy administration team. The student will be actively involved in the day-to-day pharmacy administration activities and will become familiar with the decision-making processes that maximize the patient safety outcomes and the financial performance.

9. DRUG INFORMATION CENTER (DIC). The drug information center is provide comprehensive, unbiased, evidenced-based medication information, coordination of the activities of the Pharmacy and Therapeutics (P&T) Committee and its subcommittees. The student in this rotation will provide drug information services to the patients, physicians, nurses and other health care providers. In addition, the student will have the opportunity to participate in daily issues of pharmacy services such as formulary and non-Formulary requests, drug shortages, drug recall, ADR reporting, development of departmental/hospital policies/protocols to standardize practices and improve overall safety of the medication use process, education of staff regarding medication use policy guidelines and Formulary changes.

10. PHARMACOECONOMICS AND FORMULARY MANAGEMENT. Pharmacoeconomics is the description and analysis of the costs of drug therapy to health care systems and society. It identifies, measures and compares the costs and consequences of pharmaceutical products and services. This practice experience is designed to provide the student with a basic understanding of the clinical, economic, and humanistic outcomes of healthcare interventions, focusing on Pharmacoeconomics and health care quality assessment. The rotation involves working directly with the formulary management expert, pharmacy administration, and P&T committee. The student will be exposed to and participate in many steps in conducting quality -focused, outcomes-based project and will have the opportunity to discuss various outcome studies such as CMA, CEA, CBA…etc.

11. SURGERY. The student in this rotation will become familiar with the key principles utilized in hospitals to provide pharmaceutical care services for peri-operative patients. The student will gain a general understanding of the medications involved with a surgery services with emphasis on surgical prophylaxis, parenteral nutritional support, perioperative anticoagulation management, and pain management. Other services that are normally provided by clinical pharmacist will also be addressed in the rotation.

12. DRUG MANUFACTURING. The experience rotation is designed to expose the student interns to the pharmaceutical industry. The rotation will be conducted in the manufacturer plant. The student will have the opportunity to observe all steps of drug manufacturing, from research to production. While under supervision, the students will work in the main sections of drug manufacturing: research, quality assurance, Production and Packaging Area. Topics related to drug manufacturer will be discussed during this four-week rotation such as GMP, drug recall, QS, QA, SOPs, warehouse functions …etc. since this rotation is conducted in a very restricted and well-controlled premises, the student are expected to show high level of professionalism, commitment and obedience to the facility policy and procedure.

13. DRUG COMPANY. This rotation will take place in the drug company scientific and administrative sections. The student will be given the opportunity to explore new areas for pharmacist in the drug market with an emphasis on communication, analytical and marketing skills. The student will work with the pharmacist in different sections including sales, regulatory affairs & quality, pharmacovigilance, and medical & supply chain. The preceptors will facilitate the student learning through engagement in all the above sections. In addition, the student may be required to join the preceptors in visiting institutions/agents outside the company premises, hence, the student should arrange all transportation during this rotation. Since this rotation is conducted in an outside facility, the student is expected to show high level of professionalism, commitment, self-guidance and obedience to the facility policy and procedure.

14. MEDICATION SAFETY. The Medication Safety Rotation is an opportunity for student to closely work with the interdisciplinary team of medication safety. The student will become familiar with the key principles utilized in hospitals and health systems to improve safe medication use. The rotation will expose the student to medication safety nomenclature, key principles, tools and available resources, in addition to the role of medication safety officer within the institution. The preceptors will help the student to develop skills needed to assess, manage, minimize, prevent, and report medication errors and adverse drug events. 

15. PHARMACY QUALITY ASSURANCE. In this experience, the student will have the opportunity to work closely with pharmacists in the section of pharmacy quality assurance. Definitions and basic concepts of pharmacy quality assurance and the role of “QI” pharmacist will be thoroughly discussed in this rotation. The preceptor will guide the student to how identify, categorize, investigate and report medications errors. The student is supposed to participate in investigating of medication errors and suggest strategies to prevent future events. In addition, values and process of health care system accreditation will be an area of discussion from different standpoints.

16. INFECTIOUS DISEASES. The infectious disease rotation is a learning experience directed at providing care for patients with acute infectious disease processes while practicing antimicrobial stewardship. Students will participate in all aspects of transdisciplinary care as part of the Infectious Disease Consult Service. As they will be involved with rounding with the ID team and managing the drug therapy of patients from admission to discharge. Identification of potential drug therapy problems, design and modification of drug regimens, therapeutic drug monitoring, provision of drug information, and patient counseling are core components of the rotation. 

17. ACADEMIA. The primary objective of this elective experience in academia is to offer the student the opportunity to both observe and participate in activities consistent with a full-time faculty appointment. The student will observe the faculty roles and responsibilities through several educational activities. In this experience, the students will be given the opportunity to participate in classroom teaching, course design and assessment, MCQ writing, academic quality assurance and committees.

18. INFORMATICS. The health Informatics rotation will help students become familiar with the key principles utilized in hospitals and health systems to improve pharmacy informatics, automation and health information technology. The rotation is designed to expose students to Informatics nomenclature, key principles, tools and available resources. The student will participate in several activities designed to improve the student’s working knowledge and experience with Informatics concepts. The rotation will enable the student to apply knowledge in any pharmacy practice setting to improve technology used to provide patient care.

19. ADVANCED INSTITUTIONAL OUTPATIENT. Under the supervision of the preceptor, the student will provide direct patient-centered care in an outpatient pharmacy setting. Students will experience the operation and management of outpatient pharmacy systems and the functions and responsibilities of a pharmacist in outpatient settings. Students will have the opportunity to be involved in all aspects of the medication use process and health care delivery in the outpatient setting.

20. CARDIOLOGY. This rotation is design for student to develop the knowledge base and clinical skills in order to provide pharmaceutical care services to patient with cardiovascular disease. The student will have the opportunity to work in both cardiac floor and cardiac ICU and, with close supervision, to manage variety of acute and chronic, medical and surgical, cardiac conditions. Diagnostic and treatment procedures related to cardiology will also be addressed in this rotation. 

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