Residency

Internal Medicine/GI Ambulatory Care Rotation

Preceptor:

Anthony Dalpiaz, PharmD

Site Description:

The Gastroenterology clinic is located within the University of Utah Health Care Hospital. The clinic is adjacent to many specialty clinics, infusion center, laboratory, and outpatient pharmacy. Clinical pharmacy services include patient education and consultation in hepatitis C, inflammatory bowel disease, GERD, eosinophilic esophagitis, and general GI issues. The interdisciplinary Inflammatory Bowel Disease (IBD) Clinic is composed of a gastroenterologist, colorectal surgeon, nurse, dietician, and a pharmacist and is located in the Surgery Clinic. The Internal Medicine clinic is located next door to the Gastroenterology clinic.

Rotation Description

You will observe, participate and write up SOAP notes and medication reconciliation for all patients that you see in clinic. Provide patient education on disease state management and new medications, evaluate drug therapy regimens, provide recommendations for optimizing drug therapy, monitoring, and patient compliance. You will also be involved in the triage process of medication-related problems of clinic patients. You will lead at least 1 topic discussion per week and present 1 inservice for nursing staff and do 1 major clinic project (i.e., patient education handout). You will be interacting extensively with patients, providers, and ancillary personnel. The fellows (Gastroenterology) and resident (Internal Medicine) clinics will have many opportunities to provide provider education and drug information. You will also be required to attend Internal Medicine Grand Rounds on a weekly basis, Gastroenterology clinical conference on a weekly basis if applicable, IBD conference on a monthly basis, and attend Utah Medicaid Drug Utilization Review Board meetings on a monthly basis.

RLS Goals Evaluated

R2.2	Place priority on the delivery of patient centered care to patients
R2.3	As appropriate, establish collaborative professional pharmacist-patient relationships
R2.5	When necessary, make and follow up on patient referrals
R2.12	Document direct patient care activities appropriately
E7.1	Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues
E7.3	Balance obligations to oneself, relationships and work in a way that minimizes stress

Activities Evaluated:

Rotation Activity	RLS Goal	Teaching Methods
Conduct 3-10 patient interviews per day to determine current drug therapy and relevant medication history.	R2.2	Modeling Coaching Facilitating
Evaluate medication therapy and identify medication-related problems on all assigned patients. Clearly and effectively communicate recommendations for modifying drug therapy directly to the provider on all patients (~3-10 per day).	R2.2 R2.3 E7.1	Instruction Modeling Coaching Facilitating
Respond to drug information questions from providers and patients in the gastroenterology, inflammatory bowel disease, and internal medicine clinic in and accurate and timely manner. (Questions arise daily on rotation.)	R2.2 R2.3 R2.12 E7.1	Instruction Modeling Coaching Facilitating
Participate in the multidisciplinary IBD Clinic team by providing medication information and education to the patients and providers and to ensure patient has access to drug therapy - particularly costly and complicated medications.	R2.5	Modeling Coaching Facilitating
Document all patient interventions and SOAP notes per protocol for all patients seen in clinic.	R2.12	Coaching Facilitating
Provide patient education on the various drug treatments and design patient education handouts as needed.	E7.1	Coaching Facilitating
Lead at least one formal topic discussion and at least one formal journal club.	R2.2	Coaching Facilitating
Attend Internal Medicine and GI conferences every week if applicable, and attend IBD meetings on a monthly basis. Attend Medicaid DUR Board meeting once monthly	R2.2 E7.1	Coaching Facilitating
Complete an in service for clinic practitioners and a relevant clinic project.	E7.1	Coaching Facilitating
Successfully participate in daily clinic activities and attend mandatory residency meetings, as well as attend other meetings outside of clinic time. Review progress on presentations and projects, as well as plans to accomplish patient care tasks and outside meetings with the preceptor at least weekly.	E7.3	Coaching

Core Topics to be Covered During Rotation:

GERD
Eosinophilic esophagitis
End-stage liver disease/hepatitis
Hepatitis C
NASH/fatty liver disease
Inflammatory bowel disease
Irritable bowel syndrome
General Internal Medicine topics: HTN, hyperlipidemia, diabetes mellitus, pain management, depression and anxiety, etc.

Readings and Preparatory Work:

GERD guidelines
AASLD hepatology guidelines for hepatitis C and management of end-stage liver disease
Inflammatory bowel guidelines
JNC (most current)

Project/Presentation Description:

You will give a 15-25 minute inservice to either the clinic ancillary personnel or providers AND you will create a 1-2 page patient education handout on a given topic such as a disease state, commonly new medications, or pertinent issues that arises.

Typical Daily/Weekly/Monthly Activities:

Monday — GI fellows clinic 0830-1300, Autoimmune/IBD and GERD 1330-1700
Tuesday — Internal Medicine clinic 0845-1700, Autoimmune/IBD 1300-1700 (1 Tuesday per month)
Wednesday — Autoimmune IBD clinic 0730-1230, Interdisciplinary Autoimmune/IBD clinic 1300-1700
Thursday — Internal Medicine Grand rounds 0745-0845, Internal Medicine clinic 0900-1700
Friday — Internal Medicine clinic 0830-1200, Hepatitis C clinic 1200-1700, OR Autoimmune/IBD and GERD 1330-1700 (1 Friday per month)

Evaluations:

The resident will receive regular formative feedback related to patient care activities, patient education, and inservice. A midpoint evaluation will be completed at the midpoint and a final summative evaluation will be completed at the end of the rotation in ResiTrak.

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