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Residency

Endocrinology - Ambulatory Care Rotation

 
Preceptor:

Denise Small, PharmD, CDE

 
Site Description:

The Utah Diabetes Center is a complete endocrinology clinic caring for adults in Utah, Idaho, Nevada, Montana, and Wyoming.

The clinical pharmacist working at the Utah Diabetes Center is responsible for providing diabetes education, medication review and adjustments, blood pressure and cholesterol checks, and laboratory review both as one-on-one appointments and in group classes. The pharmacist also works with the providers 1/2 - 1 day per week in our endocrinology clinic consulting on specific patient the provider is examining that day, 1/2 day per week at the hospital providing diabetes education to patients at the hospital, and 1 day per week at the hospital providing medication reconciliation and treatment suggestions. The majority of the time is spent in face to face contact with patients and providers providing pharmaceutical care.

 
Activities Evaluated:

Rotation Activity RLS Goal
As appropriate, establish collaborative professional relationships with members of the health care team. R2.1
Place practice priority on the delivery of patient-centered care to patients. R2.2
As appropriate, establish collaborative professional pharmacist-patient relationships. R2.3
When necessary, make and follow up on patient referrals. R2.5
Design evidence-based therapeutics regimens. R2.6
Design evidence-based monitoring plans. R2.7
Implement regimens and monitoring plans. R2.9
Document direct patient care activities appropriately. R2.12
Provide effective medication and practice-related education, training, and counseling. R5.1
Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and colleagues. E7.1
Communicate effectively. E7.2
Balance obligations to oneself, relationships and work in a way that minimizes stress. E7.3

 
Activities Evaluated During Rotation:

Typical expectations of residents include the following:

  1. Leading the group classes for diabetes education during the month (E7.1, R5.1, E7.3)
  2. Evaluating patients in one-on-one appointments and making appropriate changes to their medications under consultation with the provider. Typically seeing about 4-6 patients per day 3 days per week (R2.1, R2.2, R2.3, R2.5, R2.6, R2.7)
  3. Providing medication reconciliation, treatment suggestions, evaluation of drug-drug/drug-disease interactions, and other research for the patient/provider 1 day per week in our endocrinology clinic. Typically visiting 4-6 patients this day (R2.5, R2.6, R2.7, R2.9, E7.1)
  4. Providing medication reconciliation, treatment suggestions, evaluation of drug-drug/drug-disease interactions, and patient counseling on medications 1 day per week at the hospital. Typically visiting with 8-10 patients on this day. (R2.12, R2.5, E7.1)
  5. Presenting one case presentation or completing one project during the rotation. This will be determined the first week of rotation based on clinic needs and resident interests. (R2.6, E7.1, E7.2)
  6. Leading discussions with the preceptor on a variety of endocrinology topics 1-2 days per week. One topic discussion of your choice will require creation of a handout (R2.6, E7.1, E7.2)
  7. Precepting pharmacy students on rotation (R5.1)
  8. Documenting all patient care activities in the electronic medical record. Usually 4-10 patients per day depending on the area of practice (R2.12)
  9. Have resident outline their activities and project management plan for the rotation with preceptor each week (E7.3)
  10. More than 70% of your time is spent doing direct patient care. The remainder is in the other activities mentioned above. You will get to work with and wear various insulin pumps, continuous glucose monitoring systems, and blood glucose meters. (R2.2, R5.1)

 
Readings

Diabetes Care Clinical Practice Guidelines: http://care.diabetesjournals.org/content/34/Supplement_1
Additional information will be given on first day of rotation

Core Topics to Be Covered

  1. Diabetes pathophysiology, prevention and treatment
  2. Hypertension, nephropathy, and cholesterol treatment in patient with diabetes
  3. Treatment of neuropathy in patient with diabetes
  4. Hyperthyroidism and Hypothyroidism

Elective Topics

  • Diabetes insipidus
  • Adrenal excess and Adrenal insufficiency
  • Antidiuretic hormone excess and insufficiency
  • Parathyroid
  • Aldosterone

 
Typical Schedule

Monday: 8am-12pm: patient care in diabetes education
  1pm-4pm: Topic discussion and catch up time
Tuesday: 8:30am - 4:30pm: medication reconciliation at the hospital
Wednesday: 8am-5pm: patient care in diabetes education
Thursday: 8am-12pm: Endo clinic or diabetes education
  12pm-5pm: Endo clinic or diabetes education
Friday: 9am-12pm: Hospital diabetes education
  12pm-5pm: Patient care in diabetes education

 
Evaluation:

The resident will have direct contact with the preceptor nearly every day of the rotation. The preceptor will provide formative feedback on patient care activities and literature evaluation and preparation on a regular basis throughout the rotation. The preceptor will sit with the resident to complete a full summative evaluation of the rotation on the last day.