Learning Experiences
Family Medicine
The Family Medicine rotation is a required longitudinal experience at the Saint Louise Family Medicine Center. The clinic is a family practice setting composed of attendings, medical residents, nurse practitioners, nurses, medical assistants, and a social worker. Clinical pharmacy services began in 2015 with expansion to full-time clinical services in 2017. The clinical pharmacy specialist at Saint Louise provides comprehensive medication management (CMM), patient/ caregiver counseling and education, as well as drug information to other members of the healthcare team. This will usually entail the care of 15-20 scheduled clinic patients through a mixture of face-to-face and telehealth modalities. While running clinic, the resident will also be responsible for precepting other residents and students on rotation through layered learning.
Outpatient Internal Medicine
Preceptor: Rebecca Hopper, BSPharm, PharmD, BCACP, BCADM, CDE.
The Internal Medicine rotation is a required month-long experience at Ascension Medical Group Nashville . The clinic is an internal medicine practice setting composed of physicians, nurse practitioners, nurses, medical assistants, and a social worker. Clinical pharmacy services began in 2016. The PGY2 Ambulatory Care resident will develop and monitor pharmaceutical care plans to patients with chronic conditions referred by physicians via either face-to-face or telehealth modalities. The resident will assess the need for patient education, teaching and reinforcement of appropriate medical devices and techniques, and initiate, titrate and taper medications. The resident may also be responsible for precepting students on rotation through layered learning.
Family Medicine II
The Family Medicine II rotation is a required one-month experience at the Ascension St. Thomas Medical Partners (ASTMP) Hendersonville and Mt Juliet Clinics. This clinic is a family practice, composed of physicians, nurse practitioners, nurses, medical assistants, nurses, and social workers. Clinical pharmacy services began in 2021. There will be collaboration with healthcare providers to deliver chronic care management in the patient centered home. The resident will also deliver provider education and have chronic disease state topic discussions.
Family Medicine III
The Family Medicine III rotation is an elective one-month experience at the Ascension St. Thomas Medical Partners (ASTMP) New Salem Clinic. This clinic is a family practice, composed of physicians (MDs and DOs), nurse practitioners (NPs), physician assistants (PAs), nurses (LPNs and RNs), certified medical assistants (CMAs), licensed clinical social workers (LCSWs), and a certified diabetes education/dietician (RD). ASTMP New Salem follows a Pod structure, whereas physicians see their own patients and supervise nurse practitioners and physician assistants within their Pod. Each provider has at least one certified medical assistant aligned to their practice. Each Pod has a designated Pod Nurse and Pod CMA that assists in the CMAs’ daily tasks as well as in providing levels of service appropriate for a licensed healthcare practitioner. Additionally, other RN positions in this clinic focus on care coordination; local, state, and federal compliance; supervision of clinical services, and process improvement. Clinical pharmacy services began in 2019 with expansion to full-time clinical services in 2020. The pharmacist at this clinic engages in a collaborative practice agreement (CPA) with the providers in each Pod. Whereas other rotation sites have multiple patient rooms available for pharmacist visits, the ASTMP New Salem clinic pharmacist delivers services through their office space and one patient room for triage, offering the resident opportunity to navigate operational complexity while developing service efficiency, a key practice management skill when developing a new ambulatory care pharmacy practice.
Anticoagulation
The Anticoagulation rotation is a required experience at the Anticoagulation Monitoring Clinic (AMC) at Ascension Saint Thomas Hospital West. The clinic was established in 2001 and is operated by three core clinical pharmacists who are specialized in anticoagulation. The clinic is a referral-based monitoring program for any Ascension-affiliated provider. The pharmacists have a collaborative practice agreement with a medical director who oversees the operations of the clinic and evaluates all patient visits. The pharmacists provide 15-30 minute appointments for patients on warfarin that include the following: INR testing via POC machine, obtaining vitals, interviewing the patient, and adjusting the warfarin dose when appropriate, and scheduling appropriate follow-up. If a patient is new to the clinic, the pharmacists will complete a comprehensive education counseling session at the first visit. The pharmacists also provide detailed enoxaparin or fondaparinux bridging plans for high risk patients with subtherapeutic INRs or who require warfarin to be held for procedures and have a high thromboembolic risk. In the case of periprocedural bridges, the pharmacists communicate with other healthcare providers (surgeons, referring physicians, etc.) to coordinate care plans as well as obtain the appropriate labs required for safely dosing the parenteral anticoagulants (i.e. SCr, PLT).
Resident-Managed Clinic
The Resident-Managed Clinic rotation is a required 9-month experience within Ascension Medical Group Tennessee. This experience will equip the resident with the skills needed to develop and manage their own independent ambulatory care pharmacy practice. In pursuing the dual goal of both expanding clinical pharmacy services within Ascension Medical Group Tennessee, as well as providing ambulatory care residents real-life experience in developing their own practice, the PGY2 resident will be responsible developing a new clinical pharmacy service at their assigned practice site. This will include:
- Development of relationship with a supervising physician and collaborating providers.
- Construction of a patient panel through referrals from practice clinicians and direct recruitment.
- Provision of comprehensive medication management services to referred patients.
- Support of the practice in quality initiatives and other population health activities.
- Service to practice clinicians as a drug information expert.
Outpatient Antimicrobial Stewardship
The Outpatient Antimicrobial Stewardship rotation is a required longitudinal experience at Ascension Saint Thomas Rutherford Hospital. The PGY2 Ambulatory Care resident will be responsible for identifying opportunities to improve antimicrobial prescribing within Ascension Medical Group Tennessee and collecting data necessary to demonstrate the opportunity. Based on the findings, the resident will design and implement a targeted process to improve antimicrobial prescribing at the practice site. The resident will also provide antimicrobial stewardship (AMS) education to patients and providers. Additionally, the resident will work with the Ascension Medical Group (AMG) quality team on AMS related projects and initiatives.
Scholarship and Teaching
The Scholarship and Teaching rotation is a required learning experience in coordination with Belmont University College of Pharmacy. The PGY2 Ambulatory Care resident will be responsible for writing a review article, leading family medicine journal club, providing an inservice during Family Medicine didactics, and presenting a continuing education session.
Research
The Research rotation is a required longitudinal learning experience at Ascension Saint Thomas. The resident will identify a scholarly question related to clinical practice, education, or healthcare useful to the health system, related to ambulatory care, and can be completed within the PGY2 year. The resident will be assigned a research mentor, who will work with the resident to design a research project and analyze findings. The resident will have opportunities to present their research at a national pharmacy conference (either ACCP or ASHP), the MidSouth Regional Pharmacy Resident Conference, and the Ascension Virtual Pharmacy Resident Research Conference. Finally, the project will be summarized in a manuscript suitable for submission to a peer-reviewed journal.
Inpatient Family Medicine
Inpatient Family Medicine is an elective 4-week learning experience at Ascension Saint Thomas Rutherford (ASTR). ASTR is a leading health-system in Rutherford County licensed for 356 beds located in Murfreesboro, Tennessee, and home to the UT Family Medicine program inpatient rounding service. In 2017, the pharmacy was awarded the Tennessee Society of Health-Systems Pharmacists (TSHP) Innovative Health-System Pharmacy Practice Award for its decentralized pharmacy practice model.
Cardiology
The Cardiology rotation is an elective learning experience at Ascension Saint Thomas Heart West in Nashville, Tennessee. This rotation provides the Ambulatory Care resident with essential clinical skills for managing patients with conditions such as heart failure, chronic coronary disease, hypertension, hyperlipidemia, peripheral artery disease, and a history of myocardial infarction or ischemic stroke. Additionally, it offers the resident exposure to advanced treatments and modalities available to patients with significant cardiovascular disease to help reduce their risk of future events.
Academia
The Academia rotation is an elective experience with a faculty member affiliated with Ascension Medical Group. The PGY2 Ambulatory Care resident will be responsible for participation in the faculty member's service commitments, assisting the faculty member with one of the courses they direct, facilitating Introductory and Advanced Pharmacy Practice Experiences weekly, conducting topic discussion for APPE rotation students, and provide one presentation/ lecture. Additionally, the resident will participate in clinical activities with the preceptor as directed.
Outpatient Mental Health
The Outpatient Mental Health rotation is an elective experience at the Veterans Affairs Tennessee Valley Healthcare System – Nashville Campus. The elective opportunity affords the resident to provide clinical services in two mental health treatment settings, the Behavioral Health Interprofessional Program (BHIP) and Primary Care Mental Health Integration (PC-MHI). Dr. Lister practices in outpatient mental health, improving access to mental health care, evaluating appropriateness of pharmacotherapy regimens, coordinating care for veterans, fostering a collaborative interprofessional environment, and enhancing a veterans' overall satisfaction with outpatient mental health treatment. Comprehensive medication management is actively assessed and managed through the evaluation of a patient's review of symptoms, completion of applicable clinical assessment measurements, and discussion of current and past medication effects
Pain Management
Preceptor: Claire Brandt, PharmD, BCPS
The Pain Management rotation is an elective experience at the VA Tennessee Valley Healthcare System. The Regional referral Pain Clinic at VA Tennessee Valley Healthcare System provides specialty pain management services for more than 80,000 veterans enrolled in middle Tennessee. Veterans are referred from their primary care providers (PCP) to provide expert evaluation and treatment options for veteran’s struggling with persistent pain. The resident will participate in two distinct types of clinical care during this learning experience. Our interdisciplinary comprehensive pain clinic is a secondary referral clinic for our most complex cases where veterans are seen jointly by a pain physician, pain pharmacist, and pain psychologist and this clinic sees a few scheduled patients once per week. The pain pharmacotherapy clinic is a high-risk clinic and a secondary referral clinic utilized by our pain providers when veterans require more frequent clinic visits and monitoring. Both clinics will be supported by the resident and provide unique experience in the complex care of high-risk patients. The resident will participate in the care of pain patients in the outpatient clinic along with pharmacists, physicians, nurses, nurse practitioners, and psychologists specialized in pain management.
Inpatient Family Medicine
Inpatient Family Medicine is an elective 4-week learning experience at Ascension Saint Thomas Rutherford (ASTR). ASTR is a leading health-system in Rutherford County licensed for 356 beds located in Murfreesboro, Tennessee, and home to the UT Family Medicine program inpatient rounding service. In 2017, the pharmacy was awarded the Tennessee Society of Health-Systems Pharmacists (TSHP) Innovative Health-System Pharmacy Practice Award for its decentralized pharmacy practice model.