Advanced Pharmacy Practice Experience (APPE) rotations are a defining chapter of pharmacy school. After years of classroom lectures, pharmacokinetics equations, and drug interaction tables, APPE is where everything finally comes together in real time. Whether you are joining an inpatient pharmacy team, rounding in the ICU, or seeing patients in an ambulatory care clinic, the expectations are greatly increased in comparison to Introductory Pharmacy Practice Experience (IPPE) rotations. Preceptors are not looking for students who can recite a mechanism of action. They want students who can think, apply, and communicate like a pharmacist. APPEs serve as the bridge between a student that needs supervised and a pharmacist that performs the supervising. For this reason, preceptors want to ensure that their students are prepared for making real decisions in real scenarios.

The transition to an APPE rotation can feel overwhelming at first. Most students enter their first APPE rotation unsure of how to present a patient, what to look for on morning rounds, or how to structure a Subjective, Objective, Assessment, and Plan (SOAP) note that succinctly yet sufficiently provides information. The good news is that excelling throughout your APPEs is attainable, and this post will provide guidance on creating patient case workups, topic discussions, and SOAP notes that will impress your preceptor.

The Art of the Patient Case Work-Up

One of the most important experiences you will have on clinical rotations is discussing a patient case with your preceptor. Patient case presentation is a cornerstone of learning, especially during internal medicine and critical care APPEs. This is not simply reading the chart and summarizing what the nurse or provider documented. A pharmacy student workup is an active, clinical analysis of everything happening with a patient, filtered through the lens of pharmacotherapy.

• Where to Start: Begin with the admission diagnosis and the reason the patient is in the hospital. Then, review the medical history, surgical history, allergies, home medications, and any active problems. Pay particular attention to any comorbidities or lifestyle choices that could complicate treatment options. This background establishes the context necessary to understand where the patient came from before you can make meaningful recommendations. For example, if a patient with a complicated UTI has a documented sulfa allergy, it would not be wise to consider sulfamethoxazole-trimethoprim for this patient.

• Review the Medication List Critically: Instead of simply copying down the medication list, dissect it. For every drug, ask yourself:
  • What is the indication?
  • Is the dose appropriate for this patient’s renal and hepatic function?
  • Are there any drug interactions with other medications on the list?
  • Is the duration appropriate?
  • Does the route of administration make sense given the patient’s current clinical status?
  • Are there any medications from home that were inappropriately continued or held?

Since a prudent pharmacist would be looking at the medication list with this level of evaluation, preceptors are expecting their student to do the same. This gives students the opportunity to practice with their guidance before they are on their own after graduation.

• Labs, Vitals, and Trends: After the medication list has been evaluated, move to the labs and vitals of the current admission. Pay attention to trends, not just single values. A creatinine of 1.8 mg/dL looks different in a patient whose baseline is 0.9 mg/dL versus one whose baseline is 1.6 mg/dL. Look at inflammatory markers and white blood cell counts if infection is in the differential. Review cultures and sensitivities to assess whether empiric antibiotic therapy needs to be de-escalated and/or is appropriate. Evaluate glucose trends if the patient is on insulin or high-dose corticosteroids. Think about electrolytes in the context of the patient’s medications. For example, could the patient’s hypokalemia be due to furosemide use? Here is a list of reference ranges for common lab values that may be useful when reviewing a patient’s chart:

Lab Value	Standard Range	Lab Value	Standard Range
Sodium	136-142 mEq/L	AST	10-30 U/L
Potassium	3.5-5.0 mEq/L	ALT	10-40 U/L
Calcium (total)	8.2-10.2 mg/dL	Hemoglobin	12-18 g/dL
Magnesium	1.3-2.1 mEq/L	Platelet count	150-350*103 cells/mm3
Glucose (fasting)	70-110 mg/dL	WBC	4.5-11.0*103 cells/mm3
Serum creatinine	0.6-1.2 mg/dL	BUN	8-23 mg/dL

• Building Your Assessment: Once you have gathered the data, synthesize it. What is the patient’s active problem list from a pharmaceutical standpoint? What is optimized, what needs to change, and what needs monitoring? Be prepared to provide at least one concrete recommendation for each active problem. This could include adding a specific drug (with dose, route, and frequency) to the current or home medication list. It could also include changing a current drug to an alternative agent or discontinuing a current drug altogether. If an active problem does not require any medication changes, provide a lab value that should be monitored in relation to the active problem. Your preceptor does not expect you to know everything, but they do expect you to show that you thought critically about the patient in multiple capacities.

Mastering the Topic Discussion

Topic discussions (sometimes called pharmacotherapy discussions, drug information sessions, or topic presentations) are a standard expectation on nearly every APPE rotation. These are structured, educational conversations where the student is given a relevant topic, researches it thoroughly, and presents the information to the preceptor or team.

• Choosing a Topic: The best topic discussions arise naturally from a patient encounter. If you admitted a patient with community-acquired pneumonia (CAP) and had a question about the role of respiratory fluoroquinolones versus beta-lactam/macrolide combination therapy, that would be a suitable topic. If a recent patient in the anticoagulation clinic asks about the differences between rivaroxaban and apixaban for atrial fibrillation, That may be considered as a topic. Tying the discussion to a real patient not only makes the content more relevant, but it demonstrates clinical curiosity.

• Structuring Your Preparation and Research: A strong topic discussion is not merely a web-browser summary. Topic discussion should be based on primary literature and current clinical guidelines. Start with the most recent guidelines from relevant professional organization (ACC/AHA for cardiology topics, IDSA for infectious disease, ADA for diabetes, etc.). Understand the guideline recommendations and the evidence provided that led to the recommendations. Then, look into one or two key clinical trials that relates to the topic and be able to discuss the study population, primary outcome, results, and clinical implications.

• Format and Delivery: Topic discussions do not need to be formal slideshow presentations unless your preceptor requires it. In many cases, a concise verbal summary with supporting notes or a one-page reference is appropriate. Aim for clarity over comprehensiveness. A 10-minute discussion that covers the key points clearly and invites dialogue is more impressive than a 30-minute monologue that feels like the student is reading off a script.

• Responding to Questions: Be prepared to answer follow-up questions. Preceptors will probe your understanding by asking about subpopulations, contraindications, cost considerations, medication adverse effects, or patient counseling points. If you cannot answer something, it is completely acceptable to say: “I am not sure, but I will look that up and follow up with you.” Intellectual honesty is respected far more than simply guessing.

Writing a Pharmacy SOAP Note

A well-crafted SOAP note is a clinical communication tool that showcases your reasoning when providing recommendations. Learning to write one well is a skill that will carry you through APPEs, residency, and beyond. Here is how to approach each section:

• Subjective (S)
  • The subjective section captures information from the patient’s perspective such as what they report, how they feel, and what brought them to seek care. This includes the chief complaint, history of present illness (HPI), relevant social and family history, and current medications. It may also include relevant patient-reported symptoms such as pain level, nausea, shortness of breath, or adherence concerns. A common mistake pharmacy students make in the subjective section is providing too much or too little information. You do not need to recite the patient’s entire history, only what is relevant to the problems you are addressing. If you are writing a SOAP note for a patient presenting with uncontrolled hypertension, the relevant subjective data includes their blood pressure readings at home, their adherence to current antihypertensives, their diet and sodium intake, and their current symptoms (if any). Their history of an appendectomy in 1999 would not be appropriate to include in this SOAP note.

• Objective (O)
  • The objective section contains measurable, verifiable clinical data. This includes the patient’s past medical and surgical history, current home medications, vital signs, laboratory values, relevant diagnostic findings (ECG, imaging results, culture data), current inpatient medication doses and routes, and physical exam findings relevant to the problem being addressed. For pharmacy-specific SOAP notes, the objective section often becomes particularly rich because medication-related data is central to the assessment. Renal function values (SCr, CrCl, eGFR), hepatic function markers (AST/ALT), drug levels if applicable (vancomycin troughs, digoxin levels, lithium concentrations), and key lab parameters that monitor efficacy or toxicity should also be included. Keep the objective section factual and organized. This is not the place for interpretations, just providing information.

• Assessment (A)
  • This is the most intellectually demanding section of the SOAP note, and it is the one that most reveals your level of clinical thinking. The assessment is where you interpret the data and identify the drug therapy problems (DTPs) present for the patient. Organize your assessment by problem. For each active problem, state whether the condition is controlled or uncontrolled, staging of the condition (if applicable), identify any medication-related issues (subtherapeutic dosing, adverse effects, drug interactions, inappropriate therapy, unnecessary medications, need for additional therapy), and connect the objective data to support your conclusion. Proper citations should be included throughout the assessment to provide evidence-based clinical reasoning that explains how you analyzed the patient and came to your conclusions. For example, if a patient with diagnosed HFrEF is not currently receiving an SGLT2 inhibitor, you could state, “The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure recommends patients with stage C HFrEF receive an SGLT2i to reduce heart failure-related hospitalizations” to provide concrete reasoning into why you recommended the patient be prescribed empagliflozin. The provider or preceptor appreciate and expect your recommendations to have primary sources present.

• Plan (P)
  • The plan translates your assessment into specific, actionable recommendations. Every drug therapy problem identified in the assessment should have a corresponding plan. A well-written plan includes the specific intervention (with drug name, dose, route, frequency, and duration), monitoring parameters (symptoms to watch for, lab values to look at, what target you are aiming for, and how often to re-check), and patient counseling points. Using the HFrEF example above, the plan might read: “Recommend initiating empagliflozin 10 mg by mouth once daily. Monitor renal function (SCr, BUN) and electrolytes (Na, K, Cl, Mg) every 3 months, signs of euglycemic DKA, and counsel patient on signs of UTI (dysuria, hematuria, polyuria, urinary urgency).” This level of specificity is necessary to practice because it reflects how real clinical pharmacists think and document in their daily practice.

Habits of Successful APPE Students

Beyond the three core projects described above, students who truly stand out on APPEs share a few habits that are worth highlighting.

• Be proactive, not reactive: Do not wait for your preceptor to ask you to look something up. Come to each interaction with questions already formulated and answers already researched. Find the drug-related problems before they are pointed out to you.

• Own your mistakes and learn from feedback: You will make errors in judgment during your APPEs, but this is expected and part of learning. What matters is how you respond. Preceptors notice students who internalize feedback, adjust, and improve. The ability to accept constructive criticism and grow from it is a transferable skill that can be beneficial in your future career.

• Communicate with confidence, not arrogance. When presenting a patient or making a recommendation, be clear and direct. State what you found, what you think it means, and what you recommend. You are not expected to know the correct recommendation for every situation but avoid presenting all your points with hesitation.

• Build relationships with the team. Pharmacy students who take time to understand the workflow of the nurses, physicians, and other health professionals they work alongside are consistently rated higher by preceptors. Interprofessional collaboration is not a buzzword. It is daily clinical practice that is utilized in nearly every pharmacist’s career.

The Big Picture

Every patient case you work up, every topic discussion you prepare, and every SOAP note you write is building the clinical foundation that will define your practice as a pharmacist. If you ever feel stuck, be bold enough to ask questions. Every pharmacist knows what it’s like to be a student. This is your opportunity to demonstrate and observe the implementation of what you have learned from pharmacy in clinical practice. Put your best foot forward in your rotation to not only impress your preceptor, but to take advantage of your opportunity to learn and grow. The students who come out of APPEs ready for residency, fellowship, or entry-level practice are the ones who approached each rotation as an active learner rather than a passive observer. The skills covered in this post are the same skills that preceptors evaluate, residency programs reward, and employers expect. Start building these skills now, refine them on every rotation, and utilize them when you become a full-fledged pharmacist.

-APPE Student, Mollie Walters

References

1. American Society of Health-System Pharmacists. Emergency medicine APPE student rotation. Accessed June 29, 2026. https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/preceptor-toolkit/sicp-emergency-appe-student-rotation-updated.pdf
2. Podder V, Lew V, Ghassemzadeh S. SOAP Notes. In: StatPearls. StatPearls Publishing; updated August 28, 2023. Accessed June 29, 2026. https://www.ncbi.nlm.nih.gov/books/NBK482263/
3. Stamm PL, Haines ST, Edwards KL, et al. Educational outcomes necessary to enter pharmacy residency training: 2023 update. J Am Coll Clin Pharm. 2024;7(9):952-956. doi:10.1002/jac5.1994
4. Stowers L. Early APPE advice. Transitions. American Pharmacists Association. Published September 18, 2018. Accessed June 29, 2026. https://www.pharmacist.com/Publications/Transitions/early-appe-advice
5. American Society of Health-System Pharmacists. Tips and tricks for APPEs and internships – A perspective of our own. ASHP Podcasts: Student Perspectives. Published May 16, 2025. Accessed June 29, 2026. https://www.ashp.org/professional-development/ashp-podcasts/student-perspectives/2025/tips-and-tricks-for-appes-and-internships-a-perspective-of-our-own
6. American College of Clinical Pharmacy. Reference values for common laboratory tests. Pharmacotherapy Self-Assessment Program (PSAP). Published May 2026. Accessed July 1, 2026. https://www.accp.com/docs/sap/Lab_Values_Table_PSAP.pdf