Driving through Southern Idaho this summer on the way to a mountain lake vacation, I noticed something unusual in several of the sugar beet fields.  A roof, completely intact, collapsed onto the ground, around the remains of a log cabin. Perhaps a hastily built home trying to avoid the endless snow and wind across the sagebrush desert?  It definitely reminds us of the need to build a solid foundation, because without that, a roof on the ground doesn’t provide much shelter.

As a clinical pharmacist in family medicine, and faculty member at the University of Utah; currently in the midst of curriculum change – I am constantly reminded of the need for a solid foundation. Certainly for our students – who must know and understand and think critically about all areas of pharmacotherapy to be ready for their advanced rotations. But it also is core to why I have maintained my dual certifications in Pharmacotherapy (BCPS) and Ambulatory Care (BCACP).  As a junior faculty member almost 20 years ago, BCPS was the only certification available, and my clinical practice involved rounding with the family medicine inpatient team in the morning, and going to the clinic in the afternoon.  At the time, BCPS fit my inpatient/outpatient life well, as I could be asked questions and provide care to patients from the ICU to the geriatrics clinic.   Before transitions of care became the buzzword of the decade, this is what many family medicine pharmacists did – seamlessly transitioning between two worlds, and helping our patients do the same.

BCPS certification is my foundation; solid and enduring. While I am no longer rounding with the inpatient team, I am spending significant amounts of time in transitions of care.  While I am not an expert in the latest inpatient pharmacotherapy; I frequently utilize evidence based resources and colleagues and critical thinking skills to answer patient and provider questions about the care our patients have received as inpatients.  I am exceptionally proud of the time I spent as a member and chair of the Pharmacotherapy specialty council; the care and emphasis on critical thinking and foundational patient care knowledge that is infused in the exam – ensuring that pharmacists who carry the BCPS credential have a strong foundation in pharmacotherapy.

In 2013, I re-invigorated the PGY 2 in ambulatory care at the University of Utah; and amongst the changes since I was the director nearly 10 years previously, was a requirement for the director to be board certified in ambulatory care. I do have to admit I was somewhat irritated at needing to take another exam – but in retrospect – just like our students as they embark on residencies – I had built my foundation with BCPS, and then laid a solid roof by becoming board certified in ambulatory care.

As I recertify in Pharmacotherapy this year, I have read and studied many areas of pharmacotherapy that apply to both inpatient and outpatient care – and what I have really enjoyed is that many of the things I have learned (relearned?) have been in areas that I probably would never have sought out – but they have advanced my ambulatory care practice significantly. I never knew there was a guideline on the intricacies of what to do after a first seizure – and after reading the recertification article assigned for my BCPS recertification hours, my care of patients with first seizure in my clinic will be improved. Like many of my ambulatory care colleagues who were originally certified in Pharmacotherapy; I have decided to keep my BCPS credential. I think of keeping my foundation strong; so my roof can stay up.


Karen M. Gunning, Pharm.D, BCPS, BCACP, FCCP

Professor (Clinical) and Interim Chair of Pharmacotherapy

Adjunct Professor of Family & Preventive Medicine

PGY 2 Ambulatory Care Residency Director

Clinical Pharmacist – University of Utah Family Medicine Residency/Sugarhouse Clinic

University of Utah College of Pharmacy & School of Medicine