Monday, January 9, 2017

Rotation 6 - General Medicine

Posted by Millie at Monday, January 09, 2017

Although rotation block 6 is six weeks rather than the traditional five, the time really flew by! For this rotation I was back at UMHS for my general medicine rotation on the adult internal medicine service. The largest difference from my last inpatient rotation (SICU) was that instead of a very large interdisciplinary rounding team (see SICU post from October), I rounded with 1-2 medical residents and 1 medical attending. I hadn’t realized previously how different the rounding structures could be, and I’m very grateful I was able to experience both types.

My service admitted patients every other evening. We would generally round at 8:30 AM. On post-call days (the morning after the medical resident had been admitting patients ALL night), we would typically round 30 min-60 min earlier than the regular rounding time (so 7:30 AM instead) so that the resident could go home and sleep after being awake for 30+ hours!

Below is a typical schedule for if we were to round at 8:30 AM:

6:30 AM: Arrive at hospital to work up patients. I followed 11 patients, the max number of patients for my service.
8:00 AM – 8:30 AM: Meet with preceptor to go over patients. I would give an abbreviated presentation and mention any VERY pertinent issues and run my planned recommendations by my preceptor for her feedback.
8:30 AM-11:30 AM/12:00 PM: Round with medical team. These were bedside rounds, and it was a different experience from my previous inpatient rotation because we actually went into the patient rooms and spoke with the patients.
12:00 PM-2:00 PM: Grab lunch, follow up on questions for medical team, document scoring tools, medication reconciliation, anticoagulation discharges
2:00-2:30 PM: Meet with preceptor to go over patients. I would present patients, fill my preceptor in with what happened on rounds that morning, and discuss any new recommendations I had for my patients.
2:30-3:30 PM: Meet with other rotation students for case presentations, topic discussions, journal club. We each had a number of rotation projects for this block and it was really interesting to learn about different topics from each student.

Since the medical residents and medical attending changed so frequently, I made sure to always introduce myself to anyone new and make sure they knew I was part of the pharmacy team and that they were able to page me and come to me with any questions. Over the rotation, I received quite a number of pages from my team asking for my opinion or if I could look into something for them, and it was always a nice feeling to see how much they appreciated my help and how much I was able to help my patients. On the flip side, I also sent quite a few pages to my team whenever I felt there was a problem or that we could make an improvement in therapy for a patient.

Overall, I was very fortunate to have such a great preceptor who gave me a lot of autonomy and responsibility early on in this rotation. After a couple of days, she had me round with the medical team by myself and continue rounding by myself for the rest of the rotation. After the first week of the rotation, she had me documenting on the pharmacist scoring tool and gaining experience writing patient notes. By the middle of the rotation, any pages from the medical team that were directed to the pharmacist pager went to my pager and I was responsible for 1) answering any questions from the team, or 2) looking up any questions I didn’t know and following up with the team.

By the end of the rotation, I was working up patients, rounding alone, documenting on the scoring tool, writing and updating pharmacy notes, and was responsible for the pharmacist pager for my team. Although I had many responsibilities, I was still able to bounce ideas off of other students or my team and I was constantly learning new things from my preceptor, who was always there as a supportive mentor and teacher. I really grew a lot during this rotation and it was great to finally feel like a pharmacist. It was a great 6 weeks!

Apart from rotation, the other major event that happens during Block 6 is the Midyear Clinical Meeting. Jared has discussed this event at length in a blog post below so I won’t go into this too much, but I definitely will second how important it is to get your transcripts in EARLY and to ask for your letters of recommendation early as well. Although it was very busy to have rotation during the same time as Midyear, I was glad I ended up having my second inpatient rotation during block 6 because I gained much more patient care experience and I learned so much more about myself -- experiences I may not have otherwise gotten prior to the conference.

Monday, January 2, 2017

Ambulatory Care at the University of Michigan Canton Health Center (Rotation 6)

Posted by James Shen at Monday, January 02, 2017

My 6th rotation was at the University of Michigan Canton Health Center where I got to experience the day-to-day of an ambulatory care pharmacist. The University of Michigan is unique in that the structure of their ambulatory care model revolves around a patient-centered medical home (PCMH) model.  Essentially, clinical pharmacists are integrated throughout the various UMHS clinics, and are able to assist providers in managing chronic conditions, such as diabetes, hypertension, hyperlipidemia, or asthma through a collaborative practice agreement. 

There is always opportunity to improve patient care when it comes to chronic conditions, whether it is through medication related changes or lifestyle optimization. Typical services that I provided while I was at this clinic included medication reconciliations, medication adherence assessments, patient self-management and goal setting, medication initiation and dosage adjustments through the collaborative practice agreement, patient education on chronic conditions and medications, lab orders for diagnostic tests, and some physical assessments (blood pressure readings, pulse monitoring, diabetic foot exams). A large portion of my patient population was primarily diabetic, but many patients had concomitant hypertension and/or hyperlipidemia issues as well. Additionally, I also had a few pediatric asthma patients, which was an interesting change of pace from my typical patient base.

I saw approximately 5-10 patients each day, but the number could vary depending on who showed up to the clinic. We discussed everything from their lab values, their health goals, their diet and exercise, their medication adherence, their personal stress, etc. It was important to establish a strong rapport and relationship with each patient, because many of these patients would often be back within the next few weeks for follow-up visits. By the second week, I was seeing these patients independently without any preceptor backup, coming up with recommendations, and writing up full SOAP notes for each encounter. I finally felt like I was a real pharmacist – the patients truly respected my opinion and treated me as a healthcare professional, not just a student!

After meeting with each patient, it was up to me to come up with an assessment and plan for moving forward. How many episodes of hypoglycemia did they have in the past month? What is their average fasting blood sugar? Is the patient a smoker, and if so, how motivated are they to quit? Is there a major holiday coming up that may affect diet (ex: Thanksgiving)? How is the patient’s stress level at home and work? Is their A1C, blood pressure, or ASCVD risk score at goal? Do we need to order any new labs? These are just some of the many questions that I needed answers to before I could come up with a reasonable plan. Many times, patients just needed a little encouragement and reinforcement for sticking to healthy lifestyle goals. You would be surprised how far a little motivational interviewing can take you. However, we also frequently adjusted insulin regimens, started new medications, or discontinued current medications based on a patient’s status.  


Other projects during this rotation included comprehensive medication reviews, topic discussions, patient case presentations, and journal club presentations. Overall, this was an interesting rotation that provided me valuable insight into the role of an ambulatory care pharmacist. It was rewarding to establish a strong relationship with a patient, develop a plan of action, and then follow-up with the patient at the next visit to see if he or she improved. The patients were always very grateful, and enjoyed talking with us about their overall healthcare. For anyone interested in ambulatory care, the UMHS clinics and the PCMH model is definitely the way of the future. Not only do pharmacists partner with their patients and empower them to take an active role in managing their own health, but the pharmacists also have a lot of autonomy when it comes to making any medication related changes or recommendations. 

Thursday, December 29, 2016

Rotations 4-6: Working from Home, the MICU, and the Off-Rotation/Midyear

Posted by Jared at Thursday, December 29, 2016

Hello everyone! Apologies for the delayed post, but the last couple months have been quite a busy time! I'll summarize my last few rotation experiences below. Heads up, it's quite long!

Rotation 4: Drug Information

My fourth rotation was actually a work-from-home rotation! I worked for a drug company database alongside a fellow P4 student. The projects we were typically responsible for involved various inquiries from customers of the database (typically healthcare professionals) or drug companies asking us to clarify a statement about their drug that was listed in the database. Other times, we would have to look into evidence because a drug company was trying to prove that what we had in the database was false. We also typically looked into drug interactions that might not be present in the database, and wrote up drug monographs for these based on the research we found.

A typical day involved us meeting our preceptor a few times a week at an off-site location to discuss our assignments, what we found, and to discuss new things that came up. Afterwards, we were free to do as we pleased with our schedule, as long as we finished up the tasks given to us and e-mailed our preceptor with updates. This rotation really tests your time-management skills, as you really could slack off given the lack of normal structure. I tended to do many of my projects at night, as it's easier for me to work on projects like that at that time frame due to years of undergrad and pharmacy school studying. However, I really enjoyed this rotation as it helped to beef up my research skills and further interpretation of drug literature and drug labels. I got better experience understanding pharmacokinetic (PK) data and using PubMed, as often my preceptor would find things that neither me or the other student on rotation would find about our respective assignments. We also got the chance to read through foreign drug labels to help write our monographs, and they're quite different in the data that they provide compared to those here in the US!

I also appreciated this rotation, as it gave me time to finish up my PDI. If you're interested in seeing a different side of pharmacy and believe you can handle managing the time on your own, I would highly recommend this rotation! I really learned a lot more about searching strategies and drug interactions. 

Rotation 5: Critical Care - MICU

My fifth rotation brought me back to the hospital for another inpatient rotation, this time in the medical ICU at UMHS. This was actually my first rotation at UMHS, so I was both nervous and excited at the same time. However, this time I had another student with me on rotation, which was a welcome change from my infectious diseases rotation where I was the lone student.

Typical Day:

6 AM: arrive at the hospital to work-up patients.
7:30 AM: table rounds. This is when the night team would typically hand over new admits to the day teams. Also at this time, the attending doctors would typically go over various topics for the residents (i.e. sepsis, sedatives, etc.)
8:30 AM - 11 AM : Rounds. The MICU at UMHS is divided into two teams: Maize and Blue. For students on this rotation, typically one P4 will take each service and pick up all the patients for that service. There's about 20 beds or so (forgot the exact number) on the unit, so typically you'll have 8-12 patients at a time that you have to follow. For most of the time, we would each round with a pharmacist (either my preceptor or the resident on our rotation at the time). 
11 AM - 1 PM: lunch/preparation. Usually after rounds, we would have lunch, prepare for discussing our patients with our preceptor, or look up questions we were asked.
1 PM - 3 PM: At this point, we would meet with our preceptor and the resident to discuss our patients. We would typically go over our patients, discuss their status, and the changes the team made to their drug therapy. Often here, or during rounds, we would get asked what we thought about their changes. We would also discuss a certain topic that was relevant to critical care, such as sedatives, electrolytes/fluids, sepsis, etc. 
In terms of drug therapy, antibiotics were huge in terms of the pharmacist role. In the MICU, the general trend is to just throw a very broad-spectrum regimen as the patients are extremely sick (vancomycin and Zosyn are huge workhorses). We often had to remind the residents or the team that after 3 days, they needed to get ID approval to continue using vancomycin. Also, we would often recommend adjusting the antibiotics based on culture data and whether the patient was getting better/worse. The other big thing we looked for was renal dosing. Often, many of these patients developed AKIs that sometimes required them to go on dialysis or CRRT temporarily. I would always get asked if drugs were adjusted correctly given the renal function, along with when would be best to order levels for vancomycin or aminoglycosides if they were on one.
  
The MICU was challenging to me because the most common problems we saw were of a respiratory nature (i.e. respiratory failure, ARDS, etc). Beyond pneumonia, the presentation and therapies to treat these type of patients were completely foreign. Often, ventilator settings would be the common route for the team to adjust, and I generally had no idea what it meant. After the rotation, I have a better understanding of it, but I would definitely need more exposure to that and another review of the basic concepts. I also got a great refresher of topics we had learned in therapeutics that I personally wasn't great at, such as electrolytes, metabolic acidosis/alkalosis, vasopressors, and sedatives. Sedation strategy was another thing that often came up in the ICU, and I never really thought to think about it until this rotation.

Ultimately, I think a critical care rotation is a terrific experience, and one I would highly recommend. While it's not my favorite area of practice, I think it offers valuable lessons that would be useful in any setting of practice. You really get exposed to a lot of different clinical areas as these patients present as very complex cases, and you learn to prioritize what really needs to be solved now vs. what could be dealt with at a later time. Finally, it also really hits a number of gaps that our curriculum is unable to cover, particularly on the respiratory side of things.

Rotation 6: Off-Rotation / Midyear

Initially, I chose rotation 6 as my off rotation as I wanted to have time to attend Midyear and work on residency applications/letters of intent, as well as go on one last trip before graduation. However, this worked out for me really well for another reason. 

I had the opportunity to represent the College of Pharmacy at the 2016 International Forum of Pharmacy Students in Nanjing, China. This conference was sponsored and held by China Pharmaceutical University, which is one of the schools in China our College of Pharmacy has a partnership with. Here, I was asked to present a project that provided some insight into clinical pharmacy practice in the United States. In this case, I presented my PDI project as a glimpse into the roles of an infectious disease pharmacist in the US. I thought I was only going to be presenting my project in a small sub-forum, but I ended up being selected to present during the opening session in front of the entire conference, which had hundreds of attendees. Undoubtedly, I was nervous as I had just flown in from the US a couple days prior, but it ended up being a really great experience! I also got to meet other great student pharmacists from around the world, many of whom were there due to their connections with the International Pharmaceutical Student Federation (IPSF). Learning the differences in education and pharmacy practice between our respective countries was really interesting. After graduation, I'd like to get involved with the International Pharmaceutical Federation (FIP). After the conference, I had a chance to visit New Zealand, Australia, and Singapore. Needless to say, it was awesome and a perfect way to relax and clear my head before Midyear. Pictures below:

Some of the great student pharmacists I met at the conference in China

Skydiving in Queenstown, New Zealand

 Hiking the Ben Lomond Track: Queenstown, New Zealand

Mrs. Macquarie's Point at Sunset: Sydney, NSW, Australia

The famous Merlion in Singapore

Midyear

For those that don't know, the ASHP Midyear Clinical Meeting is the largest gathering of pharmacists and pharmacy students worldwide each year. It typically happens around the first weekend of December. This year, it happened in Las Vegas. I will quickly mention that I'd recommend not getting back from a trip on the other side of the world and then flying to Vegas a couple days later. I had the worst jetlag I have ever experienced, which caused me to not to sleep well during my time in Vegas, and also took me quite a while to recover from.

Anyway, this meeting is very important for those of you that are pursuing fellowships or residencies. As I plan to go the residency direction after graduation, I don't know too much about the process with pursuing fellowships. All I can say is that it requires scheduling interviews ahead of time through the Personnel Placement Service (PPS) with the companies/fellowships you're interested in. In terms of residencies, Midyear is great because every residency in the country is present in one location for you to ask questions to their residents, preceptors, or program directors, and determine whether or not you want to apply to a program. So, for those of you that are looking for residencies all across the country (like myself), this helps to put faces to programs and answer some questions that weren't possible via simply e-mailing them. However, if you're only interested in Michigan residencies, Midyear might not be necessary for you. The SMSHP Residency Showcase that occurs in October has all of the Michigan residency programs present and allows you to meet the residents / program directors and ask questions there. Anyway, here's some tips from my experiences:

  • BE PREPARED. This really can't be overstated. You will hear this all the time in Dr. Kraft's Opportunities class and from anyone you ask about Midyear. Have updated CVs, business cards, etc. While you won't be handing out CVs to most programs, they sometimes will ask for it or provide a place for you to drop it off. I often heard that if they ask for a CV, it's typically a bad thing as there's so many people at Midyear most programs likely won't remember who you are. But, in my case, I went to a couple programs that did take them to help remember who stopped by their booth, and even got asked for one from a residency program director that I had a good conversation with. Also, many programs took business cards as well, possibly another way for them to keep track of who stopped by. 
  • Do your program research ahead of time. Prior to Midyear, go to the ASHP Residency Directory. It lists all the accredited ASHP programs by location and program type, along with giving a summary of the program and the links to the program's website for more information. Prior to Midyear, ASHP provides a schedule of when each program is available during the Residency Showcase, along with a map of where their booth is. The Residency Showcase is divided into three sessions: Monday, Tuesday AM, and Tuesday PM. Each program is only present during one of these times, so it's imperative you know which programs you want to talk to, where they're located, and when they're available.
  • Prepare questions for each program you want to talk to. From my experience, it didn't seem like you could just walk up to a program and ask them to give you a general overview of the residency. The residency showcase is like a zoo, with a bunch of frantic P4s trying to figure out their futures and many residents would be talking with multiple P4s at a time. With the limited time frame, you really want to get the questions that will make or break a program for you asked and answered. You could certainly listen to other people's questions and then ask something if you think of it on the fly, but it's easier to be prepared. I personally created a general list of questions I could ask most programs, along with specific questions that pertained to the programs I was visiting. 
  • Reach out to preceptors, professors, and alumni! Prior to Midyear, I reached out to a lot of people with help in terms of editing my CV, looking at my program list, asking questions about residencies, etc. Everyone at Michigan or those who have graduated from the program are extremely helpful and really want you to succeed. Your preceptors as well can give useful insight, especially if they're at a system you're interested in possibly obtaining a residency at. 
Finally, my last tip in terms of the application process: Ask for transcripts and letters of recommendation ahead of time. Fall grades will come out way too late for them to be sent to programs on time, so I would recommend immediately sending your transcript to PhORCAS once it comes out in November. Also, I would ask for letters of recommendation ahead of Midyear as well. Many preceptors and professors will understand that you may not have your program list finalized until after Midyear. However, it is good to ask them how they would like the references generated. With PhORCAS, you generate a request to your letter writers and can provide extra directions. For most programs, one general reference will suffice. But, if your writer knows someone at the program, sending another request that's more personalized to that program can be beneficial. When submitting the app, you can designate which specific request you want to assign to a program. This might not make much sense now, but it will when you go through the process.

Wow, sorry again for the long post! Hopefully there's helpful advice in there for you, and enjoy the rest of the holidays!

Monday, November 28, 2016

Rotation 5 - Pediatric Cardiology

Posted by Brock Jackson at Monday, November 28, 2016

Most likely this will go down as my hardest rotation of the year. It was an absolute change of pace from my previous rotation (Drug Information). On this rotation, I was at Mott’s Women and Children’s Hospital. It was a drastic change from working at a desk from 9-4.
I would describe my typical day as such:
Wake up around 5am, arrive at the hospital and be working up patients by 6:30am. Because I did not have much exposure to pediatric populations before, this portion was a struggle for me. 
Around 10am – noon, we would round on the pediatric cardiology floor.
Around noon-1, lunchtime 
From 1-4pm, I would have a bit of time to work on topic discussions, adjust my SOAP notes from what we did on rounds, and present topics/patients to my preceptor.
The types of patients that I primarily saw had congestive heart failure, atrial septal defects, ventral septal defects, patent ductus arterious, hypoplastic left heart syndrome, Ebstein’s anomaly, pulmonary hypertension, and other congenital heart defects. Our main goal was to help manage their cardiac conditions and prepare them for surgery or to be discharged.
Throughout my time on this rotation, I had to complete about 10 different topic discussions, which kept me quite busy outside of rotation. When I was presenting topics (such as hypoplastic left heart syndrome, plastic bronchitis, protein losing enteropathy), I would often be accompanied by a PG-Y1 or PG-Y2. I would often listen to them present their patients or topics, as well as they would listen to me. This was a great learning opportunity for me. In addition to that, my preceptor (which I enjoyed working with) often asked questions to failure. This method involved asked questions until the person answer them was unable to answer them. This often led to me having to look up many different questions afterwards and answering them the next day. It was certainly something that I was not used to and took time adjusting to not being able to have an answer for everything. As a side note, I do not believe I am a know-it-all or anything close to that. However, it is disheartening to not be able to leave one day with having answered all the questions about a patient or topic completely.
Highlights of the rotation:
Spending time with my preceptor after hours and talking pharmacy and life
Being on rotation during Halloween. We were able to dress up and round with the kids. The children and their parents APPRECIATED this A LOT. For the record, I was a piece of pizza and the team I was with were teenage mutant ninja turtles.
The food – pediatric rotations (from what I now understand) are laden with food. There is literally good food everywhere. My inner foodie was impressed!
The team – I loved working with all of the residents and medical students. These folks were great and were wonderful to spend long hours alongside.
The wins – Seeing sick children is extremely difficult to deal with…I do not think I need to elaborate on that. However, when we have a great outcome, the whole team is ecstatic. From the beginning, we had a patient that I followed who was in dire need of a heart transplant. They struggled with weight gain and adhering to a sodium and fluid restriction. It was a major struggle watching his condition worsen and worsen and the family try to cope with the reality that a new heart may not come. On my second to last day, the entire transplant team rounded with us (usually it is just one or two of them) and they announced that they had accepted a new heart for them! It was incredible!! The whole team rejoiced, the mother cried, the patient was stunned and it made the whole experience that much better. On my last day, I was able to watch the new heart be put in and the circle was complete.

Overall, the experience was grueling but I learned a lot and I made friendships that I treasure to this day!

Rotation 4 – Drug Information at the BIG House!

Posted by Brock Jackson at Monday, November 28, 2016

This rotation presented me with a whole different view of Pharmacy. It was quite unique from the previous rotations that I have had and most likely would experience in later rotations too. On this particular service, we would answer questions from various healthcare providers such as physicians, nurses, pharmacists, etc. The types of questions we answered varied IMMENSELY from one phone call to the next. Often times, we were the last line of help before it was deemed ‘unanswerable.’

My day-to-day on this rotation was extremely manageable. It was a 9-4 service with lunch from either 12-1 or 1-2, depending on when the classmate on rotation wanted to take lunch. Everything on the rotation was laid back. The several preceptors we worked alongside with were mostly familiar faces and all accommodated us well.

How our time was spent:
Everyday we alternated who answered the phone in the morning and afternoon. When you were on phone duty, you had to work up any questions that came through. If none came through, you were able to work on anything else that needed to be worked on. Occasionally, we would be slammed with phone calls (OR POWER OUTAGES!!!) and both my classmate and I would work up questions together.

When we were not working the phones, we were most likely doing the following:

Working on previous drug information questions that we were not able to be complete the day before.

Our drug monographs – This was the big project of the rotation. We each were assigned a specific drug and had to complete a drug monograph on it. I was assigned chloral hydrate. This particular drug is not really used anywhere anymore. It was a major project researching the studies behind this drug and the requested indications that were associated with it being placed on formulary.

Journal club – We each were assigned one day to present a journal article. During this time, we went through EBM concepts with our previous EBM professor.

Random events – side projects that came up, various drug information meetings, etc.

Overall, this rotation was an excellent one. Our main preceptor was ABSOLUTELY fantastic!

Sunday, November 20, 2016

Rotation 3: Pharmacy Administration: Transitioning to a New Perspective

Posted by Emily VanWieren at Sunday, November 20, 2016

First Impressions and a Day in the Life
What does a pharmacist in administration do?? Before this rotation, I had no idea what pharmacists do on a daily basis in this non-traditional role. I quickly learned that a job in administration felt similar to being in leadership for a student organization, something I was familiar with after being president of our chapter of APhA-ASP. My preceptor was in charge of the outpatient pharmacy as well as transitions of care initiatives at the hospital. We attended many meetings with various interdisciplinary professionals working at the hospital to brainstorm new ideas, create action plans, implement new projects, and track progress. Interpersonal and written communication was key in getting a message across and producing the best outcome. I helped interview technicians and pharmacists for positions that were open. I was also assigned various projects analyzing data and creating proposals for funding and restructuring of positions.


Transitions of Care
I became passionate about transitions of care over the course of this rotation. After two inpatient clinical rotations, I understood what happened while patients were in the hospital, but I had no idea what happened when they were discharged to go home. There are many medication errors that happen upon admission and discharge (transitions of care), and pharmacists can play a huge role in reducing these errors and creating a safer experience for patients throughout the whole health care continuum. I was heavily involved in counseling patients on their new medications during my organ transplant rotation, and there was some counseling on new anticoagulants during my internal medicine rotation, but a large majority of patients receive their discharge instructions via paperwork, and sometimes nurse education. One of my major projects was to create a proposal that would encourage more use of student resources to counsel patients being discharged on their medication changes so that patients and their caregivers understand exactly how, why, and when to take their medications. Pharmacists and student pharmacists can and should take ownership in transitions of care due to our vast knowledge of medications and our primary focus on medication use.


Reflections
I thoroughly enjoyed my administration rotation because I felt my skills of interpersonal communication, teamwork, and organization were in line with the day to day activities of a pharmacy administrator. I enjoyed hearing other's perspectives and brainstorming new ideas that would affect a large number of patients. Although I didn't have one-on-one interaction with patients on this rotation, I was surprised by how much I used my clinical knowledge and understanding of pharmacist workflow in order to problem solve and create ideas for large-scale solutions.

Saturday, November 12, 2016

Rotation 5: Community Pharmacy with a Twist

Posted by Millie at Saturday, November 12, 2016

Hey there,

Currently writing this entry on the train back to Ann Arbor from Chicago! Another P4 (Erika) and I just finished our rotation at a specialty community pharmacy that serves a health center with a patient population of primarily LGBTQ individuals and a focus on HIV/AIDS. As Jimmy, another P4 blogger on here, wrote about a few entries back, this rotation provided us with a lot of really great opportunities to practice our patient counseling skills and learn so much about a disease state we don’t really focus on during pharmacy school.

The past 5 weeks have basically been “HIV Bootcamp” where we learned EVERYTHING about the disease state and medications used in prevention and treatment. HIV medications have not only a trade name and generic name, but also a 3-letter code which – for some of the meds – is interestingly enough related to the medicinal chemistry of their mechanism. We discussed at length and were expected to understand the DHHS guidelines for HIV/AIDS and opportunistic infections, as well as the CDC guidelines for pertinent STDs (prevention and treatment). We were both amazed at how much we learned in the span of just 5 weeks!

Typical days at the pharmacy included making pillboxes for patients, utilizing the script processing software, calling patients to remind them of their refills, counseling patients, and of course administering vaccines. On our first day it all seemed unfamiliar and confusing to us, but by the end of the rotation we were able to better understand the workflow and even grow much more comfortable in verifying prescriptions! We spent two afternoons out of the week at an HIV clinic downtown where we were able to meet with patients, discuss their HIV regimens, and assess their other comorbidities. This rotation really helped improve my SOAP note writing and patient counseling skills.

During any time that we had available, we worked on multiple projects, including data for an MTM study, developing a patient case for continuing education, creating a poster for an HIV/STD conference, and giving a presentation on antidepressants in HIV positive patients to an interdisciplinary team. We were also actually able to attend that HIV/STD conference and my favorite seminar during the conference was one on transgender individuals and barriers they face in receiving good health care. If you want to hear about it, definitely contact me and I will tell you all about it!

Overall, this was definitely one of my favorite rotations. Since this rotation fell during the October/November months, Erika and I had additional challenges of not only keeping up with the large work load for this rotation but also completing our PharmD Investigations manuscripts and posters, completing P4 seminar quizzes, and preparing for post-graduate plans. However, I would not trade my experience for anything and I really enjoyed these last 5 weeks (though I am definitely ready for a nap now)! My advice would be to make sure you come into the rotation with a good mindset of working hard and trying to learn as much as you can.


P.S. We also happened to be in Chicago during a very exciting time of when the Cubs won the World Series (streets were packed!), as well as Michigan beating Michigan State in football! J