Thursday, February 10, 2011

Information Overload? Not quite.

Posted by Tiffany Pfundt at Thursday, February 10, 2011

My January rotation was with Dr. Stephanie Minich at UMHS on the hematology/oncology service. This rotation was jam packed from start to finish with information and activities. I'll break it down by "what I did,"and "what I learned," then finish with a brief evaluation of the rotation.

What I did?
Each morning I'd arrive at the hospital around 6:45 am. Prior to rounding with the medical team, I would review my patients' labs, recent test results, and medication lists. Patients' medication lists changed almost daily, so keeping up on the list was an important part of my routine. The team counted on me to have an accurate and up-to-date list for each of my patients. They also looked to me for medication recommendations for anti-emetics, pain relievers, antibiotics, and dosing changes based on blood levels. Since cancer medication management can be so complex, the medical team relies heavily on pharmacy input. Because of this I was able to interact with the team and make several medication therapy recommendations, and they were grateful for my input. Being ready for rounds required a thorough knowledge of each patient, all of their medications, and the ability to anticipate future medication needs of the patients, as well as possible questions from the team. I will say I was not perfect in these areas, but I definitely improved throughout the month. The ability to anticipate questions is a skill I think I will use a lot in the future.

Projects and Presentations
In addition the patient care activities for this rotation, we were also required to present several cancer related topics. Throughout the rotation we had mini cancer topic discussions. For most of the discussions, Dr. Minich taught and we listened. However, when we discussed Hodgkin's and Non-Hodgkin's Lymphoma the students became the discussion leaders. I found this teaching activity very valuable. Teaching a subject requires a deeper understanding of the subject than learning it on your own.

We also had a to present a patient case and topic to all of the oncology pharmacy students and preceptors. The intent of this presentation was to give the other students a brief overview of a topic they may not have encountered. I enjoyed learning about my fellow classmates' experiences and learning about new topics.

Another presentation came in the form of a journal club. The intent of this presentation was to gauge our understanding of the article as well as to test our ability to critically evaluate scientific literature and assess its applicability to everyday practice. My article compared two chemotherapy drugs used to treat chronic myeloid leukemia. The two drugs were very similar, one just seemed to work a little better, at least in short term studies. After I presented the article, Dr. Minich asked me, "so, which drug would you recommend for your patients?" This meant I had to consider the information in the article at a deeper level, not just spit back the author's conclusions. Being able to take book knowledge, or in this case information from the literature, and apply it to clinical situations is what the fourth year (and beyond) is all about!

What I learned?
Obviously, since it was a hematology/oncology rotation I learned about chemotherapy regimens used for various types of cancer. Most of the chemotherapy I learned about was for the treatment of lymphoma and leukemia. I also had a few patients with solid tumor cancers, but those patients rarely received chemotherapy while under our care. In addition to learning about cancer chemotherapy, I also learned about treatment of other cancer related conditions.

For the first week and a half, the oncology students would meet with one of the preceptors to discuss various oncology related topics - they called it Oncology Boot Camp. Topics covered in these sessions included: pain management, anemia, nausea and vomiting prevention, identifying and treating neutropenic fever, monitoring for and managing tumor lysis syndrome, and properly using colony stimulating factors. At times, it felt like I was learning a new language with all the unique terminology that was used.

As I mentioned above, Dr. Minich held her own kind of oncology boot camp. A couple times a week we would meet to discuss specific types of cancer. She tried to cover topics that we wouldn't necessarily be exposed to on the rotation, in addition to ones we did see. The topics we covered were: lung cancer, Hodgkin's Lymphoma, Non-Hodgkin's lymphoma, Chronic Myeloid Leukemia, Acute Myeloid Leukemia, and Multiple Myeloma.

This rotation also included a hefty dose of infectious diseases. Many cancer patients are immunosuppressed, therefore they need to be on prophylactic antiviral, antifungal and antibacterial medications, but not every patient has the same antibiotic needs. Identifying patient specific factors that determine which medications they need is an important part of optimizing their care.

Recap and Evaluation
As you can see, this is not a rotation you can breeze through, nor would you want to. There are too many things to learn and Dr. Minich is an eager and talented teacher. To not be fully engaged during this rotation would be a disservice to yourself. Compared to other rotations, I experienced the greatest gain in professional pride and confidence during this rotation. To sum it up, this rotation was emotionally taxing, therapeutically challenging, and professionally rewarding. I would highly recommend this rotation to anyone interested in cancer, or anyone who wants a well-rounded inpatient experience with lots of opportunity to interact with other healthcare professionals.

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