Distressed into De-stressed

Posted by Matthew Lewis at Friday, December 30, 2011

After a much needed break, I've finally found the time to post again. A lot has happened since I last posted, so lets start at Midyear. The first thing to know about Midyear is that you do not and should not stress about it. Yes, you are there to make a good impression. Yes, you are there to scout out things for your future. However, you have to keep in mind that Midyear is full of opportunity and fun times, and if you're flipping out and rigid in everything you do, I think it's just as bad as being unprepared. Just be confident in yourself. Look at your CV (curriculum vitae) if you feel overmatched; you aren't in pharmacy or about to go into pharmacy at the University of Michigan because you're a slouch.

The second day is much easier than the first day, and there are two sessions instead of one. You know what people want to hear and you'll have your questions refined. I honestly think I made a mistake in going to the program I was the most interested in first, so I wasn't as fluid as I would have liked. I suggest that you talk to some other programs before you get to the ones you are really interested in, and there is plenty of time to talk to everybody you want. I also looked at the website listing of everybody there offering a PGY2 in solid organ transplant and talked to most of them, considering a position as a solid organ transplant pharmacist is my goal. As it turns out, most of the programs I was interested in before going to Midyear fell by the wayside and some I didn't even know existed, both large and small programs, rose to the top of my list. After talking to about 15 programs, I am applying to six. Hopefully, I'll get four to six interviews and eventually match with one of them.

In rotational news, I completed my community rotation, and learned quite a bit. I was lucky enough to work with Mr. Frank Pawlicki at the University Hospital. He was a great preceptor and treated me as a student instead of just another pair of hands or a volunteer tech. When you get to rank sites for rotations, and Mr. Pawlicki is available as a choice, I strongly urge you to rank him high. I also got to spend time in the sister sites of the Oncology Center and East Ann Arbor (the transplant medication hub), so I was exposed to many facets of community pharmacy. This particular site does a lot of compounding, so I got to prepare myself for a future rotation by compounding things like rifampin solutions and seeing how eye drops were prepared. My new drug review was on Tracleer, which is a newer drug for pulmonary hypertension. It looks pretty good and I think we will see more use in both pediatric and adults patients as a different option to sildenafil (Revatio).

My next rotation is infectious disease at the University Hospital. It is going to be a challenging rotation because expectations will be high and I now have half a year of clinical rotations under my belt. So, in between writing applications and relaxing during my break, I will be looking over my old therapeutics notes and getting the recommended drug reference books.

That's all for now, so until next time have a safe and happy New Year.

Drug Info at DMC

Posted by Elizabeth Kelly at Saturday, December 24, 2011

Christmas Eve... a wonderful time to avoid the tradition of watching boring tv with the family and instead blogging on this past months rotation. So, I was at the DMC with Dr. Margo Farber getting information about drugs this whole past month. And even though the rotation was technically very boring, I actually learned a lot and utilized my time very well.

Typical day:

Get there 8:30-9. Spend forever getting settled in, check my email, finally settle in and get working on a drug monograph or whatever miscellaneous drug information question that was given to me by Dr. Farber or one of the other drug information specialists.

Sometime during the day go to a meeting or lecture... note they have a lot of free food on this rotation. You probably only need to buy/bring a lunch only half the days if you play your cards right. And they have a subway right on the floor above...healthy eating!!!

Leave after 8 hours of course......................................

How I made this rotation fabulous:

1) I knew I was applying to the DMC residencies so I introduced myself to as many "big-wigs" as possible and Dr. Farber really facilitated that.

2) Asked to shadow different pharmacists... got a great experience for the other student and I in the anticoagulation clinic.

3) Made a point to learn about the material that I had to research. Might as well... I have boards to pass in a few months.

4) Dr. Farber is a great preceptor and really made an effort to teach us pertinent information and guide me in my residency search (she is even writing me a letter of rec!).

There are a few pains with this rotation:

1) Distance from Ann Arbor (although that didn't matter to me since I live at home in St. Clair Shores)

2) You have to park way away from the hospital and either take a shuttle or walk (note... if you have this rotation it is WAY faster to walk from the hospital back to the Bethel church parking lot then it is to wait for the bus... even if it is sitting right there waiting for you).

Now, if anyone has any questions about this rotation feel free to email me!

Multidisciplinary Oncology

Posted by Eric Zhao at Thursday, December 22, 2011

St. Joseph Mercy Hospital has been my home for the past month, where I rotated with Dr. Carol Yarrington in Ambulatory Care Oncology.

New Oncology Infusion Centers in Canton, MI and Brighton, MI
Patient bays increase privacy and comfort

After brushing up my knowledge on the oncology drugs, therapeutic areas, and side-effect management strategies, I was charged with setting the groundwork for a pilot pharmacy intervention at the Multidisciplinary Oncology Clinic.

The Multidisciplinary Clinic (MDC)
The clinics are held on Monday (head/neck cancer), Tuesday (lung cancer and gastrointestinal cancer), and Friday (breast cancer). In one sitting, a patient can see a nurse navigator (explained below), nurse practitioner, palliative care nurse, physician assistant, medical oncologist, radiation oncologist, and surgeon. What's nice about this initiative is that the patients receive the full spectrum of care in a single trip. Each of the healthcare professionals will individually visit with the patients, rotating between patient rooms. Afterwards, they all convene to discuss their plan for each patient.

The Multidisciplinary Team in the Cancer Care Specialty Center
[Link to Brochure]

Nurse Navigator

The nurse navigator, a rising new concept, serves as the main contact and face of the multidisciplinary clinic. They make sure the patient is acquainted to the clinic by setting up appointments with the healthcare professionals and providing follow-up when needed. Because days can get hectic, these navigators help orient the patient during their treatment visits.

Pharmacy Intervention
Between visits from the healthcare providers, patients may have 30-120 minutes of downtime before the next visit. What a convenient time for pharmacy to step in, interview the patient, and review their medication list! The clinic is mainly focused on the oncology aspect, so there is a lot of room to manage their chronic health concerns. Oftentimes, patients with cancer will try complementary or alternative medications to improve their situation. However, these medications may interact with chemotherapy to reduce their efficacy; for example, some chemotherapy agents rely on creating free radicals to destroy tumor cells, so ingesting a large amount of antioxidants may cause more harm than good.

Green tea, an antioxidant, may negate chemotherapy agents that depend on producing free radicals to destroy the tumor

Future Direction
The multidisciplinary clinic shows a lot of promise, and I hope the clinic continues to pilot the program with the next student. It's a great way for pharmacists to get involved in the multidisciplinary care of oncology patients through a review of not only their chemotherapy regimen, but their maintenance medications too.

Eric Zhao

Happy Holidays from the Ann Arbor VA!!

Posted by Anna Polk at Wednesday, December 21, 2011

Can you believe 2011 is almost over?!  This semester has flown by and rotations are now over halfway over!  I am finishing up my ambulatory care rotation at the Ann Arbor VA.  I always had a feeling that I would enjoy the practice environment at the VA and also the patient population and I’m finding this to be absolutely true.  Pharmacists play an integral role in ambulatory care at the VA, seeing patients in all sorts of clinics, from arthritis and anticoagulation to pain management and geriatrics.  I have had the opportunity to rotate through several of the clinics- I think I’ve had a pretty similar experience to Nina and am enjoying it just as much as she did!  

I am also happy to report that I’ve had a major breakthrough in terms of my long-term goals and aspirations while on this rotation.  After spending a lot of time in the pain and arthritis clinics, and speaking with my preceptor, I’ve discovered that I really enjoy practicing in areas where there several shades of gray.  Let me clarify- rather than trying to cure the patient or get their condition to a predetermined goal, I enjoy working with patients with less clear-cut goals.  I have always loved working with the geriatric population; I like how you are not trying to cure them or get all of their conditions to their recommended targets, but instead the focus is on quality of life and functional status.  I am finding that this interest is not limited to geriatrics, but rather areas that I like to think of as ‘empathy-driven care.’  These are areas where listening to your patient and developing a solid trusting relationship are essential.  You can’t treat numbers and there are few hard and fast rules to follow.  I think this helps explain why I enjoyed my psych rotation so much, as well!  

With residency application deadlines fast approaching this revelation could not have come at a better time.  I am feeling particularly passionate about pharmacy right now, and I was so excited to talk to all of the programs at the Midyear Meeting in New Orleans earlier this month.  I have ‘narrowed down’ my list of programs to apply to (I’ll admit it- there were ten that I just couldn’t bear ruling out) and am now putting all of my energy into my cover letters.

To any current or future pharmacy students:  get excited for your P4 year!!  I cannot believe how much fun I am having actually getting to practice these things that we spent so much time preparing for in the classroom!  What an exciting field we have chosen!  I guess I'll just end this post on that note- enjoy your time off for the holidays!!

Midyear Recap

Posted by Jenna at Wednesday, December 21, 2011

Midyear has come and gone and I would love if someone could tell me how it's already the end of December!! My time in New Orleans was purely exhausting and a little 
overwhelming. So how did I spend my time at Midyear?

Saturday
I landed in New Orleans around noon CST and spent the rest of the day exploring New Orleans: the pharmacy museum, Bourbon Street, Canal Street, the Riverwalk, Cafe du Monde, and the French Quarter.

Sunday
I had 4 PPS interviews. PPS stands for Personal Placement Service and is commonly used to find PGY-2 residencies or jobs. The advice is usually not to participate when you're looking for a PGY-1 but I ended up joining PPS last minute. My advice differs, though, because I had a great experience with PPS. If you're looking for a 'specialized' PGY-1, for example in administration, managed care, or pediatric-focused, PPS could be a great investment. Joining allows you to see the complete list of institutions participating in PPS and also allows you to post your CV and an objective statement. After I joined, I sent messages to 5 programs that I was interested in, and then sat back & let PPS work its magic!

I heard back from all 5 programs and also received messages from ~10 other institutions. One important thing about PPS is to be professional: if a program sends you a message and you're not interested, make sure you respond! Don't ignore their message, just thank them for their interest and nicely explain that you are currently pursuing other options.
Through PPS I got invited to a really great networking event, the CHCA (Child Health Corporation of America) reception, which I went to Sunday evening.
Monday
I had 3 PPS interviews prior to the 1st residency showcase. PPS interviews can vary in style. Most of mine were more informational, rather than a real interview. The interviews are booked for 30 minute slots and only people that are registered for PPS are allowed in the PPS area. If PPS is something you're considering, definitely be prepared to answer these typical questions:
1. Tell me about yourself.
2. Why do you want to do a residency?
3. Why are you interested in this specialty area?
4. What are your future goals?
And make sure that you have plenty of questions to ask! Some programs use PPS as a tool to weed out candidates, while others use it more as a personalized Q&A session. 

Tuesday
The 2nd residency showcase was from 8-11:30 and the 3rd session was from 1-4:30. I had my last PPS interview right after the last showcase. 

Wednesday
I had planned to use Wednesday to attend the residents' poster session. However, by Wednesday, I was honestly just sick of Midyear! So I ended up going to the Audobon Aquarium instead. I spent the plane ride home working on thank-you notes, as these should be sent out as quickly as possible. I sent out all 40, yes FORTY, thank you notes Friday. 

Things since Midyear have been a blur. I decided to apply to umm a few more programs than is typically recommended. Midyear wasn't as helpful as I had hoped in terms of eliminating programs that I wanted to apply to. I had really positive interactions with everyone that I spoke to during the showcase and my PPS interviews. I did a ton of research prior to Midyear but the 'tool' I found most useful during the showcase having a single sheet of paper detailing each program I was going to talk to. After doing so much research, programs start blending together and you don't want to seem unknowledgeable about a program when you go to their booth. As I was walking (okay, more like shoving my way through people) from booth to booth, I would get the sheet out for the program that I was going to next. That way during conversation, I could glance down to see the specific rotations offered, etc and write answers to questions right on that sheet. Just an idea of something that worked really well for me! You can never be too prepared and no matter how much time you spend preparing, you're still not going to feel prepared!

iNsTiTuTiOnAL RoTaTiOn

Posted by Melanie at Friday, December 16, 2011

Only a couple more days left at my institutional rotation at UMHCC. I feel like this month has flown by, but when I look back, I have done a lot of things this month.

The 1st week was spent developing a CE presentation for Pharmacy Technicians on aseptic technique. I was able to develop this with three other fourth year students on the same rotation. We made videos illustrating poor aseptic technique. We were given the opportunity to give two presentations. I think the presentation went really well. The technicians were very engaged and seemed to enjoy the humor in our video demonstrations. In fact, we may be able to present for a third time to a larger group of technicians!

The second week was spent in the satellite pharmacy where I took on the role of a staff pharmacist. Verifying orders and serving as the final check were my main duties.

The third week was spent in the Investigational Drug Services department. I was able to develop a set of dispensing guidelines for a new study. I spent one day with the technicians who prepare for monitor visits by people who come to make sure compliance with the study is being met. I spent another day with the dispensing technician who processes orders and gets the medication ready for the patient, and I spent a day with a technician who puts away medications and keeps inventory and who also prepares intravenous/sterile products for patients.

My fourth week I was able to participate in the clean room activities. I was able to see the flow at UMHHC and gown up and go into the clean room. I also participated in the final verification process by checking IVs that technicians had prepared. I also spent some time with the clinical pharmacists where I looked at kinetics and handled anticoagulation.

Next week, I will develop a CTools website for P3 IPPE students on their institutional rotation at UMHCC. I am putting together a list of articles for them to read, as well as guidelines and other resources. These are items that will be of value throughout their P3 and P4 years, as well as beyond.

See you again in 2012 and Happy Holidays!

Independent Community

Posted by Amanda at Sunday, December 11, 2011

I started my fifth rotation at Village Pharmacy II. I am half-way through and this place is awesome. It has made retail pharmacy not seem that bad. I have had many opportunities to counsel patients. The pharmacy also does compounding so I have made oral suspensions, and capsules. Making capsules were fun. I have also learned a lot about over the counter products.

I also learned about medicare part D and I helped some patients look up part D plans.

At Village all the medications are placed on the shelves alphabetically by brand name, so I have learned the brand names to a lot of drugs. Some that were brand names 30-40 years ago.

Transplant

Posted by April at Sunday, December 11, 2011

I spent my fourth rotation on the surgical transplant service of the University of Michigan Medical Center. This service did many kidney transplants as well as liver and pancreas transplants.

A typical day started early at 0545 rounds. This rotation was unique in that it encompassed a variety of patients including pediatric critical care, adult critical care and floor status patients. The service also follows their patients after the transplant. So, there was some internal medicine therapeutics involved. For example, a patient with a history of a liver transplant was admitted for possible kidney stones. They were automatically admitted to the transplant service for management.

Although it might seem like transplant pharmacist are extremely specialized, they need to know a lot in the areas of infectious disease, critical care and internal medicine. I enjoyed this aspect of the rotation the most.

Another aspect of this rotation that I would like to mention are the protocols. This service is highly protocol driven. These specify who gets what medications based several patient characteristics. It is one of the pharmacists many jobs to see that the drug protocols are being followed. You might be surprised how often something gets missed!

I feel like there was a huge learning curve on this rotation. We only skimmed the surface in therapeutics class when it comes to immunosuppression. Not only do you have to know all the immunosuppressive medications but also why a physician should use one over the other.

Overall, I enjoyed this rotation because I really learned a lot from it.

iNsTiTuTiOnAL RoTaTiOn

Posted by Melanie at Monday, December 05, 2011

I am currently on my institutional rotation at UMHHC with Ms. Kathy Kinsey.

This is a very diverse rotation spent in different areas on the hospital.

My first week was spent designing a CE program for pharmacy technicians on aseptic technique and preventing hospital acquired infections with my fellow fourth years (there are four of us). We designed a Powerpoint presentation and recorded some skits showing improper technique and then included videos illustrating proper technique.

The second week was spent on the 6th floor satellite pharmacy. Here, I got to verify orders, serve as the final check for products being dispensed, draw up oral liquids, go on cart fill runs with the technicians, and calculate drug desensitization dilutions.

This week, I am in IDS - the Investigational Drug Services department. Today I completed an IDS training module, learned about eResearch (the website where drug protocols are submitted for approval), read an article about the development and funding on an IDS service (published in AJHP in 1987 by UMMC when the IDS service was just beginning), and learned about Dispensing Guidelines. One of my assignments this week is to develop a Dispensing Guideline for one of the new studies. Over the course of the week, I will learn about IDS and its functions.

Next week I will be in the clean room.

In addition to these activities, I will give a patient case presentation and meet with various administrators throughout the course of the rotation to learn more about their roles and responsibilities.