Wow

Posted by Matthew Lewis at Wednesday, March 28, 2012

Another rotation done, and I've moved on to the next one. Just one more left and then some exams and I'll be a pharmacists...doing who knows what.

I say I don't know what I'm going to do next year because I did not match for residencies. Currently, I'm scrambling to find a residency. This means that places that did not find a student can be contacted by students without a place. There were roughly 3000 applicants for 2000 positions. Now there are 1000 applicants for 104 positions. Students much better than myself didn't match, and students much worse than myself didn't match. However, I'm giving it my best shot and one place looks promising, since I received a phone interview as 1 of 11 people whittled down from 128 applicants.

Oh, I'm also in Montana. I'm doing a rotation with the Indian Health Service out here. It is completely beautiful. You can't get cell service by the way, but at least the internet is still available so I can stay connected to friends and family. The Northern Cheyenne are a storied people, being one of the tribes that defeated Custer in the Battle of the Little Big Horn. I hope to learn a great deal of their culture.

The issues that the Northern Cheyenne face are increased rates of diabetes, hypertension, and hyperlipidemia coupled with poor *health* literacy (which is different from being able to read at all). There is also a great deal of substance abuse, and this has impacted which medications the pharmacy carries.

All in all, I'm looking forward to helping these people out with their medications. We should be getting our access codes and clearance today, so it will be the first full day of working with patients. I'm excited to make a difference on the rotation site and relax and recollect myself while off duty.

Bye Bye DC

Posted by Amanda at Monday, March 26, 2012

I finished my last two weeks at the FDA and it was filled with presentations and lots of learning opportunities. I visited the federal bureau of prisons (BOP). I learned all about the roles a pharmacist has in the prison system. They can participate in clinic with prisoners, so the prisoners can makes appointments with the pharmacist to discuss medications and have their questions answered. There was a museum in the BOP headquarters and we got to see what a prison cell looks like and some of the contraband in the prisons. I also went to the United States Pharmacopoeia, the USP is the organization that creates the standards for our medications, food, and herbals. We saw the labs where they test medications to determine if they are within standards.

While I was the FDA, I attended a public hearing that discussed a new idea regarding the role of pharmacists in the future. The hearing was in regards to a new drug classification which would be in between prescription and over-the-counter drugs. It would allow pharmacists to help patients in making a decision on what medications to use. Some of the medications that were discussed were albuterol inhalers and epinephrine pens. This was an interesting topic and it was enlightening to hear the opinions of other health professionals.

Those were the more interesting topics that I learned about at the FDA. I loved my rotation there and I learned a lot about the government side of pharmacy which is something we don't get to see in school.

NeUrOLOgY

Posted by Melanie at Sunday, March 25, 2012

I just finished up my neurology rotation with Dr. Dina Kennedy at UMHHC.

It was a combination of general neurology and neurology intensive care, so it was quite an interesting month.

Dr. Kennedy covers all the neurology and neurosurgical patients. For the rotation, I was assigned one of the three neurology teams.

My team had the attending, the senior resident, an intern resident, and four medical students.

Let me take you through a typical day:

• 6:00 am - arrive at UMHHC and workup patients on my team, including new admits
• 7:15 am - meet with Dr. Kennedy to discuss any recommendations that need to be addressed during rounds; this could include renal dose adjustments, medication reconciliation, adding bowel regimens, and addressing drug levels
• 8:00 am - Neurology ICU rounds - all the attendings and residents and medical students meet in a conference room and discuss the patients on the neurology teams that are in the ICU
• 9:00 am - Teams breakup and round on their patients; this is where I would make my recommendations
• 10:30 am - Rounds end; touch base with Dr. Kennedy and let her know if any pressing issues came up; work up patients completely and enter interventions in TheraDoc
• 1:00 pm - Meet with Dr. Kennedy to go over patients; formal patient case presentations
• 2:00 pm - Topic discussion/presentation
• 4:00 pm - Followup with team on any outstanding issues

During the first two weeks of the rotation, ICU topic discussions took place from 2 - 4. All of the ICU APPE students were involved with this (trauma/burn, SICU). These included PPI prophy in the ICU, tight glycemic control, and septic shock, to name a few.

Other topic discussions were neurology based, including meningitis, seizures, and stroke.

I was with another P4 student and we each had to present a journal club and a topic presentation.

This rotation was great for somebody who wants to get a little taste of an ICU rotation, since most of my patients were on the general neurology floor and only a couple were in the ICU. I highly recommend it!!

Infectious Disease at UCMC

Posted by Eric Zhao at Sunday, March 25, 2012

How fitting. I've caught an infectious disease on my infectious disease rotation at the University of Chicago Medical Center. My remedy? Lots of water and lots of sleep. Unfortunately, this is not the case with the patients on this service.

University of Chicago Medical Center

Infectious Disease (ID) Consult Team
The team I'm on consists of an 1) attending physician, 2) ID Fellow, 3) medical residents, 4) medical students, 5) ID pharmacist, 6) pharmacy resident, and 7) and yours truly, the pharmacy student. Without fail, other healthcare professionals comment on the size of our team. As a consult team, we cover the entire hospital with answers (hopefully) to anything related to ID. Some examples include what antibiotic to recommend, how to address a bloodstream infection, or how to narrow therapy to specific cultured/suspected bacteria.

Typical Day
8am - 10am Work up patients prior to discussing with my preceptor. Sometimes the list can consists of many patients (high score of 28 in one day!), so you mainly focus on what pertains to ID:

• Reason for consult
• History of Present Illness
• Allergies
• Complete Blood Count (mainly white blood cell count and platelets)
• BUN/Serum Creatinine/Creatinine Clearance
• Antibiotics
• Drug Monitoring (e.g., levels for Vancomycin and aminoglycosides
• Microbe cultures and sensitivities
• Assessment and Plan

Selling this template for $5 to future students on an ID rotation

10am-12pm Discuss patients with preceptor with any concerns or suggestions. Typically, she'll ask how you would narrow therapy or how the vancomycin/aminoglycoside levels look.

12pm-1pm Follow-up with patients and clarify any questions (and lunch)

1pm-3pm Discuss patients with full medical team

3pm-5pm Medical team visits any patients that we want to see, especially new consults.

Mix this schedule in with intermittent topic discussions, ID conferences, and Pharmacy Grand Rounds for a taste of what ID can offer. Now, to get rid of this nagging cough...

-Eric Zhao

Its been awhile...

Posted by Matt at Wednesday, March 21, 2012

A lot has happened since my last post. My wife and I had our second son, Austin, and I applied and interviewed for residencies. I just found out today that I matched at the University of Wisconsin pharmacy administration residency. It was my number one choice so I am really excited. The program is intense but it will prepare me to become a strong leader. Now I just need to figure out how to get licensed and where I will be living.

The last few weeks I have been on rotation with Dr. Hae Mi Choe at the East Ann Arbor Ambulatory Care Clinic. It has been a great experience in part because I have never experienced amb care before but also because I have been able to accompany Dr. Choe on many of her administrative meetings. I have gained a greater understanding of how amb care clinics fit into the health-system. They serve an integral role in patient care as patients’ transition from hospital to home. The University of Michigan has a great model where pharmacists pair with physicians to help manage medication therapy on an outpatient basis. For example, we had a patient who was recently diagnosed with type 2 diabetes and her primary care physician sent her to the pharmacist to learn about her medications and glucometers. I spent about 30 minutes with the patient teaching her and her daughter how to measure blood sugar levels and she was very grateful for our time together. We will be following up with the patient over the next several weeks to make sure her medication regimen is optimized to control her blood glucose levels.

I think ambulatory care is a very rewarding area of practice. You have lots of face time with patients and you are able to see them progress as you work together to meet their health care goals. This area of pharmacy practice is really expanding as health-systems begin to focus more on transitions of care and how to keep the patient healthy throughout all layers of care.

Late but never...more tips for Midyear

Posted by Bernadette at Saturday, March 17, 2012

So if anyone if interested in Rutgers, see Eric Zhao's post - it's pretty much to the letter of what happens. I just wanted to briefly add to it - not on the Rutger's portion, but on the PPS interview for other companies and programs.

The school doesn't really teach you/tell you about PPS, but it's not just for people who are interested in getting jobs upon graduation. It's also the "secret" way for you to talk to programs and get an upper hand.

What is it?

PPS is a system set up so that candidates and interviewers (employers and residency program directors) to talk to each other before Midyear to set up interview times. If you upload your resume well ahead of time, some programs will actually contact YOU to set up interviews based on what you list as your interests. You also get a chance to contact the programs you're interested in and set up an interview.

You do have to pay for PPS, but the companies participating are listed in advance so you can always check to see if it's worth your money.

**note: you can also set up different profiles of yourself. For example, if you want to interview for both jobs AND residencies, you can set up a profile focused on your strengths for a residency and another one focused on a job.

Who is it for?

1) PGY1 clinical residency candidates: Certain programs will be there usually interviewing for PGY2s, but if you're part of PPS and interested in a PGY1 program, you can still contact the programs and set up an interview - which is MUCH better than being ONE out of the THOUSANDS of other students at the showcase.

2) PGY1 Managed care residency candidates: A lot of programs don't require you to interview at PPS, but again, they're there and it only gives you advantage to meet them before the real interview invitations are sent out.

3) If you know you want to do PGY2s (already set on the specialty you want), some programs prefer/need you to sign up for PPS and interview for their PGY1 program (I don't know the exact details - you'll have to look into the program)

What do you do?

Once you sign up for PPS, you can contact the programs that are participating. I contacted them before Midyear to set up interviews. Now, if you're also doing Rutgers, keep in mind you don't know your interview times until you get onsite, so don't fill up your schedule. Also, PPS is running concurrently to the Residency Showcase, so if there are places you MUST see at the showcase, don't schedule interviews then. Remember to give time between interviews as well - if one runs over, YOU are the one that gets blamed for showing up late to the next one. You can also schedule interviews when you're AT midyear, but the times are more restricted. For some programs, I didn't even realize they were at PPS and I was able to schedule interviews just by stopping by their booth.

Pre-interview

Practice! This IS a real interview, so make sure you're ready and prepped for any questions that come your way. Remember, if they like you, you'll more likely to get an interview in February. Bring plenty of copies of your CV - some people will already have it, but you still never know. I don't think I gave out 50 copies or anything, but definitely around 30 or so (at least at PPS). Also, I'd bring granola bars or other snacks and water. If it's 10 minutes before your next interview, you don't have time to leave and stand in line for 20 minutes for food outside. I definitely used up my stash at Midyear.

What to do after?

Thank you cards/e-mail! Always remember to follow-up, even if you ultimately don't like the program or you thought the interview went bad - it's just professional courtesy.

Those are the main pointers I can think about for now. Even though it is early, good luck to all the P3s entering their P4 year! =)

FDA in DC

Posted by Amanda at Friday, March 09, 2012

I am halfway done with my rotation at the FDA. It is in Silver Spring, MD about 15 minutes from Washington DC which is where I am staying. I have definitely learned a lot during the past two weeks. I didn't realize how many pharmacists actually worked for the FDA. There are also a lot of pharmacy students.

I am in the Center for Drug Evaluation and Research in the office of regulatory policy. My department consists of mostly pharmacists and lawyers. My department handles all the policy with the FDA. All the regulation that is passed into the law and all the information that the FDA puts out to the public goes through my office.

So far I got to work on one of the acts that are being passed by congress called the prescription drug user fee act. I worked two regulations that are going to be passed in the future. I am working on a project with two other students regarding a new REMS program that is going to start next week. I also attend presentations that teach us about the other departments in the FDA where pharmacists can work. The main branch that they have talked about is the public health service. There are many benefits that come with working for the PHS, it is very tempting, but they are have a hiring freeze right now :(

News from the Underground

Posted by Matthew Lewis at Saturday, March 03, 2012

Hello Everyone,

It has been some time since I posted, and that is because I took last rotation block off. I had several interviews across the country, but much less than some of my classmates who had as many as 11. Luckily, I have a clear view of my sites and am excited to see where I go, if I will have to scramble, or if I will have to start my career.

My current rotation is at a compounding pharmacy in South Lyon, MI, and it is quite an interesting place to learn. Mr. Walkup, who is also the President of the pharmacy fraternity Phi Delta Chi, started off with an independent retail pharmacy with a small compounding pharmacy on the side. He was since bought out by Walgreen's and sold his retail store and now focuses only on the compounding side where his business has expanded about 200% in the past six months. So, I am learning about little known areas of pharmacy, which are compounding and business.

In terms of projects and tasks, I have to give a topic presentation every Thursday for all the staff, and most of the time I am doing special topics, such as drug information questions on safety and efficacy of compounded prescriptions. Many doctors and patients are still wary of compounded prescriptions, thinking that only brand name or generic manufacturers can guarantee their products and provide the desired relief. Mr. Walkup ensures all his products use ingredients with certified purity and expiration dates and are compounded according to USP 797 and 795 (industry guidelines for the preparation of sterile and non-sterile products respectively). I have also taken part in a health fair for South Lyon school employees, and was quite amazed to see how many people in the area had used the compounding pharmacy or knew Mr. Walkup. It just goes to show that when you do good work, people will know about you.

Another important aspect of compounding pharmacy is having a good, working relationship with the doctors in the area. They need to be made aware of compounding services to allow patients more options in their care, which could improve the safety or efficacy of medication therapy such as supplying a dye free product or a wound healing cream not commercially available. Doctor-Pharmacist relationships are generally improving across the whole field, as we each specialize more and gain more working knowledge with the wealth of residencies and mandatory Doctor of Pharmacy degrees pharmacists have now. The most important thing is that the patient is taken care of better and better the more the entire health care industry continues to respect and communicate with one another.

That is all for me right now. Next month is my rotation out in Montana with the Indian Health Service, and I am anxious and excited for it.

Goodbye,

Matt