Hometown Hospital

Posted by Eric Zhao at Monday, April 30, 2012

Last month, I was with Providence Park Hospital in Novi, MI. If you have the fortunate opportunity to do a rotation in your hometown and live with your parents, do it. Coming home to homecooked meals and some family loving is a nice relief from the Totino's pizza and shenanigans associated with the typical college lifestyle.

Providence Park Hospital, Novi, MI

This was no ordinary institutional rotation, however. Each week had a different theme to provide exposure to the varied aspects of a hospital pharmacist.

Week 1: Made IVs in the clean room, delivered controlled substances, dealt with medication shortages, assessed/restocked inventory, and packaged medications.

Providence's USP 797-compliant Cleanroom

Week 2: Dosed-adjusted for the pharmacokinetics/anticoagulation service. We monitored for aminoglycoside/vancomycin levels and initiated/adjusted heparin, warfarin, dabigatran, fondaparinux, and rivaroxaban doses.

Week 3: Assisted metabolic support services through ordering appropriate parenteral nutrition. Rounded in the intensive-care unit (ICU). This part of the rotation is like a mini critical care rotation!

 ICU Rounds

Week 4: Attended a Pharmacy and Therapeutics meeting at Providence Hospital in Southfield. Gave a journal club presentation on the potential use of rivaroxaban in the treatment of pulmonary embolism. Spent a day in the Operating Room and viewed implementation of a bone-assisted hearing aid, a laparoscopic cholecystectomy, and a hemicolectomy. 

 

Bone-assisted Hearing Aid

 

Hemicolectomy

(I will spare you the graphic photos, but feel free to google it)

All in all, a great rotation that far exceeded my expectations. Highly recommended. A+++! Would rotate again.

Eric Zhao

I've been everywhere, man!

Posted by Anna Polk at Sunday, April 29, 2012

Oh yeah- I’m supposed to be blogging!! I feel like I’ve been running in place for the past few months and I can never seem to quite catch up. It’s been quite a whirlwind since I last posted (in December- yikes!!) When we last chatted, I was right in the midst of residency applications, so let me bring you up to speed since then.

December: Finished up at the Ann Arbor VA and spent winter break in Germany. Worked on residency applications from Bavaria!! 

At Neuschwanstein Castle in Bavaria


January: Institutional rotation at St. Joes’s in Howell; spent a good amount time being thankful that it was the least snowy January ever!

February: Road-tripped with my mom for residency interviews!! We did Michigan to West Virginia to Arkansas then up to New York to stop in and see my brother. Then momma flew home and I continued to interviews in Connecticut and Boston. 


At Loretta Lynn's Kitchen in Hurricane Mills, TN

March: Drug info rotation at Natural Standard (and probably had too much fun while living in Boston for the month!)  It was my first time working with students from other pharmacy schools and I really loved that experience. 

Natural Standard's Angels

April: Infectious disease at UMHS (my first rotation where I actually got to hang out in the B2 pharmacy area- can you believe it!?)

Current: Ambulatory care geriatrics (and trying to stay focused for 3 more weeks- which will be even harder now that we sort-of graduated on Saturday)

The almost-PharmDs!! 

In the midst of all this, I was offered a job!!! It is at the company where I did my summer internship (you can check out all the details over on the summer experiences blog) and is pretty much my dream job! I struggled with the decision to forgo a residency, but in the end this was just too great of an opportunity to pass up! So in the end I could have had a much more relaxing December through February but it was all a great (albeit expensive) experience.

Okay, hopefully I’ve put enough pictures in that it looks like I wrote a long enough post to make up for my inexcusable four month hiatus. P4 year really does go by in the blink of an eye! 

Institutional at Karmanos

Posted by Elizabeth Kelly at Friday, April 20, 2012

Well after a month off it was really nice to just ease into things at Karmanos. I have never worked in a hospital and really gained no experience during P3 IPPE so this was a great introduction.
Some of the stuff I did the first two weeks:
1) Shadowed tech/pharmacist in unit dose
2) Investigated the Investigational Drug Service
3) Learned how to do IV's (quite easy actually)
4) Learned how chemos work
5) Went to med safety meetings, etc.
6) Asked lots of law questions - the law exam is coming up!!!

2nd 2 weeks:
1) Rounded with med onc team and gave a presentation on equianalgesic pain dosing
2) Worked in the BMT clinic with 2 P4s from Wayne State - they won't stop talking about how they only have one week left after this and then graduation (totally bragging)
3) Presented on fertility counseling and preservation in female cancer patients to the pharmacy group. It was a 40 minute presentation (but I got away with maybe 30 minutes).

Overall this rotation was a lot of fun. I am looking forward to my last rotation coming up at St. John Hospital and Medical Center in Detroit for Cardiology/Critical Care and then graduation.... 29 days!!!!

Catch Up

Posted by Nina Cimino at Tuesday, April 17, 2012

Well I have not been great at keeping up with blogging. It has been a busy, exciting time though, so I will do my best to fill in some gaps without making this post too long!

First, rotations. I had my off block in February, which was filled with interviews and residency preparation. I'll fill you in on that next. In March, I had an infectious disease rotation at U of M, and it was great! Now, I'm in my last week of pediatric cardiology at Mott Children's Hospital (also part of U of M) and I'm loving it! Things move so fast.

Infectious Disease

This rotation was really neat because it was kind of like having two rotations in one. For my first two weeks, I rounded with the ID consult service, which is a specialty team that gets consulted when patients have very difficult to treat infections. This was a great experience for me, because while I found ID really interesting in class, I also found it to be really challenging. I was definitely looking forward to this rotation in order to get more comfortable with ID and learn more about which antibiotics are best for particular situations.

After my two weeks rounding with the consult team, I did two weeks working on the stewardship team. Antibiotic stewardship involves making sure that antibiotics are used appropriately, in a way that treats infections appropriately while trying to minimize resistance and also avoiding drugs that may be harmful to a patient. While working on the stewardship team, I followed up on the use of restricted antimicrobials, and worked on a project to help write new hospital guidelines for the treatment of endocarditis.

Pediatric Cardiology

This rotation has been really challenging, but extremely rewarding. Prior to starting this rotation, I had not had much experience with pediatrics, or critical care. Thankfully, I really liked cardiology when we learned about it in class, but the world of congenital heart defects was pretty new to me! I had a lot to learn coming in.

A typical day involves me getting to the hospital between 5:00-5:30, to work up my patients and review what happened overnight. Then I round from 7:00-9:00, and after that I discuss patients with my preceptor, follow up on recommendations, conduct medication reconciliation, prepare for topic discussions...etc. My first week was pretty overwhelming, and I felt like I couldn't keep up with the pace of the ICU or all the new drugs I was being exposed to. Now though, I am rounding by myself and making recommendations- I'm feeling great! I think the lesson learned here is that even when things seem overwhelming and difficult, I can stick with it and get better fast!

What comes next

Match day has come and gone, and I matched! I'll be heading off to do a PGY1 residency at Suburban Hospital in Bethesda, Maryland next year, and I am really excited about it! I think this residency will prepare me well for clinical practice and PGY2. I will be working with one other co-resident, and I'm very excited to start. Between now and then though, there is a lot to do! I'm in the process of getting ready for getting licensed in Maryland, taking my boards, and moving. The match process is pretty stressful, but taking things step-by-step definitely helps to keep things manageable.

I'll be moving on to my last rotation, a generalist rotation next week, so I will try to post about that once I get there!

What to Do, What to Do

Posted by Matthew Lewis at Sunday, April 08, 2012

My scramble at one site did not do well. We just weren't a good match. I wanted something to prepare me for a PGY2 in solid organ transplant, and they just couldn't provide that and didn't feel comfortable trying to shoehorn me in. Oh well, now I must begin the exciting process of finding a job. This job hunt will not be like any other. This time around, I might be employed with the company for years, even decades, whatever and wherever I decide. The possibilities are limitless, and for that reason it is empowering, yet overwhelming. There is still a chance at a second scramble site, and from what I know, I am one of the few P4s still scrambling.

Speaking of overwhelming, when you thought you would do a residency, but find out that isn't an option, it is overwhelming. You go into the match having made careful plans, the investment of hundreds, if not thousands of dollars, and the full backing of those who wrote your letters of recommendation as well as your other mentors. Then you find out something didn't go right. It's crushing. You will re-evaluate why you ever went into pharmacy. You will try to find some fault in yourself or your education, anything at all, but sometimes for whatever reason things just don't go your way. It is okay. You just have to find another path. Two of the most successful people in the class of 2011 didn't match, and are currently employed in jobs they would not leave for any residency. A few scrambled successfully and are enjoying themselves as well.

To anybody considering a residency, make sure it is something you really want to do. Ask yourself if there will be positions out there once you've completed the residency, and ask yourself if those positions absolutely require the completion of a residency. After Midyear, start working on your applications but take your plan to one of our faculty, like Dean Mueller or Dr. Kraft. Our faculty is very approachable and incredibly connected. They can let you know what they think of your plan and how to make it better. Our faculty wants to see their students succeed. In hindsight, I should have done this, but you learn from experience.

Things will work out for me even if scramble site 2 doesn't work. I still will be graduating from U of M, and I still have all those people I networked with while applying for residencies and going through my rotations this year. I have my drug knowledge, which will be tested and cleared for practice in just a few short months. There are plenty of other things I still have which haven't changed.

I do hope this post will help some of you in the future find your path to a residency. I also hope that this post will serve as kind words in a troubled time for those who didn't match in the future. It just seemed fitting that this post be made on Easter, where many people celebrate the concepts of rebirth and transformation. Happy Easter, everyone!

Note: This was edited by myself to clarify events to paint a more accurate picture of the scramble.

AmBuLaToRY CaRe

Posted by Melanie at Saturday, April 07, 2012

I am halfway through my ambulatory care rotation. Let me tell you about my experience so far:

On Mondays I am in clinic at Chelsea Health Center with Dr. Shimp. On Tuesdays I am in clinic at Livonia Health Center with Dr. Tingen, and on Wednesdays I am at the Saline Health Center with Dr. Shimp.

Prior to clinic, it is necessary to work up the patients by recording their most recent labs, looking through their medical record and especially concentrating on past pharmacy notes and physician notes, and developing a plan for their appointment.

The pharmacists that I work with are in a collaborative agreement and can make medication changes, including initiating and discontinuing medications, as well as making dosage changes. They manage hypertension, hyperlipidemia, and diabetes, as well as polypharmacy.

During the appointment, the patient's blood pressure, weight, and pulse are gathered. I was even in an appointment where an A1C was taken. We talk to the patient and gather information that we need. Once we have the information, we come up with a plan. We provide education for patients ranging from administering insulin to carbohydrate counting to hypoglycemia counseling. Medication adjustments are made if needed and followup is discussed.

After seeing the patient, a Careweb note must be generated to put into the medical record that details what we covered and the plan we established.

Other activities for the rotation include journal club, topic discussion, and patient care presentations.

My ambulatory care experience has been very unique and it is very inspiring to see pharmacists having patient referrals from physicians and managing medications.