Saturday, June 16, 2012

Rotation 1: Cardiology with Dr. Dorsch

Posted by Alison Van Kampen at Saturday, June 16, 2012

Hello Everyone!

After reading a few of my classmate's previous posts, I now realized I am woefully under-qualified to write entertaining, catchy blogs.  So I would like to apologized in advance for any future writings that are so dry you feel as though you are reading an extensive "Statistical Analysis" section in a research article.  That being said, all that follows are my experiences from my Cardiology rotation at UMHS with Dr. Dorsch.

Since beginning this rotation, I have had several anxious classmates ask me about the experience (most likely anxious because many have heard that Dr. Dorsch has changed his rotation format, and they will have this rotation in the near future).  If you fall into that category, do not fret, it really is not bad and I have really enjoyed myself.

Here is basically how the set up has been operating

Week 1:

  • One day orientation to Dr. Dorsch's expectations and our responsibilities
  • Got a pager, you know you have arrived when you have a pager :)
  • We would be following the Medicine Coronary Service in the hospital which is composed of 3 teams
  • I am on this rotation with another student, Victor Truong, and we split up the teams so we would each follow one team and we split the other. This meant that we follow approximately 8-15 patients at a time.
  • Arrive at 7:30 ish in the morning to collect data on the each patient on the team, perform medication reconciliation on patients that have been admitted in the last day, and perform discharge counseling on any new medications for the patient. 
  • The teams rotate days on which they admit new patients, so each team only gets new patients every 3 days.  This means lots of work on the days that my team admits new patients, moderate amounts of work on the days that the team we split admits patients, and very little work/catching up on days that the third team admits patients.
  • We are also responsible for looking at antibiotic doses to see if they need altering, checking if the patient's insurance covers particular medications, and a few other things.
  • All of these interventions are recorded in notes on Careweb.
  • In the afternoon we meet with Dr. Dorsch and his resident, Jen Lose.  Here we went over the notes we had written in the morning and discussed why they had certain therapies.
  • We were generally able to leave by 3:00-4:00.

Overall Impression:  This week required a lot of work at rotation and outside of rotation, this was primarily because I was still figuring out the best way for me to collect the data and where to find the data one the patient's profile.  I learned a lot about the hospital system.  Both Dr. Dorsch and Jen were really great to learn from.  They ask you questions to make you think but also inform a lot about things that were kind of glossed over or not covered in class. Things like aortic stenosis and the studies that are used in diagnosis.

Week 2 and 3:
  • All of week 1's activities plus afternoon topic discussions.
  • Arrived at 7:30 ish in the morning
  • In addition to the basic med rec, we were expected to start looking more at the patients medications in terms of their medical needs (does each medication have an indication, is each medical condition adequately treated, appropriate doses, interactions, is dose adjustment needed based on lab values, etc). 
  • Often answered
  • Topic Discussions:  
    • We held topic discussions after discussing our patients in the afternoon.
    • There were 7 topics (ACS, HTN, Arrhythmias, HF(1 and 2), Pulmonary HTN, and Stable Vascular Disease) that Victor and I split up between the two of us.
    • I took 4 (2 average length and 2 short topics) and he took 3 (2 average length and 1 long topic).  
    • For these topic discussions we were expected to write a background and summarized about 4-14 research articles and present these informally in a 45 ish minute presentation.
    • These presentations actually ended up lasting around one and a half hours.  Often Dr. Dorsch or Jen would interject to add clarification to certain points, discuss a study more in depth, or deviate to a new topic entirely.
    • Topic discussions were often pretty fun.  It was a really great way to learn about optimal therapy for a particular condition and Dr. Dorsch and his residents often went off on really entertaining tangets that frequently had nothing to do with the topic at hand.
    • The purpose of the topic discussions was to give us a good knowledge base before starting rounds.
  • We usually left around 4:00-5:00 on topic discussion days.
Overall Impression:  These weeks I really learned a lot about treatments in cardiology and became more comfortable with suggesting treatments. Topic discussions were very helpful, but required A LOT of work outside of rotation, I talking dedicate your weekends to this kind of  work.  This was primarily because I did 2 topics each week and I am kind of a slow worker, so maybe it will not take others in the future so long.

Good Advice from Jen: Know all the little things about the drugs (half life, route of elimination, which might be a little better at one thing over another).  The physicians know which classes are needed but they rely on the pharmacists to know which drug in a class will be best in an individual patient. Ex.) A patient needing a beta blocker but has poor compliance and poor renal function should avoid atenolol (renally eliminated) and carvedilol (BID) so could get Metoprolol succinate.
It all seems so obvious now, lol

Weeks 4 and 5:
  • Same as weeks 1-3 but we have finished our topic discussions except for Victor's last one which he did on week 4.
  • Started rounding with the team, which means getting to the hospital at 6:30 ish in the morning to collect all the latest information on the patients and identifying any ways to improve therapy in order to be ready for rounds at 8:00.
    • Rounding is interesting because it gave me a better idea of what was going on with the patient and helped me to better understand the best way to treat the patient.
    • Also it was easier to understand what exactly was going on when I could be a part of the discussion rather than just read a note on Careweb.
  • We discussed our patients in the afternoon and found any other possible areas for therapy improvement to either bring up to the team the next morning or pager a team member about that afternoon.
  • Afternoon discussions were primarily held with Jen on week 4 and will be with Dr. Dorsch on week 5.
  • We generally left around 5:00
Overall Impressions: I was glad to start rounding because it felt more like real clinical pharmacy practice but it does take up an unpredictable amount of time (mine lasted between 50 min and 4 hours).  The rotation is very time consuming but rewarding.  Working with Dr. Dorsch and Jen has been awesome because they are so knowledgeable and try to test your knowledge but do it in a way that does not make you feel like you are a failure as a human being.  They will often have you look up an answer and then provide further clarification. 

I have really enjoyed the rotation and for all of you that have the rotation in the future, Good Luck!

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