Sunday, July 1, 2012

My Levofair with Internal Med

Posted by David Plumley at Sunday, July 01, 2012

I knew that these five week rotations would go fast but I did not realize just how fast until I looked back a few days ago and I always already done with my first rotation.
To say I learned a lot on from Dr.Regal, Charles in charge, and the members of the Medicine Dock team would be an understatement.  Most of my learning came on the fly during rounds.  Once my team members became comfortable with me and confident in my pharmaceutical knowledge they would ask me questions about almost every patient.  Most of the time I would reply with my favorite phrase, "let me look into that and get back to you" and then do some research of my own, as well as discuss the topic with Dr.Regal, in order to come up with the best recommendation.  However sometimes thanks to the knowledge I acquired from therapeutics and the confidence I gained from this rotation I was able to make a recommendation on the spot.  Most of the recommendations I made involved antibiotics (dosing, optimization, duration, and toxicity), anticoag(warfarin dosing, Lovenox bridging, and the occasional Dabigatran), and optimizing chronic therapies.
The therapeutic and medical knowledge I acquired is very important, but maybe more importantly I learned confidence and how to operate with the medical team.  It took some time for me to understand how rounds work and how to best contribute but once I did I was able to participate in my own active learning even more.
The most valuable advice I can give to students getting ready for their clinical rotations would be to pay attention to every patient on rounds, learn from the discussion the team may be having even if you may not be responsible for that patient, look up everything you aren't sure about, and to work with your team.  We have all heard this before during orientation but it is most definitely true.  
One of the most difficult parts of having a clinical rotation first was my unfamiliarity with much of the medical terminology, but by writing everything down and looking it up later I was able to learn more than I thought.
It wasn't all work however.  Many of you might not know this but Dr.Regal is quite the wordsmith and poet.  He shared with us 2 poems he wrote about protecting fluoroquinolones (one of his favorite past times) and ending levofairs and ciproflections.  I will try to get copies of these so I can share them with the world.
Before I finish today I would also like to give you a quick intro to my next rotation.  I started this past Monday at Karmanos Cancer Center located in the Detroit Medical District.  This is an ambulatory care rotation focused on bone marrow transplant.  I am excited for this rotation since I have an interest in oncology/hematology.  My preceptor is Dr. Simon Cronin, the former preceptor of our very own Dr. David Frame, which makes me semi nervous.
So far in my first week I am getting accustomed to the work flow.  I spend most of my day doing med recs, some patient education, and have opportunities to shadow Simon as he works.  The clinic has approximately 2 MDs, 4 NPs, Simon.  The 2 Wayne State students I am partnered with and myself play an important role in searching out drug therapy issues and bringing them to the attention of the other clinicians.
I will update you on how this rotation goes in a few weeks.

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