Saturday, September 8, 2012

Just when I thought I had the next five years planned…

Posted by Krystal Sheerer at Saturday, September 08, 2012

My last rotation was Cardiology Ambulatory Care at the Ann Arbor VA with Dr. Brenner. Dr. Brenner definitely challenged me and I am so thankful he did. 

Overview of my rotation: 
My first day consisted of orientation and discussing with Dr. Brenner what his expectations were and what expectations and goals I had.  


On Day 2 I gave my first topic discussion. This was my first topic discussion of my P4 year and it was definitely not what I expected. My first topic was hypertension. Basically, during topic discussions you tell him everything you know about the disease state (definitions and goals) and the medications (indications, doses, MOA, ADRs, interactions, contraindications, and monitoring parameters).  He does not want you to use any notes… he wants you to know it! Even if you thought you knew everything he will find something you do not know and that is okay. You can look it up and get back to him as soon as you find the answer.  This is how all topic discussions went. The first week and a half we covered hypertension, anticoagulation, antiplatelet therapy, CAD and stroke secondary prevention, hyperlipidemia, heart failure, amiodarone monitoring, and arrhythmia therapy.  The information he expected you to know was realistic it was information that could appear on our boards and information you should know. You definitely leave his rotation more comfortable and confident about the above topics. Did I mention that he will quiz you throughout the rotation? He will ask you questions about your first topic discussion on week 2, 3, 4, or 5. This is to make sure you actually know the material and do not just memorize things for topic discussions. The topic discussions prepare  you for the patients you will be seeing as he sees patients in anticoagulation clinic on Mondays and then Tuesday through Friday he see patients with hypertension, hyperlipidemia, heart failure, CAD, and patients taking amiodarone.

The second week I was seeing patients in anticoagulation clinic. I saw both therapeutic and non-therapeutic patients. After interviewing the patients I would discuss with Dr. Brenner what my recommendations would be. It is important to be able to state why you want to make dose adjustments or why you want to keep things the same. By week 3 I was seeing patients with hypertension, hyperlipidemia, post-discharge heart failure patients, and patients taking amiodarone. During this rotation you definitely have the opportunity to work on patient interviewing skills, therapeutics, and soap note writing.    

Other activities on this rotation included leading/presenting a topic discussion on heart failure to a resident and pharmacist and leading two cardiac rehabilitation classes on medication therapy. I also had an opportunity to write a paper on using ambulatory blood pressure monitoring to guide antihypertensive therapy. If you haven't heard of this I encourage you to look it up. I also would recommended (its free you just need to sign up). Additionally, I was able to spend a few hours observing in the cath lab.

I did not know it was possible to learn as much as I did in 5 weeks. Dr. Brenner is a great preceptor. He provides feedback all the time. You never have to guess how you are doing. He will find your weakness and help you to improve it. He also is sure to compliment you if you doing something well.  I have really enjoyed my experiences at the VA. I would encourage anyone that may be interested in cardiology to rank Dr. Brenner's rotation. You will definitely have a great experience. He tells every student that their experience may be different than their peers. The cardiology physicians are great and welcome pharmacist involvement. They work closely with Dr. Brenner and engage in conversation with the pharmacy student.
 I would recommend Dr. Brenner’s Cardiology Ambulatory Care rotation at the VA in Ann Arbor to anyone!

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