ID in the D

Posted by Anna at Saturday, February 16, 2013

I spent the last six weeks on an Infectious Diseases (ID) rotation at Sinai-Grace Hospital located in Detroit, MI. An ID rotation was a top priority for me when scheduling my P4 year, and after finishing up this rotation I stand behind my decision! Infections are seen across all areas of practice, and it was great to have a rotation specifically focused on improving my ID skills.

This rotation was an Antimicrobial Stewardship rotation, which meant I worked behind the scenes monitoring antibiotic treatment for patients and contacting physicians with any recommendations to optimize antimicrobial therapy. Sinai-Grace Hospital has a unique ID consult service which is run by independent ID physicians who round on the patients, which meant that rounding was not a component of this rotation.

One of the highlights of this rotation was the fact that although I did not have a team to round with, I was surrounded by my own pharmacy “team.” Beyond my primary preceptor—Dr. Jason Pogue—I worked under the ID PGY-2 resident for the first four weeks of my rotation. Also on my “team” was the Sinai-Grace PGY-1 resident as well as a fellow P4 student from Wayne State University. I absolutely loved having such a diverse group of individuals to work with, and I was sad when each person slowly left for other rotations leaving me all alone on my final week.

A typical day consisted of:

• Following up on my “old” patients to see how they were progressing and if anything needed to be modified or addressed
• Work up new patients and develop a care plan for their infections
• Present new patients to my preceptor and comment on any follow-up needs for “old” patients
• Call/page physicians to make recommendations as needed
• Topic discussion / Journal Club / Follow-up questions

I was responsible for my patients from the time they were assigned to me until they were either discharged or no longer had any infections requiring antimicrobial therapy.

Overall, I really loved this rotation and highly recommend any ID rotation for a P4 student. I feel that this rotation specifically provides a lot of benefits:

1.       The patients. The patient population in Detroit has a lot of infections caused by multi-drug resistant organisms. Obviously, this is not so great for the patients; however, it is the perfect setting for pharmacy students to learn about how to treat complicated and challenging infections. It also allows you to see the significant role pharmacists play in this aspect of patient care.

2.       The preceptor. Jason is a fantastic preceptor. (I’m writing this after my final evaluation so you know I’m being honest and not just trying to get a good grade). He does a great job of asking questions and challenging you to know the information without making you feel bad when you don’t. He also tries to work with you on your personal weaknesses, and he will modify the rotation to complement your specific professional goals. For instance, he knew I was trying to obtain a PGY-1 residency position post-graduation, and for my final week he cranked the workload up to “resident” mode which forced me to work at a much higher level and also allowed me to focus on some areas for improvement.

I also want to touch on some of the possible drawbacks of this rotation to provide a well-rounded evaluation:

1.       Commute. The hospital is in Detroit. I live in Ann Arbor. This meant I had a 40+ minute commute (one way) to the hospital with the other billion people on the road. Coupled with the potential for bad January/February driving weather, I was a little concerned going into this rotation. That being said, I got used to the commute and lucked out with pretty mild winter weather for the most part. I would not let the commute deter you from choosing this rotation, particularly as the weather is only a key player in a few months out of an entire year that you could take this rotation!

2.       Interviews.  Although this rotation block was designed to provide a week to take off for interviews, an interview day is not really a relaxing day “off,” and on busier weeks I found it challenging to switch from interview mode to rotation mode. Even though my interviews were all located in Southeast Michigan, I still felt overwhelmed at times. On the flip side, having rotation responsibilities prevented me from stressing out about interviews too much—no one has time for that stuff when you have patients to take care of! I also want to say that the preceptor worked with me on scheduling and I never had an issue where rotation conflicted with a possible interview. Again, this “con” really only applies for the rotations that typically fall during interview/job search months.

After the past six weeks being surrounded by ID, a possible future as an ID pharmacist is definitely on the table. It is a really interesting area of practice and (now that I am starting to get the hang of it) I get why people love it so much!

My next rotation takes me… nowhere. I am tired, and luckily I have the next five weeks to recuperate on my “off” rotation. Once I catch my breath I will attempt to tackle a huge to-do list which includes a lot of figuring out what my next steps will be as graduation approaches.

I also want to send good luck to all of my classmates starting it all over again on Monday—only two rotations left, we can do it!!!