Saturday, February 23, 2013

Q: What has been your favorite rotation?

Posted by Kristen Gardner at Saturday, February 23, 2013

This was an EXTREMELY popular question during residency interviews. Actually, I believe it was asked at every interview. My answer: the rotation I just completed in Ambulatory Care Cardiology at the Ann Arbor VAMC with Dr. Michael Brenner as the preceptor. I am going to pursue psychiatric pharmacy, not cardiology; therefore, I have to be telling the truth!

Mondays: anticoagulation clinic AM
  • Manage patients on warfarin, dabigatran, and LMWH
  • Construct periprocedural bridging calendars for patients with upcoming procedures.
  • Complete anticoagulation consults for questions and hospital discharges
  • Meet with patients new to anticoagulation (1-hr appointments)
Thursdays: post-discharge heart failure clinic AM
  • Meet with patients 1-2 weeks after D/C following admission d/t CHF exacerbation
  • Staff with the preceptor and cardiologist, Dr. Scott Hummel, who is an amazing physician! The attending will perform a physical exam and you discuss how to best manage the patient together
  • You really see how this clinic works to reduce readmissions as we caught patients whose status was tenuous (BP=80/50, on 2 diuretics vs. 1, on the verge of acute on chronic kidney failure, edemous/ascites, etc.)
All other days/time: Pharmacotherapy clinic
  • These are 1-hr appointments for amiodarone monitoring, hypertension (including resistance hypertension where he will use aldosterone/renin levels to guide therapy), dyslipidemia, angina, and CHF
  • On some Tuesdays there will be a medication education group for the cardiac rehabilitation class; there are two 1-hr sessions and then a 30min review. You will lead the 2nd med education group and the review session.
Friday: no clinic; telephone calls (he may open up this day for clinic apt in the future)
  • You will also have to call patients on other days

I loved this rotation for many reasons!
  1. For students who want to pursue a residency program and demonstrate strong work ethic, he will throw you into the workflow. For me, this happened on the first day with him. He would have me observe him interact with a patient for each new type of appointment, he would observe me once, and then I would be on my own and staff with him. For those that do not understand what staffing means, it essentially means you are interacting with the patient on your own in the room. You provide a synopsis to the preceptor/attending on your recommendations with a brief explanation.
  2. Everybody at the clinic is SUPER nice! The NPs, nurses, medical students, medical residents, fellows, and attendings are great.
  3. You engage in a variety of experiences (teaching cardiac rehab classes, updating order sets, electronic consults, direct patient care, telephone calls, journal clubs, topic discussions, formal topic discussions, etc.)
  4. He encourages scholarly activity with each student by having them summarize the articles on every Friday.
  5. Dr. Brenner LOVES his job and loves pharmacy.

It was challenging because I had never worked with the computer system at the VA; therefore, it took me a good 2 weeks before I was moving around at a fast pace to find the info I needed and pull in data/info to the notes to complete them. Additionally, you cannot access anything from home meaning all work-up and completion needs to be done on site. This could mean very long days if you have full clinic days back to back, especially with new patients. Also, the medical team outside the NPs switch on a daily basis; therefore, it is difficult to build a relationship with them where they are asking you questions all the time.

Best part= seeing/chatting with patients after you made recommendations that made a difference in the lives of the patients. 

Email me with questions!!! Oh, and you should rank this rotation #1. He only takes a few students/year.

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