Ambulatory Oncology -- A Different Perspective

Posted by Anna at Thursday, April 25, 2013

Before drafting this blog entry, I checked out Maria's post regarding this rotation. I was surprised to see how some aspects of the rotation stayed consistent with my experience while others were completely different! It does show how a given rotation will evolve as each student moves through it, as well as how the time of year may affect the tasks performed. Due to these differences, I’ve decided to share my experience, which is best broken down into two main categories: clinic days and project days.

Multidisciplinary Clinic Day:
7:30am: Present to specialty cancer clinic. Make a copy of the patient schedule for the day, work-up patients based on existing medications and disease states and determine any specific questions I want to make sure to touch on when I chat with them.
8:00-11am: Verify medication histories, answer patient medication-related questions, and make any recommendations. Document the information in the patient electronic medical record.
Afternoon: Repeat above if afternoon clinic day, otherwise work on independent projects.

The pharmacy role in the clinic flow was well established by the time my rotation started, and everyone was pretty used to seeing a student involved. I had the opportunity to chat with head and neck cancer (Monday AM), lung cancer (Tuesday AM), gastrointestinal cancer (Tuesday PM), and breast cancer (Friday AM) patients to get a thorough medication history and assess for any medication-related issues or concerns.

Project Day:
When not in clinic I would work on independent projects. This included preparing for topic discussion (five total), updating the febrile/afebrile neutropenia guidelines for the institution, and answering drug information questions presented to my preceptor. Additionally, I had the chance to shadow the Chaplain (provides spiritual care to oncology patients) and chat with the genetic counselor on staff, which provided a better understanding of the comprehensive care a cancer patient receives.

Pros:

• Beautiful hospital with a welcoming environment (and free parking ON SITE!!!)
• Good review of major cancer types and chemotherapy used
• Exposure to counseling on alternative therapy options
• Opportunities to interact with patients and support them in their fight against cancer
• A lot of autonomy and independence

Cons:

• Only a few days of clinic per week with variable volume—this meant there weren't many interventions made in a given day
• Not traditional ambulatory practice focusing on chronic disease states or delegated prescribing rights for the pharmacist
• Patients do not have appointments with the pharmacist, which can make finding time to speak with patients challenging
• Little one-on-one time with preceptor (maybe pro depending on the person!)
• Senioritis (I was very aware that this was my last rotation... this presents its own set of challenges)

Coming from someone with little interest in pursuing an ambulatory care position, I specifically chose an oncology-focused rotation for something a little more unique in the ambulatory setting. Additionally, my plan to pursue a residency post-graduation ensured I would gain exposure to chronic disease-focused ambulatory care if I so desired. However, I would say that if you are seriously considering a more traditional ambulatory care practice setting or a setting with delegated prescribing rights to the pharmacist this is not the rotation for you. Additionally, if you are the type who needs a lot of one-on-one attention, you may prefer a different rotation. Although my preceptor was always available by phone, email, page, or stopping by her office, she was much more hands off than other preceptors I had in the past. Case in point: my first day of clinic (day 2 of rotation) I was shown to the clinic, logged into the system, and then left to my own devices. I was comfortable with that, but it meant I had to be open to asking for help from the nurses and other clinic staff (all AWESOME, by the way). Overall, it was a nice way to end my final year. Due to the ample amount of project time, I only rarely had to bring work home with me and for the most part could enjoy my last few weeks as a P4 student.

This ends my P4 blogging adventure! I appreciated having the space to write about my rotation experiences, and I hope many others continue to take advantage of this opportunity. Good luck to the next P4 bloggers as you start your rotations in a few short weeks, and a HUGE congratulations to the PharmD Class of 2013!!