Monday, January 9, 2017

Rotation 6 - General Medicine

Posted by Millie at Monday, January 09, 2017

Although rotation block 6 is six weeks rather than the traditional five, the time really flew by! For this rotation I was back at UMHS for my general medicine rotation on the adult internal medicine service. The largest difference from my last inpatient rotation (SICU) was that instead of a very large interdisciplinary rounding team (see SICU post from October), I rounded with 1-2 medical residents and 1 medical attending. I hadn’t realized previously how different the rounding structures could be, and I’m very grateful I was able to experience both types.

My service admitted patients every other evening. We would generally round at 8:30 AM. On post-call days (the morning after the medical resident had been admitting patients ALL night), we would typically round 30 min-60 min earlier than the regular rounding time (so 7:30 AM instead) so that the resident could go home and sleep after being awake for 30+ hours!

Below is a typical schedule for if we were to round at 8:30 AM:

6:30 AM: Arrive at hospital to work up patients. I followed 11 patients, the max number of patients for my service.
8:00 AM – 8:30 AM: Meet with preceptor to go over patients. I would give an abbreviated presentation and mention any VERY pertinent issues and run my planned recommendations by my preceptor for her feedback.
8:30 AM-11:30 AM/12:00 PM: Round with medical team. These were bedside rounds, and it was a different experience from my previous inpatient rotation because we actually went into the patient rooms and spoke with the patients.
12:00 PM-2:00 PM: Grab lunch, follow up on questions for medical team, document scoring tools, medication reconciliation, anticoagulation discharges
2:00-2:30 PM: Meet with preceptor to go over patients. I would present patients, fill my preceptor in with what happened on rounds that morning, and discuss any new recommendations I had for my patients.
2:30-3:30 PM: Meet with other rotation students for case presentations, topic discussions, journal club. We each had a number of rotation projects for this block and it was really interesting to learn about different topics from each student.

Since the medical residents and medical attending changed so frequently, I made sure to always introduce myself to anyone new and make sure they knew I was part of the pharmacy team and that they were able to page me and come to me with any questions. Over the rotation, I received quite a number of pages from my team asking for my opinion or if I could look into something for them, and it was always a nice feeling to see how much they appreciated my help and how much I was able to help my patients. On the flip side, I also sent quite a few pages to my team whenever I felt there was a problem or that we could make an improvement in therapy for a patient.

Overall, I was very fortunate to have such a great preceptor who gave me a lot of autonomy and responsibility early on in this rotation. After a couple of days, she had me round with the medical team by myself and continue rounding by myself for the rest of the rotation. After the first week of the rotation, she had me documenting on the pharmacist scoring tool and gaining experience writing patient notes. By the middle of the rotation, any pages from the medical team that were directed to the pharmacist pager went to my pager and I was responsible for 1) answering any questions from the team, or 2) looking up any questions I didn’t know and following up with the team.

By the end of the rotation, I was working up patients, rounding alone, documenting on the scoring tool, writing and updating pharmacy notes, and was responsible for the pharmacist pager for my team. Although I had many responsibilities, I was still able to bounce ideas off of other students or my team and I was constantly learning new things from my preceptor, who was always there as a supportive mentor and teacher. I really grew a lot during this rotation and it was great to finally feel like a pharmacist. It was a great 6 weeks!

Apart from rotation, the other major event that happens during Block 6 is the Midyear Clinical Meeting. Jared has discussed this event at length in a blog post below so I won’t go into this too much, but I definitely will second how important it is to get your transcripts in EARLY and to ask for your letters of recommendation early as well. Although it was very busy to have rotation during the same time as Midyear, I was glad I ended up having my second inpatient rotation during block 6 because I gained much more patient care experience and I learned so much more about myself -- experiences I may not have otherwise gotten prior to the conference.

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