Sunday, August 18, 2019

Surgery Generalist (Gen Med) - Rotation 2

Posted by Makenzie at Sunday, August 18, 2019

For general medicine, I preferenced completing the rotation in surgery.  Surgical medicine isn’t well-covered in class so I was looking forward to exploring it.  A large part of what I learned in the beginning was what medications should be stopped prior to surgery (if at all) & how to restart patients back on their home regimens when appropriate.  This was particularly salient for patients on chronic anticoagulation regimens.  Also covered were certain drugs specific to postoperative patients (e.g. Entereg) and how to treat acute surgical pain. Patients were scheduled for surgery (day zero) & then stayed until well enough to be discharged, which ranged from 2 days to 30 days (typically 3-7 days) where I was placed.

A typical day included taking the first bus out of my neighborhood to arrive at the hospital at 6:45am.  I usually started looking at patients the afternoon before (while they were still in the operating room), making note of their scheduled procedures & going through their preop physical.  I spent my early morning reading over surgical & overnight notes for each patient.  During the first week, I covered about 6 patients/day, by the end I was covering the service which which usually included 17-26 patients, all of varying complexity.  I would meet with my preceptor 8am-8:30am to pre-round on patients.  From 8:30-9am were the interdisciplinary rounds with PAs, social workers, interns, and dietitians.  These rounds were very fast & took place in a conference room.  Thus I had to prioritize interventions that would be most acute to each patient & the team.  

After rounds I would update my preceptor & follow up with any requests from the team (e.g. coming up with an oral opioid pain regimen to get a patient off of PCA).  Mornings varied widely depending on team needs.  This also included covering the pager for service.  Around lunchtime I would attempt to look over patients entering the OR who would be admitted for postop management.

Afternoons were set aside for presentations, usually starting at 2pm.  Each general medicine student need to give one journal club, one topic discussion, and one case presentation.  With six students in the adult services, there was a presentation to attend every day.  Afterwards, I was free to return home.  In the evenings, I would work on my future presentations or go over patients for the next day.

Overall, this rotation block was busy but rewarding.  I also gave my PharmD seminar on the last day of this rotation.  Despite how busy I was throughout this block, it solidified my desire to pursue hospital pharmacy post-graduation.  My preceptor also emphasized the importance of writing weekly reflections & making note of meaningful interventions & observations.  The time I set aside for writing these reflections allowed me to keep my goals and mind & to make conscious steps towards them.

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