Rotation 9 (Community)

Posted by Sarah Choi at Tuesday, April 28, 2020

Rotation 9: Community

It’s crazy to think this is my last blog post. My last rotation was at a community pharmacy, and it was definitely very different from what I expected. I worked at a chain retail pharmacy for half of pharmacy school, so I thought I knew what to expect. My experience really goes to show that each pharmacy is run differently since they have different procedures, technologies, and ways of dispensing. This community pharmacy puts an emphasis on patient counseling, with a separate window for patients to pick up and talk to pharmacists or pharmacy students. In the time that I wasn’t filling, dispensing, and counseling patients, I was working on other projects. I had a chance to contribute to the analysis of 340B cost savings at the pharmacy, work on drafting some procedures, and work on various quality improvement initiatives.

This rotation was also very different because of the social distancing/stay at home requirements to flatten the COVID-19 curve. A large part of this pharmacy’s patient population were students, so there were less patients in general. Despite the COVID-19 pandemic, I still had some opportunities to counsel patients on their medications, and it was really beneficial to be out in the community seeing how patients and others were affected by COVID-19.

And with that, I’ll have to say goodbye now. Thank you so much for reading! I hope my posts gave you a glimpse of what P4 year is like and what opportunities/rotations you’ll have. If I had one piece of advice for anyone reading, I would have to say, be ready to make mistakes and to learn, and don’t be surprised when you realize after three years of studying the main reason you wanted to become a healthcare provider in the first place.

Rotation 7 (Hospital/Health Systems) + Rotation 8 (Ambulatory Care Oncology)

Posted by Sarah Choi at Thursday, April 02, 2020

Rotation 7: Hospital/Health Systems

During my hospital/health systems rotation, my days were split up into two parts: inpatient pharmacy tasks and counseling. As a student at this institution, I was responsible for serving as the first check on daily medications that were being hand delivered to the floor (mostly because they’re too large to be put into automated dispensing cabinets). I was also responsible for checking A-packs, anesthesia trays, and ancillary medications. I honed my ability to check medications precisely and efficiently. The major second part of this rotation was counseling. I got to improve my counseling and patient education skills, specifically around anticoagulation and pain medications post hip/knee replacement. Outside of the inpatient pharmacy tasks and counseling, I worked on drug information questions and a project, where I drafted a policy for Narcan distribution in the ED.

The main thing my 7^th rotation taught me is that a great preceptor can really make a rotation worthwhile. The 7^th block can be incredibly busy, not only with rotation requirements and opportunities, but also because residency interviews begin. I had such a supportive and understanding preceptor, and it made me love and even look forward to coming into rotation.

Rotation 8: Ambulatory Care (Oncology)

My 8^th rotation was a great experience! I haven’t had any ambulatory care experience before, but I definitely could see myself working in a similar environment in the future. Ambulatory care gave me the opportunity to build and maintain rapport with patients, especially because some of the patients I saw came in every two weeks, depending on their treatment schedule. I also liked how close my preceptor was with the clinic physicians as they’ve been working together for a long time.

I was in four different clinics during this rotation, which included genitourinary (GU), oral oncolytics, melanoma, and breast clinic. I loved the variety of patients I saw within the different clinics, but appreciated how I still felt like I was growing and learning every time I was in clinic because of the rotation. On a typical clinic day, I was doing patient educations or seeing patients prior to their provider (physician, NP, or PA). I could ask specifically about their treatments and what side effects they might be experiencing. Going in before the provider also gave me the chance to give the provider a heads-up about certain aspects for each patient and make recommendations of my own for symptom management. This rotation also taught me a lot of about being flexible; it’s different from the inpatient world where if the patient isn’t in his or her room at a certain time, you can always swing back another time and talk to them. In ambulatory care you have a small window to see a patient. Sometimes you miss it because you’re running behind your schedule or sometimes you don’t have the opportunity to see patients because the entire clinic is running behind. I learned that the way I was going to get the most out of this rotation was being willing to jump right in and see another patient rather than waiting for one you had planned.

Overall, the highlight of ambulatory care was the relationships a pharmacist can build and maintain not only with patients, but also providers. It felt very different from all my other rotations, so I was sad to lose out on the last few days because of COVID19.

My last rotation is my community rotation. I’m sure it will be a very interesting rotation with the current spread of COVID-19 and the social distancing recommendations!

           

Rotation 7: Working from Home - Drug Information

Posted by Makenzie at Tuesday, February 25, 2020

After enjoying my block off and the holidays, I went back for my drug information rotation.  This rotation was unique in that most of it was working from the comfort of my home!  The flexibility helped me immensely when it came to residency interviews as I could work from anywhere that had a wifi connection.

There truly was no such thing in as a typical day.  I would meet with my preceptor at various coffee shops around Ann Arbor for a 30 to 90 minute meeting two to three times a week to discuss projects and have topic discussions.  Otherwise, I would spend my days working on projects.  It was a rotation that had incredible flexibility, but also required motivation to stay on task and finish assignments.  Most of my responsibilities including writing drug interaction monographs and a journal club at the end.

One of my major goals P4 year was improving on my scientific writing, which is what inspired to rank this rotation so highly.  (It is also one of the reasons I signed up to be a P4 blogger.)  My next rotation (nontraditional) also features a large amount of writing.

Rotation 6: Inpatient Pediatrics

Posted by Sarah Choi at Sunday, January 19, 2020

My sixth rotation was an inpatient pediatrics rotation. Overall, it was probably my busiest rotation in terms of patient care and projects. Specifically for this rotation, I was given two teams to cover—a pulmonary team and a general team. It was really daunting at first since it was the most amount of patients I had to cover out of all my inpatient rotations. Despite that, my past rotations really gave me the skill to cover both teams fully pretty early on. I learned how to skim notes for key details, I was familiar with navigating the electronic medical record, and I knew how to work up a patient since I had done it during three other rotations (though a little differently each time). 

The biggest challenge I faced this rotation block was how unfamiliar I was with pediatric pharmacy as this was my first exposure to it. In the beginning, I wasn’t familiar with pediatric dosing (it’s always best to report in mg/kg dosing) and pediatric disease states (things like Kawasaki disease or Henoch-Schonlein Purpura). Everything was new and challenging, but this was also one of my favorite parts of my sixth rotation. There was so much pay off for the work I was putting in to learn, and it was far easier to see improvement in my skills throughout the rotation. 

Another aspect I loved about this rotation was the fact that I was exposed to cystic fibrosis. Children with cystic fibrosis will come in with exacerbations/diminished lung function and be admitted for IV antibiotics. I learned so much about vancomycin/aminoglycoside dosing and monitoring, which are vital skills for pharmacists as these antibiotics can really impact a patient’s kidneys. Cystic fibrosis patients are also on long lists of medications and this is where a pharmacist can really carve out a role and be a vital member of the team. 

Aside from patient care, I was also completing multiple projects, which included a journal club, vaccine order set, audits for a new insulin labeling process, final presentation on IV bisphosphonates use in pediatrics, and a monograph for a pediatric genetics medication. This rotation definitely kept me busy!

Next rotation with be my health system/hospital APPE!