tag:blogger.com,1999:blog-88213789556167667902024-02-20T02:46:53.765-05:00On Rotation: Life as a Fourth-Year University of Michigan PharmD StudentThe Experiential Education Program at the University of Michigan College of Pharmacy encompasses more than 450 practice sites nationwide. This blog, written by current fourth-year PharmD students, provides a glimpse into their experiences from rotation sites around the state and the country.marknelsonhttp://www.blogger.com/profile/03326708211072623338noreply@blogger.comBlogger454125tag:blogger.com,1999:blog-8821378955616766790.post-72115258562294641042020-04-28T09:24:00.000-04:002020-04-28T09:24:09.329-04:00Rotation 9 (Community)<div class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0in 0in 0.0001pt;">
<u style="font-size: 12pt;">Rotation 9: Community</u></div>
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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.<o:p></o:p></div>
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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.<o:p></o:p></div>
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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.</div>
Sarah Choihttp://www.blogger.com/profile/11702250578216439153noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-88144861089104137232020-04-02T12:55:00.001-04:002020-04-02T12:55:24.404-04:00Rotation 7 (Hospital/Health Systems) + Rotation 8 (Ambulatory Care Oncology)<div class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0in 0in 0.0001pt;">
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<u style="font-size: 12pt;">Rotation 7: Hospital/Health Systems</u></div>
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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.<o:p></o:p></div>
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The main thing my 7<sup>th</sup> rotation taught me is that a great preceptor can really make a rotation worthwhile. The 7<sup>th</sup> 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.<o:p></o:p></div>
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<u>Rotation 8: Ambulatory Care (Oncology)<o:p></o:p></u></div>
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My 8<sup>th</sup> 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.<o:p></o:p></div>
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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.<o:p></o:p></div>
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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.<o:p></o:p></div>
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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!<o:p></o:p></div>
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Sarah Choihttp://www.blogger.com/profile/11702250578216439153noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-80989452706452694212020-02-25T14:41:00.002-05:002020-02-25T14:41:17.920-05:00Rotation 7: Working from Home - Drug InformationAfter 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.<br />
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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.<br />
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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.Makenziehttp://www.blogger.com/profile/09232529368667566597noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-91299939285193916522020-01-19T16:32:00.000-05:002020-01-19T16:33:06.116-05:00Rotation 6: Inpatient Pediatrics<!--[if gte mso 9]><xml>
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<span style="font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">My sixth
rotation was an inpatient pediatrics rotation. Overall, it was probably my
busiest rotation in terms of patient care and projects. </span><span style="font-size: 12pt;">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). </span></span></div>
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<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;">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!</span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><span style="font-family: "times" , "times new roman" , serif;">Next rotation with be my health
system/hospital APPE!</span></span></div>
<div class="MsoNormal" style="text-indent: .5in;">
<span style="font-family: "times" , "times new roman" , serif;"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<!--EndFragment--><br />Sarah Choihttp://www.blogger.com/profile/11702250578216439153noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-27974327420038706182019-12-19T21:58:00.000-05:002019-12-19T22:00:06.319-05:00Rotation 6: Health System/ Hospital <span style="font-size: small;"><span style="font-family: "georgia" , "times new roman" , serif;">My health system/ hospital rotation was one of my favorite rotations so far! It probably helped that I was at an amazing site and had an awesome preceptor. With two community, two clinical (amb care and gen med), and my off rotation before this one, I feel like this was the perfect time to have this rotation! Even though I wasn't working up as many patients and going on as many rounds as I was during my amb care and gen med rotations, this rotation really helped to solidify my decision of pursuing a residency!</span></span><br />
<br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: "georgia" , "times new roman" , serif;">During this rotation, I had a lot of independence with different inpatient pharmacy tasks that needed to get done each day. I did everything from counseling patients on their discharge pain medications post-surgery, counseling on anticoagulant medications, performing medication reconciliations and histories, working on projects such as preparing dosing guides for nurses and editing medication use policy updates, checking anesthesia trays and other medications in the pharmacy to be delivered, reviewing patient's home medications, making renal dose adjustment recommendations, and much more! This provided a lot of opportunity for me to learn, grow,
and gain confidence in both my counseling skills and my abilities as a
student pharmacist in general. Through all of my activities and experiences here, there were times I was able to see that I made a real difference in patient's lives. <span style="color: black;">To see the difference that I can make as a student, it makes me excited to see the difference that I will be able to be make as a real pharmacist! </span></span></span><br />
</div>
<span style="font-size: small;"><span style="font-family: "georgia" , "times new roman" , serif;">
</span></span><br />
<span style="font-size: small;"><span style="font-family: "georgia" , "times new roman" , serif;">I think the best part of this health system/ hospital rotation was having the chance to experience something new. I was in a new setting that I have never been at before and I think it is a good experience to be able to see how different health systems work than the ones we are familiar with. It takes a little longer to get used to new systems and different policies and procedures but that's why it is such a great learning experience! </span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-78434819604017114322019-11-24T13:37:00.000-05:002019-11-24T13:37:04.182-05:00Rotation 5: Inpatient Bone Marrow TransplantA typical day for me during inpatient bone marrow transplant (BMT) started at 7am, where I would work up patients prior to 9am rounds. Most BMT patients are in the hospital for at least seven days (usually more) post-transplant which allowed me monitor long-term changes in therapy. Despite BMT being a specialized unit, the patient caseload was diverse. It included patients receiving who were receiving conditioning therapy prior to transplant and post-transplant patients awaiting engratment. It also usually included at least two patients who were readmitted. Readmission reasons usually included neutropenic fever or workup for graft vs host disease.<br />
<br />
After working up patients I would meet with my preceptor to go to interdisciplinary rounds. There were three attendings for the inpatient BMT unit who would rotate inpatient rounding weekly. There would be 8-14 patients on our service and rounds typically lasted 1.5-2.5 hours, usually longer at the beginning of the week and then shortened throughout the week as the attending became more familiar with each case. The rounding team included mid-level practitioners, a nutritionist, a BMT pharmacist, a case manager, and sometimes a social worker.<br />
<br />
After rounds, there may be a number of patient-related activities to follow up on. If a patient was being discharged, we would make a medication schedule and they would receive a visit from the BMT pharmacist prior to leaving. The autologous transplant patients would typically only be discharged on twice daily acyclovir (in addition to any medications they had prior to admission) while the allogeneic transplant patient would need careful counseling regarding their immunosuppressants. Other post-round patient care activities included immunosuppressant dosing, renal insufficiency dosing, or any other research regarding medications. During my time at BMT they were two patients who had acute GVHD that was refractory to steroids which required a significant amount of follow-up research. Afternoons were generally dominated by topic discussions or working on projects such a patient case presentation or journal club. <br />
<br />
Overall, BMT had a steep learning curve due to the specialized nature of the unit and the amount of emerging therapies. However, it helped me become an independent learner and keep current on recent literature. BMT patients, due to their immunocompromised state, were also on prophylaxis antibacterial, antifungal, and antiviral medications. At least half of the patients would spike a neutropenic fever during admission and would require broad-spectrum antimicrobials. Since I have an interest in infectious diseases, being on the BMT service helped me keep current with antimicrobials and examine more closely some less common infections.Makenziehttp://www.blogger.com/profile/09232529368667566597noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-59248483762195990582019-11-21T17:11:00.000-05:002019-11-21T17:16:04.386-05:00Rotation 4 and 5: Inpatient Oncology and Gen Med in PediatricsMy rotation 4 was my inpatient oncology rotation specifically in solid tumors. The patients I saw were admitted due to oncologic emergencies and other cancer related problems. A few patients were there to receive chemotherapy that resulted in them staying for several days at the hospital to be closely monitored. Rotation 4 was my hardest rotation by far. I was coming off of two nontraditional rotations and it was hard to get back into the groove of things. I forgot a lot of my clinical knowledge because I haven't had the chance to use it. Overall, it was...an experience.<br />
<br />
Rotation 5 was in general medicine, specifically in pediatrics at Mott. This was by far my favorite rotation. It had me seriously consider going into a pediatric residency and abandoning my fellowship route I had been pursuing since my P2 year. I was coming off of an adult inpatient rotation and I can't say I enjoyed it due to a number of reasons. I entered my rotation 5 having very low expectations. To my surprise, I actually liked working up my kiddos. In school, we focus a majority of our time on the adult population. The pediatric population was new and I liked learning about all the new disease states that were not talked about in school. From upper respiratory infections to meningitis to eating disorders, there was a good variety of things I could work up in my patients. There were many interesting cases and one particular one that comes to mind was seeing Kawasaki disease in person. I remember receiving a one sentence summary of what it was in class and that was it. It was an interesting case and was a great topic discussion! I also owed my enjoyment of this rotation to my preceptor. She was a great teacher and I could always depend on her to answer my questions, no matter how silly. It goes to show what a difference it makes having a good preceptor, versus having one that you cannot connect with.Pollyhttp://www.blogger.com/profile/05387184920934714569noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-433452014733757702019-11-21T16:51:00.000-05:002019-11-21T16:51:55.989-05:00Rotation 3: Another nontraditional – Paragon Biosciences<br />
<div class="MsoNormal">
I really enjoyed this rotation. Not just because it was in
Chicago but because it is a pharmaceutical industry rotation. Most of the projects
I completed are confidential, and I signed a non-disclosure agreement so I cannot
say in detail what I did most of the time. Some of my projects include
designing a poster for a congress, a rare disease priority review voucher,
writing up press releases, and comparing clinical trials.A large portion of this rotation was completing research, writing, and attending meetings with my preceptor</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
Like the FDA, my day to day schedule was not structured. I found
myself becoming more adapted to an unstructured schedule because I had the freedom to plan out the day for myself. I was able to see a drug approved
for narcolepsy during the end of my rotation (Look it up, it’s called Pitolisant).
Although I did not work on this drug from the beginning to the end, I saw the
happiness and satisfaction of the employees to see their drug finally be
approved by the FDA. Having a rotation at the FDA gave me an insider look at
what the FDA considers for pharmaceutical industry. During my block 3, I was
able to see the other side of the coin. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here are some tips about Chicago for those of you who got
chosen:</div>
<div class="MsoNormal">
</div>
<ol>
<li><span style="text-indent: -0.25in;"><span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span style="text-indent: -0.25in;">If you are driving from Michigan to Chicago, go
on the road that avoids the toll road. Saves you $20 and a headache. The trip
is just longer by 30 minutes and I didn’t have much of a problem navigating the
roads.</span></li>
<li><span style="text-indent: -0.25in;">Know which side of Chicago to avoid. The south
side and the west side should be avoided. There are some pocket neighborhoods
in these areas that are fine so it is not all bad. I don’t think I ever went
further than Chinatown so I can’t say for experience how these areas are.
Chicago is a great city but all big cities come with some risks. Just be smart!
I had no problems getting around the city.</span></li>
<li><span style="text-indent: -0.25in;">My rotation was downtown, and I lived in a up
and coming neighborhood called East Village on the border of Ukrainian Village
just 15-20 minutes away from downtown. Beautiful neighborhood and VERY hipster.
It was right on the blue line for the metro so I had no problem getting to my
site. Parking is awful and very expensive downtown. My suggestion is to just
get the 30-day metro pass. It was around $105 and I took the blue line the
majority of the time. I had no problems! Parking for more than 8 hours could
easily add up to 15-30 dollars a day. Public transportation saves money and it
was nice pretending to be a local </span><span style="font-family: "segoe ui emoji" , sans-serif; text-indent: -0.25in;">😊</span></li>
<li><span style="text-indent: -0.25in;">BRING REUSABLE BAGS. The amount they charge per
bag is borderline ridiculous.</span></li>
</ol>
<br />
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .25in;">
<br /></div>
<br />Pollyhttp://www.blogger.com/profile/05387184920934714569noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-89743837924455819542019-11-17T15:57:00.001-05:002019-11-17T15:57:41.903-05:00Rotation 5: Drug Information
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<br />
<div class="MsoNormal">
<span style="font-size: 12pt;">My drug
information rotation was very different from my last three rotations as it was
mainly project based. Rather than directly impacting patients with
recommendations or interventions I made on rounds, I was able to impact the
hospital as a whole while working on different projects.</span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;">One of the major projects I worked
on was creating a SGLT2 inhibitor class monograph, in order to assess whether
one agent should be added to formulary. This involved reviewing package
inserts, databases, and primary literature for each SGLT2 inhibitor and then
synthesizing the information into one document. The committee members will then
review the monograph prior to meeting and make a decision about adding SGLT2
inhibitors to formulary—an addition that impacts the entire hospital and not
just one patient.</span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;">Other projects I worked on included
analysis of ethanol (beer) use in hospitalized patients over the last year,
determining the efficacy of a “magic” mouthwash, running experiments with a
suspected faulty device, and reporting a device related adverse event to the
FDA MedWatch System and the hospital’s internal reporting system. I was also
able to attend the P&T committee’s and other subcommittees’ meetings and witness
the process of revising and approving policies firsthand. I presented a topic
discussion on literature evaluation and also a journal club on dapagliflozin’s
efficacy and safety in heart failure patients.</span></div>
<div class="MsoNormal" style="text-indent: .5in;">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The best
part of this drug information rotation was being exposed to so many different
aspects of the hospital and working on unique projects. It’s very different having
project based work and making recommendations on things that will impact the
entire health system. I’m really grateful for the opportunity to explore drug
information and I’m looking forward to being exposed to more new things in my
future rotations. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<!--EndFragment--><br />Sarah Choihttp://www.blogger.com/profile/11702250578216439153noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-56590075454466043952019-10-31T22:00:00.000-04:002019-12-19T22:37:25.489-05:00Rotation 5: Open Rotation <span style="font-family: Georgia, "Times New Roman", serif;">I took Rotation 5 off because I got married on October 5th, the Saturday right after block 4 ended before Block 5 began! The plus side of this was that it was super nice having a whole 5 weeks off after the wedding. Our wedding was the most perfect day and we were able to have a nice 9 day vacation in Jamaica after which was much needed after a stressful few months leading up to this Off Block. The time leading up to the wedding was a little busier/more stressful than normal since on top of APPE activities and requirements, I was also still working on my PDI as well as my seminar presentation that I presented in September, all while attempting to plan a wedding! Even though my first 4 rotations were more stressful than they probably needed to be, they were all still amazing experiences that ended up going well in the end. Very thankful for the awesome support system I have helping me along the way, support is key through the stressful seasons of life (pharmacy school being a big one of them)! </span><br />
<br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-66041466807095905062019-10-29T14:37:00.002-04:002019-10-29T14:37:28.546-04:00Rotation 4: General Medicine (Internal Medicine)
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<br />
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My fourth rotation was in general medicine rotation. We’re
allowed to rank the type of general medicine rotation we want. The choices
include internal medicine, surgery, emergency department, and pediatrics. I
ranked internal medicine as my top choice after hearing from previous P4
students that it’s a challenging rotation that to prepare you for residency,
and luckily I got it.</div>
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<span style="font-size: 12pt;"><br /></span></div>
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<span style="font-size: 12pt;">Typically
my days started with working up patients—either the old ones from the previous
day or any new patients who came in overnight. I had a maximum of 10 patients
at once, and my patient list typically averaged 8-10 depending on the day. After
working up patients, I met with my preceptor to pre-round, where we would
briefly go through the patients and any recommendations I wanted to make to the
team.</span></div>
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<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I rounded
with one attending and one of two residents (they would switch every other
day). Together we would go to patients’ rooms to discuss the patient outside
the room before checking in with them every day. Rounds were the time I had a chance
to make recommendations and ask any clarifying questions about the patient’s
treatment. After rounds, which typically lasted three hours, I would take the
time to educate patients on anticoagulation or ask clarifying questions.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Most days I
met with my preceptor once more to review what happened on rounds and see if
there were any other interventions to make. After that, I would attend/give a
presentation as all general medicine students are required to lead a journal
club, present a topic discussion, and present a patient case. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Overall,
this rotation was very challenging, but I learned so much about different
disease states and medication. I was able to apply the therapeutic knowledge I
built in school and see how the things we learn in class translate to patients.
I was also able to improve my patient presentation and workup skills. I didn’t
know much about being an internal medicine pharmacist prior to this rotation,
but it definitely showed me how vital they are to the team and how large of an
impact you can have on patients.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In my next rotation
block I’ll be exposed to another field of pharmacy, drug information, which I
don’t know much about, so hopefully I’ll be able to fine-tune what aspects I
want out of my career as I’m exposed to more aspects of pharmacy. It’s strange
to think that my P4 year is half done with this rotation; I’m excited to see
what else the rest of the year has in store for me! <o:p></o:p></div>
<!--EndFragment--><br />Sarah Choihttp://www.blogger.com/profile/11702250578216439153noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-9666033564344232542019-10-06T12:24:00.002-04:002019-10-06T12:24:26.533-04:00Rotation 4: PsychiatryFresh off of Labor Day weekend, the outpatient clinic started off slowly and then steadily gained business as we moved from summer vacation to back to school season. This rotation contained a lot of variety. Through the psychiatry clinics I met with the team at the beginning and the end of clinic (clinics were half-days, 8am-noon or 1-5pm) to discuss the patients visiting the office today. Between the two meetings I would call patients who visited us a week or two ago to assess for side effects and efficacy. Sometimes it included interventions such as giving the go-ahead to titrate as prescribed or to recommend reducing a dose as necessary. Some patients would be excited for the followup and others seemed to be caught off guard. Outside of clinic hours, I also responded to consults from providers via email. Usually about unusual side effects or efficacy of one drug over another in a complicated patient. Sometimes these responses took only 20 minutes, sometimes it would take up 90 minutes depending on complexity.<br />
<br />
Since classes were resuming at the College of Pharmacy after summer break, I also had the opportunity to assist in classes and academia. This included assisting in-person for a couple of classes as well as preparing materials for class. I was also able to compose some academic writing (improving my written communication was one of my goals this year).<br />
<br />
Overall, my ambulatory care rotation was varied, with opportunity to pursue more niche interests and goals. There was no such thing as a typical day with bouncing between clinic and class and being able to work from home for some half days. The variety kept me constantly learning and adjusting.<br />
<div>
<br /></div>
Makenziehttp://www.blogger.com/profile/09232529368667566597noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-21147110259084738472019-10-06T12:22:00.002-04:002019-10-06T12:22:37.892-04:00Rotation 3: CommunityI had my community rotation at a big chain pharmacy, but it felt like a family-owned pharmacy at times. There was no drive-through, the same pharmacist had been there for ten years, and the staff knew their patients well. I would estimate about half of the patients greeted the pharmacist and the full-time technician by name. Patients would call the pharmacy and ask for the pharmacist by name to discuss medication-related issues. Through this rotation I was able to witness how community pharmacists can make a huge impact on patients and how their work could keep patients out of the hospital, healthier longer, and more confident in their medications.<br />
<br />
As far as my responsibilities went, it included typing, filing, verifying, as well as helping patients with OTC medication selection. I also had one particularly memorable 45 minute telephone conversation with a patient’s insurance company. Additionally, I administered as many vaccinations as possible. The patients ranged from first-year university students about to start school as well as elderly people who had been waiting months for their first Shingrix shot. Managing the Shingrix waitlist and calling patients when they advanced on the list was a special project of mine. Towards the end of my rotation, we received our first batches of the flu vaccine. During that time, the pace certainly picked up to address the vaccination need.<br />
<br />
Overall, it was a great experience to work in a large chain pharmacy that still maintained a small pharmacy feeling. The interaction with patients were largely rewarding and positive and prepared me well to transition to ambulatory care for my next block.<br />
<div>
<br /></div>
Makenziehttp://www.blogger.com/profile/09232529368667566597noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-34554461606518163652019-09-11T17:45:00.001-04:002019-09-11T17:45:29.354-04:00Rotation 3: Infectious Diseases
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<!--StartFragment-->
<br />
<div class="MsoNormal">
My third rotation was, once again, very different from my
other two rotations. There were two parts to my infectious diseases (ID)
rotation. During the first half of the rotation, I rounded with an ID consult
team. I would work up patients (focusing on the antibiotics and their
infectious diseases), pre-round with my preceptor, and then attend rounds,
where I had the chance to make recommendations to the team. One of the things
that surprised me was how large the ID consult team could get with medical
students, residents, and the attending. Also, working up and presenting
patients was rather different from my previous rotation experience. There was
more of a focus on diagnosis and verifying there was an infection rather than
focusing solely on the appropriateness of treatment.</div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;">During the second half of the
rotation, I worked with the ID antimicrobial stewardship team. This involved
one project in particular where I was making recommendations for de-escalation
of antibiotic therapy. It gave me a chance to build my patient work up skills
once again and after discussion with my preceptor, I was able to communicate
recommendations to providers. The main difference with these recommendations
was that I usually didn’t have a relationship with the providers or teams, so
it was a useful experience to learn how to manage those situations. I was also
able to work on more research projects where I learned that I might actually
have an interest in research, which was something I never knew about myself.</span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">P4 year has been great so far. My favorite
part of rotations is that I get to learn new skills, and I get to build on my
older ones. I’m excited to see how I can apply what I’ve learned during ID in
my next rotation with my general medicine rotation for my 4</span><sup>th</sup><span style="font-size: 12pt;"> block.
Until then, thanks for reading!</span></div>
<div class="MsoNormal">
<o:p></o:p></div>
<!--EndFragment--><br />Sarah Choihttp://www.blogger.com/profile/11702250578216439153noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-55420174110645398862019-08-27T11:31:00.001-04:002019-08-27T12:09:37.514-04:00Rotation 2: Non-traditional - Food and Drug Administration (FDA)<br />
<div class="MsoNormal">
My second rotation was at the FDA in Silver Spring,
Maryland. I was looking forward to this rotation since I first heard about it
in my P1 year. I have always been interested in non-traditional pharmacy and
most of my internship and extracurriculars are geared towards the
non-traditional roles of pharmacy. I lived on the University of Maryland (UMD)
campus. This was at most a 20-minute drive to the FDA if there was traffic. I
was lucky because my rotation was during the summer where many students were looking
for subleasers! Unlike some of my peers, I had better luck finding cheaper
housing options.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
My first day was a whirl wind of meetings, badging
appointments, security checks, and trying to figure out what all the acronyms
were for each department. I was the only Michigan student onsite during this
rotation, so it was definitely a scary experience being alone in a new city. The
APPE students there besides me came from all over the country and it was a
great networking experience. <o:p></o:p></div>
<div class="MsoNormal">
<br />
My preceptor is the Deputy Director of FDA's Center for Drug
Evaluation and Research's Office of Compliance. She deals with securing our
supply chain for pharmaceutical products and was a helpful mentor. She took the
time out of her busy schedule to have one on one meetings with me almost each
day to see how I was doing and to see if I was interested in attending meetings
with her. It was nerve wracking to be in the same meeting as some of these
officers and oversea agencies. Aside from my preceptor I worked on projects
from many other departments. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My schedule was not as clear cut as my first rotation. A lot
of my time went into networking with people from the FDA and lectures given to
us by PharmDs from different departments. The rest of my time was projects from
a variety of departments. My projects varied from data analysis for MedWatch, reviewing 501k submissions for medical devices, a variety of written work, and a presentation on FDA's Medical Devices Regulatory Process. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here are some tips when you go on the road to Maryland for
those of you who get chosen:</div>
<div class="MsoNormal">
</div>
<ol>
<li><span style="text-indent: -0.25in;">If you choose to drive, it is a 9 hour car ride
and you need to bring at at least $40 dollars for the toll roads. I drove alone
and it was very boring so either bring fun music or listen to a podcast.</span></li>
<li><span style="text-indent: -0.25in;">Silver Spring is on the edge of DC and I highly
suggest visiting! Get a SmarTrip Card and just google your way around. I
wouldn’t suggest looking at the maps on pamphlets they have because it can get
annoying really quickly. Google maps is your best friend and you get alerts for
when the train is delayed or if the stop gets switched to a different area. The
trains are very well kept and is not as confusing as I thought they would be.</span></li>
<li><span style="text-indent: -0.25in;">BRING REUSUABLE BAGS. They charge money per bag
you use and it can add up especially if you are grocery shopping.</span></li>
<li><span style="text-indent: -0.25in;"><span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span style="text-indent: -0.25in;">I went in July. It was hot. It was sunny. It was
humid. Even when it rains, the humidity and heat does not let up. It was
disgusting weather and I never thought I would experience heat on par with
southern Asia in the United States. Find an Airbnb or apartment with AC and
don’t even bother packing a hoodie or a long sleeve shirt. That will only take
up room. The fall is nice though from what I heard.</span></li>
</ol>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<o:p></o:p></div>
<div class="MsoNormal">
Overall, the rotation gave me an understanding of the work
the FDA does and has solidified my intent to pursue a fellowship after graduation. <o:p></o:p></div>
<br />Pollyhttp://www.blogger.com/profile/05387184920934714569noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-69358203143449257472019-08-27T11:27:00.000-04:002019-08-27T11:28:12.150-04:00Rotation 1: Community pharmacy<br />
<div class="MsoNormal">
My community pharmacy rotation was completed at Grass Lake
Community Pharmacy in Grass Lake, MI. This was a good rotation to ease me into
APPE. This pharmacy was an independent pharmacy with a big presence in the
community. I have never worked in an independent pharmacy before, so I did not
know what to expect! My past IPPE rotation was at Kroger and it was by far the
busiest rotation I was at before APPE. My expectation of the rotation was quite
low because of my past experience in a chain community pharmacy. However, my
preceptor went above and beyond what he had to do to make me feel comfortable
and to experience what a pharmacist does. My first week, much of the time was
technician work and becoming familiar with the pharmacy. This included
answering the phone, understanding how to document opioid access, becoming
comfortable with the computer system, and knowing what products we had on the shelves.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The next four weeks, I was eased into the work of a
practicing pharmacist. I was able to have consultations on my own, take blood
pressures when requested, check filled prescriptions, and take prescriptions
over the phone. A majority of my counseling was on probiotics and it was not
something I learned at school. A lot of research had to be done for me to
become familiar with the products the pharmacy had. I had plenty of time to
complete the projects the school gave me as well as complete a project of the
pharmacy on the side. My overall experience was better than I expected!<o:p></o:p></div>
Pollyhttp://www.blogger.com/profile/05387184920934714569noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-8410995837740362692019-08-18T15:30:00.001-04:002019-08-18T15:30:17.136-04:00Surgery Generalist (Gen Med) - Rotation 2<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;">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.</span></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;"><br /></span></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;">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 </span><i style="font-size: 13.3333px; white-space: pre-wrap;">very</i><span style="font-size: 13.3333px; white-space: pre-wrap;"> fast & took place in a conference room. Thus I had to prioritize interventions that would be most acute to each patient & the team. </span></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;"><br /></span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;">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.</span></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;"><br /></span></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;">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.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;"><br /></span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 13.3333px; white-space: pre-wrap;">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.</span></span></div>
<div>
<br /></div>
</div>
Makenziehttp://www.blogger.com/profile/09232529368667566597noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-73110610541252528432019-07-31T17:09:00.002-04:002019-07-31T17:09:37.401-04:00Rotation 1 Nontraditional and Rotation 2 Psychiatric Pharmacy
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<br />
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School is hard, and pharmacy school is even harder. We’re
constantly studying for the next quiz or exam. We don’t absolutely love every
subject we learn about in Therapeutics. It is so easy to lose sight of why we
wanted to become pharmacists, but I can honestly say that P4 APPE rotations are
different<sup> </sup>(though I’ve only completed 2 rotations). It’s equally as
difficult, but now you’re experiencing new things every day and learning from
real-life examples. You get to apply all the knowledge you’ve built up in the
past three years, and it’s far easier to remember why you decided to become a
pharmacist in the first place.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
<u>Rotation 1: Nontraditional Pharmacy<o:p></o:p></u></div>
<div class="MsoNormal">
<span style="mso-tab-count: 1;"> </span>My
nontraditional rotation was at a specialty pharmacy. This was a great rotation
to have after my P3 school year ended, largely because it required a lot of
self-directed learning and projects. Specialty pharmacy is unique because there
are so many high-cost and high-touch medications that require more time
investment from every party involved, such as insurance companies, pharmacists,
patients. Specialty medications weren’t covered in depth during class, so this
rotation really gave me a chance to delve into different disease states (like
cystic fibrosis, multiple sclerosis, and plaque psoriasis) and their unique
treatments. I also completed two journal clubs during this rotation about newer
specialty medications like Risankizumab and Tafamidis. The most valuable part
of this rotation was that I was allowed to be curious and look up disease
states and drugs that I was interested in; this was a breath of fresh air after
three years of school where the curriculum was set. It reminded me of one of
the main reasons I decided to pursue pharmacy: I love researching and learning
about different diseases and treatment options. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
<u>Rotation 2: Psychiatric Pharmacy<o:p></o:p></u></div>
<div class="MsoNormal">
<span style="mso-tab-count: 1;"> </span>My second
rotation was completely different from my first. While the first showed me how
much I loved learning about different disease states and unique drugs, the second
showed me how much impact a pharmacist can have on a patient’s treatment course.
I worked with a team to manage the psychiatric care of about 9 to 11 patients a
day. My mornings on this rotation included working up new patients (focusing on
their psychiatric problems), attending table rounds with the interprofessional
team, and visiting patients daily with the medical residents and students.
Having the opportunity to go to rounds and discuss patients with other health
professionals was so valuable. After the first week, I had built up enough
confidence to speak up during rounds and advocate for my patients. Seeing
patients day after day really showed much how much he or she can improve, and this
is magnified when you know that you made a recommendation that contributed to
the patient’s improvement.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;">Overall my first two rotations only
have me excited for the rest of my rotations. I’m ready to learn and experience
more. Thanks for reading and coming along the journey with me! I’ll be back
after my third rotation (infectious diseases) is done!</span></div>
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<o:p></o:p></div>
<!--EndFragment--><br />Sarah Choihttp://www.blogger.com/profile/11702250578216439153noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-70243294316790956752019-07-10T21:06:00.000-04:002019-07-10T21:06:47.807-04:00Health System/Hospital - Rotation 1For my first rotation I was back to where it all started. I was able to go back to my hometown and complete my first APPE at the hospital I was born. I work at a different hospital in the same city but I was surprised at how many common connections there were with pharmacists & techs across institutions (pharmacy is indeed a “small world”).<br />
<br />
I also wasn’t lonely at this rotation - I was joined by 12 P4s from Ferris State who were completing all of their APPEs at this one institution. Many of us would have lunch together, go to each other’s seminars, and bounce ideas off of each other. For my first APPE, it was nice to have the safety net of a large group of students.<br />
<br />
The rotation itself was great. My preceptor took into account my previous work experience and personalized the rotation to my interests and gaps of knowledge. For example, I am already experienced at sterile compounding but haven’t done TPNs before, so I was able to modify my schedule to spend more time on TPN verification and compounding.<br />
<br />
This particular APPE also had the option of attending an open heart surgery with an anesthesiologist. The procedure was a quadruple bypass & over 6.5 hours long. The anesthesiologist placed me standing on a stool at the head of bed, with the heart only an arm’s reach away. I was prepared for what it would look like but the smells (cauterization) and sounds (cartilage breaking) was not something I was prepared for. Throughout the anesthesiologist taught me about what meds were put on cont IV vs bolus and how he monitors the patient while the surgeon explained the pathophysiology of the patient’s a-fib.<br />
<br />
The next morning I followed the patient on CCU rounds & was astounded that he was already sitting in a chair & eating after such major surgery. Attending the surgery helped me understand a patient’s cardiac journey and what role health care providers & medication management play throughout.<br />
<br />
As amazing as open heart surgery is, it wasn’t apart of a “typical day”. A typical day was divided into 2 parts. The mornings were always scheduled. I spent half of the mornings of the rotation doing staff pharmacist work. Dosing, front counter, IV, med safety, etc. The other half of the mornings I would do rounding in the PICU, ICU, or CCU and was able to spend additional days rounding in units based on my interests.<br />
<br />
Afternoons were spent doing projects. Daily, I did patient educations on post-AMI medications or anticoagulation teaching and had weekly audits for titratable medications. The afternoons were also when students would do topic discussions, clinical questions, or present patient cases as final projects. I found it helpful to attend these sessions as it kept ambulatory care, general medicine, ID, etc topics at the forefront of my mind.<br />
<br />
For rotation 2 I am back in Ann Arbor for my gen med rotation in adult surgery & to present my PharmD seminar at the end of July.Makenziehttp://www.blogger.com/profile/09232529368667566597noreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-53799076199217197132019-04-27T12:21:00.000-04:002019-04-27T12:21:49.630-04:00Rotation 7, 8, 9: Farewell, and Be Kind
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<w:LsdException Locked="false" Priority="9" SemiHidden="true"
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<w:LsdException Locked="false" Priority="9" SemiHidden="true"
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<w:LsdException Locked="false" Priority="9" SemiHidden="true"
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<w:LsdException Locked="false" Priority="9" SemiHidden="true"
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<w:LsdException Locked="false" Priority="9" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="35" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
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<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
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<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
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<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="21" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
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<!--StartFragment-->
<br />
<div class="MsoNormal">
<u><span style="font-family: inherit; font-size: small;">Hospital/Health-system<o:p></o:p></span></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">In a large academic medical center, I was specifically
assigned to the operating room pharmacies in the main hospital, eye center, and
children’s hospital throughout the week. In addition, I got to see the satellite
pharmacy, the general infusion center, and the cancer infusion center
pharmacies. Once a week, I attended meetings and worked on projects with a
pharmacist working on the management side. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">It was insightful to see how operating room pharmacies
manage controlled substances and dispense kits for the anesthesia team. They
also verify and dispense certain orders for patients before their operation. In
the infusion center pharmacies, I saw the workflow of how pharmacists verified
orders, how pharmacy technicians prepared medications, and how pharmacist
checked preparations and noted stability of the medications. On the management
side, I saw how space and workflow could impact delivery of patient medications
throughout the hospital. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">Since there were several pharmacists and pharmacy
technicians on this rotation, I worked with different teams and had to adapt to
different preferences and teaching styles. Also, while I was on this rotation,
I was also interviewing for residency positions. Traveling was intense and
time-consuming, but I’m grateful my preceptor was understanding and allowed me
to make up days missed through additional hours or projects. Overall, it was a
busy season for me, balancing rotations and interviews, but I am glad to have
the experience as it allowed me to see the bigger picture of how pharmacies
operate within the health-system.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: inherit; font-size: small;">Managed Care<o:p></o:p></span></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">I was placed at a large health plan for this rotation and
worked under a pharmacist who was a manager on the medical benefit, where drugs
managed needed to be administered by a healthcare professional. This was
different from my previous managed care rotation, which was a prescription drug
plan and focused on pharmacy benefits, where drugs managed were usually
self-administered medications. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">This rotation was project- and office-based. My main assignments
included updating medical policies with support from literature and clinical
guidelines, providing summaries of therapeutic agents for hemophilia, and
analyzing medical oncology data to complete a report with charts and graphs. During
the rotation, I also had informational interviews with pharmacists working in
different departments of the company, including drug pipeline, formulary and
rebates, legislation and policy, operations, regulatory oversight, and sales
and marketing. These pharmacists played very interesting roles, bringing insight
to the variety of positions available within managed care pharmacy. I hope to
learn more and experience these different positions as I start a managed care
pharmacy residency in the coming months after graduation. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">My preceptor during this rotation was working on a medical
oncology program, so I sat in on several internal meetings regarding the
logistics of implementation and external meetings with the vendor to ensure
responsibilities were carried out on both sides. Other meetings I attended
involved a quarterly drug pipeline update and internal sales and marketing
meetings and consultations. While I had previous experiences in managed care
through student organization involvement, internships, and a rotation, this
experience added on to that, exposing me to the medical benefit, different
pharmacist roles, and vendor relations. I am excited that there is still much
more to learn about managed care pharmacy. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;"><u>General Medicine/Pediatrics</u><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">My final rotation was in a children’s’ hospital on the
mid-day shift. Here, I got to work under a pediatric generalist pharmacist, and
my role was to assist in verification of total parenteral nutrition (TPN) orders
and pharmacokinetic service of antibiotics. It was interesting to learn about
pediatrics and nutrition, since these topics are not widely covered in the
pharmacy curriculum. Pediatric patients should not be considered as smaller
adults since they differ greatly in distribution and clearance of medication compared
to adults. To verify nutrition orders, I navigated through a patient’s chart,
collecting weight, fluid goals, recent lab values, urine output, relevant medications,
and the order put in by the dietician. I would make sure that the volume of the
TPN was calculated correctly and that changes to macronutrients and
electrolytes within the TPN made sense. For the pharmacokinetic service, I was
responsible for interpreting vancomycin or aminoglycoside levels that resulted
during my shift. From these levels, I would make recommendations on whether to
continue therapy or change therapy, noting the dose and interval of the drug
regimen, and on when to check levels again. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">The mid-day shift itself was different, but exposed me to
the endless work that pharmacists put in at the hospital. Additionally, as my
last pharmacy school practice experience, this rotation showed me that the
learning never stops. I was constantly looking up answers to my preceptor’s
questions and diving into the field of pediatrics. Even though my plans after
graduation have been set, I still very much appreciated seeing and experiencing
yet another perspective of pharmacy. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">Now that my time at the University of Michigan College of
Pharmacy has come to an end, I hope that you have enjoyed following the journey
of my final year and gained insight into the practice experiences of a pharmacy
student. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: inherit;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiateQd728wq2DVBMOTkAGedRM2qSQG295xKds8uFsrYfwhZzbj1u-dpU0IP0sLDiPnf2G6_DvgLnm-1HiiCs6ckotCBq-6aBlVPh3ObnO_Z1PcxqnWrCHSh7IKq-I2Gf2I2iWcKL_lFqnM/s1600/IMG_20190427_090858167_3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiateQd728wq2DVBMOTkAGedRM2qSQG295xKds8uFsrYfwhZzbj1u-dpU0IP0sLDiPnf2G6_DvgLnm-1HiiCs6ckotCBq-6aBlVPh3ObnO_Z1PcxqnWrCHSh7IKq-I2Gf2I2iWcKL_lFqnM/s320/IMG_20190427_090858167_3.jpg" width="240" /></a> </span></div>
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: inherit; font-size: small;">“For today, goodbye. For tomorrow, good luck. And forever,
Go Blue!" </span></div>
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: inherit; font-size: small;"><span style="text-align: center;">– Mary Sue Coleman</span></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-family: inherit; font-size: small;"><o:p></o:p></span></div>
<!--EndFragment--><br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-81955050232044387992019-03-25T21:41:00.000-04:002019-03-25T21:41:21.625-04:00Rotation 8: General MedicineToday was my last first day of school ever!! In 5 weeks I will graduate with my PharmD from the University of Michigan and will be preparing for a residency program in Colorado!! There are lots of changes coming in the next three months and I'm feeling a mix of excited, scared and sad. Excited because of the great adventures awaiting me and my husband out in Colorado (professionally and personally), scared because of the major changes and transitions about to happen, and sad because I'll be leaving my family, friends and home. I'm planning on taking some time over the next three months to prepare for these changes in an attempt to leave this place and these people well.<br />
<br />
One thing I know has helped prepare me for residency is the general medicine rotation I just finished. I was in the inpatient adult hospital working with a clinical pharmacist and a medical team taking care of patients admitted to the family medicine service. This was my most difficult and demanding rotation. I learned a ton, but it was extremely stressful. The service I was on had a maximum of 24 patients (most others had a max of 12 or 16), and there were multiple times we got close to that max. There were also 4 projects/presentations throughout the rotation, a weekend shift, and a dental on-call pager we were responsible for at different points during the rotation.<br />
<br />
The biggest thing I want to tell future P4's is that you're likely going to need to re-learn how to work up patients. The way we were taught in school was very different than what I was expected to do. Also, every inpatient rotation is going to have you work up and present patients a little differently due to the nature of the services. Make sure you ask the preceptor how they do it and what they expect of you. We were taught in school to look into all of the details about the patient including the diagnosis and history details. As a pharmacist, those things are important, but you cannot spend all of your time investigating them. You are likely not going to be asked on rounds to present the patient, and so it is more important for you to focus on other things. You need to learn how to be efficient in looking into the pharmacy-related problems and monitoring parameters. This took me longer than I expected, but once I did, working up patients was much more smooth and took less time.<br />
Additionally, MiChart has a TON of really helpful reports you can run that will save you a TON of time when working up patients. Make sure you ask your preceptor/classmates at the beginning of the rotation to make sure you are capitalizing on the reports already available to save you time.<br />
Finally, you will be amazed by what you are able to learn and accomplish during this rotation. This is a hard rotation. But, it is only 5 weeks (you can get through 5 weeks), your workload will build up over the rotation, you'll start to see repeats of the same disease states, and you'll figure out how to get the work done. You'll be able to make it through this rotation! I was so encouraged when things came up during rotation that I hadn't known only a few days prior. Even today (my first day at the new rotation), something came up that I could speak to with confidence because of what I learned on my general medicine rotation. All of these things will prepare you for residency/job/life after school.<br />
<br />
With that, I'll be back one more time to let you know how this last rotation goes!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-37150020620574058852019-02-16T20:22:00.000-05:002019-02-16T20:22:10.132-05:00Rotation 7: Oral Oncology (Ambulatory Care)Over the last 6 weeks I had the opportunity to experience a new (to me) kind of Ambulatory Care clinic. I worked with the Oral Oncology team to follow-up with people who were on oral medications for their cancer.<br />
<br />
This was a phone-based clinic where we did initial, 10 day follow-up, and 6 month follow-up calls. Initial calls included medication counseling on how to take the medication, possible side effects and how to manage the side effects. We followed up with these patients after they had been taking the medication for about 10 days (and then 6 months) to see how they were doing.<br />
<br />
This rotation required critical thinking and problem solving as each patient case was different and needed to be examined in order to know the appropriate time to contact the patient. Follow-up calls also needed to be handled differently in terms of setting up additional follow-up by the team or by clinic.<br />
<br />
I also had the opportunity to be in the Genitourinary cancer clinic one half-day a week. This was the first time I experienced an ambulatory care clinic where the pharmacist did not have a set schedule of patients to see during the day. The pharmacist would use a custom scoring tool in order to decide which of the physician's patients she was going to see that day. When she went and saw patients she did a lot of symptom management and medication counseling. She was also available for questions from the nurses and physicians. Being in the GU clinic helped break up my Monday's, but it also allowed me to see a different format of ambulatory care clinics; and for that I am very thankful.<br />
<br />
One of the best things about this rotation was the people! I got to work with multiple pharmacists, residents and pharmacy students who were extremely passionate about the work we were doing as well as extremely knowledgeable about the subject.<br />
<br />
As I finish this rotation and move on to the next I am taking with me a greater confidence and ability to counsel patients, communicate empathy and adapt to different situations quickly.<br />
<br />
As a follow-up to my last post I also wanted to talk briefly about this last rotation in terms of residency interviews. This rotation was 6 weeks long (1 week longer than the others) to allow for students to miss up to 5 days for interviews. I am very thankful that I was able to finish all of my residency interviews during the 5 days this rotation. Now all I have to do is rank the programs and wait until March 15th!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-69046090998434327032019-02-05T09:21:00.000-05:002019-02-05T09:21:24.221-05:00Rotation 4, 5, 6: Drug Information, Critical Care, General Medicine<span style="font-family: inherit;"><b><u>Rotation 4: Drug Information</u></b><br /> <br />This rotation was with a drug information company and I was able to work remotely, as my preceptor also works remotely. We met two to three times a week for about one hour and communicated often during the week via email. My responsibilities were to write monographs for drug-drug interactions and drug-gene interactions (e.g. CYP2D6, CYP4A4, etc.). This consisted of reading lots of articles, learning how to scour PubMed for literature, and writing concise summaries.<br /> <br />Time management was incredibly important in this rotation. I had the freedom to create my own schedule each day, but this also allows for time to slack off. I had to hold myself accountable and ensure I completed my work. I learned a lot about what goes into writing the monographs when we search our drug information resource for quick answers about drugs and interactions. I always thought I would enjoy working by myself, so I was surprised that I missed interacting with co-workers and patients daily. Looking forward, I hope to find a position that balances independent work with teamwork or direct patient care.<br /> <br /><b><u>Rotation 5: Critical Care</u></b><br /> <br />This rotation was in the surgical intensive care unit (SICU) at a local community teaching hospital. Going into this, I was nervous and intimidated by the complexity of critical care patients. My typical day started with working up patients (6AM-9AM), round with the team (9AM-11AM), eat lunch and finish working up patients (11AM-12PM), then meet with my preceptor (12PM-1PM). After this, I would work on assigned drug information questions or projects for the rest of the day. Working up patients in the ICU is based on the head to toe systems approach, rather than problem based like how we learned in class. This means problems were categorized by systems, which could include neurological, pulmonary, cardiovascular, GI/FEN (fluids, electrolytes, nutrition), I/O (ins and outs), ID, and heme. Patients were very sick and often had multiple problems within each system listed above.<br /> <br />I am very grateful to have had this rotation. I have a much better understanding of anatomy and how surgical changes can affect drug action/metabolism in the body. I also learned about weaning patients off pressors, opioid conversions, and nutrition. I had the opportunity to work with a large team, which consisted of an attending, fellow, residents, medical students, and dietitian. I also enjoyed working with my preceptor who was a great teacher and with another pharmacy student from a nearby school! Overall, this was a great learning experience and I am glad I was able to try it out.<br /><br /><b><u>Rotation 6: General Medicine (Adult Internal Medicine)</u></b><br /> <br />All P4 students are required to take the Gen Med rotation and I was placed on the Adult Internal Medicine service. This was a busy rotation, due to the patient load and weekly projects. My service capped at 11 patients and by the end of the rotation, I was managing the entire service. Patients had a variety of disease states, including pneumonia, UTIs, atrial fibrillation, and diabetes. The typical day started with working up patients (5AM-7:30AM), pre-round with my preceptor where I would present patients and run my recommendations by him (7:30AM-8AM), round with the team (8AM-11AM), and post-rounds with my preceptor where I would update him with any changes (11AM-11:30AM). The rest of the day was spent educating patients discharged on anticoagulation, meeting with my preceptor to go over patients or topics, and meeting with the other students also on Gen Med to present our projects. Time management and efficiency are key to this rotation and each student will develop their own schedule or system that works for them.<br /> <br />Pharmacists play an important role in antimicrobial stewardship and anticoagulation management on this service. I enjoyed the variety of patients and activities in this rotation. I was constantly learning and it made the long days fly by. My advice to students is to embrace this rotation and challenge yourself to learn as much as you can!</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">This rotation ended just before the holidays and I am currently on my off block. After this, only 2 more rotations until graduation!</span><br />
<span style="font-family: inherit;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjXRE2zuf4osf9eEnKLXtbK4FtI2KB02OS4jbTtCINRTUAos11kd8uSO9dVazsUOyktrPqnRyqswyI1JUZjc-akwNfc0eJ1I4BAehhNu0FV21PqY3_i08H1-EuDzWsouxhnrvtEXH7e1k/s1600/48385780_576193629495650_8994946215556677632_n.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjXRE2zuf4osf9eEnKLXtbK4FtI2KB02OS4jbTtCINRTUAos11kd8uSO9dVazsUOyktrPqnRyqswyI1JUZjc-akwNfc0eJ1I4BAehhNu0FV21PqY3_i08H1-EuDzWsouxhnrvtEXH7e1k/s320/48385780_576193629495650_8994946215556677632_n.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gen Med Block 6 students wearing our ugly Christmas sweaters!</td></tr>
</tbody></table>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-38613108005313444082019-01-16T20:53:00.000-05:002019-01-16T20:53:29.260-05:00Preparing for the next step<b>2019</b>. This is the year I graduate from Pharmacy school. After 8 years at the University of Michigan I will finally be done! <div>
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I've been doing a lot of reflecting recently as I am on the precipice of many major changes: the end of school, transitioning into the role of a practitioner, and possibly moving (with everything that entails). I think it is extremely important to take a step back and reflect on where you've been and where you hope to go at times like this. <div>
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I am amazed at all I've learned and how much I've grown in the last 8 years. These years have provided me countless joys and moments of growth and I am so excited to see where the next 8 years bring me. </div>
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I am so thankful for all the experiences and opportunities I've been blessed with because of my education, family, friends, and connections. I have been able to travel, learn from people different than me, discover what I'm passionate about and begin to make a plan for the rest of my life. </div>
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Last rotation was my "Off rotation". At UofM we can choose to take one rotation off. I chose the last one so I could focus on residency applications, work at the hospital and have flexibility to be with family over the holidays. I had many great conversations reflecting on the past and dreaming about the future. I am so thankful I had this time to prepare for the next steps in my life. </div>
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In just a few months things will be very different, and I am going into that change thankful and ready to take on the challenge. </div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8821378955616766790.post-28372244702689446902019-01-10T20:51:00.000-05:002019-01-10T20:51:12.036-05:00Rotation 4, 5, 6: Keeping up with Therapeutics
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<u><span style="font-family: inherit; font-size: small;">Inpatient – Cardiology</span></u></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">On this rotation, I got to experience the day-to-day of a
clinical pharmacist specialist in a health-system. My schedule would consist of
working up patients early in the morning to make sure I had the most up-to-date
lab results for the patients on my service and to check if anyone was admitted
overnight. <span style="mso-spacerun: yes;"> </span>I would start rounding with
the medical team at around 9 am. The team consisted of an attending physician
and 3 medical residents. During rounds, the medical residents would update the
attending about the patients and make suggestions. They would also see the
patient and update them on their progress. My role during rounds was to collect
information and make any recommendations I previously discussed with my
preceptor. I was actively thinking of labs to order and optimizing medication
regimens. Outside of rounds, I also was responsible for medication
reconciliations to ensure the medications the patient was taking at home was
the same ones ordered in the hospital. I educated patients if they were put on a new
anticoagulation medication and oversaw warfarin dosing and monitoring. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: small;">Throughout my rotation, I had the opportunity to work with
three different medical teams, which showed me different leadership styles and
receptiveness to recommendations. Additionally, I picked up on procedures and
surgeries commonly seen in the cardiology floor. While they are not taught in
our pharmacy curriculum, they may determine which medications the patient
should receive. <o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: small;">Days were long on this rotation since there were up to 16
patients to follow at times, but it was a worthwhile experience as it sharpened
my clinical knowledge. It also provided an experience in interprofessional
teamwork. Working with physicians showed me how little I knew about medical
procedures and surgeries, but also gave me confidence in my pharmacy knowledge,
as I answered many of their questions about medications. <o:p></o:p></span></div>
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<u><span style="font-family: inherit; font-size: small;">Drug Information – Managed Care<o:p></o:p></span></u></div>
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<span style="font-family: inherit; font-size: small;">My next rotation was with the prescription drug plan of an
employer group. This was my favorite rotation so far since I am interested in
pursuing a managed care pharmacy career after graduation. Assignments on this
rotation were project-based. The first task I had was to prepare documents for
advisory committee meeting, where formulary decisions would be made. With a new
medication recently approved by the FDA, I summarized the characteristics of
the medication, clinical trial results, proposed place in therapy, and economic
considerations. After presenting this to the advisory committee and hearing the
committee’s final decision, I drafted the prior authorization criteria and
medication request form for this medication. These were to be used by the
plan’s pharmacy benefit manager to determine if coverage would be provided for
patients requesting the medication. <o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: small;">Another highlight of the rotation was learning to use
Microsoft Excel. Managed care deals with large populations, so datasets are
commonly analyzed through Excel. I conducted a drug utilization review, where I
identified an at-risk target population from medical and pharmacy claims data. Using
this information, the plan sent out letters to prescribers identifying their
patients who were at-risk.<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: small;">During this rotation, I also got to sit in on several
meetings, including ones with a mail-order pharmacy, specialty pharmacy,
pharmacy benefit manager, and medical benefit. These meetings showed me how a
health plan interacted with these other healthcare stakeholders. Additionally, my
preceptor allowed me to attend the Academy of Managed Care Pharmacists (AMCP)
Nexus conference. On top of learning from multiple sessions about trending
topics in managed care pharmacy, I also had the opportunity to network with
managed care pharmacists and speak with residency programs at the residency
showcase.<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: small;">I enjoyed seeing projects from beginning to end on this
rotation. Since it was a smaller health plan, pharmacists were the
jack-of-all-trades and worked on all aspects of managed care pharmacy. I learned much more about this career field and gained valuable experiences. <o:p></o:p></span></div>
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<u><span style="font-family: inherit; font-size: small;">Open rotation</span></u></div>
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<span style="font-family: inherit; font-size: small;">At the University of Michigan College of Pharmacy, there is
an option to leave one rotation free. I chose to have this
rotation off to work on residency applications, serve as a groomsman in a friend’s
wedding, and visit friends and family in California. I was glad to have some
time off to rest and recuperate (and catch nice photos like the one below).</span></div>
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<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: inherit; font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJCjjaiVs9wB5yh08kcWRD0AfuwMJDJrhdTzjOG08ATxlZtdDggYbphcz5ykH1qcDLoFA10wOEZh4t5y857qGFPsSl5C8U85uNy7LFKW7Mz61PgEKMlEqHLCS7UT53FDw7IdYtYF198gV9/s1600/IMG_20181213_163727421.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="473" data-original-width="1600" height="94" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJCjjaiVs9wB5yh08kcWRD0AfuwMJDJrhdTzjOG08ATxlZtdDggYbphcz5ykH1qcDLoFA10wOEZh4t5y857qGFPsSl5C8U85uNy7LFKW7Mz61PgEKMlEqHLCS7UT53FDw7IdYtYF198gV9/s320/IMG_20181213_163727421.jpg" width="320" /></a></span></div>
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<span style="font-family: inherit; font-size: small;">Now that the sun has set on 2018, I’m looking forward to new
experiences in 2019!</span></div>
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