Rotation 5: Drug Information

Posted by Sarah Choi at Sunday, November 17, 2019

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.

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.

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.

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.

Rotation 5: Open Rotation

Posted by Anonymous at Thursday, October 31, 2019

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)!

 

Rotation 4: General Medicine (Internal Medicine)

Posted by Sarah Choi at Tuesday, October 29, 2019

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.

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.

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.

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.

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.

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!

Rotation 4: Psychiatry

Posted by Makenzie at Sunday, October 06, 2019

Fresh 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.

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).

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.

Rotation 3: Community

Posted by Makenzie at Sunday, October 06, 2019

I 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.

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.

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.

Rotation 3: Infectious Diseases

Posted by Sarah Choi at Wednesday, September 11, 2019

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.

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.

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^th block. Until then, thanks for reading!