Rotation 9 (Community)

Posted by Sarah Choi at Tuesday, April 28, 2020

Rotation 9: Community

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

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

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

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

Posted by Sarah Choi at Thursday, April 02, 2020

Rotation 7: Hospital/Health Systems

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

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

Rotation 8: Ambulatory Care (Oncology)

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

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

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

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

           

Rotation 7: Working from Home - Drug Information

Posted by Makenzie at Tuesday, February 25, 2020

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

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

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

Rotation 6: Inpatient Pediatrics

Posted by Sarah Choi at Sunday, January 19, 2020

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

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

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

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

Next rotation with be my health system/hospital APPE!

Rotation 6: Health System/ Hospital

Posted by Anonymous at Thursday, December 19, 2019

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!

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. 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! 

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!

Rotation 5: Inpatient Bone Marrow Transplant

Posted by Makenzie at Sunday, November 24, 2019

A 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.

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.

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. 

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.

Rotation 4 and 5: Inpatient Oncology and Gen Med in Pediatrics

Posted by Polly at Thursday, November 21, 2019

My 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.

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.