Tuesday, December 30, 2014

Nontraditional Paths: My Experience in Industry

Posted by Kristina Brooks at Tuesday, December 30, 2014

I spent my second rotation block in Cincinnati, Ohio, with a specific focus in Feminine Care Product Safety. When initially received the assignment, I honestly did not know what to expect. However, I realized soon after I arrived that I had been given an invaluable opportunity to improve the knowledge base of individuals working in this area once I learned more about the project I would be working on over the next five weeks.

The main project that I was given was to look into mucosal absorption of chemical compounds. Many of the individuals that I was primarily working with had backgrounds in toxicology and regulatory affairs, so they were truly excited about gaining some perspective from someone with a different perspective. Overall, my project involved gaining an understanding of key physiological features of these physical membranes, and also revisiting the importance of physicochemical properties when trying to look at what may or may not be absorbed across mucosal tissues. These components required numerous literature searches to retrieve and compile a lot of this information. However, as I came to the end of my rotation, I was able to also apply my pharmaceutical science knowledge to my final recommendations for what to do next, and was even able to discuss my suggestions with other scientists in the area to confirm that my thoughts were valid.

Throughout this project, I met with my preceptor and others in my focus area in order to understand their needs and also ensure that my project remained on track throughout the course of my rotation. My project culminated in a thorough written summary of all of the literature that I came across as I worked on the project. In addition, I gave a 50-minute presentation at the end of my rotation to the individuals in my area so they could learn about everything I had worked on, and what the next steps were that they needed to take in order to progress my project. What was especially neat about this presentation was that they turned it into a continuing education (CE) credit for all of the PharmDs at the company. 

P&G also provided us with a list of PharmDs at the company to reach out to about their experiences at the company and the career paths that led them to where they were at that time. They specialized in numerous functional areas, and were all truly passionate about the areas and projects that they were working on. The consistent message from each of these individuals was that P&G was oriented around their personal and professional development, and many noted that they had been able to pursue projects outside of their own scope of practice in order to broaden their exposures to the many products and initiatives that the company was working on. In addition, many of the individuals that I met with pointed me to other professionals in areas that I was interested in learning about.

Overall, my rotation at P&G was an amazing experience. This rotation truly pulled on the knowledge that I had developed as a PharmD student, but also challenged me to dive into an area that I had never really considered previously. I would highly encourage anyone interested in more of a research or industry career to definitely consider this rotation as part of your fourth year experience.

Internal Medicine: A Pun-tastic Rotation

Posted by Katie Dudzinski at Tuesday, December 30, 2014

Deep breath... turn on your music... okay.... here we go.

I still remember those words that I uttered to myself as I turned on my iPhone and headed to UMHS for my first APPE rotation. During my P1-P3 year, I had shadowed my P4, paid attention to the orientation, and emailed my preceptor about the ways of the rotation. Yet, I walked into the hospital that day feeling completely unprepared. How early did I have to wake-up again? How much detail should I work-up my patients? And frankly, what does work-up even mean? I let these thoughts be drowned by my music, as I cleared my head and stepped into UMHS hospital.

My preceptor was Dr. Regal, a pun-tastic preceptor who uses his seemingly endless array of jokes to help students remember tricky concepts. Known for being challenging in his P1 pharmaceutical care course, I was worried that this rotation would hold me to the same level of difficulty. However, I learned that this rotation would turn out as one of my favorites, and it would completely change my mind in pursuing residency training after graduation.

At internal medicine, we would see patients for every-day conditions, from suspected hepatitis C diagnoses to severe infections to unresolved nausea and everything in between. Instead of learning a few disease states in great detail, I learned a moderate amount of information about many of the common conditions that can land an otherwise healthy adult in the hospital. On my first day, I gave a recommendation of a vancomycin dose for a middle-aged woman, suggested a warfarin dose for a patient with afib, and observed as the medial team tried to find a therapy for a woman with a persistent GI bleed. The simple variety in patient conditions made rounds every morning feel like a new adventure.

Differing from some specialty rounds, internal medicine rounds started at 8 or 8:30am. I usually arrived at the 8th floor of the hospital, where our medical team gathered before rounding, between 7 and 7:30 am to review the patients' charts. Since the medical residents and medical students present patients and offer recommendations to the attending, I did not have to have every patient formally worked-up SOAP note style before walking through the door. As the course of the 5 week rotation progressed, I learned what aspects of patient care I needed to know as a pharmacy student and I was therefore able to work up patients very quickly. By the last day of rotation, I could work up one patient in 10 minutes.

After the initial meeting with the medical team, rounds would go until 10am-noon. After rounds I would call my preceptor to summarize interventions that the medical team made and answer any questions that he had. If I did not know an answer to a clinical question, I would look up the answer during my lunch break. The afternoons were spent in Victor Vaughan, as Dr. Regal would print out articles for us to read and teach us therapeutic concepts. The main points I learned from this rotation included warfarin optimization, calcium and vitamin D supplementation, antibiotic therapy, and different types of anemia. These concepts were solidified with an exam during the last week.

Along with the above therapeutic concepts, I also learned how to be "annoying" as the clinical pharmacist rounding with the medical team. I learned to pester the medical resident to make sure the patient was taking iron due to a ferritin deficiency, that there was a specific indication for a patient's omeprazole use, and that the patient using over-the-counter pseudophedrine had well-controlled blood pressure. I was surprised that the majority of my interventions were medication discrepancies that could have easily been settled in the outpatient setting. From this rotation, I learned that our community and outpatient pharmacists must try to optimize their patients' medication regimen as well.

On my last day of rotation, I walked home from the hospital, again taking a deep breath and turning on the music on my iPhone. I had survived my first clinical rotation, and I had learned more in those past 5 weeks than I had the entire year before. And I finally felt ready to tackle the rest of P4 year.

Welcome to Detroit City

Posted by Katie Dudzinski at Tuesday, December 30, 2014

On the first day of my community APPE, I hopped in my car and headed to a place as unknown to me as the arctic tundra: Detroit. A city where my grandparents had once found careers and raised my parents, who, like most other Polish-American middle-class families, fled to the suburbs the moment they had the opportunity. Once established in Troy, my parents only visited the Motor City for downtown hockey games and theatrical performances. Before this rotation, I had only known the city for its stretch of I-75, and everything beyond was left to footage seen on the news and the internet. Little did I know, I would be experiencing Detroit first-hand during my third rotation in community pharmacy.

I first arrived at midtown, on the northwest portion of Wayne State University's campus, on a warm September morning. After an hour and 15 minutes of sitting in traffic, the 5 minute walk to the independently-owned pharmacy felt nothing short of amazing. When I stepped inside the small downtown-like shop, I knew I would be walking into the most interesting 5 weeks of my fall semester.

University Pharmacy is an independently-owned pharmacy by an Rph whose main professional goal is getting PharmDs health provider status. While one pharmacist manages the daily duties inside the store such as checking prescriptions and maintaining inventory, the owner, my preceptor, spends her time in the community providing services and advocating for the profession. My first day, while I figured out how to park at Wayne State's campus without being a student, my preceptor quizzed me on my strengths, weaknesses, and future plans for the profession.

While I didn't spend any time during this rotation learning therapeutic concepts, I instead spent my 40 hours per week providing TB tests and flu shots to different sites within the Wayne State Physician group. My preceptor alerted me to the worries some health care workers had regarding the shot and the pharmacists that provided them. While in the clinics, the complaints patients had about pharmacists providing immunizations stung as much as the shot itself. We even had one secretary ask for a nurse to provide the shot instead of me!

In addition to perfecting my flu shot education and technique, I also learned about the unique challenges that independent pharmacies face. For example, during my internship at CVS, I never had to examine the pharmacy reimbursement for each prescription, the inventory and production used scanners for accuracy, and all tasks, including flu shots and other services, were provided right at the pharmacy front counter. At University Pharmacy, I was able to see how little the pharmacy gets reimbursed for selling generic medications, that the pharmacy did not have the funds for scanner-integrated technology, and that all services, including flu shots, were provided in a separate office in back. In order for the pharmacy to stay competitive against the nearby chains, they partnered with Wayne State University to run flu clinics, provide lectures for the medical students, and screen blood pressure, cholesterol, and glucose for Wayne State faculty and staff.

In a brisk day in mid-October, I hopped onto the Lodge freeway and headed from Detroit to Ann Arbor one final time. Even though I was excited to have less of my money spent on gasoline, I was sad to leave University Pharmacy and Midtown Detroit, a place that had very quickly felt like home. Although I did not leave my rotation with new clinical knowledge about certain disease states, I felt invigorated to become a leader in the community pharmacy setting. And I felt excited to once again visit Detroit, a city which now feels a little less unknown.