Tuesday, October 29, 2019

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!

Sunday, October 6, 2019

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.

Wednesday, September 11, 2019

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 4th block. Until then, thanks for reading!

Tuesday, August 27, 2019

Rotation 2: Non-traditional - Food and Drug Administration (FDA)

Posted by Polly at Tuesday, August 27, 2019

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.

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.

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.

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.

Here are some tips when you go on the road to Maryland for those of you who get chosen:
  1. 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.
  2. 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.
  3. BRING REUSUABLE BAGS. They charge money per bag you use and it can add up especially if you are grocery shopping.
  4.  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.
Overall, the rotation gave me an understanding of the work the FDA does and has solidified my intent to pursue a fellowship after graduation.

Rotation 1: Community pharmacy

Posted by Polly at Tuesday, August 27, 2019

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.

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!

Sunday, August 18, 2019

Surgery Generalist (Gen Med) - Rotation 2

Posted by Makenzie at Sunday, August 18, 2019

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.

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 very fast & took place in a conference room.  Thus I had to prioritize interventions that would be most acute to each patient & the team.  

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.

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.

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.

Wednesday, July 31, 2019

Rotation 1 Nontraditional and Rotation 2 Psychiatric Pharmacy

Posted by Sarah Choi at Wednesday, July 31, 2019

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 (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.

Rotation 1: Nontraditional Pharmacy
            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.

Rotation 2: Psychiatric Pharmacy
            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.

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!