Thursday, December 19, 2019

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!

Sunday, November 24, 2019

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.

Thursday, November 21, 2019

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 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.

Rotation 3: Another nontraditional – Paragon Biosciences

Posted by Polly at Thursday, November 21, 2019

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

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.

Here are some tips about Chicago for those of you who got chosen:
  1.   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.
  2. 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.
  3. 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 😊
  4. BRING REUSABLE BAGS. The amount they charge per bag is borderline ridiculous.

Sunday, November 17, 2019

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.

Thursday, October 31, 2019

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)!

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!