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.