Rotation 8: General Medicine

Posted by Unknown at Monday, March 25, 2019

Today was my last first day of school ever!! In 5 weeks I will graduate with my PharmD from the University of Michigan and will be preparing for a residency program in Colorado!! There are lots of changes coming in the next three months and I'm feeling a mix of excited, scared and sad. Excited because of the great adventures awaiting me and my husband out in Colorado (professionally and personally), scared because of the major changes and transitions about to happen, and sad because I'll be leaving my family, friends and home. I'm planning on taking some time over the next three months to prepare for these changes in an attempt to leave this place and these people well.

One thing I know has helped prepare me for residency is the general medicine rotation I just finished. I was in the inpatient adult hospital working with a clinical pharmacist and a medical team taking care of patients admitted to the family medicine service. This was my most difficult and demanding rotation. I learned a ton, but it was extremely stressful. The service I was on had a maximum of 24 patients (most others had a max of 12 or 16), and there were multiple times we got close to that max. There were also 4 projects/presentations throughout the rotation, a weekend shift, and a dental on-call pager we were responsible for at different points during the rotation.

The biggest thing I want to tell future P4's is that you're likely going to need to re-learn how to work up patients. The way we were taught in school was very different than what I was expected to do. Also, every inpatient rotation is going to have you work up and present patients a little differently due to the nature of the services. Make sure you ask the preceptor how they do it and what they expect of you. We were taught in school to look into all of the details about the patient including the diagnosis and history details. As a pharmacist, those things are important, but you cannot spend all of your time investigating them. You are likely not going to be asked on rounds to present the patient, and so it is more important for you to focus on other things. You need to learn how to be efficient in looking into the pharmacy-related problems and monitoring parameters. This took me longer than I expected, but once I did, working up patients was much more smooth and took less time.
Additionally, MiChart has a TON of really helpful reports you can run that will save you a TON of time when working up patients. Make sure you ask your preceptor/classmates at the beginning of the rotation to make sure you are capitalizing on the reports already available to save you time.
Finally, you will be amazed by what you are able to learn and accomplish during this rotation. This is a hard rotation. But, it is only 5 weeks (you can get through 5 weeks), your workload will build up over the rotation, you'll start to see repeats of the same disease states, and you'll figure out how to get the work done. You'll be able to make it through this rotation! I was so encouraged when things came up during rotation that I hadn't known only a few days prior. Even today (my first day at the new rotation), something came up that I could speak to with confidence because of what I learned on my general medicine rotation. All of these things will prepare you for residency/job/life after school.

With that, I'll be back one more time to let you know how this last rotation goes!

Preparing for the next step

Posted by Unknown at Wednesday, January 16, 2019

2019. This is the year I graduate from Pharmacy school. After 8 years at the University of Michigan I will finally be done! 

I've been doing a lot of reflecting recently as I am on the precipice of many major changes: the end of school, transitioning into the role of a practitioner, and possibly moving (with everything that entails). I think it is extremely important to take a step back and reflect on where you've been and where you hope to go at times like this. 

I am amazed at all I've learned and how much I've grown in the last 8 years. These years have provided me countless joys and moments of growth and I am so excited to see where the next 8 years bring me. 

I am so thankful for all the experiences and opportunities I've been blessed with because of my education, family, friends, and connections. I have been able to travel, learn from people different than me, discover what I'm passionate about and begin to make a plan for the rest of my life. 

Last rotation was my "Off rotation". At UofM we can choose to take one rotation off. I chose the last one so I could focus on residency applications, work at the hospital and have flexibility to be with family over the holidays. I had many great conversations reflecting on the past and dreaming about the future. I am so thankful I had this time to prepare for the next steps in my life. 

In just a few months things will be very different, and I am going into that change thankful and ready to take on the challenge. 

The Final Rotation

Posted by Adam Loyson at Sunday, June 15, 2014

Lightning McQueen fast. That is how quick my rotations seemed to go by in my final year of pharmacy school. For those of you who have joined me in completing their pharmacy education, congratulations! For those starting rotations or beginning your summer break, I write to you about my final rotation with the pediatric emergency department team.

As a prelude, the foundation of this pharmacy rotation was similar to that of the adult emergency department rotation I completed last August. Nonetheless, I was very excited to work with children and soon discovered the many unique pharmacy aspects there are to consider when working with this young population. I started the rotation with a bang and the excitement just kept building from there!

A diverse population

Children make up approximately a quarter of the population. Yet, about 60% of medications do not have FDA approval or dosing recommendations for pediatric patients. From premature infants to children big enough to be considered adults, several challenges exist when considering pharmacotherapy for children. There are differences in pharmacokinetics and pharmacodynamics, limited evidence for medication use, and lack of appropriate formulations.

With much of the data extrapolated from adult patients, I quickly found working in pediatric pharmacy more of an art than a science. Recognizing that children are not just little adults, I was faced with the challenge of taking absorption, distribution, metabolism, and elimination into consideration for each individual patient. Dosing was no longer constant, but calculated per body weight and surface area. Vital signs and laboratory values were also different from adult patients, which drove home the need for pediatric health care providers to have an eye for detail and accuracy.

Ready to work

Realizing that standardized treatment algorithms for disease states in pediatrics are extremely hard to come by, I rolled up my sleeves and prepared to round up treatment evidence in the National Library of Medicine. Monitoring patient admissions, I quickly discovered the wide level of acuity that children present with when arriving at the emergency department. Although there were a large number of children with low acuity conditions, such as mild playground injuries, but there were also many that required extensive health care provider input. These cases included asthma exacerbations, anaphylactic emergencies, traumatic brain injury, diabetic ketoacidosis, seizures, headache/migraines, cystic fibrosis, and many others.

As the student pharmacist on rotation, I was responsible for assisting physicians and recommending treatment options, providing transitions of care medication reconciliations, antibiotic kinetics, and counseling about discharge medications. This was no ordinary rotation though. I experienced a heart-tugging desire to do everything I could to help the sick children.

Another really neat aspect of my rotation was extensively helping the health care team with incoming traumas. It was not uncommon for me to anticipate the use and draw up a wide array of medications for resuscitation (epinephrine, atropine, calcium, magnesium), along with those used for rapid sequence intubation (procedure for a breathing tube), antiarrhythmics, anti-seizures, and medications used for pain control. I also frequently communicated information about the rate of administration and methods of drug delivery. I was always up to the challenge, knowing that each second counted.

Dream come true

Finishing my rotations as a student pharmacist has been bittersweet. I have had amazing hands-on learning experiences, great preceptors, and will miss the many opportunities to make a difference in so many different health care environments. From working with patients with chronic kidney disease on dialysis to studying the implications resulting from the New England Compounding Center meningitis outbreak to providing medication therapy management services to Native Americans, I couldn't have asked for a better final year. I can’t wait to use my knowledge gained to make an immediate impact after graduation.

Looking to the future, I am happy to announce that I have recently accepted a job offer to work at FDA in the Office of Generic Drugs–Division of Bioequivalence as a pharmacist project manager. In this role, I will supervise a team of pharmacologists and will act as a lead liaison to industrial applicants. As someone who has dreamed about entering the public health field right out of pharmacy school, I couldn't be more excited to see where the future takes me!

I have really enjoyed writing about my rotations in the UofM College of Pharmacy's On Rotation blog and hope I shed light on the rotations and highlighted new career opportunities that you might want to pursue in the future. I look forward to new practitioner life and continue to support the pharmacists of tomorrow.

Once again, congratulations to all of this year’s graduating pharmacists!

Adam Loyson is a 2014 graduate.

Reflecting Back & the Mysterious World of 9C

Posted by Jenna at Thursday, May 10, 2012

Seriously, where in the world has time gone?! I feel like everything post-Midyear is a complete blur but yet here we are, a mere 9 days away from graduation. 9 days?!!? We're in the single digits, people! It seems like almost yesterday that I packed up my car to make the 8-hour journey from NY to MI, moving to a completely new area where I knew no one. And now here I am 4 years later, ready to pack a Penske truck (who knew you could acquire so much in 4 years?!) and make the 8-hour journey from MI to TN, again moving to a place where I know no one. 

My four years at the University of Michigan have been some of the best years of my life. I love this University, I love this town, and I love the memories that I have made here. Not everything has been sunshine and roses though! There were plenty of times that I found myself in Dean Perry's office, whining that I had just bombed an exam and that I wasn't going to make it. To that, I heard "Oh girl, stop it!" followed by a pep talk. This place won't be the same without her, she is like the unofficial COP mascot. Though, I can't blame her for wanting to leave after the BCE graduates - it's the perfect time for her to retire, after graduating her favorite class evaa.  :-)

I cannot believe how fast this year went by. I've had 3 rotations since my last post: Inpatient Cardiology at Oakwood with Dr. Larry Diamond (Uncle Larry), Nontraditional Home Infusion at Walgreens OptionCare with Dr. Gabe Kaptur, and my current rotation is Inpatient Psychiatry with Dr. Jolene Bostwick. 

Psych is one of my secondary interests, behind peds of course! I shadowed Dr. Bostwick as a P1 and just find the patient population very interesting. What I didn't expect, however, was that I would find this rotation experience emotionally draining and depressing. Everyone knows that hem/onc and the ICU's are sad environments but I really didn't expect similar emotion with this rotation. Reading my patient's stories of past verbal, physical, sexual, & emotional abuse is rough. Your heart just breaks when you read about & hear these patient's life stories. So yes, I have some interesting stories and have had some pretty psychotic patients but most of all what I have had is a very humbling experience. 

I think psych is one of those areas you're either interested in or you're not. There is such a horrible stigma surrounding mental illness but really what I wish people would understand is that a diagnosis of schizophrenia is no different than a diagnosis of COPD. Patients with a psychiatric illness have exacerbations that require hospitalizations just as patients with COPD do. It's not uncommon for psych patients to undergo multiple medication trials before the 'ideal' medication or combination of meds is identified. There is a lot of opportunity for pharmacists (& students) to educate patients on various medications and what to expect. Dr. Bostwick is a phenomenal preceptor and will try to arrange for any experiences that you're interested in. She's a great example of what you can accomplish in a short time after graduation - she has a great rapport with all of the psychiatric docs, who value her input, and is a publishing machine! :-) I would highly recommend her as a preceptor and also the experience. It will open your eyes to the world of mental illness. Believe me, the patients are anything but scary. As healthcare practitioners, I think it's important to expose yourself to and have an open mind about all of your patients.